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Dr. Sen’s Perfect Vision System

Screen Shot 2014-07-24 at 8.02.14 AMI’m accustomed to being forwarded all sorts of videos about miraculous cures that are being suppressed by the establishment. There’s usually some “maverick doctor” who has made an astounding, shocking discovery about curing every disease known to mankind with some revolutionary herbal treatment, exotic juice or dietary supplement. There are testimonials, “rock solid” money back guarantees, and warnings about the need to click on the “buy now” button right away because of the uncertainty of keeping the video on the web. Why? Because the “establishment” is making every effort to remove it so as to protect the sales of Big Pharma’s worthless drugs. The products being promoted are usually safe but useless. Some people may actually be satisfied with their purchase because of the power of the mind over the body. I’ve seen dozens of these scams but now I’ve come across something new, at least to me. “Dr. Sen’s Perfect Vision System.” Yes, anyone can have perfect vision. Forget short sightedness, forget far sightedness, in fact forget macular degeneration, glaucoma and all other visual problems. These are not due to genetics, we are told, they are not due to a physical problem with the eyeball, they are, get this, learned traits! Our visual problems are due to focusing too frequently on books, television screens and computers. And glasses are not the answer, nor are contacts. These are scams perpetrated by optometrists and they actually make our vision worse. And laser surgery, well not only does it not correct vision, it can make you blind!

So what is the answer? Dr. Sen knows. He has made an eye-opening discovery. And of course it is all natural. Who is Dr. Sen? According to the video, he’s a retired Chinese optometrist who is now ready to reveal his secret for perfect vision for free. Why? Because he has taken the Hippocratic Oath and abides by the philosophy of doing good for his patients. He is tired of the eye care industry trying to suppress the easy solution to visual problems so they can keep digging into their endless goldmine. Actually optometrists are not physicians and do not take the Hippocratic Oath. And no trace of the mythical Dr. Sen can be found outside of this revolting video. We just hear about his miraculous eye training method from someone called Samantha Pearson who voices the video.

We are given no details except that using Dr. Sen’s “somewhat unusual” eye exercises, anyone can achieve 20/20 vision in just fourteen days. A true miracle! Actually there is a miracle here. It is that there are actually people who buy into this scam. Some must, otherwise the video would not crop up so often. What we have here is a demonstration both of the gullibility of some people and of scientific illiteracy. If you order right now, the video informs us, you also get Dr. Sen’s guide about how certain popular medications can worsen your eyesight and you also get to learn the secret of how one unusual food can cure blurry eyes in hours. This is no snake oil, we are told. For just thirty seven dollars, you are guaranteed to throw away your glasses and contacts. Actually, I’ll guarantee that the only thing you will be throwing out is thirty seven dollars.

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The Depraved Peter Popoff

miracleYou never know what you will come across when surfing TV channels late at night, hoping against hope that you will come across a Seinfeld episode you haven’t seen a hundred times. Last night I was shocked to come across the villanous Peter Popoff yet again milking the gullible in a shameless fashion with his offer of “miracle water.” Exactly what was to be done with the water was murky, but its effects were clear. Financial fortune would befall those who called the number on the screen to ask for a “free sample” of the water. There were testimonials galore from people who saw money mysteriously appear in their bank accounts and others who suddenly were able to purchase cars and houses. There is indeed wealth to be gained from the miracle water. By the crooked Popoff. When you call the number you are asked to provide your name and address. Within days a letter arrives with a plastic bag filled with the miracle water, but alas, it has to be activated. You have to quickly send in a check or money order for $27, as “seed” money to show that you have faith in God’s intent to dole out money.

This is the same Peter Popoff who was famously exposed by Randi as a fraud back in 1986 when he was shown to be receiving information from his wife via an earpiece during his faith healing act. She was backstage going through the “prayer cards” that members of the audience had submitted so that Peter could “divine” who needed what sort of healing. After the exposure Popoff went bankrupt, but like the Phoenix rose from the ashes to practice this new form of chicanery. This man is pure evil. He is not a misguided believer in some higher power, he knows full well what he is doing. He is a reverse Robin Hood, robbing the poor to give to the rich, namely himself. And he has recouped all his losses, and more. Drives ritzy cars and lives in a multi-million dollar home. If there is a hell, Peter Popoff has a room waiting. Hopefully equipped with a torture rack.

