Researchers explore cocoa as novel dietary source for prevention of cognitive deterioration in Alzheimer's disease

The potential benefits of dietary cocoa extract and/or its final product in the form of chocolate have been extensively investigated in regard to several aspects of human health. Cocoa extracts contain polyphenols, which are micronutrients that have many health benefits, including reducing age-related cognitive dysfunction and promoting healthy brain aging, among others.

Dr. Giulio Maria Pasinetti, MD, PhD, Saunders Family Chair and Professor of Neurology at the Icahn School of Medicine at Mount Sinai, Director of Biomedical Training at J.J. Peters Bronx VA Medical Center, is leading author of a recent paper entitled "Recommendations for development of new standardized forms of cocoa breeds and cocoa extract processing for the prevention of Alzheimer's disease," to be published in the Journal of Alzheimer's Disease.

This research suggests that "there is strong scientific evidence supporting the growing interest in developing cocoa extract, and potentially certain dietary chocolate preparations, as a natural source to maintain and promote brain health, and in particular to prevent age-related neurodegenerative disorders such as Alzheimer's disease, which is the most common form of age-related dementia affecting an estimated 44 million people worldwide."

Previous studies from Dr. Pasinetti's laboratory and others suggest that certain cocoa extract preparations may prevent or possibly delay Alzheimer's disease in animal experimental models of the disease, in part by inhibiting the generation and promoting the clearance of toxic proteins, including β-amyloid (Aβ) and abnormal tau aggregates, in the brain through mechanisms mediated by polyphenols. Most importantly, the role of cocoa polyphenols in preventing abnormal accumulation of toxic protein aggregates in the brain would play a pivotal role in preventing the loss of synapses that are critical for functional connection among neurons.

Recent clinical studies appear to confirm the potential beneficial role of certain cocoa extracts in delaying cognitive aging. The benefits of cocoa polyphenols in preventing synapse loss and, therefore, in preserving/restoring synaptic function may provide a viable and important strategy for preserving cognitive function and, thereby, protecting against the onset and progression of Alzheimer's disease.

In spite of the promises of cocoa polyphenols for treating and/or preventing Alzheimer's disease, Dr. Pasinetti hypothesizes in his new publication that there is a need for multidisciplinary collaborative efforts involving cocoa producers, wholesalers, and the biomedical community if we want to succeed in the development of cocoa extract for health benefits. For example, there are still major issues relating to the diminishing global supply of cocoa and the lack of consistency and reproducibility of cocoa extract processing, which should be carefully addressed. Changes in growth, climate/conditions, and cocoa plant diseases are decreasing the supply of cocoa.

To address this, new breeds of cocoa, engineered to be fruitful, more resistant to disease, and more flavorful, are currently being investigated. Furthermore, little is known about how cocoa processing may influence the biological effect of cocoa extracts. Evidence suggests that certain procedures used in cocoa processing can significantly influence its polyphenol content, ultimately influencing its biological activity. Interestingly, two of the most common processing techniques for the chocolate we consume have been reported to result in the loss of as much as 90% of the polyphenols in cocoa.

Dr. Pasinetti notes that ongoing interdisciplinary research will provide an unprecedented opportunity to strengthen our understanding of the beneficial roles of cocoa polyphenols and improve cocoa development and processing in order to promote healthy brain aging and possibly prevent Alzheimer's disease.

Yoga improves arthritis symptoms and mood

Fast facts:

• Study finds that yoga may be a safe and effective way to keeping moving for the 1 in 5 adults who live with arthritis.
• In a randomized trial, people with arthritis who practiced yoga had about a 20% improvement in physical health with similar improvements in pain, energy, mood and carrying out day-to-day activities and tasks.

A randomized trial of people with two common forms of arthritis has found that yoga can be safe and effective for people with arthritis. Johns Hopkins researchers report that 8 weeks of yoga classes improved the physical and mental wellbeing of people with two common forms of arthritis, knee osteoarthritis and rheumatoid arthritis. The study is believed to be the largest randomized trial so far to examine the effect of yoga on physical and psychological health and quality of life among people with arthritis.

