A diagnosis of Alzheimer’s disease (AD) means a slow erasure of identity. Memory slips away. Complex thoughts. Continence. Eventually, all that’s left is a shell, a dying body where once was an intelligent, complex person. And it all happens excruciatingly slowly, until finally, death.
Alzheimer’s disease is the sixth leading cause of death in the United States. Rather than killing silently and suddenly like a heart attack, dementia steals the mind before it claims the body.
Myths pervade about Alzheimer’s disease and dementia being genetic or random, but evidence shows it’s preventable. Like heart disease, it’s a result of years of daily choices. It can be avoided, and people who are already suffering can manage it and stop its progression.
Some patients put their hopes on chemical medications, but most drugs on the market have proven ineffective — yet simple herbs have had surprising benefits.
Plaques And Tangles In The Brain Lead To Cell Death
The evidence shows that Alzheimer’s disease is a cardiovascular disorder, with factors like obesity, hypertension, and elevated cholesterol being the biggest risk factors. The same risk factors that make people vulnerable to heart disease and stroke put people at risk for Alzheimer’s disease.
Dr. Michael Greger, author of the bestselling book How Not to Die and the nonprofit website NutritionFacts.org, said in a phone interview that the first indicator that Alzheimer’s is a cardiovascular disorder came from the discovery of the disease.
“This goes all the way back to the 1901 case report, Alois Alzheimer’s first patient Auguste D. The autopsy showed cerebral atherosclerosis — artery hardening,” Greger said.
Alzheimer’s first case study discovered plaques and tangles in his patient’s brain, and subsequent research confirms that these plaques and tangles cause the cell death leading to dementia.
Beta-amyloid plaques are protein clumps that block synaptic cell signaling, and possibly create inflammation by activating the immune system, according to the Alzheimer’s Association.
Proteins may also tangle and disrupt the brain’s nutrient-delivery system, essentially starving brain cells. The Alzheimer’s Association says plaques and tangles “tend to form in a predictable pattern, beginning in areas important in learning and memory and then spreading to other regions.”
Scientists aren’t certain of the mechanics that form plaques and tangles, Dr. Greger said, but the evidence shows their cause is not just genetic.
A Cardiovascular Disease
In 1993, researchers at Duke University discovered a link between the Apolipoprotein E-4 (ApoE4) gene and Alzheimer’s disease, and subsequent research has confirmed that the risk of developing amyloid plaques increases with the presence of the gene.ApoE4 has a role in regulating cholesterol metabolism, and evidence suggests that cholesterol plays a role in creating the amyloid plaques suspected in causing Alzheimer’s disease.
“Epidemiological studies linking vascular risk factors… that can set in motion metabolic, neurodegenerative, and cognitive changes in Alzheimer brains; evidence that AD and vascular dementia share many similar risk factors; evidence that [drugs that improve insufficient blood flow to the brain] also improves AD symptoms; evidence that [insufficient flow of blood to the brain] can trigger… cognitive and degenerative changes… strongly indicate that the present classification of AD is incorrect and should be changed to that of a vascular disorder,” wrote Dr. Juan C. de la Torre, a professor in the department of immunology and microbial science at Scripps Research Institute, in the Annals of the New York Academy of Sciences.
If restricted blood supply to the brain increases dementia risk, and plaques can develop from a hardening of the arteries, what causes high cholesterol and hardened arteries?
Learning From Populations With Low AD Incidence
Researchers at the Indianapolis-Ibadan Dementia Project took 2,147 African Americans over 65 without dementia living in Indianapolis, Indiana, and 2,459 Yoruba residents over 65 without dementia from Ibadan, Nigeria, and followed them for about five years. They found that the Nigerians had significantly lower dementia and AD rates.
Why would Nigerians have lower dementia incidence than African Americans in St. Louis?
Nigerian, Indian, and Japanese diets are traditionally low in saturated fat and cholesterol. Meat, dairy, and eggs are the number one source of cholesterol and saturated fat in the American diet, and saturated fat is a major risk factor of Alzheimer’s disease. That makes meat, dairy, and egg consumption a risk factor in Alzheimer’s disease.
In California, 272 residents were matched for age, sex, and location, and researchers found that people who ate meat, including fish and poultry, were more than twice as likely to become demented as vegetarians. For vegetarians who did develop dementia, the onset was delayed.
In a study conducted by the Rush Institute for Healthy Aging, out of 815 people, 131 people developed Alzheimer’s disease. The researchers found that people eating saturated and trans fats had a significantly higher risk of AD. Other studies corroborate the findings, and numerous medical organizations warn that high cholesterol and saturated fat intake increase risk of AD.