The program was on Vision Television, a channel that is dedicated to religion. The only thing Peter Popoff worships is money. Popoff’s antics were so disturbing that I had to wash them away with one of my favourite Seinfeld episodes that I had recorded. It was the one about George seeking advice about his tonsil from a kooky New Age healer equipped with a pyramid, wacky sayings and a concoction made of who the loony new age healer, with his pyramid, wacky sayings, and a tea made of “cramp bark,” “cleavers” and “couch grass.” Needless to say it made George gag. Which is just what Popoff does to any reasonable viewer.

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A miracle bites the dust

niacinIt’s frustrating, but most scientific studies end with the line, “more research is needed.” But not always. We have one of these rare cases in a study published in the New England Journal of Medicine about the use of niacin to improve cholesterol profile. Niacin is familiar to many as the B vitamin that prevents pellagra but when it is used to decrease LDL (the “bad” cholesterol) and increase HDL (the “good” cholesterol) it is given in far higher doses than the amount that prevents pellagra. At a dose of 1000 mg a day, niacin is a drug. It has been used for decades in people with cholesterol problems because it clearly does decrease LDL and increases HDL. But that is not the same as reducing cardiac events. Now we have a study that quite categorically shows that in spite of the impact on cholesterol levels, niacing does not reduce cardiac events. Furthermore, it complicates diabetes and results is an increased risk of gastrointestinal, musculoskeletal and dermatological problems.

This was a very well designed study of some 25,000 people who were taking statin drugs because of cardiac risk. They were properly randomized to take a placebo or time-released niacin in combination with laropripran, added to reduce the classic flushing side effect of niacin, After four years the results were definitive. No reduction in cardiac events and an increase in side effects. No doubt the “natural treatment” advocates will declare that this study was contrived by Big Pharma to show that natural therapies do not work. Of course at doses needed to alter blood cholesterol, niacin can hardly be called natural. We’ll see how many of the websites that promote niacin for reducing cardiac risk will change their sales pitch. Will Dr. Agatston change his mind? How about Dr. Oz who also recommends taking 400 mg of niacin a day. And Joe Mercola, who wildly promoted niacin on Dr. Oz’s show while telling people to stay away from statins? Will be interesting to see.




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exoplanetsI’ve long been fascinated by space travel. I think I was first turned onto the idea back around 1957 with one of the first television shows I remember watching. “Rocky Jones, Space Ranger” was a kind of space policeman who would blast off from Earth and travel to other heavenly bodies where wicked aliens needed to be taken care of. There was no explanation as to where these worlds were, or how it was that the aliens always spoke English. I think the only concession to science was that Rocky’s spaceship looked like a German V-2 rocket which was also the prototype for the Redstone rocket that allowed Alan Shepard to become the first American in space in 1961. By that time I was hooked on space travel and was riveted to the TV set as Shepard was launched into his suborbital flight.

Then in 1965 along came Lost in Space, a television series that actually had smidgens of science. The plot centered around a family who set out from an overpopulated Earth to colonize a planet circling the star Alpha Centauri. At the time the show was produced no planets outside the ones that orbit our sun had been discovered. But the show was actually set in 1997, which is interesting because the first planeting orbiting a sun other than our own was discovered in 1995. More than 300 “exoplanets” as they are called have been discovered since. The show also paid some attention to the huge distances involved in space travel by having the travelers be frozen in some sort of state of suspended animation, only to be reanimated when approaching their target which had been chosen because space probes had revealed that the planet possessed ideal conditions for human life.

Lost in Space overlapped with the most successful of the TV science fiction shows which of course was Star Trek, debuting in 1966. The show was set in the twenty-third century so as to allow for ample passage of time to have developed the scientific wonders like phasers, beamers and travel at warp speed. The latter was necessary because it allowed travel faster than the speed of light which would be needed to travel to the diverse planets visited by Captain Kirk and his crew. Watching all these shows was great fun. And still is. But how far are they from reality? Unfortunately very, very far. That’s because the distance that would have to be travelled to get to a planet outside our solar system is almost unimaginable. Tremendous publicity was given this year to the discovery of the first planet, Kepler-186f, that may be sort of a cousin to Earth because it may have liquid water. How far is it? About 490 light years away. So when we see Kepler-186f we are really seeing that planet as it was 490 years ago, that is how long it took for the light to reach us. And how far have we travelled in space? We have made it to the moon. That is 1.2 light seconds away! So visiting other planets or being visited by aliens that may be out there remains firmly entrenched in science fiction.