Results were published in the April issue of the Journal of Rheumatology.

"There's a real surge of interest in yoga as a complementary therapy, with 1 in 10 people in the U.S. now practicing yoga to improve their health and fitness," says Susan J. Bartlett, Ph.D., an adjunct associate professor of medicine at Johns Hopkins and associate professor at McGill University "Yoga may be especially well suited to people with arthritis because it combines physical activity with potent stress management and relaxation techniques, and focuses on respecting limitations that can change from day to day."

Arthritis, the leading cause of disability, affects 1 in 5 adults, most of whom are under 65 years of age. Without proper management, arthritis affects not only mobility, but also overall health and well-being, participation in valued activities, and quality of life. There is no cure for arthritis, but one important way to manage arthritis is to remain active. Yet up to 90% of people with arthritis are less active than public health guidelines suggest, perhaps due to arthritis symptoms such as pain and stiffness, but also because they are unsure of how best to remain active.

The study recruited 75 people with either knee osteoarthritis or rheumatoid arthritis. Participants were randomly assigned to either a wait list or eight weeks of twice-weekly yoga classes, plus a weekly practice session at home. Participants' physical and mental wellbeing was assessed before and after the yoga session by researchers who did not know which group the participants had been assigned to.

Compared with the control group, those doing yoga reported a 20% improvement in pain, energy levels, mood and physical function, including their ability to complete physical tasks at work and home. Walking speed also improved to a smaller extent, though there was little difference between the groups in tests of balance and upper body strength. Improvements in those who completed yoga was still apparent nine months later.

Clifton O. Bingham III, M.D., associate professor of medicine at Johns Hopkins University School of Medicine and director of the Johns Hopkins Arthritis Center, says the idea for the study grew out of his experiences treating patients with arthritis. "It was watching what happened with my patients and the changes in their lives as a result of practicing yoga that got me interested in the first place."

Safety was a priority in the study, the authors say. "For people with other conditions, yoga has been shown to improve pain, pain-related disability and mood," says Bingham. "But there were no well-controlled trial of yoga that could tell us if it was safe and effective for people with arthritis, and many health professionals have concerns about how yoga might affect vulnerable joints given the emphasis on changing positions and on being flexible. Our first step was to ensure that yoga was reasonable and safe option for people with arthritis. Our instructors were experienced yoga therapists with additional training to modify poses to accommodate individual abilities." Participants were screened by their doctors prior to joining the study, and continued to take their regular arthritis medication during the study.

The researchers have developed a checklist to make it easier for doctors to safely recommend yoga to their patients, Bingham says. People with arthritis who are considering yoga should "talk with their doctors about which specific joints are of concern, and about modifications to poses," suggests Bingham. "Find a teacher who asks the right questions about limitations and works closely with you as an individual. Start with gentle yoga classes. Practice acceptance of where you are and what your body can do on any given day."

Diet, exercise, smoking habits and genes interact to affect AMD risk

People with a genetic predisposition for age-related macular degeneration (AMD) significantly increased their odds of developing the blinding eye disorder if they had a history of heavy smoking and consistently did not exercise or eat enough fruits and vegetables, according to an observational study of women funded by the National Eye Institute, part of the National Institutes of Health.

Eating a healthy diet and getting exercise have been shown in earlier studies to protect against AMD, a leading cause of vision loss among people age 50 and older. Findings from this latest study, conducted by a team of investigators at the University of Wisconsin-Madison, suggest that genetic and lifestyle factors may contribute to AMD in a synergistic way. The findings were published online in the journal Ophthalmology.

If you have a family history of AMD, the good news is that the study findings suggest that there are things you can do to potentially lower your risk of developing AMD yourself,.

