Preventing Dementia and Brain Aging

Throughout our lifespan the aging process unfolds as a gradual deterioration of our bodily functions. The effects of aging include loss of muscle mass and strength, impaired immunity, reduced skin elasticity and decline in memory and other aspects of cognition. The aging process quietly manifests as a subtle and undetectable decline in our biological functions year-to-year, month to month and day to day. This incremental loss of vitality is generally unrecognized in our younger years, but it inevitably shows up.

The good news is that life expectancy continues to increase in America, but the bad news is that what we might call "age related decline" has been increasing. Specifically this would pertain to mental decline, which has to do with aging of our brain. Yes, we may be living longer, but how truly alive will we be when we turn 70, 80, 90 years old or more? We have to ask ourselves some questions. Do I really want to live until I am 100 years old with less than half the brain I now have? Do I want to spend my last years in a vegetative state in a nursing home or worse being a burden and drain on my children? This is probably the last thing anyone of us would want to leave as our legacy. Is there anything we can we do to prevent or least slow this age related brain decline? Yes, in fact, there are a lot of things we can do that are more than likely to be beneficial. First some facts.

Dementia

Dementia is a broad term for neurological conditions that impair memory, reasoning, motor skills and ability to take care of oneself. These are devastating diseases that include Alzheimer's, which is the most common form of dementia, accounting for 60-80% of all cases. Today more than 5 million Americans suffer with dementia and Alzheimer's disease. Alzheimer's disease is the sixth leading cause of death in the US and last year medical costs approximated $ 226 billion. It is interesting that for some reason 2/3 of Americans with Alzheimer's are women. According to the Alzheimer's foundation someone in the US comes down with Alzheimer's every 67 seconds and this trend is likely to continue. (Alzheimer’s Association 2015). I find all this somewhat alarming and here are some reasons why.

First of all, the combined incidence of dementia and Alzheimer's conditions have been increasing. Secondly, as it now stands there is no cure or effective treatment for reversing dementia or Alzheimer's, nor is there anything as yet very much promising on the horizon. Medications may help slow their progression, but don't stop or reverse the underlying disease process itself.

What Causes Brain Aging?

The major area of research has focused on abnormal brain structures-the beta amyloid plaque, neurofibulary tangles and tau proteins, which are commonly found in the brains of Alzheimer's. Amyloid plaques are a mixture of abnormal proteins and nerve cell fragments. It is not known exactly what causes these abnormal proteins to appear. We don't know why some people develop them and others don’t; it is still somewhat of a mystery. Another intriguing question is "Why do some people with these abnormal structures in their brain appear normal and have no signs of mental decline?" Many elderly people have amyloid plaques and tangles in their brains and yet have no obvious signs of dementia. (Scientific American White Paper 2016). So what does this tell us? That it is likely that there is more than one cause of dementia.

The causes of dementia conditions appear to be multifactorial; requiring a broad scope of thinking as to the underlying causes. In my opinion some of the most fruitful areas of finding answers for potential treatments fall within the following four categories.

    Hypoperfusion-caused by reduction in blood flow to the brain • Mitochondrial and peroxisomal metabolism-the role of oxidative stress • Toxic Chemicals-gene and environmental interactions • The gut brain relationship-interactions between brain, diet and microbiome

Hypoperfusion

For our purposes, hypoperfusion refers to reduction of blood flow. Aging of blood vessels involves the gradual narrowing, deterioration and loss of blood vessels at the microscopic level. These are the capillary beds; the microvessels, the microvascular system, which is of crucial importance; since it provides the interface for delivery of oxygen and nutrients, and equally important, the removal of waste products at the cellular level. Every organ, every cell is totally dependent on the adequate and the life-sustaining perfusion of blood through our 60,000 miles of microvessels.

