Brain health is linked to heart health, implications for blood pressure medication

An interesting study just published in the journal Circulation provides evidence of the link between brain health and the capacity of the heart to send blood to the brain. The authors first note the importance of cerebral perfusion (getting blood into the brain):

“Cardiac dysfunction is associated with neuroanatomic and neuropsychological changes in aging adults with prevalent cardiovascular disease, theoretically because systemic hypoperfusion disrupts cerebral perfusion, contributing to subclinical brain injury.

They set out to test whether the cardiac index (the amount of blood the heart pumps in proportion to body size) as a metric for cardiac function would correlate with loss of brain tissue as shown by brain MRI and neuropsychological markers of ischemia (reduction of oxygen due reduced blood flow) and Alzheimer’s disease. What did the data show?

“…cardiac index was positively related to total brain volume and information processing speed and inversely related to lateral ventricular volume…participants in the bottom cardiac index tertile and middle cardiac index tertile had significantly lower brain volumes than participants in the top cardiac index tertile.”

Even the people with the middle cardiac group (low normal) had showed signs of serious neurodegeneration with brain atrophy (lower brain volume). How important is it to get better than a low normal amount of blood to the brain?

“Although observational data cannot establish causality, our findings are consistent with the hypothesis that decreasing cardiac function, even at normal cardiac index levels, is associated with accelerated brain aging.

Consider this in light of earlier research that aggressive treatment of blood pressure is harmful. Clinicians must respect the need to balance cardiovascular protection from excessive pressure dynamics with the profound need to ensure adequate cerebral perfusion. Are you concerned that your blood pressure therapy may be stronger than it should? Read the earlier research posts and discuss the matter with your doctor.

Irritable bowel syndrome—a brain disorder

Irritable bowel syndrome (IBS) can manifest with abdominal pain and diarrhea, or constipation, or both. A study just published in the journal Gastroenterology brings to light the role of the brain in IBS. The authors first observe:

“Several studies have examined structural brain changes associated with chronic pain syndromes, including irritable bowel syndrome (IBS), but study sample sizes have been small and heterogeneous.”

They used MRI methods to examine anatomical differences in the brains of carefully screened IBS patients and normal ‘controls’. Interestingly, they found significant abnormalities in the brains of the IBS group:

IBS was associated with decreased gray matter density (GMD) in widespread areas of the brain [gray matter refers to the neuronal cell bodies]…The areas of decreased GMD associated with IBS were largely consistent across clinical subgroups, based on predominant bowel habit and pain predominance of symptoms.”

The brain regions most affected included the prefrontal and posterior parietal cortices, leading to their conclusion:

Changes in density of gray matter among regions involved in cognitive/evaluative functions are specifically observed in patients with IBS…”

Evaluation and treatment of irritable bowel syndrome, like so many other diverse conditions, must include the capacity of the brain to regulate its arousal state in general and the autonomic nervous system (which governs digestive and all other visceral functions) in particular.

Gluten sensitivity without celiac disease in the elderly: is there a concern?

Scandinavian Journal of GastroenterologyOften tests shows anti-gliadin antibodies (AGA; gliadin is the immunoreactive component of gluten) in the absence of celiac disease but with various autoimmune conditions representing the non-celiac manifestations of gluten sensitivity. The authors of a study just published in the Scandinavian Journal of Gastroenterology explore this issue for the elderly.

“…data suggest that AGA positivity [without celiac disease] might be related to distinct disease entities such as allergy and gluten ataxia (loss of muscular coordination with unsteady movements and gait). Our aim here is to explore the clinical relevance of positive AGA in the elderly population.”

The authors correlated positive lab tests for gluten sensitivity with the incidence of depression and rheumatoid arthritis in 2815 individuals aged 52–74 years. What did their data show?

Rheumatoid arthritis and depression were found significantly more often in AGA-positives than controls. The significance remained even when tTGA-positive and known celiac disease cases were excluded.”

Don’t forget that anti-gliadin antibody tests are not an absolute screen for gluten (or any other food) sensitivity because there are a number of factors that can suppress the expression of antibodies at the time of specimen collection. However, this study shows that if an elderly person is suffering from depression or rheumatoid arthritis the possibility of gluten sensitivity should be investigated.

Adolescence, a dangerous time for alcohol excess—but so is anytime

Proceedings of the National AcademyAdding more concern to the reported increase in heavy alcohol consumption among adolescents is the emerging science regarding alcohol’s effect on the brain. This research just published in the Proceedings of the National Academy of Sciences elucidates the mechanism by which binge drinking damages the developing brain.

