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Alzheimer’s

  • Depression is an increasingly common issue in the United States. The Centers for Disease Control in 2010 estimated that 11.1 percent of the American population suffers from significant depression — a whopping 35 million individuals — and this figure seems to be steadily rising. Prescribed mood modifiers are everywhere, starting as early as elementary school and continuing on into old age. How successful are these pharmacologic approaches? Not very. Optimistic estimates maintain that such interventions are reasonably successful in only one half of those treated. Less optimistic observers note that in those currently taking an SSRI (selective serotonin reuptake inhibitor) antidepressant drugs such as Prozac, despite a host of side effects, most do not attain relief. Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy; they obtain better results with, for instance, tai chi.1 For major depressive disorder, a condition for which one would think that pharmacological treatments would win out over nonpharmacological therapy, it turns out that nonpharmacological therapy not only is just as effective, but also involves far fewer adverse events.2,3

    The causes of depression and mood disorders remain an area of controversy. Human beings are prepared to react to vastly varied environmental factors. Not surprisingly, many biological and psychological factors cut in more than one direction. Metabolic factors (inflammation, insulin resistance, and oxidative stress) are not necessarily one-direction in terms of causation, for example, with regard to emotional and physical stress and the resulting stress hormones (glucocorticoids). Sex hormones (testosterone, estrogen), likewise, both influence and are influenced by emotional and physical factors.

    Is Inflammation the Central Issue?
    The concept of inflammation in the last few years has been stretched to cover more and more forms of illness and dysfunction. One reason is that inflammation is actually a set of responses that occur naturally all the time, yet each of which can itself escape proper regulation. You get a sense of this from the article on inflammation available online from Wikipedia: “Inflammation is a protective response that involves immune cells, blood vessels, and molecular mediators. The purpose of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and to initiate tissue repair.” Inflammation thus involves both destruction and repair.

    A number of researchers are looking into the issue of neuroinflammation outside of the traditional medical areas of concern, such as stroke. For instance, psychological stress has been demonstrated to increase neuroinflammation in animal models.4 Similarly, there is evidence to support the position that links chronic depression to chronic brain inflammation and acute depression to stress-triggered neuronal microdamage.5 Another line of argument is that the “metabolic syndrome and its individual components induce a proinflammatory state that damages blood vessels. This condition of chronic inflammation may damage the vasculature of the brain or be directly neurotoxic.”6

    Countering Depression without Drugs
    Inflammation and the metabolic syndrome are closely linked in physiology and biochemistry. Therefore, it should not come as a surprise that studies on obesity, diet and exercise habits often turn up implications for preventing and treating depression. For example, a large study of 15,093 people published in 2015 indicated that depression could be linked with nutrient deficits. The best results were found with two essentially Mediterranean-style diets. These diets overlapped in terms of foods such as omega-3 fatty acids, vegetables, fruits, legumes, nuts and moderate alcohol intake. Another finding was that there apparently is a threshold effect, meaning that a certain level of protective foods needed to be in the diet, but that benefits in terms of reduced risk of depression plateaued after this threshold was passed.7

    It is difficult to find many nutrients that can be given as dietary supplements that cross the blood-brain barrier. Many of the nutrients that are of use are from berries. Pterostilbene, but not resveratrol, is a potent neuromodulator in aging and Alzheimer’s disease.8 “Blueberry, strawberry, blackberry, grape and plum juices or extracts have been successfully tested in cognitively impaired rodents. Published trials of the benefits of grape and blueberry juice in the treatment of small numbers of cognitively impaired persons have recently appeared.”9 Another potentially useful item in this regard is the Chinese herb known as blue dogbane, Apocynum venetum. This interesting item, virtually unknown outside of Asia, exerts proven anti-depressant effects, in part, via brain monoamine levels and the dopaminergic system. The latter, again, is influenced by pterostilbene, but not resveratrol.10 Of importance regarding the impact of Apocynum venetum on inflammation is its high content of the potent antioxidant / anti-inflammatory, isoquercitrin.11

    A complementary option to the foregoing nutrients is to reduce the impact of stress. Phosphatidylserine (PS) supports the brain’s physiological processing of stress and promotes neuronal communication by its effect on cell membrane fluidity. It is a natural phospholipid that is an essential component of cell membranes. PS promotes brain function by increasing neuronal membrane fluidity (cell-to-cell communication), resulting in improved cognition. Also, PS protects against stress by mitigating the actions of cortisol (catabolic stress hormone.) Human research routinely demonstrates these benefits and suggests the usefulness of a combination with DHA, e.g., “The results demonstrate that consumption of 100 mg/day of PS-DHA might be associated with improving or maintaining cognitive status in elderly subjects with memory complaints.”12

    Finally, there is the issue of the relation between Alzheimer’s and sugar consumption. In old age, there tends to be an increasingly significant association between forms of cognitive impairment and depression. Some believe there’s a connection between sugar intake and Alzheimer’s disease. There are a number of theories as to why this might be. One argument is that increased consumption of simple carbohydrates leads to blood brain barrier degradation and subsequently to damage to the hippocampus.13 A related argument is that increased consumption of simple carbohydrates leads to elevations of specific advanced glycation end products (AGEs), especially the neurotoxic methyl-glyoxal derivatives (MG). High levels of AGEs also are correlated with reduced insulin sensitivity in older human adults. These factors promote chronic oxidant stress and inflammation in the brain.14

    Endnotes:

    1. Lavretsky H, Alstein LL, Olmstead RE, Ercoli LM, Riparetti-Brown M, Cyr NS, Irwin MR. Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. Am J Geriatr Psychiatry. 2011 Oct;19(10):839–50.
    2. Gartlehner G, Gaynes BN, Amick HR, Asher G, Morgan LC, Coker- Schwimmer E, Forneris C, Boland E, Lux LJ, Gaylord S, Bann C, Pierl CB, Lohr KN. Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Dec.
    3. Gartlehner G, Gaynes BN, Amick HR, Asher GN, Morgan LC, Coker- Schwimmer E, Forneris C, Boland E, Lux LJ, Gaylord S, Bann C, Pierl CB, Lohr KN. Comparative Benefits and Harms of Antidepressants, Psychological, Complementary, and Exercise Treatments for Major Depression: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016 Feb 9. [Epub ahead of print]
    4. Barnum CJ, Pace TW, Hu F, Neigh GN, Tansey MG. Psychological stress in adolescent and adult mice increases neuroinflammation and attenuates the response to LPS challenge. J Neuroinflammation. 2012 Jan 16;9:9.
    5. Wager-Smith K, Markou A. Depression: a repair response to stress-induced neuronal microdamage that can grade into a chronic neuroinflammatory condition? Neurosci Biobehav Rev. 2011 Jan;35(3):742–64.
    6. Cherniack EP. A berry thought-provoking idea: the potential role of plant polyphenols in the treatment of age-related cognitive disorders. Br J Nutr. 2012 Sep;108(5):794–800.
    7. Sánchez-Villegas A, Henríquez-Sánchez P, Ruiz-Canela M, Lahortiga F, Molero P, Toledo E, Martínez-González MA. A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project. BMC Med. 2015 Sep 17;13:197.
    8. Chang J, Rimando A, Pallas M, Camins A, Porquet D, Reeves J, Shukitt- Hale B, Smith MA, Joseph JA, Casadesus G. Low-dose pterostilbene, but not resveratrol, is a potent neuromodulator in aging and Alzheimer’s disease. Neurobiol Aging. 2012 Sep;33(9):2062–71.
    9. Cherniack EP. A berry thought-provoking idea: the potential role of plant polyphenols in the treatment of age-related cognitive disorders. Br J Nutr. 2012 Sep;108(5):794–800.
    10. Zheng M, Fan Y, Shi D, Liu C. Antidepressant-like effect of flavonoids extracted from Apocynum venetum leaves on brain monoamine levels and dopaminergic system. J Ethnopharmacol. 2013 May 2;147(1):108–13.
    11. Butterweck V, Nishibe S, Sasaki T, Uchida M. Antidepressant effects of apocynum venetum leaves in a forced swimming test. Biol Pharm Bull. 2001 Jul;24(7):848–51.
    12. Vakhapova V, Cohen T, Richter Y, Herzog Y, Kam Y, Korczyn AD. Phosphatidylserine containing omega-3 Fatty acids may improve memory abilities in nondemented elderly individuals with memory complaints: results from an open-label extension study. Dement Geriatr Cogn Disord. 2014;38(1–2):39–45.
    13. Hsu TM, Kanoski SE. Blood-brain barrier disruption: mechanistic links between Western diet consumption and dementia. Front Aging Neurosci. 2014 May 9;6:88.
    14. Cai W, Uribarri J, Zhu L, Chen X, Swamy S, Zhao Z, Grosjean F, Simonaro C, Kuchel GA, Schnaider-Beeri M, Woodward M, Striker GE, Vlassara H. Oral glycotoxins are a modifiable cause of dementia and the metabolic syndrome in mice and humans. Proc Natl Acad Sci U S A. 2014 Apr 1;111(13):4940–5.
  • If there is one disability that creates the greatest alarm for the baby boomer generation, it would be the loss of memory and brain functions. The concern is justified.

    Alzheimer’s disease and other types of dementia now affect 97,000 Canadians, and by 2031 it is estimated that this number will rise to 750,000. Unfortunately, this is a worldwide trend with an estimated 24 million people presently diagnosed with dementia and an estimated 81 million predicted by 2040.

    Are the various forms of dementia an inevitable consequence of aging or could they, in some instances, be symptomatic of an underlying (and overlooked) nutritional deficiency?

    Effects of B12 Deficiency
    There is growing evidence that a vitamin B12 deficiency, which affects an estimated one-quarter of North Americans, plays a major role in the decline of neurological functions. B12 deficiency is more commonly found in the elderly and those with predisposing conditions such as Crohn’s disease.

    Vitamin B12 (cobalamin), a fragile, water-soluble compound that performs a wide variety of functions in the body, is vital for good health. B12 is essential for normal nervous system function and normal red cell, white cell, and platelet production. A deficiency of B12, which may not be detected in a blood test, can result in neurological disorders often mimicking senility, dementia, or Alzheimer’s disease.

    Causes of B12 Deficiency
    Diet, age, and drugs are the prime culprits behind B12 deficiency. The primary sources of vitamin B12 are meat, dairy, eggs, and fish. Inadequate intake of these foods or impaired absorption directly impacts B12 levels. A vegan diet will not provide adequate sources of B12.

    It should also be noted that microwave cooking may inactivate vitamin B12. Researchers found that after just six minutes of microwaving, nearly half of the vitamin B12 in food was destroyed.

    How B12 Works
    Vitamin B12 has the unique ability to provoke the regeneration of nerves without adverse side effects. This is because B12 facilitates methylation, the process that creates and maintains nerves and brain chemicals. In addition, vitamin B12 is able to lower homocysteine levels. Homocysteine is a toxic by-product of methionine metabolism that can damage neurons. Importantly, homocysteine interferes with the methylation reactions critical for brain function. By lowering homocysteine levels, neurological functions can be improved.

    Vitamin B12 also protects brain health by helping in the synthesis of the neurotransmitters, serotonin, dopamine, and norepinephrine.

    People who do not respond to supplemental vitamin B12 may also be deficient in folate. Since vitamin B12 and folate work synergistically to restore normal homocysteine levels, increasing folate may also be necessary.

