Table of Contents
- Alzheimer’s Disease: Are You At Risk?
- Understanding Your Risk of Alzheimer’s
- What Are Risk Factors for Alzheimer’s?
- 3 Risk Factor Categories for Alzheimer’s Disease
- What We Know about Age and Alzheimer’s Disease
- Theories of Aging
- Telemerase and Aging
- What We Know about Family History and Alzheimer’s Disease
- My Genetic Risk for Alzheimer’s
- What We Know About Stress and Alzheimer’s Disease
- What We Know About Sleep and Alzheimer’s Disease
- What We Know About Obesity and Alzheimer’s Disease
- Women and Alzheimer’s Disease
- Body Mass Index and Alzheimer’s
- What We Know About Hypertension and Alzheimer’s Disease
- What We Know about Abnormal Lipids and Alzheimer’s Disease
- ATP III Classification of LDL, Total and HDL Cholesterol (mg/dL)
- What We Know about Diabetes and Alzheimer’s Disease
- Kids and Alzheimer’s Prevention
- Controlling Cardiovascular Risk Factors for Alzheimer’s
- What We Know about a Sedentary Lifestyle and Alzheimer’s Disease
- What We Know about Homocysteine and Alzheimer’s Disease
- What We Know About C-Reactive Protein and Alzheimer’s Disease
- What We Know About Metabolic Syndrome and Alzheimer’s Disease
- Other Emerging Risk Factors for Alzheimer’s Disease
Alzheimer’s Disease: Are You At Risk?
Ever since my father was first diagnosed with Alzheimer’s, a question continued to linger in the back of my mind: was the Alzheimer’s a genetic condition or was it the result of my father’s heart problems? Knowing more about the heart/brain connection, I realized that this was a good possibility. Still, I had to know more about my genetic history. After all, we are a large Italian family with many siblings and cousins, and now we all have our own children, even grandchildren. Were we, too, at high risk for early Alzheimer’s disease? When my sisters would ask me, I’d always reassure them and say no. In reality, I was uncertain.
In an effort to learn more about our ancestral history, several years ago, my two sisters joined my wife Gayl and me on an ancestral journey to Italy to find out if any relatives still remained there. There had been neither contact nor knowledge of any Fortanasce’s in Italy for over 100 years. The trek through Rome to Naples and the ancient Apennine Mountains brought us to a rural, medieval Roman fortified city, San Fele, the “supposed” birthplace on the Passport of my grandfather, Vincenzo, who had come to America in 1898.
After coming almost 10,000 miles and making a Herculean effort to find the records, we got our answer. In a dusty, aged volume of birth and death records were the certificates of birth of our grandfather and great grandfather and great grandmother, along with the records of numerous other relatives. Once we recognized the true spelling of our name, Fortannascere, we found relatives, living about 60 kilometers away.
Hours later, we stood face-to-face with three older men, who introduced themselves as Michele (Michael), Vincenzo (Vincent), and Marco (Mark) – the exact names of my father, my brother, my son, my uncle, and me. However, what we learned next was far more relevant: Not only were these Italian men related to us, they revealed our genetic history. An uncle named Michael had, suffered the same illness as our own father: Alzheimer’s disease. And Vincenzo’s father had died just a few years before also with Alzheimer’s disease.
My sisters, Joan and Elaine, and I left hand in hand, linked by a strong genetic predisposition for Alzheimer’s. We could no longer minimize our father’s Alzheimer’s disease as an “isolated” condition. This one trip confirmed the reality that Alzheimer’s disease is part of my genetic heritage.
Understanding Your Risk of Alzheimer’s
If you played the board game Monopoly as a child, you probably learned about taking risks: Do not land in jail. Watch out for the income and jewelry tax. Especially avoid landing on hotels on Broadway.
There is a major difference between the risks involved with playing Monopoly and the risk of getting Alzheimer’s disease. In Monopoly, it’s all up to chance; with Alzheimer’s disease, it’s your choice. As you will learn in these articles, I believe that lifestyle habits trigger Alzheimer’s disease in more than 70 percent of the cases. This means, avoiding Alzheimer’s disease at all cost should be your ultimate goal as you follow the 4-step Anti-Alzheimer’s Prescription.
What Are Risk Factors for Alzheimer’s?
Risk factors are conditions or habits that make a person more likely to develop a disease or health condition. Sometimes risk factors can increase the chances that a disease will worsen. Other risk factors may be directly responsible for the disease itself. As an example, scientists have found that people with metabolic syndrome, also known as insulin resistant syndrome, may be at higher risk for developing Alzheimer’s disease. In one study, researchers found that patients with Alzheimer’s disease had a larger waist circumference, higher levels of triglycerides and glucose, and lower HDL “good” cholesterol-all symptoms of metabolic syndrome. Knowing that certain health conditions like metabolic syndrome may increase your risk of Alzheimer’s, it makes sense to take steps now to control or change this serious health problem. In doing so, you will dramatically reduce the chances of getting Alzheimer’s.
Sure, there are some risk factors of Alzheimer’s disease we cannot influence or change, particularly the intrinsic risk factors including gender, age, and genetics. There are other risk factors such as obesity, hypertension, and abnormal lipids that we can control or change. These are the extrinsic risk factors. Then there are two risk factors we must do all in our power to control. I call these the sentinel risk factors, including (1) sleeplessness; and (2) uncontrolled stress. How many times have you said “I’m stressed out and exhausted”?
