CHAPTER 7

I IS FOR INFLAMMATION

MANAGE THE INTERNAL FIRE THAT DESTROYS YOUR ORGANS

Inflammation is the cornerstone of Alzheimer’s disease and Parkinson’s, multiple sclerosis —all of the neurodegenerative diseases are really predicated on inflammation.

DAVID PERLMUTTER, MD

SARAH: FAITH IN WHAT MATTERS MOST

Sarah, a 62-year-old grandmother with six grandchildren, worried that her memory was starting to fail. Several months before she first saw me, she’d had a ministroke that temporarily paralyzed her right side before subsiding 30 minutes later. Her doctor called it a transient ischemic attack (TIA). Sarah’s faith was critically important to her, and she wanted to pass it on to her grandchildren and great-grandchildren, but she feared that if she lost her mind, she would be unable to share with them what she had learned in life. Because faith adds a great deal of richness and meaning to my own life, I understood why it mattered so much to her.

Sarah also complained of chronic intestinal problems, joint pain, and mental fogginess. She was a “sugaraholic” and couldn’t imagine giving it up, especially since she loved baking cookies with her granddaughters. Sarah’s SPECT scan showed very low activity overall. Her inflammation markers (CRP and homocysteine) were high, as were her weight, blood sugar, and LDL cholesterol levels. In addition, she had low levels of omega-3 fatty acids and vitamins B12 and D. She told me she never ate fish because she could not stand the taste. She also had an abnormal gene for folate. Her cognitive testing showed significant weakness in her memory and executive function.

Sarah’s test results —the seriously low activity on her SPECT scan, her poor memory scores, and her abnormal lab tests —got her attention. She realized that if she didn’t get serious about her health, she would become a burden to her children and grandchildren. She told me that sugar wasn’t worth losing her mind over, and she changed her diet, took targeted supplements (including omega-3 fatty acids EPA and DHA and probiotics), and started to exercise. Over the next year, she dropped 40 pounds, and all her important health numbers improved. In follow-up testing, her scan and memory scores were dramatically better.

SARAH’S BRIGHT MINDS RISK FACTORS AND INTERVENTIONS

BRIGHT MINDS

SARAH’S RISK FACTORS

INTERVENTIONS

Blood Flow

Low blood flow on SPECT, high LDL cholesterol, history of vascular disease (TIA)

Exercise, ginkgo biloba

Retirement/Aging

Age 62

  

Inflammation

High CRP and homocysteine, low Omega-3 Index, low vitamin B12, abnormal gene for folate

Diet, omega-3 fatty acids EPA and DHA, probiotics, vitamin B12 and methyl folate, curcumin

Genetics

    

Head Trauma

    

Toxins

    

Mental Health

    

Immunity/Infection Issues

Low vitamin D

Vitamin D3 supplements

Neurohormone Deficiencies

    

Diabesity

Prediabetes and obesity

Weight loss and blood sugar stabilization

Sleep Issues

    

SARAH’S “BEFORE” SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

SARAH’S SPECT SCAN ONE YEAR LATER

Surface SPECT scan showing more uniform blood flow.

The word inflammation comes from the Latin inflammare, meaning “to set on fire.” Chronic inflammation acts like an ongoing, low-level fire that destroys organs. Just as poor blood flow and oxidative stress can devastate your brain, so can chronic inflammation.

Inflammation is your body’s natural way of coping with an injury or insult. It’s a vitally important response that must be elicited at the right time and in the right balance. You would never want to completely eliminate inflammation because your body would not be able to deal with foreign invaders or heal from injuries.

When you are injured or develop an infection, your body’s natural defenses against foreign invaders jump into action: Blood vessels dilate, blood flow increases to the troubled area, and your immune system’s white blood cells (plus substances they produce) rush to the scene to deal with the trouble, much like firefighters hurrying to a fire. Nearby areas become swollen, warm, and red as your immune system fights to destroy bacteria and clear the way for healing to begin.

Injury and infection aren’t the only things that trigger or promote inflammation; others include the following:

Inflammation that constantly remains on, rather than arising occasionally to heal an injury or infection, is called chronic inflammation. Even though it may operate at a low level, over time chronic inflammation can damage organs and contribute to a wide range of illnesses, including heart disease, arthritis, gastrointestinal disorders, cancer, Alzheimer’s, Parkinson’s disease, depression, and chronic pain.

