Why are U.S. Pregnancy Deaths up?

belly of pregnant woman  monochrome on dark backgroundHappy Mother’s Day! I don’t normally write about pregnancy, but I feel compelled to address the fact that more U.S. women are dying from pregnancy-related causes. According to Dr. Neel Shah, a Harvard Medical School obstetrician, an American mother today is 50% more likely to die in childbirth than her own mother was.  Possible reasons include the high rate of C-sections, high blood pressure which can lead to preeclampsia, diabetes, and obesity. Although these deaths are rare, there are about 700 of them each year and according to the CDC (centers for disease control) more than half of them are preventable.

I taught the Bradley Method of Natural Childbirth thirty years ago. Back then, I warned my students that there was a possibility that their doctor might want to schedule a delivery around a vacation or tee time. I taught ways to have the healthiest outcome possible with the least amount of intervention.

Here we are three decades later and the percentage of C-sections has nearly doubled globally since to 2000, according to a study published in The Lancet, Oct. 13, 2018. In the U.S. 32% of all babies are now delivered by C-section.

Globally, maternal mortality fell about 44% between 1990 and 2016, according to the World Health Organization. That’s good news. But in the U.S., 17 out of every 100,000 new moms die. That’s up from 12 per 100,000 25 years ago. And black women in the U.S. are three times as likely to die from a pregnancy-related health issues than others. This could be due to lack of medical care, racial bias, and/or poor health to begin with (high blood pressure, etc.).

If you or a loved one is pregnant or plans to get pregnant

  • Please see a physician as soon as you suspect you are pregnant in order to get the best medical care possible.
  • Get a comprehensive heart-risk evaluation 12 weeks after delivery.
  • Eat a healthy, whole-foods diet and monitor you salt and sugar intake.
  • Practice a stress-reducing technique such as yoga, deep breathing, meditation.
  • Take a birth preparation class—these are usually offered at hospitals throughout the county.
  • Practice a relaxation birth technique with the person who will be your support during delivery and labor.
  • Keep your fitness up or strive to improve it. Walk or swim.

There are many articles posted on this blog on ways to reduce stress, eat well, and exercise. Even though many of them pertain to caregivers, there’s a lot of general information that applies to everyone.

Best wishes for a Happy Mother’s Day, a happy pregnancy, and a happy baby!


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Grief and Relief: When caregiving ends

GedankenCaregiving for a person with dementia is one of the most difficult things anyone will have to do. The pain and suffering is intense, but the rewards are plenty. Even though the person you are caring for cannot express gratitude, on some level they know and appreciate your sacrifice. They are eternally indebted to you. As Lou Gehrig said in his farewell speech, “When you have a wife (caregiver) who has been a tower of strength and shown more courage than you dreamed exists—that’s the finest I know. So I close in saying that I might have been given a bad break, but I’ve got an awful lot to live for.”

Kim Mooney, the Board President of Conversations on Death, and Director of Community Education for Tru Community Care, Colorado’s first hospice, has said that as caregivers “the sacrifices you made changed the course of your life. As you once again look at finding a new course, you will over time grieve your loved one and what you let go of or stored away. You will also begin to discover the things you learned from giving so much. As you recognize and honor what you did, it will begin to shape the meaning of your life now. Whatever the challenges ahead in rebuilding, that understanding can give you the strength, commitment, and satisfaction to make your life more meaningful than ever.”

So, what’s next? Stop, take a deep breath, and think about your journey: where you came from, what you did, and how you feel. When my husband’s final health crisis was over and after I buried him, I realized that I hadn’t fully breathed for years and that my body was strangled with tension and fatigue. I had meditated, eaten fairly well (besides the times I was too tired to cook and made a dinner out of popcorn and ice cream), danced, exercised, and practiced yoga. All these things helped keep me calm, and brought me back to my “self.” But being on call for years took its toll. And after it was all over, while ensnared in the tentacles of grieving, I felt relief. Relief that I wouldn’t feel the pain of watching Morris lose yet another function. Relief that I wouldn’t have to fill another prescription or talk to a physician about my husband’s condition. Relief that I didn’t have to travel the 15 miles to visit him in the memory care home, where I’d inevitably get depressed. Relief that I could stay home and not have an obligation other than caring for myself.

