Today’s topic is a serious and sad one, and I apologise if it causes you distress. I write this in honour of my mother-in-law, who would have been 96 years old today.

I truly had the most amazing mother-in-law. She was a very strong and dynamic lady who overcame many heartaches in her life. She was an asset to the company she worked for for may years, only retiring at the age of 70. She was a force to be reckoned with, but never unfair and always professional. She was loved by many and had a great sense of humour. Sadly, she was diagnosed with Alzheimer’s in her early 70’s – a terrible blow for someone who had a brilliant memory and loved to keep up to date with general news. We realised something was wrong when she started missing appointments and lost her way to our house – a road she used to travel every weekend. To say it was devastating news is an understatement. But what is Alzheimer’s disease, and how does it happen?

The UK Alzheimer’s Research Organisation describes is as “a set of symptoms, including problems with remembering, thinking and speaking as well as behavioural problems”. It is caused by diseases in the brain that damage our brain cells and the links between them, killing off the brain cells. Plaques are formed in the brain that literally tangles up the brain cells. In 1907, a Bavarian doctor, Alois Alzheimer, had a patient called Auguste Deter, who was plagued by consistent and worsening forgetfulness. Her situation worsened over a year, and when she passed away, Dr. Alzheimer performed an autopsy. He found Auguste’s brain riddled with clumps of destroyed cells. Alzheimer’s begins with an accumulation of protein called beta-amyloid in the sufferer’s brain. A healthy brain clears the beta-amyloid build-up, but instead of clearing the proteins, they aggregate or clump, forming plaques. These plaques stop the brain from functioning as it should.

Alzheimer’s disease is the most common form of dementia, affecting around two thirds of cases of dementia in older people. The scary part is that there are many types of dementia, including Alzheimer’s, vascular dementia and frontotemporal dementia (where people experience changes in thinking, reasoning and behaviour). Dementia affects people in different ways. Dementia also does not just affect older people – over 42 000 people in the UK alone live with early-onset dementia, with symptoms starting in the early 30’s. Taking into account that there are over 850,000 people living with dementia in the UK, this is quite a significant number.

But let’s get back to Alzheimer’s. Mom’s Alzheimer’s probably started way before it showed itself in all its ugliness, but because she worked until a relative old age, it was never that visible. Yes, she forgot things, but we all attributed it to old age. Most people with late-onset Alzheimer’s’ symptoms appear in their mid-60’s – around the time they retire. As mentioned above, signs of early-onset Alzheimer’s appear between 30 years of age and 60 years of age. Scientist think that the damage to the brain starts a decade or more before memory and other cognitive problems appear – as early as 20 years of age. While people appear symptom-free, damaging toxic changes are taking place in the brain. Apart from memory loss, the person also experiences a decline in non-memory aspects of cognition (the skill that relates to conscious intellectual activity, such as thinking, reasoning or remembering). There are many problems and it affects people differently, such as:

• Memory loss
• Poor judgement that leads to bad decisions
• Loss of spontaneity and sense of initiative
• Taking longer to complete normal daily tasks
• Repeating questions and stories
• Trouble with handling money and paying bills
• Wandering and getting lost
• Losing things or misplacing them in odd places
• Mood and personality changes
• Increased anxiety and/or aggression

Alzheimers is usually diagnosed at this stage. It then goes on to the moderate stage, where more care is necessary. In the moderate stage, the memory loss is more severe, the person becomes confused and starts having problems with reading and writing. They can no longer organise their thoughts or think logically. Their attention span is short and they experience difficulty with simple tasks such as getting dressed. They cannot recognise family members any more and many Alzheimer sufferers experience hallucinations, delusions and paranoia. Their behaviour starts getting impulsive and inappropriate, and they may even undress in public. They are tearful and restless and can become very agitated. Some sufferers go wandering and get lost, causing more anxiety – not just to themselves, but to their family and carers as well. The tearfulness and agitation symptoms are especially noticeable in the late afternoon and evening.

The severe stage of Alzheimers is extremely tragic. The sufferer cannot communicate anymore and are completely dependent on others. They suffer from seizures , have difficulty swallowing (which leads to weight loss) and slowly lose control of their bodily functions. The most common cause of death for Alzheimer sufferers is aspiration pneumonia.

Is there a cure for Alzheimer’s? At this stage, no. But there are ways to prevent it. As you know, I am a great advisor of healthy gut = healthy brain. The list below, most of which are prescribed by Dementia UK, can prevent dementia as well as many other ailments. They are:

• 6 servings per week of dark leafy green vegetables, eg. spinach, kale, broccoli, bok choi, lettuce
• 1 serving per day of any other vegetable – carrots, potatoes, sweet potatoes, courgettes etc.
• 2 servings per week of berries. If you can’t get it fresh, use frozen berries. But always have berries in your fridge or freezer!
• At least 3 servings of whole grains per day, such as found in pasta, breakfast cereal and bread. If you are gluten intolerant, use buckwheat, quinoa or oats.
• 1 serving of fish per week – preferably wild, oily fish. Avoid farmed fish!
• 2 servings of poultry per week
• 3 servings of beans per week
• 5 servings of nuts per week
• 1 glass of wine a day – but please be careful how much alcohol you drink. Every person’s body handles alcohol differently!
• Use olive oil in your food
• 1 dessert spoon of fermented food per day (see my recipe page for my ferment recipe)
• Drink 2 litres of water per day, and keep coffee and tea to a minimum.
• Avoid sugary and carbonated drinks.
• Avoid nicotine at all costs.
• Reduce dairy intake, especially milk. Milk consumption lowers blood levels of uric acid, an important brain antioxidant that protect nerve cells. Uric acid can slow the progression of Huntington’s, Parkinson’s and Alzheimer’s. However, low levels of uric acid increase the risk of contracting the above diseases.
• Get enough sleep. Even though not 100% proven, researchers have found that people with severe sleep deprivation problems have a higher risk in contracting Alzheimer’s.

Alzheimer’s is not selective. It is rarely passed down in families. The risk of dementia in any form is made up of many factors, such as lifestyle, age, environment, health, enough sleep and genes. Mom did not have any relatives who had Alzheimer’s. But the shock of losing her husband at a very young age did not help her mental health. Everything in life is dependent on how we treat our bodies and our precious brain cells. So eat healthy, exercise regularly, meditate and above all, be kind to yourself!

(Sources: Motor Neuron Disease Association: Cognitive change and frontotemporal dementia; National Institute on Aging: What do we know about set and prevention of Al;zheimer’s Disease?; How Not to Die, Michael Greger, MD; Alzheimer’s Society: Young-onset Dementia; Alzheimer’s Research UK: Four Things You Need To Know About Dementia; The Body: A Guide for Occupants, Bill Bryson)

I have a lovely friend who suffers from Rheumatoid Arthritis (or RA for short), accompanied by Sjorgens’ Disease.  I decided to dedicate this week’s blog to RA, as it links so closely to gut heath.  I will do another blog on Sjögrens in a few weeks.

First, let’s look at inflammation.  Inflammation is usually not a bad thing, as, at times of infection, trauma or any other harm to the body; inflammation protects the injured tissue from further infection and assists in starting the healing process. It does this by increasing blood flow to the damaged tissue in order to deliver important blood cells and proteins as well as wash away unwanted breakdown products or debris.  This is best seen in the skin. Inflammation appears red and hot because of increased blood flow and the intense activity of cells. These cells leak into the skin tissues along with fluid and proteins from the blood to produce swelling. The same process occurs in all parts of the body whenever injured.

However, in an autoimmune disease, inflammation occurs by mistake.  Increased blood flow and cells arrive at a given site, causing heat, swelling, pain and loss of function, but there is no infection or trauma. So, the body is attacking a non-existing infection, there is no harm to the site and no external damage.  This is why it is called autoimmunity.  An autoimmune disease happens when the body’s natural defence system can’t tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells.

RA is a systemic autoimmune disease.  Systemic means something that affects the entire body, rather than a single organ or body part. For example, systemic disorders, such as high blood pressure, or systemic diseases, such as the flu, affect the entire body. RA is considered to be the most common inflammatory articular disease among the general population. However, not only the joints are affected; any organ can be affected. 

The above is really grim and depressing.  It puts a damper on RA sufferer’s everyday life.  And the cause of it is unknown.  Speculation and investigation have focussed on genetics, abnormal bowel permeability, lifestyle, nutritional factors and a host of other things.  RA is a multifactorial disease, meaning there are many aspects that contribute to this disease.

But all is not lost.  Research has shown that a healthy gastrointestinal (GI) tract plays a very important role in overall health and has the most immune cells in the body.  A faulty immune system causes the most common types of inflammatory arthritis, which includes gout (and you thought it was only too much red wine!) and RA. 

But what does gut health have to do with these conditions?  There are many microbes and microorganisms that live in our bodies.  The ones that live in our gut are called the microbiome.  The way these microbiome and all the other microbes and microorganisms interact with the immune system is extremely important.  The microbiome in the GI tract helps digest our food, it makes important vitamins and controls the growth of cells in our lungs, intestines and other organs.  They also help to teach our systems to differentiate between harmless bacteria and germs that cause illnesses.  Specific gut microbes activate immune T-cells that promote or suppress inflammation.  When you are healthy, your healthy microbiomes do their job and the immune system can destroy pathogens (a bacterium, virus, or other microorganism that can cause disease) and harmless cells go about doing what they are supposed to do.  The problem comes in when there are too many pro-inflammatory T-cells or not enough anti-inflammatory cells to constrain them.  And that is why researchers think that a problem with the microbiome might play a major role in inflammatory types of arthritis.

There are a host of factors that can disrupt these precious little microbiome.  Smoking, antibiotics, stress and certain food all play a role in the disruption.  As far as food is concerned, virtually any food can aggravate RA, but the biggest offenders are wheat, corn, milk and other dairy products, beef, nightshade foods (like potatoes, tomatoes, aubergines, peppers and tobacco) and (I’m sorry to say!) coffee.  When disrupted, it can trigger an abnormal immune response and inflammation in the gut.  This in turn causes problems throughout the body.  Inflammatory cells can escape into the bloodstream and travel to other parts of the body, causing other illnesses, such as Sjögrens (pronounced sher-grenz) syndrome, which is also an autoimmune condition.  The inflammation seen in Sjögren’s syndrome particularly affects the glands in your body that produce tears and saliva. This causes your eyes and mouth to become dry. Other parts of the body can also be affected, leading to dryness of the skin, throat, breathing tubes and gut.

