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Alzheimer’s Disease: New Theories
By Dr. Shafiq Qaadri, MD
You’ve written that the elderly have been regarded as wise for thousands of years, and yet this has changed. What do you mean?
This is one of the things that got me started on the book. There’s a perception in TV, the media, and novels that old people, as they get older, tend to get dotty. Dementia just seems to be an accepted fact of aging.
This never struck me as the way things used to be. Even when I was in medical school in the 60s and early 70s, it occurred to me that I had not seen very many demented people—not nearly as many as I’m seeing today.
What did your research into this question reveal?
I wanted to see if this perception was true. I went to the unabridged Oxford English Dictionary, a wonderful reference in 24 volumes. In addition to defining a word, it will also give you the first time that word has appeared in print in English.
Although the word senile appeared in the 1600s--meaning old--the idea of being forgetful or demented only came into the language in 1962.
Yes, I was just as surprised as you are.
So then I got a couple of Roget’s Thesauruses, and it was absolutely true. In the 1961 Thesaurus, all the synonyms for old have to do with being aged, decrepit, frail or weak. By 1962, you see forgetful or demented. So there seemed to be a sea-change remarkably recently.
Another semi-confirming fact is that whenever a disease becomes of concern to the general public, a society is formed. So in the United States, the Cancer Society was formed in 1913, the American Heart Society in 1915, the Multiple Sclerosis Society in 1946. The Alzheimer’s Society was formed in 1980.
The more I looked, the more it seemed that this was a recent phenomenon… I looked up the textbook of medicine by Sir William Osler, one of the founders of modern medicine. It’s in seven volumes--a wonderful, comprehensive textbook…In the 1915 edition, the only mention that he has of dementia is in association with syphilis...
Similarly, Freud does not mention dementia except in the longstanding association with schizophrenia--dementia praecox…
Then I started hanging around in libraries, and looking up the Index Medicus, and the American Army Index of Medicine which preceded it. Basically, until the 1930s or 40s, you hardly see any article [about Alzheimer’s] in medical journals, and until the 60s, you don’t see anything in lay journals.
You’ve written that Alzheimer’s disease is not due to increased lifespan, but that seems contrary to our current medical thinking about aging, vasculopathy, and deposition of protein. Can you comment?
No, I’m not saying that at all. We don’t have Alzheimer’s now just because we have more old people. There have always been people living into their sixties or seventies. Some people think we have more Alzheimer’s today because people are living longer—that’s not true…
The average life expectancy has increased immeasurably since the 1500s. For example, there’s another measure of life expectancy: life expectancy at age 21. If you reached age 21 even in the 1400s, you still could expect to live 45 to 50 more years.
There was huge amounts of infant mortality, and huge amounts of childhood mortality; in fact, 50% of people died before they were 10. That brought the average way down. But there have always been people living into their sixties or seventies.
In the book there are geographic comments. Countries like India and China, which are more vegetarian, have less Alzheimer’s disease. Is this a very robust finding?
I started looking at when various countries started reporting Alzheimer’s. In Japan and Korea, reports started coming out in the 60s. In the 70s and 80s, you started seeing papers with subjects like—Why do people living in Japan have a lower rate of Alzheimer’s than Japanese living in America?…India has the lowest rates in the world.
Is that directly tied to India being vegetarian predominantly?
That’s my thesis.
So what is medically wrong with being a cannibal?
That’s fascinating. Cannibalism is the most universal of taboos—there are other taboos that transcend cultures, but cannibalism is the most universal.
In the island of Papua New Guinea, there was a tribe called the Fore, who decided about 120 years ago—for no other reason than nutritional—to eat people who had died…Within 30 years, one in 100 people in this village of 10,000 were dying of prion disease.
According to statistics, this is a disease that hits one person in a million. So you would expect this village to have one case every 100 years, but instead they were having 100 cases every year.
The admonition against cannibalism is that once you start this practice, these diseases very quickly perpetuate in your culture.
What was the work by Dr. Gajdusek that led to the Nobel Prize in Medicine?
