More on Alzheimer's and Type 3 Diabetes

I'm not in the field of dementia care anymore but two close family members with these symptoms keep me needing to pay attention. My dad is in a nursing home right now, and my mother reports that all the patients seem to want to eat is sugar. The family caregivers I used to work with would report the same thing. Long before the scientific evidence started to pile up, those of us working in the field knew there had to be some correlation between memory loss and confusion and these bizarre sugar cravings. Patients lose their appetites for anything else. It is now thought that a lot of what we call Alzheimer's Disease is most likely insulin resistance in the brain caused by excessive sugar consumption, lack of exercise and — this is something scientists do not say — whatever it is that causes people to substitute sweets for what the rest of us consider to be the "sweetness" in life.

I feel I must go out on a limb with this a bit. Too many Alzheimer's patients have spent many years being isolated and lonely, have suffered the trauma of losing their spouse or significant other, have few if any hobbies, or otherwise feel like they have little to live for except watching endless amounts of TV with a bowl of ice cream or plate of cookies close at hand.

There is also sufficient evidence to suggest that early stage Type 3 Diabetes (and therefore most Alzheimer's Disease) can be easily reversed if caught soon enough with exercise, insulin and more moderate sugar consumption. Going for a walk three times a week is enough to make a big difference in someone who is excessively sedentary. Making it a rule never to eat sugar on an empty stomach or substituting more protein and fat and fewer carbohydrates can make a big difference right away regardless of the amount of exercise. And try arranging it so your loved one takes that walk and eats that meal with someone who loves them! That could make the biggest difference in quality of life for both the patient and all concerned.

Scientific articles:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/
http://www.ncbi.nlm.nih.gov/pubmed/22810099

Layman's articles:
http://dealingwithdiabetes.org/type-3-diabetes-attacks-your-brain/
http://opinionator.blogs.nytimes.com/2012/09/25/bittman-is-alzheimers-type-3-diabetes/

Alzheimer's Disease Cooperative Study

Image via WikipediaAre you or a family member experiencing the early signs of memory loss? Would you like to participate in research looking to put an end to Alzheimer's Disease?

The newest thinking in the future of Alzheimer's treatment is to be able to detect changes in the brain in the earliest of stages, long before full-blown Alzheimer's symptoms appear. Reversing these brain changes -- or the behaviors or predisposing physical conditions that cause them -- is thought to be the best way to stop Alzheimer's. But the only way to recognize what these changes are and learn more about who is at risk is through the participation of volunteers.

“We cannot end this terrible disease unless we know more about it,” says Dr. Paul Aisen, M.D., director of the Alzheimer’s Disease Cooperative Study (ADCS). “That is where the amazing volunteers, their friends and their families can make the difference in our success.”

If you, a friend, or a family member is experiencing early signs of memory loss, you may be eligible to participate in a groundbreaking ADNI GO study. Please visit http://adcs.org/Studies/ImagineADNI.aspx or call the Alzheimer’s Disease Education and Referral Center at 1-800-438-4380 for more information on study sites in your area.

Related articles

• Hope for Treating Alzheimer's Progression (psychcentral.com)
•  
• Researchers Trace Alzheimer Process, Hope To Find Effective Treatment (consumeraffairs.com)

Codependent No More

In my work as a family consultant I frequently thought my clients could benefit from Melody Beattie's best-selling book Codependent No More. It was written with family members of alcoholics in mind but, really, anybody who lives awhile with a person prone to demented behaviors whether it's caused by alcohol, drugs, mental illness or a dementing illness is in the same boat. We're all attempting to cope with the chaos and pain such a situation causes and we frequently develop some pretty intense coping behaviors in which all our attention gets sucked into obsessing about the person who is creating it. It's natural, it's human but it's damaging just the same.

I recently reread this book after not thinking about it for many years. It still holds up and I recommend it for the chapters on how to focus on yourself without guilt and work with your own anger, grief and pain. You may not be able to walk away as might be recommended for someone dealing with an alcoholic. Caring for a person with a dementing illness typically isn't thought of the same way. But please do take seriously the importance of cultivating detachment, a sense of humor, and time for yourself. It makes all the difference!

Codependency as a Precurser to Dementia

This may be a controversial article, especially since as far as I know nobody has done studies on this phenomenon to date. Certainly, living with someone with dementia can create codependency. That was the heart of my practice when I was a caregiving consultant. But nobody that I know of has written about the case in which the disease goes the other way around.

