Food For Thought
It's been interesting transitioning from 13 months of non-stop warm weather international adventure to waiting alone in limbo in my parent's 55+ community (they are Florida snowbirds) in Massachusetts, enduring one Nor'easter after another while I wait in limbo for my California NP license to process. Mentally I am ready to return to full-time employment, so the waiting period has been slightly frustrating, but really I have nothing to complain about. I had an unbelievable year and this down time has been a great opportunity to catch up with friends and make a solid dent on an ever lengthening reading list. During my reading, I've come across a lot of intriguing, groundbreaking research relating to lifestyle and brain health. I'm obviously a long-time believer in using lifestyle medicine to prevent and manage the majority of chronic diseases, but while it seems intuitively obvious that gorging oneself on processed foods can't be good for your brain, I hadn't read a lot about lifestyle and brain health (outside the realm of mental health). That's why I was particularly interested when I heard about 'The Alzheimer's Solution' by Drs. Dean and Ayesha Sherazi, who are co-directors of The Brain Health and Alzheimer's Prevention Program at Loma Linda University Medical Center in California. I think this book is applicable to EVERYONE of ALL ages and I highly recommend reading it, but I will do my best to summarize their research over the course of a few sequential blog posts.
It's popular belief that mental fogginess and short-term memory problems are normal signs of aging and that dementia and Alzheimer's are a result of being dealt a poor genetic hand. For decades scientists have struggled to better understand dementia and Alzheimer's and to discover a cure. Unfortunately, there is no drug or surgical treatment that prevents or reverses the disease and those medications prescribed to slow the progress of the disease (like Aricept and Namenda) are largely ineffective. As with most medical maladies, the research focus on brain related diseases has been on finding a cure rather than understanding the root causes and determining preventative methods.
While our nation has poured millions of dollars into Alzheimer's research over the last few decades, deaths from Alzheimer's have steadily increased. It is currently the 6th leading cause of death in the U.S., however many researchers believe it's underreported (for example when a death certificate lists the cause of death as malnourishment in a person with Alzheimer's whose medial temporal cortex, a part of the brain involved in feeding behavior and memory, is significantly affected as the disease progresses) and is more likely the 3rd leading cause of death. Presently there are about 47 million people living with Alzheimer's, but if we continue on our current trajectory, predictions are that dementia will affect up to 135.5 million people worldwide by 2050. This all sounds pretty dismal, but the good news (news that definitely isn't mainstream though is becoming more widely disseminated), is that lifestyle choices can prevent up to 90% of Alzheimer's cases. For the 10% of cases that can't be prevented due to very strong genetic risk (such as in those that carry the APOE4 gene), lifestyle changes can delay presentation or progression of the disease by up to 15 years.
This may be difficult to process for people that have had or have loved ones suffering from any degree of dementia or if you yourself are struggling with cognitive decline, but this information is meant to educate and empower. Fortunately, incremental lifestyle changes at any age can lead to tremendous benefits.
There are 4 biological processes that contribute to the development of dementia and most commonly it's varying combinations of these factors (for example someone that starts with lipid dysregulation goes on to develop chronic inflammation) that contribute to the disease. The processes are:
- Inflammation- there are two types of inflammation- acute and chronic. Acute inflammation actually serves very useful purposes, like wound healing and fighting off bacteria and viruses. Chronic inflammation, which occurs when the inflammatory response is activated long term from constant assaults like regular intake of processed foods and chronic stress, is destructive and starts to damage tissue, including brain tissue.
- Oxidation- this happens naturally when oxygen reacts with other substances and as a result changes them (like when an avocado turns brown after you cut it). Oxidation produces a by-product called free radicals which are missing an electron, making them super unstable and reactive. The instability incites them to swipe electrons from other molecules. This happens all over the body (contributing to aging and disease) and in the brain free radicals take electrons from neurons, glia, organelles, proteins, lipids, fatty acids and DNA- causing permanent damage. The brain consumes 25% of the body's oxygen and the space in our head that houses the brain is a closed system, which makes it particularly sensitive to oxidation. The brain is complex though, so there are special cells and molecules for clearing these byproducts, but these are often damaged by years of poor lifestyle behaviors, like poor diet and lack of exercise. And so free radicals build up, causing damage to our beloved brain.
- Glucose dysregulation- When we eat a diet filled with sugar (not the natural kind from fruits and vegetables, but the kind in a Snickers), refined carbs (like Sunbeam bread), and animal protein and fat, the mechanisms responsible for maintaining our glucose start to go haywire. Insulin is a hormone that helps regulate glucose levels and allows our body to harness glucose for energy. Glucose is the main source of energy for our entire body. When insulin binds to a cell, the cell's receptors bring glucose into the cell to use as energy. However, when there is too much intramyocellular fat (fat in and around muscle cells mostly resulting from meat and high-fat dairy consumption) cell receptors become desensitized to the effects of insulin, which means glucose levels rise outside the cells but aren't drawn in for utilization and the cells end up starving from lack of glucose. Additionally, high insulin levels in the blood trigger a cascade of inflammation, oxidation, dysregulation of lipids (see #4 below), and creation of tau protein (a protein tied to Alzheimer's). So the consequences of a damaged glucose regulation system are deleterious and these negative side effects are compounded in the brain given its significant energy requirements (the brain compromises 2% of our body weight, but uses up to 25% of the body’s energy).
- Lipid dysregulation- Lipids are fat-like substances that form the building blocks of cell walls, hormones, and steroids. They are critical to cell structure, energy storage and cell signaling. Lipids are utilized throughout the whole body and comprise more than 50% of the brain's dry weight- that means half of your brain is made up of fat! When our bodies are inflicted with excess dietary lipids (from cheese for example), chronic inflammation, oxidation, and other forms of chronic stress, lipid transport and metabolism are impaired which leads to lipid oxidation and consequently even more harmful by-products. There are many negative processes that can occur as a result of lipid dysregulation, but two especially harmful processes in terms of brain health include 1) accumulation of cholesterol in the blood vessels which eventually form artery clogging plaques that cut off the blood supply to small vessels and later, larger blood vessels (including vessels that supply blood and oxygen to the brain) and 2) the formation of amyloid plaques (brain pathology strongly associated with Alzheimer's).
The biological processes come first, followed by the physical pathology of varying degrees of cognitive decline (from mild short-term memory loss and difficulty focusing to Alzheimer's), and so contrary to popular belief, cognitive decline isn't necessarily a normal sign of aging, but rather a side effect of years and years of cumulative lifestyle habit related assaults to the body that provoke several different disease processes. Fortunately there are protective lifestyle habits that can prevent or mitigate these processes, thereby preventing cognitive decline. The choices you make on a daily basis right now influence the future of your brain health. The good news is what is good for the brain is also good for the rest of the body.
There are 5 main lifestyle tenets for optimizing brain health that I will cover over the course of this blog series. They include: nutrition, exercise, stress management, sleep and regularly engaging in complex cognitive activities. Stay tuned for a post about brain health and nutrition in the next few days.