Missing a step as you get older is perfectly normal. However, there is an increasing chance for more severe memory loss and impairment of cognition due to actual shrinking and damage to the brain. This is dementia through vascular constriction or other means. A similar but separate condition is Alzheimer’s disease in which cognition and memory decline due to the build up of plaques and other structural changes in the brain. Good overall health and an active lifestyle help to prevent or delay the impact of dementia and Alzheimer’s.

In this excerpt from the book Real Cause, Real Cure by Jacob Teitelbaum, MD and Bill Gottlieb, CHC the authors explain the changes in the brain that cause Alzheimer’s disease and dementia, and the lifestyle changes that can reduce the impact of these diseases.

Alzheimer’s Disease and Dementia

Real Causes

  • Chronic Inflammation. Low-grade, chronic inflammation fuels the buildup of the toxic clumps and tangles of protein (amyloid and tau) that are the hallmarks of the disease.
  • Nutritional Deficiencies. Many of the effects of excess amyloid and tau—such as memory loss and disorientation—can be avoided or eased by optimizing nutrition.
  • Hormonal Imbalances. Treating hormonal imbalances, particularly low testosterone and thyroid hormone, can help prevent and treat dementia.
  • Prescription Medications. For many elderly people, taking multiple medications can muddle the mind; what is diagnosed as Alzheimer’s often goes away when the medications are stopped.
  • Happiness Deficiency. As cognitive function declines, a person may become depressed, worsening dementia.
  • Inactivity. Studies show that regular activity can help prevent Alzheimer’s and that inactivity can worsen the condition.

A lot of Americans have dementia, the gradual loss of memory and other cognitive functions along with a decline into dependence. About 5.8 million have Alzheimer’s disease. Nearly one million more have vascular dementia, caused by poor circulation to the brain and strokes. (Many have both.) In the past few decades, the incidence of Alzheimer’s has gone up tenfold among people 65 and older, and twenty-four-fold among those under 65.

But here’s a surprising fact: Many, if not most, people diagnosed with Alzheimer’s do not have the disease. The only definitive “test” for diagnosing Alzheimer’s is a postmortem biopsy of the brain to detect the toxic clumps and tangles of protein (amyloid and tau) that are the hallmarks of the disease. But the severe memory loss and chronic confusion that are characteristic of Alzheimer’s and are used to diagnose the disease aren’t always caused by Alzheimer’s.

Cognitive decline also can be caused by a nutritional deficiency, such as low levels of B12. And by a drug side effect. And by depression and other treatable illnesses. In fact, in his book The Myth of Alzheimer’s: What You Aren’t Being Told about Today’s Most Dreaded Diagnosis, Peter J. Whitehouse, MD, PhD, says that a diagnosis of Alzheimer’s can only be made once other causes are ruled out, including…

  • Hypothyroidism and other metabolic causes
  • Vascular problems, such as stroke
  • Vitamin deficiencies, including B12
  • Hypercalcemia (high levels of calcium)
  • Normal-pressure hydrocephalus (an excess of cerebrospinal fluid)
  • Psychiatric difficulties, such as depression and schizophrenia
  • Head trauma •Structural brain lesions—brain tumor, injuries, or blood clots
  • Other neurodegenerative conditions, such as Parkinson’s disease
  • Dehydration and other causes of delirium
  • Brain infections, such as HIV, encephalitis, meningitis, and syphilis
  • Chronic effects of various substances, including medications and alcohol

A proper medical evaluation to detect these underlying (and often reversible) causes of dementia takes at least 30 to 60 minutes—an amount of time most doctors don’t have, because

Medicare pays poorly for visits over five minutes. That’s why, when older folks have the symptoms of cognitive decline, they’re often automatically diagnosed with Alzheimer’s or dementia—

and just as automatically get a prescription for donepezil (Aricept), an anti-Alzheimer’s drug that has very minimal disease-slowing or disease-relieving benefits.

Real Cure Regimen

In my experience with patients, a thorough exam often finds that an older person with cognitive decline doesn’t have dementia. Even if they do, natural treatments can often dramatically improve their memory, mental state, and everyday functioning. (And the treatments in this chapter also will improve the memory of most people with age-related memory loss or mild cognitive impairment, the stages of memory loss that can eventually turn into Alzheimer’s.) Here are treatments that address the underlying real causes that are worth considering if you or a loved one has been diagnosed with Alzheimer’s or vascular dementia.

