How Did I Get Alzheimer's?

I can imagine being officially diagnosed with Alzheimer's disease (AD). My first thought would be "No, this can't be!"

My second would be "How did this happen?"

The etiology of AD is multifactorial and a bit complex. But by gaining some understanding of those multiple causes we open up opportunities to prevent and even treat the disease.  

To get AD, one must have the genetic disposition to be susceptible. Then the factors of aging play a role in actually getting the disease to develop. By genetic disposition I don't mean having "the Alzheimer's gene". Very few AD victims have genetically transmitted AD. What I mean by being genetically susceptible is that one does not have the genetics to be particularly protected from the disease. This is true for most of us. So we're all at risk. In fact, AD is now the 6th leading cause of death worldwide.

So given that nearly all of us have the genetic capability to develop AD, what specifically is going on to cause the disease? And, more importantly, is there anything I can do to prevent or treat the disease if I’m already diagnosed?

As I mentioned, AD is multifactorial in its causation. The brain is being attacked along seven different avenues, much like a city under siege by an enemy approaching from seven different directions. Here are the seven avenues of attack:

1.     Oxidative Stress

2.     Glycation

3.     Inflammation

4.     Production of beta amyloid protein

5.     Reduced elimination of beta amyloid protein

6.     Brain cell destruction by beta amyloid protein

7.     Development of abnormal tau protein

Please don’t let the medical terminology discourage you. I can simplify these terms for you, albeit not in this blog alone. It will take a number of sessions to get all this on the table. For now, it’s important to understand that all seven of these “attacks” can be defended. And doing so can be very worthwhile. In fact the first three are related directly to aging itself and to our most destructive age-related diseases. For today, let’s just look at number one: oxidative stress.

If you remember from high school chemistry, an atom has a nucleus called a proton, which is orbited by electrons. Electrons like to travel in pairs. And if an electron is all by itself orbiting the proton, that atom is a free radical. That electron will do anything it can to get a mate, so what it typically does is jump ship to the next atom, knock an electron out of its orbit and take its mate. Then the atom that lost the electron becomes the free radical and it immediately goes to the next atom, knocks an electron out of its orbit and takes its mate and so on. What we end up with is a rapid fire transfer of electrons. This is called oxidative stress because every time there is an electron transfer, there is a potential structure change in a molecule. Most of the time it is of no consequence; it may simply be a skin cell ready to slough off anyway. But when brain cells are exposed to oxidative stress (electron transfers and structural changes) it often results in the death of the brain cell. Oxidative stress is one of the primary mechanisms by which we lose brain cells--as in Alzheimer’s, Parkinson’s and even normal brain ageing.

So, clearly, we would like to control oxidative stress if we could.  And the degree of oxidative stress that we undergo is related to the degree of pollution to which we are exposed. For example, when you’re driving in any degree of traffic, do you remember to use the recirc button in your car? That is the button that circulates cabin air around and around and prevents outside air from entering the car. If outside air is being sucked in from the outside, you’re breathing in carbon monoxide which is colorless, odorless and tasteless, so you can’t detect it, and you are also breathing in diesel particulates and other products of hydrocarbon combustion. These not only damage our lungs, but create a shower of free radicals in our bodies. So use your recirc button constantly until you’re completely out of traffic, and then open your vehicle to fresh air.

And what about your water source? Most drinking water is either carbon filtered or simply direct from the tap. Carbon filtration removes toxins and impurities but leaves the minerals in place. Some minerals (e.g. calcium, potassium and magnesium) are beneficial but many others (e.g. aluminum, mercury and, when in excess – even iron) are strong pro-oxidants. That means they promote free radicals and electron transfers and are toxic to brain cells. Reverse osmosis as well as distillation (another processing technique of boiling the water into vapor and recondensing) take out virtually all the impurities and minerals, both toxic and healthful. These are great systems for eliminating those pro-oxidant metals and protecting our brains but we should then be careful to supplement calcium, magnesium and potassium in some form.

Pesticides found in conventional produce also create free radicals. Pesticides are removed from our blood by the liver in a detoxification process. But in that process, a huge shower of free radicals is produced. Organic produce, containing little or no pesticide, doesn’t require hepatic detoxification, so no free radicals are produced in response to eating it.

 Eating produce itself, however, is important because fruits and non-starch vegetables are the very foods that contain antioxidants.  Antioxidants are molecules that can accept the free radical and neutralize it without creating another one, stopping the chain of electron transfers. They are able to do this just by their chemical structure.  Antioxidants are substances such as beta carotene, Vitamins C and E, selenium, alpha lipoic acid, Co Q10, N-Acetyl Cysteine and others. In addition to organic produce, it’s is good idea to take a broad spectrum of antioxidant supplement. Antioxidants work in different tissues by different mechanisms and they complement each other. Some actually help to regenerate others. For example, Vitamin C regenerates vitamin E in the body.

In summary, reducing oxidative stress is a good way to protect your brain and one of many steps we can take to combat AD. To do so, make your air and water as free as possible from free radical-generating pollutants, eat plenty of organic non-starch vegetables and fruits and take a reasonable broad spectrum antioxidant supplement.

But to have a substantial impact on AD, one must defend the brain against all seven of the avenues of attack. I’ll write more on the other six avenues in future blogs along with something about the two “supply avenues” to keep open: cognitive enhancers and brain plasticity. Sorry this is more complex than taking a pill once a day but until we have such a magic bullet, at least we have an effective means of combating this otherwise invariably fatal disease. If you want all the answers now, our book, “Alzheimer’s, Memory Loss, MCI: The Latest Science for Prevention and Treatment” will be published in early May, 2012. It was written by me and my associate, Nathan Daley, M.D.