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!

What causes Alzheimer's Disease?

Alzheimer's Disease (AD) is the most common form of dementia in the US, affecting approximately 5.4 million Americans. One in eight people over the age of 65 have AD, or nearly half (45%) of people over 85 years old (1). As the baby-boomers move ever-closer toward their golden years, these numbers are expected to increase drastically in the years to come. Health care costs for AD are expected to soar from an estimated 200 Billion in 2012 to 1.1 Trillion dollars annually by 2050 (1). As a country on the brink of bankruptcy largely due to our staggeringly high health care costs, this is a road we simply can not afford to go down. 

If you asked people off the street what disease they feared most, I'm sure many people would say Alzheimer's. The thought of losing our marbles some day, losing your memories and your personality that makes you you, is literally terrifying. But we're not going to get anywhere by crossing our fingers and hoping we don't get it. So let's talk about Alzheimer's Disease and, more importantly, what we can do to protect ourselves from getting it.

So what causes Alzheimer's Disease? Most people will tell you that it's the Beta-amyloid plaques and neurofibrillary tangles that are the causative agent behind AD. While these are indeed part of the AD pathogenesis, they are a most likely a result of the disease process, not a cause. As such, our question can be rephrased to ask "why would our brain lay down beta-amyloid plaques and neurofibrillary tangles?" The short answer is that there is no official answer yet, but there is a large body of research pointing toward one mechanism: Inflammation.

Everybody utters the phrase "I'm getting too old for this" at some point in their life. But while we all talk about the act of getting old, nobody ever talks about what happens to the body as we age. Aging is generally accompanied by an increase in oxidative stress (aka inflammation), which is most likely due to waning antioxidant defenses (2). Unfortunately, the part of the cell that is most vulnerable to oxidative stress is the mitochondria- the organelle in charge of making the cell's ATP (energy source). Mitochondrial dysfunction and damage has been implicated to play an important, possibly causative role in AD pathology (3). Without an adequate source of fuel, the cell can not repair itself and maintain function, and eventually will die. It is now believed that beta-amyloid (BA) plaque is actually an anti-oxidant, and my in fact be the cell's last futile attempt to quench the inflammation that is killing it from the inside-out (4). There has also been evidence to show that BA is an anti-microbial peptide, and may be a by-product of immune activation in the brain (5).

Before you know it you have a vicious cycle of inflammation that eventually takes out enough neurons that you experience symptoms. Only after symptoms appear will your doctor be able to make the diagnosis of AD, Parkinson's, ALS, etc... However, by this point there is often so much damage to the involved structures that it's too late to make any substantial changes. That's not to say that these patients can't benefit from the treatments I am sharing with you, but they are not a cure. With few exceptions, neurons do not regenerate. More importantly, the rate at which you are losing neurons every day far out-paces your brain's ability to make new neurons. Therefore, it is MUCH easier and FAR more effective to prevent diseases of this nature, rather than trying to fix it once the disease has set in.

Stay tuned for Part 2: Prevention soon!

Nikki

References:

(1) http://www.alz.org/downloads/facts_figures_2012.pdf

(2)  Galasko, Douglas. Biomarkers of oxidative damage and inflammation in Alzheimer’s disease. Biomark med. 2010 February: 4 (1): 27-36

(3) Bonda, David. Mitochondrial dynamics in Alzheimer’s disease opportunities for future treatment strategies. Drugs aging 2010 March 1; 27 (3): 181-192.

(4) Mondragon-Rodriguez, Siddhartha. Causes versus effects: the increasing complexities of Alzheimer’s disease pathogenesis. Expert rev neurother 2010 May: 10 (5): 683-691

(5) Soscia, Stephanie. The Alzheimer’s disease-associated amyloid B-protein is an antimicrobial peptide. 2010; PLoS ONE 5(3): e9505

Quote of the Day

Land of Confusion

I honestly think that 75% of the reason we eat so unhealthy in this country is because we are genuinely confused.

