Running head: RELATIONSHIPS BETWEEN DIETARY CHANGES AND

ALZHEIMER’S DISEASE

Specialized diets and supplements reduce the progression of Alzheimer’s disease among seniors

aged 65 to 70.

James McWaters, Jessica Rodriguez, Deidra Lewis

University of North Florida

HSC 4730: Public Health Research

Dr. Jobli

July 26, 2019

RELATIONSHIPS BETWEEN DIETARY CHANGES AND ALZHEIMER’S DISEASE 1

Introduction

Currently, there are approximately 5.8 million Americans living with Alzheimer’s disease

(AD) (Alzheimer’s Association, 2019). While most medical researchers try to find a cure in a

traditional lab, other professionals look to dietary changes for a solution to cure AD. Research

reveals that dietary changes and supplementation can reduce the progression of dementia, which

leads to AD. On average, people that have been diagnosed with AD generally live from four to

eight years. However, according to the Alzheimer's Association, it is possible for them to live up

to twenty years if rendered proper care (2019). Past studies on similar illnesses related to AD

including coronary artery disease (CAD), and heart disease (HD) had been an integral part of

treating these illnesses.

This study will present evidence to support the need for diet and supplementation to slow

the progression of dementia to AD while giving the test subjects the opportunity to participate in

combating this devastating disease. The objectives in this study will be to examine clinical test

results, and overall health outcomes on patients to improve quality of life while providing

evidence for another approach to slowing the progression of dementia to AD. The purpose of this

study will determine the relationship between dietary changes and the progression of AD among

seniors aged 65 to 70.

Review of Literature

Dietary Supplementation

There is sufficient evidence that suggests that ones diet impacts their overall health.

When it comes to chronic diseases such as type II diabetes and hypertension, the first thing a

medical professionals will implement is a dietary change and or supplementation. So why is it

RELATIONSHIPS BETWEEN DIETARY CHANGES AND ALZHEIMER’S DISEASE 2

that when it comes to AD, this same approach is not taken? Several studies have been completed

that show a correlation between diet and memory loss. Foods benefiting healthy cognition such

as salmon, blueberries, and broccoli have been proven to increase memory retention as well as

healthy neuroglia (Murad, 2019). An article by Murad stated that leafy greens and berries have

been found to have the most significant impact on the progression of dementia (2019). This same

article found that adults following healthy diets, such as the Dietary Approaches to Stop

Hypertension (DASH) and the Mediterranian diet had brains functioning equivalent to those 7.5

years younger than them (Murad, 2019). A recent study conducted used a beverage that was

designed to increase amino acids and lower cholesterol (Rubio-Perez, Vidal-Guevara, &

Zarfrilla, 2016). The data was initially captured through random human studies (Rubio-Perez et

al., 2016). It eventually went more in depth and began to perform clinical trials using lab mice.

Lab mice are the best simulator for human metabolism and basal metabolic changes in clinical

research (Rubio-Perez et al., 2016).

Nutrition and Diet

Nutrition and diet are key elements that are known to have a great impact on health. It is

now recognized that AD is associated with obesity and malnutrition (Hu, Yu, Tan, Wang, Sun, &

Tan, 2013). Obesity in middle-aged populations increases the risk of AD, whereas obesity in the

later stages of one’s life reduces the risk. Furthermore, the weight loss a person experiences in

older age is correlated to the rapid cognitive decline in AD patients (Rubio-Perez et al., 2016). It

was also determined that the manipulation of adiposity of one’s body could help in the

prevention of AD (Hu et al., 2013). Additionally, observational studies provide evidence that a

low concentration of vitamin D puts one at a higher risk for developing AD (Abate, Marziano,
RELATIONSHIPS BETWEEN DIETARY CHANGES AND ALZHEIMER’S DISEASE 3

Rungratanawanich, Memo, & Uberti, 2017). The Endocrine Society recommends keeping

vitamin D3 concentrations above 75 nmol/L to lesson the risk of developing AD (Gillette-

Guyonnet, Secher, & Vellas, 2013). Therefore, introducing a specialized diet that is designed to

diminish the progression of dementia will aid in the reduction of developing Alzheimer’s

(Gillette-Guyonnet et al., 2013). With the vast amount of cases and the rapid rate of new cases

accruing, different strategies must be invented to combat this new epidemic.

