It’s just a head ache right? Why should we be so concerned about concussions? Every one of my coaches in high school and college have reminded me that I am a student-athlete and follow it with this overused quote, “The student is first because you’re a student first and then you’re and athlete.” What they mean by this is that unless you are one of the lucky 0.1% of all athletes who make it to the professional level you better be more concerned with academics and how you are going to support yourself after athletics. For the other 99.9% of us athletes it is important we protect our brain because that is what will be bringing home the bacon later in life.
As an athlete I have seen many people, myself included walk the fine line of how to deal with a concussion. In sports it is very common to get a head injury. The question is how should you react to a head injury. Since it is hard to distinguish between whether a player does or doesn’t have a concussion, many athletes will avoid telling their coach they think they have a concussion because they are worried it might be a minor injury that will get misdiagnosed as a concussion. I have seen many people underplay their injury because they know that the word concussion in sports is taboo. Even some parents will push their kids towards avoiding mentioning they have a concussion until they are absolutely positive it isn’t just a headache.
Many people understand that concussions are bad because any injury to the brain is worthy of concern, but they don’t always understand why sports have begun to take them so seriously with their athletes. So what exactly happens with a concussion? A concussion occurs when a blow to the head causes the brain to crash into the side of the skull. The initial collision causes the death of neurons and results in the release of glutamate from these neurons. An excess amount in glutamate is poisonous to surrounding neurons and can lead to the death of these cells also. As your brain tries to deal with this injury it goes into hypermetabolism where it is burning a lot of energy. It is during this hypermetabolism period where it is important to avoid another injury. Your brain has used up a vast majority of its energy supplies so if you were to injure your brain again it would have insufficient energy supplies to deal with the second injury. It is these second injuries that most often lead to decreased mental function and even death. That is why athletic programs will often require an athlete to refrain from competition for one week minimally.
The more concussions one has had, the easier it is to get another one. Individuals who have had multiple brain injuries are at risk for chronic traumatic encephalopathy which is a neurodegenerative disease that begins years after the brain injuries occurred. The symptoms of this disease include slurred speech, impaired coordination, attention deficits, and memory loss. It can also result in personality changes that can lead to depression.
The dangerous short term effects, and the undesirable long term effects of concussions is the reason why our nation is “putting their foot down” on athletes competing with concussions. The school districts, NCAA, and professional leagues can only make so many rules and regulations regarding concussions though. It is up to us fellow athletes to make the responsible action and report our injury. Remember that it’s your brain. Even if people are telling you to wait and see if it truly is a concussion, is it worth the risk of permanently damaging the only muscle in your body that doesn’t repair itself? If you pull a muscle, or sprain and ankle, it’s easy to remove yourself from competition. Why wouldn’t you take the same measures when you injure your brain?
Knock Knock Who's There? Concussion!
If you wondered what many Americans were doing Sunday afternoon, I could give you an answer. They were watching football. Baseball claims that its America’s pastime, but it has to be football. There’s high school ball on Fridays, college ball on Saturdays, and professional on Sundays. This country is obsessed with the game. We love it so much that we’ve created fantasy leagues. Football is a big part of my life. I love watching the game, but more importantly my “little” brother, who is 6’3′ and 290 lbs, plays football.
In the past few years, football has had to confront the issue of concussions. Science has shown that multiple concussions can cause a syndrome called chronic traumatic encephalopathy (CTE). A brain with CTE is smaller and morphed differently. There are NFL players who have been diagnosed with CTE. Some of their symptoms include memory problems, behavioral changes, and sometimes motor impairment. The most disturbing part of CTE is depression. In the last decade, twelve NFL players committed suicide. Eleven of the twelve had their brains analyzed, and all eleven showed signs of CTE.
While these numbers are scary, we can’t ignore them. To decrease the number of CTE cases, it is important to understand what’s happening when someone gets a concussion. When the head is hit, the membrane of cells in the brain are damaged. This disturbs the ions (ex. calcium and potassium) levels to change. Then an excitatory neurotransmitter (ex. glutamate) is released. This will eventually lead to neurons being suppressed. The body tries to fix this by making the pumps in cells work more. This requires energy and will deplete the energy stores. In the end, the brain can become to acidic and there will be swelling. If a person experiences multiple concussions, this process can cause tangles and plaques to form. This is when CTE occurs, and symptoms will begin to show.