Only by controlling these two sentinel risk factors, can you begin to change the extrinsic risk factors that increase your chances of Alzheimer’s disease. These sentinel risk factors are directly linked to our motivation, determination, and ability to follow through with set goals. Without conquering these two sentinel risk factors, there will always be failure in whatever goals you set out to achieve.
For example, when you feel relaxed because you wisely control your commitments and you feel rested from adequate sleep, it’s easier to stay compliant to a balanced diet and exercise regimen. Thus, when you are compliant to a healthy diet and exercise program, you then reduce the chances of obesity, hypertension, type 2 diabetes and other similar problems (all extrinsic risk factors for Alzheimer’s disease).
You will learn some easy strategies to control your two sentinel risk factors in the 4-step program. By using the 4-steps as a preventive game plan, you can extend the cognitive functioning of your brain and continue to be an active and productive player in life well into your seventies, eighties, and beyond.
3 Risk Factor Categories for Alzheimer’s Disease
- Intrinsic (those you cannot change)
- Genetics (family history)
- Prior head injury
- Prior heart attack
- Sentinel Risk Factors (those you must change)
- Uncontrolled stress
- Too little sleep
- Extrinsic Risk Factors (those you can change)
- Abnormal lipids
- Sedentary lifestyle
- C-reactive protein
- Metabolic syndrome (insulin resistance syndrome)
- Other lifestyle addictions (alcoholism, drugs, environmental factors such as pesticides, aluminum, and copper)
What We Know about Age and Alzheimer’s Disease
Of all the risk factors, age is a strong determinant of Alzheimer’s. While the incidence of Alzheimer’s is about 1 percent in those aged 60 to 65, it skyrockets to 33 percent in adults 75 to 80. Then, at 85, the incidence of Alzheimer’s boosts to 50 percent. Women are more likely to develop Alzheimer’s disease than men, even when accounting for age differentials. In study after study, researchers confirm that Alzheimer’s increases exponentially with age, until age 85 when it begins to level off. The reason why this occurs may be that those elderly adults who are genetically predisposed to Alzheimer’s already have the disease. Or, it might be that those elderly adults who are not genetically predisposed have lived an “anti-Alzheimer’s” lifestyle, or they may have the APOL e2 gene, which is potentially protective against Alzheimer’s.
Let me explain. We know that the apolipoprotein-E2 (APOL e2) gene is associated with resistance to Alzheimer’s disease, while the APOL e4 allele is associated with an increased risk for Alzheimer’s disease. There is a test that can show if you have the APOL e4 gene. Along like many physicians, I encourage patients to get this test. If they do have the APOL e4 gene that shows an increased risk of early Alzheimer’s, they can control their risk by adopting the 4-steps in the Anti-Alzheimer’s Prescription, changing necessary dietary and lifestyle habits to delay getting this horrific disease. Not all of my colleagues agree with this tactic, they say there is nothing we can do. I believe this attitude can be a self-fulfilling prophecy.
Theories of Aging
There are many theories of why we age. These reasons range from degradation of bodily proteins due to free radicals, cellular toxic waste build up, genetic-mutation, and autoimmune reactions (inflammation or when your body becomes allergic to itself). A number of other theories exist, such as those that view aging as a progressive response to stress. Another theory is aging is a result of a change in metabolic rate or gradual deterioration of the nervous system. There are facts that prove and disprove many of these concepts and theories, and the causes of aging are mysterious even to the most brilliant scientists. That said, the risk factors associated with an increase in the likelihood of Alzheimer’s are not in question at all. We know which factors increase the risk of Alzheimer’s disease, and I’ve outlined these in this article.
Telemerase and Aging
Zeroing in on the impact of stress on aging, neuroscientists find that chronic stress can lead to disorders like depression, diabetes, and cognitive impairment in aging. The reason? Scientists think that cumulative stress may lead to shortened telomeres and decreased telomerase activity.
Telomeres are specialized stretches of DNA that cap the ends of human chromosomes, helping to protect them from damage and degradation. Telomerase (from the Greek word “tele,” meaning “end”) is an enzyme that regulates the growth at the ends of chromosomes (bundles of DNA where genetic info is stored).
Scientists now believe telomeres are critical in aging. Each time a cell divides, its telomeres get a little bit shorter. Eventually, if the telomeres become too short to divide, the cell will die. Age-related diseases and premature aging syndromes are characterized by short telomeres. Some experts have suggested that preserving the telomere may protect the chromosomes, giving the cell a longer life and slowing the aging process. In other words, the telomere seems to act as a body’s “biological clock” that stops cell division and activates aging. This is believed to be the reason our anabolic hormones (growth, testosterone, and estrogen) wane with age and so do our reparative abilities. Aging is the inability to repair our bodies with sagging, wrinkled skin being the most obvious sign.
Some neuroscientists theorize that by keeping the cells alive and dividing, it may be possible to control age-related disorders ranging from some types of blindness to cardiovascular disease to autoimmune diseases like rheumatoid arthritis or multiple sclerosis (MS). These researchers have also discovered that by adding telomerase to the chromosomes of cells, the cells continue to divide and show no signs of aging or dying. One day, this work could lead to breakthrough drugs that will stop cells from dying and preserve the functioning of body parts-even the brain–that normally break down as we age.
