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by Parris M. Kidd, Ph.D.
The 1st International Conference on the Integrative Medical Approach
to the Prevention of Alzheimer’s Disease, Phoenix, Arizona, October, 2003.
Alzheimer’s and related dementias
are epidemic in industrialized
societies and their
emotional, social and financial
burdens are increasing at
an unbelievable rate. This world-class conference
proved that dementia prevention is
already achievable through an integrative
medical approach.
The conference was held from October 10
through 12 at the scenic Wyndham Buttes
Resort in Tempe, Arizona, jointly sponsored
by the Alzheimer’s Prevention Foundation
International (APFI) and the Foundation for
Care Management (FCM). It was attended by
several hundred medical and naturopathic
practitioners, scientists, nurses and other
health care professionals, with Continuing
Medical Education credits made available.
Dharma Singh Khalsa, M.D., the president
and medical director of the APFI, in his
welcome to the conference talked about a
marked paradigm shift in the approach to
Alzheimer’s. Just a decade ago few qualified
clinicians believed anything could be done
against dementia. “The research direction
was almost exclusively toward finding a
magic bullet, drug, vaccine or genetic twist
to prevent or treat this horrible disease,” said
Dr. Khalsa. “Now I am very pleased to report
that this magic bullet philosophy has
changed. We now have firm, if not compelling,
scientific evidence that Alzheimer’s
disease is in large measure a disease of
lifestyle and, as such, can be prevented.” The
eclectic but high-quality presentations
strongly support an integrative medicine
approach that mobilizes every safe and available
intervention to prevent Alzheimer’s or
slow its progression.
One welcome address came (by video)
from Dr. Richard H. Carmona, Surgeon
General of the United States. Like Dr.
Khalsa, he also took a firm position that
lifestyle does influence cognitive function
and that “This provides an exciting new
opportunity to begin evaluating the benefits
of integrative medicine on the prevention of
brain degenerative diseases.” He welcomed
participation with his office to formulate an
action plan against the public health challenges
posed by the epidemic of Alzheimer’s.
The conference featured some 16 speakers
from academe, industry, government, and
private institutions. David Rakel, M.D.,
director of the University of Wisconsin
Center, covered the principles and practice of
integrative medicine for integrative medicine.
Yogesh Shah, M.D., associate program
director for integrative medicine of the
Mercy/Mayo Clinic, covered Alzheimer’s
pathogenesis, progression and prospects for
early diagnosis. Richard Powers, M.D., associate
professor at the University of Alabama
at Birmingham School of Medicine, spoke
on understanding dementia prevention
based on neuropathology. Dr. Khalsa presented
an emerging hypothesis for prevention
based largely on the catastrophic
damage that stress can inflict on the brain.
Later Dr. Shah returned to review new drug
prospects for AD management.
Certain lifestyle practices are linked
with increased risk of Alzheimer’s or
related dementia. William Grant,
Ph.D., a senior research scientist at NASA in
Hampton, Virginia and an independent
Alzheimer’s researcher, addressed this topic.
High alcohol consumption (more than 14
drinks a week) may increase dementia risk,
especially in persons carrying the apoE4
gene. Lower alcohol consumption, especially
from wine, may be somewhat protective.
High intake of saturated and/or trans fats
may increase risk. Poor antioxidant status is
linked to increased risk and intakes of redoxactive,
transition metals (aluminum, copper,
iron, mercury) may aggravate this risk. Dr.
Grant and other speakers argued for a caloric
restriction diet strategy and for consumption
of cold water fish or fish oil supplements.
Dr. Alan Mintz, CEO and CMO of the
Cenegenics Medical Institute, concurred
with Dr. Grant on the positive correlation
between physical exercise and dementia prevention.
Dr. Mintz also addressed the benefits of mental exercise in prevention.
According to Dr. Grant and others, reproductive
hormone abnormalities may contribute
to dementia risk. In men, low
testosterone levels may increase risk. In postmenopausal
women, hormone replacement
with non-bioidentical estrogen and/or progesterone
may double the risk for AD. But
Neal Rouzier, M.D., director of preventive
medicine of the Clinics of the Desert in Palm
Springs, emphasized that bioidentical
estrogen and progesterone lower dementia
risk by as much as half. HRT has received a lot
of bad press recently but bioidentical HRT
has great potential for improving life quality
and lengthening lifespan.
Among AD researchers, both mainstream
and alternative, a consensus is emerging that
oxidative stress contributes to AD. Recently
this recognition has extended to inflammation
being a major driving force in neurodegenerative
diseases. David Perlmutter, M.D.,
medical director of the Perlmutter Health
Center, presented impressive evidence for
oxidative stress and inflammation in AD. He
indicted that poor blood sugar control, elevated
blood homocysteine, environmental
toxins, dietary fats, infectious agents, even
pharmacologic agents (e.g., levodopa for
Parkinson’s or the myriad drugs that deplete
B12 or folic acid) as candidate factors driving
brain inflammation. His clinic routinely
measures oxidative and inflammatory
markers and administers potent antioxidants
as part of their integrated management of
AD, Parkinson’s, amyotrophic lateral sclerosis
and other CNS degeneration. Dr. Perlmutter
also did an informative sponsored presentation
on omega-3 fatty acids.
