June 2024

DEAR DR. ROACH: I recently lost a brother to non-small cell carcinoma in his lungs. He was 82 years old. He was a heavy smoker in his younger years, but quit smoking 31 years ago. He worked many years in the construction trade as a union carpenter and also worked with roofing materials. He had been exposed to many toxic materials during those years.My question is: Is it possible that he may have come into contact with materials such as asbestos, or any foreign material that may have caused lung cancer in his later years? Would the pathologists who studied his cancer find cells that would have indicated this? -- C.S.ANSWER: I am very sorry about your brother. I can't answer which risk factor -- smoking or occupational exposure -- was responsible for him getting lung cancer. They have additive effects, which makes understanding the relationship more complicated.Many people in different occupations are exposed to asbestos, but the occupations most likely to result in lung cancer include ship repair, building construction, and some types of electrical work. It is entirely possible that he was exposed to asbestos, especially when he was working as a young man when there were fewer or no regulations. I always ask about prior military service, since this is another possible exposure to asbestos.Pathological evaluation of lung cancer tissue often finds asbestos fibers among those who have had occupational exposures, and some expert groups feel that this is a major criterion for determining whether the cancer was due to asbestos exposure. This should have been part of the pathology report that made your brother's diagnosis of non-small cell lung cancer.DEAR DR. ROACH: I have read and heard recently that long-term use of the medication pantoprazole leads to a 33% increased risk of dementia. I am concerned because I have been using this medication for approximately eight years, and lately, I get really concerned every time I can't recall a name or place.What have you heard about this? And if this is true, is it a risk for everyone? Are there any over-the-counter medications that might work as a substitute? -- L.G.M.ANSWER: It is true that some studies have shown an increase in dementia risk with people who take proton-pump-inhibitor drugs like pantoprazole or omeprazole. It is also true that other studies haven't shown an increase in risk.Some experts think the apparent increase in dementia risk may be explained by an issue called confounding. People with early dementia may be more likely to be prescribed these kinds of medications due to other reasons, like the known increased risk of heart disease whose treatment sometimes calls for proton-pump inhibitors to be prescribed.Early work has suggested a plausible mechanism (a change in metabolism of the amyloid and tau proteins thought to be responsible for Alzheimer's), so it is possible that there is a real interaction. A different type of study design is necessary to answer the question definitively.In the meantime, because of the possible effects of dementia and the known harms of long-term proton-pump-inhibitor risk, these drugs should only be used long-term when they are really necessary, such as in people with Barrett's esophagus or people who have severe erosive damage to the esophagus.Many people with occasional heartburn due to gastroesophageal reflux do very well with OTC medications like Zantac or Pepcid, which are less likely to cause long-term harm.Finally, having difficulty with recall is a common phenomenon that does not necessarily indicate dementia.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2024 North America Syndicate Inc.All Rights Reserved

Q: I want to do everything I can to avoid dementia. What do you recommend in terms of diet?-- Dorthy T., Gainesville, FloridaA: You know the saying, "It takes a village"? Well, sometimes it takes a metropolis! At least that's true when it comes to using food to help protect your brain from premature aging and dementia. The trillions -- yes, trillions -- of microbes that live in your digestive tract impact the back-and-forth communication between your gut and brain and are hugely influenced by the foods you eat. When you feed them well, they help protect your brain power, and according to the Cleveland Clinic, positively affect everything from your hunger, satiety and cravings to your mood, behavior, sensitivity to pain and cognition.To nurture good-for-your-brain microbes and hold harmful ones in check so they don't damage brain neurons and cognition, several new studies stress the benefits of eating whole, unprocessed foods. Research published in npj Aging found that the key nutrients that support healthy gut-brain communication include fatty acids, antioxidants and carotenoids, two forms of vitamin E and choline - similar to what's provided by the Mediterranean diet. The researchers also saw that folks 65 to 75 years old who consumed foods providing a good dose of those nutrients had slower-than-expected brain aging. Carotenoids are in spinach, kale, orange bell peppers, tomatoes, watermelon, cantaloupe, broccoli, and carrots. Antioxidants are in fruits, vegetables, whole grains, nuts, seeds, herbs and spices, and cocoa. Fatty acids are found in olive oil, fatty fish, walnuts, and leafy greens. Choline is in salmon and shitake mushrooms and vitamin E is in salmon and avocado. In addition to adopting a plant-based diet, research also shows the brain-loving benefits of supplements that provide pre- and probiotics. The prebiotics feed good-for-you probiotics and the probiotic supplements reinforce your brain-supporting gut microbes. For more information, read iHerb.com's blog, "What Are Prebiotics?" And consider the benefits of taking probiotics to bolster your healthy gut biome and help protect your brain.* * *Q: I have arthritis in my knees and I'm afraid to jog anymore -- the pounding seems to make it worse. What can I do at age 57 to stay active and help my knees? -- Dwayne J., Terra Haute, IndianaA: Knee pain from arthritis and joint injury is very common. Almost a third of people ages 18 to 39 are bothered by it as a result of physical activity. Among older folks, it is also the result of being overweight and having obesity and osteoarthritis. Around a quarter of folks ages 55 and older experience at least one episode of knee pain annually.But it does not have to sideline you, not by a long shot. A new study in Medicine & Science in Sports & Exercise reveals that bicycling -- indoors or outside -- may help prevent arthritis and knee pain. Researchers found that folks who were cyclists at some point in their lives were 17% less likely to have knee pain and 21% less likely to have osteoarthritis. And for folks who already contend with those conditions, the benefits also apply. Building up your muscles around your knees and on your thighs helps cushion and protect knees from damage and energetic movement of the joint helps drive nutrients and stem cells into knee cartilage -- your buffer against pain.If you want to optimize the results, another study suggests interval training. Adding variable-intensity periods to your cycling workout is a more effective way to improve your fitness level and battle the effects of aging than doing a workout at a consistent intensity, according to Harvard Medical School. And another recent study found that doing two 20-second sprints with 160-second recovery between your more intense efforts may be the best variable-intensity pattern for building leg muscle strength -- and protecting your knees.To protect your cartilage, in addition to cycling, investigate the benefits of hyaluronic acid in the iHerb.com blog, "Support Your Joints." And sign up for Dr. Mike's free newsletter at LongevityPlaybook.com. * * *Dr. Mike Roizen is the founder of www.longevityplaybook.com, and Dr. Mehmet Oz is global advisor to www.iHerb.com, the world's leading online health store. Roizen and Oz are chief wellness officer emeritus at Cleveland Clinic and professor emeritus at Columbia University, respectively. Together they have written 11 New York Times bestsellers (four No. 1's). (c)2024 Michael Roizen, M.D. Distributed by King Features Syndicate, Inc.