As our blood vessels age so do we. It is this steady reduction in microvessel function with aging that has profound life and death consequences for our overall health and brain function. Consider for a moment the importance of oxygen in maintaining life. At one end of the spectrum-high levels of oxygen can result in optimal levels of energy and health. At the other end of the spectrum with low levels of oxygen, we get heart attacks, strokes or just sputter out and gradually die. Think of this process as a continuim over your lifetime-this incremental progressive reduction in blood flow results in gradual subtle deterioration of bodily and mental function as our microvessels gradually shut down. According to the renowned medical physiologist Arthur Guyton, M.D., "All chronic pain, suffering an disease is caused by a lack of oxygen at the cell level". In my opinion, the dementias and heart disease are essentially the same condition in that there are both diseases of the vascular system. The point is-we are only as old as our blood vessels and if we want to stay healthy it is essential that we make it a priority to take care of them.

The idea that blood vessel damage is primary in causing dementia has a long history of documentation in medical research. More recent studies from Yale University indicate that in Alzheimer's, initial pathological changes involve oxidative induced inflammatory damage to small blood vessels.The subsequent reduction in blood flow activates amyloid-processing enzymes and other pro-inflammatory factors, leading to the lesions characteristic of Alzheimer's disease. (FASEB J.2011 Jan;25(1):5-13).

Vascular Dementia

The vascular dementias are the second leading cause of dementia. They are a diverse group of degenerative brain disorders characterized by a range of blood vessel abnormalities. Vascular dementia also known as multi-infarct dementia or post stroke dementia is very common in older adults with dementia with about 50% having pathological evidence of vascular dementia. Cerebral microvascular disease is indicated by the presence of white matter lesions frequently seen on CT scans. (Experimental Physiology 16 January 2009). The incidence of vascular dementia, but not Alzheimer's disease has gradually decreased since 1977 most likely due to improved treatments for cardiovascular disease. (N Engl J Med 2016 374:523-532). Commenting on this, Alan Lerner, M.D., stated " We know what good for the heart is good for the brain". Again supporting my proposition that dementia and heart disease share very similar causes.

Cardiac output-the amount of blood that leaves the heart and pumped through the body is known as the cardiac index, a measure of heart health. A recent study found that individuals with low cardiac index had significantly lower brain volume and increased brain aging, which means the brain actually shrinks. (Circulation 2010, June 4). Another study indicated that low cardiac index is associated with increased risk of dementia and Alzheimer's. (CirculationAHA, January 2016). Cardiac output is regulated by the body”s tissues need of oxygen, which is dependent upon the blood supply delivered by the microvessels.

The overall message here is that in order to prevent, treat and slow the progression of aging and brain shrinking it is essential that we keep our blood flowing by keeping our microvessels open and free of inflammation. So how do we do this?

The Best Kept Secret in Medicine

External Enhanced Counterpulsation (EECP) is a safe and highly effective treatment for heart disease and improving microvessel function. EECP has been well documented to improve the health of 90% of cardiovascular patients by improving endothelial and microvessel function. ( Clin Med Res. 2013 Dec; 11(4): 226–232.

The key player in keeping our blood vessels open and flowing is our endothelium. The endothelium is the one cell thick innermost lining of our heart and blood vessels. Our endothelium is a truly amazing organ-comprised of about one trillion cells, 60,000 miles long, the surface area of 6 tennis courts and weighs more than our liver. It regulates blood vessel diameter, blood flow, vascular inflammation and is the starting point of plaque formation.

EECP is FDA approved to treat angina and heart failure. It is also being used to treat peripheral vascular disease, erectile dysfunction, peripheral neuropathy, type 2 diabetes (J Appl Physiol 2012; 112 (5)) and restless leg syndrome, all of which are related to blood flow. Studies in the US and other countries have demonstrated that EECP improves blood flow to the brain. (Acta Neurol Scand 2003:107; 405-411) The Chinese have been using EECP to successfully treat Alzheimer's, vascular dementia, Parkinson's disease and stroke for almost 20 years. (J Geriatr Cardiol 2010; 7:88-92). EECP improves blood flow from the top of your head to the tip of your toe and everything in between. So why wait for vascular related disease conditions to develop? Wouldn't it make more sense to preempt their onset with EECP?

