Compare common weight-loss strategies and ask yourself these key questions to judge their effectiveness.
When it comes to weight loss, there's no shortage of advice. Check any magazine rack or bookstore, and you're bound to discover that latest and greatest cure for being overweight. Some even work — for a while.
Unfortunately, people often find diets hard to sustain, in part because they tire of avoiding certain foods, loading up on others, or feeling deprived and hungry. And their diet is often temporary, something to endure for a while before returning to former ways. As a result, any lost pounds come right back once the diet stops.
Here's a summary of six common weight-loss strategies in circulation today, and the questions to ask yourself to determine if any of them will help you make the lifestyle changes required to maintain a healthy weight.
Low-carb diets
Followers of these eating plans believe that a decrease in carbs results in lower insulin levels, which causes the body to burn stored fat for energy. Initially, when you follow a low-carb diet you may lose more weight than if you followed a low-fat, low-calorie diet. This increased weight loss may or may not continue long term depending on your commitment to following the eating plan.
A low-carb diet doesn't appear to be any easier to maintain than are other diets. Studies comparing low-carb diets and low-fat diets have found that after a year, people drop out of both diets at similar rates. This suggests that the low-carb diet, like so many diets, is no easier to stick to long term. Well-known low-carb diets include the Atkins diet, Zone diet and Protein Power.
Normal aging and memory loss
Normal age-related memory loss doesn't prevent you from living a full and productive life. You just need more time to remember a name or the task you had set out to do. You're aware that you're forgetful and may even joke about it.
People with memory loss due to something other than normal aging, such as Alzheimer's disease, may feel that something's not quite right, but they're unable to pinpoint what's bothering them. Rather than call attention to a memory lapse, they may behave as if everything is fine.
Reversible causes of memory loss
Many other medical problems cause symptoms similar to Alzheimer's. That's why it's so important to consult a doctor if you've noticed memory lapses or uncharacteristic mood swings in yourself or in someone close to you. The problem may be a potentially reversible illness, such as depression, a metabolic disorder such as hypothyroidism, a reaction to a drug, or a vitamin deficiency.
Detective work
A multitude of things can cause forgetfulness, and many of them are reversible. Work with your doctor to determine what's going on with your memory and what can be done about it.
Symptoms
Everyone has occasional lapses in memory. It's normal to forget the names of people whom you rarely see. But it's not a normal part of aging to forget the names of familiar people and objects.
Alzheimer's disease — a progressive, degenerative brain disease — causes more than simple forgetfulness. It may start with slight memory loss and confusion, but it eventually leads to irreversible mental impairment that destroys a person's ability to remember, reason, learn and imagine.
Most people with Alzheimer's share certain signs and symptoms of the disease. These may include:
- Increasing and persistent forgetfulness. At its onset, Alzheimer's disease is marked by periods of forgetfulness, especially of recent events or simple directions. But what begins as mild forgetfulness persists and worsens. People with Alzheimer's may repeat things and forget conversations or appointments. They routinely misplace things, often putting them in illogical locations. They frequently forget names, and eventually, they may forget the names of family members and everyday objects.
- Difficulties with abstract thinking. People with Alzheimer's may initially have trouble balancing their checkbook, a problem that progresses to trouble recognizing and dealing with numbers.
- Difficulty finding the right word. It may be a challenge for those with Alzheimer's to find the right words to express thoughts or even follow conversations. Eventually, reading and writing also are affected.
- Disorientation. People with Alzheimer's often lose their sense of time and dates, and may find themselves lost in familiar surroundings.
- Loss of judgment. Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer's is characterized by greater difficulty in doing things that require planning, decision making and judgment.
- Difficulty performing familiar tasks. Once-routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to do even the most basic things.
- Personality changes. People with Alzheimer's may exhibit mood swings. They may express distrust in others, show increased stubbornness and withdraw socially. Early on, this may be a response to the frustration they feel as they notice uncontrollable changes in their memory. Depression often coexists with Alzheimer's disease. Restlessness also is a common sign. As the disease progresses, people with Alzheimer's may become anxious or aggressive and behave inappropriately.