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What kind of exercise is best?

Screen Shot 2014-07-13 at 1.19.34 PMLet’s face it, running on a treadmill isn’t one of life’s most exciting activities, but it does provide time to contemplate life and think about what is likely to extend it. There’s plenty of evidence that exercise will, which is why one plods away on the treadmill in the first place.

But should one gear up for short bursts of high-intensity exercise or scamper along at a slower pace for a longer time? The scientific literature is ambivalent on the issue, but it is one that I follow closely because I am sort of addicted to the treadmill. That’s why a New York Times blog with the headline “For Fitness, Push Yourself” accompanied by a photo of competitive runners obviously at full tilt got my attention.

“Intense exercise changes the body and muscles at a molecular level in ways that milder physical activity doesn’t match, according to an enlightening new study,” the article began.

Was there finally an answer to the exercise conundrum?

The study was enlightening all right, if you are a mouse. This is not a criticism of the research, which was carried out by a very reputable group at the Scripps Research Institute in Florida. But it is a criticism of the interpretation of the study, not only by the New York Times blog, but by many other media reports that concluded “to realize the greatest benefits from workouts, we probably need to push ourselves.” There were also quotes from one of the researchers involved in the study about “no pain, no gain.” Coming to such a conclusion based on a study involving specially-bred mice scuttling on a treadmill is way too adventurous.

The study’s basic goal was to examine how the hormones adrenalin and noradrenaline affect muscle structure. These hormones are released under stressful conditions and are known to prime muscles for “flight or fight.” Since intense exercise is also known to release these chemicals, it is reasonable to explore its potential to increase muscle strength. The effects of the stress hormones are thought to be manifested through the activation of a specific protein termed CRTC2, present in mice as well as in people. The Scripps researchers therefore bred mice that were genetically programmed to produce more of this protein, put them on a program of strenuous treadmill exercise and found that they developed larger muscles and were more efficient at releasing fat for use as fuel than control animals. Interesting, but genetically modified mice are a long way from humans and the study does not justify giving any sort of advice to people.

The researchers also talk about “searching for molecular therapeutics that will activate the CRTC2 protein so that even an average exercise routine could potentially be enhanced and made more beneficial.” Sounds like an attractive research project, but I suspect it won’t be long before an inventive marketer puts the cart before the horse and starts promoting some sort of “CRTC2 enhancer.”

In the anti-aging business, making more of reputable science than is warranted is par for the course. Consider these headlines: “Cocoa Extract Highly Effective in Protecting Against Alzheimer’s disease, Says New Study” or “Worried About Alzheimer’s? Go on a Chocolate Binge, Study Says.” Well, no. The study doesn’t say anything like that. The grossly exuberant headlines were prompted by a paper published in the Journal of Alzheimer’s disease titled “Cocoa extracts Reduce Oligomerization of Amyloid-beta: Implications for Cognitive Improvement in Alzheimer’s disease.”

Did the researchers from the Mount Sinai School of Medicine in New York carry out experiments with cocoa on Alzheimer’s patients? No. Did they feed cocoa to animals? No. What they did was study the effects of a specific type of cocoa extract on the activity of nerve cells in mouse brain tissue dosed with synthetic compounds thought to model Alzheimer’s disease.

One of the hallmarks of Alzheimer’s disease, which affects an estimated 36 million people worldwide and is expected to double by 2030, is the deposition of a protein known as amyloid-beta between nerve cells. This virtually gums up the workings of the brain by preventing neurotransmitters, the chemicals nerve cells use to communicate with each other, from crossing the synapse, the gap between nerve cells. Since amyloid proteins are formed from smaller fragments called peptides, any interference with the ability of peptides to aggregate into the troublesome proteins is worthy of investigation.

Flavanols are a class of compounds found in cocoa that have been proposed as candidates for interfering with the formation of the amyloid proteins. The Mount Sinai researchers decided to use an unfermented, lightly processed cocoa known as “Lavado” in their investigation because of its high flavanol content. Most commercial cocoa is “Dutched” and has undergone alkali treatment to reduce bitterness, a treatment that also significantly reduces flavanol content. As far as chocolates go, their flavanol content is minimal.

