Diabetes Raises Dementia Risk, But You Can Lower It

[David1941]

(Want to keep your heart & brain healthy as you age? See my other helpful, research-based posts in the Healthy Diabetes Living group forum (http://www.rvillage.com/group/878/diabetes-healthy-living) & the Healthy RVers (http://www.rvillage.com/group/80/healthy-rvers group forum at www.RVillage.com)

 

Copyright 2015, David Leonard, Nutrition Educator (retired), Univ. of New Hampshire Cooperative Extension

 

Diabetes Raises Dementia Risk, But You Can Lower It

Diabetes, especially over many years, raises the risk of minor memory & thinking problems (called mild cognitive impairment or MCI), as well as dementia (Alzheimer’s accounts for about 60-80% of all dementias).

In fact, a study of 13,693 Swedish twins found that developing type 2 diabetes before age 65 increased Alzheimer’s risk by 2.25 fold (journal Diabetes, 1/09). In other research, diabetes increased the risk of progressing from MCI to Alzheimer’s by 65%.

 

A 12-year study of over 400,000 type-2 adults aged 50 & up found that the progression and severity of diabetes complications like heart disease, kidney disease, neuropathy (nerve damage), and eye damage were all strongly linked to increased dementia risk, especially if they occurred early on. Only about 6.2% of the total group developed dementia over 12 years, but those with early-onset complications had up to a 24-fold higher risk than those with few or no complications) [J of Clin Endocrinol & Metab, e-pub 7/9/15]..

 

A Harvard study (Neurology, e-pub 7/8/15) using brain MRI’s followed 40 adults for 2 years. Average age was 66, all were free of cognitive decline at baseline, and 19 had type 2 diabetes (average duration 13 years). Findings:

• In all 6 brain regions, the diabetes group had a decrease in blood flow regulation that is vital for redirecting blood to supply extra oxygen & glucose to brain areas experiencing increased activity. In fact, it fell by an average of 65% while non-diabetics had a more minor decline and in just one brain area.
• Scores on several memory & executive function tests also fell about 12% vs. no change in the non-diabetics except in a verbal learning test. (Executive function includes complex problem solving, planning/organizing, emotion control, and attention.)
• Higher chronic (constant) low-grade inflammation was linked with poorer blood flow regulation plus brain cell loss in affected brain areas, even if blood sugar and blood pressure were well controlled. But, those with higher A1c’s at the start of the study also had greater declines in blood flow regulation.

Now the good news. You can do a lot to reduce your risk of MCI & dementia.

1. Reduce low-grade, chronic (long-term) inflammation (CI). This is different from the beneficial temporary inflammation your immune system produces in response to an infection or injury. CI of the blood vessels and body organs is linked to many diseases like dementia, diabetes, heart disease, depression, cancer, rheumatoid arthritis, asthma, and digestive diseases like Crohn’s. It also accelerates aging.

What causes chronic inflammation? Smoking, excess body fat, lack of exercise, the typical American diet, gum disease, high cholesterol, high blood sugar, and high blood pressure are all pro-inflammatory.

 

How to Reduce Chronic Inflammation

• Reduce excess body fat
• Get regular exercise: It also has many other powerful brain benefits, and brisk activity can even help build new brain cells. If you sit too much, get up and walk around every 20 minutes. (See my 12/19/15 & 12/16/15 exercise posts in the Healthy RVers group forum at RVillage.com.)
• Stop smoking.
• Eat a healthy, anti-inflammatory diet (details below)
• Go easy on high-temperature cooking (grilling, broiling, frying, baking) of meats, fish, eggs, and cheese which produces pro-inflammatory compounds (see my 3/9/15 post in the Healthy Diabetes Living Group at RVillage.com). Do more boiling, poaching, steaming.
• Reduce stress & treat depression (both increase the stress hormone cortisol which is inflammatory).
• Treat high blood pressure, high cholesterol, gum disease, and high homocysteine.
• Get enough vitamin D: About 1500-2000 IU daily, but check with your doctor since these amounts can adversely affect some medical conditions.
• Take fish oil capsules if you don’t eat oily fish like salmon, sardines, arctic char, rainbow trout, herring, and mackerel at least twice a week. Aim for a total of 1000 mg actual omega-3 fat (mainly EPA & DHA). Most fish oil formulations are only about 30% omega-3 fat, so “1000 mg fish oil” often means only 300 mg omega-3). Fish and fish oil also have other brain & health benefits (see my 3/1/15 post in the Healthy RVers group forum at RVillage.com).

2. Control your blood sugar to lower your risk of diabetes complications. Good control lowers cognitive decline risk (Am J of Psychiatry, epub 2/20/15). Plus, your thinking ability temporarily suffers during periods of high blood sugar.

