Marwan Sabbagh, M.D., a board-certified geriatric neurologist and member of the NIH-funded Alzheimer's Disease Cooperative Study (ADCS) hopes to put himself out of business. As founder and director of clinical research at Sun Health Research Institute's Cleo Roberts Center for Clinical Research in Sun City, Arizona, Dr. Sabbagh has dedicated his career to curing Alzheimer's and other age-related neurodegenerative diseases. John Wiley & Sons recently published his book, "The Alzheimer's Answer". The book advises readers on the latest strategies for preventing the onset and slowing the progress of Alzheimer's disease. In the interview below he discusses real strategies people can initiate at any age to prevent Alzheimer's disease.
JWI: How early should a person start lifestyle changes to prevent AD?
MS: Today. Ultimately we know that changes in the clinical manifestation of Alzheimer's disease start 20-30 yrs before the onset of symptoms. Start your prevention as early as possible. It's very important to embrace the concept of prevention early on.
JWI: Some risk factors such as age, gender and family history can't be modified but some can. Is it true that modifying diet can reduce one's risk of getting AD?
MS: Yes, absolutely.
JWI: Can reducing calorie intake reduce AD risk?
MS: There is growing evidence in the lab that calorie restriction is the most basic anti-aging approach available. Calorie restriction lowers insulin levels in the body, the core body temperature and changes some of the metabolic factors related to longevity and aging. Data from the CALERIE project (Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy) suggests that calorie restriction might prevent cognitive decline. Data from animal research also suggests that calorie restriction extends life but studies haven't yet been done on people that examine calorie restriction and cognitive health. However we have proven that obesity is bad and can influence cognitive decline.
JWI: The Mediterranean diet has been touted as a way to stave off AD. What is it about this diet that works better than others?
MW: This is the work of Nicholas Scarmeas from Columbia. He showed that people who consume the Mediterranean diet on a regular basis have reduced risk. The top third of the group that followed the diet had a 40 percent reduced risk of developing Alzheimer's disease over the lowest third. They found that even years later the top third of the group that continued to adhere to the diet had a 68 percent lower risk of developing Alzheimer's compared with the bottom third of the study's subjects. In short it wasn't one change that made the difference but rather the sum total of all the foods that provided the best chance for a protective benefit.
The Mediterranean diet is based on the eating habits of people who live in the Mediterranean region. In general it consists of little red meat, few dairy products, limiting foods with saturated fat, eating fish high in Omega 3s, a bit of red wine, legumes, fresh fruits and vegetables, whole grains, nuts and olive oil. The Mediterranean diet isn't a diet, per se, but a way of eating. There is very little sugar in their diet. And no corn syrup, which is prevalent in the American diet. The difference is in the actual food. It has been shown to protect against a number of major health conditions such as cardiovascular disease, hypertension, high cholesterol, obesity, and cancer.
JWI: How does exercise reduce AD risk?
MS: It's a perennial problem. Physical exercise is essential to maintaining good blood flow, and it reduces the risk of some of the biggest killer diseases such as heart attack, stroke and diabetes. These health conditions also happen to be well-known contributors to cognitive decline. A number of recent epidemiological studies have shown that exercise and physical activities might protect against cognitive decline. The observation is apparent but now we have to figure out how that works. Is it improved circulation? Is it improved blood flow? Is it that exercise reduces weight and thus reduces co-morbidities? The mechanism isn't clear but there's a variety of possibilities. We know that aerobic, cardio exercise works. There are clinical trials now underway to test exercise as a possible intervention against cognitive decline. Nevertheless everyone should strive to do some kind of aerobic exercise 30 minutes a day, five days a week.
JWI: Is there anything else people should do?
MS: Everyone wants the five second sound bite, the quick fix. But the true reduction of risk comes from adopting all strategies, not just one or two. The strategies outlined in my book resulted from my work with ADCS colleagues throughout the country. These recommendations come from the best minds in Alzheimer's research. We all agree that it's equally important to reduce all modifiable risks such as high blood pressure, extra weight, saturated fat in the diet, heart disease, vitamin deficiency, diabetes, elevated homocysteine levels, and high cholesterol. If you control these factors you can seriously modify your risk of Alzheimer's disease.
