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Over the past four to five years, I have met people here in Finland who have told me about their relatives suffering from Alzheimer's disease. These people lived what seemed to be a typical healthy lifestyle, but suddenly their memory deteriorated. According to Wikipedia:
“Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens.[2] It is the cause of 60–70% of cases of dementia”.According to WHO:
“Dementia is a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological ageing.
Although dementia mainly affects older people, it is not an inevitable consequence of aging. Currently more than 55 million people live with dementia worldwide, and there are nearly 10 million new cases every year.
Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain.
Alzheimer's disease is the most common form of dementia and may contribute to 60-70% of cases.
Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people globally.
Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and society at large”.55 million victims globally looks like a massive amount of people, and it is. But the prevalence of a population of ~8 000 000 000 people, expressed in percentage, is 0,69%.
Applying that number on a country like the USA, you would expect to find 0,69%*333 000 000=229 770 persons. But according to Bright Focus Foundation:
“More than 6 million of all Americans, or an estimated 6.5 million Americans older than 65, have Alzheimer's disease”.Applying the global number on a country like Finland, with a population of 5,550, 000, the expected amount of Alzheimer's cases would be ~38 000. That is, people who are still living with the disease.
In 2020, 10,673 people died because of dementia ((statistics Finland). If 60 – 70 % of these people suffered from Alzheimer's, that means that 6000 – 7000 Finnish people died because of Alzheimer's in 2020.
According to World health ranking, Finland is the number one Dementia and Alzheimer's country on the planet.
Link to source.
Between 1971 - 1980, every year 25 Finnish men and women per 100,000 died of Alzheimer's/dementia. After that, the number of cases started to increase (see picture below).
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| Diagram from Statistics Finland. |
(link to source).
What happened in 1980?
The early 1980s saw the introduction of new dietary guidelines, which were influenced by the result from The Seven countries study. Finland was one of the seven countries.
In 2018, the University of Helsingfors wrote the following on their home page:
“North Karelia Project – An unrepeatable success story in public health.”.
Link to source.
As late as March 2022, Finnish Institute for Health and Welfare wrote this on their home page:
“From the outset, the goal was to lower cholesterol and blood pressure levels through dietary changes, including a reduction in the use of butter and salt”.
Link to source
On the same page, The Finnish institute for Health and Welfare (THL) presents a diagram of life expectancy in Finland between 1971 – 2020:
Consequently, when I talk to people in Finland about their high rate of Alzheimer's/dementia, they typically attribute the prevalence to age.
At first glance, it seems easy to conclude that a reduction of butter and salt increased life expectancy in Finland. But was that also why Alzheimer's/dementia increased to such an extent?
Members of our species are prone to mental fallacies. For example:
- Confirmation bias, the tendency to apply the same theory on all situations, or search for information which fits the conviction (Nickerson, 1998; Wason, 1960, 1966; 1968; Wason och Shapiro, 1971).
- Natural stupidity – our species propensity to rely on information which are either prototypical (Kahneman och Tversky, 1972), available (Tversky och Kahneman, 1973), or just easy to access (Kahneman and Tversky, 1977).
- Dysrationlia – the inability to think and behave [epistemic and instrumental] rationally despite adequate intelligence (Stanovich, 1993, 2011, 2016).
- Myside bias – a psychological disinclination to abandon a favored hypothesis (Stanovich, West och Toplak, 2013).
- Continued Influence Effect – Misinformation continues to influence memory and reasoning about an event, despite the misinformation having been corrected (Cacciatore, 2021).
In order to escape the bias-loop, I propose Rational Entrepreneurial thinking (Österberg, 2021, chapter 3). The model suggests that we use three established theories in concert:
- epistemic vigilance (Sperber et al. 2010).
- numeracy (Brooks och Pui, 2010). Note. Numeracy is the foundation for instrumental and epistemic rational thinking (Stanovich, 2011, 2016).
- disjunctive reasoning (Stanovich, 2009) in concert.
