Evolving Past Alzheimer's

Today we tackle one of the more controversial topics around brain health and Alzheimer's - hormone replacement therapy (HRT). Our guest is Dr Ann Hathaway (no...not the actress) a hormone expert.

We have an extended conversation about the history of hormone replacement, where the fear of using Premarin (estrogen) and Progestin (Progesterone) in the form of medroxyprogesterone has come from.

We discuss drops in estrogen and its role in Alzheimer's disease. These changes happen up to 30 years before actual memory problems occur.

We discuss the difference between standard hormone replacement and Bioidentical HRT.

Dr Hathaway answers the question "Why take estrogen and progesterone if nature is saying your levels should be low after menopause?"

Dr Hathaway shares some of her experience with patients on hormone replacements and some of the benefits they have seen and some of the scenarios that she has observed do not respond to HRT.

We discuss testing options and ideal hormone levels for estrogen and progesterone.

Discussion of some other things women can do to optimize their estrogen (eg vitamin D, b-vitamins, dietary strategies).

Dr Hathaway relays statistics on risks vs benefits from the medical literature around the use of estrogen and progesterone hormone therapy.

Learn more about Dr Hathaway here

This week we interview another leading scientist and author who views Alzheimer's as a more complicated process than one simple disease. Our guest, Dr Peter Whitehouse, is an MD, PhD trained at Johns Hopkins and currently is a professor of Neurology at Case Western University in Cleveland, Ohio. He authored the book, The Myth of Alzheimer's. Dr Whitehouse does not deny that Alzheimer's exists he just maintains that it is a condition with tremendous heterogeneity and is more like a syndrome, or a collection of multiple disorders. These may be characterized as a spectrum of disorders. Dr Whitehouse notes that is very difficult to distinguish senile dementia - brain changes that occur over the result of time - and dementia. He notes some of the key drivers of Alzheimer's of earlier onset being. 1) genes 2) concussions 3) environmental toxins (eg lead) 4) diet 5) exercise 6) infections (meningitis) 7) perhaps low oxygen states during surgery/anesthesia. Dr White discusses the controversy in the title of his book "the Myth of Alzheimer's" and how it was received. He disagrees to some extent with the conventional approach to finding a cure for Alzheimer's advocated by the NIH and Alzheimer's Association's view. The prevailing view is very much geared toward finding a single drug or set of drugs that will attack the problem. We discuss "Scientism," the faith in science based on 'pumping enough money into a proble' that Dr Whitehouse takes issue with. More and more he has adopted the idea that public health measures and intergenerational relationships are a key to successful aging and minimizing symptoms of cognitive impairment. A lot of this focuses on personal narratives, telling one's own stories, either through a journal or organizations like Storycorps or Timeslips. He tells stories about elders passing on stories of activism to younger generations. Reminiscence "therapy" is one modality he mentioned. He explains why he thinks the Babyboomer generation may have the collective power to work with other generations to evolve the conversation about aging and Alzheimer's. Read Dr Whitehouse's book "The Myth of Alzheimer's"

We finally have evidence for and Alzheimer's prevention diet and the best foods to eat to prevent alzheimer's. We apologize for the recording sound quality of this episode. Our guest this week, Dr Martha Clare Morris is the architect of the MIND Diet and a leader in the field of nutrition and the brain. Dr Morris' team showed that the MIND Diet, a hybrid diet of the Mediterranean Diet + the DASH Diet. To summarize the basic component of the MIND diet is: Foods to Eat:

• Green leafy vegetables (eg mixed greens, spinach and salads): At least six servings a week
• "Other" vegetables: At least one a day (eg squash, broccoli, etc)
• Berries: Two or more servings a week
• Nuts: At least five servings a week
• Beans: At least three servings a week
• Whole grains: Three or more servings a day
• Fish: at least once a week
• Poultry (e.g. chicken or turkey): at least twice a week
• Olive oil: Use as your main cooking oil.
• Alcohol or Wine: One shot/glass a day (note: a "glass" is not half a bottle)

Foods to Avoid:

• Red meat: 3 times per week or less.
• Butter and margarine: Less than a tablespoon daily
• Cheese: Less than one serving a week
• Pastries and sweets: Less than five servings a week.
• Fried or fast food: Less than one serving a week.

