By Jerome Burne
There have been at least 300 trials of drugs to prevent or slow the damage that Alzheimer’s does to the brain but none of them has produced anything clinically useful (New York Times, Gina Kolata Feb. 10, 2020). Could it possibly be that companies have been barking up a tree in the wrong part of the woods?
The result is that conventional wisdom says there is no treatment available yet, but we are working on it. That is true if you are a drug company, desperate for a drug, any drug, that has some effect, however slight.
But if you are prepared to look in a different part of the woods, at what is already on offer from diet and lifestyle changes, there are plenty of promising options.
This may well come as a surprise, if not frankly unbelievable. Eating more veggies and swallowing vitamins and nutrients to slow down the remorseless progression of something as grim and deadly as Alzheimer’s? That’s surely fake news and peddling false hope.
But the single-minded and massively expensive but failed focus on drugs that clear the plaque and tangles of proteins found in the brains of Alzheimer’s patients, has forced some researchers and clinicians to look elsewhere to find out what is actually causing brain cells to die off and what could prevent it.
Latest drug not clinically significant
As a result, it is looking increasingly plausible that Alzheimer’s is a metabolic disease. One clue is that diabetics are at raised risk of developing it. In fact, Alzheimer’s had been dubbed diabetes of the brain and since diabetes can be helped and even reverse the disease with changes in diet and lifestyle, it’s not unreasonable to think that the same approach might work for Alzheimer’s.
Certainly, a new approach is desperately needed. The latest drug, called lecanemab, has been hailed as a breakthrough – it might reduce your dementia rating by 0.45 points on an 18-point scale, which doesn’t reach clinical significance.
It also comes with side effects that include brain swelling and has a likely cost of anywhere between $9,000 and $35,000 a year.
Researchers investigating the alternative approach which promises to be far cheaper and less likely to generate severe side effects, point out that the brain is linked to all the organs and systems in the body and that when they are not working well or diseased, this affects the brain. The implication is that keeping yourself healthy reduces the chances of damage to brain cells and Alzheimer’s.
Could the Mediterranean Diet plus exercise help?
Professor Claudia Cooper, a psychiatrist at the Faculty of Brain Research UCL (University College London is running a pioneering study called Apple Tree to test the effectiveness of the Mediterranean Diet plus exercise in warding off Alzheimer’s.
‘The diet provides lots of fruit and vegetables,’ she says, ‘which have brain benefits such as reducing inflammation, lowering insulin resistance and improving brain blood flow.
She is NOW recruiting over 700 HEALTHY people over 60 who will be following a Mediterranean diet and exercising for a year. ‘They will be supported by fortnightly group sessions,’ she says, ‘to encourage them to stick to the program. At the end changes to thinking and memory will be assessed.’
A big review of the benefits of this diet done by the Harvard Department of Nutrition and published in 2021, found that it was ‘associated with less age-related cognitive dysfunction and lower incidence of neurodegenerative disorders, particularly Alzheimer’s disease.’
Other diets that help against similar disorders
But it would be a mistake to think that the Mediterranean diet was a kind of dietary vaccination against Alzheimer’s. It seems very likely to help but the hugely optimistic message emerging from such research is that Alzheimer’s is not something awful and mysterious caused only by a rogue protein like plaque that must be defeated.
Instead, things we already know about what works against other chronic disorders, such as heart disease and type 2 diabetes, means they are also likely to help against Alzheimer’s. The implication is there is much that we can start doing right now to lower our risk.
One of these might be to cut back on, or avoid, sugar. ‘A high sugar intake, along with filling yourself with other refined carbohydrates – cakes, buns, biscuits – is a major risk factor for Alzheimer’s,’ says Professor Emeritus Robert Lustig of the Endocrinology division of the University of California.
Warning signs of dementia show up early as 30
‘Dementia is a metabolic disease, just like diabetes,’ he continues. ‘Overweight children and adolescents whose diets involve lots of sugar and refined carbs have brain shrinkage in the same area of the brain seen in Alzheimer’s patients, as well as cognitive decline.’
The probable link with high blood sugar means that testing blood sugar levels in people in their 30s could turn out to be a valuable early warning system for dementia decades later, according to a study published in ‘Alzheimer’s and Dementia’ last March. Those with high levels in their 30’s had a 15% increased risk of dementia decades later.
‘But the amount of benefit any one person got would depend on what else they did,’ says David Smith Emeritus Professor of Pharmacology at the University of Oxford and expert in Alzheimer’s prevention.
The changes that can make a difference
‘The diet and lifestyle approach makes it clear that there are many things in our environment and the way we live that can hurt or heal the brain, so the really good news is that many of them are things we can individually do something about.
‘These include how well you sleep and handle stress, how healthy your guts are – lots of brain-gut connections – how much you exercise and, possibly just as important, how strong and rewarding your social connections are.
Another project, set up like Apple Tree, to find how effectively it’s possible to help people protect their thinking and memory skills, is the charity Foodforthebrain.org.
Visitors to the site can take, (for free), a test and a questionnaire to assess their risk. The Cognitive Function test – similar to the one used in memory clinics – can pick up changes in memory and thinking skills years before a diagnosis.