And yet, the final letting go of my role as caregiver was uncomfortable and felt strangely similar to sending my children out into the world. How would I define myself if I were no longer a caregiver? How would I fill up the time I had spent caring for my husband for an entire decade, one fifth of my life? Creating a new identity takes time, practice, and patience. And we are told by grief counselors to not rush things. Do not make a major change in your life, such as moving out of the house you’ve lived in for years, or to another state. But day-by-day, it’s okay to acknowledge that we are not the same person who heard the dreaded words from our loved one’s doctor: “You have dementia, most likely of the Alzheimer’s type.”

As caregivers we take a journey through fire and ice and land on solid ground surrounded by calm waters. Then it’s time to swim to shore and get our bearings. Be patient, be kind to yourself, and set out to discover different activities, small and large, that ease you to calmer waters. Here are some ways to help you get there:

  1. Choose at least one healing modality in this book and integrate it into your life. Dance, do yoga, try journaling, find someone to walk with, etc.
  2. Clean out your closets and drawers.
  3. Wash the garage floor and then paint it.
  4. Take a cooking class.
  5. Join a health club or YMCA.
  6. Take a Zumba® fitness class.
  7. Ride your bike.
  8. Join a hiking club.
  9. Learn how to sew or knit.
  10. Serve food at a community table or sort food at a food bank.
  11. Plant a garden.
  12. Play a musical instrument.
  13. Learn a new language.
  14. Travel! Visit friends and family.
  15. Take long nature walks.
  16. Make it a habit to soak in a bath with Epsom salts.
  17. Get a puppy or kitten.
  18. Volunteer at the Humane Society.
  19. Read to elementary school children.
  20. Join a book club.

My journey to calmer waters

My husband’s illness changed the course of my family’s lives in ways that were unexpected, devastating, and empowering. I developed into a strong matriarch and quickly learned how to take charge of my husband’s care, family business, and my children, without the help of my partner. And not having a partner, with whom I would typically make important decisions with, was one of the hardest things of all about being a partner to someone with Alzheimer’s disease.

Not having a partner, with whom I would typically make important decisions, was one of the hardest things of all about being a partner to someone with Alzheimer’s disease. Deciding where and when to place Morris in a memory care home, figuring out how to finance it, and deciding when to enlist the help of hospice were the kinds of decisions I would have discussed with my husband.

I became a compassionate caregiver, not just for Morris, but for other residents of the memory care home where he lived the last two years of his life. I went through a lot—as all caregivers do—but I’ve come through. I’ve recreated my life, and have learned to look forward with hope, wonder, delight, and inspiration after giving so much of myself to the person I vowed to spend my life with.

There are days that go by without my thinking about Morris. After all, it’s been over eight years since he’s been gone. It’s still hard for me to look at family photos because our family was happy, and a link is missing. I know for my children the hardest thing is that their own children are growing up without knowing their grandfather, who would have loved to be a part of their lives. We will always miss him, but our happy memories fill in the gaps, and we honor him eery year on his yahrzeit the anniversary of a Jewish loved one’s death.

I have a new love in my life and grandchildren to enjoy and cherish. I feel good and I am happy! As my beloved teacher Swami Kaleshwar always said, “Life is short, make it sweet.” I will and I do.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Mushrooms may reduce risk of mild cognitive impairment by 50%

Mushrooms - morchella mushrooms, boletus mushrooms, oyster mushrooms, on white background.If  you eat golden, oyster, shiitake and/or white button mushrooms, as well as dried and canned mushrooms, you’re in luck! A team from the Department of Psychological Medicine and Department of Biochemistry at the Yong Loo Lin School of Medicine at the National University of Singapore (NUS) has found that seniors who consume more than one and one-half cups of mushrooms weekly may reduce their odds of having mild cognitive impairment (MCI) by 50%. 

What is MCI?

Mild cognitive impairment causes cognitive changes that are serious enough to be noticed by people experiencing them or to other family and friends. The changes are not severe enough to interfere with daily activity. People with MCI that involves memory problems are more likely to develop Alzheimer’s disease or other dementias than people without MCI. Approximately 15-20 percent of people age 65 or older have MCI.

Mushrooms might be a key to reducing MCI

The correlation between eating mushrooms and reducing risk of MCI is surprising and encouraging, according to Assistant Professor Lei Feng, who is from the NUS Department of Psychological Medicine, and the lead author of this work.