Study Guidelines

A study conducted using white mice as test subjects that highlighted the danger of HFD

in conjunction with BCAA (Tournissac, Vancassel, & Vandal, 2018). Clinical trial lasted 6 to18

months. 3xTg-AD mice were fed either a control diet or a high-fat diet from 6 to 18 months of

age (Tournissac et al., 2018) . For the last 2 months, dietary BCAA content was adjusted to high

(150%), normal (10%), or low (250%) (Tournissac et al., 2018). This approach in this study gave

a vast range of findings that showed mixed results. Conversely, a study was conducted and used

human subjects in the following method: 100 subjects, 48 of them were Alzheimer’s patients,

aged 76.5 ± 3.5 years, and 52 were control subjects, aged 79 ± 4 years, without dementia (Rubio-

Perez et al., 2016). Lab testing included three blood and urine samples taken from each

participant, the first (Ti) before starting the antioxidant or placebo beverage intake, the second

(Tm) 4 months after the antioxidant or placebo beverage intake and the third (Tf) 8 months after

the antioxidant or placebo beverage intake (Rubio-Perez et al., 2016). Concentrations of

biomarkers of oxidative stress were measured on serum, lysed erythrocytes or urine by UV– Vis

spectrophotometry or by competitive in vitro enzyme- linked immunosorbent assay, according to

the parameters analyzed (Rubio-Perez et al., 2016). The results from this study were consistent
RELATIONSHIPS BETWEEN DIETARY CHANGES AND ALZHEIMER’S DISEASE 4

and clear. Data showed that those who took the intervention beverage showed lower

concentrations of oxidative stress (Rubio-Perez et al., 2016).

Diet Changes and Commonalities

Dietary changes have many attributes that include ways to increase blood flow to the

Central Nervous System (CNS) (Gillette-Guyonnet et al., 2013). A nutrient dense diet high in

antioxidants and heart healthy fats are known to reduce oxidative stress (Gillette-Guyonnet et al.,

2013). Thus, resulting in more efficient oxygenation to the neuroglia. Positive outcomes can be

achieved with diet changes that facilitate the reduction of cholesterol and increasing antioxidants.

The dietary changes shown in previous studies to positively affect the early onset dementia

(Romagnolo & Selmin, 2017). Daily consumption of high fat density (HFD) diets that include

branch-chained amino acids have shown to exacerbate the effects of dementia (Romagnolo &

Selmin, 2017). The studies provided show the positive effects of changing to a low fat density

diet (LFD) and increasing antioxidant consumption (Tournissac et al., 2018).

The desired effects of these studies is to reduce HFD and increase antioxidants to allow

better blood flow through the blood brain barrier (BBB) (Bloomfield, Greer, Kane, Koeller,

Macdonald, & Wilt, 2015). This is associated with overall better health for patients suffering

with dementia, later presenting as AD . The studies highlighted used both serologic and urine

testing to check for stress oxidative markers, cholesterol, and fat density levels in the blood

(Bloomfield et al., 2015). Although these studies demonstrate that subtle dietary changes do not

stop the eventual progression of dementia to Alzheimer’s, they show that positive dietary

changes increase quality of life and slow the progression to AD. Other studies conducted found
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little to no evidence that cognition was improved or impaired based on diet (Bloomfield et al.,,

2015).

Conclusion

The importance of theses studies are to find ways to positively affect the quality of life

for patients, while the medical community looks for chemical cures. This problem is so far

reaching in society that it needs to have a two dimensional approach. This issue is at an infancy

stage like the pioneers of cardiovascular medicine in the late 70’s. Eventually, as medical science

banded with nutrition, greater positive outcomes for patients were brought about. What is

demonstrated in these studies is that proper diet and nutrition is beneficial and will hinder the

progression of the disease (Swaminathan & Jicha, 2014). The provided studies can be used as a

template of how to care for AD patients until medicine is available for more effective outcomes.

Research Methods:

Participants

A sample size of 150 participants, ages 65 to 70, with early onset dementia will be

administered a questionnaire. They will be randomly assigned to either a control group (75

participants) or an experimental group (75 participants). This questionnaire will be provided and

collected at the time of pre-testing to eliminate bias. Participants’ co-morbidities will be

eliminated by predisposing factors such as CAD, diabetes, hypertension (HTN), hyperlipidemia,

and obesity.

Instrumentation

The data collection tools include serologic testing (pre, post, and monthly serologic

testing) with 150 test subjects chosen at random using patient chart id numbers and algorithms.
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The dependent variable or desired outcome is to lower the level of oxidative stress hormone

levels. The baseline level is established by using serologic testing of the patient by a pre-test, 6

monthly tests, and a post-test. The timeline of the study will include serologic testing as well as a

brief survey. The two will be compared to the initial survey to test the theory that diet, and

antioxidant supplements will lower oxidative hormone levels while improving overall cognition.

Serologic Testing

The serologic testing will be collected using two types of vacutainers. One purple capped

vacutainer will use tripotassium salts as an anticoagulant. Additionally, one Tiger topped

vacutainer will contain gel as well as a clot activator. This will allow for the sample to be spun in

a centrifuge. After the blood has been successfully separated, it will be tested. The oxidative

hormone and antioxidant levels will then be recorded. Serological testing to check antioxidant

and cholesterol levels is important because group A and B will both be given a nutrient dense

diet. Only group A, the experimental group, will receive the beverage containing antioxidants.

