Read an Excerpt
NANA, LISA, AND RUTH
KNOW YOUR NUMBERS TO KEEP YOUR MIND HEALTHY AND PREVENTALZHEIMER'S AND OTHER DISEASES OF AGING
I can never find my keys. Sometimes they show up by theeggs in the refrigerator.
I am fifty-two. Isn't that normal?
When Lisa was a young girl she adored her nana, hermother's mother. Nana and Lisa baked cookies together, played cards for hours,told silly jokes, and picked plums in Nana's backyard. Nana taught Lisa how tocan the fruit for plum jam, which they loved to share. Nana was veryoverweight, so she would hold the ladder while her granddaughter climbed theladder for the plums. On nights Lisa slept over, Nana always read to her. Lisaremembers laughing so hard that she would sometimes snort at the silly voices Nanaused when she read the stories. At night in the dark they promised each otherto always be best friends. Lisa loved snuggling into Nana's body, which wasever so soft. She felt unconditional love in Nana's presence, which was one ofthe best feelings she remembered from her childhood.
Then, when Lisa was about twelve years old, somethingstarted to change. At first, it was barely noticeable. Nana seemed lessinterested in their time together. There were no more jokes, fewer stories, andNana said she was too tired to play games or pick plums. Nana was also moreirritable with Lisa, even sometimes yelling at her for what seemed like noreason at all. Lisa was devastated, but Nana did not pick up on the social cuesthat should have told her that her granddaughter needed soothing. Lisaremembers this as one of the saddest, most confusing times in her life. Shewondered if she had done something to make Nana mad. "What's wrong withNana?" Lisa would ask her mother, but time and again her mother would say,"Don't worry. Nana is fine." This only deepened Lisa's pain andconfusion. Maybe she really was the problem and Nana had just stopped lovingher.
Her grandmother was sixty-five years old when Lisanoticed the changes. Around this time, Nana had been diagnosed with diabetesand high blood pressure. Lisa remembered watching Nana take her pills and hershots to feel better, but no one seemed overly concerned about her health.
When Lisa was fourteen, Nana took a dramatic turn for theworse. With Lisa in the car, Nana got lost on the way home from the store. Nanapanicked and stopped a man who was walking across the street to ask for help,but she could not tell him where she lived. She appeared frightened andconfused, like a child. Lisa asked the man to call her grandfather, who came topick them up.
Once they got home Lisa cornered her mother. "Look,Mom, I know something is really wrong with Nana. Her brain isn't working right.She needs help." Still, the family continued making excuses, normalizingwhat was obviously not normal behavior. Looking back on this time, as an adult,Lisa remembers being furious, feeling she was, even as a young teen, the lonevoice of reason shouting into a bitter wind. After Nana got lost several moretimes, the family finally was concerned enough to take her to a doctor whodiagnosed her with something called senile dementia. He recommended Nana livein a nursing home for people with memory problems.
Gone were the happy warm feelings she once enjoyed whenshe visited her grandmother. The nursing home where she now lived smelled"medical" and felt cold, and Lisa felt odd and afraid in it. Shenever knew which Nana she'd find on these visits: Sometimes Nana smiled whenshe saw Lisa; sometimes she did not recognize her at all. Sometimes when Lisaread to Nana she seemed engaged and happy, other times her grandmother justwanted to be left alone. After a few years, Nana died in the nursing home.However, Lisa felt that Nana had really died years earlier when her personalityslowly ebbed away. At Nana's funeral, all of their special times circledthrough Lisa's mind. She couldn't help wondering how a person could disappearwhile her body continued living on, and she couldn't help feeling how sad itall was. Lisa wondered if she or her mother would have the same problem asNana. She prayed to God they would not.
Lisa's mother, Ruth, was also a lot of fun. They too hadmany special times, cooking, reading, and playing together. Like Nana, Ruth wasa fabulous baker who also struggled with her weight, early onset diabetes, andhypertension. Lisa's mother was also a wonderful grandmother to Lisa's threedaughters, which reminded Lisa of the closeness she'd shared with her own nana.In fact, her girls called her mother Nana as well. In the back of her mind shekept watch over her own mother's brain health. She didn't want hergranddaughters to lose this vibrant and wonderful relationship they'd enjoyedwith her mom, as she'd lost hers with Nana. It was this concern that promptedLisa, now in her early forties, to pick up my book, Change Your Brain, ChangeYour Life.