After learning about CTE, the banning of football was proposed. I don’t think that banning football is the answer. If we ban this game, then anything that can cause a concussion should be banned. Playing a dangerous sport is a personal decision and should remain that way. There do have to be some changes though. Research into safer helmets should be a priority. On a grander scale, concussion education should be mandatory for all coaches, players, and parents. Not only should they understand the signs of a concussion and how to treat it, but they should learn the repercussions of an unhealed brain. I want to make sure that this game is safe for my brother and all future players.
Sources:
http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/the-four-stages-of-cte/
https://moodle.cord.edu/pluginfile.php/401841/mod_resource/content/1/pathophys%20of%20brain%20traumas.pdf
The Deadly Truth About Concussions
For generations our parents have been telling us to “just walk it off” or “rub some dirt in it”. However, recent studies have suggested that this may not be the best motto to go by for people today. With many competitive sports injuries and situations related to those injuries occurring, research is being conducted to explore what those injuries could mean for people in the future. The latest data has shown that concussions and brain injuries athletes in football and boxing have obtained have many of the same characteristics of Alzheimer’s Disease and other neurodegenerative diseases. In fact some of the same genetics that make people prone to developing Alzheimer’s Disease has been shown to increase the damage done and recovery time for the brain in athletes with similar genetics.
What does this mean for athletes in the future? Will more athletes need to be genetically tested to continue to play? As of right now, high school, college, and professional level sports have regulations in place for athletes when a concussion or other injuries occur. However, many times people overlook concussions or players feel so much pressure that they attempt to hide their injury in order to continue playing or get back to playing sooner. This competitiveness to play down injury, such as a concussion, could be the reason that many athletes continue to suffer mentally and emotionally after they are done playing a sport. However, is this not what we have been taught from a young age, to stop being a “baby” and get back into the game? Yet, the brain is such a delicate part of our bodies that needs time to heal. The complication in brain injury is it is less noticeable. You do not see swelling, bruising, or lacerations, like you do in other injuries. This makes brain injuries harder to detect and diagnose.
Yet, how does a concussion occur? A concussion can occur from a force hitting the body so hard as to cause the brain to slam into the walls of bones that make up the skull. As a result people have many cognitive signs and symptoms that show the physical damage the brain has undergone. Victims begin having troubles focusing, as well as performing academically, and have troubles with short-term memory retention. Repeated injuries can eventually cause the membrane that protects the brain, the blood brain barrier, to loose its protective ability. These injuries also cause the cell membranes of neurons to allow the transport of particles, ions, and so forth across without regulation. The crossing of these particles results in overexcitation of the neurons of the brain, increased risk of further brain damage, and sometimes neuronal death. As the neurons become compromised by the injuries sustained, similar characteristics found in neurodegenerative diseases, such as plaque build up and neuronal degeneration begin to appear.
Does this threat than have enough of an influence to change the way we play contact sports such as boxing or even eliminate them? At what point does enough become enough and we need to realize our limitations? These are many of the questions that athletic committees have to address and inform athletes of when deciding on rules and regulations for games. In fact the World Medical Association (WMA) suggested banning the sport of boxing altogether.
If we are increasing our risks of brain disease by participating in a sport, is that worth the pain and suffering it could potentially cause in the future? Do we simply continue to teach coaches, players, and family to understand the signs and symptoms of concussions and brain injury, while informing them of the consequences of not allowing the brain to fully heal? As our sports become more competitive and physical only time can tell what will happen to our athletes. Yet, we should look into the effects before it is too late. With so many health organizations pointing out the effects of such sport injuries, it becomes the responsibility of the athlete, as well as their family and coaching staff to become informed of the risk factors involved with each successive brain injury and determine the risk and benefit of continuing on.
Resources:
Blennow, K.; Hardy, J.; Zetterberg, H. The Neuropathology and Neurobiology of Traumatic Brain Injury. Elsevier Inc. Cell Press, 2012 Vol. 76, pp. 886-900.
Concussions: When enough is enough
Recently, the long term effects of repeated concussions suffered by NFL players has been huge news because of the increasing number of suicides that are being committed by former and even current players. What is disturbing about most of these suicides by former NFL players is that they make sure to preserve their brains when taking their life to allow their brains to be researched in the hopes that in the years to come former players like them won’t have to live the same tragic life that they did.
