Adam's Corner

Stay Sharp: PART 1: Prevention

Natural Medicine to Prevent and Treat Age-Related Cognitive Decline and Dementia

This is one of those topics I’ve shied away from writing about for a long time, mostly because it’s hard to write about without either oversimplifying on one hand, or getting lost in the details on the other. 

There are mountains and mountains of research out there.  And that research is, for the most part, highly nuanced, and still inconclusive.  It’s nuanced because there are so many different kinds of dementia, with dozens if not hundreds of etiologies, and such a complicated matrix of risk factors, it’s enough to make you dizzy.  And it’s inconclusive because of the inherent difficulties in drawing solid conclusions from studies that track people, sometimes for decades, in the messy, confounder-filled Real World. 

Part 2, next month, will talk about treatment.  And it will be easier to write about.

So I’ll do my best.  I’ll talk about five things that I believe can prevent dementia.  I’m going to talk about general health, omega-3 fats, vitamin D, and using your brain.

Maintaining General Health may very well be the single greatest thing we can do to prevent Alzheimer’s disease and other forms of age-related dementia.  This may sound trite, or a little vague.  But it’s very real.  And surprisingly well-researched.   

No matter our age, we’re susceptible to what I’ll call “health setbacks” – random infections, surprise injuries, acute diagnoses, and other physiologic surprises.  When we’re younger, we tend to bounce back.  However, as we get older, falls lead more easily to broken bones, which leads more frequently to hospitalizations.  Infections can be more tenacious.  It may take us longer to recover, and we may not recover fully.

We see a lot of research connecting hospitalization in older age to an increased risk of dementia.  People who spend more time in the hospital tend to get dementia faster.  It doesn’t seem to matter what sends you to the hospital, either. 

However, I don’t think it’s the hospitals that are hurting us.  Rather, it’s the stress and trauma that sends us to the hospitals.  So, limit health setbacks by strengthening those bones, those muscles, that heart. 

Even when we take trauma and hospitalizations out of the equation, there are strong links between dementia on the one hand, and diabetes, high blood pressure, lack of exercise, and poor diet on the other.

In 2011, a study was published on 7,000 people enrolled in the Canadian Study on Health and Aging.  For 10 years, those 7,000 people were tracked, diagnoses of dementia, along with 19 other seemingly random health measures like broken bones, hearing loss, arthritis, gastric reflux, sinus problems, and poorly fitting dentures, were noted.  The only thing these 19 other health measures had in common is that, at the time, they were not considered to be related to dementia.  It turned out that, for every one of these health factors a person had, there was a 3.8% increased risk of developing dementia. 

What I think we’re seeing is not that these illnesses cause dementia.  Rather, it’s that these illnesses share underlying causes with dementia: inflammation, poor circulation, fluctuating blood sugar, stress, poor sleep, low vitamin D, insufficient methylation secondary to a B-vitamin deficiency, etc.  If this is true, the trick would be to get to the root of these diseases.  So instead of taking a painkiller for arthritis, control underlying inflammation.  Instead of drinking coffee to combat fatigue, sleep more.  That kind of thing. 

What’s especially interesting for me (seeing as how this is a health food store) is diet.  We see that diets higher in bad fats, and lower in good fats, are most problematic.  We see that sugar intake is a problem.  We see that fruits and vegetables help.  None of this is in question anymore. 

But almost all the research looks at elderly adults.  The question still remains: does diet in middle age or even young adulthood make a difference? 

One study published just this year scored 385 Finnish adults on a “healthy diet index” at age 50.  The index wasn’t complex:  you got points for eating fruits, vegetables and healthy fats, and lost points for sugars, salty foods and trans-fats.  Fourteen years later, subjects were evaluated again.  Those who scored highest on the healthy diet index had a 90% reduction in dementia risk vs. those who scored the lowest.

That’s pretty impressive.  And then the optimist in me sees that, and wonders if we couldn’t do even better: what if we moved the merely simplistic measures of a healthy diet (salt, sugar, fat) into something more complex that weighed freshness, sprouting, seasonality, fermentation, organics, whole grains, ORAC values, nutrient ratios, preservatives, unhealthy packaging, animal husbandry, and balance…   In other words, a really, really healthy diet. 

B-Vitamins: I don’t normally lump the B-vitamins all together.  However, I will here.  Research is littered with tantalizing tidbits of evidence here and there that B-vitamins in general may prevent or slow dementia.  Very little of the evidence is especially impressive, or points to a specific B-vitamin, or a specific dose.  But, to my mind, tidbits add up.  We see evidence that methylating B-vitamins (B6, B12, folate) are valuable.

A solid multivitamin ought to be sufficient for most people, with two caveats.  First, by solid, I do not mean “100% of the RDA.”  The RDA tends to be sufficient for folate, but quite low for B6 and B12.  I’d shoot for at least 50 mg daily of B6.  And for B12…  B12 is very hard to come by in a vegetarian diet.  If you’re vegetarian, look to take a separate B12, and look for at least 1,000 mcg a day.  Look for it in the pills that dissolve under your tongue (“sublingual lozenges”), and get a kind called “methylcobalamin,” which is better for brain health than the standard “cyanocobalamin.”

