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A Breakthrough approach to reducing risk of Alzheimer's diseaseNutrients for Memory

The Hawaii Dementia Prevention Trial

Steve Blake, ScD



July, 2017

"It was good meeting you today and I very much appreciated your informative discussion of nutritional approaches to prevention and treatment of Alzheimer's disease and related dementias."
BRENT P. FORESTER, MD Instructor in Psychiatry, Harvard. Director Mood Disorders Division, Geriatric Psychiatry Research Program and Site Director, McLean Hospital,
Harvard Medical School.

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      Please see below for a two-page article and the table of contents.

      Nutrition and Alzheimer's Disease
      By Steve Blake, ScD

      We all know that our diet can affect our chances of getting diabetes and heart disease. What about Alzheimer's disease? Evidence from medical journals indicates that we may be able to dramatically cut our risk of Alzheimer's disease—simply by getting enough of four vitamins. Further reduction of risk may be possible with a diet high in antioxidant fruits and vegetables. Are there dietary factors that increase our risk? Yes, the saturated fats in meat and dairy products can double our risk of developing Alzheimer's disease. In fact, high blood cholesterol levels can triple the risk. Let’s take a look at how this dreaded disease develops?
      How amyloid plaques develop
      Brain cells have certain long proteins embedded in their surrounding membranes. These long proteins are called "amyloid precursor proteins." They cause no trouble while in the membranes. The trouble begins when enzymes inside brain cells begin snipping off protein chains. These snipped-off proteins are called amyloid-beta. The snipped-off amyloid-beta proteins form clumps between the brain cells. These clumps are called amyloid-beta plaques and they are one signature feature of Alzheimer's disease.
      The amount of amyloid-beta formed is controlled by secretase enzymes inside brain cells. If there is more secretase, then we produce more amyloid-beta. If these secretase enzymes are quenched, then the risk of forming amyloid-beta plaques is greatly reduced. [The following sentence could be in a box or otherwise highlighted] The interesting part is that we can control these enzymes and thus the build-up of amyloid plaque.
      We need two B-vitamins to quench the secretase enzymes, and thus the formation of amyloid plaque. Vitamin B12 and folate work together to create SAMe (s-adenosylmethionine). SAMe quenches the genes that produce secretase enzymes inside our brain cells.
      Many diets do not supply enough folate. However, it is simple and easy to get enough folate from green leafy vegetables and beans. It is not so easy to get enough vitamin B12 and to absorb it properly. A cheap and safe sublingual vitamin B12 supplement is good insurance against Alzheimer's disease. People with dementia might consider taking SAMe supplements. SAMe needs to be taken in the morning and can react with certain drugs.
      Just getting enough folate and vitamin B12 can cut the risk of Alzheimer's disease by one quarter.
      Advanced Glycation Endproducts
      When sugars react with proteins or fats, they can cause advanced glycation endproducts. The acronym AGE is appropriate as these malformed proteins are a major cause of aging. These AGEs can lodge in the amyloid plaques in the brain. The AGEs then create massive amounts of free radicals that cause the cooking and shrinking of an Alzheimer's brain. First, it is a good idea to get enough folate and vitamin B12 to lower the production of amyloid plaques. Second, it is important to reduce our internal production and intake of AGEs.
      AGEs are made inside our bodies when blood sugar is high. After drinking a big, sugary drink, AGE formation will be higher than normal. These AGEs can circulate to the brain and build up in amyloid plaques. Happily, when we eat slow-releasing carbohydrates, we do not tend to create AGEs inside our bodies. Beans, vegetables, and yams are examples of slow-releasing carbohydrate sources that are safe to consume. White bread, white rice, and sugary desserts are examples of foods that boost blood sugar and AGE formation.