A concussion, which is considered a type of traumatic brain injury, is an injury that usually occurs due to an impact to the head that causes the brain to slam against the walls of the skull. This collision of the brain against the skull causes the membranes of the cells that make up the brain to be disrupted. This disruption leads to a chemical imbalance that causes a disruption in the overall functioning of your brain potentially causing the signs and symptoms of what we know as concussions: unconsciousness, dizziness, nausea, headaches, and reduced concentration. These symptoms can last from 5 days or so up to weeks or even months. During this time the brain is attempting to heal itself so that is why it is so important for someone who has suffered a concussion to let the injury completely heal before trying to compete again because if they don’t the likelihood of re-injury is very high and potentially even worse damage could be done to the brain.
As an athlete myself (I wrestle) I know how difficult it can be unable to compete due to an injury, but at the same time there are also a handful of injuries that if I suspect may have happened to me I don’t mess around with them until I know I am cleared by our trainer or a doctor and one of those injuries is a concussion. If I felt that I had a concussion I would immediately stop competing and get checked out by a trainer or a doctor because concussions are a serious injury and if I was reckless with it I could have long term side effects. All of the stories that have come out about NFL players and the neurological issues that they are having due to the number of concussions they have had is quite frightening, so to me competing while you have a concussion is not worth it. Some might be very hesitant to report suffering a concussion because in most high school and college athletics if an athlete suffers a certain number of confirmed concussions they are no longer able to compete in contact sports. So, often times athletes hide concussions so that they can compete. Now I know that it would be hard to step away from a sport you love because of something you really have no control over but, when it could come at a cost to your health I think that stepping away from the sport is 100% the right thing to do.
I had a friend in high school who was an amazing athlete, he was an All-Conference football player, baseball player as well as a state champion wrestler but, he was susceptible to suffering concussions. After his sophomore year he was told by his doctors that he would no longer be able to play football because the likelihood he would suffer a concussion was just to great so, he decided to just wrestle as a junior. That year he went on to win the state title. Now going into his senior year he was excited to defend his state title and was looking forward to possibly wrestling in college but sadly early in the season during practice he suffered another concussion and this one would be what ended his sports career. Stepping away from a sport he loved and was successful at was one of the most difficult things he has ever had to do but he knew he had to do it for his own long term health. He sometimes wondered what it would have been like if he could have continued to compete but, he knows he made the right decision in stepping away. After his last concussion he knew that enough had been enough.
Concussions: Not Always Worth Taking One for the Team
Concussions seem like such a common thing. It happens because we fall off the jungle gym on the playground as kids or because we run into the walls during a basketball game. If we haven’t had a concussion ourselves, we know a handful of people who have had at least one. I understood that there was brain trauma, but I never stopped to think of the repercussions of that trauma. For instance, the immediate symptoms are dizziness, nausea, inability to concentrate, memory problems, and the obvious, headaches.
However, there are much greater long-term consequences to multiple traumas. Some high school and college athletes may rank up a handful of concussions. Professional athletes whose entire careers fall on the line whether they shake it off and get back on the field may have even more severe brain traumas. But for some reason, they go unreported. Professionals have the greatest risk of developing long-term health issues because of the severity and number of concussions they may accumulate. Very few people stop to think how their brain and their future health they are put at risk when they tell their coach to put them back in. For example, that college student may be putting their degree on the line if the cognitive issues may prevent them from finishing a semester or a year of classes. If the general public were more aware of the neurophysiological changes that occur to brains with head traumas, especially repeated and intense traumas, they may think twice about going out on the field or court too soon.
So what exactly happens to the brain after a concussion? Interestingly, a couple of the culprits are quite similar to Alzheimer’s disease discussed last week on our blog. First, the neurons in the brain are stretched and broken by the blunt impact with the inside of the skull. The neuron undergoes a rapid depolarization because without a membrane the Na+ and K+ are able to flow down their concentration gradients. Immediately following, certain biochemical processes, such as glycolysis and Na+/K+ pump, increase their activity and quickly deplete glucose and ATP. The brain is then left to try to replenish this ATP and restore ion balance over the next few weeks. The Alzheimer’s-like pathology happens during neuronal repair. Amyloid precursor protein (APP) is upregulated in the repair process, and once it is cleaved by b-secretase it forms the amyloid-b (Ab) plaques also found in Alzheimer’s. Another similar process is the hyperphosphorylation of tau protein, a protein that stabilized microtubules in axons, due to the trauma. Tau proteins and Ab aggregate to block the neuronal signal.
