Alzheimer’s Disease, an Integrative Approach
Oct 31, 2014 10:54PM
By Dr. Fred Harvey, Harvey Center for Integrative Medicine
Alzheimer’s disease is a progressive and irreversible disease of the brain that causes significant problems with memory, thinking and behavior. It is a type of dementia, a general term for memory loss and loss of other cognitive abilities. As the most common form of dementia, it comprises approximately 70 percent of dementia cases. Although some memory changes may occur with aging, Alzheimer’s disease is not a normal part of aging. As a progressive disease, dementia symptoms gradually worsen over time. The age of onset is usually 60 years and older, however 5 percent of those afflicted are in their 30’s, 40’s or 50’s.
Alzheimer’s disease appears to be a metabolic illness. Microscopic changes begin in the brain long before symptoms appear. The brain has 100 billion neurons (nerve cells). Each nerve cell connects to many others to form communication networks. It appears that inflammation triggers an aggressive response in the brain in people, susceptible to this problem. The inflammation results in excessive formation of two protein structures called plaques and tangles that occur in the brain cells. These occur in normal brains in smaller amounts, and they appear to be related to infectious and other insults. They may play a role in normal immune function; however, they appear to cause dysfunction, destruction and death of the neurons in the Alzheimer’s patients.
The diagnosis of Alzheimer’s disease is primarily made by medical history. Since this is not the only reason for memory loss, cognitive impairment and behavioral changes, we must first identify other possible causes of these problems, such as stroke, tumor, Parkinson’s Disease, sleep disturbances, gluten sensitivity, toxicity, medication adverse effects, hypothyroidism, diabetes, nutrient deficiencies or any other condition that may be treatable. We also evaluate cognitive function with numerous psychological tests. PET scans can reveal the underlying metabolic process to help discern between different causes of dementia.
The biggest “risk” factor for Alzheimer’s disease is age. Since we cannot stop the clock, we need to look at other risk factors and for the other causes of memory loss. Since vascular disease incidence increases with age, it is often a secondary cause of memory loss, even in patients with Alzheimer’s. Vascular dementia is the second most common form of dementia. Genetic predisposition for a dominant inheritable form of the disease is very rare; however, other genetic predisposition for metabolic changes that would lead to Alzheimer’s disease are much more common. Other inflammatory problems, such as infection with herpes simplex virus (the common cold sore), can trigger cognitive decline. Toxic metals, such as mercury, have been implicated in dementia, as well.
There is no cure for Alzheimer’s disease. The current medical approach is to treat the symptoms rather than the disease. The medications used (cholinesterase inhibitors) do not treat or delay or reverse the underlying process, and, at best, they modestly slow symptom progression in some people when evaluated on psychometric testing. However, the American Geriatrics Society warns that the adverse effects from the drugs, like diarrhea and loss of appetite, and distraction from other aspects of managing dementia, should have physicians and patients question their use in this condition. If no benefit is seen in 12 weeks, they should be discontinued.
Since there is no cure and no drug treatment, it is imperative that we begin preventive programs well before the onset of symptoms. If there is a family history of diabetes or dementia, metabolic screening should begin as early as age 30. Basic laboratory testing for cholesterol and lipids balance, blood glucose and glycohemoglobin, fasting insulin levels and markers of inflammation, such as C-reactive protein, vitamin D level, B vitamin levels and gluten sensitivity testing, can all shed light on current health status and future health risk.
The approach we use at the Harvey Center starts with testing. If symptoms are present, more advanced testing is indicated. A PET scan can show the underlying abnormality in glucose metabolism that is present in the areas where we find damage in the Alzheimer’s brain. In addition, it can reveal the metabolic pattern, associated with hardening of the arteries for vascular dementia. Toxic metal testing is indicated for anyone with any significant neurologic degenerative disorder. Neurotransmitters are the chemicals that the brain uses to communicate between brain cells. Urinary neurotransmitter testing can illustrate the balance or imbalance of these communication chemicals.
Since we are unable to treat the underlying problem at this point, it is important that we work diligently to maintain cognitive function. Research has shown that several very basic things can be done to improve and maintain brain reserve. Exercise is the single most powerful thing that anyone can do to both prevent and treat Alzheimer’s disease. Numerous studies show that brain reserve is improved with vigorous exercise on a regular, daily basis. Diet is extremely important, as well. We know that this is a metabolic problem with glucose or sugar metabolism in the brain cells, just like diabetes is a problem with sugar metabolism throughout the body. Therefore it is extremely important to limit carbohydrate intake, just like with diabetics. Many forward-thinking neurologists place their patients on a ketogenic diet because the brain does better metabolizing fat for energy than it does with sugar. It is also very important to keep diabetes under strict control with a hemoglobin A-1 C of less than 5.5 percent. Vitamin D appears to help cognitive function, as well, and maintaining a vitamin D level in the functional range over 50 would be highly beneficial. Mental exercise, such as learning to play a musical instrument, solving crossword puzzles or learning a new language also build brain resilience.
If vascular dementia is present, chelation therapy has been shown to be quite effective in improving vascular health. It has been used successfully in combination with personalized nutrition supplementation, neurotransmitter balancing, metal detoxification, physical exertion and mental exercise programs to improve cognitive function. We have seen dramatic improvements, using these techniques at the Harvey Center for Integrative Medicine.
Even though we have no current drug to directly treat Alzheimer’s disease, there are many simple, foundational interventions that can improve life, while we wait for medical science to find a safe, effective treatment.
For more information or to schedule an exploratory consultation, please contact Dr. Fred Harvey at 941-929-9355. The Harvey Center for Integrative Medicine is located at 3982 Bee Ridge Road, Sarasota.