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ZusammenfassungDie Prävalenz der Demenz ist in den letzten Jahren gestiegen und nimmt mit dem Alter exponentiell zu. In Deutschland sind ca. 1,7 Mio. Menschen betroffen, die jährliche Neuerkrankungsrate wird auf 300 000 geschätzt. Der Begriff Demenz umfasst verschiedene Krankheitsformen mit unterschiedlichen Ätiologien. Dem demenziellen Syndrom des höheren Lebensalters liegen meist vaskuläre und metabolische Risikofaktoren zugrunde, die der klinischen Demenzmanifestation um Dekaden vorausgehen. Dies bietet ein enormes Zeitfenster für die Prävention, welche insbesondere vor dem Hintergrund weitgehend fehlender kurativer pharmakologischer Ansätze eine große Bedeutung erlangt. Lebensstilmaßnahmen, die eine hohe Nahrungsqualität und eine ausreichende Versorgung mit Omega-3-Fettsäuren, körperliche Aktivität und erholsamen Schlaf beinhalten, verbessern metabolische und vaskuläre Risikofaktoren und mindern das Demenzrisiko. Da multimodale Konzepte synergistisch wirken, versprechen sie den größten präventiven Nutzen.

The prevalence of dementias is on the rise, increases exponentially with age and constitutes a major healthcare burden nationally and worldwide. Dementias are clinically heterogeneous and encompass numerous etiologies. Noteworthy, late onset dementias are closely related to vascular and metabolic risk factors in midlife. Cardiometabolic risk factors commonly precede the onset of cognitive decline for decades. This opens a huge window for prevention. Given the lack of established pharmacological options for treatment of most dementias, preventive strategies are of utmost importance. Several factors have been identified that have the potential to preserve a healthy metabolic phenotype and to attenuate the onset of late onset dementias. Evidence exists for low-risk lifestyle factors including a real food dietary pattern, an adequate supply with long chain omega-3 fatty acids, regular physical activity and restorative sleep, with multimodal concepts showing the greatest cumulative benefit.Die Prävalenz der Demenz ist in den letzten Jahren gestiegen und nimmt mit dem Alter exponentiell zu. In Deutschland sind ca. 1,7 Mio. Menschen betroffen, die jährliche Neuerkrankungsrate wird auf 300 000 geschätzt. Der Begriff Demenz umfasst verschiedene Krankheitsformen mit unterschiedlichen Ätiologien. Dem demenziellen Syndrom des höheren Lebensalters liegen meist vaskuläre und metabolische Risikofaktoren zugrunde, die der klinischen Demenzmanifestation um Dekaden vorausgehen. Dies bietet ein enormes Zeitfenster für die Prävention, welche insbesondere vor dem Hintergrund weitgehend fehlender kurativer pharmakologischer Ansätze eine große Bedeutung erlangt. Lebensstilmaßnahmen, die eine hohe Nahrungsqualität und eine ausreichende Versorgung mit Omega-3-Fettsäuren, körperliche Aktivität und erholsamen Schlaf beinhalten, verbessern metabolische und vaskuläre Risikofaktoren und mindern das Demenzrisiko. Da multimodale Konzepte synergistisch wirken, versprechen sie den größten präventiven Nutzen.

Die meist fruh in der Pathogenese einer Alzheimerdemenz auftretenden Storungen im Zucker- und Insulinstoffwechsel fuhren zu einem Energiedefizit im Gehirn. In Kasuistiken deutet sich an, dass MCT-reiches Kokosol eine ideale Erganzung in der Ernahrung von Patienten mit milden Demenzformen und in der Prophylaxe ist, da die enthaltenen Fettsauren bevorzugt in Ketone umgewandelt werden, die das Defizit ausgleichen konnen.

Longitudinal monitoring of patients suggests a causal link between chronic periodontitis and the development of Alzheimer’s disease (AD). However, the explanation of how periodontitis can lead to dementia remains unclear. A working hypothesis links extrinsic inflammation as a secondary cause of AD. This hypothesis suggests a compromised oral hygiene leads to a dysbiotic oral microbiome whereby Porphyromonas gingivalis, a keystone periodontal pathogen, with its companion species, orchestrates immune subversion in the host. Brushing and chewing on teeth supported by already injured soft tissues leads to bacteraemias. As a result, a persistent systemic inflammatory response develops to periodontal pathogens. The pathogens, and the host’s inflammatory response, subsequently lead to the initiation and progression of multiple metabolic and inflammatory co-morbidities, including AD. Insufficient levels of essential micronutrients can lead to microbial dysbiosis through the growth of periodontal pathogens such as demonstrated for P. gingivalis under low hemin bioavailability. An individual’s diet also defines the consortium of microbial communities that take up residency in the oral and gastrointestinal (GI) tract microbiomes. Their imbalance can lead to behavioural changes. For example, probiotics enriched in Lactobacillus genus of bacteria, when ingested, exert some anti-inflammatory influence through common host/bacterial neurochemicals, both locally, and through sensory signalling back to the brain. Early life dietary behaviours may cause an imbalance in the host/microbial endocrinology through a dietary intake incompatible with a healthy GI tract microbiome later in life. This imbalance in host/microbial endocrinology may have a lasting impact on mental health. This observation opens up an opportunity to explore the mechanisms, which may underlie the previously detected relationship between diet, oral/GI microbial communities, to anxiety, cognition and sleep patterns. This review suggests healthy diet based interventions that together with improved life style/behavioural changes may reduce and/or delay the incidence of AD.

