Alzheimer’s Prevention: What You Need to Know

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Alzheimer’s disease is one of the most debilitating and dreaded age-related conditions of our time. According to the Alzheimer’s Association, someone in the US develops this disease every 66 seconds. Overall, 5.5 million Americans are living with Alzheimer’s —with 10% of the 65+ population affected.

Barring any major breakthroughs in treatment or cure, it is predicted that nearly 14 million people aged 65 and older will have Alzheimer’s by 2050.1-2

Sadly, the probability of a breakthrough continues to look bleak. Right now, few pharmaceutical treatments exist, and the ones that do aren’t all that effective. They do nothing to fully stop the progression of the disease, and they certainly don’t cure it.

For that reason, prevention is the best option we have right now. But fortunately, great strides have been made in understanding the underlying factors that cause Alzheimer’s. The more we know, the better we’re able to make important lifestyle changes to protect our brains.

Causes of Alzheimer’s

While much of Alzheimer’s inner workings remain a mystery, researchers believe that the causes likely include a combination of age-related changes in the brain, along with genetic, lifestyle, and/or environmental factors.

The gene associated with Alzheimer’s is apolipoprotein E4 (APOE4). However, most people who develop Alzheimer’s don’t have this genetic variant—and not all those who do have this gene end up with Alzheimer’s. Why’s that?

An emerging field called epigenetics has shown that genetic predisposition may actually have less of a significant role than we have been led to believe when it comes to developing diseases. In fact, proteins that turn our genes on or off (either inhibiting or activating diseases) can be greatly influenced by factors such as environment, diet, medications, stress, and other lifestyle habits. This highlights the incredible adaptability of genes.

What this means, in plain English, is that you really can put up a valiant fight against genetic susceptibility, all by living a healthy lifestyle.

When it comes to Alzheimer’s, researchers are learning that the lifestyle choices you make today can determine how well your brain ages. Furthermore, it’s never too late to make important changes in an effort to prevent disease.

How Inflammation Affects the Brain

With Alzheimer’s, one of the most important things you can do to lower risk is to reduce chronic inflammation.

This type of inflammation is triggered in the body by a perceived internal threat. Generally speaking, poor lifestyle choices (unhealthy diet, lack of exercise, obesity, chronic stress) and environmental exposure to things like pollution, chemicals/toxins, and allergens, are the catalysts for chronic inflammation.

The immune system responds the same way it would to a “real” threat, such a virus or injury. Disease- and infection-fighting white blood cells swarm the body looking for something to “attack and destroy,” but they have nothing to single out. So they instead set their sights on healthy organs, tissues, or cells—and eventually, disease can develop. In the case of Alzheimer’s, the inflammation homes in on the brain.

Not only does chronic inflammation cause damage that can accelerate the progression of Alzheimer’s, it also plays a role in the formation of amyloid plaques and neurofibrillary tangles in brain tissue—two hallmark characteristics of Alzheimer’s. Both are known to disrupt cellular communication and eventually trigger the death of brain cells.

According to Dr. Dale Bredesen, a recognized expert in neurodegenerative diseases and Alzheimer’s, by eliminating the “threats” in your life that typically lead to inflammation, “the brain will not be pushed to produce the amyloid that we associate with Alzheimer’s disease.” 3

As you’re probably well aware, the typical American lifestyle is notoriously pro-inflammatory. Poor diet, lack of exercise, obesity, and excessive stress are the main culprits, setting the stage for chronic, low-grade inflammation.

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Preventing Alzheimer’s

So, what steps can you take to eliminate these threats to your brain and overall health?

Anti-Inflammatory Diet

An overwhelming amount of research has shown that the Mediterranean diet—rich in fresh fruits, vegetables, olive oil, and seafood—is an excellent choice for not only cardiovascular health, but also cognitive function. In fact, one study found that those who followed this type of diet had greater brain volume and less shrinkage over a three-year period.4

My preferred way of eating—the Pan-Asian Modified Mediterranean (or “PAMM”) Diet —is anti-inflammatory as well. It combines the best of traditional Asian and Mediterranean dietary approaches so that you have a wide variety of foods to choose from, and you never feel deprived.

Some research also supports ketogenic diets for Alzheimer’s. Keto diets dramatically limit the amount of carbohydrates you eat and increase your intake of fats. Without the carbs, your body doesn’t get the glucose it needs for energy, so it seeks out an alternative source—fats.  Fats get broken down into ketones, which then generate energy. Not only do these ketones appear to be neuroprotective, the state of ketosis appears to slow cognitive decline and prevent amyloid plaques.