What exactly is EECP and how is it administered?

The actual treatment process is ingenious in its overall simplicity. There is no need for injections, needles or catheters. During EECP treatments you lay on a special bed with a series of blood pressure cuffs wrapped around your legs. You are hooked up to a computerized EKG system, which triggers the cuffs to inflate and deflate in sync with the heart beat. You are administered high levels of oxygen. During the resting phase of your heart, the cuffs inflate, pumping oxygen rich blood to your heart, body core and throughout your body. When your heart pumps, the cuffs rapidly deflate and the blood vessels expand creating a vacuum-like effect so blood gets ejected from the heart with less work for the heart muscle. You get a the benefits of a second heart pumping between each heartbeat acting as an auxiliary heart. The procedure is not painful- you will feel a strong squeezing sensation as the cuffs sequentially inflate upward over the calves, thighs and buttocks.

What does EECP do?

What EECP does it is rather extraordinary. EECP is an FDA approved treatment for angina and heart failure. It has been shown to open up collateral blood vessels, create new blood vessels, strengthen the heart and prevent plaque buildup. In addition to wnhanced blood flow to the brain EECP improves type 2 diabetes and can prevent unsuspected heart disease while it generally slows the aging process. It decreases the level of oxidative byproducts, reduces inflammation and increases production of nitric oxide, which dilates the blood vessels.

EECP detoxifies the body as it clears out toxic chemicals and metabolic wastes that have accumulated over the years. It stimulates the bone marrow to produce endothelial precursor cells, which are stem cells that regenerate the systemic and cerebral vascular system. EECP reduces stress by its calming effect on the autonomic nervous system, which is probably why some patients reported sleeping better after doing EECP. You get all this plus the benefits of one hour of aerobic exercise with no risk of injury to your joints. And you don't need to increase your heart rate to get these benefits, in fact, the heart rate decreases and doesn't have to work as hard while doing EECP.

Increasing evidence indicates that too much exercise can have a deleterious effect due to the production of free radicals and oxidative byproducts in addition to the physical trauma to the joints. With EECP you actually lower your level of free radicals, while at the same time, stimulate detoxification of metabolic acids such as lactic acid. (J Heart Disease 1:1 May 99). In addition, there is no risk of traumatizing your back, hip, knee and hip joints. You get all the benefits of one hour of aerobic exercise without having to increase your heart rat. Consider this proposition for a moment-Could we be programmed with a limited amount of heartbeats in our lifetime? If so, then why use them up prematurely? The heartbeats faster in order to fulfill the body demand for more oxygen during exercise, which isn't necessarily all that beneficial for the heart itself. The addition of EECP to a moderate exercise program would have a synergistic effect. I don't think one should be substituted for the other. Ideally we should do both.

By protecting and regenerating our microvessels at an earlier stage we stand a better chance at preempting the ongoing aging process. I would encourage you to add EECP to your brain protection program. An ideal program would start with 3-4 sessions weekly up to 30-35 total followed by a maintenance program of once weekly. I personally did 35 sessions close together about 10 years ago, which is the FDA approved protocol for treating angina. After that, my bicycle performance-both speed and endurance increased by at least 30%. I have never had angina and don't plan on having any. I did this preemptively to prevent cardiovascular and neurovascular problems. I did another series of 35 again about one year ago. My maintenance program is 1 hour once weekly.

Our heart performs an incredible function pumping blood throughout our body 24 hours a day. Depending on your heart rate, the number of beats averages between 86,000-100,000 beats per day. Eventually the pump gets older and gradually begins to fail. At the same time the microvessels deteriorate resulting in reduced blood flow, decreased levels of oxygen and accumulation of cellular waste. We gradually become weaker and more susceptible to a whole spectrum of diseases, which are, at least in part, due to insufficient blood flow. EECP strengthens the heart and pumps blood back into the core of the body as it opens the blood vessels. By doing EECP we will make ourselves stronger internally and less susceptible to disease of all kinds.

