September 30, 2015

Advance Directives: One More Time

Last week, I ran a series of posts about advance directives... the documents that clarify and formalize what I want – and don’t want – when I can no longer make healthcare decisions myself.

It is hard to describe the peace of mind that comes with knowing that my family, key providers, and healthcare proxy understand my wishes.

Still, there are millions of Americans who cannot know that peace of mind, because they haven’t taken the fairly simple steps involved to complete the documents – 1) a living will and 2) a power of attorney / healthcare proxy.

Maybe some of those people really haven’t given any thought to the Final Things. But I suspect most of the unprepared are simply uncomfortable addressing their own last days and/or initiating the difficult discussions with families, friends, and doctors.

I’d be much more uncomfortable thinking I was leaving my nearest and dearest to fend for themselves when the time comes… subjecting them to indescribable emotional (and financial) distress.

I don’t give advice on this blog; it’s a decision I made at the start. But I don’t mind offering this recommendation: if you don’t have an advance directive in place, think about doing it soon.

There are many online resources to help. If you search “advance directives,” many links appear. Here is just one, from AARP: Advance Directives: Creating a Living Will and Health Care Power of Attorney.

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After my posts last week about advance directives, I was intrigued to see a piece by Paula Span in The New York Times’ “The New Old Age” (a blog feature I regularly enjoy) titled Near the End, It’s Best to Be ‘Friended’.  

I hope running it here underscores the importance of getting the documents in place. The very last line in this story – uttered by its 88-year-old protagonist -- says it all: “I should have done it yesterday.”

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The unconscious man in his 90s was brought to an emergency room where Dr. Douglas White was a critical care physician. The staff couldn’t find any relatives to make medical decisions on his behalf.

“He had outlived all his family,” recalled Dr. White, who now directs an ethics program at the University of Pittsburgh Medical Center. “We were unable to locate any friends. We even sent the police to knock on his neighbors’ doors.” 

September 29, 2015

Supporting Brain Health: Chocolate? Yes. Anticholinergic Drugs? No.

Today brings another post from the health grab bag.

The Case for Cocoa
A recent report in the Journal of Alzheimer’s Disease suggests that polyphenols -- the micronutrients in chocolate -- might be used to maintain brain health and even prevent age-related neurodegenerative diseases like Alzheimer’s disease (AD).

For some time, the good reputation of chocolate-for-health has been on a roll. We’ve already heard that flavanols – cocoa’s particular polyphenols – have blood-thinning properties and pack a powerful antioxidant effect that reduces cell damage caused by coronary disease. A study published this summer in Medical News Today suggested that eating 100g of chocolate every day was linked to reduced risk of heart disease and stroke.

Earlier research also suggests that eating cocoa extract helps reduce age-related cognitive decline and supports healthy brain aging.

In the latest study, Dr. Giulio Maria Pasinetti -- professor of neurology at the Icahn School of Medicine at Mount Sinai in New York, NY – and his team found that cocoa polyphenols did a couple things in particular:
  • help reduce the production of damaging proteins now linked to AD – beta-amyloid and tau clumps.
  • help clear out those harmful proteins already aggregating in the brain.

Cocoa’s polyphenols are particularly adept at crossing the blood-brain barrier, an obstacle we’ve frequently encountered in both prescription meds and dietary supplements. For any substance to have an impact on brain function, it must first find its way into the brain from the blood… not always an easy hurdle.

Pasinetti summed up his study this way:
Therefore, emerging biomedical research experimental evidence, and new clinical translational studies all support the major interest in the development of cocoa as a botanical source for the maintenance and promotion of health, in particular, in the brain.

After urging additional studies, particularly with human subjects, Pasinetta sounded an alarm. Demand for cocoa is increasing as we learn more about it, but its availability is now challenged by disease and climate change. He recommends the development of new strains of cocoa that are more fruitful, and less vulnerable to disease.

The Case Against Anticholinergic Drugs
Articles often recommend what we SHOULD do to support brain health and function -- especially among seniors – with advice about diet, exercise, supplements, games, sleep.

September 25, 2015

Advance Directives: Reducing Costs and Improving Healthcare

With the death of Oliver Sacks, Atul Gawande becomes my favorite doctor/medical writer. He has taken on issues that resonate with me. His recent book Being Mortal describes how doctors, uncomfortable discussing their patients' anxieties about death, fall back on false hopes and treatments that actually shorten lives, not improve them.

