Tuesday’s Northern Colorado Health Research Coalition (NCHRC) Meeting offered perspectives on gerontology. Dr. Michael Towbin presented first providing information on alternative and complementary therapies for osteoarthritis, a condition that becomes more likely with age and affects 70-90% of those over age 75. Towbin urged physicians to ask patients to evaluate five questions when considering these alternative treatments: Does it work? Is it safe? Can you afford it? Is it legal? If the patient answers yes to all of the questions, why not try it? Towbin noted that these alternative treatments, which can be supplements or activity-based (e.g. physical therapy, accupuncture), do not go through the same approval process and sometimes have limited data on safety and efficacy. A good source for information on these alternatives is the naturalstandard.com, which aggregates trial data and evidence and rates the level of support for each treatment.
Towbin ran through a variety of the treatments available for osteoarthritis, but focused on a trial that compared supplements chondroitin and glucosamine (separately and combined), and Cox-2 Inhibitor celecoxib (Celebrex) to placebo for patients with osteoarthritis. This trial included 1600 patients, a very large sample by supplement standards. In the trial only the group taking celecoxib showed significant improvement over placebo overall, although the trial did see an extremely high placebo response rate (defined as a greater than 20% decrease in pain) of 60%. For the subgroup of patients experiencing moderate to severe pain, chondroitin and glucosamine combined led to significant improvements in pain compared to placebo.
Dr. Manfred Diehl stepped up next to provide thoughts on “successful aging” which he defined with three key attributes:
- Low risk of disease and disease related disability
- High mental and physical function
- An active social life and productive engagement with life
Diehl urged those in attendance to discard the belief that old is synonymous with sick. While many diseases do become more prevalent with age, lifestyle choices have a substantial impact on the progression of physical and cognitive function. Important behavioral choices include diet and exercise (physical and mental), sleep hygiene (amount and quality), and alcohol and tobacco use. Diehl also took odds with the notion that the effects of aging are irreversible, citing “human plasticity” and reverse capacity in a variety of areas – including neurogenesis induced by exercise and increases in bone mass and density from strength training. Diehl concluded by noting that “successful aging does not begin at 60” but rather is the result of lifelong behavioral choices.
Samuel Henderson, scientific founder of Accera, concluded the evening discussing the metabolic defects associated with Alzheimer’s disease (AD). The brain receives essentially all its energy through the metabolism of glucose, and although it represents only 2% of body mass it actually uses about 25% of the glucose in a person at rest. Given this high need for blood sugar, it makes sense that brain cells unable to metabolize glucose would begin to lose function, with the most substantial losses occurring in areas of the brain with higher glucose needs like the default network. This hypothesis has proven true, as the brains of people who go on to develop AD show substantial decreases in glucose metabolism decades before the onset of symptoms. With this knowledge, Accera set out to provide the brain with an alternative source of fuel, specifically ketone bodies. These ketone bodies are created by having the patient ingest medium chain triglycerides, one of which is the key ingredient in Accera’s recently launched medical food Axona (RockyRadar previously profiled Accera). Axona was tested initially to verify that it did increase ketone body levels and then to evaluate its affects on the symptoms of AD (using the ADAS-Cog score). Interestingly, trial results demonstrated that affects on symptoms vary depending on a patients’ ApoE4 status, a common genetic factor associated with AD. In a 90 day trial, Axona showed a significant effect in ApoE4(-) patients. According to Henderson, the reasons behind this difference are still be explored. Henderson’s hopes for Axona include conducting a longer-term study and an imaging study to gain further insight into the impact of ApoE4 status.
The NCHRC is a partnership among Colorado State University, Poudre Valley Health, and the Colorado BioScience Association focused on enhancing opportunities for local health-related research. The next NCHRC event will focus on neurology.
