by Sara Gottfried, MD
My granny blinked behind her glasses as she drove us to her home after school, trying to conceal her panic. It was 1975. I was 7 years old, and she was 50. Granny wasn’t sure where to turn her Oldsmobile Cutlass Supreme next. The distance between the school bus stop and her home was only 5 miles, but we were lost.
When my grandmother’s memory and then her personality drained out of her due to Alzheimer’s disease, I didn’t know that women are at double the risk of Alzheimer’s compared with men.1-3 I didn’t recognize that her risk began in her 40s, at the time that she was taking caring of me after school because my parents both worked full time. Now I understand that her cognitive decline was probably due to issues related to her blood sugar, fondness for drinking two or three martinis every night, and loss of estrogen associated with perimenopause and menopause.
As one of the top 10 leading causes of death in the US, Alzheimer’s disease has a weighty burden.4 While an estimated 5 million Americans 65 years or older have Alzheimer’s, that number is predicted to triple by the year 2060.5 I went to medical school because I wanted to help people. When I was 21 and my beloved grandmother was in a nursing home unable to recognize me, I got clear about my “why.” I wanted to cure Alzheimer’s disease.
At Harvard Medical School, I learned the wretched news about Alzheimer’s disease. Not only was it miserable for the patient, caregivers, and family—but the lack of treatment made the medical training grim. Neurologists were beaten. Their mantra was, “Diagnose and adios,” because there was no reliable way to prevent or treat it. I chose instead to go into gynecology. Since then, more than 99% of drug trials for Alzheimer’s have been total failures.6-7 Currently approved medications fail to stop or slow the progress of the disease; the four Alzheimer’s drugs on the market that may reduce memory loss and confusion do so only for a limited time.8
But as a gynecologist, I discovered another approach. It’s called personalized lifestyle medicine, and it acknowledges that all chronic disease—including Alzheimer’s disease,9 cancer, diabetes, high blood pressure, and cardiovascular disease—stems from inflammation that begins years, maybe decades, before the diagnosis.10-11 So the strategy is to work upstream and systematically with lifestyle changes—the way you eat, move, think, and supplement—in order to prevent the inflammation and therefore the diagnosis. (Inflammation, which I think of as a frat party gone wrong, starts in your brain in your forties, like it did with my grandmother.) In mainstream medicine, the old-school idea is that there’s a pill for every ill, but that hasn’t worked in Alzheimer’s. But there is a multidimensional approach, which ultimately has pleiotropic effects, meaning that it is simultaneously capable of producing multiple benefits—it lowers inflammation, increases brain metabolism and connections between nerve cells, increases remembering and decreases forgetting, and may even reverse cognitive decline. Lifestyle medicine serves as the basis of the work of my friend and colleague Dale Bredesen, MD, who has improved or reversed early Alzheimer’s disease in a series of 100 patients.12 He describes Alzheimer’s as a disease where you have “36 holes in the roof.”13 You need to patch all of the holes to see improvement.
In my medical practice, I do not take care of patients with Alzheimer’s disease. Instead, I take care of women aged 35 and older who are noticing the earliest signs of cognitive issues, like the forgotten keys or appointments, the stopping midsentence because they can’t find the word they are looking for. They don’t have 36 holes in their roof;13 they have 3 or 5. Together we patch the holes, they feel better, and we may have dodged a diagnosis in their future.
In this blog series, I’ll be writing about my experience with helping women care about their brains much earlier—ideally in your 30s, 40s, and 50s. I’ll describe what has been most effective based on which holes you may have in your roof.
Here’s today’s tip: One of the best ways to stave off a scary diagnosis like Alzheimer’s is to pay attention to your blood sugar. Know your fasting blood sugar, a simple test that most patients undergo once every year or two. According to the latest estimates from the CDC, more than 100 million US adults are now living with diabetes (i.e., fasting blood sugar ≥126 mg/dL) or prediabetes (i.e., fasting blood sugar ≥100 mg/dL).14 I don’t want you to be one of those statistics; I want you to live long and well with a healthy brain clear of debris and deposits. Starting at age 40, fasting blood sugar climbs about 1-2 mg/dL per decade (and blood sugar levels following a meal increase up to 15 mg/dL per decade),15-16 unless you are actively doing something about it. High blood sugar levels (e.g. diabetes) pointedly increase risk for developing dementia, by about 60%.17-18 Make normalizing your blood sugar a top priority by doing the following.
- Know your numbers, including fasting blood sugar and hemoglobin A1c (HbA1c is a 3-month average of your blood sugar levels).
- Keep your blood sugar from rising too high by avoiding sugar and foods that trigger inflammation for you, which may include gluten and dairy, among others. Follow an elimination diet.
- Limit alcohol. The latest research shows there is no safe level, especially for women.19 Alcohol is a brain toxin and increases the risk of many cancers, including breast.20
- Exercise a minimum of 30 minutes per day and ideally 1 hour. Perform high-intensity interval training (HIIT) to make your cells hungry for glucose so that the glucose can be pulled out of the bloodstream to feed your muscles.