I know you’ve read the latest media headlines on aging studies, claiming you can “turn back the clock.” The reality of life is that you cannot reverse your age. That said, I believe that we must assess all risk factors for Alzheimer’s in relationship to aging because aging affects all the risk factors. For instance, we characterize aging by a progressive loss of cell and tissue function, so that we become less fit to reproduce and survive. As we age, there is an imbalance between the anabolic and catabolic hormones. It’s now believed that this hormone imbalance is likely responsible for many of the psychiatric and medical diseases associated with aging-and even subtle changes in hormonal patterns can exert pathological effects on health over time. As an example, elevated levels of the stress hormone cortisol can reduce lean body mass, bone density, and fat distributions that result in osteoporosis and painful fractures, metabolic syndrome, type 2 diabetes, major depression – and Alzheimer’s disease. Specific lifestyle habits such as diet, exercise, mental activities, social ties, and relaxation can moderate chronic stress and reduce levels of cortisol.
What We Know about Family History and Alzheimer’s Disease
If you have a first-degree relative, meaning a parent or sibling, with Alzheimer’s disease, this means you have a 10 to 30 percent increased risk of developing Alzheimer’s, too. Also of importance are first-degree aunts, uncles, and cousins. Of course, various factors can interfere with this risk. For instance, if your relative developed Alzheimer’s late in life (after age 85), the risk of you getting Alzheimer’s is the same as someone who didn’t have a relative with the disease. That said, if your relative was young when he or she developed Alzheimer’s, then your risk of getting Alzheimer’s is higher. If they died early because of other diseases like cancer or heart disease, you must depend on the grandparents and immediate relatives to gain an understanding of your health history.
I encourage you to talk with your parents and your grandparents. Ask about your family mental health history. Do they remember aunts and uncles who may have had Alzheimer’s disease at a young age? Perhaps they remember a sibling or cousin who suffered with memory problems or cognitive dysfunction, yet no one ever diagnosed it as Alzheimer’s. Keep a record of family members who may have had Alzheimer’s disease-if not for your own benefit, then for the sake of your children and grandchildren.
On a side note, while family history is related to genetics, environmental factors can also contribute greatly to Alzheimer’s disease. For instance, Cameron, 44, came to see me to inquire about her personal risk for Alzheimer’s disease. She said she didn’t smoke, drank one glass of wine with dinner and had normal blood pressure and lipids. An active woman, Cameron was at a normal weight and in excellent health at the time.
Cameron’s greatest fear was her genetic risk of Alzheimer’s, as her father, Bert, was diagnosed with Alzheimer’s disease at age 62. Cameron described her father as a heavy drinker and smoker most of his life. He ate a diet high in saturated fat and had high blood pressure and type 2 diabetes for several decades. Each of these negative lifestyle habits and health conditions increased Bert’s chance of Alzheimer’s disease. Because Cameron was at a normal weight, physically active, did not smoke, drank wine moderately, and ate a healthy diet, her risk for developing Alzheimer’s was not nearly as high as her father’s. I challenged Cameron to go home, review her family tree, and see if other family members had Alzheimer’s disease.
When Cameron called my office the following week, she reported that no other relatives had Alzheimer’s disease. If her father was the only one with Alzheimer’s, maybe it wasn’t Bert’s genetic predisposition but rather his unhealthy lifestyle that destroyed his brain! I believe that lifestyle plays a strong role in 70 percent of Alzheimer’s patients.
Know the Alzheimer’s risk factors. Then work on changing those factors you can control so that Alzheimer’s never becomes a reality in your life.
My Genetic Risk for Alzheimer’s
Family history is my own major risk factor for Alzheimer’s disease with my father showing symptoms at age 72. I cannot rewrite my family history. However, I do take the following steps each day to reduce my risk of Alzheimer’s disease:
- Get 7 to 8 hours of sleep a night after treating my obstructive sleep apnea.
- Schedule and prioritize my day to prevent over commitments and undue stress.
- Eat a diet high in fruits, vegetables, whole grains, legumes, nuts and seeds, and fish.
- Exercise at least five times a week, 30 minutes each time of moderate exercise.
- Read, study, and continue to educate my brain daily.
- Take time to renew my spirit with meditation, prayer, and worship.
- Enjoy social gatherings with family and friends on a regular basis.
All of these steps are vital to keep my hormones balanced, to decrease levels of the stress hormone cortisol that increase with age, and to reduce the chances of Alzheimer’s disease-and all of these steps are within my control.
What We Know About Stress and Alzheimer’s Disease
Stress is a sentinel risk factor. You can’t avoid it, but you can learn to control it!
“Stressed out” is used to describe the impact of life’s stressors. When you’re stressed out, you feel increased anxiety, moodiness, distractibility, and a host of other physical symptoms. Studies now show that stress doubles or quadruples your chance of Alzheimer’s disease. My professional experience tells me that it’s much higher because stress is responsible for an imbalance in anabolic and catabolic hormones, even when we’re young.
If you want to know how stressed you are, look down at your expanding waist-the belly fat around the abdomen. Under stress, we begin to take on an apple or lollipop shape, and this shape is linked to a greater risk of heart disease, diabetes, high blood pressure, cancer, and, yes, Alzheimer’s disease. The bottom line is we now know that lifelong allostatic (stress) load may accelerate changes in the brain that can lead to memory loss.
