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Why Yet Another Study of Homeopathy?

homeopathy ADHDThis post needs a bit of a background. A few weeks ago we noted that the Dean of Pharmacy at the University of Toronto was organizing a trial on using homeopathic preparations for the treatment of ADHD. A letter to the Dean asking how a Faculty of Pharmacy would get involved in studying something that is dismissed by the vast majority of the scientific community seemed appropriate. Eventually this letter was signed by more than ninety scientists and physicians and was sent off. There was no reply. In our view, not only is this a waste of funds, it adds an aura of respectability to a scientifically bankrupt notion. This is especially disturbing now in face of the measles outbreak since the private clinic where the study is to be carried out is a supporter of “nosodes,” the homeopathic “alternative” to vaccination. The original letter sent to Dr. Boon is reproduced below the following opinion piece that appeared in the Montreal Gazette.

Academic Freedom Comes With Academic Responsibility

Academic freedom is sacrosanct in universities. Researchers must be free to pursue their ideas, be they conventional or peculiar. But academic freedom also includes the freedom of others to question those ideas, and scholastic consideration dictates that those questions be addressed, especially when they are posed in a courteous letter signed by ninety scientists and physicians from around the world, including two Nobel Laureates.
The letter in question was sent to Dr. Heather Boon, Dean of the Leslie Dan Faculty of Pharmacy at the University of Toronto and focused on a study she was organizing to investigate the use of homeopathic preparations in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children. Those of us who signed the letter, along with the vast majority of the scientific community, believe that numerous studies have concluded that the effects of homeopathy do not extend beyond a placebo response. The letter sought Dr. Boon’s views on why a Faculty of Pharmacy was organizing a trial that legitimizes homeopathy, a practice that has no scientific plausibility.
Homeopathy is not an umbrella term for alternative modalities. It is a very specific practice that originated before the dawn of the scientific era when little was known about disease or chemistry. Samuel Hahnemann, a well-meaning German physician, concluded that a substance that causes symptoms in a healthy person cures those symptoms in a sick person if it is sufficiently diluted. His process involved thumping the solution into a leather pillow between dilutions, and finally using a drop to impregnate a sugar tablet that would then serve as a “homeopathic medicine,” the term deriving from the Latin for “similar” and “disease.”
Hahnemann could not have realized at the time that the final solution did not contain a single molecule of the original substance. Today, homeopaths have to contend with chemical knowledge and have proposed that the curative effects are to be explained by the sequential dilutions leaving an imprint on the solution, although they appear to be at a loss to explain how such an image is transferred to a sugar pill or how a molecular ghost can have healing properties.
Stymied by the implausibility of nonexistent molecules having therapeutic potential, homeopaths point to papers in the scientific literature demonstrating a larger than placebo effect, as well as to the millions around the world who use homeopathy with satisfaction. Neither of these is surprising. Toss a hundred coins into the air and count heads and tails. Maybe 45 heads, 55 tails. Maybe 48 tails 52 heads. But do this a hundred times, and one event may come out 30 heads and 70 tails. If this is the only one reported, the impression would be that the coins were not fairly weighted. So it is with studies of homeopathy. Just by chance alone, some results will indicate efficacy. That’s why we look at all the studies and come to the conclusion that we are looking at a placebo response, which of course is valuable and should not be dismissed. Indeed, couple the placebo response with the fact that homeopathic treatments are administered by caring people who spend a lot more time with patients than physicians can, and that they mostly target self-limiting conditions or diseases that have their ups and downs, and you have a formula for satisfaction.
ADHD is a serious condition that merits serious research. Apparently the University of Toronto researchers carried out a pilot study involving homeopathy that seemed to indicate benefit. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it essentially meaningless. Even if we were to attach some importance to the claimed reduction of symptoms, the effect was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior. Furthermore the proposed study would use individualized treatments for each subject as determined by a homeopathic consultation, so at best the results would be ambiguous in terms of making any recommendation.
The study is actually to be carried out at the Riverdale Homeopathic Clinic, a private institution that also offers ear candling, cranial sacral therapy and “nosodes,” which are homeopathic versions of vaccines. No public funding is involved; support comes from a foundation dedicated to alternative medicine. Nevertheless, one wonders why with various nutritional and biofeedback treatments with significant potential for helping with ADHD needing exploration, a scientifically insolvent notion is being pursued. One also wonders why a Dean of Pharmacy at a major Canadian Institution did not take the time to respond directly to repeated requests for her comments on a contrary opinion expressed by a large number of notable scientists and physicians.