 

3. Eat a healthy diet high in antioxidant-rich, anti-inflammatory, brain-protective foods like fruits (esp. blueberries), vegetables, whole grains, beans, nuts, flaxseed, extra virgin olive oil (see my post), spices, and dark chocolate. Avoid trans fat and excessive saturated fat (both inflammatory).

A Mediterranean-style diet has the most research-backed brain & overall health benefits (see my 3/15/15, 2/6/15, 2/11/15, 1/10/15 nutrition posts in the Healthy RVers group forum at RVillage.com). See also http://oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid

 

4. Go easy on high-temperature cooking of meats, fish, eggs, and cheese which produces pro-inflammatory compounds (see my 3/9/15 post in the Healthy Diabetes Living group forum at RVilage.com). Do less grilling, roasting, frying, baking and more steaming, broiling, poaching, and microwaving.

 

5. Avoid excessive alcohol (0-1 one daily drink women, 0-2 for men)

 

6. Get enough vitamin B12 (see my 4/6/15 post in the Healthy Rver’s group forum at RVillage.com).

 

7. Avoid long-term use of benzodiazepine tranquilizers. The long-acting ones like Valium (diazepam) and Librium (flurazepam) were linked to a 32% increase in dementia risk (3 months usage) and an 84% increase (more than 6 months. The shorter acting ones like Xanax (alprazolam), Ativan (lorazepam), and Halcion (triazolam) are linked with less risk, Benzos have a high addiction risk.

 

8. Other risky meds (called anticholinergics): Many bladder control, GI, antidepressant, allergy, and anti-nausea meds may cause memory problems, confusion, and dizziness. Some of the strongest are dicyclomine, amitriptyline, doxepin, meclizine, tolterodine (Detrol), oxybutynin (Ditropan), and imipramine. Their long-term use (3 years or more) was linked to a 50% increase in dementia risk in one study, and they may also worsen existing cognitive problems. Ask your pharmacist for a medication review. Don't stop these meds without your doctor's permission.

 

9. Keep your mind active, but a review of 51 studies with 4800 seniors found that computer brain training programs weren't very helpful. Group programs conducted at a center had somewhat better results (PLoS Medicine, 11/18/14). But research shows regular brisk exercise is more effective.

 

10. Socialize & volunteer.

 

On the horizon: Preliminary research reveals that directly supplying the brain with insulin via a special nasal spray (to help glucose enter brain cells for energy ) improves cognition in MCI and early Alzheimer’s disease (http://www.j-alz.com/content/nasal-spray-insulin-equivalent-shows-promise-treatment-adults-mild-cognitive-impairment ).

[Medico]

David,

 

Nice blog post. I am following much of the recommendations already.

 

I have found and read that the use of Statins to control cholesterol can affect memory as well. I am also working toward getting rid of statins in my daily regime.

 

My doctor states if I can get my A1C down enough he may try to decrease or remove my Metformin. I would love to become med free, excluding my vitamins and glucosamine.

[j2catfish]

This may be slightly off subject but - my kidney doc recommended that I not take metformin as he had received info from some agency (FDA?) that the metformin causes reduced kidney functions. I have not taken metformin in about a month and my sugar level is just slightly higher (118mg/dl) that with the metformin. This info is NOT for any action but as a suggestion to check with your PCP.

Catfish

[Medico]

My kidney function seems to work VERY well, peeing all the time. I do however want to stop both Metformin and Atorvastatin after talking with my PMD. All meds have some side effects. Recently I have had an embarrassing amount of flatulence, and this is one reported side effect with Metformin.

[budeneighe]

Very interesting, indeed. I was on all those meds, hurt all the time (statins) had numbers getting worse no matter what I did. Metformin really scares me, both short and long term. I finally got enough of a handle on what affects what to realize that the Blood pressure meds (all of them I have tried) make my glucose numbers worse and a lot more erratic. Beta blockers are notorious for that because they impact most glandular functions, not just the heart. Besides insulin, the Pancreas also is responsible for controlling the latency of insulin. Screw with it and glucose goes up.

On the other side, meds that control glucose usually have an effect on blood pressures. Again, a case of see-saw dosing. The net of it has been that once all the numbers get sortof stabilized the amount of meds (in dosages and variety) get so high that it's like controlling one's speed by pushing the brake harder rather than letting off on the accelerator. The body's own control mechanisms get pushed so close to their margins that whenever something needs better control it cannot respond because it is all working at its limits.

Does not take much to completely exhaust one or more systems over time and then the real problems begin. Things like kidney failure, heart arrhythmias, thyroid and pituitary malfunctions and memory problems follow.

 

I started taking meds (against the orders of multiple doctors) on an as-needed basis and gradually unwound this physiological backlash. A great cardiologist in Florida told me to eat oatmeal and a salad every day (whole rolled, not instant) and manage my numbers based on a real perspective of what is going on. Now, after 3 years, I am on no daily meds and my glucose and bp are within age adjusted limits most of the time.

