#090 How to Prevent Alzheimer’s Disease

How to Prevent Alzheimer’s Disease Dr. John Day
Dr. Day is a cardiologist specializing in heart rhythm abnormalities at St. Mark’s Hospital in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and cardiac electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and the Utah chapter of the American College of Cardiology.

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How to Prevent Alzheimer’s Disease

My dear friend just learned this week that her father was diagnosed with Alzheimer’s Disease.  The tragedy is that he is only 50 years old.

Does Alzheimer’s run in the family?  Is there anything you can do now to prevent you from suffering the same fate?  In this article I discuss the 10 things you need to do now to minimize your risk of ever suffering from this devastating condition.

Do You Have the Alzheimer’s Gene?

If you have a family history of Alzheimer’s Disease then there is a high chance that you have the “Alzheimer’s gene.”  Specifically, half of all people with Alzheimer’s Disease have the ApoE4 gene.  While this is the most important gene for Alzheimer’s Disease, there are also other “lesser” genes which may also be involved.

The ApoE gene controls cholesterol and lipid metabolism.  There are 3 main forms of this gene, ApoE2, ApoE3, and ApoE4.

If you have the “ApoE2” form then you are protected against developing Alzheimer’s Disease. ApoE3 is the “normal” form of this gene and has no increased or decreased risk of Alzheimer’s Disease.  Unfortunately, about 25% of Americans have at least one copy of the ApoE4 form which puts them at significant risk of high bad cholesterol (LDL) as well as heart disease and Alzheimer’s Disease.

We each have two copies of the ApoE gene.  One from our mother and one from our father.  If you have just one copy of the ApoE4 gene then your risk of Alzheimer’s Disease is increased 2-3 fold.  Tragically, if you have 2 copies of the ApoE4 gene your risk of Alzheimer’s Disease is increased 20-30 fold.  Not only does the ApoE4 gene put you at high risk of Alzheimer’s Disease, it also causes the disease to develop as early as age 30.

How Do You Know if You Have the ApoE4 Gene?

You can now know if you have the Alzheimer’s gene for a little over $100.  You don’t even need your doctor to help you with this test.  This is something you can order for yourself online.

Not only will you learn your Alzheimer’s gene status, you will also learn about thousands of other genes for cancer, obesity, autoimmune diseases, etc.  Other than filling out a few online forms all it requires of you is some of your saliva in a test tube.  To learn more, I describe the details of how to test your genes in a previous blog post.

Are Your Genes Your Destiny?

Do our genes determine whether or not we will develop certain diseases?  Absolutely not!  Our DNA is not our destiny.

Our genes just represent the seed.  For a seed to grow it requires the right nutrients in the soil, water, and sunlight.  The same is true for our genes.

If we can live a perfectly healthy lifestyle we can turn the ApoE4 gene off.  This is done through a process known as epigenetics.  In fact, only 25% of our health future is determined by our genes.  The other 75% is completely up to us based on the decisions we make every day.

How Do You Silence the ApoE4 Gene?

Fortunately, even if you have the ApoE4 gene it doesn’t need to cause high cholesterol, heart disease, and Alzheimer’s Disease.  While this often happens with our Western lifestyle, we have scientific evidence from 3 groups of people living an ancestral lifestyle who do not suffer any bad effects from the ApoE4 gene.

1. Pima People Living in Mexico

The Pima people reside in Arizona and Mexico.  They were once known for their lean bodies, great athleticism, and health.

Unfortunately, after being driven from their native lands and way of life, the Arizona Pima people were given government rations of white flour, sugar, canned goods, and industrial oils to keep them from starving.  A few generations later they now have one of the highest rates of obesity, diabetes, and Alzheimer’s Disease anywhere in the world.

In 1999, researchers studied a group of Pima people still following the traditional Pima diet and lifestyle in Western Mexico.  Even among those Pima people with the ApoE4 gene, they saw no evidence of high cholesterol, heart disease, or Alzheimer’s Disease.  The researchers concluded that this ancestral lifestyle protected the Pima people from the ravages of the ApoE4 gene.

2. Yoruba People Living in Nigeria

Later, in 2004, researchers evaluated two groups of people of African descent with regards to the ApoE4 gene and Alzheimer’s Disease.  Of the two groups in this study, one group lived in Indianapolis, Indiana and the other Ibadan, Nigeria.