The question is when do concussions or acute brain traumas become more serious? The chronic brain injury, CTE, is a neurodegenerative disorder that has similar mental degradation because of the similar pathology. The symptoms in CTE vary greatly depending on the location of the trauma in the brain. Attention and memory deficits are commonly seen farther down the line as the disease progresses. There are no clinical tests to distinguish whether the neurological changes are due to Alzheimer’s and CTE because they are so similar, however age may be one distinguishing factor. There are very few tests that can definitively say whether an individual has a concussion. There is also a fine line between when concussed brain is fully healed and when it isn’t. Once an individual has a concussion, they are more likely to get another concussion and the damage due to the concussion increases.
It is important to protect our brains as much as we can. Certain things are sporadic or genetic, such as Alzheimer’s or ALS, but some things can be prevented. Limiting harmful behaviors which may lead to the neurodegeneration due to concussions is just one way. The athlete’s dreams may be crushed or a professional’s career may be shortened, but the long-term quality of their life will be increased. They won’t be plagued with memory issues, headaches, or behavioral issues because they took one hit too many. I’m not saying athletes need to step away completely from their sport, but they should really think about whether they had enough time to heal and can take a hit without affecting their future health.
Rub Some Dirt In It..?
Concussions are a problem in today’s athletes. Concussions are difficult to diagnose and their severities can vary greatly. The long term effects of frequent concussions in athletes (especially football and boxing) are starting to be known with the growing number of former athletes found to have permanent brain damage. With this knowledge becoming more known, questions have been raised. Should boxing/ ultimate fighting be banned? Should young children not play football?
Concussions can lead to brain damage through various cellular pathways. The two I’ll focus on here are the production of NFTs as well as ATP depletion leading to acidosis and edema.
Concussions occur due to the rapid acceleration and deceleration forces put on the brain during trauma. Trauma causes stretching and disruptions of the neuronal cell membranes leading to unregulated influx of calcium ions and an efflux of potassium ions. This rapid depolarization leads to hyper-phosphorylated pathways leading to hyper-phosphorylated human tau proteins causing microtubule and microfilaments in neurons to aggregate and form neurofibrillary tangles (NFTs). When NFTs form in neurons, the microtubules and microfilaments are no longer effective with transporting necessary cell components down the axon of the neurons.
The ATP-active membrane pumps on cell membranes are used for maintaining cellular ion concentrations necessary for proper neuronal function. Rapid depolarization of the neuron due to cellular stretching and disruptions in the membrane cause ATP-active membrane pumps to activate and restore the cell back to normal ion levels. However, because of the disruptions in the membranes, normal ion concentrations are difficult to achieve and thus these pumps run constantly, depleting the neuron’s ATP stores. The cell relies on the mitochondria to replenish its stores of ATP through oxidative metabolism; however this process relies on very important concentration gradients of ions within the cell and the organelle itself. The rapid influx of calcium causes impaired oxidative metabolism in the mitochondria because it disrupts ion concentration gradients already established for effective metabolism, thus ATP must be generated through anaerobic glycolysis which leads to accumulation of lactate. The high levels of lactate accumulation cause acidosis and edema in these affected neurons.
NFT production, as well as depletion in ATP stores in neurons both leads to neuron death. Concussions are so dangerous because of these processes (as well as others not touched on here). Long term effects set in from the damage to neurons when re-injury occurs before proper healing has had a chance to run its course. The problem seen with so many athletes today stems primarily from cultural tendencies. In college sports, coaches need to win to keep their jobs. If one of their best players goes down due to concussion, the coach is pressured to get him/her back in the game ASAP in order to win. Pro-athletes are pressured to fight through concussions because there’s millions and millions of dollars on the line every time they sit out. On top of all of the pressure imposed on others to get athletes back into the game, athletes themselves are faced with inner struggles about how long to sit out.
