Brain Drain

Why We Can and Must Focus on Preventing Alzheimer’s

New research shows that our diet has a significant impact on our neurological health. But why aren’t doctors acting to prevent diseases like Alzheimer’s, rather than only treating them? Dr. David Perlmutter, author of the new book Grain Brain, on the need to change our approach to health care. 

Tom Grill/Corbis,Tom Grill

Last week, a study published in The New England Journal of Medicine showed how levels of blood sugar directly relate to risk for dementia. The investigation followed over 2,000 elderly individuals for an average of 6.8 years and found that even small elevations of blood sugar translated into a significant increased risk for dementia, even among persons without diabetes.

The implications of this report are profound. While the correlation of dementia risk, and specifically Alzheimer’s disease, with diabetes has been established, this new finding throws a much wider net in terms of defining an at risk population for an incurable brain disorder. But despite the potential public health impact of these findings, this correlation received almost no media attention.

The United States has now been granted the distinction of ranking first in terms of increased number of deaths from neurological diseases including dementia. In a recent report in the journal Public Health, Prof. Colin Pritchard and colleagues from Britain’s Bournemouth University evaluated causes of death in the 10 largest Western countries between 1979 and 2010. During that time period, deaths in America related to brain conditions rose an astounding 66% in men and 92% in women.

These compelling statistics are supported by what we’ve recently learned about monetary expenditures for caring for dementia-afflicted patients. In a recent RAND study published in The New England Journal of Medicine, costs for dementia care in 2010 were estimated to be as high as $200 billion, roughly twice that expended for heart disease and almost triple what was spent on treating cancer patients.

These figures, as well as the staggering statistics that in America there are currently 5.4 million Alzheimer’s disease patients with that number poised to double by the year 2030, provide enticement for pharmaceutical companies to develop drug strategies to cure or at least slow the inexorable mental decline characteristic of this disease. As yet, they have failed, miserably. Indeed, as reported in a recent issue of The New England Journal of Medicine, the latest and perhaps most promising drug treatment for Alzheimer’s disease not only failed to halt the disease, but actually worsened functional ability while increasing the risk for infection and skin cancers.

As a practicing neurologist dealing with Alzheimer’s patients and their devastated families on a daily basis, and as a caregiver for an afflicted parent, this current state of affairs is frustrating. But what’s so much more challenging is the recognition that to a very significant degree Alzheimer’s disease is preventable. Research clearly shows that up to 54% of Alzheimer’s cases in the U.S. could have been avoided if proper attention was given to various modifiable lifestyle factors, including diet and physical activity, as published in the journal The Lancet Neurology.

Mayo Clinic researchers have told us, for example, that risk for mild cognitive impairment, the harbinger for Alzheimer’s disease, or full -blown dementia is an astounding 42% lower in elderly folks who consume a diet higher in fat and lower in carbohydrates, as reported in the Journal of Alzheimer’s Disease.

And while many in the health sciences still cling to the notion that gluten sensitivity, affecting about a third of us, is almost exclusively a gastrointestinal disorder confined to the small intestine, British researchers have now clearly demonstrated that sensitivity to gluten, a protein found in wheat, barley and rye, can manifest as any number of neurological conditions, including dementia, without “typical” gastrointestinal complaints. Writing in the Journal of Neurology, Neurosurgery, and Psychiatry, Dr. Marios Hadjivassilou stated, “That gluten sensitivity is regarded as principally a disease of the small bowel is a historical misconception. Gluten sensitivity can be primarily and at times exclusively a neurological disease.”

Back in 2008 the Journal of the American Medical Association published a study demonstrating substantial risk reduction for developing Alzheimer’s disease in individuals who were given a simple exercise protocol in comparison to a control group that remained more sedentary. This is powerful medicine that dramatically reduces the risk for a disease for which nothing exists in the pharmacopeia.

With highly respected peer-reviewed journals providing such compelling data and giving health-care providers powerful leverage points to meaningfully impact the incidence of this disease, why is the topic of Alzheimer’s prevention virtually absent from the public forum?

The fundamental operating system underlying the practice of medicine in America today seems myopically focused on treating our ills with highly profitable remedies directed at symptom management while causality is ignored. Preventing disease is derogated, and relegated to the province of alternative modalities. Watching our elected leaders debate the merits of funding the ever-changing iterations of a health-care plan designed to treat illnesses presents a poignant irony, as it has little to do with health and everything to do with illness. But it has become clear that both sides of the aisle enthusiastically agree that Americans must have access to their pills, and lots of them.

Getting the word out that people can make simple changes that might well prevent a disease for which there is absolutely no meaningful treatment makes sense. The word doctor means teacher. And while physicians seem steeped in providing drug remedies, it certainly seems like the right time to take a step back, review current science, and get the word out that the patients for whom we care can make choices, today, to remain healthy.

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It was well over 2,000 years ago when China’s Yellow Emperor wrote, “Maintaining order rather than correcting disorder is the ultimate principle of wisdom. To cure a disease after it has manifest is like digging a well when one feels thirsty, or forging a weapon when the war has already begun.”