A New Model of Health Care

stephanie_taylor

A Wellspring for Our Community Renewing Mind, Body and Spirit From Stephanie Taylor, M.D., Ph.D.

 

True wellness and deep healing is more than the application of a pill to a diagnosis. I have pioneered a new approach to healthcare that is based on personal and community wellness. Here is what this means:

The first community is you. Each person is a composite of their own life experiences and their own circle of support. Every factor needs to be evaluated to develop a picture of the whole person. Each element can then be recruited into the healing process.

The second community is where you live. The majority of public health research shows that the health of individuals is not separate from the health of the community. We have an obligation to ourselves to care for our community. This means taking the ecological initiative and also supporting the small businesses that are based in our community, especially our local farmers. Over time the community that you care for will also care for you.

The center of the program is the office visit. We offer 30 and 60 minute patient visits. This gives us enough time to really get to know you. The relationship does not end at the office visit. You will enter a supportive community linked by regular newsletters and educational programs. You will have the opportunity to re-discover yourself and the joys of living on the Monterey Peninsula. Visit Medical Program and Educational Program and see how this unique holistic program can benefit you and assist you in achieving your life’s purpose.

    Mindfulness: Practical Applications

    Mindfulness: Practical Applications
    Mini-Medical School #2, April 8, 2017
    Stephanie Taylor MD, PhD

    Between stimulus and response there is a space.
    In that space is our power to choose our response.
    In our response lies our growth and our freedom.
    Viktor E. Frankl

    Mindfulness is attending to the present. There is nothing foreign, difficult or exotic about mindfulness. Mindfulness as applied to stress reduction is the most widely known practice, and was developed in the 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center. It is, at its heart, a meditation practice that can be learned and used by anyone. It was initially applied in medical settings with excellent results on depression, anxiety and fear of disease recurrence.
    Mindfulness means attending to your current internal and external perceptions. This is greatly facilitated by attending to breathing. Here is a three minute body scan meditation:

    Begin by bringing your attention into your body. You can close your eyes if that’s comfortable for you. You can notice your body seated wherever you’re seated, feeling the weight of your body on the chair, on the floor. Take a few deep breaths. And as you take a deep breath, bring in more oxygen enlivening the body. And as you exhale, have a sense of relaxing more deeply. You can notice your feet on the floor, notice the sensations of your feet touching the floor. The weight and pressure, vibration, heat. You can notice your legs against the chair, pressure, pulsing, heaviness, lightness. Notice your back against the chair. Bring your attention into your stomach area. If your stomach is tense or tight, let it soften. Take a breath. Notice your hands. Are your hands tense or tight? See if you can allow them to soften. Notice your arms. Feel any sensation in your arms. Let your shoulders be soft. Notice your neck and throat. Let them be soft. Relax. Soften your jaw. Let your face and facial muscles be soft. Then notice your whole body present. Take one more breath. Be aware of your whole body as best you can. Take a breath. And then when you’re ready, you can open your eyes.
    From www.mindful.org

     

    Mindfulness based exercises are currently applied in a wide variety of settings.

    We will review several and give practical tips for application.

    Schools and Education

    http://www.mindfulschools.org/

    http://greatergood.berkeley.edu/article/item/research_round_up_school_based_mindfulness_programs/success

    Relationships and Parenting

    https://www.theatlantic.com/health/archive/2015/07/mindfulness-meditation-empathy-compassion/398867/

    Everyday Blessings: The inner work of mindful parenting by Jon Kabat-Zinn
    Veterans, First Responders, Police Officers

    In 2010 alone, 8,030 veterans died by suicide. This represents more loss of life than the total number of deaths in the Iraq and Afghanistan conflict since 2003.

    https://www.ptsd.va.gov/public/materials/apps/mobileapp_mindfulness_coach.asp

     Sports

    The Mindful Athlete: Secrets to Pure Performance by George Mumford, who was the mindfulness coach for the Chicago Bulls Basketball team.
    Here are his three principle points in quotes taken from Mindful Feb 2016, pg. 47-54 written by Hugh Delehanty, www.mindful.org:
    “Be still and know”: Mumford learned the power of stillness from Tai Chi practice. “When the mind is still you have an inner knowing when and how to strike.” This has also been describes as being in the flow.
    Forget Yourself, Find Yourself: “not how you are doing but what are you doing.”

