Prevent Alzheimer's Disease, Remove the Source of Inflammation

 As we discussed in the previous post, research is pointing more and more toward Alzheimer's Disease (AD) being a disease of inflammation (aka oxidative stress) and mitochondrial dysfunction. We also discussed previously that while there is no cure for AD, there is much that can be done to prevent or delay its onset. Inflammation is present in the AD brain long before symptoms show up- and by the time a person becomes symptomatic it is generally too late to make a big difference. Think of it this way- you can't unscramble a scrambled egg.

Combating inflammation is a two step process: you need to REMOVE the source of inflammation as well as beef-up your ability to combat inflammation. You can take all the omega-3s in the sea, but if your diet and lifestyle are otherwise unhealthy it's not going to do a lick of good.

Step 1: Removing the source of inflammation

A. Obesity, particularly central obesity, has been linked with decreased volume in the hippocampus, the part of the brain that is primarily affected by AD, as well as cognitive impairment (1). The authors of this particular study make note that adipose tissue (fat) actually produces inflammatory molecules called cytokines, meaning that obesity in and of itself is an inflammatory process in and of itself. There has been research into the gastric bypass playing a role in AD prevention (as well as diabetes), but ideally it shouldn't come down to that. I will write posts about weight loss and bariatric surgery in the future, but the thing to know from this post is that obesity is a risk factor for AD. Similarly influcenced factors such as hypertension and abnormal lipid profiles also have been shown to increase your risk for AD.

B. Diabetes and insulin resistance is undoubtedly a risk factor for AD, however in recent years the link has been shown to be so strong that they are starting to call AD "type 3 diabetes" (2). Handling type 1 diabetes comes down to managing and calming down the immune system as we discussed before. Type 2 diabetes can be REVERSED by eating a healthy, low sugar, anti-inflammatory diet and physical exercise. Particularly in the case of type 2 diabetes, doctors will frequently check a blood marker called "HbA1C", or glycosylated hemoglobin. Basically, when this marker is high it indicates that the persons glucose level was so high, that the body started trying to do something with the sugar- so it bound a protein to it. HbA1C is not only a marker for how high your blood sugar has been recently, but more importantly it is a marker of inflammation. Not surprisingly, studies have shown that the higher your HbA1C is, the more you lose brain volume (particularly in the hippocampus) as you age (3).

C. Traumatic brain injury (TBI) such as concussion ignite a mean inflammatory cascade in the brain, as well as the gut (more on that later). Interestingly, research on former NFL players have been shown to be more prone to AD and mild cognitive impairment (MCI) compared to age-matched controls (4). The most important window of opportunity for trying to mitigate the inflammation associated with TBI is the first few months after the injury. During that time I recommend patients to eat a super anti-inflammatory diet which includes avoiding dietary antigens such as gluten and dairy (more on why later), take anti-oxidant supplements such as N-Acetyl Cysteine and DHA (an omega-3), and try to get enough physical exercise to increase blood flow to the brain. That last bit of information is in direct conflict to what most doctors would recommend, but there has been some interesting research that shows that concussion patients who exercise within their symptomatic tolerance (aka exercise that does not provoke symptoms) actually heal faster (5). Also interestingly enough, there has been research that shows that mice who were fed a diet high in omega-3 fatty acids ("fish oils") for several weeks prior to TBI were actually protected from the harmful, inflammatory effects seen in TBI (6). Once again we see that an ounce of prevention goes a long way!

D. Stress is no joke, folks. Stress has been shown to disrupt the hypothalamus-pituitary-adrenal axis (HPA axis) and put stress on the brain. This is particularly true of the hippocampus- the part of the brain that is generally most involved in AD (1). Things such as meditation and relaxation techniques, new hobbies, physical activity, quality relationships (friends, family), certain "adaptogen" supplements, and pets can all help you deal with stress- don't let stress age you prematurely.

E. Lack of physical exercise is not only related to obesity, heart disease, hypertension and diabetes, but it is an independent risk factor for AD in and of itself. Weather your goal is to lose weight or to just stay healthy and age gracefully, everybody should strive to get at least 30-60 minutes of physical activity a day. My biggest advice is to find an activity that you truly enjoy- if you have to drag yourself to the gym and force the work out it's not going to do much for your stress level and HPA axis.

F. Other hidden sources of inflammation include autoimmune diseases, infections, leaky gut, and food sensetivities. Remember, it has been estimated that 23 million Americans or 8+% of the population have an autoimmune disease (see previous post), so this is no joke.

Stay tuned for Part 2: Supplements!

Nikki

References!
(1) Jagust W et al "Central Obesity and the Aging Brain" Archives of Neurology Oct 2005; vol 62
(2) http://www.time.com/time/health/article/0,8599,1673236,00.html

(3) Enzinger, C er al "Risk factors for progression of brain atrophy in aging: six-year follow-up of normal subjects" Neurology 64: 1704-11; May 24, 2005

(4) http://healthland.time.com/2011/07/18/nfl-players-may-be-more-vulnerable-to-alzheimers-disease/

(5) Leddy J et al "Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: Implications for treatment" Neurorehabilitation 22 (2007) 199-205
(6) Reference to come- The article is back home on my desk!