Virtually every person, including myself, at one time or another has wondered if they might be developing early Alzheimer's disease. Such fear is usually triggered by our daily ritual of forgetfulness…”where did I put my keys?” “what was that person's name I just met a few minutes ago?” “did I shampoo my hair when I showered earlier this morning?” “did I leave the garage door open or the stove on?”
Such common episodes of forgetfulness in isolation do not usually represent Alzheimer's disease, but instead our increasingly distracted, multi-tasking modern day brains. Having said that, we also need to be aware that Alzheimer's disease is on a steep rise and I wrote this post to raise awareness and inform you of the latest research behind prevention and potential reversal in early stages.
Before I started focusing on insulin resistance in my practice, I saw all types of patients in my busy internal medicine clinic. My patients who suffered from Alzheimer's disease or other forms of dementia are etched in my mind because I watched them deteriorate in front of my eyes .
Unlike heart attack patients who have specific procedures and medications available to effectively treat their condition (but not the root cause which is a lifestyle issue), with Alzheimer's disease I felt helpless because there were no useful therapies. I often took care of the spouse and other family members and watched how their emotional and physical health deteriorated from the tremendous toll it took from taking care of a family member with Alzheimer's.
Today we are understanding more about the origins of Alzheimer's which makes it a potentially preventable and in early stages a possibly reversible condition.
One key point you must understand is that Alzheimer's is not a disease that just starts developing in older people.
The seeds for this condition are planted early in our lives through our modern diet and lifestyle habits. This is why we're seeing an alarming increase in Alzheimer's cases. Many of us are in a “pre-Alzheimer's state” and the clock is ticking in terms of how reversible this condition becomes.
In fact, Alzheimer's experts like Dr.Dale Bredesen, who I'll introduce at the end of the post, highlight a critical 10 year window from the occurrence of noticeable memory changes to the development of clinical dementia, which is neurodegenerative memory loss. Although genes play an important role, they may not get turned on if we make the right choices. Such knowledge is very empowering!
Before we jump into the stats, I wanted to provide the table below from the Alzheimer's Association to help you sort out “normal” memory loss from Alzheimer's symptoms.
The steep upward rise in Alzheimer's disease incidence globally is nothing short of startling. I wanted to highlight a few statistics below, pulled from the Alzheimer's Association website, a great resource which includes a 24/7 helpline for support (1-800-272-3900):
- Since 2000, deaths from heart disease have dropped by 14%, while Alzheimer's deaths have increased by 89%. By the way, the heart disease deaths have dropped mainly because of advances in modern medicine (medications and procedures), not because of diet and lifestyle habits (other than lower smoking rates) which continue to deteriorate
- Alzheimer's disease kills more people than breast and prostate cancer combined.
- 35% of Alzheimer's caregivers have developed worsening health compared to caregivers of patients without dementia.
In regards to the last bullet, the caregiver stress (often family members) for individual's with Alzheimer's disease is tremendous, which is why refusing to make healthy lifestyle choices is an irresponsible and selfish decision that puts your loved one's future emotional and physical health at risk. When you decide to get married (or enter some type of relationship) and have children, your health becomes their health, so take better care of yourself right now. Sorry to be so blunt, but I've seen too many families suffer from one individual too stubborn to make changes.
There is mounting evidence pointing to the strong link between insulin resistance, the root cause of diabetes and most heart attacks, and Alzheimer's disease. If you're new to my work and not familiar with insulin resistance, please refer to my book or at least read this post, so you have a better understanding.
Essentially, when your body stops responding properly to insulin, your blood glucose goes up and your pancreas compensates by producing more insulin, a state we call hyperinsulinemia. Now let's discuss 3 mechanisms by which insulin resistance can increase Alzheimer's risk:
- Increased inflammation: Excess insulin levels increase inflammation throughout the body, including in the brain, as shown in this study. Inflammation in the brain is an underlying cause for Alzheimer's disease, in addition to being the root cause for most other chronic health conditions including heart disease.