The people with the best MIND Diet scores (in the top 3) developed half of the cognitive decline than the people with the lower scores. 53% reduction in the risk of developing Alzheimer's disease. We discuss a little bit about how difficult nutrition research is to conduct. Dr Morris discusses how some of the foods/nutrients work to prevent the changes that occur in Alzheimer's. Dr Morris discusses her current research trial that is being conducted at Harvard and Rush University at Harvard. We discuss the controversies of gluten sensitivities and other food sensitivities. We discuss which foods are good and bad for the mind. She notes that transfats and saturated fats increase the risk for Alzheimer's. High saturated fat may impair the blood brain barrier. Unsaturated fats seem to correlate more with good brain health and lower levels of Alzheimer's. She points out DHA (an omega 3 fatty acid) as an important fat in particular for neurotransmission. Fried foods are bad for the brain because they have high amounts of harmful fats as well as leach out the good fats. It's not clear whether or not coffee is good or bad long-term for the brain.

The next couple of episodes we are going to do a deeper dive into the role nutrition and best (and worst) foods for Alzheimer's prevention and treatment.

Our guest on this show is Dr Annie Fenn, M.D from BrainHealth Kitchen. She is a retired OB/GYN physician, writer and culinary instructor.

We discuss the format for Annie's - BrainHealth Kitchen (formerly known as Brainworks Kitchen) a multi-dimensional program designed to prevent and improve brain health and Alzheimer's. The main focus of this program is learning techniques of healthy eating and cooking in a group/community setting.

We discuss the virtuous cycle of becoming proactive about health. Whether you start with food or exercise or community, one good thing tends to lead to another.

We discuss the scientific evidence for Annie's approach. She has primarily adopted the approach of communities in Blue Zones.This is primarily a plant-based, Mediterranean diet. She points to one study of nearly 2000 people that had 40% reduced chance of developing Alzheimer's. She also mentioned the MIND Diet published by Martha Clare Morris which we will discuss in more detail in future episodes.

We touch on "anti-nutrients" and the controversy of legumes/beans from a Paleo diet perspective. Legumes and beans do seem to be an important part of the Mediterranean. Bottom line, Annie recommends a personalized approach because the long term data is not clear on the health of beans and legumes.

Annie (minute 24) discusses a couple of specific tips and tricks on oils and cooking. Olive oil use in general. Avocado oil for cooking at higher heats.

We discuss "Intermittent Fasting" - Annie has her student's:

1. no eating 3 hours before they go to bed.
2. no wine after 9pm to avoid sleep disruption
3. attempting to eat nothing for 15 hours straight (with the exception of black coffee in the morning) - this is the ketosis idea.

We discuss the strategic use of caffeine and how that might be helpful for the brain.

We briefly discuss Annie's 23 years of experience as an OBGYN and the use of hormone therapy which we will discuss more in future episodes as well.

Find Annie Fenn on her website

https://www.brainhealthkitchen.com/

Twitter: https://twitter.com/anniefennmd

LinkedIn: https://www.linkedin.com/in/annie-fenn-md-27159a32/

To sign up for a monthly newsletter about what's new in keeping our brains healthy (with recipes), register at BrainHealthKitchen.

Dr Marvin Berman recieved his PhD in Psychoeducational Processes. He is trained in Bioenergetic Analysis and is trained in numerous other therapeutic interventions including EEG biofeedback and the Feldenkrais methodologies. He consults with senior executives and management teams on the application of cognitive neuroscience in leadership development and performance. Recently, he is exploring the application of EEG biofeedback and related technologies into the treatment of neuropsychological and neurodegenerative disorders including Alzheimer's disease and Parkinson's.

In Alzheimer's disease the brain shrinks over time. Certain forms of light energy may help defeat this problem. Near infrared wavelengths are particularly good because not only do they travel deeper into tissues; they are not lost by being absorbed by blood and water before they reach the brain.

On this show we talk about two different and distinct technologies on this episode. One is Photobiomodulation the other is Neurofeedback. Neurofeedback we have talked about with Drs Majid Fotuhi (episode 3) and Dr David Merrill (episode 9).

Photobiomodulation (PBM) introduces certain frequencies of light. The light has an impact on the brain's mitochondria. Institutions like Harvard, Standford and MIT all have and continue to explore Photobiomodulation. There are LED lights that are placed on head or shined into the nose and they seem to do a several beneficial things. To be clear, the signaling within the (brain) tissue takes place as a result of exposure to light (photonic) energy.