ORIGINAL LETTER

Dear Dr. Boon

The following originates from the McGill University Office for Science and Society and has been signed by scientists and physicians from the international community. We are all devoted advocates of academic freedom and support the right of researchers to pursue any field of study they feel has merit. But we also feel that it is fair to ask colleagues questions about how a particular study they are engaged in may contribute to the bank of scientific knowledge. It should be emphatically stated that those who have added their name to this letter, including two Nobel Laureates, in no way wish to interfere with your research. Everyone is just interested in your response to the concerns expressed here.
Those concerns deal with the trial we understand you are organizing to investigate a homeopathic approach to the treatment of ADHD. First, let us point out that the McGill Office for Science and Society accepts no funds from any vested interest; our only allegiance is to the scientific method and to evidence-based science. It makes no difference to us whether any substance, including homeopathic products, is regulated or not, as long as the decision is arrived at through proper scientific evaluation rather than emotion, “they say” or pressure from vested interests.
Along with the majority of scientists, we find the notion of nonexistent molecules having a physiological effect through leaving some ghostly impression in water that is then transferable to a sugar pill simply untenable. Even if some sort of “memory” effect prevailed, there is no reasonable explanation for how it could affect biology. Furthermore, after all the sequential dilutions and succussions, the original impurities in the solvent would be more extensively present in the final solution than any component from the original homeopathic source. After evaluating the scientific literature, including a comparison of 110 homeopathic studies with 110 conventional studies for a number of disorders and outcomes, the most likely conclusion is that any benefit attributed to homeopathy can be ascribed to a placebo response.
Generally, scientists look askance at homeopathy, but don’t bother much with it because they consider it to be harmless folly. Unfortunately, this is not the case when homeopaths recommend “nosodes” as alternatives to vaccination, or attack the use of antibiotics for infections, or offer unproven treatments for ADHD.
The reason for this extensive email is to solicit your rationale, given your training as a pharmacist, for the study you are carrying out. Is the motivation a concern that parents are wasting money and possibly sacrificing effective treatment by resorting to homeopathy for ADHD, and that the study may clarify the situation? Or is there a belief that there may be some factor other than a placebo response involved? In that case, what mechanism may be operative?
You allude to the results of a pilot study that warranted this further research. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it highly questionable. You also note that the reduction of symptoms found in the pilot study was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior.
Basically, as you have gathered, we are curious about why, given the need to investigate natural therapies that may actually have a potential for benefit, and faced with a scarcity in funding, a Department of Pharmacy is interested in investigating a subject that has been addressed extensively in the literature and has been found wanting both in evidence and plausibility. There is also a concern that just the mounting of such a study by a highly reputable researcher at a top notch university will be used by homeopaths to justify diverse aspects of their practice, including steering patients away from evidence-based treatments.
Looking forward to your comments,

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Lead – A stain on chocolate?

chocolateLead is nasty. Since the body has a tough time eliminating it, exposure to very small amounts can cause poisoning over the long term. Diagnosis of lead poisoning is challenging because of the variety of symptoms it can produce. Vomiting, constipation, abdominal pains, headaches, mood disorders, high blood pressure, tingling sensations and fatigue can all be the result of lead poisoning, but of course these symptoms can also have other causes. Then there are the truly worrisome issues like developmental problems, learning difficulties and eventual loss of mental faculties. Lead poisoning is most worrisome in children under the age of six when the nervous system is still forming.

Exposure to lead-based paint in old buildings is a big problem, and lead paint still crops up in some imported toys that kids may put in their mouths. There is also the problem of lead in water in areas where old lead pipes are still in use. Since our body has no requirement for lead, every effort should be made to avoid ingesting lead compounds, but total avoidance is impossible since lead occurs naturally in the soil and gets incorporated into anything that grows in the soil. And that includes cacao trees and therefore chocolate. Yes there is lead in chocolate and that has raised the ire of some activist groups who claim this represents a risk especially to children. And what better time to get publicity for a warning about chocolate than Valentine’s Day. So a California watchdog group called “As You Sow” has trotted out its annual chocolate scare.