While all of these diets are quite different in many ways, they do have one thing in common—their primary focus is to minimize or eliminate inflammatory foods and substances such as sugar, wheat and gluten-containing grains (which can promote a leaky gut and inflammation in susceptible people5), and processed junk food. And doing so is always a good path to follow.

All of these dietary approaches also keep blood sugar in check, which is crucial for proper brain health and functioning. In fact, Alzheimer’s and type 2 diabetes/blood sugar imbalances are so closely linked that many researchers now refer to Alzheimer’s as “type 3 diabetes.” A common link between the two conditions is insulin resistance, which deprives the brain cells of energy, but inflammation is another major factor.

Exercise: Physical and Mental

Exercise is also a critical element when it comes to preventing—and even slowing the progression of—Alzheimer’s.

According to a 2015 study: “Aerobic physical exercise activates the release of neurotrophic factors and promotes angiogenesis, thereby facilitating neurogenesis and synaptogenesis, which in turn improve memory and cognitive functions.” Exercise also increases the production of several compounds that protect against damage, and decreases the production of free radicals in areas such as the hippocampus, which is involved in memory.6

Just how effective is exercise? A meta-analysis that reviewed 16 studies found that regular exercise reduced Alzheimer’s risk by a whopping 45 percent!7

Additionally, exercise lessens inflammation, which, as mentioned earlier, is a major driver of Alzheimer’s and countless other diseases.

But it’s not just physical activity that benefits the brain…

Mental exercise and stimulation can also have profound effects on the brain. Those who challenge their brains throughout life are less likely to develop dementia.

In the ACTIVE study, funded by the NIH, older adults who got as few as 10 sessions of mental stimulation experienced better cognitive function in the months that followed—and continued to show improvement up to 10 years later.8

 Other studies have examined the ability of various activities to stop the development or slow the progression of Alzheimer’s and cognitive decline.

According to one study, “The positive impact of games on…cognitive and physical decline, and social isolation… suggests that game-based interventions might contribute to delay the onset of dementia. Thus, playing games might be considered as a protective factor in dementia and even more as a potential non-pharmacological strategy in dementia rather than leisure activity.”9

Chess is one mentally challenging activity that’s been studied for its potential preventive effects,10 but any kind of new or interesting game, skill, activity, or practice can exercise your brain:

  1. Learn to speak a new language or play an instrument
  2. Try a gentle, mind-focused modality like Tai chi or yoga
  3. Do daily crossword puzzles, word searches, Sudoku, or some other language- or number-based game
  4. Take up a new skill or hobby, such as chess, knitting, sewing, dancing, etc.

Trying something that you’ve never done before helps your brain form new neural pathways—and this keeps the brain young and engaged.

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Brain-Supportive Supplements

While no drugs or supplements are able to cure Alzheimer’s, there are some nutrients that have been shown to boost brain function and protect against dementia. The sooner you start taking one or more of these, the better. Here are a few of the most effective options:

  • Phosphatidylserine (PS) is a phospholipid—a part of the membrane that surrounds every cell. PS, which is abundant in brain and nerve cells, is necessary for proper cellular function. A study conducted in 1992 on 51 patients with probable Alzheimer’s found that PS improved “several cognitive measures,” most especially in those with less severe dementia. (This highlights the importance of starting early in Alzheimer’s prevention.) Other more recent studies concluded that “improvement of some memory functions has been observed in cognitively impaired subjects as a result of PS supplementation.”11-12
  • Omega-3 fatty acids are one of my top recommendations for heart health—but they benefit the brain too. Up to 60% of the brain is comprised of fat—the majority of which the omega-3 fatty acid DHA. Research has found that omega-3s can help prevent and even treat a number of brain diseases. A recent study concluded they “are beneficial to improve the cognitive function in very mild [Alzheimer’s disease] and major depressive disorder.” Even better, omega-3s are potent anti-inflammatories.13