Overkill, his most recent article for the New Yorker, carried this subtitle: 
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

One of the best things we can do is prepare an advance directive that spells out for doctors and other healthcare providers what we want them to do, and what we don't want them to do. When I read and write about healthcare issues, I'm often frustrated because there's often so little I can do. That's not the case here.

Drafting an Advance Directive
There are two types of advance directives, and it’s important to have both.
  • A living will spells out what types of medical treatment you want at the end of life if you are unable to speak for yourself.
  • A health care power of attorney is someone you appoint to make healthcare decisions on your behalf. That agent (also called an attorney-in-fact or proxy) becomes your spokesman and advocate on all the medical treatments you address in the document.
Many states combine the two forms into one document. Advance directives are legally valid throughout the United States, and you don't need a lawyer to complete one.

One state's advance directive doesn't always work in other states. If you spend significant time in several states, you should complete advance directives for each state.

An advance directive does not expire. It remains in effect until you change or rescind it. If you want to make changes, you should complete a new document.

To download a free advanced directive form for your state, click here.

September 24, 2015

The Addendum to My Advance Directive: Palliative Care, not Life-Sustaining Procedures

In yesterday's post, I provided the text of the basic advance healthcare directive I'll attach to my revised will. It's fairly standard.

My directive first provides for the appointment of "my durable power of attorney for health care." This individual (also the executor of my will) is empowered to make decisions about my healthcare if there comes a time when I cannot make those decisions myself.

I want to know there is someone who can respond fluidly as my medical situation changes, someone who can deal with situations I can't foresee. I'll add instructions above and beyond what is detailed in the standard directive, to help my healthcare attorney/agent carry out my wishes.

I want to clarify these key preferences in most health care crises: 
  • for palliative care, not life-sustaining procedures, and 
  • for hospice, not hospital.

Questions have been raised about the legality of a provision, like the one I have here, that authorizes my agent to arrange for VSED (voluntarily stopping eating and drinking) in the event I have dementia. I discussed this issue in an earlier post

I'll wrap up this series on advance directives tomorrow.

Here are the additional instructions I'll add to the standard directive:

September 23, 2015

My New Advance Health Care Directive: Will It Be Honored?

I'm about to sign off on a revised draft of my will and the advance healthcare directive that accompanies it. I've gone through this drill before, but this time I'm making more of an effort to publicize the directive.

An 86-year-old with Parkinson's, I want any healthcare providers to know that in the event of a life-threatening condition, I want comfort care only... no heroics. Earlier this year in its "The New Old Age" blog, The New York Times reported on the trouble with advance directives. Researchers and medical personnel working with patients near the end of life have grown increasingly disenchanted with advance directives, including living wills and powers of attorney for healthcare.

Frequently, directives never get to the right place at the right time, or they're not referenced when decisions must be made. Even clear, formalized instructions are often overridden when relatives on the scene are unaware of their loved ones' end-of-life stipulations.

This time, rather than have my advance directive filed away in my desk drawer, I'm making sure my immediate family, my housemates, and my attorney for healthcare know its contents. I'll also send copies to my geriatrician and neurologist, the two doctors most likely to be involved should a health crisis arise.

The POLST Form for Emergency Care
Emergency medical personnel operate under standing orders to attempt resuscitation regardless of any specific instructions to the contrary in advance directives. In fact, patients may already be hooked up to breathing machines before they even arrive at the emergency room.

Only a do-not-resuscitate or POLST (Physician Order for Life-Sustaining Treatment) form can prevent that unwanted scenario. Research suggests that these forms do a better job than advance directives of keeping dying people out of hospitals. Completed by healthcare professionals in consultation with patients, the documents can exactly stipulate expected medical responses, from comfort-only measures to full life-prolonging interventions and all the options in between.

POLST documents are designed for people with severe illnesses. They're generally appropriate only for people who are in the final year of life, suffering from an advanced terminal illness or an illness from which there is no expectation of recovery.

Unfortunately, Washington, D.C. currently doesn't have a POLST program.

To see if your state has one, click here.

