Supplements Help Fight Vascular Dementia

Protect Brain Function by
Enhancing Vascular Health

Keeping your brain's plumbing in order can help you stay mentally sharp
By Will Block

hat do you do when the drain in your sink gets clogged? You certainly don't call a plumber, if you can help it. Instead, you get one of those chemical drain cleaners. How very satisfying it is to see (except that you don't really see it) that yucky stuff you know is down there getting dissolved away, as if by magic. Is chemistry great or what?

But what about the yucky stuff - the cholesterol-laden plaque - that's clogging your arteries? You can't see that either, but it's there, you know. Unless you've been living a life of the most extraordinary dietary purity and virtue, your internal plumbing, like that of everyone else who's been around for awhile, is not a pretty sight. And that has implications that we don't really like to think about, do we?

In fact - and here's a nice irony - the worse our plumbing gets, the less likely it is that we will even be able to think about the implications, because our capacity for thinking clearly about anything at all may become severely impaired. When that happens, it's called vascular dementia, a fancy way of saying that our mind is being destroyed by our blood vessels' inability to deliver enough nutrients to our gray matter to keep it in the pink.

TWO WAYS TO ENHANCE BLOOD FLOW
When the buildup of arterial plaque restricts the flow of blood in our arteries, our brain cells - not to mention our heart cells and all our other cells - can become increasingly malnourished. This condition of inadequate blood supply is called ischemia. If it becomes severe enough, the oxygen-and nutrient-deprived cells begin to die of starvation. Wouldn't it be great if we could take some sort of "liquid plumber" to dissolve the plaque in our arteries, releasing a flood of blood to those starving cells?

Well, we can do that - sort of - but the process is not nearly as quick and efficient as it is in the bathroom sink, mainly because the chemicals needed to clean our arteries must be delicate and subtle in their action so as not to kill the patient while treating him. Furthermore, unclogging is not the only valid approach to the problem. The other approach is through vasodilation, a process in which the walls of the blood vessels are induced to relax and expand, thereby allowing the vessels to carry more blood, with less resistance, even if they are partially clogged.

VINPOCETINE - VIAGRA FOR THE BRAIN
Chemical compounds that expand the blood vessels in this manner are called vasodilators. One such molecule, vinpocetine, has been used for many years in the treatment of senile dementia (age-related dementia, or what used to be called senility), as well as for a variety of other conditions that benefit from increased blood flow. Dementia is defined as a progressive loss of memory accompanied by significant impairment in other areas of mental function or behavior - or, to put it simply, it's losing one's marbles.

Vinpocetine is known to enhance cerebral blood flow, which boosts the amounts of life-giving (and energy-producing) oxygen and glucose delivered to the brain cells.1 In this regard it's not unlike a well-known drug that is known to enhance blood flow to another part of the body. No wonder vinpocetine is called "Viagra® for the brain," especially when you consider that the brain is, after all, the body's most important sex organ.

Biochemically, vinpocetine's action is similar to that of Viagra in causing the smooth-muscle cells of arterial walls to relax, thereby facilitating vasodilation. But vinpocetine also has other beneficial modes of action: it improves oxygen utilization by the brain cells; it makes red blood cells more pliable, thereby making the blood "thinner" (less viscous) and improving its flow properties; and it inhibits platelet aggregation, the process that induces the formation of blood clots.2 All these things protect our brain cells from harm and help us safeguard those precious mental marbles.

DEMENTIA SHORTENS LIFESPAN
Two months ago in Life Enhancement, we saw the toll that dementia takes on human life.* Evidence from a recent Canadian study has shown that life expectancy in people suffering from dementia is much shorter than had previously been believed.3 The study found that the median survival rate for elderly dementia patients was 3.3 years after the onset of the disease. Previous, less carefully controlled studies had suggested that the survival rate was anywhere from 5 to 9.3 years. The clear implication is that dementia shortens lifespan. The Canadian study showed that the prognosis for victims of dementia is similar to that for patients with such malignant diseases as cancer and heart disease.4


*The article, "Preventing Dementia Can Boost Life Expectancy," discussed the risk factors for dementia and the protective measures (other than supplements) that can be taken to combat it.