The Key players in the PBM story are 1) Cytochrome C oxidase (substance that absorbs light) 2) ATP (energy and healing) 3) Reactive Oxygen Species - mild oxidant that signals cellular repair 4) Nitric Oxide (increases blood flow)

Mitochondria have a substance called the cytochrome oxidase that can absorb red and near infrared light and convert the enregy into a form of bilogical energy called ATP. Part of what ATP does is lead to healing and tissue repair. The process - among other things- generates a mild level oxidant (ROS) which acts as a signaling molecule to activate transcription factors that lead to tissue repair. Some people see this as a "redox" signaling molecule. Herein is where the physical healing can be accelerated when photonic therapies (red and near infrared light) is introduces.

Another important player is Nitric oxide (NO) - if it sits in the cell it "clogs" the respiratory chain that leads to ATP production. PBM frees the NO back into the body and restors the function fo the respiratory chain. Then it takes on an impotant wide ranging role of improving nerve function and improving circulation by relaxing the blood vessel walls.

Dr Berman explains how he connected Neurofeedback and PBM in the development of a comprehensive treatment model.

He explains the use of light frequency of 1060-1080nm.

For those not involved in research is there any risk or benefit in doing Neurofeedback with a particular doctor and trying out a Vielight (one PBM device) on their own. contact Dr Berman directly.

Learn more about Dr Berman's work with the QuietMIND Foundation http://www.quietmindfdn.org/

Scott Sherr MD lives in the San Francisco Bay area where he works both as a hospital medicine physician as well as operates his own independent hyperbaric oxygen consultation practice. He is also Director of integrative Hyperbaric Medicine and Health Optimization with Hyperbaric Medical Solutions.

What is hyperbaric oxygen (HBOT)

Bottom line....it's high pressure oxygen. Originally used to treat underwater injuries ("the bends" or "decompression illness"). Nowadays, Hyperbaric oxygen also refers to a treatment in which the entire body is exposed to 100% oxygen under increased pressure. Using pressure allows for more dramatic delivery of oxygen to the entire body. Bottom line "it heals wounds."

How HBOT Works:

The basic mechanisms of how HBOT works:

1. reverse hypoxia (low oxygen state)
2. reduce inflammation
3. fight infection
4. stimulate stem cell release
5. increase mitochondrial (energy) function.

There are only about 14 FDA Approved uses for HBOT. Most of what insurance pays for are wounds, diabetic ulcers, infections, and radiation therapy treatments.

Investigational uses (non-FDA approved) for HBOT are Alzheimer's, Traumatic Brain Injury, post-stroke neurologic injury, Parkinsons, Multiple Sclerosis, some chronic pain syndromes, and several others.

We discuss synergies between HBOT and ketogenic diet (like a modified Atkins diet) or exogenous diet (min 18:30) and some of Dr Sherr's experiences with patients. These appear to cause changes at the level of genetic expression.

We talk about "leaky brain or a broken blood brain barrier" and how HBOT may be used to address issues with a "broken" blood brain barrier.

Typical use of HBOT is with a "hard chamber." Hard chambers are regulated and physicians running these places need to be certified in its use. "Soft chambers" or Mild HBOT may actually be more appropriate for cognitive impairment, but are not as regulated. Soft chambers are more widely available than larger hard chambers.

What are the side effects of HBOT?

• ear barotrauma (completely preventable)
• myopia (vision changes)
• cataracts get worse
• increased insulin sensitivity (so diabetics run risk of low blood sugar)
• claustrophobia
• seizure

How much does HBOT cost?

Cost $120-$420/treatment depending on what type of chamber and where you are. People would likely need successive treatments - eg several "dives" per week for 4 weeks in some cases. So that can add up, but benefits may be worth it for some. Need to consult an expert.

Towards the last 15 minutes of the interview we talk about considerations when making a decision if this is right for you and what complications may be involved.

Connect with Dr Sherr and learn more at

www.integrativeHBOT.com

Michael Lewis MD is an expert on brain health, prevention, treatment, and management of brain injuries. He is a retired Colonel in US Army and has impacted the military's approach to traumatic brain injury. Since retiring from the Army he founded the Brain Health Education and Research Institute outside of Washington DC. He is the author of the recently published, "When Brains Collide."