As an athlete, I love to compete. There is something so special about being able to give everything you have for yourself and your team in an effort to achieve a common goal. Athletes love being able to see how they match up with their opponents and want to be able to go to battle whenever they can. Concussions are tricky injuries because they’re the definition of “grey area” as far as “how long is long-enough to sit out”? With a lack of accurate testing available for diagnosis of concussions, doctors are reliant on the honesty of their patients. However, like I stated above, athletes want to compete, not sit out. This inner struggle causes many athletes to down-play their symptoms and get back on the field. Having a knee injury or shoulder injury is pretty obvious about when the right time is to compete again. The athlete can visually and physically see they aren’t ready. Head injuries are difficult because even though you may feel fine, your brain is still in its “healing stage”.
People who claim that sports like football and boxing/ultimate fighting should be banned or kids shouldn’t become involved in them should recognize that the sports aren’t necessarily the entire problem. Many injuries former boxers/fighter and football players are seeing were caused because they didn’t take the proper time to heal after initial concussions. They started competing again too early leading to long-term problems. It’s more of a cultural problem or an inner-athlete problem because athletes hate being told “you are not ready to play” or “you have to sit out”. Therefor athletes are competing too soon after injuries and causing permanent damage upon frequent head traumas.
Until next time,
Sebastian
Putting A Price On The Brain: Concussions And Football
Paul Oliver, Andre Walters, David Duerson, Junior Seau, Ray Easterling, Shane Dorness and Terri Long have three things in common. They are all former NFL players, they all have taken their own lives and they all suffered from chronic traumatic encephalopathy (CTE). CTE is caused by repetitive traumatic brain injuries (TBIs) and usually does not start to appear until after the athlete’s sports career has come to a close. Unfortunately there are no accepted guidelines for a clinical diagnosis of it.
When the brain is jarred, for example due to a big hit to the head during a football game, there is a stretching and overall disruption of neuronal and axonal cell membranes. Once this occurs, there is an influx of potassium and calcium ions across the membranes, eventually leading to an increased release of neurotransmitters. The brain tries very hard to keep itself in equilibrium by turning on different pumps in the cell membrane to try and restore itself. This activity takes up a lot of energy so the cell must produce large amounts of it. Picture having to turn on the heat in the house when it gets cold outside. As it gets colder, it takes more energy to keep the house at the temperature desired. This cascade of events ultimately causes the cells to go into a state of hyper metabolism. Protein plaques and neurofibrillary tangles can form, cell to cell communication can be at a loss and worst-case scenario, cell death can occur.
It is said that 3 in 10 ex-NFL players will face some type of neurological problem including but not limited to CTE, Alzheimer’s disease or dementia. So what is being done? For starters with regards to the NFL, the organization has proposed a $765 million settlement for ex-players over concussion-related injuries. But is money enough to cover chronic memory loss, the inability to sleep, personality changes or even suicide?
TBIs, especially concussions in football players, have been of high priority and discussion in recent years and at this point in time there seems to be a lot of finger pointing. It is the NFL’s fault because it doesn’t warn players of the risk, it’s society’s (and the NFL’s) fault for pushing players past their limit and encouraging them to continue playing even after a head injury, it’s the players fault for not reporting their concussions, it’s the helmet manufacture’s fault for producing faulty helmets. The list could go on. Regardless of whose “fault” it is or how much money a player will get from a settlement if they develop concussion-related injuries, education and prevention should be of upmost importance at all levels of the game.
TBIs, such as concussions, have occurred often enough that signs and symptoms as well as tests can be administered to determine if one is present as well as determine its severity. Clearly several players knew they had severe problems and wanted to do something to spare future players. Dave Duerson took his own live by a self inflicted gun shot wound to the chest (not more commonly the head) and in an eerie postmortem letter specifically stated that it was his wish to have his brain studied. As stated earlier, CTEs cannot be diagnosed and are only able to be accurately diagnosed post mortem. I can only hope that more studies are done so that we have the ability to better understand the human brain and the affects that repeated traumatic events, like CTE, have on it.
Sex, Drugs, and Rock-n-Roll (and Concussions)
It seems as though every time we turn around some prominent NFL retiree is committing suicide, tired of being afflicted by the effects of the repeated concussions from his glory years. Yet while the dangers of traumatic brain injuries (TBIs) such as concussions are well known, sports such as boxing and football have done little to protect their participants. The athletes, feeling extreme pressure from a society obsessed with its sports and competitions, are forced to put their health on the line daily, risking a future full of memory impairment and cognitive degradation.
