Dementia and Alzheimer's

Dementia is caused by a range of different conditions, the most important of which are Alzheimer’s, Lewy body dementia and vascular dementia. Mild cognitive impairment or MCI is a condition that may precede any of these conditions.

Most elderly people with cognitive problems would show some evidence of all 3 of the main conditions if their brain tissue was examined. Having more conditions exacerbates the decline in dementia, and the further advanced any one of the three conditions is, the worse the decline due to the others will be.

The rest of this article is about the most commonly diagnosed condition of the 3 main dementias, namely Alzheimer’s.

Introduction

Alzheimer’s (AD) is a disease of old age that features memory loss and a reduced ability to understand and interact with the people and objects in one’s vicinity. As it progresses those it affects find it increasingly difficult to lead an independent life and then become a burden on relatives and other caregivers. Early on it features a loss of spatial abilities, making navigating to previously visited places more difficult. It also features a loss of self, as some memories of what they have done in the past are destroyed. Other narratives can take the place of those memories, leading those with Alzheimer’s to claim they did things that their relatives could never dream they would have done.

AD is arguably the 3rd largest cause of death in the Western world after heart disease and cancer.

Epidemiology

In most places in the UK the percentage of people with dementia is between 1-2%. However the risk rises with age and for all those over the age of 65 the prevalence is around 7%. In the year 2000 the prevalence among Europeans aged over 65 was 4.4%, making up around 65% of all cases of dementia. That statistic however may mislead you into thinking that you only have a 1 in 20 chance of getting AD.

In reality however most people are living well beyond 65 and more recent statistics from 2015-2017 show that the prevalence of this disease has increased significantly and is expected to increase further. These more recent statistics from the USA show that more than ¼ of Americans dying in 2017 had AD. In other words, for the average American, that suggests that between 25-30% of their friends will die with AD.

Causes

Like virtually all the major chronic diseases that have increased in prevalence over the last 200 years, there is no one cause of AD. A combination of genetic and lifestyle factors are responsible for the disease ranging from the genetic susceptibility of the ApoE mutation to environmental toxins and poor diet.

Genetic influences

Genetic influences are important when it comes to AD risk. The most important genetic factor is a gene for a protein called ApoE. Everybody has two copies of their genes, one from their mother and another from their father. For most people the ApoE gene comes as ApoE3 for both copies. However 14% of people have one copy as an ApoE4 and of this 14% about 1 in 7 have two copies of ApoE4. The lifetime risk of AD in Americans is currently 9% for those without E4, 30% for those with one copy of the E4 gene and around 70% for the 2% of the population with two copies.

There is also an ApoE2 version of the ApoE gene that reduces risk of AD. Globally prevalence of the different forms of ApoE gene is 7% for E2, 79% for E3 and 14% for E4. Interestingly the E4 version is also worse for cardiovascular disease risk with the E2 version again being beneficial.

If you get your genes tested please remember that the ApoE4 risk I’ve quoted is for those following a typical western diet and lifestyle. If you modify your lifestyle these percentages can be drastically reduced, as evidenced by the much lower rates of AD found in the past. Also while the E4 version of the gene increases your risk of early onset AD, if you get to your 80th birthday, the impact of having the E4 version on disease risk seems to be diminished. For instance at the age of 85 nearly 50% of people are affected by AD and this implies that many people with ApoE3 are also ending up with AD.

Toxic overload

There are a number of industrial chemicals, medicines and natural immune factors which have been identified as possible causative agents for AD. These include:

  • Pesticides of many types have been associated with cognitive impairment, which is strongly associated with subsequent AD risk.
  • Heavy metals such as mercury, cadmium and aluminium in the serum are associated with increased risk of AD, while lead is associated with a decreased risk. Aluminium was extensively studied in the 1990’s, but it is not the only metal to increase risk, and probably not the most significant. Mercury has increasingly been identified more recently as the most dangerous of the heavy metals for AD risk. Think dental amalgam fillings and coal burning.
  • Medicines such as the very common acid blocker medications called proton pump inhibitors (PPIs) are associated with increased rates of AD. The PPIs are the 2nd most commonly prescribed medication after statins and so the fact that there are clearly increased risks of developing AD is concerning.
  • Antimicrobial proteins produced naturally as part of our immune defences include amyloid-β which is a potent defence against some infections including the bacteria that cause gum disease and Lyme disease as well as the fungi that cause Candida. Now, amyloid- β has been identified as the cause of the amyloid plaques of AD, but that does not make it intrinsically bad. However, if over produced, due to continued gum disease, Lyme disease, Candida and a number of other chronic infections it could contribute to AD risk. As with so many things you can have too much of a good thing.

