Even more ways that exercise heals the brain

In Beating the Dementia Monster, we told a rather simplistic story about exercise and brain health.  Of course, exercise increases blood flow to the brain, but it also promotes generation of the brain-derived neurotrophic factor (BDNF).  BDNF not only has the power to repair damaged brain cells, but it can also prompt stem cells in the hippocampus to form new neurons.  These activities repair damage caused by Alzheimer's disease, and they are almost surely responsible for my much improved brain health.

But a lot has happened since we originally went to press -- which is why we keep this blog.  Back in May 2024, we wrote that new research has found a much more complex relationship and many more pathways between exercise and brain health than had been understood until then.  And so, recently, my friend Teale sent me an article diving more deeply into one of these pathways.

The article cites research at MIT finding that, not only are there biochemical pathways, but there are also mechanical ones.  Apparently, when muscles are exercised, they release a small protein (a cytokine) called a myokine.  (We have discussed cytokines before, mainly in the context of their role in inflammation.)  The myokines boost neuron growth and maturity.  If this principle can be applied to the brain, the myokines might have a benefit similar to BDNF.  Also, stretching of nerves promotes their health as well.  Of course, we're not expecting to see much stretching of neurons in the brain, but investigation of this phenomenon may still lead to helpful insights on how nerves work, insights that could lead to better treatments for brain health.

If the the myokines are generated in muscles, can they make their way to the brain?  (Other cytokines do.)  Can they cross the blood brain barrier?  The researchers didn't say.  Although they are interested in how these results might affect progress in treating neurodegenerative diseases, their main focus at this point was on new treatments for damaged nerves outside of the brain.

This research may ultimately be irrelevant to Alzheimer's research, but it nevertheless underscores the incredible power that exercise has in all aspects of your health, not just your brain.

My Cerebellar Dysfunction Ataxia

You may recall that, in June 2023, I saw a neurosurgeon to investigate whether I should receive a shunt for hydrocephalus.  But he agreed with other doctors that I do not have hydrocephalus.  So no shunt.  He also agreed with the diagnosis of Alzheimer's disease (and wasn't surprised by my experience of improvement with lifestyle changes), but he added a new diagnosis of ataxia due to cerebellar dysfunction.  He said this was what was causing problems with my balance.

My balance problems and insomnia are currently the most frustrating aspects of my condition.  While I haven't had any serious falls, balance problems affect pretty much everything fun I want to do.  And a sleep doctor told me that the cerebellar dysfunction was probably causing my chronic insomnia.  I am very, very grateful to be alive, and I truly enjoy life.  But it would be nice to have some improvement in my balance.

Back in August, I said that I saw a new neurologist in Seattle who is well known as a specialist in movement disorders.  He ordered another MRI and some blood tests, and he said he'd have a Zoom call with me in November -- which is now.  At the time, I was not optimistic that he'd find anything useful to help.

I just finished the Zoom call, and I'm more encouraged than I was before.  When I asked him, he said that there is about a 30% chance that he will find something that will actually help me.  This will be a result of genetic tests that he intends to do.  Now 30% is what I'd call "less likely," but it's better than the 0% I had inferred from our first visit.  One thing he pointed out is that they are finding more and more ways that cerebellar dysfunction emanates from newly identified genetic causes.  So there may well be something they can do for me.

In the world of Alzheimer's research, I'm seeing more and more studies regarding how it is that exercise, diet, and other lifestyle changes can affect development and progress of the disease.  But as far as breakthroughs in the disease mechanisms and pharmacological treatment ... not so much.  Also, no new scandals.  I have a couple of things I've been wanting to post on, but my life has been refreshingly full.  While I haven't been posting as much lately, it's not because something is wrong.

And it gets worse ... or does it?

I've remarked before that, when I speak on the diet aspects of the Dementia Toolkit, I hear groans ... notably, when I talk about avoiding sweets, cheese, butter, and margarine.  In her book, Diet for the Mind,  the late Martha Clare Morris says that American pizza is one of the worst things you can eat, at least with respect to brain health.  (This is different from pizza you might find in Italy.)  Aside from all of the cheese, most pizza toppings will include "ultraprocessed foods" like pepperoni.  We wrote previously about ultraprocessed foods.

So there's some new research about ultraprocessed foods.  The researchers used data derived from the Nurses' Health Study and the Health Professionals Follow-up Study to dig deeply into the influence of ultraprocessed foods on the development of dementia.  This gave them access to the experiences of 130,000 people over periods as long as 43 years.  

Of the 130,000 people, 11,173 developed dementia.  So what did they eat, and what did they not eat?

One finding was that people who ate one-quarter serving or more of processed red meat daily had a 14% greater risk of dementia.  But they also found that substituting nuts and legumes for processed red meat was associated with a 20% lower risk of dementia as well as fewer years of cognitive aging.

