Glucose Levels and Risk of Dementia: What Will They Find Next?

Michael Gordon MD, MSc, FRCPC is a geriatrician working at Baycrest Health Science System. He is medical program director of the palliative care program, co-head of the clinical ethics program and a professor of Medicine at the University of Toronto. He is the author of Late Stage Dementia, Promoting Compassion, Comfort and Care; Moments that Matter: Cases in Ethical Eldercare and Brooklyn Beginnings: A Geriatrician's Odyssey

It seems that “having fun” is just not in the cards for the human species. The old well-worn phrase, “Everything I like is either illegal, immoral or fattening," attributed to the theatre critic and writer Alexander Woollcott in about 1934. One might attribute the attitude to an underlying history going back to the Puritans where anything that gave “pleasure” was likely to be labeled as “evil” but it so happens that the ills of many of the so-called “vices” of humanity have been shown through the world of medical evidence to be detrimental to one’s health, either immediately or over time. Thus despite the billions spent by the tobacco industry to quell the evidence, most knowledgeable people accept the serious risk of tobacco products in all forms and of course excessive alcohol, obesity, and more recently red meat, and so on.

For those trying to lead what many researchers consider to be the “healthy” life for humans, one might focus on one of the more recent favorites, the Mediterranean Diet, which according to the one site, “The Mediterranean diet incorporates the basics of healthy eating — plus a splash of flavorful olive oil and perhaps even a glass of red wine — among other components characterizing the traditional cooking style of countries bordering the Mediterranean Sea. Then there are the vegetarian followers and the more extreme Vegans and then those who espouse the dictum of the writer, activist and nutritional expert Michael Pollan, "Eat food. Not too much. Mostly plants."

The “Puritans” of our age tried to do in coffee, as something that so many people loved and some might even say craved but the many years of research have resulted in the opposite conclusion, first coffee is in general not dangerous and perhaps beneficial. Ask for the benefits espoused more recently of red wine and dark chocolate- the list can go on and one which makes it very difficult for individuals to decide what they should eat to the point that it can become either a fetish, a fad or an obsession with the deleterious eating disorder complexities that often accompanies all kind of beliefs and attributes of one food variety or another.

With the virtual explosion of the dementia industry it is not surprising that everything possible is being looked at as possible mediators, accelerators, inhibitors, and any combination of life-style intervention that seems to have a beneficial effect is being explored and sometimes touted as being significant based on often minimal and questionable evidence. The fact that on an epidemiological and population basis there has been recent evidence of a flattening out of the incidence curve of dementia. Some may explain the improvement due to a decrease in vascular risk factors which are known to augment the risk of even Alzheimer’s disease, some might say it is the decrease in other risk factors but if the vascular component is important it would or might explain this recent finding about the relationship between glucose levels and the incidence of dementia even for those whose levels are not in the diabetes diagnostic range- rather the continuum effect of average glucose levels all other factors being accounted for.

So what is the new enhanced, message that should presumably add on to all the other recommendations… try to maintain your blood glucose levels as low as you can using presumably life-style management techniques which reflects all we seem to know about diet and exercise and blood pressure control and smoking and lipids……my gosh what is left to enjoy? It seems that dark chocolate is not only not dangerous but may be beneficial. If what they say about coffee is so that can be taken in your health diet. There is also good news for wine lovers: it seems that red wine when used in correct amounts can be cardiovascular beneficial and that should benefit the brain if the vascular theory about dementia has any validity.