Receive Vitamin B12 Injections

Make sure your doctor checks your blood levels of B12. Optimal levels are a must for a healthy brain. That’s because B12 strengthens the myelin sheath, the protective covering around axons, which are wirelike extensions of brain cells that help relay messages between those cells.

Any reading above 209 picograms per deciliter is designated “normal” by most labs—but it’s not necessarily a healthful level. My suggested strategy: If your B12 level is under 540, you should receive a series of at least 15 B12 shots over three months. (B12 shots can take three months to fully kick in and revive memory and cognitive function.) Make sure each injection has 1,000 micrograms to 5,000 micrograms of B12. If your B12 level is under 340, you should continue to receive B12 shots monthly for the rest of your life.

Also, add one tablespoon of apple cider vinegar mixed into some food at each meal (for example, in salad dressing). Low vitamin B12 is often linked with low stomach acid, and apple cider vinegar is a simple way to help that problem.

When Dutch scientists studied more than 1,000 older people who didn’t have dementia, they found that people with low B12 levels (but still well within the “normal” range) had decreased function in their axons (white matter). “B12 status in the normal range is associated with severity of white-matter lesions,” concluded the researchers in the Journal of Neurology, Neurosurgery & Psychiatry. This is one more study indicating that our so-called normal ranges for many blood tests have nothing to do with good health—and that the normal range should be the range that helps your body function optimally.

Five hundred micrograms of B12 can often help take care of low levels of vitamin B12, even if your doctor won’t agree to give you B12 injections.

Consume More Fish Oil

The membranes (outer coverings) of brain cells are made of DHA (docosahexaenoic acid), one of the omega-3 essential fatty acids found primarily in fish oil. Without enough DHA, your brain can’t function normally.

I recommend eating three to four servings a week of fatty fish, such as salmon, tuna, herring, or sardines. Or take omega-3 supplements. A unique form, called Vectomega, has a chemical structure identical to that found in salmon and dramatically increases absorption. One to two tablets a day are plenty, instead of the typical eight to 16. Another good brand is Nordic Naturals. Follow the dosage recommendation on the label.

In one study, a supplement of 1.7 grams of DHA and 0.6 gram of EPA (eicosapentaenoic acid) improved the appetite of people with mild to moderate Alzheimer’s and helped them gain weight, reported Swedish researchers in the Journal of the American Geriatrics Society. In another study, published in the journal Molecular Neurobiology, Spanish researchers discovered a form of DHA in the brain called neuroprotectin D1 (NPD1) that protects the brain cells against many biochemical stressors, including amyloid-beta.

Try Curcumin and Ginkgo

Studies have shown that Alzheimer’s is much less common in India than in the United States, and a dietary factor may be making the difference. It’s turmeric, the spice that gives curry its yellow color. The active ingredient in turmeric is curcumin, and studies show that curcumin can dissolve the amyloid plaques that are a hallmark of Alzheimer’s. Unfortunately, you have to eat as much curry as they do in India to absorb enough for the protective effect.

An alternative: A unique form of curcumin (BCM-95) boosts absorption of the compound sevenfold. For my patients with memory loss, I recommend one capsule to two capsules a day of a product that contains BCM-95: CuraMed, from Terry Naturally. Also try the herb ginkgo biloba, which can improve circulation to the brain. Use 40 milligrams to 80 milligrams, three times a day, for six weeks, to see if it works for you.

Treat Hormonal Deficiencies

If you have a diagnosis of Alzheimer’s or dementia, I would consider treating hormonal deficiencies even if your blood tests for those hormones are “normal.” You’ll need to work with a holistic practitioner or a compounding pharmacy for these treatments…

•A trial of prescription desiccated thyroid. For most people with unexplained chronic confusion and memory loss, I recommend a three-month trial of this natural thyroid hormone to see if it helps. If you have risk factors for heart disease—high LDL cholesterol, high blood pressure, and the like—your doctor should start with a low dose and increase it slowly.

In a study by Brazilian researchers, published in the journal BMC Public Health, men with subclinical hypothyroidism (low levels of thyroid hormone that are still considered normal) had an eight-times-higher risk of developing Alzheimer’s or dementia. And in a study by researchers at Harvard Medical School and Boston University School of Medicine, published in the Archives of Internal Medicine, women with low-normal levels of thyroid hormone had a 2.4-times-higher risk of developing Alzheimer’s. “The most important thing to take away from this study is the question of whether our currently accepted standard of what normal thyroid levels are is too broad,” wrote Zaldy S. Tan, MD, the lead researcher of the study.