So, how much should we worry about eating chocolate? Let’s play with numbers a little. Total avoidance of lead is impossible, but the World Health Organization has determined that a tolerable daily intake for children is 3.6 micrograms per kg per day. This means that even if this amount is consumed every day, no problems are foreseen. A 20 kg child can therefore consume 72 micrograms of lead a day. Dark chocolate has the most lead with 0.07 micrograms per gram. That means 50 grams, a pretty good chunk of chocolate, will contain 3.5 micrograms of lead. Milk chocolate has less, but cocoa powder has more, at 0.25 micrograms per gram, but a serving of cocoa would only be about 7 grams which yields 1.75 micrograms of lead. Far from the daily tolerable limit of 72!

Of course lead is found in other foods as well. Berries contain as much as chocolate, and one normally eats a greater weight of berries than of chocolate. A glass of canned apple juice would have more lead than a serving of chocolate. Liver contains thousands of times more, but warnings about liver do not make the headlines. Even when the lead in all food consumed is totaled, it is unlikely that a child would exceed the 72 micrograms. Nevertheless, lead intake should be minimized as much as possible. And with chocolate, improved processing can reduce levels because studies have shown that the lead content of the finished product is greater than that found to occur naturally in the beans. The lead likely comes from machinery and air drying in places like Nigeria where leaded gasoline is still used. The bottom line here is that if you are eating enough chocolate to have to worry about lead, you are eating way too much chocolate. Happy Valentine’s Day.

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Academic Freedom

Academic FreedomAcademic freedom is sacrocent in institutions of higher learning. According to standards adopted by Canadian universities, academic freedom includes the right to freely communicate knowledge and the results of research. To do this, faculty must be free to take intellectual risks and tackle controversial subjects in their teaching, research and scholarship. The views expressed by faculty must be based on solid research, data and evidence.Thus, academic freedom must be based on reasoned discourse, rigorous extensive research and scholarship, and peer review.”

Clearly, academic freedom does not mean that professors have the right to teach anything that strikes their fancy, and they certainly do not have the right to confuse facts with opinion and demand that students recite these opinions on tests lest they be penalized. Yet this is exactly what seems to be happening in a course called “Physical Determinants of Health” at Queens, one of Canada’s most prestigious universities.

The course is taught by a professor whose background is in sports sociology which hardly equips one to deal with the intricacies of vaccination, electromagnetic radiation, prescription drugs, toxic wastes, personal care items, artificial sweeteners and genetically modified organisms. All of these, according to Professor Melody Torcolacci contribute to our “toxic load,” whatever that may mean. As is clearly evident from student reports and her classroom slides, she strays far and wide from facts and exhibits a stunning ignorance of epidemiology, immunology and toxicology. She may once have been a nationally ranked shot putter, but that doesn’t qualify her for taking shots at vaccination.

Professor Torcolacci has a clear distrust of vaccines that she attempts to infuse into her students. Her scientific shortfall is demonstrated in one of the first slides with which she accosts the students in her lecture titled “Vaccines: Good or Bad.” Guess what conclusion she want them to come away with? “No scientific evidence exists showing vaccines are NOT contributing to increased incidence of chronic illness and disability in children,” her slide flagrantly declares. What an absurd statement this is. Science can never prove a negative. Could anyone ever prove that aliens do not kidnap people? Or that Professor Torcolacci is actually not an alien? Of course not. I think, however, we can prove that she is alien to science. Her comments that pregnant women should not be vaccinated against the flu goes against the documented evidence of a positive benefit-risk ratio.

Professors are free to express their opinions, but they are not free to make up facts. And when you teach students that vaccines are connected to AIDS and autism, you are making up facts. When you teach students that colloidal silver, oil of oregano and fresh garlic work like broad-spectrum antibiotics, you are making up facts. It seems that this professor has not come across a Google myth she hasn’t readily swallowed and then regurgitated in front of impressionable students. This isn’t academic freedom. It is an academic crime.

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Number Needed to Treat

NNTWe all want to be healthy and live as long as possible. So we think about popping vitamin pills, a daily dose of aspirin, eating foods with probiotics and taking statin drugs. And we puzzle over dietary regimes that claim to result in weight loss, lower blood cholesterol and reduced risk of Alzheimer’s disease. All of these are supported by some evidence. But the chances of significant benefit are in general much less than what people think.

