May 31, 2019 02:00AM
Smart Strategies for Preventing Dementiaby Melinda Hemmelgarn
With 5.8 million Americans living with Alzheimer’s disease, there’s no shortage of advice on how to enhance, preserve and restore brain function. Judging from the assortment of brain training games and apps to the multitude of books promising ways to avoid or even reverse dementia, a growing number of aging Americans want to know the best strategies for preventing and treating cognitive decline and memory loss.
Prevention: A ‘No-Brainer’As with any disease, prevention throughout the life cycle is key, but especially important for Alzheimer’s—the leading cause of dementia worldwide. According to the Alzheimer’s Association, the illness is considered a slowly progressive brain disease that begins well before symptoms emerge. Despite predictions that the number of afflicted Americans will reach nearly 14 million by 2050, there are no drug cures.
David Perlmutter, M.D., a board-certified neurologist based in Naples, Florida, and an editorial board member of the Journal of Alzheimer’s Disease, summarizes a recent study evaluating the effectiveness of currently available Alzheimer’s medications. “Not only were Alzheimer’s patients who were taking these drugs not gaining any benefit, but their rate of cognitive decline was worsened when they were on the Alzheimer’s medications,” thus making lifestyle risk reduction even more critical.
Dale Bredesen, M.D., a professor in the UCLA Department of Neurology and author of The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline, has studied the disease’s neurobiology for decades. He believes drug therapies have failed because scientists neglected to focus on why individuals develop the disease in the first place. He emphasizes, “Alzheimer’s is not a single disease,” even if the symptoms appear to be the same. Bredesen says it’s the result of the brain trying to protect itself from multiple metabolic and toxic threats.
Bredesen developed the ReCODE (reversal of cognitive decline) protocol, an ambitious, comprehensive and personalized therapeutic program that includes genetic, cognitive and blood testing, plus supplements and lifestyle improvements, including stress reduction, improved sleep, diet and exercise. With the goal of identifying and treating the individual’s pathway to disease, ReCODE addresses fixing five key areas he believes form the underlying origins and progression of Alzheimer’s disease: insulin resistance; inflammation/infections; hormone, nutrient and nerve growth factors; toxins; and dysfunctional nerve synapses.
The Lancet International Commission on Dementia Prevention, Intervention and Care also advocates multiple points of action. By addressing nine “potentially modifiable risk factors” throughout the lifespan, the commission says, “More than one-third of global dementia cases may be preventable.” These factors include maximizing education in early life; controlling hypertension, obesity and hearing loss in mid-life; and in later life, managing depression and diabetes, increasing physical activity and social contact, and not smoking.
Food as MedicineMartha Clare Morris, Sc.D., a nutritional epidemiologist at the Rush University Medical Center, in Chicago, and author of Diet for the MIND: The Latest Science on What to Eat to Prevent Alzheimer’s and Cognitive Decline, says, “Given that Alzheimer’s disease is known as an oxidative-inflammatory disease, there has to be a dietary influence.” From two decades of research involving more than 10,000 people, Morris developed the MIND diet, which stands for “Mediterranean-DASH Intervention for Neurodegenerative Delay”. It’s a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, modified to include specific components from each that offer the most protection against dementia. Morris identifies 10 brain-healthy dietary components: leafy greens, vegetables, berries, whole grains, nuts, seafood, poultry, beans and legumes, olive oil, and one glass of wine per day; plus five unhealthy components to limit: sweets and pastries, red meats, fried and fast foods, whole-fat cheese and butter or margarine containing trans fat.
Morris found those individuals that most closely followed the dietary recommendations lowered their risk for Alzheimer’s disease by as much as 53 percent, while those following the diet moderately well showed a reduction of about 35 percent.
Morris acknowledges a number of common aging-related, yet treatable, conditions that can cause “dementialike symptoms,” including low thyroid hormones and vitamin B12 deficiency. She also identifies specific brain-protective compounds including vitamins E, B12, folate and niacin, plus lutein, omega-3 fatty acids, beta carotene and lavonoids found in colorful fruits and vegetables, tea and nuts.