The researchers studied the risk among women ages 50 to 79 years who had participated in the Carotenoids in Age-Related Eye Disease Study (CAREDS), an ancillary investigation of the much larger Women's Health Initiative, an observational study that has tracked the health-related behaviors and outcomes of more than 160,000 women since 1991.

For the current study, first author Kristin J. Meyers, Ph.D., and her team evaluated the diet and exercise patterns of 1663 women and categorized them into lowest-, moderate- and highest-risk groups. They also evaluated whether the women smoked and, if so, how many years they smoked a pack of cigarettes or more each day. They also assessed genetic data from the women to determine whether they carried known genetic risk factors for AMD. They looked most closely at an allele (version) of the complement factor H (CFH) gene that is known to be associated with greater AMD risk, probing whether the women had zero, one, or two copies of the allele.

A total of 337 women in the study developed AMD, of whom 91 percent had early-stage disease.

Among women with stable diets, those who carried two high-risk genetic alleles, smoked at least seven pack-years, and were in the highest-risk diet and exercise categories were more than four times more likely to have AMD compared to those women who did not have genetic risk factors and who ate a healthy diet and got at least 10 hours/week of light exercise (such as housework or walking at a pace you could sing to) or at least eight hours of moderate activity (such as brisk walking).

In addition to lifestyle contributions, vitamin D levels may play a synergistic role with genetic factors, according to the findings of another study by the same team involving 913 CAREDS participants. Amy E. Millen, Ph.D., that study's first author, found that blood levels indicating vitamin D deficiency (less than 12 ng/mL of 25 hydroxyvitamin D) were associated with a 1.8-fold increase in the odds of having AMD among women with no risk alleles, but a 6.7-fold increase in the odds of having AMD among women with two risk alleles, compared with women who had no genetic risk alleles and adequate levels of vitamin D. The findings of the vitamin D study, which was also funded by NEI, were published in JAMA Ophthalmology.

"The findings of both studies support the notion of biologic synergy. That is, that one's genes, lifestyle factors and nutrition all come together in a synergistic way to mediate inflammation, which is a key mechanism involved in AMD," said Dr. Mares. "There's a large body of evidence that unhealthy lifestyle habits are associated with inflammation and that CFH risk alleles augment inflammatory responses. Vitamin D is believed to suppress inflammation, which is thought to enhance the AMD disease processes both directly and indirectly."

Mediterranean diet plus olive oil associated with reduced breast cancer risk

 Eating a Mediterranean diet supplemented with extra virgin olive oil was associated with a relatively lower risk of breast cancer in a study of women in Spain, according to an article published online by JAMA Internal Medicine.

Breast cancer is a frequently diagnosed cancer and a leading cause of death in women. Diet has been extensively studied as a modifiable risk factor in the development of breast cancer but epidemiologic evidence on the effect of specific dietary factors is inconsistent.

The Mediterranean diet is known for its abundance of plant foods, fish and especially olive oil. Miguel A. Martínez-González, M.D., of the University of Navarra in Pamplona and CIBEROBN in Madrid, Spain, and coauthors analyzed the effects of two interventions with the Mediterranean diet (supplemented with extra virgin olive oil [EVOO] or nuts) compared with advice to women to follow a low-fat diet. Study participants in the two intervention groups were given EVOO (one liter per week for the participants and their families) or mixed nuts (30 grams per day: 15 grams of walnuts, 7.5 grams of hazelnuts and 7.5 grams of almonds).

The study was conducted within the framework of the large PREDIMED (Prevención con Dieta Mediterránea) trial, which was designed to test the effects of the Mediterranean diet on the primary prevention of cardiovascular disease.

From 2003 to 2009, 4,282 women (ages 60 to 80 and at high risk of cardiovascular disease) were recruited. Women were randomly assigned to the Mediterranean diet supplemented with EVOO (n=1,476), the Mediterranean diet supplemented with nuts (n=1,285) or the control diet with advice to reduce their dietary intake of fat (n=1,391).