My Advance Health Care Directive
What follows is the main part of my advance directive. Most directives today are similar, listing healthcare options that address different medical situations. I'll be checking the first option -- the one calling for the least medical intervention -- in each situation.

I've added an unusual provision at the end, which I'll discuss tomorrow.

September 22, 2015

Want to Lower Your Blood Pressure? Just Stand Up.

Here’s the kind of news I like to hear: Just standing up can help lower your blood pressure (bp).

Occasional visitors to this blog know a frequent theme here is bp – its highs and lows, its many causes, its acceptable ranges.

Those readers also know that I take my blood pressure at home regularly through the course of each day, and that I record the numbers in an ever-growing log. That log includes notes -- what I’ve been doing, where I am on my Parkinson’s pill cycle, how I’m feeling.

I’ve devoted many blog posts to the various strategies I use to control blood pressure: sipping hibiscus tea  at least once a day and beet juice first thing in the morning, meditating, drinking lots of water, using specially designed electronic devices, and exercising. I no longer take the blood pressure meds that I used for years

Not that many years ago, I rode my bike regularly... to work most every day and to Great Falls or Mount Vernon or most anywhere on our many bike trails on weekends. The most depressing setback from my Parkinson's was having to give up biking due to the balance problems.

In my early years with Parkinson's, I enjoyed long walks around my DC Palisades neighborhood. Now, whatever walks I take are short and brief… and rare.

Needless to say, an article in The New York Times last Friday got my attention. It began like this:
Question: What is the best exercise to control high blood pressure? 
Answer: Take your pick, as the best exercise to control high blood pressure seems to be virtually any exercise, like walking or cycling or light weight training, especially if your workouts are spread throughout the day. 
“Even standing might work,” says Glenn Gaesser, the director of the Healthy Lifestyles Research Center at Arizona State University and an expert on exercise and hypertension.

My kind of news.

Several Brief Exercise Periods Better than One Longer One
In a study he completed three years ago, Gaesser found that three ten-minute walks spread throughout the day prevented bp spikes (my big worry) more effectively than one 30-minute walk.

September 18, 2015

Health Grab Bag: Coffee and Parkinson’s Risk, “Old People Smell,” Exercise for Brain Health

Occasionally, I’ll combine several recent stories that caught my attention in a general “health update.” Here’s one today.

Coffee Lowers Parkinson’s Risk
If you drink coffee, your risk of developing Parkinson’s disease is lowered by 31 percent, according to a meta-analysis presented at the First Congress of the European Academy of Neurology in Berlin this past June.

As reported in a recent article in Medical News Today, Dr Filipe Brogueira Rodrigues and his team at the Instituto de Medicina Molecular in Lisbon conducted a systematic review of 37 studies from all over the world. “Men and women benefit equally from the effects of caffeine,” he said.

While there are still many possible explanations, the researchers think that coffee’s caffeine interacts with the neurotransmitter adenosine. According to Brogueira Rodrigues, "This may have neuroprotective effects on specific brain regions which play an important role in relation to Parkinson's."

The good news about coffee’s positive health benefits wasn’t especially surprising, since the popular drink has already been linked with reduced risks for type 2 diabetes, stroke, depression, Alzheimer’s, liver cirrhosis and liver cancer.

Prof Kailash Bhatia from the Institute of Neurology, UCL, London, said, “Better understanding of environmental factors which reduce or increase the risk of developing Parkinson's disease is crucial to safeguard against developing this disorder.”

He urged continuing study to more clearly understand the link between caffeine in coffee and its association with reduced risk of Parkinson’s.

Old People DO Smell Different
And it’s all about “Nonenal,” a component of body odor that develops in men and women after about age 40. Maybe you’ve smelled it in nursing homes or other elder care facilities.

September 17, 2015

Forget Blood Pressure. Happy New Year!

Today, I'd intended to discuss what I've learned from my blood pressure monitoring and my research on levodopa. Tomorrow, I'd intended to cover orthostatic hypotension, the sudden low blood pressure spells many of us with Parkinson's experience.