This chapter will focus on two major causes of chronic inflammation that damage your memory: (1) leaky gut and (2) low omega-3 fatty acid levels.

LEAKY GUT: TROUBLE IN THE GASTROINTESTINAL TRACT

Here’s a pop quiz:

  1. Where are three-quarters of your neurotransmitters made?
  2. What organ system contains two-thirds of your body’s immune tissue?
  3. What system contains 10 times more cells than the rest of your body combined?
  4. What system hosts a foreign legion that protects you?
  5. What do 70 percent of people have problems with?

Answer: the gut!

The gut —your gastrointestinal (GI) tract —is often called the second brain because it is loaded with nerve tissue. It is in direct communication with your brain, which is why you get butterflies when you’re excited or have loose bowels when you’re upset. Anxiety, depression, stress, and grief all express themselves as emotional pain and, quite often, GI distress. The gut lining is a single cell layer thick and connects your internal organs with substances from the outside world. It is one of your body’s initial defenses against invaders. Big trouble happens when the lining becomes excessively permeable, a condition known as leaky gut.

Besides chronic inflammation, a long list of health problems is associated with a leaky gut, from autoimmune diseases (such as lupus, rheumatoid arthritis, Hashimoto’s thyroiditis, and multiple sclerosis) and digestive issues (gas, bloating, constipation, and diarrhea) to seasonal allergies and skin problems (acne, rosacea). Not surprisingly, leaky gut is also linked to brain problems, including mood and anxiety disorders, ADHD, Parkinson’s, and Alzheimer’s.

Make friends with good bugs

Your gut plays an important role in the health of your brain. About 100 trillion microorganisms (bacteria, yeast, and others) live in your GI tract. This community of “bugs” is collectively known as the microbiome. For you to be healthy, your microbiome should contain about 85 percent good bugs and only about 15 percent troublemakers. When that ratio is reversed, you can develop a leaky gut, along with corresponding physical and mental problems. Keeping your gut microbiome in proper balance is essential to your mental health.[219]

The microbiome functions to protect your gut lining, digestion, and nutrient absorption. It synthesizes vitamins (K, B12) and neurotransmitters, such as serotonin. It is involved in detoxification and helps manage inflammation, immunity, appetite, and blood sugar levels. New evidence indicates that friendly gut bacteria deter invading troublemakers, such as E. coli bacteria, and help us withstand stress. If the good bugs are deficient —either from a poor diet that feeds yeast overgrowth (such as from sugar) or excessive use of antibiotics (even as far back as childhood), which kills good bacteria —you are more likely to feel anxious, stressed, depressed, and tired.

What Decreases Healthy Gut Bacteria?

The level of healthy bacteria in your gut can be compromised by a number of factors, including:

Actually, most of your exposure to antibiotics comes, not from those prescribed by your doctor, but from your food. An estimated 80 percent of the antibiotics used in the United States are given to livestock, and the prevalence of these drugs in conventionally raised meats and dairy may disturb the balance of good to bad bacteria in the gut. This is why it is critical to eat antibiotic- and hormone-free meats whenever possible.

In a 2016 study, mice given antibiotics showed decreased gut bacteria, which lowered the number of white blood cells that communicated among the gut, brain, and immune system.[221] Surprisingly, the antibiotics stopped the growth of new cells in the hippocampus and impaired memory. Probiotics and exercise reversed the trouble in the hippocampus. In short, you need to take care of your gut or your brain could be in big trouble.

LOW OMEGA-3 FATTY ACIDS: WHY EATING FISH BOOSTS BRAIN HEALTH

One of the leading preventable causes of death is having a low level of the omega-3 fatty acids EPA and DHA in your bloodstream, according to researchers at the Harvard School of Public Health.[222] Low levels of EPA and DHA are associated with

Unfortunately, most people are low in the omega-3 fatty acids EPA and DHA unless they focus on eating fish (which can be high in mercury and other toxins) or take an omega-3 fatty acid EPA plus DHA supplement. In 2016, Amen Clinics tested the omega-3 fatty acid levels of 50 consecutive patients who were not taking fish oil (the most commonly used source of EPA and DHA) and found that 49 had suboptimal levels. In another study, our research team correlated the SPECT scans of 130 patients with their EPA and DHA levels and found that those with the lowest levels had lower blood flow —the number one predictor of future brain problems —in the right hippocampus and posterior cingulate (one of the first areas to die in Alzheimer’s disease). On cognitive testing, we also found low omega-3s correlated with decreased scores in mood.