  • Curcumin is the medicinal compound in turmeric. Not only is it a potent antioxidant, it’s also a powerful anti-inflammatory. When it comes to the brain, curcumin interferes in the pathway that leads to the formation of plaques and tangles.14
  • Extra Virgin Olive Oil, one of my all-time favorite superfoods, is also associated with healthier brain function in various studies, including 2010 research demonstrating olive oil’s potential to repress the expression of genes that cause brain inflammation. Additionally, a promising 2017 study on mice has also linked daily extra virgin olive oil consumption to increased autophagy – a process in the brain which helps prevent the formation of protein tangles and amyloid plaques, which are hallmarks of Alzheimer’s disease.15-16
  • Lithium is best known as a psychiatric drug prescribed to treat bipolar disorder, major depression, and schizophrenia. But it also happens to be a naturally occurring trace mineral. (Check the periodic table, and you’ll see it’s #3.) An extremely exciting new study concluded that lithium—at a dose that’s 400 times lower than what is currently being used for mood disorders—can halt signs of later-stage Alzheimer’s (amyloid plaques, neuroinflammation, and oxidative stress) and even help patients recover some cognitive ability.17

 Finally, I cannot over-emphasize the importance of letting go of excess stress and getting good sleep, as poor quality rest has been linked to cognitive decline.

Without a doubt, Alzheimer’s is a formidable disease. But you have the power to keep your brain healthy and your mental capacity at its peak. Don’t wait until it’s too late…start today.

References and Resources

  1. Alzheimer’s Association. 2020 Alzheimer’s Disease: Facts and Figures. org, March 2020.
  2. The Silver Book. New Case of Alzheimer’s Every 66 Seconds. org, last accessed Oct. 6, 2020 at https://www.silverbook.org/fact/new-case-of-alzheimers-every-66-seconds/.
  3. Bredesen, Dale. The End of Alzheimer’s. New York, Penguin Random House LLC, 2017.
  4. Luciano M, et al. Mediterranean-type diet and brain structural change from 73 to 76 years in a Scottish cohort. 2017 Jan 31;88(5):449-55.
  5. Obrenovich, Mark E M. “Leaky Gut, Leaky Brain?.” Microorganisms 6,4 107. 18 Oct. 2018.
  6. Paillard T, et al. Protective effects of physical exercise in Alzheimer’s disease and Parkinson’s disease: A narrative review. J Clin Neurol. 2015 Jul;11(3):212-9.
  7. Hamer M and Chida Y. Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med. 2009 Jan;39(1):3-11.
  8. Tennstedt A and Unverzagt F. The ACTIVE study: Study overview and major findings. J Aging Health. 2013 Dec;25(80):3S-20S.
  9. Narme P. Benefits of game-based leisure activities in normal aging and dementia. Geriatr Psychol Neuropsychiatr Vieil. 2016 Dec 1;14(4):420-8.
  10. Lillo-Crespo M, et al. Chess practice as a protective factor in dementia. Int J Environ Res Public Health. 2019 Jun;16(12):2116.
  11. Crook T, et al. Effects of phosphatidylserine in Alzheimer’s disease. Psychopharmacol Bull. 1992;28(1):61-6.
  12. Kim H, et al. Phosphatidylserine in the brain: metabolism and function. Prog Lipid Res. 2014 Oct;56:1-18.
  13. Ajith TA. A recent update on the effects of omega-3 fatty acids in Alzheimer’s disease. Curr Clin Pharmacol. 2018;13(4):252-60.
  14. Huang HC, et al. Curcumin attenuates amyloid-β-induced tau hyperphosphorylation in human neuroblastoma SH-SY5Y cells involving PTEN/Akt/GSK-3β signaling pathway. J Recept Signal Transduct Res. 2014 Feb;34(1):26-37.
  15. Camargo A et al. Gene expression changes in mononuclear cells in patients with metabolic syndrome after acute intake of phenol-rich virgin olive oil. BMC Genomics. 2010 Apr 20;11:253.
  16. Lauretti, Elisabetta et al. “Extra-virgin olive oil ameliorates cognition and neuropathology of the 3xTg mice: role of autophagy.” Annals of clinical and translational neurology 4,8 564-574. 21 Jun. 2017.
  17. Wilson E, et al. NP03, a Microdose Lithium Formulation, Blunts Early Amyloid Post-Plaque Neuropathology in McGill-R-Thy1-APP Alzheimer-Like Transgenic Rats. J Alzheimers Dis. 2020;73(2):723-39.
  18. Masley, S. The Better Brain Solution. (2018 Vintage Books).

© Stephen Sinatra, MD. All rights reserved.

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