17 Sep September is World Alzheimer’s Month
Did you know that Alzheimer’s is the most common cause of dementia and affects 5 million Americans?
Many of us have or have had a loved one afflicted by this terrible disease and yes, it is a disease. It’s a disease process where plaques build up in neural tissue and eventually cause death. It can take years and in that time, we lose the person we knew. It’s a heartbreaking disease. I’ve lost two loved ones to dementia.
Alzheimer’s afflicts women more than men. Over age 65, one in five women will be diagnosed with Alzheimer’s versus one in eleven men. The increased risk in women is possibly due to menopause and lack of estrogen. Certainly, men’s testosterone decreases with age but not as much as women’s estrogen does. A menstruating woman’s circulating estrogen rises as high as 300 but in menopause, it can be undetectable.
A man’s testosterone levels may be 600-1000 as a young man and 400 to 700 in later years. Also, a man will experience a drop in testosterone later in life than women experience a drop in estrogen. The average age of menopause is 52 years. Men typically don’t experience a drop in testosterone until their mid-60s. So, do sex hormones prevent dementia? It seems that estradiol, an estrogen, does and it has something to do with a gene variant called ApoE4.
ApoE4 Gene and Sex Hormones
Estrogen & Testosterone
ApoE4 is the gene associated with Alzheimer’s and dementia. Having one copy of this gene increases risk by 2-3 times. Having two copies of this gene increases risk by 12 times! But it seems to only affect women! “Only that the increased Alzheimer’s risk ApoE4 confers is largely restricted to women.”
A study at Stanford found that women who initiated estrogen therapy soon after menopause, experienced less brain degeneration. All the women in the study either had a family history of Alzheimer’s or the ApoE4 gene variant. ”The findings indicate that hormone therapies’ neurological effect on women at risk for dementia will depend critically on when they begin therapy and on whether they use estradiol or Premarin”. In fact, they found that estradiol was effective but Premarin and synthetic progestins were not.
What about testosterone? The association is unclear. Some studies show that androgen deprivation therapy (given in prostate cancer) increases the risk of dementia by its interaction with the ApoE4 gene.
Why does testosterone and estrogen have the same effect on a gene? They’re very similar. There’s only one atom of difference!
Should women take estradiol to prevent Alzheimer’s and dementia? The answer is unclear and we must weigh the risk of breast and uterine cancer against the risk of Alzheimer’s and dementia. Women in their 60s are twice as likely to develop Alzheimer’s than breast cancer. Currently, treatments for Alzheimer’s and dementia are poor to none.
If you have the variant of the ApoE4 gene, I recommend speaking with me or your doctor about estrogen therapy if you are recently menopausal or currently in perimenopause. If you do not know if you have the ApoE4 gene variant, ask me or your doctor about testing.
Can Fish Oil Prevent Alzheimer’s & Dementia?
Sara Gottfried MD, author of “The Hormone Cure”, once said at a seminar that she took 4 grams of fish oil per day to prevent dementia. I’ve since been taking that much myself after years of taking 3 g per day to prevent eczema. I don’t know where she got this information. Many studies have shown that essential fatty acids & Omega-3s, abundant in fish oil, are associated with an increased risk of Alzheimer’s and dementia. But can taking fish prevent Alzheimer’s and dementia? The results have not been favorable. Why is that? A recent study reports that the problem may be the dosage and for people at higher risk, they may need to take even higher doses of fish oil. “ApoE4 carriers, despite having the same dose, have less Omega threes in the brain”. They are currently recruiting volunteers for a much larger study to see if higher doses of omega-3s can prevent cognitive changes in ApoE4 gene carriers. You can find more information here.
Inflammation plays a large role in the development of Alzheimer’s and dementia. Indeed, Omega-3s have anti-inflammatory properties. For years, increased levels of cytokines have been found in patients with Alzheimer’s and recently a researcher found a pro-inflammatory protein involved with this plaque development in the brain (it’s these plaques that cause neuroinflammation and Alzheimer’s). It’s the first direct link found between neuroinflammation and plaque development.
Besides eating a diet high in omega-3’s and taking your fish oil, there’s a lot more you can do to lower your body’s inflammatory load. First, take out sugar! Sugar is very pro-inflammatory. Eat a diet high in fresh fruits and vegetables (frozen is fine too). Lower your alcohol intake. Stop smoking. Keep a healthy body weight. Keep exercising. Keep your blood sugars, blood pressure, and bad cholesterol in check!
Medications Found to Increase Risk of Alzheimer’s
For years, anticholinergic drugs have not been recommended for people over 65. This recent study found that taking these drugs when younger, can increase the risk of dementia later. “Researchers reported that cognitively normal study participants who were taking at least one anticholinergic drug at baseline were 47 percent more likely to develop mild cognitive impairment (MCI), often a precursor to dementia such as AD (Alzheimer’s disease), while being tracked over a period of up to a decade compared to participants who did not take such drugs.”. It begs the question whether people with the ApoE4 gene mutation should be taking any of these drugs at any age.
Here is a link to the medications. It includes prescriptive Paxil. The over-the-counter anticholinergic medication is Diphenhydramine (Advil PM, Aleve PM, Bayer PM, Benadryl, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM, Unisom, etc.).