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.

"Blind Spots" by Dr. Marty Makary

Dr. Marty Makary's book, Blind Spots, was available September 17 of this year and now shows up as #14 on the NY Times non-fiction best sellers list.  The subtitle is, "When Medicine Gets It Wrong, and What It Means for Our Health."  I have skimmed it and am now reading it.  The book takes a rather critical view of the approach medicine has taken to a number of health issues, pointing out that incorrect ideas propagate in the medical community and are not challenged until many people have been hurt.

The book attracted my attention because I hoped it would address how medicine has focused on a pharmaceutical approach to Alzheimer's disease as opposed to taking lifestyle head on.  That's not outside of the scope of the book, but he doesn't really spend time there.  

In Beating the Dementia Monster, we mentioned that Dr. Dale Bredesen had encouraged post-menopausal women who had stopped taking hormone replacement therapy to resume it.  Makary has the same assertion.  Women were discouraged from taking it, after a study connected the therapy with an increased risk of breast cancer.

Makary cites this as a major fail of medical science.  He cites studies that failed to support the connection with cancer, and he says the benefits of the therapy far outweigh the risks.  He specifically cites some significant statistical evidence that women taking hormone replacement therapy have a very much reduced probability of developing Alzheimer's disease.

Makary cites other conditions he believes represent failures on modern medicine, including:

-- Promotion of nut allergies in children by preventing their early exposure to nuts

-- Abuse of antibiotics

-- Demonization of dietary cholesterol and red meat

-- Origins of the opioid crisis

and more.

Makary focuses on the phenomenon of "group think."  A chunk of my engineering career was taken up with accident investigation.  I investigated serious industrial accidents as well as nuclear facility events and accidents.  The goal was always to find the root cause, a cause that could be corrected to prevent recurrence.  And quite often, we identified group think as a cause.  In group think, a consensus on a process or solution to a problem arises in the group.  Being consensus grants a proposed process or solution special authority, and so bad ideas are not easily challenged.  When the idea arises in the medical community and propagates in the culture that peanut allergies can be prevented by keeping peanuts away from young children, we get an epidemic of peanut allergies.  Even though evidence arises to contradict this belief, it remains embedded in the thinking society in general and doctors in particular. 

When I bought the book, I was hoping for more focus on chronic diseases (like Alzheimer's disease).  He seems to have some thoughts there, but they don't come out so much in this book other than in hormone replacement therapy.

Robert F. Kennedy, Jr. has some serious thoughts on chronic diseases.  While I definitely don't want to get into any political discussion on this blog, I was impressed to hear the focus he wants to bring to chronic disease.  I heard him speak on the subject.  He wants to make changes to the food supply and otherwise discourage the lifestyle habits that lead to many chronic diseases.  Alzheimer's disease would, of course, be a prime target for such an effort.

My New Speculation on the Sundowning Phenomenon

In Beating the Dementia Monster, I commented on mild depressions I was experiencing in 2015, 2016, 2017, and perhaps later.  They would begin in late afternoon, but disappear in the later evening.  During my diagnosis, my doctors asked me a number of questions suggesting they were investigating my reports as sundowning.  They never concluded anything, but I'm convinced this was sundowning.

Originally, the depressive episodes occurred four or five times per week, but became less frequent when I began changing my exercise, diet, and other habits.  To my recollection, they did not decrease in intensity, but they became less frequent as I proceeded with implementing the Dementia Toolkit.  After six months, they occurred something like twice per week; and after a year, once every two or three weeks.  Or so I recall.  It seems that during 2017 they might occur once every couple of months.  At this point, it's been several years since I had an episode.

In Beating the Dementia Monster, we discussed the conventional medical hypothesis that changing shadows late in the day cause confusion among the elderly with dementia.  But I haven't seen this explained as proven fact, and, quite frankly, I reject it.  I said that during one of the worst periods of my experience, we traveled to Alaska during summer.  At 9 p.m., the sun was still high in the sky, and I didn't experience an obvious period of "changing shadows."  Nevertheless, I experienced the depressive episodes according to the same timing as back at home.  As near as I could tell, the experience in Alaska was identical to what I experienced at home.  I speculatively concluded that the timing of the episodes was more associated with my circadian rhythm than environmental factors. 

What may (or may not) support my speculative take on this is this article referred to me by my friend, Teale.  We've written several times about new methods for diagnosing Alzheimer's disease, including blood tests.  The article refers to some new research from the University of Surrey in the UK exploring some of these blood tests.  The tests, of course, look for proteins and other chemical biomarkers for Alzheimer's disease in the blood.  What the researchers were surprised to discover is that the biomarker concentrations varied with the circadian rhythm and were highest in the evening ... right when sundowning occurs.  So ... something we don't understand about Alzheimer's disease varies according to the circadian rhythm.  For some reason -- without a clear cause and effect relationship -- both chemical activity and depressive episodes vary together.

Now I am making this connection all by myself.  From what I can see, no one has tried to connect this phenomenon in blood tests with sundowning.  But for me, it makes a lot more sense than the changing shadows hypothesis. 

BTW, here's a picture I took on our trip to Alaska.  I kind of like it.