Alzheimer is a devastating condition. Despite much research, we are still far from being able to effectively prevent or treat it. Some claim that relatively simple dietary interventions might work. What does the evidence tell us?
The aim of this systematic review was to evaluate the effect of dietary interventions on the cognitive performance of individuals with Alzheimer’s disease (AD). Thirty-two RCT could be included.
The findings show that a wide range of supplements have been submitted to testing in RCTs. Most of the supplements seem to be less than useful. However, some seem to show some promise:
- Omega-3 fatty acid has positive effects at different doses.
- ‘Fortasyn Connect’ (a multi-nutrient mixture) seems to be effective in the early stages of the disease.
- Probiotic, Ginseng, Inositol and specialized nutritional formulas seem to have a positive effect on cognition.
Most of the primary studies had poor methodological quality, included patients with mild AD, small samples, and did not obtain significative results for all the cognitive outcomes.
The authors concluded that the effect of most dietary interventions on cognition in AD patients remains inconclusive, however, several nutrients, isolated or not, show potential to improve cognitive function in AD, especially in its early stages.
I am relieved that the authors of this thoroughly-researched review phrased their conclusions as cautiously as they did. The thing is, most of the primary trials are truly not worth writing home about. Some are just 4 weeks long, others include merely 30 odd patients. Many look more like marketing excercises than science.
The authors also stated that better quality studies are urgently needed to confirm the therapeutic potential of the diet so that a dietary recommendation in AD that contributes to the quality of life of patients and relatives can be established. This has become almost a standard sentence for ending a scientific paper. In this instance, however, it seems very true.
Vitamin D and Omega-3 supplements help the elderly avoid Covid-19 infection by boosting their immune systems, study claims. Yes, that was the headline in the DAILY MAIL on 11/11/2020. Naturally, I found this interesting. So, I looked up the original paper. Here is its abstract:
Importance: The benefits of vitamin D, omega-3 fatty acids, and exercise in disease prevention remain unclear.
Objective: To test whether vitamin D, omega-3s, and a strength-training exercise program, alone or in combination, improved 6 health outcomes among older adults.
Design, setting, and participants: Double-blind, placebo-controlled, 2 × 2 × 2 factorial randomized clinical trial among 2157 adults aged 70 years or older who had no major health events in the 5 years prior to enrollment and had sufficient mobility and good cognitive status. Patients were recruited between December 2012 and November 2014, and final follow-up was in November 2017.
Interventions: Participants were randomized to 3 years of intervention in 1 of the following 8 groups: 2000 IU/d of vitamin D3, 1 g/d of omega-3s, and a strength-training exercise program (n = 264); vitamin D3 and omega-3s (n = 265); vitamin D3 and exercise (n = 275); vitamin D3 alone (n = 272); omega-3s and exercise (n = 275); omega-3s alone (n = 269); exercise alone (n = 267); or placebo (n = 270).
Main outcomes and measures: The 6 primary outcomes were change in systolic and diastolic blood pressure (BP), Short Physical Performance Battery (SPPB), Montreal Cognitive Assessment (MoCA), and incidence rates (IRs) of nonvertebral fractures and infections over 3 years. Based on multiple comparisons of 6 primary end points, 99% confidence intervals are presented and P < .01 was required for statistical significance.
Results: Among 2157 randomized participants (mean age, 74.9 years; 61.7% women), 1900 (88%) completed the study. Median follow-up was 2.99 years. Overall, there were no statistically significant benefits of any intervention individually or in combination for the 6 end points at 3 years. For instance, the differences in mean change in systolic BP with vitamin D vs no vitamin D and with omega-3s vs no omega-3s were both -0.8 (99% CI, -2.1 to 0.5) mm Hg, with P < .13 and P < .11, respectively; the difference in mean change in diastolic BP with omega-3s vs no omega-3s was -0.5 (99% CI, -1.2 to 0.2) mm Hg; P = .06); and the difference in mean change in IR of infections with omega-3s vs no omega-3s was -0.13 (99% CI, -0.23 to -0.03), with an IR ratio of 0.89 (99% CI, 0.78-1.01; P = .02). No effects were found on the outcomes of SPPB, MoCA, and incidence of nonvertebral fractures). A total of 25 deaths were reported, with similar numbers in all treatment groups.
