The quick answer: Hippocrates first observed that what's good for the heart is good for the brain. Living the Healthy Changes helps to protect your brain from the twin threats of dementia and stroke.
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Preventing dementia, including Alzheimer’s disease
We went to a funeral the other day for one of the loveliest people you could hope to know. Her name was Nancy and she left us at a relatively young age. Nancy was in her mid ‘60s, just entering what should have been her golden years. But in truth, Nancy had left us some time before, for she died of Alzheimer’s disease. Alzheimer’s, the most common form of dementia, is growing at a frightening rate. This post is dedicated to the memory of Nancy, and the proposition that the Word of Wisdom Living lifestyle can reduce the risk of dementia, as well as stroke.
A 2005 Columbia University study found four risk factors that were highly predictive of Alzheimer’s disease (AD). Per the study, your risk of AD is 240% greater if you have three of these four conditions:
- Smoking,
- Diabetes,
- Hypertension,
- Heart disease.
A 2010 study, also at Columbia, found a strong link between HDL cholesterol—known fondly as the “good” cholesterol, though in fact we need all the forms of cholesterol, just in the right ratio—and the risk for AD. Those with higher HDL levels (>55 mg/dL) had 60% less risk of AD than those with lower levels. How do we improve our level of HDL? Here is a summary:
- Get regular aerobic exercise (more is better).
- Lose excess weight.
- If you smoke, stop. (Is there no end to the ways tobacco harms the body?)
- Eliminate manmade trans fats (eat nothing hydrogenated).
- Eat whole foods (lower glycemic index plus more fiber and nutrients). A diet high in sugar is a special risk for AD—those who consume the most sugar have a six-fold greater risk vs. those who eat the least.
- Eat fish (rich in the essential fat, omega-3).
- Get adequate B-complex vitamins (including niacin).
The last protective action—getting adequate B-complex vitamins—brought to mind a study of AD among Catholic nuns reported in the book, Amazing Grace. In a prior post we discussed the link between the B vitamin folic acid and spinal cord birth defects, particularly spina bifida.
Amazing Grace found a similar protection for folic acid against AD. It’s most interesting to learn how vitamins that are protective at birth also protect our brain at the end of our lives.
There was also a link between AD and homocysteine, a normal chemical which can be harmfully high when folic acid and other B vitamins are deficient. In the post on heart disease, elevated homocysteine was an important risk factor. In fact, if you look over the lifestyle habits that protect from heart disease, you find the same constellation that is protective of dementia. Because tradition is one of the three sources of wisdom for this blog, we should now honor the ancient physician Hippocrates who said:
“Food that is good for the heart is likely to be good for the brain.”
A Personal Story
May I tell a story? In 1991 I took a position with a new medical device company called Target Therapeutics. With the help of leading doctors, this company founded a new field of medicine called interventional neuroradiology. Basically we provided doctors with miniature catheters and other tools to treat structural brain disorders by working from inside the blood vessels. (This was much less invasive than surgery by cracking open the cranium.) At first we provided catheters for diagnosis but our fame came from an innovative treatment for treating aneurysms. Yet all the time our big goal—a task still unfulfilled—was better treatment of strokes.
My work here brought an unexpected moment of closure. When I was just three years old—this is the short version of the story—I fell out of a moving car and suffered a brain injury that might have proved fatal. The concussion caused a slow-developing hemorrhage that put increasing pressure on my brain. As the clot grew over weeks, I became less active, sleeping more and more. Because the progress was slow, the doctor involved was not concerned. My parents were frightened, however, and through a serendipitous chain of events my Mom got into the office of a neurosurgeon in San Francisco. This was during the early years of neurosurgery but the doctor immediately saw the problem and arranged a life-saving surgery not available where I lived. (Yes, that's me in the picture above, wearing a protective cap during recuperation.) Years later, while working at Target Therapeutics and observing the use of our products I visited that same hospital where my life had been saved as a child. I think it was this moment of closure that sparked a continuing interest in promoting brain health. For this reason, I call your attention to stroke prevention and treatment.
Treating Stroke
Stroke is the 3rd leading cause of death in the US, causing 160,000 deaths each year. Because breast cancer has been so well advertised we should note that more women die of stroke than breast cancer. In fact, strokes are much more easily avoided—up to 80% of strokes are preventable. It’s a tragedy that our society is not more effective at preventing, or quickly treating, strokes.
Most strokes are ischemic, meaning a clot blocks an artery in the brain, cutting off the flow of blood and life-giving oxygen to brain cells. A minority of strokes is hemorrhagic, meaning a blood vessel bursts, usually due to an aneurysm, and leaks into the brain cells. Avoiding high blood pressure is the first protection against stroke.
It’s important to remember that when a stroke occurs, it takes 4-8 hours for brain cells to die—a much longer treatment window than in heart attacks. Therefore, recognizing the signs of a stroke and quickly getting to a major hospital—one with a certified stroke center and interventional neuroradiologists trained in methods of treatment—is essential to survival. I repeat: essential! (If you don't know the best hospital, get to the biggest one and inquire.)
Borrowing from the success our society had in alerting people to the signs of heart attacks, it’s helpful to see strokes as brain attacks, and be aware of the signs. Because the brain is separated into two halves, stroke symptoms usually affects one side of the body. As a public service, the American Stroke Association posts these stroke signs to watch for:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side,
- Sudden confusion, trouble speaking or understanding,
- Sudden difficulty speaking,
- Sudden trouble seeing in one or both eyes,
- Sudden trouble walking, dizziness, loss of balance or coordination,
- Sudden, severe headache, with no apparent cause.
If someone you know shows these symptoms, respond quickly.
One other fact about strokes—strokes can be “tiny”, and these are called “transient ischemic attacks” or TIAs. With TIAs the above symptoms may pass, but there can be loss of brain cells and the accumulation of TIAs is one cause of dementia. It’s equally important to see a doctor about TIAs because treatment can prevent a more devastating stroke, as well as progressive dementia.
Preventing Stroke
We should follow Hippocrates’ advice; the following protect both the heart and the brain: Manage your blood pressure, avoid the use of tobacco and alcohol, eat a healthy diet, get plenty of exercise, avoid or control diabetes, and watch out for TIAs. One more thing (I hope this isn't too much information): be aware that the heart problem of atrial fibrillation can increase your stroke risk by 500%! For more information, visit the website of the National Stroke Association.
Please comment: We’re not used to thinking of the brain when we discuss diet and other lifestyle improvements. Have the posts this week helped you to know how to hang on to your marbles?