Revealing studies in the field of psychoneuroimmunology now focus on the mind and body being interconnected, and in many cases, your emotional state can determine your physical well-being. In Step 4 of the Anti-Alzheimer’s Prescription, I discuss the importance of adopting coping strategies to deal with your emotional and physical stress, including not worrying by letting go, taking things one day at a time, finding purpose in life , strengthening meaningful social ties, exercising daily, and even working on your sleep quality. Studies confirm that adults who do not employ these coping skills are more vulnerable to chronic stress, higher levels of cortisol, and subsequent illness (the body only knows what the mind tells it!) I know that chronic stress leads to both physical and mental decline years before your time. There is a reason why after a good vacation friends will remark how well you look and conversely how bad when you are stressed and sleepless.
What We Know About Sleep and Alzheimer’s Disease
Sleep is the second sentinel risk factor that you must control. Work with your doctor to increase your sleep to 7 or 8 hours nightly.
With aging, sleep disturbances are frequently triggered by stress, emotional trauma, metabolic problems, muscle and joint pain, and low-grade inflammation. Poor sleep (less than 7 hours) can then lead to increased daytime fatigue with resultant diminished exercise causing worsened physical fitness and the establishment of a vicious cycle of inactivity and sleep disturbance with physical and mood-rated symptoms. As you will continue to read, many of the extrinsic risk factors for Alzheimer’s disease are linked to the two sentinel risk factors: chronic stress and poor sleep.
Sleep apnea, which occurs when you regularly stop breathing for 10 seconds or longer during sleep, is one of the most dangerous and undiagnosed diseases that also increases the risk of Alzheimer’s disease. Obstructive sleep apnea is caused by a blockage or narrowing of the airways in your nose, mouth, or throat that occurs when the throat muscles and tongue relax during sleep. I believe that sleep apnea may be responsible for the epidemic of Alzheimer’s that we see today, and the most prevalent symptom is snoring and daytime fatigue and irresistible sleep. If you or your loved one snores, talk with your doctor about ways to test for sleep apnea. If you have sleep apnea, follow your doctor’s instruction for treatment.
Quality sleep helps decrease pro-inflammatory markers in the body and also triggers human growth hormone. Human growth hormone can decrease by as much as 75 percent by the time the person is fifty-five-years-old and 90 percent by age seventy. Studies show that human growth hormone deficiency leads to obesity, loss of muscle mass, and a reduced capacity to exercise-and getting quality sleep may reverse these problems in older adults. Are you beginning to understand how taking care of the two sentinel risk factors – sleep and stress – can help you conquer other extrinsic risk factors?
By the way, I’m often asked why President Ronald Reagan had Alzheimer’s disease. After all, President Reagan was the picture of health and obviously ate right, exercised regularly and had no apparent genetic predisposition. However, what he did have was tremendous stress and probably associated sleeplessness as he dealt with ongoing crises in his position as the preeminent world leader. Through no fault of his own-but perhaps as a result of his position in life–he probably was at higher risk for Alzheimer’s disease.
What We Know About Obesity and Alzheimer’s Disease
If people keep gaining weight at the current rate, fat will be the norm by the year 2015, with 75 percent of Americans overweight and 41 percent obese. Using the body mass index (BMI), a key indicator of comparing weight to height, overweight individuals have a BMI of 25 to 30. Obese individuals have a BMI of 30 and above. The problem is, obesity increases the risk of Alzheimer’s disease by 300 percent for women and 30 to 50 percent for men.
Obesity represents a state of excess storage of body fat and is epidemic in the United States. An estimated 110 million adults in the United States (about 65 percent of the adult population) are clinically overweight or obese with a body mass index higher than 25. Researchers have clearly linked obesity with similar pro-inflammatory markers or physiological substances in the blood that indicate disease when present in abnormal amounts. These markers of inflammation are also linked with Alzheimer’s.
Obesity, particularly abdominal obesity, is associated with insulin resistance that often leads to type 2 diabetes mellitus. While poorly understood, we now know that adipose or fatty tissue is a major endocrine organ that produces hormones just like other organs in the body and secretes influential pro-inflammatory chemicals, messengers that contribute to low-grade inflammation.
It is thought that as fat tissue in the body increases, the blood vessels feeding this tissue are not sufficient to maintain a normal oxygen supply and there is a localized reduction of oxygen. This triggers pro-inflammatory reactions, which can produce more cell-damaging substances in the body. Obesity can cause this response to go out of control and can add to health problems such diabetes mellitus, hypertension, heart disease and some types of cancer. High levels of dopamine and serotonin help you control your weight. Both dopamine and serotonin depend on adequate sleep.
The increase in the concentrations of pro-inflammatory markers is now suspected to play a determinant role in the development of Alzheimer’s disease. In other words, the fatter you are, the higher the levels of pro-inflammatory markers, and the increased chance of other illnesses as well as Alzheimer’s with aging. When pro-inflammatory markers activate fat cells in the obese person to produce even more pro-inflammatory markers, a vicious cycle of obesity, inflammation, and brain disease has begun.
Women and Alzheimer’s Disease
When people ask me why Alzheimer’s disease is more prevalent in women, I tell them that body fat is one of the reasons. Women have a greater fat to muscle ratio with a subsequent increase in pro-inflammatory markers and oxidated stress that result in cell damage.
Obesity Inflammation Alzheimer’s Disease
The cause of obesity is simple: our input exceeds our output. In simple words, we eat more than we exercise. However, why are some people able to control their eating and others are self-abusive? Why is it that we can control our diet at certain times, yet at other times we are completely out of control? Does our lack of dietary control correlate with times of high stress and sleeplessness? You betcha! Obesity is the result of an imbalance in your hormones. With aging, there’s a decrease in the neurotransmitters dopamine and serotonin (associated with both stress and sleeplessness), which is linked to an increase in appetite and addictions. Recent research has revealed that a drop in dopamine levels signals the hypothalamus to action. Within the hypothalamus are our carnal appetites; our rage area is right next to our appetite. These are areas you’d like to keep calm-not active!