This research has not yet been published, but here's an article about it.

We continue to see research on the Mind Diet we discussed in Beating the Dementia Monster.  In reality, it doesn't seem to be the game-changer it originally promised.  So maybe that cheese is OK after all, especially if you're a guy.

A new study was just published in the journal, Neurology, about benefits of adherence to the Mind Diet.  It was entitled, "Association of Adherence to a MIND-Style Diet With the Risk of Cognitive Impairment and Decline in the REGARDS Cohort."  While the study found that, overall, greater MIND diet adherence was associated with decreased risk of cognitive decline, this was almost entirely among female subjects.  It also found that black subjects experienced better improvement than white subjects when they adhered more strictly to the diet.

A question I had was, what diet did they compare against?  Did the control group live on pizza and ice cream, or did they eat something more like a Mediterranean diet?  (Which wouldn't be much different from the MIND diet.)

I don't have access to the actual research, but what I do see is that the control group ate a "usual diet."  Of course, what's usual in New Orleans may not be usual in Omaha.  Nevertheless, all participants, both subjects and control, were coached on diet and calorie reduction.  This seems to have modified everyone's diet, so they actually had improvement even in the control group.  And, after coaching, was that still a control group?

Here's an article on this study.

What do I think?  I think the evidence (that we've discussed before) tells us that there is a clear association between the Mediterranean diet and a reduced incidence of of dementia.  But it's not clear now how much modifying the Mediterranean diet to the MIND diet improves on this.  We have also discussed how studies that failed to confirm this about the Mediterranean diet finding relied too heavily on self-reporting of what people ate.  When actual dietary intake was more carefully regulated or observed, the benefits of the Mediterranean diet are more clearly defined.  (Are you surprised?)

Alzheimer's disease advances in two phases? Yeah, we knew that.

If you read Beating the Dementia Monster, you know that there are five stages in the advance of Alzheimer's disease.  We said that the first stage, the preclinical stage, may last 15 to 20 years.  In that stage, there are no symptoms and no reason to believe there's a problem.  The disease progresses silently until it hits a "tipping point" when there is a sudden spread of beta amyloid throughout the brain.  This begins the "prodromal" stage producing the symptoms we call mild cognitive impairment.

Here's an article on this from 2019. 

The prodromal stage is when you begin to notice that something isn't right.  Yes, you're older, and older people have trouble with memory and cognition.  But this is different.  You are experiencing more serious problems than your peers.  What you don't realize is that things have already been going wrong for a long time.

If you've been watching the news, you may have seen a stir over new research about two stages of Alzheimer's disease.  For the news story, the two stages are simply the preclinical stage with no symptoms and the other four stages with symptoms taken together.   In popular media, the big takeaway of the story is that there is this preclinical period when the disease is at work, but there are no symptoms.  But this isn't news.  

The research was published in Nature Neuroscience.

I know from experience that a lot of people don't know about the preclinical phase, especially how long it lasts.  So that's what made the story newsworthy.  What's special to the science about this research is that if focuses on what's going on in one part of the brain, the middle temporal gyrus.  This is an area important to memory, language, and vision.  

A gyrus is one of those irregular ridges that you see all over the brain.  Those ridges have names and specific purposes.  And they are the same from one person to another.  If you set my brain down next to the brain of my wife, they would look the same.  (But don't try that.)  Except the brain of Albert Einstein looked a lot different from the brains of the rest of us.  His gyri (or gyruses, depending on your dictionary) were all different from everyone else.

What was the real contribution of this research?  It was to more clearly identify some of the processes occurring as the disease progresses, and it changed our understanding of which cells are being affected.  There's more to explain about that, but it's beyond the scope of this blog.  But you can read about it here if you're interested.

The research was conducted in Seattle by a collaboration of the University of Washington Alzheimer's Disease Research Center and the Allen Institute for Brain Science.  (As someone who is a regular at the UW ADRC, I recognized a name or names among the researchers listed as contributors in the published report.)

12,000 Copies of Beating the Dementia Monster

I am so gratified to report that I ran the numbers on book sales for Beating the Dementia Monster: 12,000 copies sold!  (That's sales from both editions and reports of page reads on Amazon Ultimate.)  And sales continue to be far brisker than I had thought possible when I started this project.

I said before that I remember the signs over McDonald's restaurants blaring, "One million sold!"  Six months or maybe a year later it was, "Two million sold!"  Now, of course, it's "Billions sold!"  They can't keep up any more.

Well, it'll be a while before we hit a million copies of Beating the Dementia Monster sold.  But what's gratifying to me is not only the sales but the stories I sometimes hear from readers regarding how they have been helped or encouraged by the book and/or by this blog.  Thanks to all of you who have read the book and given your feedback by posting comments here, by posting on Amazon, or by writing.

A Clarification...

