How to Reduce the Risk of Dementia

Columbia Icefield - the largest ice field in the Rocky Mountains. (Dr. Noorali Bharwani)
Columbia Icefield - the largest ice field in the Rocky Mountains. (Dr. Noorali Bharwani)

Dementia is not a specific illness. It is a combination of symptoms that affect memory, thinking and social abilities. It reduces a person’s ability to perform everyday activities.

According to a report in the Lancet (Prevention of dementia by targeting risk factors – April 21, 2018), dementia epidemic is the greatest global challenge for health and social care in the 21st century.

There are a number of causes of dementia. Alzheimer’s disease is the most common cause of a progressive dementia accounting for 60 to 80 per cent of dementia cases.

Over 747,000 Canadians are living with Alzheimer’s or another dementia. Worldwide, at least 44 million people are living with dementia – more than the total population of Canada – making the disease a global health crisis that must be addressed. It affects about 14 per cent of Americans over age 71.

Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behaviour.

Can we do anything about it?

Dementia involves damage of nerve cells in the brain, which can occur in several areas of the brain. Dementia affects people differently, depending on the area of the brain affected. Finding a cure for something like that is difficult.

In this new Lancet report, a team of international researchers identifies nine key risk factors that together account for about 35 percent of cases. Depending on the cause, some dementia symptoms can be reversed.

Following nine steps can reduce the risk of dementia, but researchers say they need to be undertaken over the course of one’s lifetime. Here is the summary:

1. Education. Having higher education helps. Keep learning new skills through out your life. Keep your brain active.

2. Hypertension. Dementia and high blood pressure are closely linked.

3. Obesity. Obesity is a key risk factor in mid-life. Previous report from the U.K. found that being underweight in mid-life was also associated with an increased risk of dementia. So maintain proper weight.

4. Hearing loss. Hearing loss affects nearly a third of people over 55. Hearing loss can lead to social disengagement, depression, or brain atrophy.

5. Smoking. Smoking has ill effect on cardiovascular health. Cigarette smoke also contains substances that are toxic to the brain.

6. Depression. There are definite links between depression and dementia.

7. Physical inactivity. Research has shown that older adults who exercise are more likely to maintain cognition than those who do not exercise. Studies have suggested tai chi, longer exercise sessions (at least 45 minutes at a time), and resistance training may all have particular benefits for the brain.

8. Social isolation. Loneliness and a lack of physical contact, especially later in life, are linked to dementia.

9. Diabetes. Diabetes is a potential risk for many of the same reasons as obesity.

Finally, keep your brain sharp by playing brain games. Eat healthy with fruits, vegetables and nuts. Exercise. Remember, what is good for the body is good for the brain. Dementia will compromise your lifestyle, put extra burden on your family and will compromise your longevity. Most studies seem to show that the average number of years someone will live with dementia after being diagnosed is around ten years.

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Do you feel lonely?

Loneliness - a bridge to nowhere!
Loneliness - a bridge to nowhere!

“Loneliness and the feeling of being unwanted is the most terrible poverty.”
-Mother Theresa

According to research, doctors and lawyers are the loneliest professionals. That is not good because loneliness is linked to social isolation and increased risks of cardiovascular disease, dementia, depression and anxiety.

How do you define loneliness?

I went to Wikipedia to look for a definition. It says, “Loneliness is a complex and usually unpleasant emotional response to isolation.”

People may surround you, as doctors are, and still feel lonely. It seems there is lack of connection and/or communication with other people. You may be close to them but still do not feel connected. This can create a lot of anxiety and unhappiness.

According to a survey published in the Harvard Business Review, doctors and lawyers are among America’s loneliest workers, followed by people who work in engineering and science.

Lauren Vogel’s article in the Canadian Medical Association Journal (CMAJ July 20, 2018) quotes a study that says, “Lawyers and doctors were the loneliest by far, reporting levels of loneliness 25 per cent higher than respondents with bachelor’s degrees and 20 per cent higher than those with PhDs.”

What makes doctors lonely?

After high school doctors have to go through a challenging ordeal to get into a medical school and then go through residency and specialisation. That is about 10 years. During that time the doctor gets married and has children. Starting a practice and providing dedicated service takes a lot of years. After all that the doctor has very little time to have friends to unwind with.

All the friends you had in your high school years are not around. And if you do run into them then you find there is nothing much to talk about. There is no common ground.

By contrast, workers in marketing, sales and social work are the least lonely, likely because these fields are highly social. Income is not important when it comes to loneliness. And workers with higher levels of education report higher levels of loneliness.

What are the health effects of loneliness?

Early death is one possibility, says an article in Perspect Psychol Sci. (March 2015). One study showed loneliness has similar health effects to smoking 15 cigarettes a day.

A lonely individual costs the health care system more than those who are in a socially happy environment. As mentioned earlier research has linked social isolation to increased risks of cardiovascular disease, dementia, depression and anxiety.

Social isolation is considered such a growing problem in the United Kingdom that the government appointed a Minister for Loneliness whose tasks will include helping to develop “the evidence-base around the impact of different initiatives in tackling loneliness, across all ages and within all communities.”

What can we do?

It is important for doctors and other professionals to build a social circle. It is easy to face the challenges of loneliness if you have good family and friends to stand by you.

Behaviour experts say loneliness among doctors and other professional depends on how much of a culture of social support is in the workplace. Doctors and lawyers have none of that, as they are independent practitioners.

Loneliness affects someone in every family. That should not be the case as we are biologically designed to be nourished by connections. Let us sing Buck Owens’ lyrics:

Hello happiness, goodbye loneliness
Farewell heartaches and so long strife
No more sadness only gladness…

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Risks and benefits of using melatonin for a good night’s sleep.

