“I felt like jumping up and down in the middle of the conference hall… Diet, exercise, sleep and stress: those are generally not considered culprits for a problem as big as dementia. But for the first time, we have evidence that levels of tau”— thought to be a marker of Alzheimer’s— “can change with lifestyle interventions such as exercise. The whole thing is coming together.”
Those were the recent words of Dr. Majid Fotuhi, former science director for the Alzheimer’s Assoc (when I started teaching for them back in 2008) after their international conference in July. Unfortunately, not long after he left that post the Alz Assoc took a turn away from diet and lifestyle, to hang their hat on pharmaceutical interventions. However, these have, by in large, turned out to be a waste of time and money. But now we are seeing a return to these simple lifestyle practices and researchers are finding that indeed they can have a powerful impact on brain health. And that’s what this recent (Aug 22) article from Time magazine is all about.
I wish this article were available online and I could just link you to it,* but since it is not I will herein try to summarize and reinforce what I think are it’s (or Dr. Fotuhi’s) most important points. Some of these you have likely heard here before, but repetition is the mother of memory and another authoritative confirmation can be reassuring, both to you and your patients/clients, that we are on the right track.
First, they note “doctors do not have a reliable way to treat dementia with drugs.”
Second, you can take care of your brain the same way you take care of your teeth or the rest of your body – i.e. by developing brain healthy habits.
Third, A “glut of new research” shows that “reasonable lifestyle choices―including exercise and targeted brain training―may indeed protect the brain as it ages.”
Forth, Dr. Fotuhi is described as “a neurologist who specializes in the prevention of Alzheimer’s disease.” That’s interesting since just last year the PR director for the Alzheimer’s Assoc, chided me for suggesting Alzheimer’s could be prevented. Moreover, Fotuhi’s efforts are primarily focused on lifestyle interventions, rather than pharmaceuticals, which begs the question as to which are really the most powerful in promoting brain health.
Fifth, they note that while the amyloid cascade hypothesis once dominated the field, now “other factors—such as heart health, sleep quality and physical activity—are emerging as potential ways to help prevent dementia in some people.” “Lifestyle changes” they note, “may be the best prevention we know of right now.”
They mention a 2014 article published in The Lancet Neurology, wherein researchers projected that almost a third of the cases of Alzheimer’s disease worldwide—9.6 million of them—could be prevented by things that are within most people’s power to change: hypertension in middle age, diabetes, obesity, physical activity, depression, smoking and low education were all found to play a role.
Actually “a third” is likely low as the Wales Carephilly 34 year study (one of the only studies to actually measure this effect) suggested at least 60% of cases could be prevented by living a lifestyle that reduced such risk factors. That does not include the protective impact hearing aids could have in upwards of 36% of dementia cases.
The article noted six areas for intervention. These include:
HEART
“Of all the things you can do, reducing the risk of heart disease has the strongest evidence of benefits for the brain. That means treating hypertension, … obesity and Type 2 diabetes.” Other recommendations they include:
EMPHASIZE EXERCISE
LEARN NEW THINGS
BE SOCIAL
TREAT DEPRESSION
SLEEP WELL
Note all of these are discussed at length in our Dementia Prevention course. The one omission here being Diet and Nutrition, although the Mediterranean diet is emphasized at Fotuhi’s center. Although there is no mention of supplements, which may account for the fact that, even though Dr. Fotuhi’s course cost’s up to $7000 for three months, the results so far have not proven to be quite as good as in Dr. Bredesen’s program, or Dr. Shea’s research. As Dr. Shea has noted, it’s very difficult for older seniors to overcome their nutritional deficits with diet alone.
Nevertheless, when Fotuhi and his colleagues tallied the effects of their program in the Journal of Prevention of Alzheimer’s Disease, they noted that of 127 older patients with mild cognitive impairment, 84% showed significant improvement in at least three areas of cognitive function. Which is a much higher percentage than the 33% “third” the above noted experts and advocates of lifestyle predicted.
The article also has a nice quote from Dr. Kristine Yaffe of the University of California, San Francisco, who is a leading researcher on predictors of dementia. She notes “Lifestyle factors are so important, even though they sound sort of soft, and a lot of people therefore think they can’t possibly be that effective. But…. They’re not expensive, they don’t have side effects, and they’re good for the rest of the body too. So why wouldn’t you make lifestyle changes?”
Additionally they note that “the earlier that people begin preventive measures, the better. That said, it’s never too late to adopt a healthy lifestyle.” A randomized controlled trial presented at the Alzheimer’s Association conference showed that even sedentary elderly people with mild cognitive impairment can improve their brains by starting to exercise.
* All in all it was a great article. I would encourage you to obtain a copy to share with your patients. To do so you can go to http://search.time.com/?q=Untangling+Alzheimer%27s&site=time
But you’d have to pay at least $2.99 for a month’s subscription. Or find and copy it from your local library which is what I did. Time will also send you the issue for $6.
“Calcium supplements tied to higher dementia risk for some women”
Such is the headline accompanying a new study recently reported online. See http://www.aol.com/article/2016/08/18/calcium-supplements-tied-to-higher-dementia-risk-for-some-women/21453942/
I wanted to share this bit of news with you because many seniors are advised to take calcium supplements to strengthen their bones. However, as this new study suggests, if they don’t take in other nutrients to control and direct that supplement it can end up in their arteries rather than their bones. Such is said to be a significant contributor to hardening of the arteries in old age, which can affect cognitive health, as this study showed.
I have a close friend, who lives a very healthy lifestyle, who nearly died from such (a blockage in his heart due to calcium supplements and excessive calcium in his veins). In fact had he not been exercising on a regular basis he would have.
Moreover, while calcium is also used in the brain, calcium disregulation in the brain is a major contributor to cognitive decline.
So, if a person is going to take a calcium supplement, it’s important that they take magnesium and other nutrients as well. Actually magnesium deficiencies are more common in seniors than calcium deficiencies, especially in those with hearing problems, and magnesium (which has more than 300 uses in the body) helps to balance calcium in the body and brain. A tiny trace mineral called boron, is also critical for proper calcium assimilation as well as exercise and hormones particularly estrogen in women. Vitamin D3 from sunlight or supplements, and vitamin K2 from green veggies, are also important. In fact the best sources for calcium and magnesium are likely a good assortment of vegetables, which contain those other cofactors as well.
Last year we were able to turn around a case of osteoporosis in one of my clients who is now 90 years of age, with such a regimen.
Dairy is touted as being high in calcium, but it lacks cofactors and many adults have problems with dairy and lactose intolerance. Canned sardines or salmon may be an easy way to replace a large portion of dairy calcium. Tofu, bok choy, collard green, beet greens and turnip greens are examples of good veggie sources, containing important cofactors like K2 and magnesium.
p.s. At the beginning of the Time article they mention tau tangles as being a sign of Alzheimer’s. You may recall that Dr. Shea’s research at UMass showed that folate can also help to keep tau from getting tangled, and the primary source for this important nutrient, is… you guessed it ― vegetables!
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Prevention Strategies 