But last night, two familiar thoughts came to mind:
  1. I've been overdoing this blood pressure stuff.
  2. I'm eager to discuss some new subjects.
My dear friend Kathy will read #2 above, smile, and think "the more things change, the more they remain the same." When I was vice president for human resources at the Bureau of National Affairs (BNA), Kathy was our benefits manager, and she had to repeatedly endure my attempts to fire everybody up about a new idea. I'd quickly get bored with that idea and move on to something else, leaving my teammates to scratch their heads.

A Brief Wrap on Levodopa and Blood Pressure
For several years, I’ve kept records of my blood pressure, with accompanying notes showing what I was doing at the time, and how I was feeling.

I’d bet the ranch there are very few others nutty enough to keep such obsessive records. Mostly, they show the relationship between falling levodopa levels in my body and rising systolic (upper) blood pressure numbers.

I take two levodopa pills for Parkinson’s every three hours. Toward the end of each cycle, my pressure begins to increase. Soon after I take the next pill, it soon drops back into the normal zone.

The levodopa/blood pressure link is clearly there for me. Is this just a fluke? Or have others with Parkinson's experienced anything similar. I'd love to hear more.

September 16, 2015

From Blood Pressure Log to Health Journal

I started keeping blood pressure records at home years ago, even before I became concerned about the levodopa "off" period pressure spikes. Why? As it turned out, the supplement 5-HTP that I’d been taking for years was causing high upper (systolic) numbers.

5-HTP boosts serotonin, just as levodopa boosts Parkinson’s-depleted dopamine. It took me a while to recognize that the carbidopa used to enhance levodopa’s effectiveness has the same impact on 5-HTP. The result was a pressure-spiking serotonin overload.

At first when I decided to keep a log, I simply entered my pressure numbers – top number over bottom diastolic number. Recently, I’ve added explanatory notes, too – what I was doing and how I was feeling at monitoring time. The log has become a good resource for someone with a failing memory… and a kind of health journal.

The log has been helpful. Next to an entry with high pressure numbers, I may have entered “3  hours at the computer -- missed 6 pm pill.” These notes helped me confirm the connection between pill intervals and pressure readings.

Next to an entry with lower numbers, I may have written, "after 20 minutes meditating.” I learned something there, too.

Most people with Parkinson’s (PWPs) know when they’ve waited too long since the last pill: their tremors worsen. I’m in the 30 percent minority of PWPs who have no tremor. Instead, my warning signs are smaller, cramped handwriting (micrographia) and shortened walking stride. It’s easy for me to miss those symptoms, especially if I’m working on the computer or reading in my chair.

So far, I haven’t devised a foolproof method to make sure I take my pills every three hours. There's a big difference between three hours and four.

My increasing forgetfulness doesn’t help. I’ll find myself standing at the bathroom sink where my pill bottles are arrayed, wondering, "Did I just take those pills?"

Now, there’s a way for me to know for sure: I’ll take my blood pressure once, and again in about 15 minutes. If the numbers are going up, I didn’t take the pills. If the numbers are going down, I took the pills.

Each time I take my blood pressure, I wait a minute and take another… and then another after a minute or two. Multiple readings are recommended, though I’ve noticed it rarely happens in doctors’ offices.

September 15, 2015

So... Why the Wheelchairs on Your Colorado Trip?

Initially, I blamed altitude sickness for my health issues over our Labor Day weekend trip to Colorado. But later, I realized it was mostly the same old problem I've been dealing with for the past several years.

Here's What Happened
As I reported in my last post, we began our visit to the Rocky Mountain National Park by driving along the Trail Ridge Road, the nation's highest continuously paved road. As we headed up, I noticed that my breathing was becoming more labored. When we reached the visitor center near the road's highest elevation (12,183 feet), I decided to stay in the car while my travel mates headed for the center.

After a while, I got restless and decided to take my cane and hobble up to the visitor center. The place was mobbed, and soon I was feeling weak. I sat down and got out my cell phone to call my friends. But there was no phone signal, which exacerbated my anxiety.(I learned later that cell phones often don't work at high elevations,)

I finally asked a passerby to find one of the employees. Luckily, these National Park centers are well equipped to handle emergencies. Within a few minutes, a medical staffer arrived with a wheelchair and extra oxygen. We headed for the center's health clinic.

Fortunately, my friends showed up as we worked our way through the crowd. The clinic nurse checked me out. I had a high blood pressure reading, but there were no other danger signs. I was released with a warning to take it easy and to head down from the high elevation.

