From: olivercranglejr@gmail.com   
      
   Alzheimer's: The State of Prevention, Treatment   
   brain   
   By Matt McMillen   
      
   A lot's happening in Alzheimer's disease research right now. A recent study   
   suggests that low levels of vitamin D may boost older adults' risk of   
   Alzheimer's; a second suggests that up to one-third of cases are preventable.   
      
   To walk us through the latest, most exciting developments, we turned to UCLA   
   professor of neurology Dale Bredesen, MD, director of the university's Mary S.   
   Easton Center for Alzheimer's Disease Research.   
      
   Q: What can you tell us about Alzheimer's risk? Do factors like diet,   
   exercise, and stress play a role?   
      
   A: There are those who take the nihilistic view that there is nothing that can   
   be done to reduce your risk. While you might argue that there's no guaranteed   
   avoidance of the disease, I think there's every indication from many studies   
   that one can reduce    
   one's risk through lifestyle modifications.   
      
   Exercise, for example, is a critical piece. So are sleep and chronic stress.   
   Inflammation, of course, is also a huge issue. Look at all the things that   
   feed into inflammation, from your diet to your hygiene to your homocysteine   
   levels. All of these    
   things are critical to Alzheimer's. My argument -- and not everyone agrees --   
   is that, yes, there are things that you can do to reduce your risk, such as   
   exercising and eating a healthy diet.   
      
   Of course, you can't ignore the genetics. Some people have a very strong   
   genetic tendency towards the disease, but even for those people, there are   
   things that do seem to reduce the risk. Diet, sleep, exercise, stress   
   reduction - all of these things are    
   important.   
      
   Here's just one related example: When you eat sugar or simple carbs, you drive   
   up your glucose level, which requires your body to manufacture insulin. Then,   
   your body has to degrade that insulin. To do that, it uses insulin-degrading   
   enzyme. But it turns    
   out that insulin-degrading enzyme is also important for degrading amyloid beta   
   [a protein that builds up in the brains of people with Alzheimer's disease],   
   and it can't be doing both things at the same time. That makes diets that are   
   low in simple    
   carbohydrates promising in terms of prevention.   
      
   There's also been discussion about saturated fats and high cholesterol and   
   their association with Alzheimer's. Type 2 diabetes and metabolic syndrome   
   have a strong correlation with Alzheimer's. All of these things seem to   
   indicate that one's diet over    
   the years is going to be important. When we have the optimal treatment   
   program, it will presumably include an important dietary component.   
      
   Q: Recent research suggests vitamin D may play a role in Alzheimer's. How   
   significant is that discovery?   
      
   A: You're going to see some follow-up on this. If we take vitamin D, is it   
   going to be preventive? Is it just an association or is there a causal   
   relationship in terms of risk reduction? There are all sorts of questions that   
   have been brought up by this.   
      
   The results also bring into focus a question that is coming up again and   
   again. I think it's fair to say that many people increasingly believe that the   
   optimal treatment for Alzheimer's disease and mild cognitive impairment (MCI)   
   will not be a single    
   agent but will be some sort of combination. How do we find that optimal   
   cocktail, that ultimate therapeutic program, which may go beyond   
   pharmaceuticals? Maybe vitamin D is going to be part of that cocktail. That   
   remains to be seen.   
      
   As an analogy, look what happened with HIV. With HIV, you had 3    
   harmaceuticals, each with a very modest effect. But when you combine them, you   
   have triple therapy, which works very, very well.   
      
   Now, let's turn to Alzheimer's, which is a more complicated illness. Let's   
   imagine that the cocktail requires 15-20 drugs rather than three and that none   
   of those drugs by themselves have any statistically significant effect on the   
   disease. If that is    
   the case, then we currently do not have a way forward. After all, once   
   something fails in scientific and/or clinical trials, we're not going to be   
   adding it to something that also has failed. How, then, are we going to find   
   those 15-20 drugs or agents    
   that work well together, and how are we going to convince the FDA to allow us   
   to test them, and, ultimately, how are we going to convince patients that they   
   are going to have to go through a whole program rather than take a single   
   drug, which is what    
   everyone wants.   
      
   Q: What are we now learning about the causes of Alzheimer's disease ?   
      
   A: Genetics and genomics have taught us a lot about this. While we've   
   recognized the importance of inflammation for years, there's now increasing   
   awareness of its role in Alzheimer's and in the possibility that amyloid beta   
   itself is part of the    
   inflammatory response.   
      
   Having said that, you could look at Alzheimer's as you would other chronic   
   illnesses and see that this is really a network, and there are many ways to   
   feed into this network. In other words, we can't point to one single cause. So   
   many things can    
   contribute to the development of Alzheimer's. Inflammation will be part of   
   this. So will metabolism. And, of course, there's the diabetes connection. All   
   of these things are part of it. One of the interesting questions in the field   
   is, why is it that    
   there are so many different risk factors? If you didn't go very far in school,   
   if you had head trauma, if you had low levels of vitamin D, if you went   
   through early menopause -- you just go on and on and on. How do all these   
   different and apparently    
   disparate risk factors relate to what we call one disease, or what we should   
   probably call one syndrome?   
      
   Q: What to you are the most exciting recent discoveries in Alzheimer's   
   research and how will they influence treatment?   
      
   A: There are a lot of interesting things going on. I think the discovery of   
   the Iceland mutation (a gene that may protect against Alzheimer's) is quite   
   interesting, and the exciting part about it is that it not only seems to   
   reduce risk for Alzheimer's    
   disease, but it also seems to reduce the risk for non-Alzheimer's-related   
   cognitive decline.   
      
      
   [continued in next message]   
      
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