There’s been a lot of talk around the health food store lately about coconuts being a miracle cure for Alzheimer’s disease and tofu causing it. Being that I have the good fortune of friendship with one of the few doctors who is actually working to cure the disease, I asked him to write an article for JayVay.com that would put the rumors to rest and tell us where the science is in terms of prevention. He answered the call and here it is. Thanks again, Tyler. — Jeremy Vaeni
Eat More Reality
Tyler A. Kokjohn
There is no cure for Alzheimer’s disease (AD). Worse, we have no reason to expect one to be forthcoming any time soon. Why is it so hard to do anything about this terrible condition? One problem is that we still cannot identify a specific cause for AD dementia. The brains of AD patients are often loaded with amyloid deposits, aggregates of small, toxic proteins and other molecules. The ‘amyloid hypothesis’ posits that the neurodegeneration and dementia of AD are due to these deposits and a lot of effort has been expended trying to eliminate them. However, AD dementia may represent the culmination of a long process involving far more than just simple amyloid accumulation. Controlling dementia may require something more than the typical ‘one target, one pill’ mentality that dominates pharmaceutical research at the moment. All this tells us is that we should be quite concerned about preventing AD in the first place.
Most neuroscientists agree that AD development risk depends on genetics, environment and behavior; in other words, literally everything. The most significant AD risk factor by far is advanced age. Simply live long enough and the odds for getting demented increase dramatically. The emerging epidemic of AD is thought to reflect the fact that more people now survive to old age coupled with complicating factors like diets rich in saturated fats and sedentary lifestyles. In principle, these facts suggest that lifestyle modifications might help delay the onset of dementia or allow some individuals to avoid it altogether.
The really bad news is that the underlying complexity of AD frustrates prevention efforts as well. Another way to put this is that it is difficult or impossible to correct a problem when you are uncertain about precisely what it is that has gone wrong in the first place. A number of dietary supplements such as curcumin have been suggested on the basis of convincing laboratory tests which revealed they might decrease production of amyloid. That is a great idea, but what if amyloid is not the primary culprit in dementia? Or what if amyloid IS the sole problem? The evidence suggests that amyloid deposits accumulate slowly over time, how early does one have to begin dietary supplementation and at what levels to prevent problems? Disappointing AD immunotherapy clinical trials have led many scientists to hypothesize that beginning treatments in patients who show signs of even early dementia are doomed to failure; the pathology is irreversible at that point. Simple, just get people before they show AD signs. OK, when? Five years before, ten years before? And how do you time something that hasn’t happened yet? If you start with young people the problem becomes one of waiting for the endpoints of dementia and death which might be decades away. All you have to do as a scientist is wait and hope that (a), your subjects adhere to the diet and (b), you don’t die before they do. Now let’s complicate the picture even more; AD dementia might be a bit different in each of us and reflect our personal activity levels, occupations, dietary preferences, education and life history such as head injuries, participation in sports or military service. Those additional factors make testing nutritional supplements (nutra-ceuticals) for beneficial cognitive effects, a tricky enterprise in itself, a literal nightmare.
Tabulated below are some supplements with alleged utility for coping with or preventing AD dementia. The bottom line is that a number of compounds and supplements do have a clear biochemical potential to impact processes that might conceivably influence AD dementia. However, when subjected to rigorous clinical trials, results have often been disappointing and many so-called alternative treatments have not been tested in scientific studies at all. In addition, the precise purity of many concoctions is uncertain and the producer is allowed to set standards for purity and safety. Remember, anything you ingest might induce undesirable side effects or interact with other medications in unpredictable ways. I do not endorse their use nor recommend anyone use them without first consulting with a physician.
Clearly, people will persist in seeking a simple cure for an extremely complex and heterogeneous disease process. Instead of waiting for a miracle, can anything helpful be done to decrease the chance you will become an AD victim? One thing that has been noted is that having a healthy heart and vascular system improves the odds of avoiding AD dementia. Have a look at these arteries from the circle of Willis which feed the brain.
On the left are examples of arteries from a healthy, non-demented patient. One the right are vessels typical of a person with advanced vascular disease (atherosclerosis) who was demented. Our work and the work of other labs confirm that the presence of vascular disease is often associated with AD.
This means that until the day when a cure is discovered, personal actions and some standard medical interventions to keep your heart and blood vessels in peak condition – maintaining a healthy weight, controlling diabetes, cholesterol levels and hypertension, not smoking or stopping smoking, eating an anti-oxidant rich diet featuring fresh fruits, vegetables, whole grains and legumes – will greatly improve your odds of avoiding AD dementia. And do not forget to exercise. The now all-too-common sedentary lifestyle may be a hugely underappreciated killer. Save your life – turn off the TV or computer and move. If you just sit there, AD might find you.
A reliable source of information regarding current Alzheimer’s disease news, research and therapy is the Alzheimer’s Research Forum web site (http://www.alzforum.org/).