Welcome to our colleague and consulting physician Dr. Edwin Ferguson. He is a respected leader and partner in our mission. His article below describes our collective approach to disease prevention. State of the Art Preventive Strategies to reduce the risk for cardiovascular disease, type 2 diabetes and dementia DEMENTIA The economic devastation to society and patients families of those afflicted by dementia is huge and unsustainable. Dementia is one of many chronic diseases that are treated by the “pill for every ill” approach and standard medications used to treat Alzheimer’s disease provide no long term benefit, if any. Patients and families fear dementia far more than cardiovascular disease(CVD) (heart attack and stroke, with stroke being feared more than heart disease) but advanced laboratory testing, which is not often utilized, can help reduce the risk of these diseases as well as type 2 diabetes mellitus (DM), but are little taught or utilized. Better treatments that are more specific or aggressive can reduce the risk of suffering from disability and death from CVD.
These must involve a functional medicine approach which is now a broader and more logical concept to chronic disease prevention. One type of dementia can be thought of as a vascular disease related to multiple ministrokes (microinfarcts) that can be prevented largely by proper treatment of hypertension, abnormal lipoproteins, insulin resistance and DM. Going back to the root causes and not just trying to add more and more medications is vital. Vascular dementia is common and is often seen concurrently with Alzheimer’s disease (AD). Risk factors for AD overlap with those for vascular dementia.Another type of dementia is the feared Alzheimer’s disease where abnormal Beta-amyloid proteins accumulate and cause brain damage as neurons die. Other processes occur that destroy brain cells and neuron connections and begin the downward spiral from mild cognitive impairment (MCI) to frank dementia with profound memory loss and loss of bodily functions dependent on a healthy brain. It should now be realized that even with a family history of dementia, proper treatment may halt the onset or progression of memory loss and brain function. Patients often do not seek medical care because they are taught that there is nothing that can be done, and fear the stigma of a diagnosis of dementia, loss of driver’s license, inability to obtain long-term care with the expense, and ultimately nursing home placement. Primary care providers often do not refer since it has been taught that there is no effective therapy. Specialists often put patients through hours of neuropsychological testing, expensive imaging (CT scan, MRI, PET scanning), lumbar punctures, but little is thought available therapeutically. It is now recognized that chronic diseases like cardiovascular disease, diabetes (DM), and the dementias are linked to multiple environmental insults to our bodies, which are often little recognized or looked for, much less treated. We may inherit genes or acquire mutated genes that are linked to any one or multiple chronic diseases, but our genes do not determine our destiny. Gene expression is controlled by environmental factors, which requires a rethinking of the traditional medical care model of looking at patients as having a disease or diseases that seem distinct from one another, and demanding medication as the first treatment option. Patients usually get recommendations to follow a certain diet, lose weight, and exercise but advice as to avoidance of environmental toxins, dietary sensitivities, and a full exploration of functional medicine concepts is not done. Appropriate diagnosis of cardiovascular risk factors and proper treatment and follow-up may prevent vascular dementia and slow progression of AD. With hypertension, home BP monitoring is essential, and a 24 hour ambulatory BP recording which has the advantage of identifying the absence of the normal overnight “dip” in BP that is clearly linked to AD. Lipoproteins must be done that identify more than standard total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol. Advanced testing to look at LDL particles (or apoB) is necessary. While blood glucose and the long term marker hemoglobin A1C may be normal, a strong predilection to develop DM can be picked up by advanced insulin resistance markers. Rarely are providers taught about these advanced tests. Insulin resistance with elevated but functionally inadequate blood glucose in the brain (type 3 DM) is strongly linked to AD and thus the need for proper diagnosis and treatment. AD is actually a protective response against metabolic and toxic insults that cause inflammation and oxidative stress. There are dozens of interventions, based upon these insults. These include optimization of vitamin D levels, identification of adrenal fatigue, control of stress, exposure to toxins, recognition of depression, optimization of metal metabolism (lead, zinc, copper, selenium, mercury etc.). Nutrition changes to an anti-inflammatory diet low in low fiber carbohydrates and with good fats and proper amounts of “organic” meats. Exercise has strong benefits, and proper sleep (look for sleep apnea) that helps the brain clear toxins through its glymphatic system. A critical component is optimal gut health. The GI tract and brain are interlinked. A change in the gut bacteria (the microbiome) is a complex topic but essential to our overall health, especially brain health. Probiotics are one of many components available to modify the microbiome. With an abnormal microbiome the gut wall becomes “leaky” and endotoxins leak through, and are causally linked to autoimmune diseases, and brain function. The energy factories in all of our cells and the brain, called mitochondria, are often dysfunctional. This can be addressed. There are other factors that can be sought and potentially treated. Patients need to be seen sooner and start prevention or an early reversal program. The many components of a protection program against dementia would be discussed during your consultation.