Shownotes:

We discuss the mechanism of concussion and how it creates brain deterioration both in the short and long terms. "Primary injury" is the near term injury. "Secondary injury" can lead to persistent oxidative stress, reactive oxygen species, oxygen deprivation and ultimately brain damage that relates to Alzheimer's disease.

We have more discussion on concussions and head trauma and how that may lead to blood brain barrier permeability AKA "leaky brain." This seems to relate to inadequate drainage of the newly discovered "glymphatics system" of the brain and inefficiency with the healing process therein.

The ApoE4 gene - linked to significantly higher risk of Alzhiemer's - is also an indicator of higher risk of having difficulty recovering from head injuries or having more severe symptoms if and when a head injury occurred in the past. Some researchers, for example Dr Caleb Finch at USC maintains that from an evolutionary biology perspective the ApoE4 gene status -which confers a 50-90% increased lifetime risk of developing Alzheimer's - seems to be more associated with a proinflammatory state thereby making recovery from persistent oxidative stress and inflammation more challenging.

30% of the brain is fat. Omega fatty acids are analogous to bricks in the wall of your brain. The balance between Omega 3 and Omega 6 fatty acids is important. Omega 6 fatty acids are more inflammatory and an overabundance of them in your body can prevent healing.

The critical omega 3 fatty acids seem to be DHA and EPA. DHA, a precursors of Resolvins and neuroprotectins, and EPA influence healthy blood flow, cell to cell communication, and mediate anti-inflammatory and antioxidant effects.

You can ask your doctor to measure your Omega 3 (i.e. EPA + DHA) levels with a lab called an

"omegacheck"

"omegaquant"

"omega3index"

These terms are commercialized lab terms that can be drawn at many of the larger standard lab companies.

Ideally Omega 3 (EPA +DHA) levels should be greater than 8% on one of these tests (there may be exceptions depending of your family history and what medications you are on so - as always- check with your doctor when looking into this, this is not medical advice as there is some risk to high omega 3 levels for a small subset of people). We think the ideal ratio of Omega 6:3 is about 4:1. Most Westerners have proinflammatory diets making this ratio much higher.

Through this interview there is discussion about processing practices for fish oil companies and how to understand if your fish oil is of high quality. Quality fish oil should be molecularly distilled for safest processing and lowest toxicants and in triglyceride form for best tolerance on your stomach and most easily digested. Dr Lewis recommends a concentrated form so you can get enough with a minimal number of pills.

There is also a brief discussion about bleeding with high dose omega 3 fatty acids.

It takes 12 weeks to saturate the brain, but Dr Lewis with his Omega 3 protocol uses 3-6 times the regular dose for the first month or so.

If you can't consume clean fish multiple times per week or are a vegan consider using algae-based omega 3 fatty acids. This is, in fact, where fish get their omega 3 fatty acids from.

A newer supplement, Specialized Pro-resolvin Mediators (aka: SPMs) which seem very promising, primarily based on the work of Dr Charles Serhan and his group at Harvard, are a downstream product of omega 3 fatty acids and are important in the resolution of inflammation. Some of the "SPM" products on the market today may in fact not be actual SPMs but simply closer down the metabolic chain of events to SPM than traditional Omega 3 fatty acid oils.

Transparency note: at the time of the recording, Dr Lewis was a paid consultant to Nordic Naturals a purveyor of Omega 3 supplements.

Resources:

Learn more about Dr Michael Lewis and his work with the Brain Health Education and Research Institute

http://www.brainhealtheducation.org

or his Book "When Brains Collide" on Amazon or other common outlets.

Interventional neuroendocrinology is a relatively new concept. It is championed by, Dr Mark Gordon. He promotes proactive monitoring and replacement of multiple hormones as needed to optimal levels. Dr Gordon elucidates his approach and clarifies his issues with the current standard of care and the use of standard reference ranges.

Dr Gordon introduces the concept of "neurosteroids" which are hormones that are made by glial cells - support cells - in the brain. Hormones like Growth Hormone in Insulin Like Growth factor protect the brain and can be given or stimulated to create supportive neurochemistry and aid against brain damage.

The Blood-Brain-Barrier - which protects the brain from things that are running around in the rest of the body - can get leaky after a head injury. This allows things that aren't normally given access to the brain to get access. White blood cells among other things from the rest of the body get into the brain and initiate an autoimmune response (e.g antibody against pituitary and hypothalamus) and set off a cascade of harmful reactions.