- Meditate, pray, or find some other way to objectively witness your experience so that stress doesn’t raise your cortisol (stress hormone) and drive up blood sugar.21
- Optimize your levels by keeping fasting blood sugar 70-85 mg/dL and HbA1c < 5%.
- To learn more about personalized lifestyle medicine for the prevention of Alzheimer’s disease, check out Alzheimer’s-related science and educational tools.
If you remember nothing else from this column, know that rising blood sugar leads to metabolic inflexibility, which decreases plasticity of the nerve cells, particularly in the hippocampus,22 the part of the brain involved in memory consolidation and emotional regulation. So the trick is to stay metabolically flexible with lots of connections between nerve cells in the brain. Pay attention to “holes in your roof” and patch them early, starting with your blood sugar. My granny didn’t, but you can.
- Hamilton J. NPR. Women’s brains appear more vulnerable to Alzheimer’s than men’s. https://www.npr.org/sections/health-shots/2015/07/21/425054345/womens-brains-appear-more-vulnerable-to-alzheimers-than-mens. Accessed November 7, 2018.
- Fifield K. AARP. What being a woman means for your dementia risk. https://www.aarp.org/health/dementia/info-2018/women-alzheimers-pregnancy-link.html. Accessed November 7, 2018.
- Lin KA et al. Marked gender differences in progression of mild cognitive impairment over 8 years. Alzheimers Dement (N Y). 2015;1(2):103-110.
- Xu J et al. Deaths: final data for 2007. Natl Vital Stat Rep. 2010;58(19):1-19.
- Matthews KA et al. Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015-2060) in adults aged ≥65 years. Alzheimers Dement. 2018;S1552-5260(18)33252-7.
- Cummings JL et al. Alzheimer’s disease drug-development pipeline: few candidates, frequent failures. Alzheimers Res Ther. 2014;6(4):37.
- Bushak L. Medical Daily. 99% of Alzheimer’s drug trials in the past decade have failed, and there’s an ‘urgent’ need to improve therapies. https://www.medicaldaily.com/99-alzheimers-drug-trials-past-decade-have-failed-and-theres-urgent-need-improve-therapies-291566. Accessed November 9, 2018.
- Alzheimer’s Association. Medications for memory. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory. Accessed November 9, 2018.
- Kinney JW. Inflammation as a central mechanism in Alzheimer’s disease. Alzheimers Dement (N Y). 2018;4:575-590.
- Hunter P. The inflammation theory of disease. The growing realization that chronic inflammation is crucial in many diseases opens new avenues for treatment. EMBO Rep. 2012;13(11):968-970.
- Minihane AM et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. Br J Nutr. 2015;114(7):999-1012.
- Bredesen DE et al. Reversal of cognitive decline: 100 patients. J Alzheimers Dis Parkinsonism. 2018;8:5.
- Ash M. Clinical Education. https://www.clinicaleducation.org/resources/reviews/36-holes-in-the-roof-the-dawn-of-the-era-of-treatable-and-preventable-alzheimers-disease/. Accessed November 9, 2018.
- CDC. https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html. Accessed November 7, 2018.
- Samos LF et al. Diabetes mellitus in older persons. Med Clin North Am. 1998;82(4):791-803.
- Pani LN et al. Effect of aging on A1C levels in individuals without diabetes: evidence from the Framingham Offspring Study and the National Health and Nutrition Examination Survey 2001-2004. Diabetes Care. 2008;31(10):1991-1996.
- Chatterjee S et al. Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care. 2016;39(2):300-307.
- dLife. Type 3 diabetes. https://dlife.com/type-3-diabetes/. Accessed November 7, 2018.
- GBD 2016 Alcohol and Drug Use Collaborators. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5(12):987-1012.
- McDonald JA et al. Alcohol intake and breast cancer risk: weighing the overall evidence. Curr Breast Cancer Rep. 2013;5(3).
- UCSF. Diabetes Education Online. https://dtc.ucsf.edu/types-of-diabetes/type2/understanding-type-2-diabetes/how-the-body-processes-sugar/blood-sugar-stress/. Accessed November 9, 2018.
- Kanoski SE et al. Western diet consumption and cognitive impairment: links to hippocampal dysfunction and obesity. Physiol Behav. 2011;103(1):59-68.
Sara Gottfried, MD is a board-certified gynecologist and physician scientist. She graduated from Harvard Medical School and the Massachusetts Institute of Technology and completed residency at the University of California at San Francisco. Over the past two decades, Dr. Gottfried has seen more than 25,000 patients and specializes in identifying the underlying cause of her patients’ conditions to achieve true and lasting health transformations, not just symptom management.
Dr. Gottfried is the President of Metagenics Institute, which is dedicated to transforming healthcare by educating, inspiring, and mobilizing practitioners and patients to learn about and adopt personalized lifestyle medicine. Dr. Gottfried is a global keynote speaker who practices evidence-based integrative, precision, and Functional Medicine. She recently published a new book, Brain Body Diet and has also authored three New York Times bestselling books: The Hormone Cure, The Hormone Reset Diet, and Younger.