EECP has been available for over 30 years and its effectiveness has been documented in over 300 peer reviewed medical publications. Most cardiologists think it's only used for cardiac patients when surgery doesn't work anymore. Up to now it hasn't been the right time for it to be used as a health enhancing wellness choice. EECP actually uses your own body to make it healthier, it is essentially self-healing.

If you think you are already healthy, why not get more healthy, better, stronger? Set your goals higher. Getting and staying healthy takes being proactive. Fundamental to maintaining good health is our heart and circulation. Poor circulation is the probably the basis of many illnesses. EECP can offer tremendous benefit and help delay illness. EECP makes perfect sense, it is logical-"a no-brainer". Check it out, try it a few times and you will feel better and know that it is good for you.

Improving blood flow is a major part of the answer to help prevent and perhaps reverse these brain aging conditions. However, we also need to get control of the oxidation/inflammation that causes damage to blood vessels and brain cells. Although EECP has been shown to have antioxidant and anti-inflammatory properties, it should be utilized along with other modalities, including protecting our mitochondria, detoxification of environmental toxins, appropriate nutrient supplementation and preserving a healthy gut brain relationship.

Mitochondria, peroxisomes and oxidative stress

Mitochondria are intracellular organells, specialized subdivisions in cells that have numerous life-sustaining functions. They are the power producers within the cell, converting food into the energy needed to sustain life. If they are damaged less energy is produced by the cell and various organ function begin to fail. This is especially true for the brain, heart, liver and muscles. The energy that mitochondria generate comes from a complex process called the electron transport chain. This energy production comes at a cost since it creates high energy oxidative free radical byproducts. If uncontrolled these free radicals can destroy the mitochondria and its DNA and other cellular components, resulting in impaired cellular function and eventually death of the cell.

Mitochondrial dysfunction and oxidative stress are among the most discussed hypotheses related to causation of dementias. The mitochondrial free radical theory of aging was first proposed by Denham Harmon in 1956. (J American Geriat Soc 1972, 20:145-47). The mitochondrial cascade hypothesis of Alzheimer's disease proposes that changes that occur in mitochondrial function as we age lead to the key brain changes that wreak havoc in Alzheimer's disease. Although widely accepted, these theories remain unproven.

Inflammation is well accepted as the underlying factor in most degenerative diseases such as arthritis, cardiovascular disease, inflammatory bowel disease, lupus, diabetes and dementia. The primary cause of inflammation is mostly due to uncontrolled oxidation from the production of free radicals, also known as reactive oxygen species (ROS). Alzheimer's disease exhibits extensive oxidative stress throughout the body, especially vulnerable regions of the brain. Extensive research strongly associates Alzheimer's disease and cognitive disorders with increased oxidative stress and mitochondrial dysfunction. (Cell Adh Migr. 2009 Jan-Mar; 3(1): 88–93).

The underlying message here is that uncontrolled production of reactive oxygen species can impair and destroy mitochondria and brain cells. The research implicating mitochondrial dysfunction and oxidative stress as a prominent feature of aging appears strong, although the underlying mechanisms are still unclear.

There is no question that free radicals/ROS cause widespread cellular damage to cell membranes, mitochondria and DNA. If we have sufficient antioxidants on board then these free radicals will neutralized. So the conventional wisdom would appear that if we take enough antioxidants we can reduce risk for most degenerative diseases and slow the aging process. Taking large doses of antioxidants might seem logical, but happens to be an over simplified conclusion for a complex interwoven process .What antioxidants should one take, how much, how often? Are somewhat important and others? Could antioxidants actually be harmful? Could free radicals have both beneficial effects and negative effects?

Unfortunately the research gives only contradictory results. Some studies indicate benefits from taking antioxidants, while others show no benefit, while still others indicate increasing risk for a heart attack and cancer. Keep in mind that once antioxidants perform their antioxidant function, they get converted to free radicals (pro-oxidants); so that it is possible taking too many could be harmful. They need to be taken in balance with other antioxidants, which are able to regenerate one another.