Body Mass Index and Alzheimer’s
In one 27-year study of more than 10,000 volunteers, obesity was linked to a 74 percent increase of the risk of Alzheimer’s; overweight participants had a 35 percent increased risk. Other findings link a higher body mass index with a decline in cognitive function in healthy individuals aged 32 to 62 years.
The problem is, in most obese patients, not only do they suffer from obesity, but they also have coexisting health problems. One patient, Ginah, age 51, came to see me about her own family history of Alzheimer’s disease, as I had diagnosed her mother two years before. Problem is, not only did Ginah have the risk of family history, but she had her own health risks, too. Ginah was considered obese with a BMI of 31. The lab tests taken at her last doctor’s exam revealed that she had high triglycerides, high LDL (“bad”) cholesterol, and low HDL (“good”) cholesterol. (You want your triglycerides and LDL cholesterol to be low; your HDL cholesterol should be high.) Ginah’s lab results also indicated that she had metabolic syndrome or insulin resistance, which occurs when the body steadily becomes less responsive to the actions of insulin. Despite high levels of insulin, the blood sugar levels rise and eventually type 2 diabetes results. People like Ginah, who are insulin resistant, tend to gain belly fat with increasing waistlines (the apple shape as opposed to the pear shape).
Diet plays a role in obesity and in Alzheimer’s. For example, a diet high in saturated and trans fats appears to be associated with an increased risk of cognitive dysfunction and developing Alzheimer’s. Because oxidative stress is important in the pathogenesis of Alzheimer’s, a diet high in antioxidants, particularly foods containing vitamin E, may decrease the risk of getting this brain disease.
Obesity in women causes a three-fold increase in Alzheimer’s disease. In men, it is less than this (30 to 50 percent), but it’s still significant. In fact, it’s pretty much set in stone that obesity at midlife is a risk factor for Alzheimer’s in later life. Here’s what you can do starting today:
- If your BMI is above 30, check here ______. You are at higher risk for Alzheimer’s disease.
- If your waist/hip ratio is higher than .80 for women or higher than .95 for men, check here _____. A waist/hip ratio in this range puts you at higher risk for Alzheimer’s disease.
Following the specific strategies in steps 1 and 2 of the Anti-Alzheimer’s Prescription, you can change the way you eat and move around and start losing the excess pounds. In doing so, you will also reduce your risk of Alzheimer’s later in life.
What We Know About Hypertension and Alzheimer’s Disease
Hypertension or high blood pressure is another extrinsic risk factor for Alzheimer’s. Not only can elevated levels of blood pressure cause damage to the blood vessels throughout the entire body, but also hypertension leads to heart attacks. We’re now learning that problems with the heart and brain share common triggers and characteristics including inflammation, oxidative stress, and hypoxia, an oxygen deficit caused by impaired blood flow.
High blood pressure makes your heart work harder than it should, putting stress on the heart muscle and arteries and setting them up for possible injury. The effects of hypertension are profound, including the following:
- For every 7 mm Hg increase of diastolic blood pressure, the risk of stroke increases by 42 percent.
- For every 7 mm Hg increase of diastolic blood pressure, the risk of heart attack goes up by 27 percent.
- Findings show that higher levels of baseline systolic, diastolic, and mean blood pressure in both younger and older age groups are significantly associated with decline in cognitive ability (this means that young adults are just as vulnerable as older adults to blood pressure related dementia).
- The Rotterdam study was started in 1990 in Ommoord, a suburb of Rotterdam, among 10,994, men and women aged 55 and over to investigate the prevalence and incidence of and risk factors for chronic diseases in the elderly. This study found that a high diastolic pressure five years before magnetic resonance imaging (MRI), a type of brain scan, in patients with untreated hypertension was associated with hippocampal atrophy (which means the loss of neurons that are needed for learning and memory.
The causes of hypertension are many. Some reasons are genetic but the majority of hypertension cases are self-induced-such as hypertension resulting from chronic stress. With increased stress, the catabolic hormones cortisol and aldosterone soar, resulting in retention of sodium with increased blood volume and resultant higher blood pressure. Sleeplessness can also increase levels of cortisol at night time, keeping you in a state of constant alarm and making you crave carbohydrates (a key reason of night time refrigerator raids).
Keep regular tabs on your blood pressure and talk to your doctor about the best medications, if necessary. If medications are prescribed, take them religiously. Follow up with your doctor regularly to make sure the blood pressure medications are working. Adequate treatment of blood pressure has been shown by many large clinical trials to reduce the risk of heart disease, stroke, and, possibly, Alzheimer’s disease.
For some people, eating a healthier diet, exercising more, losing weight, and managing stress may help to reduce high blood pressure with or without medication. Find the answers that work best for you and work with your doctor to keep your blood pressure in a normal range.