Nutrition is a very intimidating topic for most people- doctors and patients alike, because there is a lot of conflicting information and hype in the mainstream media. Is it soluble or insoluble fiber that lowers cholesterol? Which one is better, low carb or low fat? How many servings are in one large apple? After asking these questions for so long, we’ve come to believe that nutrition is merely about nutrients, but it can be so much more than that. Foods are far more than the sum of their nutrient parts and can be far less complicated if we take a step back and appreciate them for what they are: food. Before the days of Pop-Tarts® our ancestors didn’t worry about serving sizes or nutrients, they just ate food. If we simplify the way we think about food and eat real, whole foods that come from a farm rather than a factory we can reverse the downward spiral of chronic disease in America. 

At the end of this post I will leave you some links to some of my favorite youtube videos and lectures about nutrition. Ironically, my favorite nutrition advise comes from an investigative journalist, not a nutritionist! Michael Pollan has authored several best selling books including two of my favorites, Food Rules: An Eater's Manual and In Defense of Food. The nice thing about Pollan is that he makes nutrition so incredibly easy to understand. For example, Pollan starts by giving the advise "Eat food. Not too much, mostly plants." He goes on to elaborate on what he considers actual "food" and what he calls "edible food-like substances", but he really does a beautiful job of enlightening without intimidating the reader.

I highly recommend Food Rules- don't worry, it's a pretty quick read (for most 45-60 minutes straight through), but this book will surely prove to be invaluable. Here's a few of my favorite food rules out of this book:

1.  "Don't eat anything your great-grandmother wouldn't recognize as food." Grandma would know what broccoli is, but I'm not so sure she would understand what a fruit role up is..

2. "Avoid food products containing ingredients that a third-grader cannot pronounce."

3. "Shop the periphery of the supermarket and stay out of the middle isles." Fresh stuff is on the outside, and (for the most part) all the junk is in the middle.

4. "Eat animals that have themselves eaten well." This is a HUGE issue today- Almost all of the meat in grocery stores is raised in dirty, crowded pens, fed food that no animal should be eating, and been drugged with various hormones, antibiotics and food additives. In the mean time, take my advise and eat meat sparingly, but when you do, spring for the good stuff.

5. "Stop eating before you're full." The point of eating is not to get full necessarily, but to not be hungry. There's a subtle difference, but it comes down to eating until your about 80% full, or as the Japanese say "hara hachi bu".

6.  "Don't get your fuel from the same place your car does." 'Nuff said!

7. "Do all your eating at the table" and take your time! Americans eat too many meals in a hurry and on the go, which robs your body of both time and digestive enzymes it needs to actually digest that food. Approximately 80% of your digestive enzymes are secreted in the cephalic phase of eating, meaning that time you're thinking about eating (while cooking or waiting to be served). Without that mental prep time you don't have the enzymes to actually use the nutrients you take in!

Remember, ultimately we all have the power to affect change in the food system every single day. When you support your local CSA, farmers markets, and farms not only are you getting high quality, wholesome food, but you are stimulating the local economy and helping that farm stay in business. If enough people show that they have an interest in healthy food some day we will evoke the change we want to see. You vote with your fork every day, people. What are you voting for?

Here's some of my favorite youtube videos about nutrition~

Michael Pollan 

Marion Nestle 

Another Michael Pollan 

Gary Taubes

Watch out for sugar.. 

Food Inc Trailer- This movie is a MUST SEE

Getting healthier every day,

Nikki

Big Pharma Wants YOU

In 1976 CEO of Merck Pharmaceuticals Henry Gadsden told Fortune magazine that his dream was to make drugs for healthy people- that he wanted to sell drugs like chewing gum. To Gadsden, it was a shame that the pharmaceutical companies market was limited to only those who suffered from a disease or illness- Gadsden wanted more (1, 2)

Fast-forward to today. "Big Pharma" has more power than ever and is rapidly expanding their market. For example, the new cholesterol guidelines state that LDL cholesterol should be below 100 if you are at moderate to high risk of heart disease. With the lowering of what we consider "normal" LDL cholesterol from 130 to 100, millions of Americans may now be told by their doctors that they too need a statin drug.

