Why Alzheimer's is a Women's Issue
/As Brain Health Awareness week comes to an end, I thought I would talk about the most dreaded form of brain illness, Alzheimer’s Disease. Many people think of Alzheimer’s as an “old age” disease. Please think again.
Yes, age is the biggest risk factor, and yet we are all living longer, so our risk automatically goes up. But it’s not an “old age” disease.
That’s because Alzheimer’s starts in the brain decades before symptoms start to show.
Not only that – some of the biggest risk factors for Alzheimer’s Disease (AD) are very prevalent nowadays – high blood pressure, high cholesterol, obesity, and of course diabetes.
Another risk factor? Being a woman.
Some sobering facts
Every 65 seconds another person develops Alzheimer’s disease, and of these “newcomers”, two-thirds will be women.
In 2020, there were 5.7 million people diagnosed with Alzheimer’s (the most common form of dementia) in the US (the rates are similar in Canada). If rates continue at the present pace, the numbers will triple by 2050.
Did I mention that two out of every three Alzheimer’s patients are women?
In fact, a study from The Netherlands of more than 12,000 people found that women at 45 years of age had a 25.9% risk of going on to develop dementia, compared with 13.7% for men.
Finally, women in their 60s are about twice as likely to develop Alzheimer’s over the rest of their lives as they are to develop breast cancer.
These are serious statistics.
Sadly, research has lagged behind, especially when it comes to research on the female brain. For years we have been lumped into the “one brain fits all” category.
Thankfully, that’s changing, in part thanks to the research of Lisa Mosconi, a neuroscientist and Director of the Women’s Brain Initiative at Weill Cornell, and Dr. Richard Isaacson, a world-renowned neurologist and Director of the Centre for Brain Health at Florida Atlantic University (both of whom I’ve mentioned in past newsletters).
The critical role of hormones, especially estrogen
Women’s brains become more vulnerable to Alzheimer’s in the years leading up to and after menopause, with estrogen playing the lead role. In fact, estrogen is a major, if not the major, hormonal driver of women’s brain health.
Estrogen, among many of its roles, is a neuro-protective hormone, boosting the brains immune system. With the decrease of estrogen and other hormones during menopause, we not only experience many of the symptoms associated with menopause (which, by the way, originate in the brain, not the ovaries), we also lose key protective elements in our brains.
As per Lisa Mosconi, for most women these changes manifest themselves as a host of symptoms associated with menopause, but for some women, hormonal changes diminish the brains ability to resist diseases like Alzheimer’s.
The good news?
Alzheimer’s starts in our brain decades before any symptoms start to show. In fact, studies say that 46M Americans have Alzheimer’s in their brain right now with no symptoms. It’s referred to as Stage 1 – the presymptomatic stage or preclinical stage.
And why is this good news? Because THIS is the time where we can make a difference in our brains – both with respect to Alzheimer’s, as well as cognitive decline in general. We have the power to potentially change the course of this debilitating disease through lifestyle.
Risk factors
Given that diabetes is one of the pathways to Alzheimer’s, the presence of three or more of the following markers could suggest prediabetes (often referred to as metabolic syndrome), so it’s very important to know your numbers:
elevated fasting glucose
elevated triglycerides
reduced HDL
high blood pressure
obesity
excess belly fat
Other risk factors include lack of social connection, hearing loss and long term sleep deprivation.
As well, having the APOE4 gene increases our risk (approximately 25% of the population has this gene), but it doesn’t mean we are destined to get it. Having multiple risk factors along with the APOE4 variant, such as high cholesterol, does increase the risk though.
As does being a woman.
So what to do?
There is no effective cure in sight. But evidence, through brain scans and an increasing number of studies, is showing that lifestyle plays a critical role in both preventing or postponing Alzheimer’s. Some researchers would even venture as far as saying that lifestyle could reverse AD.
So at this point the key is to do everything we can to not only reduce our risk of developing the disease, but to simply avoid cognitive decline as we age - even enhance it.
In subsequent newsletters, I will delve into specifics (especially exercise, which, for many researchers is at the top of the list). But for now, broadly, I will sum up things we can do in five key points, based on the mnemonic NEURO, coined by Dean and Ayesha Sherzai, authors of The Alzheimer’s Solution:
NUTRITION – The Sherzai’s believe that a plant-based diet gives us the most protection for our brain, in part because they feel plants have all the nutrients we need for our brain to operate at an optimal level, and in part their belief that animal products are highly inflammatory for the brain.
On the other hand, Richard Isaacson and Lisa Mosconi are supporters of the Mediterranean diet (or versions of it such as the MIND diet) for cognitive health.
BOTH agree that sugar intake should be minimized.
EXERCISE – As mentioned, this is at the top of the list for many researchers, including Dr. Isaacson:
“If there is one single thing that you can do today to improve your mind, to optimize cognitive function and reduce your risk of Alzheimer’s disease, by far, hands down, the number one thing you can do is physical exercise”.
Excerpt from the Mastering Brain Health Series, Physical Exercise and Habits
Exercise, including BOTH strength training and aerobic, has an enormous impact on brain health, boosting cognitive function by increasing blood flow and other chemicals. Long periods of inactivity mean less blood flow to the brain.
UNWIND – Chronic stress keeps our cortisol levels high, affects our hunger centres, our immune system, other hormones and ultimately our brains. Breathing, meditation, yoga, social connection and having purpose are all ways to help decrease stress levels.
RESTORE – As we all know by now, restorative sleep is critical for good health. It is necessary for memory consolidation and removal of toxic by-products, like amyloid, which build up in the brain.
OPTIMIZE COGNITIVE ACTIVITY – I read a great way of describing this recently, “We should all live at the overlap of complex, purpose and challenge”. Learn something multi-dimensional, like dancing, learning a new language, writing a book or learning a new instrument. We need to truly engage our brains.
These recommendations are broad, and I look forward to getting into more detail on both exercise and nutrition, as there are some key takeaways within those areas that I feel will be helpful.
The place to start right now? If you haven’t done so already, get your blood tests done. And take your blood pressure (all pharmacy's offer this). Then do your research to find out if you need to take some steps to better your numbers. As I mentioned in a recent newsletter, the ranges on our lab tests in terms of what is considered “normal” provide a bit too much leeway.
I listened to an excellent podcast recently by Dr. Casey Means, MD, Stanford-trained physician, Chief Medical Officer and Co-founder of the metabolic health company Levels Health. She provides some solid guidelines on what we should be aiming for when it comes to our key lab test results.
Summary
We have to be active participants in our health care, whether it be prevention of Alzheimer’s disease, enhancing our cognitive health or taking care of our overall health. We know that lifestyle modifications make a difference.
And as women, we need to be extra-vigilant when it comes to our brain health. The key? Start now.
Thanks for reading :)
Gillian x
PS - for those of you in Toronto and surrounding area, Spring arrived today (!) and my Walk & Talk Wellness Reset is up and running. It's a fantastic way to get the therapeutic benefits of a walk in nature while getting personalized nutritional and lifestyle recommendations. Let me help you set some goals - nutrition, sleep, cognitive health, stress management or movement - and put some systems in place to help take you to the next level. You can reach me by replying to this email or at gbwellness.ca.