Alzheimer’s Disease & Related Dementias

Getting Help From a Naturopathic Doctor

By Dr. Rahim Habib, Naturopathic Doctor

By the time the ‘dementia’ diagnosis comes, including the more and more common ‘Alzheimer’s’ form of dementia, families are already deeply frustrated, tired and often fearful of the future. We now know that the actual disease process in the Alzheimer’s patient had been developing over 20-30 years prior to the diagnosis. It’s important to note that early assessment and treatment leads to the best results, so taking quick and comprehensive action is extremely important. By incorporating the help of a naturopathic doctor, useful adjunctive treatments can actually improve cognitive health status, mood and behaviour typical of those who suffer from Alzheimer’s Disease and help slow the disease process, with the chance of regaining lost cognitive capacities. As for the caregiver, they need not suffer in silence, as they often withdraw to handle everything on their own – there are useful supports that naturopathic medicine can offer, in addition to preventative measures.

Common medical treatments for people with Alzheimer’s Disease involve medications to try and slow down the progress of the disease and also include medications to help with depression, sleeplessness, agitation and other behavioural problems; as well as referrals to day programs at local institutions; a newer option is accessing day/evening multi-modal care programs at a memory health club. Useful naturopathic medicines and approaches can be additionally helpful for the patient with Alzheimer’s Disease and also for caregivers.

What causes Alzheimer’s Disease

Either genetics or environmental factors contribute to the development of Alzheimer’s disease (or both). We know that early-onset Alzheimer’s is genetic (also called ‘familial Alzheimer’s disease’), however this explains only about 5% of those who develop Alzheimer’s disease (AD). ‘Environmental factors’ are what are likely predominantly at play with a large portion of those who have ‘sporadic’ Alzheimer’s disease. Environmental factors may include inadequate nutrition, excess sugar, toxicity, infections, hormonal fluctuation, dysfunctional brain micro-circulation and other triggers of neuroinflammation and neurotoxicity. Often there is a ‘mixed’ dementia picture with components of vascular dementia in those with Alzheimer’s disease.

Risk factors

Dementia is more predominant in those who have one or more of the following conditions: different forms of cardiovascular disease, carotid atherosclerosis, history of hypertension or high cholesterol, Type II diabetes, stroke or transient ischemic attack and brain trauma. People with these conditions exhibit ‘chronic inflammation’ and may be an underlying factor that relates to dementia risk. Having the APOE4 gene also increases your risk of developing the more common, or ‘sporadic’ form of Alzheimer’s disease as well as having a history of depression, low level education and head injuries. Those who report to be more socially isolated typically have significantly more amyloid plaque in their brain. Additional important factors are described below.

Hormones and Alzheimer’s Disease

Hormones that are important to cognitive function include thyroid hormones, estrogens, testosterone, insulin and melatonin. Cortisol is another hormone that can promote inflammation. A 2015 Japanese study found that patients with AD who also had subclinical hypothyroidism, had reduced blood flow to the parts of the brain associated with memory (temporal lobe) and consciousness, sleep and sensory interpretation (thalamus). It is known that brain cells depend on thyroid hormones to not only replicate brain cells, but also to allow brain support cells (glial cells) to function properly. Several studies have found that cognitive decline may be associated with imbalanced thyroid function, whether hyperthyroid or hypothyroid. Common signs of hypothyroidism include impaired memory, anxiety, depression and reduced hippocampal size – features common in many with dementia. What these studies indicate is that some cases of cognitive decline may be reversible, particularly in those with a mood-associated hypothyroidism in adults. Thorough hormonal testing is imporant to help determine if there is a hormonal factor involved.

Neurotoxicity & Alzheimer’s– Eg: Toxic Metals

When it comes to toxicity, we all carry a load in our world today, particularly with spreading industrialization and technological advances. Some of these toxins are especially damaging to the nerves. One example is the theory that particular metals (eg: mercury, cadmium, iron, copper, aluminum) are involved in the development of Alzheimer’s Disease. In the 2010 German review study conducted at the Department of Environmental and Integrative Medicine, researchers concluded that mercury may play a role in the development of Alzheimer’s Disease, as it is found in the autopsy’s of some people with Alzheimer’s Disease. They also found that subjecting animals to mercury leads to the Alzheimer’s-type of brain plaque formation. A recent Taiwanese study found that women were particularly susceptible to Alzheimer’s based on the presence of mercury amalgam dental fillings they had in their mouth. Another study that involved over 10,000 people looked at the impact of chronic aluminum exposure and found that the study participants were 71% more likely to develop Alzheimer’s disease. There is a likely role that neurotoxicity has to play in Alzheimer’s Disease. For this reason, a naturopathic evaluation of toxic metal status is important and treatments to bind and rid these toxins is a rational approach to treating these patients.

A study published in The Lancet in 2016 examined the relationship of where Canadians lived in relationship to the distance to the nearest major roadways. It found that those who lived less than 100 meters from a major road had an increased risk of dementia, and the relationship was stronger for those living less than 50 meters from such roads. It’s possible that the pollution from the vehicular exhaust (or possibly the noise) affects the brains micro-circulation or initiates the chemical damage that starts neuroinflammation. The coauthors of this study conclude that “we must implement preventive measures now, rather than take reactive actions decades from now.”