Background Information on Blood Pressure and Levodopa and Me
Before continuing my Rocky Mountain High story, I need to provide some background information.

Blood pressure spikes have been an ongoing problem for several years. They always occur during medication "off" periods, when the last carbidopa-levodopa pill is wearing off and the next one hasn't yet kicked in.

For the uninitiated, carbidopa-levodopa is the gold standard treatment for Parkinson's disease (PD). The levodopa replaces some of the dopamine that PD destroys, and the carbidopa enhances the levodopa's bio-availability. These days, I take two pills every three hours.

The systolic (upper) pressure readings can hit 180, 200 and above -- the danger zone for stroke or heart attack.

In April 2014, I stopped taking the blood pressure meds I'd been using for years. All but one of my doctors wanted me to keep taking those pills, so I went back on them for a while. But I don't take any hypertension medication now.

September 12, 2015

Rocky Mountain High . . . and low

Rocky Mountain Low
Here's  what I rode when traveling in Europe 10 years ago:

And here is what I used this past Labor Day weekend in Colorado:

I had to use one of these at the visitors center at the Rocky Mountain National Park

And these at Denver and Dulles airports
This was the first time I've used wheelchairs outside a hospital. I'll save the details for a later post. It's part of my continuing saga about blood pressure and levodopa, but this time with a bit of altitude sickness thrown in. I ended up getting a helpful new perspective on my blood pressure management from an emergency clinic doctor in Estes Park, Colorado.
To be continued.

Rocky Mountain High Itinerary
My housemates Nimesh and Bhawana and I flew out of Dulles Airport about 8 o'clock Friday night. We stayed at one of the Denver airport hotels that night.

For the next three nights, we had reservations at the Estes Park Hotel just outside the eastern entrance to Rocky Mountain National Park but rather than drive there directly Saturday morning, we headed for the western entrance at Grand Lakes. We then spent much of the day leisurely exploring the spectacularly scenic Trail Ridge Road, pulling off to the side of the road frequently to take photos of the elks and other wildlife.

This winding highway in the sky is 48 miles long and 11 of those miles are above the tree line elevation of nearly 11,500 feet where the last stunted, wind-battered trees yield to the Alpine tundra. The visitor center, where I got my first wheelchair ride, is just below the road's high point at 12,183 feet elevation.

Sunday, as I said in my last post, was a highlight of trip for me because we spent most of the afternoon having lunch and chatting with my BNA colleague and friend Bob Velte and his wife Ivy on the deck of their beautiful mountainside house overlooking Boulder Colorado.

Monday, our last full day in the mountains, featured what was probably my favorite drive -- the Old Falls River Road. Unlike the Trail Ridge Road, which is the highest continuously paved road in the nation, the old Fall River Rd. is primarily a gravel, one-way uphill road, punctuated by switchbacks. The slow-paced, 11-mile drive was a delight.

I won't talk about Tuesday which, thanks to United Airlines last-minute schedule changes, got us back to Dulles in the dark of night rather than mid-afternoon as originally scheduled. Using a wheelchair at both ends of this miserable flight was a lifesaver.

Now, Best of All: THE PHOTOS
I am just learning how to use my new iPhone 6 and I've had even less experience using a phone camera rather than a regular.So when I downloaded the photos from my camera, most of them were pictures of my feet and the inside floor of the car. Of the 50-plus photos I downloaded, only five were barely worth saving.

September 10, 2015

At BNA, Many Coworkers Became Great Friends. One Became My Wife. Many of those Coworkers are Friends Still.

My housemates and I spent Labor Day weekend touring the gorgeous Rocky Mountain National Park. The highlight for me was spending Sunday afternoon with my Bureau of National Affairs (BNA) pal Bob Velte and his wife Ivy.

While the Velte's house has a Boulder, Colorado address, you can barely see the city in the valley below their house, built on the forested mountainside. Relaxing on the deck, we watched hummingbirds at the feeder, had a terrific lunch and -- most of all -- enjoyed catching up with one another.

I retired from BNA at the end of 1994, over 20 years ago. Even after all that time, many of my good friends now -- like Bob and Ivy -- are former BNA colleagues.

