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Brainy News #1

The big news on the brain front is still The End of Alzheimer’s by Dr. Dale Bredesen: a multi-faceted, lifestyle approach that can effectively prevent and reverse Alzheimer’s and other causes of dementia. Lagging a bit behind the times, and hopefully redressed in their Letters section, the New York Times asks the question I asked five years ago: would you want to know if you were at increased risk for Alzheimer’s disease (AD)? Five years ago, I would have wondered whether lifestyle interventions, so successful in every other chronic disease, might possibly impact the course of AD. Three years ago, when I learned of Dr. Bredesen’s first clinical reports, I knew I was rushing home to check my genes and the genes of all the patients who had shared with me their data. Of course you'd want to know, because you can prevent the disease, and get healthier overall while you're at it!  I read last week’s article at 7 a.m. and had a letter fired off by 7:30, but I’m hoping I haven’t heard about its publication because of the flood of letters they received and that they are preferentially picking out letters penned directly by Dr. Bredesen and his team!

Meanwhile, AD is quite the topic of interest and conversation, so I can say with some confidence that each month there will be a Brainy News column. In fact, I’ll start numbering them so you can easily reference any item you read.

This month I’ll limit myself to three interesting news articles.

First, the smelly one:  for some people, perhaps a large proportion, a loss of the sense of smell precedes any loss of brain power. In fact, four years ago I wrote about an unequal loss of smell discernment (greater loss in the left nostril) showing clinical correlation with more careful diagnostic measures! Well, it turns out that if you lose your sense of smell, prior to an AD diagnosis but in the setting of mild cognitive impairment, early treatment with one of the cholinesterase inhibiting drug  boosts mental powers. The researchers were delighted that the smell test helped identify those who would respond to the medication, but I will use the test differently. Dr. Bredesen’s suggestion is that any use of drugs be thought of as the dessert, not the main course. In patients who are following the Bredesen protocol, eager for more improvement, and who have impaired sense of smell, it seems likely that a medication (in this study, donepezil) would be helpful to them.

I would also add that you can monitor your brain a bit yourself: if you forget names of objects don’t let yourself cheat with a “whatsit” and a forgiving friend: find the name! and if you find yourself losing your sense of smell, ask your doctor for a cognitive evaluation!

The second “news” is an older article, recently brought to my attention, reviewing the benefit of a “ketogenic” diet in treating degenerative disease, both neurological (AD) and neuromuscular, such as Parkinson’s (PD), Huntington’s (HD) and Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s Disease). For over 80 years a ketogenic diet has been used to treat patients with persistent epilepsy: a diet high in fat, very low in carbohydrates, and with only minimal to moderate protein. The diet is designed to keep the blood ketone level from 0.5-5.0 ng/mL, way below that level of ketosis associated with out-of-control diabetes (diabetic ketoacidosis), and a bit higher than the mild ketosis (0.3-0.4) associated with skipping a meal. Ketones are produced in a carbohydrate-starved liver and provide an alternate fuel for the brain which most often fuels itself on carbohydrates. They will also be produced in a carbohydrate-deprived liver when it is generously supplied with certain kinds of fats, specifically the medium-chain triglycerides (MCT’s) derived from coconut oil. The sweet spot of blood ketones is probably in the upper half of the normal range, and at that level, they can calm an injured brain (think either football or epilepsy) and serve as an alternate fuel for a brain with degenerative disease. In PD, HD, and ALS the brain’s energy centers, the mitochondria in the brain’s cells, are starved for energy. For various reasons, there is not an adequate supply of glucose that normally fuels a healthy brain. Ketones are a wonderful alternate fuel. I have worked with both PD and HD patients, and besides the slowed rate of the disease,

Ketones are also a preferred fuel for those interested in improving brain and body performance. There is a growing body of anecdote and research that suggests a benefit to anyone from an intermittent or occasional higher level of ketones: smarter brain, better immune function, more resistance to the insulin resistance that comes with age. Easily achieved by anyone with a low-carb meal and a boost of MCT oils, now available in multiple forms. Personally, I like Phat Fibre and put it in my water for rowing team workouts: better endurance, easier recovery. Not necessary or even helpful for short bursts of extreme exertion (1K races) but good for longer and moderate exertion (5K races and training workouts).

Finally, talkin’ clocks. “Early to bed, early to rise, makes a man (sic) healthy, wealthy, and wise.” And indeed, part of the Bredesen protocol is the regular recuperation offered by 7-9 hours of sleep every night, preferably occurring between late evening and early morning. Older folks commonly wake earlier in the morning, probably because we make less melatonin, but the rising sun still summons up decent and awakening cortisol levels, which easily overwhelm our lesser levels of melatonin. Often written off as, “Older folks need less sleep,” an elder sleep pattern is simply a common observation, to be managed not just accepted. “Oh you know, older folks just have worse vision, get used to it.” Uh, no, and I won’t be happy with less sleep either. Getting to bed earlier, so you have a sunny, easy and refreshing wake-up, might involve turning off televisions and mobile devices earlier in the evening. No worries, you’ll be able to check your email in the morning! 

The recent research paper of interest points out that the causation arrow likely goes in both directions. Degeneration of the cells in your brain impair your ability to get a decent and normally timed night of sleep, which in turn contributes to further impairment of your brain function. Keep your sleep healthy, both in length and timing, and you are serving your brain well. Night owl hours are not conducive to a thriving elder brain.

Interestingly, a similar bi-directional arrow might be drawn between impaired sleep and insulin resistance, obesity, and type 2 diabetes. You have to fix them both to fix either one.

So, how are you doing? How's your brain and recall for elusive words? How well does that nose of yours work to find something outdated in the fridge? And, as always: how did you sleep last night?


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