In Alzheimer’s Disease (AD) research, it is generally accepted that once the disease has progressed there is no way to reverse it. Knowing your risk and what makes up AD is important in understanding the role you can play in your own health. My focus as a nutrition student is to look towards what changes we can make in our lives to reduce the chance of developing AD (modifiable risk factors). We will look at the genetic component, status of treatment, and three dietary patterns that have shown an impact on development of AD symptoms.
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Your genes are not your destiny
The APOE-E4 is commonly referred to as the Alzheimer’s gene. However there is only a single mutation (allele) on the gene that is recognized as contributing to risk. We all have an APOE gene because it is used for transportation of cholesterol and fats throughout the body. Although, at this important spot you may have APOE-E2, APOE-E3, or APOE-E4.
You can think of these as “genetic cards” in your APOE gene, and each person gets two of them, one inherited from each of your parents. Firstly, E2 is associated with some protection against Alzheimer’s disease. E3 is the most common and does not influence your risk. Finally, E4 is known to increase your risk for developing AD. Note that you can have any combination of these, but a double E4 puts you at the highest risk.
Although, just being at an elevated risk does not mean that you will develop Alzheimer’s disease. Not everyone who has two E4’s goes on to develop Alzheimer’s! On the contrary, according to the Alzheimer’s Association, only “40-65% of people diagnosed with Alzheimer’s have the APOE-e4 gene“. This means that up to 60% of patients with Alzheimer’s don’t have this marker. Additionally, more genes and mutations are being identified that have a minor contribution to an individuals risk of developing AD. However, all of these together only account for a fraction of your risk.
So while genetics are important, it isn’t the only variable to consider. What we are missing is the environmental impact on your genes. Just as someone who has alcoholism running in their family won’t become an alcoholic if they never drink. Taking preventative measures may help keep the genetic component at bay when it comes to AD.
Holding out for the next drug?
Research has identified potential targets in the AD, such as reducing tangles (tau proteins) and plaques (amyloid-beta). These common signs are shown on brain scans of patients AD who have impairment and memory loss. However their presence does not automatically equal AD as noted in a study of Nuns who had these signs, but their mental capabilities remained intact (Religious Order Study).
Even if the treatments do have the potential to dissolve plaques in the brain, these may not work for everyone and are likely to be targeted and function similar to cancer treatments. If you have a certain mutation, there is a chance that it may work for you. Although, if you do not have that genetic “card,” then it could be ineffective and not reduce your risk or progression of AD.
The problem is that with most of these treatment options, we are targeting the symptoms and not the cause. Just as the overflowing facet, we can try to mop up the floor, or we can turn off the running water.
Mop comic
While you can’t exchange the cards that you are dealt, there is a role that lifestyle has to play in the matter.
Vascular Dementia (VD)
Our vascular system does not stop when it comes to the brain. Your brain is a very blood hungry organ and is full of small blood vessels. If you have clogged arteries in your heart, then what impact does this have on your brain?
Originally, Alzheimer’s disease was separated from vascular dementia from a clinical standpoint. However, with the advances in brain scans, about half of Alzheimer’s cases may include VD (Mixed Dementia). This is great news because vascular health is highly impacted by diet and lifestyle! If Dr. Caldwell Esselstyn can reverse 99% blocked coronary arteries, than just imagine what progress could be made in the area of VD with similar treatment.
Brain Healthy Diets
Different ways of eating (dietary patterns) can be assessed through surveys called food frequency questionnaires (FFQ). These are typically done every 1-2 years in long-term (longitudinal) research studies in an attempt to define how the ways we eat change overtime. So if you have AD in your family, what are the diets that you may consider to protect your brain health?
The Mediterranean Diet (MedDiet)
The Mediterranean diet is a widely known diet that emphasizes fruits and vegetables, in addition to wine, fish, and healthy fats. A head to head test of the following three diets were completed by the team at RUSH University (see MIND diet reference). Each individual was scored on how well what they ate matched each diet and AD diagnosis was monitored over 4.5 years.
