Gut Biome Linked with Alzheimer's: What do PTs Need to Know?

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CNPT, CSCS, Cert-DN

Alzheimer's Disease

Physical therapists (PTs) play a crucial role in helping patients and caregivers in the management of Alzheimer's disease (AD). Alzheimer's disease is a chronic neurodegenerative disease that slowly destroys a person's memory, personality, and physical functioning. Currently there is no none cure, so often PTs are left with help patients try to maintain as much physical and cognitive functioning as they can. The costs associated with managing patients with AD are projected to be over $2 Trillion dollars by 2030 -- yes, trillions!

Promising News

While there's much doom and gloom there is also hope: diet and the gut biome. A major, and first of its kind, study out of Edith Cowan University has established a genetic link between AD and several gut-related disorders. In the Nature Communications Biology Paper, the authors analysed large sets of genetic data from AD and several gut-disorder studies – each of about 400,000 people. The results were that people with AD and gut disorders have several genes in common, which could lead to earlier identification of AD and possible gut-brain axis treatments down the road. While gut disorders may not be causal, due to obvious limitations of the study's design, it can prove to be valuable for clinical management and future research. 

Cholesterol

One other significant finding from the study was the connection between cholesterol and AD. Prior observational studies has shown a connection between high amounts of dietary and serum cholesterol in the development of AD; however, this study highlights evidence that high cholesterol can transfer into the central nervous system, resulting in abnormal cholesterol metabolism in the brain. Furthermore, the other gut conditions, like H. Pylori infections, can further worsen fat metabolism, which can further worsen cholesterol metabolism in people at risk for AD. The authors of the study state the importance of using statin drugs and dietary modifications as ways to reduce serum cholesterol. 

Physical Therapy Bottomline

 Some DPTs may say: "So what can I do about this?" The answer is fairly simple at this point, as there is more research that needs to be done before we have bedrock clinical research outcomes. First, PTs need to screen for gut disorders. As part of our examination we're supposed to do a review of systems -- how many times do you ask about about stomach, bowel, or bladder issues? Getting patients to registered dieticians and/or gastroenterology sooner may help them control their irritable bowel syndrome, undiagnosed Crohn's, or GERD. Second, physical therapists need to support patients that are on statins to stay on statins. In an ideal world patients should eat a predominantly plant-based or true Mediterranean diet to keep their cholesterol as low as possible; however, sometimes patients can't make this change or they have familial hypercholesterolemia, one of the most common genetic disorders in general practice. As such, PTs need to discuss family history, recommend patients to stay on statins, and refer them to the primary care physician for continued management of the hypercholesterolemia. Lastly, we as PTs need to talk more about diet! Encourage patients to dump the junk, focus on fruits and vegetables, and limit their saturated fat intake, which comes mostly from excessive animal product consumption. In the end, stopping AD may not be possible, but preserving function and quality life is obtainable.

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Keywords: nutrition, diet, continuing education, online, neuro, alzheimer's disease, PT, physical therapy, learning, AD, resources, prevention, DPT

 Photo by Mikhail Nilov: https://www.pexels.com/photo/man-and-woman-near-the-lake-7698931/https://www.pexels.com/photo/man-and-woman-near-the-lake-7698931/

Disclaimer: The above article is written as an opinion piece and does not convey specific legal, medical, and/or practice act advice.