One of the best way to evaluate such interventions is through a determination of what is referred to as the “number needed to treat,” or NNT. Basically this is a measure of the number of people who need to follow the particular regimen for one to have a successful outcome. Take for example the possibility of reducing the risk of cancer by taking a daily multivitamin. And let’s not even consider the numerous studies that have failed to show any reduction in risk, lets consider one that did. The Physicians Health Study followed close to 15,000 doctors over the age of fifty who took either a placebo or a multivitamin for eleven years and found an 8% lower risk of cancer in those who took the multivitamin. By comparing this reduction to the normal rate of cancer in such a population, we can calculate that to prevent one case of cancer about thirty people have to be taking the multivitamin. So the chance of prevention is small, but on the other hand, the risk of taking a multivitamin is essentially none.

The situation is more complicated when it comes to medications with potential side effects. The American Heart Association recommends that people who have a greater than 10% chance of suffering a heart attack within the next ten years based on risk factors such as high cholesterol, high blood pressure and family history, take a daily low-dose aspirin pill. Statistics show that this intervention can prevent a heart attack. With what efficacy? Depending on which study one looks at, it is in the range of 1-2000 people who have to be treated to prevent one event. So with the best scenario, about 1000 people have to take the daily aspirin for one death from a heart attack to be prevented. But what about side effects? Aspirin can cause bleeding and over a ten year period in 1000 people there would be about two extra deaths from bleeding. So that doesn’t look so good. But wait. There is mounting evidence that aspirin can reduce the risk of colorectal cancer. Here the NNT over a ten year period is about 60. So in the case of the 1000 people taking aspirin 16 deaths from cancer would be prevented. Putting it all together, more people benefit than are harmed. But the overall NNT works out to be roughly 50-60, meaning that the chance that a single individual will benefit from a daily aspirin regimen is pretty slim. But if sixty million people followed the regimen, a million premature deaths could be prevented. Most people, though, I think would decide that if their individual odds of benefitting are 60 to 1, the intervention is not worthwhile. Yet they will go out and buy a lottery ticket where the odds of winning are millions to one.

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The Fat Conundrum

fatButter or margarine? Olive oil or canola oil? Low fat diets or high fat diets? You would think that after literally thousands of studies we would have some straight forward answers about the effect of fat on our health. But such is not the case. There is pretty solid evidence that saturated fats raise blood cholesterol. There is also solid evidence that high levels of blood cholesterol are a risk factor for heart disease. But then there is the conundrum. Studies have not been able to show that saturated fats raise the risk of heart disease. How is that to be explained?

There are several ways that the relationship between fat intake and health can be studied. Animals, rodents mostly, can be fed diets containing different fats and their health can be monitored. This is close to useless. The natural diet of these animals is very different from that of humans, as is their physiology. Also the manipulated dietary changes are much greater than that seen in human diets. Of greater significance are observational studies in which people are asked to fill out food frequency questionnaires from which the fat components of the diet are calculated. But people are notoriously unreliable in remembering what they have eaten and in judging amounts. Somewhat better are studies that actually measure blood levels of fatty acids which are a reflection of diet, but these do not determine the source of the fats. For example, saturated fats from meat may not have the same effect on health as those from dairy because both meat and dairy contains numerous other compounds that can have an impact. Then there is the issue that not all saturated fats are created equal and their effect may depend on the number of carbon atoms in the molecule. So-called medium chain fats, as found in coconut fat, may have a different impact than the longer chain saturated fats in chocolate, which may yet be different from those found in meat or dairy. Add to this the fact that diets also contain a variety of monounsaturated and polyunsaturated fats, which again can have a different effect on health than saturated fats, and we have an increasingly complex picture. Of course, fats are not eaten in isolation, they are part of a diet. If someone cuts down on fatty foods, they have to be replaced with something. Unfortunately, the replacement often turns out to be loaded with refined carbohydrates, particularly sugar, which pose a cardiovascular risk themselves. So in such a case, cutting back on saturated fats would not lead to a reduction in cardiovascular risk.

Where does this leave us? While studies examining saturated fats in isolation have not been able to link them to heart disease, there is plenty of evidence that replacing saturated fats with polyunsaturated ones leads to lower cholesterol levels and a reduction in the risk of cardiovascular disease. So if saturated fats are to be replaced, they should be replaced by unsaturated fats rather than by carbohydrates. As they are in the Mediterranean diet, which is heart healthy despite being high in fat. But the fat comes mostly from nuts, seeds and olive oil, not meat or butter.

