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Daily Archives: May 3, 2012
Subject: About Dementia – Prevention and Management.
“Dementia” in the age groups of 60′s and 70′s are rarely due to Alzheimer’s, though often gets mislabeled and it is rare in India and among Indians. So, let us analyze the cause of Dementia. Please note various causes that need to be investigated and see if there is a definitive cure and improvement of the condition instead of just management by looking for rehabilitations only. Daily management of a person with dementia is very difficult for family members that will drain all the time and energy of everyone. Neurological and vascular problems that occur due to aging process, metabolic syndromes like diabetes, hypertension and lipid disorders and many genetic defects can be corrected and reversed well with proper nutritional supplements and antioxidants.
Let us first analyze the causes of Dementia and loss of memory in older age groups. When we forget where we parked our car in a parking garage, when we came in our car that is just memory loss due to our age. But if you are searching for your car when came and was dropped by a taxi or bus [and we don’t drive anymore], then that is dementia. Our brain is made up of lots of Fat and Cholesterol, needs constant blood circulation to every area, with constant supply of Oxygen and Glucose. With low oxygen, when I lived in Ladakh at altitudes above 15,000 feet, I noted that my comprehension and memory were poor and get tired on reading any technical book or science fictions as much as we get after strenuous exercise. This will give you an idea of what I am talking about.
1. If you have diabetes, taking Insulin or Sulfanylurea medicines, you need to watch out for the early morning Hypoglycemia that can lead to brain damage and dementia. Many are suggested to take a very-long acting Insulin Glargine etc. at bed time. If, instead, NPH Insulin [cheaper] at bed time is given, it peaks in action at 3 AM and you will end up in early morning hypoglycemia, followed by reactive hyperglycemia at 7 AM. Based on this, you will increase the dose of NPH Insulin and you will then get more Hypoglycemia. NPH is the wrong Insulin to take at bedtime. This is a common mistake. Instead of this, Insulin 70/30 as split dose 2/3 before breakfast and 1/3 before supper is a sensible dosing schedule. Every Diabetic must eat a small snack before going to bed.
2. Second reason, most common is drug induced. Lack of good sleep is a common problem and people take strong sleeping pills like Tranquilizers and psych meds. This is like hitting a fly with a gun. A simple cup of Milk at bed time, Melatonin 3 mgm and occasional dose of Benadryl 25 mgm or Chlorpheniramine 2 mgm can help. [These two also may affect the heart in the elderly]. Just go to bed and keep lying down, do meditation and read a book. If you feel sleepy during the day, just go to sleep whenever you get sleep. No fixed schedule is needed for this. But, good sleep is important.
3. Next is dehydration, which can cause memory problems, that needs to be corrected. As we age, we do not drink enough water leading to the kidney malfunction. Water is not balanced well, as we pass lots of urine at night. To compensate, we need to drink ½ to 1 cup of water every time we get up at night. Also, we must drink one full cup [8 oz or 250 ml] of water at night before going to bed and also 1 cup of water, as first thing in the morning, before our morning cup of coffee or Tea. Similarly, we must drink water during day also, as juices or watery buttermilk with sugar and salt. Water intake may be restricted due to Cardiac failure and Chronic Renal failure by your physician.
4. The fourth is the most important. This is the circulatory problems, as part of the metabolic syndrome, consisting of Diabetes, High Blood Pressure, high Cholesterol, leading to heart disease, blood vessel and nerve problems. We all know and recognize Heart attack, Stroke and poor circulation in the legs. But, more common is the “Little Strokes” – with small thrombus or micro-emboli from the Carotids to the frontal cortex leading to Multi-Infarct Dementia. We will need to get Carotid artery Doppler test, just like doing an EKG, to see the situation even when feeling normal. One Aspirin-a-day may not help much, as this can increase bleeding also.