First, let's try to define codependency. This is a term very familiar to those in Alcoholics Anonymous and Al-Anon to describe the dynamic that frequently occurs between the alcoholic and those who have to live with one. Basically, the codependent person gets trapped in a system of trying to compensate for the alcoholic's behavior in a variety of ways—everything from constantly monitoring how much a person drinks to covering for them when they've drunk too much. It takes constant vigilance to cope with being in a relationship in which a significant portion of the day is spent avoiding or coping with the aftermath of giving in to an addiction. There's no criticism intended in this description. But the inevitable upshot of the dance that occurs enables the alcoholic to continue their dysfunctional and dangerous behaviors because they never wind up taking responsibility and living with the consequences of their own actions.

Unfortunately, the codependent is usually just as addicted as the alcoholic. They are addicted to being needed, to being the competent one, to being the one who "really is in charge", etc., etc. And it's not just family members of alcoholics who wind up adopting these addictive coping behaviors. Anyone who grew up with a parent with any kind of disorder that made them undependable or even a little dangerous will have tended to develop a number of behaviors meant to help control the crazy circumstances they live within. Children of abusive parents and those with mental illness are a prime example. "What do I have to do to keep dad from hitting me?" "How do I handle the fact that mommy isn't making us dinner?" Children who live in these circumstances can become super-competent. That's the good part. The bad part is that they become terrified to do anything else.

A codependent personality always has their attention on someone else. In my caregiving practice I would say "How are you?" and nine times out of ten whoever was sitting in front of me would tell me about their Alzheimer's patient instead. Seriously. I'm not exaggerating. I met with hundreds of family caregivers in a year. Most of them couldn't answer the simple question of how THEY were without being asked twice.

Every once in awhile a caregiver would say "My mom was always the one everyone depended on. She was the caregiver for the whole family. She took care of both her parents until they died. She took care of my mentally ill sister. She took care of our grandparents and my cousin Mary, too!" Now she's finished with her caregiving duties and what happens next? She can't even enjoy it because now she's been diagnosed with dementia, too!"

The first time I heard that story I felt bad for the person involved and thought "how terrible!" The second time I heard it from a different caregiver I thought "that's sad and how interesting that it's happened here, too." Then I heard it again and then a fourth time. It wasn't the most common story I heard. THAT story was "Mom was perfectly alright until dad died!" But it was a variation that made me wonder.

Right now I'm living with someone who has such acute codependency behaviors that she worries and talks about other people —and ONLY other people—all day long. ALL DAY LONG ALL THE TIME. She does not have Alzheimer's disease. But she can't concentrate on her own interests and things she wants to do at all. She leaves food on the stove to burn while she takes care of a stranger's problems on the phone—even a telemarketer gets her undivided attention. She loses things every day. She forgets things that she "cares" about all the time. But not other people. Other people are the only thing in her view.

If you were to step into this situation and see it from the outside you would see behaviors that smack of dementia. But her family members say, no! She's been this way most of her life. She's always been the caregiver. It's just a little worse now because she doesn't actually have a person who really needs caregiving these days and she does have a little age-related memory loss that contributes to the problem now. She WANTS to be caregiving! She's constantly getting into other people's business and attempting to do so until they get mad and tell her to go away. And she can be extremely engaged and competent when she gets set loose. But without it. . . she doesn't know what to do, she gets a little batty, she withdraws her attention from life and acts out addictive behaviors like constant TV watching on her own. And she acts like a little girl who needs watching over. . . which was probably the truth when she believed she needed to do the caregiving she no longer knows how to do without.

It's what I suspected when I worked for the Caregiver Resource Center. I'm seeing it acted out in front of me on a daily basis now. Give a person with "dementia" a job where they feel like they can take care of someone else and many of them come back to life. I heard about that time and again. I only wish I knew how to help this person and those of you dealing with someone like them now.

Buyer Beware! Caregivers Take Notice

Recently a good friend of mine, an elderly woman we'll call "Mary", was contacted by Wells Fargo Bank. She consented to speak to the "nice man" on the phone right away-- after all this was her bank, could something be wrong? No, but after several minutes of chatting with the person she thought was a bank employee she had been talked into allowing Wells Fargo to deduct $25 a month from her account for an insurance policy she didn't want.

I was there when it happened and said "Mary, why did you do that?! Why would you buy insurance you didn't want?"

"Oh, don't you worry about a thing" she said. "It's free the first month! And when I get the paperwork I'll just cancel it. The nice man said I could do that any time."

"But why would you say yes to this in the first place?"