She is currently testing the MIND diet, plus a mild calorie restriction on 600 individuals 65 to 84 years old living in Boston and Chicago; results are expected in 2021. The Alzheimer’s Association is also recruiting individuals for a new lifestyle intervention study.
Aarti Batavia, a registered dietitian based in Ann Arbor, Michigan, and a certified practitioner of functional medicine trained in the ReCODE protocol, says, “Diets that are good for the heart are good for the brain.” But she also warns that many common medications such as statins, antihistamines, some antidepressants and proton pump inhibitors (that reduce stomach acid, which is required for absorbing vitamin B12) can increase the risk for dementia.
Smart StepsAs we continue to discover how genetics environment and lifestyle factors intersect, take the following smart steps to promote longevity and vibrant brain health:
- Monitor and control blood sugar: Type 2 diabetes increases the risk for dementia. Brenda Davis, a registered dietitian in Vancouver, British Columbia, and author of The Kick Diabetes Cookbook: An Action Plan and Recipes for Defeating Diabetes, advises reducing the glycemic load of the diet by limiting refined carbohydrates and sugars, and eating a high-fiber, plant-based diet. Dorothy Sears, Ph.D., a member of the executive committee of the Center for Circadian Biology at the University of California, San Diego, says it’s not just what we eat that matters, but when. She discovered multiple metabolic benefits, including reduced blood sugar, with prolonged nightly fasting—13 hours between the last meal at night and the first meal in the morning. Brenda Davy, Ph.D., a registered dietitian and researcher at Virginia Tech, in Blacksburg, says hydration can influence blood sugar, weight and cognition, especially among middle-aged and older populations. She recommends drinking two cups of water prior to meals to moderate food intake.
- Focus on ‘good’ fats: Olive oil, nuts, avocados, and omega-3 fatty acids found in fatty, cold-water fish protect both the heart and brain. Michael Lewis, M.D., based in Potomac, Maryland, recommends an “omega-3 protocol” to help his patients recover from traumatic brain injury, which can increase risk for dementia.
- Spice up your diet: Batavia recommends cooking with brain-protecting herbs and spices such as turmeric, cinnamon, thyme and rosemary, which can help reduce inflammation and risk for dementia.
- Mind your gut: Western medicine has historically separated the brain from the rest of the body. But research on the “gut-brain axis” shows there’s communication between our gut microbes and brain, plus direct links to neurodevelopmental disorders and dementia. “What goes on in the gut influences every manner of activity within the brain: the health of the brain, the functionality of the brain, the brain’s resistance to disease process and even mood,” says Perlmutter. Both Perlmutter and Teresa Martin, a registered dietitian in Bend, Oregon, emphasize the importance of high-fiber plant foods that gut microbes need to produce beneficial, short-chain fatty acids to protect against inflammation, insulin resistance and “leaky gut”.
- Prioritize sleep: All brain (and gut) experts recommend adequate sleep— seven to eight hours each night—to restore body and mind.
- Exercise: Both Morris and Perlmutter recommend aerobic activities in particular, like walking, swimming and cycling, to improve blood circulation to the brain and increase the production of a hormone called brain-derived neurotrophic factor, which is responsible for stimulating neuron growth and protecting against cognitive decline.
- Avoid environmental toxins: Exposure to pesticides, pollutants and heavy metals such as lead, mercury and arsenic can increase the risk of neurodegenerative disorders, including Alzheimer’s and Parkinson’s. Choosing organic food both reduces exposure to toxins and protects water quality and farmworker health. Virginia Rauh, Ph.D., deputy director of the Columbia Center for Children’s Environmental Health, in New York City, spoke at the National Pesticide Forum in Manhattan in April. She explains that of the 5,000 new chemicals introduced each year, “at least 25 percent are neurotoxic,” and even very low-level exposure can harm children’s neurodevelopment.
- Socialize: In studies of “Blue Zone” populations that enjoy longevity with low rates of dementia, social engagement appears to be the secret sauce for quality of life.