“Binge alcohol consumption in adolescents is increasing, and studies in animal models show that adolescence is a period of high vulnerability to brain insults. The purpose of the present study was to determine the deleterious effects of binge alcohol on hippocampal neurogenesis…”

The authors made a number of startling observations regarding the effect of alcohol on the brain’s center for short-term memory and adrenal regulation, the hippocampus:

“Heavy binge alcohol consumption over 11 mo dramatically and persistently decreased hippocampal proliferation and neurogenesis…Alcohol significantly decreased the number of actively dividing type 1, 2a, and 2b cell types…suggesting that alcohol interferes with the division and migration of hippocampal preneuronal progenitors. Furthermore, the lasting alcohol-induced reduction in hippocampal neurogenesis paralleled an increase in neural degeneration mediated by nonapoptotic pathways.”

Yikes. The authors sum up their findings with these memorable comments:

“Altogether, these results demonstrate that the hippocampal neurogenic niche during adolescence is highly vulnerable to alcoholThis lasting effect, observed 2 mo after alcohol discontinuation, may underlie the deficits in hippocampus-associated cognitive tasks that are observed in alcoholics.”

Journal of NeuroscienceA fascinating paper published last month in the Journal of Neuroscience now reveals how alcohol feeds an immune inflammatory attack on the brain:

Toll-like receptors play an important role in the innate immune response, although emerging evidence indicates their role in brain injury and neurodegeneration. Alcohol abuse induces brain damage and can sometimes lead to neurodegeneration. We recently found that ethanol can promote TLR4 signaling in glial cells by triggering the induction of inflammatory mediators and causing cell death, suggesting that the TLR4 response could be an important mechanism of ethanol-induced neuroinflammation.”

This is an extremely persuasive argument for moderation for anyone interesting in preserving brain health.

The authors go on to report that TLR4 is critical for ethanol-induced inflammatory signaling in glial cells by demonstrating that ‘turning off’ TLR4 prevents the neuroinflammatory brain damage:

“Our results demonstrate, for the first time, that whereas chronic ethanol intake upregulates…cytokine levels [interleukin (IL)-1β, tumor necrosis factor-{alpha}, IL-6] in the cerebral cortex,…TLR4 deficiency protects against ethanol-induced glial activation, induction of inflammatory mediators, and apoptosis. Our findings support the critical role of the TLR4 response in the neuroinflammation, brain injury, and possibly in the neurodegeneration induced by chronic ethanol intake.”

Science Translational Medicine 0710For us the main message is that excessive alcohol consumption fires up the brain’s glial cells (immune cells) and the resultant neuroinflammation does serious damage to the brain. This important research was highlighted in an editorial published last week in Science Translational Medicine which contains some notable comments:

“Ethanol is the most widely used psychotropic substance in the world, and chronic ethanol abuse leads to harmful changes in virtually every organ system in the body. Notably, this includes the brain, where consumption of alcohol can lead to irreversible changes in cognition, mood, and behavior. Although it has been known that this often involves degenerative, inflammatory-mediated processes, their precise nature has not been characterized. In a recent article, Alfonso-Loeches and colleagues report that much of the ethanol-induced inflammation in the brain depends on signaling through Toll-like receptors (TLRs). These receptors participate in innate immunity responses to infection but are also implicated in reactions to injury and degeneration in the brain.”

The editorial concludes with the compelling comparison of the brain damage done by activation by alcohol of neuroinflammation through Toll-like receptors with other common neurodegenerative conditions:

“These results suggest that TLRs play a critical role in alcohol-related brain changes, just as they have been previously implicated in Alzheimer’s disease, ischemic brain injury, and HIV infection.”

Inflammation ResearchBesides curtailing excess and enjoying alcohol only in moderation we may be able to use coffee as protective therapy. There is abundant evidence of the benefit of coffee for the liver, including this recent study published in the journal Inflammation Research. The authors present data that:

“Treatment with caffeine significantly attenuated the elevated serum aminotransferase enzymes and reduced the severe extent of hepatic cell damage, steatosis and the immigration of inflammatory cells… Furthermore, caffeine decreased serum and tissue inflammatory cytokines levels, tissue lipid peroxidation and inhibited the necrosis of hepatocytes. Kupffer cells isolated from ethanol-fed mice produced high amounts of reactive oxygen species (ROS) and tumor necrosis factor alpha (TNF-α), whereas Kupffer cells from caffeine treatment mice produced less ROS and TNF-α.”

The authors conclude:

“These findings suggest that caffeine may represent a novel, protective strategy against alcoholic liver injury by attenuating oxidative stress and inflammatory response.”

Experimental NeurologyCould this protective effect extend to the brain? There’s a lot of emerging evidence that suggests the answer is ‘yes’. Fascinating research published last month in the journal Experimental Neurology demonstrates that caffeine protects the brain from the kind of damage involved in Parkinson’s disease caused by pesticides:

“Environmental exposures suspected of contributing to the pathophysiology of Parkinson’s disease (PD) include potentially neurotoxic pesticides, which have been linked to an increased risk of PD. Conversely, possible protective factors such as…caffeine have been linked to a reduced risk of the disease. Here we assessed whether caffeine alters dopaminergic neuron loss induced by exposure to environmentally relevant pesticides (paraquat and maneb) over 8 weeks.”