"Oh," she said. "You know those poor Wells Fargo people have a 'quota' to fill, don't you? If they don't sell so many policies a month they could lose their jobs. I couldn't let that happen!"

I was flabbergasted but she assured me that she would get a notice from the bank and when she got it she would cancel it, so I stashed the experience in my memory bank, in case it should matter some day, and let it go.

Well, the paperwork either never came or didn't look like what Mary had expected. She has a vague recollection of getting something from AIG but she "knew" she hadn't bought anything from them so she threw it away. Three months later both of us had forgotten all about the insurance buying incident and Mary found herself unable to buy groceries at the end of the month because $50 she counted on was "missing" from her account.

Now, luckily, Mary is not so demented that she didn't notice what was wrong and immediately called the bank. She only has age-related memory loss and perhaps some misguided judgment. Wells Fargo promised to cancel the policy and, hopefully, that will be the end of it. But what if Mary wasn't that on top of her bank account? Could this even happen to you?

How To Help A Lonely Elder

This info was written for people in Santa Cruz, CA but there's enough good suggestions here to help you find similar possibilities in your hometown, I'm sure:

Everyone feels lonely from time to time but the elderly are at a greater risk because most of their loneliness comes from long established habits combined with the loss of longtime friends and companions.

The key to breaking isolation is to very slowly and gently add activities that get the lonely person into the presence of others. In addition to extra contact from existing family and friends, start with activities that are easy to participate in such as church services or special interest classes. Senior centers offer a variety of activities especially geared towards seniors but Santa Cruz is also rich in adult education opportunities ranging from Parks and Recreation classes to community education courses at the University or Cabrillo College. If travel was always a source of pleasure try group tours or day trips. If the person enjoys reading try the public readings and book signings presented by local bookstores. If the person used to gain pleasure by caring for others (children or a spouse) consider volunteer opportunities with a social service agency or child care center. Even a part-time job can make a difference.

For very frail or housebound seniors, an adult day program that includes transportation and medical supervision might serve the purpose. (In Santa Cruz, try Elderday 458-3481 and Cindy's Celebrations 479-7509). If the person truly can't or won't leave the house, it is possible to arrange for a volunteer or paid companion to visit there. Try a Friendly Visitor program (427-5070) or Senior Companion (475-0816 ext. 10). Many others find that what they need most is to live with other people -- try assisted living or retirement communities or rent out a room to another senior citizen or college student (Senior Network Services Shared Housing Program 462-6788). In Santa Cruz it is even possible to try out having a housemate for a very short time by offering a room to a visiting professor or foreign exchange student for one semester or by providing space for a Shakespeare Santa Cruz performer for the summer. (458-3506)

Loneliness May Be Hazardous To Your Health

Social isolation and loneliness is a major contributing factor in all kinds of illnesses. A famous study exposed paid volunteers to a cold virus and then recorded how many actually came down with symptoms. It was found that those who described themselves as more lonely or isolated were far more likely to get sick. Other studies have shown that loneliness increases the risk of heart disease and cancer and reduces the life expectancy of those already diagnosed. A recent article in Science News reported that people who live alone are 50% more likely to develop dementia than others and that those who live alone and have no friends are 60% more at risk. It is my opinion that loneliness is probably more dangerous than smoking, lack of exercise and poor diet combined and there are some physicians who are beginning to agree.

Dr Dean Ornish became famous for his multi-faceted program for recovery from heart disease. It included a very strict diet, exercise, meditation and support group participation. He had tremendous results and assumed that the most important factors were the exercise and diet plans. However, his follow-up research did not bear this out. In his most recent book Love and Survival: The Scientific Basis for the Healing Power of Intimacy he writes that he is now convinced that, although diet and exercise is important to the success of his program, the single most effective factor seems to be the support group. People who feel loved and cared for thrive.

It is theorized that having only one strong social bond isn't as effective as having a variety of social relationships which is why a support group can be so effective. Strong family relationships or church and community ties are equally helpful. So my question to you all today is: how are your friendships and social ties? Is there a way they could be strengthened? Are there social activities you would like to try but keep putting off? Make social activity a priority and see how it affects your life. It's well worth the effort over time.

From my book The Spiritual Journey of Family Caregiving, available directly from me for $14.95 plus shipping.

Is it possible to prevent Alzheimer's Disease and Reverse Early-Stage Memory Loss?

As soon as people find out what I do they often ask me what they can do to prevent Alzheimer's Disease and other brain-impairing illnesses. There are no definitive answers but in my work as a family consultant I've noticed a few trends.