The experiment that generated all the publicity consisted of bathing brain slices from mice specially bred to be prone to Alzheimer’s disease in solutions of the amyloid precursor peptides mixed with different cocoa extracts. When the nerve cells in these tissues were electrically stimulated, transmission of information between them was enhanced with Lavado cocoa extracts.

While this is interesting research, it cannot be used to draw any conclusion about people consuming cocoa. There is no way to know how the amount of the cocoa extracts used in these experiments relate to amounts of flavanol that may make it to the brain from eating chocolate or drinking cocoa. And mouse brain slices in a lab are a long way from a functioning human brain. Although maybe not so far from the human brains that clutter the media implications for human health based on preliminary laboratory or animal experiments.

Needless to say, I won’t go out searching for Lavado cocoa, at least not until a proper randomized trial in humans shows a benefit. And as far as the treadmill goes, I have no idea what “intense” mouse exercise means in human terms, but on looking into the issue, I did come across a scientific paper that added some pep to my treadmilling. The title was “Physical Exercise Protects Against Alzheimer’s disease.” I won’t be shouting about it from rooftops, though. The study was on mice genetically modified to develop the disease.


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Safe Sunscreens But No Safe Tans

sunscreenWhen it comes to health matters, scientists rarely make statements that do not begin with “may.”  But here is one.  Excessive exposure to sunlight causes skin cancer!  There’s no “may” about it.  And here is another one.  Chemical protection can effectively reduce exposure.  Uncertainties do, however, emerge when it comes to deciding on which specific chemicals to use.  Activists claim that some sunscreens are unsafe and blame regulatory agencies for not looking after the welfare of the public while manufacturers profess that their products have been thoroughly tested for safety and efficacy.  As usual, the public is left confused.  Actually, when you blow away the superfluous blather emanating both from the alarmists and from industry, there is some simple advice to offer.  Let’s work it out.

The challenge is clear.  Find a chemical or mixture of chemicals that can be applied to the skin to reduce exposure to the full spectrum of ultraviolet light.  Then make sure these chemicals do not degrade upon exposure to light, have no topical or systemic toxicity, are minimally absorbed into the body, are resistant to water, do not have a greasy feel, are cosmetically acceptable, do not stain clothing and can be incorporated into a “vehicle” that allows for easy spreading.  Quite a list of demands.

The first commercial “sunscreens” appeared in the 1960s and were designed to filter out “UVB,” the shorter wavelengths of ultraviolet light (290-320 nanometers).  These are the rays that cause sunburn, which was the main concern at the time.  Slightly longer waves, those responsible for tanning, were deemed safe.  Finding chemicals that absorb the nasty UVB rays was not particularly difficult, with para-aminobenzoic acid (PABA), octocrylene, phenylbenzimidazole sulfonic acid and various cinnamates and salicylates being up to the task.

Products with different concentrations of these ingredients were introduced for different skin types, each prominently featuring a “Sun Protection Factor (SPF),” basically a measure of the time it takes for skin to redden compared with having no protection.  The SPF value is determined in the laboratory by applying 2 mg of product per square centimeter to the skin of volunteers.  Using a product with an SPF of 15 means that a person who normally begins to burn in ten minutes can in theory stay in the sun for a hundred and fifty minutes before experiencing any visible effect on the skin.

It didn’t take long for this scenario to prove to be too simplistic.  As a clear link between skin cancer and UVB emerged, the focus shifted from preventing sunburn to preventing skin cancer, resulting in an industry frenzy of products with higher and higher SPF values.  In truth, an SPF of 15 already blocks 94% of UVB, only 3% less than one labeled as SPF 30.  In any case, these numbers are only meaningful if the product is applied the same way as in the lab studies, which turns out not to be the case.  Most people were applying far less than 2 mg per square centimeter and were not getting the protection they thought they were getting.  What many were getting, though, were various skin reactions.  And something else became apparent as well.  The longer wavelengths of ultraviolet light, 320-400 nm, known as UVA, previously thought to be inoccuous, were found to be more deeply penetrating than UVB and responsible for premature wrinkling and aging of the skin (“photoaging”).  Unlike UVB, they can even pass through glass.  Furthermore, UVA also was found to be potentially carcinogenic.

