Starts With A Healthy Gut

By Alex Martinez and Jamie Bussin

There’s a recent study that found that Urolithin A, a polyphenol found in pomegranates, could potentially boost cognition in Alzheimer’s patients. Likewise, other recent research found that certain lifestyle changes, including diet, can help improve some Alzheimer’s symptoms. But how can our diet impact Alzheimer’s symptoms when the disease is commonly considered a brain disorder? 

In episode #342 of The Tonic Talk Show/Podcast (airing July 13 and 14) healthcare CEO Alex Martinez and I speak about that recent research and the implications for diagnosis and treatment of chronic diseases previously thought to be “brain disorders”. This is a digest of that conversation.

Most of us are used to thinking of conditions such as Alzheimer’s disease or Parkinson’s disease as brain disorders. However, it may make sense to reframe how we think about our own biology in this context.  Our systems aren’t compartmentalized. Rather, our biology is really a comprehensive, bidirectional system. And when you think, in particular, about brain disorders, consider what the brain ultimately is; a terminal beneficiary for all of our activity.  In that context, the gut is essentially the first entry point by which we intake not only caloric nutrition but also the resources to take care of our body. And so, perhaps, we should conceptualize that the gut is in fact, upstream of brain health.

The Role of Our Guts: The gut is sort of the “thin blue line” between our bodies and the external environment. Every day we bring the external environment via food and beverage into ourselves, separated by only a thin layer of cells. The gut environment has both direct and indirect communication directly to our brain. Direct communication between the gut and brain occurs via the vagus nerve. As Alex explains; “For example, when you have a leaky gut or local inflammation in the gut, chemical-signalling molecules, cytokines and chemokines, which occur based on the local inflammation, can mediate signals directly up to the vagus nerve. This is essentially an early warning system to the immune cells in the brain; which can then lead to neuroinflammation. With degenerative brain disorders you see a profound amount of collateral damage caused by neuroinflammation.”

The indirect pathway between the gut and brain is linked to the gut microbes. Historically it was understood that there was an association between the composition of the microbes in the gut biome and brain disorders. What those microbes are doing is taking the food that you are ingesting and they’re metabolizing it. Again, Alex explains; “For example, certain gut microbes live off of prebiotic and fermentable fibre, and they convert it into a whole host of small molecule metabolites. These are really important because they can diffuse throughout the entire system of the body, including passing through the blood-brain barrier. So they’re directly active at all levels of our body, and really no space is privileged, including the brain.”

How Should We Describe Alzheimer’s Disease? According to Alex, it’s a multifactorial disorder. We can use the “gut-immune-brain-axis” as a term that helps people think about these as different manifestations of common biological causality, that being immune dysregulation and dysbiosis. However, says Alex, “Some researchers are championing that Alzheimer’s be called Type 3 Diabetes because of the well-known association between insulin resistance and poor glycemic control directly being able to mediate the occurrence of the tau and amyloid beta proteins in the brain associated with the disease. Those proteins can be considered as the terminal output of a broader systemic dysregulation.”

Diagnosis and Treatment: If conditions such as Alzheimer’s Disease and Parkinson’s Disease are understood as being rooted in the gut, what does that mean for diagnosis and treatment? There are associations with what we would call functional gastrointestinal disorders (ie. IBS) and what were considered diseases of the brain (ie. Parkinson’s Disease). Says Alex, “For example, chronic constipation was linked with a 73% higher risk of subjective cognitive decline. There’s a striking Parkinson’s paper that was published in the British Medical Journal last summer looking at 24,000 Parkinson’s patients. The odds of getting Parkinson’s if you had a previous diagnosis of constipation-dominant irritable bowel syndrome was over 400%. So if you had this type of constipation, your relative risk of getting Parkinson’s was, 2.38 – a number strongly suggestive that the correlation be tested for causation.”

We should look at our gut health, not in isolation, but perhaps as the earliest signal that something’s wrong, that could have really a profound impact on our health. In the Parkinson’s example above, constipation is a comorbidity in 80% of Parkinson’s patients. It’s been found to be a preceding symptom, sometimes by a decade before motor associated symptoms. So in fact that original gastrointestinal impairment (IBS-associated constipation) might be the right intervention point for brain disorders such as Parkinson’s Disease. Alex believes that going forward there will be a shift in the diagnostic paradigm that can be centered around a functional impairment with the understanding and gravity that the impairment could lead to something like Alzheimer’s or Parkinson’s. 

If lifestyle choices such as eating a plant-based, whole-grain diet which is low in fat and added sugar, undertaking consistent moderate exercise and stress reduction modalities can slow or even reverse cognitive impairment, then there’s a potential roadmap for new types of treatment for conditions such as Alzheimer’s disease and Parkinson’s disease. People may be able to take better control of these types of ailments through lifestyle choices at an earlier stage.