Nourish Your Neurons: A Nutritional Strategy for Alzheimer s Disease

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Irma Hines
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1 Nourish Your Neurons: A Nutritional Strategy for Alzheimer s Disease

2 Alzheimer s Disease as a Metabolic Condition

concerned with memory and cognition, are among the first to exhibit functional

3 The Brain is an Energy Hog When the brain s energy supply is insufficient to meet its metabolic needs, the neurons that work hardest, especially those concerned with memory and cognition, are among the first to exhibit functional incapacity (e.g., impairment of memory and cognitive performance). (Hashim & VanItallie 2014)

4 Basic Neuron Structure

5 Nerve Impulse Transmission Close-up of a Synapse

7 Cell Membrane Structure

Mitochondrial Dysfunction If the amount of free radical species produced overwhelms the neuronal capacity to neutralize them, oxidative stress occurs, followed by

8 Mitochondrial Dysfunction If the amount of free radical species produced overwhelms the neuronal capacity to neutralize them, oxidative stress occurs, followed by mitochondrial dysfunction and neuronal damage. (Moreira et al., 2007) Mitochondrial dysfunction and the resulting energy deficit trigger the onset of neuronal degeneration and death. (Ibid)

AD: Type 3 Diabetes? the predominant abnormality in incipient late onset Alzheimer's disease was a 45% reduction in cerebral glucose utilization (Fukuyama et al.

9 AD: Type 3 Diabetes? the predominant abnormality in incipient late onset Alzheimer's disease was a 45% reduction in cerebral glucose utilization (Fukuyama et al., 1994) Progress in understanding changes in brain energy metabolism during aging and AD has grown rapidly in the past three decades to the extent that it is now widely acknowledged that brain hypometabolism accompanies AD (Cunnane et al., 2011) A prominent and well-characterized feature of AD is progressive, region-specific declines in the cerebral metabolic rate of glucose. (Henderson, 2008) Reductions in regional cerebral glucose metabolic rate (CMRglu) [ ] are also associated with increased AD risk and can be observed years before dementia onset. (Baker et al., 2011)

10 It s the Insulin, Stupid! Abdominal obesity PCOS Low HDL & high triglycerides Hypertension Gout Skin tags; acanthosis nigricans Erectile dysfunction BPH (benign prostate hypertrophy)

11 Hyperinsulinemia The risk of AD doubled in the 39% of the sample with hyperinsulinemia and was highest in people without diabetes. (Luchsinger et al., 2004) Insulin resistance may be a marker of AD risk that is associated with reduced CMRglu and subtle cognitive impairments at the earliest stage of disease, even before the onset of mild cognitive impairment. (Baker et al., 2011) (Talk about a canary in the coalmine!)

ApoE4: The Alzheimer s Gene? It should be noted that E4 is not an inherently damaging allele; it is only deleterious in combination with a HC [high-carb] diet (which is deleterious on its own).

12 ApoE4: The Alzheimer s Gene? It should be noted that E4 is not an inherently damaging allele; it is only deleterious in combination with a HC [high-carb] diet (which is deleterious on its own). (Henderson, 2004) The APOE Ɛ4 allele may not be inherently damaging but only in combination with a highcarbohydrate diet, which is damaging in itself and is likely to be a major contributor to the high risk of CAD [coronary artery disease], and possibly AD, in modern populations with or without the APOE Ɛ4 allele. (Lane & Farlow, 2005)

13 Amyloid Plaques

14 Amyloid Plaques

15 Amyloid: Cause or Effect? Low regional CMRglu appears to be a very early event in the disease process, well before any clinical signs of dementia are evident, and well before cell loss or plaque deposition is predicted to have occurred. (Henderson, 2008)

16 Additional Obstacles to Healthy Cognitive Function

17 Prescription Antacids (PPIs)

Statin Drugs From the U.S. Food & Drug Administration FDA Drug Safety Communication: Important safety label changes to cholesterollowering statin drugs (https://www.fda.gov/drugs/drugsafety/ucm293101.

18 Statin Drugs From the U.S. Food & Drug Administration FDA Drug Safety Communication: Important safety label changes to cholesterollowering statin drugs ( Adverse Event Information Information about the potential for generally nonserious and reversible cognitive side effects (memory loss, confusion, etc.) and reports of increased blood sugar and glycosylated hemoglobin (HbA1c) levels has been added to the statin labels. FDA continues to believe that the cardiovascular benefits of statins outweigh these small increased risks.

19 The statin plot thickens Additional Information for Patients Memory loss and confusion have been reported with statin use. These reported events were generally not serious and went away once the drug was no longer being taken. Additional Information for Healthcare Professionals There have been rare post-marketing reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use. These reported symptoms are generally not serious and reversible upon statin discontinuation... -U.S. FDA (

20 Higher Cholesterol is Protective for Healthy Aging High LDL-C is inversely associated with mortality in most people over 60 years. [ ] Our analysis provides reason to question the validity of the cholesterol hypothesis. (Ravnskov et al., 2016) Nondemented elderly with levels of total cholesterol, non-hdl-c, and LDL-C in the lowest quartile were approximately twice as likely to die as those in the highest quartile. (Schupf et al., 2005) High cholesterol in late life was associated with decreased dementia risk (Mielke et al., 2005) These findings suggest that cholesterol levels within the high normal range are associated with better cognitive performance in Chinese elderly, specifically in the oldest old. With further validation, low cholesterol may serve as a clinical indicator of risk for cognitive impairment in the elderly. (Lv et al., 2016)

21 What Do We Do About It? AD may be similar to obesity, coronary artery disease, and type II diabetes mellitus in being a consequence of the conflict between our Paleolithic genetic constitution and our current Neolithic diet. (Lane & Farlow, 2005)

22 Human Brain Hybrid Car

Ketones: High Octane Brain Fuel Throughout much of human evolution, ketosis likely served as a valuable survival mechanism to fuel brain metabolism during times of food scarcity.