What We Know about Abnormal Lipids and Alzheimer’s Disease
With increased reports of a connection between the heart and the brain, we’re learning that abnormal lipids (high LDL bad cholesterol, low HDL good cholesterol, high triglycerides) not only increases the risk of heart disease, but also increases the risk of brain disease (Alzheimer’s). Simply put:
- Elevated LDL (“Bad”) Cholesterol Increases the Risk of Alzheimer’s Disease
- High Levels of HDL (“Good”) Cholesterol Decrease the Risk of Alzheimer’s Disease
- High Triglycerides Increase the Risk of Alzheimer’s Disease
Check the chart below to determine if your cholesterol levels are normal or abnormal (LDL is high; HDL is low). Then take steps to lower your LDL (“bad”) cholesterol with lifestyle modifications such as reducing intake of saturated fats and cholesterol, eating more high-fiber fruits, vegetables, and whole grains, losing weight, and increasing physical activity. All of these lifestyle measures are covered in the 4-step Anti-Alzheimer’s Prescription. Now if you use the lifestyle measures and still have high LDL cholesterol, talk to your doctor about medications that can reduce LDL cholesterol.
ATP III Classification of LDL, Total and HDL Cholesterol (mg/dL)
|100-129||Near optimal/above optimal|
|>/= 190||Very high|
What We Know about Diabetes and Alzheimer’s Disease
Diabetes is defined as elevated levels of sugar (glucose) in the blood. Type 2 diabetes, often called non-insulin dependent diabetes, is the most common form of diabetes, affecting 90 to 95 percent of the 21 million people with diabetes in the United States. About 54 million Americans over age 20 suffer with pre-diabetes, which causes higher blood glucose levels than normal. Problem is, a large portion of these individuals do not even know they have diabetes or are at risk for diabetes. That’s because many times pre-diabetes and type 2 diabetes have no signs or symptoms until damage is done to internal organs.
In diabetes, there is either too little insulin being produced (type 1 diabetes) or there is a resistance to the existing insulin levels in the blood (type 2 diabetes). Insulin is a hormone produced by the pancreas that facilitates the movement of sugar from the bloodstream into the cells of the body.
A simple test that measures the level of blood sugar in the body can determine if you have diabetes. You have diabetes if you have a fasting blood glucose level of 126 mg/dl or higher. You have pre-diabetes if your fasting glucose level is between 100 and 125 mg/dl. If you have pre-diabetes, talk to your doctor about steps you can take right now to prevent type 2 diabetes.
Diabetes mellitus is an independent risk factor for coronary artery disease, stroke, and Alzheimer’s disease. Some large studies have found that diabetes is associated with an increased risk of cognitive decline and Alzheimer’s. Findings also indicate that diabetes is associated with a 50 to 100 percent increase in risk of Alzheimer’s disease and of dementia overall, and a 100 to 150 percent increased risk of vascular dementia. Scientists have determined a relationship between hyperinsulinemia and insulin resistance in the brain, as well as a relationship between insulin and beta amyloid metabolism.
The American Diabetic Association encourages all people over age forty-five to have a blood glucose test every 3 years. Early detection for diabetes will let you get proper treatment and prevent complications before there are serious problems.
Kids and Alzheimer’s Prevention
Diabesity is a term coined by Dr. Fran Kaufman at Children’s Hospital Los Angeles. Diabesity, the triad of a high potency sugar diet, obesity, and the subsequent type 2 diabetes, is rapidly developing in children. Parents (and grandparents) must monitor their kids’ diets to create a healthier habit environment where foods high in simple carbs (sugar, white four) are scarce, digital games are minimized, and exercise is maximized. Get up and get your child or grandchild to exercise with you. They’ll love it, and it shows that you love them.
Controlling Cardiovascular Risk Factors for Alzheimer’s
It’s not news that smoking, hypertension, abnormal lipids, and diabetes are key risk factors for cardiovascular disease. But new findings confirm that these cardiovascular risk factors at midlife may increase the risk of Alzheimer’s in old age. In one study, if participants had one of the four cardiovascular risk factors at age 40 to 44, the associated risk of Alzheimer’s was increased to 20 to 40 percent. If study participants had two of the risk factors, they were 70 percent more likely to have Alzheimer’s. If individuals had all four risk factors-smoking, hypertension, abnormal lipids, and diabetes-they had a 237 percent (2.37 times) greater risk of getting Alzheimer’s.
Treating the risk factors for cardiovascular disease and Alzheimer’s using the 4-step Anti-Alzheimer’s Prescription can decrease the risk of both debilitating illnesses and let you enjoy optimal health in your older years.
What We Know about a Sedentary Lifestyle and Alzheimer’s Disease
Lack of exercise compounds the detrimental effects of eating too much. According to the US Department of Health and Human Services, adults 18 and older need at last 30 minutes of physical activity on five or more days a week to be healthy; children and teens need 60 minutes of activity a day for their health. Some recent findings show that only 30 percent of our kids in the United States get 30 minutes of exercise at one time each week. The lack of exercise in our children is a grave problem that all adults-parents and grandparents-must take seriously in order to improve the health of our nation.
So we know we need physical activity to stay well and be productive. Then why do 37 percent of adults report they are not physically active? Only 3 in 10 adults get the minimal amount of physical activity each day.
Adults who engage in regular physical activity and exercise are leaner and have higher levels of good HDL cholesterol and lower blood pressure than adults who do not exercise. Physical activity can also reduce the chance of obesity, insulin resistance, and type 2 diabetes-all risk factors for Alzheimer’s disease.