Increasing scientific evidence points to a connection between cognitive function and the consumption of fish rich in omega-3 fatty acids EPA and DHA. For example, a team of Danish researchers compared the diets of 5,386 healthy older individuals and found that the more fish in the diet, the longer people were able to maintain their memory and avoid dementia.

These beneficial fatty acids are not to be confused with omega-6 fatty acids, which are plentiful in the American diet. Unfortunately, eating too much omega-6 fatty acids can erase the benefits of omega-3s. (For more on the distinction between these fatty acids, see chapter 16.)

CHECKUP FOR INFLAMMATION ISSUES

Lab tests

Testing amounts of the following substances in your blood will help you and your doctor determine the level of inflammation in your body and provide direction on what to do about it.

PRESCRIPTION TO REDUCE YOUR INFLAMMATION RISK

The Strategies

  1. 1. Address the health of your gut with four strategies:
    • Avoid anything that hurts your gut (see list on page 99).
    • Increase prebiotics (the food for probiotics): apples, beans, cabbage, psyllium, artichokes, onions, leeks, asparagus, and root veggies (sweet potatoes, yams, squash, jicama, beets, carrots, and turnips).
    • Increase probiotics to strengthen your microbiome. You can do this with probiotic supplements (see page 106) or fermented foods that contain live bacteria: kefir, kombucha, unsweetened yogurt (goat or coconut), kimchi, pickled fruits and vegetables, and sauerkraut.
    • Be careful with antibiotics. If you have had a lot of them in the past, taking probiotics and eating a healthy diet become even more important to maintaining brain health.
  2. 2. Reduce homocysteine. B vitamins, especially B6, B12, and folate, help lower high levels of homocysteine, and they also support brain health. A 2010 Oxford University study[231] tested the presumption that by controlling levels of homocysteine, the amount of brain shrinkage (which tends to precipitate Alzheimer’s disease) could be reduced. Study participants received relatively high doses of B vitamins, including 800 mcg of methyl folate, 500 mcg of B12 (cyanocobalamin), and 20 mg of B6 (pyridoxine hydrochloride). Two years later, those who had received the vitamin B regimen suffered significantly less brain shrinkage than those who had received a placebo. After taking the vitamins, even the brains of those who had the highest levels of homocysteine at the start of the study shrank at half the rate of the brains of those taking a placebo. In another study, participants taking high doses of folate and vitamins B12 and B6 lowered homocysteine and the associated brain shrinkage by 90 percent.[232]
Bright Minds Tip icon

Load up on omega-3s. Getting more of the fatty acids EPA and DHA will improve your blood flow, mood, and weight, and they’ll give your brain a boost.
  1. 3. Boost your omega-3s. The omega-3 fatty acids EPA and DHA can increase blood flow;[233] slow brain atrophy;[234] increase working memory,[235] executive function,[236] fluid intelligence (problem solving) and mood;[237] and decrease inflammation[238] and anxiety.[239] Before we started offering the Omega-3 Index to our patients, I tested our employees, several family members, and myself. When my test results came back, I was very happy: An Omega-3 Index score above 8 is good, and mine was nearly 11. But the results for nearly all of our employees and family members were not so good. In fact, I was horrified at how low their levels were, which put them at greater risk for both physical and emotional problems. It was an easy fix: They just needed to eat more clean, cold-water fish or take fish oil supplements.

    EPA and DHA are practically vitamins because the body has very limited capacity to make them, and we have to obtain most of our supply from foods or supplements. Most Americans have low levels as measured by the Omega-3 Index. Plants don’t make them, but cold-water fish are a good dietary source. You do have to be careful that the fish you eat don’t poison you with mercury, PCBs, and dioxins. Check where they were caught and be sure they are free of such toxic contamination. The safest way to increase your Omega-3 Index is to take highly concentrated fish oil supplements that provide at least 1,000 mg of EPA plus DHA per day.