So, how do we optimize our gut health?  Firstly, we need to look at gut bacteria, as it plays a critical role in autoimmune diseases.  To start with, you need to introduce probiotics and prebiotics to your gut. Probiotics are live bacteria or yeast with lots of beneficial health benefits that are found in certain foods or supplements, and prebiotics are types of fibre that feed the friendly bacteria in the digestive system.  Gut bacteria in your digestive tract help protect you from harmful bacteria and fungi and aid in immune system functions among other benefits.  Some gut bacteria form vitamin K.  Vitamin K is a group of vitamins that the body needs for blood clotting, helping wounds to heal, and may help keep bones healthy.

What should you eat?  Many foods naturally contain prebiotics, such as legumes, beans, and peas; oats; bananas and berries; Jerusalem artichokes; asparagus; dandelion greens and alliums such as garlic, leeks and onions.  Prebiotics are found in vegetables, fruits, and legumes.  Humans are not able to digest these types of fibre, but your good gut bacteria can digest them.   These types of fibre provide nutrients to the bacteria that support healthy digestion and immune function.

As far as probiotics are concerned, foods such as yoghurt, (especially plain yoghurt with live cultures) contain natural probiotics.  Other foods that contain probiotics are fermented foods, such as sauerkraut, kimchi, kombucha, kefir (dairy and non-dairy) and unpasteurised pickles.  Fermented foods contain beneficial bacteria that thrive on the sugar that occurs naturally in the fibres that are in the food.  However, make sure these fermented foods are not pasteurized, as pasteurisation kills the bacteria.  I am attaching a lovely recipe for tomato ferment with this week’s blog.

Which food should an RA sufferer avoid?  At this stage, research has found no concrete research on diets that can treat RA, but advises against pro-inflammatory foods such as grilled and fried meats and fried foods (rather steam, simmer, or braise lean proteins); trans-fats that are found in processed foods such as biscuits, margarine, and vegetable oils.  Trans-fats and are used to reduce the chance of food spoilage and to increase shelf life. Trans-fats can increase inflammation as well as increase the risk of insulin resistance and obesity, which is a known risk factor for RA. On top of this, trans-fats can also raise bad cholesterol and lower good cholesterol, thus increasing the risk of heart disease.

What other foods should be avoided?  The main culprits are sugars and refined carbohydrates. The molecules in these foods trigger the release of cytokines, or inflammatory messengers in the body. Fizzy drinks, fruit juices and pastries contain sugars that lead to inflammation.  Unfortunately, sugar substitutes and foods that end in “–ose”, such as fructose, sucrose, glucose can also cause inflammation.

Gluten is another enemy of the joints and should be avoided.  Preservatives and flavour enhancers such as monosodium glutamate (MSG), a chemical ingredient added to many foods as a flavour enhancer can also trigger inflammation.

Should alcohol be avoided?  “Alcohol in moderation might be okay,” says Dr Halyna Kuzyshyn, certified in rheumatology and internal medicine. “In fact, red wine contains resveratrol which has been found to have anti-inflammatory effects. On the other hand, though, too much alcohol can cause liver damage, enhance medication-induced liver toxicity, and cause inflammation.”  Women should not have more than one glass of wine per day, and men not more than two.  Alcohol taken with anti-inflammatory drugs can increase your risk of stomach bleeding and liver problems.

Food Prescriptions. Start by eliminating possible food allergies by excluding certain foods (such as those mentioned above) from your diet, and increasing foods that contain antioxidant nutrients, such as in a vegetarian diet.  Alter your daily oils and dietary fats as well.  After a few weeks, start to reintroduce the food you eliminated slowly and carefully in order to detect which foods triggers inflammation.  A diet rich in whole foods (food that is free from additives and other artificial substances), organic vegetables, fibres low in sugar, organic, free-range meat, refined carbohydrates and animal fats is recommended.  A diet rich in fresh fruit and vegetables is extremely important, especially fruits such as berries, which are an excellent source of antioxidants.  Yellow and green vegetables, such as squashes, pumpkin, sweet potatoes, carrots and the cabbage family contain carotenoids, another beneficial antioxidant.  Cold-water fish such as mackerel, halibut, herring, sardines and salmon are known for decreasing inflammation as they are a rich source of Omega-3.  Fish oils and olive oil acts as neutral fat in the diet and should replace all other fats. 

To end my blog, one last bit of excellent advice – pineapples, along with fresh ginger and turmeric root, relieve symptoms of RA.  This is due to bromelain in the pineapple and the anti-inflammatory actions in ginger and turmeric.  So, at times of flare-ups, make a mixture of pineapple juice, grated ginger and grated turmeric for quick relief!

(Sources: Oxford University Hospitals; National Library of Medicine; The Encyclopedia of Healing Foods; Linda Rath)