Home Mind & Brain Rethinking Alzheimer’s: Why Diet and Lifestyle Could Hold the Key

Rethinking Alzheimer’s: Why Diet and Lifestyle Could Hold the Key

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The number of cases of Alzheimer’s is rising. Nearly a million people now have the disease in the UK and the number continues to rise: an estimated 6 million by 2050. A little over 20 years ago I discovered I have the gene, APOE4, which has been linked to a raised risk of developing Alzheimer’s. I have a strong personal interest in keeping up with the science on the subject.

As a medical and health journalist I was confident I could tap into new developments, but for years there was little to be hopeful about. Billions of pounds have been spent on pharmaceuticals that clear the deposits and tangles of sticky plaque found in the brains of sufferers and thought to be a cause of the disease.  But the results are far from impressive, with several hundred failed trials of plaque-busting drugs, that barely moved the dial on the rate of brain cell death in sufferers. 

The cavalry 

Enter independent researchers and academics with a simple and hugely encouraging idea: there is no single cause because brains are not isolated in a bony box but have a two-way connection with almost all the systems at work in our bodies. So, you need to keep these systems in a healthy state, to ensure the same for your brain. 

The main areas include the cardiovascular system, your metabolism (how energy is used), the immune system, the vast colony of bacteria and other microbes (the microbiome) in your gut, and the processes involved in rest and repair.  The very good news is you could start making changes to all of them with diet and lifestyle today.

I’ve been exploring this radical new approach with the help of my nutritionist friend and co-author Patrick Holford, who runs a charity called foodforthebrain.org. Their website is a mine of information where you can take a free cognitive function test and discover your Dementia Risk Index (DRI) based on answers to a questionnaire designed to reveal your mental and physical health. 

The “Food for the Brain” test explores things like how well you handle cognitive challenges, how effective is your exercise regime, how well you sleep, what your diet and social life is like and how effectively you look after the microbiome, home to much of the immune system. 

The team

Guiding the advice is an impressive scientific board of a dozen consultants and researchers, whose work focuses on Alzheimer’s, including Professor Emeritus David Smith of Oxford who has run pioneering studies on the brain-sparing combination of B vitamins and omega3 fats, Professor Emeritus Robert Lustig, expert on the metabolic effects of blood glucose and insulin at the University of California San Francisco, and Dr Tommy Wood, Assistant Professor of paediatrics and neuroscience at the University of Washington whose studies are uncovering why exercise is so good for the brain.  

In addition, there is a home pin prick biochemical test, available alongside the DRI that few doctors’ surgeries would routinely check. It measures your omega-3 index, vitamin D, homocysteine (a marker for B vitamin status), and HbA1c.

HbA1c shows a person’s blood sugar resilience and is used to diagnose diabetes. Professor Lustig has shown that if it is too high, it could be damaging brain cells and causing weight gain. “Essentially, lowering blood sugar changes your metabolism in ways that help reduce Alzheimer’s risk,” he says. 

The high levels of blood glucose from a carb-rich diet will come with too much insulin because its job is to clear it away into storage as fat. Fairly soon, however, your system stops responding to insulin – insulin resistance – which is bad news because insulin delivers the glucose needed for energy in the brain and muscles.”

The members of the board emerged as a crack team of biological engineers, with a grip on nutrition and the effects of lifestyle that few regular doctors could match. What they also had was a deep knowledge of the underlying biology and how to shift it in a healthier direction. 

The science

Lustig’s account of the body’s work-around for the glucose shortage is a perfect example of a biologically based approach at work. When glucose supplies drop, the liver switches to making small packets of energy, known as ketones, from its fat stores, which are a perfect fuel for the brain and muscles. Dietitians still warn against the ketogenic diet.

The last strand of Food for the Brain’s approach involves testing for nutritional and vitamin deficiencies that directly affect the brain and boosting them if they are low.  But it is here that the charity comes into direct conflict with rest of the Alzheimer’s establishment, especially over giving high doses of vitamin B6, B12 and folate.

It’s a perfectly logical approach and is now backed by an impressive body of trial evidence gathered over the last ten years.  However, the Alzheimer’s charities have doggedly refused to examine it, test it themselves or recommend it. In fact, they seem to deny it exists. 

The battle dates back ten years when Oxford Professor of Pharmacology David Smith, who was the Chair of the charity’s scientific advisory board, ran a trial on over 200 people with Mild Cognitive Impairment (MCI), sometimes called pre-dementia, when memory and clear thinking is starting to go. It’s the stage before an Alzheimer’s diagnosis. 

Half got a high dose of the B vitamins, the others a placebo. Crucially, a proportion of each group had a brain scan at the beginning and end of the trial to check for changes. The patients were also tested for levels of a potentially toxic protein called homocysteine, known to be found in Alzheimer’s patients’ brains. B vitamins were used because they are the only way of lowering homocysteine.

The results

The results were astonishing. Brain shrinkage – a critical indicator of Alzheimer’s – was 73% greater in the placebo group than among those getting the vitamins, especially in those with good omega-3 blood levels. 

You might have expected such dramatic good news would have been rushed out by the Oxford press office. Instead, even though the results seemed to promise a safe, effective, and cheap treatment, they were ignored, both by the Oxford press office, and by the charity Alzheimer’s Research UK (ARUK), set up to investigate promising research, which had partially funded the trial.

Undaunted by this refusal to acknowledge his work, Smith continued, unsuccessfully, to apply for funding for the obvious follow up, to find out if giving B vitamins to patients with mild cognitive impairment (MCI), slowed or blocked the progression to Alzheimer’s.

The boost from good levels of omega-3 fats also makes sense at a biological level because the omega 3 is needed inside brain cell membranes where they transfer information, while the B vitamins are needed to bind them in. They are like a hammer and a nail.

I became more intrigued by the potential of B vitamins when I discovered they provided the answer to my personal quest – how to lower the risk from the APOE4 gene. Again it was a matter of following the underlying biochemistry. B vitamins are essential for a process known as methylation, which is the way that the action of genes, such as APOE4, can be changed.  Omega-3 has become part of my daily cocktail of nutrients.

Meanwhile foodforthebrain.org has now tested 430,000 people and is aiming for a million by the end of next year.  As well as the questionnaire estimating your risk, tests are now available for blood sugar levels, omega-3, vitamin D and homocysteine to see if you need the B vitamins. The results of their ongoing research are shared with everyone.

It’s hard to understand the continuing refusal to test the effectiveness of B vitamins and the keeping of information from patients. Could something that can significantly reduce brain cell damage, costs pennies and has virtually no side effects be considered a serious threat to a billion-dollar market?  

The free Cognitive Function Test is available at Food for the Brain.

Jerome Burne is a medical journalist.

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