Preventive Medicine Column

Dr. David L. Katz

There has been enormous attention of late to the grim and genuinely frightening problem of Alzheimer’s disease.  The problem is grim by its very nature- there is little we contemplate with greater dread than the loss of our minds.  The problem is frightening at the personal level because we feel vulnerable to this increasingly common condition we don’t know how to cure, and at the collective level, where estimates suggest it could cost the nation a trillion dollars annually by 2050.  There is also the terrible burden on family members, who must face the high demands of care, compounded by the heart-wrenching loss of a loved one who is still there, yet already gone.

It is in this context that President Obama has declared a war of sorts on this scourge, calling for means of both prevention and treatment by 2025, or even 2020

To create the President’s future, it will be important to develop new treatments, as it is for obesity and diabetes.  But as with obesity and diabetes, it will be important not to let the hunt for breakthrough treatments become the tail that wags the dog.

The evidence is strong if not incontrovertible that whatever the genetic underpinnings, the epigenetics of Alzheimer’s- the exposures that influence how genes behave- are of profound importance.  By and large, Alzheimer’s is a vascular disease.  By and large, the practices that prevent cardiovascular disease – eating well, being active, avoiding tobacco- slash the risk of Alzheimer’s.  Studies that have shown an elimination of up to 80% of all chronic disease with the application of lifestyle as medicine have NOT carved out an exception for Alzheimer’s.  The evidence that we can alter gene expression with the power of lifestyle almost certainly pertains to Alzheimer’s as it does to cancer.  By minding our bodies, we can mind our minds, too.  We can best mind both, by minding the short list of what matters most to health.

So, see a doctor at regular intervals to have your blood pressure and cholesterol monitored.  High cholesterol can contribute to dementia by accelerating the development of atherosclerosis; controlling blood lipid levels with diet or medication can protect against this.  High blood pressure can damage the blood supply to the brain in several ways, and is the leading risk factor for stroke.  At least one European study suggests that treatment of high blood pressure all by itself can cut dementia risk in half.

There is some evidence to support what most of us have heard about “brain foods.”  Fish consumption appears to protect brain function, most likely by contributing omega-3 fatty acids to the diet.  An omega-3 oil supplement, 1 to 2 grams daily, is an alternative.  Antioxidants in food appear to be protective as well, contributing to the reputations of blueberries, red wine, and green tea.

But while an inventory of potential brain foods can be assembled, the evidence is much stronger for the importance of the overall dietary pattern.  Eating well is as important to the brain as it is to the heart.  Lower your risk of Alzheimer’s with plenty of vegetables and fruits, whole grains, beans and lentils, olives and avocado, nuts and seeds.  Limit consumption of highly processed foods, fast foods, sugar, salt, saturated and trans fat.  Physical activity, too, nurtures the health of body and mind alike.

Finally, population studies consistently suggest that those who exercise their brains protect their minds from dementia.  Crossword puzzles and Sudoku are aerobics for your brain.  Just as physical activity defends the body against aging and infirmity, mental activity seems to help preserve the vitality of the brain.  The Mayo Clinic and the Alzheimer’s Foundation, among others, provide nice summaries of prevention strategies on-line.

A healthy brain needs clean arteries; a sound heart; clear lungs; fit kidneys; a robust liver.  Even if your brain is your 2nd favorite organ, you can tend it best by looking after all the other less-favored organs on which it is co-dependent.

Altogether too many of our loved ones have Alzheimer’s already; and too many more will get it.  There is no question we need the government; and big Pharma; and the biomedical community at large to wage the battle of treatment on our behalf. 

But prevention is the greater prize in the long run- and is largely already within our grasp.  There is no need to wait for the government, or big Pharma.  Take matters into your own hands.  Mind your mind and mind your body with the zeal and diligence you routinely apply to minding your own business.  Because, they are.




Dr. David L. Katz;