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Consider three dimensions of mental acuity.

The foods you eat and when you eat them directly influence your energy, alertness and acuity – throughout a day, seasonally and as you age.

Food is your ‘brain fuel’ through your waking day (it also affects
how you sleep). Seasonally, the mind and body depend on
augmented nutrition to counteract effects of longer hours of
darkness and susceptibility to illnesses. Over a number of years,
key nutrients drive the body’s metabolism and the brain’s health and
sharpness.

Let’s put this into context and explain what you can do about it.

Mental acuity is directly influenced by multiple factors - genetics,
health status, hormones and quality of sleep, as well as by nutrients.
Nutrition, in turn, influences each of these other factors. For example,
key nutrients can offset bad genes and stressful lifestyle habits.

Genetics: Obviously, we each start out life with certain genetic
‘givens’, but gene expression can be influenced – through lifestyle,
diet and more. Predisposition to diseases of the brain is always a
deeply troubling factor and, of course, Alzheimer’s is feared by all.
One of the known genetic traits that can lead to Alzheimers is the
tendency to accumulate excess amyloid (“brain garbage”) which
clogs communication in the brain’s nerves. High doses of a blend
of pure types of Vitamin E reduce amyloid formation.

Health status: Common disease conditions contribute to brain
“damage”. This occurs when inflamed, damaged or blocked
blood vessels constrain oxygen and nutrient supply to the
brain. For example, high blood sugar (diabetes) can
permanently damage small blood vessels. Inflammation,
along with high cholesterol, lead to atherosclerosis (plaque
formation). High blood pressure also reduces blood flow to
fine vessels. Keeping sugar, cholesterol, inflammatory proteins
and blood pressure levels low can be protective.

Hormone Factors: Two, in particular, play a role. Cortisol, the
‘fight or flight’ hormone, when elevated, engenders survival
instincts – quick decisions based on minimal analysis. Sharp
strategic thinking ability is impaired. Caffeine is a major cause
of stimulated cortisol secretion. Insulin – secreted in response
to cortisol – causes sugars (from ingested carbohydrates) to be
stored in the form of fat, blood sugar levels decline and ‘brain
fog’ ensues.

Sleep: Deprivation for as little as 48 hours can result in diabetic
tendencies and secretion of cortisol and insulin hormones. Caffeine
and alcohol affect sleep quality.

Nutrients: Damage to DNA cells of brain tissue is a leading cause of brain
cell death. Certain nutrients, known as anti-oxidants, repair this cellular
damage. Foods containing high levels of anti-oxidants include certain
fruits (especially berries), green leafy vegetables and grains. Other foods,
such as red meat, increase inflammation in the body and brain, causing
scarring of tissue. Foods to counter this with anti-inflammatory effects
include fish and nuts – high in omega 3 and 6 fatty acids. These ‘good’
fats, along with B vitamins found in many grains, are critical in healthy
nerve conduction – essential to communication within the brain and to
the body. Sugar has a direct effect on long-term memory. Spikes in
blood sugar levels decrease blood flow within the hippocampus where
memory is formed. This can permanently damage brain tissue and
impair memory.

How should you translate this into your own eating behavior for
peak acuity?

A practical approach is to think about your intake of the three
major categories of ‘food as fuel’. Let’s examine how they function.

Carbohydrates – found mainly from plant and grain sources
- bread, pasta, rice, potatoes, fruits and vegetables.
‘Carbs’ provide a quick source of energy within 15 minutes,
but effects diminish rapidly - within 30-60 minutes.

Proteins – found primarily from animal (mammal, fowl, fish)
sources, beans and legumes. Proteins provide an even level
of energy starting about 30 minutes after ingestion and
lasting for 2-3 hours - very important for sustained brain
stamina throughout the day!

Fats – found in both plant and animal sources – provide
slow and delayed brain energy. Certain fats are more
important in protecting and repairing brain cells.

Here’s how this translates into actions you can take to achieve
peak mental acuity.

Improve intra-day alertness:

Eat ALL three sources of ‘fuel’ at EACH meal:     Carbohydrates – more complex carbs rather than simple quick sugars     Protein – eat a variety, but limit inflammatory protein as in red meat     Fats – mainly the healthy types – from fish and seeds (olive and flaxseed) Eat three meals a day – snack if you need to but include a protein source (e.g. nuts); avoid pure sugar. Don’t skip meals - this increases the cortisol effect and sets in motion the insulin-low sugar cycle. Early morning travel, hotels, airport lounges and airline food engender bad habits. Limit caffeine – triggers the cortisol-insulin effect.

Increase mental stamina through the sluggish winter months:

Sleep at least 7 hours daily to prevent secretion of cortisol and insulin. Nutritional supplements are especially important in winter, when fruits and vegetables are low in nutrient quality and sun exposure is minimal. Vitamins to focus on: antioxidants (vitamins A, C, E), B and, in particular, D. Ensure sufficient intake of fatty acids – anti-inflammatories to protect brain function Exercise regularly – aerobic and resistance – to get blood flow and oxygen to the brain.