Our body cannot convert food into energy without producing free radicals. Free radicals are natural byproducts of breathing and necessary for our immune cells needed for attacking viruses, bacteria and cancer cells. Free radicals are essential for life and proper cellular function. These much maligned molecules are not entirely harmful; they are also beneficial and may help us live longer. After all they are part of our fundamental design and function. It has been well established that reactive oxygen species function as signaling molecules activating or inhibiting various gene and metabolic processes. Recent studies from the Karolinska Institutet have shown that increased production of free radicals in the mitochondria contribute to stronger contraction of heart cells so it is able to pump more blood under stress. (J Physiol 28 Feb 2011) So it appears that free radicals function a a two-edged-sword. They are both good and bad for us, so there has to be a balance.

Peroxisomes

Enter the peroxisome-another fascinating cellular organelle, which shares many features with mitochondria. They play an essential role in regulating longevity processes and are linked to the free radical theory of aging. Peroxisome dysfunction has been associated with cellular aging and development and progression of specific age related degenerative diseases. (Geriatr Gerontol Int all 2014; 14:740-749). They are involved with breakdown of fatty acids, energy production and both the production and scavenging of free radicals, especially hydrogen peroxide. Peroxisomes oxidize fatty acids to acetyl-coenzyme A, which are utilized to replenish substrates destined for mitochondria energy production, so they help supply "food" for the mitochondria.

At low nontoxic levels, free radicals can function as potent anti-aging signaling molecules that induce protective stress, but at concentrations above a specific threshold, a pro-aging course is triggered. Peroxisomal generated free radicals, particularly hydrogen peroxide, appear to be an upstream initiator of age-related mitochondrial dysfunction and aging. Peroxisomes contain catalase, an enzyme which converts hydrogen peroxide into oxygen and water. Catalase has one of the highest enzymatic turnover rates and is able to convert approximately 5 million molecules of hydrogen peroxide to water and oxygen each second!

The communication between mitochondria and peroxisomes involves a very complex and dynamic integration. (Cell Metab 2008;7: 200–203). When mitochondria start to dysfunction, our cells activate the mitochondrial retrograde signaling pathway to hundreds of nuclear genes causing global changes in beneficial gene expression. (Front Physiol 2012; 3:283, Antioxidants & Redox Signaling (Impact Factor: 7.41). 10/2013; 20(4).

In summary, the overall message is that a certain amount of free radical production is protective and essential to our well-being. The right amount of oxidative stress is beneficial by stimulating genetic global protective processes.

A large array of nutrients of various types have been shown to protect the mitochondria and brain cells. A partial includes alpha lipoic acid, glutathione, vitamin C, N-acetylcysteine, nicotinamide riboside, vitamin E, resveratrol, NADH, sulforophane glucosinolate, catalase, omega-3 fatty acids, DHA, extra virgin olive oil, coconut oil , chocolate, coffee, green tea, black tea, tumeric, vitamin D , probiotics and flavinoids. These nutrients can be either beneficial or harmful and should be appropriately selected based on individual requirements.

Perhaps the safest and best thing to do is keep it simple and play it safe- just eat a healthy diet-like the Mediterranean and/ or DASH diet. The combination of these two diets is known as the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND). A recent study at Rush University Medical Center showed that the MIND diet lowered the risk of Alzheimer's by 35 percent for people who followed it moderately well and up to 53 percent who strictly adhered to the diet. The emphasis focuses on eating 10 different brain healthy food groups:, nuts, berries, beans, whole grains, fish, poultry, olive oil, wine, green leafy vegetables and all other vegetables.

At the same time avoiding excessive amounts of unhealthy foods: red meats, butter, margarine, cheeses, pastries, sweets and fried or fast foods. Rather than focus on caloric restriction and difficult diets the focus is on increasing your intake of foods that are good for the brain. It is more of a lifestyle change as opposed to a "diet "and therefore easier to stick to. All of this would be also protective against heart disease and diabetes. What is good for the brain is good for the heart.