The women were an average age of 67.7 years old, had an average body mass index of 30.4, most of them had undergone menopause before the age of 55 and less than 3 percent used hormone therapy. During a median follow-up of nearly five years, the authors identified 35 confirmed incident (new) cases of malignant breast cancer.

The authors report that women eating a Mediterranean diet supplemented with EVOO showed a 68 percent (multivariable-adjusted hazard ratio of 0.32) relatively lower risk of malignant breast cancer than those allocated to the control diet. Women eating a Mediterranean diet supplemented with nuts showed a nonsignificant risk reduction compared with women in the control group.

The authors note a number of limitations in their study including that breast cancer was not the primary end point of the trial for which the women were recruited; the number of observed breast cancer cases was low; the authors do not have information on an individual basis on whether and when women in the trial underwent mammography; and the study cannot establish whether the observed beneficial effect was attributable mainly to the EVOO or to its consumption within the context of the Mediterranean diet.

"The results of the PREDIMED trial suggest a beneficial effect of a MeDiet [Mediterranean diet] supplemented with EVOO in the primary prevention of breast cancer. Preventive strategies represent the most sensible approach against cancer. The intervention paradigm implemented in the PREDIMED trial provides a useful scenario for breast cancer prevention because it is conducted in primary health care centers and also offers beneficial effects on a wide variety of health outcomes. Nevertheless, these results need confirmation by long-term studies with a higher number of incident cases," the authors conclude.

Editor's Note: Can Diet Prevent Breast Cancer?

In a related editor's note, Mitchell H. Katz, M.D., a deputy editor of JAMA Internal Medicine, writes: "Of course, no study is perfect. This one has a small number of outcomes (only 35 incident cases of breast cancer), the women were not all screened for breast cancer with mammography, they were not blinded to the type of diet they were receiving, and all were white, postmenopausal and at high risk for cardiovascular disease. Still, consumption of a Mediterranean diet, which is based on plant foods, fish and extra virgin olive oil, is known to reduce the risk of cardiovascular disease and is safe. It may also prevent breast cancer. We hope to see more emphasis on Mediterranean diet to reduce cancer and cardiovascular disease and improve health and well-being."

Low vitamin D level predicts cognitive decline in older population

Older adults with deficiencies in vitamin D experience more rapid cognitive decline over time than those with adequate vitamin D levels.

In a study published Sept. 15, 2015 in the Journal of the American Medical Association-Neurology, Joshua Miller, professor of nutritional sciences at the Rutgers School of Environmental and Biological Sciences, found that people with low levels of vitamin D experienced rates of cognitive decline at a much faster pace than people with adequate vitamin D status.

"There were some people in the study who had low vitamin D who didn't decline at all and some people with adequate vitamin D who declined quickly," said Miller. "But on average, people with low vitamin D declined two to three times as fast as those with adequate vitamin D."

Vitamin D - known for its importance for bone health -- is obtained primarily through sun exposure and some foods. Researchers have also found that vitamin D has a major impact on how the body, including the brain, functions.

Miller's study -- conducted with Charles DeCarli, Danielle Harvey and others at the Alzheimer's Disease Center at the University of California-Davis -- was conducted between 2002 and 2010. The 382 people involved were assessed for vitamin D levels and cognition once a year for an average of five years. They ranged in age from their 60s to their 90s, with the largest group in their 70s.

The study included people with normal cognition, mild cognitive loss, and dementia. Unlike previous studies of vitamin D and dementia, this group was racially and ethnically diverse, including whites, African Americans and Hispanics. Most (61 percent) had low vitamin D levels in their blood; 54 percent of the whites and 70 percent of the African-Americans and Hispanics had low blood levels of vitamin D.

While individuals with darker skin are more likely to have low levels of vitamin D because melanin, the pigment that makes skin dark, blocks the ultra-violet rays that help the skin synthesize vitamin D, the researchers found no difference in the rates of cognitive decline based solely on racial or ethnic lines. In other words, low vitamin D was associated with faster cognitive decline regardless of race or ethnicity.