He studied the Fore, and their strange disease, Kuru. Over several years he ascertained many things. First, the disease was transmissible. Second, that it had an extraordinarily long incubation period—up to 40 years.
He also showed that once the disease manifested, it was always fatal in short order, and that it left a very distinctive plaque and void, a sponge-like appearance in the brain. He called these Transmissible Spongiform Encephalopathies…So he won the Nobel Prize for being the first to describe this kind of disease and prove its transmissibility.
You’ve called prions miniscule assassins. What is a prion?
Prions were first thought to be a one-of, a bizarre pathogen…Prions are malfolded proteins. I’ll give you an example: if you picture a bowl of albumin, egg white, it’s translucent, it’s liquid, it’s soluble in water. If you inject it, it’ll act as albumin in the blood stream.
If you take just a tiny bit of that albumin, that egg white, and boil it, you haven’t changed any atoms, it’s exactly the same molecule, but it’s folded differently now. It’s assumed a different configuration... It now has totally different properties, and most importantly, you can’t unboil it. You can’t make the reaction go the other way.
Prions are like egg whites that have been boiled, and assumed the wrong shape. The thing that makes it pathogenic is that it has the ability to induce other similar molecules to assume the wrong shape…It sets in motion an extraordinarily slow chain reaction in the brain.
What is noteworthy about the recognition of plaque-forming diseases?
If you look at all the plaque-forming diseases of the brain—Multiple Sclerosis, Parkinson’s, Creutzfeldt Jakob disease, and Alzheimer’s—all of them were described within 40 years of each other, within a relatively tight geographic area, Germany and Western Europe…Creutzfeldt and Jakob in 1920…Alzheimer’s in 1906…Charcot described MS in the 1890s.
What is the connection to animal feed?
Every animal species has an endemic prion disease. Sheep have scrapie…Animals which died, or parts of animals that were deemed to be unfit for human consumption, were added to cattle feed to make the feed higher in protein. This is thought to be the precipitating factor for the mad cow crisis…When you take animals that have died, and feed them to animals that are still alive, you’re asking for trouble, because you’re concentrating bad things.
You have written that we are eating dangerously. What is the connection between Alzheimer’s disease and modern meat processing?
I think the similarity of Alzheimer’s disease and all the other prion diseases is very striking: they all have dementia as a major characterstic, they all have plaques, they’re all untreatable, they all appeared in Europe at the same time…I think prions set Alzheimer’s disease in motion.
So what about meat processing? Prions occur in all animals at the rate of about one in a million. So if one in a million cows get a prion disease, you’d expect that one in a million people got that disease, and it would remain very rare.
But it’s been shown there’s two things that can make a rare agent common. One is cannibalism. The second thing is batching…Commercial hamburger packers take hundreds of thousands of tons of meat, and mix it together to form a very uniform product.
If even one of the cows that went into that batch had a prion disease, then once again you’re taking something that’s very rare, and making it very common…And prions are totally resistant to standard methods of sterilization.
What has the response by the medical community been to these claims?
The prion scientists say that Alzheimer’s is not a prion disease…What I’m saying is that prions start Alzheimer’s off.
Were there human victims of that Black Angus cow in Alberta that started the Canadian mad cow crisis?
That Black Angus cow, probably at some point in its life, ate contaminated feed, but they’re not sure from where…But nobody knows if there was a human victim.
I’ll give you an example. Let’s say that you’re a young anthropologist in 1950, and you’re off with your buddies in Australia. One night you have a barbecue, you prepare the burgers, decide to have a soccer game, and decide to leave the burgers out for an hour and a half. You cook them nice and rare, and six hours later you’re all vomiting and have diarrhea. Then you all think--you know it’s probably something to do with those burgers.
Let’s say the next day you go off to Papua New Guinea, you visit this tribe, you take part in one of their feasts, and then you go home, and 35 years later you’re married with three kids living in Muskoka. And then you develop a dementing disease. It might be hard to make the connection.
This is the great problem—these huge incubation periods.
Dr. Shafiq Qaadri is a Toronto family physician and Continuing Medical Education lecturer. www.doctorQ.ca
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