Memory has infinite power. It defines who we are. It gives us our individuality and sense of self. It can change who we are and our reality. Memories of the past help us make sense of our present and consider the future. It is defined by our senses. It can either be a prison, a terrifying and confined space that distorts reality or an endless expanse of creativity and information. It is essential to our lives, yet it is something we often take for granted.
Alzheimer’s dementia is a disease that many of us fear as we age. Many families are coping with or have had relatives who have suffered a steady decline in their health due to this disease. Both patient and family ultimately suffer tremendously. With the advent of World Alzheimer’s Day, we share some of our thoughts on the disease and possible treatments to help.
Dementia and its’ most common form, Alzheimer’s disease, is likely to be, if not already, the next epidemic in chronic disease worldwide. There is 1 new case of dementia diagnosed every 4 seconds which works out at 7.7million cases per year. The journal Alzheimer’s research and therapy in 2012 calculated that more than 600million people in the world will live with the disease in the next 40 years and 2/3rds of these cases are women. Alzheimer’s is a disease of gender bias.
The cost of being able to look after these cases is staggering. The World Alzheimer report in 2010 looked into the economic cost of dementia with sobering conclusions. The economic cost of dementia in 2010 was US$604 billion. If dementia was a country it would be 18th largest worldwide in terms of gross domestic product.
Functional Medicine Associates
At Functional Medicine Associates (FMA) we have a particular interest in cognitive decline and early-stage Alzheimer’s. Following extensive training from Prof Dale Bredesen and other specialists in Neuro-inflammation such as Dr. Datis Kharrazian and the Institute for Functional Medicine, we have been constantly developing, implementing and refining our cognitive decline programme. For associates Pete and DeDe it’s also of personal interest.
Here are just some of their thoughts based on current science and experience with patients.
New ways to think about and treat early-stage Alzheimer's
For most people in the UK, the diagnosis of Alzheimer’s predicts a very bleak future both for themselves and their relatives. This is amplified by the fact that conventional treatments only temporarily improve symptoms of memory loss and problems with thinking and reasoning. For people with mild cognitive impairment and early-stage Alzheimer’s these treatments do not stop the underlying reasons why their brain cells are dying.
At FMA we believe this is the crux of potential new treatments, what are the underlying processes that destroy brain cells? Surely once we understand “what” is it? (the diagnosis) we then need to ask “why” is it happening? If we look at Alzheimer’s in this way, like all chronic diseases there is a root cause pathway that clinicians can logically and scientifically follow. Alzheimer’s is not a single disease with a single cause. It is a disease with many causes and no two people with this diagnosis can be treated in the same way. It is our challenge at Functional Medicine Associates to look at mild cognitive impairment and diagnosis of early-stage Alzheimer’s disease from a single disease to a disease that has many facets and faces.
Many of our patients are left scared and depressed about the future because they are told there is nothing that can be done and “they had better get their house in order”. Most of these patients and their families are highly motivated to do something that may help slow down or even reverse their diagnosis. We are constantly surprised when we see patients who have been told that improving their lifestyle will have little or no impact on their condition. In actual fact making positive lifestyle changes has been shown (over many modalities and biomarkers) to help improve brain function and reduce risk. The knowledge that improving lifestyle can help outcomes gives immense hope to these patients.
Over the last 10 years, the work of Professor Dale Bredesen has shown that you can produce successful outcomes if you are prepared to make significant changes. Professor Bredesen has developed a multimodal approach which is focused on personalised dietary and lifestyle interventions that have had positive outcomes in many cases. For some patients, it has successfully reversed cognitive decline following a diagnosis of early-stage Alzheimer’s disease.
We believe it is important not to think of Alzheimer’s as a single disease but as a diagnosis of many parts of the brain and body that may not be working properly. Professor Bredesen likes to use the analogy of the leaking roof. There may be 50 holes in the roof that if identified and fixed over time can improve the way the roof works and reduce leakage. This example demonstrates why, so far, drugs for Alzheimer’s have had little effect on outcomes. They can be helpful of course but each drug is only going to be capable of fixing a couple of holes at best and therefore need to be integrated into a much larger strategy over time.
If someone gave you a scientifically sound text that showed how you could find out how to measure and repair the holes in the roof would you take action? We believe from our last few years of implementing our programmes that Prof Bredesen’s book is an excellent starting point for everyone.
Don’t accept there is nothing you can do, take action to improve your lifestyle, be consistent and accept that you will have to make life-long changes going forward. But you can improve.
