Today’s big health story is the National Institute of Clinical Excellence’s (NICE) final decision to restrict the prescribing of drugs for Alzheimer’s disease.
Basically, NICE has said that there’s not enough evidence of cost-effectiveness to support the use of such drugs in individuals in the early stages of this condition. Patient groups, including the Alzheimer’s Society are, not surprisingly, up in arms about this. While I am a fervent advocate of the individual, I get nervous about this increasing tendency for patient groups to attempt to influence health policy and healthcare provision. It is my belief that that are plenty of medical treatments already out there with limited effectiveness, and I personally support any policy which has come from taking an honest, hard look at a drug, and found it wanting.
However, as an advocate of individuals, I also believe that we should have access to information and advice that can help us take the management of our health in our own hands. To this end, I have attached here a couple of articles which look at natural approaches to the prevention and even treatment of Alzheimer’s disease. Of particular relevance here is the herb Ginkgo biloba, which looks like it has real potential to combat dementia, mainly by enhancing blood supply to the brain.
Observer Column – 20th March 2005
The National Institute of Clinical Excellence (NICE) – the body which assesses and makes recommendations about medical care in the UK – has recently suggested that doctors should desist from treating patients newly diagnosed with the brain drain condition known as Alzheimer’s disease. After reviewing the evidence, NICE’s panel of experts have come to the conclusion that the drugs currently used to treat Alzheimer’s disease, known as the ‘cholinesterase inhibitors’, are not worth the tens of millions of pounds the NHS spends on them each year. However, the fact that the cholinesterase inhibitors are the only drugs that appear to have the ability to slow the progression of Alzheimer’s disease has led some psychiatrists to wonder whether the experts at NICE have lost their minds.
The recent pronouncement from NICE got me thinking about what natural approaches may benefit those suffering from Alzheimer’s disease. One the nutritional side, there is some evidence that the so-called omega-3 fats found in oily fish may have some role here. These fats come in two principal forms: eicosaentenoic acid (EPA) and docosahexaenoic acid (DHA). Together, these fats are believed to play critical roles in the structure and function of the brain. These omega-3 fats also have a natural ability to quell inflammation – a process that has been implicated in the development of Alzheimer’s disease.
Studies show that Alzheimer’s disease sufferers tend to be short on omega-3 fats, and consuming more of these fats has been associated with relative protection against Alzheimer’s disease. Two studies, for instance, have found that eating fish just once a week is associated with a 60 per cent reduction in risk. For those looking to get therapeutic benefit from omega-3 fats, I recommend eating two or three portions of oily fish such as mackerel, herring or sardine each week, or supplementation with 2 – 3 grams of concentrated fish oil each day.
The effects of boosting omega-3 intake on Alzheimer’s disease has not been formally studied at this time, though one might anticipate some improvement in symptoms and a slowing in the progression of the disease in the long term. For quicker results, however, I recommend the herb Ginkgo biloba. This herb is renowned for its ability to boost circulation, which will help supply the brain with essential nutrients and fuel. In addition, Ginkgo biloba appears slow the deposition of the extraneous substance found in the Alzheimer’s disease-affected brains known as beta-amyloid. One analysis of 33 trials found that the herb is generally safe, and may lead to significant improvements in brain function in those who take it . Ginkgo has blood-thinning effects, and should be used with some caution in individuals taking conventional blood-thinners such as warfarin. The normal recommended dose is 120 – 240 mg of Ginkgo biloba extract per day. For those looking for an alternative to conventional Alzheimer’s disease drugs, I reckon fish fats and Ginkgo biloba are well worth getting into their heads.
Observer Column – 16th October 2005
The rising popularity of cosmetic surgery in the UK and a proliferation of body makeover shows on TV point to our increasing preoccupation in allaying the visible signs of ageing. While it seems that many of us have a desire to protect ourselves from any external evidence of ageing, my experience is that there is considerable interest in approaches that might ward off the internal effects of the ageing process too. I quite commonly see individuals in practice who, for instance, complain that they are not as mentally sharp as they used to be. Some are particularly concerned that their loss of mental edge may represent the first steps on the road to a brain drain condition such as Alzheimer’s disease.
While the processes underlying brain function deterioration are many and varied, there has been considerable interest recently in the potential part played here by a substance known as homocysteine. Excesses of this natural blood constituent appear to have the capacity to damage the lining of the arteries and predispose to atherosclerosis – the process responsible for the gradual furring up of our arteries that is common in ageing. Atherosclerosis may end up compromising blood supply to the brain, and is a recognised risk factor for diminishing brain function and dementia in later life.
Not surprisingly, studies have found that high blood levels of homocysteine are associated with an increased risk of dementia including Alzheimer’s disease. One such study, published in this month’s American Journal of Clinical Nutrition, discovered that high homocysteine levels were linked with increased risk of Alzheimer’s disease, even in individuals unaffected by compromise to the blood supply to their brains. This finding suggests that homocysteine, in addition to increasing the risk that the brain will be starved of blood, may be directly toxic to the brain tissue as well.
Scientists have now started to put forward the idea that quelling homocysteine levels may help to preserve brain function and protect against dementia in time. While studies that have tested this theory are yet to be published, the evidence to date is certainly consistent with this notion. Nutrients known to help reduce homocysteine levels include folate, vitamin B12 and vitamin B6. Interestingly, the recent AJCN study found that low levels of folate were found to be a risk factor Alzheimer’s disease. Also, another study in the same edition of the journal found that a low level in any of the nutrients folate, B12 or B6 appeared to increase the risk of general brain function decline.
Foods rich in folate include oranges and green leafy vegetables. Vitamin B6 can be found in liver, avocado, bananas and fish, while meat, fish and eggs are all good sources of vitamin B12. In addition to including such foods in the diet, I recommend supplementing with 800 ” 1000 mcg of folic acid, 10 mg of vitamin B6 and 400 mcg of vitamin B12 each day. For those keen not to do what they can to preserve brain function, I reckon ensuring a good intake of these nutrients is certainly worth thinking about.
1. Birks J, et al. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2002; 4:CD003120.