Alzheimer’s disease is very complicated, and there are many factors to consider. This is one explanation. I’ve spent the last few days listening to lectures from David Perlmutter, a neurologist who is a published author and leader in understanding the basic cause of Alzheimer’s disease (AD). In Alzheimer’s, we have identified changes in the brain, specifically, deposits of Beta amyloid protein that is toxic to brain tissue, and neurofibrillary tangles that are abnormal accumulations of a protein called tau that collect inside nerve cells.

In healthy brains, tau stabilizes microtubules that supply nutrients to the nerve cells. The damaged nerve cells lose their connections to one another, affecting memory and eventually the brain shrinks. Microglial cells support neurons and clear debris from the brain. When microglial cells fail to clear waste, debris and protein collections, like beta amyloid, are allowed to accumulate, leading to chronic inflammation. High blood pressure and diabetes is especially devastating to the brain, resulting in mini strokes and less blood supply to the brain. Vascular problems lead to loss of the blood brain barrier which usually prevents harmful substances from reaching the brain.

We used to think this was a hereditary disease. While people who have APOE4 are at greater risk , it is now known that much of this devastating disease can be prevented by lifestyle modification. Huge effort has been made to find a way to remove beta amyloid from the brain. Drugs have been discovered and recently released but they are terribly expensive and have significant adverse effects. Perhaps we need to go back further, recognizing that the damage begins many years before we start seeing the clinical presentation of Alzheimer’s loss of function.

This is so complex and difficult to treat but maybe we are missing important steps that can be taken to prevent this devastating disease.

DIET

Fifty-four per cent of the North American calorie intake is composed of processed foods — these are foods that have been altered — have added preservatives, salt, sugar, oil, and some products that have nothing to do with nutrition. Many of these foods make our bodies less responsive to insulin, that hormone that allows our cells to take in glucose. Eventually, cells are even unable to use ketones for fuel. It is well documented that people who eat a lot of ultra processed food have a higher incidence of mental decline, even at a younger age! These foods cause inflammation, oxidative stress, changes in the helpful bacteria in their mouth and elevation of uric acid- the significance of this will be further explained.

EXERCISE

Exercise helps glucose to be taken into muscles, reducing insulin resistance — very important in preventing pre-diabetes and diabetes. People with diabetes have a four-fold increase in AD. Exercise also increases nitric oxide, that increases blood supply to the brain and helps the brain utilize glucose. The brain requires a lot of blood, and uses 20 per cent of the energy used by our bodies.

ALCOHOL

Alcohol — especially beer and hard liquor — increases uric acid, a powerful connector of metabolic change associated with chronic disease. The least likely to cause an increase in uric acid is red wine, especially in women.

NITRIC OXIDE

Nitric Oxide has a major influence on how the brain utilizes glucose and improves blood flow. You will recognize this because we use “nitro spray,” nitroglycerin to dilate the coronary arteries when you have angina. Using big data, they identified many drugs to see if any had a benefit on Alzheimer’s. Sildenafil (Viagra) had a 77 per cent reduction in the development of Alzheimer’s disease! This affects not only blood flow to the genitals, but to your whole body. Not only does it increase blood flow, it also aids in the utilization of glucose. It increases nitric oxide. This is studied with PET scans that show glucose utilization and blood flow. As we age, blood flow decreases (much more so in AD), and so does our level of nitric oxide. Foods we eat contain nitrate, healthy bacteria in our mouth convert it to nitrite, that our body uses to make nitric oxide (NO). Foods high in nitrate are beets, dark green vegetables, citrus fruits, carrots, garlic, beetroot, fennel, and parsley to name a few. Nitrates from vegetables, combined with vitamin C and antioxidants in the vegetables play a significant role in creating nitric oxide. Foods that are metabolized create 50 per cent of nitrite that we use. Interestingly, people who use mouth wash regularly, disrupt these healthy bacteria that convert nitrates to nitrites. were followed for three years. If they used mouth wash more than two times a day, they had a 50 per cent greater risk of developing type two diabetes, thus increasing risk of AD. They have an increased risk of developing hypertension by 117 per cent. Nitrate rich supplements can increase these healthy bacteria. This will be studied more extensively, so stay tuned. Processed meats — bacon, sausage, deli meats etc. — also contain nitrates but cooking them at high temperatures creates a compound that causes cancer especially in the bowel.

URIC ACID

What has a negative effect on NO? Uric acid. Many of you have heard of uric acid because it is elevated in gout. We have come to realize that this is an important metabolic marker and elevation of uric acid is associated with inflammation, obesity, insulin resistance, elevated blood pressure, metabolic syndrome , increased triglycerides and abnormal cholesterol. Fructose is a sugar that is found in fruits and vegetables, a healthy source. High fructose corn syrup has been added to many processed foods and sodas, and is very unhealthy. It needs to be metabolized by the liver, and can lead to fatty liver, insulin resistance, obesity, and diabetes. It is prevalent in our diet – 60 per cent of packaged goods have added fructose or similar sugar like compounds. Fructose is metabolized to uric acid. Other sources that increase uric acid are alcohol and purines found in canned fish and shell fish. High uric acid is found in these metabolic issues; metabolic syndrome, hypertension, MS, diabetes, non-alcohol fatty liver, kidney disease, type 2 diabetes, and Alzheimer’s disease. A study of 90,000 people for eight years found that if uric acid in the blood was greater than 7, they had 16 per cent increase in death from all causes – 40 per cent increase in death from cardiovascular events and 35 per cent from ischemic stroke. A report in Science in February 2023 reported a study on 1,600 people for 12 years and found that comparing the lowest to highest value in uric acid in their blood, there was a 79 per cent increase in dementia, 55 per cent increase in Alzheimer’s disease, 166 per cent increase in vascular disease and four times the risk of cognitive impairment. Controlling uric acid is essential!

ALCOHOL

Alcohol is known to increase uric acid. Startling news is that even three drinks of alcohol or fruit juice a week can result in shrinkage of the brain and loss of logical memory.

CONCLUSION

The writing is on the wall, so they say. We know that as a country we are in trouble. We are struggling to provide elder care as it is and with the rising rate of Alzheimer’s, how are we going to cope? We need a major overhaul of our diet. 1. Stop eating processed foods and concentrate on eating whole fresh foods. Avoid foods containing high fructose corn syrup. 2. Eat foods rich in Vitamin C that increase the clearance of uric acid such as citrus fruits, papaya, strawberries, tomatoes, red pepper etc. 3. Alcohol must be reduced or stopped. 4. Exercise, exercise, exercise!

Dr. Vicki Holmes is a Saskatoon retired family physician who has a special interest in Palliative Care and Women’s Health. She is passionate about sharing medical information with the public! (Vicki’s Photo: Memories by Mandy)

– Dr Vicki Holmes