Preventing Alzheimer’s Disease Is Easier Than You Think

Psychology Today–  Science shines new light on root cause of memory problems.

Posted Sep 07, 2016

Do you have Insulin Resistance?

If you don’t know, you’re not alone. This is perhaps the single most important question any of us can ask about our physical and mental health—yet most patients, and even many doctors, don’t know how to answer it.

Here in the U.S., insulin resistance has reached epidemic proportions: more than half of us are now insulin resistant. Insulin resistance is a hormonal condition that sets the stage throughout the body for inflammation and overgrowth, disrupts normal cholesterol and fat metabolism, and gradually destroys our ability to process carbohydrates.

Insulin resistance puts us at high risk for many undesirable diseases, including obesity, heart disease, cancer, and type 2 diabetes.

Scarier still, researchers now understand that insulin resistance is a powerful force in the development of Alzheimer’s Disease.

What is insulin resistance?

Insulin is a powerful metabolic hormone that orchestrates how cells access and process vital nutrients, including sugar (glucose).

In the body, one of insulin’s responsibilities is to unlock muscle and fat cells so they can absorb glucose from the bloodstream. When you eat something sweet or starchy that causes your blood sugar to spike, the pancreas releases insulin to usher the excess glucose out of the bloodstream and into cells. If blood sugar and insulin spike too high too often, cells will try to protect themselves from overexposure to insulin’s powerful effects by toning down their response to insulin—they become “insulin resistant.” In an effort to overcome this resistance, the pancreas releases even more insulin into the blood to try to keep glucose moving into cells. The more insulin levels rise, the more insulin resistant cells become. Over time, this vicious cycle can lead to persistently elevated blood glucose levels, or type 2 diabetes.

Insulin resistance and the brain

In the brain, it’s a different story. The brain is an energy hog that demands a constant supply of glucose. Glucose can freely leave the bloodstream, waltz across the blood-brain barrier, and even enter most brain cells—no insulin required. In fact, the level of glucose in the cerebrospinal fluid surrounding your brain is always about 60% as high as the level of glucose in your bloodstream—even if you have insulin resistance—so, the higher your blood sugar, the higher your brain sugar.

Not so with insulin—the higher your blood insulin levels, the more difficult it can become for insulin to penetrate the brain. This is because the receptors responsible for escorting insulin across the blood-brain barrier can become resistant to insulin, restricting the amount of insulin allowed into the brain. While most brain cells don’t require insulin in order to absorb glucose, they do require insulin in order to process glucose. Cells must have access to adequate insulin or they can’t transform glucose into the vital cellular components and energy they need to thrive.

Despite swimming in a sea of glucose, brain cells in people with insulin resistance literally begin starving to death. 

Insulin resistance and memory

Source: Suzi Smith, used with permission

Which brain cells go first? The hippocampus is the brain’s memory center. Hippocampal cells require so much energy to do their important work that they often need extra boosts of glucose. While insulin is not required to let a normal amount of glucose into the hippocampus, these special glucose surges do require insulin, making thehippocampus particularly sensitive to insulin deficits. This explains why declining memory is one of the earliest signs of Alzheimer’s, despite the fact that Alzheimer’s Disease eventually destroys the whole brain.

Without adequate insulin, the vulnerable hippocampus struggles to record new memories, and over time begins to shrivel up and die. By the time a person notices symptoms of “Mild Cognitive Impairment” (pre-Alzheimer’s), the hippocampus has already shrunk by more than 10%.

The major hallmarks of Alzheimer’s Disease—neurofibrillary tangles, amyloid plaques, and brain cell atrophy—can all be explained by insulin resistance. A staggering 80% of people with Alzheimer’s Disease have insulin resistance or full-blown type 2 diabetes. The connection between insulin resistance and Alzheimer’s Disease is now so firmly established that scientists have started referring to Alzheimer’s Disease as “Type 3 Diabetes.”

This does not mean that diabetes causes Alzheimer’s Disease—dementia can strike even if you don’t have diabetes. It’s more accurate to think of it this way: Insulin resistance of the body is type 2 diabetes; insulin resistance of the brain is type 3 diabetes. They are two separate diseases caused by the same underlying problem: insulin resistance.

Are you already on the road to Alzheimer’s Disease?

You may be surprised to learn that Alzheimer’s Disease begins long before any symptoms appear.

