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Alzheimer's disease

Alzheimer’s disease currently affects about 4 million Americans and is the 8th leading cause of death, accounting for about 50,000 deaths per year in the U.S. The chance of having Alzheimer’s disease doubles every 4 to 5 years after the age of sixty. Although the risk at age 60 is low (1%), by the age of 75 this reaches almost 10%, and by age 85 between a third and half of Americans have some form of dementia (of which about 75% are the Alzheimer’s type of dementia). Estimates place the risk at about two-thirds of Americans age 90 and above.

This is particularly disturbing news for all of us, since the average American lifespan has been steadily increasing – most women will live to be over 80, and men now average over 75, which means that more than one in ten of us will develop Alzheimer’s disease in our lifetimes.

Despite the many millions of dollars being spent on Alzheimer’s research, the treatment options remain extremely disappointing. Even with earlier, more sensitive diagnostic tests, no effective therapy to has been shown to halt or reverse the disease. The four FDA-approved drugs on the market for Alzheimer’s disease (Aricept®, Exelon®, Reminyl® and the seldom-prescribed Cognex®), only marginally improve function in less than half of patients.

Because of recent research we have gained substantial insight into how, when and why Alzheimer’s disease develops. This provides tremendous ability to identify people at risk and to PREVENT Alzheimer’s from occurring. Particularly when the brain is concerned, once injury and damage has occurred it is quite difficult to reverse that damage. But we now have greater insights into what causes that injury and how to avoid it.

Last July (2002) in Stockholm, the 8th International Conference on Alzheimer’s and Related Disorders was the largest-ever gathering of researchers studying Alzheimer’s. The research results that were presented were very consistent and compelling. Researchers consistently found that the same risk factors for cardiovascular disease (heart attack and stroke) were also risks for Alzheimer’s. The same factors that lead to atherosclerosis (“hardening of the arteries”) also sharply increased the risk of Alzheimer’s. This is great news, since we already have effective means of identifying people at risk, measuring, preventing and reversing the risk factors for cardiovascular disease.

Thankfully, the same measures that protect us from heart attack and stroke are also protective from Alzheimer’s. Here is a listing of the steps we feel are most important to prevent Alzheimer’s from developing:

• Keep blood pressure under control – The older prevailing wisdom of keeping blood pressure at 140/90 or below is no longer felt to be ideal. We now feel that lower blood pressure readings, even for older Americans should be targeted. Blood pressure should be no higher than 130/80. There are many means of controlling blood pressure other than medications. Maintaining a healthy weight, avoiding salt and salty foods, exercising regularly, eating a diet rich in fruits and vegetables and low in saturated (animal) fat, and supplementing with calcium, magnesium and potassium-rich foods or vitamins can all help to control blood pressure.
• Keep cholesterol down – Keeping LDL (the “bad” cholesterol) level down under 100 is a target level. It’s also helpful to raise the “good” or HDL level with an increase in aerobic exercise, weight loss and dietary changes. An optimal diet is low in animal (saturated) and hydrogenated fats, low in sugar and refined grains (e.g. white flour, white rice, white pasta & bread) and high in FIBER. You should be getting about 20 grams of fiber daily for every 1000 calories you eat.
• Lower your Lipoprotein(a) – Lipoprotein(a) is one of the “bad” forms of cholesterol, with a particular tendency to run in families and cause stroke. Lp(a) levels can be lowered with supplemental vitamin B3, a.k.a. niacin. Before you start taking niacin supplements check your Lp(a) level with a fasting blood test – your result should be less than 30.
• Control your homocysteine level - A high homocysteine level is a strong, independent risk factor for Alzheimer’s disease. Homocysteine is an amino acid – one of the building blocks of protein. A simple blood test will measure your homocysteine level. Your level should be less than 9.0. Homocysteine levels can be lowered by taking supplements of folic acid, along with vitamins B6 and B12. I recommend that everyone take 400 micrograms of folic acid daily as a bare minimum. B6 and B12 supplements should be 25-50 mg, and 100-1000 mcg, respectively. If your homocysteine level is elevated you may need much higher amounts of folic acid.
• Eat less – Independent research has suggested that a lower intake of calories, as well as saturated fat and cholesterol can cut the risk of Alzheimer’s disease in half in certain people. Fewer calories mean fewer free radicals – the dangerous byproducts of metabolism caused by the processing of food with oxygen. These free radicals have been shown to cause the type of brain injury (known as “oxidative damage”) seen in Alzheimer’s disease.
• Eat better – Diets rich in colorful fruits and vegetables, olive oil, avocados, nuts & seeds, small fish, beans & whole grains and lean protein sources including eggs, soy and nonfat dairy products are recommended.
• Exercise regularly - Regular exercise is proven to lower the risk of cardiovascular disease in several different ways.
• Reduce inflammation – Even low levels of inflammation from any cause in your body trigger a response by our immune system that can lead to cardiovascular disease and Alzheimer’s. Inflammation may result from infections, allergies, poor dental health, some medications (e.g. the birth control pill or hormone replacement therapy) or just from being overweight. Weight gain is particularly dangerous if that weight tends to settle around the abdomen and trunk, as opposed to the hips, thighs and buttocks. Central weight gain is associated with higher risk and is also a trigger for systemic inflammation. The best way to test your level of inflammation is with a blood test known as the hs-CRP (high-sensitivity C-reactive protein). Your hs-CRP level should be less than 0.7.
• Reduce stress - Chronic stress (as well as anxiety and depression) raises your body’s production of the adrenal hormone cortisol. High levels of cortisol have been shown to lead to memory impairment and atrophy of memory centers in the brain. Stress reduction techniques such as exercise, meditation, yoga, Tai Chi and biofeedback may help to combat chronic stress, anxiety and depression.
• Use your head – If you don’t use it, you’ll lose it. Studies suggest that engaging the brain in complex tasks, interesting activities and social engagement may have a protective effect.
• Rest up – A regular pattern of restful sleep is an important “battery charge” for the brain. Disordered, irregular sleep may have long-term effects on brain function.
• Hold off on heavy metals – Heavy metals such as mercury and lead are known to cause brain injury that may not be reversible. Sources of heavy metals include large fish (such as swordfish, tuna steaks, tilefish, king mackerel, shark, halibut and mahi-mahi), which are high in mercury and “silver” dental fillings. Lead exposure may occur from old paint and some calcium supplements, which have recently found to be contaminated with lead.