How to Prevent Alzheimer's Disease with Bottled Water

Alzheimer's disease is a slow, tragically insidious, soul wrenching disease. It grinds out a gradual destruction of neurons by causing neural atrophy, and gumming up the wiring with amyloid plaques and neurofibrillary tangles. It doesn't just result in a slow death, it also washes out a person's personality and independence. Who they are ceases to be before their physical shell does, and that is traumatizing to witness. We can't say that we've got a full understanding of everything that is happening. What we can say that it is a multi-factorial disease. Like most diseases of modernization (autism, diabetes, auto-immune disease, cancer) there are a lot of causative factors in Alzheimer's disease.

Our current understanding puts a lot of emphasis on a few key factors: insulin function in the brain, vascular damage, and neurotoxicity from environmental toxins. Aluminum has come up in research over the years, and while there is nothing approaching a consensus on this factor, it remains a significant area of ongoing research. Aluminum, like any mineral, is important but not by itself. Our understanding of minerals, and indeed all nutrients, has evolved. Our current understanding of minerals (not yet embraced by all) is that minerals act in coordination with each other, and no mineral can be understood in any valuable way without the context of other minerals and nutrients it occurs with.

One mineral that has gained a lot of popularity for its importance in chronic disease is magnesium. Most of the people who read this blog know that most people eating the Standard American Diet (SAD) are deficient in magnesium, and that supplementing it is important for their health and can improve various conditions from insomnia to heart disease and high blood pressure. But there are a lot of other minerals that are being ignored and the intake of them can be just as important. One that is less talked about is silica. Silica is an important mineral to discuss, and as you will see it bears heavily on the development and prevention of Alzheimer's disease.

Silica is one of the 3 most abundant elements on the planet (along with aluminum and oxygen), but isn't much talked about. On the surface there doesn't seem to be much to talk about. When we examine the presence of silica in our bodies not a whole lot shows up. We see it present in connective tissue and bones mainly, where it contributes to the matrix lending those structures their strength and resiliency. But, when it comes to interacting with our biology from an enzymatic stand-point, it is basically inert. Magnesium plugs in as a key player in all sorts of enzymatic processes in our bodies. Unlike magnesium, there don't seem to be any enzymes that use or rely on silica to function.

It does, however, perform one very, very important job in the body. Remember that aluminum and silica are 2 of the 3 most common elements on our planet, and as such our biology is built around these elements existing in a particular ratio in the food and drink we take in. Our body, in its incredible, brilliant complexity, has evolved a process using silica to chelate excess aluminum out of our bodies. Silica in a meal with aluminum will also prevent it from being absorbed in the first place. In the proper, naturally occurring ratio it does a pretty good job of doing that. When our intake of micronutrients is generally low, as it is with current agricultural techniques, we don't get nearly enough silica. Yet aluminum is ubiquitous. It comes from our cookware, it's in storage containers, and it's used in drinking water treatment plants so it's in city water. Basically, we get way too much aluminum, and without the silica to counter it, our bodies accumulate excess aluminum. That's not a good thing.

Getting that excess aluminum out of the body is important, because aluminum has been found to be neurotoxic. The plaques formed in Alzheimer's disease contain aluminum. Most of the studies on Alzheimer's find that people with higher aluminum exposure are more likely to develop Alzheimer's. (For instance: http://www.sciencedirect.com/science/article/pii/S0361923001004592).  And all of the studies looking at the effect of aluminum on brain function find it to be neurotoxic.

Studies also demonstrate that patients who consume more silica (due to increased amounts in their food and water) tend to have lower levels of dementia and Alzheimer's disease. (Here are two examples: http://ajcn.nutrition.org/content/81/4/897.short, and http://aje.oxfordjournals.org/content/169/4/489.short.)

This is a great example of evolutionary biology setting us up to function best in a particular environment. Our job then is to fix our exposure to come more in line with the biology we have developed. The trick is, how to get that silica? Unfortunately, in the majority of food sources silica is not well absorbed. We don't get a lot out of the fibrous vegetables that contain the most (celery, chard, kale). Silica also comes in barley, oats and other grains, in which it can be much better absorbed. It will be concentrated in the outer layers of the grain so whole grains are the best source. Its presence in grains in turn means that it will be present in beer, the highest content is found in IPA, (Indian Pale Ales, cheers). Without knowing the aluminum content of those foods you won't really know the amount of silica you are absorbing (remember that silica is bound to aluminum in food, preventing your absorption of either). While it's great to not absorb that aluminum, the silica isn't helping to clear excess aluminum from your body if it is just going through the intestines, so the trick is to get it from sources free of aluminum.