•In men, try testosterone, too. If the total testosterone is under 400 ng/dl, I recommend using natural testosterone cream to bring the level to 600 ng/dl to 800 ng/dl. (A dose of 25 milligrams to 50 milligrams a day is plenty in older men with decreased mental function. Too much can unmask a hidden case of heart disease, possibly causing a heart attack or stroke.)

•In women, consider bioidentical estrogen/progesterone. Synthetic forms of estrogen/ progesterone (Premarin and Provera) do not improve brain function and do increase your risk of breast cancer, heart disease, and stroke. However, estrogen affects memory (the brain is packed with estrogen receptors), and I think a six-month trial of bioidentical estrogen/progesterone is worthwhile in women with cognitive decline. Talk to your doctor about whether this treatment is right for you.

Sleep Eight Hours

Sleep protects and restores brain function. (In a 10-year study from the UK of 1,225 men, those with sleep disturbances—particularly daytime sleepiness caused by poor sleep—were 4.4 times more likely to develop vascular dementia.) For those diagnosed with dementia, I recommend a bedtime dose of three milligrams to five milligrams of melatonin, the sleep-inducing hormone. Another excellent sleep-inducing product is the herbal mixture Revitalizing Sleep Formula from Nature’s Way (available at Amazon.com).

Also, treat sleep apnea or restless legs syndrome (RLS). These two sleep disorders can also cause insomnia and increase your risk of dementia. In sleep apnea, excess tissue in the throat cuts off breathing during sleep, repeatedly rousing the sleeper to a semi-awake state. Its main symptoms are snoring and daytime fatigue. (You can find treatments for sleep apnea in Insomnia and Other Sleep Disorders on page 268.) In restless legs, you have intensely uncomfortable feelings in your legs that cause you to move them around, seeking relief—particularly when you’re trying to fall asleep. Your legs may also jerk around while you sleep. Optimizing blood levels of iron often works to ease or solve RLS. (See Nutritional Deficiencies on page 22 for advice.)

Investigate Your Meds

It is amazing how many people “diagnosed” with Alzheimer’s recover normal mental function when they are weaned off unnecessary medications. Ask your doctor if he’s willing to work with you to find out if any (or many) of your medications are contributing to the confusion. The best approach, if it’s safe: Your doctor tapers you off your medications, slowly reducing their dosages to see if the lower dose provides relief from any memory loss and other mental difficulties. For a few critical medications (heart medications and the like), your doctor may stop the medication for two to three days to see if your mind clears, or change medications to see if that helps.

A Prescription Option for Dementia

Aricept is a prescription drug used to treat dementia. It works by raising levels of the neurotransmitter acetylcholine, but the effect is minimal. (In fact, I think its main effect is boosting the profits of drug companies.) In an analysis of 13 studies on Aricept and Alzheimer’s, researchers found that, on average, the drug raised cognitive function less than three points on a 70-point scale. Also, side effects (most commonly nausea, vomiting, and diarrhea) caused nearly one-third of those taking the drug to stop taking it.

However, if you have been diagnosed with Alzheimer’s, and you have insurance that covers prescription medications, I would add Aricept to your Real Cure Regimen. Taking five milligrams (not the standard 10) is optimal, because there’s less risk of side effects. The rest of the treatments in my Real Cure Regimen for Alzheimer’s and dementia are probably much more effective than Aricept, but it’s worth adding this medication for the small benefit you might derive.

Does this sound like a drastic strategy? I don’t think it is. I suspect that many of the elderly would be fine without many (if not most) of their medications. For example, a study from the National Institutes of Health showed that, after a few months of use, the arthritis medication celecoxib (Celebrex) was no more effective than a placebo. So why continue to take it?

Sadly, it’s easier for a physician to add a medication (it takes about one minute to write the prescription and discuss its use with the patient) than stop a medication (which requires a thorough review of why the medication was started and entails a degree of risk to the physician).

Don’t Forget About Other Diseases

Many medical conditions can contribute to cognitive decline: heart disease, diabetes, depression, liver disease, anemia, chronic infections, and others. Make sure your doctor checks to see if another disease is the underlying cause. For this—as with many other health problems—I recommend seeing a holistic physician, who will take the time to conduct a proper evaluation of your condition, rather than blaming something reversible on “old age.”

Preventing Alzheimer’s With Nutrition

Is there a diet that can lower your risk of Alzheimer’s?

