How Many Steps per Day?

When I call my Mom, she's often a bit distracted.  That's because she's "getting in her steps."  One way or another, she's going to get in her recommended 10,000 steps per day as reported by her Apple Watch or Fitbit ... not sure which. 

But who prescribed 10,000 steps per day, and is that a good number for every age and every goal?  Some people are interested in weight loss (or weight control), others want to optimize cardiovascular health, while others just want to live longer, healthier lives.  And the benefits may vary based on how old you are.

Some recent research provides more of a breakdown on all of this.  The research was published in the European Journal of Preventive Cardiology, and it offered a threshold as low as about 4,000 steps per day if your only interest is cardiovascular health.  Of course, if you want other benefits, you will need to do more ... even up to that 10,000 steps per day.  (10,000 steps is about five miles for most people.)

So what did the researchers do?  They performed a "meta-analysis" of other research to synthesize findings suggested by the sum of the data.  They evaluated 17 studies involving 227,000 participants.  They evaluated changes in mortality based on increments of 500 steps per day, mortality due to cardiovascular issues and all-cause deaths.  They evaluated 1,884 deaths due to cardiovascular causes and 7,574 deaths due to all causes.  They went so far as to assess the effect of 20,000 steps per day.

A conclusion was that more steps is always better, but we don't all need to be at the 10,000 steps per day level.

CNN Health quoted Dr. Maciej Banach, deputy editor-in-chief of the European Society of Cardiology, "Adults 60 and older who walked between 6,000 and 10,000 steps a day saw a 42% reduction in risk of early death, while people under 60 who walked between 7,000 and 13,000 steps a day had a 49% reduction in risk."

There was another meta analysis in 2022 with similar results.  Here is a guide someone developed from this analysis. 

I have a FitBit.  Do I track my steps?  No, I use it to track my sleep.  For my regimen, I don't think step-counting would be worth the effort.  I'm on the treadmill six-days per week at 3.5 mph with an incline of 15 degrees for 55 minutes.  As we discussed in Beating the Dementia Monster, I am going for sustained aerobic exercise, and, according to this research, about 5.5 hours a week is optimal for people known to have Alzheimer's disease.  In fact, going more than six hours per week is actually associated with a decline in cognitive ability.  (This decline applies to people with Alzheimer's disease, not the healthy control group--people who do not have Alzheimer's disease.)  If you look at the article and scroll down to their graph, you find that study participants with the amount of exercise I'm getting have nearly the same cognitive health as the control group. 

But one way or another, just keep stepping.

Interesting new insight on intermittent fasting

I've been a bit distracted and so haven't posted in a while.  I do hope everyone had a wonderful Christmas, Hanukkah, or whatever you celebrate.  This is a season of light and hope.

I have come across news on intermittent fasting that I thought was interesting.  It has to do with the gut-brain axis.  We've written before about the influence of the gut-brain axis on brain health.  Somehow, there is a two-way communication between microbes in the gut (bacteria and archaea) that regulates brain function.  Meaning that healthy gut = healthy brain.  Or something like that.

When we discussed intermittent fasting in Beating the Dementia Monster, it was credited by the sources I referenced with raising the level of brain-derived neurotrophic factor (BDNF) in the body.  BDNF not only repairs damaged brain cells, but it also prompts stem cells in the hippocampus to form new neurons.  BDNF is generated during sustained aerobic exercise, and so exercise is the most powerful tool in the Dementia Toolkit.

But, after reading an article in the New England Journal of Medicine, I was prompted to began a 20 hour/day (sort of) fasting protocol in 2020.  Intermittent fasting is not recommended for the elderly, because many of us have trouble maintaining an adequate weight.  But I am currently five pounds over where I want to be, and fasting appears to have been beneficial to me.  So I continue.

For the past year and a half or so, my memory and cognition have been tested weekly by researchers from the University of Washington's Alzheimer's Disease Research Center.  While I don't have access to their protocols for analyzing the data, I have no trouble telling that I'm doing just fine.  I've also found that I score best late in the morning, after some coffee, after the gym, but before eating anything.