Design and Procedures

The intervention for the experimental group is an antioxidant beverage. The antioxidant

beverage is the independent variable, which is designed to reduce the concentration of the

oxidative stress levels in patients with AD which is given to group A.This study will utilize a

specific timeline. A pretest and initial survey will be administered the first month of the

experiment. This test will be followed by six monthly serologic tests. This experiment will be

concluded by a comprehensive survey, post test, and follow up testing six months later to

determine efficacy of all aspects of the intervention. The collection of sample specimens will

follow all laboratory guidelines set forth by the Office of Safety and Health Administration
RELATIONSHIPS BETWEEN DIETARY CHANGES AND ALZHEIMER’S DISEASE 7

(OSHA). All sample participants will be selected at random by computer software to avoid

contamination. Sample subjects will be divided into either group A or group B. Both group A

and B will be given a nutrient dense diet as well as a fruit beverage. Group A will receive the

antioxidant drink, while group B will receive a placebo drink. Meals and beverages will be given

at the same time each day to both groups. The time frame for testing will be evaluated over six

months. The results will clarify that dietary changes, lowering calorie consumption, and reducing

cholesterol levels allows for better blood flow through BBB.

Data Analysis

Using descriptive statistics, all data collected will be evaluated by measuring the

serologic levels of oxidative stress hormones. In order to measure concentrations of oxidative

stress levels, all data collected will be tracked in a software program designed to analyze data.

This software will provide bar graphs and scatter plots to depict the declination of hormone

levels. Hormone levels range from 0 to 0.6. The data collected will allow for data interpretation

using mean of 0.2 to 0.4 and a median of 0.4. The dangerous levels will begin at 0.6 and above.

The mode will distinguish between the average and the outliers. A scatter plot will be utilized to

display these numbers. A bar graph will be used to display the mean and median in the study.

These methods of data analysis will highlight the distinctions between groups A and B. Linear

regression will be highlighted to predict conclusions and trends hypothesized by previous

studies. Due to this study containing one independent variable, it will require simple linear

regression. This tool highlights the X (experimental group A) giving the result Y (control group

B) by using the placebo solution. Thus showing the efficacy of diet alone and antioxidant

supplementation, which lowers the oxidative stress hormone levels.

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Inferential statistics in this study will demonstrate the need for further testing. The

hypothesis will infer that using the antioxidant beverage in the experimental group will establish

the need for diet, and supplementation. By using the medical information gathered with the

questionnaire, we will conclude that dietary and supplemental interventions are needed to slow

the progression from dementia and AD.

Summary

The research provided shows a need for proper nutrition and supplementation. Early

lifestyle changes can help reduce the risk and progression of the development of chronic

diseases. Further research is necessary to support the need for dietary changes in patients with

predisposing factors for developing AD. Ultimately, this proves the high demand for more

research when it comes to slowing the progression of AD through diet changes. The clinical

trials discussed support the notion that nutrition can in fact affect the speed of progression from

dementia to AD. The purpose of this study was to determine the relationship between dietary

changes and the progression of AD among seniors aged 65 to 70. As stated earlier, there are

approximately 5.8 million Americans living with AD (Alzheimer’s Association, 2019).

RELATIONSHIPS BETWEEN DIETARY CHANGES AND ALZHEIMER’S DISEASE 9

References

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aging: focusing on Alzheimer's disease. Oxidative Medicine and Cellular Longevity,

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34-55. doi: http://dx.doi.org/10.1155/2017/7039816

Alzheimer’s Association. (2019). Retrieved from https://www.alz.org/alzheimers-

dementia/stagesn

Bloomfield, H. E., Greer, N., Kane, R., Koeller, E., MacDonald, R., & Wilt, T. (2015). Benefits

and harms of the mediterranean diet compared to other diets. National Center for

Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK3

Gillette-Guyonnet, S., Secher, M., & Vellas, B. (2013). Nutrition and neurodegeneration:

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Hu, N., Yu, J., Tan, L., Wang, Y., Sun, L., & Tan, L. (2013). Nutrition and the risk of

Alzheimer's disease. BioMed Research International, 13, 2-12. doi:

http://dx.doi.org/10.1155/2013/524820

Murad, A., (2019). 15 simple diet tweaks that could cut your Alzheimer's risk. Mayo Clinic.

Retrieved from:

`https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/15-simple-

diet

Romagnolo, D. & Selmin, O. (2017). Mediterranean diet and prevention of chronic diseases.

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https://dx.doi.org/10.1097/NT.0000000000000228

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