Inability to focus and concentrate, trouble learning, communication issues, and difficulty understanding information are just a few of the problems associated with the harm caused by TBIs. When a person has a TBI, the head can be hit in one of two ways: a straightforward blow which causes lateral acceleration of the brain, or a blow from the side which causes rotational acceleration of the brain. In either case, the acceleration of the brain and subsequent deceleration can cause huge problems to the cell membranes in the brain. When these membranes are disrupted, ions such as potassium and calcium are able to leak across, causing stimulation and the release of neurotransmitters. In turn, various pumps in the cell membrane kick in to restore the ion balance, which uses up energy in the cell. This places a demand on the cell to produce more energy and go into a stage of hypermetabolism. All of these things can lead to disruption in brain cell communication, the accumulation of protein plaques, and even brain cell death. These things can obviously cause huge mental impairment that is currently irreversible.
But it’s not just professional sports that have a problem with TBIs. High school and college athletes also experience pressure to perform from coaches and parents alike, in addition to the pressure they place on themselves. Furthermore, athletes fear losing their eligibility after suffering repeated concussions. As a result, they often neglect to inform their coaches, parents, or health professionals about head injuries they experience, and continue to place themselves in harm’s way despite the potentially grave consequences.
Our society’s obsession with sports is driving its participants into situations that force them to take risks they shouldn’t need to take. Athletes should feel comfortable sitting out due to a head injury. There should be no pressure to get back on the field or into the ring if they aren’t feeling 100%. Yet that’s not the way it works. So how do we combat this pressure that society creates? Certainly we could outlaw sports such as boxing and football that have the highest incidences of TBI, but I don’t such a drastic step is quite necessary. Do we place regulations on how boxers can punch, football players can tackle, or hockey players can check? Do we focus our research on better equipment, or monitoring systems to track damage caused by TBIs? Should tackle football be banned for middle school and elementary school children? High schools have been doing a great job as of late bringing about awareness to the detrimental effects of concussions and TBIs, but more needs to be done. The next decade or two will be very interesting as today’s athletes age and the effects of their concussions begin to show. Not all that different than the rock stars we see suffering from their “wild” years, these athletes are in for a bitter future. Certainly there are many alternatives, and action is essential. But what that is exactly, is up for debate.
Walk, Run, and Eat Your Way Awar From Alzheimer's Disease
Alzheimer’s disease has always been a disease that older generations get and us youthful people don’t need to worry about it until later. That is what many Americans believe at least. I also believe this unfortunate misconception of the truth until recently when I discovered the role of insulin in Alzheimer’s disease. There is a metabolic pathway controlled by insulin in the brain that leads to many of the issues in Alzheimer’s disease. When this pathway is activated normally by insulin you get a healthy working brain. Issues arrive when this pathway begins to be overly activated by a molecule called amyloid-beta peptide. The over activation of this pathway leads to protein tangles that disrupt neuron communication and leads to cell death. This cell death is what causes the memory loss in patients who suffer from Alzheimer’s. Over activation of this pathway does another important thing also. It decreases the activity of a protein abbreviated FOXO. This an awesome protein that we definitely want to be activated. This protein is responsible for activities such as DNA repair and cellular stress relief. When this protein was activated within mice in the laboratory, the mice lived on average 26 percent longer lives than normal. That sounds like a very important protein if you ask me.
So what is the take home message from all this and why should those of us who are still young be doing about this disease now? Well when amyloid-beta peptide over activates the pathway described above we say that the pathway is now resistant to the affects of insulin because it is always activated. That sounds a lot like what happens in diabetes when people become insulin resistant. In fact it’s so similar that many scientists are now calling Alzheimer’s disease a form of diabetes 3. A poor diet and lack of exercise, along with genetics and aging is what leads to an increase in amyloid-beta peptide. Simply maintaining a healthy diet and exercising can greatly reduce one’s chances of getting Alzheimer’s disease. I know there are a million reasons to take care of oneself, but this is just another reason and an important one if you ask me. We don’t want our brains to be insulin resistant, we want FOXO to do its job, and we don’t want Alzheimer’s disease so the most important thing we can do is take care of our bodies.
