How about B12, D3, Natural E, and what Jesus fixed for breakfast?  And how long should we live in a world far from the Tree of Life?  There are worse things than dying.

By Jack Hoehn (John B. Hoehn, M.D.)

BrainlightsHe was a retired pastor and was once the president of an SDA Conference. His formerly active and intelligent wife of many years had progressive Alzheimer’s dementia.  He cared for her kindly and faithfully in their own home.  She lost more and more awareness of the present, although her past memories could be surprisingly accurate.  So one day in the afternoon she said to her graying partner and caregiver, “You’ve been very kind to me, but  you had better leave now, for my husband will be coming home soon.…”

One could laugh and cry at the same time.  Obviously her memories of her husband were of a younger, vigorous man who had courted and wed her many years ago.  Now there was this kindly older gentleman who had been with her all day, but she could not connect her present reality with her remaining older memories.

Alzheimer’s Dementia is a plague in many health reforming Adventist homes, as well as in our neighbors’ homes.

I’ve watched leading pastors and evangelists, brilliant men and women, administrators, executives, teachers become worse than shells of their former selves by dementia.  Spiritual and moral leaders have become quite amoral and parodies of their former selves.  At times I almost hear the demons’ dancing about their destruction and conquest of not only a mind, but a soul destroyed by multi-infarct dementia, Pick’s disease, Parkinson’s disease (Lewy body dementia), and Alzheimer’s disease.

Living Too Long

The causes of all this loss of cognition are not known but include several factors.  As we live longer with the conquest of infectious diseases, cancers, and cardiovascular deaths by medical science, people are now commonly living to their 90’s.  If we were all dying in our 70’s there would be far less dementia.

For this reason, as a physician, I do not share the common sentiment that says, “What a tragedy; she died so young!” or “Why did he have to die; he’d never been sick a day in his life!”  The alternative of a long life without mental comprehension, the so called “living as a vegetable” is surely not desirable.  Death and loss is a big problem for the survivors who are left alone and in grief, but death is a sure cure and sometimes a preventative for dementia, so personally I mourn for the survivors, not for the departed that I sometimes envy.

75yearsDr. Ezekiel Emanuel wrote a controversial article for the Atlantic Monthly, October 2014 issue titled, “Why I Hope to Die at 75.”  This physician with a 90-year-old father details why living longer is not always desirable.  Although you may not like his personal plan for stopping all preventative care and most curative care after that age, he does have reasons for his decision that have some morality and unselfishness behind them, and are worth considering even by Adventists striving to outlive the rest of the population with our Health Reform message.[1]   Dr. Emanuel has a very clear list of what he would and would not do after age 75.  (See footnote for more specifics.)[2]

At what cost to our family, our society, the children of the world, do we invest expensive resources in keeping alive elderly people with limited quality of life and no prognosis for regaining productive independent living?  At what age should we stop doing high tech bypasses, angioplasties, valvuloplasties, intensive care, cancer chemotherapy that is palliative and not curative?  When is comfort care and hospice the moral choice for Christians of age when facing an illness?  If we do not fear death, why should we behave as if we do, with life preservation and prolongation at all cost and at all ages?

Three Wills

There is a very practical issue here that some of us neglect.  And that is to have a clear statement of our intentions on life-prolonging procedures legally left for our family members and available to our health care providers.  Adventist have had advice from Ellen White on this for many years:

Wills should be made in a manner to stand the test of law… Death will not come one day sooner, brethren, because you have made your will.”[3]

Wills regarding our property disposition at death are still important, but there are two additional “wills” and another document that need to be added.

“Living Will (Attorney for Health Care)/POLST

The second Will you need is a document stating that you do NOT wish your life to be artificially prolonged, in case of death or near death.  This is sometimes called a “Living Will,” and you need to make a document (Attorney for Health Care) to give legal authority to a younger sibling, a child your trust, or other relative or friend who will outlive you and who can act on your behalf if you are unconscious or otherwise impaired.  This legal document can be made with your lawyer or by using legal software you can buy for your computer.

These documents are only valid if you are unconscious or incapable of expressing your will; at any time you can say, if you are aware and able to speak or write, “Take me to the hospital, I want to be treated.…”  But if you are found on the floor, unconscious, half alive, or alive and unable to speak, you need to leave instructions on what you want done or on what you do not want done.