Finally, folate.  Folic acid is the most common form of folate in pills, but there are other kinds of folate out there, in particular methyltetrahydrofolate (MTHF).  The evidence is still shaky, but it’s starting to look like this kind is especially important to brain health, while regular folic acid may disappoint us.  Stay tuned.

Fish Oil and other Omega-3 Fats: Researchers have been excited about this one for a long time.  First of all, fish oils reduce inflammation, one of the big risk factors for dementia.  Fish oil also contains the “bricks and mortar” our brain cell membranes are made of.  It prevents the erosion of brain volume and membrane fluidity as we age.   

And we’ve seen that diets higher in fatty coldwater fish – the kinds of fish that are highest in these healthy fats – are protective against all sorts of dementia.  It seems like a slam dunk: eat more fish, take more fish oil, amen.

Except fish oil supplements have had mixed results.  There are some studies that show benefit.  But there are just as many that show no benefit at all.  Perhaps (say the skeptics) fish oils themselves aren’t so healthy, but simply markers for a constellation of other healthy behaviors…?

Certainly, eating fish is a marker for other healthy behaviors.  People who eat more fish tend to be more health-conscious in general – tend to eat better in other ways, and exercise more, and take more vitamins, etc., etc.  But I wouldn’t write off fish oil supplements just yet.  Many of the large trials have shown little benefit, it’s true.  But most of them have only tracked people for a year or less, which may not be enough time to show a benefit.  I mean, when your placebo group hardly gets any dementia, it’s hard for your treatment group to get less dementia!   The studies also used relatively low doses.  To put in perspective, a quarter-pound of good quality wild salmon is going to give you about 1,500 mg of omega-3s.  So a trial in which people are given 500 mg a day is far from a robust dose.  Yet these are the sorts of doses that are studied: the amount that’s in 1-and-a-half ounces of fish, over six months or two years.    

There is also evidence that the ratio between omega-3 fats and omega-6 fats is equally important. PMID: 23451843

So, the evidence, to my mind, does not show that fish oil is ineffective.  It just shows that low doses of fish oil aren’t effective enough to make a noticeable reduction in risk in a year or two.  I still recommend fish oil to people.  I would shoot for about 3,000 mg a day of omega-3s (that’s not total fish oil; that’s omega-3s from fish oil… sometimes you need 6,000 mg of a fish oil to get 3,000 mg of omega-3s).  Why that dose?  That’s the dose we see really start to work in rheumatoid arthritis, which is a solid model for systemic inflammation.  It’s a half-pound of high quality wild salmon.  It’s enough to feed the brain. 

Turmeric and Curcumin: Turmeric is an Indian spice plant, probably the most ubiquitous flavor in Indian cuisine.  Curcumin is a compound found in turmeric, and one of the most intensively researched natural compounds in science. 

Crude turmeric is about 5% curcumin dry weight.  Most of the pills you buy today are concentrated to 95% curcumin, so about 20 times stronger.  Of course there’s more to turmeric than just curcumin, and when you concentrate the one compound, you leave a lot of the other compounds behind.  Well, that’s a debate I’ll leave off these pages…

The research to suggest that curcumin could prevent Alzheimer’s disease is tantalizing and exciting – but not entirely solid yet.  In test tubes, it looks like the greatest thing ever.  In animal models, sort of…  In humans… controlled trials over a decade or two would be prohibitively expensive, and retrospective studies are almost by definition inconclusive, since turmeric consumption is almost always linked with a few dozen other cultural and lifestyle confounders. 

But it’s still tantalizing and exciting.  My advice to you: consume turmeric regularly, and curcumin supplementally.  It’ll do you a lot of good regardless.  And it may reduce your Alzheimer’s risk to boot.  

Vitamin D: There is a strong and consistent link between levels of vitamin D in the blood, and general health.  People with higher blood vitamin D tend to age better.  They tend to have healthier hearts, healthier brains, healthier cells, healthier joints, and healthier moods. 

However, there’s a big asterisk attached to all this epidemiological research: we make vitamin D in our own bodies, when sun hits our skin.  So, is blood vitamin D itself protective?  Or is it simply a marker for other healthy behaviors, i.e. exercise, and the fact that these people are outdoors more, indicating better underlying health?     

Would vitamin D supplements actually work? 

Slowly but surely, we’re starting to see that question answered.

One study followed over 7,000 American women (average age 71 at the start of the study) for a little more than 7 years, who were given 400 i.u. a day of vitamin D – a dose that we now understand is very, very low.  They did not see a reduction in dementia risk.  However, another study in France did show benefit.  This was a smaller study (498 women), but it involved older women (starting age = 80), and higher, variable doses of vitamin D.  Here, it turned out that D intake did reduce the risk of Alzheimer’s, but not other types of dementia. 

I think what we’re seeing here is that vitamin D will likely prevent dementia, especially in populations that tend to be low in it to begin with – and especially in doses that actually make a difference.

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