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Life Extension Magazine

LE Magazine July 1997

Dr. Khalsa's Medical Program for Alzheimer's Disease and Brain Aging

By Neville Adams

imageYou forget names, lose track of your keys, have trouble concentrating. Is it just a normal part of growing older, or symptoms of a serious disease, perhaps even Alzheimer's? Here, in this exclusive Life Extension Interview, Dr. Dharma Singh Khalsa discusses his comprehensive program for the prevention and treatment of brain diseases and aging.

Anti-aging physician Dr. Dharma Singh Khalsa's new book "Brain Longevity: The Breakthrough Medical Program that Improves Your Mind and Memory," features his comprehensive, coordinated program for age-related cognitive decline.

Written with medical writer Cameron Stauth, "Brain Longevity" outlines a program that Khalsa claims halts and even reverses clinically diagnosable "age-associated memory impairment," which is virtually pandemic among people over age 50. The brain, Khalsa states, "is flesh and blood, just like the rest of the body." However, he says, "most people neglect the health care of their brains, and this contributes to cognitive impairment as they grow older." .

A number of Alzheimer's disease patients on Khalsa's program report that the progression of their disease has been at least temporarily arrested. Some even report partial restoration of their former cognitive abilities. Traditional medical treatment for Alzheimer's is extremely limited in scope and effect, and does not substantially alter the course of the disease. Similarly, there is no existing medical treatment for common age-associated memory impairment, which has long been considered an inevitable aspect of aging. Khalsa's patients, many of whose case histories appear in "Brain Longevity," have recorded remarkable gains in memory, concentration and learning power, and also have shown marked improvement in immunity, physical energy, stamina and sex drive.

Khalsa's success appears to stem, in part, from his attempts to counteract the stress hormone cortisol, which can be toxic to brain cells when produced in excess. Cortisol, Khalsa believes, significantly accelerates brain aging. His program is designed to inhibit over-secretion of cortisol, and to repair damage created by cortisol and by other destructive factors.

Khalsa's program consists of four primary elements:

1) Nutritional therapy, including dietary modification, nutritional supplements and natural medicines;
2) Exercise therapy, including cardiovascular exercise, mental exercise, and yogic mind/body exercise;
3) Stress management, including stress reduction and meditation; and
4) Drug therapies.

This program of complementary medicine combines therapies derived from both Eastern and Western medical traditions.

Khalsa is a Creighton Medical School graduate who received post-graduate training at Harvard Medical School and UCLA, a diplomat of the American Board of Anesthesiology, and a founding member and secretary of the American Academy of Anti-Aging Medicine. He also is the president and medical director of the Alzheimer's Prevention Foundation, and is a member of the Gerontological Society of America. Khalsa practices medicine in Tucson, Ariz. He granted his first interview about the book to Life Extension magazine. Life Extension Magazine: Does your program cure Alzheimer's disease? Dharma Singh Khalsa: No. Alzheimer's disease is characterized by the extensive death of brain cells, and once a neuron is dead nothing can bring it back to life. Therefore, by definition, Alzheimer's will always be incurable, the same way a stroke is considered incurable; what's done is done. However, many stroke victims employ undamaged neurons to regain at least partial neurological function, and Alzheimer's patients also can stimulate their healthy neurons to function more efficiently. When this happens, some mental capabilities can return. Perhaps more importantly, further neuronal loss can be slowed down.

LE: Why is the slowing of neuronal loss so important for Alzheimer's patients?

Khalsa: It's pivotally important for one primary reason: If the progression of the disease can be decelerated, the elderly victim can live his or her full life before the disease becomes debilitating. If progression can be slowed by five years, the deaths caused by Alzheimer's could be cut in half. If it can be slowed by 10 years, death by Alzheimer's will become a relatively rare event.

LE: Is Alzheimer's now a common cause of death?

Khalsa: It's the third-highest cause of death by disease in America, after cardiovascular diseases and cancer. It's also the leading cause of entrance into nursing homes. And unfortunately, incidence of the disease is rapidly increasing, even when improved reportage is accounted for.

LE: Why is Alzheimer's increasing?

Khalsa: A major factor is simply that people are living longer. Up to half of all people who live to age 85 contract Alzheimer's, and that segment of our population is ballooning. In the future, as the 78 million people in the baby boom generation continue to age, America's elderly population will skyrocket. If nothing is done on a wide scale to prevent Alzheimer's, or to intervene in its progression, the disease could become epidemic in our lifetime. Epidemiologists at the National Institutes of Health believe that it might disable up to 15 million people in the near future. If that happens, it will be social holocaust. It might bankrupt the country, and it will certainly destroy the well-being of millions of families.

LE: Speaking of baby boomers, aren't a great many of them now reaching the age when cognitive decline can begin?