Elevated blood homocysteine (hyperhomocystinemia)
is consistently linked to AD risk. Alan Miller, N.D.,
senior editor for the leading journal
Alternative Medicine Review, showed how
homocysteine has been implicated both in
vascular dementia and in AD. So also are low
levels of folic acid, vitamins B6, and vitamin
B12, the major nutrients that control homocysteine.
Dr. Miller emphasized the ease and cost-effectiveness with which these nutrients can
be repleted, to eliminate another AD risk factor.
Stephen Sinatra, M.D., a leading integrative
cardiologist, also strongly indicted homocysteine
in dementia. His topic was “The
Heart/Brain Hotline.” He linked hypertension
to vascular dementia and insulin resistance
to hypertension. Dr. Sinatra also made
valuable specific dietary recommendations for
controlling these various syndromes: The Pan-
Asian/Modified Mediterranean (PAMM) diet.
New technologies for assessing brain
damage and functional capacity played a significant
role at the conference. Dr. Daniel
Amen, associate clinical professor at the
University of California at Irvine and a close
collaborator with APFI, described how SPECT
(Single Photon Emission Computed
Tomography) works. SPECT quantitates blood
flow and brain activity and produces a 3-
dimensional image of the brain. Zones that are
underactive come out as holes in the brain
map and SPECT scans tend to go abnormal five
to seven years years before Alzheimer’s appears
as a clinical condition. Such early indication of
Alzheimer’s risk could (should) motivate the
individual to enter a prevention program. The
technique is not yet readily available outside
research centers but the dollar cost is not prohibitive.
Several speakers addressed the financial
burden of Alzheimer’s on society. Dr. Rakel
made the fundamental point that the integrative
approach saves money by stimulating the
body’s inner healing process so that less money
is spent on fixing the parts. Dr. Shah stated
that at present there are 4 million Alzheimer’s
cases with 40 new cases every hour, projecting
14 million cases by 2030. Currently the lifetime
cost per patient is $174,500. William
Shankle, M.S., M.D. of the Medical Care
Corporation of Orange County, California
calculated that delaying AD onset by 3.5 years
using established prevention protocols could
reduce annual health care costs by $50 billion.
Currently the cholinesterase inhibitor drugs
can delay disease progression by at least two
years; lifestyle modification and nutrients offer
even better prospects and these approaches can
be integrated.
David Leonardi, M.D., medical director of
the Leonardi Institute for Vitality and
Longevity in Denver, Colorado, spoke on
evidence-based use of brain specific nutrients.
He reviewed the positive associations of vitamins
C, E and other vitamin and antioxidant
nutrients with dementia prevention, then
zeroed in on the best documented brain
nutraceuticals: PhosphatidylSerine (PS),
GlyceroPhosphoCholine (GPC), Ginkgo
biloba standardized extract (EGb), acetylcarnitine
(ALCAR) and the omega-3 fatty acids EPA
and DHA.
Yours truly explained how the phospholipid
nutrient PS (phosphatidylserine) can
offset severe memory loss. PS is a safe and well
tolerated nutraceutical effective in restoring
mild to moderate memory loss. PS is part of
the integrative strategy to use nutrients in
combinations, also in tandem with approved
pharmaceuticals, and to take advantage of the
burgeoning diagnostic tools to begin disease
management as early as possible.
Nisha Money, M.D., ABHM, is a neurology
resident at the University of California-San
Diego with a strong interest in integrative/
holistic neurology. She updated the latest
developments concerning U.S. national AD
legislation then turned her attention to
developing mental stamina through guided
meditation and imagery.
So then, what should an effective
Alzheimer’s prevention program be like? The
APFI, founded 10 years ago by Dr. Khalsa,
offers the most comprehensive program for
Alzheimer’s prevention. The four pillars of
their Brain Longevity Program are nutrition,
stress management, combined mental and
physical exercise and pharmacology. APFI concentrates
on meditation as a key to stress management
and their initial collaborative studies
with Dr. Amen and Dr. Money indicate that
functional “holes” on SPECT can become filled
in as function is restored by daily meditation
practice. To illustrate, Dr. Khalsa led a floor
session on eliciting the relaxation response and
this was a lot of fun for the attendees.
The dinner hosted by APFI featured excellent
food and memorable camaraderie. APFI’s
guest speaker was Somers White, their close
colleague and entertaining motivator.
Following this highly stimulating
conference, the APFI plans to continue with all
the medical options at their disposal—conventional and complementary, Eastern and
Western, nutritional and pharmacologic—to
further the science and art of Alzheimer’s prevention.
An ambitious program of future
research is planned. No longer is dementia
mystifying or unconquerable.
Primary Contact:
Alzheimer’s Prevention Foundation International
Web: www.alzheimersprevention.org
Tel: (520) 749-8374
Fax: (520) 296-6640
Parris M. Kidd, Ph.D. is a noted biomedical consultant
and health educator with a basic science Ph.D. from the
University of California-Berkeley and diverse clinical
research experience from the UCSF Medical Center.
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