- Excess Beta-Amyloid: Beta-amyloid is a sticky protein that accumulates in the brains of Alzheimer's disease patients, causing significant damage. Excess insulin levels actually block beta-amyloid from being cleared from the brain.
- Reduced Glucose Use by Brain: Our brains rely on glucose as a major source of energy. Just like insulin resistant muscles can't take up glucose adequately, insulin resistant brain cells are also unable to absorb glucose to use for energy. This study shows how all patients with Alzheimer's disease had insulin resistance in the brain and how 97.5% of type 2 diabetics had insulin resistance in similar regions of the brain as Alzheimer's patients.
This is a key reason why Alzheimer's disease is referred to as Type 3 Diabetes, since insulin resistance appears to be a prerequisite for disease development.
When we take all these effects together, we can better understand the direct toxicity insulin resistance causes to our brain. For example, a key structure of the brain that is initially damaged in Alzheimer's disease is the hippocampus, a sea-horse shaped region of the brain that allows us to learn new information and store it as long-term memory.
Type 2 diabetics characteristically have greater atrophy of the hippocampus represented by smaller hippocampal volumes on a brain MRI scan due to the mechanisms we just discussed. Type 2 diabetic women in particular are more susceptible than men, to diabetes-related hippocampal damage as shown in this study.
I know I just threw a lot of science at you, but hopefully by now you are convinced that insulin resistance is not just about prediabetes/diabetes and heart disease risk. It is a powerful contributor to Alzheimer's disease.
I don't like to use fear tactics in my patients, but if heart disease doesn't “scare” you into positive action, then maybe progressive loss of brain function might. I'm often surprised to see my heart attack patients go back to their prior lifestyles after the initial shock factor of their heart attack wears off.
They go through cardiac rehab and maybe stick to a heart healthy diet for a few months or a year, but after experiencing the wonders of modern medicine and feeling protected by regular visits to their cardiologist who typically tell them “they're doing great” based on pharmaceutically-corrected cholesterol and blood pressure levels, they slip into their old patterns of unhealthy eating, no exercise, high stress and compromised sleep.
Just like they never imagined they could develop heart disease, they are in equal denial now about developing a neurodegenerative condition like Alzheimer's disease in the future.
However, this time there won't be a panel of wonder drugs or medical procedures or a confident medical specialist telling them “they're doing great.” This time they won't be able to return to their workaholic lifestyle because they may be unable to work, pursue other forms of intellectual stimulation, or even take care of themselves. I've unfortunately seen this happen to CEOs, professors and the brainiest of patients who could never imagine a single point drop in their IQ. Bottom line is don't take your brain power for granted and start making healthy changes right now!
What About Genes?
The Apo E gene is the one that is tested when assessing for Alzheimer's disease risk. “Apo” stands for apolipoprotein, which is a protein involved in cholesterol metabolism. The type of Apo E gene you carry dictates your genetic risk, with Apo E4 having the highest risk. If you have no copies of the Apo E4 gene, your genetic risk is low, if you have 2 copies of Apo E4 your genetic risk is considerably higher, and if you have 1 copy of Apo E4 your risk falls somewhere in between.
Inheriting the E4 gene is like inheriting the “switch” for Alzheimer's disease. Improper lifestyle can turn the switch on even if your genetic risk is low, while a healthy lifestyle can keep it off, even if your genetic risk is high. Many labs offer Apo E gene testing, including services like 23&me which sequence the entire human genome.
Regardless of the genetic risk, 95% of Alzheimer's disease is not familial and is driven predominantly by lifestyle changes.
Coming back to diabetes, this 2017 study shows that diabetes is the most significant reversible risk factor for AD and as an independent risk factor it's pretty darn close to having the ApoE4 gene based on a number called the hazard ratio. You need to make sure you do everything possible to prevent, reverse, or stall insulin resistance and diabetes, especially if you carry the ApoE4 gene. My new online program which I'll introduce in detail in a future post, is focused on reversing insulin resistance.