Is your sweet tooth breaking down your brain? Insulin’s role in Alzheimer’s Pathology
Living in a society where overindulgence of food is commonplace and obesity rates are rampant, we are well aware that too much sugar and fat in our diets is bad for our health, as it can lead to diabetes and heart problems. But it’s not just our hearts that we should be concerned about: this sugar overload may very well be breaking down our brains too. Recent research has discovered that insulin resistance seen in Type 2 diabetes is involved in the development and pathology of Alzheimer’s disease; some scientists are even referring to Alzheimer’s as Type 3 diabetes.
Many people know someone with diabetes or have at least heard about it from a popular infomercial and this man’s pronunciation of the disease:
My first exposure to diabetes was seeing my uncle, who has Type I diabetes, inject insulin into his leg and asking my mom why he got to eat M&M’s for dinner and I didn’t. I didn’t fully understand how sugar in the body worked or why he needed to give himself shots several times a day. Insulin is a hormone created in the body that helps regulate glucose levels in your blood. Too much glucose in your blood is toxic. However, in the case of diabetes, insulin is either not being produced in the body at all or in insufficient amounts (Type 1) or in the case of Type 2 diabetes, the body becomes resistant to insulin, meaning that cells fail to respond to the normal actions of insulin, so blood sugar is no longer being regulated. Type I is often referred to as childhood diabetes, the type that is not related to food or lifestyle choices.Type II is the type of diabetes whose onset results from an unhealthy lifestyle, correlated with obesity. With increased levels of sugar in your diet, the body will initially produce more insulin to help regulate blood glucose levels, but eventually it cannot make enough insulin to keep up with the demand, and the body no longer responds to insulin.
So how does insulin relate to Alzheimer’s? Alzheimer’s disease is a progressive neurodegenerative disease characterized by neurofibrillary tangles and beta-amyloid plaques. Insulin and insulin-like hormones activate the PI3-kinase/Akt pathway. This pathway is involved in transmission of pathophysiological responses from amyloid-beta to tau, two important proteins. When insulin responses are desensitized in the brain, it leads to an increased activation of this pathway. When this pathway is over-activated, it leads to changes in amyloid-beta modulation and missorting and hyperphosphorylation of tau protein. Amyloid-beta is a protein fragment produced normally in the body. In Alzheimer’s, these fragments are not broken down like they should, and they clump together, forming plaques in the brain, which kill neurons. This means decreased neuronal communication in parts of the brain responsible for memory, resulting in worsening memory recall as the brain degenerates.
Tau missorting creates another problem seen in AD brains: neurofibrillary tangles. Let’s think of tau in terms of a college student doing laundry, and assume that the student normally folds and sorts their clothes and puts them in organized drawers (and for the sake of their mother’s sanity). Normally, clothes are always folded neatly, sorted by article of clothing, and put in their respective drawers. However, with increased stress with too many things to do, the student is overactivated, working too hard, and becomes fatigued. This affects their laundry routine. Clothes are missorted and no longer folded properly, ending up in piles on the floor instead of where they are supposed to be. Eventually, the piles become so severe, the tangles of clothes obstruct pathways needed to get to their bed, and the student can no longer reach it. Like the piles of clothes, tau gets misfolded and missorted and accumulates, creating tangles eventually blocking pathways and neuronal communication, causing neurons to die in areas of the brain involved in memory, like the hippocampus, this is how the progressive memory loss occurs in Alzheimer’s disease.
Without insulin being regulated and used properly, the PI3-kinase/Akt pathway is overactivated, causing malfunctions in protein breakdown and sorting, leading to plaques and tangles that destroy neurons in brain areas involved in memory, key characteristics of Alzheimer’s disease. With so many factors contributing to the onset of AD, it is difficult to pinpoint an area that is effective for treatment. However, with the knowledge of the relationship between insulin resistance and Alzheimer’s disease, we do have a possibility of effective prevention: eating healthy and exercising. We’ve been told time and time again that this is important, but this is further proof that we need to take care of our bodies to not only keep us in good physical shape but also good mental shape as we age. If not for you, do it for the ones you love. Because I’d rather be able to relive memories with my loved ones than to have my loved ones be witness to me losing the memories we once shared and eventually, forgetting who my loved ones are altogether.
Image retrieved from: http://www.quickmeme.com/meme/3rr0nc