    Boosting B12
    In the past, vitamin B12 was administered by injections. However, oral B12 supplements have been found to be as good as or better than injections. While there are several forms of B12, methylcobalamin is the most neurologically active form. When taken sublingually (under the tongue), it is immediately assimilated into the brain.

    A daily dose of 1,000 mcg of B12 is usually sufficient. However, if there is a deficiency then 2,000 mcg daily for one month is recommended, followed by 1,000 mcg daily.

    There is little question that many people exhibiting symptoms of Alzheimer’s and other forms of dementia actually suffer from a vitamin B12 deficiency. For so many people, simply taking a B12 supplement could rescue them from the darkness.

    Effects of Dementia
    While depression is a common symptom of early-stage dementia, the following can also be affected:

    • language
    • comprehension
    • motor skills
    • short-term memory
    • reaction time
    • personality traits
    • mood or behavior

    Who is at Risk of B12 Deficiency?
    The elderly are most at risk of B12 deficiencies. There are several reasons for this:

    • reduced production of intrinsic factor, a protein secreted by the stomach to help the body absorb B12
    • low levels of hydrochloric acid, necessary for digesting proteins and maintaining intrinsic factor
    • prescription and over-the-counter drugs for stomach ulcers, heartburn, or gastroesophageal reflux

  • As we grow older, we may grow wiser, but we can also experience age-related memory impairment (ARMI). ARMI is relatively common1 and should not be confused with Alzheimer’s or other dementia, while ARMI is simply mild memory problems associated with normal aging (e.g. “Where did I put my keys?”). Even so, the memory loss and cognitive slowing associated with ARMI can interfere with our daily routines.2 In fact, according to a national survey, worries over retaining mental sharpness with age was the number two health concern among consumers (second only to worries about continuing with normal activities with age).3

    So what can we do to help maintain mental sharpness with aging? Aside from eating a healthy diet and getting regular exercise (which is good advice for everybody in all age groups), there are some very specific nutraceuticals (i.e. vitamins, herbs, amino acids), which have been shown to be effective for just this purpose. These include Bacopa monnieri leaf extract, Panax ginseng root extract, Rhodiola rosea root extract, natural caffeine and L-theanine, folic acid and vitamin B12.

    Bacopa monnieri leaf extract
    The leaves of the Bacopa monnieri plant have been used for centuries in the traditional East Indian system of healthcare (i.e. Ayurveda) for purposes of promoting “healthy longevity, and strengthening life, brain, and mind.”4 While that is certainly impressive, it is even more impressive that several modern, human clinical studies have been conducted showing that supplementation with Bacopa helped:

    • Improve occasional, age-related absentmindedness.
    • Promote a healthy memory.
    • Improve some measures of delayed recall.
    • Promote cognitive function.
    Percentage Increase in Total Memory Score

    Most of these studies5,6,7,8,9,10,11 found that daily supplementation with 300 mg of Bacopa monnieri leaf extract (standardized for 50 percent total bacosides), provided significant benefits by week 12—although progressive benefits in Total Memory Score were also seen during week four and eight as well.12

    It should also be noted that these studies were conducted in men and women who were at least 40 years old, and in most cases more than 55 years old. That means that you’re more likely to experience similar benefits if you’re middle-aged and older, rather than if you’re in your 20s or 30s.

    If you’re wondering how Bacopa works, research13 suggests that it helps to maintain healthy levels of acetylcholine, a compound your body makes that works in your brain to help facilitate memory, learning ability and cognitive performance.

    Panax ginseng root extract
    Panax ginseng root, or ginseng for short, is a traditional Chinese herb, which has been used for thousands of years for various aspects of healthcare. It is also one of the most widely-researched herbs in modern science with over 5,000 published studies. Ginseng belongs to a category of herbs known as adaptogens. Adaptogens are herbs that help stabilize physiological processes and promote homeostasis (i.e. stable, healthy functioning of the body), especially in the case of stress and fatigue. This property was seen in two human clinical studies14,15 examining the effects of ginseng on mental performance. The results demonstrated that 200 mg of ginseng root extract daily:

    • Improved speed of mental performance within 60 minutes.
    • Enhance performance of mental arithmetic within 60 minutes.
    • Reduce feelings of mental fatigue within 60 minutes.
    • Quickly reduced feelings of mental fatigue during sustained mental activity.
    • Quickly improved some measures of mental performance.

    While many nutraceuticals may take weeks to work, these studies found that ginseng root extract provided beneficial results in as little as 60 minutes.

    Rhodiola rosea root extract
    Like ginseng, Rhodiola rosea root is an adaptogen. This plant has been used for centuries in the traditional systems of healthcare throughout Russia, Scandinavia, and other countries where it was used to increase physical endurance, work productivity, longevity, and to treat fatigue, mood and promote a healthy nervous system.16 Currently, there are over 500 studies on Rhodiola demonstrating the value of this plant. The reason for its inclusion in Ageless Memory is that human clinical research17,18,19 shows that supplementation with Rhodiola:

    • Improved capacity for mental work during stress.
    • Supports healthy cognitive function during stress.
    • Reduced fatigue during stress.

    These benefits were seen when 370 mg of Rhodiola root extract was used daily, and when it was standardized for 3 percent salidroside and 1 percent rosavins—key compounds in Rhodiola. This standardization is particularly important since most Rhodiola extracts have the opposite standardization: 1 percent salidroside and 3 percent rosavins. Consequently, products with this opposite standardization are not providing the correct balance of Rhodiola compounds used in these cited studies.

