Sowing the Seeds

By Dale Bredesen, M.D., Chief Science Officer for Apollo Health

When I was a resident in neurology, we thought of Alzheimer’s disease as a disease of old age, typically diagnosed in patients in their 70s, 80s, or 90s. It was often referred to as “senile dementia of the Alzheimer’s type.” It would be decades before studies analyzing PET scans and spinal fluid would reveal that changes characteristic of Alzheimer’s are observable about 20 years before a diagnosis, and in fact sometimes appear even in the 20s and 30s. Thus just as pre-diabetes may precede diabetes by years, pre-Alzheimer’s typically precedes the dementia phase of Alzheimer’s for many years.

However, as we are studying the underlying drivers of cognitive decline more thoroughly, it is becoming clear that the seeds of what will become Alzheimer’s disease are often sown right from birth (!). As worrisome as this may sound, it offers an unprecedented opportunity to identify the risk factors and prevent Alzheimer-related dementia in the vast majority of patients. As Prof. Robert Lustig points out in his book, Metabolical, babies are exposed to sugar in their formula, so our life-long addiction to sugar, and future development of insulin resistance, inflammation, and suboptimal gut microbiome, are in the works from the first year of life. As we begin to progress from formula to “baby food,” we are fed with products that do not require significant mastication (and this is continued with processed food throughout our lives), and thus our jaws are underdeveloped — indeed, the skulls of our ancestral cavemen show virtually no malocclusion, whereas 25-50% of children now require orthodontics due to malocclusion. This is not just about appearance — it means that our airways are smaller and often compromised, leading to obstructive sleep apnea, which contributes to dementia risk via multiple mechanisms such as hypertension, hypoxia, gastroesophageal reflux, and suboptimal sleep time. Furthermore, the mouth breathing associated with sleep apnea reduces nitric oxide, increasing risk for vascular occlusion and thus compounding risk for cognitive decline, as well as altering the oral microbiome and engendering gingivitis.

From the beginning, most of us are fed processed foods that are deficient in nutrients, high in sugar and toxic additives such as preservatives, and pro-inflammatory. We develop chronic deficiencies in critical nutrients such as magnesium, zinc, iodine, choline, potassium, and DHA. Add the time spent in toxic indoor environments, the chronic stresses so many of us face, and an often sedentary lifestyle, and unfortunately, we have a recipe for Alzheimer’s that is incubating from our earliest days.

The good news is that, as the drivers of cognitive decline are being revealed, they are arming us with the ability to identify and correct these potential contributors long before they exert the chronic effects that will lead to Alzheimer’s disease. The era in which Alzheimer’s disease appears to strike from out of nowhere, and is thought to be unavoidable, is ending, thankfully.