Alzheimer’s

Dr. Kerry Hildreth of the University of Colorado–Denver, who’s conducting research on ways to prevent or slow cognitive decline in patients with memory impairment, weighs in on our aging population, Alzheimer’s disease treatments, and the potential of her team’s clinical trial.

5280: Earlier this year, there was a lot of buzz about the speculation that Ronald Reagan had Alzheimer’s when he was president. This is a major health issue in our society, especially as the first wave of baby boomers turns 65 this year.
Dr. Hildreth: It’s a huge and growing problem for our aging population, especially because we don’t really have any way to prevent or treat it at this point. It’s really scary.

5280 April 2011
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5280: According to the Centers for Disease Control and Prevention, Alzheimer’s is one of the top 10 causes of death for men in the United States. What’s the prevalence of the disease in men versus women?
Dr. Hildreth: Actually, it’s a little more common in women than in men. Women live longer, and that’s part of it, but there have been some suggestions that it goes beyond longevity. But, yes, obviously this is a disease that strongly affects men; I think it’s now the fifth leading cause of death in people over the age of 65.

5280: What about treatments for Alzheimer’s? Dr. Hildreth: As you may know, there are approved treatments for Alzheimer’s, but they’ve been pretty disappointing. They don’t really do anything to affect the underlying course or progression of the disease. They address some symptoms in some people, pretty modestly. The bottom line is that we don’t really have any good treatments right now.

5280: Tell me a bit about the work you’re doing at CU.
Dr. Hildreth: One of the things we’re most interested in is prevention—is there a way to prevent the disease, or a way to slow the decline so that people may have some mild impairments, but they don’t get to the functional impairments where they can’t take care of themselves and need 24-hour help? So far, nothing’s really been proven definitively on this front.

5280: That’s a little disheartening, isn’t it?
Dr. Hildreth: Well, with that said, there are a number of factors that keep showing up that look like they’re related to the development of Alzheimer’s disease. And what we’re really interested in looking at is this connection between cardio-metabolic risk factors. These are the same things that put you at risk for cardiovascular disease, diabetes, and stroke. All of those things—high blood pressure, high cholesterol, obesity, diabetes, and what we’re studying specifically, pre-diabetes—either individually or in aggregate have been linked to Alzheimer’s. What we’re looking at is if you address those, does that have any effect or delay things at all?

5280: So diabetes or pre-diabetes is somehow related to Alzheimer’s disease?
Dr. Hildreth: We know that insulin is important in regulating blood sugar, but it’s also active in the brain in ways that have to do with learning and memory. The thinking is that if we can take people that are insulin-resistant and treat that very early, can that make any difference in their cognitive function? This is an area that’s really exciting because it’s actually something we can do something about. We can’t do anything about our age, we can’t do anything about our genetics. But there are a lot of things we can do about lifestyle, and if that makes a difference, that will be great.

Heart Disease

How a cardiac scare forced me to consider arresting my unhealthy—and immature—ways. By luc hatlestad

Last december, shortly before my 44th birthday, as my girlfriend Dana slept soundly nearby, I thought to myself, You’ve got to be kidding me. I can’t believe this is how I’m going down.

I’d awakened in the wee hours with tightness under my sternum and shortness of breath, and so I did what just about any rational man would do these days: I clicked away on Google, anxious but not quite panicked, trying to self-diagnose. Why yes, my jaw does seem tight. And is that my left arm tingling? The next few hours were a surreal middle-of-the-night blur as my sensible and stubborn sides debated what to do. Although something out of the ordinary was happening, it definitely didn’t feel like an elephant was standing on my chest—one of the reddest of red flags for a heart attack. I was temporarily placated, so I simply returned to bed. I felt better the next morning (though Dana was alarmed and irritated that I hadn’t woken her up). I scheduled an overdue physical, just to make sure everything was really OK.

The three-week wait for that appointment set me up for a holiday season full of even more existential contemplation than usual. Whatever might be going on with my heart, even if it was nothing, forced me to consider topics I’d long avoided: not only aging and mortality, but also simply growing up.

My forties have been kind so far. People thrive during this decade, personally and professionally, and I’m no exception. The age grants you wisdom and gravitas, yet you still possess, at least theoretically, a lingering vigor that older folks miss and regret not nurturing more. The forties are also the time when people, usually men, begin to suddenly drop dead, when the loaded term “natural causes” first becomes a reasonable explanation for an unexpected plunge down the terminal drain.