As expected, the ApoE4 gene increased the risk of Alzheimer’s Disease in African Americans living in Indianapolis.  However, quite unexpectedly, the ApoE4 gene had absolutely no effect on the risk of Alzheimer’s Disease among the Yoruba people living in Ibadan, Nigeria.

Once again, the researchers concluded that the traditional diet and lifestyle of the Yoruba people living in Nigeria silenced the ApoE4 gene and protected them from developing Alzheimer’s Disease.

3. Sub-Sahara Africans

In 2014, researchers reviewed data published in 522 studies on the risk of dementia in Africa.  As with the previous two studies, this study came to the same conclusion.  In Sub-Sahara Africa, Africans who have the ApoE4 gene but yet still eat the traditional diet and follow the traditional lifestyle completely silenced the ApoE4 gene.

Are ApoE4 People the Canary in the Coal Mine?

In the past, canaries were used in coal mines to warn miners of impending danger.  The build up of toxic gases in the mine, like carbon monoxide or methane, would kill the canaries long before the miners were affected.

In our modern Western way of life, people with a copy of the ApoE4 gene represent the canary in the coal mine.  In other words, the Standard American Diet (SAD) and physical inactivity harms people with the ApoE4 gene long before people with the other forms of the ApoE gene.

For people with the ApoE4 gene, to escape the fate of the canary in the coal mine, they must give up the Standard American Diet (SAD) and embrace a physically active lifestyle.  Indeed, studies have shown that for people with just one copy of the ApoE4 gene, a poor diet and lifestyle increases the risk of Alzheimer’s Disease by 11-fold!

How to Prevent Alzheimer’s Disease: 11 Strategies

If you have a family history of Alzheimer’s Disease then odds are that you also have the ApoE4 gene.  If you have this gene or a family history of Alzheimer’s Disease, let me share with you 11 ways to prevent this tragic fate.

1. Exercise Faithfully

For people with the ApoE4 gene or a family history of Alzheimer’s, exercise is the single most important thing they can do to decrease this risk.  While exercise is good for everyone, the benefits seem to be most pronounced in people with the ApoE4 gene.

It doesn’t matter what form of exercise you do as long as you do something physical every day for the rest of your life.  In addition to exercise, make sure you minimize any sitting throughout the day.

2. Maintain a Perfect Weight

Following exercise, maintaining an ideal weight is absolutely critical for people with the ApoE4 gene or a family history of Alzheimer’s Disease.  Unfortunately, I have found that most people have no idea what their ideal weight is.  If you weigh more than your ideal weight this extra weight can turn the ApoE4 gene on.

People with the ApoE4 gene or a family history of Alzheimer’s need to have a body mass index (BMI) at least lower than 25 which is the bare minimum to no longer be considered overweight.  To learn your own BMI, here is an excellent online BMI calculator.

3. Keep Your Mind Active

Countless studies have shown that stimulating your mind over a lifetime can help to prevent Alzheimer’s Disease.  The same is true for people with the ApoE4 gene or a family history of Alzheimer’s.

4. Eat a Low Cholesterol Diet

New dietary guidelines in the U.S. will now stop recommending that people avoid cholesterol in the diet.  While dietary cholesterol does not affect blood cholesterol levels in most people, this is not true for the 25% of Americans who possess at least one cope of the ApoE4 gene.  For people with the ApoE4 gene, minimizing dietary cholesterol still matters!

5. Avoid Trans Fats and Minimize Saturated Fats from Animals

As with dietary cholesterol, saturated fats may no longer be dangerous to cardiac health as was once thought.  Once again, this is true for most Americans, not those with the ApoE4 Alzheimer’s gene.  For these people, minimizing saturated fats from animal products (meat and dairy) are critical to preventing dementia.

Trans fats are still rampant in processed foods, fast foods, bakery items, and restaurant foods.  Anything processed or prepared could be loaded with trans fats.   Even if the label says no trans fat this may not be the case due to loopholes in U.S. labelling laws.  You have to read the ingredient list carefully.  Trans fat for people with the ApoE4 gene are particularly dangerous.