Khalsa: Millions of them have already hit what I call "the memory barrier." At about age 50, most people begin to experience at least a slight diminution of cognitive power. For many people, this cognitive decline is profound, and feels like the beginning of what we used to call senility.

LE: But they're not really becoming senile, are they?

Khalsa: Technically, they have "benign senescent forgetfulness." The word "benign" implies that this condition is normal, and relatively harmless. But I don't agree with that perspective at all. Just because something is common, doesn't mean it's normal. And people who experience this condition certainly don't think it's harmless. Many people in their 50s are at the peak of their careers and family responsibilities, and the last thing they need is a fuzzy mind. I believe age-associated memory impairment can be prevented and often reversed, and my clinical results strongly support this belief.

LE: Does it seem easier to treat age-associated memory impairment than Alzheimer's?

Khalsa: Much easier. Alzheimer's patients require a more stringent program, but still generally do not respond as dramatically as patients with age-associated memory impairment. By the same token, both of these conditions are easier to prevent than to treat. The wisest course of action a person can take is to start building "mental fitness" at as young an age as possible. I'm convinced that this can prevent age-associated memory impairment, as well as Alzheimer's. Besides, when healthy people create an optimal biological milieu for their brains, they can achieve remarkable mental feats. My program can, in effect, help smart people become smarter.

LE: What's the most important element of your program?

Khalsa: Because it's a synergistic program, there is no single most important element. Also, because all people differ biologically, some elements may be more helpful for some people than other people. Therefore, it's important that all patients with memory loss participate in each of the four basic elements of the program: nutritional therapy, exercise therapy, stress management and pharmacology. However, if a person does not yet have memory loss, and is seeking only creation of optimal cognitive function, pharmaceutical drugs are generally not necessary.

LE: What type of diet do you recommend?

Khalsa: A low-fat, nutrient-dense diet, with a stable glycemic base. Dr. Candace Pert, one of the discoverers of endorphins, once told me, "What's good for the heart is good for the head." And she was absolutely right. The brain uses about one-fourth of all the blood that's pumped by the heart, so anything that hampers circulation, such as a high-fat diet, can have disastrous neurological results. In fact, about 20 percent of all cases of extreme cognitive decline are not due to Alzheimer's, but to a series of imperceptible minor strokes. This condition, called multi-infarct dementia, is often misdiagnosed as Alzheimer's. The other thing dietary fat does is to greatly increase production of free radicals, and this now appears to be a primary cause of neuronal death in Alzheimer's patients and in others with memory loss.

LE: Does a healthy diet alone supply enough nutrients?

Khalsa: Not enough to achieve brain regeneration. The brain has an amazing degree of plasticity-the ability to rebuild neurons and forge new synaptic connections-but this rebuilding requires higher concentrations of particular nutrients than a person could ingest solely in foodstuffs. For example, to obtain the amount of Vitamin-C that I recommend, a person would have to eat 60 oranges every day. LE: Why is Vitamin-C so important to the brain?

Khalsa: It's used in so many of the brain's metabolic processes that levels of Vitamin-C are 15 times higher in the brain than in the rest of the body. I recommend one gram of it, three times daily, to optimize cognitive function in a healthy person, and up to twice that amount if memory decline has begun. People with age-associated memory impairment, and with Alzheimer's, always require more aggressive treatment than cognitively healthy people. LE: What other vitamins and minerals do you recommend?

Khalsa: Vitamin B-complex is absolutely necessary for neuronal growth, so I usually recommend 50 mg per day for prevention of cognitive decline, and up to 200 mg per day for Alzheimer's patients. Vitamin E is a powerful antioxidant that inhibits free radical formation, so I prescribe 400 units of it, once or twice a day. Interestingly, I've discovered that Vitamin-C has the ability to "revive" vitamin E as an antioxidant, even after E has been oxidized. This is a good example of the synergistic effects of the nutrients I recommend. Partly because of synergism, I also always recommend a daily vitamin/mineral tablet. It's important that the tablet contain an abundance of magnesium, because the brains of most people with Alzheimer's have a deficit of magnesium. The tablet should also contain 50 to 100 mg of selenium; it's an invaluable antioxidant, and selenium levels in the blood typically decline as we age. Zinc, in dosages of 30 to 50 mg per day, also has powerful anti-aging properties, and almost 90 percent of all people fail to meet the RDA for zinc on most days.

LE: Do you recommend specific amino acids, since they are the nutritional precursors of the brain's neurotransmitters?