The six-year study, which was conducted from 2011 to 2017, collected data from more than 600 Chinese seniors over the age of 60 living in Singapore. The research was carried out with support from the Life Sciences Institute and the Mind Science Centre at NUS, as well as the Singapore Ministry of Health’s National Medical Research Council. The results were published online in the Journal of Alzheimer’s Disease on 12 March 2019.

The researchers found that the compound called ergothioneine (ET), a unique antioxidant and anti-inflammatory which humans are unable to synthesize on their own, is the key to possibly reducing MCI. Ergothioneine is found in liver, kidney, black beans, kidney bean and oat bran. But the highest levels are found in bolete and oyster mushrooms.

Other compounds contained within mushrooms may also be advantageous for decreasing the risk of cognitive decline. Certain hericenones, erinacines, scabronines and dictyophorines may promote the synthesis of nerve growth factors. Bioactive compounds in mushrooms may also protect the brain from neurodegeneration by inhibiting production of beta amyloid and phosphorylated tau, and acetylcholinesterase, the culprits of Alzheimer’s disease.

How much do you need to eat?

In the study, a portion was defined as three quarters of a cup of cooked mushrooms with an average weight of around 150 grams. Two portions would be equivalent to approximately half a plate. While the portion sizes act as a guideline, it was shown that even one small portion of mushrooms a week may still be beneficial to reduce chances of MCI.

An article in Science Daily said this: According to Robert Beelman, professor emeritus of food science and director of the Penn State Center for Plant and Mushroom Products for Health, it’s preliminary, but you can see that countries that have more ergothioneine in their diets, countries like France and Italy, also have lower incidents of neurodegenerative diseases, while people in countries like the United States, which has low amounts of ergothioneine in the diet, have a higher probability of diseases like Parkinson’s Disease and Alzheimer’s,” said Beelman. “Now, whether that’s just a correlation or causative, we don’t know. But, it’s something to look into, especially because the difference between the countries with low rates of neurodegenerative diseases is about 3 milligrams per day, which is about five button mushrooms each day.”

 

Mushroom recipes

Cooking mushrooms does not seem to significantly affect the compounds. Roasted or baked mushrooms are simple to make and delicious, and go well with most foods as a side dish or topping.

Wash and slice musthrooms. Lightly oil shallow baking pan large enough to hold mushrooms in single layer. Add mushrooms and toss with 2 to 3 tablespoons oil. Add garlic; season with salt; roastfor 20 minutes stirring on occasion; mushrooms should be browned. Season with pepper.

For baked mushrooms with parmesan, thyme and lemon simply toss with olive oil, Paremesan cheese, garlic, thyme, lemon zest and lemon juice.

For more mushroom recipes google for mushroom risotto, mushroom gravy, cream of mushroom soup, creamy mushroom pasta, mushroom and barley soup.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

What happens to your body when you’re a stressed caregiver?

Woman having a headacheStatistics show the stress of care giving can result in chronic disease for the caregiver and take as many as 10 years off one’s life. In comparison to caregivers of people in all categories, caregivers of Alzheimer’s patients in particular rate their health more poorly, take worse care of themselves, and spend more money on their health care. Feeling more tired and depleted, they evaluate themselves as less healthy, engage in fewer health-promoting behaviors, and use more health services.

Given the demands on caregivers’ time and energy, they may neglect their own self-care by sleeping less, eating too much or too little, not exercising, or not managing their own health problems. Neglect of their own health may worsen pre-existing illnesses or increase vulnerabilities to new stress-related problems.

The Physiology of Stress

Walter Cannon described the fight or flight response in 1929.  Adrenaline is the fight-or-flight hormone: It causes cells, especially muscle cells, to speed up energy production so that the body will be ready to fight a foe or run away. It is needed for short blasts of stress.

  • Pupils dilate to sharpen vision.
  • Heart rate and blood pressure increase to accelerate the delivery of oxygen to fuel the muscles and critical organs.
  • Blood flow is diverted from non-critical areas such as the gastrointestinal tract to the critical areas such as the heart, skeletal muscles and liver.
  • Liver releases glucose and fatty acids into the bloodstream. Glucose is for immediate energy; fat is needed when the fight-or-flight response lasts longer than expected.
  • Bronchial tubes dilate to maximize the exchange of oxygen and carbon dioxide.

Cortisol bolsters us in long-lasting stress situations. But when the body is dealing with chronic stress, the adrenals get “stuck” in the on position and the whole system goes into chronic “fight or flight.”