„Sinn oder Unsinn von Diaten“ lautete die Uberschrift des Editorials zur Ausgabe 1/2012 der „Diabetes aktuell“. Christina Ruch aus dem TUMAINI Institut fur Praventionsmanagement GmbH in Dresden und Gesine Weser aus der Medizinischen Klinik III des Universitatsklinikums Carl Gustav Carus der Technischen Universitat Dresden dokumentierten und bewerteten in dieser Ausgabe unterschiedliche Diatkonzepte aus ernahrungswissenschaftlicher Perspektive fur die Primarpravention des Diabetes mellitus. Dass diese Analyse nicht ohne Resonanz blieb, ist nicht uberraschend. Ein umfangreicher Leserbrief zu dieser Ausgabe von „Diabetes aktuell“ sowie die Replik der Autorinnen ist fur alle Leserinnen und Leser von Interesse.

Worldwide, each year approximately one million women are newly diagnosed with breast cancer (BC), in Germany 65 new cases per 100,000 inhabitants are registered, yearly. The fact that incidence has been rising in parallel with economic development indicates that environmental factors might play a role in the causation of BC. Migrational data have pointed to nutrition as one of the more relevant external factors involved. Preventive dietary advice often includes a reduction of alcohol, red meat and animal fat and increasing the intake of vegetables, fruit and fibre and lately, phyto-estrogens from various sources. Clearly, the scientific basis for these recommendations appears sparse. The available prospective data from epidemiological studies and interventional trials do not support the overall hypothesis that higher fat-intakes are a relevant risk factor for BC development, more important seems the relative distribution of various fatty acids. A non-vegetarian eating habit (consumption of animal products) per se does not elevate BC risk, while consumption of broiled or deep fried meats cannot be ruled out as a risk factor in genetically susceptible individuals. It appears prudent to abstain from regular and increased alcohol consumption. This should be particularly true for pubescent girls, in whom glandular breast tissue is particularly vulnerable. In general, if alcohol is consumed on a regular basis, a sufficient supply of fresh vegetables and fruit is essential. While there is no overall protective effect of a high fruit and vegetable consumption speculation remains over possible beneficial effects of certain subcategories, especially brassica vegetables like broccoli, cauliflower and cabbage. In essence, regional differences in BC incidence are probably partially attributable to life long dietary habits. There is no need to adopt a foreign dietary plan in order to protect oneself against BC. Traditional western diets also have their beneficial ingredients that should be regular constituents in our meals. Lignans from traditionally made sourdough rye bread, linseed/flaxseed and berries are local sources of potentially canceroprotective phyto-estrogens. Furthermore, indole-3-carbinol rich cabbage species might contribute to BC protection by diet. Nevertheless, clear cut recommendations for or against single nutrients or secondary plant metabolites are not yet possible, lacking sufficient data on individual bioavailability, safety and long term outcome. BC prevention by dietary means therefore relies on an individually tailored mixed diet, rich in basic foods and traditional manufacturing and cooking methods.

Author(s): Klement, Rainer J. | Abstract: Evolutionary Medicine is an emerging medical field that mainly addresses the causes of diseases under the consideration of evolutionary principles [1]. Viewing diseases through the evolutionary perspective also opens up new and innovative treatment strategies. In particular, the understanding that most of the so-called “diseases of civilization” emerge from a discrepancy between our modern, civilized lifestyle and that towards which our human species (as hunters and gatherers) has evolved, challenges the concept of these diseases being chronic and provides new treatment approaches. Examples of such approaches were provided in the first annual symposium of the recently founded German Society for Paleo Nutrition (Deutsche Gesellschaft fur Palaoernahrung e.V., DGPE). The meeting entitled ”Modern Lifestyle – Modern Diseases” took place on October 5th 2013 in Schweinfurt, Germany, and focussed specifically on nutrition in health and disease from an evolutionary perspective. This paper is a collection of abstracts of the scientific talks given at the sympoisum.