Serialised in the Daily Mail and featured in a long review article in The Saturday Times, a new book called The Alzheimer’s Solution, written by neurologists Dr Dean Sherzai and Dr Ayesha Sherzai, has generated a huge amount of interest in the British press. Perhaps this is a reflection of our concern in the UK with this disease; many of us being touched by it directly or through friends and loved ones. Dementia is now the leading cause of death in the UK and Alzheimer’s disease is the main form of dementia.
Sherzai & Sherzai’s research adds to the growing evidence that a diet and lifestyle approach can dramatically cut the risk of Alzheimer’s – they suggest that The NEURO Plan, outlined in the book, reduces the risk of Alzheimer’s disease by 90% – NEURO stands for – nutrition, exercise, unwind, restore and optimise and has many similarities to The Bredesen Protocol and Cytoplan’s Action Against Alzheimer’s programme – www.action-against-alzheimers.co.uk (and see below for more information)
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NEURO stands for:
Nutrition – the focus is on a whole food, plant-based diet. The importance of B vitamins and omega-3s are emphasised along with plenty of fibre and antioxidants from vegetables. Animal products are discouraged.
Exercise – this includes being active through the day, not just going to the gym (although it is recognised that exercise that raises heart rate and increases muscle strength should also be included). Exercise is important for ensuring adequate oxygen and nutrient delivery to the brain has anti-inflammatory benefits and stimulates an increase in a brain peptide called brain-derived neurotrophic factor (BDNF) often described as miracle-gro for the brain.
Unwind – managing stress using meditation, yoga, music, or walking (a slow meditative walk). Stress has many damaging effects on the brain – for example, chronically high levels of cortisol (the stress hormone) destroys neurons (i.e. causes brain shrinkage), triggers inflammation, affects the gut, contributes to insulin resistance and increases blood pressure – all of which are relevant for brain health.
Restore – this refers to ensuring adequate sleep. Lack of sleep is linked to brain shrinkage (via activation of microglia, the brain’s immune macrophage cells), loss of concentration, focus and attention, low mood and increased risk of stroke. It is also during sleep that beta-amyloid plaques, part of the pathology of Alzheimer’s, are broken down.
Optimise – undertaking complex activities that challenge multiple functions and which therefore result in increased cognitive reserve. These would include activities such as learning a new language or musical instrument, playing chess or bridge, learning to dance. This also includes social interaction.
If you have read some of our previous blogs on Professor of Neurology, Dale Bredesen’s approach – ‘The Bredesen Protocol’ you will notice the similarities. The Bredesen Protocol includes all the above elements. As might be expected, there are a few differences in some of the detail and this may be partly related to the patients each has predominantly been working with. In the case of the Sherzais, the book suggests that they have mainly been working with people with early stages of brain impairment – subjective cognitive impairment (SCI) or mild cognitive impairment (MCI); whereas Professor Bredesen has been working predominantly with people with MCI or who have progressed to mild or moderate Alzheimer’s disease.
Both the Sherzais and Professor Bredesen emphasise the importance of vegetables and healthy fats. However, The NEURO Plan has a greater emphasis on the inclusion of whole grains and does not embrace the use of coconut oil, which The Bredesen Protocol recommends for people with diagnosed Alzheimer’s for the production of ‘ketones’ which the brain can use as fuel. Both approaches suggest limiting red meat, but The NEURO Plan also limits eggs and chicken (due to concerns about the saturated fat content) and favours the inclusion of daily intake of beans and pulses.
Other differences are that Professor Bredesen considers a more extensive use of supplements, for example, to support nutrient status (the brain has significant energy and micronutrient requirements), to reduce inflammation and optimise gut health, which is a key priority area.
Interestingly the Sherzais’ memory clinic is in California close to two very different communities – the healthy population of Seventh Day Adventists in Loma Linda and the adjacent community in San Bernardino, a deprived area with high rates of chronic disease and poor access to health care.
“We consistently found that people living a healthy lifestyle [the Seventh Day Adventist community] had a much lower prevalence of dementia. By contrast, those who lived unhealthy lifestyles got dementia more often and it usually emerged earlier in life” [referring to the neighbouring typical modern community of San Bernardino].
Loma Linda is considered one of the healthiest places in the world. A third of its residents are Seventh-Day Adventists whose faith is deeply connected to health and wellness. They are active, vegetarian, manage stress, are spiritual with strong community and family ties. This results in the people there living on average 7-9 years longer and importantly living longer free from the chronic disease compared to the general population.
This area is notable as being one of five areas in the world that have been designated a ‘Blue Zone’. Blue Zones were described by Dan Buettner in his excellent book of that name – these are areas in the world where communities of people live longer and importantly live well for longer (rates of chronic diseases are lower and it is common for people to live into their 90s or even over 100).