    Mindfulness and more: “Steadiness of mind, right effort and wisdom.”

    Specific examples from Tai Chi Chuan Practice.

    Exercise in focused attention. Tai Chi walking for fall prevention.

    Tools: Useful cell phone apps: Headspace, and
    http://www.mindful.org/free-mindfulness-apps-worthy-of-your-attention/

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    Mini-Med #1 2017-Navigating the Healthcare System

    Mini-Medical School #1 2017
    Navigating the Health Care System with Stephanie Taylor MD PhD

    Introduction: The basis of integrative health is the harmonious union of mind, body and spirit. An additional essential component is the health of the environment and of our socio-political system. We are in a time of rapid evolution, and it is in our best interest to understand these processes in depth and to act for positive outcomes. Medicine is no exception, and this Mini-Medical School provides basic tools for understanding healthcare USA.

    Providers:

    Physicians- Degree is M.D or D.O., and they are the only provider that can use the designation “Physician”. Four years of Medical School after College. Average debt from medical school alone is $170,000. In order to enter private practice, a residency is mandatory. Duration of this apprenticeship is 3-8 years depending on specialization and pay is $50-60,000/year for a 100-140 hour work week. Specialty board examinations are required, and maintenance is mandatory. Physician salaries are proportional to specialty. The ability to perform procedures dramatically increases income. Average duration of office visits is 15-20 minutes.

    Naturopathic Doctors-Degree is N.D. Usually four years of Naturopathic School after four years of college. No residency required to practice. Bastyr (Seattle) is the best followed by Southwest College (Tempe, Ariz) and The National College of Naturopathic Medicine in Portland. Licensing varies by state.

    Nurse Practitioner-Degree is R.N., N.P. and requires 4 years of nursing school (after high school), and 1-3 year Masters level training. They function semi-independently.

    Physician’s Assistant-Degree is P.A. and certification usually requires 2 years after a four year college. PA’s require direct physician supervision, physically or by electronic communication.

    Midwife-Certified Nurse Midwives (CNM) are registered nurses who have taken additional training. They are regulated by the California Board of Registered Nurses. Certified professional midwives/licensed midwives complete a three year post-secondary program in an approved midwifery school and pass the licensing exam.  Licensed midwives are regulated by the Medical Board of California.

    Payers:

    Insurance-Persons under age 65 are usually insured through their employer. The rest are in the “individual” insurance market. State supported insurance in California is called MediCal. At 65, citizens who have qualifying earnings may have Medicare. Thirty million remain uninsured.
    The cost of your premium is not everything: Your cost out of pocket depends on your deductible, formulary and covered benefits.

    Medicare- It is not as complex as it appears:

    Part A- Hospitalization. Funded primarily by payroll taxes
    Part B-Doctor’s fees and visits. Funded by general revenues and premiums.
    Part C- Medicare Advantage (combines A, B and D)
    Part D- Drug Plan. Funded by general revenues and premiums.
    Supplemental-Covers to 20% that Medicare does not pay.

    Medicare is more financially stable since the passage of the Affordable Care Act (ACA/Obamacare), and is currently solvent until 2028. Repealing the ACA would increase Medicare spending by $802 billion over 10 years. People over 80 account for most of the spending. Prescription drug coverage is projected to grow faster than any other cost segment.

    Formulary- A list of drugs covered by your plan. Your cost depends on the Tier of the drug, usually 1-5. This changes annually. You are mailed a copy annually and it is vital that you keep this accessible for reference as your needs change. Your doctor does not have access to your formulary.