The brain sugar processing problem caused by insulin resistance is called “glucose hypometabolism.” This simply means that brain cells don’t have enough insulin to burn glucose at full capacity. The more insulin resistant you become, the more sluggish your brain glucose metabolism becomes. Glucose hypometabolism is an early marker of Alzheimer’s disease risk that can be visualized with special brain imaging studies called PET scans. Using this technology to study people of different ages, researchers have discovered that Alzheimer’s Disease is preceded by DECADES of gradually worsening glucose hypometabolism.

Brain glucose metabolism can be reduced by as much as 25% long before any memory problems become obvious. As a psychiatrist who specializes in the treatment of college students, I find it positively chilling that scientists have found evidence of glucose hypometabolism in the brains of women as young as 24 years old.

Real hope for your future

We used to feel helpless in the face of Alzheimer’s Disease because we were told that all of the major risk factors for this devastating condition were beyond our control: age,genetics, and family history. We were sitting ducks, living in fear of the worst—until now.

The bad news is that insulin resistance has become so common that chances are you already have it to some degree.

The good news is that insulin resistance is a major risk factor for Alzheimer’s Disease that you CAN do something about.

Eating too many of the wrong carbohydrates too often is what causes blood sugar and insulin levels to rise, placing us at high risk for insulin resistance and Alzheimer’s Disease. Our bodies have evolved to handle whole food sources of carbohydrates like apples and sweet potatoes, but they simply aren’t equipped to cope with modern refined carbohydrates like flour and sugar. Simply put, refined carbohydrates cause brain damage.

You can’t do anything about your genes or how old you are—but you can certainly change how you eat. It’s not about eating less fat, less meat, more fiber, or more fruits and vegetables. Changing the amount and type of carbohydrate you eat is where the money’s at.

Three steps you can take right now to minimize your risk for Alzheimer’s Disease

1. Find out how insulin resistant you are. Your health care provider can estimate where you are on the insulin resistance spectrum using simple blood tests such as glucose, insulin, triglyceride and HDL cholesterol levels, in combination with other information such as waist measurement and blood pressure. In my article How to Diagnose, Prevent and Treat Insulin Resistance, I include a downloadable PDF of tests with healthy target ranges for you to discuss with your health care provider, and a simple formula you can use to calculate your own insulin resistance.

2. Avoid refined carbohydrates like the plague, starting right now. Even if you don’t have insulin resistance yet, you remain at high risk for developing it until you kick refined carbohydrates such as bagels, juice boxes and granola bars to the curb. For clear definitions and a list of refined foods to avoid:http://www.diagnosisdiet.com/refined-carbohydrate-list/

3. If you have insulin resistance, watch your carbohydrate intake. Unfortunately, people with insulin resistance need to be careful with all carbs, not just the refined ones. Replace most of the carbs on your plate with delicious healthy fats and proteins to protect your insulin signaling system. The infographic below provides key strategies you’ll need to normalize blood sugar and insulin levels.

You can wield tremendous power over insulin resistance—and your intellectual future—simply by changing the way you eat. Laboratory tests for insulin resistance respond surprisingly quickly to dietary changes—many people see dramatic improvements in their blood sugar, insulin, and triglyceride levels within just a few weeks.  

If you already have some memory problems and think it’s too late to do anything about it, think again! This 2012 study showed that a low-carbohydrate high-fat diet improved memory in people with “Mild Cognitive Impairment” (Pre-Alzheimer’s Disease) in only six weeks.

Yes, it is difficult to remove refined carbohydrates from the diet—they are addictive, inexpensive, convenient, and delicious—but you can do it. It is primarily your diet, not your DNA, that controls your destiny. You don’t have to be a sitting duck waiting around to see if Alzheimer’s Disease happens to you. Armed with this information, you can be a proactive swimming duck sporting a big beautiful hippocampus who gets to keep every single one of your marbles for the rest of your life.

Oprah’s Investment in Weight Watchers Was Smart Because the Program Doesn’t Work

By Traci Mann

On October 19, Oprah made news by buying a 10 percent stake in Weight Watchers. Analysts quickly speculated about what the move could mean for Weight Watchers, with the general consensus being that Oprah’s involvement, endorsement, and ability to promote it on her OWN network will be a boon to the company. Sure enough, stock prices more than doubled by the end of the day of the announcement and have stayed up since.

At first glance — and in stark contrast to some of the other wellness ideasshe touts — Winfrey seems to be investing in a scientifically sound weight-loss company. Studies have shown, after all, that Weight Watchers, along with three other popular diets (Zone, Atkins, and South Beach), leads to modest weight loss (an average of about ten pounds) in a year. In fact, those same studies found that only Weight Watchers participants reliably lost more weight than people in control groups who were not enrolled in a diet program at all. At first glance, Weight Watchers works.