The top third of participants were strict enough with the MedDiet to receive some benefits (score 35+ = 54% reduction). For instance, if you only partially adopt the MedDiet, the study found that you are less likely to impact your risk of AD.
Is alcohol consumption really protective against AD?
This topic has been debated as certain groups avoid alcohol entirely. An example of this is the Seventh Day Adventists in Loma Linda, CA who Alzheimer’s disease is almost non-existent. Some researchers believe that the benefit of wine could be the micro-nutrient (resveratrol). However you can get this just by eating grapes alone. Another idea is that the alcohol content in red wine helps to relax the arteries, if you’ve ever had a glass after a long stressful day you can see why. It is important to note that the MedDiet only supports one glass a day, and red wine over white wine. This is because the micro-nutrient is only found in the skin of red grapes.
It could also be a case of correlation and not causation. Cultures that mainly eat the Mediterranean diet tend to make meal time an important part of the day. This is a social activity in which friends and family gather to take a break from their busy lives. Rather than running through the drive through for your 15 min break before your next meeting. The calm and togetherness that meal time provides could result in some protection against AD, but it may not be the diet alone.
While the MedDiet looks good compared to the Standard American Diet, is this the best that we can do?
Dietary Approaches to Stop Hypertension (DASH)
The DASH diet was developed by National Institutes of Health (NIH) to treat/prevent high blood pressure while reducing cholesterol levels. The diet emphasizes vegetables, fruits, whole grains, low-fat dairy, lean proteins and promotes low salt intake. The diet works better than some anti-hypertension medications and can start lowering blood pressure in as little as two weeks. Similar to the MedDiet, only the top third showed results by closely following the diet pattern to reduce AD risk (score 5.0+ = 39% reduction).
While this diet has had success in the field of blood pressure, it wasn’t designed specifically to focus on brain health. Enter the MIND diet…
The MIND diet
The MIND diet is a specifically designed diet that merges the Mediterranean and the DASH diet. It stands for Mediterranean-DASH diet Intervention for Neurological Delay. What sets this dietary pattern apart is that it emphasizes green leafy vegetables and de-emphasizes the importance of fish consumption. It also singles out baked goods and sweets as a negative factor and minimizes saturated fat intake.
In this case, two thirds of the participants had an impact on their AD risk (score 8.5+ = 53% reduction, score 7-8 = 35% reduction). This is great news! A big reason why diets fail, is because they are not sustainable. Although, if we use a diet that has more flexibility to it, then overtime it will be easier to stick with. Of course, the more parts of the diet that you can add to your daily life, the better!
Where does your plate fall?
You might be wondering where your current eating habits fall in the scale of these three diets. What better way then to score yourself based on eat diet? This is how the MIND diet team was originally able to show that, for brain health, the MIND diet offered the most protection against decline.
Normally you would complete a FFQ that over an hour or two and a hundred questions later you would have a score. Instead, for our purposes, just think of what you eat in a typical week and complete the chart below. It won’t be as accurate, but it will show you where you stand.
Beneficial foods are in black and foods to limit are in red. The max score is provided for each category, meaning what you eat in a day/week is equal to or greater than the amount set. Higher diet score ->increased protection against AD.
Thinking about AD Risk
If you have a family history of Alzheimer’s disease, speak with your Doctor to help you decide whether you should undergo genetic testing. Even without an official diagnosis, it’s never too early to start stacking the deck in your favor. While there is a lot of information here today, this is just the beginning to what you can do to lessen your risk of developing Alzheimer’s disease. Physical activity, sleep, and social contentedness have been shown to have an impact on Alzheimer’s (Dr. Ornish’s Lifestyle Clinical trial currently underway). Check back in for our next post! We will go through specific foods to include or avoid and how they relate to Alzheimer’s disease.
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Resources:
- Alzheimer’s Association:
- Religious Order Study
- Research on Seventh Day Adventist Community
- MIND Diet
- Lifestyle Intervention Trial for Alzheimer’s Disease
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