  • Glucose that is dumped into your bloodstream goes unused, so your body has to produce an enormous amount of insulin to handle it. Eventually, this may result in hypoglycemia or diabetes.
  • Fat that is dumped into your blood also goes unused, so it clogs your arteries, leading to cardiovascular disease.
  • If you drink caffeine, the stress hormone cortisol becomes elevated, which can set you up for countless health problems including: poor quality of sleep, impaired immunity and age-related deterioration.

Adrenal exhaustion–The adrenal glands produce or contribute to the production of about 150 hormones. When they are stressed, they become exhausted. Once the adrenal buffer is gone, you become a prime candidate for asthma, allergy, fibromyalgia, chronic fatigue syndrome, autoimmune disorders, hypoglycemia

Alcohol, caffeine, sugar and salt put added stress on the adrenals.

Stimulate, such as caffeine increase the effects of your body’s own stimulating neurotransmitters: norepinephrine and dopamine, which are similar to adrenaline in their effects. Caffeine and these natural stimulants provide short-term energy, focus and even a lifted mood. But in the long-term, caffeine depletes your stores of norepinephrine and dopamine, leaving you more tired, sluggish and down than you were before the caffeine habit.

Psychological stress can impact cardiovascular function and lead to cardiovascular disease, and possible stroke/heart attack.

Stress and sleep

Adequate sleep repairs your body, sharpens your mind and stabilizes emotions. Lack of sleep triggers the body to increase production of cortisol, which makes it harder to fall asleep and stay in a deep sleep because on some level your body and brain think they need to stay alert for danger.

  • Loss of sleep as a result of caring for a loved one can lead to serious depression.
  • As little as five nights of poor sleep can significantly stress the heart.

Weight gain and insulin resistance

  • Increased cortisol production leads to weight gain. The adrenals increase gluconeogenesis, which provides the body with glucose from protein, rather than carbohydrates. This decreases serotonin and melatonin, which results in poor sleep and leads to food cravings for carbohydrate-rich foods in order to uplift mood, which releases more serotonin and insulin. This leads to more stress and insulin production to regulate glucose, which may lead to fat storage, weight gain and insulin resistance. It becomes a vicious cycle.
  • Insufficient sleep is also associated with lower levels of leptin, a hormone that alerts the brain that it has enough food, as well as higher levels of ghrelin, a biochemical that stimulates appetite. Consequently, poor sleep may result in food cravings.

Exercise

  1. Insufficient sleep may leave us too tired to burn off extra calories with exercise.
  2. When your body is stressed and prepared to fight or run it’s full of stress hormones. If you’re sedentary, those hormones will continue to circulate and cause damage to your body. Vigorous exercise, however, burns off those hormones. Exercise also releases the neurotransmitter serotonin and endorphins, the body’s natural pain relievers.
  3. Doctors from Nottingham Trent University suggest the chemical phenylethylamine is released during exercise and could play a part in uplifting mood as a result of exercise. Phenylethylamine is a naturally produced chemical that has been linked to the regulation of physical energy, mood and attention.

Impact of food on mood and physiology

Hazards of caffeine

  1. Caffeine stresses the adrenal glands and can contribute to anxiety, insomnia, depression, irritability, anxiousness—not good for caregivers. In fact, studies show that those who drink the most coffee often suffer from chronic depression. It depletes the body of B1, biotin, inositol, vitamin C, calcium, potassium, and zinc. It increases thirst because it is dehydrating, over stimulates and weakens the kidneys, pancreas, liver, stomach, intestines, heart, and nervous system.
  2. Can increase production of cortisol, leading to stronger cravings for fat and carbohydrates. This increases blood glucose, release of insulin and fat stored in the abdomen.
  3. Increases dopamine levels, making you feel good until it wears off
  4. May interfere with restful sleep
  5. Try not to drink coffee after 2pm
  6. Simple carbohydrates increase insulin production.

People who are stressed often crave and overeat sugar and simple carbohydrates, like chips, cookies and white bread or pasta, because those foods provide a fast release of the feel-good chemical serotonin. But eating this way causes a blood-sugar crash a couple of hours later, leaving you tired and moody. The more of these foods that you eat the more you crave. Although these foods are high in calories, they contribute few nutrients and deplete the body of essential vitamins and minerals, raise triglycerides, and contribute to inflammation and excess weight.

