We speak often about brain chemicals known as neurotransmitters like gaba, serotonin, and dopamine, and their respective association with things like anxiety, depression and motivation. Another powerful neurotransmitter, ironically often forgotten during the conversation is acetylcholine which is essential for memory, focus, spatial orientation (sense of direction), and overall cognition.

Symptoms of low acetylcholine levels are nearly identical to those of early Alzhemier’s dementia. These include:

– loss of visual and photographic memory
– loss of verbal memory
– memory lapses
– impaired creativity
– diminished comprehension
– difficulty calculating numbers
– difficulty recognizing objects and faces
– slowness of mental responsiveness
– difficulty with directions and spatial orientation

Real life examples of above symptom manifestation could include:

– being able to vividly recall a graduation, wedding or birth of a child decades ago, but blanking on what was consumed for lunch an hour ago
– memory lapses in the middle of a conversation and not being able to recall what they were saying, where they were going with their thoughts or why (unfortunately, we see this quite often during initial consultations)
– these conversational memory lapses can also manifest in obliviously restarting the same conversation or unknowingly conveying the same information repeatedly to the same person
– an inability to find the appropriate word, although struggling and expressing frustration due to it being on the tip of their tongue
– forgetting where the car is parked in a parking lot
– difficulty learning due to not being able to remember what was just read or seen
– seeing someone and knowing they know them, but unable to recall the name due to the lost memory of the person’s face
– due to slow processing speed, this may be that endearing individual driving 20-30 mph less than all other traffic
– lack of spatial orientation leading confusion as to what direction to go when exiting a parking lot that was just entered moments ago
– diminished creativity, lack of comprehension and inability to calculate numbers (a common test is known as Serial 7s: counting back from 100 by 7s. Try it)

(In the last two examples mentioned above we can see somewhat of a technologically driven disturbing trend; and that is an increasing reliance or reassignment of thinking to technology, compute and remember for us, leading to negative plasticity in our brains and a strong contribution to the “use it or lose it” phenomenon. Don’t get me wrong, I am grateful for many of the things these handheld computers allow us to do (as I type this on my iphone), but defaulting to the calculator for addition and subtraction, mindlessly obeying GPS, even always defaulting to picking up the phone to check email or hop on social media, replaces beneficial time formerly devoted to independent thought, creativity, and basic brain exercising function. A bit of a tangent I know, but just another reason to disconnect from the phone more; and another piece of the holistic approach to attacking Alzheimer’s. But I digress…what were we talking about again? I know. I know. Another bad joke.)

Acetylcholine strongly influences an area of the brain called the hippocampus and is the most important neurotransmitter for the conversion of short term memory to long term memory. In the Alzheimer’s or demented brain we see degeneration, damage and/or atrophy (shrinkage), with the hippocampus being the first region to suffer. With Ach being vital to hippocampul function, it only makes sense to include this as a piece to the puzzle.

So as you can see manifestations of low acetylcholine (Ach) levels and dementia are strikingly similar. This means that enhancing Ach levels is not only imperative if levels are low to begin with, but it is a strong strategy to implore in the presence of Alzheimer’s or any form of dementia in order to optimize cerebral function that may be diminished due to dementia and the plethora of contributors to it. Hence the acetylcholine included, multifaceted approach to a multifaceted disease. It’s all about tilting that scale in your favor.

Ach is made up of:

An acetyl group derived from energy metabolism of what was formerly thought to be a exclusive byproduct of carbohydrate metabolism and the krebs cycle. However, when your body burns fat for fuel (a strategy you may want or actually need to preventatively and protectively implement due to the brain’s diminished capacity to use glucose as fuel; see past discussions:)
one of the main ketones (the energy currency or fuel for your body that is formed when metabolizing fats over carbs) is called acetyl-acetate. As seen in the name, this can be another dietary source of the acetyl group necessary for ACETYLcholine.

The choline portion of acetylCHOLINE is derived mainly from dietary fats. (Yet another reason why substantial healthy fats are essential to combatting this and many other conditions.) Ach deficiency, due to a lack of the choline precursor, go hand in hand with the low fat diet which has been the steadfast top down advice for decades; concurrent with an exponential increase in Alzheimer’s. It is healthy fats (NOT processed vegetable oils: canola, cottonseed, corn, soy, etc.), particularly animal fats that are richest in the choline for acetylcholine. These include:

– liver & organ meats
– egg YOLK (eat the entire egg)
– beef
– nuts
– cream
– full fat milk
– fatty cheeses
– cod
– Brussel sprouts
– broccoli
– shrimp
– salmon
– wheat germ
– tofu (must be NON-GMO)

It is vitally important to provide the body with choline via the diet or supplementation. In the absence of these exogenous sources, the body will less efficiently and effectively attempt to create choline endogenously. This comes at the expense of our own nervous tissue, as the body breaks down brain cells in order to weakly provide a brain chemical vital to brain function. As you can tell, this is not a productive or net beneficial process, further emphasizing the need for choline in the diet.

In the presence of Alzheimer’s, genetic susceptibility, a diet lacking in choline sources, or any of the symptoms listed above associated with Alzheimer’s and low acetylcholine levels, taking nutritional compounds to optimize the activity of the Ach pathways may be a strong, proactive step to add to your synergistically comprehensive strategy. (I personally cycle a supplement that contains all 4 compounds listed below to enhance cognitive function, focus, clarity, and creativity; especially in the absence of coffee.)

L-Huperzine A: this potent compound acts to inhibit the breakdown of acetylcholine in the brain. It has been shown to be an effective aid in memory, cognition, and Alzheimer’s.

***One of the most relatively effective and common strategies for slowing the progression of Alzheimer’s has been through drugs known as acetylcholinesterase inhibitors. Acetylcholinesterase is an enzyme that breaks down Ach, therefore lowering levels. These drugs work by blocking the breakdown of Ach, creating higher levels.  L-Huperzine A functions in a similar manner, making it a wise choice if symptoms of low Ach or Alzheimer’s exist.***

Alpha GPC: is a form of choline that is very effective in boosting Ach levels due to being very well absorbed by the GI tract, and through the blood brain barrier. Oral administration of Alpha GPC has been shown to increase brain Ach levels, improve cognitive capacities (suggesting potential for preventing and slowing the progression of Alzheimer’s), as well as aid in stroke recovery.

L-acetyl carnitine: binds to and activates the Ach receptor, making it effective in improving cognition and potentially delaying progression of cognitive impairment.

Pantothenic Acid (B5): plays a critical role in the biosynthesis of Ach, thus assisting in increasing levels.

One more encouraging, action inspiring note when it comes to Ach enhancement. Optimizing levels and stimulating the receptors has a positive effect on Ach potency in the body. The opposite is seen with neurotransmitters like GABA, serotonin or dopamine, where constant exogenous (supplemental or pharmaceutical) receptor stimulation can actually have a negative or down regulating effect in that the receptors tend to gradually become resistant to the stimulant. This results in the same dose having a progressively weaker effect; thus needing higher dose of say xanax to achieve the desired anxiolytic effects.

The powerful characteristic behind Ach receptor stimulation is that the more it is done, the more sensitive (less resistant) or up-regulated the receptors become. This means even less is needed to harness the desired effects which can be critical in the face of diminished overall Ach levels or areas of function in the neurodegenerative brain.

Acetylcholine optimization from all angles is no doubt a potentially game changing approach to include or at the very least entertain in order to protect, preserve, and potentiate the brain’s capacity to function; regardless of where you may find yourself on the cognitive spectrum.

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