God, Hope & Helping Others
May 22, 2014
By Dr. Mercola
An estimated 5.4 million Americans have Alzheimer's disease, a severe form of dementia,1 and hundreds of thousands more may suffer from an often misdiagnosed subtype called "hippocampal sparing" Alzheimer's, according to recent findings.2
The most recent data3, 4 suggests that well over half a million Americans die from Alzheimer's disease each year, making it the third leading cause of death in the US, right behind heart disease and cancer.
As discussed by Dr. Danielle Ofri in a recent New York Times blog,5 losing your mind, and with it, much of your personality and dignity, is a terrifying proposition. Making matters worse, many doctors shy away from addressing dementia—both with colleagues and their patients.
The reasons are many. Dr. Ofri suggests Alzheimer's strikes at the emotional heart of many clinicians, whose careers depend on the stability and functioning of their own minds and intelligence. In short, it frightens them too much to talk about it.
However, I strongly disagree with her commentary on the lack of strategies to prevent or modify the course of Alzheimer's.
"I suspect... that our reticence stems from deeper issues," Dr. Ofri writes. "All the top 10 killers in America are potentially preventable, or at least modifiable — all except dementia... We have tests to screen for many cancers, and treatments that prolong life... But there's nothing, really, that we can do about dementia.
There aren't any screening tests that can pick up the disease before symptoms appear. And even if there were, there aren't any treatments that make a substantial difference.
For doctors, this is profoundly frustrating. No wonder dementia gets pushed onto the back burner. In the dishearteningly limited time of a medical visit, we're forced to focus on the diseases we can treat."
On the contrary, while early diagnostic tests are in short supply and successful treatments are virtually nonexistent, the evidence shows there's plenty of hope when it comes to prevention!
This is exactly why doctors need to get with the program and start directing their patients toward healthier lifestyles rather than fall into the trap of thinking the situation is hopeless and their patients are helpless victims.
I firmly believe that since there's no conventional cure, now or in the foreseeable future, the issue of prevention is absolutely critical if you want to avoid becoming an Alzheimer's statistic.
Ideally, doctors would begin counseling patients who are in their 20s and 30s on lifestyle strategies that promote heart and brain health throughout life. Then we would probably see a major shift in Alzheimer's statistics for that generation.
As it stands, the evidence points to lifestyle factors, primarily diet, as the driving forces of dementia. There are also many connections between Alzheimer's and other dietary-related diseases, such as diabetes and heart disease, suggesting that ALL of these diseases are preventable through identical means.
For example, previous research suggests diabetics have a doubled risk of developing Alzheimer's disease. Alzheimer's disease was even tentatively dubbed "type 3 diabetes" in 2005, when researchers discovered that your brain produces insulin that is necessary for the survival of your brain cells.
They found that a toxic protein called ADDL removes insulin receptors from nerve cells, thereby rendering those neurons insulin resistant, and as ADDLs accumulate, your memory begins to deteriorate. Recent research also points out that heart disease increases your odds of developing Alzheimer's. As reported by MedicineNet.com:6
"Researchers found that artery stiffness -- a condition called atherosclerosis -- is associated with the buildup of beta-amyloid plaque in the brain, a hallmark of Alzheimer's disease."
'This is more than just another example of how heart health relates to brain health. It is a signal that the process of vascular aging may predispose the brain to increased amyloid plaque buildup,' said lead researcher Timothy Hughes...
Plaque builds with age and appears to worsen in those with stiffer arteries, he said. 'Finding and preventing the causes of plaque buildup is going to be an essential factor in the prevention of Alzheimer's disease and extending brain health throughout life,' Hughes added."
In related news, research7, 8 presented at the 2014 American Academy of Neurology's meeting in Pennsylvania sheds new light on Alzheimer's cases that are often misdiagnosed. Researchers from the Mayo Clinic believe they have identified a variant of the disease, referred to as "hippocampal sparing" Alzheimer's, which is thought to affect an estimated 600,000 Americans. As explained by Medical News Today:9
"All subtypes of Alzheimer's have two specific hallmarks in the brain. Amyloid beta is responsible for the formation of brain plaques, while tau produces tangles in the brain. In order to classify each subtype, the team used tangle counts to create a mathematical algorithm.
