Avoiding Alzheimer's

The statistics associated with Alzheimer’s disease are staggering:
Over 5 million Americans currently have it, a number that may balloon to 16 million
by 2050. Amid the facts and figures lies the heartbreak of families who helplessly
watch loved ones slip into a shadowland where spouses, children and grandchildren
no longer have names. Science hasn’t completely mapped the biochemical changes
responsible for this thief of selfhood. But we do know that a healthy lifestyle,
including brain-protective nutrition, can give you a fighting chance against it.

By Lisa James

September 2008

 It started when Emily Balfour’s dad, Bob, could no longer handle the math required for his job as a construction project manager. “At one point his boss noticed something was wrong, so they had him do less intensive tasks at work and he struggled with them,” says the 22-year-old from Alpharetta, Georgia. Two years after signs first appeared, the elder Balfour was diagnosed with Alzheimer’s disease in February 2007—at age 53.

The Balfour family is no stranger to Alzheimer’s; Emily’s grandmother died of it and her uncle, David, was diagnosed about the same time as her father. “He just became so quiet and distant,” she recalls about her uncle, “and would become confused if you asked about something that happened two months prior.” Early-onset Alzheimer’s, which tends to appear among people in their fifties, often runs in families. This puts Emily, a student at Georgia’s Valdosta State University, at a higher risk than most of her classmates. “I’m not too worried about it right now,” she says.

For people like Emily Balfour, the search for an Alzheimer’s cure takes on personal meaning. Eventually, though, advancing age means that Alzheimer’s disease can catch up with anyone; more than 90% of those afflicted show symptoms after age 65. “Advanced age is the strongest risk factor for Alzheimer’s,” says Marwan Sabbagh, MD, geriatric neurologist, founder of Sun Health Research Institute’s Cleo Roberts Center for Clinical Research in Sun City, Arizona and author of The Alzheimer’s Answer (Wiley). If preventative measures—especially the widespread adoption of healthy habits—aren’t taken soon, “one in every eight baby boomers is destined to get it. That’s 8 to 10 million people,” Sabbagh warns. “This could be one of the diseases that swallow up whole budgets.”

It is important to note that Alzheimer’s is not inevitable: “There are people who go to their graves who are fine from a cognitive standpoint,” Sabbagh says. Some memory loss occurs as part of the aging process, but when it becomes “extensive or is starting to impact your daily life, that’s when you know it has moved past being benign."

Missing Neurons

Alzheimer’s disrupts brain function by killing neurons—the brain itself actually shrinks. Plaques consisting of beta-amyloid, a protein processing byproduct, accumulate outside the cells, while neurofibrillary tangles form within them. Researchers don’t know all the reasons these abnormalities develop. They believe, though, that at least part of the explanation lies in oxidation, in which rogue molecules called free radicals damage the cells’ mitochondria, the structures that generate energy within the cell.

Alzheimer’s disease is only one of many possible causes of dementia, although it does account for the bulk of the cases. “Doctors should do a very thorough medical history and exam, looking first for findings that would suggest stroke or a Parkinson’s-like disease,” Sabbagh says. “We look at walking, reflexes. Then we would do blood tests and scans of some kind.”

One common Alzheimer’s precursor is a condition called mild cognitive impairment (MCI); Sabbagh likens it to “the chest pain before the heart attack.” MCI indicates memory and thinking problems that are more pronounced than those experienced by most people of the patient’s age. “We do know that if you have an amnesic form of MCI—one that involves mostly memory—you are very, very highly prone to developing Alzheimer’s,” says Sabbagh. What’s worse, the number of MCI cases is growing faster than anticipated; the rate of increase is now 5% yearly (International Alzheimer’s Disease Conference 7/08).

Once thought of as a “brain-only” disease, Alzheimer’s is now known to occur along with other common chronic disorders. “The brain is not an isolated organ,” says Sabbagh. “We know that what is bad for the heart is bad for the brain—diabetes, heart disease and high blood pressure are all independent risk factors.” People who have abdominal obesity in middle age are more likely to suffer from dementia in old age, as are those with depression (Neurology online 3/26/08, 4/8/08).

So what can stop the Alzheimer’s onslaught? Zoë Ann Lewis, MD, FACP, internist and author of I Hope They Know…The Essential Hand-book on Alzheimer’s Disease and Care (Virtualbookworm.com Publishing), consults in emergency room cases at North Shore Medical Center Salem Hospital in Salem, Massachusetts. “One weekend I saw three men over the age of 90 who were totally lucid; they were there for complaints that would bring somebody to the ER if they were in their twenties,” she says. “The things they have in common are that they have a great home life, they are active, they participate in their communities, they have a good diet and none of them smoke.”

Making Connections

The experience of Lewis’s ER patients makes an important point: Researchers have found that people who keep active both socially and mentally appear to avoid the brain degeneration seen in Alzheimer’s. The key lies in neurogenesis, or the creation of new brain cells. Long believed to happen only in young, developing brains, neurogenesis has been found to occur in older ones as well—even those far past childhood.