Because early Alzheimer's symptoms progress slowly, diagnosis is often delayed. People developing the condition may be frighteningly aware of their problems — but careful to keep them hidden, refusing to see a doctor. As a result, even their families may fail to see what's going on. When the signs and symptoms are too obvious to miss, those closest to the person often realize that similar — but less severe — difficulties have been present for years.
The disease's course varies from person to person. Eight years is the average length of time from diagnosis of Alzheimer's to death. Survival begins to decline three years after diagnosis, but some people live more than a decade with the disease.
Risk factors
Alzheimer's is a complex disease likely caused by a combination of factors — such as infection or reduced circulation — and genetic susceptibility. Although all the contributing factors may never be known, scientists have identified several common threads. They include:
- Age. Alzheimer's usually affects people older than 65, but can, rarely, affect those younger than 40. Less than 5 percent of people between 65 and 74 have Alzheimer's. For people 85 and older, that number jumps to nearly 50 percent.
- Heredity. Your risk of developing Alzheimer's appears to be slightly higher if a first-degree relative — parent, sister or brother — has the disease. Although the genetic mechanisms of Alzheimer's among families remain largely unexplained, researchers have identified a few genetic mutations that greatly increase risk in some families. Three genetic mutations are known to cause early-onset Alzheimer's. In addition, one form of the apolipoprotein E (APOE) gene increases your chance of developing late-onset Alzheimer's.
- Sex. Women are more likely than men are to develop the disease, in part because they live longer.
- Lifestyle. The same factors that put you at risk of heart disease, such as high blood pressure and high cholesterol, may also increase the likelihood that you'll develop Alzheimer's disease. Poorly controlled diabetes is another risk factor. And keeping your body fit isn't your only concern — you've got to exercise your mind as well. Some studies have suggested that remaining mentally active throughout your life, especially in your later years, reduces the risk of Alzheimer's disease.
- Education levels. Studies have found an association between less education and the risk of Alzheimer's. Some researchers theorize that the more you use your brain, the more synapses you create, which provides a greater reserve as you age. It remains unclear, however, whether less education and less mental activity create a risk of Alzheimer's or if it's simply harder to detect Alzheimer's in people who exercise their minds frequently or who have more education.
- Toxicity. One long-standing theory is that overexposure to certain trace metals or chemicals may cause Alzheimer's. For a time, aluminum seemed a likely candidate, because some people with Alzheimer's have deposits of aluminum in their brains. After many years of studies, however, no one has been able to link aluminum exposure directly to Alzheimer's. At this point, there's no evidence that any particular substance increases a person's risk of Alzheimer's.
- Head injury. The observation that some ex-boxers eventually develop dementia suggests that serious traumatic injury to the head (for example, a concussion with a prolonged loss of consciousness) may be a risk factor for Alzheimer's. Several studies indicate a definite link between the two, but others show no link.
- Hormone replacement therapy. The exact role hormone replacement therapy may play in the development of dementia isn't yet clear. Throughout the 1980s and '90s, evidence seemed to show that estrogen supplements given after menopause could reduce the risk of dementia. But results from the large-scale Women's Health Initiative Memory Study indicated an increased risk of dementia for women taking estrogen after age 65. The verdict is not yet in on whether estrogen affects the risk of dementia if given at an earlier age.
Tests and diagnosis
There's no one test to diagnose Alzheimer's disease. Typically, doctors start the diagnostic process by ruling out other diseases and conditions that also can cause memory loss.
Small, undetected strokes, for example, can cause dementia by temporarily interrupting blood flow to the brain. People with Parkinson's disease, a degenerative nerve disorder, also can develop dementia. Depression, too, can cause lapses in memory. In addition, many older adults are on multiple medications that may impair their ability to think clearly.
To help distinguish Alzheimer's disease from other causes of memory loss, doctors typically rely on the following:
- Medical history. Doctors may ask about a person's general health and past medical problems. They'll want to know about any problems a person may have in carrying out daily activities. If possible, doctors will also want to speak with a person's family or friends to get more information.