Although there are over 60 different causes of dementia, most cases fall within two broad categories: Alzheimer's disease and vascular dementia. Both are diseases of aging, and many cases are intermingled, i.e., many of the victims have underlying symptoms of both diseases, which can make the diagnosis, as well as the preferred therapeutic strategy, somewhat ambiguous. It's useful to bear in mind that the cause (or causes) of Alzheimer's - a degenerative disease of the brain cells - is largely unknown, whereas the cause of vascular dementia is well known: it is cerebrovascular disease (diseased blood vessels in the brain), which causes degeneration of brain cells by starving them of nutrients.


Vinpocetine is known as an
effective enhancer of memory and
other cognitive functions.

And does the brain ever need those nutrients! The average human brain (not that yours is average, of course) weighs about 3 pounds, or just 2% of a 150-pound person's weight. Yet it typically accounts for about 25% of the body's energy output, even when that body is not doing algebra or playing chess. In one way or another, we're thinking all the time, and thinking requires a lot of chemical energy.

FLOWER POWER FIGHTS DEMENTIA
In last month's article in this series ("Protect Brain Function by Enhancing Neurotransmission"), we saw that one of the most effective anti-Alzheimer's agents, galantamine, is derived from certain flowers. Coincidentally, vinpocetine is too: it comes primarily from the periwinkle (Vinca minor). Because of its ability to facilitate cerebral metabolism by improving blood flow to the brain, vinpocetine is known as an effective enhancer of memory and other cognitive functions - and that's a pretty good working definition of an antidementia agent. (For a comprehensive overview of vinpocetine's many health benefits, see "Almost Everything You Want to Know About Vinpocetine" in Life Enhancement, September 1999.)

NOT ALL AGING IS INEVITABLE
Of course, there are degrees of impaired mental acuity that are less severe than outright dementia, and not surprisingly, vinpocetine is beneficial here too. Collectively these conditions are often called age-related cognitive impairment (ARCI) or age-related cognitive decline (ARCD). We know intuitively about them - the memory lapses, the declining ability to perform accustomed tasks, the behavioral eccentricities, etc. They often seem as natural a part of aging as getting wrinkles, and we tend to accept them as inevitable.

But should we? No! Note that "age-related" does not necessarily mean the same thing as "age-caused." In other words, the progressive loss of memory or other aspects of cognitive function may not necessarily be due to the aging process itself. It may be due, at least in part, to the way in which we allow ourselves to age - especially by eating too many fatty foods and not getting enough exercise. These "errors of living" contribute to the buildup of plaque in our arteries and threaten the health not only of our brains but also of our heart, kidneys, and other vital organs.

We should fight the pernicious tendency toward age-related decline, not only through prudent diet and exercise, but also through the enlightened use of supplements, such as vinpocetine, that can give us an extra edge. This is not to say that we can stop Father Time's relentless assault on our bodies and minds, but we can certainly slow it down. He and his consort, Mother Nature, may have won every battle thus far, but, by taking better care of ourselves, we may yet be able to slow the rate of loss of our brain cells, giving us extra time (and enlightenment) to challenge the inevitability of nature's conquest.

VINPOCETINE IMPROVES COGNITIVE FUNCTION
In a randomized, placebo-controlled, double-blind trial conducted in England, researchers administered vinpocetine or placebo every day for 16 weeks to 203 patients with mild to moderate dementia.5 The vinpocetine doses were either 10 mg or 20 mg, each taken three times per day, for a total daily amount of 30 or 60 mg. The patients receiving vinpocetine showed statistically significant improvements in cognitive functions compared with those in the control group. Interestingly, the ones on 30 mg/day did slightly better than those on 60 mg/day. No clinically relevant side effects were noted.

In another, similar, study, 42 elderly patients with chronic cerebral dysfunction received 10 mg of vinpocetine three times per day (30 mg/day total) for 30 days, then 5 mg of vinpocetine three times per day (15 mg/day total) for 60 days.6 A control group of 40 patients received placebo for the 90-day trial period. The treatment group scored consistently better in all cognitive evaluations than the control group, and there were no serious side effects.