5. Nutritional problems are the next most important things to attend to. As we age. Our appetite gets less and we tend to eat lest calories and less varieties. Our food will be just starch and fat. Fewer proteins, fewer fresh vegetables and fruits lead to malnutrition and lack of proteins and vitamins. These need to be corrected with proper nutritional low calorie diet plans. Vitamin deficiency can lead to muscle weakness, nerve problems and general tiredness. Vitamin C, Folic Acid and B-Complex are needed as also adequate protein intake, unless restricted due to renal problems. A good multi-vitamin supplement and also several antioxidants are very useful.
6. Vitamin B12 is the most important nutrition that we, as Indians, need to consider. As vegetarians, we do not get any Vitamin B12 from any Vegetable product. We get it only from the small amount of Milk and butter we eat as also the meat-eaters from the animal products. As age advances we try to avoid milk, may be from lactose intolerance or fear of fat intake, and meat-eaters also reduce meat and eggs due to Cholesterol, leading to Vitamin B12 deficiency from food intake changes. Besides, problems in stomach and terminal ileum cause problems in absorption of Vitamin B12 which is a complicated process. This B12 deficiency may not show up as anemia as we get enough Folic acid from vegetable sources. But, we may develop B12 deficiency Neuropathies and also dementia like neurological problems. One must get their Serum B12 levels checked and also repeat the same after a course of oral Vitamin B12 supplement. If there is an absorption problem, Injection Vitamin B12 1000 Mcgm once a month will help.
7. Normal aging process is often blamed for several of the health problems we face as we reach our age, including memory-loss. Normal cells deteriorate with aging and get replaced with fibrous scar tissues. However, some of these changes can be slowed or reversed by controlling Diabetes, Hypertension and Lipid problems as also taking good care of our heart and brain with proper nutrition and physical exercise including Yoga and meditation, including change of our eating habits with lots of fresh vegetables and fruits and taking some nutritional supplements, vitamins and anti-oxidants.
How do we prevent or reverse the problems of Dementia and others
How do we prevent these or reverse these conditions is similar to management of heart attack. Proper control and correction of Hypertension, Diabetes, Nutritional Deficiency and Dehydration will help. Once people show early signs of loss of memory, reading lots of books, writing, – like exercise for brain is very important. Good daily physical exercise, Mental Exercise, Yoga, Meditation and such activities will definitely help.
Of all the nutritional supplements and antioxidants, I would like to mention of some very important ones. Everyone is familiar with the advantages of Green Tea, Grape-seed extracts, Vitamin B12, Vitamin D3, Vitamin-E, other Vitamins, Fish oil, Resveratrol, Omega-3 and co-enzyme Q10, but not well documented.
I want to make a special mention here of some I found extremely useful and successful in several individuals. This is Acetyl-L-Carnitine [ALCar] which is a modified Amino acid [Protein] and Alpha-Lipoic Acid [ALA] which is a modified Fatty Acid as nutritional supplement. I have used ALCar 500 mgm + ALA 300 mgm once daily in several situations. Few incidents, after 3 to 6 months use, where a person had multiple Coronary lesions with chest pain remarkably improved; few cases where repeat nuclear stress test revealed less blockages. The LDL molecules become larger [safer] and cause less coronary obstruction. In patients with Diabetes, the sugar control becomes easy and lowering of A1C levels to near normal with less Diabetic medicines; Hypertension becomes well controlled with less fluctuation and require less medicines.
Since this is nutritional supplement and anti-Oxidant, there should be no problem. It can cause some gas in stomach. So, it needs to be taken in the morning, in empty stomach or after a light breakfast only. In addition, it improves neurological damages in Diabetic Neuropathy as also other similar conditions. Alzheimer’s, Dementia due to other causes and other neuropathies also show improvement. It is said that family members can take this to prevent or postpone such conditions.
Some other good effects of ALCar and ALA:
I tried this on a young patient with Down’s syndrome with remarkable success in that, the person was able to attend regular school and after 6 years, the facial features are slowly changing to normal, except for the mouth and teeth. Two persons with Autism [very important to note] took this regularly and after one year, slowly were showing normal behavior patterns, socializing with friends and classmates and studying well in school. These are not controlled studies but worth trying on others to see if someone can benefit from this. Please read about Acetyl L Carnitine in the internet / Google search sites. If you have friends with family members having Down’s syndrome or Autism, you can recommend these nutritional supplement therapy for a trial; let them first try it for one year, and continue the same for a longer time for full benefits.