    The Explanation of Benefits (EOB) is an important report generated when you have a billed medical expense and you must understand and save the form or be able to access it on line. Here is an example:

    Claim date and provider Billed Amount Allowed Amount Non-Allowed Amount Applied to Deductible Paid Amount Remark Code

     

    11/11/2016

    LabCorp

    300.00 100.00 200.0 50.00 50.00 230

     

    Changes to Healthcare considered: The Affordable Care Act instituted many positive and popular reforms: Children on parents insurance until 26, no exclusion for prior conditions, no retroactive cancellations, subsidies for low income, increased coverage for preventive services, contraceptive and maternity coverage. There are also effects on Medicare, specifically closing the Doughnut hole. There are over a hundred subprograms of the ACA and any changes will affect the entire structure. An excellent summary of the current ACA and the Ryan and Price plans are available at the Kaiser Family Foundation Site.

    Summary of the ACA:

    http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/

    Summary of the Speaker Ryan Proposal:

    http://kff.org/report-section/proposals-to-replace-the-affordable-care-act-speaker-paul-ryan/

    Summary of Rep. Price Proposal:

    http://kff.org/report-section/proposals-to-replace-the-affordable-care-act-rep-tom-price/

    Summary of Medicare Financial Outlook:

    http://kff.org/medicare/issue-brief/10-essential-facts-about-medicares-financial-outlook

    AARP Action Plan for Medicare:http://www.aarp.org/politics-society/advocacy/info-2016/why-medicare-matters-special-report.html

    During our discussion, the rising cost of health care attributable to administrative fees was identified as a key concern. Corporations are required to articulate a primary duty to their shareholders to maximize financial return on investment. A suggestion was made to require insurance companies to be structured as B Corporations. In California, B Corps received legal status in 2012. Rather than shareholder profit, the B Corp primary duty is to create general public benefit. Further information can be found at:

    https://www.bcorporation.net/what-are-b-corps

     
    “Change will not come if we wait for some other person or some other time. We are the ones we have been waiting for. We are the change that we seek.”
    -President Barack Obama

     

    Contacting your Representative and Senator:

    Rep. Jimmy Panetta
    228 Cannon House Office Building
    Washington, D.C. 20515
    Phone 202-225-2861
    https://panetta.house.gov

     

    Senator Dianne Feinstein
    331 Hart Senate Office Building
    Washington, D.C. 20510
    https://www.feinstein.senate.gov/public/index.cfm/contact

    Senator Kamala Harris
    112 Hart Senate Office Building
    Washington, D.C. 20510
    202-224-3553
    https://www.harris.senate.gov/content/contact-senator

     

     

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    Mini-Med 2016 #6- Weight Gain and Obesogens

    Avoiding Weight Gain-it is not what you think.
    Mini-Medical School #6 2016

    Stephanie Taylor MD PhD

    The holiday season is a very special time of the year and there are very special foods associated with holiday celebrations. Most celebration foods are high-calorie and many of us worry about weight gain during the holiday season. Traditional cookies are gingerbread, Pfefferneuse, Springerle, Lebkuchen, Pizelle, Spitzgeback, Repostria and Tirggel. Tirggel has been a traditional holiday food since the third millennium BCE. All of these are wheat based and high fat foods. The calorie count alone is enough to make you fret but in our complex contemporary society, today’s cookie is not the same treat it was just 100 years ago.

    The world is experiencing a dramatic increase in body weight. Surveys comparing 1982 body weight to 2008 body weight show a doubling of obesity in adults and tripling in children. There are 100 million obese adults in the United States and 25.8 million adult onset diabetics. The incidence of diabetes is rapidly increasing.

    Just how do you gain weight? You need to consume 3500 calories to gain 1 pound. To gain 100 pounds you need to consume an additional 350,000 calories or 1500 candy bars, or an additional 500 calories a day for 700 days. The observed increase in obesity does not directly match the increase in caloric intake, leading to an investigation into other causes of the obesity epidemic. In 2006, researchers at UC, Irvine discovered and named a class of chemicals which they call Obesogens. Obesogens cause weight gain not attributable to increased calories, exerting their metabolic effects on multiple pathways. They prevent mobilization of fat stores for energy and give directions to increase fat deposition. Obesogens also change metabolic set points which determine your body’s ideal weight or fat percentage. Even more concerning, animal studies show that these changes can pass through to subsequent generations.