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Hormones in cattle

A&WThose ads from A&W claiming that their beef is raised without hormones or steroids are popping up on TV with annoying frequency. The intent obviously is to suggest that this meat is somehow safer than competitors’ brands. There is absolutely no evidence for this. The growth promoters used in cattle, usually released from capsules implanted in the ear, are regulated just like drugs intended for human use and residues are carefully monitored. The use of growth promoters results in better conversion of feed to muscle, meaning that meat can be produced more economically. Six such substances are approved. Three are natural hormones (testosterone, estradiol, and progesterone) and three are chemically similar synthetic hormones (melengestrol acetate, trenbolone acetate and zeranol). All of these, except for zeranol, are chemically classified as steroids. Zeranol is extracted from a mould found on corn. That should please the “natural” crowd who assume that natural substances are always better than syhthetics. Zeranol is mildly estrogenic, with 25% of the estrogenic activity of natural estrogens at the same dose level. The fact is that hormonal activity in treated beef sold for consumption is indistinguishable from that in non-treated beef. And remember that meat contains hormones naturally produced by the animal in far greater amounts than any residue from growth promoters. Furthermore, far, far more natural estrogen is produced by the human body on a daily basis than that consumed in meat from treated cattle. For example, a woman produces about 500,000 nanograms of estrogen a day (40 times that much when pregnant) while the amount in a quarter pound hamburger is about 2 nanograms! The estrogenic activity of milk, butter or eggs is much greater than that of meat from implanted cattle and soy products are millions of times more estrogenic. A&W’s suggestion that their beef is healthier than other beef is not supported by science. It is a marketing gimmick. Eating an A&W burger is no better in terms of health than any other burger. Another way of putting this is that burgers made from cattle raised without hormone implants are just as suspect nutritionally as any other burger. And that suspicion involves an increased risk of cancer in carnivore populations when compared with vegetarians. Of course that doesn’t mean hamburgers can’t be a part of a healthy diet, but they shouldn’t be a staple. I do occasionally eat an A&W burger, when I can’t find an open Harvey’s. And I certainly do not give any consideration to whether the meat comes from implanted cattle or not.

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Whole grains and protein, part of a complete breakfast

oatmeal“Eat Your Oatmeal! Study Finds That A Bowl A Day May Keep The Grim Reaper Away,” screams a headline reporting on a study by researchers at Harvard University.

Somewhat overly optimistic, given that there is pretty good evidence that the Reaper eventually gets us no matter what we have for breakfast. But according to this study, we may be able to put off his inevitable visit, even without oatmeal. The study did not investigate oatmeal per se, rather it dealt with the consumption of whole grains.

The Nurses Health Study and the Health Professionals Follow-Up study that followed over 110,000 subjects for 25 years have provided Walter Willett and colleagues at Harvard with a wealth of information. Initially free of heart disease, the participants filled out periodic questionnaires about diet and various lifestyle factors. Close to 27,000 died during the study, and after adjusting for confounders such as age, smoking, physical activity and body mass index, the researchers concluded that higher whole grain intake was associated with lower mortality. And the effect wasn’t marginal.

Total mortality was reduced by 5 per cent and deaths from heart disease by 9 per cent during the 25 years spanned by the study. Since bran intake had a similar protective effect and cereal germ intake did not, the results imply that the benefits seen can be attributed to whole grains. And how much do we have to eat to see a reduction in mortality? About 30 grams, which is not a lot. That’s roughly the common serving size for whole grain cereals.

So how does oatmeal fit into this? It’s just an example of a whole grain, perhaps the reporter’s favourite. Although this study did not look at oats in particular, many others have, because oats contain beta-glucan, a form of soluble fibre that has been shown to lower cholesterol. Indeed, when Chinese researchers gave subjects with moderately elevated cholesterol either 100 grams of instant oat cereal or 100 grams of wheat flour-based noodles for six weeks, they found that total cholesterol and LDL cholesterol decreased by seven and nine per cent respectively, which is significant. An added benefit was a decrease in waist circumference of about 1.3 centimetres (half an inch), while the noodle eaters slightly increased their waist circumference. The researchers concluded that increased consumption of whole grains, including oats, should be encouraged.