    Natural Caffeine and L-Theanine
    Black tea leaf extract provides natural caffeine as well as the amino acid L-theanine. This is an important distinction because not all sources of caffeine are natural, and not all sources provide L-theanine as well. Consider that if you buy one of those popular energy shots that are supposed to last a few hours, they contain caffeine anhydrous. That’s a synthetic form of caffeine. And while coffee certainly contains natural caffeine, we all know about the jittery effect on your nerves if you get too much—and some of the freshly brewed coffee you get from popular coffee houses can contain hundreds of milligrams of caffeine. Tea, on the other hand, also provides L-theanine, which has a calming effect. That’s likely the reason why drinking tea isn’t typically associated with caffeine jitters like coffee—it contains L-theanine, which helps sooth over-stimulated nerves. Now to be clear, the amount of caffeine used in research with L-theanine is only 50 mg—that’s the amount of caffeine you’d typically find in one-half cup of moderately brewed coffee. Furthermore, 100 mg of L-theanine was used alongside the caffeine. When this combination was used together, human clinical research20,21,22,23,24,25 has shown that supplementation:

    • Helped maintain focus.
    • Helped with mental flexibility, the ability to shift attention from one task to another and efficiently adapt to different situations.
    • Helped improve focus on the information while filtering out other stimuli.
    • Helped improve focus during cognitively demanding tasks.
    • Helped improve speed and accuracy of cognitive performance.
    • Helped improve mental alertness.

    Folic Acid and Vitamin B12
    Folic acid and vitamin B12 are both critical B vitamins that perform a variety of functions in the human body. Among those functions are the roles they play in cognitive performance. For example, in one study26 older adults were supplemented with 400 mcg of folic acid and 100 mcg of vitamin B12 daily. The results showed that this combination:

    • Supported healthy cognitive function in older adults.
    • Promoted healthy memory performance in older adults.

    Furthermore, vitamin B12 deficiency can result in memory loss, and supplementation can help prevent it.27,28 Since vitamin B12 deficiency is estimated to affect 10 –15 percent of individuals over the age of 60,29 supplementation is certainly worthwhile.

    What to Expect When Taking Ageless Memory
    It should be noted that the aforementioned nutraceuticals tend to provide their effects at different times, so even if you use all of them your results will be progressive rather than instantaneous. Essentially, here’s how it will likely work (although everyone is different and results and timing may differ for you as well):

    Nutraceutical Effects on Memory and Cognitive Function

    Endnotes:

    1. Hanninen T, Koivisto K, Reinikainen KJ, Helkala EL, Soininen H, Mykkänen L, Laakso M, Riekkinen PJ. Prevalence of ageing-associated cognitive decline in an elderly population. Age Ageing. 1996 May;25(3):201–5.
    2. Hedden T, Gabrieli JDE. Insights into the ageing mind: a view from cognitive neuroscience. Nat Rev Neurosci. 2004;5:87–96.
    3. Sloan AE, Hut CA. Reading the Compass: Up-and-Coming Market Trends. Nutraceuticals World. October 1, 2013. Retrieved November 9, 2015 from http://www.nutraceuticalsworld.com/issues/2013-10/view_features/reading-the-compass-up-and-coming-market-trends/.
    4. Engels G, Brinckmann J. Bacopa. HerbalGram. 2011;91:1–4.
    5. Morgan A, Stevens J. Does Bacopa monnieri Improve Memory Performance in Older Persons? Results of a Randomized, Placebo-Controlled, Double-Blind Trial. J Altern Complem Med. 2010; 16(7): 753–9.
    6. Calabrese C, Gregory WL, Leo M, Kraemer D, Bone K, Oken B. Effects of a Standardized Bacopa monnieri Extract on Cognitive Performance, Anxiety, and Depression in the Elderly: A Randomized, Double-Blind, Placebo-Controlled Trial. J Altern Complem Med. 2008;14(6):707–13.
    7. Roodenrys S, Booth D, Bulzomi S, Phipps A, Micallef C, Smoker J. Chronic effects of Brahmi (Bacopa monnieri) on human memory. Neuropsychopharmacology. 2002 Aug;27(2):279–81.
    8. Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, Nathan PJ. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl). 2001 Aug;156(4):481–4.
    9. Stough C, Downey LA, Lloyd J, Silber B, Redman S, Hutchison C, Wesnes K, Nathan PJ. Examining the nootropic effects of a special extract of Bacopa monniera on human cognitive functioning: 90 day double-blind placebo-controlled randomized trial. Phytother Res. 2008 Dec;22(12):1629-34.
    10. Raghav S, Singh H, Dalal PK, Srivastava JS, Asthana OP. Randomized controlled trial of standardized Bacopa monniera extract in age-associated memory impairment. Indian J Psychiatry. 2006 Oct-Dec; 48(4): 238–42.
    11. Pase MP, Kean J, Sarris J, Neale C, Scholey AB, Stough C. The cognitive-enhancing effects of Bacopa monnieri: a systematic review of randomized, controlled human clinical trials. J Altern Complement Med. 2012 Jul;18(7):647–52.
    12. Raghav S, Singh H, Dalal PK, Srivastava JS, Asthana OP. Randomized controlled trial of standardized Bacopa monniera extract in age-associated memory impairment. Indian J Psychiatry. 2006 Oct-Dec; 48(4): 238–242.
    13. Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, Nathan PJ. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl). 2001 Aug;156(4):481–4.
    14. Reay JL, Kennedy DO, Scholey AB. Single doses of Panax ginseng (G115) reduce blood glucose levels and improve cognitive performance during sustained mental activity. J Psychopharmacol. 2005 Jul;19(4):357–65.
    15. Reay JL, Kennedy DO, Scholey AB. Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained ‘mentally demanding’ tasks. J Psychopharmacol. 2006 Nov;20(6):771–81.
    16. Brown RP, Gerbarg PL, Ramazanov Z. Rhodiola rosea: A Phytomedicinal Overview. HerbalGram 2002; 56:40–52.
    17. Darbinyan V, Kteyan A, Panossian A, Gabrielian E, Wikman G, Wagner H. Rhodiola rosea in stress induced fatigue—a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine. 2000 Oct;7(5):365–71.
    18. Spasov AA, Wikman GK, Mandrikov VB, Mironova IA, Neumoin VV. A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Phytomedicine. 2000 Apr;7(2):85–9.
    19. Shevtsov VA, Zholus BI, Shervarly VI, Vol’skij VB, Korovin YP, Khristich MP, Roslyakova NA, Wikman G. A randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work. Phytomedicine. 2003 Mar;10(2–3):95–105.
    20. Einöther SJ, Martens VE, Rycroft JA, De Bruin EA. L-theanine and caffeine improve task switching but not intersensory attention or subjective alertness. Appetite. 2010 Apr;54(2):406–9.
    21. Kelly SP, Gomez-Ramirez M, Montesi JL, Foxe JJ. L-theanine and caffeine in combination affect human cognition as evidenced by oscillatory alpha-band activity and attention task performance. J Nutr. 2008 Aug;138(8):1572S–1577S.
    22. Foxe JJ, Morie KP, Laud PJ, Rowson MJ, de Bruin EA, Kelly SP. Assessing the effects of caffeine and theanine on the maintenance of vigilance during a sustained attention task. Neuropharmacology. 2012 Jun;62(7):2320–7.
    23. Owen GN, Parnell H, De Bruin EA, Rycroft JA. The combined effects of L-theanine and caffeine on cognitive performance and mood. Nutr Neurosci. 2008 Aug;11(4):193–8. 24. Giesbrecht T, Rycroft JA, Rowson MJ, De Bruin EA. The combination of L-theanine and caffeine improves cognitive performance and increases subjective alertness. Nutr Neurosci. 2010 Dec;13(6):283–90.
    24. De Bruin EA, Rowson MJ, Van Buren L, Rycroft JA, Owen GN. Black tea improves attention and self-reported alertness. Appetite. 2011 Apr;56(2):235–40.
    25. Walker JG, Batterham PJ, Mackinnon AJ, Jorm AF, Hickie I, Fenech M, Kljakovic M, Crisp D, Christensen H. Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms—the Beyond Ageing Project: a randomized controlled trial. Am J Clin Nutr. 2012;95:194–203.
    26. Food and Nutrition Board, Institute of Medicine. Vitamin B12. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, vitamin B12, pantothenic acid, biotin, and choline. Washington, D.C.: National Academy Press; 1998:306–56.
    27. Healton EB, Savage DG, Brust JC, Garrett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine (Baltimore). 1991;70(4): 229–45. [ABSTRACT ONLY]
    28. Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annu Rev Nutr. 1999;19:357–77. [ABSTRACT ONLY]
  • For people who have used the early warning diagnostic tools from “Is Alzheimer’s Preventable” and show none of the typical symptoms of Alzheimer’s, or some beginning symptoms, the following modified nutritional program will likely be sufficient to slow symptom progression and perhaps delay symptoms indefinitely. Here are the basic elements of this modified program, which may be easier to implement and less expensive, compared to the original comprehensive program.

