What five steps can you take to reduce your risk of Alzheimer’s?

Today I watched Episode 02 of Alzheimers – Science of Prevention, a groundbreaking documentary series, featuring David Perlmutter, MD, board-certified neurologist and #1 NYT bestselling author, along with leading experts in the field of brain health. For my notes on Episode 01, click here.

This fantastic series reveals the powerful ways we can decrease our chances of developing Alzheimer’s disease. According to Wikipedia, Alzheimer’s is a chronic neurodegenerative disease that usually starts slowly and worsens over time. It is the cause of 60–70% of cases of dementia.

With Alzheimers reported to be the fastest growing epidemic among the aging, I want to know what I can do now to optimize my brain health long-term. I took copious notes while watching this episode and want to share these important insights from the series with you below.

For full access to this series, as well as for bonus interviews not included in the free series, check out access to the series here.

Episode 02 Notes:

“Your Brain’s Destiny Is In Your Hands.”

Are you at risk of developing Alzheimer’s?

• Diabetes: One of the main risk factors for Alzheimer’s is diabetes. If you have Type 2 Diabetes, your risk more than doubles.
• Women: Female gender is the second biggest risk factor for this disease. Women are more likely to get Alzheimer’s by a ratio of 2:1. 1 in 6 women are at risk of developing Alzheimer’s disease in their lifetime as opposed to 1 in 11 men. ⅔ of all people with Alzheimer’s are women. Women metabolize lipids and fats in a different way than men. Glucose dis-regulation affects women in a different way. The timing of menopause and when women start taking hormones is a big risk factor for Alzheimer’s disease.
• Obesity: We also know that being overweight significantly increases the risk for development of Alzheimer’s. – Dr David Perlmutter
• Inflammation: Inflammation can also trigger Alzheimer’s.
• Insulin Resistance: There are a whole set of things that contribute to Alzheimer’s disease but high priority items include insulin resistance and obesity. And ultimately before that diabetes and before that, pre-diabetes. These are all important risk factors for cognitive decline.
• Biological Age: (The singular most important risk factor is age. So anyone over 65 is at higher risk compared to younger people. That said – “when you dig deeper you realize it’s not your age in birthdays, it’s your biological age. And now we have metrics to measure your biological age and the most interesting measurement to me is the measure of damage your immune system has undergone over the course of your life.”
• Lack of exercise: Physical inactivity is an important risk factor for cognitive decline in aging and for Alzheimer’s disease (PubMed) 

What are the signs & symptoms of Alzheimer’s disease?

• “Alzheimers does not show up overnight. Rather, there’s a slow progression from normal cognitive function to ultimately manifesting Alzheimer’s disease. Typically, this begins with what’s called Subjective Cognitive Impairment. That moves to Mild Cognitive Impairment or what we call MCI.” – Dr David Perlmutter
• “Alzheimer’s doesn’t just turn on in your brain. There’s a slow progression phase that goes from normal cognition to some subjective cognitive impairment. So, people becoming aware that there’s become some cognitive change. And for some people that leads to a diagnosis of mild cognitive impairment.” – Lisa Mosconi, PhD, Women’s Brain Initiative, Weill Cornell Medical College

What tests can you take to determine your risk for developing Alzheimer’s?

• Important tests are Fasting Blood Sugar & Fasting Insulin Level.
• C-Reactive Protein (measured via a blood test): As we mentioned before, inflammation plays a very important role in the genesis of Alzheimer’s. C-Reactive Protein is a powerful marker of inflammation and should be included in the tests.
• Look at inflammatory markers because we know there’s a significant connection between inflammation and Alzheimer’s disease.
• Look at blood-sugar relationships because we know that high insulin levels are another marker for later stage cellular or apoptosis damage.
• Look at immune complexes and things we can measure like antibodies in the blood that may relate to an autoimmune response.

“These tests give information on your risk from a genetic perspective, a metabolic perspective and an inflammation perspective. These are some routine tests that we as an individual are responding to our environment. We can use these as markers to track going forward.”

Why have conventional pharmaceutical treatments for this disease failed?

• “The effects of the current Alzheimer’s drugs is minimal. In fact, a publication has appeared that showed that people on these drugs over time actually did worse. It was pointed out in the paper that this outcome may not be related to the drugs, it may be something separate. It is not yet known but it’s a concern and something we need to be aware of. It’s clear that these are not a significant improvement. And it’s clear that they don’t help you with a long-term outcome.”
• The medications never make the claim that these drugs slow down the disease or abate the disease. These drugs are not meant to slow the disease.
• The standard treatment for Alzheimer’s is based on pharmaceuticals. These drugs relieve the symptoms of Alzheimer’s but they are not a cure for Alzheimer’s. They cannot stop the progression.”
• You may have heard of Amyloid, a protein that is found in high levels in the brain of some people with Alzheimer’s disease. And because of this connection, some have hypothesized that the Amyloid may in fact cause Alzheimer’s. This has led researchers to try to remove or stop the production of Amyloid in the brain. Unfortunately, those studies have been disappointing. And it turns out that trying to fix Alzheimer’s by targeting one specific problem may not be the best way to approach this complex disease.

Why has a pharmaceutical cure been so elusive?