They found that while all Alzheimer's subtypes had the same amount of amyloid beta, the hippocampal sparing variant showed tau tangles in unequal areas of the hippocampus. They discovered that in patients with this subtype, tau specifically damages neurons in areas of the brain associated with behavior, motor recognition and awareness, and use of speech and vision."
Of the more than 1,800 Alzheimer's patients included in the study, 11 percent were found to have hippocampal sparing Alzheimer's, which does not destroy memory to the degree typically associated with Alzheimer's. Instead, this subtype of the disease tends to alter behavior, causing uncontrollable anger, visual impairments, speech problems, and the feeling that your limbs do not belong to you. Hippocampal sparing appears to affect more men than women, and the disease tends to set in much earlier than traditional Alzheimer's. Patients with hippocampal sparing also tend to deteriorate at a fast pace.
Misdiagnosis is common, as this subtype spares your memory. Quite often these patients end up being diagnosed with frontotemporal dementia or corticobasal syndrome10 instead. The former is associated with personality changes, while the latter is a progressive neurological disorder that can involve your motor system, cognition, or both, but patients typically present language problems first, followed by motor symptoms.
While the researchers believe that currently available Alzheimer's medications may be more effective for those with hippocampal sparing Alzheimer's than those with more traditional dementia, I firmly believe that drugs are not the answer to any of these conditions. Clearly, at the heart of it all is insulin and leptin resistance, fueled by a diet too high in refined sugars, processed fructose, and grains, combined with far too little healthful fats.
Download Interview Transcript
Last year, and again this spring, I interviewed Dr. David Perlmutter, author of the New York Times' bestseller Grain Brain. In my view, Dr. Perlmutter is probably the leading integrative medicine neurologist in the US, and his advice is clear: Alzheimer's is preventable through proper diet. After spending years treating people's neurological symptoms, he grew increasingly frustrated with his profession's lack of ability to get to the root cause. This frustration eventually led him to investigate the role of nutrition, and he became convinced that brain dysfunction is rooted in our modern-day high-grain diet. According to Dr. Perlmutter:
"[Alzheimer's] is a preventable disease. It surprises me at my core that no one's talking about the fact that so many of these devastating neurological problems are, in fact, modifiable based upon lifestyle choices… What we've crystallized it down to now, in essence, is that diets that are high in sugar and carbohydrates, and similarly diets that are low in fat, are devastating to the brain.When you have a diet that has carbohydrates in it, you are paving the way for Alzheimer's disease. I want to be super clear about that. Dietary carbohydrates lead to Alzheimer's disease. It's a pretty profound statement, but it's empowering nonetheless when we realize that we control our diet. We control our choices, whether to favor fat or carbohydrates."
His book, Grain Brain, reveals how and why sugars and carbohydrates destroy your brain, and how to eat for neurological health. He notes Mayo Clinic research that reveals diets rich in carbohydrates are associated with an 89 percent increased risk for dementia while high-fat diets are associated with a 44 percent reduced risk. This combination of very little sugar and carbs, along with higher amounts of healthful fats is KEY for addressing not only Alzheimer's, but diabetes and heart disease as well.
All of these conditions are rooted in insulin and leptin resistance, and the dietary answer is identical for all of them. Understanding this can make your life easier, as you don't need to memorize the dos and don'ts for each and every disease you seek to avoid. Instead, what you need to do is shift over to a mindset that is focused on optimizing health. Disease prevention then becomes a beneficial "side effect."
A study published in the New England Journal of Medicine in August 2013 demonstrates that even mild elevation of blood sugar—a level of around 105 or 110—is associated with an elevated risk for dementia. Dr. Perlmutter believes it's very important for physicians to become cognizant of this link, and to stop downplaying the risks associated with even mildly elevated blood sugar. So what is an ideal fasting blood sugar level?