Yesterday morning, my first back at home, I tossed out most of the newspapers, magazines, and junk mail that had accumulated in my absence, except for the "Sunday Review" section of The New York Times. Since my visit with the Veltes was fresh in my mind, I was intrigued by this headline:

"Friends at Work? Not so Much."
It had this subtitle: "Americans need to socialize more with their colleagues."

The article reports that work was once a major source of friendships. These days, we go to the office not to make friends, but to be efficient.

In 1985, about half of Americans said they had a close friend at work; by 2004, the number had dropped to 30%. "We are not only bowling alone," observes Jeffrey Pfeffer, a professor at Stanford. "We are increasingly working alone."

That sad reality isn't true everywhere. In a three-country survey, only 32% of Americans reported inviting work colleagues to their homes, compared with 66% in Poland and 71% in India.

What's Happening?
When I was looking for a job 60 years ago, people feared submitting a resume that included three employers within the past several years. You'd be considered a job hopper.

Not today.

September 9, 2015

A Loving Granddaughter Improves Mealtimes for Alzheimer's Patients

CNN carried an interesting story about industrial designer Sha Yao’s creative effort to make mealtimes easier and better for her Alzheimer’s-afflicted grandmother.

Focusing on her elderly relative’s well-being and dignity, Yao decided to create tableware that would assist and encourage her grandmother at the dining table.

The result? Eatwell, an “assistive” tableware set for people with Alzheimer’s disease (AD) and other cognitive impairments.

Yao discovered that white dishes were sometimes difficult for AD patients. She learned that it helped to contrast the inside and outside of bowls with different bright colors. Less food spilled when the bowls had perpendicular sides.

It was also easier for patients when bowls featured slanted bases, so food collected on one side, making it easier to locate and eat.

 Curved spoons made mealtimes even easier.

September 8, 2015

FDA's Approval Protocol for New Drugs

Last week, Acadia Pharmaceuticals announced it had submitted an application with the Food & Drug Administration (FDA) for its new product Nuplazid (pimavanserin), a treatment for psychosis associated with Parkinson’s disease (PD).

Psychosis isn’t a condition we regularly hear associated with PD. Most often, we read about the motor symptoms of PD, including:
  • Resting tremor
  • Slowed movement (bradykinesia)
  • Rigidity
  • Involuntary muscle movements (dyskinesia)
  • Postural instability
  • Freezing of gait
  • Small, cramped handwriting (micrographia)
  • Mask-like expression
  • Stooped posture
  • Swallowing difficulties 
We hear often about PD’s non-motor symptoms, too, which typically include:
  • Constipation
  • Depression
  • Insomnia
  • Loss of sense of smell (anosmia)
  • Medication issues, such as compulsive behaviors
In its announcement about its new drug, Acadia’s website described Parkinson’s disease psychosis this way:
People are generally familiar with the motor disturbances associated with Parkinson’s disease such as tremors, limb stiffness, balance problems, and slowness of movement. However, there is increasing recognition that “non-motor” symptoms, such as psychosis, can be the most burdensome to Parkinson’s patients and deeply affect their quality of life. Studies have suggested that Parkinson’s disease psychosis (PDP), commonly consisting of visual hallucinations and delusions, occurs in about 40 percent of patients with Parkinson’s disease. PDP is associated with nursing home placement, increased morbidity and mortality, and increased caregiver distress and burden. Currently, no drug is approved to treat PDP in the United States.
This new application with the FDA seemed a good opportunity to recap the lengthy and complicated process that precedes the release of any new drug on the market.

Here’s how the FDA describes the approval protocol on its website:

September 4, 2015

Finally, I Pick (Another) Brand of the Supplement Curcumin

On August 18, I posted about my intention to switch to a new brand of the supplement curcumin: CurcuWIN.  Now, three weeks later, I've decided instead to use Doctor's Best Curcumin C3 with bioperine.

What happened? Why the change?

Background on Curcumin
I'm generally opposed to taking supplements. I believe I'm better off getting the vitamins and minerals I need from diet, not pills. I make an exception for curcumin; so many studies have demonstrated its powerful antioxidant, anti-inflammationary properties. I'm especially excited to consider its potential to fight Parkinson's, Alzheimer's, and other neurological disorders known to involve inflammation.