COENZYME Q10 ENERGIZES THE MIND
Another nutrient that can improve cerebrovascular health is coenzyme Q10, a compound known primarily for its role in enhancing cardiovascular function, particularly in patients with congestive heart failure. It is also known as a "mind energizer" through its important role in stimulating cellular energy metabolism. In addition, however, coenzyme Q10 is an excellent antioxidant that helps to suppress the oxidation of LDL (the "bad" cholesterol) in the bloodstream. The virtue in this is that LDL oxidation is one of the key factors in the formation of atherosclerotic plaque in our arteries. Anything that can inhibit this process helps to keep our blood flowing freely - to the brain, to the heart muscle itself, and everywhere else. A good daily serving of coenzyme Q10 is 120 mg.

GINKGO BILOBA IMPROVES CIRCULATION
The herb Ginkgo biloba has been shown to have beneficial effects in dementias of both major types - probably through different mechanisms of action.7-9 For vascular dementia, it's known to improve circulation by improving the tone and elasticity of blood vessels and by inhibiting platelet aggregation, thus reducing the chances of blood clots (in the latter regard it acts like aspirin, making the blood less "sticky"). For Alzheimer's, it's known to improve cognitive function by enhancing neurotransmission. Both of these functions may be related to the antioxidant properties of flavonoid compounds in the ginkgo extract. This is significant because it is believed that many aspects of aging may be due, in part, to oxidative damage caused by free radicals.10 A good daily serving of Ginkgo biloba is 60-180 mg.


Coenzyme Q10 enhances
cardiovascular function, operates
as a "mind energizer," and is
an excellent antioxidant.

LIPOIC ACID & VITAMIN E ARE ANTIOXIDANTS
When it comes to antioxidant nutrients, none is more versatile and important than lipoic acid, mainly because of its unique role in preserving and protecting (in effect, boosting the levels of) four other vital antioxidants: glutathione, coenzyme Q10, vitamin C, and vitamin E.11 Called "the antioxidant's antioxidant" for that reason, lipoic acid helps prevent, both directly and indirectly, the oxidation of lipoproteins (fat-protein complexes - notably LDL) in the bloodstream, thereby inhibiting the formation of arterial plaque.

Actually, the antioxidant most directly involved in this protective function is vitamin E, whose role in the prevention of cardiovascular disease is well known. Lipoic acid helps to maintain high vitamin E levels in the blood, but it also works inside the brain cells themselves to provide powerful protection against damage that can occur when the blood supply to the brain is insufficient despite our best efforts to maximize it. A good daily serving of lipoic acid is 400 mg. A good daily serving of vitamin E is 600-800 IU.

EDTA CLEANS OUT THE ARTERIES
When it comes to actually cleaning out our arteries, probably the best bet is to use compounds called chelating agents. These molecules act as molecular scavengers of metal ions, which they seize and carry away to be excreted in the urine. The most widely used chelating agent is EDTA (ethylenediaminetetraacetic acid), which is exceptionally capable in this regard. EDTA is a synthetic amino acid that is routinely used by physicians to treat cases of toxic metal poisoning, but it is also used to treat atherosclerosis. By scavenging calcium ions, EDTA acts to degrade the arterial plaque that is the hallmark of this life-threatening disease. A good daily serving of EDTA is 400-800 mg.


EDTA acts to degrade the arterial
plaque that is the hallmark of
atherosclerosis.

Calcium plays an integral role in the complex process of plaque formation, and removing it from the deposits allows the remaining fatty material, especially cholesterol, to be more easily removed by other means. For example, it can be more easily picked up and carried away to the liver in the form of HDL (the "good" cholesterol), which ultimately leads to its excretion in the bile. Thus, chelation helps to prevent or even reverse the development of atherosclerosis. Another molecule that has been found to be effective in this regard is malic acid (found in fruits such as apples, cherries, and tomatoes), and certain compounds in garlic are also effective chelators.

DHA INHIBITS INFLAMMATION
Coldwater fish, such as salmon, tuna, mackerel, halibut, herring, and rainbow trout, are rich in fish oils that contain omega-3 fatty acids. These are polyunsaturated fatty acids of a special kind that is known to be highly beneficial, through various mechanisms, for both heart health and brain health. In the bloodstream, the omega-3s inhibit platelet aggregation and reduce triglycerides (the chief constituents of most fats and oils). They also thin the blood by making the blood cells more pliable, which in turn makes them better able to wriggle through the tiniest capillaries to nourish every cell. Most importantly, perhaps, the omega-3s inhibit inflammation of the arterial walls, which is a key factor in the development and buildup of atherosclerotic plaque. The most important of the omega-3 fatty acids is DHA, which stands for docosahexaenoic acid. A good daily serving of DHA is 200 mg.