We discuss what Dr Gordon means by "the neuropermissive environment" which is a fascinating idea of giving the body all thing things it needs to heal the brain.

Dr Gordon notes the importance of zinc in down regulating the production of harmful products in Alzheimer's and explains this process. He also discusses why aluminum is thought to a contributor to developing Alzheimer's.

Long discussion about inflammation and oxidative stress in the brain and the use of N-acetyl cysteine and mixed tocopherols (E vitamins) that slow down inflammation.

Extensive discussion about thyroid hormone and the brain and nutrients and thyroid hormone's role in the "neuropermissive" environment.

Conversation about whether or not there is a role for progesterone in men with brain damage.

Dr Gordon's tells us about his work with brain injury and those who have served in the military.

Resources:

To find out about Dr Mark Gordon's work: TBIMedLegal.com

A documentary in which he is featured will be release soon as well:

Dr Mark Hyman - Mark is the world renowned leader of the Functional Medicine movement. He is the Director of the Cleveland Clinic Center for Functional Medicine.

Functional Medicine is an approach that tries to discover the root cause of chronic disease and personalize and approach to getting better. Dr Hyman has been using this approach for years and shares a couple of stories of patients with cognitive impairment that improved with this approach.

We explore the idea of Alzheimer's as a syndrome with drivers including metals, environmental toxins, and infections.

(Min 11:23). We have a deep discussion about cholesterols and fats and the relative benefits versus harms of fats and MCT (coconut oils). We discuss practical lab testing of cholesterol, statins and other medications.

7 Steps for Do It Yourself Prevention of Alzheimer's

(Dr Hyman points out that what is good for your brain is good for the rest of your body as well):

1. Adopt a Low glycemic diet - low sugar and sugar like processed foods that contain shelf stabilizers and preservatives
2. Increase your fat intake - eg avocado, olive oil, nuts, seeds
3. Eat 6-9 servings of vegetables (serving = 1/2 cup) every day. A little bit of colorful fruit fairly often may be good to.
4. Exercise (increasing antioxidant enzymes, increasing brain chemicals, increasing brain connections, increasing blood flow)
5. Reduce stress - easiest way is to do adopt a daily meditation practice 20 minutes, once or twice per day.
6. Nutritional Supplementation - MCT Oil, B-vitamins for methylation support, basic multivitamin, omega 3 fatty acids (e.g high quality fish oil), detoxification support.
7. Minimize Toxic Exposures - use the EWG.org - Environmental Working Group website to learn about how to minimize toxicants in food and personal care products.

If the Do-It-Yourself approach isn't working consider visiting with a Functional Medicine doctor.

Find one on: https://www.ifm.org/find-a-practitioner/

Dr Hyman is leading the way on getting the word on Alzheimer's and cognitive impairment. Check out his upcoming documentary "Broken Brain" - anticipated to be out in Late 2017.

Learn more about Dr Hyman by reading one of his many NYTimes bestselling books or on his website http://drhyman.com/

This week's guest is Dr David Merrill MD, PhD Assistant Clinical Professor, Psychiatry and Biobehavioral Sciences at UCLA. Dr Merrill is an active proponent of prevention of Alzheimer's and an expert in many areas relating to this.

Quantitative Electroecephalography - AKA: qEEG - and structural MRI are two technologies that are widely available. Dr Merrill explains how they can be used to assess if you have brain wave or structure changes that look like impending dementia.

qEEG essentially creates a map of the function and electrical activity of many of the parts of your brain. These maps can also give you an indication of how "efficiently" your brain is connected. Dr Merrill talks about the signatures that distinguish depression and cognitive impairment or dementia including Peak alpha frequency interpretation (

A good "brain dose" of exercise is about 30 minutes a day, 5 times per week, intensity of the exercise should be enough so that you feel breathless/winded/sweaty. But recent evidence suggests that walking one mile per day about 6 days per week that this preserves gray matter (or the area in the in the brain that does the work so to speak, ie neurons).

Neuronetrix - Cognision is the office-based cognitive testing product that Dr Merrill uses: www.neuronetrix.com.

We have a discussion around 23andMe and ApoE4 and Alzheimer's genetics and how these relate to brainwave activity and the p300 wave.

Deep discussion about trauma, stress and concussion and their roles in developing Alzheimer's and dementia. Discussion about the Adverse Childhood Experiences score.

Connect with Dr Merrill at www.cogclinic.net