De­feat­ing Alzheimer's t A z ’ s



The pos­si­bilit y of los­ing mem­ory and cog­ni­tive func­tion is one of our great­est age- re­lated fears. But is men­tal de­cline re­ally in­evitable? A grow­ing num­ber of ex­perts say, “no.”

Ask any­one over age 40 what they most fear in old age, and chances are that mem­ory loss— and its far more se­ri­ous cousins, de­men­tia and Alzheimer’s — are at the top of the list, right up there with run­ning out of money.

We’ve all had some con­tact with de­men­tia or Alzheimer’s. Whether a friend, rel­a­tive, mother, fa­ther, or spouse, no one is ever more than six de­grees of sep­a­ra­tion from this de­gen­er­a­tive dis­ease, which not only robs us of our sense of self, but has the po­ten­tial to bank­rupt the en­tire U. S. health care sys­tem. In 2014, the cost of treat­ing Alzheimer’s was $ 214 bil­lion, most of which went to nurs­ing homes and home care. By 2050, the cost is ex­pected to ex­ceed $ 1.5 tril­lion.

For many peo­ple, the thought of de­vel­op­ing Alzheimer’s is al­most worse than death. As my own mother put it, when talk­ing about my fa­ther’s fi nal years with de­men­tia, “It’s like he’s there ... but he’s not.” The last years of an Alzheimer’s pa­tient are in­deed a dis­mal aff air, aptly char­ac­ter­ized by Nancy Rea­gan as “the long good­bye.”

Emerg­ing Re­search

The good news is that a grow­ing band of sci­en­tists are be­gin­ning to con­clude that we have more con­trol over brain health than was pre­vi­ously be­lieved. Some— like car­dio­tho­racic sur­geon Steven Masley, MD, au­thor of The Bet­ter Brain So­lu­tion— be­lieve there’s rea­son to hope that we may be able to win the war against mem­ory loss, brain de­gen­er­a­tion, and even Alzheimer’s it­self. Oth­ers— like Dale E. Bre­desen, MD, pro­fes­sor and founder of the Buck In­sti­tute and au­thor of the new book, The End of Alzheimer’s— agree.

I asked Masley— who is best known for his book, The 30 Day Heart Tune- Up and his PBS Spe­cial, 30 Days to a Younger Heart— why an ex­pert on heart dis­ease would turn his at­ten­tion to the brain. “It turns out there’s a di­rect con­nec­tion be­tween the health of the heart and the health of the brain,” he told me. “The risk fac­tors for heart dis­ease, di­a­betes, and Alzheimer’s over­lap con­sid­er­ably.”

Older peo­ple with hy­per­ten­sion ( long con­sid­ered a ma­jor risk fac­tor for heart dis­ease), for in­stance, have a 300 per­cent in­creased risk for Alzheimer’s. So do di­a­bet­ics, and that’s just for the ones not us­ing in­sulin. Di­a­bet­ics who use in­sulin see their risk for Alzheimer’s go up a whop­ping 400 per­cent, just a bit more than the in­creased risk that

comes with hav­ing a cer­tain form of the so- called Alzheimer’s gene, ApoE4.

The Blood Sugar Con­nec­tion

Why would di­a­betes be a risk fac­tor for a dis­ease of the brain? Ac­cord­ing to Masley, “un­con­trolled blood sugar is one of the most sig­nifi cant ori­gins of mem­ory loss." In­te­gra­tive neu­rol­o­gist and au­thor of Grain Brain, David Perl­mut­ter, MD, agrees. “The re­la­tion­ship be­tween poor blood sugar con­trol and Alzheimer’s dis­ease is so strong that re­searchers are now call­ing Alzheimer’s ‘ Type 3 Di­a­betes,’” he says.

To un­der­stand why, you have to know a lit­tle about some­thing called in­sulin re­sis­tance, which is at the core of type 2 di­a­betes. As it turns out, it’s cen­trally in­volved in Alzheimer’s as well. And that's where things get in­ter­est­ing— be­cause it all starts with the food you eat.

When you eat, food gets bro­ken down ( di­gested) into com­po­nents such as fatty acids, amino acids, and sugar ( glu­cose), which then travel out of the gut and into the blood­stream. This causes your blood sugar to rise— even more so when you eat a high- carb meal that breaks down into a lot of sugar. When blood sugar rises, the pan­creas releases in­sulin, which helps trans­port that sugar from the blood into the mus­cles, where it can be used for en­ergy.

When blood sugar is con­tin­u­ally raised— as it is with a typ­i­cal, high- carb Amer­i­can diet— the pan­creas has to se­crete more and more in­sulin to get the job done. And if you’re also not ex­er­cis­ing, your mus­cles don’t need that much sugar to be­gin with, so they be­gin to refuse en­trance to in­sulin and its sugar pay­load. In­sulin then takes the sugar to be stored in fat cells, which con­tinue to ac­cept it for a while, as you’ll be able to ob­serve all too eas­ily. But even­tu­ally, even the fat cells stop suck­ing up sugar, the state known as in­sulin re­sis­tance— cells re­sist the ac­tion of in­sulin and leave it ( and the sugar it car­ries) stranded in the blood­stream.