Key areas to keep healthy pinpointed
The questionnaire is designed to find out how well you are looking after those areas of your lifestyle and body that can impact brain health. The site picks out eight to pay special attention to. They include the quality of your sleep, how well your gut is fed, how mentally active you are and the amount of 0mega 3 fats you are getting.
The results give you a Dementia Risk Index (DRI) that rates the areas as either good could be improved or poor. Then you get advice on how to improve. A follow-up a year later tells you if your DRI is changing in the right direction.
The test for Cognitive Function was compiled by Dr Celeste de Jager Loots, an expert in neuropsychological assessment at Imperial College London. The DRI questionnaire has been developed by a team of academics and researchers headed by Professor Smith.
The Cognitive test and the DRI have already been taken by nearly 5000 people. The results were analyzed by Professor Cooper’s team, which reported that 88 per cent found the combination ‘useful’, and 37 percent said they had made dietary or lifestyle changes as a result.
Just two nutrients could make a big difference
So, there is no shortage of intriguing and promising new areas for reducing Alzheimer’s risk with diet and lifestyle. However, most need more research before their effectiveness is firmly nailed down.
One very promising but less familiar approach involves just two nutrients – B vitamins and omega-3 fatty acids.
‘The theory behind it makes a lot of sense,’ says Dr Simon Dyall, head of the Clinical Neuroscience programme at the University of Roehampton and an expert in fatty acids. ‘Brain cell walls are made up of the omega 3 fatty acids found in fish oil, while B vitamins help to get the fats into the cells. https://pubmed.ncbi.nlm.nih.gov › 30958356)
‘High doses of a complex of B vitamins also have another benefit. They are the only way of reducing the raised levels of an amino acid called homocysteine, which is found in Alzheimer’s patients and known to damage brain cells.
‘But the results of studies using B vitamins or Omega 3 were mixed, until recently,’ Dyall continues. ‘They are now showing that combining B vitamins plus omega 3 is more reliably effective.’. One large review of ways of lowering Alzheimer’s risk, published in 2020, reported that lowering homocysteine was the most effective form of prevention. (Journal of Neurology Neurosurgery and Psychiatry doi: 10.1136/jnnp-2019-321913)
New research on why exercise helps
Less controversial is the benefit of exercise in reducing brain shrinkage and cognitive problems, but how does it work?
This has recently become clear thanks to the work of Dr Tommy Wood, an assistant professor of paediatrics at the University of Washington in the US. He’s found what is going on thanks to his work with brain-damaged children. (Published in Cells 2022 Sep 7. doi: 10.3390/cells11182789)
‘Exercise is important because it makes the brain do things that keep it healthy, such as growth and repair, maintaining its temperature and your weight,’ he says. ‘When BRAIN tissues aren’t stimulated, their health deteriorates with a knock-on effect on memory and thinking.’
Sleep as a brain protector also fits in here. It’s vital for recovering from physical exercise and to store and organise what you have learnt in the day.
‘But sleep and exercise aren’t enough on their own,’ Wood continues. ‘All that repair and maintenance needs a good supply of nutrients.’
Don’t forget to look after your guts
And that brings us back to diets such as the Mediterranean, those that don’t push up blood sugar, are higher in Omega 3 fats and support the good bacteria in your guts.
‘Gut bacteria are involved in many important brain functions and help in protecting against damage to brain cells and educating the immune system,’ says Dr David Vauzour, Research Fellow in Molecular Nutrition at Norwich Medical School.
‘The immune connection is important’, he adds, ‘because chronic low-grade inflammation develops when it the immune system is out of whack, something which is found in most neurological conditions, including Alzheimer’s.
‘Fibre-rich foods are essential for feeding the gut bacteria, which in turn helps the brain.’ They include oats and oatcakes, beans, nuts, seeds, whole fruit and vegetables.’
New App can keep you on a healthy track
Last month foodforthebrain.org launched a free app called COGNITION, which is an upgraded version of the cognitive test and the DRI questionnaire. It guides you through any suggested changes with personalised advice and coaching via emails and texts.
Like AppleTree, the COGNITION app is designed as a ‘Citizen science’ project, sharing the research results with everyone involved, including other research groups. It tracks the changes you make and how your mental ability changes every six months.
Despite the obvious attractions of using nutrition and lifestyle changes and the growing evidence for their benefits, the funding for research is a tiny fraction of the billions spent on unsuccessful drug trials.
Patient power could kick the charities into action
This is the reason why there are, as yet no large-scale randomized trials. It is not a reason for dismissing the available evidence and returning to peering down a microscope at plaques and tangles.
If patients with ‘mild cognitive impairment’ and their friends and relatives were the boards of the Alzheimer’s charities, you can bet that proper funding would start to flow.
A funding strike by supporters of the charities until they started spending money on research into the benefits of nutrition and lifestyle, might have a similar effect.
Jerome Burne
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WINNER: 
Hi Jerome,
Responding to your last point, I have long since given up donating to health charities because they are so locked in with Big Pharma. I wonder, are there any better charities that you can recommend?