Way too much stress. Not nearly enough sleep.
If you’re a typical middle-aged American, you may be experiencing either of those — or worse yet, both.
“I find a lot more mid-lifers, including myself, have had trouble with sleep and stress,” says Dr. Nate Bergman.
And that’s worrisome, because these maladies of modern life can leave you at higher risk for cognitive impairment or dementia, even if you’re taking care of yourself in other ways.
Bergman, a functional medicine physician and host of the podcast “Evolving Past Alzheimer’s,” sees it in the patients he treats.
They’re often attuned to the importance of exercise and diet, and making a real effort in those areas.
“For many people nowadays in the middle of life, between 25 and 65, I think you’ll find a lot of them are very dialed in when it comes to the food they eat,” Bergman says. “They are trying to eat well. And anyone who’s educated at all is aware of the benefits of exercise. A lot of people are exercising, and have been for a long time.”
Yet people in their 40s and 50s and 60s who appear otherwise healthy show up at his office complaining of “brain fog” or, in some cases, memory loss serious enough to suggest they may be on their way to full-blown dementia.
“You’ll say, ‘Wow, these people look so good on paper. They’ve got normal body weight, they’re athletic, their diet is good, what could be wrong?’” Berman says. “But their sleep is wrecked or they are stressed beyond belief.”
It’s not just something he sees in his patients. He’s experienced it in his own life, too.
Bergman understands first-hand what it feels like to “lose your mind.” During his second and third years of medical training, he began to suffer severe memory loss.
“It was absolutely, totally terrifying,” Bergman says. “I wasn’t sure if I had a brain tumor. When you’re 30 or 35 years old, you aren’t thinking about Alzheimer’s. It’s extremely frightening. You worry about your spouse and children. You worry about your ability to make a livelihood.”
In his case, the debilitating memory loss wasn’t a product of a brain tumor or neurodegenerative disease. Between the demands of being a parent with young children and a medical student putting in grueling hours, the stress and exhaustion had taken a toll on his cognition.
By learning how to deal with those conditions in a healthy way, improving his sleep and embracing stress-reduction techniques, Bergman was able to reverse his own memory loss.
That harrowing experience shaped the path of Bergman’s career. He dedicated himself to brain health, preventative care and functional medicine. Now, in his practice and on his podcast, he preaches that just as he reversed his own cognitive loss, Alzheimer’s and other brain diseases are “generally treatable and reversible.”
It’s a bold statement, but one that Bergman and some other practitioners are willing to make, based on an accumulation of evidence that healthy lifestyle choices and a preventative, personalized approach to wellness care can potentially change the trajectory of cognitive decline when it’s caught in the early stages.
Bergman says the time to address the threat of Alzheimer’s isn’t when the memory loss has become so pronounced that the person can no longer care for themselves.
“With Alzheimer’s, there has been a big shift — and it’s been recent, in last year or two — where there’s this broad recognition that the time to do radical things is not when someone needs a nursing home or assisted living,” he says. “That’s usually an end stage, where there’s so much brain damage, it’s really a challenge to accomplish anything in terms of getting better.”
These days, Bergman says, it’s all about early detection, and the sooner the better.
“The time where we’re seeing the best results is early on,” he says. “When you start to notice a problem, that’s when you want to go in and get it checked out. That’s the time to do something about it. If you get it when the disease is more at a minimum, that seems to be more responsive to the treatments that I have at my disposal.”
Bergman has been working toward this preventative approach to brain health dating back to his time as a research fellow at the National Institutes of Health. He went on to help found the program for cognitive impairment at the Cleveland Clinic Center for Functional Medicine.
Bergman now serves as chief scientific wellness officer for Kemper Cognitive Wellness, a Cleveland-based center that focuses on an individualized, proactive approach to Alzheimer’s, dementia and other forms of cognitive impairment.
In his podcast, “Evolving Past Alzheimer’s,” he talks with leading medical experts, with a focus on what can be done to identify, prevent and treat Alzheimer’s.
In medical circles, the traditional view of Alzheimer’s has been “there’s not much we can do about it.” Bergman can be counted among an emerging cadre of practitioners who challenge that attitude. They contend that cognitive decline, even in the case of Alzheimer’s, can be slowed, halted or reversed if caught early enough.
Others who share that view include: Dr. Dale Bredesen, author of “The End of Alzheimer’s,” who has been a mentor to Bergman; Dr. Richard Isaacson, founder of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine; and Drs. Dean and Ayesha Sherzai, authors of “The Alzheimer’s Solution,” who were recent guests on Bergman’s podcast.
To even suggest that Alzheimer’s can be reversed remains a radical notion. But the way these doctors approach it isn’t radical at all.
While they may incorporate sophisticated technology or concepts like epigenetics into their practice, what they do is grounded in the most basic concepts of wellness, including what Bergman identifies as the four pillars of brain heath — exercise, diet, sleep and stress reduction.
“There is very robust data to support the four pillars,” he says. “If people have a poor diet, or are not exercising or not sleeping, when you clean it up, the majority of people respond in a positive way. The key is not waiting until there is so much disease.”
Nutrition is one area where people can make real gains, even if their diet isn’t pristine, Bergman says.
“Going from a poor diet to a good diet is where we see the biggest improvement,” he says. “Going from a good diet to a great diet does not always equate to the same level of improvement.”
While some doctors push diets that are highly regimented, Berman says many of his patients do well without going to dietary extremes, as long as they strive to eat in a healthier way.
“What we’ve seen is it almost doesn’t matter what diet you put people on, whether it’s the Mediterranean diet or a lifestyle diet or the ketogenic diet,” he says. “If they are eating highly processed food, high in omega 6s, high in inflammatories, high in sugar and you put them on any diet that focuses on real food, whole food, whether it’s vegan or plant-based but it’s real food with significant amounts of amount of vegetables, it doesn’t seem to matter that much for the average person.”
While diet and exercise are vitally important to brain health, people will remain vulnerable to cognitive loss and the risk of dementia if they don’t attend to the other two pillars of prevention, those being sleep and stress.
Bergman knows that from his own personal experience. For him, meditation and deep-breathing exercises were instrumental in addressing the stress he was experiencing as a medical student.
He’s a proponent of mindfulness as well. There are many approaches to mindfulness, but a common one is to sit quietly and focus on the breath, and seek to stay in the present moment without judgement.
Research has shown that mindfulness can reduce stress, improve working memory, cognitive speed of processing and focus.
“Mindfulness can apply in multiple stages,” Bergman says, “not just in healthy people but people with neurodegenerative disease.”
There are ways to address sleeplessness and sleep disorders as well. Adults of all ages need seven to eight hours of sleep a night, and for people who are not sleeping soundly, the cause of sleep problems is usually treatable. You can learn how to practice better sleep hygiene or talk to your doctor about the problem.
Whether the issue is lack of exercise, a poor diet, the ravages of stress or lack of sleep, Bergman says addressing those issues can bring good results for people experiencing memory loss.
“The people who are successful are the ones who are ready to make changes and when they do, we see improvements,” he says. “The earlier on the symptoms are, the more improvement we see.”
That’s why it’s so important to take action as soon as memory concerns begin to present themselves, he says.
“The key is not to wait,” Bergman says. “There’s still this notion that, ‘We’ll just wait because everyone knows there’s nothing they can do about it.’ There’s probably something you can do about it in most cases.”