    You can be exposed to Obesogens from many sources, some quite unexpected. A common source is food and water. Obesogens are fat soluble and accumulate in animal and fish fat, especially if animals are fed non-organic feeds. Plastics and can linings can leach chemicals into food. Many herbicides and pesticides are obesogens. Another very common exposure is house dust. Household dust contains flame retardants from foam furniture, and degrading plastic from kitchen appliances and computers. Spraying of agricultural fields exposes children and adults to drift. Obesogenic air pollutants include auto exhaust, and particulates from the road and burning fuels. Many chemicals can be absorbed through the skin, and are present in cosmetics, skin products and household cleaners. In addition to the weight gain issue, many of these chemicals, especially glyphosate, are linked to other very serious diseases: diabetes, autism, neurological degeneration of all types, osteoporosis, atherosclerosis, mitochrondrial damage and chronic fatigue, overgrowth of pathogenic gut bacteria, infertility and even prion diseases.

    Obesogens-the Rogues Gallery

    • Bisphenol A plastics, carbonless paper, can linings
    • Perfluoroalkyl Nonstick cookware, water-repellent fabrics
    • Organotins In Agriculture and industry, wood preservative
    • Dithiocarbamates Cosmetics and Ag products
    • Nonylphenol Cosmetics and household cleaners
    • Pesticides Gardening, household control and pet collars
    • Atrazine Contaminates drinking water
    • DDE Breakdown product of DDT
    • PCBs Lubricants and flame retardants
    • HCB Fungicide, now banned
    • Oxychlordane Pesticide, now banned
    • Dioxanes and furans PVC plastics
    • PBDEs Flame retardants
    • Phtalates Some plastics-See scorecard
    • Prescription Rx DES, some antidepressants, Thiazolidinediones(PPAR-ɣ agonists)
    • Glyphosate Food, water, herbicides

    This last chemical, glyphosate is more familiar as an ingredient in the herbicide, Roundup. Exposure to glyphosate has dramatically increased since 1975, and especially with the recent adoption of pre-harvest spraying. In the last 10 years, 2.4 Billion pounds of Roundup have been used in the USA. Roundup is used on all GMO (genetically modified) crops, and also non-GMO crops to facilitate the harvest processing.  .  In the USA, 93% of all soybeans, and 89% of all corn crops are genetically modified. Additional staple foods that are usually GMO are cotton, sugar beets and canola. These basic foods are processed into other common ingredients such as canola oil, high fructose corn syrup, and beet sugar. They are incorporated into about ¾ of all processed foods. Non-GMO grains which are sprayed pre-harvest are: wheat, oats, barley and other grains. Purchasing a grain labelled Non-GMO does not protect you from glyphosate exposure. The label must state the grain is produced organically. Unfortunately, even organic foods are contaminated with glyphosate due to groundwater contamination and drift.  Roundup cannot be removed by washing or peeling. It is incorporated into the body of the plant.

    Weeds are smart and are increasingly resistant to Roundup. The newer Roundup and herbicide formulations include 2,4-D ( a primary ingredient in Agent Orange) and dicamba which are even more toxic. It is also important to know that the dose does not make the poison. Endocrine disruptors are active at doses much lower than specified toxic levels, and over a longer period of time. These low doses and long durations are not included, nor required, in most applications for safety certification.

    Prudent Avoidance

    Eat Organic, including the feed for the chickens, dairy cows and meat animals.
    Vacuum a lot.
    Read labels and reject products with unfamiliar chemical names OR “Fragrance”.
    Remember “Natural” has no legal meaning.

    Helpful Resources

    Environmental toxin screening of blood and urine is available from several specialty labs. Once you have your results, you will need to search your environment for sources, and they are not always what you expect! You may need help tracking contaminants. More physicians, naturopaths and food advocates are educating themselves on the health effects of environmental chemicals. One local active resource is Hayward Healthy House.
    http://www.haywardhealthyhome.com
    Food Democracy Now! Food testing results on glyphosate. Access the full report here:
    https://s3.amazonaws.com/media.fooddemocracynow.org/images/FDN_Glyphosate_FoodTesting_Report_p2016.pdf
    Food and Water Watch   http://www.foodandwaterwatch.org
    UCSF Program on Health and the Environment http://prhe.ucsf.edu/
    Health and Environment Online    https://healthandenvironmentonline.com/
    Environmental Working Group      http://www.ewg.org/