    Increasing your intake of omega-3 fatty acids EPA and DHA is one of the best ways to improve your brain power, mood, and weight. EPA is important for controlling inflammation and maintaining a positive mood, and it works with DHA to help brain stem cells mature into functioning neurons. DHA is an important contributor to the lipids in your brain that build cell membranes, which play a vital role in how your cells function. DHA actually makes up a large portion of the gray matter of the brain. It is also a main component of the brain’s trillions of synapses (where neurons come together to form connections). DHA and EPA work together to improve blood flow, which boosts overall brain function.

    Researchers have discovered that a diet rich in omega-3 EPA and DHA helps maintain emotional health and positive mood as people age. Taking fish oil high in EPA and DHA helps ease symptoms of depression. In fact, a 20-year study of 3,317 men and women found that people with the highest consumption of EPA and DHA were less likely to have signs of depression.

    Omega-3 EPA and DHA can benefit cognitive performance at every age. In 2010, scientists at the University of Pittsburgh reported that middle-aged people with higher DHA levels performed better on a variety of tests, including nonverbal reasoning, mental flexibility, working memory, and vocabulary. Swedish researchers surveyed nearly 5,000 15-year-old boys and found that those who ate fish more than once a week scored higher on standard intelligence tests given three years later than those teens who ate no fish. A follow-up study found that teens eating fish more than once a week also had better grades in school than students with lower fish consumption. Additional benefits of omega-3 EPA and DHA include increased attention in people with ADD, reduced stress, and a lower risk for psychosis. And when we put a group of retired football players on highly concentrated fish oil supplements, many of them were able to decrease or completely eliminate their pain medications.

  2. 4. Take care of your gums. This is an easy one. To decrease inflammation, it is critical to avoid periodontal (gum) disease, which is a risk factor for dementia.[240] Be sure to brush your teeth twice a day after meals and floss daily. Flossing your teeth is a brain exercise! And see a dentist regularly for checkups and cleanings.

The Nutraceuticals

  1. Folate, vitamin B12, and vitamin B6: I recommend that my patients with high homocysteine levels take the following:
  2. Omega-3s: My recommendation for most adults is 1,400 to 2,800 mg a day of EPA and DHA omega-3 fatty acids. Other omega-3s such as alpha-linolenic acid are not likely to be beneficial because they are so poorly converted to the larger active EPA and DHA molecules.
  3. Curcumin: This is the collective name for the three active curcuminoids from turmeric root (used in making curries), which have potent anti-inflammatory effects. More than 7,000 published articles have revealed the benefits of curcumin, including its powerful antioxidant properties, its ability to help regulate blood sugar, and its anti-inflammatory and anti-cancer activities.[241] But the curcuminoids are poorly absorbed when taken by themselves. I recommend 500 to 2,000 mg a day of a highly bioavailable curcumin supplement. (Longvida is an excellent brand, proven to have high absorption.)
  4. Probiotics: Clinical studies show that probiotics decrease homocysteine and inflammation.[242] They are even more effective when given with prebiotics,[243] which support and promote the growth of probiotics. Look for products that contain both Lactobacillus and Bifidobacterium strains. The number of probiotics in a supplement is less important than the quality of the strains. The probiotic I often recommend is effective at 3 billion live organisms a day.

The Foods

AVOID (OR LIMIT):

CONSIDER ADDING:

PICK ONE HEALTHY BRIGHT MINDS HABIT TO START TODAY

  1. Floss your teeth daily and care for your gums.
  2. Eat more green leafy vegetables.
  3. Test your CRP and homocysteine levels.
  4. Test your Omega-3 Index; aim to get above 8.
  5. Eliminate trans fats.
  6. Limit omega-6-rich foods (corn, soy, processed foods).
  7. Increase omega-3-rich foods (fish, avocados, walnuts).
  8. Take vitamin B6, vitamin B12, and methylfolate.
  9. Add prebiotic foods to your diet.
  10. Add probiotic foods and/or supplements.