Nutrition
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Lower brain glucose metabolism is present before the onset of clinically measurable cognitive decline in two groups of people at risk of Alzheimer's disease--carriers of apolipoprotein E4, and in those with a maternal family history of AD. Supported by emerging evidence from in vitro and animal studies, these reports suggest that brain hypometabolism may precede and therefore contribute to the neuropathologic cascade leading to cognitive decline in AD. The reason brain hypometabolism develops is unclear but may include defects in brain glucose transport, disrupted glycolysis, and/or impaired mitochondrial function. ⋯ Nevertheless, aging appears to increase the risk of deteriorating systemic control of glucose utilization, which, in turn, may increase the risk of declining brain glucose uptake, at least in some brain regions. A contributing role of deteriorating glucose availability to or metabolism by the brain in AD does not exclude the opposite effect, i.e., that neurodegenerative processes in AD further decrease brain glucose metabolism because of reduced synaptic functionality and hence reduced energy needs, thereby completing a vicious cycle. Strategies to reduce the risk of AD by breaking this cycle should aim to (1) improve insulin sensitivity by improving systemic glucose utilization, or (2) bypass deteriorating brain glucose metabolism using approaches that safely induce mild, sustainable ketonemia.
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Proinflammatory cytokines and essential fatty acids (EFAs) and their metabolites are altered in coronary heart disease, stroke, diabetes mellitus, hypertension, cancer, depression, schizophrenia, Alzheimer's disease, and collagen vascular diseases, indicating that these diseases not only are low-grade systemic inflammatory conditions but also have defects in the metabolism of EFAs. EFAs and their metabolites such as eicosanoids, lipoxins, resolvins, protectins, maresins, and nitrolipids are biologically active molecules that regulate gene expression and enzyme activity, modulate inflammation, the immune response, and gluconeogenesis by direct and indirect pathways, function directly as agonists of a number of G-protein-coupled receptors, and thus regulate several cellular processes. ⋯ Stem cells are pluripotent and expected to be of benefit in the management of many clinical conditions. Therefore, I propose that the beneficial actions of EFAs and their metabolites seen in coronary heart disease, stroke, diabetes mellitus, hypertension, atherosclerosis, cancer, depression, schizophrenia, Alzheimer's disease, and collagen vascular diseases could be ascribed to their ability to enhance the proliferation and differentiation of embryonic stem cells in addition to their capacity to suppress inflammation.