Is Dementia Really Preventable?

 Is dementia really preventable? The answer is more complicated than a simple yes or no. There are some things we can control and other things we cannot, but  groundbreaking research shows that up to 40 percent of dementia cases might be preventable through lifestyle changes.  That's nearly half of all cases that could potentially be delayed or avoided.

In today's episode, we'll explore the science behind daily habits that can protect your brain health. We'll separate fact from fiction about dementia and examine the latest research and most importantly, share practical tips you can take today to reduce your risk.

Whether you're concerned about your own cognitive health or caring for a loved one, this month long series will give you lots of information, motivation, and inspiration regarding brain health. And what could be more important than saving the brains.  

But first, let's do a quick mini medical school review about dementia and Alzheimer's. Today's focus will be on Alzheimer's disease because it accounts for 60 80 percent of all cases of dementia. 

There are currently over 6 million people in the United States who are 65 or older who have Alzheimer's disease. It is the 6th leading cause of death in this country, but it moves up to number 5 if we're talking about older Americans.  Over the last 20 years, the incidence has increased by an alarming One hundred and forty five percent. Wow. So, what causes it? Well, that's a good question, and there isn't a clear answer.

One way to think about dementia is to think about the way other organs fail, like heart failure and kidney failure. Dementia is, quite simply, brain failure. Now, the brain is made up of neurons, which are nerve cells, and those are found throughout the body. In the brain, these cells are responsible for complex connections and communication, and that enables us to think, smell, talk, see, hear, remember, make decisions, plan, and move our bodies.

And with dementia, these cells start to die, and the brain begins to shrink.  But listen, brains typically begin to shrink around age 30 or 40 in perfectly healthy people. Then it ramps up around age 60, even more after age 70. We call this shrinkage atrophy, and to some degree it is normal. 

But the good news is that we have some reserve to the tune of about 100 billion nerve cells, 100 trillion synapses, which are the connections between nerve cells and a whole bunch of neurotransmitters, Which are the chemicals that go between nerve cells to make communication possible.

So, this network has some resilience even when there's an overall loss of brain volume. However, Alzheimer's is not normal atrophy. The brain shrinks at an accelerated rate. And no one knows for certain what happens inside the brain of people affected by Alzheimer's disease. But the two most notable things are plaques and tangles. If you've never seen it up close and personal, you may envision someone who doesn't know how to get around and can't remember your name.

But, it's not really like that at first, and it's tricky. It's not uncommon for family members and close friends to get a little concerned about someone's mind, then see times of brilliance and you think, Oh, everything's fine. So, This visual of tangled neurons really helps us understand that. Sometimes you're brushing your hair and everything's smooth and then sometimes you hit a mess and the brush gets hung up. 

These tangles interrupt the transport system in the brain. And it's thought to be related to the Tau protein.

The other process that seems to contribute to Alzheimer's is plaque.  Now, When I say the word plaque, you may think of the dental hygienist prying your mouth open and picking at that buildup on your teeth.

The plaques on your teeth are made of tartar, but the plaques in the brains of people with Alzheimer's disease are made of beta amyloid. And these are just sticky pieces of protein that come from the fatty membrane around the nerve cells. And things that stick together clump together, and these form plaques.

And it blocks cellular communication.  On top of that, there's an immune response where inflammation causes cells to just be gobbled up.  There are going to be some great resources to better understand this process.  I'm going to put all of this together for you and send it out every Friday this whole month so you have all these resources at your fingertips.

And of course, if you aren't on my email list. You should be. You can sign up so you don't miss it. Now that you have an overall understanding of Alzheimer's, let's get back to prevention. When we look at the research, we divide the risk factors into two buckets, modifiable and non modifiable. We're going to focus on the modifiable.

Simply put, it's things you can control versus things you cannot. And this might be a really good time to recite the serenity prayer. Lord, help me to change the things I can. And accept the things I cannot.  Today, we will focus on what we can change. And I'm going to give you a quick list of known contributing factors for dementia.

And this is not a complete list and these are not your practical steps, but I think this is good information for you to have before we really get started.

Number one, diabetes, and it's way more prevalent than you might think.  Next is midlife, high blood pressure, high cholesterol, midlife obesity, smoking, physical inactivity, poor diet, which is the standard American diet, stress, and lack of quality social connectedness.  Notice there's a strong correlation between things that affect heart health and things that affect brain health. 

We often don't think of heart disease or dementia as being reversible. But what if,  what if, that's a question that deserves an answer. What if it's preventable and what if it's reversible? Dr. Dean Ornish addressed that question in the 70s for heart disease. And in June of this last year, he released a small research study showing reversal of cognitive decline.  Let's pause for a minute and let that sink in.

Not only is evidence showing that 40 percent of dementia is preventable, but now we have some evidence that at least in some people and to some degree, It's reversible. And if that doesn't motivate you, I don't know what does.