    1. The first step is to follow the Mediterranean Diet with emphasis on vegetables being about 40 percent of caloric intake. (8–10 helpings per day.)

    2. Eat as many detoxifying foods as possible, such as cabbage, celery, curry, asparagus, garlic, spinach, kelp, spirulina, wheat grass, silica water (Fiji or Volvic) and green tea.

    3. Use exercise, sauna or steam bath to remove toxins.

    4. Use meditation, yoga, music, deep breathing or tai chi to reduce stress.

    5. Chew your food very thoroughly and eat in a peaceful place with family and/or friends.

    6. Drink a green powdered drink every day; one with a high ORAC value such as Greens First.

    7. Use the following nutritional supplements from a quality company such as Source Naturals, Metagenics, Life Extension or MyGreenVillage.

    • Take a multiple vitamin and mineral supplement.
    • Use probiotics in the morning about 15 minutes prior to breakfast. Take with an organic yogurt.
    • Take a digestive enzyme with each cooked meal or with every meal if you have digestive issues.
    • Take a vitamin B complex (100 strength) preferably with the dinner meal. Helps make neurotransmitters.
    • Take a sublingual vitamin B 12 1000 mcg, preferably in the morning. Alzheimer's protection.
    • Take vitamin D3 in gel form throughout the day. From 1000 IU to 10,000 IU depending on blood levels, which should be maintained at 50-90 ng/ml. Antioxidant and genetic protection.
    • Take vitamin C in Ester or Liposomal form at 1500-3000 mg/day. Take in split doses with each meal for antioxidant protection.
    • Take omega 3 oils at 2000-4000 mg ( DHA and EPA). Take in split doses with each meal.
    • Take curcumin at 750-2000 mg/day. Take in split doses for amounts over 750 mg. Anti-inflammation.
    • Take Co-enzymes Q 10 at 300-1200 mg/day, depending on energy levels and other conditions such as heart, kidney or liver issues, which need more Co Q10. Energy and DNA protection.
    • Take astaxanthin at 4 mg/day in the morning for antioxidant protection.
    • Take magnesium glycinate at 400 mg in the morning. Helps with insulin and glucose absorption.
    • Take coconut oil or MCT powder at 3-20 grams/day. Easier to take with green drink in a shake.
    • Known to help with Alzheimer's.
    • Take Lithium orotate at 5-20 mg/day as directed by your primary care physician. Prevents damage to the brain from toxins and grows new brain cells to prevent brain shrinkage.
    • Take phosphatidylserine at 200-500 mg to improve communication between neurons.

    8.Dosage depends on your doctor's recommendations and the use of tests such as the IGG test for food sensitivities and the Spectro Cell Test for nutritional supplement needs and sensitivities.

    This nutritional protocol is based on the program, Is Alzheimer's Preventable? by Healthy at Work, November 2017, as well as a clinical trial by Dr. Dale Bredesen reported in AGING, September 2014, Vol.6 No.9.