Mould-related exposure can lead to mycotoxins which can damage the neurological system. Researchers in Finland are investigating this particularly since they have very high rates of dementia mortality.

Sugar excess, insulin resistance – Is Alzheimer’s a Type of Brain Diabetes?

According to research published in the February 2015 journal Histology and Histopathology, the common factor involved in all of these dementia-associated conditions is the role of brain proteins that are associated with elements that are bound to glucose (known as receptors for advanced glycation endproducts (RAGEs)). Previous research has also associated RAGE-induced neurodegeneration in Alzheimer’s disease. Therefore, it may be that excessive glucose (a form of sugar), particularly in how the brain handles it, can be a significant contributor to the development of AD. According to Australian research published in the April 2015 journal Neurobiology of Disease, both AD and type II diabetes display similar features: brain atrophy, reduced brain glucose handling and neurological insulin resistance; it’s no wonder that researchers refer to some forms of Alzheimer’s disease as ‘type III diabetes.’

Vitamin B1, also known as thiamine, may be one important factor. Research from the Weill Cornell Medical College published in the journal Molecular and Cellular Neurosciences summarizes some important facts regarding thiamine, diabetes and dementia:

thiamine-dependent processes are highly correlated to the decline in clinical dementia rating scales
in animal models, thiamine deficiency exacerbates plaque formation and impairs memory
treatment of mouse models of AD with the thiamine derivative, benfotiamine, diminishes plaques and reverses memory deficits
benfotiamine diminishes peripheral neuropathy in diabetic humans
benfotiamine induces key thiamine-dependent enzymes to reduce accumulation of toxic metabolites including advanced glycation end products (AGE)

A few studies associating and noting improvements with thiamine in AD have been conducted, but not on a large scale; however, it is a vitamin worthwhile testing and to consider supplementing with naturopathic/medical supervision in therapeutic trials in those with AD.

Dementia and Brain Infections

Evidence of several microbes have been found in the post-mortem brain tissue of those diagnosed with Alzheimer’s type dementia. These microorganisms include bacteria, yeast, mould and viruses. It is likely that the amyloid plaque is a protective response of the brain’s local immune system to fight the microbes. A recent study found that components of a bacteria commonly found in the mouth (P. gingivalis; associated with periodontal disease) can trigger amyloid production. Microorganisms can promote the neuroinflammation that is associated with Alzheimer’s disease, as well as the associated damage to the blood-brain-barrier. It is important to consider the role of such microorganisms in the cause and treatment of those with dementia.

Naturopathic Treatments to Help Slow Alzheimer’s Disease

Naturopathic Dietary Changes

One of the observations in seeing who tends to be more susceptible to Alzheimer’s disease, it is people who have higher levels of insulin in their blood (ie, people with diabetes and pre-diabetes), high LDL cholesterol, and those who have lower levels of protective antioxidant nutrients in their blood. So the foods a patient with Alzheimer’s Disease should eat are those that would be good for someone with diabetes and or heart disease. One example is a Mediterranean style of eating: lots of vegetables, beans, fish, nuts, seeds and fruit.

Another reasonable dietary approach is to avoid foods that tend to raise the blood sugar level too fast, so following a diet called a “low glycemic-load diet” can be helpful. Reducing sweet foods and ensuring sufficient healthy fats (such as fish oil and flaxseed) is also important.

Oxidative damage is also a feature in those with dementia, so adopting a diet higher in antioxidants make sense (more on this below). Foods specifically high in antioxidants include berries, red beans, vibrant coloured vegetables and many spices such as cardamom and turmeric.

Other diet-related changes that may help those with dementia is based on promising research from Thailand in the 2011 British Journal of Nutrition which showed that young coconut juice may help women in particular.

Exercise and stress management

Obesity is associated with lower brain volumes in cognitively normal elderly subjects but also those with mild cognitive impairment (MCI) and Alzheimer’s Disease. Combining exercise and stress-reduction also goes a long way to help balance stress hormones, insulin levels and restoring insulin sensitivity.

Therapeutic Levels of Antioxidants & Other Nutrients

‘Free radicals’ are waste products that our cells make in the process of making energy for our body. They also come from external sources like chemicals in our environment and pharmaceuticals. At some point, they can become toxic to our nerves and actually damage them, reducing their ability to function. Antioxidants help to neutralize these damaging free radicals. There are many ways to get higher antioxidants from what we get from our diet, however, when faced with progressive disease such as Alzheimer’s, higher and quicker absorbing antioxidants can be very helpful. For instance, studies have shown that high supplemental doses of the antioxidants vitamin E, and lipoic acid, can help significantly delay the Alzheimer’s disease process. However, 2010 research conducted at the Karolinska Institute in Sweden has shown that even better results can be had when specific forms of vitamin E are used.

