Behavior Change and Brain Disease: Lessons from History

Jul 15, 2009 | By: Brian Mossop

Featured, Health & Disease

From 1900 to 2005, the average life expectancy at birth in the US increased from 48 to 80 for women and from 46 to 75 for men. How did our lives become 30 years longer? Modern medicine? The last time I checked, there still wasn’t a magic pill (or assortment of pills, for that matter) that increased our life expectancy by that much. I believe that history has shown us that the 30-year addition to our lives is really due to an intense collaboration between the medical community that developed new drugs, and society, which improved health education, changed public health policy, and altered people’s behaviors.

Basic hygiene helps as much for health as the CDC

Basic hygiene helps as much for health as the CDC

Looking at two specific examples — infectious disease and heart disease — I hope to convince you that society, through shifts in policy and personal behavior change, played an equally important role in increasing our life span as any blockbuster drug. By incorporating lessons from the past, I hope we can address the stark reality of a new dilemma: We are faced with an increasing elderly population and diseases such as Alzheimer’s Disease and stroke are affecting millions of people. Researchers scratch their heads as to how brain diseases originate. Physicians hem and haw about what treatments are best for managing symptoms.

Brain disease has become the 500 lb elephant in the room that no one wants to talk about. The gravity of this situation hit home for me while recently attending a seminar by a leading Alzheimer’s Disease clinician and researcher. A member of the audience asked the physician-scientist giving the lecture, “Given how few treatments are currently available for Alzheimer’s Disease, what do you tell the patient when you confirm a positive diagnosis?”. The speaker responded, “I don’t say much, I just give them a hug”.

The fact that we don’t have any good treatments for these diseases scares the crap out of most of us — so much so, that every time some people misplace their keys, they wonder if such a mental slip is really a warning sign of dementia.
I know the outlook seems bleak. But rest assured, a little knowledge goes a long way in understanding the brain. I hope that by unraveling the mysteries behind brain disease over the next few months, you will see there are strong beacons of hope on the horizon. Developing medicines takes time, but behavior changes in hygiene, diet, and exercise are made much faster, and may lead to more rapid results. Can we leverage what we’ve learned from history, and use health policy reform and personal behavior change to ease the burden of the disease until medicine catches up?

Infectious Disease

To gain some perspective, let’s step back to the early 1900′s. For the first half of the 20th century, infectious disease was the leading cause of death in the United States. In fact, in 1900, pneumonia and tuberculosis killed more people than heart disease, cancer, and injuries, combined. That’s saying a lot, considering at the dawn of industrialized society there were many new machines, which large moving parts, which I’m sure claimed more than a few unsuspecting body parts in the early years.

Less deadly than disease in 1900

Less deadly than disease in 1900. Thanks flickr user daryl_mitchell.

The medical community prepared for battle against infectious disease, ardently looking for new leads on antibiotics and vaccines. Their work paid off, and as shown in the figure below, the first use of penicillin in the clinic for in 1942, and the approval of Jonas Salk’s polio vaccine in 1955, caused a sharp decrease in the death rate due to infectious disease. At the same time discoveries were pouring out of the labs, policy makers were bringing the public up to speed on what they needed to do to stay healthy. Improvements in public health standards, including water purification and sanitation, together with public education that led to behavior changes in hygiene (e.g. food handling, hand washing), were equally important in decreasing the number of infectious disease deaths. This was big news; once educated about how infectious disease spreads through the community, people realized that something as simple as washing one’s hands went a long way in terms of prevention. It’s kind of funny that just as the United States turned the corner into the industrialized era — the age of modernization — society realized that old-fashioned human behavior changes were just as important and effective as fancy new medicines.

Winning the battle against infectious disease

Winning the battle against infectious disease

Heart Disease

By 1950, the life expectancy of women and men in the US rose to 71 and 66, respectively, and new life-threatening health challenges emerged. People were no longer dying of infectious disease. Instead, a new killer emerged, the heart attack, spurred by a decrease in the quality of personal diets, and an increase in cigarette use after World War II.

