Saturday, July 30, 2011

The Myth of Alzheimers

The Myth of Alzheimers: What You Aren't Being Told About Today's Most Dreaded Diagnosis
Peter J. Whitehouse, M.D., Ph.D, with Daniel George, M.Sc.
St. Martin's Griffin, New York, 2008

Peter J. Whitehouse is a respected neurologist with over 30 years experience in the relevant field.

The Website for the book. 

Amazon Link.

This text takes a courageous stand. I appreciate the central thrust of their argument but also believe they have somewhat overstated their case. Nonetheless this text offers some valuable insights into what is wrong with so much media reporting about dementia and helps us understand why the concept of a cure of alzheimer's is predicated upon faulty assumptions concerning the causes and nature of the condition.

It is pleasing to note that the authors are quite upfront and acknowledge that loss of cognitive function is inevitable with age. There is far too much nonsense out there which purports to provide strategies so that we can have a timeless mind that does not age. Such claims are errant nonsense peddled by the either the naive or dishonest who are more interested in selling books than being honest to the truth about aging. My typical response to people who make such claims is this:

You say you can halt brain aging. Tell me, could you run as fast as when you were 20 years old? Can you recover from sleep deprivation or a night out partying as quickly as when you were 20 years old? The brain is the most vulnerable organ in our bodies yet you expect me to believe that  with your greying and receding hair, your reading glasses, your creaking joints and liver spots, your spider veins and botox manipulated forehead, you have managed to protect your brain from the effects of aging. I suggest that to entertain such a fallacy is evidence to the contrary.
We can, if we so choose, adopt many habits which can be very valuable in limiting the impact of aging on the brain. Towards the end of the text the authors provide many valuable ideas in this regard. On page 230 the authors mention the Mediterranean Diet as a useful strategy. In so called developed nations our diet is seriously imbalanced and the Mediterranean Diet does help redress some of these imbalances. In particular:


  • There is too much lysine and too little arginine in our diets, this leading to insufficient nitric oxide production which can have wide ranging deleterious effects on our health. 
  • The omega 3- omega 6 balance is completely out of kilter, especially given our red meat consumption derives mostly from beef fattened with grain feed, which promotes a much higher level of omega 6 fats in their bodies. We need to be eating much more fish for the long chain omega 3's and plants and nuts for the short chain omega 3's. Some argue that humans cannot adequately convert these short chain omega 3's to the preferable long chain omega 3's(DHA and EPA) but I suspect that case is over stated. 
  • There is far too much saturated fat and far too little monounsaturated fat in our diets. Trans fats are poison, avoid these at all costs. 
  • We consume far too much sugar and simple carbohydrates, leading to excessive sugar spikes, a great way to accelerate aging. Fructose, a sugar from fruits, appears to be even worse than glucose. So when you eat fruits try to focus on fruits that are not so heavily laden with fructose or eat fruit with other foods so as to slow asorption. Fruit juices may well do more harm than good. Our culture is addicted to sugar. Recently I watched a documentary on a tribe of Malay hunter gatherers. Sugar is almost absent in their habitat. The principal source is from honey. In order to obtain the honey the men must climb up forest trees to raid honey from beehives. This is very dangerous with many men falling and suffering serious injury if not death. Now consider this: if we saw a person scrambling high up a tree to obtain some amphetamines we would consider that person to have a serious drug addiction problem. I trust you get the point. 
  • Too much salt and too little potassium in our diets. As studies on hunter gatherers have demonstrated, where potassium intake is high blood pressure levels tend to be low. It is not enough to reduce salt intake, increasing potassium intake is not only vital for controlling blood pressure but also helps prevent excessive neural activity. When I was in my early 20's I undertook a little personal experiment. I studiously eliminated all sugar and salt from my diet. At the time I was something of a fitness nut and had exceptional health markers. My blood pressure became so low that if I stood up too quickly I would experience orthostatic hypotension, a state where the sudden rising caused a momentary loss of blood supply to the brain. My blood pressure was 110\60.  My fasting blood sugar was down to 4.5, again an optimal reading. While on this elimination diet, whenever I visited friends or went out for a meal, the faintest taste of sugar or salt almost reviled me. My point is this: our constant exposure to salt and sugar has conditioned us to accept it as normal. It is normal in our culture and it is also an invitation to age related health deterioration.  
  • The emphasis on red meat consumption often leads to excessive iron intake. Iron is a vital nutrient but aging brains tend to accumulate iron and excess iron is a very strong driver of oxidative stress. 
  • Micronutrients, especially magnesium, boron, iodine, and selenium, are too infrequent in our diets. 
  • Vitamin D insufficiency is widespread. Vitamin D can be made from sunlight exposure but as we age many people will not produce sufficient vitamin from sunlight exposure. As a precaution I occasionally dose up on vitamin D supplements, often taking 4,000-5,000 iu per day. Vitamin D is not only vital in preserving our aging brains but as a welter of recent research has revealed can play a very important role in cancer prevention and maintaining cardiovascular health. 
  • As luck would have it, only last night I happen chanced upon a Nature blog wherein this interesting comment was made: 

It is known that calcification may take place if there is a lack of inhibitors of calcium salt crystallization, of which inositol hexaphosphate (IP6, abundant in typical Mediterranean diet) is one. Thus, Professor Grases and colleagues propose that deficiency of IP6 may be a risk factor for AD. 