Conclusions and relevance: Among adults without major comorbidities aged 70 years or older, treatment with vitamin D3, omega-3s, or a strength-training exercise program did not result in statistically significant differences in improvement in systolic or diastolic blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function. These findings do not support the effectiveness of these 3 interventions for these clinical outcomes.
The study has noting to do with COVID-19 and very little with infections. The bit about infections shows almost the opposite of what the MAIL claims. So, where does the notion stipulated in the headline come from?
The MAIL article gives the answer: Professor Heike Bischoff-Ferrari from Zurich University in Switzerland, who led the latest study, said: ‘Our findings suggest supplementation of vitamin D and omega-3s in adults aged 70 or older who lead an active lifestyle and have no pre-existing conditions does not provide any benefits when it comes to bone health, memory and muscle function. ‘However, we believe there is an effect on infections – such as Covid-19.’
I would not be surprised, if the last sentence in the quote was taken out of context.
I would not be surprised, if this is the worst health related article in the DAIL MAIL this year.
And, by Jove, there are plenty to choose from.
And why do I report all this?
As I have pointed out before, I believe that journalists have a lot to answer for when it comes to misleading the public about so-called alternative medicine (SCAM):
- “Scientists have shown how homeopathy works” – journalists’ obsession with ‘balance’
- ACUPUNCTURE: journalists, be aware of your responsibility not to mislead the public
- Drowning in a sea of misinformation. Part 10: Journalists
My hope is that, by reminding them of their ‘errors’ every now and then, I might contribute to some progress.
Yes, I know, I am an incurable optimist!
Fish oil (omega-3 PUFA) preparations are today extremely popular and amongst the best-researched dietary supplement. During the 1970s, two Danish scientists, Bang and Dyerberg, remarked that Greenland Eskimos had a baffling lower prevalence of coronary artery disease than mainland Danes. They also noted that their diet contained large amounts of seal and whale blubber and suggested that this ‘Eskimo-diet’ was a key factor in the lower prevalence. Subsequently, a flurry of research stared to investigate the phenomenon, and it was shown that the ‘Eskimo-diet’ contained unusually high concentrations of omega-3 polyunsaturated fatty acids from fish oils (seals and whales feed predominantly on fish).
Initial research also demonstrated that the regular consumption of fish oil has a multitude of cardiovascular and anti-inflammatory effects. This led to the promotion of fish oil supplements for a wide range of conditions. Meanwhile, many of these encouraging findings have been overturned by more rigorous studies, and the enthusiasm for fish oil supplements has somewhat waned. But now, a new paper has come out with surprising findings.
The objective of this meta-analysis was to evaluate the association of anxiety symptoms with omega-3 PUFA treatment compared with controls in varied populations.
A search was performed of clinical trials assessing the anxiolytic effect of omega-3 PUFAs in humans, in either placebo-controlled or non–placebo-controlled designs. Of 104 selected articles, 19 entered the final data extraction stage. Two authors independently extracted the data according to a predetermined list of interests. A random-effects model meta-analysis was performed. Changes in the severity of anxiety symptoms after omega-3 PUFA treatment served as the main endpoint.
In total, 1203 participants with omega-3 PUFA treatment and 1037 participants without omega-3 PUFA treatment showed an association between clinical anxiety symptoms among participants with omega-3 PUFA treatment compared with control arms. Subgroup analysis showed that the association of treatment with reduced anxiety symptoms was significantly greater in subgroups with specific clinical diagnoses than in subgroups without clinical conditions. The anxiolytic effect of omega-3 PUFAs was significantly better than that of controls only in subgroups with a higher dosage (at least 2000 mg/d) and not in subgroups with a lower dosage (<2000 mg/d).
The authors concluded that this review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. Further well-designed studies are needed in populations in whom anxiety is the main symptom.
I think this is a fine meta-analysis reporting clear results. I doubt that this paper truly falls under the umbrella of alternative medicine, but fish oil is a popular food supplement and should be mentioned on this blog. Of course, the average effect size is modest, but the findings are nevertheless intriguing.