I value quality of life, more than quantity of life, so here are my personal instructions after age 60:

  1. If I have no heart beat or respirations, say a prayer for me; don’t try to bring me back. No cardiopulmonary resuscitation, no CPR. No code, no shocks. No intubation or ventilation.
  2. If I am half alive, keep me comfortable, but don’t slow down my natural death. Comfort care only.  No intubation.  No ventilator.  Don’t take me to the hospital unless you can’t keep me comfortable at home.  No ICU care, no lab tests, no surgery.  No antibiotics.
  3. If I am alive but unconscious and not able to chew and swallow, No tube feeding, no artificial nutrition.  Comfort care only.
  4. Hospice care is welcome anytime during my incapacity. Sing to me; talk to me. I don’t want to be alone during my last hours. But I am happy to be at rest in death with Jesus.

(You may also need to indicate if you wish your body parts to be recycled after your death as an organ donor. This is more important for young people, as the older we get the less value our organs have, but you may wish to have your body used for medical education as well.)

In my state there is a shorter form for this information that your doctor can fill out for you at your next office visit.  This POLST (Physician Order Life-Saving Treatment) is a standardized form your doctor fills out and you then post on your fridge at home in case an ambulance has been called to your house and finds you unable to tell them what to do and your Attorney for Health care is not there to tell them what not to do.  The POLST is a summary of the above information and directs first responders to know what or what not to do to your dying body.

Attorney-in-fact (POA)

The third extra “Will” you need is to give full authority to a younger sibling, a child you trust, or other relative or best friend you have complete trust in to manage your financial affairs before you die.  This is called giving them “Power of Attorney” (POA), and lets them control your finances if you are incapable of this.  This gives that person the right to made decisions on your behalf, even if you disagree with them, so only give this to someone you trust.  You can make the document now and put it someplace to be used only when you become incompetent, but please do it now before it is needed, so it is there “in case.”  This legal document also can be made with your lawyer or by using legal software.

This POA does not give them the legal right to tell the doctors or hospitals what to do for you, so you need to have all three separate Wills (Last Will and Testament/Attorney for Health Care/Attorney in Fact), and a POLST form filled out, to meet the needs if you become demented or otherwise incapable of managing your own care.

Good Genes?

For some reason, dying young is not the most welcome advice doctors can give their patients, so most of us wish to know how to prevent or treat dementia.  The first way to prevent dementia is to choose good parents.  There are some genetic mutations (APOE, APP, PSEN1, or PSEN2) that are known to cause dementia.  If your parents have these genes your chances of becoming demented early or in your old age are much greater than if you don’t have the gene.  However, sadly, to date there are no interventions specific for these genetic mutations.  Testing for this gene tells you if you have it, but doesn’t offer any way to escape your destiny, so testing is not advised at this time.

Medication for Dementia?

Medications for Alzheimer’s dementia can slow the progression of the disease, but Aricept, Namenda, Rivastigmine (Exelon) patches, are not a cure for dementia.  In some countries they are not even paid for by insurance because they are thought to be nearly useless.  But some people do improve with them and need institutional memory care later than if they don’t use them.  They are worth a try.

Feeding Your Brain

Most of us want prevention, not cure.  And according to the latest information, such as Dr. Gary Small’s book The Alzheimer’s Prevention Program,[4] it all boils down to– eat nutritious foods, exercise more, and reduce stress. Does that not sound like our classic Adventist health/spirituality message? Just practice your Adventism.

But if that is true, why do so many Adventists, even vegans and marathon runners, and very spiritual people still suffer the different dementias?

Here are a few specific hints:

Vitamin B12

All vegans and even many omnivores should have their vitamin B12 level checked. Most all vitamins just flow into your body with food; if you eat them, you get them. But not B12. Some people take in enough B12 but their bodies do not absorb it. This is especially true for people with stomach problems, people who have surgeries, or people who need to take acid blocking medicines, etc.  True vegans do not have any easy plant source of B12, and attempts to pretend it is OK to have low B12 levels are misguided. So just have a blood test, and if you are low, take a supplement by mouth (those you dissolve before you swallow are the best).  And then recheck, if you still are low even with a supplement (500 to 2500 mcg a day), you will need to take vitamin B12 shots on a monthly basis for the rest of your life. Low B12 can cause dementia.

