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Vitamin E May Offer Benefits for Patients with Alzheimer’s Disease

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Story at-a-glance -

  • At present, an estimated 5.4 million Americans have Alzheimer’s disease. In the next 20 years, it is projected that Alzheimer's will affect one in four Americans
  • A recent study found that 2,000 IUs of vitamin E per day helped delay the loss of function, such as planning and organizing, in Alzheimer’s patients
  • It’s important to realize that modern medicine has very little to offer in terms of treatment, so prevention is paramount
  • Research suggests the best hope is in prevention focusing on diet, exercise, and staying mentally active
  • Avoiding fructose and gluten appears to be of critical importance, as is making sure you’re getting plenty of healthful fats. Fasting can also be beneficial for the prevention of Alzheimer’s

By Dr. Mercola

Memory loss is so common among Westerners, many write it off as an inevitable fact of aging. Alzheimer's disease, a severe form of dementia, is also on the rise, now affecting an estimated 5.4 million Americans.1 Alzheimer's is a devastating disease that develops slowly and gets progressively worse.

The first stages involve mild memory loss, but as the disease progresses, it can make you unable to carry on a conversation or respond to your external environment. It's been projected that in the next 20 years, Alzheimer's will affect one in four Americans, rivaling the current prevalence of obesity and diabetes!

However, losing your memory is not part of "normal" aging—regardless of the severity—and the answer to "senior moments" and more severe dementia is the same. These are lifestyle-related conditions that are largely, if not entirely preventable by a healthy diet and lifestyle.

It's important to realize that modern medicine has very little to offer in terms of treatment, so prevention is paramount, and the earlier you start, the better. I've written a number of articles over the past few years highlighting important research into the effectiveness of diet and lifestyle intervention on Alzheimer's.

Most recently, a study published in JAMA2 found that vitamin E may help delay the loss of function, such as planning and organizing, in Alzheimer's patients.3

How Vitamin E May Benefit Alzheimer's Patients

The study compared the effects of vitamin E (alpha-tocopherol) and the Alzheimer's drug memantine, to assess which one might be more effective for slowing progression of mild to moderate Alzheimer's disease in patients taking an acetylcholinesterase inhibitor.

Alzheimer's has been linked to a deficiency in the brain neurotransmitter acetylcholine. Acetylcholinesterase inhibitors are frequently used to treat the symptoms of Alzheimer's.4

Data from 561 patients diagnosed with mild to moderate Alzheimer's was assessed in this double-blind, placebo-controlled, parallel-group, randomized clinical trial. Participants were divided into four groups, and received either:

  • 2,000 IUs per day of vitamin E
  • 20 mg per day of the drug memantine
  • A combination of vitamin E and mematine
  • Placebo

Follow up was just over two years. Results showed that clinical progression of Alzheimer's slowed by 19 percent per year in the group receiving vitamin E, compared with placebo. (This delay translated into just over six months of delayed progression over the two-year follow-up period.)

Caregiver time also increased the least in the group receiving vitamin E. This does not mean vitamin E prevents the disease, but it appears it might allow patients to retain their independence a bit longer. The authors concluded that:

"Patients with mild to moderate Alzheimer's Disease (AD), 2,000 IU/day of alpha tocopherol compared with placebo resulted in slower functional decline. There were no significant differences in the groups receiving memantine alone or memantine plus alpha tocopherol. These findings suggest benefit of alpha tocopherol in mild to moderate AD by slowing functional decline and decreasing caregiver burden."

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Commonly Prescribed Alzheimer's Drug Is Ineffective

It's worth noting that this isn't the first time memantine, sold under the brand name Namenda, has been found to be more or less useless for mild to moderate Alzheimer's. The drug is approved for moderate to severe cases, but doctors often prescribe it off-label for mild Alzheimer's cases. It's even prescribed off-label for mild cognitive impairment (MCI), which is frequently the prelude to Alzheimer's.

A 2011 analysis of data5 from three clinical trials showed that patients with mild Alzheimer's who took Namenda had no improvement in mental function or their ability to perform everyday tasks when compared to placebo.

Even among moderate to severe Alzheimer's patients, for which the drug is approved to treat, the researchers found only "meager" improvements. The researchers concluded that:

"Despite its frequent off-label use, evidence is lacking for a benefit of memantine in mild Alzheimer's disease (AD), and there is meager evidence for its efficacy in moderate AD."

Namenda paired with a cholinesterase inhibitor—as in the featured study—is the go-to treatment for Alzheimer's, but so far the research really doesn't offer much support for this treatment protocol for mild to moderate cases. Besides offering little, if any, benefit, Namenda can produce troubling side effects.