  1. Lack of water/fiber can rob the body of nutrients because of problems with digestion and assimilation
  • HFCS and other artificial sweeteners can interfere with your natural production of neurotransmitters. Aspartame (NutraSweet and Equal) competes with tryptophan by blocking its conversion into serotonin. Artificial sweeteners contribute to numerous adverse symptoms, as compiled by the Food and Drug Administration and include everything from menstrual changes, weight gain, and headaches to severe depression, insomnia and anxiety attacks.

High fructose corn syrup (glucose and fructose) can lead to a decrease in leptin production leading your body into thinking it’s hungry so you eat more, especially processed foods. HFCS can lead to insulin resistance and higher levels of triglycerides, as well as obesity, hypertension and cardiovascular disease.

Bad habits, i.e. forgetting to eat, eating on the run, not eating breakfast all contribute to unstable blood sugar and adrenal exhaustion, which makes you grab foods that aren’t good for you, so you end up feeling irritable, moody, and even more stressed.


You get the picture? It’s important to take care of yourself, especially when you are taking care of someone else. I don’t want to overwhelm you with information or preach to you. Here’s a short checklist to help you stay healthy and balanced.

  • Eat a serving of high-quality protein with every meal and snack
  • Focus on complex carbohydrates (whole grains, veggies and fruits), and eliminate junk foods (refined carbs).
  • Enjoy unlimited amounts of fresh veggies.
  • Eat a good breakfast!
  • Eat 3 balanced meals and 1-2 snacks/day.
  • Magnesium, B complex, fish-oil, walnuts, flax seeds, dark leafy greens, and high quality all help reduce stress and uplift mood.
  • Meditate or find some quiet time for yourself
  • Exercise! At least take a short walk everyday.
  • Put on a funny YouTube video and laugh.
  • Use aromatherapy.
  • Do the best you can.

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Calmer Waters: Spring 2019 book signings and events

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Especially for folks in the Denver-metro area: You are warmly invited! Please drop by at a book signing to say hello, or attend the caregiver symposium or conference (or both!) for lots of great information, networking and support. Respite care is available for both events. Click on the links to find out more.

Falling in love while caring for your spouse with Alzheimer’s

This is a controversial and delicate topic. Is it possible to judge someone unless we’ve walked in their shoes? Watch the video and let me know what you think.

In the meanwhile, you might want to check out my article “Sexual intimacy between care partners” at The topic of sex is often uncomfortable in the best of relationships in the best of times. The topic is especially prickly when one of the partners has Alzheimer’s disease.

 

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

What are you doing for your brain health?

Brain Nutrition

MIND diet includes salmon, beans, greens, nuts, berries

This week is Brain Health Awareness Week, and I’m reposting this piece so you can evaluate your diet and make improvements to support your brain–and heart health. Here’s to your healthy brain and heart!

Have you heard of the MIND diet? It’s the Mediterranean diet and DASH diet slightly remade and combined to form the MIND diet. (MIND is an acronym that stands for the Mediterranean-DASH intervention for Neurodegenerative Delay.)

In a study published in September 2015 in Alzheimer’s & Dementia, the nutritional epidemiologist Martha Clare Morris and her colleagues at Rush University Medical Center borrowed concepts from the Mediterranean diet and the DASH diet. The result is the MIND diet.

The study followed 923 participantsages 58 to 98 years, for an average 4.5 years, and found the MIND diet lowered Alzheimer’s risk by about 35 percent for people who followed it moderately well and up to 53 percent for those who adhered to it rigorously. While more study is needed to better understand the long-term impact of the diet, Morris’s team’s second paper on the MIND diet notes that it’s superior to the DASH and Mediterranean diets for preventing cognitive decline. But it should be noted that high adherence to all three diets may reduce risk of Alzheimer’s disease.

Food to eat on the MIND Diet

  • Green leafy vegetables: a minimum of 6 servings a week (kale, Swiss chard, spinach, collard, etc.)
  • Nuts: a minimum of 5 servings a week (walnuts, pistachios, almonds, cashews, etc)
  • Berries: a minimum of 2 servings a week
  • Beans: a minimum of 3 servings a week (garbanzo, red, black, kidney, white, pinto, etc.)
  • Whole grains: a minimum of 3 servings a day (millet, oats, brown rice, quinoa, wheat berries, etc.)
  • Fish: at least 1 serving a week
  • Poultry (like chicken or turkey): at least twice a week
  • Olive oil as the primary oil used
  • Wine: no more than 1 glass a day