Dr. Perlmutter suggests that anything over 92 or 93 is too high. He believes the ideal fasting blood sugar level is around 70-85, with 95 as the maximum. If your fasting blood sugar is over 95 mg/dl, it's definitely time to address your diet to lower it. If you're fat adapted, there's no reason to shun fasting blood sugar levels below 70, as your body is then able to tap into body fat as an energy source. According to Dr. Perlmutter:
"This notion that your brain needs sugar is really old news. Fat, specifically ketones, which your body produces by metabolizing your fat, is now called a 'brain superfuel.' There is even a pharmaceutical product; a medical food that you can write as a prescription, which raises the level of ketones or fat in the bloodstream of patients, offered up now as a treatment for Alzheimer's disease. Who knew? The point is the brain loves to burn fat. That's what we have to shift it over to..."
Intermittent fasting is a great tool to help "reset" your body to burn fat as its primary fuel again. Dr. Perlmutter also recommends starting off with a period of fasting, and he's particularly aggressive about it in patients who are insulin/leptin resistant. I typically recommend keeping your fasting insulin level below 3. The so-called normal, however, is anywhere from 5-25 microU per mL. As with fasting blood sugar, please do not make the mistake of thinking that the "normal" insulin range equates to optimal! As noted by Dr. Perlmutter:
"If somebody has an insulin level of 26, they need a lot of work. They need to fast; drop the carbs; add back the good fat. They need to add in some anti-glycating agents like benfotiamine and resveratrol. We need to hit these people aggressively. This is what works. This is what reduces their risk of converting to diabetes, and therefore has a huge role to play in protecting their brains."
Our ancestral diet was very high in saturated fats and virtually void of non-vegetable carbohydrates. Today, not only do we eat tremendous amounts of carbohydrates, these carbs are refined and highly processed. In the last decade, we've also shifted over to genetically engineered grains and sugar (GMO sugar beets and corn). Adding insult to injury, for the past 60 years conventional medical authorities have also warned that saturated fats cause heart disease and should be severely restricted.
This inappropriate fat phobia has undoubtedly played a significant role in the dramatic rise in dementia and other neurological disorders, because your brain cannot function properly without fats! The type of fat you eat makes all the difference in the world, though. You want to avoid all trans fats or hydrogenated fats that have been modified in such a way to extend their longevity on the grocery store shelf. This includes margarine, vegetable oils, and various butter-like spreads. Sources of healthy fats to add to your diet include:
Avocados Butter made from raw, grass-fed organic milk Raw dairy Organic pastured egg yolks Coconuts and coconut oil (coconut oil actually shows promise as an effective Alzheimer's treatment in and of itself) Unheated organic nut oils Raw nuts, such as pecans and macadamia, which are low in protein and high in healthy fats Grass-fed meats or pasture raised poultry
Here's a summary run-down of diet-related strategies that will help optimize your brain function and prevent Alzheimer's:
- Avoid sugar and refined fructose. Ideally, you'll want to keep your sugar levels to a minimum and your total fructose below 25 grams per day, or as low as 15 grams per day if you have insulin/leptin resistance or any related disorders.
- Avoid gluten and casein (primarily wheat and pasteurized dairy, but not dairy fat, such as butter). Research shows that your blood-brain barrier is negatively affected by gluten. Gluten also makes your gut more permeable, which allows proteins to get into your bloodstream, where they don't belong. That then sensitizes your immune system and promotes inflammation and autoimmunity, both of which play a role in the development of Alzheimer's.
- Optimize your gut flora by regularly eating fermented foods or taking a high-potency and high-quality probiotic supplement.
- Increase consumption of all healthy fats, including animal-based omega-3. Health-promoting fats that your brain needs for optimal function are listed above. Also make sure you're getting enough animal-based omega-3 fats, such as krill oil. (I recommend avoiding most fish because, although fish is naturally high in omega-3, most fish are now severely contaminated with mercury.) High intake of the omega-3 fats EPA and DHA help by preventing cell damage caused by Alzheimer's disease, thereby slowing down its progression, and lowering your risk of developing the disorder.
- Reduce your overall calorie consumption, and/or intermittently fast. Ketones are mobilized when you replace carbs with coconut oil and other sources of healthy fats. As mentioned above intermittent fasting is a powerful tool to jumpstart your body into remembering how to burn fat and repair the inulin/leptin resistance that is also a primary contributing factor for Alzheimer's. To learn more, please see this previous article.