Improve your fitness to improve your brain.
The better your overall fitness is the more chance your brain has to get better. We have seen encouraging research into aerobic fitness and how it reduces the risk of Alzheimer’s and starts to rebuild the Hippocampus, the area of the brain involved with memory. A 2017 study amongst older adults demonstrated that taking 150 mins per week of moderate aerobic exercise increased memory and executive function compared to a control group that did not exercise. Exercise not only increases oxygen levels to the brain it also brings nutrients to it and increases the secretion of molecules such as BDNF which help to rebuild the brain.
We believe that similar research will emerge demonstrating the effects of weight training on the risk of dementia.
“Lifting weights or even your own bodyweight not only builds your muscles but builds and protects your brain”
A 2014 Australian study found increased muscle strength led to improved brain function in adults with Mild Cognitive Impairment (MCI). Mild Cognitive Impairment defines people who have noticeably reduced cognitive abilities such as reduced memory but are still able to live independently. MCI is a precursor to Alzheimer’s disease. Participants in this study were prescribed resistance training (weight-lifting) sessions twice a week for six months, working at least 80 percent of their peak strength. What makes this study stand out is that the improvements in brain function were very much dependent on the gains in strength from the weight training. The lead scientist Yorgi Mavros stated
“Basically, the stronger the people became, the greater the benefit for their brain”
We are proud as a practise that we all have a good understanding of how exercise can be one of the most influential strategies for treating not just Alzheimer’s but all chronic diseases. So much so we believe its implementation should be the “main course” in any treatment. We find it difficult to ignore the overwhelming science on exercise particularly as we have experienced it first-hand with our patients. As part of our cognitive decline programmes we have a set of physical tests which we implement and test over time. Our aim is to objectively measure how much fitter, stronger and more mobile our patients get during the course of their programme. An example of one of these tests is the grip strength test. This is an important marker to test as evidence shows that declining grip strength is associated with increased risk of Alzheimer’s.
Another reliable measure of strength, balance and muscle endurance is the “Sit to Stand test”. During this test patients are asked to stand and sit over various time frames. Another simple test is to try balancing on one leg. If you cannot hold this for 20 seconds you may need to pay attention. These simple tests have been proven to measure the risk for possible accelerated aging in the brain and body. To sum up, the fitter and stronger you are, the healthier you age. Rather than spending less time moving and keeping fit as we age, the evidence shows that, ideally, we should be spending more time maintaining and improving physical fitness.
Know your ApoE gene status.
The ApoE4 is the strongest known genetic risk factor for Alzheimer’s disease and therefore knowing your status gives you an indication of potential risk. ApoE is a protein that is involved in the handling of fats including cholesterol around the body.. It is a gene that several million years ago was beneficial for very early man to survive in a very harsh and pro-inflammatory world. According to Professor Caleb Finch:
“In effect, it enhanced our fitness to survive during early life but at the expense of longevity”
The conditions in modern society, however, are the opposite of our ancestors and yet many of us will still carry these risks. ApoE4’s impressive influence means that it is also involved with cardiovascular diseases and other diseases that are influenced through increased inflammation. ApoE4 also dials down SirT1, a molecule that has been associated with longevity. Some genes predispose people to much earlier dementia (in their 40s) but these are quite rare. The majority of the population carry two copies of ApoE3 giving them a genetic risk of only 9%. About 25% of the population carry a single copy of ApoE4 which increases your risk by 30%. Some people inherit a double dose of ApoE4 (ApoE4/4) one from mum and one from dad. This pushes their lifetime risk to over 50% or more.
Research has gone on to show that out of approximately 20,000 genes we have, ApoE can negatively influence 1700 of them. Very recent research is also looking at multiple genetic risk factors which they call “polygenic risk score” which is likely to give a more accurate genetic risk. At FMA, we appreciate that there may be other gene influences (such as genes associated with oxidative stress, inflammation, detoxification) which we will test for and integrate into a larger patient programme.
Testing for genes within a larger programme of health can be very beneficial. It’s important to note however that just because you may have increased risk from the ApoE gene this does not mean you, as an individual, go on to develop Alzheimer’s (It’s much more complicated than that). We currently have a 60yr old male with highest risk ApoE gene for developing “later-onset ” Alzheimer’s who is showing no signs of any changes in brain function.