  • Contributing Author Eric Dohner, MD

    THE DOMINANT RISK FACTOR FOR DEMENTIA IS ADVANCING AGE, UNFORTUNATELY, NO ONE KNOWS HOW TO REVERSE AGING. HOWEVER, THE SECOND MOST IMPORTANT RISK FACTOR IS POOR CIRCULATION, AND THIS IS SOMETHING YOU CAN EASILY CORRECT.

    Advancing age is the dominant risk factor for dementia. Individuals under age 65 rarely develop dementia, but then risk doubles every five years after age 65. In individuals over age 85, up to one-half exhibit signs of the onset of dementia.

    There is little we can do about aging, but we can address other dementia risk factors which arise with aging. In particular, low blood flow to the brain has repeatedly been shown to be one of the most important risk factors for dementia, and it is an easily correctable factor.

    Brain Blood Flow and Blood Pressure

    Though the brain makes up only about two percent of the body, 15 to 20 percent of the blood circulation in young adults goes to the brain to provide the necessary oxygen to support the energy demands of the brain. However, as we age, blood flow to the brain steadily declines. In men, brain blood flow falls about 15 percent over 50 years. In women, the decrease in brain blood flow is far greater, up to 30 percent by age 75.

    Blood flow to the brain declines with age because blood pressure typically declines with age. Lower blood pressures correspond to lower brain blood flow, particularly when sitting or standing as the brain is at the top of the body, and blood pressure must overcome the force of gravity. While in middle-aged people a major health concern is high blood pressure (hypertension), in older individuals, low blood pressure (hypotension) is common and can become a serious health issue, particularly with respect to brain health.

    Blood pressure begins to decline around age 60, and by age 75, half of Americans have a resting diastolic blood pressure (the lower number in a blood pressure recording) below 70 mmHg. 70 mmHg is considered a critical threshold for dementia risk, as the risk of dementia more than doubles for an older individual with a resting diastolic pressure below 70 mmHg for several years or more. By age 85, two-thirds of people have a resting diastolic pressure below this level.

    Blood Pressure and Dementia—The Evidence

    The influence of low blood pressure on the development of Alzheimer's was first reported more than 20 years ago in a Swedish study of 1800 people which showed that below normal (less than 120/80 mmHg) blood pressures were associated with a 2-fold to 10-fold increased risk.1

    The Bronx aging study subsequently confirmed that below normal blood pressures were associated with an increased risk of Alzheimer's, and also indicated that for individuals with resting diastolic pressures below 70 mmHg, the risk increased by a factor of two or more.2 Additional confirmation has recently been provided in a very large study completed in Norway and involving almost 25,000 patients who were followed for up to 27 years.3

    Additional research also confirms that reduced brain blood flow arising from chronic low blood pressures is likely the primary underlying cause of dementia. Direct measurements of brain blood flow have shown that increased blood flow is associated with reduced risk of dementia.4 Also, a very recent mouse study completed in Israel demonstrated that one hour daily exposures in a hyperbaric chamber, which increased oxygen levels in the blood, significantly reduced the physiologic nd behavioral effects of Alzheimer's within a two week period of time.5

    Blood Pressure and Aging

    So why does resting blood pressure fall as we age? Whenever we are sitting or standing, gravity is pulling the blood in our veins, and other fluids in our body, down towards our legs. Because people have relatively soft skin (women more so than men), our skin expands allowing blood and fluid to pool into our legs and lower body.

    In young individuals, the soleus muscles in the calf of the legs prevent this pooling from becoming excessive. These specialized muscles serve as pumps which collect the fluid pooling into the legs and pumps it back to the heart. The soleus muscles play such an important role in ensuring blood return to the heart that they are often called our "secondary hearts."

    As we age, however, it is common for our soleus muscles to become unable to perform the task of continually pumping blood and lymphatic fluid back up to our heart. The soleus muscles are maintained through squatting activity, and while our ancestors squatted to rest, adults in the western world rarely squat. To rest, we sit in chairs, and sitting does not exercise the soleus muscles.

    Weak soleus muscles allow fluid to continually build up in the legs during the day. This pooling is often first recognized by the presence of swollen feet or ankles, or by the appearance of varicose veins. But, if the fluids in your body are not being returned back to the heart, the output from your heart falls. This drop in cardiac output leads to a drop in blood pressure, and as a result, a decrease in blood flow to the brain.

    Maintaining a Healthy Blood Pressure

    The good news is that low blood pressure can be easily corrected. While low blood pressure can be due to medication interactions, or other condition, if you have swollen feet and ankles, varicose veins, unexplained fatigue, or cold hands and feet, it is most likely that the cause of your low blood pressure is weak soleus muscles.

    Like any muscle, your soleus muscles can be retrained. The best way to do this, of course, is to replace your sitting time with squatting time or to take up Tai Chi or Yoga. But if active exercise does not fit your lifestyle, you have the option of utilizing a "passive exercise" approach to building up your soleus muscles.

    The soleus muscles can be activated through a reflex initiated with an appropriate mechanical stimulation to the bottom of the feet. To take advantage of this reflex response, "passive exercise" devices have recently been introduced onto the market which allows you to exercise your soleus muscles while you sit. Retraining your soleus muscles generally requires a couple of hours a day of "exercise", but over the period of several months, your soleus muscles will regain their pumping ability, your symptoms of fluid pooling will disappear, and your resting blood pressure will return to normal.

    Preventing Dementia

    Recent research has provided encouraging evidence that correcting low blood pressure in older individuals is capable of reversing the earliest stages of dementia in a relatively short period of time.6 In a study on 70– 90-year-old participants living in an assisted living center, those with chronically low resting blood pressure were found to require twice as much time to complete a cognitive test than their fellow residents who had normal blood pressures. Undertaking soleus exercise for just one hour per day, over a four-month period of time, served to correct the low blood pressures, and cognitive test times fell by half.