Even in 2001, statistics estimated that 55% of women and 37% of men in the US take one or more prescription medication (3). Those numbers have surely gone up since that time. Of course, it’s no secret that America is getting more and more unhealthy, which would surely merit more medication… But is medicine really the answer we’re looking for? Like I described in a previous post, modern medicine is very good at keeping you alive when your life is in immediate danger, but has a particularly bad track-record when it comes to getting people healthier in the long term. At the risk of sounding like a hippy, I take several issues with the world of pharmacology and medicine as a whole:

1.      The reality is that most drugs are not researched enough prior to going on the market, and may in fact be dangerous. So many times we have heard of drugs being pulled off the market because they didn’t realize until now that drug x actually causes cancer/stroke/heart attacks/death. This always made me wonder just how much they actually researched drug x prior to its launch. According to the FDA’s Center for Drug Evaluation and Research director, Dr. Janet Woodcock “The sad truth is that, even after all the clinical development that occurs with every drug and even after drugs have been approved for a time, we only have a crude idea of what they do in people.” A great deal is learned about drugs after they have been used (or as I see it, tested) by millions of consumers, and that new information may or may not ever make it into the Physician's Desk Reference (PDR), which is what most doctors use as a reference(4). Overall, 51% f approved drugs have serious side effects not detected prior to approval (5).

2.      Most drugs are known to cause a variety of side-effects, and to top it all off, many of them may not be recognized by your doctor (4). This is usually either because the side effect isn’t well known or documented yet, or it may be a known side-effect that has yet to make it into the PDR. If you believe one of your prescription drugs is to blame for a new symptom you are experiencing, talk to your doctor about trying a different medication, or better yet- trying a natural alternative. If your doctor belittles your concern, insist that they take it seriously and work with you. The only person who will advocate for your health is you- it is up to you to make sure that all of your concerns are addressed, no matter how small it may seem to them.

3.      A serious (and all too common) problem that occurs when side effects are not recognized is the so-called “prescribing cascade”. This is when a side effect is misinterpreted as a new medical condition that merits another prescription drug… And so the vicious cycle is started. As a chiropractic intern, I can tell you that not only does the body not heal itself as well or as quickly when heavily medicated, but it’s darn near impossible for the doctor to figure out which symptoms are really you rather than your drugs. 

4.      The system is crooked, and I would personally rather not give them my money. K.L. Carlson, a former pharmaceutical rep, does a lovely job of describing just how crooked the system is in her book “Diary of a legal drug dealer”. The pharmaceutical companies will do anything to sell their drugs; including marketing drugs for something they are not approved to treat (For example, the recent GlaxcoSmithKline story) or pressuring and bribing doctors to sell more of their drug. They say actions speak louder than words, and in 2005 the top ten drug companies spent a whopping $84 Billion in marketing, but only $42 Billion in research (2). I think that clearly demonstrates where their priorities lie.

5.      Natural alternatives such as a healthy diet, supplements, herbs, chiropractic, acupuncture, homeopathy, and many more are often safe and effective. For example, I personally used to take three (yes, three) prescription medications for my seasonal year-round allergies. And even with all that, I still had allergy symptoms and got two or three sinus infections every year. It wasn’t until I cut dairy completely out of my diet and started getting regular chiropractic adjustments that I was able to stop taking all three medications and completely alleviate my allergy symptoms. In the two years I have been dairy-free I have only suffered one sinus infection, from which I managed to bounce back remarkably fast.

In health,

Nikki
 

References:
(1) http://dissidentvoice.org/2009/09/big-pharma-a-real-war-against-drugs/
(2) Diary of a Legal Drug Dealer By K.L. Carlson

(3) Bowman, L “51% of U.S. adults take 2 pills or more a day, survey reports” Scripps Howard News Service, San Diego Union-Tribune Jan 17, 2001

(4) What you Must Know about Statin Drugs and Their Natural Alternatives by Jay S Cohen, M.D.

(5) Moore, T.J. “Time to act on drug safety” JAMA 1998; 279(19):1571-1573

Quote of the Day

"The goals you seek are straight ahead in every direction"

-Carbon Leaf (from their song, Paloma)

Autoimmunity is More Common Than You Think..

