Dr. Joseph Kass Discusses Alzheimer's, Parkinson's, and Diet
Please tell us a little about yourself.
My name is Joseph Kass, and I am a physician in Houston Texas. I am an assistant professor of neurology at the Baylor College of Medicine, and I am chief of neurology at Ben Taub General Hospital, which is a large public hospital. My areas of interest have to do with Alzheimer's and Dementia. But I do a lot of general neurology; so I take care of patients with all different types of neurological disorders including Alzheimer's, Parkinson's, seizures, strokes, neuropathy and muscle diseases.
Can you talk about what's going on when someone has Alzheimer's?
Sure. Alzheimer's is the most common neurodegenerative disease, which means it's a disease where brain cells are dying. It's a disease primarily of older people, and their first complaint will be memory problems. It starts with the inability to learn new information, where grandma can't remember what she did yesterday, but she remembers what she did when she was twenty years old, and that's because the older memories are well consolidated.
As the disease progresses, other parts of cognitive functions start to deteriorate as well. For instance people forget where they put things, they have difficulty with names, or their language might deteriorate, and become more simple. Usually their interpersonal skills stay okay until later in the disease. But, unfortunately as the disease progresses, all cognitive domains begin to get affected, and they lose a lot of who they are. When it becomes very advanced, they forget their loved ones, and start forgetting biographic information as well. At the end stages of the disease they are unable to care for themselves, and are unable to take care of even basic toileting and feeding.
Ultimately, it ends in death. There are medications in the market that help in slowing down the progression or stabilizing the disease for a few years. And, in the field of Alzheimer's, there has been a lot of interest in the role of mental exercises, the role of diet, the role of nutrition, the role of supplements, certain vitamins (particularly vitamin E and some of vitamin C) and some other supplements. And, generally with vitamins, in how they might affect the progression of disease, or risk for the development of the disease.
Can you talk a little bit about Parkinson's as well?
Parkinson's is the second-most commonly degenerative disease. Some very famous people have had it recently, such as Pope John Paul II, Janet Reno, and Michael J. Fox. It's a disease of motor slowing, and Parkinson's is characterized by a visible tremor, and people develop a typical shuffling gait. Their face looks like a mask because their facial movements become much slower. They also are going to have difficulty with balance and stability of their posture.
The way that we treat this disease is to replace dopamine in the brain. Unfortunately, as with everything in medicine, there are long-term side effects of doing that, but these people can't function without the treatment. Even though they are getting the treatment, they can develop fluctuations in their functioning, and as the disease progresses it becomes harder and harder to treat the disease. As the disease progresses, there can be cognitive dysfunction within as well.
With Parkinson's, people are examining certain types of supplements, and there have been examinations of the role of diet.. So, that's another area that people are looking beyond just pharmacotherapy.
What are the diet considerations people should take into account to minimize or delay the development of these diseases, and or deal with them as they do develop?
I think there is better data on Alzheimer's in terms of diet and prevention. With Alzheimer's if you look at an MRI of the brain you will see lots of vascular changes. This can happened from a lifetime of high blood pressure or other vascular disease, such as diabetes, which plague Americans nowadays in epidemic numbers. As a result, the kind of things that make your heart healthy are going to make your brain healthier too. So, diets that are full of sugar, fat, cholesterol, saturated fat, those are going to be things that are going to make you brain not too happy either.
To be more specific than that, there have been studies that have looked at role of a diet high in Folic acid, vitamin B12, and vitamin B6. There are population studies that look at whether people who have diets that are high in these B vitamins and Folic acid have high rates of Alzheimer's. Some studies show no effect, and there was actually one study few years ago that said that high folic was associated with a high risk of Alzheimer's. But, there is only one study that said that.
And, there have been a number of studies that show higher homocysteine levels are associated with higher rates of Alzheimer's, and homocysteine is something that is found high in the blood when you have lower rates of B12, B6, and Folic acid. So, then you can extrapolate and say, well does that mean that if you have high rates of those things in your diet, you willhave a lower risk of Alzheimer's? More studies are now suggesting that a diet rich in B6, B12, and Folic acid, such as a Mediterranean style of eating, should lower your risk of getting Alzheimer's.