But the truth is a bit more complicated: Winfrey’s venture is, in fact, a brilliant investment, although not necessarily for the reason she thinks. It’s brilliant not because Weight Watchers works but because it doesn’t. It’s the perfect business model. People give Weight Watchers the credit when they lose weight. Then they regain the weight and blame themselves. This sets them up to join Weight Watchers all over again, and they do.

The company brags about this to its shareholders. According to Weight Watchers’ business plan from 2001 (which I viewed in hard-copy form at a library), its members have “demonstrated a consistent pattern of repeat enrollment over a number of years,” signing up for an average of four separate program cycles. And in an interview for the documentary The Men Who Made Us Thin, former CFO Richard Samber explained that the reason the business was successful was because the majority of customers regained the weight they lost, or as he put it: “That’s where your business comes from.” 

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But what about those aforementioned studies showing Weight Watchers works? There’s an important catch: While most dieters do lose weight in the short term, they gain most of it back in the long term. In the one study that followed up with Weight Watchers dieters over a longer-term span, the average dieter had already regained six of the 12 pounds they had lost when researchers checked in two years later. This general pattern is true no matter the diet, and the weight regain only continues in the years that follow. My labreviewed 60 years of clinical trials of diets, and we found that people lose an average of 10 percent of their starting weight on most diets but within two to five years have gained back all but about two pounds.

So, in reality, despite the short-term effectiveness of certain diet regimes, the most common outcome of dieting itself, by a landslide, is either weight regain or trivial weight loss — which leads to a lot of repeat business for companies like Weight Watchers. But no diet, not even Weight Watchers, can claim that more than a small minority of its customers successfully keep the weight off in the long term. To be fair, Weight Watchers doesn’t explicitly promise long-term weight loss, but it neglects to mention that it’s extremely unlikely and instead makes vague claims on its website, such as, “Our proven program works.” Works for what? It would be easy for potential customers to misconstrue the website’s statement that they’ve “helped millions of people change their relationship with food for good.”

The problem is that dieting itself leads to a host of physiological changes that undermine long-term efforts to maintain the weight loss. Some of these changes probably evolved to keep us alive in times of famine. For example, if your body detects that not enough calories are coming in, your metabolism changes so that you can run your body on fewer calories than before, leading your body to store more as fat. So if you eat the same amount of calories that you were eating when you lost weight on your diet, after a while you will stop losing weight, and maybe even start gaining it. Dieters sometimes refer to this as “the plateau,” and it is a predictable result of calorie restriction. Few dieters make it past this plateau.

Dieting also leads to changes in the hormones of the gastrointestinal system, the so-called gut hormones. Some of those hormones (such as leptin and peptide YY) influence when you feel full, and others (including ghrelin) influence when you feel hungry. Levels of leptin and peptide YYdecrease after dieting, whereas levels of ghrelin increase. So food that made you feel full before you dieted will feel less satisfying as your diet goes on, and the extra hunger makes it that much harder to stick to your diet.

To make matters worse, another counterproductive result of dieting is neurological changes that may make food seem even more tempting and even harder to resist than before. Brain-imaging studies by Eric Stice and his colleagues found that, when shown pictures of high-calorie foods, people who had fasted for as few as five hours that day or had lost even two pounds in the last two weeks had increased activation in brain regions associated with liking and craving those foods, paying attention to those foods, and being motivated to acquire and eat them. Stice and his colleagues also found that the longer you deprive yourself, the more appetizing and tougher to resist the foods get. Not surprisingly, these neurological changes have been linked to weight gain.

None of this is to suggest that no one successfully loses weight and keeps it off for several years. But based on surveys of those who do, conducted by Rena Wing at the Brown University’s Alpert Medical School, these folks are not casual dieters. Rather, they tend to make weight loss a singular focus of their life, weighing themselves and everything they eat every day. They tend to eat the same foods in the same amounts most days, and they exercise a ton: a minimum of an hour a day, seven days a week. As obesity expert Kelly Brownell, dean of Duke University’s School of Public Policy, told the New York Times, “They never don’t think about their weight.”

So, despite the inspirational stories of a few outliers, the bottom line is that your goal to keep weight off is at odds with your body’s goal to keep you alive. And your body has the upper hand, making this an unfair fight. When the weight invariably comes back, as it does for all but about 5 percent of dieters, they shouldn’t blame themselves. The problem isn’t the dieter. The problem is dieting itself, as well as the constant temptations in our current food environment. Until people understand this, Weight Watchers will continue to create repeat customers instead of successful dieters, and Oprah will get an impressive return on her investment.