Foods to limit or avoid

  • Red meat: no more than 4 servings a week
  • Butter and margarine: no more than 1 tablespoon (tbsp) daily
  • Cheese: no more than 1 serving a week
  • Sweets: no more than 5 servings a week
  • Fried or fast food: no more than 1 serving a week

To summarize the MIND DIET—

On a daily basis you eat at least three servings of whole grains, a salad and another vegetable, along with drinking a glass of wine. The jury is still out on whether a little alcohol consumption is better for the brain than none at all. I just heard a panel of researchers and neuroscientist address this issue. If you don’t consumer alcohol, there is certainly no reason for you to start now. But if you do, limit your consumption to one glass of wine a day.)

It’s advised that on most days you should snack on nuts, and every other day eat half a cup of beans. At least twice a week eat poultry and a half-cup serving of berries (blueberries are best), and eat fish at least weekly. Olive oil is the preferred cooking oil.

What is the DASH diet?

The healthy DASH diet plan was developed to lower blood pressure without medication in research sponsored by the US National Institutes of Health, Dietary Approaches to Stop Hypertension. The first DASH diet research showed that it could lower blood pressure as well as the first line blood pressure medications, even with a sodium intake of 3300 mg/day!  Since then, numerous studies have shown that the DASH diet reduces the risk of many diseases, including some kinds of cancer, stroke, heart disease, heart failure, kidney stones, and diabetes. It has been proven to be an effective way to lose weight and become healthier at the same time.

The DASH diet eating plan is a diet rich in fruits, vegetables, low-fat or non-fat dairy. It also includes mostly whole grains; lean meats, fish and poultry; nuts and beans. It is high fiber and low to moderate in fat. It is a plan that follows US guidelines for sodium content, along with vitamins and minerals. In addition to lowering blood pressure, the DASH eating plan lowers cholesterol and makes it easy to lose weight. It is a healthy way of eating, designed to be flexible enough to meet the lifestyle and food preferences of most people.

How is it different from the Mediterranean diet? It can be considered to be an Americanized version of the Mediterranean diet, and to be easier to follow, since it has more specific guidelines. But if you love tabouli, hummus, and olives, you might prefer the Mediterranean diet.

Although there are similarities among all three diets, the MIND diet is the only one that encourages the consumption of foods that have been found to promote cognitive health.

There is a saying that “what’s good for your heart is good for your brain.” So please start switching over to the MIND diet while eliminating foods high in calories and low in nutrients. You will feel better and your brain will stay healthier longer.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Urinary incontinence, UTIs, and dementia

Incontinence inscription isolated

There are lots of reasons that people develop incontinence. This blog focuses on people with dementia: their care and ways to prevent urinary tract infections, a serious consequence of incontinence in the elderly.

People with Alzheimer’s disease and dementia often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, not being able to find the toilet, or limited mobility.

Ways a caregiver can help

  • Avoid giving drinks like caffeinated coffee, tea, and sodas that may increase urination. It is important, however, that healthy liquids including water, smoothies, and fresh fruit juices are not restricted. Hydration is vital to overall health and to prevent urinary tract infections.
  • Keep pathways clear and the bathroom clutter-free, with a light on at all times.
  • Make sure you provide regular bathroom breaks–at least every 2-3 hours.
  • Mark the bathroom door with a large sign that says “Bathroom.”
  • Provide a portable commode or a toilet frame with handrails or grab bars to make getting on and off easier. Make sure it’s the right height.
  • Supply underwear that is easy to get on and off.
  • Use absorbent underclothes for trips away from home and/or adult diapers.
  • When going to a restaurant or public place such as a movie theater, try to sit as close to the bathroom as possible.
  • Limit liquid intake after dinner

Talking to the doctor

  • Ask if it’s possible to cut back on prescribed medications such as water pills that increase urination
  • Does the patient have undiagnosed diabetes? Diabetes increases urination.
  • Is an enlarged prostate the problem? Rule out any medical issues that increase urination or block urination.

Preventing urinary tract infections

Urinary tract infections, commonly called UTIsare more common in people who are elderly, bed-ridden and incontinent. Symptoms can include general weakness, confusion, nausea, dizziness, sudden incontinence or increased severity of incontinence. Often these symptoms seem connected to other conditions that are unrelated to a UTI, and can make it difficult to determine that the cause is an infection.