    While dementia is often considered an irreversible effect of aging, research has clearly shown that dementia arises, in large part, as a result of the reduced brain blood flow which occurs as we age. By maintaining normal blood pressure as we age, we should be able to slow, or even reverse, the development of dementia and perhaps even prevent future cases of Alzheimer's and other debilitating forms of dementia.

    References

    1. Guo Z, et al. (1996) Low blood pressure and dementia in elderly people: The Kungsholmen project. BMJ 312:805–8.
    2. Verghese J, et al (2003) Low blood pressure and the risk of dementia in very old individuals. Neurology 611:1667–72.
    3. Gabin, JM, et al (2017) Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis. Zlaheimer's Research and Therapy. DOI10.1186/s13195-017-0262
    4. Ruitenberg A, et al (2005) Cerebral hypoperfusion and clinical onset of dementia. Annals Neurology 57:789–94.
    5. Shapira R, et al (2018) Hyperbaric oxygen therapy ameliorates pathophysiology of 3xTg-AD mouse model by attenuating neuroinflammation. Neurobiology of Aging 62:105.
    6. McLeod K, et al (2017) Reversal of cognitive impairment in a hypotensive elderly population using a passive exercise intervention. Clinical Interventions in Aging 12:1859–66.
  • Current blood tests are very inadequate and usually detect chronic disease five to ten years after it has already begun. Good examples are kidney disease, liver disease, heart disease, breast cancer, Alzheimer’s, Parkinson’s Disease and diabetes.

    • Kidneys can be diseased by 90 percent before tests ever indicate a problem.
    • Liver disease is often detected after the liver is 70 percent diseased.
    • Heart disease has often been developing 20 years before traditional tests reveal a problem.
    • Breast cancer is usually detected with a mammogram, which is eight to ten years before cancer begins to develop.
    • Diabetes tests include the AIC test, which often detects a problem five to ten years after it could have been detected.
    • Alzheimer’s cannot be detected, by conventional medicine, until there is a beginning of loss in cognitive function.
    • Parkinson’s Disease is only detected when a slight trembling occurs in one finger of one hand. By then about 80 percent of all dopamine receptors in the brain have died or been seriously damaged.
    Disease usually happens in five distinct stages:
    1. Stressed cells happen when there is poor nutrition,high toxin levels, high stress levels and genetic or biochemical deficiencies.
    2. Weakened cells occur when cells have been stressed too long, and cells lose their energy level.
    3. Dysfunctional cells are the third stage of deterioration when cells begin to experienced functional challenges. This is when most traditional tests detect a problem, such as high blood pressure, high glucose or chest pain known as angina.
    4. Mutated cells occur when the nucleus of the cell becomes damaged and can no longer produce a healthy replacement cell.
    5. Diseased cells happen when the cell cannot function and begins to damage other neighboring cells.
  • An Environmental Protection Agency (EPA) study of chemicals found in human body fat through biopsy showed the wide array of toxic chemicals that each of us carries within. The “toxic load,” also known as “total body burden” or “bio-accumulation” occurs when the body exceeds the capacity of the organs of detoxification to reduce or neutralize toxins. Since the end of the Second World War, our planet has been experiencing a dramatic chemical revolution. Our existence, at the cost of our health and quality of life, now depends upon thousands of synthetic chemicals that are used to create virtually everything we associate with modern life—agriculture, health care, energy production, food supply, household and personal care products, and manufacturing all pumping tons of chemicals—most sold to consumers or dumped into the environment. A portion of these foreign chemicals, referred to as xenobiotics (foreign to the body), end up within the human body.

    “The contamination of our world is not alone a matter of mass chemical spraying. Indeed, for most of us this is of less importance than the innumerable small-scale exposures to which we are subjected day by day, year after year. Like the constant dripping of water that in turn wear away the hardest stone, this birth-to-death contact with dangerous chemicals may in the end prove disastrous. Each of these recurrent exposures, no matter how slight, contributes to the progressive buildup of chemicals in our bodies and so to cumulative poisoning…Lulled by the soft sell and the hidden persuader, the average citizen is seldom aware of the deadly materials with which he is surrounding himself; indeed, he may not realize he is using them at all.”
    Rachel Carson, Silent Spring

    INNOCENT UNTIL PROVEN GUILTY
    With over 75,000 chemicals currently registered with the Environmental Protection Agency, only very small fractions are assessed for their toxicity in humans. In fact, only about 25 percent of commonly used chemicals have undergone even the most basic toxicity testing— even fewer are tested for their effects on the developing fetus, brain or the immune system. Chemicals, like criminals, are presumed innocent until proven guilty. Unfortunately, because of our lax environmental laws, most of these toxic offenders never go on trial and are presumed safe until widespread harm occurs or the public demands accountability.

    The use of mercury in dental amalgam fillings is a perfect example of toxic chemical “grandfathers” that remain in widespread use without any adequate safety testing required of the manufacturers. I worked in dentistry for many years prior to embarking on my career in natural health. I am one of those victims of heavy metal poisoning as a result of not only handling mercury in the course of dentistry, but also as a result of a mouthful of mercury amalgam fillings from age seven to eighteen. The only way we can preserve or repair our health from these toxic saboteurs is through education and finding safe alternatives.

    Most of these untested chemicals make their way into natural ecosystems and end up in the human body. Because of this, we are unknowing victims in a giant, uncontrolled experiment with billions of humans functioning as the experimental animals. It’s making millions very sick. As a result of this toxic exposure and buildup, we’re developing “invisible illnesses” like fibromyalgia, arthritic disorders, chronic fatigue, lupus, scleroderma, multiple sclerosis, Alzheimer’s, Parkinson’s, Gulf War syndrome, multiple skin disorders, a myriad of chemically-induced immune system disorders, and yes, even cancer.