Traci Mann, Ph.D., is a professor of psychology at the University of Minnesota and the author of Secrets From the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet Again.

How Junk Food Can Damage Your Kidneys as Much as Type 2 Diabetes

BY ADAM BIBLE AND BRITTANY SMITH

Seems every month another bit of smart research craps on fast food’s head—and this month is no different. A study in Experimental Physiology has tied fast food to the type of kidney damage seen in folks with type 2 diabetes. Supersize that insurance plan!

In the study, rats were fed either high-fat rodent chow (60% of calories from fat) for 5 weeks or junk food consisting of cheese, chocolate bars, biscuits, and marshmallows for 8 weeks to see how insulin resistance and too much sugar or fat affect the kidneys.

The researchers tested the effect of these diets on blood sugar levels and glucose transporters. They then compared changes seen in their diet-induced obesity and insulin resistance to changes in rats with actual type 1 and type 2 diabetes.

How Much Junk Food Can You Really Get Away With Eating? >>>

Little background info: Type 2 diabetes is typically linked to obesity; in short, your body doesn’t react properly to insulin, or doesn’t produce enough of it, which causes a surplus to accumulate in the blood. This raises blood sugar levels, and certain types of glucose transporters and their regulatory proteins. This can have severe long-term consequences for organs, especially the kidneys. 

For type 2 diabetic rats, there was a higher number of glucose transporters (GLUT and SGLT) and regulatory proteins; this was also the case for rats fed a high-fat and junk food diet.

“The Western diet contains more and more processed junk food and fat, and there is a well-established link between excessive consumption of this type of food and recent increases in the prevalence of obesity and type 2 diabetes,” lead study author Havovi Chichger said in a press release.

Researchers document troubling rise in strokes in young adults, starting at age 25

By Jennifer Breheny Wallace May 11

From the WashingtonPost
Robin Dickinson and her family. (Adam Houseman)

There’s a troubling statistic in the United States when it comes to strokes. Although stroke hospitalizations have declined in recent years among the aged, the opposite appears to be be happening among younger Americans. In a study released Wednesday in the Journal of the American Heart Association, researchers found that between 2000 and 2010, hospitalizations for ischemic stroke, the most common type, dropped nearly 20 percent overall — but among people ages 25 to 44, there was a sharp 44 percent increase in the rate.

Ischemic stroke accounts for about 80 percent of all strokes and occurs when a blood vessel in the neck or brain is blocked. Deprived of blood’s oxygen and vital nutrients, brain cells begin to die and the abilities controlled by that part of the brain, like muscular control or speech, are compromised.

Doctors attribute the apparent rise in strokes among younger adults to the same lifestyle risk factors traditionally found in older patients, such as obesity, diabetes and high blood pressure. For other young adults, stroke may be caused by rare conditions, like congenital heart defects, or injury to the arteries in the neck, which can be caused by even minor trauma.

[Pop a daily aspirin to help prevent heart attacks, stroke and colon cancer]

“When people think of stroke, they think of Grandpa who smokes and has high blood pressure,” says neurologist Lee Schwamm, director of Massachusetts General Hospital, Acute Stroke Services. “And while he’s more likely to have one, it doesn’t mean that if you’re young and healthy you can’t have a stroke too.”

Roughly 90 percent of the 800,000 strokes each year in the United States happen to adults age 50 and older, but the new study underscores just how significant the risk is for those who are younger.

The data analyzed includes information on 8 million hospital stays and came from the Nationwide Inpatient Sample, the largest publicly available database in the United States on these patients. The researcher found that stroke hospitalizations decreased in the two oldest age groups: For those 85 and older, stroke hospitalizations went from 2,077 per 100,000 to 1,618; those ages 65 to 84, the ratio dropped from 846 per 100,000 to 605. But for those ages 45 to 64, the rate rose from 149 per 100,000 to 156; and for those ages 25 to 44, from 16 to 23 per 100,000.

[They said my dad was having a stroke. I wish I had been able to handle it better.]

The researchers said their results should be interpreted with caution because some people fail to recognize that they are having a stroke and don’t seek medical attention, so the number of hospitalizations may be lower than the actual number of people experiencing the condition. Also, among the younger individuals, “we cannot rule out that changes were due to chance since the number of events were small.” However, the researchers added that their findings are consistent with smaller regional studies — such as one in Cincinnati and northern Kentucky — that also showed a similar trend of increasing strokes among younger Americans.