Still: I have sound, youthful genes. I don’t drink or smoke cigarettes. I work out regularly and play basketball with guys much younger than I am—sometimes with guys whose fathers are probably younger than I am. However, I eat like a teenager: No breakfast, too few vegetables, too many snacks. My friends celebrate and lampoon my Falstaffian appetite for goodies like cookies and cheese steaks, and I have a sweet tooth that would make Willy Wonka repent.

After my physical, my doctor referred me to a cardiologist whose tests showed an irregular heartbeat, and a more detailed examination revealed the probable culprit of my scare to be some combination of anxiety and acid reflux. I haven’t had any episodes since that initial flare-up, and my blood work looked good.

Now that I have a little distance from the crisis, I’m beginning to realize that my poor dietary choices aren’t merely bad habits; they’ve been a way to dodge real life, the level-headed decisions adults must make to be mature rather than merely old. I know changing my nutritional ways won’t be easy. (To wit: Although I’ve ramped up my salad intake lately, I’m writing this while enjoying a cupcake.) Four-plus decades of shoddy eating won’t be quickly undone, and I don’t have kids to provide a daily motivator to live longer.

What I do have is a reasonably clean bill of health and marching orders for maintaining it. And I have Dana, who’s young, lovely, intelligent, and—for some reason—adores me. She’s embraced the role of nutritional traffic cop—How many sodas is that? Dessert? Really?—and helped me understand that while having a strong heart is crucial, all that really matters is having the heart to make the kind of choices that will enable me to not just survive, but to thrive.

Heart health

According to the American Heart Association, more than one in three men has cardiovascular disease (CVD). It is the leading cause of death among males in this country, and the second most common cause of death in Colorado. But heart disease is preventable. Dr. Brett Fenster, a cardiologist at National Jewish Health, recommends three dietary tips for a healthy ticker.

Cut Carbs Everyone knows that carbohydrates, especially simple carbs like refined sugar, are major culprits when it comes to weight gain. “What has been underappreciated is that carbs—heavily processed and refined sugars, like high-fructose corn syrup—may be playing a bigger role in heart disease than we originally thought,” Fenster says. QUICK TIP: Men should keep their sugar intake to 36 grams per day. Your heart—and your waistline—will thank you.

Decrease Sodium The Dietary Guidelines for Americans 2010 recommends keeping your daily sodium intake to less than 2,300 milligrams; for most people, sodium intake should be closer to 1,500 milligrams. “That’s difficult to do,” Fenster says. But following the guidelines has a big payoff: Lowering sodium intake—and combining that with exercise and a healthy diet—acts like a blood pressure–lowering medication. QUICK TIP: Substitute strong flavors such as garlic, oregano, and lemon for salt.

Increase Fiber A study in the Archives of Internal Medicine suggested a high-fiber diet could decrease overall mortality by about 22 percent; not only is fiber good for your heart, but it’s also helpful in lowering cholesterol and preventing death from infectious and respiratory diseases. QUICK TIP: “The closer you get to natural sources of fiber, the better it is for you,” Fenster says. Getting fiber from pizza crust—bad idea. Go for green, leafy vegetables; oatmeal; brown rice; and apples.

Prostate Cancer

What are the risks—and benefits—of early preventive screening for someone with a family history of prostate cancer? One man wants to know.

I have what might be politely termed the burden of knowledge when it comes to prostate cancer. Seventeen years ago, at the age of 47, my father was diagnosed, through routine screening, with an aggressive form of the disease. He sought the opinions of three physicians, all of whom advised him to have his prostate removed. And so my dad underwent the surgery, avoided chemotherapy and radiation, and last month turned a very healthy, cancer-free 65 years old.

My relationship with cancer, however, doesn’t end with my prostate. The incidence of cancer in my family is, in the words of one characteristically understated physician, “interesting.” I might call it terrifying. Paternal grandfather: fatal colon cancer. Paternal grandmother: fatal breast cancer. Father: prostate cancer and colon cancer survivor. Brother: acute leukemia survivor. For the past 15 years or so, I’ve joked that cancer for me was a matter of when, not if. I used to warn my then-fiancée, now wife, about what she was getting into. It was a transparent, and somewhat clumsy, defense mechanism to deal with the existential fear of thinking—in some way, intuitively knowing—that someday I’d be diagnosed with the big C.

Now, with two young sons, and having just turned 37, the time has come for me to put the jokes aside and to think responsibly about my health, specifically about that walnut-size gland down there. Among men, prostate cancer is the second most common form of cancer, after melanoma. But, that statistic notwithstanding, screening for, and the treatment of, prostate cancer is something of a health riddle: According to the American Cancer Society, one in six men will be diagnosed with the disease, but only one in 36 men will die from it.