A great option is drinking water from a region where the water is naturally high in silica. This is the case with water coming from areas with a significant amount of volcanic rock. One safe and easy source is the "Fiji" brand of mineral water. They list the silica right there on the side of the bottle, 92 mg/L (more than twice the daily intake of the subjects in the study below). This is an effective and safe way to obtain a measurable increase in your silica intake on a regular basis. This pilot study (http://www.ncbi.nlm.nih.gov/pubmed/22976072) found that silica rich mineral water resulted in reduced body burden of aluminum (measured by a steady reduction in urinary excretion of aluminum). This study also found that the cognitive function was measurably improved in 20% of the dementia patients in this study with the only intervention being regularly consuming 1 liter of water containing 35 mg of silica daily for 12 weeks.

Given this information it should follow that the rate of Alzheimer's Disease should be very low in Fiji, and in fact it is. In a 192 country ranking Fiji rates right near the bottom at 190th out of 192. The United States, for comparison, is number 3.

The participants in this study used 35 mg of silica per day in drinking water. One half liter of Fiji mineral water is enough to maintain that dosage, which amounts to less than a dollar per day. It's also a therapeutic option that has no significant down side. If it works (which the science certainly indicates it should), then great. If it doesn't work, you paid a little extra for water, but still probably improved your health by staying better hydrated.

There is obviously another significant argument to make here about whether or not you can justify shipping water bottles made in China to a remote island to be filled with a jungle damaging industry in an otherwise pristine area, then shipped further across the ocean to briefly support our cognitive function before becoming just another empty plastic bottle in the recycling or the landfill. I'm going to gracefully decline involvement in that argument and leave that decision up to you. If you can't bring yourself to do it, and I don't blame you, you can always just supplement with silica instead.

PS: Here's the cheapest option I found for Fiji water:
FIJI Natural Artesian Water, 50.7 -Fl. Oz Bottles (Pack of 12)

And here's a great book about Alzheimer's by my aunt, and about my grandmother:
Elsie at Ebb Tide: Emerging from the Undertow of Alzheimer's

The Synergy of Chinese Herbs

Herbal prescription in Chinese Medicine follows advanced and sophisticated dosage and combining protocols. For example an herb may have a specific action like raising prolapsed organs (for instance the herb sheng ma), however that action may only come out when that herb is prescribed with other herbs with similar actions. An herb might treat a particular symptom, but when prescribed with a guiding herb is capable of treating a related but different symptom in a different part of the body. In short, herbal medicine combining, or Dui Yao is not a additive, cumulative science, but a complicated science of synergy and complex interaction.

(entirely off topic, here's a really great video for any adrenalin junkies out there, if you haven't seen this nut, you should.)

Anyway, this is a pretty fascinating topic. We have a sense of how these things operate from a Chinese Medical Paradigm. Within our strange and interesting Chinese Medicine brains, acupuncturists really get these relationships, they make sense and are intuitive, because we have taken the time to build the rules and thought processes for how this world operates. Within the framework of western sciences these relationships are much more difficult to identify. In truth, like a lot of what happens in Chinese Medicine, western science just hasn't caught up yet. But there are some promising approaches developing out there, and I found one particularly interesting study.

"Synergistic therapeutic actions of herbal ingredients and their mechanisms from molecular interaction and network perspectives." (sorry no full text, but I'll try to give you all the juicy details.)

What this paper sought to do, was to elucidate the mechanisms by which herbs interact. (one example of this is Jiao Tai Wan. Huang lian and rou gui interact synergistically to improve symptoms of xin shen bu jiao (noninteraction of heart and kidney)). Chinese Medicine is rife with these sorts of combinations: nu zhen zi and han lian cao; gan cao, sheng jiang and da zao; sheng ma and huang qi; huang lian, huang bai, and huang qin; ma huang and gui zhi; bao shao and gan cao...and so on. We identify each of these combinations as embodying powers beyond the contributions of each individual herb. In some cases entirely new functions are created that are not found, even in lesser power, in the constituent ingredients.

