Preventing Dementia–Part Two



As we age, one of the most common concerns for all of us is loss of cognitive function and the risk of dementia. In the last few years it has been found that there are many ways to reduce that risk, including dietary practices and a bevy of new supplements including magnesium threonate, CDP choline, PQQ and lions mane mushroom.

I have previously written a blog post about diet’s impact on prevention and reversing of dementia (read Preventing Dementia). Now a new study from the University of Chicago has confirmed many of these ideas. The study’s authors are calling the best preventive diet for maintaining a healthy brain the MIND diet - a combination of Mediterranean diet and the DASH diet for hypertension.  

The MIND diet includes:

  • 3 servings of whole grains (avoid gluten if sensitive but whole grains are an important food)

  • 2 vegetables per day
  • 1 glass of red wine

  • nuts as snacks

  • beans every other day

  • berries twice weekly

  • poultry twice weekly

  • fish once weekly

People who adhere strictly to these suggestions have a 53% lowered risk for Alzheimer’s disease (these suggestions seem easy to follow and I know many of my patients already do better than this).

In addition to dietary patterns, individual nutrients such as flavanoids in fruits and cocoa have shown benefits in preventing dementia. Higher intake of blueberries and strawberries in a study of 16,000 nurses over several decades was found to significantly reduce cognitive decline. Studies show EPA and DHA, omega 3 fatty acids mostly found in cold-water fish, can also reduce the risk of dementia. Genetics also play a role in what nutrients can make a difference. For example, people with high homocysteine levels from MTHFR mutations (this can be measured in blood tests) will reduce their risk of dementia by taking folate, B12 and B6, whereas others might not see benefit.

There are several supplements that have also shown promise in preventing cognitive decline. Some of them are included in a supplement we use in the office called Wellness Brain. One is something few people have heard of-a mushroom called lion’s mane (hericium erinaceus).  The active compounds in this mushroom, hericenones have been found to stimulate Nerve Growth Factor, a protein that is needed for nerve cell growth and repair. NGF decreases beta-amyloid in animal models of Alzheimer’s disease leading to reversal of the damage found in this life-changing disease.  In addition, hericenones have been found to reduce cell death in brain cells.  Lion’s mane mushrooms also contain DLPE that protects brain cells from oxidative damage. In a 2009 study of 30 people with dementia, those given lion’s mane showed significant improvement in a double-blind study.

Another nutrient in this formula that can be of great value in preventing or treating memory loss is CDP choline or citicholine. It appears to work by increasing dopamine receptors in the brain.  In rats with an Alzheimer like disorder, citicholine prevents nerve damage and reduces the number of dying cells. In Japan and Europe, citicholine is approved for use in head trauma, strokes and dementia - improving clinical outcomes and lowering death rates. Citicholine increases the amount of choline available for synthesizing the neurotransmitter acetylcholine as well as rebuilding cell membranes and restoring mitochondrial function in neurons. It prevents excess inflammation in the brain by inhibiting release of free fatty acids and preventing breakdown of the blood brain barrier. The many facets of citicholine’s effects make it a significant factor in maintaining a healthy brain.

Other newer nutrients that help keep the brain healthy include PQQ - a novel vitamin like compound found in plants such as parsley, green peppers, kiwi, papaya and tofu that acts as a powerful antioxidant and stimulates mitochondrial biogenesis. This impacts brain function since aging and diseases such as Parkinson and Alzheimer’s have mitochondrial disorders as a part of their pathology. PQQ also reduces inflammatory chemicals such as IL-6 and CRP that damage vascular walls and contribute to brain inflammation. In addition, it prevents neurotoxicity from toxins such as mercury and glutamate.

