Eat Well, Get Fit, Beat Diabetes, Heart Disease and Cancer

The brain wears out; it’s as simple (or as complex) as that. The ageing brain has a propensity to lose function, but you can do a lot to slow or halt this progress. Various dementias and Alzheimer’s disease are possible outcomes. Both result in substantial and progressive loss of mental capacity — and in the case of Alzheimer’s disease (AD) at least, a rapid decline and death.

So what can you do to prevent or at least minimise the risks, even allowing for a genetic susceptibility?

I know it might sound trite, and you may be tired of hearing it, the cornerstone of prevention is nutrition and exercise once more – along with social interaction and lifelong education and brain stimulation. You can fool around with funny-sounding herbs and supplements and odd dietary practices until you’re blue in the face (and hair), but it won’t make much difference in the scheme of things unless you eat well, stay fit, keep the arteries clean and the brain stimulated and those neuronal synapses firing.

You need to keep that brain rolling along; keep it working hard with challenging reasoning, numerical, textual, social, and logical analytical exercises and experiences. Like muscle, you use it or you lose it. That’s the best guesses we have anyway, in the absence of definitive scientific studies.

Ways to boost brain power and stop dementia

Holding onto your marbles until an old age is surely something we all should aim for. As we age, maintaining brain power may be more of an issue than boosting brain power, but even that does not seem impossible. Genetics seems to play a part in how well each of us might do this. Yet again, in many instances, genes are only templates and it’s how we interact with them environmentally that activates or quietens them. This is the science of epigenetics.

Several forms of dementia or organic brain syndrome exist, although Alzheimer’s disease is probably the most recognised among non professionals. Some have genetic causes and others are multifactorial and related to ageing and lifestyle. See a great discussion of dementia at Medicine.net.

Several genes have been identified for Alzheimer’s disease, both early- (before 65) and late-onset Alzheimer’s disease. However, it’s complicated because some people with certain genes will be very likely to get the disease, particularly early-onset; some with the same genes will not get the disease; and some without the genes will get the disease.

The main gene cluster for over-65 Alzheimer’s (the most common form), is the APOE gene, of which there are several types, some protective and some causal. What you need to know about this is that even if you have an “unlucky number” you may still be able to avoid the disease by optimising your lifestyle to prevent those toxic plaques (amyloid protein) accumulating in the brain, which is what the causal genes promote.

Risk factors for dementia and Alzheimer’s disease (AD)

1. Age. Ageing increases dementia and AD risk over time.
2. Genetics / family history. Dementia in the immediate family predisposes you to dementia but does not guarantee it. If you see it, work hard to lower your risk factors and increase your protective factors.
3. Smoking and alcohol use. Both smoking and excessive alcohol use increase the risks of dementia. Both habits may be related to artery health and circulation. It’s worth noting that low to moderate consumers of alcohol have lower risks of dementia than abstainers or heavy drinkers. (The Rotterdam Study and others.)
4. Atherosclerosis (cerebrovascular disease, stroke, artery disease). Any process that blocks delivery of blood flow to the brain, or causes high blood pressure or stroke, can lead to failing cognitive skills. Arteries are the pipes of life and degradation of them causes many diseases, including dementia.
5. Cholesterol. Similarly, cholesterol, especially low-density cholesterol (LDL), causes plaque in arteries, poor blood flow to the brain and probably vascular dementia. Alzheimer’s disease is also linked to high cholesterol, possibly because it promotes amyloid plaque buildup, but this relationship is less certain.
6. Homocysteine. Homocysteine is a protein found in the blood. It is associated with chronic inflammation. In some studies homocysteine is associated with dementia (and cardiovascular disease) and AD. Whether it’s a cause or a product of other inflammatory factors is still being debated. Sufficient folate and vitamin B12 in the diet reduce homocysteine levels.
7. Diabetes. Diabetes is a risk factor for atherosclerosis and stroke and therefore AD and vascular dementia. Damage to the small, as well as large blood vessels contributes to this.
8. Being sedentary. Physical activity improves blood flow and oxygen transport to the brain, cholesterol and glucose metabolism, and other factors related to the prevention of atherosclerosis and consequent dementias.

Protective factors for dementia and Alzheimer’s disease

A recent study of older people following healthy eating patterns plus exercise, published in the Journal or the American Medical Association (Aug 2009), showed that this lifestyle pattern reduced their risk of AD by about one third, and that both healthy eating (Mediterranean diet) and physical activity were independently associated with reduced risk of Alzheimer’s disease. On the other hand, a panel of experts constituted by the US National Institutes of Health recently reported an absence of strong evidence that lifestyle adjustment could prevent Alzheimer’s disease. This particular review was influenced by the fact that randomised controlled trials are mostly absent from Alzheimer’s research in relation to lifestyle approaches. This does not mean that lesser levels of evidence don’t exist, as the JAMA paper shows.

Here’s a summary of lifestyle and biomedical factors that possibly reduce dementia risk.

1. Nutrition – omega-3, antioxidants, folate and B12, high intake of fruit and vegetables, polyunsaturated fats, low intake of saturated and trans fats
2. Physical activity and formal exercise – cardiorespiratory fitness, blood flow to brain and heart, collateral blood supply
3. Moderate alcohol consumption – 1 to 2 drinks/day, preferably with meals
4. Mind games, education and cerebral stimulation – puzzles, computer games, crosswords, writing, art, music, learning
5. Social interaction – family, groups, clubs, charities, public speaking
6. Meditation, relaxation – brain changes, neurons, connections
7. Manage cholesterol, glucose, hypertension, homocysteine, inflammation

• Scarmeas N, Luchsinger JA, Schupf N, Brickman AM, Cosentino S, Tang MX, Stern Y. Physical activity, diet, and risk of Alzheimer disease. JAMA. 2009 Aug 12;302(6):627-37.
• Middleton LE, Yaffe K. Promising strategies for the prevention of dementia. Arch Neurol. 2009 Oct;66(10):1210-5. Review.
• Scarmeas N, Luchsinger JA, Schupf N, Brickman AM, Cosentino S, Tang MX, Stern Y. Physical activity, diet, and risk of Alzheimer disease. JAMA. 2009 Aug 12;302(6):627-37.
• Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, et al. IANA task force on nutrition and cognitive decline with aging. J Nutr Health Aging. 2007 Mar-Apr;11(2):132-52. Review.  
• Scarpa S, Cavallaro RA, D’Anselmi F, Fuso A. Gene silencing through methylation: an epigenetic intervention on Alzheimer disease. J Alzheimers Dis. 2006 Aug;9(4):407-14. Review.   
• Taguchi A. Vascular factors in diabetes and Alzheimer’s disease. J Alzheimers Dis. 2009 Apr;16(4):859-64. Review.    
• Ruitenberg A, van Swieten JC, Witteman JC, Mehta KM, van Duijn CM, Hofman A, Breteler MM. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet. 2002 Jan 26;359(9303):281-6 

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