Inflammation and infection

Infections often cause inflammation as do components of the diet such as excess sugars and processed vegetable oils. Inflammatory markers are strongly associated with AD and correcting the diet should reduce risk considerably. It is not always possible to avoid infections, but the ones most closely associated with AD are:

  • Spirochetes commonly found in parasitic diseases such as Lyme disease, syphilis, gum disease (periodontitis) and leptospirosis. These bacteria pass through the blood brain barrier easily and once in the brain cause an immunologic response that mirrors the changes known to occur in AD.
  • Herpes (HSV1) the type of herpes virus that causes cold sores. This virus lies dormant for long periods in those affected. It is the flare ups that are thought to present an increased risk for AD. For those with the ApoE4 protein it is likely that herpes virus infection is more dangerous than for others.
  • Pneumonia can be caused by the chlamydophyla bacterium. In some cases the chlamydia has been found in the brains of people with AD suggesting a causal link.

Lack of food for the brain

There are a number of chemicals that are needed for brain development such as brain derived neurotrophic factor – BDNF, sex hormones, vitamin D and omega 3.

  • BDNF is one of the main hormones that help to nourish the neurons in the brain. It is known to be boosted by exercise and prebiotic consumption (cold potatoes, sweet potato, parsnip, beetroot, squashes and celeriac are all good examples), while it is lowered by stress, depression and also by antibiotic use.
  • Sex hormones such as oestradiol, testosterone and progesterone help the brain.
    • There is evidence (1) that oestrogen therapy taken within 5 years of menopause is beneficial for AD risk, whereas taken after this time it has a risk enhancing effect. Oestrogen is also important for men, where it is primarily produced by the testes. It may be raised in conjunction with high sensitivity C-reactive protein (hs-CRP) where there is chronic inflammation.
    • Equally there is evidence that low levels of testosterone in men may enhance risk (2). To increase testosterone levels do more heavy weights (without causing injury), keep sugary foods and drinks to a minimum, eat plenty of red meat and organ meats, avoid stress and get around 8 hours sleep every night.
    • Finally progesterone has been found to exert protective effects against AD (3).
    • So an imbalance of sex hormones is seen as causal and HT therapy can in some instances help.
  • Vitamin D also helps brain cells. It is boosted by sunlight exposure and so outdoor exercise is a great prescription for feeding the brain as it boosts both BDNF and vitamin D.
  • Omega 3 fats also help. It is available from seafood and some marine algae. Fatty fish are the most concentrated source, with fish liver oils being the most potent of all.

Conventional medical research

Initially AD was thought to be caused by extracellular amyloid plaques accompanied by thinning of the grey matter in the cerebral cortex. However the build-up of amyloid plaques precedes onset of symptoms by many years.

A later focus of research became intracellular neurofibrillary tangles consisting of misfolded tau proteins. These proteins stabilise the microtubules (think motorways) that run down the length of every axonal process of your brain’s neurons, allowing materials to be sent to the synapses in order to facilitate communication with other neurons. The tau hypothesis seems more realistic than the amyloid plaque hypothesis as the development of tau dysregulation follows a path through the brain similar to the range of symptoms exhibited by Alzheimer’s patients. Early symptoms are seen in capabilities deriving from the entorhinal cortex, which contains spatial, and to some extent autobiographical memories followed by hippocampal effects and finally neocortical effects. This mirrors the pattern of tau protein associated neurofibrillary tangles and threads.

Tau proteins are affected by poor sleep patterns: https://www.sciencedaily.com/releases/2019/06/190627114105.htm?fbclid=IwAR25SbCL8sMvn6UVQRuy4GVawTaPtZN7hO2tVYPb3PR4QlPbGzroAY2NJD8

Remedies

With AD no drug is particularly effective and the greatest impact can be had by making complete lifestyle changes including changes to the diet, exercise, sleep patterns and stress levels.

Exercise

Exercise boosts levels of chemicals called neurotrophins that nourish the brain, helping to maintain connections and the adaptive abilities of brain cells. The two major neurotrophins are BDNF - Brain-derived neurotrophic factor and NGF – nerve growth factor. They are important factors in neuronal preservation (4) and both are depleted in AD.

Cholesterol containing foods provide precursors to DHEA, so eggs, liver and prawns may help as higher DHEA levels are associated with higher neurotrophin levels.

Diet

The sugar connection

Diet should be low in easily absorbed carbohydrates as these boost blood sugar levels, which in turn boosts insulin levels. When insulin levels are raised for too long, the nerve cells in the brain become insulin resistant. Insulin resistance is strongly associated with AD.

The importance of nutrients

With the elderly adequate intake of nutrients is absolutely vital. In fact absence of proper nutrients including water makes old people appear demented. One of the great scandals of modern geriatric medicine is the complete failure to feed and water geriatric patients properly in institutional settings.