Along with dizziness and headache, confusion is listed as one of the most common side effects of the drug, and this is certainly the last thing a person with Alzheimer's needs... Cholinesterase inhibitor drugs such as Aricept, Exelon, and Reminyl may also do more harm than good. This class of drugs is known to provoke slower heart rates, significantly increasing your chances of getting a permanent pacemaker, as well as increasing your risk of hip fracture.

All Vitamin E Are Not Created Equal

Ever since its discovery in 1922 there has been much discussion over what type of vitamin E is best. This is information that the media or your doctor will not likely share with you when they respond to new studies like this. Many do not know that the term "vitamin E" actually refers to a family of at least eight fat-soluble antioxidant compounds, divided into two groups of molecules:

  • Tocopherols (which are considered the "true" vitamin E)
  • Tocotrienols

Each of the tocopherol and tocotrienol subfamilies also contains four different forms:

  • Alpha-
  • Beta-
  • Gamma-
  • Delta-

Each one of these subgroups has its own unique biological effects. Ideally, vitamin E should be consumed in the broader family of mixed natural tocopherols and tocotrienols, (also referred to as full-spectrum vitamin E) to get the maximum benefits. And there's the main problem: the vitamin E most often referred to and sold in most stores is a synthetic form of the vitamin, which really should NOT be used if you want to reap any of its health benefits.

Besides the potential benefit for Alzheimer's patients, research has found vitamin E can be helpful in the prevention of certain cancers.6 For example, a study published in the International Journal of Cancer in 20117 found that gamma-tocotrienol, a cofactor found in natural vitamin E preparations, decreases prostate tumor formation by 75 percent. An earlier study, published in 2008 found that 300 IUs of vitamin E per day reduced lung cancer risk by 61 percent. You can tell what you're buying by carefully reading the label.

  • Natural vitamin E is always listed as the "d-" form (d-alpha-tocopherol, d-beta-tocopherol, etc.)
  • Synthetic vitamin E is listed as "dl-" forms

Note that when vitamin E is stabilized by adding either succinic acid or acetic acid, the chemical name changes from tocopherol to tocopheryl (as in d-alpha-tocopheryl succinate, for example).

Food Is Your Best Source of Vitamin E

Your body can easily distinguish between natural and synthetic vitamins, and several studies have shown that natural vitamin E is between two and three times as bioactive as the same amount of synthetic vitamin E. Ideally, you'll want to get most if not all your vitamin E from the foods you eat. This way, there's no question you're getting the kind your body can use. Tocopherol and its subgroups are found in certain nuts and green leafy vegetables. Sources of tocotrienols include palm oil, rice bran, and barley oils. However, many Americans do not get nearly enough of dietary vitamin E due to their poor dietary choices.

Always remember that not only are nuts and leafy greens rich in vitamin E, they also contain hundreds of other natural chemicals that create a synergistic effect where the total benefit is far greater than the sum of its parts. When buying vegetables, I strongly recommend you try to find locally grown organic produce, as they often contain greater concentrations of vital nutrients.

While supplementation with the appropriate vitamin E supplement can be helpful, you need to be very cautions. Why? Because, most vitamin E supplements are synthetic and only provide one of the tocopherols and none of the tocotrienols. They tend to overdose on high amounts of synthetic D alpha tocopherol, completely unbalanced with the other parts of the vitamin E family discussed above, and that can cause more harm than good. That is likely the result of some of the negative studies you might have previously seen on vitamin E.

Interestingly, and not surprisingly, that is precisely what happened in the featured study. They used a VERY high dose of synthetic alpha-tocopherol (2,000 IUs). This was not balanced with tocotrienols or any of the other tocopherols (beta, gamma, and delta). Can you imagine what the results would have been had they used the balanced natural version? Chances are, the benefits would have been even greater...

Dietary Guidelines for Maintaining Healthy Brain Function and Avoiding Alzheimer's Disease

Because of the very limited treatments, and no available cure as of yet, you're really left with just one solid solution, and that is to prevent it from happening to you in the first place. The beauty of following my optimized nutrition plan is that it helps prevent and treat virtually ALL chronic degenerative diseases, including Alzheimer's disease. As explained by neurologist Dr. David Perlmutter, Alzheimer's is a disease predicated primarily on lifestyle choices; the two main culprits being excessive sugar and gluten consumption.

Another major factor is the development and increased consumption of genetically engineered (GE) grains, which are now pervasive in most processed foods sold in the US. Dr. Perlmutter's book, Grain Brain, provides powerful arguments for eliminating grains from your diet, particularly if you want to protect the health of your brain. In terms of your diet, the following suggestions may be among the most important for Alzheimer's prevention:

  • Avoid sugar and refined fructose. Ideally, you'll want to keep your sugar levels to a minimum and your total fructose below 25 grams per day, or as low as 15 grams per day if you have insulin resistance or any related disorders. In one recent animal study, a junk food diet high in sugar and fat resulted in impaired memory after just one week!8 Place recognition, specifically, was adversely affected.