In the realm of alternative medicine, the Internet is a double-edged sword. It can be most useful to many, particularly to those who are able to think critically. To those who do not have this ability, it can be outright dangerous. We have researched this area in several way and always arrived at this very conclusion. For instance, we evaluated websites providing advice for cancer patients and concluded that “the most popular websites on complementary and alternative medicine for cancer offer information of extremely variable quality. Many endorse unproven therapies and some are outright dangerous.”
This makes it abundantly clear that, for some, the Internet can become a danger to their health and life. Recently I was reminded of this fact when I saw this website entitled ‘Foods that will naturally cleanse your arteries’. Its message is instantly clear, particularly as it provides this impressive drawing.
The implication here is that we can all clear our arteries of atherosclerotic plaques by eating the right foods. The site also lists the exact foods. Here they are:
START OF QUOTE
Salmon is one of the best heart foods as it is packed with healthy fats which reduce cholesterol, triglycerides, and inflammation. However you must make sure that the fish is organic.
Orange juice is rich in antioxidants which strengthens the blood vessels and lowers blood pressure. Simply drink 2 glasses of fresh orange juice a day and you’re good to go.
According to numerous studies 2-4 cups of coffee a day can significantly reduce the risk of stroke and heart attack by 20%. However don’t drink excessively as it may cause problems with your digestion.
Nuts are packed with omega-3 fatty acids, healthy properties and unsaturated fats which regulate your memory, cholesterol and prevent joint pain.
The persimmon fruit is packed with fiber and sterols which help lower cholesterol. It makes a great addition to salads and cereals
Curcumin, the active ingredient in turmeric provides a large variety of health benefits. It helps reduce tissue inflammation and prevents overactive fat accumulation. Feel free to add it to your meals or to your tasty cup of tea.
Aside from having a soothing effect, green tea helps energize the whole body, boost the metabolism and lower the absorption of cholesterol. Just drink 1-2 cups of green tea a day and you have nothing to worry about.
Cheese can also help lower blood pressure and cholesterol.
Watermelon is the most delicious summer fruit. But aside from its amazing taste, it also improves the production of nitric oxide which enhances the function of the blood vessels.
Whole grains are rich in fiber content which helps lower cholesterol and cholesterol accumulation in the arteries. Consume more whole grain bread, brown rice and oats.
Cranberries have been long known to be the richest source of potassium. Due to this, they can easily lower bad cholesterol and increase the good one. 2 glasses of cranberry juice a day can lower the risk of heart attack by 40%.
Seaweeds are packed with vitamins, proteins, minerals and carotenoids which easily regulate your blood pressure.
Cinnamon prevents buildups in the arteries and lower cholesterol.
It is an exotic fruit that provides a healthy portion of phytochemicals. These improve the production of nitric oxide, and boost circulation. Add pomegranate seeds to your salads.
It is high in folic acid and potassium. You need this to lower your blood pressure, strengthen muscles, and prevent heart attack.
Broccoli is rich in vitamin K, which help lower blood pressure and cholesterol when eaten steam-cooked or raw.
Olive oil helps maintain your health at its peak. Be sure to use cold-pressed oil as it is rich in healthy fats which lower cholesterol and reduce the risk of heart attack by 40%.
Asparagus prevents inflammation, clogging and lowers cholesterols. Implement it to dishes, noodles, soups or potatoes.
Blueberries are high in potassium and as we mentioned above, potassium is the key to reducing bad cholesterol and increasing the good one. Drink 2 glasses of blueberry juice a day.
Avocadoes are without a doubt – one of the healthiest fruits known to man. They’re rich in healthy fat and improve the balance of bad and good cholesterol.
END OF QUOTE
As far as I know, there is no good evidence for the claim that any of these 20 foods will clear arteriosclerotic arteries. There is some evidence for fish oil and some for green tea to reduce the risk of cardiovascular disease. But surely, this is quite a different matter than reversing atherosclerotic plaques.
What’s the harm? I believe the potential for harm is obvious: people at high risk of suffering a major cardiovascular event who read such nonsense and believe it might think they can abandon the treatments, drugs and life-styles they have been advised to follow and take. Instead they might eat a bit more of the 20 ingredients listed above. If they did that, many would die.