Protect your brain function over time:

Your diet for life’s ‘marathon’ – high in anti-oxidants and anti-inflammatory foods and low in ‘bad’ carbs, ‘bad’ fats and inflammatory foods. Manage your stress level – stress stimulates cortisol and insulin. Engage in restorative activities such as exercise, yoga, massage daily and throughout the year. Engage annually in thorough, up-to-date screening of nutrient, cardiovascular and diabetes risk – do not wait until disease to develop. Plan ahead – take time to manage all of these recommendations. Time-pressured business, travel and family schedules make it more challenging!

Elaine Chin, MD Chief Medical Officer

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Painful Lessons We wish you a healthy, successful 2009. In these stressful times the 2008 financial meltdown creates a powerful metaphor for our personal health. The financial ‘tumor’ was allowed to fester out of control. Now we’re in ‘economic chemotherapy’. Will it work? When? Who will survive? There’s more reason than ever in times as these to prevent the same from happening to your health.  Know your risks  Do not ignore warning signals Protect your most valuable asset.

The colonoscopy has been accepted for years as the almost-infallible
procedure for detecting and removing potentially cancerous polyps -
some have claimed a success rate of 90% in reducing death from
colorectal cancer.

In early 2008 researchers reported that colonoscopies might miss
flat or indented lesions – potentially the most lethal.

Then, in December, a significant Canadian study published in the Annals of Internal Medicine resoundingly reinforced the warning. It reported that the procedure missed just about every cancer on the right side of the colon (where about 40% of cancers arise and are more difficult to detect) and, in fact, also missed about 33% of cancers on the left side.

“This is a really dramatic result,” said Dr. David F. Ransohoff, a
gastroenterologist at the University of North Carolina, who wrote
an editorial accompanying the colonoscopy paper. “It makes
you step back and worry, ‘What do we really know?’.” He
cautioned that 60-70% risk-reduction rate seems more
reasonable (than 90%).

And yet, physicians argue in favor of continuing to preventively
screen with the colonoscopy, albeit with certain cautions.

Colorectal cancer risk factors include age (50 or older), smoking, drinking excessively, being overweight, bowel disease such as ulcerative colitis, and family history. The disease has few symptoms in its early stages, but symptoms in later stages can include: Blood in the stool Changes in bowel habits Consistently narrow stool Constant fatigue Unexplained anemia

A Quick Guide For You - Traditional vs. New, Precise, Less Invasive Tests

Traditional Procedures

Fecal Occult Blood Test – a simple kit to detect blood shed from colon
tumors. Major shortcoming – individuals more commonly shed blood
from hemorrhoids! An ‘ancient’ procedure that should have no place in
medicine today, it can fail to detect serious tumors and it produces
misleading false positives, inevitably leading to a colonoscopy anyway.

Colonoscopy – advantage is that it allows for immediate excision of
potentially cancerous polyps (if detected) and enables the specialist
to identify certain other abnormal, potentially risky conditions such as
diverticulosis (weakness of the colon wall that can lead to infection and
rupture). But, what are the shortcomings?

• Reliance on literally seeing the tumor means:
•  the load of cancer cells could, at this point, already be
  very high
•  inadequate bowel cleansing preparation impairs detection
•  parts of the colon, as we have seen, are less visible
  even to experienced operators
•  ‘invisible’ small, flat or indented tumors, particularly
  prevalent on the right side of the colon
• Potential for human error among all but the most experienced
  and careful gastroenterologists is significant; exacerbating this
  risk is the allotted and monitored 6-minute time in which the
  procedure has to be performed
• Bowel preparation is unpleasant and disruptive
• Procedure is risky – the camera can rupture delicate bowel wall,
  triggering a potentially life-threatening event
• Suggested 3-to-5 year (sometimes 7-year) intervals between
  colonoscopies leaves you vulnerable – serious problems can
  develop in a year

‘New Medicine’ Techniques for Cancer Detection

Science has delivered important advances in our approach to screening
for and prevention of colorectal cancer:

Scienta Health has been an international leader in introducing testing for
genetic predisposition, DNA-based screening for early detection. While this
is self-serving, we frankly don’t know of any other clinic anywhere with a
comparable portfolio of preventive screening or the experience to advise
you, despite being very aware of what’s going on around the world.

DNA-based Stool Test – a stool sample is analyzed to detect
presence of abnormal cells – DNA - which would indicate tumor
formation in the colon. A study published in the September 2008
American Journal of Gastroenterology reports the test as high in
specificity (83%) and sensitivity (77%). It’s even possible to detect
tumor formation before it becomes visible. In March, 2008 American
Cancer Society guidelines added this test to its recommended portfolio
of screens for colon cancer. The stool sample is collected in easy-to-use
kit in the privacy and convenience of the home, picked up by courier
on request for shipment to the lab. No prep, no down time.

