A new model for treating Alzheimer’s

Brain Function with gears and cogs.I spent my June long weekend at a naturopathic conference in Brisbane where the topic was Neurology and Psychiatry. One of the surprise standouts from the weekend was a US researcher who presented 3 reversed cases of Alzheimer’s , something which really isn’t supposed to be possible. Even more surprising was his holistic focus on the treatment and his view that the solution was in treating a wide range of factors rather than a simple “pill for an ill” model.

The current research in this area has identified amyloid plaque as the source of the damage to the brain and the focus is finding a drug which will break this down. Unfortunately this approach ignores the underlying reason for the formation of the plaque which is the presence of inflammation in the body. Dr Dale Bredesen and his team looked at what was driving the inflammation and have developed an approach to treating Alzheimer’s looking at those drivers.

What emerged was a very holistic treatment protocol looking at key drivers such as diet and lifestyle, hormonal factors, such as insulin resistance as well as oestrogen and testosterone levels as well as other risk factors such as obesity and cardiovascular disease. They also saw a need to look at other possible causes of inflammation such as heavy metal toxicity. For more detail on his training and studies have a look at the MPI Cognition site.

Health food ingredients in white porcelain bowls over papyrus baCurrently around 342,000 Australians are living with dementia and up to 70% of those suffer from Alzheimer’s and with an ageing population this is expected to increase signficantly. In terms of preventative care its clear from these presentations that its critical to ensure that we start reducing our risk by following these guidelines;

  1. Eat a whole food, plant based diet with small amounts of animal protein and reasonable amounts of good quality plant based fats, such as coconut oil, olive oil  and avocado.
  2. Exercise at reasonable intensity on a regular basis, at least three to five times a week.
  3. Manage stress effectively.
  4. Ensure good blood sugar regulation.
  5. Monitor hormone levels as “atrophic withdrawal” or the sudden decline in hormones post hysterectomy for example are associated with a higher risk of developing Alzheimer’s for example.
  6. Identify and minimise toxicity, particularly heavy metals but also consider the impact of long term low grade infections.
  7. Stay at a healthy weight range.

Fortunately as a natural medicine practitioner there are a number of areas where we can work with clients to reduce their risk factors. However I am also planning a trip to the States to attend the MPI Cognition 4 day training program for practitioners. Stay posted for further updates!!

Christine Pope is a practicing homeopath and nutritionist based at Elemental Health, St Ives and is available for appointments on 8084 0081.

 

Are probiotics worth the money?

Spoon Of Yogurt With Blueberries On Top

Probiotics seem to one area where even doctors and pharamacists seem to be comfortable recommending that patients take a probiotic with or after an antibiotic. However regular probiotics can help you avoid the need for the antibiotics in the first place.

The Cochrane Collection, which is the gold standard of scientific research, has reviewed 14 clinical trials on probiotics involving over 3454 people. Overall they concluded that probiotics reduced the risk of developing upper respiratory tract infections and reduced the need for antibiotics. Nice to have the scientific evidence however I know from my own practice that a good general preventative through winter is a daily probiotic plus Vitamin C, particularly if your children are in daycare.

Home Made Cultured Or Fermented Vegetables

Probiotics for the whole family may be an expensive option (although getting sick is often more expensive) and some other great ways to include a good range of gut bacteria are to introduce fermented foods. This can be through a good quality yoghurt without a lot of sugar and additives or through regular consumption of fermented vegetables such as kim chi and sauerkraut. If you are interested in making your own fermented foods there are a number of people running workshops – have a look at Georgia at Stirring Change on facebook or Pinkfarm. The ladies at Pinkfarm even provide lists of people with starter cultures who are happy to share.

There are quite a few different strains of probiotics and we are just beginning to understand all the different roles that they can play in terms of keeping our immune system strong as well as in supporting effective digestion. The advantage in using foods is that often there are up to 50 strains or good bacteria in keffir whereas a commercial probiotic will only have a few strains.

There are several strains that we know are useful in the gut and often because they help crowd out problematic strains, such as candida. Some strains are known to be anti-inflammatory such as the lactobacillus plantarum which is often recommended to people with IBS. The predominant strain researched in the Cochrane collection was lactobacillus rhamnosus. If you do have more specialised health problems you may need advice on tailoring the strains to suit your particular needs.