I think many of us who know better have become far too tolerant of dangerous nonsense of such nature. We tend to think that either nobody is as stupid as to follow such silly advice, or we assume that taking a bit of daft advice will not do much harm. I fear we are wrong on both accounts.
The regular consumption of fish-oil has a potentially favourable role in inflammation, carcinogenesis inhibition and cancer outcomes. An analysis of the literature aimed to review the evidence for the roles of dietary-fish and fish-oil intake in prostate-cancer (PC) risk, aggressiveness and mortality.
A systematic-review, following PRISMA guidelines was conducted. PubMed, MEDLINE and Embase were searched to explore PC-risk, aggressiveness and mortality associated with dietary-fish and fish-oil intake. 37 studies were selected.
A total of 37-studies with 495,321 participants were analysed. They revealed various relationships regarding PC-risk (n = 31), aggressiveness (n = 8) and mortality (n = 3). Overall, 10 studies considering PC-risk found significant inverse trends with fish and fish-oil intake. One found a dose–response relationship whereas greater intake of long-chain-polyunsaturated fatty acids increased risk of PC when considering crude odds-ratios [OR: 1.36 (95% CI: 0.99–1.86); p = 0.014]. Three studies addressing aggressiveness identified significant positive relationships with reduced risk of aggressive cancer when considering the greatest intake of total fish [OR 0.56 (95% CI 0.37–0.86)], dark fish and shellfish-meat (p < 0.0001), EPA (p = 0.03) and DHA (p = 0.04). Three studies investigating fish consumption and PC-mortality identified a significantly reduced risk. Multivariate-OR (95% CI) were 0.9 (0.6–1.7), 0.12 (0.05–0.32) and 0.52 (0.30–0.91) at highest fish intakes.
The authors concluded that fish and fish-oil do not show consistent roles in reducing PC incidence, aggressiveness and mortality. Results suggest that the specific fish type and the fish-oil ratio must be considered. Findings suggest the need for large intervention randomised placebo-controlled trials.
Several other recent reviews have also generated encouraging evidence, e.g.:
…omega-3 fatty acids may exert their anticancer actions by influencing multiple targets implicated in various stages of cancer development, including cell proliferation, cell survival, angiogenesis, inflammation, metastasis and epigenetic abnormalities that are crucial to the onset and progression of cancer.
If I was aiming for a career as a cancer quack, I would now use this evidence to promote my very own cancer prevention and treatment diet. As I have no such ambitions, I should tell you that regular fish oil consumption is no way to treat cancer. It also is no way to prevent cancer. If anything, it might turn out to be a way of slightly reducing the risk of certain cancers. To be sure, we need a lot more research, and once we have it, fish oil will be entirely mainstream. Raising false hopes regarding ‘alternative cancer cures’ based on fairly preliminary evidence is counter-productive, unethical and irresponsible.
As I have said on several occasions before: I am constantly on the lookout for new rigorous science that supports the claims of alternative medicine. Thus I was delighted to find a recent and potentially important article with some positive evidence.
Fish oil has been studied extensively in terms of its effects on health. We know that it has powerful anti-inflammatory properties and might thus benefit a wide range of conditions. However, the effects of FO in rheumatoid arthritis (RA) have not been examined in the context of contemporary treatment of early RA.
A new study has tried to fill this gap by examining the effects of high versus low dose FO in early RA employing a ‘treat-to-target’ protocol of combination disease-modifying anti-rheumatic drugs (DMARDs).
Patients with RA <12 months’ duration and who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or low dose (for masking). These groups, designated FO and control, were given 5.5 or 0.4 g/day, respectively, of the omega-3 fats, eicosapentaenoic acid + docosahexaenoic acid. All patients received methotrexate (MTX), sulphasalazine and hydroxychloroquine, and DMARD doses were adjusted according to an algorithm taking disease activity and toxicity into account. DAS28-erythrocyte sedimentation rate, modified Health Assessment Questionnaire (mHAQ) and remission were assessed three monthly. The primary outcome measure was failure of triple DMARD therapy.