23 Ketones: High Octane Brain Fuel Throughout much of human evolution, ketosis likely served as a valuable survival mechanism to fuel brain metabolism during times of food scarcity. Hence, in some ways, the modern diet can be considered keto-deficient. (Henderson, 2008) Two points are clear (i) AD is at least in part exacerbated by (if not actually caused by) chronic, progressive brain fuel starvation due specifically to brain glucose deficit, and (ii) attempting to treat the cognitive deficit early in AD using ketogenic interventions is safe, ethical, and scientifically well-founded. (Cunnane et al., 2016)

24 Raising Ketone Levels Low carbohydrate / ketogenic diet Fasting Exercise Coconut oil and/or MCT oil Exogenous ketones*

25 Prevention via Diet The primary event leading to the development of AD is consumption of an evolutionarily discordant diet. This hypothesis predicts that relatively simple preventative measures, such as lowering the consumption of starchy carbohydrates and increasing EFA [essential fatty acids] in the diet will be effective. (Henderson, 2004) Simple dietary modification, towards fewer highly-processed carbohydrates and relatively more fats and cholesterol, is likely a protective measure against Alzheimer s disease. (Seneff et al., 2011)

26 A Nutrient-Dense, Low(er) Carb Diet

27 There IS Hope

28 Book Signing Today!

29 Questions?

30 Supplements for Cognitive Function Foundations: Vitamin B12 DHA & EPA (omega-3 fats) Zinc Choline Extras: MCT oil (or coconut oil) Alpha-lipoic acid Berberine Coenzyme Q 10 (CoQ 10 ) Huperzine A; PQQ

31 Sleep =

32 Exercise =

33 Good Fats vs Bad Fats The OLD way of thinking Good fat Mono and polyunsaturated; heart healthy Avocado Salmon Walnuts Flaxseed oil Soybean oil Corn oil Bad fat Saturated ( arterycloggingsaturatedfat ) Lard, bacon fat Beef tallow Chicken fat, duck fat Butter Cream Coconut oil

34 Good Fats vs Bad Fats The NEW way of thinking Good fat BEST CHOICES FOR COOKING Mostly saturated or monounsaturated fats and oils Animal fats from grass-fed/pastured animals Dark bottles, stored away from heat & light Organic when possible Bad fat WORST CHOICES FOR COOKING Polyunsaturated vegetable oils Partially hydrogenated oils (trans fats) Margarine & shortening Transparent, clear plastic bottles Avocado oil Bacon fat Beef/lamb tallow Butter (for lowmedium heat) Coconut oil Duck & chicken fat Ghee Lard Olive oil Palm oil Peanut oil (occasionally) Sesame oil (occasionally) Corn oil Cottonseed oil Flaxseed oil (fine for cold uses see below) Grapeseed oil Safflower oil Soybean oil Sunflower oil (small amounts of high-oleic sunflower oil are okay)

35 The Skinny on Fats Source Saturated Monounsat. Polyunsat. Oleic Acid Linoleic Acid (n-6) Beef Tallow 49-54% 42-48% 3-4% 39% 2% Lard 44% 45% 11% 45% 10% Butter 65% 30% 4% 28% 3% Olive Oil 15% 73% 10% 73% 10% Soybean Oil 15% 23% 62% 23% 53% Cottonseed Oil 29% 18% 52% 18% 53% Safflower Oil 9% 11% 80% 13% 78% Source: Mary Enig, PhD, Know Your Fats (2000)

36 Saturated Fats LEAST susceptible to oxidation and rancidity Typically do NOT form free radicals Most stable for cooking, especially high-heat cooking Required for cell membrane stability and fluidity Usually solid at room temperature

Mono and Polyunsaturated Fats The more unsaturated,

Most vegetable & seed oils are high in inflammatory

Excess dietary PUFAs get incorporated into cell

High amounts of dietary PUFAs inhibit the

37 Mono and Polyunsaturated Fats The more unsaturated, the more susceptible to oxidation and rancidity. Most vegetable & seed oils are high in inflammatory n-6 fatty acids. Excess dietary PUFAs get incorporated into cell membranes and alter the permeability. High amounts of dietary PUFAs inhibit the desaturase enzymes that make EPA and DHA from ALA. Usually liquid at room temperature (mono can solidify in fridge)

38 For a modern disease to be related to an old-fashioned food is one of the most ludicrous things I ever heard in my life. -Dr. T.L. Cleave, British naval surgeon ( ) Replacement of (saturated fat) with a higher carbohydrate intake, particularly refined carbohydrate, can exacerbate the atherogenic dyslipidemia associated with insulin resistance and obesity that includes increased triglycerides, small LDL particles, and reduced HDL cholesterol. Despite the conventional wisdom that reduced dietary saturated fat intake is beneficial for cardiovascular health, the evidence for a positive, independent association is lacking. Recent evidence indicates that limitations in carbohydrate intake can improve all features of atherogenic dyslipidemia. There is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. --Siri-Tarino, et al. American Journal of Clinical Nutrition, Jan. 2010

Fats, Oils, Triglycerides. About which Americans seem confused

Fats, Oils, Triglycerides. About which Americans seem confused Fats, Oils, Triglycerides About which Americans seem confused Learning Objectives Define fats and oils Understand triglycerides Consider the benefits of saturated fats Identify trans fats in your food