Vitamin D

Those living in the southern states of the USA have less problem with this, but Canadians and most people living in the northern states need to take supplemental Vitamin D. This is important for bone health, but you may not know that low Vitamin D levels can also cause depression, and there is a higher incidence of multiple sclerosis (MS) in people with low Vitamin D levels. Again, have your blood tested, and in this case, a low “Normal” level of 30 is not safe. You need to have an optimal level of 60-100 on your test. Babies can take 400 units a day, but Adults often need 10,000 units a day to get up to optimal levels. Vitamin D3 is the safest and most active form, it comes from the lanolin of sheep’s wool, so nothing has to die to get Vitamin D3 if you have a tender vegetarian heart. Once you get optimum levels, you can keep it there with 2,000 to 5,000 units a day, depending on your body size, in most cases. The recommended allowances are much lower than the optimal levels for brain and bone health.

Vitamin E, Only Natural

Many years ago Vitamin E was advised for preventing or treating dementia, and some studies suggested it helped. Then later studies suggested it was just a placebo or even harmful. Recently, new studies have shown some benefit. Until recently I advised people to get vitamin E only from foods like wheat germ. But the more nuanced advice is now this: Vitamin E, 400 units a day, may help prevent or treat dementia, but DO NOT use synthetic Vitamin E (dl-alpha tocopherol—a petroleum by product); use only natural source Vitamin E (d-alpha-tocopherol—sold as “natural” or “mixed” tocopherols).  There is a difference in how the body uses it.

Omega-3 Fatty Acids

I’m not talking about heart disease here; I’m talking about brain.  As scientists of the brain will tell you, your human brain is rich in Omega-3 fatty acids, especially the EPA and DHA types. Plants have lots of Omega-6 and also Omega-3 fatty acids of the ALA type (flax seed, canola, soybean oils, walnuts, Brussels sprouts, kale, spinach, salad greens), so if you are eating your seven plants a day you can get your ALA. Your body can convert some ALA to EPA and DHA, but not very efficiently.

I recommend that babies, who grow a lot of brain from birth to 8 years, take an EPA, DHA supplement if they are not fed fish. I recommend that adults trying to keep healthy brains take an EPA/DHA supplement if they don’t eat fish. 1 gram capsules of purified fish oil a day will do the trick for most adults. If you are wealthy and want to remain pure vegan you can get algal source EPA/DHA supplements. Others will take what Jesus fixed for breakfast[5] and eat some fish (salmon, mackerel, sardines, herring, trout, or swordfish), or take an inexpensive fish oil capsule.

Turmeric – Curry to the Rescue?

Turmeric There is a yellow flower that grows in the southern parts of India, whose root was boiled and then dried and powdered and was used first as a yellow dye and then as a spice. It has been used for almost everything in traditional medicine in India, but has proven to be a possible preventative of Alzheimer’s dementia. This yellow powder is called turmeric and this contains an active ingredient known as curcumin. Turmeric is used as a major ingredient in the spices used to make the curries characteristic of Indian and other nearby Asian traditional diets. Observation has shown that Alzheimer’s dementia is less frequent among curry eaters. One study in Indian showed that adults over 60 who had curry occasionally or often (more than once a month) had less dementia than those who never or rarely had curry. So a visit to the Taj Mahal or Thai Palace in your community for a yellow curry dish made with turmeric twice a month might be brain medicine. You can’t just eat powdered turmeric; it has to be in oil to release the curcumin, and black pepper needs to be mixed with it to increase the absorption. Sorry, Adventist health reformers, some spices, including curry powder with turmeric and pepper, need to be back on your table at least twice a month.[6]

Caffeine?

Another reversal for Adventists is that Postum, decaf, herbal tea, Rooibos, and Peppermint won’t do it. But for “people who already had an increased risk of cognitive decline because of cardiovascular risk factors, consuming about 500 milligrams of caffeine a day was strongly associated with memory preservation,” says Har­vard’s Jae Hee Kang.” [7] That is a lot of coffee–4 or 5 cups of brewed coffee. Starbucks straight brewed Pikes Place coffee (not their Lattes or Mochas!) is pretty strong and has 260 mg caffeine in a 12 oz. “tall.” Two cups a day could slap your memory back in place!

Espresso based drinks actually have less caffeine than brewed coffee; a “double shot” at Starbucks has 150 mg, a single shot half that amount. So you would need to drink seven “tall” single shot Americanos, Lattes, Cappuccinos, Mochas or three and a half double shot “grande” versions of the same to get the memory boosting dose every day.