One other nutrient that has become an essential in reversing cognitive decline is magnesium. Magnesium is the fourth most prevalent mineral in the body and has a wide array of functions and is utilized in over 300 enzymes. I have been using magnesium treatments for asthma, migraine, fatigue and muscular problems for years, but a new form of magnesium, researched at MIT, is now available that promises dramatic benefits for the brain. Magnesium threonate (Opti-Mag) is the only form of magnesium that readily crosses the blood brain barrier, helping symptoms like anxiety, sleep disturbance and memory issues.

Magnesium threonate improves the plasticity of the hippocampus, the center of emotional memories, often damaged by excess cortisol and stress (it has been shown to help in recovery from PTSD).  Improved plasticity is key to maintaining neuronal connections throughout the brain, resulting in improved memory, learning and cognition. Magnesium acts by controlling ion channels, which affect the electrical signals moving from neuron to neuron. In animal studies, magnesium threonate also was shown to protect synapses, memory and learning in diabetic rats prone to Alzheimer’s like dementia.  It was also found to help clear toxic beta-amyloid from the brain. In human studies, magnesium threonate was found to increase brain reaction speed, working memory, and episodic memory and to lower markers of brain age.

With these promising new natural therapies, as well as the findings about diet, sleep and exercise, we can be more confident in maintaining a healthy brain as we age.  With our increasingly polluted environment and food sources and greater societal and personal stress levels, protecting the brain requires good self care, healthy choices and judicious use of appropriate nutritional supplements - a worthwhile undertaking.



Candida: The Yeast in Your Gut that Changes How You Feel


Back in the 1980’s a revolution in the practice of integrative medicine and thinking about health and illness occurred, though no one at the time realized its significance. William Crook, a physician in Alabama, recognized that candida albicans, a yeast organism found in all human digestive tracts, had a major impact on health. He found that patients with overgrowth of candida not only were subject to vaginitis and thrush (commonly recognized as being caused by candida) but fatigue, allergies, digestive problems and a myriad of other problems.

Academic medicine scoffed at the idea that an organism found in the gut of almost all humans and not actually causing infection, has any impact on health. Despite this attitude, those of us practicing what was then called alternative medicine found many of our patients had this problem and responded to a treatment approach including dietary restriction of sugar, simple carbohydrates and aged foods, medication like Nizoral, Diflucan and Nystatin as well as probiotic therapy. I frequently observed enormous improvements in energy, digestive complaints, headaches and allergies when treating candida problems.

Today I continue to use these treatments and more sophisticated botanical therapies to reduce the candida load in the gut and build immune tolerance to this organism. The revolution that Crook foretold was the realization that the inhabitants of the gut, now called the microbiota (including candida, bacteria, viruses and parasites and numbering in the 10 trillion cell range), has enormous effect on health and disease. (See previous blogs on the microbiota and obesity). Academic medicine has now embraced the importance of our gut organisms in staying healthy, yet the candida issue is still not widely accepted.

We are now discovering the mechanism of how candida is so disruptive to the immune system and overall health. One of the keys is the adherence to the digestive tract wall from the hyphae form of candida. In response to this, the immune system produces anti-gliadin antibodies, the same antibody associated with gluten intolerance. These antibodies are associated with fatigue, mood changes, attention issues and even depression. In addition, candida creates a biofilm of protein around the colonies, making the body’s immune response less effective. However, treatment can make a big difference. In a study done in Norway in 1998, 21 of 25 patients placed on an anti-yeast diet and oral Nystatin had resolution of symptoms of digestive issues, fatigue and depression over a 3 month period.

There are some studies showing candida colonization is also associated with inflammatory bowel disease (Crohn’s disease and ulcerative colitis) as well as celiac disease and gluten intolerance. Current treatments include the same medications I have used for decades, Nystatin, fluconizole and itriconizole as well as newer botanical therapies designed to disrupt the biofilm, including Interfase, saccharomyces boulardi and quercitin. We need to keep candida overgrowth and intolerance  in mind as a contributing factor for any digestive complaint ranging from bloating, gas, heartburn  to colitis as well as systemic problems such as fatigue, depression, attention issues and allergies.