So how do fasting, the gut-brain axis, and brain health intersect?  There was recent research from China published in the journal Frontiers in Cellular and Infection Microbiology finding an association between weight loss due to intermittent fasting and brain health.  The researchers correlated intermittent fasting, improvements in the health of gut microbiome (all those little things swimming around inside your gut), and brain health.  Long story short, intermittent fasting is good for the health of the gut microbiome, so the gut microbes do a better job of regulating brain activity.

Here's an article about the study from Newsweek -- a little easier reading than the journal article.  Most people do intermittent fasting for weight loss, so that's the context for the study.  But there are other reasons to fast, so I don't think the association with weight loss in either the Newsweek or journal articles are central to the phenomenon.  If you do all the things to support your gut, it will help your brain.  This Healthline article lists 10 things you can do to support your gut biome.  Notables include eating fiber, eating fermented foods (I eat kimchee and yogurt every day), eating whole grains, etc.

How does the gut-brain axis work?  It's pretty mysterious to me, but this passage from the Wikipedia article is interesting: 

"Chemicals released in the gut by the microbiome can vastly influence the development of the brain, starting from birth.  A review from 2015 states that the microbiome influences the central nervous system by 'regulating brain chemistry and influencing neuro-endocrine systems associated with stress response, anxiety and memory function.' The gut, sometimes referred to as the 'second brain,' may use the same type of neural network as the central nervous system, suggesting why it could have a role in brain function and mental health."  

Your body is truly amazing.

Sushi for Brain Health?

While I grew up on the East Coast, I moved to Hawaii right after school and lived there many years.  My wife was born there and graduated from the University of Hawaii.  (Go Rainbows!).  All of our children were born there.  Like about a third of the population of Hawaii, Amy's ancestry is Japanese, and she and many others share their Japanese cultural artifacts in the Hawaii cultural smorgasbord.  One of these is a love for sushi, although more than a century of separation from its islands of origin have led to a form of sushi quite different from either modern Tokyo or, for that matter, Seattle.  

While I like the sushi I've had in Japan and Seattle, I've never really cared for the sushi people make in Hawaii.  But one thing they all share is wasabi as an ingredient, and I do love that.  I had been told, and always believed, that wasabi was just the Japanese name for horseradish.  And I like to put horseradish on various foods.  But I recently learned that they are not the same thing, although horseradish (a product cheaper to produce) is often portrayed as wasabi.  (Just add green food coloring.)  They do share similar taste and the ability to clean out your nose.

So why are we talking about this?  Some recently published research from Japan found that consumption of an extract from wasabi (something that's apparently not in horseradish) can significantly improve cognition in older adults -- age 60 to 80.  Note that this is among cognitively healthy adults.  No research has been conducted with Alzheimer's patients.

The research was published in the journal Nutrients.  It studied a cohort of 72 subjects, about half of whom were given an extract from wasabi called  6-MSITC.  (The rest received a placebo.)  The study's lead researcher, Rui Nouchi, told reporters, "We knew from earlier animal studies that wasabi conferred health benefits.  But what really surprised us was the dramatic change. The improvement was really substantial."

According to the research, participants who received 100mg of wasabi extract at bed time improved episodic memory scores an average of 18%.  They scored on average 14% higher than the placebo group overall. 

Why should this happen?  The researchers believe that the wasabi reduces oxidation and inflammation in the hippocampus.  What a coincidence.  Those are the main modes of action of the dementia toolkit we describe in Beating the Dementia Monster.

Reading this research prompted my wife and me to immediately start scouring the refrigerator and pantry to see if we had any on hand.  We, of course, were looking for genuine wasabi, and not horseradish disguised as wasabi (dyed green).  The tube of paste we thought we had was gone, but we did find a small unopened can.  It had expired in February 2020.

Here's a news article about this.

Apparently, to be effective, the wasabi needs to be fresh.  In paste form, it's usually refrigerated.  Since I do like wasabi, and the researchers say it doesn't take much to see a result, I went ahead and ordered some on Amazon.  We'll see if anything amazing happens.