There's a backstory to THL's take on fat. In 1950, Haqvin Malmros (1895 – 1995), a professor of medicin at Lund University, published The Relation of Nutrition to Health: A Statistical Study of the Effect of the War-time on Arteriosclerosis, Cardiosclerosis, Tuberculosis and Diabetes which tested the diet-heart hypothesis. Dr. Malmros concluded that saturated fats raise serum cholesterol, which increases the risk of contracting arteriosclerosis.
1954, an epidemiologist by the name of Ancel Keys (1904 – 2004), reiterated Dr. Malmros claims:
“a major factor in this difference lies in the relationship among dietary fats, serum cholesterol and atherosclerosis” (Elliott, 2014).In 1958, Dr. Keys launched an international project to further test the diet-heart hypothesis, the Seven Countries Study. One of the countries was Finland (but not Sweden). Again, they reiterated Dr. Malmros conclusion.
But, in 2006, a paper based on the largest study of Women's health was published (Howard et al. 2006). In the section for main results, there was no link between saturated fats and heart issues. But on page 661, a separate table showed that women who lowered their consumption of saturated fats by 10%, increased their risk of contracting cardio-vascular disease by 28%.
In 2014, investigative journalist and adjunct professor Nina Teicholz published The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. Teicholz spent 10 years exploring research about nutrition, including Seven countries study and the North Karelia Project (NKP). Teicholz noticed that there was another cohort in Finland that was never mentioned – Åbo in the southwest. This is actually visible on the map of the countries in Seven countries study:
An important premise to take into account is language, which explains culture (Reich, 2019). What since 1917 has been called Finland, was prior to 1809 the eastern part, and a grand duchy, of the Swedish kingdom, which was once called Svithjod.
Svithjod was an entrepreneurial trade empire, and when Satakunda applied to become a member, Svithjod expanded eastwards. Svearnas (Sweons) language became the trade language around the Gulf of Botnia and the Baltic sea, that is, the same language which is common to current day Finland and Sweden. The implication: Finland still have some of that entrepreneurial thinking, which is about the “knowledge structures” that people use to make judgments and decisions that involve the evaluation, creation and growth of opportunities (Cacciolatti och Lee, 2015 ;Mitchell et al. 2002; Österberg, 2012). Åbo, meaning 'settlement by the river', was founded on January 23, 1229 as the first trading place/city in the eastern part of the Swedish kingdom. Probably therefore, data was sampled from the areas around Åbo.
But because Uralic tribes lived in the inland of the eastern part of Svithjod/Sweden, and one of these languages became official Finnish in ~1863, and reached break-even in ~1925, data was also sampled from North Karelia in the northeast. Contrary to Sweden's entrepreneurial culture, the Uralic-Finnish culture is marked by tribalism (Pagel, 2019).
And the cultural differences between Åbo and North Karelia was significant; in Åbo, 300 out 10 000 people died of cardiovascular disease. In North Karelia, that number was 995/10 0000, a factor of 3.3 (Teicholz, 2014). According to Findings from the Seven countries study, physical health was better in the Swedish-speaking area.
In 2016, another paper was published, with raw data originating from The Seven countries study. The data was found in the basement of one of the researchers in the project, and therefore forgotten. The result of the study again rejected any causal link between dietary saturated fats and CVD. (Ramsden et al. 2016).
In 2019, the Nutrition Coalition published a summary of studies based on RCT which had tested the Diet-Heart Hypothesis (DHH). And in all cases, DHH was rejected.
Why?
Studies in biological/paleo anthropology typically sample data from the African continent. In 2010, a research team found marks on bones, and concluded that our ancestors consumed bone marrow 3.5 million years before the present (McPherron et al. 2010).
In 2018, another team of paleo anthropologists published a paper with some interesting findings. After digging in the Afar region in Ethiopia, they found stones and crushed bones from big dead animals. The researchers concluded the Human Predatory Pattern-theory (HPP), meaning that Lucy's kind used stones to extract bone marrow, which is dense in micro-nutrients like heme-iron, zink, and DHA and so forth (Thompson et al. 2018).