The big problem with curcumin is its bioavailability -- its ability to penetrate the blood/brain barrier. Curcumin is the active ingredient in the Indian curry spice turmeric, but the spice by itself has little bioavailability.

Even so, Indian peasants who consume lots of turmeric/curcumin in their curries show unusually low rates of Alzheimer's. Researchers note that their curries also include large amounts of black pepper, a common spice shown by studies to increase curcumin's bioavailability.

September 3, 2015 Guilty. CurcuWIN? Still No Verdict

This is an embarrassing post.

Several weeks ago, I wrote about switching to a new brand of the botanical supplement curcumin, the active ingredient in the Indian curry spice turmeric.

Curcumin has shown proven antioxidant properties, enabling it to combat inflammation found in many diseases, like the Parkinson's I have and the Alzheimer's I fear.

To make it more effective, manufacturers keep trying to enhance curcumin's ability to cross the blood-brain barrier (bioavailability). I've tried several varieties since adding the supplement to my daily routine in April, 2012. For over six months now, I've been using Longvida Optimized Curcumin from Vitamin Research Products.

Several weeks ago, I saw reports touting the enhanced bioavailability of a new product -- CurcuWIN from OmnuActive Health Technologies.

ConsumerLab Reports
One of those reviews came from ConsumerLab Reports, which I've used as a supplement reference for several years. I should have checked out ConsumerLab, too. (I should have seen red flags when several products I investigated in the past didn't show up at all among's reviews.)

Immediately after inquiring online about the new product, I received comments from readers questioning ConsumerLab's CurcuWIN report. One of the comments also challenged the bona fides of the organization itself.

My belated investigation of ConsumerLab revealed that the organization's work is not as independent or impartial as it claims to be. Here is an excerpt from one of the critical reports I found: says its stated mission is “To identify the best quality health and nutritional products through independent testing.” Unfortunately, their claim to independence does not appear to us to be valid. (CL) approaches dietary supplement makers and asks them to enroll in its “voluntary” testing program—for a fee. CL doesn’t publicly disclose its fee schedule, but we know that one company was charged over $4,000 to test a single product. Companies that pay the fee are guaranteed that if one of their products passes the testing under their Voluntary Certification Program, it gets listed on the site and may carry the CL Seal of Approval—and if it fails the testing, the product will never be identified publicly because the results are “proprietary to the manufacturer”!
However, companies that do not agree to pay for the voluntary certification program risk having their products tested anyway through the firm’s “product review program.” If they fail the test, those failures will be publicized on’s website and in the media, with complete details for sale in CL’s Product Review Technical Reports.
This arrangement strikes us as nothing short of scandalous. It sounds like, “Pay up, and you won’t have to worry about the results. Don’t pay up, and you may be exposed to bad publicity.” What kind of game is this?
Three years ago, the investigating organization sent CL a letter with questions about its testing and reporting... and never received a reply.

September 1, 2015

Reproducing Study Results: Why It’s Hard, and Why It’s Important

An article in the August 27 edition of The New York Times reports that the results of scientific studies may not be as dependable – or at least as reproducible – as we might think.  

Hundreds of millions of people – doctors and patients around the world – use those studies to make important healthcare decisions. This blog regularly features recent study results.

In a new analysis called the Reproducibility Project, University of Virginia psychologist Brian Nosek recruited a team of 250 researchers four years ago. They identified 100 studies published in 2008 in three of psychology’s top journals (Psychological Science, the Journal of Personality and Social Psychology, and the Journal of Experimental Psychology: Learning, Memory, and Cognition).

Next, in close collaboration with those studies’ original authors, Nosek’s team undertook the daunting task of reproducing the results.

Almost 2/3 of All Study Results Didn't Hold Up
Their finding? Of the 100 studies, 35 held up, while 62 did not, according to a statistical measure of the likelihood that a result did not occur by chance. The remaining three studies were excluded because statistical significance wasn’t clear.

The team asked original study authors for guidance in replicating study design, methodology, and materials. In most cases, Nosek’s replications involved more subjects than the original studies, thus giving his own results more statistical heft.

The research team also measured whether the original research groups’ expertise or academic affiliations – their “prestige” – had any effect on the likelihood that results would hold up. They didn’t. Only one factor seemed to matter: the robustness of the original finding.