• “We’re asking one drug to patch 36 holes. We always make the analogy, imagine you have a roof with 36 holes. We use that number because we initially identified 36 different mechanisms that leads ultimately to this imbalance that we call Alzheimer’s disease. So if you try to patch 36 holes with one patch, it’s a great patch for one hole. And I think in the future, the drugs will be very important, in combination with personalized programs. But the idea of taking one and trying to do all these different things – change your inflammatory status, change your insulin resistance, change your nutrient levels, change your hormone levels, change your trophic levels, change your toxin detoxification – these things are major systemic changes. And to do all that with one drug, it really doesn’t make any sense.”
• Truth be known there remains a great deal of reluctance in mainstream medicine to embrace the notion that Alzheimer’s may well be preventable. I think there are several reasons for this. One reason might be that you can’t patent, sell or write a prescription for the various lifestyle interventions that can play a role in Alzheimer’s prevention. In addition, these ideas are not taught in medical school and therefore, they are not widely understood by mainstream medicine. And this makes it difficult for Alzheimer’s prevention to be incorporated into the traditional healthcare system.
• “It’s hard to change the inertia that’s there. With complex chronic illnesses, whether you’re talking about Alzheimer’s, whether you’re talking about Parkinson’s, whether you’re talking about Type 2 Diabetes, they have multiple factors. And when that is taught in medical school, I think we will make a major step forward.

What can you or your loved one do to potentially improve cognition?

• “The neurology guidelines were just updated to include exercise as an intervention that could potentially improve cognition. That’s an incredible thing because there actually are no FDA-approved pharmaceutical interventions to treat mild cognitive impairment. – Max Lugarve, NYT Best Selling Author, Genius Foods
• “There are so many things that people can do to prevent Alzheimer’s disease. We actually have an acronym: N.E.U.R.O. NEURO stands for Nutrition, Exercise, Unwind or stress management, Restorative sleep, the kind of sleep that allows you to go to each and every stage of sleep and “O” is for Optimizing cognitive activity. And it’s not one of them at one time, it’s all of them comprehensively. And in a very multi-faceted way, all the time and as early as possible. – Ayesha Sherzai, MD, Alzheimer’s Prevention Program, Loma Linda University

An integrated approach can reduce the risk of Alzheimer’s.

• “#1, our diet is super inflammatory in the USA and in the rest of the world. Lack of exercise is inflammatory. Stress is inflammatory. Not sleeping is inflammatory. Being nutritionally deficient is inflammatory. Having toxins is inflammatory. Bad gut microbiome is inflammatory. These are all things that are modifiable risks so we can change those things which will lead to reductions in inflammation and healing repair of the brain. – Dr Mark Hyman
• “We have thousands of papers over the last decades that lifestyle, including nutrition and exercise by themselves, slow the disease down or stop you from ever getting the disease if started earlier by as much as 50% when it comes to nutrition and 48% when it comes to exercise. – Dean Sherzai, MD

We cannot depend on pharmaceutical interventions to cure Alzheimer’s or even meaningfully treat it. Prevention is the most prudent course of action.

3 key points:

1. Alzheimer’s is an incredibly disabling and progressive disease for which we have no meaningful treatment.
2. The best research suggests that many of the risk factors for Alzheimer’s are within our control.
3. You can start making changes today to potentially reduce your risk of developing Alzheimer’s – Dr David Perlmutter

All roads are pointing to prevention when it comes to Alzheimer’s disease.

• “Healthcare is not something you’re going to receive at your pharmacy. It’s something you will procure for yourself when you’re pushing your shopping cart through the supermarket – that part of the day when you’re able to summon your will power to subvert the aisles with the packaged, processed foods and stay away around the perimeter. That’s really when you are procuring healthcare for you and your loved ones. It’s when you are deciding whether or not you’re going to hit the gym. That’s really what health and wellness is about. – Max Lugarve, Author of Genius Foods
• “One of the most impactful things I’ve learned about the prevention of Alzheimer’s disease is that you can affect your brain at any moment, every single day of your life. Every decision you make affects your brain. Everything you do either makes your brain or breaks your brain. – Ayesha Sherzai, MD, Alzheimer’s Prevention Program, Loma Linda University
• “Take charge … you are the captain of the ship. – Michael Merzenich, PhD Professor Emeritus, UCSF & Founder and CSO, Posit Science

Gratitude

Thank you, Dr. David Perlmutter and experts featured in this series for sharing your life-changing knowledge, practical tips and habits to help us optimize our brain health. It’s incredibly empowering and inspiring to know that we have more control over our cognitive health than statistics suggest.

Here are some takeaway actions from Episode 02 that we can implement today:

Know the risk factors.

1. Diabetes, Pre-diabetes or insulin resistance
2. Women
3. Obesity
4. Inflammation
5. Lack of exercise
6. Biological Age

Understand the signs of cognitive decline.

1. Subjective Cognitive Decline
2. Mild Cognitive Impairment (MCI)

Determine your risk of developing Alzheimer’s by taking some tests

1. Fasting Blood Sugar & Fasting Insulin Level tests
2. C-Reactive Protein (via a blood test)
3. Inflammatory markers
4. Blood-sugar and insulin sensitivity tests
5. Immune complexes and antibodies (via a blood test)

Understand you are your own best health insurance. Take control.

1. Nutrition: eat anti-inflammatory foods (side note: if you are vegan, make sure you take B12 supplements)
2. Exercise: aerobic exercise & strength training
3. Unwind or stress management: consider developing a daily mindfulness or meditation practice
4. Restorative sleep
5. Optimizing cognitive activity

To your health xx
Katrina