    As a general rule, you'll want to keep your fasting insulin levels below 3, and this is indirectly related to fructose, as it will clearly lead to insulin resistance. However, other sugars (sucrose is 50 percent fructose by weight), grains and lack of exercise are also important factors. Lowering insulin will also help lower leptin levels which is another factor for Alzheimer's.

  • Avoid gluten and casein (primarily wheat and pasteurized dairy, but not dairy fat, such as butter). Research shows that your blood-brain barrier, the barrier that keeps things out of your brain where they don't belong, is negatively affected by gluten. Gluten also makes your gut more permeable, which allows proteins to get into your bloodstream, where they don't belong. That then sensitizes your immune system and promotes inflammation and autoimmunity, both of which play a role in the development of Alzheimer's
  • Eat a nutritious diet, rich in folate, such as the one described in my nutrition plan. Vegetables, without question, are your best form of folate, and we should all eat plenty of fresh raw veggies every day. Avoid supplements like folic acid, which is the inferior synthetic version of folate.
  • Increase consumption of all healthful fats, including animal-based omega-3. Beneficial health-promoting fats that your brain needs for optimal function include organic butter from raw milk, clarified butter called organic grass-fed raw butter, olives, organic virgin olive oil and coconut oil, nuts like pecans and macadamia, free-range eggs, wild Alaskan salmon, and avocado. Contrary to popular belief, the ideal fuel for your brain is not glucose but ketones. Ketones are what your body produces when it converts fat (as opposed to glucose) into energy.

    The medium-chain triglycerides (MCT) found in coconut oil are a GREAT source of ketone bodies, because coconut oil is about 66 percent MCTs. In fact, ketones appear to be the preferred source of brain food in patients affected by diabetes or Alzheimer's. In 2010, I published Dr. Mary Newport's theory that coconut oil might offer profoundbenefits in the fight against Alzheimer's disease. She recently launched one of the first clinical trials of its kind to test this theory.

    Also make sure you're getting enough animal-based omega-3 fats, such as krill oil. (I recommend avoiding most fish because, although fish is naturally high in omega-3, most fish are now severely contaminated with mercury.) High intake of the omega-3 fats EPA and DHA help by preventing cell damage caused by Alzheimer's disease, thereby slowing down its progression, and lowering your risk of developing the disorder.

  • Optimize your gut flora by regularly eating fermented foods or taking a high-potency and high-quality probiotic supplement
  • Eat blueberries. Wild blueberries, which have high anthocyanin and antioxidant content, are known to guard against Alzheimer's and other neurological diseases. 
  • Improve your magnesium levels. There is some exciting preliminary research strongly suggesting a decrease in Alzheimer symptoms with increased levels of magnesium in the brain.

    One of the best ways to consume this mineral is through organically bound magnesium, found in whole foods. Green leafy vegetables like spinach and Swiss chard are excellent sources of magnesium, as are some beans, nuts and seeds, like almonds, pumpkin seeds, sunflower seeds and sesame seeds. Avocados are also a good source. Juicing your vegetables is an excellent option to ensure you're getting enough of them in your diet. Beware that most magnesium supplements do not pass your blood brain barrier, but a new one, magnesium threonate, appears to do so and may be superior to other forms.

Other Helpful Dietary Tips, and Valuable Supplements

Another helpful tip is to reduce your overall calorie consumption, and/or intermittently fast. As mentioned above, ketones are mobilized when you replace carbs with coconut oil and other sources of healthy fats. A one-day fast can help your body to "reset" itself, and start to burn fat instead of sugar. As part of a healthy lifestyle, I prefer an intermittent fasting schedule that simply calls for limiting your eating to a narrower window of time each day. By restricting your eating to a 6-8 hour window, you effectively fast 16-18 hours each day. To learn more about intermittent fasting, please see this previous article.

Also, be aware that when it comes to cholesterol levels and Alzheimer's, lower is NOT better. Quite the contrary. According to Dr. Perlmutter, research shows that elderly individuals with the lowest cholesterol levels have the highest risk for Alzheimer's. They also have the highest risk for dying. As he says, the war on cholesterol is fundamentally inappropriate and harmful.

Finally, there's a short list of supplement recommendations worth noting for their specific benefits in preventing and treating dementia. So, although your fundamental strategy for preventing dementia should involve a comprehensive lifestyle approach, you may want to take special note of the following natural dietary agents. These four natural foods/supplements have good science behind them, in terms of preventing age-related cognitive changes:

  • Astaxanthin is a natural pigment with unique properties and many clinical benefits, including some of the most potent antioxidant activity currently known. As a fat-soluble nutrient, astaxanthin readily crosses your blood-brain barrier. One study9 found it may help prevent neurodegeneration associated with oxidative stress, as well as make a potent natural "brain food."