Often one herb alters the ADME (absorption, distribution, metabolism and excretion) of the other. This is suspected to be the case in Jiao Tai Wan, and particularly with regard to absorption. As this study shows, the specific ratio of huang lian to rou gui enhances the absorption of huang lian across the intestinal membrane, thereby increasing the activity of huang lian without increasing its dose.

Constituents also act as teams to influence change in the body. This sounds oddly reminiscent of our understanding of how to build a formula with chief, deputy, assistant, and envoy.

a. Anti-Counteractive: reduce a network's counteractive activities against a constituent's effect. 

b. Complementary: actions positively regulate a target or negatively regulate a competing target. 

c. Facilitating: secondary actions of one constituent in enhancing the activity level of another. 

d. Potentiative modulation: affecting things like cell transports, permeability, delaying or reducing first pass excretion, or metabolism, all of which enhance the activity of the first constituent. 

 The paper gave some examples of studies that have been done into single herb synergism (multiple constituents in one herb act together to have effects larger than the effects of the individual constituents added together), as well as synergism from multiple ingredients.

Berberis:  Plants of this family contain the two key ingredients berberine and 5' methyoyhydnocarpin (5 MHC). What's interesting about these two ingredients is that while berberine has pretty good antibacterial actions, it is much more potent when in the presence of 5 MHC. In order to see why think about a bacteria. Bacterial cell walls have special little pumps on them that work to pump out synthetic and natural antibacterial agents, and keep them from killing the bacteria. These pumps are called multi drug resistant pumps. 5MHC inhibits the activity of these pumps allowing berberine to accumulate inside the bacteria and result in much more effective treatment. I'm not sure whether our big berberine herbs (huang lian, and huang bai) contain 5MHC. A quick glance at Chen didn't answer that question. If anybody out there knows let me know. (here's a link to the full text of this interaction.)

Onions and Garlic: Ancient food pairing. Goes together like acupuncture and flutes, especially in the presence of rich or fatty foods. Conveniently enough when together onions and garlic act in a synergistic manner to inhibit the peroxidation of lipids. You heard me right, go big on the onions and garlic to keep those newly absorbed triglycerides and free fatty acids from turning into little artery cloggers. This one is pretty tangled and complicated...what they found is that they could feed someone 100 grams of butter (sounds like a dare I responded to as a teenager), and onions and garlic limited the increase in serum cholesterol and plasma fibrinogen, and increased fibrinogen activity and clotting time.    Onions contain quercitin, myricetin, and kaempferol all of which inhibit various enzymes involved in splitting fats (lipoxygenase 5, 16, and phospholipase A2). Garlic contains sulfurous substances (diallyl disulfide, diallyl disulfide, allicin, alliin, ajoene, N-acetyl cysteine, S-allyl cysteine, S-ethyl cysteine, S-methyl cysteine, S-propyl cysteine) all of which inhibit the mechanisms that the body uses to upregulate those now-downregulated lipase enzymes, allowing the onions to have a stronger effect than they would otherwise. This is an example of an anti-counteractive effect.

Gou Teng and Tian Ma: These two herbs are found in the formula Tian Ma Gou Teng Yin, used for wind due to rising liver yang. This study looked at these two herbs and their actions on decreasing convulsions. Gou teng contains Hirsuteine, which decreases the incidence of seizures by blocking nicotinic receptor ion channel complexes. Tian Ma contains vanilline which inhibits acetylcholinesterase and butyrlcholinesterase, which results in decreased seizures caused by acetylcholine. But unfortunately this decreases acetylcholine degradation, which increases the activity of nicotinic acetylcholine receptor, which would lead to more seizures, if it wasn't for the actions of Gou Teng and that Hirsuteine, blocking nicotinic receptor channels. An example of what the study called an "anti-negatie effect."