The Gut Brain Relationship

Another important aspect of staying healthy relates to the microbiome-the complex relationship between our trillions of intestinal microbes and how they and their genes interact with our immune system and brain. Microbiome researchers are beginning to discover some answers as to what groups of bacteria may be more beneficial than others. Taking probiotics might seem to be good idea, but which probiotics and how much? We don't have the answers as yet. What is known according to several leading authorities- the best way of developing and maintaining healthy intestinal bacteria is through a healthy diet This means, at the very least, eliminating toxic and sugary processed foods, food additives, soft drinks etc.. Some experts are calling Alzheimer's, diabetes of the brain, sending a clear warning about excessive consumption of sugary foods, high fructose corn syrup and refined carbohydrates, etc. Consider the correlation between the exponential increase in type 2 diabetes and dementia conditions. Once again, we are back to the fundamental importance of a healthy diet-think Mediterranean or MIND diet.

Toxic foods include not just overly processed sugary foods, but could also include any food that you are allergic to, since allergic reactions are inflammatory in nature. Gluten intolerance can cause inflammatory reactions in the intestinal tract and brain in someone with gluten sensitivity. Gluten intolerance doesn't just mean celiac disease; it also includes non-celiac gluten intolerance. Gluten intolerance appears may be more widespread than we used to think. However, in my opinion, much of what we think is gluten intolerance is actually wheat allergy.

Gene-Environmental Interactions-Toxic Chemicals and the Brain

The next part of this discussion is an overview of the relationship between our genes, toxic metals and dementia conditions. Tau proteins, which we previously discussed are structures that help form the microtubules of neurons. Microtubules transport nutrients and other constituents throughout the nerve. When these structures are damaged, and they become part of the neurofibrillary tangles commonly found in Alzheimer's. Both mercury and lead are known to damage microtubules resulting in nerve dysfunction or destruction.

Toxic chemicals are ubiquitous in today’s environment. We absorb them from the air, water and food and we either eliminate or store them. Ninety-five percent of the patients that I have tested have evidence of toxic chemical accumulation in their body. This includes lead, mercury, cadmium and aluminum among others. The level of toxic metals I'm talking about are considered normal according to EPA and CDC standards, nevertheless, they are a toxic burden on the body.

Normal levels of toxic metals don’t necessarily mean all is well. They are metabolic poisons, extremely neurotoxic and immunotoxic and cause increased oxidative stress even at so-called "normal or safe levels". Is it possible that these toxic metals and other chemicals could be contributing to the dementias? Some experts say that the reason that we are seeing an increase in dementias is simply because we are living longer. This is true; on the other hand, we are living in a toxic world and the longer we live the more toxins we accumulate.

The most common genetic risk factor for developing Alzheimer's disease is related to a protein called apolipoprotein E (APOE). APOE is one of the lipoproteins that carries cholesterol and plays a significant role in the formation of amyloid plaques. Everybody carries two different APOE genes; one inherited from each parent. There are 6 different gene combinations possible. Individuals with one copy (from one parent) of APOEe4 have a 2.5 times greater risk of developing Alzheimer's.

A person with two copies of APOE e4 has a 50 percent chance of developing Alzheimer's by age 80. The APOEe4 combination appears to increase the risk of Alzheimer's and is present in about 25-30 percent of the population and about 40 percent of all patients with late onset Alzheimer's. Not all people with Alzheimer's disease have the APOEe4 combination and not all people who have it will develop the disease. (Scientific American White Paper- Memory 2016)

How APOEe4 increases a person's susceptibility to Alzheimer's is not yet known. What is known, however, is that this combination is associated with an increased number of protein clumps called amyloid plaques in the brain of affected people. The buildup of this toxic amyloid is associated with death of the neurons and progression of disease. Other research has shown that people with this mutation are more genetically susceptible to degenerative neurologic conditions. You might be asking yourself, "Why would I want to know if I had this genetic mutation since genes control my destiny and there is nothing I can do about it? First and foremost, genes don't control our destiny. They are basically libraries of information, which are controlled by our environment-what we eat, what we are exposed to, at our attitude and what we think.