Blue Zones have been identified in Okinawa in Japan, Ikaria in Greece, Sardinia in Italy, Nicoya in Costa Rica and Loma Linda in California. In the book Dan Buettner identifies a number of diet and lifestyle characteristics that these communities around the world have in common:
People living in Blue Zones:
1) Move naturally – activity is part of daily life. This is about more than going to the gym, movement is within the fabric of their day-to-day;
2) Eat a diet that is mainly plant-based, meat is treated as a ‘side dish’ and may not be eaten every day. The diet is based on whole foods, processed foods are avoided;
3) Stop eating before they are full. The Okinawans have a name for it Hara Hachi Bu – which means that they stop eating when 80% full. Other research has also linked calorie restriction to anti-ageing benefits and longevity;
4) Drink red wine in moderation – this means just one small glass daily (however its worth mentioning that contrary to what is often reported in the press, research has shown that there is no benefit to mortality from moderate drinking – ‘all-cause mortality’ increases in line with alcohol consumption, with alcohol there is no safe dose. Having said that a small amount of red wine may reduce the risk of certain specific diseases e.g. heart disease)
5) Have a purpose in life. This means they know their reason for waking up in the morning
6) Take time to relax
7) Participate in a spiritual community
8) Make family a priority
9) Be surrounded by those who share their Blue Zone values
Multi-modal approaches to Alzheimer’s
Both Professor Bredesen’s and the Sherzais; approach take account of the multiple biological mechanisms that are involved in the development and progression of Alzheimer’s. On the other hand, drug therapy and monotherapies (single agent drug therapy) for neurodegenerative diseases have failed because they do not address the multifactorial nature of these conditions.
There are many studies supporting each of the elements (nutrition, exercise etc) on cognitive health, but fewer that have used a multifactorial approach. One other major study that has is the FINGER Study (Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability). The research, published in The Lancet in 2015, was a multi-domain approach to preventing cognitive decline in at-risk elderly people from the general population in Finland. The findings from this large, long-term trial suggested that the multi-domain intervention could improve or maintain cognitive functioning.
The main hypothesis of this trial was that simultaneous changes in several risk factors would lead to a protective effect on cognition in at-risk elderly from 60-77 years of age.
The participants were divided into 2 groups. The control group of 565 people received regular health advice. The intervention group of 554 received additional intervention including nutritional advice (a plant-based diet high in omega 3 fatty acids), a physical exercise training programme (aerobic and resistance training), a cognitive training programme and social activities. Vascular risk monitoring was also undertaken for the intervention group.
At the end of the two year period, the intervention group had a significantly higher score in cognition (the primary outcome) and secondary outcomes of executive functioning and processing speed, plus BMI, dietary habits and physical activity.
Action Against Alzheimer’s Programme
Th Action Against Alzheimer’s programme has been developed at Cytoplan. Whilst Alzheimer’s and dementia may be diagnosed in our 70’s or 80’s, the processes that eventually result in dementia occur much earlier – in our 30’s, 40’s, 50’s, and 60’s. The Action Against Alzheimer’s Programme is for people BEFORE they develop dementia; it is an upstream workshop programme based on a multi-modal diet and lifestyle approach. It is being delivered by Cytoplan Licensed Nutritional Therapists to small groups of the general public through a series of 8 workshops.
The workshops are designed to help people engage with each aspect of the programme and understand what they need to do to optimise brain function, thus the workshops cover: Nutrition, Gut Health, Stress, Sleep; Exercise & Brain Training. A home study module – the Self Care Journey – runs alongside the workshops and is designed to support the change process.
To find out more please visit – www.action-against-alzheimers.co.uk
1) The NEURO Plan uses a multi-modal approach to brain health – Nutrition, Exercise, Unwind, Restore and Optimise
2) Similar in approach to The Bredesen Protocol which recognises that brain health is dependent on multiple factors – many biological mechanisms need to be optimised to bring the brain back to health
3) The Sherzais clinic in California is close to the Seventh Day Adventist community of Loma Linda. This is one of five Blue Zones that have been identified around the world. These are areas where people live without chronic ill-health for longer and where there are a larger proportion of people living into their 90s and 100s
4) People living in Blue Zones around the world share similar values and behaviours – they eat a whole food, unprocessed diet; activity is part of their life; family, community and having a sense of purpose are all important
5) Other research which has shown the benefits of a multi-modal approach is the FINGER study. This two-year study in Finland showed that diet and lifestyle change could prevent cognitive decline
6) The Action Against Alzheimer’s diet and lifestyle programme is being run by Cytoplan Licensed Nutritional Therapists working with small groups
you have any questions regarding the topics that have been raised, or any other health matters please do contact me (Clare) by phone or email at any time.
firstname.lastname@example.org, 01684 310099
Clare Daley and the Cytoplan Editorial Team
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Bredesen D (2017) – The End of Alzheimer’s
Buettner D (2008) – The Blue Zones. National Geographic Society
Morris M C et al (2015) – MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimer’s & Dementia, 11, 9, 1007-1014
Ngandu T et al (2015) – A 2 year multidomain intervention of diet, exercise, cognitive training and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet, 385 (9984), 2255-63
Sherzai D & Sherzai A (2017) – The Alzheimer’s Solution. A revolutionary guide to how you can prevent and reverse memory loss. Simon & Schuster UK Ltd