6. Make 9 Servings of Fruits and Vegetables the Goal

The American Heart Association now recommends 9 servings of fruits and vegetables each day.  While fruits and veggies are good for everyone, people with the ApoE4 gene or a family history of Alzheimer’s seem to benefit the most.  Indeed, studies have shown that fruits and vegetables can decrease the risk of Alzheimer’s Disease by 76% in people with the ApoE4 gene.

7. Minimize Sugar

It goes without saying, if you want to protect your brain you need to minimize any added sugars or even foods that behave like sugar in the body.  This includes fruit juice and 99% of breads, pastas, crackers, pastries, breakfast cereals, white rice, french fries, etc. If you enjoy these foods, you can be part of the 1% to eat the healthier options I have discussed in other blog articles.

Many researchers now feel that any elevation in blood sugar levels can be toxic to the neurons in our brains.  Do your brain a favor and stick to lower glycemic foods to help maintain a healthy blood sugar level.

8. Use Supplements Wisely: B12, Fish Oil, Turmeric, and Vitamin D

Having the right amount of B12, turmeric/curcumin, and vitamin D can be protective of Alzheimer’s Disease in people with the ApoE4 gene or a family history of Alzheimer’s.  However, people with the ApoE4 gene need to be very cautious with fish oil.  Higher doses of fish oil in people with the ApoE4 gene can actually increase the risk of Alzheimer’s Disease.

I should point out here that eating fish has been shown to be very helpful in preventing dementia in many studies.  However, for people with the ApoE4 gene there may not be as much of a benefit.

 9. Avoid Smoking and Alcohol

Both smoking and alcohol activate the ApoE4 gene.  Thus, for people with the ApoE4 gene, abstaining from smoking and alcohol are important in minimizing the risk of dementia.

10. Minimize Stress

We all know that stress is dangerous to the brain.  Once again, this is most pronounced in people with the ApoE4 gene.  In these studies, perceived stress directly reduced memory.

11. Avoid too Much Iron and Copper

Iron and copper are critical micronutrients for health.  However, when levels of copper or iron get too high in the body this can trigger dementia.

Final Thoughts

Does Alzheimer’s run in the family?  Do you have the ApoE4 gene?  What have you found that has been helpful in maintaining a healthy brain?

Disclaimer

Do not self diagnose or treat based on anything you have read in this article.  I am not recommending genetic testing or any supplements in this article.  If you have a family history of Alzheimer’s Disease, please discuss with your physician which lifestyle changes would be most important to decrease your risk of Alzheimer’s.

April 3rd, 2015

Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.

24 Comments

  1. In your article on Prevent ALZ page, one paragraph says:
    11. Avoid too Much Iron and Copper – Iron and copper are critical micronutrients for health. However, when levels of copper or iron get too high in the body this can trigger dementia.

    Generally what foods are high in copper – my entire family has ALZ and I am the last person alive.

    • So sorry to hear about your family history. Copper toxicity generally isn’t a concern unless you are supplementing with copper or you are drinking tap water from copper pipes in your house.

      While people eating the Standard American Diet may benefit from copper in their multivitamin, the same is not true for people eating a healthy diet. For people eating a healthy diet, which includes lots of vegetables, fruits, legumes, etc., then you don’t need any extra copper.

      Hope this helps!

      John

  2. Hi Dr. Day. Thanks for the nice article. I am APOE 4/4. 49 years old, BMI of 24.3 and I exercise faithfully. I do have a family history of AD and PD. Please take a look at the study linked below and let me know your thoughts. She stressed that 4/4’s go off Statins and eat plenty of protein. I’d love to hear your comments once reading. Thanks.

    • Hi Greg,

      Unfortunately, I do not see the link you are referring to. Please try posting it again.

      Best,

      John

        • Hi Greg,

          Thanks for the link. Definitely an interesting theory and an interesting read. The problem is that there are just not enough data to prove or disprove this theory. We really need a lot more research on APOE4, diet, and Alzheimer’s Disease.

          Best,

          John

          • Thank you. Can you recommend a Dr. for folks with 4/4? I live in South Florida but I’m willing to travel.

            I’d be open to a consultation with you if you think that would be appropriate. Please let me know and thank you again.

            Regards,
            Greg

          • Hi Greg,

            Unfortunately, I don’t know anyone who specializes in 4/4. Unfortunately, my practice is primarily hospital-based interventional heart rhythm care. If you find someone good, let me know, so that I can refer others.