- Improve your magnesium levels. There is some exciting preliminary research strongly suggesting a decrease in Alzheimer's symptoms with increased levels of magnesium in the brain. Unfortunately, most magnesium supplements do not pass the blood brain levels, but a new one, magnesium threonate, appears to and holds some promise for the future for treating this condition and may be superior to other forms.
- Eat a nutritious diet, rich in folate. Vegetables, without question, are your best form of folate, and we should all eat plenty of fresh raw veggies every day. Avoid supplements like folic acid, which is the inferior synthetic version of folate.
Besides diet, there are a number of other lifestyle factors that can contribute to or hinder neurological health. The following strategies are therefore also important for any Alzheimer's prevention plan:
- Exercise regularly. It's been suggested that exercise can trigger a change in the way the amyloid precursor protein is metabolized,11 thus, slowing down the onset and progression of Alzheimer's. Exercise also increases levels of the protein PGC-1alpha. Exercise also leads to hippocampus growth and memory improvement.12 I would strongly recommend reviewing the Peak Fitness Technique for my specific recommendations.
- Optimize your vitamin D levels with safe sun exposure.Strong links between low levels of vitamin D in Alzheimer's patients and poor outcomes on cognitive tests have been revealed. Researchers believe that optimal vitamin D levels may enhance the amount of important chemicals in your brain and protect brain cells by increasing the effectiveness of the glial cells in nursing damaged neurons back to health. Vitamin D may also exert some of its beneficial effects on Alzheimer's through its anti-inflammatory and immune-boosting properties. Sufficient vitamin D (50-70 ng/ml) is imperative for proper functioning of your immune system to combat inflammation that is also associated with Alzheimer's.
- Avoid and eliminate mercury from your body. Dental amalgam fillings, which are 50 percent mercury by weight, are one of the major sources of heavy metal toxicity, however you should be healthy prior to having them removed. Once you have adjusted to following the diet described in my optimized nutrition plan, you can follow the mercury detox protocol and then find a biological dentist to have your amalgams removed.
- Avoid and eliminate aluminum from your body. Sources of aluminum include antiperspirants, non-stick cookware,vaccine adjuvants, etc. For tips on how to detox aluminum, please see my article, "First Case Study to Show Direct Link between Alzheimer's and Alumin...."
- Avoid flu vaccinations as most contain both mercury and aluminum, well-known neurotoxic and immunotoxic agents.
- Avoid anticholinergics and statin drugs. Drugs that block acetylcholine, a nervous system neurotransmitter, have been shown to increase your risk of dementia. These drugs include certain nighttime pain relievers, antihistamines, sleep aids, certain antidepressants, medications to control incontinence, and certain narcotic pain relievers. Statin drugs are particularly problematic because they suppress the synthesis of cholesterol, deplete your brain of coenzyme Q10 and neurotransmitter precursors, and prevent adequate delivery of essential fatty acids and fat-soluble antioxidants to your brain by inhibiting the production of the indispensable carrier biomolecule known as low-density lipoprotein.
- Challenge your mind daily. Mental stimulation, especially learning something new, such as learning to play an instrument or a new language, is associated with a decreased risk of Alzheimer's. Researchers suspect that mental challenge helps to build up your brain, making it less susceptible to the lesions associated with Alzheimer's disease.
According to Dr. David Perlmutter, fat avoidance and carbohydrate overconsumption are at the heart of the Alzheimer's epidemic. To learn more about how you can protect your brain health by eliminating non-vegetable carbs from your diet, I highly recommend reading his book, Grain Brain. In order to reverse the Alzheimer's trend, we simply must relearn how to eat for optimal health. Processed "convenience foods" are quite literally killing us, inducing diabetes, heart disease, cancer, and dementia.
The beauty of following my optimized nutrition plan is that it helps prevent and treat virtually ALL chronic degenerative diseases, including diabetes, heart disease, and Alzheimer's. Other lifestyle factors, particularly sun exposure and exercise, are also potent allies against all forms of dementia. Ideally, you'll want to carefully review the suggested guidelines above, and take steps to incorporate as many of them as you can into your daily lifestyle. The sooner you begin, the better, considering that one in nine Americans over the age of 65 end up with Alzheimer's.