When Ruth turned sixty-eight Lisa's worst fears startedto actualize. At first, Ruth struggled with finding the right words. If shemeant dog, she might unintentionally say bark; if she meant milk, she sometimessaid cow. One time when she asked her granddaughter for a hug, she said,"Give Nana a slap."
Ruth's memory was also becoming a problem. Lisa watchedher reach for the phone to dial her sister whom she'd just called five minutesearlier. Her sister said this sort of thing was happening more frequently.Lisa's father mentioned that there were times when he found her mother standingand staring and not knowing why she was in a room. There were also twooccasions on which Ruth got lost driv-ing in a town where she had lived forthirty years, forcing her to call her husband for directions. Her father hadinstalled a GPS system in Ruth's car to help her. (I sometimes wonder if havingGPS systems actually delays the diagnosis of early Alzheimer's disease, aspeople do not have to rely as heavily on their own memories to get from point Ato point B, so their deficits are not seen early by those who could encouragethem to get help.)
Initially, Lisa's dad just laughed off her mother's struggles.He explained it away with, "She is just getting older. She's under a lotof stress." Or "You know your mom has never had a good memory orsense of direction. It will pass. Everything is all right."
Because early signs of dementia may alternate withperiods of lucidity, families tend to deny what's happening. This is tragic,because the earlier someone seeks help, the better the prognosis. Rememberingher Nana, Lisa wasn't about to ignore her concerns or let others downplay them.She anxiously and emphatically told her father, "Mom needs help and sheneeds it now." Together they approached her mom with their observationsand concerns, urging her to go to the Amen Clinics. At first Ruth wasresistant. "I'll be okay," she said, which frightened Lisa even more.Then Lisa reminded her of Nana and told her that early intervention might helpher avoid Nana's fate. At this, Ruth agreed to come to the Amen Clinics for anevaluation and brain SPECT imaging.
I greeted Lisa and Ruth when they came into my office andlistened to their story. From these descriptions alone, I suspected Ruth hadearly Alzheimer's disease. However, after being a neuropsychiatrist for thirtyyears, I knew I couldn't proffer a diagnosis based on my suspicions alone. Ihad to look, test, probe, and get as much information as possible.
Ruth's brain SPECT scan showed three findings consistentwith
1. Decreased activity in her parietal lobes, at the back,top part of her brain. The parietal lobes help with direction sense.
2. Decreased activity in her temporal lobes, which helpget memories into long-term storage. The temporal lobes are also involved inword finding.
3. Decreased activity in an area called the posteriorcingulate gyrus, deep in the back part of the brain. The posterior cingulategyrus is one of the first areas in the brain that dies in Alzheimer's diseaseand is involved with visual memory.
The structured memory testing that we do at the AmenClinics also showed significant problems in both immediate and delayed recall.
KNOW YOUR NUMBERS: YOU CANNOT CHANGE WHAT YOU DO NOTMEASURE
The next step in the process was to look at her importantnumbers. These are also vital numbers for you to know and optimize; they're acritical step in helping you live longer and look younger.
Here is a list we use at the Amen Clinics.
2. Waist-to-height ratio
3. Calories needed / calories spent
4. Number of fruits and vegetables eaten a day
5. Average of hours slept each night (with sleep apnearuled out)
6. Blood pressure
7. Complete blood count
8. General metabolic panel with fasting blood sugar
9. HgA1C test for diabetes
10. Vitamin D level
11. Thyroid levels
12. C-reactive protein
16. Lipid panel
17. Folic acid and B12 levels
18. Syphilis and HIV screenings
19. Apolipoprotein E genotype test
20. Twelve modifiable health risk factors
1. Know Your BMI Ruth's BMI, or body mass index, was 32,which was too high. A normal BMI is between 18.5 and 24.9, overweight is between25 and 29.9, and obese is greater than 30. You can find a simple BMI calculatoron our website at www.amenclinics.com. Ruth was obese, which was not helpingher brain remain healthy. As already mentioned, being obese has been associatedwith less brain tissue and lower brain activity. Obesity doubles the risk forAlzheimer's disease. There are probably several mechanisms that underlie thisfinding, including the fact that fat cells produce inflammatory chemicals andstore toxic materials in the body.