Many of my clients tell me that their brain-impaired relative was "just fine" until they suffered some devastating emotional setback such as the death of a spouse or other close relative, a change of residence or community, or a forced retirement. Then, what used to look like normal aging blossomed into full-blown dementia.

Why is that? My boss at the Alzheimer's Association always used to say that the disease must have been present before, it just wasn't noticed because there was nothing to bring it to the family's attention. I think it is much more likely that the changes we associate with "normal" aging actually indicate accumulated damage from multiple causes and then emotional devastation delivers the final blow.

What are the multiple causes? We know that the brain depends on the proper utilization of amino acids to create the neurotransmitters we depend on for healthy brain functioning. In Alzheimer's Disease these neurotransmitters become scarce. However, things that disrupt amino acid metabolism are plentiful and well known.

First and foremost is nutrition and, in particular, how much protein a person eats and how well they metabolize it. Amino acids are found in protein sources like meat, chicken or fish and in adequate vegetarian combinations of beans and whole grains. In order to properly utilize these amino acids, however, a person needs to have adequate amounts of folic acid, B6, B12 and Vitamin C. The body breaks down the amino acids to create other compounds the body needs for various functions. If that does not happen properly in the case of the amino acid methionine, compounds that would otherwise be used to lower cholesterol are not made while a metabolite called homocysteine is created which is toxic in large amounts. High levels of homocysteine injure the arteries and encourages the formation of plaque. There also seems to be some correlation between high homocysteine levels and early stage Alzheimer's Disease.

Things that interfere with amino acid metabolism include not eating enough vegetables (the dark leafy kinds have folic acid in them), having an allergy or sensitivity to wheat or other foods, excessive exposure to pesticides and other environmental toxins, and long term exposure to mental stress and depression.

Things that help the body cope and recover from these things include:

* Adequate but not excessive protein consumption (remember, you need B vitamins and folic acid to metabolize the protein -- it takes a lot of spinach to make up for that Big Mac!)

* High dosages of folate, Vitamins B6 and B12

* Lots of lightly cooked fruits and vegetables

* If you have a wheat sensitivity (which is very common) give up bread, pasta, cookies and other wheat-containing products (I guarantee you'll lose weight!)

* Adequate fresh clean water

* Exercise and mental stimulation (don't watch TV all day!)

* Love and active engagement in life

I believe these last two items are most important. Even people who have already been diagnosed with Alzheimer's Disease ward off the worst effects of the disease and maintain their ability to function longer if they are positively engaged in life than people who are clearly depressed and withdrawn. And sometimes -- I've seen it only a few times in five years of doing this work -- the symptoms of memory loss and confusion can go away almost completely when a person renews their ability to find joy and excitement in being alive and gets the care and attention it takes to make that happen.

The previous blog post is an excerpt from my book The Spiritual Journey of Family Caregiving available now directly from me for $14.95 plus shipping.

Rosemary is For Remembrance

"There's rosemary; that's for remembrance.
Pray, love, remember."
~Shakespeare, Hamlet

Paul's mom sent us a nice article about aromatherapy that she clipped from Prevention Magazine. In it was reported that a study with college students at the University of Northumbria showed a significant increase in memory and feelings of alertness for those who used rosemary essential oil as compared to a control group. Oddly, the Prevention Magazine article did not report that the study also showed that rosemary slowed memory recall for the same test subjects. In other words, the students outperformed other students in two different kinds of memory tests (and felt more awake doing it) but took a little longer to come up with the results. Hmmm. Could it be that if we stay awake and slow down our brains function better?

I took a quick look around the internet to see if I could find more about this. According to research done by the Burnham Institute for Medical Research there are ingredients in the rosemary herb that protect the brain from the injurious effects of free radical production. Free radicals are thought to contribute to a wide variety of neurological conditions such as stroke and Alzheimer’s in addition to what is considered "normal" age-related memory loss. You can read more about free radicals in another blog I wrote here. In that post I was talking about antioxidants such as those found in blueberries that have a useful effect in counteracting free radical reproduction in the human body. It turns out that the carnosol and carnosic acid found in rosemary are powerful antioxidants. In addition to having a significant effect on memory loss they have been shown to have a protective effect against cancer.

Scientists are hard at work trying to use these findings to create powerful drugs which could be used for the same purpose. Meanwhile it couldn't hurt to add a little rosemary into your life. I like it in my garden--I can't seem to resist picking a little bit and rubbing the leaves between my fingers whenever I can. The smell is irresistible. I use it in my Mama Love for Focussed Attention perfume.