By the way, when my patients successfully reverse insulin resistance, they almost unanimously report improved alertness, memory, and brain function. Reversing or significantly reducing insulin resistance means you are removing a process that causes direct toxicity to the brain, allowing you to think clearly and restore overall cognition and intellect.
The medical approach to treating Alzheimer's disease has been a failure. Drugs are targeted at the amyloid plaque rather than the underlying cause. This is analogous to just treating heart disease plaque and ignoring the causes for plaque formation in the first place like insulin resistance, excess weight, smoking, stress, etc. However, for the first time there is hope that a disease previously considered irreversible may actually be reversible in the early stages and more preventable than we ever imagined.
Fortuitously, I had the privilege as an undergraduate of being the research assistant for Dr.Dale Bredesen, a well known clinician researcher at UCLA at the time. He is a world renown expert on Alzheimer's and understands its molecular underpinnings better than most. He was one of my role models who inspired me to go into medicine.
Dr.Bredesen spent decades inside the lab understanding the molecular biology of Alzheimer's disease, trying to discover a single molecule or drug that could cure the disease, but has now come to the realization through compelling research and clinical experience that lifestyle, rather than drugs is the only effective way to beat Alzheimer's. For anyone concerned about Alzheimer's disease, I strongly recommend reading his recently released book, The End of Alzheimer's, and check out his Youtube and podcast interviews. If book sales are any barometer of how concerning this condition has become in our society, as of me writing this post, his book is ranked #1 on Amazon out of over 8 million books. Also read about Dr.Bredesen and his Alzheimer's protocol here.
His cutting edge work reveals the first evidence of an intervention that has led to actual regression of Alzheimer's plaque in early stage patients as shown in this study. The intervention is not a miracle drug, but rather a lifestyle protocol that includes elements such as exercise, fasting, a nutrient dense diet, sleep and stress reduction in addition to testing for specific micronutrient deficiencies, hormonal imbalances, and toxin exposures which may require a supplemental strategy as well. Many of these concepts should sound familiar since they are covered in my book and prior posts. How do some of these ancestral practices specifically help fight Alzheimer's disease?
- Exercise: Exercise is one of the most powerful triggers to releasing a hormone called BDNF (Brain-derived Neurotropic Factor). BDNF is often referred to as “brain fertilizer” because it helps trigger the growth of new nerve cells and connections between nerve cells called synapses, in addition to promoting the health of existing nerve cells and synapses. Resistance training, especially using large muscle groups like your legs and interval training (alternating intensity between high and low) are especially great ways to boost BDNF.
- Fasting: Fasting, which we've discussed in prior posts, has tremendous benefits on brain health and is especially effective for individuals carrying the higher risk Apo E4 gene.
- Nutrition: Based on my detailed discussion about the link between insulin resistance and Alzheimer's, making sure you eat a nutrient dense diet that eliminates or significantly limits added sugar and excess carbohydrates is key. You must eat lots of plants, healthy proteins, optimal fats and spices like turmeric to help reduce inflammation and combat insulin resistance.
- Sleep: The recently discovered glymphatic system in our brain is active during sleep and helps to remove accumulated toxic byproducts, including the Beta-amyloid found in Alzheimer's, as explained in this study.
- Stress: Stress destroys neurons in the hippocampus, which as you recall is the key brain area damaged in Alzheimer's, in addition to damaging synapses (connections between neurons)
For the first time ever there is now hope that neurodegenerative conditions like Alzheimer's disease can actually be prevented and potentially cured in the early stages through lifestyle changes. Once again, it's not a miracle drug or a cutting edge piece of medical technology, but instead the use of modern medicine to prove what our ancestors have known for thousands of years. We keep replaying this same sequence for nearly every chronic health condition modern humans face. Don't let the medical system ever make you lose hope on your body's innate ability to heal from conditions typically considered irreversible or incurable.