One of the reasons I want my patients to know their BMIis that it stops them from lying to themselves about their weight. I wassitting at dinner recently with a friend who seemed totally indifferent abouthis weight, even though he was injecting himself with insulin for his diabetesat the table. As we were talking, I calculated his BMI for him. Trust me, I canbe a very irritating friend if I think you are not taking care of yourself. HisBMI was just over 30, in the obese range. That really got his attention. Sincethen he has lost 20 pounds and is more committed to getting healthy. The truthwill set you free. Know your BMI.
I put Ruth on a structured weight-loss program.
2. Know Your Waist-to-Height Ratio (WHtR) Another way tomeasure the health of your weight is with your waist-to-height ratio. Someresearchers believe this number is even more accurate than your BMI. BMI doesnot take into account an individual's frame, gender, or the amount of musclemass versus fat mass. For example, two people can have the same BMI, even ifone is much more muscular and carrying far less abdominal fat than the other;this is because BMI does not account for differences in fat distribution. TheWHtR is calculated by dividing waist size by height. As an example, a male witha 32-inch waist who is 5'10" (70 inches) would divide 32 by 70 to get aWHtR of 45.7 percent. The WHtR is thought to give a more accurate assessment ofhealth since the most dangerous place to carry weight is in the abdomen. Fat inthe abdomen, which is associated with a larger waist, is metabolically activeand produces various hormones that can cause harmful effects, such as diabetes,elevated blood pressure, and altered lipid (blood fat) levels. Many athletes,both male and female, who often have a higher percentage of muscle and a lowerpercentage of body fat, have relatively high BMIs, but their WHtRs are within ahealthy range. This also holds true for women who have a "pear"rather than an "apple" shape.
You want your waist size in inches to be less than halfyour height. So if you are 66 inches tall, your waist should not be more than33 inches. If you are 72 inches tall, your waist should not be more than 36inches.
Note: You have to actually measure your waist size with atape measure! Going by your pants size does not count, as many clothingmanufacturers actually make their sizes larger than they state on the label soas not to offend their customers. I remember preferring to purchase pants orshorts that were labeled "relaxed fit" because I could still fit intoa size 34-inch waist. There was no way I could get into a slim-fit 34 inches,which, looking back, actually was 34 inches. Since doing this work, I have seenthat most people do not know their waist size and are in total denial. Most ofour NFL players and patients significantly underestimate their waist size. Oneof the pastors we work with said his waist size was 42 inches, but when wemeasured (at the belly button) it was really 48 inches. Ruth was 5'4"tall. She told me her waist was 33 inches. It measured at 37 inches.
This was further confirmation that Ruth needed astructured weight-loss program.
3. Know the Number of Calories You Need and Spend in aDay I think of calories like money: If I eat more than I need, my body willbecome bankrupt. Wise caloric spending is a critical component to gettinghealthy. Don't let anyone tell you that calories don't count. They absolutelydo. The people who say calories don't matter are just fooling themselves. Youneed to know how many calories you need to eat a day to maintain your currentweight. The average fifty-year-old woman needs about 1,800 calories, and theaverage fifty-year-old man needs about 2,200 calories a day. This number can goup or down based on exercise level and height. You can find a free personalized"caloric need" calculator at www.amenclinics.com.
Set a realistic goal for your desired weight and matchyour behavior to reach it. If you wish to lose a pound a week, you typicallyneed to eat 500 calories a day fewer than you burn. I am not a fan of rapidweight loss. It does not teach you how to live for the long term. One of mypatients went on the hCG diet and lost 40 pounds in three twenty-six-daycycles, but it was at a pretty high cost. Within the next six months, she putall the weight back plus another 10 pounds. Slow and steady teaches you newhabits. I like it for people to lose a pound a week, which teaches them a newway of living for the long term.