How Pre-Diabetes Increases Risk for Dementia

One of the definitions of pre-diabetes is a high rise in blood sugar after meals, and a recent study suggests that many cases of dementia are linked to these high rises in blood sugar (JAMA Netw Open, Jan 8, 2021;4(1):e2033012). This study of 3889 adults found that people who suffer from loss of mental function and dementia have much higher levels of Advanced Glycation Endproducts (AGEs) in their skin. AGEs form in your body when your blood sugar rises too high after you eat, causing the sugar to stick irreversibly to proteins, fats, or nucleic acids (Diabetologia, 2001;44(2):129-146). The AGEs turn on your immune system to cause inflammation that can damage all types of cells in your body and increase risk for dementia, heart attacks, strokes, and certain cancers (World J Cardiol, Apr 26, 2012;4(4):90-102).

This new study is the first to show that high levels of AGEs in the skin may be used to predict future loss of mental function and dementia. Many previous studies show that AGEs can accumulate in the brains of people who suffer from dementia (Biochem Biophys Res Commun, 1997;236(2):327-332), and researchers can measure the amount of AGEs in the skin to determine the amount of AGEs in the brain (Diabetologia, 2004;47(7):1324-1330). Measuring the amount of AGEs in the skin can also be used to demonstrate increased amounts of AGEs in arteries to predict risk for heart disease (Arterioscler Thromb Vasc Biol, 2014;34(12):2695-2699). Doctors use a blood test called APOE4 to check for genetic susceptibility for dementia. AGEs may well be the link to this dementia as people with this genetic susceptibility for dementia have higher levels of AGEs in their brains (J Gerontol A Biol Sci Med Sci, 2020;75(10):1899-1905).

Dementia Associated with a High Rise in Blood Sugar After Meals
Pre-diabetics have a high rise in blood sugar after meals and are at very high risk for episodic loss of memory, decreased executive function, and loss of verbal fluency, processing speed, cognitive flexibility, and cognitive control (Lancet, 2012;379:2291-2299). Blood sugar control can help to preserve brain function (J Gerontol A Biol Sci Med Sci, 2016;71(Suppl 1):S62-S71).

Everyone’s blood sugar rises after they eat. If your blood sugar rises too high, sugar sticks to cells to form AGEs. To prevent blood sugar from rising too high, your pancreas is supposed to release insulin, which lowers blood sugar by driving sugar from the blood into the liver and muscles. However, if your liver is full of fat, it does not accept the sugar and blood sugar levels rise even higher. This is called insulin resistance. You can also have high blood sugar from lack of, and failure to respond to, insulin.

Clues That You May Be Pre-Diabetic
Having a normal fasting blood sugar (less than 100 mg/dL) does not rule out diabetes. You are probably pre-diabetic and are at increased risk for Type II diabetes if:
• you can pinch more than two inches of fat under the skin near your belly button
• you have a big belly
• you have small buttocks compared to your belly
• you have an HBA1c blood test higher than 5.7
• your blood sugar one hour after a meal is greater than 145 mg/dL
• your triglycerides are greater than 150 mg/dL
• your HDL is less than 40 mg/dL
• you have small-particle lipids
See The Hidden Epidemic of Early Diabetes

Preventing and Curing Type II Diabetes
Many people are susceptible to develop diabetes because they genetically store fat primarily in their belly. Skinny people can be diabetic just because their liver is full of fat (“fatty liver“). A simple sonogram of your liver can show if you have a fatty liver. To reverse the progression toward diabetes, you need to lose enough weight to get the fat out of your liver.
• lose weight by whatever means works for you (I recommend intermittent fasting)
• try to exercise for at least 30 minutes every day
• eat plenty of vegetables, whole un-ground grains, beans, nuts, and whole fruits (not fruit juice)
• restrict or avoid meat from mammals, processed meats, sugar-added foods, fried foods, and all refined carbohydrates (found in foods made from flour and many processed foods)
• drink only water, coffee or tea with no calories or artificial sweeteners

My Recommendations
At age 45, you have a 20 percent chance of developing dementia as you age (Dementia, 2015;11(3):310-20), and more than 35 percent of North Americans over the age of 85 have early or full-blown dementia. More and more studies are showing that a high rise in blood sugar is a major risk for dementia. If you have any of the risk factors for diabetes, you should immediately begin a program to lower the rise in blood sugar after you eat.

Note: I did another radio show this week on WRTA in Altoona PA. You can listen here: https://soundcloud.com/talkradio985/dr-gabe-mirkin-january-2021-wrtas-the-11th-hour-with-doug-herendeen