Although taking too much vitamin D can be dangerous, Miller said these findings suggest that people over 60 should consult their physician about taking vitamin D supplements.

"Some people may have had melanoma or fear getting it," Miller said. "Or, they may live in climates where the sun isn't powerful enough, or do work that keeps them out of the sun. That's where supplements come in."

Meanwhile, he said, more research needs to be done including performing randomized controlled clinical trials.

"This will give us the additional information that we need to help determine whether vitamin D supplements can be used to slow the rate of cognitive decline and prevent dementia in older adults," Miller said.

Intensive blood pressure management to lower rate to 120 saves lives

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More intensive management of high blood pressure, below a commonly recommended blood pressure target, significantly reduces rates of cardiovascular disease, and lowers risk of death in a group of adults 50 years and older with high blood pressure. This is according to the initial results of a landmark clinical trial sponsored by the National Institutes of Health called the Systolic Blood Pressure Intervention Trial (SPRINT). The intervention in this trial, which carefully adjusts the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg), reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg.

 “This study provides potentially lifesaving information that will be useful to health care providers as they consider the best treatment options for some of their patients, particularly those over the age of 50,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), the primary sponsor of SPRINT. “We are delighted to have achieved this important milestone in the study in advance of the expected closure date for the SPRINT trial and look forward to quickly communicating the results to help inform patient care and the future development of evidence-based clinical guidelines.”

High blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems. An estimated 1 in 3 people in the United States has high blood pressure.

The SPRINT study evaluates the benefits of maintaining a new target for systolic blood pressure, the top number in a blood pressure reading, among a group of patients 50 years and older at increased risk for heart disease or who have kidney disease. A systolic pressure of 120 mm Hg, maintained by this more intensive blood pressure intervention, could ultimately help save lives among adults age 50 and older who have a combination of high blood pressure and at least one additional risk factor for heart disease, the investigators say.

The SPRINT study, which began in the fall of 2009, includes more than 9,300 participants age 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States and Puerto Rico. It is the largest study of its kind to date to examine how maintaining systolic blood pressure at a lower than currently recommended level will impact cardiovascular and kidney diseases. NIH stopped the blood pressure intervention earlier than originally planned in order to quickly disseminate the significant preliminary results.

The study population was diverse and included women, racial/ethnic minorities, and the elderly. The investigators point out that the SPRINT study did not include patients with diabetes, prior stroke, or polycystic kidney disease, as other research included those populations.

When SPRINT was designed, the well-established clinical guidelines recommended a systolic blood pressure of less than 140 mm Hg for healthy adults and 130 mm Hg for adults with kidney disease or diabetes. Investigators designed SPRINT to determine the potential benefits of achieving systolic blood pressure of less than 120 mm Hg for hypertensive adults 50 years and older who are at risk for developing heart disease or kidney disease.

Between 2010 and 2013, the SPRINT investigators randomly divided the study participants into two groups that differed according to targeted levels of blood pressure control. The standard group received blood pressure medications to achieve a target of less than 140 mm Hg. They received an average of two different blood pressure medications. The intensive treatment group received medications to achieve a target of less than 120 mm Hg and received an average of three medications.

“Our results provide important evidence that treating blood pressure to a lower goal in older or high-risk patients can be beneficial and yield better health results overall,” said Lawrence Fine, M.D., chief, Clinical Applications and Prevention Branch at NHLBI. “But patients should talk to their doctor to determine whether this lower goal is best for their individual care.”

The study is also examining kidney disease, cognitive function, and dementia among the patients; however, those results are still under analysis and are not yet available as additional information will be collected over the next year. The primary results of the trial will be published within the next few months.

Diet beverage drinkers compensate by eating unhealthy food,

Want fries with that diet soda? You aren't alone, and you may not be "saving" as many calories as you think by consuming diet drinks.