Yes, say researchers from the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, at Columbia University, who published their results in the Archives of Neurology. They studied 2,148 people over age 65 for four years and found that people with a “dietary pattern” that emphasized vegetables and fruits and limited red meat and dairy products were 48 percent less likely to be diagnosed with Alzheimer’s. The prevention pattern…

High intake: Dark green, leafy vegetables (such as spinach and kale); cruciferous vegetables (such as broccoli and cabbage); tomatoes; fruits; nuts; fish. Several studies show that nutrients in whole foods like leafy green vegetables can help prevent or treat Alzheimer’s disease or dementia.

Low intake: High-fat dairy products; red meat; organ meat; butter.

Niacin (vitamin B3): In a five-year study of more than 3,700 people, researchers at the Centers for Disease Control and Prevention found that the more niacin people consumed, the less likely they were to develop cognitive decline and Alzheimer’s, with a daily intake of 45 milligrams offering the most protection. (The RDA is 16 milligrams for men and 14 milligrams for women.)

Folate: Researchers in the Department of Neurology at the University of California, Irvine, analyzed the link between several nutrients and the development of Alzheimer’s disease, and found that folate intake at or above the RDA was the most powerfully protective. “The participants who had intakes at or above the 400 microgram RDA of folate had a 55 percent reduction in the risk of developing Alzheimer’s,” commented the researchers, in Alzheimer’s & Dementia. “But most people who reached that level did so by taking folic acid supplements, which suggests that many people do not get the recommended amounts of folate in their diets.”

Stopping Memory Loss Long Before Alzheimer’s

Memory loss proceeds in stages: from age-related memory loss to mild cognitive decline to Alzheimer’s and dementia. But specific nutrients have the power to prevent age-related memory loss.

•Vitamin E. Researchers at Utah State University conducted a long-term study on people age 65 and older called the Cache County Study on Memory Health and Aging. They found that those with the highest blood levels of vitamin E and vitamin C also had the highest scores on the Modified Mini-Mental State examination. (The researchers also found that those who took antioxidant supplements containing vitamin E had a 36 percent reduced risk of developing Alzheimer’s. In a similar study of more than 1,000 older people, Italian researchers found that those with the lowest blood levels of vitamin E were 2.6 times more likely to develop dementia.

•Beta-carotene. Researchers at Harvard Medical School studied nearly 6,000 men older than 65. Those taking 50 milligrams of beta-carotene every other day had “significantly higher” scores on tests of memory and general mental prowess. The results were in the Archives of Internal Medicine. And in a study by researchers at the UCLA School of Medicine, high blood levels of beta-carotene were linked to lower risk of memory loss and decline—89 percent lower in those with a genetic predisposition to Alzheimer’s and 11 percent lower in those without Alzheimer’s genes.

•Vitamin B12. When researchers at the University of Illinois matched vitamin B12 intake and the amount of gray matter in various areas of the brain (gray matter processes information), they found that those with the highest B12 intake had the most gray matter. “These effects were driven by vitamin supplementation,” they wrote in the journal Brain Research. (In other words, it was vitamin supplements and not B12 from food that made for bigger, healthier brains.)

In other studies on B12 and brainpower…

•Lower blood levels of vitamin B12 were linked to poorer performance on memory and mental tests in 84 people age 69 and older who didn’t have dementia, reported Welsh researchers in the American Journal of Clinical Nutrition.

•Five months of B12 injections given to older people with low B12 levels improved their scores on memory and mental tests, reported Dutch researchers.

•In a five-year study, researchers at Harvard Medical School found that supplementing the diet with vitamins B12, B6, and folate helped preserve memory and mental ability in women over 40 with low dietary intake of B vitamins.

•Folate. Commenting in the journal Lancet that “low folate and raised homocysteine concentrations in blood are associated with poor cognitive performance” (by which they mean poor memory, less ability to take in and understand information, and slow reflexes), Dutch researchers tested the ability of folate to boost memory and mental performance in 818 people 50 to 75 years old. For three years, half the study participants took 800 micrograms a day of folate and half took a placebo. After three years, the “cognitive functions that decline with age” were “significantly improved” in those who took folate, but not in the placebo group. In fact, on memory tests, the supplement users had scores comparable to those of people 5.5 years younger, and on tests of mental speed, the folate group performed as well as people 1.9 years younger.

•Zinc. English researchers studied 387 people ages 55 to 87, giving half zinc supplements (15 milligrams to 30 milligrams daily). After three months, those taking zinc “performed significantly better” on memory tests, reported the researchers in the British Journal of Nutrition.

Vitamin K: People with early-stage Alzheimer’s had a 55 percent lower intake of vitamin K than people of the same age who didn’t have Alzheimer’s, reported researchers in the Journal of the American Dietetic Association.

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