Now, this study was promising, but small. We're going to dive into the details in an upcoming episode in this series, but we're also going to look at information published by a reputable medical journal called the Lancet Commission, as well as recommendations and facts from the World Alzheimer Report, the National Institutes of Health, or NIH, and the Alzheimer's Association.

If you're interested in more information. , I'm going to put together a list of helpful resources, and some of them have some really cool visual tools where you can tour the brain.

There's a link in the show notes to sign up for my email, or just go to my website, www. healthylooksgreatonyou.com There's some great resources for you there, and episodes on diabetes and hypertension, because those are also contributing factors.

 And if all of this does motivate you to make lifestyle changes, as a bonus, you can sign up for a free mini course that I put together to help you work through making healthy habit changes. It's called seven day kickstart to healthy habits, but let's jump to the bottom line to quote the World Alzheimer's report 2024.

"There is no magic bullet for dementia, but there are tangible steps big and small that individuals can take to reduce risk. And any step is better than doing nothing."  

So let's look at those any steps.  There were nine risk factors that were identified to be modifiable, meaning you can change them, but they've added three more for a total of twelve.

I've divided them up into eight steps. Step one is literally a step, and that's physical activity. Any activity is better than no activity. And I would also say, the more, the better. Aim for at least 30 minutes a day to promote blood flow to the brain, which feeds your brain by delivering oxygen and nutrients.

Most experts have focused on aerobic exercise, which is getting your heart rate up. So, while it's great to walk three miles a day, if you aren't huffing and puffing just a little bit, But you probably aren't getting the maximum benefits. High intensity exercise can optimize the environment for creating new connections between neurons in the brain by releasing something called brain derived neurotropic factor or BDNF. This is a warrior in the brain that goes to battle to fight cognitive decline. 

More recently, strength training is being emphasized, especially quad strength. The muscles in the legs are some of the biggest in the body. According to "The Brain Docs", Dr. Aisha and Dean Shirazi, research has consistently shown that leg strength correlates with enhanced cognitive function. And on top of that, strong legs means less falls as we age and falling is associated with all kinds of bad things besides bruising and breaking bones. 

Another area that is currently being studied is called combined cognitive physical interventions. I'm going to talk more about this later, but it refers to activities that force you to use your muscles and brain at the same time. Now the studies are not conclusive, but the concept is that if you challenge your brain while exercising, you get more benefit.

Some people call it exergames, but think dancing, tai chi, virtual reality games, walking and recall, such as memorizing scripture while you walk. That's something I really enjoy because it's also outside in nature, which is a great stress reliever. And the instructor at the gym where I go comes up with all kinds of things to make sure our brains are being challenged in our circuits class.   And speaking of moving, let's move on to step number two. 

You probably knew this was coming, but the next step is diet. And of course, the big question is always, which diet? Let me just cut to the chase and tell you that lifestyle medicine promotes a whole food plant predominant diet. That means cutting out processed foods, especially ultra processed foods, and eating instead whole foods.

You know, the way God designed them instead of the way food manufacturing industry packages them. And yes, I know it's expensive and confusing and I talk about that in other episodes, but if you want to protect your brain, you've got to nourish it and nutrients come from food. The more the food resembles the way it exists in nature, the more nutrients it contains.

And that seems simple enough, but what does research and evidence tell us exactly? Well, Dr. Ornish says, whole food, minimally processed, plant based diet is best. for preventing and reversing dementia. And listen, his program is intense. The American College of Lifestyle Medicine says we should limit the amount of sugar and saturated fats. And make sure to eat plenty of fruits, vegetables, and whole grains. The World Alzheimer's Report tells us to diversify the food groups you consume and avoid ultra processed foods. In fact, we always say, eat the rainbow. That means different foods with different colors and that provides the different nutrients that we need.

And, by the way, when we talk about foods with different colors, we're not really talking about Fruit Loops, regardless of whether or not they contain dyes. Listen, junk food is junk food whether it's brightly colored or pale.  So what kind of diet? We're talking about diets that are rich in fruits, vegetables, whole grains, and healthy fats.

Those are all associated with better brain health. The Mediterranean diet is a classic example. The Mediterranean diet is rich in fruits, vegetables, whole grains, legumes, fish, and healthy fats, and has been consistently linked to lower rates of Alzheimer's disease. 

And the MIND diet is a combination of the Mediterranean diet and the DASH diet, which is used to treat and prevent hypertension. And it has also been shown to reduce dementia by as much as 53 percent. I have a separate episode on that. 

If you actually read the list of 12 modifiable risk factors, it doesn't specify diet, but instead includes maintaining a healthy weight and diabetes. And both of those are directly related to diet.  

Step number three is don't smoke. I'm not going to spend a lot of time on this one because fortunately most people don't smoke. That's one of the reasons that the rates of heart disease and stroke are decreasing. However, marijuana use is skyrocketing and we are starting to see evidence that it can increase the risk of heart attack by four fold. And I imagine as this trend plays out, we'll see more and more negative effects.

