Alzheimer’s disease is a chronic neurodegenerative disease that usually starts slowly and gradually worsens. The German psychiatrist and pathologist Alois Alzheimer coined this form of dementia in the early 1900s. In clinical practice it is the cause of about 60–70% of cases of dementia. Alzheimer’s disease disproportionately targets women about 2 times more than men. To highlight the magnitude of Alzheimer’s disease, in 2015 there were about 30 million people worldwide with the disease.
The Big Picture
Failing to remember recent events is often the first presenting symptom. Problems with language, disorientation, mood swings and unexplained irritability are also prevalent. Interestingly, forgetting your keys is not a symptom. As a person advances with Alzheimer disease they often withdraw from family and society.
The big picture for Alzheimer’s disease is that it is poorly understood and to date there is no cure. The ironic thing is that we have found about a 90% cure rate for breast cancer, but ZERO percent for Alzheimer’s disease. Many theories involve genetics, traumatic brain injuries, depression and cardiovascular disease. There are no treatments to stop or reverse the progression and at best we have some temporizing treatments that improve symptoms. Exercise programs are beneficial as well as maintaining muscle mass and avoiding sarcopenia. Refer to my earlier article on sarcopenia. It is also important to avoid sarcopenic obesity.
Alzheimer’s Disease and the Estrogen Connection
Scientists have long suspected that sex hormones such as estrogen and progesterone play a role in Alzheimer’s. For years, estrogen and progesterone replacement were hailed as a miracle. Starting estrogen around menopause could ease many of the symptoms associated with menopause, namely memory loss. Most doctors stopped prescribing hormone therapy after the billion-dollar study called the Women’s Health Initiative showing a suspected link to breast cancer in women taking hormones. Estrogen was deemed a carcinogen and the rest is history.
Menopause related memory and cognitive disturbances are being increasingly described in scientific literature and are generally responsive to estrogen treatments. There’s good evidence that a woman’s levels of female sex hormones, including estrogen and progesterone, can influence her risk of Alzheimer’s and other forms of dementia. Women are less likely to develop dementia later in life if they begin to menstruate earlier, go through menopause later, and have more than one child. Several studies are now pointing to the fact that estrogen may offer protection against Alzheimer’s disease in post-menopausal women. One study on 90,000 postmenopausal women found that those taking estrogen had a significantly longer life and by the time of their deaths, the women on estrogen had a 40 percent lower incidence of Alzheimer’s disease. It is hard to say if there were any conformational biases in this study, but it deserves mentioning.
Estrogen is important to the building and maintenance of nerve networks in the brain from early on in life. Estrogen is an important regulator of neurons and brain function. In basic lab studies it has been shown to protect neurons from amyloid beta-mediated toxicity. However, the role of estrogen replacement therapy in brain protection is not entirely clear and may be dependent upon age at initiation. A very good read about the connection of estrogen to Alzheimer’s disease and many other diseases) is the book – Estrogen Matters by Bluming and Tavris.
Alzheimer’s Disease, Exercise and the Ketone Connection
Stephen Cunnane PhD, looks at Alzheimer’s disease as a situation where the brain is in a fuel supply crisis and is a disease where one of its manifestations is the brain compensating for deteriorating energy metabolism. We all know relative to its size, the human brain requires 25% of the total energy available. Although not well known, the brain can function perfectly on both glucose and ketones. Dr. Cunnane has performed studies about ketogenic interventions that may help delay progression of Alzheimer’s. One of his research studies involved taking humans with Alzheimer’s disease and prescribing exercise three times a week as well as maintaining a ketogenic diet with MCT Oil supplementation. He was able to show improvement in people with severe Alzheimer’s.
Insulin Resistance and Alzheimer’s disease
Alzheimer’s disease is often referred to as type 3 diabetes. With over 90 million people in the United States who have diabetes and prediabetes, the number of these individuals who will eventually be diagnosed with Alzheimer’s disease is alarming. Mild insulin resistance is of particular interest because it has a definite increased risk of Alzheimer’s disease in middle age and older adult humans. Chronic sedentary lifestyles commonly contribute to chronic hyperinsulinemia insulin resistance which compromises tissue glucose uptake throughout the body, but very notably in the brain. The result of this is the brain getting insufficient glucose but also insufficient ketones.