    The Cornucopia Institute. The Cornucopia Institute engages in educational activities supporting the ecological principles and economic wisdom underlying sustainable and organic agriculture. Through research and investigations on agricultural issues, The Cornucopia Institute provides needed information to consumers, family farmers, and the media. The Cornucopia Institute is recognized by the IRS as a tax-exempt 501(c)(3) public interest group. Donations are tax-deductible to the full extent of law. Access at:  https://www.cornucopia.org/

    Attend the EcoFarm Conference held at Asilomar Conference Center in late January. Single day tickets are available, and you do not need to be a farmer to attend. One of the biggest thrills of EcoFarm is seeing the large number of young people participating.

    The scheduled EcoFarm speakers for 2017 are here:
    https://eco-farm.org/conference/2017/schedule

     

     

     

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    Sleep Mini-Med #5 2016

    October Mini-Medical School #5
    Stephanie Taylor MD PhD
    Sleep Essentials

    More than twenty years ago Dr. William Dement gave a Community Hospital Grand Rounds on Sleep Medicine. Dr. Dement is one of the founders of the field. At the time it was new and without much professional recognition. His efforts to convince the Traffic Safety officials that drowsy driving was as dangerous as drunk driving met with no success. Somewhat disheartened and at the end of a long day, he settled into his back yard with a beverage to contemplate his next step. Within a few minutes, a car crashed through his fence and safely came to rest in his yard. The driver had, of course, fallen asleep at the wheel. This event was a bit misplaced, since he, himself, did not need convincing, but rather the local officials down the road. It does make a good teaching point, however, as we now have a greater appreciation of the risks of sleep deprivation to both airline and road traffic safely. There has been significant progress since Dr. Dement’s backyard incident. In 2010, the National Transportation Safety Board appointed its first trained sleep scientist, Dr. Mark Rosekind. In 2003, the accrediting agency for graduate medical education approved Sleep Medicine as a formal training program.

    Sleep medicine is a vast topic, and this essay will be an introduction to the field with some helpful practical advice.

    The two most common sleep complaints are sleep apnea and insomnia.

    Sleep apnea (OSA) is defined as the cessation of regular breathing during sleep, usually attributable to a collapse of the airway. The prevalence is variable and can be as high as 20% of the general population.  The health risks associated with sleep apnea are: daytime sleepiness, heart failure, hypertension, lung disease, obesity, stroke, depression, and diabetes. Associated morbidities are decreased work performance and an increase in work and leisure time injuries.  The cost of untreated OSA is high with OSA related traffic accidents alone reaching $15.9 billion and 1400 lives in the year 2000.  OSA is successfully treated with positive pressure ventilation or dental appliances. The difficulty is in getting individuals in to be diagnosed and treated. Common questions on diagnostic questionnaires are: Do you snore? Is your snoring loud?  Does your bedpartner notice you not breathing or gasping during sleep? Have you fallen asleep during the day? Do you have high blood pressure?

    Insomnia is even more common than OSA. The incidence varies depending on the severity, ranging from 20-40% of adults. Insomnia is commonly treated with oral prescription medications. In the last year surveyed, 2011, there were 60 million prescriptions written, amounting to $3.7 billion in sales. Alcohol is also commonly used for relaxation and will induce sleep, but there is usually a recurrence of insomnia between 1 and 3 AM. Taking a sleeping pill regularly is not a solution. Most sleep medications can induce dependence, both psychological and physical. Furthermore, the quality of medication induced sleep is uncertain and is the subject of much research.

    Some think it is fashionable to brag about not needing much sleep. This brag is unwise. There is a newly discovered mechanism in the brain called the glymphatic system. It seems to be the “trash collector” for the brain and is most active during sleep. Part of that trash includes beta-amyloid, which is associated with the development of Alzheimer’s disease. It is possible that deliberate reduction of sleep duration will increase risk of dementia. Indeed, the diagnosis of dementia is often preceded by several years of sleep disorder.