The data led to a conclusion that increases my enthusiasm for exercising the French press:

Caffeine at 20 mg/kg significantly reduced TH+ neuron loss (to 85% of the respective control). The results demonstrate the neuroprotective potential of caffeine in a chronic pesticide exposure model of model of PD.”

Journal of Alzheimer's DiseaseAs for Alzheimer’s disease, a supplemental issue of the Journal of Alzheimer’s Disease has no less than 22 papers on the benefits of caffeine for AD and other neurodegenerative disorders. I suggest you have a look, drink alcohol in moderation (or not at all if you prefer), and enjoy your coffee and tea if there are no contraindications.

With alcohol, as with so many other substances and stimuli, we can appreciate the principle of hormesis: a small amount may have benefit while a larger amount is harmful.

Another biological necessity for sleep indicates a tool for brain health

Journal of NeuroscienceA fascinating study was just published in The Journal of Neuroscience that demonstrates one of the elusive biological necessities for sleep. The authors set the stage by noting:

“Although many theories of function, indirect evidence, and even common sense suggest sleep is needed for an increase in brain energy, brain energy levels have not been directly measured with modern technology.”

They demonstrate for the first time that brains regions active only during the waking state produce a surge in the production of ATP (the body’s cellular ‘energy currency’).

“We here report that ATP levels, the energy currency of brain cells, show a surge in the initial hours of spontaneous sleep in wake-active but not in sleep-active brain regions of rat. The surge is dependent on sleep but not time of day…A significant positive correlation was observed between the surge in ATP and EEG non-rapid eye movement delta activity (0.5–4.5 Hz) during spontaneous sleep…these observations suggest that the surge in ATP occurs when the neuronal activity is reduced, as occurs during sleep.”

This has profound implications for brain health and the capacity for neurons to regulate their threshold of excitability and do neuronal work. Cognition, mood, the subjective experience of energy and fatigue, and every function regulated by the brain depend on the ability of the brain cells to produce ATP. Besides the importance of attaining spontaneous (natural) deep delta wave sleep for ATP production, it also implies that deficiencies of the precursors and cofactors for brain ATP production can be a cause of waking up fatigued and degradation of brain function. This is good news in that we have the resources to restore them.

Mechanisms of cognitive decline, one of the greatest threats of aging

Nature Vol 464There is a lot being written about the ability of the brain to compensate for age-related changes with enhanced connectivity and efficiency that makes for better judgment and emotional maturity. The sad truth is that the brains of at least 50% of us will have sustained too much damage for this to come to fruition. The authors of an extensive review just published in the journal Nature begin with a statement important for anyone reading this:

Cognitive frailty is emerging as one of the greatest health threats of the twenty-first century. As the life expectancy of the population has increased, so too has the prevalence of cognitive decline and dementia, largely in the form of Alzheimer’s disease, which now affects almost 50% of adults over the age of 85 in the United States1. This startling figure can only grow as the average age of the population rises, so understanding the basis of cognitive decline during ageing is critical.”

They proceed to describe some of the major categories that define the process of molecular aging as it pertains to cognitive decline, noting that:

“…altered regulation of fundamental mechanisms of ageing may contribute to the pathogenesis of neurodegenerative disorders.”

It is this kind of attention to fundamental mechanisms with a systems biology perspective that is inherent to the functional medicine approach. The authors identify these major factors:

  1. Mitochondrial dysfunction (the ability of brain cells to produce energy to function and repair)
  2. Oxidative damage
  3. Epigenetic changes (changes in genes due to environmental stimuli)
  4. Autophagy and protein turnover (housecleaning)
  5. Insulin signalling

Additionally, they describe the role of the brain as the master regulator of aging throughout the body.

Their list is not complete—there are additional factors that we attend to including neurotransmitter metabolism and receptor sensitivity, fatty acid cell membrane integrity, the role of steroid hormones in the brain, autoimmune inflammation, excess cortisol (stress hormone) production, etc. If you want to be realistic about a strategy for preventing cognitive decline and Alzheimer’s disease, these are the kinds of things that you have to ask you doctor about and make sure they are being attended to.

Depression is linked to immune system changes

Current Psychiatry ReviewsThis may seem like a “no-brainer”, but many are still poorly informed about the biological dimension of depression that can be evaluated and treated with a functional medicine approach. This paper recently published in the journal Current Psychiatry Reviews is a reminder. The authors state: “Epidemiological findings indicate a connection between depressive symptoms and changes in status of the immune system in depressed patients…medical treatment of depressed patients may be adjusted by more specific knowledge about the interaction between neuroimmunology and depression.”