The most important nutrient is water, with dehydration being almost the rule with geriatrics, especially when they are in hospital or in care settings. The carers should be well versed in the importance of water if your elderly relative is to stand any chance of recovery.

The most important food that virtually all old people can tolerate is bone broth. I would strongly recommend vegetarians to consider bending the rules on this one, even if your relative was an ardent vegan, unless of course this scenario was specifically discussed beforehand.

Other foods that are very beneficial include liver and other organ meats. Fermented foods such as sauerkraut and vegetables are also extremely important. When it comes to antioxidants please bear in mind that whole foods will be better than supplements. However if wholefoods are not being eaten then water with supplements should provide some scope for improvement.

Sleep

A lack of deep sleep has been associated with a build-up of tau protein in the brain. This is currently also the best known clinical sign of Alzheimer’s. Taking daytime naps and sleeping more are also potential signs of future cognitive decline. In these instances the extra sleep taking place is of poorer quality. https://www.sciencedaily.com/releases/2019/01/190109142704.htm

Sleep deprivation has also been linked to an increase in amyloid-β. However many older people without Alzheimer’s exhibit a build-up of amyloid- β and so this may also just be a sign that old people often have both poor sleep patterns and amyloid build up concurrently.  https://www.nih.gov/news-events/nih-research-matters/sleep-deprivation-increases-alzheimers-protein.

Good sleep hygiene is vital for anyone with or at risk of AD. If sleep is not deep then avoidance of blue light in the evening (TVs and computers), early morning exposure to sunlight and cool, dark sleeping quarters are likely to be beneficial.

Stress Reduction

Chronic stress in which the HPA axis is hyperactive normally features elevated cortisol levels. This in turn leads to levels of hyperphosphorylated tau proteins being raised, and it is these proteins that lead to the neurofibrillary tangles that cause the major symptoms of AD.

Deep breathing exercises, walks in nature, yoga and meditation can all help control stress levels.

Detox

Various environmental exposures to toxins can speed up Alzheimer’s disease. Some of the most important are:

  • Excess sugar which over time causes insulin resistance. As insulin is responsible for feeding the brain with its main nutrient, namely sugar, insulin resistance means that the brain is short on fuel for its day to day activities. The excess sugar left in the blood stream gives rise to advanced glycation end products (AGEs), which in turn cause inflammation that in the brain can lead to Alzheimer’s.
  • Other dietary anti-nutrients such as grains and soya which contain chemicals that inhibit the absorption of many valuable vitamins, minerals and phytonutrients.
  • Heavy metals such as mercury and pesticides such as organophosphates, Paraquat and Dieldrin.
  • Fungus derived toxins such as trichothecenes and ochratoxin A which form on damp grains as well as some pork products, coffee and grapes and grape derived products such as wine and raisins.

To detoxify excess sugar and anti-nutrients dietary changes are required. These changes include:

  1. Avoidance or removal heavy metals
  2. Avoidance or removal of leaky dental fillings
  3. Avoidance of automobile fumes
  4. Eating predominantly organic agricultural produce.

As with most toxins the dose is the poison and so complete elimination of some of these dietary factors is not necessary, especially if Alzheimer’s is not already present.

Hormonal support and infection treatment

  • Reduce stress. Deep breathing exercises can help.
  • Stabilize blood sugar. Good quality and quantity of sleep help stabilise blood sugar levels as does a low GI diet and intermittent fasting. Magnesium and green tea are 2 nutrients that help.
  • Cut out inflammatory foods. High glycaemic index carbohydrates, processed oils and soy based foods should be avoided. Note that soya actually helps with Parkinson’s!
  • Carry out some detoxification. DIM – diindolylmethane is a chemical formed in the body from green leafy vegetables. It can be directly supplemented for people needing more than is available in their diet or that their bodies can produce.
  • Heal the gut. Consume the following: a) prebiotic fibres from low GI starchy vegetables such as sweet potato, parsnip, swede, celeriac, beetroot and yams; b) fermented foods such as kimchi and sauerkraut; c) probiotics such as kefir and yoghurt.
  • Avoid endocrine disruptors. Plastics such as bisphenol A (present in polycarbonates found in canned food liners and receipts), other plastics which have been used to replace BPA, which normally start with the prefix “BP”, phthalates (used in cosmetics and medicines) and soya based foods. Another way to detect these problem plastics is to avoid those with recycling numbers: 3(PVC), 6(Polystyrene) and 7 (polycarbonate etc.).
  • Fix excess aromatization. Aromatization is a process that converts testosterone to oestrogen. This can manifest as feminisation of men. DIM – diindolylmethane is a compound found in cruciferous vegetables such as cabbage, cauliflower etc. It can help reduce aromatization.