I’m all for that. Steel-cut oatmeal, or oat bran, with berries or other fruits, along with some Greek yogurt is my favourite for starting off the day. Indeed, the adage that breakfast is the most important meal of the day actually has some traction. It turns out that what is eaten for breakfast has an effect on the ups and downs of blood glucose for the rest of the day. And that is important because fluctuations in blood glucose stress the pancreas and increase the chance of developing diabetes. Furthermore, a skimpy breakfast not only reduces energy levels throughout the morning, it increases the chance of overeating at lunch.

Unfortunately, some people think that skipping breakfast is helpful for weight loss. After all, no breakfast means no calories. But studies show that this is not an effective strategy. Breakfast skippers are more prone to “Night Eating Syndrome,” and moderately overweight women have been shown to lose more weight when they consume 70 per cent of their daily calories before noon instead of the afternoon or evening. To further boost the arguments for a good breakfast, we can look at studies that show people who do not eat breakfast have a higher risk of developing heart disease and diabetes. They also may be less creative and slower at processing information in the morning.

Now that we know how important breakfast is, we can get down to the nuts and bolts of what it should be. I like oatmeal, fruit and yogurt, but there’s no magic formula. First, breakfast should not be meagre: 400-500 calories is a ballpark figure. But what we don’t want is a lot of sugar. No more than about 10 grams. What we do want is whole grains and some protein. Roughly 25-35 grams of protein in the morning stabilizes blood glucose, increases satiety and reduces calorie consumption during the rest of the day.

While cereals that are low in sugar are available, they generally contain only a few grams of protein. Plain Greek yogurt is a good choice for increasing protein intake because a serving has 20-25 grams and generally less than 10 grams of sugar. It is available in a no-fat version. Some whole grain toast with almond butter, and you’ve got a breakfast that nutritional scientists would drool over.

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Pills for the Brain

Screen Shot 2015-01-15 at 9.11.26 AMPop this pill and improve your memory. Swallow that one and reduce your cognitive decline. We see ads for such products all the time and I suspect they will increase as the baby boomers reach senior citizenhood. The most popular brain boosting supplements are fish oil pills and they are also probably the best studied ones. The results are not encouraging. When all the studies are pooled, we are left with the possibility of a barely significant improvement in recalling lists of words soon after they have been learned, but the effect does not last. Extracts of the ginkgo biloba tree are also popular, and here the prospects are even dimmer. There is no impact on memory, despite claims of increased circulation in the brain. And ginkgo can interfere with the action of anticoagulants and has also been shown to be an animal carcinogen.

B vitamins are also sold with claims of enhancing memory, usually rationalized by their reduction of homocysteine, a chemical in the blood that may affect circulation in the brain. No benefits from B vitamin intake have been demonstrated when it comes to memory or cognitive function except in the case of people who have high homocysteine levels due to a diet that is very low in B vitamins. There is some concern that folic acid, one of the B vitamins, may spur the growth of polyps in the colon at doses greater than 800 micrograms a day. Phosphatidyl serine is a natural component of nerve cell membranes and its promoters argue that a deficiency leads to impaired communication between nerve cells which in turn impairs cognitive function. Sounds reasonable, except that proper controlled trials have come up empty. The same goes for vinpocetine, a compound originally isolated from the lesser periwinkle plant by Hungarian chemist Csaba Szantay in 1975. It is widely used in Europe to treat strokes and memory problems with claims of increased circulation to the brain. It does indeed increase circulation, much like ginkgo, but there is no compelling evidence for memory improvement.

People with failing memory and worried about Alzheimer’s disease are sometimes seduced by advertisements for Huperzine A, extracted from a type of moss. Some studies have shown that it increases levels of acetylcholine in the brain, a chemical that is in short supply in Alzheimer’s. But despite increasing acetylcholine, aside from a few questionable studies in China, there is no evidence that it improves memory. Unfortunately when it comes to memory pills, they are best forgotten. There is, however, hope that a nasal spray containing insulin can increase the absorption of glucose into brain cells and improve cognitive function. But in the meantime, the best bet to maintain good brain function is to monitor blood glucose and blood pressure, eat a diet rich in fruits, vegetables and whole grains, and low in simple carbs and saturated fat. And don’t forget that physical exercise also exercises your brain.

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Blog authors are solely responsible for the content of the blogs listed in the directory. Neither the content of these blogs, nor the links to other web sites, are screened, approved, reviewed or endorsed by McGill University. The text and other material on these blogs are the opinion of the specific author and are not statements of advice, opinion, or information of McGill.