RED YEAST RICE AND POLICOSANOL LOWER CHOLESTEROL LEVELS
An excellent way to avoid excess cholesterol from building up as plaque deposits in our arteries is to prevent that excess from being produced in the first place. (Our livers produce most of the cholesterol in our bodies; for most people, dietary cholesterol is a relatively unimportant factor.) And the best way to do that is by inhibiting cholesterol biosynthesis so that production is normalized and our bloodstream carries only as much of it as our cells need. Red yeast rice, a natural food product used in Southeast Asia for many centuries, accomplishes this trick by means of compounds called statins - the same kinds of molecules that are widely sold as expensive prescription drugs for cholesterol reduction12 (see the article on red yeast rice on page 27 of this issue). A good daily serving of red yeast rice extract is 2400 mg.

Another completely natural product that inhibits cholesterol biosynthesis - and in the same manner as the statins, although it doesn't contain those compounds - is policosanol, which is an extract from sugar cane. Policosanol is actually a mixture of eight or nine related compounds that are waxy solids. They may not taste sweet, but how sweet it is, as recent research has shown, that together they act to lower cholesterol levels as effectively as the statin drugs13 (see the article on policosanol on page 4 of this issue). A good daily serving of policosanol is 10-20 mg.


*See this month's Q&A for more information on these products.

In their different but often overlapping ways, vinpocetine and all the other nutrients discussed in this article can help keep your blood running the way it wants to run: fast and free. It has places to go and things to do. So if you want to keep the specter of dementia at bay, you'd better be good to your brain and make sure that it gets what it wants: plenty of blood.

References

  1. Milanova D, Nikolov R, Nikolova M. Study on the anti-hypoxic effect of some drugs used in the pharmacotherapy of cerebrovascular disease. Meth Find Exp Clin Pharmacol 1983;5(9):607-12.
  2. Kiss B, Karpati E. Mechanism of action of vinpocetine. Acta Pharm Hung 1996;66(5):213-24.
  3. Wolfson C, Wolfson DB, Asgharian M, M’Lan CE, Østbye T, Rockwood K, Hogan DB. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001 Apr 12;344(15):1111-6.
  4. Kawas CH, Brookmeyer R. Aging and the public health effects of dementia. N Engl J Med 2001 Apr 12;344(15):1160-1.
  5. Hindmarch I et al. Efficacy and tolerance of vinpocetine in ambulant patients suffering from mild-to-moderate organic psychosyndromes. Int Clin Psychopharmacol 1991;6(1):31-43.
  6. Balestreri R et al. A double-blind placebo-controlled evaluation of the safety and efficacy of vinpocetine in the treatment of patients with chronic vascular senile cerebral dysfunction. J Am Geriat Soc 1987;35(5):425-30.
  7. Le Bars PL, Katz MM, Berman N, et al. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. JAMA 1997;278:1327-32.
  8. Hofferberth B. The efficacy of EGb 761 in patients with senile dementia of the Alzheimer type, a double-blind, placebo-controlled study on different levels of investigation. Human Psychopharmacol 1994;9:215-22.
  9. Kanowski S, Herrmann W, Stephan K, et al. Proof of efficacy of the Ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi-infarct dementia. Pharmacopsychiatry 1996;29:47-56.
  10. Harman D. Free radical theory of aging: a hypothesis on pathogenesis of senile dementia of the Alzheimer's type. Age 1993;16:23-30.
  11. Packer L, Colman C. The Antioxidant Miracle. John Wiley & Sons, New York, 1999.
  12. Heber D. Herbs and atherosclerosis. Curr Atheroscler Rep 2001 Jan;3(1):93-6.
  13. Castano G, Mas R, Fernandez JC, Illnait J, Fernandez L, Alvarez E. Effects of policosanol in older patients with type II hyperlipidemia and high coronary risk. J Geront 2001;56A:M186-92.

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