  • We consume far too many calories and burning it off with exercise is not going to alleviate a core issue in relation to caloric consumption. By now most have heard of caloric restriction, there is evidence from studies on a great many species, from yeast to primates, that reducing total caloric intake is one of the best measures for reducing the effects of aging. Learn to limit your caloric intake, learn to stay a little hungry. This is difficult, it took me a few years to tolerate not eating all day and for myself at least one undesired consequence of that is it very much exacerbates my lifelong insomnia, which is probably a result of increased cortisol production arising as a means of maintaining energy levels. Reducing caloric intake is supported by strong evidence from animal, human, physiological,and cellular studies to indicate the it is one of the most valuable strategies we can undertake to enhance our personal health. 

The above list was off the top of my head and given my age you should not regard it as comprehensive. For example, I haven't addressed the importance of vitamin K1,2, though I suspect a Mediterranean Diet will provide these neglected nutrients. Do your homework, if you are serious about improving your health there is a plenty of good information out there although the signal to noise ratio is very frustrating.

What is good for the body is good for the brain. Regular exercise, even brisk walking is an excellent idea. The authors make a very important point in regard to exercise. Wherever possible make your exercise a social activity.The above Nature link makes reference to a form of dancing. Excellent idea, not just because of the physical activity but also because of the socialisation, the co-ordination demands of dancing, and the opportunity to get out of the house. The authors make a very important point when they assert that lack of socialisation has serious health implications.

They advocate that baby boomers seek out opportunities to engage in volunteer work, especially in helping children and young adults. I regard this as excellent advice. We make a terrible mistake in creating villages and retirement homes for the elderly, confining them to an environment where they are shut off from the wider community. Sad and silly, as a culture we ostracise the elderly and thereby condemn our own later years to loneliness and lack of meaning. Now if that isn't a classic example of that biblical saying: the sins of the fathers are visited upon their children ... . For an example of how important socialisation is, consider this study from PLOS Medicine which found that a poor social life equated to the mortality risk associated with lifelong smoking! I'll take that with a grain of salt. No, that's a bad idea ... .

The authors assert the drugs commonly prescribed in treating Alzheimers are of little value. I can't comment on this but I wouldn't be surprised because I have read similiar statements elsewhere. Another behavioral pathology of our culture, and the medical profession in general needs a huge kick up the backside for promoting this, is the idea that illness always needs pills. There is too much prescribing of too many often useless drugs. Dr. Whitehouse has had extensive experience providing consultancy services to pharmaceutical companies and does not speak highly of these organisations. Modern drugs have saved millions of lives, make no mistake about that, but pharmaceutical companies typically rely on the work of a great many researchers working in universities throughout the world. Costs are socialised, profits are privatised. Such as it needs to be but unfortunately pharmaceutical companies are increasingly focusing on producing new drugs at great cost but with minimal health benefits. In relation to geriatric drugs the companies spend more on advertising than R&D. That is ridiculous, the value and prescribing of a drug should be determined by the available evidence, not free trips to sporting events for doctors and advertising. That really pisses me off. The law of decreasing returns is in play and there may be little we can do about that.

Where do they overstate their case? Dementia is prevalent to some extent in many elderly individuals. There is a cross over region between normal aging and dementia, on that point I agree with the authors. Where I disagree with them is that in many cases of dementia the person is not just getting old but becoming very difficult to handle with violent behavior being a major reason why many dementia patients are moved into nursing homes. Now I think you'll find the rate of violent behavior in dementia patients is many times in excess of that found in the general elderly population. Violence in dementia patients, sometimes referred to as "sundowning syndrome" is a very real problem and cannot be simply attributed to growing old. The problem of violent behavior also occurs in relation to traumatic brain injury.

To sum up, if you would like a good introduction that will help understand the nature of Alzheimers and how it manifests itself in the brain, this book is worth a serious look. To understand why we need to completely rethink our attitude to dementia you will benefit by reading this book. To find strategies that help you to maintain cerebral and total health this book has many valuable suggestions.

1 comment:

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