From the results of the Framingham Heart Study in 1949, doctors identified several risk factors, such as elevated blood pressure and high serum low-density lipoprotein (LDL) cholesterol level, that were correlated with the occurrence of heart disease. Heeding advice from medical professionals and public health officials that these risk factors can be regulated through diet and exercise, people soon began cutting saturated-fats out of their diet and getting more exercise in an effort to lead longer, healthier lives. As shown in the figure below, substantial decreases in heart disease-related deaths occurred from 1950-1970, which was before any medicines to treat these risk factors were available. In the late 1970′s and early 1980′s, the medical community hit pay-dirt with new drugs to combat high blood pressure and elevated LDL cholesterol levels, and the death rate for heart disease plummeted through the 1990′s, as shown in the figure below.

As was the case 50 years prior with infectious disease, Americans once again saw that health policy changes, human behavior modifications, and medical advancements converged to drastically reduce the numbers of a leading cause of death. The combined efforts reduced the number of heart disease-related deaths from 1980 to 2000. With more research conducted on the effects of diet and exercise on heart disease risk factors, we now know that serum cholesterol levels can decrease by 20% as a result of the foods we eat and how many steps we take per day. At first glance, 20% may not seem significant, but it’s enough to take someone from the “at-risk” category (200+ mg/dL) to the normal range (160 mg/dL).

Decreasing heart disease through the 80s

Decreasing heart disease through the 60s and 80s

Brain Disease

Now our life expectancy is pushing us into our eighties. For the most part, infectious disease is held at bay. Heart disease is still kicking around, but we now know and understand the risk factors, which gives us a fighting chance of avoiding the disease. But now, we are at the crux of another problem: brain disease.

There’s no way around it, the brain is complex. Weighing in at roughly 3 lb, this jelly-like substance in our skulls is made up of a highway of 100 billion neurons that make complicated connections which enable us to move our arms, breathe, and even daydream. Intertwined with the billions of neurons, are an equal number of blood vessels that supply blood, oxygen, and nutrients to power the rapidly firing cells. Due to its complexity, the brain can be susceptible to problems in both the neurons and the blood vessels, making it a bit tricky to keep healthy over the years. For simplicity’s sake, the two particular brain diseases I’ll cover here are stroke and Alzheimer’s Disease.
Stroke is often caused by either a fat deposit (atherosclerosis) or a blood clot (thrombosis) getting stuck in a blood vessel, which decreases blood flow, and ultimately oxygen, to the brain. Neurons don’t respond well to lack of oxygen, and will die within minutes when their supply is cut short. The good news is many more people are surviving strokes these days, but the bad news is that these people are left with brain damage requiring months or years of rehabilitation to re-learn how to walk or talk.

Some new science suggests you can prevent this....

Some new science suggests you can prevent this....

Fortunately, we’ve learned that some of the same rules for keeping the heart healthy are just as effective in keeping us
stroke-free. Keeping blood pressure regulated, LDL cholesterol levels low, and exercising 3-5 times per week, will go a long way in keeping blood vessels clear, regardless if they are in your chest, leg, or brain.
Preventing strokes is only part of the solution to maintain brain health with age. In our eighties, cognitive function decreases – the mind slips, people begin forgetting things or are often confused. Although it’s understandable that the
brain can’t keep its staying power forever, and that there will be some cognitive slips as we get older, the term dementia is reserved for memory problems or other cognitive issues beyond what is considered “age-appropriate”.

