Jeffrey Bland, PhD, recounts tracing the idea that nutrition and inflammation affect dementia back to his 1985 tape series and early gut–brain work. He contrasts skepticism (a Feb 2019 JAMA piece calling some lifestyle claims 'pseudo medicine') with accumulating evidence from epidemiological, retrospective and prospective studies and press coverage (Oct 30, 2019 Wall Street Journal) that link diet and exercise to Alzheimer's risk and progression. He highlights mechanisms in systems biology: neuroinflammation mediated by microglia and the gut microbiome's role. He notes exercise benefits (e.g., hand-grip strength correlates with better cognitive outcomes) and discusses an algae-derived polysaccharide drug (an "oligomannate") first approved in China after a phase 3 trial for early-stage dementia that appears to act by altering gut flora to reduce neuroinflammation. He cites clinicians (Dale Bredesen, David Perlmutter) and argues lifestyle interventions remain a promising, clinically relevant approach for prevention and early treatment.
Chapters
Well, I've got a little story I'd like to share with you here for a second.
I hope you'll bear with me because.
It has a personal component to it. It takes me back in my life to 1985. 1985 seems like a while ago. And I just had a friend of mine send me actually a cover of.
A tape series that I did in.
1985 on the concept of nutrition and inflammation for doctors, in that the contents was the connection between nutrition, inflammation and dementia.
So I was really kind of amazed to think that we had been talking.
About this topic going all the way.
Back, probably even earlier than 1985. And in fact, it really derived out of some of the early work that was being done looking at gut connections to the brain in this whole gut brain concept that has now grown up to be a very, very big advancing frontier in the understanding of dementia and Alzheimer's dementia specifically.
And we actually started talking about that in the early 1980s.
Well, that then leads forward to February of 2019. And you probably recall, if you've been following some of the information that I've.
Been musing on, that there was an.
Article in the Journal of the American Medical association that was authored by neurologists from the University of Californ, San Francisco, in which they were talking about the fact that some of these discussions that were ongoing as it relates to diet and exercise and its effect on Alzheimer's were really misleading. In fact, in the article, they even.
Call it the rise of pseudo medicine in dementia. That's a pretty strong term to condemn.
These constructs, that there may be things that one can do in their lives to modulate the risk and even progression of Alzheimer's based upon exercise and diet and their interrelationship to lowering inflammation. Well, if you then roll forward From February of 2019 to more recent papers, you'll see that there are other studies in very top tier journals that have now demonstrated with clinical studies, either epidemiological, retrospective, or in some kind of prospective evaluation as to how dementia is associated with altered diet, altered altered lifestyle, certain both exercise and diet patterns.
So this model is starting to emerge to maybe be considered controversial, but I think it's starting to actually demonstrate that there is something here that has clinically important payoff, particularly when we start to.
Evaluate the fact that there is no.
Proven drug that really works successfully for the treatment of Alzheimer's or late stage dementia. Now, with that in mind, we start asking, what role would exercise and diet have on dementia? And it takes us now into the new Systems biology understanding of this condition, which is a neuro inflammatory related condition, meaning the brain is undergoing some kind of a neurological inflammatory response, probably through the microglia, the brain's immune system that is triggering in the neurons, the business end of the of the brain, a response that leads to the death of neurons and ultimately in specific regions of the brain like the hippocampal regions, through the production of maybe beta amyloid plaque and other types of agents that are actually pathologic in certain forms and cause brain tissue to be diseased. Well, with that in mind then you say, well, what would exercise do? Exercise is known to have a positive effect on all sorts of processes related to immune system function. And it can increase both systemic whole body function through immune activation or immune regulation as well as the brain's immune system. And now we know that things like hand grip strength in older age people is associated with brain function. So people with low hand grip strength as they age have greater associations with neuroinflammation and with Alzheimer's. And there's a whole series of reports now as to how exercise can in fact improve function that increases then the hand grip strength and that's a associated with a better prognosis of neurological function. So there's one example, but then more recently, and I'm now talking about October of 2019, actually October 30th to be.
Specific, a report that there's a link.
Between or among diet, exercise and Alzheimer's that appears to be growing in significance. And this now was an article in the Wall Street Journal, not kind of a tertiary publication for the general public. And what is it all about, particularly.
In light of what we saw in.
The February issue of the that said pseudo medicine. So why is this not pseudo medicine? And that leads us then into a recognition that there may be a new drug approved first in China for the treatment of Alzheimer's that is a drug that is actually quite interesting in its chemical composition. It's an oligomannate. What is an oligomonate? It's basically a polysaccharide derived from seaweed from algae. And this oligomonate has a positive effect on doing what?
On changing bacterial flora in the gut to lower the inflammatory potential of the gut microbiome, which then has been shown in animal studies to have a very positive effect on lowering brain neuro inflammation and dementia in the animals. And in fact this is such a powerful advancing frontier in new science that they've actually in China taken this all the way through a phase 3 clinical trial in humans. With early stage dementia, showing in this study that it in fact fulfills the criteria of being approved as a drug for the treatment of early stage dementia. Treating the gut to improve the gut microbiome, to lower the inflammatory potential on the body, which lowers neuroinflammation, which lowers Alzheimer's. So you can see that we're really into an interesting new era. And I find it so perplexing that there are these extraordinary people who have great medical backgrounds and credentials who are pushing back so strongly against this, what appears to be the rising tide of strong scientific information supporting it. The best approach that we know of today to reduce the risk of dementia and even in treatment in early stage may be these lifestyle principles, these personalized lifestyle interventions with diet and exercise and things like sleep, things that people like Dr. Dale Bredesen have been speaking about, Dr. David Perlmutter, for some time, and actually goes back in my life to, to 1985 with my discussion of nutrition and inflammation in the early days of the emergence of this field.
So keep tuned.
But this is really, I think, opening up a door for real clinical improvement.
