1: Alzheimer’s disease is scary. Many of us fear dementia more than death itself.
We “would rather die from cancer or heart disease than lose our minds, our very selves,” Dr. Peter Attia observes in his influential book Outlive: The Science and Art of Longevity.
Alzheimer’s and other neurodegenerative diseases have “causes we still do not fully understand, and for which we lack effective treatments,” he notes.
“Despite the billions and billions of dollars that have been spent chasing these complex conditions,” Peter writes, “There is no cure for any of them.”
What, then, are we to do? The answer: Focus on prevention.
“The very concept of Alzheimer’s prevention is still relatively new,” Peter writes. There are already signs of hope, however, as the idea of preventing Alzheimer’s disease has begun to gain scientific support.
“A two-year randomized controlled trial in Finland, published in 2015,” he notes, “found that interventions around nutrition, physical activity, and cognitive training helped maintain cognitive function and prevent cognitive decline among a group of more than 1,200 at-risk older adults.
“Two other large European trials have found that multidomain lifestyle-based interventions have improved cognitive performance among at-risk adults.”
2: Earlier this week, we looked at the case of Stephanie, one of Peter’s clients whose blood work showed that she had two copies of the e4 marker.
Which means her risk of Alzheimer’s disease was up to twelve times greater than the norm.
“In spite of everything, I remain cautiously optimistic for patients like Stephanie, even with her highly elevated genetic risk,” Peter writes.
“I actually think we know more about preventing Alzheimer’s than we do about preventing cancer,” he notes. “Our primary tool for preventing cancer is to not smoke and to keep our metabolic health on track, but that’s a very broad-brush approach that only takes us so far. We still need to screen aggressively and hope we somehow manage to find any cancers that do develop before it’s too late.
“With Alzheimer’s disease, we have a much larger preventive tool kit at our disposal, and much better diagnostic methods as well. It’s relatively easy to spot cognitive decline in its early stages, if we’re looking carefully.”
3: We begin by addressing metabolic issues, including obesity: “Our goal is to improve glucose metabolism, inflammation, and oxidative stress,” Peter writes.
“One possible recommendation for someone like her would be to switch to a Mediterranean-style diet, relying on more monounsaturated fats and fewer refined carbohydrates, in addition to regular consumption of fatty fish.
There is evidence, Peter suggests, that taking fish oil supplements with the omega-3 fatty acid may help maintain brain health.
“This is also one area,” he writes, “where a ketogenic diet may offer a real functional advantage: When someone is in ketosis, their brain relies on a mix of ketones and glucose for fuel.
“Studies in Alzheimer’s patients find that while their brains become less able to utilize glucose,” he notes, “their ability to metabolize ketones does not decline. So, it may make sense to try to diversify the brain’s fuel source from only glucose to both glucose and ketones.
“A systematic review of randomized controlled trials found that ketogenic therapies improved general cognition and memory in subjects with mild cognitive impairment and early-stage Alzheimer’s disease.”
Peter recommended that Stephanie eliminate added sugar, highly refined carbohydrates, and alcohol.
“The precise role of alcohol in relation to Alzheimer’s disease remains somewhat controversial,” he observes. “Some evidence suggests that alcohol may be slightly protective against Alzheimer’s, while other evidence shows that heavier drinking is itself a risk factor for the disease, and e4 carriers may be more susceptible to alcohol’s deleterious effects.
“I’m inclined to err of the side of caution, and so is Stephanie.”
But the number one tool in the anti-Alzheimer’s tool kit is exercise: “So along with changing Stephanie’s diet, we put her on a regular exercise program, focusing on steady endurance exercise. . . Endurance exercise produces factors that directly target regions of the brain responsible for cognition and memory. It also helps lower inflammation and oxidative stress.”
Her new workout regimen also included strength training.
“A study looking at nearly half a million patients in the United Kingdom found that grip strength, an excellent proxy for overall strength, was strongly and inversely associated with the incidence of dementia,” Peter notes.
“People in the lowest quartile of grip strength (i.e., the weakest) had a 72 percent higher incidence of dementia, compared to those in the top quartile,” he writes.
“There appeared to be no upper limit or ‘plateau’ to this relationship; the greater someone’s grip strength, the lower their risk of dementia.
Peter shares that he initially questioned the impact of exercise. But now the research is “so uniform in its direction and magnitude that my own skepticism of the power of exercise, circa 2012, has slowly melted away,” he writes. “I now tell patients that exercise is, full stop and hands down, the best tool we have in the neurodegenerative prevention tool kit.”
Sleep is yet another tool we can utilize to fight Alzheimer’s disease.
“Sleep is when our brain heals itself,” he notes. “Sleep disruptions and poor sleep are potential drivers of increased risk of dementia. If poor sleep is accompanied by high stress and elevated cortisol levels, as in Stephanie’s case, that acts almost as a multiplier of risk.”
Other somewhat surprising tactics to reduce the risk of dementia include addressing hearing loss as well as oral health.
“Studies have found that hearing loss is clearly associated with Alzheimer’s disease, but it’s not a direct symptom,” Peter writes. “Rather, it seems hearing loss may be causally linked to cognitive decline, because folks with hearing loss tend to pull back and withdraw from interactions with others. When the brain is deprived of inputs—in this case auditory inputs—it withers. Patients with hearing loss miss out on socializing, prescribing them hearing aids may help relieve some symptoms.”
There is also evidence that brushing and flossing our teeth is also important: “Gum disease is responsible for large increases in levels of inflammatory markers,” he notes.
“Gingivalis has also shown up inside the brains of patients with Alzheimer’s disease, although scientists are not certain that this bacterium is directly causing dementia, notes Dr. Patricia Corby, a professor of dental health at New York University.
“Nevertheless, the association is too strong to be ignored. (also, better oral health correlates strongly with better overall health, particularly in terms of cardiovascular disease risk, so I pay much more attention to flossing and gum health than I used to.)”
One final tactic to consider is the use of dry saunas. “Until about 2019 I was very skeptical of the data linking sauna use to brain and heart health,” Peter writes.
“However, the more time I spend buried in this literature, the more I become convinced by the magnitude of the benefit, the uniformity of the studies, and the mechanisms providing plausibility. . . The best interpretation I can draw from the literature suggests that at least four sessions per week, of at least twenty minutes per session, at 179 degrees Fahrenheit (82 degrees Celsius) or hotter seems to be the sweet spot to reduce the risk of Alzheimer’s by about 65 percent.”
The bottom line? “Time is key,” Peter suggests. “We need to think about prevention early, and the more the deck is stacked against you genetically, the harder you need to work and the sooner you need to start. As with cardiovascular disease, we need to play a very long game.”
More tomorrow!
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Reflection: Which of Peter’s recommendations to reduce the risk of Alzheimer’s disease do I want to know more about?
Action: Talk to my doctor.
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