This topic comes to mind lately as I’ve run into a number of people who tell me someone close to them has been experiencing memory loss. Invariably, they also tell me that the person in question consulted with their primary care doctor, then neurologist, underwent a number of tests such as a brief memory assessment, blood tests for vitamin B12, TSH, and folate levels, and a MRI scan of the brain and was advised that there was no identifiable cause for the memory loss. They were labeled with mild cognitive impairment, offered a prescription for a drug such as Aricept or Exelon, then sent on their way.
I find this deeply bothersome as there are indeed many strategies to consider that have potential to slow, stall, or even reverse cognitive impairment, provided it has not resulted in irreversible changes in brain anatomy. Conveying this in a casual conversation, however, is quickly overwhelming to the recipient. So I thought it would be helpful to encapsulate briefly some of the concepts and practices that could be helpful in managing cognitive impairment that are adoptable and actionable on your own, or to advise the loved one diagnosed with cognitive impairment, without the doctor, yet provide benefits beyond the non-effect of the drug prescribed. I cannot obviously provide a comprehensive and complete coverage of this topic via a blog post, but I can at least get you started with basic strategies. Once you or your loved on has mastered the basics, then it’s time to explore further issues, such as heavy metal toxicity or intestinal fungal overgrowth (SIFO).
Let’s first get one issue out of the way: Do the drugs prescribed by doctors slow or reverse cognitive impairment? No, absolutely not. They are nothing more than fairly lousy nootropics, i.e., agents that slightly improve memory transiently but have no beneficial effects on brain anatomy, physiology, nor the progression of cognitive impairment. They are, in truth, little better than placebo. This applies also to widely advertised nutraceutical agents purported to maintain brain health because they improve memory slightly: this is simply not true. Just because some agent increases the activity of a neurotransmitter such as acetylcholine or dopamine, it does not mean that brain health has been improved.
Instead, we are interested in practices that are neurotrophic, i.e., exert some improvement in brain anatomy or physiology. It could be an increase in the number of neurons (brain cells), an increase in synaptic richness (the web of interconnections between neurons), an increase in “trophic” factors (i.e., mediators of neuronal growth and synaptic connections) such as brain-derived neurotrophic factor (BDNF), it could be a reduction in insulin resistance by the brain. (Recall that Alzheimer’s dementia is sometimes called “type 3 diabetes,” meaning that insulin resistance of brain tissue is a fundamental driving force in cognitive impairment.)
What starting practices therefore stack the odds in favor of maintaining or reversing cognitive impairment? Among the most important are:
- Omega-3 fatty acids—DHA, in particular, is a building block for brain tissue. Fish oil is the only assured source (except in populations that consume animal brains, which virtually no one does anymore in the modern world). Note that absurd prescription drugs like Vascepa mean that, if you take this EPA-only agent, you have to take fish to obtain the cognitive-sparing benefits of DHA. Omega-3s exert favorable effects in a number of ways, including a reduction in postprandial (after-meal) lipoproteins that contribute to insulin resistance, inactivation of the LPS endotoxin of unhealthy intestinal microbes that can enter the bloodstream and also add to insulin resistance, as well as providing a building block for brain tissue.
- Vitamin D—Restoration of vitamin D adds further to reducing insulin resistance, as well as exerting other benefits such as an enhanced intestinal immune response that reduces endotoxemia.
- Wheat/grain/sugar elimination—-Not only does elimination of these foods reduce blood sugar and insulin resistance, it also reduces potential for gluten encephalopathy (a malignant form of dementia), protein glycation (irreversible modification of brain proteins from high blood glucose), and reduces body-wide inflammation.
- Iodine—Because modern people do not consume the thyroid glands of animals, nor do we consume sufficient quantities of seaweed or seafood to obtain iodine, a considerable proportion of modern people are deficient in iodine. This results in hypothyroidism that contributes to cognitive decline. The solution? Get iodine. And, because there are causes of hypothyroidism beyond iodine deficiency and because disruption of thyroid status is so common in the modern world, it helps to also have a full thyroid assessment.
- Rebuild a healthy intestinal microbiome—Modern people have disrupted their intestinal microbiomes from antibiotic exposure, glyphosate in foods, statin drugs, emulsifying agents and numerous other factors. As a result, we lack important species such as Faecalibacterium prausnitzii and Lactobacillus reuteri, while allowing over proliferation of unhealthy microbes such as Klebsiella and Aeromonas. This combination of events impairs the intestinal barrier, increases intestinal permeability (“gut leak”), and results in endotoxemia, i.e., the entry of microbial breakdown products into the bloodstream that, in turn, exerts major effects on brain tissue. In my view, endotoxemia may be THE major factor driving the development of dementia, worsened by the further increase in intestinal permeability from consumption of the gliadin protein of wheat, disruption of the intestinal mucus barrier by such things as chlorinated drinking water and emulsifying agents in salad dressings and ice cream, and the genetic pattern apoprotein E4. (Inflammation is a major issue in this genetic pattern.) Though preliminary, addressing intestinal fungal overgrowth may prove to be a very important strategy, given the evidence that fungal infestation of the brain is a major process in dementia.
- Exercise—Exercise provides advantage in reducing insulin resistance, but it also exerts a neurotrophic effect on the hippocampus, i.e., the part of the brain that deteriorates with Alzheimer’s dementia.
- Engage in speed-of-processing activities—I.e., activities that force you to respond faster and faster to incoming auditory and visual stimuli. Unlike activities such as memory exercises, reasonable evidence suggests that speed-of-processing exercises reduce long-term potential for dementia. My favorite strategy for an older demographic (i.e., people in their 70s and 80s) is to play PacMan or Ms. PacMan.
Yes, there is more you can do. You can assess for mercury and cadmium toxicity, consider acetyl-L-carnitine or phosphatidylserine, even consider the unconventional such as transcranial direct current stimulation (t-DCS) for for focused site-specific neurotrophic effects. But be careful: There is also no shortage of useless, even harmful, advice based on poor evidence such as learn a new language, do crossword puzzles, take N-acetyl cysteine (a potent disrupter of the intestinal mucus barrier) or other supplements with unsubstantiated claims of improving brain health.