Statistics show that roughly half of the population in their 80′s exhibit some form of dementia. To be clear, dementia is not a disease; it’s a symptom. The leading cause of dementia is Alzheimer’s Disease (AD), which is not the on-the-spot killer that a heart-attack may be, but instead leads to years of progressive cognitive decline, straining the lives of both the patient and the family members taking care of them. Because Alzheimer’s Disease is a chronic problem that worsens over time, it affects quality of life just as much as quantity of life.
Alzheimer’s Disease is characterized anatomically by neurodegeneration, which means there is a loss of neurons and brain mass. In other words, the brain size of an Alzhimer’s Disease patient will be smaller than average due to lots of brain cells dying off. Unfortunately, there are few treatments available when someone is positively diagnosed — medical technology just isn’t there yet. So given the grim prognosis of AD, what options do we have to keep our brains healthy as we get older?

...by eating these and....          Thanks flickr user muffet.

...by eating these, and.... (Thanks flickr user muffet.)

We just don’t know as much about preventing Alzheimer’s Disease as we do when it comes to stroke. However, new
evidence is mounting that the same behavior changes that keep our hearts healthy and prevent strokes, e.g. diet and
exercise, also contribute to our likelihood of developing dementia. In a previous post, I talked about a research study that showed that a fast-food diet actually changed the levels of a certain brain chemical called brain-derived neurotrophic factor (BDNF), and another that showed the benefits of exercise on decreasing the occurrence of dementia. The bottom line is: diet and exercise, which we’ve known for years are extremely important in keeping our hearts healthy, are proving to be just as important in keeping our brains healthy.

Conclusion

The research is too preliminary to know for sure if there is a direct link between diet/exercise and long-term brain health.But will we be any worse off by preemptively leading a healthy lifestyle? At the very least, we are going to continue to prevent heart disease and stroke, and if science eventually solidifies the link between dementia and diet/exercise, then we’ll all be ahead of the game.
The brain remains the last great physiological frontier, and many talented people will spend their entire careers trying to unwind its complexity. We are on the cusp of understanding how diet and exercise affect the brain; new studies and reports are coming out every day. I’d be flat-out lying if I said that I have all the answers regarding the effects of nutrition and exercise on the brain, but I hope that over the next few months, we can at least crack the surface on the questions…together.

You guessed it, Exercise!  (Thanks flickr user Ed Yourdon)

You guessed it, Exercise! (Thanks flickr user Ed Yourdon)

Looking at the data presented in this post, it may seem that we just keep trading one set of problems for another. Instead of worrying about contracting pneumonia or tuberculosis, we are keeping our eyes on heart disease, diabetes, and dementia. Add in the fact that since modern medicine has tacked on another 30 years to our lives, we’ll have to worry about risk factors for a much longer period of time than our ancestors. Is an increase of personal responsibility the price we pay for a longer life? I think so, and I believe it’s a fair trade. If you want to make the most of the extra years science has given us, medical technology and pills can help, but you’ve got to take on some of the burden yourself through proper diet and exercise. Something tells me you agree, or you wouldn’t be at this site, reading this article in the first place!

  • http://www.antioxidants-for-health-and-longevity.com Stan Mrak

    Why do we need proof that nutrition affects brain function — isn’t it obvious? There’s a reason why neurological diseases are reaching epidemic levels: Americans mostly eat a diet of refined, processed and chemical-laden garbage. Many of the taste-enhancing food additives work their magic by attacking brain cells. MSG and aspartame are the main perpetrators. Food additives are also addictive; just look at the obesity statistics. In the movie “Super-Size Me,” the guy gets so “addicted” to fast food that he starts going into clinical withdrawal symptoms a few hours after eating at McDonalds.

    • http://thedecisiontree.com/blog/?author=258 Brian Mossop

      Hi Stan,

      Thanks for your comment. You’re right, it is common sense that nutrition is tied to brain function, after all, it affects every other part of our overall health (heart, immune system, etc.). I guess what I’m talking about in this post isn’t necessarily about what’s BAD for us, but what may be particularly GOOD for us. In other words, can science determine that certain foods protect our brains from damage.