So, in terms of helping people translate this into food, green leafy vegetables is a great source of folic acid.
Yes, exactly. Green leafy vegetables are a good thing to be eating. I wouldn't say as a headline that eating green leafy vegetables will prevent Alzheimer's, but it seems to be good on many levels. And, it's definitely not going to hurt, and there is some support in the research literature that that could be good.
And, what are good ways to get the B vitamins, such as B12 and B6, or vitamin E? Blueberries, and blackberries?
Yes. There is an article in the Archives of Neurology that talks about folic acid verses the other B vitamins, that said; they looked at the whole issue of homocysteine vs. folic acid, B6 and B12. There are these population studies that show that increased homocysteine correlates with high risk of Alzheimer's. They've looked at over two thousand people who were over sixty-five, and they did questionnaires, and they looked at what their intake of folic acid was (B6 and B12). They looked at the total calorie intake, and they did an analysis based on that.
In this study they had almost two hundred cases of Alzheimer's. Those with the highest quartile of total folic intake were less likely to have Alzheimer's. The study was adjusted for age, sex, education, ethnic group, diabetes, hypertension, smoking, heart diseases, and strokes. The B6 and B12 levels did not appear to be related to the risk of Alzheimer's. Keep in mind that this is just one study.
I think it's important to emphasize that it's an extremely early stage in this research, and that nothing is proven.
Yes. If you focus on eating a healthy diet, it's going to be healthy for you in so many ways. It will be healthy for your brain; it will be healthy for your heart; it will be healthy for your blood. And, it will be healthy for a lot of organ systems, and it doesn't have to require a radical readjustment in your diet. It just means eating more of the things that are good for you. Unfortunately Americans love to have fad diets, and obsessive kinds of behaviors when it comes to diet, such as high protein, or high fat, or whatever. But, it's really just eating what's good for you.
Is there anything known about diet and Parkinson's?
Sure, the only thing I can tell you about that is that I don't think there is an association between higher caffeine intake and a lower risk of Parkinson's. Coffee, strangely enough, might be somewhat protective with regard to Parkinson's. Unfortunately, with this disease it's not as clear as with Alzheimer's.
Isn't a key part of the process that free radicals attack mitochondrial cells in the brain?
There are people who believe that there is mitochondrial dysfunction in Parkinson's disease.
But, also with Alzheimer's, what I have read suggests that Alzheimer's relates to free radical-related problems. I have seen discussions of a number of supplements such as the R+ form of Alpha Lipoic acid, N-Acetyl-Cysteine, acetyl-L-carnitine, idebenone, and CDP-choline to name a few. Are these potentially beneficial?
If you do a search in PubMed for L-carnitine and Parkinson's, you get four hits, so there is definitely not very much that has been done. There is one supplement that has been studied with regard to Parkinson's, and that's coenzyme Q10.
Coenzyme Q10 is also heart healthy, correct?
Yes. But, the data on Coenzyme Q10 and Parkinson's is actually probably better, than the heart data. There was a study a few years ago, where they looked at Coenzyme Q10 and Parkinson's. It was a small study and the participants took 1200 milligrams of Coenzyme Q10, which is very expensive, so that's a problem with it. We have a big Parkinson's centre at Baylor. Every time they see a patient with Parkinson's they do a United Parkinson's Disease Research Scale (UPDRS) standardized assessment of the patients so they can track their symptoms' progression. In the study of Coenzyme Q10 there was actually an improvement of five or six points. So, there was actually a symptomatic benefit in the patients who were on Coenzyme Q10.
But they took 1200 milligrams a day which is very expensive.
I know of another study that's starting and, the supplement they have chosen to look at more besides Coenzyme Q10 is L-carnitine. We don't' have the results of the study yet, and we don't know what the doses are, but if we find it helps, it's a lot cheaper. Even a few points on that UPDRS scale matters to people. My patients generally can't afford Coenzyme Q10, so there is no way that I can recommend it to them. But, if you have the money, you may benefit from taking it. But I wouldn't go mortgage the house on it because it's a mild effect.