Khalsa: Some patients take isolated aminos, such as phenylalanine, the precursor to the neurotransmitter norepinephrine, but I generally prefer to use whole-food sources of amino acids, such as protein powder, or spirulina-type "green juice" products. The green juice products are among the richest possible sources of combinations of amino acids called peptides, which the brain converts into neuropeptides, such as the beta endorphins. Some of my patients get a dramatic boost from the green juice products and also from some of these other nutrients. Subtle nutritional deficiencies are rampant today because of our society's generally casual approach to nutrition. However, the brain is extremely sensitive to these deficiencies. When you correct them, for some people, it's like a light bulb suddenly turning on inside their heads. People feel like, "Gee! I can think again, like I did in college!" As a matter of fact, the college years and just after are the years of peak cognitive function for most people, because these nutritional deficiencies as well as other biochemical insults haven't yet had time to do their damage. After about age 25, though, the brains of most people begin to shrink due to neuronal death, and eventually decrease in size by about 20 percent.

LE: You also recommend particular brain-specific nutrients, such as phosphatidylserine?

Khalsa: Yes, it's extremely important to take these natural medicinal tonics. There are a number of natural substances that are so cognitively powerful that they have an almost pharmacologic effect. Phosphatidylserine is one. It's a naturally occurring form of fat that's far more abundant in the brain than any other organ, and helps conduct neuronal impulses. One study showed that patients using it were able to roll back their "cognitive ages" by an average of 12 years. For relatively healthy patients, 100 mg twice daily is appropriate.

LE: And phosphatidylcholine?

Khalsa: Definitely. I consider it one of the most important natural substances, along with phosphatidylserine, Ginkgo biloba, acetyl-L-carnitine, coenzyme Q10 and ginseng. Phosphatidylcholine is the brain's only "building material" for acetylcholine, the primary neurotransmitter of thought and memory. Phosphatidylcholine is not very effective for reversing the symptoms of Alzheimer's-even though the brains of almost all Alzheimer's patients are deficient in acetylcholine-but it's excellent for heightening normal cognitive function and for preventing degeneration. For maximum effectiveness in creating acetylcholine, phosphatidylcholine should be taken in conjunction with the nutrients that convert it into the neurotransmitter: vitamin B5, and dimethylaminoethanol, or DMAE. I've seen this combination elicit an effect equal to that of the most common Alzheimer's drug, tacrine, but without side effects.

Two other substances that often produce immediate, demonstrable results are coenzyme Q10 and acetyl-L-carnitine, both of which "rev up" the mitochondrial "power plants" in neurons. Acetyl-L-carnitine also has the fascinating ability to improve communication between the brain's two hemispheres. The only other substance known to do that is the European drug piracetam.

LE: What's ginseng's primary mechanism of action?

Khalsa: It's an adaptogen that tones adrenal function, helping the adrenal gland to produce sufficient amounts of adrenaline in response to stressful situations. This is extremely important, because when the adrenal gland doesn't produce enough adrenaline to deal with stress, it compensates by producing another adrenal hormone, cortisol, which can be very toxic to the brain. Cortisol is a much longer-lasting stimulant than adrenaline, and it wreaks havoc on neuronal metabolism. Cortisol causes excessive amounts of calcium to enter brain cells. This calcium creates massive production of free radicals, which kill neurons from within. When cortisol is produced in very moderate amounts, it doesn't appear to do severe damage to the brain, but when it's produced in excess, day after day, year after year as a result of chronic stress, it's so disruptive to neuronal metabolism that it kills neurons by the billions. Over-production of cortisol also harms the brain on a day-to-day basis by interfering with neurotransmitter function, and by depriving the brain of its only source of fuel, glucose.

LE: Does this mean stress contributes to cognitive decline?

Khalsa: That's exactly what it means. You've probably experienced a transitory version of this phenomenon many times when you were under stress and your mind "went blank." Psychologists sometimes refer to this as the "bonehead effect," but no one really understood the physiology of it until the late 1980s when the prominent Stanford neurobiologist Dr. Robert Sapolsky began studying the effects of cortisol. I consulted with him several years ago, and his work confirmed what I had long suspected -that stress impinges on cognitive function by physically impacting the brain. Recently, studies by Dr. Sonia Lupien at McGill University confirmed that stress levels in elderly people often correlate directly with their levels of memory loss.

LE: What can be done about the neurological harm of stress?

Khalsa: To some extent, we can repair the damage that cortisol does, using nutritional therapy, pharmacology, mind/body exercise and even mental exercise. We can also limit further damage by controlling cortisol over-production with substances like ginseng, and with stress management. I believe that controlling cortisol over-production is absolutely vital to neurological health, and that this approach will be widely employed in the future. At present, though, I'm the only clinician who is actively addressing this aspect of brain aging.

LE: Is your program appropriate only for people whose cognitive impairment was caused by cortisol?