While each autoimmune disease by itself is relatively rare, when you add up the 80+ and counting diseases and look at them as one problem, it becomes quite common. The CDC Estimates that 5-8% of the US population has an autoimmune disease(1). According to the NIH, that accounts for approximately 23.5 Million Americans(2). Compare that to the 9 million who have cancer, or the 22 million who have heart disease and it's easy to see we have a situation on your hands, here. Women account for 78% percent of autoimmune diseases in the US(1), with many of the "big players" such as Hashimoto's Thyroiditis, Graves Disease, Rheumatoid Arthritis (RA) and Celiac Disease favoring women. One study found that 7-8% of the US population has antibodies against their thyroid(3), so the problem may very well be even bigger than the CDC and NIH statistics reflect.

Some of the most common autoimmune diseases include:
Hashimoto's Thyroiditis (which is the cause of about 90% of hypothyroidism in the US(4))
Grave's Disease (85% of hyperthyroidism in the US)
Rheumatoid Arthritis
Celiac Disease
Multiple Sclerosis
SLE

Some conditions that are now thought to be autoimmune or at least related to autoimmunity include:
Crohn's Disease
Ulcerative Colitis
Fibromyalgia
Autism

So why are we seeing more and more of these conditions? The long and short of it is that our unhealthy lifestyle is finally catching up with us. Things that have been linked to autoimmunity or are thought to cause autoimmunity include:

• Some form of genetic predisposition (though this is not set in stone)
• Trauma (particularly head trauma)
• Infections (particularly gut infections/food poisoning, Lyme disease, and Mononucleosis and herpes)
• Poor diet- particularly one short of antioxidants
• Lack of or shortened breast feeding time as a baby
• Toxins

When you get down to it, any autoimmune condition is really an immune system problem, NOT an end organ problem. Very rarely does an autoimmune patient have their immune system attended to- and when they do it is often with harsh immuno-suppressant drugs that make them feel like dirt. It is because of this that I believe autoimmune patients are one of the most under-served and miss-understood patient populations in the United States. For example, most hypothyroid patients today are given levothyroxine (thyroid hormone), but are given nothing to help their immune system. A Hashimoto's patient that is on thyroid hormone and nothing else is doing nothing to treat the immune system- their TSH is being managed. This is not to say this is a bad thing to do- a hypothyroid patient needs thyroid hormone- but these people require more immune support than anything else.There are TONS of natural compounds that have been shown to modulate the immune system and dampen inflammation such as curcumin, resvertrol, and vitamin D. Because 70% of the immune cells in your body hide out in the gut, a fantastic way to impact the immune system is through diet and supplements.

If you have an autoimmune disease here's what I would recommend:
-Clean up your diet- Eat more plants and less food that was made in a plant
-Try an elimination diet and cut out the allergens you react to
-Add supplements that dampen inflammation like vitamin D, curcumin and resvertrol
-Get as many harsh chemicals out of your life as possible (cleaning products, pest-control products)
-Beef up your antioxidant stores with Omega-3 oils
-Boost your glutathione levels by taking supplements such as N-Acetyl Cysteine and/or find a naturopathic doctor near you who administers glutathione in an IV
*Find a functional medicine doctor near you to tailor your treatment and manage your case (Particularly a Chiropractor who does Functional Neurology, as many of them do both functional medicine and functional neurology)

To find a functional neurology doctor near you: http://www.acnb.org/locator/index.php

References:
(1) http://wwwnc.cdc.gov/eid/article/10/11/04-0367_article.htm#r1
(2) http://www.aarda.org/autoimmune_statistics.php
(3)Betterele C “Update on autoimmune polyendocrine syndromes (APS)” Acta Bio Medica 2003;74:9-43
(4) Baillieres “Autoimmunity and Hypothyroidism” Clin Endocrinol Metab. 1998; Aug 2 (3):591-617

I do not intend this or any of the information on this website to be con strewn as a cure or treatment. It should also be known that as of today, July 2nd 2012 I am not a doctor, but a chiropractic intern. I am providing this information as a public service in hopes of helping people who are needlessly suffering, but this can not and should not replace the advise of a doctor.