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Health See other Health Articles Title: The Startling Link Between Sugar and Alzheimer’ The Atlantic | A high-carb diet, and the attendant high blood sugar, are associated with cognitive decline. In recent years, Alzheimers disease has occasionally been referred to as type 3 diabetes, though that moniker doesnt make much sense. After all, though they share a problem with insulin, type 1 diabetes is an autoimmune disease, and type 2 diabetes is a chronic disease caused by diet. Instead of another type of diabetes, its increasingly looking like Alzheimers is another potential side effect of a sugary, Western-style diet. In some cases, the path from sugar to Alzheimers leads through type 2 diabetes, but as a new study and others show, thats not always the case. A longitudinal study, published in the journal Diabetologia, followed 5,189 people over 10 years and found that people with high blood sugar had a faster rate of cognitive decline than those with normal blood sugarwhether or not their blood-sugar level technically made them diabetic. In other words, the higher the blood sugar, the faster the cognitive decline. Dementia is one of the most prevalent psychiatric conditions strongly associated with poor quality of later life, said the lead author, Wuxiang Xie at Imperial College London, via email. Currently, dementia is not curable, which makes it very important to study risk factors. Melissa Schilling, a professor at New York University, performed her own review of studies connecting diabetes to Alzheimers in 2016. She sought to reconcile two confusing trends. People who have type 2 diabetes are about twice as likely to get Alzheimers, and people who have diabetes and are treated with insulin are also more likely to get Alzheimers, suggesting elevated insulin plays a role in Alzheimers. In fact, many studies have found that elevated insulin, or hyperinsulinemia, significantly increases your risk of Alzheimers. On the other hand, people with type 1 diabetes, who dont make insulin at all, are also thought to have a higher risk of Alzheimers. How could these both be true? Schilling posits this happens because of the insulin-degrading enzyme, a product of insulin that breaks down both insulin and amyloid proteins in the brainthe same proteins that clump up and lead to Alzheimers disease. People who dont have enough insulin, like those whose bodies ability to produce insulin has been tapped out by diabetes, arent going to make enough of this enzyme to break up those brain clumps. Meanwhile, in people who use insulin to treat their diabetes and end up with a surplus of insulin, most of this enzyme gets used up breaking that insulin down, leaving not enough enzyme to address those amyloid brain clumps. According to Schilling, this can happen even in people who dont have diabetes yetwho are in a state known as prediabetes. It simply means your blood sugar is higher than normal, and its something that affects roughly 86 million Americans. Schilling is not primarily a medical researcher; shes just interested in the topic. But Rosebud Roberts, a professor of epidemiology and neurology at the Mayo Clinic, agreed with her interpretation. In a 2012 study, Roberts broke nearly 1,000 people down into four groups based on how much of their diet came from carbohydrates. The group that ate the most carbs had an 80 percent higher chance of developing mild cognitive impairmenta pit stop on the way to dementiathan those who ate the smallest amount of carbs. People with mild cognitive impairment, or MCI, can dress and feed themselves, but they have trouble with more complex tasks. Intervening in MCI can help prevent dementia. Rebecca Gottesman, a professor of neurology at Johns Hopkins, cautions that the findings on carbs arent as well-established as those on diabetes. Its hard to be sure at this stage, what an ideal diet would look like, she said. Theres a suggestion that a Mediterranean diet, for example, may be good for brain health. But she says there are several theories out there to explain the connection between high blood sugar and dementia. Diabetes can also weaken the blood vessels, which increases the likelihood that youll have ministrokes in the brain, causing various forms of dementia. A high intake of simple sugars can make cells, including those in the brain, insulin resistant, which could cause the brain cells to die. Meanwhile, eating too much in general can cause obesity. The extra fat in obese people releases cytokines, or inflammatory proteins that can also contribute to cognitive deterioration, Roberts said. In one study by Gottesman, obesity doubled a persons risk of having elevated amyloid proteins in their brains later in life. Roberts said that people with type 1 diabetes are mainly only at risk if their insulin is so poorly controlled that they have hypoglycemic episodes. But even people who dont have any kind of diabetes should watch their sugar intake, she said. Just because you dont have type 2 diabetes doesnt mean you can eat whatever carbs you want, she said. Especially if youre not active. What we eat, she added, is a big factor in maintaining control of our destiny. Roberts said this new study by Xie is interesting because it also shows an association between prediabetes and cognitive decline. Thats an important point that often gets forgotten in discussions of Alzheimers. Its such a horrible disease that it can be tempting to dismiss it as inevitable. And, of course, there are genetic and other, non-nutritional factors that contribute to its progression. But, as these and other researchers point out, decisions we make about food are one risk factor we can control. And its starting to look like decisions we make while were still relatively young can affect our future cognitive health. Alzheimers is like a slow-burning fire that you dont see when it starts, Schilling said. It takes time for clumps to form and for cognition to begin to deteriorate. By the time you see the signs, its way too late to put out the fire. Olga Khazan is a staff writer at The Atlantic. This post originally appeared on The Atlantic and was published January 26, 2018. This article is republished here with permission. Make your inbox more interesting. Get The Atlantic's Daily newsletter Post Comment Private Reply Ignore Thread
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