There are some reasons we should know about some of our genetic mutations. People with the APOe4 mutation may have impaired ability to detoxify toxic metals (J Alzheimer's Disease, 5(3):189-195,2003). This suggests that those with these gene mutations would be more susceptible to the effects of toxic metals and more likely to sustain neurological damage from them. Whether or not you have this bad combination of genes, you should consider getting your level of toxic metals tested and if elevated go through a safe and selective detoxification program (which would be enhanced with a series of EECP treatments).

There are other genetic mutations that may play a role in degenerative diseases of the brain. Glutathione is the most critical molecule involved in detoxification process and is essential for proper mitochondrial functioning. Many people are not able to produce sufficient levels of glutathione due to genetic mutations GSS and GSTP1. This mutation has been proposed as one of the causes of aging. (J Aging Res 2011). Mutations in the MTHFR genes may also result in impaired production of glutathione.

In summary, genetic mutations can lead to increased susceptibility to the neurotoxic effects of toxic metals and other toxic chemicals. These are toxins that we have accumulated over the years living in a less than ideal world. Whether or not you have one of these mutations, it would still make sense to lower the level of the various chemical toxins you have accumulated over the years. One way of doing this is by leading a nontoxic lifestyle.

Stop using toxic cleaning agents, body care products, detergents, fabric softener, etc. Avoid unsafe building materials. Improve the air quality in your home. Be sure the ventilation system is functioning properly and frequently maintain the filters. Start eating mostly organic foods. Sweating in a sauna he has been shown to reduce the level of toxic chemicals in humans. These are just some of things you can do to reduce your toxic load.

Putting It All Together

Basic Principles

    • Improve microvascular blood flow • Reduce oxidative free radical damage • Protect your mitochondria • Eliminate toxins • Be happy

What To Do

A combination of the following is a program designed to minimize the negative effects of aging:

    • Maintain good blood flow using EECP and exercise • Reduce inflammation and oxidative stress-supplementation with specific antioxidant nutrients based on laboratory testing • Preserve mitochondrial and peroxisomal function with some of the nutrients needed for energy production such as l-carnitine, ubiquinone,, D-ribose, catalase and nicotinamide ribinoside. • Reduce level of metabolic and environmental toxins. • Maintain a healthy intestinal microbiome with diet and maybe probiotics • Consider an attitude change if needed. Don't worry, be happy! At

What To Eat

MIND diet-focusing on brain healthy food groups

    o Green leafy vegetables-one salad a day o Vegetables and fruits-at least 6 servings a day o Nuts-especially walnuts, which are good to snack on o Berries-particularly blueberries and strawberries o Whole grains o Fish o Poultry o Olive oil and/or olives o Wine

Eliminate sugar, refined carbohydrates, junk food, soft drinks etc. No need to go into details here, since there is so much available information on how to eat healthy. My basic recommendation is to eat more vegetables-at least 6-8 servings a day; better 8-10. Eat a wide variety of colored vegetables and be sure to include cruciferous vegetables, which contain sulfur and glucosinolate groups that are important in detoxification and mitochondrial protection. Common cruciferous vegetables include broccoli, cabbage, cauliflower, brussels sprouts, kale, collard greens, bok choy, chard,turnip greens, arugula, rutabaga and wasabi.

What About Fats?

Cell membranes contain many different receptor sites for chemical messengers such as hormones and neurotransmitters. They are mostly made of fats including cholesterol and omega-3 fatty acids. Omega-3 fatty acids are very susceptible to oxidative damage from free radicals, so they have to be constantly replenished with healthy non- oxidized essential fatty acids. Eat more cold water fish and/or take omega-3 fatty acids at least 1 g a day. Some saturated fat is okay-even the American Heart Association guidelines include 2 tablespoons of butter a day. The only truly "bad fats" are transfatty acids, which are actually toxic.

