An integrated approach to preventing and treating Alzheimer’s Disease by Dr Cornelia Botha

Alzheimer’s disease (AD) is a degenerative brain disease that slowly destroys memory, intellectual skills and, eventually, the ability to carry out the simplest tasks of daily living.  As AD progresses, symptoms will include confusion, irritability, aggression, mood swings, language breakdown, long-term memory loss, and general withdrawal from society and even family.  AD is usually diagnosed in people over the age of 60 years of age. However, the less-prevalent early-onset Alzheimer's Disease can occur in people as young as 30 – 40 years of age. 

AD is considered irreversible, since there is no known cure. But the results of recent research indicate that someday it might be possible to delay the onset of AD, slow its progress, or even prevent it altogether.

Medical scientists don’t yet fully understand what causes AD, but it is clear that it develops due to a complex series of events that occur over a long period of time. There are various risk factors for developing AD, which include genetic, environmental, and lifestyle factors.  We may not have much control over certain risk factors such as age and genetic profile, but research is showing that modifying other factors (e.g. physical and mental activity, diet, and exposure to environmental toxins) may impact on the more fixed risk factors such as genetic make-up.

Genes:
There are a number of genes that predispose a person to developing AD.  Possessing genetic risk factors does not mean that you will definitely develop AD; it only increases the risk.  This is because genes often need to be activated: Genes + Environmental / Lifestyle Factors = Disease.  Because there are a variety of different genes that contribute to AD development and progression, it is important to employ individualised treatment and / or prevention regimes. 

Physical activity:
Epidemiologic studies have found associations between physical activity and improved cognitive skills and reduced AD risk.  In fact, researchers have found that the risk of AD is 35 to 40 percent lower in those who exercise for at least 15 minutes 3 or more times a week than in those who exercise fewer than 3 times a week.  Exercise increases the number of small blood vessels that supply blood to the brain and increases the number of connections between nerve cells. Furthermore, exercise raises the level of specific brain-growth factors in an area of the brain that is particularly important to memory and learning.

Mental activity:
Studies have shown that keeping the brain active is associated with reduced AD risk. Investigators reported that the risk of developing AD was 47 percent lower for people who spent the most time involved in information-processing activities (e.g. listening to the radio, reading newspapers, playing puzzle games etc). www.whatsyourbrainage.co.za
Lifelong learning also confers a substantial benefit. Researchers have reported that cognitively healthy older people had engaged in more mentally stimulating activities and spent more hours doing them than did those who ultimately developed AD. 

Social Networks:
Research has shown people who have a higher level of social engagement have a higher level of cognitive function and that this is related to a reduced rate of cognitive decline over time.

Diet:
Several epidemiological studies have reported an association between eating a diet rich in fruit, vegetables, beans and spices, but low in dairy, red meat and poultry and a reduced rate of cognitive decline.  The antioxidants found in various foods may work by neutralizing free radicals, reducing inflammation or stimulating neurons to protect themselves better against some of the aging and AD.
Scientists have found that curcumin, the active ingredient in turmeric (a spice used in curry), can suppress the build-up of the harmful proteins (beta-amyloid) that are characteristic of AD. Populations that regularly consume turmeric during their lifetime may benefit.  However, giving the extracted and concentrated curcumin in capsule form in the correct dose with synergist antioxidants and nutrients has shown significant benefit in the treatment of AD.
One’s intake of omega fatty acids also appears to play a role in AD.  A diet high in omega 6 and low in omega 3 fatty acids is more inflammatory.  This is important because general inflammation plays a role in many diseases including AD.  Increasing one’s intake of the DHA type of omega 3 fatty acid creates an anti-inflammatory effect.  Research has shown that DHA (only found in some fish and certain micro-algae) reduces the presence of beta-amyloid and plaques. For vegetarians and others who do not eat fish I recommend supplementing with a standardized, concentrated micro-algae supplement (I’m not referring to Spirulina here) in capsule form.