Fat and cholesterol harden arteries, creating plaques, called atherosclerosis. In AD, plaques occur in the brain. While dietary interventions give people with heart disease a second lease on life, once people exhibit symptoms of AD, their best hope is to arrest it.
What To Add To Diet, And What To Remove, To Manage And Prevent AD
“The problem with AD is that once you have it, that’s bad news,” said Dr. James Loomis, Medical Director at the Barnard Medical Center in Washington D.C. “The horse is out of the barn. It’s really hard to reverse some of this cognitive decline, and it’s hard to measure whether you’ve changed anything. But putting someone on a plant-based diet, in my experience, tends to stabilize it.”
Loomis, the former team physician for the St. Louis Rams, St. Louis Cardinals, and St. Louis Symphony Orchestra, said in a phone interview that diet is the most important factor in illness.
“The root cause of atherosclerosis, and cancer for the most part, is driven by oxidative stress. We consume oxygen, and free radicals are normal byproducts, and we have an intrinsic mechanism to scavenge them. But if you look at the Standard American Diet — or a hospital cafeteria tray — the only color you see is the red from ketchup, which isn’t even food. One of the huge benefits of a plant-based diet is to increase free radical scavenging capacity through antioxidants,” he said.
“There was a longitudinal study called the Nurses’ Health Study that showed that nurses with the highest vegetable intake had a much lower incidence of cognitive decline in aging. Broccoli, kale, spinach, beans, citrus reduced heart disease, too,” Loomis said.
“If you look at studies with supplements, they have no benefit, but diets high in natural vitamin E provide benefit — avocado, mango, spinach, bell pepper, nuts, and seeds,” Loomis said, adding that vegetarians and vegans should supplement with vitamin B12.
Loomis also emphasized polyphenols — brightly colored plant foods such as grapes, cranberries, and blueberries. Various studies support berries’ effectiveness in slowing cognitive decline. One study of nine people with early stages of dementia showed improved learning and less depression thanks to the simple intervention of wild blueberry juice.
“Think of your caloric intake as money,” Loomis said. “You have $2,000 to invest in one day. You have $100 right now. You want to get your highest investment. Let’s invest $100 in olive oil. What’s your nutrition return on investment (ROI)? Not much. It’s five cubic centimeters, so it doesn’t take up much room in your stomach. There’s no fiber, no polyphenols. An avocado would give you more.”
Loomis pointed out that every meal is an opportunity to invest in health. “The more you process food, the more you deplete nutrition. That’s how to think about eating meat versus eating plant food.”
“You process whole grains and make flour. That concentrates calories and depletes nutrition. Animals do that for us. They concentrate the nutrients in plants into fat and protein, but they use the nutrition in that process, and leave us with nothing much more than the fat and proteins,” he said.
“Cows are vegan,” he added. “Where do they get all that protein? They use the good stuff.”
“In one ounce of chicken, what’s your ROI? You miss out on phytonutrients, vitamins. As for protein, 100 calories of broccoli has two times as much protein as 100 calories of chicken or beef, but without the saturated fat and cholesterol,” Loomis said. “And the beauty is, you cannot eat enough broccoli, blueberries, legumes, or brown rice to overeat and have high cholesterol and saturated fat.”
Omega-3s, Turmeric, Saffron, And Sage
Omega-3 fatty acids are well-known essential anti-inflammatory nutrients for brain and heart health that doctors and nutritionists recommend for preventing Alzheimer’s disease and other cardiovascular diseases.
Flax, walnuts, and chia seeds are excellent sources of omega-3s, but some experts recommend fish as a source of a form of long-chain omega-3s called DHA.
DHA is why fish oil has become a media darling, but studies have shown that fish oil isn’t as promising as hoped, and comes with its own problems — cholesterol and toxicity risk.
“I have great concerns about fish oil,” Loomis said. “One is the environmental impact of fish oil, because fish oil plays a huge role in depleting the world’s fisheries. Second, the heavy metal contamination in these fatty fishes. Ultimately, all of the omega-3 in fish oil is plant derived, coming from algae that slowly gets concentrated as you go through the food chain. The omega-3 gets concentrated, but so do the heavy metal and toxins. Farm fish is probably even worse because of the dioxins that get into fish meal.”
Since fish oil and DHA studies have proved mixed for Alzheimer’s disease, it may be best to seek non-toxic supplements made from algae or bacteria to limit pollutant exposure.