- Basic medical tests. Blood tests may be done to help doctors rule out other potential causes of the dementia, such as thyroid disorders or vitamin deficiencies.
- Mental status evaluation. These tests screen memory, problem-solving abilities, attention spans, counting skills and language. They help doctors pinpoint specific problems a person may have with cognition. For instance, doctors might test recent and long-term memory by asking: What day is it today? Or: When was World War II? Recall tests are another example. Doctors may list familiar objects, and then ask a person to repeat them immediately, and again five minutes later.
- Neuropsychological testing. Sometimes doctors undertake a more extensive assessment of memory, problem-solving abilities, attention spans, counting skills and language. This is especially helpful in trying to detect Alzheimer's and other dementias at an early stage. Doctors use formal psychological tests to determine if a person's mental abilities are as expected for his or her age and education. The patterns of any mental deficits observed during neuropsychological testing can help doctors sort out possible causes of dementia.
- Brain scans. Doctors may want to take a picture of the brain using a brain scan. Several types of brain scans are available — including a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan and a positron emission tomography (PET) scan. By looking at images of the brain, doctors may be able to pinpoint any visible abnormalities. Researchers are studying whether brain scans can eventually be used to detect an increased risk of Alzheimer's in healthy people before symptoms begin.
Using the methods above, doctors can accurately diagnose 90 percent of Alzheimer's cases. Alzheimer's can be diagnosed with complete accuracy only after death, using a microscopic examination of brain tissue, which checks for plaques and tangles.
Genetic testing for Alzheimer's is in its beginning stages. Blood tests are available that can tell whether a person carries the genetic mutations believed to be associated with Alzheimer's, but the tests can't tell who will or will not get the disease.
Prevention
Right now, there's no proven way to prevent the onset of Alzheimer's disease. Researchers had developed what looked to be a promising vaccine against Alzheimer's that worked by stopping deposits of beta-amyloid in the brain. Animal studies were so encouraging that human trials began in 2001. Unfortunately, they soon had to be stopped because some people experienced serious inflammation of the brain. While these results were disappointing, scientists learned from these experiments and many researchers continue to look for ways to reduce the risk of this disease. Several leads are hopeful, but still preliminary. They include:
- Healthy aging. Some of the most recent research indicates that taking steps to improve your cardiovascular health, such as losing weight, exercising and controlling high blood pressure and cholesterol, may also help prevent Alzheimer's disease.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Several studies have shown that the NSAIDs ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) and indomethacin (Indocin) may reduce the risk of developing Alzheimer's. This may be because inflammation appears to play a role in Alzheimer's. What isn't known, however, is whether inflammation is a cause of Alzheimer's or simply an effect of the disease. Because NSAIDs can cause serious gastrointestinal bleeding, clinical trials need to be completed before it's clear whether people should take NSAIDs solely to prevent Alzheimer's.
- Statins. These drugs — a class that includes atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) — are normally used to lower cholesterol levels, but recent studies have shown that they may also reduce the risk of Alzheimer's disease. More studies are being done to determine exactly what role, if any, statins may have in Alzheimer's prevention.
- Selective estrogen receptor molecules (SERMs). A SERM called raloxifene (Evista) is used to protect against the bone loss associated with osteoporosis. It also appears to lower the risk of developing mild cognitive impairment, a memory disorder that often precedes Alzheimer's.
- Vitamin E and ginkgo. Both these substances have been linked to improvements in cognitive abilities, and their potential effects on Alzheimer's are being studied. One large study, however, showed that vitamin E has no effect on the development of Alzheimer's in people who have mild cognitive impairment.
- Mental fitness. Maintaining mental fitness may delay onset of dementia. Some researchers believe that lifelong mental exercise and learning may promote the growth of additional synapses, the connections between neurons, and delay the onset of dementia. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia. This advanced level of education simply may help some people "cover up" their condition until later.
Delaying the onset of Alzheimer's is an important step in fighting the disease. If the onset of Alzheimer's could be postponed by just five years, it would dramatically reduce the number of people who have the disease.
Last Updated: 07/19/2008