Ren Shen and Zhi Gan Cao: The formula ban xia xie xin tang, among others, utilizes this combination. This combination was investigated in ulcerative colitis.  The authors used the entire formula, as well as individual isolates and those isolates in combination. The combination of ginsenoside saponins (GS) and glycyrrhizin (GZ) was effective beyond the effect of both used alone. GS is effective in decreasing the activation of defective Th1 response, while GZ is effective in suppressing defective Th2 response. Together they cover both divisions of aberrant immune response, resulting in benefit beyond either alone. I wasn't aware before reading this paper that this division existed in between these two herbs. That makes these two herbs a handy herb pair that I am likely to employ in my auto-immune formulas in the future, as long as the pattern fits.

It's nice to have western science backing us up for a change, but I'm not convinced of the power of these sorts of methods to really offer a whole lot to our understanding of Dui Yao at the moment. I for one will continue to trust the time honored classics in my herb pairing over the pages of "Bioinformatics and Drug Design." I think that most herbalists out there feel the same way. Studies can provide us with the nitty gritty molecular interaction details about why what we've been doing for thousands of years works so well, but at this point the main things they are likely to add are improvements on delivery methods and small tweaks on use. But the real gems are still to be found in the pages of the Shang Han Lun, Jin Gui and, for me the Pi Wei Lun. It doesn't mean that the information about absorption, distribution, metabolism and excretion isn't important. We are likely to need to know more and more of this in order to stay current in this field. Now excuse me while I go get some onions and garlic chopped for dinner.

Choosing Effective Supplements

The subject of supplements comes up a lot with my patients and the brand you choose has a lot to do with whether or not it is going to work for you. There are some not great companies out there selling substandard product. Here's all the information you need to navigate this area of health. In this blog post we cover:

-How to distinguish quality products from inferior products.

-How to ensure safety in dosage and use.

-A few strategies you can use to maximize benefits.

-Some general recommendations

First: How to distinguish quality from inferior products:

In 1994 the FDA passed the DSHEA (Dietary Supplement Health and Education Act. It laid the responsibility for the products safety on the shoulders of the manufactures, and left as well the responsibility of screening and testing on the companies as well. As long as no one is watching, many companies would just as well not do the testing, or put out inferior products knowing there would be no repercussions for it. From he FDA website: 

“the dietary supplement or dietary ingredient manufacturer is responsible for ensuring that a dietary supplement or ingredient is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements.”

This means that it is up to use to police these supplements. There are a lot of ways that manufacturers can create inferior products. The first thing to understand is that there are a lot of possible ingredients in a supplement besides just the ingredient you are looking for. Let’s say your taking milk thistle for liver health. Well, there may be much more than just milk thistle in your supplement. Here’s a picture of the typical anatomy of a supplement:

As you can see there is much more going on here than just the main ingredient. In a lot of cases these other ingredients may be causing serious harm in your future, while you think you are taking care of your health. Here’s a look at some of the most dangerous additives to supplements:

Parabens: Common preservative material, have estrogen like activity in the body affecting both men and women:

-Methyparaben

-Ethylparaben

-Polyparaben

-Butylparaben

Pthalates: Used as a plasticizer. Estrogen like material that will stimulate our receptors. Resulting in infertility, sexual dysfunction, and increase risk of cancer.

-Benzylbutylpthalate

-Di2ethylhexylpthalate 

-Diisodecylpthalate

Notice that “paraben” or “pthalate” is only at the end of the ingredient name, without knowing this, you might well pass right over the ingredient name as you scan through.

Titanium Dioxide is another interesting additive. In it’s natural form it is pretty benign. But much of the titanium dioxide is in the form of superfine particles, or nanoparticles. These have been found to cause some pretty significant health issues. Here’s Christopher Chang from the May, 2010 issue of the “Journal of Autoimmunity.”

“Nanomedicine has already opened up a new avenue of research in cancer therapy, drug delivery, and immune regulation. While the benefits of this new science to human civilization are seemingly immeasurable, it is also important to appreciate that these particles can also lead to harmful effects on human health.”

-and again:

“Increased mutation frequency has also been described in cultured human lymphoblastoid cells exposed to ultrafine TiO2 particles. TiO2 nanoparticles have been shown to be cytotoxic in mouse fibroblast cells...”

And a paper out of the UCLA research laboratories found that titanium dioxide damages cells and the genetic level.