    Future generations may look back upon this era with contempt for the indiscriminate way we’ve allowed toxic chemicals to pollute our world, erode our quality of life, and in general cause disease and death.

    A PHYSICIAN’S PERSPECTIVE
    Dr. Claudia Miller, Department of Family Practice, University of Texas Health Science Center at San Antonio, believes we are on the threshold of a new theory of disease— one that recognizes the impact of toxic chemicals. In a paper discussing chemical intolerance in Annals of New York Academy of Sciences, Miller wrote:

    “In the late 1800’s, physicians observed that certain illnesses spread from sick, feverish individuals to those contacting them, paving the way for the germ theory of disease. The germ theory served as a crude but elegant formulation that explained dozens of seemingly unrelated illnesses affecting literally every organ system.

    “Today, we are witnessing another medical anomaly—a unique pattern of illness involving chemically exposed people who subsequently report multi-system and new-onset chemical and food intolerances. These intolerances may be the hallmark for a new disease process, just as fever is a hallmark for infection.”

    Miller and other prominent scientists believe this new disease process is the key to the emergence of a totally new type of chemically related disorders and undiagnosed diseases. Disorders such as Gulf War syndrome, chronic fatigue, fibromyalgia, lupus, environmental illness, chemical sensitivities and multiple allergic response syndromes (MARS), are now believed to have a common denominator, toxic overload.

    POISONS WITHIN
    Toxic stress comes from more than the absorption of environmental chemicals. A wide range of potentially toxic substances are generated from processes at work within our body. When the natural mechanisms of detoxification malfunction, or when internally generated toxins are produced in excessive amounts faster than the ability of the organs to detoxify and neutralize, significant health disorders and disease result.

    For example, if a person does not have sufficient intake of vitamin B6, B12, or folic acid to meet their body’s specific demands, their cells are unable to properly metabolize and excrete the amino acid methionine—an important nutritional substance derived from protein digestion. When this occurs, a normally harmless amino acid is broken down into toxic homocysteine, a waste material that damages arteries and causes atherosclerosis.

    Even the processes within cells that generate energy from food molecules and oxygen result in the release of toxic free radicals — unstable molecules that have to be snuffed out by a complex system of dietary and internally generated antioxidants. If these complex antioxidant systems fail to perform properly, accelerated aging, disease and eventually death occurs.

    Toxins are also continuously generated from microbial activity in the digestive tract. Everything we eat is either absorbed into the body or it ends up in the colon where it is fermented by over 400 different species of bacteria and several kinds of yeast. Some of the fermentation by-products are harmless substances like lactic acid, but a wide variety of more toxic substances are also produced; ammonia, hydrogen sulfide, methane, butane, cadaverine, and putrescine—a few of the many microbial toxins generated in our own gut. Most of these toxic by-products remain in the gut and those that are absorbed are quickly neutralized by the liver. However, if unfriendly gut microbes overgrow, or if liver function is compromised, serious health problems occur.

    Many individuals living with chronic health problems suffer, in part, because of the condition commonly known as “leaky gut syndrome,” in other words, autointoxication, meaning they are being poisoned by the toxic substances within their body—the condition does not have to be acute for the person to manifest symptoms.

    This condition, technically known as increased intestinal permeability, occurs when the normally leak-proof lining of the small intestine becomes inflamed or damaged and tiny gaps open up between intestinal cells. In this condition, large molecules from partially digested food and microbes pass through the leaky gut and into the surrounding blood and lymph.

    When a person has leaky gut, every meal places an unhealthy load on their immune system, particularly their liver, resulting in an increase in overall body burden—often escalating into multiple allergic response syndromes (MARS™). Once this occurs, the allergic responses to food and the environment can escalate to multiple chemical sensitivities and even anaphylactic shock. As a recovered victim of leaky gut syndrome and MARS, I can attest to the life-threatening and life-altering challenges that a victim of these disorders endures. In order to achieve full recovery, complete life-style changes must be implemented. The best insurance against these disorders is knowledge. However, knowledge without action is just as deadly as no knowledge.

    BODY BURDEN—The Chemical Assault
    The human race is now contaminated with hundreds of synthetic chemicals, which were not found in our ancestors. Exposure in the womb to these contaminants can cause birth defects and affect our children’s future ability to reproduce and their susceptibility to diseases, including cancer. In some cases, developmental problems can result and affected children may never reach their full potential. Put simply, the integrity of the next generation is at stake. Protecting our children from the legacy of these chemicals is a major challenge and responsibility of modern society.

    CHEMICAL TRESPASS?— Pesticides in Our Bodies
    Many U.S. residents carry toxic pesticides in their bodies above government assessed “acceptable” levels. “Chemical Trespass: Pesticides in Our Bodies and Corporate Accountability,” makes public for the first time an analysis of pesticide-related data collected by the Centers for Disease Control and Prevention in a study of levels of chemicals in 9,282 people nationwide (2,644 of whom were tested for pesticides).

    Many of the pesticides found in the test subjects are linked to serious short- and long-term health effects including infertility, birth defects, learning disorders, childhood and adult cancers. Chemical Trespass finds that children, women and Mexican Americans shoulder the heaviest “pesticide body burden.” For example, children—the population most vulnerable to pesticides—are exposed to the highest levels of nerve-damaging organophosphorous (OP) pesticides. CDC data shows the average six year-old sampled is exposed to the OP pesticide chlorpyrifos (commonly known by the product name Dursban) at four times the level the EPA considers “acceptable” for a long-term exposure.

    Future articles will discuss specific challenges and the modifications necessary to live healthy in a toxic world through nutrition-based medicine employing pluralistic health principles, naturally.