Turmeric is another essential herb for preventing and managing dementia.
Inflammation is an aspect of Alzheimer’s disease, as well as other feared diseases such as cancer. Inflammation is basically the body’s immune response — heat and swelling as the immune system tries to protect the body from a perceived threat. Food high in saturated fat causes inflammation. Dairy from cows is especially pro-inflammatory, containing hormones such as estrogens, whereas fruits, vegetables, legumes, grains, herbs, spices, and nuts are anti-inflammatory.
Turmeric — the bright orange root spice used in Indian curries — is well known for its anti-inflammatory properties, and its ubiquitous use in Indian cooking may help explain why Indian AD rates are low.
Hundreds of studies have examined turmeric’s beneficial effects on Alzheimer’s disease, including one anecdotal report about three patients whose severe symptoms of irritability, agitation, and anxiety “decreased significantly” after taking turmeric for one year. Two patients even came to recognize family members again. However, studies show that curcumin extract, an isolated compound found in turmeric, is not effective. The spice should be taken whole.
Dried or fresh turmeric is safe to take regularly, and to maximize absorption, can be mixed with pepper — a common combination in Indian recipes that is both delicious and healing.
Another exotic spice that may help Alzheimer’s disease, saffron, may stop beta-amyloid from forming, and helped patients improve in a double-blind, placebo-controlled study.
A more common herb, sage, produced significant improvements in a four-month AD trial, and appeared to calm agitated patients, without any adverse side effects.
Exercise And Sleep Improve AD Where Pharmaceuticals And Coconut Oil Disappoint
Dr. Larry Altshuler, Director of Oncology Intake at Cancer Treatment Centers of America, said, “We’ve been very disappointed overall with the meds we’ve seen.”
In a phone interview, the 40-year veteran internist and author of the Doctor Say What? guides to integrative medicine said a lot of drugs have an initial effect that wears off within a few months.
“Although conventional medications haven’t been so effective, there is an older drug called hydergine that decreases symptoms in some people. It has very few side effects,” he suggested.
For those seeking natural remedies, two other much-hyped supplements, coconut oil and gingko biloba, have produced little help. As a saturated fat, coconut oil may increase LDL cholesterol and the single study looking into its effectiveness for AD showed no significant benefit.
The evidence suggests that the best ways to reduce risk for Alzheimer’s disease is a healthy diet of whole plant foods high in antioxidants. But other aspects of lifestyle also contribute to brain health.
Dr. Joe Feuerstein, Director of Integrative Medicine at Stamford Hospital in Connecticut and author of Dr. Joe’s Man Diet, counts sleep, exercise, and brain activities as next in importance after diet for preventing and managing AD.
“Not sleeping properly inhibits the proper washing-out of the brain,” he said in a phone interview, citing research from the Oregon Health & Science University that shows that sleep may play a pivotal role to flushing out beta-amyloid plaques that are forming in the brain.
“The researchers found that the cerebrospinal fluid coating the brain goes inside the brain during deep sleep and gets rid of metabolic toxins,” he said. He added that using your brain, such as performing puzzles, or learning and practicing foreign languages, also staves of dementia.
Movement is also critical in preventing dementia. On February 10 researchers at Boston University published a study of 1,583 people that showed physical fitness in midlife was associated with larger brain size 10 years later. Although the study’s authors didn’t speculate what caused the association, as Feuerstein said, “There is absolutely a link — we know categorically that exercise and activity have a positive effect on brain health and reduce risk of dementia.”
One last lifestyle factor — mindfulness meditation — hasn’t been studied for its effect on Alzheimer’s disease risk, probably because a state of mindfulness is difficult to control with a placebo. However, a breakthrough randomized, placebo-controlled study published on January 29 found that mindfulness meditation — the practice of observing the present moment without judgment — has a lasting positive effect on the brain, and reduces inflammation in the body.
Lifestyle Is Everything In Preventing And Treating Alzheimer’s Disease
A diet low in saturated fat and cholesterol, and high in antioxidant, flavonoid and phytonutrient rich foods — in other words, a plant-based diet — is critical in preventing AD and may help people manage AD once they have it. Exercise, sleep, and brain activity are also essential factors, while at the same time, daily mindfulness meditation may also play a role in preventing dementia.
A recent report from Boston University shows that contrary to expectations, AD rates may be declining, possibly thanks to recent trends in healthy eating and exercising. As more people become health-conscious, the suffering of Alzheimer’s may become nothing more than a memory.