2012-03-09 / Columnists

Health & Harmony

Alzheimer’s Disease Prevention And Treatment
By Dr. Nancy Gahles

All diseases are recognized as serious and disruptive to lives and families. They become all too real when they hit home. It seems that the more “mature” I become, the more I come into contact with the devastation of chronic and terminal diseases.

I chose the profession of chiropractor because it was disease-free and deathproof. After working my way through college and chiropractic school in both the emergency room and morgue of a hospital, it was with conscious aforethought that I chose a healing profession. Chiropractic, hands-on healing, nutrition, the promotion of health, a philosophy of wellness. All true. All good. The one element I hadn’t taken into consideration was the aging process. A community family practice means that we all grow old together. Some of us make it further along than others. We all share in the joys and sorrows of our community.

As a healer, it becomes incumbent upon me to investigate the trends in diseases and ferret out the information that we can avail ourselves of to limit exposure, to be pro-active in prevention and to access the best treatment protocols.

Over the last several years, my dear friend and our cousin, have both become victims of early Alzheimer’s Disease. All diseases are devastating. Alzheimer’s is particularly so because the mind dies and the body lingers on. The toll it exacts on families and caregivers is staggering.

It is general consensus that there is nothing that you can do for this condition.

The treatment protocol of choice is Aricept, a cholinesterase inhibitor, and if that doesn’t work, combination therapy with Namenda. According to a study published in the BMJ on Neu-rology, Fall 2005, there is question as to their efficacy.

Cholinesterase inhibitors for patients with Alzheimer’s disease: systematic review of randomized clinical trials: Kaduszkiewicz, H. et al. BMJ on Neurology 1:15-21; Fall 2005

Review of all published double blind, placebo controlled, randomized trials examining efficacy on the basis of clinical outcomes - Aricept, Exelon, Reminyl.

Conclusion: Because of flawed methods and small clinical benefits, the scientific basis for recommendations of Cholinesterase inhibitors for the treatment of Alzheimer’s disease is questionable. The study adds, recommendations for the use of Cholinesterase inhibitors do not seem to be evidence based. Benefits measured on rating scales were minimal. The methodological quality of the available trials was poor. The use of Cholinesterase in-hibitors in mild cognitive impairment was not associated with any delay in onset of Alzheimer’s or dementia. Moreover, the safety profile showed that the risks associated with these are not negligible. The uncertainty regarding mild cognitive impairment as a clinical entity raises the question as to the scientific validity of these trials.

Not evidence based, not associated with any delay in onset of AD, risks that are not negligible, minimal benefits, questionable scientific validity of trials and here is what the advertisement for Aricept says: “slows the worsening of symptoms, proven to maintain cognition in placebo controlled studies, well tolerated, proven safety profile.”

Now, who are you going to believe? Me or your own two eyes?, as the saying goes. If that isn’t bad enough, when one medication doesn’t work, why not combine it with another one that also doesn’t work? Namenda is advertised this way: “Combination therapy is effective at slowing the advance of Alzheimer’s symptoms.”

The Archives of Neurology, April, 2011;68(8):991-998 published a study with quite different findings.

Lack of Evidence for the Efficacy of Memantine (generic name) in Mild Cognitive Disease.

Conclusion: Despite it’s frequent offlabel use, evidence is lacking for a benefit of Memantine in mild AD, and there is meager evidence for its efficacy in moderate AD. Prospective trials are needed to further assess the potential for efficacy of Memantine either alone or added to Cholinesterase inhibitors in mild to moderate AD.

In my experience, desperate people do desperate things. When given the prospect of no treatment at all, they will opt for treatment that doesn’t work and that has side effects or risk factors associated with it.

Thus, my investigation began. I looked up a prominent neurologist whom I had heard speak over the years at a symposium where we share Advisory Board seats. He was a pioneer in cutting edge thinking in his field. He spoke about the neoplasticity of the brain. The ability of the brain to grow new networks. He authored several books, his latest, “Power Up The Brain.” Dr. David Perlmutter has delved deeply into the evidence-based literature for nutritional protocols for preventing and treating neurodegenerative diseases such as Alzheimer’s, Parkinson’s, multiple sclerosis and autism.

Lo! And Behold! What did he find? Diet and exercise were prominent risk factors! The old “you are what you eat” story is true! As is, “use it or lose it”! Equally true was the fact that diet and exercise also play a significant role in treatment.

The big players are Vitamin D3 deficiency and obesity. A study published in Neurology 2010;74:18-26 25-Hydroxyvitamin D, dementia, and cerebrovascular pathology in elders receiving home services.

Conclusion: Vitamin D insufficiency and deficiency was associated with allcause dementia, Alzheimer’s disease, stroke ... and MRI indicators of cerebrovascular disease ...

Neurology 2010;74;27-32 Association of vitamin D deficiency with cognitive impairment in older women.

Conclusion: 25-hydroxy vitamin D deficiency was associated with cognitive impairment in the cohort of community dwelling older women.

Obesity is epidemic. Obesity is preventable. Obesity is associated with Alzheimer’s disease.

Neurology Reviews, “Midlife Obesity Is Associated With Higher Risk of Alzheimer’s Disease

Archive of Neurology 2005;62- 1545-1548 “Central Obesity and the Aging Brain” William Jagust, MD; Danielle Harvey, PhD; Dan Mungas, Ph.D; Mary Haan, DrPH

Conclusion: A larger WHR (waist to height ratio) may be related to neurodegenerative, vascular, or metabolic processes that affect brain structures un-- derlying cognitive decline and dementia.

At a conference this past weekend, Dr. Perlmutter impressed with a plethora of evidence-based studies showing the relationship of diet and exercise to the incidence and rise of Alzheimer’s. He also discussed the role of systemic inflammation in causation. Inflammation from the herpes simplex virus was the most astounding discovery to me. The risk of developing Alzheimer’s associated with fever blisters means that we can begin prevention at the first sign of these blisters. Lysine therapy as well as anti-virals are showing promise for prevention. Homeopathic medicine is well known for its successful use in viral syndromes.

Oxidative stress figures prominently in neurodegenerative diseases and the role of anti-oxidants as neuro protective was emphasized. One study showed that use of both Vitamins C and E reduced prevalence of Alzheimer’s by 78 percent! Insulin resistance and cognitive impairment is a given. Diabetes is a known predictor of Alzheimer’s. What we do know is that obesity is a known predictor of diabetes.

The long and the short of this story is this ... the ability to reduce our chance of getting this terrible disease is within our direct control. Diet, exercise and lifestyle changes will yield the benefit of a healthy brain as we age. Cognitive decline can be forestalled if not averted completely with conscious aforethought. A review of your family history along with an honest evaluation of your food and exercise choices and an assessment of your stress strategy will help you determine if you are at risk for this or other neurodegenerative diseases associated with aging. It is not the aging that is the problem, it is what you are doing while you are aging!

This is an overview to give you facts that give you hope and a direction for prevention and treatment of Alzheimer’s disease.

I have studied this thoroughly and will be presenting a lecture series over the next few months on exactly which protocols fit your needs and how to use them. For personalized individual consultations or to find schedule of events, please call me at 718-634-4577 or e-mail at askdrnan cy@aol.com.

May The Blessings Be!

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