  • The most important method of prevention is to keep the genital area clean and healthy. Wipe from front to back to avoid transferring bacteria to the urinary tract, especially in women.
  • Remove used diapers from front to back.
  • Dry the skin when changing or after bathing since bacteria grows better in moist areas.
  • Use recommended hygienic products for washing that are not drying to the urogenital area.
  • Keep the patient hydrated since urination can flush out unwanted bacteria from the urinary tract.
  • Try to make sure your loved one gets help to empty their bladder entirely, since urine remaining in the bladder can help bacteria thrive and multiply.
  • Help to prevent constipation by providing plenty of fruit (applesauce, apples, berries, prunes, figs) and other foods high in fiber, such as oatmeal, legumes, peas, chia seeds, carrots, beets, broccoli, Brussels sprouts, popcorn, nuts, and whole grains.

The dangers of UTIs

Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who died from a UTI that quickly became septic.

If you suspect a UTI

  • Get medical help, especially if your loved one has fever or complains of nausea or back pain. An antibiotic will be prescribed. Make sure the entire prescription is taken even if the symptoms subside. Otherwise, the infection can come back with a vengeance.
  • If it is appropriate, have the patient drink unsweetened cranberry juice on a regular basis, and/or take a cranberry/D-Mannose supplement to help stave off future infections.
  • Give the patient plenty of water to flush out the harmful bacteria
  • Apply a heating pad to the lower abdomen and/or back to help with discomfort
  • A pain reliever such as Advil can help alleviate pain and fever

Urinary tract infections are nothing to mess around with. Please get your loved one medical help if you suspect an infection.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Motivating family members to help

Until age eight, I lived in an extended family house with my parents, brother and me on the top floor, my grandparents on the middle floor, and my aunt, uncle and cousin on the bottom floor. We all took care of each other, no questions asked. It was a close, loving family.

But that was then, this is now. Times have changed. People move away, and families don’t always stick together. I was lucky that my daughter and her newly-wed husband live near me and helped care for my husband (her father) who had Alzheimer’s disease. Every Sunday afternoon they took him out to a movie or to lunch. It gave me a break and it uplifted his spirit. My son, who was in graduate school, came home when he could to take his dad to a football game. And friends took my husband out to lunch on a regular basis.

But I needed extra help so I hired two graduate psychology students. I had promised myself that I wouldn’t become a martyr to my husband’s illness. I took care of myself by pursuing my interests and meeting with friends. Because I had time for myself, I had more energy to be present for my husband. Still, caring for someone with Alzheimer’s disease was a daunting task, as is caring for anyone with a chronic disease.

It really does take a village to provide care for someone with a chronic illness. If you have family that offers to help, you are lucky. Sadly, it’s often the case that one family member bears the brunt of the caregiving, which can lead to conflict and bad feelings.

What can you do to encourage family and friends to help?

  • If your loved one has Alzheimer’s or another form of dementia you are well aware of the difficult task of caregiving. But if your sister or brother, son or daughter, etc. only sees the ill person once in a while they might not realize the full impact of the disease. Try to plan a respite day or weekend by having another family member care for your loved one. This is the best way to help your family realize how much care your loved one needs and what the task requires.
  • Plan a conference call and divvy up the caregiving. If your family is spread out, encourage a rotation of caregiving. In some cases, the ill person stays with a daughter or son for a few months and then moves on to stay with another family member. This eliminates guilt and bad feelings among siblings. The logistics are complicated, but it can work.
  • If it is impossible for others to share in the physical caregiving because of where they live or other circumstances, encourage family members to take on a specific responsibility such as: refilling medications, driving to and/or making doctor appointments, providing meals, researching community assistance programs that include respite care and volunteer programs, setting up automatic bill payments and/or dealing with financial issues, providing a housecleaner or cleaning the house once a month, mowing the lawn, shoveling the snow, etc.
  • Speak your truth. Do you need a night out with friends? Time to go for a walk or to the gym? Say so, and don’t be afraid of offending anyone. The worst that can happen is that your sister or brother, or son or daughter will say “no.”
  • Is it possible for you to get paid for the help you provide? Discuss the options with your financial planner and other family members.
  • Ask a family member to create an online caring community such as “Share The Care” https://sharethecare.org/getting-started/ or “Caring Bridge.”  “Share The Care” is a system that creates a support network among caregivers that lets everyone share responsibilities. “Caring Bridge” https://www.caringbridge.org/how-it-workshelps you create a site that enables you to share updates about your loved one, coordinate help, and get emotional support.
  • It’s a fact of life that you can’t force another family member to help. Even if you do get help, you might be the one who does the disproportionate amount of caregiving. Try to accept it and be grateful that you will not feel guilty for not being there for your loved one. You are appreciated and even if your loved one can no longer communicate, he or she appreciates you and loves you. Just know that you are doing the best that you can . . . and that is all you can do.. 

