We have all heard of the benefits of the Mediterranean diet and olive oil. A new study from Temple University now demonstrates the potential of additional benefits for the brain, including prevention of Alzheimer’s disease.
Dr. Domenic Pratico of Temple University demonstrated that the consumption of olive oil protects memory and learning ability and reduces the formation of amyloid plaques and neurofibrillary tangles in the brain, which are hallmarks of Alzheimer’s disease. It seems that the EVOO activates a process called autophagy, which is the process by which cells clear out debris and toxins that accumulate in the brain and cause neuron cell dysfunction.
The studies were performed in animal models. The animals, which typically developed the hallmarks of Alzheimer's disease, demonstrated dramatic differences in neurologic behavior between the group fed EVOO vs. the control group. Even more dramatic were the microscopic differences in the nerve cell and their connections with other nerves. The activation of the autophagy process in the animals who were fed the olive oil led to the preservation of memory and synaptic integrity.
Dr. Pratico plans to study the effects of EVOO on animals that have already developed Alzheimer’s disease to see if there is a curative potential.
One more reason to make extra-virgin olive oil a staple in your kitchen!
Reference: Extra-virgin olive oil preserves memory and protects brain against Alzheimer’ study
Annals of Clinical and Translational Neurology, June 21, 2007
Dr. Domenico Pratico, Professor, Department of Pharmacology and Microbiology, Center for
Translational Medicine, Lewis Katz School of Medicine, Temple University
Rarely does a day go by that a patient does not complain of decreased libido. I imagine that for every patient that mentions it, two or three have the complaint but do not bring it up. Sexual problems can be difficult to discuss. On the intake form in our office, decreased libido is an item that we ask all patients. This certainly helps to begin a discussion. There is no doubt that as patients experience the hormonal changes in menopause, they mention this problem more often.
This condition is now called HSDD, or hypoactive sexual desire disorder. It is the most common sexual dysfunction in women of all ages. It is defined as persistent or recurrently deficient or absence of sexual fantasies and the desire for sexual activity that causes marked distress or interpersonal problems. Other causes of HSDD including medical problems, drugs, psychiatric problems, relationship issues or conflicts, or other stresses of life would preclude this diagnosis.
To screen for this disorder, certain questions need to be asked:
Was your sexual desire at one time good, and has it decreased?
Is this causing distress, and would you like to improve it?
Understanding the history of the development of the problem, including relationship issues, medical and psychiatric problems, uses of medication, and social situation can help to understand the etiology of the problem and determine if HSDD is truly the diagnosis.
What are the treatment options?
Many physicians have used hormonal treatments for low libido. It is postulated that the increase in estrogen and testosterone at mid-cycle, during ovulation, were the cause of sexual motivation. Although attempts were made to bring testosterone to the FDA for approval for low libido, no product was ever approved. Testosterone is available as products for men, but the doses for men are too strong for women. Testosterone can be compounded for women, and this is done as off-label use. So, does it work? With few other choices, physicians do prescribe testosterone transdermal creams for decreased libido. The results are variable. Some patients respond well, others have no benefit. In a previous article on this site, it was noted that there is a window of benefit, too little or too much testosterone had no benefit. If prescribed off-label, the dose must be monitored carefully, and there is very little data about long-term risks. Short-term
risks are oily skin, facial hair growth, and aggressive or angry mood changes. These side effects will resolve after discontinuation of the drug. Patients who have been administered injectable pellets have experienced very high doses of testosterone in their bloodstream, and sometimes loss of hair.
The only drug approved for HSDD by the FDA is flibanserin. This drug is not a hormone. It works in the central nervous system by increasing dopamine and epinephrine. It was approved by the FDA for pre-menopausal women only, although studies in postmenopausal women demonstrate similar safety and efficacy. An increase is arousal, desire, orgasm and frequency of sexual activity were statistically increased, and distress was decreased. A response was noted in about 55% of women within 8 weeks, and if it did not work by then, it was unlikely to work. Side effects were dizziness, sleepiness, nausea and fatigue, each were noted in less than ten percent of study participants. Because of an interaction between the drug and alcohol causing fainting and low blood pressure, even though this side effect occurs in less than one percent of users, physicians are obligated to have patients sign that they will not use alcohol when taking this drug.
Bupropion is FDA approved for depression and smoking cessation, and is sometimes used in patients on SSRI’s and SNRI’s (some antidepressants) to treat the sexual side effects of these drugs. Benefits have been seen in some small studies, with side effects including tremor, agitation, constipation, dry mouth, sweating, dizziness and nausea.
Buspirone is FDA approved for anxiety. It has been used off-label for patients with HSDD who were taking SSRI’s. More than 50% of study participants noted increased sexual function. Side effects included dizziness, nausea, headaches, and nervousness.
Bremelanotide is being studied in men and women for decreased sexual interest. Side effects of nausea, vomiting and increased blood pressure were noted with intra-nasal and subcutaneous use. Phase 3 trials are in progress, hoping to find a beneficial dose with minimal side effects.
Clitoral stimulation: a small device that provides mild suction and vibration of the clitoris is available and intended to increase arousal. Unlike a vibrator which is intended to produce an orgasm, this device is meant to increase arousal and prepare for sexual activity.
Decisions regarding treatment of HSDD are best accomplished with your physician who can evaluate all medical issues and prescribe the best treatment for an individual situation.
Marilyn C. Jerome, MD
Supplement to OBG Management, October 2016
Hypoactive sexual desire disorder: definition and description, by Sheryl A. Kingsburg, PhD
Biologically based treatments for hypoactive sexual desire disorder, by James A. Simon, MD
Most of us know someone who has experienced dementia in their later years, and watching someone you love decline from dementia is so very difficult. We fear dementia for ourselves, the loss of function and independence, and the toll it would take on our loved ones. If we could possibly prevent it, we would certainly try. The good news is that the incidence of dementia seems to be decreasing in the U.S.
Alzheimer’s disease is the most common form of dementia, and affects 5 million Americans. There is no cure for Alzheimer’s disease. Symptoms often begin with loss of memory, and difficulty with language and logic.
A recent article in the Journal of the American Medical Association outlines 3 main areas of focus, in an effort to decrease dementia. Here are their recommendations:
1. Physical activity is very important for brain health. A brisk walk of as little as 15
minutes per day will suffice. .
2. A healthy diet can lower the risk of dementia. A Mediterranean diet of fish, olive oil,
non starchy vegetables, and nuts is recommended.
3. A good night’s sleep allows the brain to repair itself and function is improved.
4. Avoid smoking which can damage the brain cells.
1. Heart health: treating heart problems, avoiding heart attacks, heart failure and
strokes will increase blood flow to the brain, and prevent dementia.
2. Controlling blood pressure and glucose levels can improve the health of the brain.
3. Avoid head injury. Wear seat belts and helmets when indicated.
4. Check your hearing. Hearing loss and dementia are linked.
Mental and social well-being:
1. Continue to learn: remaining engaged and continual learning can benefit memory
and information processing.
2. Social engagement: brain function is increased in those who are socially active in
sports, cultural programs, and social groups.
It is never too early to begin these lifestyle and health changes to try to prevent dementia in later life.
Source: Journal of the AMA, Volume 317, Number 19. May 16, 2017