Regular exercise also helps to decrease our stress levels. As discussed, chronic stress triggers the catabolic hormone cortisol, which is found in high levels in those with Alzheimer’s disease. In animal studies, researchers have found markedly diminished cortisol levels in stressed mice who exercise. Exercise is also important for stimulating the anabolic hormones such as testosterone, estrogen, progesterone, and human growth hormone-all hormones that decrease with aging. Another benefit of exercise is that it increases neurogenesis, the creation of new brain cells, and neuroplasticity, the maturation of those brain cells into the type the body needs. With exercise, these processes stimulate some trophic hormones such as brain-derived trophic factor (BDTF) that will increase the number of cells and dendrites in the brain for connecting arms or dendrites that make us brighter in the hippocampus, the learning center of the brain. If you were a computer, exercise would be like giving your CPU an upgrade!
Exercise also increases lean muscle mass. Lean muscle burns 9 to 15 calories per pound at rest while fat burns only 2 calories per pound at rest. Exercise rids the body of excess glucose, especially postprandial glucose (after a meal), so that the glucose is not converted by insulin into fat. For this reason, exercising after a meal when blood glucose is high is beneficial. Exercise has a direct effect on insulin by suppressing it. Exercise also has a direct effect on leptin and grelin, helping to decrease our appetite while increasing our metabolism.
I recommend that you engage in 30 minutes of moderate aerobic physical activity at least three times a week-and every day if you can do it. With the exercise program I prescribe, there is no excuse not to exercise daily. Exercise will reduce your waist size and BMI – both risk factors for obesity that quadruples the risk of Alzheimer’s in women, and increases the risk by 30 percent in men. Exercise also decreases levels of cortisol and stimulates human growth hormone production. It’s vital for nerve growth and the health of dendrites and synapse, which are important in retrieving memories and maintaining neurons to store in that memory.
What We Know about Homocysteine and Alzheimer’s Disease
While you may know your blood pressure reading and cholesterol numbers, other indicator numbers are also very important to your health- today and in the future. One of these is the level of homocysteine in the blood. Homocysteine is a nonessential sulfur-containing amino acid that’s formed by the conversion of methionine to cysteine. When elevated, this number is a warning that inflammation is destroying the body. If your serum homocysteine level is higher than 12, you may be in trouble; higher than 14-you are in trouble. You do not need surgery, radiation or chemotherapy to reduce this number-only the 4-step Anti-Alzheimer’s Prescription.
Elevated homocysteine levels are a clear indicator that your hormones are imbalanced and it’s about to get much worse as homocysteine can destroy your heart, your pancreas, and finally, your brain.
Homocysteine is an independent marker of the risk for cardiovascular disease, including ischemic heart disease, stroke, and peripheral vascular disease (fatty deposits in the peripheral arteries). In fact, many experts rank homocysteine as equal in importance to LDL (“bad”) cholesterol. Homocysteine makes blood clot more easily than normal and increases the risk of heart attack, as well as death by heart attack.
It was in the early 1960s when scientists linked homocysteine to neuropathy, a disease or abnormality of the nervous system. Since then, we’ve learned that serum homocysteine, similar to a sticky acid, increases with age, and elevated levels of total homocysteine are associated with atrophic changes in the hippocampus and cortical regions in the brain, particularly in the elderly at risk of Alzheimer’s disease. Numerous studies now indicate that plasma homocysteine concentrations are inversely related to cognitive function in older adults – meaning higher levels of plasma homocysteine might indicate a decrease in cognitive function. As an illustration, some findings conclude that the chance of getting Alzheimer’s disease is 4.5 times greater for those with higher levels of homocysteine compared to those with low levels.
Aware for some time that high levels of homocysteine may also be associated with poor cognitive function, scientists have theorized that reducing homocysteine may also reduce the chance of Alzheimer’s, or, better still, increase cognitive function. What if preventing or delaying Alzheimer’s were as easy as eating the right foods? Who among us wouldn’t eagerly agree to this daily regimen?
Current findings show that taking supplements of the B vitamins, including folic acid and vitamins B6 and B12 may be necessary to lower elevated homocysteine levels. I believe that homocysteine can also be managed with the right diet, including these nutrients found in whole foods:
- Folate, which is abundant in green leafy vegetables, oranges and fortified cereal
- Vitamin B 6 and B-12 are found in fortified cereals, potatoes with skin, and bananas.
If you don’t know your homocysteine level, call your doctor and find out soon.
What We Know About C-Reactive Protein and Alzheimer’s Disease
C-reactive protein is a special type of protein produced by the liver that is only present during episodes of acute inflammation. High levels of C-reactive protein are highly correlated with obesity, cardiovascular disease, diabetes, and cancer. Some groundbreaking findings now indicate that there are elevated levels of C-reactive protein in patients with Alzheimer’s disease.
People who smoke, have high blood pressure, are overweight, and don’t exercise often have elevated levels of C-reactive protein, whereas lean, active people usually have lower C-reactive protein levels. We now know that individuals who are prone to anger, hostility and depressive symptoms respond to stress with increased production of the stress hormones norepinephrine and cortisol, among others. Scientific evidence suggests that an increase in stress hormones activates the inflammatory part of the immune system and triggers the expression of genes that cause low-grade inflammation, which is characterized by high levels of C-reactive protein and other pro-inflammatory markers.
In a fascinating study done at Duke University, healthy volunteers were asked to describe their psychological attributes, including anger, hostility and depression. The volunteers did not have conditions such as cardiovascular disease or high blood pressure that would predispose them to having high C-reactive protein levels. The researchers used blood tests to measure the C-reactive protein levels and found that the volunteers who were prone to anger, had high hostility levels, and showed mild to moderate symptoms of depression had two to three times higher C-reactive protein levels than the calmer volunteers. Researchers concluded that the more pronounced their negative moods, the higher C-reactive protein levels they had.