Artificial colors are another issue. Many studies have shown that artificial colors contribute to, or exacerbate the symptoms of autism, ADHD, and other behavioral disorders. The artificial colorings are usually found as either “lakes” or “dyes” the difference is that the lakes are the fat soluble forms of coloring and the dyes are those used for water soluble applications. Fat soluble toxins are more damaging than water soluble toxins, because they detoxify from our bodies differently and likely will be present for longer in our tissues that water soluble. If you have to chose between a product containing “lakes” and another containing “dyes,” I’d recommend the dyes. But there are many natural ingredients that can be used for color, including caramel, beet juice, and beta carotene, so in truth there is no need for any artificial dyes or colorings in our supplements.

Magnesium Stearate: is an excipient that is often added to supplements for a few reasons. First it provides bulking so that it can fill out a supplement to a larger size if that is something that makes taking the supplement more convenient. Second it is added to help lubricate the machines. As the tablets or powder moves through the processing and manufacture machinery it is likely to cause binding, slowing, or may stick to the machines. Magnesium stearate is a fatty acid (stearic acid) bound to magnesium and as a result it’s presence in supplements results in less physical friction in processing. In and of itself it is already present in our diet. However its presence does decrease the speed at which supplements break down, and if it is used in excess in supplements then it can decrease our absorption of the ingredients. My recommendation would be to consider it a necessary evil in some brands, and to not necessarily exclude a product by virtue of seeing magnesium stearate on the ingredients, but rather to look for where it appears on the ingredients. It should be a minor player. In unethical and poor quality manufacturing it may make up 50% or more of the weight of the product. It should appear near the end of the additional or inactive ingredients list. Here's some more information on this.

Allergens: are often present in supplements. Due to the relative freedom that supplement companies enjoy, the presence of things like corn, soy, and wheat may not be clearly stated on products containing them. If you have an issue with any of these, or other items I would recommend that you seek products that clearly state they do not contain these ingredients. You can also call the company and have them send you confirmation that these ingredients are safely absent (in writing or email), not just verbal confirmation. Some things to look for include:

Zein: a corn derived protein coating.

Gluten: even if it doesn’t say on the ingredients assume it’s there, unless it states that it is free of it.

Maltodextrin: a corn derived starch

Whey, Casein, and Lactose: dairy derived ingredients

Soy Lecithin: soy lecithin is typically extracted from soybean oil, rather than from the bean itself and is rarely allergenic, however it still can be in people who are especially sensitive. 

Dosage and Use

Supplements and herbs are capable of interacting with medications and their use should ideally be evaluated by an herbalist, naturopath or your acupuncturist. If you are on any of the following medications you are especially at risk for interactions. 

Serotonin modifying medications such as Zoloft, Prozac, Celexa, Lexapro, etc.

Highy protein bound drugs: Warfarin, Phenytoin, Carbamazepine, Valproic Acid, Valium.

Digoxin

Some supplements, such as PGX and Huang Lian Su may be used specifically to decrease absorption, and will interact with your absorption of many medications. Magnesium can interfere considerably with the amount of thyroid medication absorbed. There are a number of contraindicated herbal combinations in traditional chinese medicine because the actions cancel one another out. Such combinations include seaweed and licorice and ginseng and radish. This is another reason that it is best to consult with a trained herbalist or naturopath when selecting supplements. 

In general it is best to avoid supplements with long lists of ingredients. In that case there is often too little of each ingredient to have a significant benefit for your condition. If you have any adverse effects, you won’t know which ingredient you need to eliminate. 

If a little bit of a supplement is good, more is not necessarily better. There is often an ideal therapeutic dose, below which you won’t get results and above which you either won’t get results, or you’ll get adverse reactions. Vitamin C is a good example of this. Above a certain dosage the Vitamin C is no longer absorbed and will result in diarrhea instead. Another concern is that when you take in a supplement your body requires particular metabolic pathways in order to convert that supplement to a usable form for you, or as it works in your body you need to metabolize the byproducts of it’s actions. Above a certain dosage your body can’t keep up with the byproducts. Toxins buildup and instead of helping you, your supplement is slowly poisoning you. Stick to your dosage recommendations. 