“Mental exercise changes your brain,” Lewis explains. “If I learn how to play a musical instrument, I’m creating new brain pathways.” The idea is to keep feeding your head different kinds of information. “Crossword puzzles are great, but if you’ve been doing them for the last five years, try something different—do math games,” Lewis advises. “Challenge yourself.”

Balfour says her family tries to keep her father mentally stimulated. “We just purchased a system so he could play Brain Age, a game on Nintendo developed by a neurologist,” she says. “He plays it daily; we’ll play too and it helps keep us close to him.” In one study, older adults who received cognitive training enjoyed better mental function and less decline in the ability to care for themselves (JAMA 12/20/06).

Bob Balfour’s social interactions extend beyond his family. Still living at home, he “works for neighbors doing construction projects,” his daughter says. As well he should; researchers at Harvard’s School of Public Health have found that socially connected seniors have less than half the memory decline of more disconnected individuals (American Journal of Public Health online 5/29/08). Taking courses at a local community college, as Sabbagh suggests, can provide mental exercise in a social setting—giving you the best of both worlds.

An active mind operates best within a busy body. “I like running, cycling, everything and anything to be outdoors,” says Emily Balfour. What’s more, she adds, “I’m pretty cautious about what I eat, eating organic foods as much as I can.”

Living a Better-Brain Life

Balfour’s lifestyle is right on target as far as brain health is concerned. Physical activity not only provides oxygen to the brain but may also promote better connections between neurons. The problem lies in an exercise-adverse environment: “We have long work days, and a lot of it is spent sitting in front of a computer,” Lewis says. “It’s a challenge for people to break the hold modern society has on them.”

Eating organic foods is also a good idea, especially colorful fruits and vegetables. The Alzheimer’s Association recommends cruciferous veggies—broccoli, cabbage and their relatives—along with berries, grapes, bell peppers, spinach and onions. Many of these items, along with fish, olive oil, spices and whole grains, are part of the Mediterranean diet, which has been associated with reduced Alzheimer’s risk (Annals of Neurology 6/06). Studies have also linked compounds found in a number of Mediterranean ingredients to better brain health, including polyphenols in grapes, carnosic acid in rosemary and hydroxytyrosol in olives. Regular consumption of tea, a worldwide favorite, has also been linked to a lower risk of impaired mental functioning (American Journal of Clinical Nutrition 7/08).

One reason produce packs a brain-healthy punch is that it’s loaded with antioxidants, substances that smother cell-damaging free radicals. Vitamin E and beta-carotene (a vitamin A precursor), two notable antioxidants, particularly shine: High-dose E has helped lengthen lifespan among people with Alzheimer’s, while long-term use of beta-carotene has been found to protect against dementia (American Academy of Neurology meeting 4/08, Archives of Internal Medicine 11/12/07).

The B vitamins are also crucial to proper mental function, but because of depleted farmlands, “the standard American diet actually suppresses B vitamins because the food sources that we naturally derive them from actually have less and less B vitamin in them,” Sabbagh explains. “And then there’s the problem that as we age we don’t absorb particularly vitamin B12 as well as when we were younger.” One B called choline is vital for forming cell membranes. Along with phosphatidylserine (PS), found in soybeans and egg yolks, choline may help replenish the brain’s stores of acetylcholine, which carries messages between neurons.

Omega-3 fatty acids are among the best-known brain protectors. “DHA, one of omega-3s in fish oil, has been shown to help heal neurons—high doses seem to be protective,” says Sabbagh. “One study showed that DHA did slow down the rate of decline.” Ginkgo, another popular brain supplement, is “a free radical scavenger and increases circulation,” according to Sabbagh.

Other supplements, while not as well-known, have been subjected to scientific scrutiny. “There is now ample evidence that huperzine A acts just like prescription drugs for Alzheimer’s, probably works just as well,” says Sabbagh. “In China, they actually recommend huperzine A.” He adds that curcumin, a substance found in the spice turmeric, has been found to protect cells from beta-amyloid injury in lab studies. And Pycnogenol, a pine-bark extract, has been found to improve mental function in older people.

Despite the grim statistics on Alzheimer’s, Balfour remains optimistic about the future. “We’re slowly getting to the point where we care about what we’re putting in our bodies instead of what’s fast and cheap to eat,” she says. Balfour has channeled that positive energy into efforts on behalf of the Alzheimer’s Association, including work on a concert called Better Start Livin’ by country singer Keith Urban and songwriter Monty Powell to benefit the group’s Georgia chapter.

Balfour has also learned from her family’s experiences. “If you think about what you can do instead of what you can’t do, you’ll get a lot farther,” she says. “It’s easy for an outsider to think, ‘Their lives must be collapsing.’ But actually it’s richer—you realize the brevity of life.”

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