Many non-pharmacological interventions have theoretical justification and attractive but very limited clinical data suggesting benefit for cognition. Most of these are relatively safe. But, very little research in these areas get funded. So, that even very encouraging pilot studies rarely get replicated.
In contrast, the public has immense interest in these areas e.g. see huge following of Dr. Oz, Dr. Perlmutter, etc.
I propose that we in the mainstream responsibly capture some of the attention by Dr. Oz and his friends, to engage the public's optimism and support that funding research on the cognitive effects of diet and nutrition should be a priority.
We can do this by reviewing the most promising research and posting it on highly respected mainstream websites.
I would like to see a mainstream group provide aggressive publicity for the most promising diet and nutritional interventions, including the limitation of the data, with the purpose of exciting the public about the need for further research to pursue the most promising hypotheses. We need to attract major private donations and also pressure NIH to pay more attention.
Examples, while the benefit of a mediterranean style diet for heart disease and stroke is fairly strong, we have only one small modest size controlled study on whether this diet delays cognitive decline in high risk older persons (The Barcelona MEd Diet study). The mediterranean diet we superior to the low fat diet over a 5 year follow up period. We need a replication.
Oxford University in a contorlled study found that treating high homocysteine with B vitamins improved cognitition compared to placebo. The same treatment had no benefit for those who had normal homocysteine. Among those with high homocysteine, only those omega 3 blood levels in the top 3d benefitted. So, we need to replicate these findings with a study of people with high homocyctsteine giving a b vitamin arm, a fish oil arm, both together, versus placebol.
Only if the public demand make these studies become "fashionable" or we likely to see adequate funding.
Richard Podell, MD, MPH
Dept of Family Medicine
Rutgers-Robert Wood Johnson Medical School