So, I strongly believe that in Dementia, giving ALCar 500 mgm + ALA 200 or 300 mgm once daily regularly for few years, taken in the morning, will definitely show improvement and prevent further deterioration of the condition. This is available in India – check with Spencer’s or such big drug stores, but is expensive. In USA and Canada, it is available in all drug stores in different combination or individually. It is also available in GNC stores, Vitamin Shops and through the internet. Several of my relatives and friends are taking them for several years now for Diabetes, High Blood Pressure and Coronary heart disease and find them useful. In addition, you can get Vitamin-E, Calcium with Vitamin D3, Coenzyme Q10 and Resveratrol 250 mgm which are useful for muscle and nerves and also for blood vessels. These also are needed to be taken in the morning only.
Goa CM flies the way you and I do.
While returning to Delhi from Goa yesterday, I was pleasantly surprised to find the chief minister of Goa, BJP’s Manohar Parrikar, on the same flight. No, this isn’t the first time I was on board with a CM, a senior minister or a politician. But what I saw – right from the time he boarded the aircraft till the moment he exited the airport building at New Delhi – impressed me so much that it has stayed with me till now and has made me write this piece.
I tried to remember when was the last time I saw a CM or a senior political leader of Mr Parrikar’s stature queuing up like a common man to board a flight. No flunkeys, no security, no attendant, carrying his own luggage – and he was flying economy on a low-cost carrier, not first-class on a full services airline. He wasn’t the last to enter the flight nor was the flight held up for him to arrive.
He walked into the Go Air aircraft like any average passenger, almost unnoticed, and well in time. Like everyone else, he queued at the gate, boarded the bus, and climbed into the plane when his turn came. He didn’t sit in the first row which has become the exclusive preserve of the high and mighty on flights that have no first class. He quietly slipped into row three (or was it row four) and sat there without any fuss. I think most people on the aircraft didn’t realise who he was and therefore no attempt was made to mob him or try and catch his attention.
The cabin crew spent no more time attending to him than they did to any other passenger.
When I shared this with a colleague who was travelling with me, he said, “I am sure the airline would have left the seat next to him unoccupied or his office would have booked two seats so that he is not disturbed.” But when I went to attend to nature’s call, I realised on my way back that this was not the case. All seats in his row were occupied and absolutely no special privilege seemed to have either been demanded or offered. Yes, he did have an aisle seat – as did two people in every row.
When the flight landed in Delhi, he wasn’t the first to get off it. Usually, it is only when the VIP is ushered into a special car waiting for him at the tarmac (with a suitable red light mounted on the roof of the car), that the other passengers are allowed to deplane. In this case, neither was he the first to disembark, nor was there a car waiting. Nobody came to receive him on the tarmac and he boarded the same bus which took all other passengers to the airport terminal. Again, he carried his own luggage (two pieces) right up to the car which came to fetch him.
While in the bus, a couple of co-passengers did recognise him and began to chat with him. The conversation which followed left me in no doubt that he was not just a gentleman but very understated in his demeanour. Dressed in a simple but formal shirt and trousers and black sandals, he didn’t look or sound like a typical politician. Having worked in the news business for a while, I did know that he is the first IIT-ian to head a state government in India. I had also heard that he was trying to clean up the murky world of Goa politics. But what I observed first-hand left me pleasantly surprised.
I am not a resident of Goa and therefore not in a position to cast my vote for Mr Parrikar – in a political sense. But purely from a personal standpoint, he has my vote for the kind of person he seems to be.
I had gone to Goa to attend the Network18 Leadership Meet and I learned my last lesson of leadership this weekend watching Mr Parrikar from a distance.
Mr Parrikar, take a bow!
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