A new study that examined the dietary habits of more than 22,000 U.S. adults found that diet-beverage consumers may compensate for the absence of calories in their drinks by noshing on extra food that is loaded with sugar, sodium, fat and cholesterol.

University of Illinois kinesiology and community health professor Ruopeng An examined 10 years of data from the National Health and Nutrition Examination Survey, conducted by the National Center for Health Statistics, which asked participants to recall everything they ate or drank over the course of two nonconsecutive days.

An compared participants' daily calorie intakes, including their consumption of discretionary foods and five types of beverages - diet or sugar-free drinks; sugar-sweetened beverages, such as sodas and fruit drinks; coffee; tea; and alcohol.

Using a U.S. Dept. of Agriculture food database, An compiled a 661-item list of discretionary foods, which includes foods that do not belong to the major food groups and are not required by the human body but may add variety to a person's diet. These energy-dense, nutrient-poor foods include products such as cookies, ice cream, chocolate, fries and pastries.

More than 90 percent of the people in the study consumed discretionary foods daily, averaging about 482 calories from these products each day, An found.

Although previous research on beverage preferences and consumption of discretionary foods focused on between-meal snacking, An chose to look at the nutritional quality of the food participants consumed rather than when it was eaten. His paper will appear in a future issue of the Journal of the Academy of Nutrition and Dietetics.

About 97 percent of the study population consumed at least one of the five types of beverages daily, with about 41 percent of respondents drinking beverages from at least two of the categories. More than 25 percent of the participants consumed three or more types of beverages daily.

Coffee was participants' beverage of choice, consumed by more than half - 53 percent - of the population, followed by sugar-sweetened beverages (43 percent), tea (26 percent), alcohol (22 percent) and diet beverages (21 percent).

Alcohol consumption was associated with the largest increase in daily calorie intake (384 calories), followed by sugar-sweetened beverages (226 calories), coffee (108 calories), diet beverages (69 calories) and tea (64 calories).

While coffee and diet-beverage drinkers consumed fewer total calories each day than people who preferred alcohol or sugary drinks, they obtained a greater percentage of their daily calorie intake from discretionary foods - a finding that suggests a possible compensation effect, An said.

"It may be that people who consume diet beverages feel justified in eating more, so they reach for a muffin or a bag of chips," An said. "Or perhaps, in order to feel satisfied, they feel compelled to eat more of these high-calorie foods."

A third possible explanation might be that people opt to drink diet beverages because they feel guilty about indulging in unhealthy food, An said.

"It may be one - or a mix of - these mechanisms," An said. "We don't know which way the compensation effect goes."

Associations between beverage consumption and daily calorie intake differed substantially across population subgroups, An found. African-Americans who consumed diet beverages, sugary drinks and coffee, as well as Hispanics who drank alcohol, had the highest daily calorie intakes across all of the racial and ethnic groups.

However, among people with the most education and highest incomes, diet beverages and alcohol were linked with increased calorie consumption, whereas, sugar-sweetened beverages and coffee were associated with elevated caloric intake among people with the lowest incomes.

Obese adults who drank diet beverages consumed more calories in discretionary foods, as did normal-weight participants who drank sugar-sweetened beverages.

In exploring associations between beverage type and dietary quality, An found that people who consumed sugar-sweetened beverages or coffee had the worst nutrition profiles.

Switching to diet drinks may not help people control their weight if they don't pay attention to the quantity and quality of the foods they consume, An said.

"If people simply substitute diet beverages for sugar-sweetened beverages, it may not have the intended effect because they may just eat those calories rather than drink them," An said. "We'd recommend that people carefully document their caloric intake from both beverages and discretionary foods because both of these add calories - and possibly weight - to the body."

An also recommended that public health interventions take a holistic approach, encouraging people to assess their beverage consumption in the context of their overall dietary behavior.