The inflammatory response in the body not only destroys the cells intended, but the surrounding tissue. As we age, this out of control inflammation may be producing Alzheimer’s.
Scientific methods have now revealed that both plaque and tangles seen in the brains of Alzheimer’s victims contain many markers of inflammation. The plaques are full of cytokines or prostaglandins, markers of inflammation in the body. Most important of all, the microglia, the brain’s roaming professional killers, are prominent in Alzheimer’s type plaques. It is now thought that microglia play the key role in attacking neurons near plaques. The neurons in the vicinity get badly burned as part of the collateral damage.
The problem with inflammation and destruction in the brain is that we can’t see it or feel it; the brain has no pain sensitive neurons. So unlike arthritis where you might feel pain that indicates inflammation, the inflammatory attack in your brain goes undetected until Alzheimer’s has us in its clutches. Not every brain will suffer the same. As you’ve learned by now, those individuals who are most affected are those with hypertension, diabetes, head trauma, poor diet, sleeplessness and emotional stress.
The good news is that by controlling the other health risk factors for Alzheimer’s disease – obesity, hypertension, type 2 diabetes, homocysteine, stress, sleep disorders, and more-you can decrease C-reactive protein and other markers of inflammation in the body.
What We Know About Metabolic Syndrome and Alzheimer’s Disease
Another related problem is insulin resistance syndrome or metabolic syndrome, a combination of health problems that includes obesity, type 2 diabetes, high blood pressure, abnormal cholesterol levels, heart disease, and polycystic ovarian syndrome (PCOD), and also increases the risk of Alzheimer’s disease. It’s estimated that from 25 to 33 percent of baby boomers have insulin resistance syndrome, perhaps resulting from the low-fat, high carb diet phase of the 1970s.
According to the American Heart Association and the National Heart, Lung, and Blood Institute, they recommend that the metabolic syndrome be identified as the presence of three or more of these components:
- Elevated waist circumference Men – equal to or greater than 40″ Women – equal to or greater than 35″
- Elevated triglycerides Equal to or greater than 150 mg/dL
- Reduced HDL (“good”) cholesterol Men – less than 40 mg/dL Women – less than 50 mg/dL
- Elevated blood pressure Equal to or greater than 130/85 mm Hg
- Elevated fasting glucose Equal to or greater than 100 mg/dL
Not only does metabolic syndrome greatly increase one’s risk for heart attacks, strokes, and diabetes, it’s a major risk factor for Alzheimer’s disease.
If you are insulin resistant with the triad of increased blood sugar, abnormal cholesterol, and obesity-all risk factors for heart disease–talk to your doctor about a glucose tolerance test. If you have type 2 diabetes, follow your doctor’s instructions about diet, exercise and other lifestyle changes you must make to self-manage this common disease. If you do not have type-2 diabetes, focus on losing weight and exercising daily to manage your blood sugars and to prevent diabetes from happening to you. For many people, weight loss alone will help prevent type-2 diabetes and keep insulin resistance syndrome from damaging the heart, brain and other organs.
Other Emerging Risk Factors for Alzheimer’s Disease
Of course, still other risk factors for Alzheimer’s are emerging. For example, studies show that people who have higher education or continue to learn throughout their lives may be at lower risk of Alzheimer’s disease than those who have less education. Please note that by education, researchers are not referring to the number of years of formal education. My uncle Louie had only a 3rd grade school education but was one of the most self-educated men I knew and lived to be a bright 94-year old. What findings show is that people who continue to learn-by traveling to new places, reading books, visiting art galleries and museums, and discussing their findings with family and friends, doing crossword puzzles daily, playing a musical instrument or learning a new language – boost the size of their brain reserve and reduce their chance of Alzheimer’s disease. You don’t need a college education to do this!
Findings indicate that people who have a strong social network with friends and family members may have a lower risk of Alzheimer’s disease than those who are loners and spend a lot of time cocooning without interaction with others. As our family unit begins to disintegrate, the elderly become increasingly isolated. This is a tremendous social issue and one that we need to address individually, as families, and as a nation.
Still other studies link cigarette smoking with Alzheimer’s disease. Smoking does increase blood pressure, causing the arteries to constrict, and increases the likelihood of clots to form and obstruct the arteries. Smokers also have higher levels of LDL (“bad”) cholesterol and lower levels of HDL (“good”) cholesterol-all risk factors of Alzheimer’s disease. In addition, researchers are trying to determine the causal role for aluminum or other transition metals (copper, zinc, iron) in Alzheimer’s disease. While the link between Alzheimer’s and chemicals and toxins in our food and environment has not been confirmed, there is some increasing evidence that elevated levels of these particular metals in the brain may play a role in the development of Alzheimer’s. In addition, we know that Alzheimer’s patients invariably have high levels of copper in the brain, which has led researchers to link copper to this form of dementia. I always tell my patients to check their vitamin labels to see if there is added copper. If so, toss the vitamins and find a brand without copper.
While researchers continue to seek the perfect pill to stop Alzheimer’s disease, I believe there is a better way. Years of clinical research and treating patients have shown that the key intervention to stopping or reversing Alzheimer’s disease is a multi-faceted approach. Learning how to control your risk factors for Alzheimer’s disease is essential to prevention. With some daily discipline, you can accomplish the goal of enjoying your later years in life and living independently as long as possible.