            Best,

            John

  3. If you don’t have really high LDL and none of your family members do despite some being overweight and obese, would that suggest you do not carry APOe4?

  4. Hi John,

    Sorry, a couple more questions. You mention taking out saturated fats from your diet is a good goal, however what about coconut oil? From what I understand it is a saturated fat and therefore ‘bad. However, there also has been research that demonstrated that coconut oil tends to increase the “good” (HDL) cholesterol, rather than the “bad” (LDL) cholesterol.

    2) I read that drinking 3 cups of orange juice a day raises the good cholesterol that takes away the fat build up in the brain particularly for people with APOE4. Yet you mentioned cutting out orange juice as it is a sugar.

    Am a little confused and any clarification would help.

    Thanks very much

    Any enlightenment would help, thanks

    Bella

    • Hi Bella,

      Unfortunately, research around ApoE4 is still in its infancy. As such, you many see contradictory small studies.

      People with the ApoE4 alleles have problems with fat metabolism. There are also different forms and sources of saturated fats. Unfortunately, many studies do not identify the source of saturated fats (saturated fat from meat and dairy versus the saturated fat say in nuts and seeds).

      As there are so many unanswered questions from many small somewhat contradictory studies when it comes to ApoE4, I like to look at groups of people who ate a particular way for generations to assess their long-term dementia risk. What we do know is that people living a traditional lifestyle (physically active outside, no processed foods, minimal sugar, many vegetables, unrefined grains, nuts/seeds, close family relationships, etc.), have a low risk of dementia even with the ApoE4 alleles.

      When it comes to coconut oil it is even more complicated. Historically, coconut oil was shunned. Now it is an internet favorite. Some small studies say it is OK. I have seen some cases where coconut oil shot their LDL up very high. While high LDL is associated with more cardiovascular disease, does this same possible risk apply to people with a high LDL from coconut? These are all questions that have not been settled in the medical literature.

      Unfortunately, fruit juice behaves a lot like sugar in medical studies. Fruit juice has also been associated with weight gain in many studies. Fruit juice causes a spike in blood glucose levels. Elevated blood glucose has consistently been linked to diabetes and dementia.

      Hope this helps!

      John

    • Hi Bella,

      Thanks for sharing this with me. As with my previous response, there is so much that we don’t understand when it comes to ApoE4. As such, you will get many small contradictory studies.

      In cases such as these, we like to look at the entire body of research rather than one outlying study or opinion (you will always have the outlier study/opinion). When you look at everything that is published on the subject, exercise seems to be particularly helpful for anyone wishing to prevent dementia, especially those with the ApoE4 allele.

      Also, this study was with mice. Humans are not mice. What is seen in lab mice or lab rats often does not translate to humans.

      Lastly, as mentioned in my previous response, I like to look at groups of people eating and living a certain way to assess their long term dementia risks. As such, people living a traditional lifestyle (physically active and outside most of the day, no processed or fast foods, minimal sugar, mostly plant based eating, etc.) tend to have low rates of dementia, even with the ApoE4 allele.

      Hope this helps!

      John

  6. Hi John

    Thank you for this most comprehensive review on Apoe
    I am a 4/4 and now have cut all Saturated fat from my diet and animal products with the exception of fish
    Avoid grains and legumes also due to serve negative reactions
    This leave me with fruit veg,starchy tubers to eat, nuts and seeds. However I find myself still overeating on the fat side of these foods. I am averaging 35 %-40% of daily energy eating chia, flax, hemp, pumpkin seeds, almonds,avocado and EVOO.
    I avoid cocunut products as I developed a fatty liver and elevated cholesterol and LDL when using them.
    Are these fats still hazardous to my health despite the fact now I have normalized my cholesterol and liver ezymes are within normal range
    However I have not had a follow up CT scan to confirm the liver is recovered
    I would like to find the balance between protecting my arteries and my brain
    Any advice would be gratefully received
    Thanks Ber:)

    • Hi Ber,

      Congratulations on being so proactive on prevention!

      Your question on the role of real food plant based sources of saturated fat for people who are ApoE4+ is an excellent question. Unfortunately, the medical literature is mostly silent on this issue.

      At least when it comes to the heart, nuts, seeds, and olive oil all seem to be protective. Interestingly, there are some data from traditional cultures living a natural, pre-modern, lifestyle (physically active, mostly plant based, no processed foods, etc.) who don’t show an increase of Alzheimer’s Disease despite being ApoE4+.