Yesterday, I wrote about chronic diseases stemming from metabolic syndrome.  These included heart disease, high blood pressure, type 2 diabetes, Alzheimer’s disease, some cancers, etc.  I said that RFK Jr had taken a position on this that I thought was important.  However, this should not be taken as an endorsement of all things RFK Jr.  Even in the area of medicine and health, some of his ideas are, well, fringe, and I'm not on the same page with him.  I simply agree with him that our response to the diseases stemming from metabolic syndrome needs much more focus on prevention as opposed to medications.

An anecdote:  When I was 17, I worked in a shoe store not far from Hickory Hill, the Robert F. Kennedy estate.  At back-to-school time, Ethel would have their chauffeur (can't remember his name) load all the kids into their limousine and send them to our store for new shoes.  RFK Jr would have been about 12.  Robert and Ethel eventually had 11 children, two of whom had not yet been born.  I remember them all sitting in a row against the wall, waiting for Mort, my boss, to fit each one.  (Note: I may have worked at a store near where the Kennedy's lived, but we definitely lived on the other side of the railroad tracks from them.)

The first Alzheimer's survivor is out there. And the second. And the third...

As you know, I support the work of the Alzheimer’s Association.   They do wonderful things to support families in their terrible struggles with dementia, and, behind the governments of the US and China, they are the third largest sponsor of Alzheimer’s research in the world. 

That being said, I have been thinking recently about their fundraising hook, “The first survivor of Alzheimer’s is out there…”  Hey, I’m a survivor of Alzheimer’s disease, and I’m not the first one.  From 2015 through 2018, the evidence of my disease was as strong as it could be, but the symptoms are now apparently behind me.  So, I count myself as a survivor of the disease. 

I didn’t make up the “Dementia Toolkit” on my own.  It’s based on the experience of others who overcame the disease through lifestyle changes.  Others had similar experiences, such as those involved in the FINGER study and the subjects of Dr. Dean Ornish’s work.  In Beating the Dementia Monster, we discussed the success Dr. Dale Bredesen has had, although I’m skeptical of some features of his program outside of lifestyle changes.  So, I’m not alone.  We don’t know who that first survivor was, but he or she has been around for a while. 

What has me thinking about this is the book, Blind Spots.  I’ve been considering it along with what RFK Jr. has been saying about chronic diseases.  A way of looking at the practice of medicine is to identify an ailment, name it, and search for a medication that will cure it. 

For example, I remember when polio terrified parents, as many thousands of children succumbed to it.  I remember the rows of iron lungs working to keep so many four- and five-year-olds alive.  Today, I know a couple of people who are living in wheel chairs or are otherwise physically impaired due to having the disease in the 1950s.  The March of Dimes raised the money to do the research that led first to the Salk vaccine and then to the Sabine vaccine. Many lives were saved. 

But RFK Jr’s point is that, for the chronic diseases presently advancing in the culture, just inventing pills to fix things isn’t the right approach.  Most of the chronic diseases—heart disease, high blood pressure, type 2 diabetes, Alzheimer’s disease, some cancers, etc.—are a consequence of poor lifestyle choices.  We call Alzheimer’s disease “type 3 diabetes,” because the same factors that drive metabolic syndrome—leading to diseases like type 2 diabetes—also drive Alzheimer’s disease.  You may invent a pill or come up with an infusion to help control symptoms, but the disease itself is a consequence of lifestyle choices, and pharmaceutical treatments here are not cures.

After speaking with quite a few knowledgeable people, it appears to me that no one believes there will ever be an outright pharmaceutical cure for Alzheimer’s disease.  Instead, there will ultimately be a cocktail of medications that, coupled with appropriate regimens of exercise, diet, sleep, and social activity, will get us as close as possible to a “cure.” 

Regarding Blind Spots, Dr. Makary’s point is that the medical profession gets stuck on certain paradigms, and it is too slow to recognize it’s not on the best path.  My take is that, when all the focus is on coming up with a pharmaceutical solution, the best path forward—lifestyle change—is overlooked. 

Now, this ain’t easy.  I’ve had a number of people approach me for help with their issues on cognitive decline.  Usually, when someone is concerned enough about cognitive issues to seek help, they probably are actually dealing with disease, not the consequences of normal aging.  But the people who come to me are usually spouses of people with issues. 

Of course, the first thing I do is tell them I’m not a doctor, and I recommend specific specialists I trust. Nevertheless, I do explain my experience and suggest that, in addition to seeing a real doctor, they adjust their lifestyle.  But when I get to that part, they usually lose interest.  Get daily exercise?  Cut out desserts?  Stop eating processed foods?  For many people, these are non-starters. 

Every morning when I wake up, I can’t believe how wonderful my life became after I got control of my lifestyle.  Beyond that, the reason I get up is to share my experience with those who could benefit from it, even if not everyone is willing to listen.