Elephants Never Forget—They Eat Brahmi

The word “Brahmi” means the creative energy or intelligence of the Universe. It is used to refer to plants that appear to personify this energy by revitalizing the sensory organs of the body, in particular the nerves and brain cells. Sounds pretty good, huh? Want to know how to get some of that? Let’s take a look at the two herbs most commonly given this designation that we can find in the United States today: bacopa monniera or bacopa herpestis (known as bacopa) and Centella asiatica or Hydrocotyle asiatica (known as gotu kola or pennywort). Gotu kola is supposed to be a favorite food of elephants in South India.

Bacopa

Bacopa is considered to be the most important Ayervedic herb for treating brain problems and age-related mental decline as well as for improving cognitive processes such as memory. It is prescribed for all body types in the Ayervedic tradition because of its balancing effects.

The Central Drug Institute of India, established in 1953 to create formal scientific studies to determine how Ayervedic herbal remedies work, has studied bacopa. They found that the herb contains chemicals that help repair damaged neurons by augmenting kinase, the protein involved in the synthesis of new neurons to replace old ones. It has a strong antioxidant effect (similar to Vitamin E) that helps the body clean up toxins that damage DNA and cell membranes. It also aids blood circulation throughout the body, a known factor in the development of dementia for some people. Studies with rats have conclusively shown that rats treated with bacopa learn new skills faster than control subjects and retain the information longer. Preliminary studies with humans indicate similar effects.

Bacopa is currently being used in India to treat ADD (Attention Deficit Disorder), age-related mental deterioration, and concentration difficulties due to stress. It has a mild sedative or nerve-calming effect and has been used successfully by people with irritable bowel syndrome and by those recovering from nervous breakdown. Unlike other herbs with sedating properties, however, bacopa increases mental clarity while reducing nervous anxiety. Bacopa is commonly taken in tea with sweeteners added or in capsule form. It can be used as a salad vegetable or added to soup but by itself it is very bitter.

Side Effects and Precautions: Bacopa is a diuretic and should not be used with diuretics or anti-diabetic drugs without a doctor’s supervision. It should not be used with methotrimeprazine, a potent CNS depressant analgesic. Other central nervous system drugs have not been tested for possible interactions at this time. Use of aminoglycoside antibiotics such as clindamycin increases bacopa’s sedating effect By itself it has no known side effects or toxicity at normal dosages.

Gotu Kola

Gotu Kola is thought of as a spiritual herb in Ayurveda as well as having superior rejuvenating effects throughout the body. It is commonly used in India to improve meditation. It is said to develop the crown chakra, the energy center at the top of the head, and to balance the right and left hemispheres of the brain. Traditionally, gotu kola is used to strengthen the immune system, the adrenals and the circulatory system, and to promote healthy skin.

Studies have found three main chemical constituents in gotu kola. One has an antibiotic effect. The second, similar to Bacopa, is diuretic and slightly sedating. The third is a strong anti-inflammatory agent. It is also high in Vitamin B and K, magnesium, and calcium. It has been found to be extremely effective for wound healing and tissue repair, even being used in India to treat second and third degree burns. Studies with rats show that rats fed gotu kola retained new information significantly longer than control subjects. Preliminary results in one clinical trial with mentally retarded children showed increased scores on intelligence tests. Gotu Kola can be found as a tea, capsules, and tincture.

Side Effects and Precautions: Although widely used for skin ailments, gotu kola has been known to be a skin irritant for some people. It can cause headaches or elevate blood pressure in high doses and might create narcotic stupor with extreme usage. Do not use during pregnancy or if you have an overactive thyroid. Avoid using it with sedative drugs as the effect may be cumulative. It should also not be used with antidiabetic or cholesterol-lowering medications without a doctor’s supervision. Older adults should start with a lower dose and increase it if necessary.

Gotu kola should not be confused with the kola nut which contains caffeine and has a stimulating effect. Gotu kola is not the same plant and contains no caffeine.

Should you use either of these herbs?

Well, it always pays to consult your doctor to make sure they won’t conflict with medications you’re already taking but after doing that why not consider it? To be perfectly honest, there is no dementia medication on the market today (2005) that offers more than temporary symptomatic relief while allowing the disease to proceed unchecked. These herbs, especially bacopa, appear to actually repair damage and improve brain function. Follow your instincts. If you try it let your doctor know and monitor how it works and how it makes you feel.

The previous article is an excerpt from The Spiritual Journey of Family Caregiving. Click here to buy it now.