      We know that the fast-food diet is contributing to the obesity epidemic in this country. But determining the particular toxic component is not as straightforward as we might hope. It’s very difficult to conduct the proper controls in a nutrition study. For example, in the “Super Size Me” movie, was the decline in his health due to a certain component in the fast food, an increase in the total number of calories consumed, or the fact that he wasn’t consuming other important foods (e.g. greens, fruits, etc.)??

      According to the FDA, there has been no solid evidence that MSG is neurotoxic. Don’t get me wrong, I am with you on this — I am extremely cautious about eating processed foods, and try to use fresh, local ingredients whenever possible. So another benefit of having good scientific results would be that we could finally prove that preservative chemicals are toxic, which may sway the policy makers to finally do something about it.

      Michael Pollan addresses questions like these in his book “In Defense of Food”, which has been a go-to source for me recently. Have you read this? What did you think?

      Again, thanks for the insightful comments. Looking forward to having discussions with you in the future!

      -Brian

  • http://www.antioxidants-for-health-and-longevity.com Stan Mrak

    Why do we need proof that nutrition affects brain function — isn’t it obvious? There’s a reason why neurological diseases are reaching epidemic levels: Americans mostly eat a diet of refined, processed and chemical-laden garbage. Many of the taste-enhancing food additives work their magic by attacking brain cells. MSG and aspartame are the main perpetrators. Food additives are also addictive; just look at the obesity statistics. In the movie “Super-Size Me,” the guy gets so “addicted” to fast food that he starts going into clinical withdrawal symptoms a few hours after eating at McDonalds.

    • http://thedecisiontree.com/blog/?author=258 Brian Mossop

      Hi Stan,

      Thanks for your comment. You’re right, it is common sense that nutrition is tied to brain function, after all, it affects every other part of our overall health (heart, immune system, etc.). I guess what I’m talking about in this post isn’t necessarily about what’s BAD for us, but what may be particularly GOOD for us. In other words, can science determine that certain foods protect our brains from damage.

      We know that the fast-food diet is contributing to the obesity epidemic in this country. But determining the particular toxic component is not as straightforward as we might hope. It’s very difficult to conduct the proper controls in a nutrition study. For example, in the “Super Size Me” movie, was the decline in his health due to a certain component in the fast food, an increase in the total number of calories consumed, or the fact that he wasn’t consuming other important foods (e.g. greens, fruits, etc.)??

      According to the FDA, there has been no solid evidence that MSG is neurotoxic. Don’t get me wrong, I am with you on this — I am extremely cautious about eating processed foods, and try to use fresh, local ingredients whenever possible. So another benefit of having good scientific results would be that we could finally prove that preservative chemicals are toxic, which may sway the policy makers to finally do something about it.

      Michael Pollan addresses questions like these in his book “In Defense of Food”, which has been a go-to source for me recently. Have you read this? What did you think?

      Again, thanks for the insightful comments. Looking forward to having discussions with you in the future!

      -Brian

  • http://www.brainhealthandpuzzles.com/brain_disease_information.html Brain Disease Information

    Thanks for the post Brian, specially for focusing on brain disease. Yes, brain is the most complex part of our body and it is also the most relevant. Brain diseases like Alzheimer’s Disease is a great challenge for the present neurologists and researchers. Currently this disease cannot be cured completely but I am quite sure that our neurologists and researchers will certainly find a remedy for this strange and disastrous disease.

  • http://www.brainhealthandpuzzles.com/brain_disease_information.html Brain Disease Information

    Thanks for the post Brian, specially for focusing on brain disease. Yes, brain is the most complex part of our body and it is also the most relevant. Brain diseases like Alzheimer’s Disease is a great challenge for the present neurologists and researchers. Currently this disease cannot be cured completely but I am quite sure that our neurologists and researchers will certainly find a remedy for this strange and disastrous disease.

  • http://ovarianpain.net Susan

    I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

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  • http://ovarianpain.net Susan

    I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

    Susan

    http://ovarianpain.net

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