Virtual (CT) Colonoscopy - a scan of the colon approaches the
colonoscopy in sensitivity for polyp detection. In March, 2008 the
American Cancer Society announced support for CT in colon cancer
screening. A study of 2500 people in September 2008 concluded CT
colonographic screening identified 90% of subjects with adenomas
(precancerous lesions) or cancers measuring 10 mm or more in
diameter. Where risk of colon perforation is too great to justify
routine colonoscopy, this procedure is especially useful and offers
an important substitute. Nevertheless, should troublesome lesions
be detected a colonoscopy is required to biopsy and excise. Preparation
(bowel cleansing, fasting) required as for colonoscopy. The screening
itself is non-invasive.

Our Advice to You

No family history / ‘clean’ genetics:
Begin screening for colon cancer no later than 45. Typical ‘guidelines’ suggest
50, but this is based on population-wide “cost-benefit” analysis by insurers.

Family history of colon cancer or polyps / genetic predisposition
Begin screening no later than 40.

Which tests? Colonoscopy at suggested intervals (depending on your risk profile) DNA-based Stool Test annually If high risk (history/genetics), consider Virtual Colonoscopy in intermediate years between Colonoscopies (with physician’s advice – there is a radiation risk) Stay informed of new tests such as RNA-based blood tests which measure cellular changes caused by developing cancer

Elaine Chin, MD, MBA Chief Medical Officer

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The key finding of this much-publicized study (the ‘Jupiter Study’)
– there’s a very high correlation between presence of the inflammatory
protein hsCRP (highly sensitive C-Reactive Protein) and heart attacks.
In other words, inflammation (rather than cholesterol) is at the root of
cardiac artery disease.

This at least begins to explain why half of all cardiovascular events occur among apparently healthy individuals …… with ‘average’ or even low levels of cholesterol.

What is ‘inflammation’? It’s when the “abrasion effect” of inflammatory
proteins in the blood damages the walls of blood vessels. The body’s
response is to develop a protective plaque – a combination of cholesterol,
calcium and other fibrous particles. Plaque grows and can restrict arteries,
blocking the flow of blood and oxygen to heart tissue. Worse, particles of
plaque can break free and become lodged elsewhere, causing a fatal stroke.

In order to prevent formation of plaque, the inflammatory process that l
damages vesse walls must be reduced and levels in the blood of all
components of plaque should be kept as low as possible. Low LDL is
necessary but not sufficient.

Certain statin drugs do lower LDL Cholesterol and inflammatory
hsCRP. Unfortunately, for many individuals (perhaps half of the
population), these simplistic measures do not adequately identify
risk - they fail to detect key underlying sources of risk. They also
have long-term side-effects, including liver impairment and risk of
developing cataracts.

It’s Time for Today’s Science in Cardiac Risk Assessment

Your physician, or your executive health service, is probably still using
decades-old testingfor cholesterol. Unfortunately, they could be completely
misinforming you. The ‘stress test’ still so widely applied is even more
antiquated in determining risk.

Traditional techniques for testing cholesterol have been found to identify only 40% of those at risk for coronary disease.

Why?

First, the LDL (bad cholesterol) and HDL (good cholesterol) they report are
derived or indirect measures – easily distorted by unusual patterns in certain
factors from which they’re calculated.

Second, LDL and HDL are made up of sub-particles. It is dangerously misleading
to not test for these. The characteristics of LDL and HDL particles are far more
important than the ‘derived’ aggregates.

Take HDL, for example. Not all particles contribute to its ‘good’ cholesterol role. A
preponderance of a ‘bad’ HDL particle can offset the protective characteristics of
‘good’ HDL particles. (Each of five main particles of HDL can be quantified. High
levels of small preß-1 and a-3 particles indicate high risk for vascular disease;
high levels of the large a-1 HDL indicate presence of the protective influence.)

Testing to measure these sub-units of LDL and HDL has been shown to identify 40% of individuals at risk for heart disease.

Implication - many who test “normal” in a routine or traditional cholesterol
panel are found to be at risk when subjected to this more precise, particle-
based testing.

The Jupiter Study does not address this serious problem with traditional
cholesterol testing. It does recommend testing for inflammatory C-Reactive
Protein. We believe this is only one of several inflammation markers. It
should be augmented by screening, at least, for arachidonic acid and
homocysteine. As we discover more about detecting types of inflammation
we find that additional markers contribute to the accuracy in understanding
specific risk – in this case cardiovascular.

Where does this leave you?

Do you need a statin?

This is where we say that ‘one size does not fit all’. Science has progressed
far beyond that. It’s time medicine caught up. Guesswork is unnecessary
and dangerous.

We know that cholesterol is derived from two sources – production by the
liver (synthesis) or absorption through the digestive system from dietary
intake of fat. We can test for each and, of course, knowing the result, the
treatment is no longer based on guesswork.

If the source of the problem is over-production of cholesterol by the liver, ‘statin’
drugs are appropriate. If the source is over-absorption, diet must be modified.
We also know that no single diet guidelines apply to all.

Find out what you need. Tests are available to do this.

Elaine Chin, MD Chief Medical Officer

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