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Does gum disease really cause Alzheimer’s disease?

Doctor holding blue crystal ball with gum disease sign on medical background.A study published January 23, 2019 in Science Advances caused a lot of people to freak out. It implied that the bacteria called Prophyromonas gingivalis that cause gum disease—gingivitis– might be the culprit in Alzheimer’s disease. It sounded too good to be true. But can you reduce your risk by getting regular dental check-ups, and brushing and flossing every day?

I posted a link to the study on my Facebook page and got some heated responses such as “I don’t believe that. My mom and husband always went to the dentist??????” Another person called the study “BS.” 

So, what is the bottom line? And what is the response of scientists who were not involved in the research paid for and conducted in part by employees of Cortexyme, Inc., a San Francisco–based biotech company? 

Here’s the gist of the Cortexyme study: the researchers found that enzymes made by P. gingivalis, called gingipains, interact with amyloid-beta and tau (the proteins implicated in Alzheimer’s disease) in test tube experiments and in the brains of mice. According to the study, gingipains cause A-beta to accumulate and tau to behave abnormally. These are the primary signposts of Alzheimer’s disease in the brains of humans.  The Cortexyme group also found genetic material from P. gingivalis in the cerebral cortex – an area involved in conceptual thinking – in the three Alzheimer’s brains they examined. Cortexyme, Inc. is developing compounds that block gingipains, which their scientists claim reduce the amount of A-beta in the infected mice.

In a previous study, Sim Singhrao at the University of Central Lancashire, UK, found that P. gingivalis can migrate from the mouth to the brain in mice with gum infections. Her group of researchers concluded that periodontal disease is a polymicrobial inflammatory disease that leads to chronic systemic inflammation and direct infiltration of bacteria/bacterial components, which may contribute to the development of Alzheimer’s disease.

A cautious response

Rudolph Tanzi,PhD, an Alzheimer’s researcher at Massachusetts General Hospital in Boston says that the Science Advances study is inconclusive.  An interview in Science News (January 31, 2019) conducted by Laura Sanders reported Tanzi’s responses to the following questions:

Do we now know what causes Alzheimer’s disease?

No. “It would be a complete fantasy to say that now we’ve solved Alzheimer’s based on this,” Tanzi says.  “People need to know that this was a small study…. It’s way too early to say that this result is valid.  We need to see many more samples. We need much more replication.”

Headlines that claim gum bacteria causes Alzheimer’s disease stretch the science way too far, he says. “It got out of hand. People should not be freaking out just because they didn’t floss enough. It doesn’t mean you’re going to get Alzheimer’s.”

But did it make sense to look at whether gum bacteria play a role in Alzheimer’s?

Yes. Tanzi and his colleagues suspect that Alzheimer’s is kicked off by brain inflammation, perhaps prodded along by bacteria, viruses or fungi. His team has been looking at large swaths of genetic material found in brains to figure out exactly which infectious entities might be in the brains of people with Alzheimer’s.

“We went in expecting to see periodontal bacteria in the brain. That was a leading hypothesis. One of the biggest pools of bacteria in your body lives in your gums if your gums are not clean. We expected to find them, but we didn’t.” (Those negative results, from dozens of brains, are unpublished.)

What you need to know

Periodontitis is the most common infectious inflammatory disease of humans. A recent survey in the USA concluded that 47.2% of adults aged 30 years and older had periodontitis. The disease is characterized by the loss of periodontal ligament, connective tissue, and alveolar bone, and is a major cause of tooth loss. 

Now we know that virulent strains of P. gingivalis can affect the central nervous system, which can result in Alzheimer’s and dementia. Although the research is still in its early stages, it’s a good idea to amp up your dental care and get thee to a dentist at least once a year for an exam and cleaning. It is certainly worth the bucks if it will help reduce your risk of Alzheimer’s disease. Don’t you think?

For more information about periodontal disease and why it’s important to floss please take a look at my previously published blog Do you still need to floss


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.