Bottom Line Health: What You Don’t Know About Preventing Alzheimer’s

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Alzheimer’s disease is hands-down one of the most feared diseases. But simply worrying that you’ll develop the illness doesn’t do any good. A far better approach is to take action—now!

What’s new: Around the country, respected medical centers and hospitals are now creating Alzheimer’s prevention programs staffed by neurologists and researchers who help people do all that they can do to avoid this devastating condition.*

Even if you’re only in your 30s or 40s, it’s wise to see a neurologist if you have a family history of Alzheimer’s disease…or if, at any age, you’re noticing mental changes (such as memory loss) that concern you. Everyone has momentary lapses—forgetting where you left your keys, for example—but those that impact your life, such as missing appointments, should be evaluated.

WHAT CAN YOU DO?

An increasing number of Alz-heimer’s experts now believe that preventive lifestyle approaches may help preserve memory and cognitive abilities. It’s best to start before any disease-related changes occur in the brain. By the time symptoms are recognizable, the disease already has a foothold and the benefits of intervention will be nominal. While you may think that you already know the main Alzheimer’s prevention strategies, key recommendations from Dean Sherzai, MD, director of the Alzheimer’s Disease Prevention Program at Cedars–Sinai Medical Center in Los Angeles, include specifics that really make a difference. Steps to take…

Control your blood sugar.

Most Alzheimer’s patients have higher-than-normal blood sugar levels or full-blown diabetes. In a study that tracked more than 2,000 patients for roughly seven years, those with a glucose reading of 115 mg/dL, on average, had an 18% higher risk for dementia than those with levels of 100 mg/dL or lower (normal range). The higher the blood sugar levels, the greater the Alzheimer’s risk. It’s not yet clear why elevated blood sugar increases cognitive risks, but it could be linked to the inflammation that accompanies blood glucose disorders.

Dr. Sherzai’s advice: Avoid simple carbohydrates such as white bread and white rice that cause blood sugar to spike. Also, emerging evidence shows that eating a lot of sugar may cause Alzheimer’s brain changes—so avoid sugar.

Recommended: No more than nine teaspoons of added sugars for men each day…six teaspoons for women. This may sound like a lot, but it’s actually a lot less than many people get. Added sugars are in many foods—not only in such things as sweetened yogurt and fruit drinks but also in pasta sauces, breads and salad dressings. Also, get screened for diabetes at three-year intervals, starting at age 45—sooner (and more frequently) if you have diabetes risk factors such as obesity and/or a family history.

Consume the “Big 3.”

The Mediterranean diet, which includes fish, fruit, beans, vegetables, whole grains and monounsaturated fat (such as olive oil), has been widely promoted for brain health. But which specific foods are most likely to help keep you mentally sharp? There’s strong evidence for…

Fruit and vegetable juices, such as pomegranate, blueberry and grape. A nine-year study of 1,836 participants found that those who drank fruit or vegetable juices at least three times a week were 76% less likely to develop Alzheimer’s than those who had them less than once a week. Possible reason: Juices have a high concentration of anti-inflammatory antioxidants—and this may help interrupt some of the brain changes (such as beta-amyloid deposits) that occur in Alzheimer’s patients. A daily serving of a juiced mixture of fresh vegetables and low-sugar fruits, such as berries, lime or cantaloupe, is a good source of antioxidants and nutrients. Fruits high in sugar, such as bananas and mangoes, should be avoided, since as mentioned earlier, recent research has linked higher sugar levels with cognitive decline and dementia.

Fatty fish. Researchers recently announced that people with high blood levels of omega-3 fatty acids had increased volume in the hippocampus, a part of the brain that’s affected in those with cognitive decline. Other research has shown that there’s less Alzheimer’s in parts of the world where people eat the most fish.

One problem is that people often eat the wrong kind of fish. It must be omega-3–rich, fatty fish. Best choices: Salmon, herring, mackerel, sardines or tuna, eaten at least twice a week. If you don’t like fish, you can take a daily supplement. Lovaza is the only fish oil supplement approved by the FDA. Because it’s available by prescription, it may be covered by your insurance. Alternatively, you can take an over-the-counter fish oil supplement (check with your doctor first—fish oil can raise risk for bleeding). Flaxseed, chia seeds and walnuts contain a plant-based omega-3.

Vegetables—and more vegetables. With all the focus on brain-healthy fruits such as blueberries, vegetables are often forgotten. That’s a mistake. In a study of more than 3,700 people, those who consumed the most vegetables (a median of 4.1 daily servings) had 38% less cognitive decline than those who ate the least. Good choices for those four or more daily servings are kale, spinach, brussels sprouts, broccoli and red bell peppers.

Give your mind the right kind of workout.

Crosswords and Sudoku help but less than you might think. They get easy with practice and -target only some parts of the brain.

Better: Activities that challenge your brain on multiple levels—and stay challenging no matter how long you do them. Examples: Playing a musical instrument, painting and even playing some challenging video or board games. Also: Look for hobbies that use the hands and the mind—they require focus, memory, problem-solving, spatial visualization and other skills.

Dr. Sherzai’s advice: List 10 activities that you enjoy, and try to do three or four of them daily. If one activity doesn’t stimulate a part of your brain, another probably will.

Get more exercise—safely.

When it comes to preserving brain health, nothing beats exercise. It improves circulation and increases the amounts of glucose and oxygen that reach the brain.

Dr. Sherzai’s advice: Be sure to exercise safely. An injury will deprive you of one of your strongest defenses against Alzheimer’s. Outdoor exercise can increase risk for falls and other injuries. If you’re not that sure-footed, go for indoor exercise using a machine such as a recumbent bicycle or elliptical trainer. Otherwise, take brisk walks outdoors. Aim for 30 minutes of moderate-to-vigorous exercise (breathing hard and fast with increased heart rate) on most days of the week, plus strength, flexibility and balance-improving activities. (Start with five-minute sessions if you’re not used to it.)

A Medication Worth Trying?

High blood pressure is widely known to increase Alzheimer’s risk. What you may not realize is that the type of medicine used to control high blood pressure could also affect your Alzheimer’s risk.

Interesting finding: When the medical records of more than 5 million patients were reviewed, those who took blood pressure drugs called angiotensin II receptor blockers (ARBs), such as irbesartan (Avapro), losartan (Cozaar) and azilsartan (Edarbi), had a 35% to 40% lower risk of developing Alzheimer’s or other brain diseases than those prescribed other blood pressure drugs. What makes these drugs different? It’s possible that blocking the renin-angiotensin system provides neurological benefits in addition to lowering blood pressure.

The research is not definitive, so your doctor won’t prescribe an ARB just to prevent Alzheimer’s disease. But if you’re already taking blood pressure medication, you may want to ask about trying an ARB.

*To find an Alzheimer’s prevention program near you, check with a local chapter of the Alzheimer’s Association, ALZ.org, a local university or state or local agency for the aging.

Source: Dean Sherzai, MD, a neurologist and director of the Alzheimer’s Disease Prevention Program at Cedars-Sinai Medical Center in Los Angeles. A member of the American Academy of Neurology and the American Society on Aging, he is a former director of the Memory and Aging Center at Loma Linda Medical Center, where he directed neurology research and research and education for residents and fellows.