Part of the job of the physician is to inspire, educate and advise patients on health. We don't do this off the cuff, however. We don't base our recommendations on the latest magazine article or fitness fad. We base our recommendations on long-standing population-derived analytical trials evaluating the many lifestyle aspects that may or may not contribute to health. As cardiologists, our focus is on heart health. What is the healthiest diet for the heart? What is the ideal number of minutes per week to exercise? We know the answers, and when someone brings us the latest fad diet and asks us about it, we can assess it based on what we know for sure. We feel confident in our recommendations because they are backed by the science.
But here's the funny thing about science -- it keeps changing the rules! It evolves, and we learn more all the time, and so our recommendations evolve, too. They are no more random because of that. They are still based in science, but to keep those recommendations as effective as possible, we have to stay current.
I tell you this because something new is happening in the world of heart health. It comes out of a notion that has been floating around out there for awhile, but which is only recently being proven: that what is good for your heart is also good for your brain.
Cardiologists don't study the brain, so this isn't often on our radars, but recently, I had the honor of attending The Judy Fund salon series, "Keeping Your Brain and Heart Healthy in 2013 and Beyond." The Judy Fund is the largest private family fund in the history of The Alzheimer's Association, whose mission is focused on care and cure. It raises and grants money exclusively with the Alzheimer's Association for research and public policy, and they have raised approximately $5 million to date. Elizabeth Gelfand Stearns, whose mother died of Alzheimer's, has headed this organization and, along with her father and two sisters, has not only raised money, but has embraced and empowered herself with the same concepts we usually devote to heart disease: that Alzheimer's is preventable. This concept is now reaching the scientific community in a way that it never has before. What I learned at this lecture was fascinating to me.
Until now, most doctors have thought that Alzheimer's disease was a genetic disease and that if you get it, you are unlucky, but that there isn't much you can do about it. That thinking is changing. We already know you can lower your risk of heart disease with lifestyle changes. It turns out those same changes can also lower your risk of early-onset Alzheimer's disease In both cases, genetics plays a role, but it is far from the only player. How you live affects your heart... and your brain.
One of the most interesting ways these two systems in your body are related is through a gene on chromosome 19 called the Apo E gene. Everybody has two copies, one from each parent, and each gene may be one of three types: ApoE2, ApoE3, or ApoE4. In preventive cardiology, the role of Apo E has been on the radar for the last decade or so. In people with one or two copies of the ApoE4 gene, the body has a more difficult time metabolizing fat. In people with an ApoE4 gene, eating a lot of meat, dairy products, and fatty foods tends to cause the build-up of arterial plaque in both the heart and the brain. When I have a patient with the ApoE4 gene, I advise them to eat a mostly vegetarian or even a vegan diet because I've seen what a high-fat diet can do to that person's heart.
In the world of brain science, ApoE4 is notorious. If you have one copy of the gene, your risk of developing Alzheimer's disease is higher than average. If you have two copies of the gene, your risk is even higher, with up to an 80 percent correlation between Alzheimer's and ApoE4. You are not necessarily doomed to Alzheimer's disease, however. Knowing you have one or two ApoE4 genes is a warning to be very, very careful about what you eat and how you live.
But there is more to the story. Sugar and simple carbs like white bread, pasta, and baked goods have also been implicated in an increase in both heart disease and Alzheimer's disease. Those who have one or two ApoE2 genes are less able to process sugar, which can lead to a tendency to develop diabetes. We already know that diabetes, or pre-diabetes conditions like metabolic syndrome, predispose people to both heart disease and Alzheimer's disease. And lest you think you are off the hook if you have two of the so-called normal ApoE3 genes, meaning you metabolize both fats and sugars normally, think again. Despite ApoE status, diets high in fats as well as diets high in sugar and simple carbs are still both implicated on both fronts: heart disease and Alzheimer's disease. If your diet is high in both, you are headed in the wrong direction.
Dr. Maria Carillo, the Director of Medical and Scientific Relations at the Alzheimer's Association in Chicago, made clear the connection between the brain and the heart by citing how, in many trials, those lifestyle recommendations for diet and exercise have proven to be beneficial for brain health. In other words, the body is more integrated than doctors once believed. What affects one vital organ also affects another, and the bottom line is that you can affect how those organs perform and age based on your lifestyle choices. If you have two ApoE4 genes, you may have a greater risk of developing Alzheimer's, but only if you "turn on" that gene with a high-fat diet (and even with ApoE4, a high-sugar inflammatory diet will only make things worse). http://ghr.nlm.nih.gov/gene/APOE
In the world of medicine, making claims about associations is a lot more daring than it might seem to the layperson. With cardiologist Dr. Jill Kalman and neurologist Dr. Carillo behind her, when Ms. Stearns got up and boldly stated that the prevention of Alzheimer's is akin to the prevention of heart disease, and that the conversation about brain health and the conversation about heart health are really the same conversation, she was talking not only about diet and exercise, and cognitive wellness, but also about the genes, and the choice of lifestyle that might or might not ignite these genes and allow them to express themselves in the form of chronic disease. This is about much more than "eating better" and "exercising more." It's about interacting with our own genetics to optimize whole-body health. http://www.alz.org
For the first time in history, we are now able to say that heart disease is 90 percent preventable, and now we are on the cusp of being able to make a similar claim about Alzheimer's disease. That is groundbreaking news! Genetically, we are who we are, with our parents and ancestors passing along the genes that may lead to heart disease or early-onset dementia. But now we are learning that family history can be rewritten. If we know that those genes inside of us may not ever have to express themselves, then wouldn't that make a big difference in how we choose to live, and what we choose to eat?
So the next time you read a best-selling book touting saturated fats as the key to health, for example, keep this in mind, or ask your doctor whether that kind of diet really is good for your heart and your brain. Everybody tends to listen to what they want to hear, but it is important for your health not to experiment. Base your lifestyle choices on what science knows.
As we wait for the research to unfold, clearly more dollars need to be allocated to the world of Alzheimer's. In the meantime, we can say one thing with confidence: Watch what you eat very carefully, for the sake of your heart as well as your brain. Before you take a bite of that steak covered in butter or that icing-covered donut, think about it and make a deliberate decision based on the research. In fact, think with that brain that you need to take care of, and know that in this situation, your heart will always back you up.