    There are many more sleep disorders, but OSA and insomnia are the most common and familiar. Here are some practical suggestions for better sleep.

    The ideal sleep duration is different for individual adults, but is 7-8 hours is ideal.  If you suspect sleep apnea, that requires evaluation by a sleep specialist, but occasional insomnia will respond to home remedies. Pre-sleep preparation is very important. Here are some basic tips:

    Minimize stimulants after 2 PM. That would include caffeinated beverages and some nasal decongestants. Do not exercise or eat within 3 hours of bedtime. There is clear association of poor sleep quality and use of cell phones, computers and pads before bed. Not only is the information stimulating, but the blue light prevents the normal release of sleep inducing neuro-chemicals. There are some pads that have a blue filter scheduled to apply at 8 PM, and these are worth investigating if you need to keep working in the evening.

    Psychological issues-tension and stress. Avoid stressful activities before bed. This would include listening to the evening news, paying bills, arguments and general worry. You are not going to get anything solved between midnight and 7 AM, so just let it go for the evening.

    Plan to go to sleep and arise at a regular time each day. This help train your body to a regular cycle. Stop eating 3 hours before you plan to go to bed. If your gut is busy, your brain will not have a chance to relax.  If you get home late and need to eat, try something very light and digestible.

    If you are having difficulty sleeping, stop trying after 30 minutes, and leave the bed and do something relaxing, and not computer based. Reading with a small focused light is helpful. Too much illumination will reduce the neuro-chemicals that are needed to induce sleep. If you are fretting, try writing down your worries. You can keep a self-illuminating pen and journal near the bed.

    Your best sleep environment is a dark room with no disturbing noises. Background white noise or a HEPA air filter are soothing. Electromagnetic fields are not helpful to sleep, and you should be 8 feet away from those fields. You can assess your environment with a Tri-field meter, and common sources are clock radios, cell phones and computer screens.

    Your bed should be a source of comfort, and good mattress, bed linens and blankets contribute to a positive sleep experience.  Ariana Huffington wrote a lovely book called The Sleep Revolution that I highly recommend. There is a great list of sleep friendly hotels in the back. Very handy for your next travel adventure. Her TED talk is available at: https://www.ted.com/talks/arianna_huffington_how_to_succeed_get_more_sleep?language=en

    Supplements that help sleep are very popular and fairly effective. You may need to try several before you find the right combination for your own chemistry. These are sold over the counter, and like all OTC supplements, you need to be sure you are buying good quality. Popular herbs are Valerian, ashwaganda and passion flower. Supplements that are also effective and safe are glycine, taurine, magnesium, l-theanine and melatonin. If you are on antidepressants, do not take 5-HTP for sleep as it would be contraindicated, but it is otherwise helpful.

     

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    Maintaining Your Cognitive Edge

    Mini-Medical School #4         August 6, 2016
    Stephanie Taylor MD PhD

    "I have reached an age when, if someone tells me to wear socks, I don't have to." Albert Einstein (1879-1955).

    Healthy aging is the most popular topic in the Mini-Medical School Series, and for good reasons. The average lifespan has increased dramatically in the last 100 years, and nothing in our social structure has kept pace with that fact.
    In 1900, the average lifespan for women was 48 years (men 46), in 1950 it was 71 years (men 66) and in 2000 it was 80 (men 74). Social Security was enacted in 1935 and was intended to support the aging population for the few years before their natural death. We have moved from a time when an elder could look forward to a few years of rest before a quiet death by infectious disease or multi-organ failure to a prolonged maturity of three decades. This is an international crisis, especially in the developed world.
    Popular interest in maintaining vitality is exploding. Fortunately, the science is keeping pace.

    "Those who think they have no time for bodily exercise will sooner or later have to find time for illness." Edward Stanley (1826-1893)

    The first principle of healthy aging is to not break the equipment before you wear it out. There is robust scientific evidence for these assertions:
    Stress and social isolation accelerates aging possibly by shortening telomeres.
    Environmental toxins accelerate aging, often by direct damage to DNA.
    Excess calories accelerate aging, possibly through hormonal signaling by fat cells.
    Vascular disease and diabetes accelerate aging.
    Exercise and meditation slow aging. The most physically active were 40% less likely to decline, and 50% less likely to develop Alzheimer’s. Scans show an increase in hippocampal size and in tests of memory. Animal studies show that physical activity increased blood vessels, and increased hormones that support nerve growth.
    A diet rich in phytonutrients shows aging, probably through its antioxidant effects. Mediterranean Diet.