      AGEs can also be taken in from certain foods. The presence of water or steam prevents AGEs from forming during cooking. Plant foods are generally safe from high amounts of AGEs because of their water content. When meat, chicken, or fish are fried, broiled, or barbequed, AGEs are produced in large quantities. High amounts of AGEs are also found in cheese. This is because milk sugar reacts with milk protein to produce AGEs during the aging process. This is another good reason to avoid these animal products.
      Avoiding fried meat and sugary drinks can reduce your risk of Alzheimer's disease by half or more.
      We have learned that free radicals are produced in amyloid plaques studded with advanced glycation endproducts. These free radicals cause the oxidation and inflammation in Alzheimer's dementia. Antioxidants are helpful to lower the risk of Alzheimer's disease as well as other chronic diseases such as cancer and arterial disease. There are two types of antioxidants. Some come to us in plant foods. Other antioxidants are created inside our bodies. The antioxidants created inside our bodies need certain minerals to function.
      Antioxidants are abundant in fruits and vegetables. Vitamin C and carotenes are examples of antioxidants found in plant foods, but they are not found in animal foods. Polyphenols are found in berries and grapes. Not coincidentally, consumption of berries and grapes has been found to lower the risk of Alzheimer's disease.
      The most important antioxidant for cell membranes is vitamin E. Vitamin E protects the cell membranes in the brain from attack by free radicals. This is especially important because the cell membranes in the brain are particularly vulnerable to free radicals. The best sources of vitamin E are walnuts, almonds, sunflower seeds, and hazelnuts. Certain cold-pressed oils are the only other dietary source. Most vitamin E supplements are not helpful because they contain only the synthetic form of alpha-tocopherol and little or none of the other tocopherols that make up vitamin E.
      Getting enough antioxidant vitamins can reduce the risk of Alzheimer's disease by four to eight times.
      One of the main antioxidants inside our bodies is called glutathione peroxidase. Glutathione peroxidase needs the mineral selenium to function. The high amount of free radicals generated in Alzheimer brains depletes glutathione peroxidase and selenium. Many nuts and seeds are high in selenium, especially Brazil nuts and brown sesame seeds.
      The other important antioxidant enzyme formed within our bodies is called SOD (SuperOxide Dismutase). SOD needs three minerals to function. Copper, zinc, and especially manganese are needed to quench free radicals with this enzyme. Manganese has been found to be lacking in some diets, particularly high-meat diets. Whole grains, spinach, peanut butter, and sunflower seeds are good sources of these three minerals.
      Other dietary influences
      It is interesting that DHA from fish or fish oil has been found to be unhelpful in preventing or treating Alzheimer's disease. A recent, pivotal study showed that DHA is useless in treating Alzheimer's disease.
      Medical plants are vegetables with concentrated nutrients. There are two medical plants that have been shown in several double-blind studies to be quite helpful for Alzheimer's patients. One of these plants is the most-purchased medical plant in Europe. Gingko biloba increases circulation in the brain. Nine double-blind, randomized, placebo-controlled trials showed that ginko biloba helped both in delaying the onset of Alzheimer’s disease and in treating it. Ginkgo biloba is contraindicated if there are bleeding tendencies or with blood-thinning medication.
      Another medical plant used for Alzheimer's disease is gotu kola (centella asiatica). One study found that gotu kola lowered amyloid-beta in the hippocampus of the brain. The Hippocampus is a memory area of the brain. Another study using gotu kola showed an improvement over six months in moderate Alzheimer's disease, rather than the all-too-common degeneration.
      Diet can also influence our intake of pollutants. Certain pollutants have been found to double the risk of Alzheimer's disease. Solvents and pesticides were found to double the risk. Pesticide exposure is vastly lower in plant foods than in animal products. 