Now there was a need for a novel class of products that would protect the skin both from UVB and UVA.  Ideally, not one that would just absorb some wavelengths, but one that would reflect all ultraviolet light.  Titanium dioxide and zinc oxide, both mineral pigments, fit the bill, but left a white residue on the skin.  That was alright for lifeguards’ noses, but not for vane sunbathers.  The search was on for cosmetically acceptable molecules capable of absorbing UVA.  Oxybenzone and avobenzone (Parsol 1789) were up to this task, but as usual, there are some “buts.”

When oxybenzone absorbs ultraviolet light it becomes energized and some of this energy is dissipated through the production of free radicals.  These are very active molecular species that have been linked to cancer.  Oxybenzone also undergoes a reaction in the presence of ultraviolet light to form a compound called a semiquinone which in turn can inactivate some of the naturally occurring antioxidants in the skin, such as reduced glutathione.  Not a good thing since antioxidants offer protection against free radicals.  And if that weren’t enough, it turns out that oxybenzone can also mimic the behaviour of estrogens, at least in fish exposed to high doses.  It has therefore been labeled a potential “endocrine disruptor.”  Concern has been raised, mostly by the Environmental Working Group, an American activist organization, because surveys have shown that ozybenzone can be found in the blood of 97% of the population.

But, and a big but it is, there is no evidence reported in the scientific literature of oxybenzone being linked to any human health problem, except for photodermatitis, a skin reaction triggered by exposure to sunlight. There are hundreds and hundreds of compounds, both natural and synthetic, that if scrutinized the same way as oxybenzone, could be linked to problems.  Phthalates, bisphenol A, soy extracts and various pesticides are estrogenic.  We live in a world full of hormone-like substances and a complete analysis of our blood would reveal hundreds of these.  All of this goes to say that the risks of oxybenzone as implied by the Environmental Working Group, I think, are overstated.

Avobenzone is cosmetically elegant, non-irritating, but becomes unstable after a couple of hours of exposure to ultraviolet light.  However, its stability is increased when combined with oxybenzone, especially if another stabilizing agent known as diethylhexyl-2,6-napthalene (DEHN) is added.  This combination, developed by Neutrogena, is known as Helioplex.  An important question arises here.  What happens to the UV energy that these chemicals absorb?  The energy has to go somewhere, might it not have a damaging effect?  DEHN takes the energy absorbed by avobenzone and transfers it to oxybenzone which then fluoresces it as harmless red light.

Another effective broad spectrum sunscreen is tetraphalydine dicamphor sulphonic acid, which goes by the trade name Mexoryl.  It is stable, absorbs UV light and dissipates the energy as harmless heat.  Mexoryl isn’t absorbed through the skin and so far there are no safety issues.  And recently, excellent products using “micronized” titanium dioxide and zinc oxide have been developed which do not leave a tell-tale white residue.  Presently it is difficult to judge exactly how much protection a product affords against UVA because there is no SPF-like system has yet been devised.  But regulatory agencies are working on it.

There is one more “may” about sunscreens that has been converted to fact.  We no longer have to say that sunscreens may prevent skin cancer, we can say they do.  A study in Australia, where skin cancer is a huge concern, involved 1600 subjects who were given sunscreen to use every day for four and a half years.  They developed 40% fewer squamous cell cancers than a control group who just maintained normal skin care without being given specific instructions about the use of sunscreens.

So there it is.  Sunscreens can prevent skin cancer, which is not a rare disease.  The World Health Organization estimates 48,000 deaths a year from melanoma (likely sun related but not conclusively proven) and 12,000 from other forms of skin cancer.  What to do?

Look for a product with SPF 30 containing for avobenzone, Mexoryl, titanium oxide or zinc oxide.  Apply fifteen minutes before going out in the sun, use a shot glass full for the body and half a teaspoon for the face.  Reapply frequently.  Forget terms like “waterproof,” “all day protection” and “sweatproof.”  They’re meaningless.  And if you are buying something that is “chemical-free,” you are not getting a good deal because you’re buying a vacuum.  Sunscreens should not be used to prolong sun but rather to protect the skin when exposure is unavoidable.  Above all, remember that unfortunately there is no such thing as a healthy tan.