    "Grow old along with me! The best is yet to be." Robert Browning (1812-1889)

    What healthy brains do as they age: they adapt. Let me show you!
    First meet the players-The major brain regions in aging research are the frontal cortex (proactive planning and working memory), the hippocampus (episodic memory). The structure of the brain is composed of nerve cells and their supporting glial cells. These cells are very high fat and high water, and this will become important later.
    The fMRI studies show there is a difference in young and old brains, but what that means is very open to interpretation. The good news is that the older brain recruits new regions when there is a slowdown in a prior processing area. The brain may recruit another region, but the most fascinating fact about the older brain is that this recruitment crosses into the opposite hemisphere. This does not happen in younger people.

    "He who is of a calm and happy nature will hardly feel the pressure of age, but to him who is of an opposite disposition, youth and age are equally a burden." Plato (427-346 B.C.)

    The aging brain responds best to active management. This has many layers of meaning, and here are some from the researchers:
    Enhancing memory-repetition is less effective than investing the memory with meaning, especially if it is surprising or funny.
    We are hard wired to remember visual and spatial information much better than words.
    We remember things better if they are associated with something else that we already know.
    Recalling information (self-testing) enhances memory much better than repetition.

    "Because I could not stop for death – He kindly stopped for me." Emily Dickinson (1830-1886)

    As a society, we are developing a more mature attitude toward dying. This is most welcome, but we have not solved the crisis of losing your mind long before the death of the body. Alzheimer’s disease is the third leading cause of death, and affects 5.2 million Americans. The lifetime risk is 15%, which means that 45 million Americans will be affected as the population ages. This is a national emergency.

    There are several types of dementia, but the most common is called Alzheimer’s disease. Alzheimer’s disease is defines by the presence of amyloid plaque and tau protein. These “scars” in the brain are thought to cause Alzheimer’s disease and have been the target of therapy. Unfortunately, all the pharmaceutical therapies to date have failed. Here is the reason:

    There is more than one kind of Alzheimer’s disease, and they have different causes. All three types are beta-amyloid positive and tau positive, and are currently diagnosed as Alzheimer’s disease.

    Type 1-Inflammatory-Multiple inflammatory associated genes; inability of the innate immune system to remove amyloid, persistent “wound-like” micro-pockets; systemic inflammation affecting the brain, and ApoE4 associated. Symptoms are focused on memory loss, and MRI shows hippocampal atrophy, with no cortical atrophy.

    Type 2-Non-inflammatory-Insulin resistance, low Vitamin D, elevated homocysteine, steroid hormonal  loss. Systemic markers of inflammation are usually normal. Also associated with ApoE4.

    Type 3-Cortical-non-amnestic.  A fundamentally different process than Types 1 &2. Typically early onset (with preceding stress or toxic exposure), with loss of long-term memory, no family history, ApoE4 negative, MRI shows general cortical atrophy rather than hippocampal loss, and a reduction in glucose utilization. Zinc levels are low. The six patients reviewed by Bredesen MD all had a history of toxic exposures, including mycotoxins. This subtype is also called “Inhalational Alzheimer’s disease.”

    Treatment depends on the type and by metabolic characterization. This work is being done at the Easton Lab for Neurodegenerative Disease, UCLA and the Buck Institute for Research on Aging in Novato.  The protocol (MEND) is in development, and I think we can expect some news stories in the coming year. In the meantime, don’t break the equipment and keep yourself well fed, exercised, safe and happy.

    Bredesen, Dale E. “Reversal of cognitive decline: A novel therapeutic approach.” Aging. September 2014.
    Bredesen, Dale E. et al. “Reversal of Cognitive Decline in Alzheimer’s disease.” Aging, June 2016.

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