And common knowledge in paleo anthropology is that animal source food had influenced a reduction of our ancestors guts and an expansion of their brain, from the occipital lobeand forward (Aiello and Wheeler (1995; Coolidge and Wynn, 2018; Hublin et al. 2015; Pontzer et al 2016).
We need to eat saturated fats to produce myelin – a lipid-rich material that surrounds nerve cell axons (Poitelon et al. 2020):
“However, myelin assembly requires a significant amount of lipids, and lipids play an important role in glial cell myelination”.In 2019, Georgia Ede published The brain needs animal fats ins Psychology Today, where she conclude that our brains need Docosahexaenoic acids (DHA) and Eicosapentaenoic acids (EPA), a precursor to DHA, to sustain normal cognitive functioning.
One other important component is salt. Since the early 1970s, based on the findings from NKP, people at THL have been convinced that salt is bad. I remember a similar approach from my upbringing in Sweden, and in Helsingfors, most people I speak to believe that salt is bad.
But current research on salt suggests that we should consume 1.5 – 2.5 teaspoons a day, because salt is a systemic component that regulates all sorts of things in the body (Mente et al. 2021). Check out Dr Andrew Mente's presentation for an orientation about salt (Mente, 2018).
So, if fat is not the villain, who, or rather what, is?
In 2005, a research group proposed type 3 diabetes as an alternative name for Alzheimer's:
“The strikingly reduced CNS expression of genes encoding insulin, IGF-I, and IGF-II, as well as the insulin and IGF-I receptors, suggests that AD may represent a neuro-endocrine disorder that resembles, yet is distinct from diabetes mellitus. Therefore, we propose the term, "Type 3 Diabetes" to reflect this newly identified pathogenic mechanism of neurodegeneration” ((Steen et al. 2005=).Three years later, another research group made a similar conclusion:
“We conclude that the term “type 3 diabetes” accurately reflects the fact that AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both type 1 diabetes mellitus and T2DM” ( 2008, de la Monte and Wands conducted a review and concluded).Fourteen years later, In 2022, a similar statement was made in a popular science article:
“Type 3 diabetes is not a medically recognised term and is not something doctors use for diagnostic purposes. However, insulin resistance and decreased insulin signaling in the brain may play a role in the development of Alzheimer's disease. Not to mention, the risk of developing Alzheimer's disease is significantly higher in those with type 2 diabetes (Mudge , 2022).
A review on insulin resistance in Frontiers in Neuroscience(opens in new tab) indicates that insulin is involved in multiple common conditions, such as obesity, dementia and diabetes. The review discusses how antidiabetic medications may be used to prevent and/or treat Alzheimer’s dementia, along with addressing stress, life events and other environmental challenges.
Finally, type 2 diabetes doubles the risk for developing Alzheimer's disease. This is likely due to the fact that in both diabetes and Alzheimer's disease, there is a deficiency of insulin signaling.”This is a list of behavioral markers associated with Alzheimer's/Type 3 diabetes:
Early to moderate symptoms of Alzheimer's include:
- Lack of judgment
- Memory loss
- Confusion
- Agitation/anxiety
- Problems with reading, writing, numbers
- Difficulty recognising family and friends
- Disorganized thoughts
- Lack of impulse control
Note, these are the markers for a young person lacking emotional and social adjustment.
It's likely to state that after THL's focus on the North Karelia Project (but not Åbo?) and the implementation of new dietary guidelines in early 1980s, three things happened:
- Life expectancy increased
- The prevalence of obesity increased
- The prevalence of Alzheimer's increased
In January 2020, the head of the department of Food and Nutrition at the University of Helsingfors invited me to do a presentation to open their seminar series for experts in food and nutrition.
My speech: What’s the Prospect of Sustainable Food: The Case for Mental health (Link to abstract).
Link to source.
On the one hand I met people whose careers were built on the claims from the North Karelia Project, and still depend on it. They defended their viewpoint. On the other hand I met people who were open to anthropology, and current research about fat and salt. With them I reasoned.
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Excellent article
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