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Diet, Hygiene and Alzheimer’s Disease

cocoa extractThe incidence of Alzheimer’s Disease varies widely around the world. There are far more cases diagnosed in Europe and North America than in Africa, Asia or India. The question is why. Is it genetics? Some difference in lifestyle? Or is the disease just underreported in developing countries? India has a low rate of Alzheimer’s but with less access to physicians and fewer tests available it is possible that many cases of Alzheimer’s are not being recognized as such.

Genetics is not likely to account for the pattern of Alzheimer’s around the globe. For example, Asians who have grown up in North America have the same rate of Alzheimer’s as other Americans. Nigerians in the U.S. experience a higher rate than Nigerians in Africa. In Japan, a country that has traditionally had a low rate of dementia, Alzheimer’s has been increasing significantly. This obviously cannot be attributed to a change in genetics, so it seems that some sort of lifestyle factor that distinguishes poorer and wealthier countries is at play. Diet would seem to be a prime candidate because of significant differences in what people consume around the world. Rice is a staple in most developing countries and is far less widely consumed in the West. Meat, on the other hand, is a western institution. Could it be that the fat content, or the cholesterol, or the iron in meat somehow predispose to Alzheimer’s? In Japan, the incidence of the disease appears to have increased in step with a increase in meat consumption and a decrease in rice consumption. That could mean that rice has some protective factor, or that something in meat is a problem or it could mean nothing.

Epidemiological studies cannot distinguish between associations and cause and effect relationships. For example, there is a highly significant correlation between the divorce rate in the state of Maine and the per capita consumption of margarine. Interesting, but in all likelihood meaningless. There is also a correlation between strict hygiene and sanitation methods as practiced in wealthy countries and the prevalence of Alzheimer’s Disease. Could that be meaningful? In countries with access to clean drinking water the incidence of Alzheimer’s is increased and in countries with a low rate of infectious disease such as Switzerland or Iceland the rates of Alzheimer’s are higher by some 12% than in China and Ghana, both countries with high rates of infectious disease. Is this some spurious correlation or is it meaningful?

The “hygiene hypothesis” is gaining traction when it comes to allergies and asthma with the theory being that exposure to bacteria, viruses and worms early in life primes the development of a healthy immune system. In the absence of exposure to organisms that can actually cause disease, the immune system targets innocent bystanders such as certain food components. Maybe, some researchers suggest, the deposition of proteins in the nervous system, one of the hallmarks of Alzheimer’s, is a result of an immune system that has gone astray. Sounds pretty far fetched, but the absence of any proven cause of Alzheimer’s makes for all sorts of half-baked theories being hatched.

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souvenaidI suspect we will soon be hearing a lot about “Souvenaid,” a dietary supplement that is supposed to be of some help in the early stages of Alzheimer’s Disease. It was developed by Dr. Richard Wurtman of MIT, a very reputable researcher and the formulation of Souvenaid is based on legitimate science, but unfortunately the evidence for its effectiveness is virtually negligible.

In Alzheimer’s there is a loss of synapses, the connections between nerve cells that form when protrusions develop in cell membranes and reach out towards neighbouring nerve cells. The theory is that providing nutrients needed for healthy cell membranes encourages the formation of new synapses to compensate for the experienced loss.

Souvenaid provides a range of nutrients that include including omega-3 fatty acids (EPA and DHA), phospholipids, choline, uridine monophosphate, vitamins E, C, B12, B6, folic acid and selenium based on the theory that these are needed for the synthesis of phosphatidylcholine, a major constituent of synaptic membranes. The more phosphatidylcholine in cell membranes, the greater the likelihood of synapse formation, at least so goes the theory. But a theory needs evidence to back it up if it is to evolve into practical recommendations. And that evidence is not forthcoming. It isn’t for lack of effort.

A number of studies have been carried out on Alzheimer’s patients with Souvenaid using standardized assessment scales. The results are disappointing. There is no evidence of decreasing the rate of cognitive decline or delaying the progression of the disease in any way, but one of the studies offered a slight glimmer of hope. In patients experiencing early Alzheimer’s Disease, who are not yet taking medication, there was an improvement in verbal recall. That isn’t much to hang a hat on, but at least the supplement was tolerated without side effects. Souvenaid is on the market in Europe and Australia but not yet in the US or Canada despite the low level of evidence that is required for selling dietary supplements. My guess is that Souveanaid will not be of much aid in Alzheimer’s Disease.

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