      In general, what is good for the heart is usually good for the brain. Sorry I can’t provide any more guidance other than observational studies of traditional, pre-modern, cultures.

      Hope this helps!

      John

  7. Dr. Day, thank you for tackling this important subject! You’ve hit on many important strategies to avoid Alzheimer’s while delivering a very hopeful message.

    Could you please cite your resource for: “Not only does the ApoE4 gene put you at high risk of Alzheimer’s Disease, it also causes the disease to develop as early as age 30.” That seems quite early and contradicts other published research.

    I warmly invite you and your readers, who are interested in delving into this topic further, to join our community of APOE-ε4 carriers working to elucidate the role of this gene while trying to hammer out a prevention path to optimal health: http://www.apoe4.info

  8. My grandmother has Alzheimer’s and I have been concerned about it being genetic and what could be done to prevent it. So, thank you for the very helpful information. Just sign up for your newsletter and look forward to reading more.

    • Thank you so much for your comments and for signing up for the newsletter! Yes, Alzheimer’s is a very devastating condition. Fortunately, it can often be prevented if we can live a healthy lifestyle! As I don’t give any medical advice online, please continue to work with your doctor.

      • Alzheimers has found its way to my family once again. My mother’s mother passed with it in her mid 80’s in 1998, and my mom at age 75 was just diagnosed week before last with this horrible disease. I have five children,and sitting in the dr.’s office with my mom getting that traumatic news was like a knife in my heart. My mom, dad and I all just sat and cried. I honestly can’t remember much of what the four dr’s told us that day. I’ve had to do more research since I’ve been home on this awful disease. What I do remember them saying is “we need to talk to all of you about prevention.” Those words have stuck with me. ISS if it wasn’t enough that I was losing my mom to this awful disease…I now need to worry about dying from this too and my poor kids!

        I have been reading a lot: I don’t get out and excercise, but am very active. I will be starting a better routine on “real” exercise.
        My other concerns: my mother has been on a great deal of medication all of her adult life due to high BO, heart disease, not sleeping well, breast cancer, etc. I have always stayed upset because it seems every time she goes to the dr they change her meds or add one or two more and she goes downhill. What I like to refer to is a “pill dr.” When we took her to the specialist, it took the memory dr at least 30 min to figure out her medications because there were one and half sheets typed…my dad types them up for the appt.
        my concern, I have been researching and I have chronic migraines and have been on topamax for several years (300-400 mg) daily. I have taken other anxiety meds periodically, but not for extensive lengths of time like my mom. It still scares me. I read up on topamax. It has awful reviews and is on the drug list connected to Alzheimers. I am in the process of getting off Topamax. I am not sure what I will do for my migraines. They are chroniic, but it’s not worth the risk of adding to Alzheimers connection.

        Can you help me in suggestions for prevention from this disease with the family history?

        Can you help me with any other suggestions for migraines?

        Can Alzheimers be reversed/ stopped in early stages? I’ve been told “yes and no”?

        Do you recommend the new RAIN product sold independently—For brain, heart and over all health? Products taken straight from the seeds of plants… Products “Core and Soul”? All natural products.

        Thank you ffor your guidance on this awful disease!
        KC

        • Hi Karena,
          I don’t know if you got a response back but I wanted to contribute to your question about migraines. Have you tried albion magnesium prior to bed? I also ise blue light filtering glasses starting at 8 pm, 1 mg of Melatonin (controlled release) at bedtime, and 5-HTP (xymogen CR, 100 mg) prior to bedtime. I sometimes use full spectrum light therapy in the morning as well, particularly on gray, gloomy days or if I wake up with a headache. The light therapy raises serotonin which migraine sufferers are often low in. I am a chiropractor and have found that cervical adjustments can address the tension component of the headaches. Best of luck!

        • Sorry,, cont…

          Above all else, I need to know how I can help my mom. We are so very close. They put her on a medication. Seems to help, except at night. We are changing her diet. Adding Omega 3 pills. Anything else we can do? Dr weaned her off of some of her meds. Seems to be responding to meds well. doing better since off of some medications. Thinking more clearly. Meds have always been an issue.

          Thanks again!
          KC