 

Some keys have been realizing that whenever I am exposed to something that my immune system attacks, my glucose and BP will go up long before I have any symptoms. Having a good daily track record on these provides a much better insight into changes like this than a single finger stick and BP check once a day. One does not have to become anal about testing but it helps to develop a sense of what is changing and how much based on variances in foods, weather and activities. Once one can get past all the daily doses of things, the patterns start to emerge and so does one's ability to recognize that glucose can be up for a few days or even weeks due to viral exposures and not because the pancreas is screwing up.

 

My dw let the doctors control her meds based on a few annual tests and now her kidneys are borderline and struggling. She is on insulin and a few other things but off the beta blockers and that is helping a lot but not upping insulin doses because her glucose is 20 or 40 points higher one morning is helping to recover functionality.

 

She has gotten stable most of the time and tracks her numbers multiple times a day and the history track shows a very clear relationship between what her body knows and what her numbers show. In the past 6 months she has been stable on minimum doses until suddenly her glucose jumps up for days and maybe her BP, too. In each case and with no other symptoms, it has been due to a UTI and once antibiotics clear it up, her numbers fall back into the pattern.

 

It is vital to develop a perspective about how all this works and unfortunately, one cannot get a reliable sense of it from a single doctor. Cardiologists push BP control. GPs and endocrinologists push glucose control and insulin but few will check free insulin levels before prescribing insulin injections. When free insulin levels get above 10-12, things start hurting more and the body reacts more erratically to both abnormal environments and medications. Bouncing between hyper and hypo glycemia may be a good clue to this situation.

 

Glucose and insulin resistance are like a wind up toy airplane. For the body to be able to instantly react and perform in a fight or flight situation, it must have plenty of glucose available in the bloodstream and tissues. But it must also have large quantities of readily available insulin there at the same time to enable the cells to utilize the glucose in anaerobic mode and that uses a lot of glucose in a very short period of time. Insulin resistance can be thought of like one's finger holding the propeller of the toy plane after the rubber band has been tightly wound. All of the energy is stored and ready to be released at a moment's notice.

 

Today, there are many things that trigger the preparation process for a fight or flight situation but it never actually comes and unless one can then release this condition, it eats away at the very body it is there to protect. Animals release this energy by physical play at the end of the day. Most species will get "frisky" around late afternoon to dusk to flush these excess hormones in preparation for a restful sleep. Humans are not that smart. Instead, they engage in suspenseful entertainment that keeps them on edge, drinking stimulants and then go to bed exhausted but not relieved so it is no wonder they don't rest and wake refreshed. This just builds day after night after day until one is functioning right at the margins of their body's ability to accommodate all this abnormal stress and that is when systems start to fall behind and symptoms, like hyperglycemia and hypertension start to show up.

 

End of lesson.

 

The most vital tool to managing one's health is to learn how it all works together and then become smart enough to actively work with whatever doctors one can find that will work with you to manage it and not just prescribe meds like a vending maching.

[David1941]

This may be slightly off subject but - my kidney doc recommended that I not take metformin as he had received info from some agency (FDA?) that the metformin causes reduced kidney functions. I have not taken metformin in about a month and my sugar level is just slightly higher (118mg/dl) that with the metformin. This info is NOT for any action but as a suggestion to check with your PCP.

Catfish

I would recommend making a separate topic out of metformin/kidney function since it has nothing to do with the original diabetes/dementia topic. That way, more people interested in the metformin/kidney function issue can more easily find it. Thanks, David

[Medico]

I have gotten to a point that I only check my BG once per day, and have been consistently 110 or under. My last A1C was 6.4 so I am confident we can cut out the Metformin. I also feel that the statins are affecting my memory. Very often I am trying to think of a word, sometimes very common words, that eventually come to mind, but I have to work at it. I believe from what I have read that this is a side affect of the statins. My last cholesterol check was very good so when I see my PCP this fall. we will have a discussion of cutting out both meds. I'm sure he will want to check regularly, perhaps monthly for a while afterward to ensure things are still maintaining properly.

 

My BP seems to stay close to high, but within normal limits for my age group. I have never had to take BP meds.

 

The one thing I still have problems with is slightly over weight. During summers here in Florida I do not have enough activities outdoors. Our coach does not have much opportunities for physical activities inside. We are in the process of building a home in a new planned community (Trilogy at Ocala Preserves) here in Ocala. Hopefully will be completed in Oct. Between the indoor health club and the new golf course as well as upgrade activities around the house, I hope to solve this problem. Last winter I was working a lot outside, and lost 26 pounds. This summer I have probably gained most back.

 

Oops, sorry off topic again. I guess in summation, it's not only the long term (>5 years) of diabetes on health of the mind, it's also after affects of meds and med combinations as well as normal aging that affect how well our minds age and how well we are able to fight other disease processes such as senility and Alzheimer's.