Obviously taking that much caffeine can cause nervousness, rapid or irregular heartbeat, nausea, anxiety, difficulty sleeping, sweating, dizziness, vomiting, so take this drug with care if trying to improve your or grandma’s memory.   Memory loss is so corrosive to the quality of life that finding out if you would only have a little difficulty sleeping might be worth the risk of taking caffeinated beverages. (I realize that for an Adventist to admit that coffee can be a good drug for some people involves swallowing not only coffee, but also some pride.)

Obesity

Overweight people have twice the risk of Alzheimer’s dementia as normal weight people. Obese people have four times the risk of Alzheimer’s dementia. So get that BMI down below 30 at least. And believe me, I understand how difficult this can be for many of us, but we need to know the facts. Yet I have seen many slender vegans with dementia.

Stroke Prevention

The sudden and massive loss of brain function of a stroke (a brain “heart attack”) is well known to all of us. What is not as well known is that tiny strokes happen to our brains much more often than large strokes, and the cumulative effect of many small cerebrovascular accidents (little strokes, even those without symptoms or silent strokes) can lead to a progressive form of memory loss called “Multi-infarct Dementia.” This is common enough that on MRI’s of the brain most people show these so called “lacunar infarcts” and “white matter changes,” so radiologists call them “age-related” white matter changes. And in almost all of us as we age the brain itself shrinks in size and the fluid about the brain increases.

We know that avoiding high blood sugar, high cholesterol, high blood pressure, smoking, alcohol use and atrial fibrillation is important. Some doctors think taking aspirin can help prevent some of these mini-strokes from happening. Again the slim vegan who takes fish oil, B12, Vitamin D, and natural Vitamin E supplements will have some advantage here, but may also need to take a baby aspirin.

Avoiding Dementia?

  1. Follow the traditional SDA lifestyle of plant-based diet; exercise; avoid alcohol; avoid tobacco; don’t get fat; trust in God; and have frequent socialization with family and friends.

  2. But have your doctor check your B12 level (aim for 400-900 range) and your Vitamin D levels (aim for 60-100 range) as well as your blood sugar and cholesterol, and take supplements or medicines if needed.

  3. If you eat fish, have fatty fish once a week or more. If you don’t want to eat anything fishy, take a fish oil capsule once a day or its algal equivalent. (Be sure your babies have a DHE/EPA chewy once a day till they are eight.)

  4. Consider a Turmeric curry meal at least once or twice a month.

  5. Consider Natural Vitamin E, 400 units a day, not synthetic.

  6. Consider a baby aspirin, 81 mg a day, for men and women over 55 if you have risk factors for heart attacks, strokes or mini-strokes.

  7. At some age, the moral choice is to stop doing preventative and curative care, and let God’s will that all die the first death take place. There is a time to be born, and there is a time to die. We would like that time to die to be before our brains have died. Living too long can be worse than death.

  8. And at whatever age you must die, be sure to die young, hanging on to Jesus with full hope of the resurrection of a new body, not desperately hanging on to a poor quality semi-life with this old worn out one!

 

 

FOOTNOTES:

[1] https://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

[2] See article above for full context of Dr. Emanuel’s suggestions, but here is a summary:

 “Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either.   This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age…  After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.  

“What about simple stuff? Flu shots are out…  A big challenge is antibiotics for pneumonia or skin and urinary infections.…. It is really hard for us to say no…But, as Osler reminds us, unlike the decays associated with chronic conditions, death from these infections is quick and relatively painless. So, no to antibiotics.

“Obviously, a do-not-resuscitate order and a complete advance directive indicating no ventilators, dialysis, surgery, antibiotics, or any other medication—nothing except palliative care even if I am conscious but not mentally competent—have been written and recorded.  In short, no life-sustaining interventions. I will die when whatever comes first takes me.”

[3] Ellen White, 4T, page 482.

[4] https://www.drgarysmall.com/books/the-alzheimers-prevention-program

[5] John chapter 21.

[6]  See this review article from Indian Academy of Neurology for more details on Turmeric and Alzheimer’s disease:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781139/

[7] Nutrition Action Health Newsletter, January/February 2014, page 5.

 

 

COMMENTS:  on the ideas in this article are welcome and will all be read, but may be shortened, deleted, or edited by the author to keep them on topic for the Adventist Today audience.