Now that that renowned selfless generation, the Boomers, is getting old (instead of just older) it should be no surprise that senile dementia in all its forms is getting more than its fair share of research dollars. With Alzheimer’s disease set to triple in the next twenty years and the cost of long term care along with it, it looks like they have now found a way to to take it with them.

 Grain Brain

Can you imagine that I have been so bold as to claim that lifestyle factors over which we have control may play a role in determining whether or not we develop Alzheimer’s disease? To be sure, I read the criticism from the skeptics and have elected not to fan the flames by commenting on their blog sites. There are those who cling to the idea that our choices in terms of what we eat, how much exercise we get, whether we sleep enough and even whether we put ourselves in stressful situations matter little in terms of the fate of our brain function.
This ideology is flawed on at least two counts. First, it relinquishes your cognitive fate to a prescription for an as yet nonexistent drug. And second, it is not in line with our most current and well-respected scientific journals. Nonetheless, some people tend to be “down on what they are not up on.”
Let’s take a look at what our thought leaders are telling us. Dr. Deborah Barnes is a neuroscientist in San Francisco. Her work gets published in some of our most highly regarded journals. She recently published some really great science in Lancet Neurology in which she concluded that factors like obesity, diabetes and high blood pressure dramatically increase a person’s risk for developing Alzheimer’s disease.
“Over half of all Alzheimer’s disease cases could potentially be prevented through lifestyle changes and treatment or prevention of chronic medical conditions”, she concluded. Analyzing data from studies around the world involving hundreds of thousands of participants, Barnes concluded that worldwide, the biggest modifiable risk factors for Alzheimer’s disease are, in descending order of magnitude, low education, smoking, physical inactivity, depression, mid-life hypertension, diabetes and mid-life obesity. Together, these risk factors are associated with up to 51 percent of Alzheimer’s cases worldwide (17.2 million cases) and up to 54 percent of Alzheimer’s cases in the United States (2.9 million cases), according to Barnes.
This is powerfully important information. Fifty-four percent of Alzheimer’s patients in America didn’t have to get this devastating diagnosis—if they had only known. And yet, somehow we are supposed to buy in to the notion that we can live our lives however we choose and that soon there will be a cure for whatever malady befalls us.
As of this writing, there is no meaningful treatment for Alzheimer’s disease. Several months ago, to great fanfare, federal monies to the tune of $33 million were allocated to help pharmaceutical companies develop a drug to prevent Alzheimer’s, a disease affecting more than 5.4 million Americans.
In my commentary in MindBodyGreen I wrote, “While the idea of creating a drug to prevent Alzheimer’s seems honorable, it’s important to consider that the development of such a drug means big business beyond measure. Deutsche Bank estimates that the development of an efficacious drug treatment for the disease once it has taken hold could generate $20 billion in annual sales. But the value of a drug employed to treat people before there is any evidence of dementia—a far larger treatment group compared to those already afflicted—would be staggering.
New York Times writer, Pam Belluck reported that the goal of this grant would be to develop a preventive treatment using a strategy much like the one for heart disease. Belluck quoted Laurie Ryan, program director for the Alzheimer’s clinical trials at the National Institute on Aging, who said, “We’re going to look at people at risk, just like we do with people who have high cholesterol and are at risk for cardiovascular disease.”
Is this really what we should be doing? We already know that modifiable lifestyle factors profoundly influence Alzheimer’s risk, but, as I recently wrote for The Daily Beast, “The fundamental operating system underlying the practice of medicine in America today seems myopically focused on treating our ills with highly profitable remedies directed at symptom management while causality is ignored. Preventing disease is derogated, and relegated to the province of alternative modalities. Watching our elected leaders debate the merits of funding the ever-changing iterations of a health-care plan designed to treat illnesses presents a poignant irony, as it has little to do with health and everything to do with illness. But it has become clear that both sides of the aisle enthusiastically agree that Americans must have access to their pills, and lots of them.”
Just the simple act of getting regular exercise can dramatically lower Alzheimer’s risk, and this isn’t new information. In fact, just the simple act of exercising regularly has been demonstrated to actually improve memory in adults with memory impairment. Where would such an iconoclastic report have been published? It was published in the Journal of the American Medical Association way back in 2008!
So it’s time we accept the idea, with gratitude, that how we live our lives matters a whole lot in determining how we will be functioning in the future from a cognitive perspective. Dietary choices determine blood sugar levels and even mild elevation of blood sugar levels translates to a dramatic increased risk for dementia as recently reported in The New England Journal of Medicine. And keep in mind that this study showed a marked increased risk for dementia even in individuals without diabetes or even pre-diabetes.
In fact, there is a direct relationship between fasting blood sugar and the rate of shrinkage of the hippocampus (the brain’s memory center) as demonstrated in a recent issue of the state of the art journal Neurology. When it comes to your brain’s memory center, size does matter.
As the authors of this study stated in their conclusion: “High plasma glucose levels within the normal range were associated with greater atrophy of structures relevant to aging and neurodegenerative processes, the hippocampus and amygdala. These findings suggest that even in the subclinical range and in the absence of diabetes, monitoring and management of plasma glucose levels could have an impact on cerebral health.
And what should your first choice be in terms of “management of plasma glucose”? Dramatically reduce carbohydrate intake while increasing your consumption of healthful fats. This is a central theme of the Grain Brain program and is fundamentally supported by a recent publication by researchers at the Mayo Clinic in the Journal of Alzheimer’s Disease in which they found that elderly individuals favoring a high carbohydrate diet experienced an increased risk for developing dementia of close to 90% while the dementia risk was decreased by 44% in those consuming the most fat.
There is no question that what I’m suggesting runs counter to the status quo underlying the practice of medicine in America. Keep in mind that President Ronald Reagan defined “status quo” as “the mess we’re in.”  No one would deny the fact that health care in the United States is less than satisfactory when evaluated from a number of perspectives. According to the World Health Report as published in the New England Journal of Medicine, the U.S ranks 37th out of 191 countries in terms of overall performance. Included in this overall composite ranking are our dismal rankings in more specific categories. We were ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality and an astounding 36th for life expectancy.  And what’s really alarming is the research showing that year to year we are slipping further and further behind despite the fact that we spend significantly more per capita on health care than any country on the planet.
As it is with brain health, our total health is vitally dependent on our lifestyle choices like the very foods we choose to eat. We are breaking the bank these days in trying to develop monetizable solutions for so many chronic health issues that may well have their genesis in factors that are virtually ignored.
As a practicing neurologist and a child of an Alzheimer’s patient, recognizing how the misguided attention as it relates to dealing with as opposed to prevention of brain degenerative disorders is well beyond frustrating—it is downright painful.
Each and every one of us needs to fully embrace the notion that yes, the choices we make in terms of what we eat, the sleep we do or don’t get, the exercise we pursue, all have both an immediate as well as long term effect on not only the destiny of our brains, but our total state of health as well.

By David Perlmutter MD