Put simply, men who are diagnosed with prostate cancer are six times more likely to die with the slow-growing disease than from it. And that brings us to the controversial PSA screening test, and whether taking it makes sense for someone like me. PSA is an acronym for prostate-specific antigen, a substance produced by the prostate. If a man’s PSA is high, that does not necessarily mean cancer. It may mean nothing—PSA levels can be affected by any number of variables, including a benign enlarged prostate, recent ejaculation, or riding a bike. But an elevated PSA may mean something, and the next step would be either another PSA test or a prostate biopsy, which would reveal whether cancer is present.

Getting the simple blood test seems like a no-brainer for someone with a first-degree relative who’s had the disease (which increases my risk of developing prostate cancer by 20 percent). But, of course, it’s not quite so simple. The PSA test is notorious for producing false positive results, and there’s debate within the medical community about whether PSA screening actually saves lives. Further diagnostics and treatments—in some cases, overtreatment—in turn can lead to awful side effects. Biopsies can result in infection, difficulty urinating, and bleeding.

But the real issue for many men comes from the potential side effects of prostate removal: incontinence and impotence. When I was younger, I thought I’d rather be dead than have erectile dysfunction. In the Coen brothers’ cult hit The Big Lebowski, one character asks Jeff “The Dude” Lebowski what makes a man: “Is it being prepared to do the right thing, whatever the cost? Isn’t that what makes a man?” The Dude, played by Jeff Bridges, deadpans, “Sure, that and a pair of testicles.” I always bought into that notion—as juvenile as it may be, there’s a bit of truth there. So for years, that mind-set, coupled with the vagaries of the PSA test, was reason enough to not want to know what might be wrong with me.

And yet…my wife. My boys. I want to be around to spend time with all of them for a long time to come, no matter what. Maybe prostate cancer will hit me when I’m young. Maybe when I’m old. Or maybe not at all. But as someone who makes a living asking questions, I now think I’d like to know what’s coming my way. And, if I’ve learned anything from my father, it’s that preventive screening can work.

So I made an appointment with the Urology Center of Colorado. Dr. Mark Jones recommended a digital rectal exam, and we had a discussion about doing a PSA test. I decided to go for it. I may even undergo genetic testing to see what secrets my DNA holds. Will I find mutations that mean I have a higher risk of developing prostate cancer? Will I find something else entirely? And what will it all mean for my boys, who share my genetic material? There are so many questions. Now it’s time to start finding some answers.

Diabetes

Colorado may have the lowest obesity rates in the nation, but Type 2 diabetes is still a major health threat for men. We spoke with endocrinologist Dr. Leonard Zemel of Creekside Endocrine Associates and Rose Medical Center for his wisdom on obesity, the Colorado lifestyle, and the epidemic of diabetes.

Obesity is really going to set this country back.

I can eyeball a person with a high BMI [body mass index] and get a sense of whether or not they’re at risk for diabetes.

Many countries have done large studies that show that there’s a strong relationship between your BMI, or your central weight, and the risk of dying at an earlier-than-usual age.

Colorado is the last thin state, with the lowest BMI—but that’s changing fast. Everyone says the last thin person in the country will be in Colorado…and then we’ll be down to none.

It’s the classic chicken-or-egg question. You look around here and you see thin people. The question is: Did the thin people who like the active lifestyle move here, and we’re blessed because everybody starts that way? Or does the environment make us value that lifestyle? I’d say it’s a little bit of both.

It amazes me when you travel around the United States, say, to Mississippi or the Carolinas. You look around, and you say, “Wow, people just don’t look the same here.”

We’re living in a society in which we’re able to be marketed to—I think marketing is one of the strongest forces out there. It’s like a force of nature. We’re marketed things that we glom on to that help us gain weight.

The remission rate of diabetes is close to 80 percent, or better, when people lose weight, either with help from procedures like bariatric surgery or through more routine measures like weight loss, willpower, and one-on-one nutrition counseling.

There are promising drugs out there that could help reverse weight gain, but they have side effects. And the FDA, under this administration, is opting for safety over getting these drugs out to the public.

The word “epidemic” is what’s been used to describe what’s going on with diabetes in this country because it keeps climbing with no plateau. We never used to see people in their teens who had gained enough weight to bring out a disease that’s supposed to wait until adulthood.

There’s an arms race between age and obesity, and obesity is catching up.

Is this preventable? Yes. I guess where I’d start is that we need a change in ideology, or a change in our personal hygiene. We need a change in how we take care of ourselves—how we follow a basic healthy diet and exercise routine.