Now a more reliable way of evaluating diet and cognitive decline

Nutritionists and other researchers have been trying for years to correlate the Mediterranean diet with its influence on the rate of cognitive decline.  Does adhering to the diet slow cognitive decline, either from normal aging or from disease?  

We discussed this in Beating the Dementia Monster.  Research to date has actually been a bit confused.  Some research finds the diet is great for the brain, while other studies found no help.

What's going on here?  Well, the big challenge is knowing whether people are accurately reporting what they eat.  The studies are all based on surveys, and the study participants must accurately report how they eat.  My observation is that this information is highly subjective and subject to wishful thinking.  Aren't we all good boys and girls that always eat our Brussels sprouts?

And what about pizza?  Isn't that Mediterranean?  To dieticians like the late Dr. Martha Clare Morris, it's the worst possible food for brain health.  But I'd bet that gets reported as Mediterranean in some surveys.

Studies to date have been qualified and held at arms length by many researchers.  So what to do?

Recently, researchers in France published 12 years worth of research that took a novel approach to verifying what people actually consumed.  Basically, they sampled the blood of the participants and analyzed for the metabolites that should be there if someone is adhering to the diet.  They did this in two geographically distinct study populations.

So what's a metabolite?  A metabolites is a molecule from the chemicals that result when food is metabolized, and they can be found in the blood stream.  Spinach will produce one set of metabolites, while a chocolate eclair will produce another set.  Ingenious.

The research was published in October in the journal Molecular Nutrition and Food Research.  The researchers concluded, "A greater adherence to the [Mediterranean diet], here assessed by a serum [Mediterranean diet metabolic score], is associated with lower odds of [cognitive decline] in older adults."  Here's an article about the study.

How much did the diet help with cognitive decline?  Good question.  And they aren't clear about that.  So I'm guessing not as much as you might hope.

You probably know that I try to follow the MIND diet.  MIND stands for “Mediterranean-DASH Intervention for Neurodegenerative Delay.”  It tries to derive the best from both the Mediterranean and DASH diets.  The DASH diet was designed to help with heart health.  And you know what the neurologists all say: "What's good for the heart is good for the brain!"  I'd just say most simply that the MIND diet is the Mediterranean diet without cheese, butter, and stick margarine.  And maybe an extra helping of blueberries.  The MIND diet seems to produce better results than the Mediterranean and DASH diets for brain health,

Where I'm At

In Beating the Dementia Monster, we discussed an interview I had with a researcher/neuropsychologist about my condition and path forward.  This was in 2016 (or maybe 2017) when I was about 66 and had just begun to experience improvement from my lifestyle changes.  He indicated (a bit indirectly, due, I think to professional considerations) that I was on track to be dead from Alzheimer's disease by 75.  But, he said, if I would just keep up what I was doing, I would last to 85.  I was buying 10 years.  (Again, he indicated this kind of indirectly, but that's what I took from the conversation.)  Considering that I was, at the time, on the edge of a transition to actual dementia, the 75 number is consistent with research I've read.

Of course, with the changes in my exercise habits, sleep, diet, and other lifestyle improvements, I improved steadily until 2019.  But in 2019 I hit something of a speed bump, and I was concerned that the trend was now downward.  So did I peak in 2019?  Or maybe in some subsequent year?

Well, I certainly bounced back in 2020.  Since then I've experienced a few more milder hiccups, but I have bounced back again each time.  As part of a research project at the University of Washington, I've been tested weekly for about 18 months, and I'm happy with how I've been doing.  Also, I practice speaking in Spanish a couple of times a week (in addition to reading in Spanish), and I'm happy with how that goes.  I don't seem to be able to add to my vocabulary, but I can still hold up my end of the conversation.

These measures give me feedback on certain special functions of my brain (notably short-term memory and language).  When I'm tested at Harborview in Seattle, the tests last at least 3 hours, and they probe just about every nook and cranny of my brain.  But I'm not doing any more of those for the foreseeable future.  The results are interesting, but they won't lead to any changes in my treatment ... unless some totally unexpected medication appears on the market.  We drive four hours to get to Seattle, and the tests are quite expensive ... both to us and the insurance company.  So I continue to rely on feedback from the various studies that I participate in and from my personal experience.