Khalsa: No. My program helps repair damage to the brain, regardless of what causes the damage. For example, I've had several dramatic responses among patients whose problems were caused by severe head injuries that they suffered in auto accidents. Another patient recovered from cognitive dysfunction due to high-altitude pulmonary edema. Ultimately, my program is not an anti-cortisol program, or even an anti-disease program; it's a pro-brain program. It helps the brain to achieve self-healing through the mechanism of brain plasticity.

LE: What else can people do to avoid over-production of cortisol?

Khalsa: The stress management element of my program is designed to obviate cortisol over-production. In addition to controlling cortisol, stress management also enhances cerebral circulation by lowering blood pressure, encouraging abundant production of neurotransmitters and helping shift brain waves to the "alpha" and "theta" conditions, which are more conducive to peak cognitive function.

LE: What composes the stress management element of your program?

Khalsa: Basically, patients learn coping skills for stressors, learn to limit stressors, and learn to meditate. We describe all the best techniques in detail in "Brain Longevity."

LE: How important is meditation?

Khalsa: I consider it to be a veritable magic bullet against stress. It induces the relaxation response which has been described fully by Herbert Benson of Harvard, under whom I received postgraduate training. The relaxation response is the opposite physical condition of the stress response, and it has a profoundly positive effect on cognitive function. It reduces cortisol output, elicits alpha and theta waves, decreases blood pressure, reduces lipid peroxidase (a marker of free radicals), improves oxygenation, and increases blood flow to the brain by up to 25 percent. For many years, I've observed that patients who meditate are better able to reach their maximum cognitive potential. I, personally, have been meditating for more than 20 years, first as a participant in transcendental meditation, and then as a member of the Sikh religion. Sikhism, which emphasizes taking personal responsibility for health and well-being, places great emphasis on meditation and also upon another aspect of my program, mind/body exercises.

LE: What are mind/body exercises?

Khalsa: They're a form of yogic exercise that have been used for more than 5,000 years by people seeking to optimize their cognitive powers. The exercises drive nutrient-rich blood to the brain, and also to various glands in the endocrine system, which links the mind and body through hormones.

LE: The mind/body exercises are a component of the exercise element of your program?

Khalsa: Yes, and the other components are aerobic exercise and mental exercise. Aerobic exercise stimulates production of the hormone called nerve growth factor, which is needed for the repair of neurons. It also increases blood flow to the brain, and potentiates production of norepinephrine, which the brain uses to carry short-term memories to long-term storage in the neocortex. Exercise is also a good stress reducer, and produces endorphins.

LE: When you say mental exercise, do you mean memorizing things?

Khalsa: I mean anything that engages the intellect-reading, board games, quiz shows, whatever. Thinking actually increases the size of the brain, and helps prevent atrophy. In animal experiments, animals in intellectually stimulating environments had brains that were 16-percent larger than animals in non-enriched environments. This same phenomenon holds true for humans. Use it or lose it.

LE: What about the fourth element of your program, pharmacology?

Khalsa: Traditionally, the medical community has been very unaggressive about treating cognitive decline with medication. There are only two drugs that are commonly used for Alzheimer's, both of which encourage acetylcholine production. But acetylcholine deficit is only a small part of the puzzle of Alzheimer's. I believe that the entire brain should be biologically supported as much as possible, and use of pharmacology is one way to do this. I've gotten very good results, for example, with drugs that are not typically employed for memory loss.

LE: Such as?

Khalsa: Such as deprenyl, a drug that's been used effectively against Parkinson's disease for many years. Deprenyl prevents degradation of the neurotransmitter dopamine, and has transmitter dopamine, and has elicited startlingly positive results in many of my memory-loss patients.

LE: What other drugs to you prescribe for memory loss?

Khalsa: Hydergine can be an effective "smart drug," particularly if applied at the standard European dosage of 9 mg daily, rather than the standard American dosage of 3 mg per day. It's particularly adept at stabilizing glucose metabolism in the brain.

LE: Is it true that estrogen can help Alzheimer's patients?

Khalsa: Some clinical research has shown that estrogen can be effective for memory loss. But I prefer to use two hormones that are precursors of estrogen and other hormones: DHEA and pregnenolone. They're much safer, and I've found them to be more effective. Pregnenolone, especially, seems to be quite promising.

LE: What does the future hold for treatment of cognitive decline?

Khalsa: I'm convinced there will be many new breakthroughs. The cognitive enhancement products that have emerged in just the past few years-mostly non-pharmaceutical nutrients-have changed the course of neurology. It's become apparent that most people, using simple common sense and reasonable health-care techniques, can preserve their peak cognitive powers throughout their lives. This is something that we now know can be done. And, considering the disastrous effects of a possible "epidemic" of Alzheimer's, it's something that must be done.