In the FO group, failure of triple DMARD therapy was lower (HR=0.28 (95% CI 0.12 to 0.63; p=0.002) unadjusted and 0.24 (95% CI 0.10 to 0.54; p=0.0006) following adjustment for smoking history, shared epitope and baseline anti–cyclic citrullinated peptide. The rate of first American College of Rheumatology (ACR) remission was significantly greater in the FO compared with the control group (HRs=2.17 (95% CI 1.07 to 4.42; p=0.03) unadjusted and 2.09 (95% CI 1.02 to 4.30; p=0.04) adjusted). There were no differences between groups in MTX dose, DAS28 or mHAQ scores, or adverse events.
The authors concluded that FO was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission.
So here we have a dietary supplement that actually might generate more good than harm! There is a mountain of data of good research on the subject. We understand the mechanism of action and we have encouraging clinical evidence. Some people might still say that we do not need to take supplements in order to benefit from the health effects of FO, consuming fatty fish regularly might have the same effects. This is true, of course, but the amount of fish that one would need to eat every day would probably be too large for most people’s taste.
The drawback (from the perspective of alternative medicine) in all this is, of course, that some experts might deny that FO has much to do with alternative medicine. Again: what do we call alternative medicine that works? We call it MEDICINE! And perhaps FO is an excellent example of exactly that.
For this blog, I am constantly on the lookout for ‘positive news’ about alternative medicine. Admittedly, I rarely find any.
All the more delighted I was when I found this new study aimed to analyse the association between dietary long-chain n-3 polyunsaturated fatty acids (PUFAs) and incidence of rheumatoid arthritis (RA) in middle-aged and older women.
Data on diet were collected in 1987 and 1997 via a self-administered food-frequency questionnaire (FFQ). The risk of RA associated with dietary long-chain n-3 PUFAs and fish intake was estimated using Cox proportional hazard regression models, adjusted for age, cigarette smoking, alcohol intake, use of aspirin and energy intake.
The results show that, among 32 232 women born 1914–1948, 205 RA cases were identified during a mean follow-up of 7.5 years. An intake of dietary long-chain n-3 PUFAs (FFQ1997) of more than 0.21 g/day (lowest quintile) was associated with a 35% decreased risk of developing RA compared with a lower intake. Long-term intake consistently higher than 0.21 g/day (according to both FFQ1987 and FFQ1997) was associated with a 52% decreased risk. Consistent long-term consumption (FFQ1987 and FFQ1997) of fish ≥1 serving per week compared with<1 was associated with a 29% decrease in risk.
The authors concluded that this prospective study of women supports the hypothesis that dietary intake of long-chain n-3 PUFAs may play a role in aetiology of RA.
These are interesting findings which originate from a good investigation and which are interpreted with the necessary caution. As all epidemiological data, this study is open to a number of confounding factors, and it is therefore impossible to make firm causal inferences. The results thus do not led themselves to clinical recommendation, but they are an indication that more definitive research is warranted, all the more so since we have plausible mechanisms to explain the observed findings.
A most encouraging development for alternative medicine, one could conclude. But is this really true? Most experts would be surprised, I think, to find that PUFA-consumption should fall under the umbrella of alternative medicine. Remember: What do we call alternative medicine that works? It is called MEDICINE!
Many experts are critical about the current craze for dietary supplements. Now a publication suggests that it is something that can save millions.
This article examines evidence suggesting that the use of selected dietary supplements can reduce overall disease treatment-related hospital utilization costs associated with coronary heart disease (CHD) in the United States among those at a high risk of experiencing a costly, disease-related event.
Results show that:
- the potential avoided hospital utilization costs related to the use of omega-3 supplements at preventive intake levels among the target population can be as much as $2.06 billion on average per year from 2013 to 2020. The potential net savings in avoided CHD-related hospital utilization costs after accounting for the cost of omega-3 dietary supplements at preventive daily intake levels would be more than $3.88 billion in cumulative health care cost savings from 2013 to 2020.
- the use of folic acid, B6, and B12 among the target population at preventive intake levels could yield avoided CHD-related hospital utilization costs savings of an average savings of $1.52 billion per year from 2013 to 2020. The potential net savings in avoided CHD-related health care costs after accounting for the cost of folic acid, B6, and B12 utilization at preventive daily intake levels would be more than $5.23 billion in cumulative health care cost net savings during the same period.