We are all, to varying effect, at risk for Alzheimer’s and we cannot change our genetic inheritance. But we can make lifestyle choices which can powerfully impact our risk for a disease that conventionally we have been told we have no treatments for. In a very recent JAMA study, 200,000 individuals were organised into high, intermediate and low genetic risk. It showed that modifying lifestyle choices for the better reduced risk of dementia. The greatest changes were amongst the high genetic risk group who demonstrated a 40% reduced risk. At Functional Medicine Associates, we like to think that “genes load your gun” but it’s your lifestyle choices that determine whether you fire it.
At Functional Medicine Associates, we believe that whilst mainstream medicine does not yet focus on prevention it will be a slow process for studies like this to come to the forefront. Genetic risk is important to know and understand because risk can be offset by making specific and individualised choices. Avoiding smoking and drinking, increasing physical activity and diet, getting more sleep and reducing stress are proven ways to help prevent, slow down and in some cases reverse Alzheimer’s.
Is your body and brain inflamed?
Associate De De Nazereth has been interested in this field since she was a teenager. I was around 16 years old when I worked in Greystone Psychiatric Hospital for a work experience internship and I was awed by these patients and their conditions. Outwardly, some were just like me, where you wouldn’t have been able to tell they were not well. Upon speaking, however, either their sentences and word choices did not make sense or suddenly their behavior would change.
The expressive face that was connected to mine with the usual visual cues and friendly disposition suddenly became detached and even angry and scared at the same time, once the realization of not knowing where or who they were was apparent. This would result in strange behaviour, even violence. I was intrigued by how quickly this would happen in some of the patients. I also was struck by how easily this could be an eventuality for anyone, including myself.
This experience was one of many that drove my interest in studying the brain and understanding how it can be impacted by our internal and external environment. Just as there is a shift in understanding that many chronic illnesses can be the result of bad lifestyle and diet, we are understanding that good brain health is also influenced by these things.
Another shift is the understanding that hidden trauma can impact the brain in such a way that it can alter the way the brain interprets the world, thus presenting an altered reality.
There is now an appreciation that the underlying link between bad diet and lifestyle choices and trauma stress or stress from our internal and external environments is inflammation.
We can improve the health of the brain by reducing the elements causing inflammation, but also by supplementing with nutrients that are deficient and also ones that help combat the further impact of this inflammation. Again, identifying the “why” through objective testing is key to following a scientifically validated approach. These nutrients can be found in our food as well as key nutraceutical’s that can cross the blood-brain barrier. Omega 3 fatty acids, glutathione and curcumin, for example, are ones that we could potentially use. The brain can also be trained out of the confines of trauma through different practices such as mindfulness and movement.
The area that I am focused on in practice is positive brain training or neuroplasticity. My focus as an osteopath is working with the body which also works the mind, they cannot be separated. I am testing and treating the overall resilience of the individual by analysing their stress level in their body and teaching them how to be able to manage their stress with practical tools that positively affect neuroplasticity. The easiest and most effective way that I do this is to teach how to breathe diaphragmatically. The ability to do this is like a switch in the brain that takes it out of a stress mode into a relax mode right away. There is a measurable difference that they feel in their body and that can be a feeling of lightness or a decrease in pain sensitivity. There is a visible difference in the posture because the body has come out of a posture of defence or protection and into a posture of calm, certainty and confidence. When the body is in a relaxed state, so is the mind, because the body is a reflection of what is going on in the mind. When the mind is in a relaxed state, decisions become more logical, creativity and strength are enhanced. It is from this relaxed state that one can find solutions more easily and the mind does not feel trapped or in a state of fear and anxiety, the states most commonly associated with chronic inflammation, stress and mental illness.
Chronic Inflammation is a highly significant process that underpins all chronic diseases and when the body is inflamed the brain is likely to be as well. Hence in a programme to help the brain, we must help the body as one has an impact on the other.
The Future of Alzheimer’s
There is a change in the way both in attitudes to and the science surrounding Alzheimer’s. Scientific studies have already shown a complete reversal of the disease and symptoms in patients with mild cognitive impairment and early-stage Alzheimer’s.
As a group of experienced practitioners, we strongly believe that it is a misconception that there is nothing you can do and that Alzheimer’s is something you just end up getting. The fact is, Alzheimer’s, like all chronic diseases, has been slowly developing in individuals for decades due to how we have chosen to live our lives.
You have what it takes to change, you just need to know-how. An understanding of how your genes and your day to day living affect your future paves the pathway for the destiny of your brain.