Sunday, February 3, 2013

Causes of Alzheimer's Disease

My mother used to joke that she couldn't retire, because she had far too much work to do.   She would also forget things, and then joke that she had "oldtimers' disease".  

The joke was really on her, because part of the reason for her huge workload, was that even at a fairly young age - probably in her mid to late fifties - her brain was beginning to short circuit.  She would complain that her computer wasn't working, but I could never understand how her computer could be so spectacularly faulty all the time.

It wasn't a funny joke at all.  It turned out that she had early onset Alzheimer's Disease.  She is now in her early seventies and lives in an institution where she is well-cared for and happy.  But she doesn't remember anything for longer than about one second.  She used to be able to speak more than five languages and was brilliant at word puzzles and sudoku.  Now, she spends her days sitting in a chair holding an Italian book (sometimes upside down) but not taking in anything.  She can't say much anymore either because she can't remember the second half of a simple sentence she has just begun.  So much for the theory that keeping your mind active and doing word puzzles keeps Alzheimer's at bay.   Clearly it didn't work for my mother.

I suppose the positive side of what happened to her is that she is not unhappy.  Although we feel sorry for her, she appears to be blissfully unaware of the disease that is eating away at her brain.

If you perform a google search on the causes of Alzheimer's Disease, popular media websites will usually return something along the following lines:
We still don't understand exactly how Alzheimer's disease damages the brain. Somehow, cells are damaged and eventually die in different areas of the brain. The damaged areas of the brain contain abnormalities called senile plaquesand neurofibrillary tangles. The death of brain cells leads to dementia, characterized by memory loss, impaired judgment, and behavioural changes.
The article I found this in goes on to claim that:

Possible risk factors include:
  • head injury: Studies show that people who have suffered concussions are more likely to develop Alzheimer's later on.
  • vascular disease: Coexisting small strokes increase the risk and severity of memory problems in Alzheimer's disease.
  • inflammation: People with arthritis are less likely to get Alzheimer's. It is speculated that the medications used to reduce inflammation in arthritis may have a beneficial effect on an inflammatory process in the brain.
  • gender: Women are nearly twice as likely as men to suffer from Alzheimer's.
  • education: Research suggests that better educated people are less prone to Alzheimer's. Those who already have the disease do better if they keep mentally active - an unused brain may deteriorate faster.
  • toxins (e.g., aluminum): A controversial and unproven theory links aluminum in drinking water to senile plaque formation. Earlier studies hinted at a connection, but not according to recent studies that are larger and better-designed.
  • prions: Some scientists speculate that prions, tiny infectious particles made of protein, may be involved in Alzheimer's disease by infecting the brain.
Did you notice that diet wasn't mentioned at all?  Last week I listened to a radio interview with a spokesperson from the local chapter of the Alzheimers Society.  She talked about much of the same stuff, though I do remember her mentioning that it was important to maintain a normal weight, to eat whole foods, plenty of fruits and vegetables, and in particular, to keep fat intake low.

We grew up eating only home-cooked foods, though in retrospect there was a fair amount of refined carbohydrate in our diet:  potatoes, pasta, white rice and store-bought wholewheat bread.  As a teenager in the early eighties, we drank skim milk and ate lean cuts of meat.  We dutifully spread fat-reduced margarine on our bread.  My mother was overweight for much of her adult life, and about 5 years ago, she was diagnosed with type 2 diabetes.

You may find it fascinating that there is peer-reviewed scientific research which differs quite radically from the mainstream media view of what causes Alzheimer's Disease.  Looking at what happened to my mother, I am beginning to uncover papers that provide a more satisfactory explanation as to why my multilingual, brainteaser-loving mother succumbed to this cruel disease.

For example, a 2011 study published in the European Journal of Internal Medicine is titled Nutrition and Alzheimer's disease:  The detrimental role of a high carbohydrate diet:


Alzheimer's disease is a devastating disease whose recent increase in incidence rates has broad implications for rising health care costs. Huge amounts of research money are currently being invested in seeking the underlying cause, with corresponding progress in understanding the disease progression. In this paper, we highlight how an excess of dietary carbohydrates, particularly fructose, alongside a relative deficiency in dietary fats and cholesterol, may lead to the development of Alzheimer's disease.
Did you see that?  Relative deficiency in dietary fats and cholesterol?  The paper goes on to explain that 
The strong influence of Ancel Keys, beginning in the 1960s, has led to dietary avoidance of fats and cholesterol along with over-zealous prescription of cholesterol-reducing medications over the same decades in which there has been a parallel rise in AD prevalence. Although this epidemiological coincidence is not proof, it gives weight to underlying research showing a possible link between cholesterol depletion and neuronal failure.
It has been shown that patients with type-2 diabetes are at two to five times increased risk to AD ... A ketogenic diet has been found to be therapeutic in AD patients.  It involves an extremely high fat diet, with up to 88% of calories derived from fats. This benefit may be likely due in part to the bioavailability of a plentiful supply of fats to repair damaged membranes. 
What I found particularly fascinating, not to say downright disturbing, is that the study claims a correlation between dementia, depression, Parkinson's Disease and low LDL cholesterol.  Aren't we bombarded with advice to lower our so-called "bad" LDL cholesterol?  

In a nutshell, the authors hypothesize that a diet high in processed carbohydrates results in elevated blood glucose levels which, over time, impair serum proteins, which in turn results in the appearance of advanced glycation end-products, commonly known as AGEs.  AGEs cause damage to LDL, which in a roundabout way causes the neurons in the brain to become cholesterol and fat depleted and stressed.

This is complex stuff and I certainly don't have the background or expertise to critique the authors' hypothesis in an educated way.  However, I do find that it makes more sense than any explanation I have ever read in the mainstream media.  

It also makes me very curious to read how proponents of low fat vegan diets like Dr. Neal Barnard, whom I wrote about yesterday, would respond to this paper.  It would make for an incredibly interesting academic discussion.

To wrap it all up, the paper concludes with the following rather simple recommendation:
Simple dietary modification, towards fewer highly-processed carbohydrates and relatively more fats and cholesterol, is likely a protective measure against Alzheimer's disease.
I do realize it's not necessarily the only factor in the development of my mother's disease, but it's advice I'm taking seriously, just in case I inherited a genetic predisposition to Alzheimer's Disease from her.  

And while it's too late to do anything about it now, I do harbor a painful feeling of regret that my children may have lost out on knowing their grandmother, in large part because she was taken in by the prevailing dietary advice to eat more grain and less fat.

Edit:  here is a picture of her that was taken at the beginning of 2015.  I know it isn't very flattering, but at her stage of disease progress, nothing is flattering any more.  She needs a wheelchair to get around, and no longer feeds herself.  I noticed her lunch is exactly the kind of food I never touch, but at her stage of disease progression, I imagine it doesn't really matter.

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