The authors conclude that targeted dietary supplement regimens are recommended as a means to help control rising societal health care costs, and as a means for high-risk individuals to minimize the chance of having to deal with potentially costly events and to invest in increased quality of life.
These conclusions read like a ‘carte blanche’ for marketing all sorts of useless supplements to gullible consumers. I think we should take them with more than a pinch of salt.
To generate results of this nature, it is necessary to make a number of assumptions. If the assumptions are wrong, so will be the results. Furthermore, we should consider that the choice of supplements included was extremely limited and highly selected. Finally, we need to stress that the analysis related to a very specific patient group and not to the population at large. In view of these facts, caution might be advised in taking this analysis as being generalizable.
Because of these caveats, my conclusion would have been quite different: provided that the assumptions underlying these analyses are correct, the use of a small selection of dietary supplements by patients at risk of CHD might reduce health care cost.
The fish oil (FO) story began when a young Danish doctor noticed that there were no heart attacks in Greenland. Large epidemiological studies were initiated, mechanistic investigations followed, and a huge amount of fascinating data emerged. Today, we know more about FO than most other dietary supplements.
Fish oil contains large amounts of omega-3 fatty acids which are thought to be beneficial in treating hypertriglyceridemia, preventing heart disease. In addition, FO is often recommended for a wide variety of other conditions, such as cancer, depression, and macular degeneration. Perhaps the most compelling evidence exists in the realm of inflammatory diseases; the mechanism of action of FO is well-studied and includes powerful anti-inflammatory properties.
Australian rheumatologists just published a study of FO supplements for patients suffering from rheumatoid arthritis (RA). Specifically, they examined the effects of high versus low dose FO in early RA employing a ‘treat-to-target’ protocol of combination disease-modifying anti-rheumatic drugs (DMARDs).
Patients with chronic RA <12 months’ who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or plaacebo (low dose FO for masking). These groups were given 5.5 or 0.4 g/day, respectively, of eicosapentaenoic acid + docosahexaenoic acid. All patients received methotrexate (MTX), sulphasalazine and hydroxychloroquine, and DMARD doses were adjusted according to an algorithm taking disease activity and toxicity into account. DAS28-erythrocyte sedimentation rate, modified Health Assessment Questionnaire (mHAQ) and remission were assessed three monthly. The primary outcome measure was failure of triple DMARD therapy.
The results indicate that, the FO group, failure of triple DMARD therapy was lower (HR=0.28 (95% CI 0.12 to 0.63; p=0.002) unadjusted and 0.24 (95% CI 0.10 to 0.54; p=0.0006) following adjustment for smoking history, shared epitope and baseline anti–cyclic citrullinated peptide. The rate of first American College of Rheumatology (ACR) remission was significantly greater in the FO compared with the control group (HRs=2.17 (95% CI 1.07 to 4.42; p=0.03) unadjusted and 2.09 (95% CI 1.02 to 4.30; p=0.04) adjusted). There were no differences between groups in MTX dose, DAS28 or mHAQ scores, or adverse events.
The authors conclude that FO was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission.
These findings are most encouraging, particularly as they collaborate those of systematic reviews which concluded that evidence is seen for a fairly consistent, but modest, benefit of marine n-3 PUFAs on joint swelling and pain, duration of morning stiffness, global assessments of pain and disease activity, and use of non-steroidal anti-inflammatory drugs and …there is evidence from 6 of 14 randomized controlled trials supporting a favourable effect of n-3 LCP supplementation in decreasing joint inflammation in RA. And you don’t need to buy the supplements either; regularly eating lots of fatty fish like mackerel, sardine or salmon has the same effects.
So, here we have an alternative, ‘natural’, dietary supplement or diet that is supported by reasonably sound evidence for efficacy, that has very few adverse effects (the main one being contamination of the supplement with toxins), that generates a host of potentially useful effects on other organ systems, that is affordable, that has a plausible mechanism of action…. Hold on, I hear some people interrupting me, FO is not an alternative medicine, it is mainstream! Exactly, an alternative medicine that works is called….MEDICINE.