I'll turn 75 this summer, but I don't plan to be dead by then.  But will that be the turning point for a steady decline down to 85?  I'll leave that in the Good Lord's hands, but I seem to be doing about as well as other men my age that I know.  We compare notes, and we all seem to be having the same experiences.  

In Beating the Dementia Monster, we cited a study that I've used as a basis for the amount of exercise I get per week.  Basically, it showed that people known to have Alzheimer's disease, but who were getting about six hours of exercise a week, experienced nearly the same level of cognitive decline as people in the control group (those without Alzheimer's disease) whether they exercised or not.  Exercise very much affected the rate of decline for people with Alzheimer's disease, but it did not affect decline among people without the disease.

My personal assessment is that my rate and level of decline at this point is consistent with others my age who have not made lifestyle changes and do not have Alzheimer's disease.  They are experiencing cognitive decline consistent with normal aging.

I have one major fear that we discussed in Beating the Dementia Monster ... the return of what I believe was Benson's Syndrome, or posterior cortical atrophy.  Or "the visual syndrome."  My assessment is that this was what caused me to stop driving in 2015.  My vision was quite good, but I might miss seeing the pedestrian in the crosswalk, even though I looked.  Before changing lanes, I would look but not see the car right there.  My eye might see something, but my brain was struggling to discern what was in the image being presented.  I absolutely would not drive with that kind of thing going on, but the deficiency responded really well to my lifestyle changes.  I now drive as well as I ever have.  But will that problem return?  I'm constantly alert for any changes in vision that might be caused by changes in my brain.

A Crisis in Alzheimer's Research

No, I haven't posted in a while.  For various reasons.  We are presently in Colorado to attend the wedding of our nephew to a wonderful young woman.  But something showed up on my news feed that was worth a comment.

According to the philosopher of science, Thomas Kuhn, a paradigm in a scientific theory ends when the evidence no longer supports the theory.  This is called a crisis for the theory.  So the theory of the solar system with earth at the center went into crisis when Copernicus showed evidence that the sun was the center.  From that crisis grew the heliocentric model (which is not as straightforward as believed in popular culture).  Well, some are saying that "the amyloid hypothesis" of Alzheimer's disease is now in crisis.

We discussed the amyloid hypothesis in Beating the Dementia Monster, noting that it's the most widely accepted hypothesis about how the disease begins and progresses.  Amyloid plaques build up on brain cells, interfering with the information passing between cells and killing the cells.  We also noted that this could be a complete misinterpretation of the data ... that amyloid plaques may actually be part of the body's effort to fight off bacterial or viral causes of the disease.

For sure, Aduhelm and Leqembi remove amyloid plaques and also produce some limited improvement in symptoms of the disease.  The assumption is that the disease slows because the plaques are being removed.  But now another monoclonal antibody successfully removes the plaques, but there has been little or no improvement in the condition of the patients.  This challenges the assumption that has underpinned the vast majority of Alzheimer's research and the pursuit of pharmaceutical treatments.

The monoclonal antibody is gantenerumab.  We did discuss this failure back in 2020, but the implications of this now seem to be sinking in.  Here's the article that caught my attention.

My early manuscript of Beating the Dementia Monster was actually quite skeptical of the amyloid hypothesis.  But reviewers led me to think I should tone that down, and so I did.  Maybe I should have kept my original treatment.

 

My interview at the Hip Senior online magazine

A few days ago, I was contacted by Marianne at The Hip Senior magazine, where they wanted to feature Beating the Dementia Monster.  The Hip Senior is an Internet resource for all things senior living-related.  I, of course, thought this was a really good idea, and the book is now available on their web site.

As part of the book promotion, she also taped a podcast (video interview) with me about my experience and about the book.  She posted it with the book entry.  So click here for the book entry.  You can then scroll down to see the interview.  (I am grateful for her editing skills...)  You can also see it here on YouTube.