Christine Pope is a nutritionist and homeopath who practices at Elemental Health at St Ives. She can be contacted on (02) 8084 0081. If you are looking for practitioners in other areas of Australia have a look at the metagenics website which lists practitioners who are experienced at working with probiotics and natural medicine.

Research – is it all lies, lies and damned statistics?

bigstock_Homeopathic_Medicine_3415467

A recent press release by the National Health and Medical Research Council (NHMRC) stated that where there was evidence to support the use of homeopathy the trials were too small and not well designed. Its kind of damning with faint praise isn’t it?? By the way most of the headlines were a lot less favourable but I read the detail of the report.

So I decided to write about research and try and explain what is contained in the report and perhaps shed a little light on the whole process. I did try and avoid a lot of maths in this discussion but this is going to be a little longer than my usual blog as it covers a fair amount of information.

Research – hierachy and different types

First up there is a hierachy in terms of research evidence in western medicine. At the top of the research hierachy is the randomised controlled trial (RCT) , which is regarded as the gold standard of evidence. Unfortunately it takes a lot of gold to meet the gold standard and it will always be more difficult with natural medicine which can’t really patent its findings to generate the types of revenues that fund this standard of research.

How much of western medicine is based on the gold standard of RCT’s? Surprisingly a lot less than you would think. Back in the 1980’s when the Cochrane Collection was established only 10- 15% of drugs in use had been subject to this research. The rest of the time they relied on long term clinical use (kind of like a lot of natural medicine). That number has at least doubled in part due to the efforts of the Cochrane Collection which is an independent research body promoting the use of evidence based research in clinical decision making.

Before you get to the RCT however there are other forms of research which contribute to the picture , this can include case study reports, in vitro research (cells in a test tube), animal studies and cohort studies, case control studies and clinical use. A case study report is usually a report which can highlight problems with an existing treatment or a way of dealing with a case which yields some new information. Studies on cells in test tubes or animals may be done at the start of research. They are  not considered as reliable as human trials as humans may react differently to animals.

Case control studies try to identify what is different between a group who have developed a condition and those who didn’t. They tend to be more cost effective but not always as reliable as a Cohort study where participants are tracked over a long period of time. Try remembering what you were eating like ten years ago? See? Its really not that easy. A Cohort study that tracks it over time can document what you were eating at different times in your life and see if the group who develop a condition were eating differently or eating more of a particular food group.

How do we design an RCT?

Whilst the RCT is the gold standard its fairly hard to find any RCT that is perfect. Typically an RCT is set up to compare one treatment against another or against placebo. You then recruit a group of people to your trial who need treatment for that condition – therefore you need to make sure they have the type of condition that will respond to your drug. To avoid complications you try to exclude people in the research who have other conditions as well. In the US students are often happy to participate in those trial’s as its a good way to earn some extra money.

So is that group of people you have just recruited to your study the same as the group of people who will ultimately take your drug? Quite often people as they get a little older are on multiple medications and they aren’t as robust as the group of students who did the trial.

So in your analysis you have just looked at the recruitment of participants and already you may not be that happy with the design.

See how easy it is to start to poke holes in the design of any trial and I haven’t even looked at numbers of participants yet?

Size of trial

To determine how many people you need in a trial you need to look at what the size of the treatment effect is and then a calculation is done (called a power calculation) to determine how many participants you need in your trial at the end to be able to see that the treatment effect is actually statistically significant.

This means a bigger group doesn’t add up to better research. It tends to mean that the smaller benefit someone gets from treatment the larger the group you need to show that it was  statistically significant and didn’t just occur by random chance. When newer drugs are being trialled against older drugs you often see only small improvements in the treatment so large scale trials will be needed.

Most natural medicine trials are quite small as funding is usually restricted however there are processes in place to ensure that the size of the group is adequate to measure the treatment effect. The NHMRC was generally negative about the fact that so few of the homeopathic trials had in excess of 500 participants but neglected to explain why that may not be necessary. They completely omitted the explanation of power calculations or whether in fact these indicated that smaller studies were still reliable evidence. Sometimes its not all about size!

Natural Medicine and RCT’s

In the next blog I will look at some of the reasons why natural medicine doesn’t fit well into the world of RCT’s. I was going to cover it here but its already a bit long!! Would love to hear your thoughts so please feel free to comment.