Antioxidants tend to work best as a team, so combining the right ones can get even better results. For example, in a UCLA. study, published in 2009 in The Journal of Alzheimer’s Disease, the research team found that by giving a combination of an activated form of vitamin D3 with particular extracts from turmeric (both have antioxidant effects) helped clear the amyloid neural plaque found in patients with Alzheimer’s disease. Other studies of combined concentrated brain-supporting nutrients have found benefits at maintaining cognitive function as well as mood (behavioural and psychological symptoms of Alzheimer’s dementia).

Vitamins, Homocysteine and Alzheimer’s Disease

Vitamins that show the most promise in helping those with AD include vitamin B1 (thiamine), vitamin B12 (methylcobalamin), vitamin B6 (pyridoxine), vitamin B9 (folate), vitamin C, vitamin E, vitamin K and vitamin D. Deficiencies of B12, B6 and B9 can lead to elevated ‘homocysteine’ levels (a transient amino acid produced in the body that can be toxic to blood vessels, nerves and bones) and studies have shown that reducing elevated homocysteine in patients with Alzheimer’s and related-dementias (as well as those with cerebrovascular disease) can slow brain deterioration in the hippocampus and cortical regions of the brain. Elevated homocysteine in patients with Alzheimer’s has also been associated with behavioural and psychological symptoms such as: delusions, agitation/aggression, depression/dysphoria, elation/euphoria, apathy/indifference and disinhibition. Vitamin B3 and B5 may also be important as they have roles in regulating sugar levels.

Herbal medicines

There are several herbs that have a long history of safe use for cognitive benefit. Each may be appropriate in their own unique situation or purpose for each individual. The most researched herbs include turmeric, bacopa, ginkgo, salvia and those from Chinese herbal medicine. Essential oil plant extracts may also be of benefit to promote calm, less agitated behaviours. There are possible interactions with pharmaceutical medications so it is important to have a health professional review the combination so that the patient can obtain the effective dose without negative interactions.

Environmental Medicine and Alzheimer’s

Since toxic chemical exposures are associated factors in AD development, then removal or reducing the toxicity of these chemicals is a logical adjunct treatment for those with elevated levels of such chemicals (eg: mercury, lead, aluminum, mycotoxins, etc.). A relevant treatment in environmental medicine that can facilitate removal of chemicals is sauna therapy. In fact, 2016 research has shown that those who used saunas more frequently had less risk of developing AD and other dementia’s. It’s yet to be determined if sauna treatment can treat existing AD, though it makes sense from the point of view of how saunas can improve overall blood flow. Investigating mould presence is also important and eliminating mould from the home/work environment can be crucial to improved neurological function. Antioxidants such as glutathione and others can help protect the nerves and encourage recovery.

Acupuncture

Increasing research is showing the potential value of acupuncture in the care of those with Alzheimer’s disease, vascular dementia and mild cognitive impairment (MCI). One study found cognitive activation in the brain as found on functional MRI readings after 3 minutes of acupuncture needling of 4 acupuncture points (on the hand and foot). Another meta-analysis study found that several research trials found improvements in MMSE (mini-mental state examination) scores after acupuncture treatments, whether the Alzheimer’s patients were on medication or not.

Intensive naturopathic treatment of Alzheimer’s Disease

One of the most comprehensive case-series studies on using naturopathic approaches in helping people with Alzheimer’s Disease was conducted at UCLA and published in the 2014 journal Aging. The study comprehensively tested 10 people with either AD or MCI and comprehensively treated these people with a customized approach. Treatments included dietary change, stress management, exercise, herbal and nutritional supplements and hormonal medications as needed. Nine of the ten participants showed significant improvements in cognitive functions, six of whom were able to return to work. This approach may make the most sense since there are many factors relating to AD and so the treatment must be multifaceted and intensive – a program – particularly since it is such an intense disease to try and reverse/manage. See our cognitive/dementia program that has integrated the approach from this important study. The ‘Finger’ study is ongoing and has found that by regularly assessing and addressing known risk factors for cognitive decline, actual improvements were found for those with higher dementia risk scores. Improvements were demonstrated in memory, executive function and psychomotor speed over the course of two years of this multifaceted treatment. Diet, exercise, cognitive training and social engagement were incorporated. This is again, further evidence that multiple factors must be addressed in order to improve cognitive function.

Naturopathic Caregiver Support in Alzheimer’s Disease

Most caregivers, spouses and children in particular, often feel they have to do all the support alone. It is difficult to ask for help, yet in most cases at some point, this is necessary. Support can come in the form of respite through day programs for the patient to attend; as well as social worker support services directly for care givers. Support can also be family and friends helping with errands, cooking, etc. One-on-one or group stress management programs are helpful to learn ways to handle stress, to cope with the workload, and to get perspective of the situation.

I have found that acupuncture, breathing exercises, correcting stress-induced nutrient deficiencies, counseling, and herbal extracts that support the nervous system can all benefit the caregiver. There is support out there, and it is important to get support before you yourself run out of energy to care for your loved one and yourself.

To arrange for comprehensive naturopathic assessment, contact the clinic and arrange for your (or your loved ones) assessment – 905-597-7201.