Make sure you supplements have been independently analyzed by a third party. Any supplement company worth spending your money on will have their products independently analyzed by a third party. Because the FDA doesn’t do this, many companies realized the need to prove to their customers that their brands actually contain what they say they do. In order to do that they pay another company to come in and do quality analysis on their supplements. They ensure purity, potency, shelf stability, the lack of any contaminants, and the proper dissolubility of the products. Usually this will appear on the supplement. There are a few logos you can look for on your products to ensure that they are independently analyzed: 

USP stands for United States Pharmacopeia. It is a non-profit group that analyzes products and those that pass are able carry their logo on the product:

There are quite a few other companies as well, and just because a product you are looking at doesn’t carry the USP logo doesn’t mean it isn’t quality assured. You often need to call the company and request a copy of their certificate for the product you are getting. 

Maximize your benefit:

Water soluble vitamins get cleared out of the body faster, to maintain idea levels these need to be dosed multiple times per day. Examples include Vitamin C, B vitamins, and Choline.

Fat soluble supplements should bring more caution when it comes to pollutants and contaminants. Make sure that these especially are coming from reputable sources. Examples include: fish oil, flaxseed, CoQ10, Vitamin D, A, E, and K.

Minerals such as magnesium, iron, calcium and zinc are best absorbed with a small amount of an acidic material such as orange or tomato juice (this is especially true in the elderly who often have insufficient stomach acid production).

Phytates are naturally occurring molecules that plants use to store phosphorus. When these are consumed they bind to minerals in our diets, especially iron and zinc, but also magnesium and calcium and pull them out of solution (chelate) so that we cannot absorb them. Beans, tofu, grains, and nuts are some the largest sources of phytates in our diets. Taking mineral supplements with meals containing these molecules will significantly decrease the absorption of these minerals. (Also remember that a lot of grains and flours are enriched with these types of minerals, however they do us little practical good nutritionally because we can’t absorb them bound to phytates.)

Synthetic vs Natural: Vitamins are complex molecules and as such they possess the quality of "chirality". This means that they can exist in two mirror images configurations. When you look into the mirror you see yourself not identical to how people see you, but reversed, the same is true of chiral molecules. They can exist in what’s called a D or an L configuration. Identifying which is which involves shining light through a tube of the molecule and seeing which way it rotates the light. (I know, pretty far out huh?). When these molecules are being used by our bodies they are being plugged into enzymes and receptors. That means it matters which configuration they are in. In order to visualize this think about your two hands. They are chiral, in that they are mirror images of one another, that cannot be superimposed on one another. They look identical otherwise, but when you go to shake someone’s hand, if you have your right hand full and you go to shake their hand with your left hand, it doesn’t really match up and you have an awkward handshake, the right hands, or left hands however fit together nicely. Such is the case with the enzymes and receptors in your body. They are used to seeing molecules come in with a particular configuration, all of life has pretty much agreed that all amino acids are used in their L configuration and all sugars are used in their D configuration. When biological process create these molecules they are in their correct orientation. When the ingredients in your supplement come from natural sources they work well with the body. When they are synthesized in a laboratory they are made in equal parts D and L (in fact a good way to spot a synthetic supplement is to look at the ingredients and look for ingredients preceded by DL, such as DL alpha tocopherol). The part we can’t use needs to be excreted from the body, requiring biological energy that could be better used on making sure you are healthy and thriving. 

Here’s your take away: make sure your supplements are:

-All independently quality assured.

-Sourced from natural means rather than synthetic.

-Not interacting with your medications.

-Not chalk full of additives, binders, flavorings, and colorings.

-Taken in a way to maximize the benefits and minimize the harms.

My list of recommended supplements. Unless you are totally dialed in when it comes to diet, I think these are things you should be on to maintain optimal health. These are links to these supplements available from manufactures I trust and use for my own patients.

-Magnesium
Pure Encapsulations Magnesium - Citrate - 180 capsules
-Cod Liver Oil

Green Pastures - Blue Ice Fermented COD Liver Oil, Unflavored, 120 capsules
-Probiotics

Jarrow Formulas Jarro-dophilus EPS, 120 Capsules
-Vitamin D3

Metagenics, D3 5000, 120 Softgels

Thanks for reading!