High blood sugar and high in­sulin lev­els are re­ally bad for your heart, and as it turns out, your brain, as well. “In­sulin re­sis­tance can make you up to 60 per­cent more likely to de­velop Alzheimer’s," says Masley. “The brain des­per­ately needs in­sulin to de­liver glu­cose to brain cells. When you’re in­sulin re­sis­tant, your brain cells can’t get the fuel they need and they be­gin to die. That’s when you’re on the road to de­men­tia or Alzheimer’s."

And that’s why a grow­ing num­ber of sci­en­tists are call­ing Alzheimer’s dis­ease, "type 3 di­a­betes."

One of the hall­marks of the Alzheimer’s brain is an ac­cu­mu­la­tion of some­thing called beta- amy­loid plaque. Con­tro­versy con­tin­ues to reign about whether the plaques are a cause or a re­sult of Alzheimer’s, but they’re al­ways present in cases of the dis­ease. “The en­zyme needed to break down in­sulin is the very same en­zyme needed to break down beta- amy­loid plaque," Masley says. “When there’s ex­cess in­sulin in the brain, the en­zyme gets di­verted by the in­sulin and doesn’t break down beta- amy­loid plaque eff ec­tively.”

The Di­etary Pre­scrip­tion

Luck­ily, type 2 di­a­betes is a dis­ease that is enor­mously re­spon­sive to di­etary and life­style changes. If Alzheimer’s dis­ease turns out to be a re­sult of the same mech­a­nism that causes di­a­betes, then the same changes that re­duce the risk for ( or in some cases re­verse) di­a­betes should be able to re­duce the risk for Alzheimer’s.

One fac­tor com­mon to di­a­betes and Alzheimer’s is infl am­ma­tion, which causes, ac­com­pa­nies, pro­motes, or ex­ac­er­bates every known de­gen­er­a­tive dis­ease. Not sur­pris­ingly, then, infl am­ma­tion is con­sid­ered to be a main tar­get in the bat­tle for brain health.

Perl­mut­ter’s Grain Brain Life Plan pro­gram states that one of the fi rst goals is to re­duce and con­trol infl am­ma­tion. Ac­cord­ing to Perl­mut­ter, one of the best ways to keep infl am­ma­tion in check is to main­tain healthy blood sugar lev­els.

In Masley’s book, The Bet­ter Brain So­lu­tion, he out­lines a mul­ti­fac­eted pro­gram de­signed to con­trol blood sugar and re­duce infl am­ma­tion. Note the em­pha­sis on mul­ti­fac­eted— it’s not an ac­ci­dent.

Mul­tipronged ap­proaches to brain health and Alzheimer’s pro­tec­tion work bet­ter than any “sin­gle” in­ter­ven­tion. Dale Bre­desen’s book, The End of Alzheimer’s, out­lines a com­pre­hen­sive pro­gram that in­cludes life­style- fo­cused in­ter­ven­tions. Like Masley, Bre­desen rec­om­mends nutri­tional sup­ple­ments, brain- nour­ish­ing foods, blood sugar con­trol, hor­mone train­ing, proper sleep, and brain train­ing. In one study of 10 pa­tients with symp­toms of mem­ory loss, nine dis­played im­prove­ment in cog­ni­tion within 3– 6 months on this pro­gram, and many who had stopped work­ing were able to re­turn to work.

The Com­pre­hen­sive Plan for Brain Health

The Bet­ter Brain So­lu­tion ap­plies the knowl­edge gained from putting thou­sands of pa­tients at the Masley Op­ti­mal Health

Cen­ter in Florida through the pro­gram and care­fully mon­i­tor­ing re­sults. The book out­lines four key pil­lars for main­tain­ing a healthy brain: food, nu­tri­ents, ex­er­cise, and— not sur­pris­ingly, as stress is a huge source of infl am­ma­tion— stress man­age­ment.

For his part, Masley rec­om­mends a mod­ifi ed Mediter­ranean- style diet that's rich in food sources of good fats, such as nuts, seeds, avo­ca­dos, and olive oil; ad­di­tional sources of sup­ple­men­tal healthy fats, in­clud­ing fi sh and MCT oils; and “clean," non­toxic sources of protein, such as grass- fed meat and wild sal­mon.

With a few mi­nor diff er­ences, this is the pro­gram that all of to­day's “brain pioneers” are ad­vo­cat­ing. None of the au­thors men­tioned in this ar­ti­cle rec­om­mend low- fat di­ets, and none are par­tic­u­larly con­cerned about sat­u­rated fat. “Sat­u­rated

fat may not help you, but it cer­tainly isn’t go­ing to hurt you,” says Masley.

In fact, be­cause fat is the one macronu­tri­ent that does not raise blood sugar or in­sulin lev­els, it plays a par­tic­u­larly im­por­tant role in the di­ets of those who want to man­age their blood sugar and in­sulin while keep­ing their brains healthy and sharp.

In ad­di­tion to diet, vir­tu­ally all of the op­ti­mistic pioneers in this in­te­gra­tive and func­tional way of think­ing about brain health— the three doc­tors cited above as well as oth­ers such as Daniel G. Amen, MD— agree that no brain health pro­gram is com­plete un­less it in­cor­po­rates re­la­tion­ships, feel­ings and con­nec­tions to oth­ers.

"Lone­li­ness," says Masley, "is linked to de­pres­sion. Re­la­tion­ships mat­ter in every area of health, in­clud­ing— or es­pe­cially— in brain health. We all have to re­mem­ber that we can’t go it alone.”

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