By Dr. John Neustadt

Alzheimer’s disease (AD) is a devastating diagnosis. The progressive loss of memory and functional abilities creates confusion, loneliness, and anger as a person slowly experiences that they’re losing the ability to recognize their children, friends, partner, function independently and care for themselves. It also takes a toll on family members, especially those that become the primary caregiver. 

AD is the most common type of dementia. Since dementia affects people more often as they get older, and the average age of the global population is increasing, it’s estimated that by 2050 more than 115 million people will have dementia. Since there is no effective treatment of AD that can reverse it, understanding how we can slow down its progression or even prevent it, is a pressing global public health focus.

Risks

Like osteoporosis, AD primarily affects people as they age. About 95% of all AD cases are in people 65 years old and older.¹ And when people have AD, it increases their risk for other problems too. For example, the risk for an osteoporosis hip fracture is doubled in people with AD compared to those without AD.^2,3

Fortunately, research shows that you can control many of the risk factors. When you do, you decrease your chances of getting AD. Learn how you can decrease your risk. These include:⁴ 

• • • cerebrovascular diseases (most commonly reported risk factor)
    • diabetes
    • hypertension
    • obesity
    • dyslipidemia 
    • stress
    • smoking
    • vitamin D status
    • diet
    • lack of physical activity

Cerebrovascular disease

Cerebrovascular disease describes a group of conditions that damage delicate brain tissue because of decreased blood flow to the brain. This can be caused by blood vessel narrowing (atherosclerosis), blood clots, blocked arteries, or rupturing of blood vessels. One common type of cerebrovascular injury is caused by a stroke, and 80% of strokes are caused by blood clots.⁵ Therefore, anything you can do to promote healthy blood flow and circulation can help. 

Hypertension

Multiple studies have found an association between elevated blood pressure and decreased cognitive function, especially in middle age.^6,7 How high blood pressure can contribute to AD is straightforward. Over time, the increased pressure damages blood vessel walls. This leads to decreased blood flow, less nutrients, and less oxygen delivery to the brain. This initiates a cascade of events that can lead to AD. Therefore, anything you can do to promote healthy blood pressure can help.  

Diabetes

Epidemiological studies clearly demonstrate an association between non-insulin dependent diabetes (type 2 diabetes) and developing AD. There are several proposed mechanisms to explain how poor blood sugar control increases your risk. But the bottom line is that elevated blood sugar attaches to molecules in your body and creates advanced glycation end production (AGEs). These damage neurons and create inflammation.⁸ Eliminating high-sugar, processed foods can help support healthy blood sugar control. 

Stress

Chronic stress wreaks havoc on your health. Previous research has shown strong associations between elevated levels of the stress hormone cortisol and heart disease, collagen damage, and low bone mineral density. In people with chronic stress, it’s even been shown to shrink their brain, literally making it smaller. Increased levels of cortisol have also been found in people with AD compared to control groups.^9,10 And one study found that people with elevated cortisol and AD had a faster decline in cognitive function and smaller hippocampus compared to the control group.¹¹ The hippocampus is that part of the brain that stores memories. Learning natural ways to de-stress can help. 

Vitamin D

Epidemiological studies have observed strong associations between decreased vitamin D and increased risk for AD. A serum vitamin D level of <20 ng/mL is associated with a 21% increased risk for AD compared to people with vitamin D >20 ng/mL.^12,13 One way this might work is by balancing inflammation.¹⁴ Making sure you know how much vitamin D you need for optimal levels can help.

Diet

Since diet provides the raw materials for our biochemistry and physiology, it’s not surprising that research has determined that diet is strongly associated with your risk for getting AD and how fast it progresses. We all have to eat anyway, so we might as well be eating to improve our health instead of creating and feeding our diseases. 

And the research is clear: following a healthy dietary pattern decreases the risk of cognitive decline. What does a healthy diet include? It’s a plant-forward diet, with probiotics, antioxidants, soybeans, nuts, and omega-3 fats, and a low intake of saturated fats, animal-derived proteins, and refined sugars, have been shown to decrease the risk.¹⁵ And all of these are healthy components of the Mediterranean Diet, which has been shown over decades of research to reduce the risk for heart disease, osteoporosis, dementia, diabetes, obesity, cancer, and death from cancer.¹⁶ Following my 3-steps to eating healthy for life can improve your diet and healthy by following more of a Mediterranean dietary pattern.

Physical activity

Your body was built to move, and physical activity is one of the best ways to reduce your risk for heart disease, diabetes, osteoporosis, and lots of other nasty diseases nobody wants. As it turns out, it also decreased AD risk. Two meta-analyses looked at this issue both concluded that exercise helps. The first meta-analysis evaluated data from sixteen studies with more 3,219 volunteers concluded that exercise is so protective that it reduces AD risk by 45%.¹⁷ The second, larger study pooled data from 58 studies with 257,983 volunteers. In this study, exercising reduced AD risk by about 20%.¹⁸ 

There are lots of great options for exercise. You can join a class, go to the gym, walk, and many ways in which you can work exercise into your daily life, even while brushing your teeth.

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