It is exciting to know that there is a supplement that does have some benefit, but it wouldn't be enough to get a person through more through even a mild disease. The other million dollar question is, "Are these kinds of things neuroprotective?" Nobody knows that answer.
So, there is basically no clear research that shows some neuroprotective approach to diet or supplements at this point?
Right. We don't know that.
What about Alpha Lipoic acid, the R+ form of it? A lot of people talk about that out there as a supplement with a bunch of beneficial effects.
I was just telling one of my patients to use this for HIV neuropathy. I take care of a bunch of HIV patients, and I do an HIV neuro-AIDS clinic. And, he was asking me for supplements and I would think well, maybe it would be helpful in HIV neuropathy. In HIV neuropathy they get mitochondrial dysfunction. So, that's a good question, because of the whole mitochondrial dysfunction issue. But, it's basically a theoretical therapeutic intervention that hasn't been sufficiently studied for me to be able to say anything about it.
Are there issues with refined and processed foods? In other words, regarding Alzheimer's and Parkinson's, should we be looking for more natural foods that were made with less processing?
I became very interested in diet, and was very against medicine, because I was really suspicious of it. Then I became a doctor, but still I am one of those doctors that is very sympathetic and interested in the role of diet. This is becoming more common with younger doctors, as we get more and more evidence of the role diet plays in disease prevention in general. For example, there is a lot of science related to diet and cardiovascular disease. We really don't know sometimes what we are putting into our bodies and what will be the untold effects are in terms of neuron-degeneration. Not to be alarmist, because we probably won't ever be able to study these things. And, probably most of the things that are going into our bodies are probably not going to cause horrible harm. But, if it's within your budget, choosing less processed, healthier foods, makes sense on a gut-level basis. These are kind of foods that our ancestors have been eating for millennia; and that's how we evolved. We didn't evolve eating things added to our diets that have longer words than our brains have evolved to be able to handle or pronounce.
So it would only make sense that these are the kinds of things that are more compatible with our neuron-systems as well.
I don't think a scientific answer is really available. But I know my own personal philosophy has been that if a cave man was able to get it and eat it, it's probably good for you.
Yes. We didn't evolve in a place where we had number three dye. So, I think the thing with all the diets and soda there may be no data that says that that is bad, but you know instinctively it's probably not the greatest thing to be doing.
The other issue with a lot of this research is ensuring the quality of the research. A lot of it has to do with food questionnaires. It's really hard to know how well people are recalling what they eat. This makes good studies kind of hard. You are dealing with murky science sometimes.
Can we talk a bit more about vitamin E and Alzheimer's? Doesn't this illustrate some of the problems with the studies in general?
It's kind of controversial, because there are some studies that definitely showed vitamin E have a modest benefit. And, then there was another study that came out a while ago that said that it increased or caused mortality. Then there is a study that showed vitamin E plus vitamin C actually together had greater positive impact. And, there is also a study that shows that people with lower levels of vitamin E had a higher risk of getting dementia. So, I think that people are all over the place. And, there is one study that showed that eating foods that have high vitamin E levels like nuts, and eating good quality oils, would be beneficial.
By good quality oils, you mean Omega 3 fatty acid?
Yes. That sort of thing would be beneficial over your lifetime. I think for a lot of these neurodegenerative diseases, it's not one of those things that you can address with diet when you are diagnosed. Of course you are going to do what you can do at that point. But, these diseases start so many years before you show symptoms. For Alzheimer's it is happening decades before you have symptoms. The question is we don't know who has it. Is it you? Is it me? Is it the neighbor next door?
It would be great if we knew, because then we could start trying to look at prevention studies. But, with nutrition, the benefits are going to be very subtle. Of course if you are fifty-five years old, and you've been eating poorly, start changing now. But, if you are a younger person; now is the time to change, too. That means eating a sensible diet that has vegetables, good oil, high antioxidants, and no saturated fat. But, it doesn't necessarily mean mega dosing on supplements. If you could just basically eat enough in your own diet, that will have the good antioxidants, and the good folic acid, and good vitamin E levels, and maintain that naturally, then you'll probably do as much as you can to protect yourself without suffering the ill effects of too much of anything. That's probably the best take-home message I can give until we have more data.
Thanks for taking the time to speak with us today.