Exposure environmental toxins:
Heavy metal imbalances (e.g. toxic build up of mercury, lead, cadmium, copper, iron, zinc) in AD brains have been reported many times.  This does not occur in all people who developed AD, since an impaired ability to eliminate heavy metals is genetically determined and the same gene (APO-E4) is only associated with certain cases of AD. The percentage of people possessing the APO-E4 allele makes up approximately 20% of the general population.
This area of investigation and treatment, however, tends to be controversial.  It may be more beneficial to test for and treat general heavy metal toxicity to prevent AD (before a diagnosis of AD), although chelating heavy metals as part of a holistic treatment regime has shown significant benefit. No large scale research has, however, been done on this intervention, but good clinical evidence exists.  Chelation in the context of Alzheimer’s should ideally form part of a holistic approach to treating / preventing AD and administered by a practitioner who generally deals with Alzheimer’s patients.
Heavy metals represent just one example of the many toxic substances we’re exposed to in our environment that can damage our brains.  Nitrites and nitrates belong to a class of chemical compounds that are known to be harmful to humans and animals. They are found in many food products, including fried bacon, cured meats and cheese products, as well as beer and water. Sodium nitrite is deliberately added to meat and fish to prevent toxin production; it is also used to preserve, colour and flavour meats. Not only do we consume them in processed foods, but they get into our food supply by leeching from the soil and contaminating water supplies used for crop irrigation, food processing and drinking. Exposure also occurs through the abundant use of nitrate-containing fertilizers for agriculture, pesticides and cosmetics.
Nitrosamines are formed by a chemical reaction between nitrites or other proteins.  Nitrosamines become highly reactive at the cellular level, which then alters gene expression and causes DNA damage.  Researchers propose that the cellular alterations that occur as a result of nitrosamine exposure are fundamentally similar to those that occur with aging, as well as Alzheimer's, Parkinson's and Type 2 diabetes mellitus.  In addition to this, more than 90 percent of these compounds have been determined to be carcinogenic in various organs.
The authors of a recently published study stated that the time course of the increased prevalence rates of Alzheimer's, Parkinson's and diabetes cannot be explained on the basis of gene mutations. Instead they mirror the classical trends of exposure-related disease. Because nitrosamines produce biochemical changes within cells and tissues, it is conceivable that chronic exposure to low levels of nitrites and nitrosamines through processed foods, water and fertilizers contributes to the current epidemics of these diseases and the increasing mortality rates associated with them.
It is not only ubiquitous environmental toxins that increase the risk of developing AD.  A recent study found that one of the most commonly used inhaled anaesthetics, Isoflurane, produces Alzheimer's-like changes in the brain.

Stress:
Stress management and other psycho-social interventions are emerging as an important factor in treating (and preventing) AD.  Researchers have reported that stress hormones, including cortisol, rapidly accelerate the formation of the brain lesions that cause Alzheimer's disease.  Studies have shown that even brief periods of stress (such as we experience in everyday life) can increase the brain proteins linked to AD disease by as much as 42% in just 3 days.

“Natural” Treatments / Preventions :
Pharmaceutical drugs employed in the management of AD generally aim to offer a certain degree of symptomatic relief of memory impairment.  But AD is a degenerative disease in which neurological destruction continues unchecked despite the administration of these symptomatic treatments. 
Researchers have investigated various nutrients and natural substances to find a possible cure or at least an intervention that will slow the progression of the disease.  I will mention just a few of the most promising substances here.

The B vitamin family has been studied in relation to AD.  Vitamin B6, B12 and folic acid will only benefit those who have a specific genetic type of AD that increases homocysteine levels.  On the other hand, vitamin B1 and vitamin B3 (nicotinamide) have been found to be generally therapeutically promising and even employed therapeutically in AD.  However, these two (thiamine and nicotinamide) have to be given in very high doses in specific formulations.  Such treatments should only be administered by a practitioner who is trained and experienced in both specific nutraceutical treatments and AD.

Antioxidants have been widely studied for their role in preventing and treating AD.  Some antioxidants have shown no specific benefit in AD.  Some of the anti-oxidants that have shown promise and have been employed therapeutically are Co-enzyme Q10, Acetyl-L-Carnitine, Alpha Lipoic Acid, Resveratrol, and ECGC. 

The choice of antioxidant or antioxidant combination is based on the individual’s unique medical history.  This is because each anti-oxidant mentioned affects distinct enzymes, genes, and disease mechanisms, not to mention the fact that certain antioxidants are only effective in the early or late phase of AD.  It is important to take into consideration concomitant medical conditions and medicines so as not to interfere with ideal treatment outcomes. A trained, experienced practitioner will give the adequate effective and safe dose, which is often not available over the counter.
The same concepts apply to herbal treatments.  Herbs are best employed by a qualified practitioner who has access to pharmaceutical grade, standardised herbs that provide the correct dose.  This ensures purity, which not only impacts on quality but also on safety.

Most people have heard of Gingko biloba for treating memory problems.  It generally works by improving micro-circulation in the brain.  Although vascular dementia and AD are different diseases, research has should that hypoperfusion of the brain contributes to the pathology of AD.  For this reason it may be beneficial is some cases of AD.  I generally use it as an add-on to one of two more beneficial herbs, Withania somnifera and Bacopa monniera.  Both of these herbs have been studied in AD and have shown significant benefit.

Conclusion:
This article has superficially explored the very complex disease process that manifests as AD.  AD is difficult to treat once it has progressed and is therefore best prevented and should be treated early.  An individualised combination of therapies as those mentioned here can go a long way in preventing AD and forestalling disease progression, even in those who are already receiving medical symptomatic treatments.  If you wish to explore complementary therapies in the treatment and prevention of AD it is best to partner with a trained, experienced practitioner who will be able to guide you and provide a balanced approach.

Dr Cornelia Botha is a registered homeopathic doctor who does a lot of work in her practice with various degenerative diseases (including Alzheimer’s and Parkinson’s Disease), autoimmune diseases, cancer and HIV.  She employs a holistic approach, tailored for each patient, which may include any combination of homeopathy, herbs, nutrition, nutraceuticals and chelation of heavy metals.  www.healthinc.co.za