On top of that, air pollution has been linked to dementia. Now, I do have an episode on smoking cessation with some helpful resources. I'll link it in the show notes. You can find it on my website, but suffice it to say that anything that damages blood vessels damages the heart and the brain. Smoking contributes to cardiovascular disease, high blood pressure and stroke. And is clearly a risk factor for dementia. Hypertension is independently listed as one of the 12 modifiable risk factors and so is a high LDL cholesterol.  

Step 4 is meaningful social interaction. We need people in our lives.

Ideally, we could combine all these measures together. Eat your meals with people. Exercise in a class. Stimulate your brain with games that involve another person. There is strong evidence that links social connectedness to overall health in general and brain health in particular. Not only that, the one thing that is the strongest indicator for both happiness and longevity is It's social connectedness. 

I have a couple of episodes on loneliness. The latter focuses on mood and it turns out that depression is also a risk factor for dementia.  To be honest, it's hard to know the difference or which came first,  but it's clear that loneliness is linked to poor health outcomes in general.

Step number five is stay mentally active. Now, people with less education to begin with have an increased risk of dementia. But that doesn't mean that once you graduate, you can stop there. Be a lifelong learner. And this doesn't just mean to sit around and do brain teaser puzzles, although there may be some benefit to that. But there's clearly benefit in learning new things, especially hard things. Challenging your brain helps create new connections, and new connections help maintain reserve during the aging process. Learning a new language is probably one of the best things you can do to challenge your brain. But it's hard. Memorizing is another good thing, and I cannot tell you how much memorizing scripture has meant to me personally. Not only for brain health, but for spiritual health.  

Number six is just protect your body. 

Pay attention to your overall health, that includes your teeth, but specifically protect your noggin. Head injuries are associated with an increased risk of dementia. I'm going skiing this month and I will be wearing a helmet, but also make sure your home is safe. Rugs can be a hazard, so can puppies and bathtubs. Remove clutter and cords so you don't trip.  

Other things that fall under protect your noggin are hearing aids. You see, when sound enters your ears, it goes to your brain for processing. And when you can't hear well, those parts of your brain start to shrink. Wearing hearing aids may help prevent dementia.

And more recently, research has also found an association between vision loss and dementia, likely for the same reasons. So, maximize those inputs to your brain through your eyes and ears and protect your head.  

One of the most common causes of traumatic brain injury is car accidents. Two of the biggest factors associated with motor vehicle crashes are alcohol and sleepy driving. 

So, step number seven is avoid excess alcohol. Previously, evidence indicated that one to two drinks a day was considered safe and maybe even protective. Admittedly, people who live in blue zones often consume red wine on a regular basis. And if you aren't familiar with blue zones, I'll have an upcoming episode, but basically, It refers to five geographic areas in the world where people routinely live to be over 100 years old with vim and vigor. 

Only one of them is in the United States. It's in Loma Linda, California. There's a large population of people there who belong to the seventh day Adventist faith in that part of the country. And their lifestyle is marked not only by faith, but also strong social ties, a vegetarian diet, time in nature, and no tobacco, and no alcohol.

Regardless, there is an alarming trend of increasing alcohol consumption, and excess alcohol is clearly linked to dementia. For more on alcohol, I included a previous episode link in the show notes. There is no controversy in the literature that two drinks a day is the limit. Quitting is hard, but And I've included some resources on my website. 

Lastly, step number eight is sleep. I know, I know I said there were 12 modifiable risk factors. Thank you so much for paying attention. I will list them out, one through 12 in my newsletter. But for this episode, I grouped them together.  

In a recent episode, I called sleep the mood mechanic. But the brain repair work that goes on during sleep is so much more than mood.

Poor sleep is associated with so many of the risk factors for dementia, like diabetes, high blood pressure, heart disease, depression, and obesity.  Poor sleep, especially in late midlife, is associated with an increased risk of dementia. And if this is an area where you struggle, you will be glad to know that I have an entire series on sleep coming up next month with lots of great resources. Some of them are already on my website so hop on over there and snag them. 

The Lancet Commission states that "Our new life course model and evidence synthesis has paramount worldwide policy implications."  And they conclude by saying, "It is never too early and never too late in the life course for dementia prevention." So, no matter how old you are and what your risk factors are, prioritize your physical health and your brain health because healthy looks great on you. 

RESOURCES:

Join the email list for all the resources

Preventing Cognitive Decline

Practical tips for caregivers and friends of people with dementia

How to prevent and reverse type 2 diabetes

Control your blood pressure

How to quit 

Sleep - the mood mechanic

Kickstart Healthy Habits in 7 Days

The deadly epidemic of loneliness

From loneliness to belonging

Which diet is healthiest?

 

      The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change.