Happy Halloween (Dr. Noorali Bharwani)
Happy Halloween (Dr. Noorali Bharwani)

Sleep is important for mind, body, and mood. We spend roughly a third of our lives sleeping.

A poll conducted by the University of Michigan in 2017 showed nearly half of the adults between ages 65 and 80 said they often have trouble sleeping. Many of these individuals regularly seek sleep aids.

Insufficient sleep (insomnia) has been linked to an increased risk of falls, collisions, cognitive decline, and dementia. It can increase your risk of cardiovascular problems, obesity, and even cancer. It can drain your energy and affect your work performance and quality of life.

How much sleep do you need? That varies from person to person, but most adults need seven to eight hours a night. Does melatonin help to have a good night’s sleep?

Melatonin is synthesized and secreted by the pineal gland in the brain. Melatonin levels are regulated by exposure to light. Levels peak around 2 a.m. at concentrations 10 to 100 times daytime levels.

Melatonin regulates the body’s sleep cycle. It plays an important role in initiating and maintaining sleep. Natural melatonin levels slowly drop with age. Some older adults make very small amounts of it or none at all.

Melatonin balance may be disrupted if you are in a different time zone or doing shift work. Clinical trials suggest melatonin can reduce the time it takes to fall asleep, increase total sleep time and improve quality of sleep.

One study found a relatively low dose of melatonin (0.3 mg) was enough to improve nighttime sleep in older adults without drowsiness the next day. Studies have shown melatonin increases sleep time by 12.8 minutes and increased sleep efficiency by about three per cent. Is this good enough? The clinical significance of this is unclear. There is no consensus among experts regarding the use and benefits of melatonin for insomnia.

In spite of that in the U.S., sales have increased by more than 500 per cent between 2003 and 2014, and where melatonin is the second most popular natural product used by children.

Very small amounts of it are found in foods such as meats, grains, fruits, and vegetables. You can also buy it as a supplement. Melatonin supplements generally have fewer side effects than do many prescription sleep drugs. They do not produce dependence or hangover effect.

Side effects of melatonin are few but may include daytime sleepiness and tiredness on waking. Headaches, nausea and dizziness also can occur. You should avoid activities that require alertness, such as driving, for five hours after taking melatonin. These pills can also undermine the effectiveness of blood pressure drugs and diabetes medication. Do not start taking melatonin without consulting your doctor. Do not use melatonin if you have an autoimmune disease.

If you do decide to take melatonin, choose commercial supplements produced in a lab. Melatonin supplements made from animal sources may contain contaminants. Melatonin should only be taken in its man-made form (myhealth.alberta.ca).

Know what you are buying. Make sure to look for the “USP verified” label. This means product is accurately labeled and free of harmful substances (Consumer Reports February 18, 2017).

People commonly use melatonin for sleep disorders, such as insomnia and jet lag. Evidence that melatonin supplements can treat sleep disorders is shaky, and over-the-counter melatonin has been banned for years in the United Kingdom, European Union, Japan, and Australia.

Melatonin is the only human hormone available in Canada without a prescription.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Infertility in men is on the rise.

A photograph taken on African Day in Calgary, Alberta. (Dr. Noorali Bharwani)
A photograph taken on African Day in Calgary, Alberta. (Dr. Noorali Bharwani)

Not being able to conceive a child can be stressful. Male infertility refers to a male’s inability to cause pregnancy in a fertile female. Male infertility is commonly due to deficiencies in the semen.

In Canada, about 16 per cent of couples struggle with infertility – a figure that has doubled since the 1980s. Men are solely responsible for infertility in about 30 per cent of those cases, and contribute to half the cases overall, according to Health Canada.

A comprehensive study published this summer shows sperm counts of Western men dropped by more than 50 per cent in less than four decades. Sperm count is the best measure of male fertility.

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperms. Illnesses, injuries, chronic health problems, lifestyle choices (drugs, alcohol, sexually transmitted diseases) and other factors can play a role in causing male infertility, says Mayo Clinic website.

How does fertilization occur?

During the fertile window, the female creates a sperm friendly fluid that enables sperm to swim up towards the egg.
Of the millions of sperms released upon ejaculation, only a handful make it to the fallopian tube where the egg is released. There, the sperm must survive long enough to meet and fertilize the egg. Isn’t that an amazing act of nature!

Besides the quality of sperms, sperm count matters. There needs to be enough sperms in the semen. A low sperm count is fewer than 15 million sperms per milliliter of semen or fewer than 39 million per ejaculate.

Likely causes for poor sperm count are: chronic smoking, obesity, diabetes, drugs, alcohol, emotional problems, stress, depression, hormonal problems and previous surgeries.

According to the British Medical Journal (BMJ October 4, 2018), around one in seven couples in the UK seek treatment for infertility when they are unable to conceive, despite regular unprotected intercourse. In about a third of patients, no cause can be identified.

Even though male partner may have suboptimal sperm parameters both partners need to be assessed for infertility, so the couple should ideally be seen together when investigating infertility.

Managing infertility is not always easy, as often exact cause is not identified. But help is there.

According to Mayo Clinic website treatments for male infertility include:

  1. Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. In cases where no sperms are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm-retrieval techniques.
  2. Treating infections. May or may not help.
  3. Treatments for sexual intercourse problems. Medication can treat some issues that affect male fertility, including hormone imbalances and erectile dysfunction.
  4. Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperms are then inserted into the female genital tract, or used to perform in vitro fertilization.

When treatment doesn’t work then one can consider using sperm from a donor or adopting a child. As somebody has said, “Parenthood requires love, not DNA.”

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!