      As we have seen, it is possible to greatly reduce the risk of this dreaded dementia.


      Table of Contents

      Introduction       2
      Table of Contents            4
      Table of figures 11
      Chapter 1: Diet can be powerful                13
      Age and delaying dementia         13
      The Nurses’ Health Study             14
      The MIND diet  15
      Rush Memory and Aging Project               16
      Supplements to improve cognition          18
      The Hawaii Dementia Prevention Trial    20
      Chapter 2: Overview of Alzheimer’s disease        24
      Changes to the brain in Alzheimer’s disease        25
      What are amyloid plaques           27
      Meet tau tangles             29
      An epidemic of Alzheimer’s disease        31
      Junk food, diabetes, and Alzheimer’s disease     33
      Diabetes and dementia risk         34
      Drugs and Alzheimer’s disease  34
      Prevalence of dementia               37
      Chapter 3: Food and nutrient changes that worked          40
      Vitamin E             40
      Advanced glycation endproducts              41
      Berries for memory        43
      Vascular dementia and saturated fat      44
      Supplements used in the trial     46
      Two B-vitamins 46
      SAMe    47
      Antioxidants      48
      Vitamin E supplement used        49
      Vitamin C supplement used        50
      Coenzyme Q10 51
      Four antioxidant minerals            52
      Two medical plants used              53
      Ginkgo biloba    54
      Centella asiatica (gotu kola)         54
      Chapter 4: Folate, vitamin B12, homocysteine, and SAMe             56
      How amyloid plaques are made                56
      How two B-vitamins reduce the formation of amyloid plaques   59
      Folate and vitamin B12 transform homocysteine into SAMe.       61
      Homocysteine and Alzheimer’s disease 62
      Are we getting enough Folate and Vitamin B12?                65
      Getting enough vitamin B12        66
      SAMe and Alzheimer’s disease  69
      Chapter 5: Advanced Glycation Endproducts       72
      Absorption of AGEs        73
      Formation of AGEs          74
      AGEs as a cause of brain damage in Alzheimer’s disease                79
      Cooking methods to reduce AGEs in food             81
      Chapter 6: Antioxidants and Alzheimer’s disease              83
      Vitamins E and C protect brain cell membranes from free radical attack  84
      Causes of excess free radicals    85
      Radiation and medical testing as sources of free radicals                86
      Plant Antioxidants Defend Us from Free Radicals              88
      Vitamin E and Alzheimer’s disease           88
      Why synthetic vitamin E is ineffective     90
      Food sources of vitamin E            95
      Vitamin C and Alzheimer’s disease           97
      Dietary sources of antioxidants 99
      Plant antioxidants            102
      Antioxidants made in your body               106
      Protecting our little energy factories, the mitochondria  109
      Coconut oil, ketones, and mitochondrial function             110
      Coenzyme Q10, the only fat-soluble antioxidant made in the body           113
      Are statins related to memory loss?        115
      Antioxidant content in diets        119
      Chapter 7: Saturated fat and dementia  121
      Saturated fat in diets      123
      Blood cholesterol and risk of Alzheimer’s disease             126
      Oxidized dietary cholesterol and vascular dementia         128
      Crystallized cholesterol 133
      Lowering cholesterol using phytosterols               135
      Fiber and blood cholesterol         138
      Chapter 8: Medical plants to treat Alzheimer’s disease   140
      Ginkgo biloba    140
      How does ginkgo work?                141
      How ginkgo protects brain cells 142
      Ginkgo and bleeding      143
      Ginkgo and memory       144
      Gotu kola            145
      Gotu kola as an antioxidant         146
      Gotu kola improves memory scores        146
      Gotu kola for memory in healthy elders                147
      Chapter 9: Exercise and Alzheimer’s disease       149
      Exercise and vascular dementia 150
      Muscle strength and Alzheimer’s disease             150
      Exercise decreases brain shrinkage          151
      Exercise can reduce risk of dementia      152
      Exercise can cut risk of dementia in half 152
      More exercise cuts risk further  153
      Chapter 11: Environmental toxins and Alzheimer’s disease           155
      Seafood, mercury, and DHA        155
      Organophosphate pesticides and dementia        158
      Organochlorines and dioxins       159
      Aluminum, does it cause Alzheimer’s disease?   160
      Chapter 10: Nutritional approaches to Alzheimer’s disease           162
      Acknowledgements       166
      Index    167
      Reference citations         172

      Table of figures
      Figure 1  Three supplements helped cognition   19
      Figure 2  Improvement in our trial            21
      Figure 3  No degeneration was noted with food changes               22
      Figure 4  Normal decline of memory score            22
      Figure 5  Normal brains on the left and advanced Alzheimer’s disease on the right            25
      Figure 6  Amyloid plaques look like fuzz balls between neurons.                27
      Figure 7   Amyloid plaques and tau tangles           28
      Figure 8  Tangled neuron looks like a fried egg    29
      Figure 9  The great increase in Alzheimer's death rate     31
      Figure 10 Dementia forecast for less developed countries            37
      Figure 11 Forecast increase in Alzheimer's disease            38
      Figure 12 Types of dementia graph          45
      Figure 13 Folate and vitamin B12 and amyloid plaque      57
      Figure 14 How amyloid plaque is formed               58
      Figure 15 Homocysteine and B-vitamins                60
      Figure 16 Folate can be low on an American diet                64
      Figure 17 Folate in food from the Diet Doctor      66
      Figure 18 Folate and vitamin B12 in diets               68
      Figure 19 List of foods highest in AGEs    77
      Figure 20 Synthetic vitamin E structure   92
      Figure 21 Nut and seed sources of vitamin E        96
      Figure 22 Vitamin E in some common foods         97
      Figure 23 Vitamin C in food graph             100
      Figure 24 Antioxidants in common diets                101
      Figure 25 A tiny amount of manganese on an Atkin's diet              108
      Figure 26 Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study.                120
      Figure 27 Saturated fat in various food servings 123
      Figure 28 A mostly clogged artery             125
      Figure 29 LDL diagram showing signaling proteins              131
      Figure 30 Cholesterol crystals in plaque  135
      Figure 31 Sources of plant sterols to block cholesterol     137

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