Alzheimer’s researchers have long noted a connection between infection and the development of the disease. One important player in this association comes from the oral cavity. The bacterium, which is a causative factor in the development of the periodontal disease called gingivitis, is suitably named, P. gingivalis, short for Prophyromonas gingivalis. We’ve discussed this in a prior blog post here. Take a look there for more information.
The point of this post was to share the following cool video which describes the entire mechanism! A company named Cortexyme is developing a novel agent targeting the destructive effects of the gingipain proteins produced by P. gingivalis bacteria.
Wasn’t that a cool video? Leave your thought in the comments section below!
The main reason I was excited to share this video was that it beautifully illustrates of the complex interplay between something as small as a microbial derived protein and an individual’s potential to develop a devastating disease. For most of the 20th century, medicine has been focused on eradicating bacteria to cure disease. Remember in the video how they mention that we cannot use drugs to eradicate the microbe once it has entered the brain? Wow! This forces us to think outside of the box.
So what DO we do? Start with something as simple as proper daily oral hygiene. Then consider regular dental checkups and cleanings. We take great pains to address this in our practice. Even though we’re doctors, we probably will spend nearly 5 minutes of our physical exam just looking inside the mouth. I have an entire one page form I use just to document the oral exam and make certain I don’t miss any critical findings. We also have access to specialized holistic dentists who understand the fundamental importance of oral health as it relates to an individual’s overall health and wellness.
So, first step, try to contain the bacteria at it’s source, in the mouth. Make conditions unfavorable for it’s migration out of the mouth. This means barrier protection. Good fences make good neighbors. Heard that expression before? It applies as well here as in many other areas. Take steps to treat gingivitis and heal the tissues with supportive nutrients and proper care.
What else? Next we work with identifying factors which may be hindering the body’s immune response. All of us have P. gingivalis bacteria, they are what’s known as a “keystone species.” That means a species that are present in high abundance and are a critical foundation of our normal mouth flora. We might, in fact be worse off without them! But we want them in our mouth, and not in our brain. So the next step is a healthy immune system. Did you notice the part in the video that when the little purple-green P. gingivalis bacteria left the mouth and entered the blood stream? They show it entering a white blood cell and traveling through through a blood vessel. Many infections will do this, not just P. gingivalis. It’s a Trojan horse phenomenon. Hijacking one of our own immune cells and using it as a getaway vehicle to a distant site. And it’s a common mechanism by which other chronic infections enter the brain, as well. And the brain makes a lot of sense for microbes to evade capture. Why? The brain is normally beyond the surveillance of the immune system. With no cops around, it’s a perfect hiding place for criminals to hide. Want more bad news? Well, P. gingivalis is not the only microbe that has figured this out! Other bacteria and viruses use this strategy, many of which have been identified as causative factors in cognitive decline and Alzheimer’s. By working to promote proper immune function, it may be possible to reduce the chances of this occurring in the first place.
What about the next step? That’s where the white blood cell, carrying it’s nefarious cargo of the bacteria leaves the blood stream and enters the brain. You can see it squeezing out through a tiny crevice in the lining of the blood vessel. That opening is in the blood brain barrier. As the word barrier implies, under normal conditions, this shouldn’t happen. The video mentions risk factors such as old age and cerebrovascular disease, as well as hereditary predisposition may increase the permeability of the blood brain barrier. Almost making it sound as if the permeability, or opening of that barrier, “just happens” could leave the viewer believing that it cannot be controlled. WRONG! Permeability of the blood brain barrier is a serious issue. Remember the good fences analogy? It applies here as well. Conventional medicine is late to the recognition of this problem. Scientists have known about it for decades. But there is little taught in conventional medicine on how to identify the causes or existence of a leaky blood brain barrier, let alone what to do about it. But that’s where Functional Medicine comes in. We’ve known about the existence of this problem for a long time. And we’ve made the vital connections to identify it’s causes. Like anything, if we can find the cause, then generally we can get a good grasp on how to fix it. This problem is actually pretty common. And while it is something we see become more common with aging, it isn’t something we consider a part of normal healthy aging. We advocate testing for all of our patients with cognitive concerns. And we have some incredible tests available to do so! I can’t wait to tell you about those in a future post. Leave a comment below if you’re interested to hear more!
The final point I want to make about the video is possibly the most important. Remember the yellow clumps of “A-beta” proteins they mention gathering around infected cells? A-beta is amyloid beta, the sticky protein which accumulates in a high percentage of Alzheimer’s patients. It has been commonly mistaken as being a cause for the disease. But you can see in the video, this is part of the brain’s adaptive response to a process, in this case, an infection it simply cannot eradicate. Similar to a mine field which keeps an enemy from invading, an analogy Dr. Dale Bredesen uses, it may be the brain’s attempt to simply wall off the infection to keep it from spreading. Not surprisingly then, pharmaceutical companies have frequently targeted eradicating A-beta only to find the disease worsens. It may be taking away the brain’s last line of defense, especially if the primary reason for the response has not been dealt with first. Back to Functional Medicine, that’s what we do. Identify the cause(s) and direct treatment there first. Our body’s came equipped with the means to make A-beta, and not surprisingly, also have the means to get rid of it, too. Just as we address and eliminate the factors responsible for the abnormal production of the protein, we will recommend strategies to get rid of it, too. One of those is as simple as getting the proper amount of good quality sleep. Something we need for a whole host of other health reasons, as well.
Back to the video and the company attempting to bring a treatment to market. I hope that the do. Anything we have to fight this devastating disease is a step in the right direction. Do I think it will be a panacea? Obviously, not. Just as in Dr. Bredesen’s analogy of the “36 holes in the roof” (see my last post here), this small molecule only patches one hole. For a given individual, it may be an important hole, but it would rarely be the only one. What about the immune system? What about the leaky blood brain barrier? If this pathogen got through, couldn’t others have as well? Yes. Certainly it’s not only possible, but very likely. So even if this new treatment comes to market, we’ll still need a comprehensive approach to all of the other factors involved. And, in the meantime, that’s where our practice can help. We address the underlying causes as we “Look Deeper(TM)” to find the cause(s), and the causes of the cause(s). If you’d like to learn more, visit our website for new patients and FAQs.