Robin Dickinson’s case serves as a cautionary tale about why even the young should be vigilant about recognizing symptoms of stroke. At age 31, she was married with two young children and working as a family physician near Denver when she unknowingly suffered two strokes within days of each other. The second sent her to the hospital.

“With both strokes, I instantly started spinning and would fall over if I closed my eyes,” she said, “but I dismissed them as migraines.”

While the extreme dizziness gradually got better, she says, it never went away. “Like so many other young adults who have suffered a stroke, I was in denial, even though as a doctor I knew what the symptoms were telling me,” says Dickinson.

[Another reason not to binge-drink: It can give you a heart attack or stroke]

Doctors found the cause of her strokes was due to a tiny tear in a large vessel in her neck that allowed a blood clot to form, break off and limit blood flow to the part of the brain that’s responsible for balance and coordination.

After the strokes, which occurred three years ago, Dickinson said her family’s life was turned upside down. Extreme dizziness, triggered by fatigue, forced her to severely limit her work schedule. “Our finances got so bad that we could only afford to eat potatoes, oatmeal and rice, so we went on food stamps,” she says.

“Three years later,” says Dickinson, “I’m doing better and better, but I still struggle to bring a sense of normalcy back to our family’s lives.”

With a stroke, time-loss is brain-loss — nearly two million brain cells die every minute a stroke goes untreated, increasing the risk of disability or death. Unsuspecting young adults like Dickinson often delay seeking medical attention. But, this delay can cause them to miss the small, critical window when the clot-busting drug tissue plasminogen activator (tPA) may be administered to rescue dying brain cells and stop further damage. Research shows the sooner the drug is given, the better the results — and after four-and-a-half hours, the window for receiving it closes.

“Unfortunately, not all patients qualify for this drug and not every hospital has the staff to administer it 24 hours a day,” says neurologist Salina Waddy, a stroke expert with the National Institutes of Health. “So, the best thing a patient can do is to prevent a stroke in the first place.” Up to 80 percent of strokes are preventable by managing key risk factors, like eating well, exercising, not smoking and limiting alcohol consumption.

Each year significantly more women die from stroke than from breast cancer — and yet many women think of stroke as a man’s disease. According to a 2015 national survey, only 11 percent of the 1000 women surveyed could identify female-specific stroke risk factors, like migraine headaches with aura, hormone-replacement therapy, oral contraception and pregnancy, particularly in the final month and postpartum.

Catherine Zalewski (Zalewski family)

In the summer of 2010, new mom Catherine Zalewski, now 34, was getting ready to feed her 6-month old daughter when she felt a sudden wave of exhaustion accompanied by a tingling of pins-and-needles throughout her body. “I didn’t know what was going on, just that I felt off and my vision was doubled,” says Zalewski. “I remember that I kept missing my daughter’s mouth with the bottle.”

As a former Mrs. New Jersey and a certified personal trainer, Zalewski has always been healthy and in shape, so it never occurred to her that she could be having a stroke. After she managed to put her daughter down in her crib, Zalewski climbed into bed herself for a nap, assuming parental exhaustion was to blame for her symptoms.

Seven hours later, her husband returned home, found her in bed and brought her to the hospital. The stroke left her partially paralyzed. For six weeks, Zalewski underwent in-patient rehabilitation, relearning how to walk, talk and dress herself. “It took me weeks to be able to hold my daughter all by myself,” she says.

In looking for the cause of the stroke, doctors discovered that Zalewski had a patent foramen ovale (PFO), a hole in her heart that required surgery to close. She had the surgery later that year.

With a successful recovery behind her, Zalewski gave birth to a baby boy last year. “Three months later, I was back at the gym training with a client when I suddenly began to feel a numbing sensation,” she says. “My words began to slur, and I quickly realized I was having another stroke — but I couldn’t get the words out.”

Luckily, the manager of her gym noticed the warning signs and called 911. Within an hour she was given the clot-busting drug tPA. Because of the early intervention, her recovery this time was quick. She was back at home and resuming her normal routine within a week.

While doctors still don’t know the cause of her two strokes, Zalewski says she believes it has to do with her pregnancies. “My advice to young mothers is to pay close attention to your own health, too,” says Zalewski. “As women we often take care of everyone else first — let my story be the lesson of the devastating consequences that can come from putting yourself last.”

May is National Stroke Awareness Month. As Catherine Zalewski’s story shows, strokes are highly treatable if you act fast. The American Stroke Association teaches the acronym FAST to help you quickly spot a stroke and take quick action:

• Face drooping. Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
• Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• Speech difficulty. Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
• Time to call 911. If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.