Informative lab Tests

    • Routine blood tests, CBC, chemistry panel, electrolytes, lipid profiles • CRP, GGT, interleukin-6, oxidized LDL, homocysteine, hemoglobin A1c- to measure the level of occupational/inflammation. • Spectracell Analysis-functional requirements for vitamins, minerals, amino acids and antioxidants • Peripheral arterial tonometry (EndoPat) to assess microvessel and endothelial function • Levels of toxic metals-blood and urine. Urine tests before and after provocation. • Venous blood gases-determines the level of oxygen at the cell level • Genetic testing

Supplements to Consider

Glutathione

Glutathione is essential for its detoxification and antioxidant effect. You can improve your glutathione status by taking N-acetylcysteine (a precursor to glutathione) 500-1000 mg daily or more. Some of the liposomal glutathione supplements also appear to be effective. (Redisorb 1-2 teaspoons daily)

Nicotinamide ribinoside

Mitochondria regulate the relative ratios of NADH/NAD of all necessary for driving and maintaining proper function of the electron transport chain; the energy generating system of the mitochondria. This system is dependent upon nicotinamide ribinoside, which can be taken as a supplement. (Niacell 125 mg 1-2 tablets twice a day)

Vitamin E

Research on vitamin E effects on dementia are conflicting. Some studies indicate it is beneficial for Alzheimer's and others find no evidence. The studies that did show benefit for vitamin E used high doses- 2000 units of alpha-tocopherol. A related study of the use of vitamins in 49 different trials indicated that vitamin E was associated with significant reduction in cardiovascular mortality. (Advances in Nutrition: An International Review Journal. Jan 2017 vol. 8 27-39). My take on it is that if it is good for the heart, then it is good for the brain and probably beneficial and worth taking. I take 2000 units of mixed tocopherols-alpha, beta, gamma and delta tocopherols, not just alpha.

Resveratrol

Extensive research indicates the presence of "longevity genes"-specifically the SIRT group of genes, which have major regulatory roles in the immune system, inflammation control, DNA repair, gene stability and antioxidant activity. Resveratrol has been shown to activate this group of genes, which then switches on various survival mechanisms-the same ones that get turned on during fasting and caloric restriction. By activating various biochemical processes, it appears that it may be important in preventing and treating cardiovascular disease and neurodegenerative disorders. Resveratrol has been shown to reverse type 2 diabetes in a double blind human study. (Journal of Clinical Endocrinology Metabolism 2008; 93 (7)).

I take other nutrients that can offer both neurological and cardiovascular benefits including ubiquinol, l-carnitine, SOD/catalase and alpha lipoic acid. Alpha lipoic acid is unique in that it is both water and fat-soluble is able to regenerate other antioxidants after they become oxidized. SOD/catalase are extremely important in protecting our cells from the damaging effects of hydrogen peroxide by converting it to water and oxygen.

Final Thoughts

Based on my research and experience I take most of these supplements 5-6 days a week. I do EECP once weekly, basically follow a Mediterranean diet, walk at least 30 minutes daily and do strength training 4 days a week. This is my own personal decision and not a general recommendation for anyone. Is this expensive? Yes and no. My thought is-pay now or pay later. I would rather spend a couple hundred dollars a month extra now than take the risk of having a major health crisis that might have been prevented by a healthy diet and wisely chosen supplement program. Unhealthy aging can be a lot more expensive financially, physically and emotionally. Getting older does not have to mean we have to spend our later years in hospitals and clinics, undergoing imaging studies and numerous medical "procedures" or worse in a nursing home facing burdensome medical costs, etc. Do I think that all this will guarantee prevention of a serious health crisis? Of course not. There are no guaranteed treatment outcomes in the field of medicine. Consider this a reasonable comprehensive risk reduction program.