    You can get some astaxanthin by taking krill oil, which is a fantastic omega-3 fat supplement. But you can boost your astaxanthin even more by adding a pure astaxanthin supplement to your nutritional regimen. For optimal absorption, make sure to take krill oil and/or astaxanthin with a fat-containing meal, since both are fat-soluble.

  • Ginkgo biloba: Many scientific studies have found that Ginkgo biloba has positive effects for dementia. A1997 study from JAMA showed clear evidence that Ginkgo improves cognitive performance and social functioning for those suffering from dementia. Another 2006 study found Ginkgo as effective as the dementia drug Aricept (donepezil) for treating mild to moderate Alzheimer's type dementia. A 2010 meta-analysis also found Ginkgo biloba to be effective for a variety of types of dementia.
  • Alpha lipoic acid (ALA): ALA has been shown to help stabilize cognitive functions among Alzheimer's patients and may slow the progression of the disease.
  • Vitamin B12: A small Finnish study published in the journal Neurology10 found thatpeople who consume foods rich in B12 may reduce their risk of Alzheimer's in their later years. For each unit increase in the marker of vitamin B12 the risk of developing Alzheimer's was reduced by two percent. Remember, sublingual methylcobalamin may be your best bet here.

Lifestyle Strategies That Can Help Ward Off Alzheimer's Disease

As mentioned, diet is but one part of the equation. Lifestyle choices such as getting regular sun exposure and exercise, along with avoiding toxins are also important factors when it comes to maintaining optimal brain health. Here are several of my lifestyle suggestions:

  • Optimize your vitamin D levels with safe sun exposure. Strong links between low levels of vitamin D in Alzheimer's patients and poor outcomes on cognitive tests have been revealed. Researchers believe that optimal vitamin D levels may enhance the amount of important chemicals in your brain and protect brain cells by increasing the effectiveness of the glial cells in nursing damaged neurons back to health.

    Vitamin D may also exert some of its beneficial effects on Alzheimer's through its anti-inflammatory and immune-boosting properties. Sufficient vitamin D is imperative for proper functioning of your immune system to combat inflammation that is also associated with Alzheimer's.

  • Exercise regularly. It's been suggested that exercise can trigger a change in the way the amyloid precursor protein is metabolized,11 thus, slowing down the onset and progression of Alzheimer's. Exercise also increases levels of the protein PGC-1alpha. Research has also shown that people with Alzheimer's have less PGC-1alpha in their brains12 and cells that contain more of the protein produce less of the toxic amyloid protein associated with Alzheimer's. I would strongly recommend reviewing the Peak Fitness Technique for my specific recommendations.
  • Avoid and eliminate mercury from your body. Dental amalgam fillings, which are 50 percent mercury by weight, are one of the major sources of heavy metal toxicity. However, you should be healthy prior to having them removed. Once you have adjusted to following the diet described in my optimized nutrition plan, you can follow the mercury detox protocol and then find a biological dentist to have your amalgams removed.
  • Avoid aluminum, such as antiperspirants, non-stick cookware, vaccine adjuvants, etc.
  • Avoid flu vaccinations as most contain mercury and aluminum, well-known neurotoxic and immunotoxic agents.
  • Avoid anticholinergics and statin drugs. Drugs that block acetylcholine, a nervous system neurotransmitter, have been shown to increase your risk of dementia. These drugs include certain nighttime pain relievers, antihistamines, sleep aids, certain antidepressants, medications to control incontinence, and certain narcotic pain relievers.

    Statin drugs are particularly problematic because they suppress the synthesis of cholesterol, deplete your brain of coenzyme Q10 and neurotransmitter precursors, and prevent adequate delivery of essential fatty acids and fat-soluble antioxidants to your brain by inhibiting the production of the indispensable carrier biomolecule known as low-density lipoprotein.

  • Challenge your mind daily. Mental stimulation, especially learning something new, such as learning to play an instrument or a new language, is associated with a decreased risk of Alzheimer's. Researchers suspect that mental challenge helps to build up your brain, making it less susceptible to the lesions associated with Alzheimer's disease.

Prevention Is FAR Easier and More Effective Than Treatment After Onset

Knowing that Alzheimer's is a disease brought on by inappropriate lifestyle choices places you firmly in the driver's seat. Applying the strategies discussed in this article can dramatically reduce your risk of succumbing to Alzheimer's, as well as other chronic diseases, since your diet and lifestyle is responsible for a majority of your health problems. Overall, it will also raise your general quality of life. Clearly, prevention is much easier than treating it after the fact.

The take-home message is that your best hope lies in prevention. In terms of recommended dietary changes, replacing carbohydrates with higher amounts of healthful fats and moderate amounts of high-quality protein is at the top of the list. Other lifestyle factors, particularly sun exposure and exercise are also potent allies against all forms of dementia.