Fungi and an Ageing Population: Degenerative Disease

For the past eleven months, Brits have barely gone a day without hearing or reading the words ‘Protect the NHS’. We’re all pretty well versed in what that means for now, but let us indulge ourselves in thinking about the public health issues that the NHS faced before the pandemic. These issues continue to pose an ever-growing challenge to health services today, and will do so long into the future without big changes to the trajectory of health along which the UK population is travelling.

In this series of short essays we are going to be looking at the major challenges the NHS faces, and the ways in which fungi can help address these challenges. Today we’re going to talk about the ageing population and degenerative conditions. Why is an ageing population a problem? In 1900 the leading cause of death was infection. Today, causes of death are almost entirely age related: heart disease, cancer, and dementia. Old age is the single biggest risk factor in these diseases. This isn’t likely to surprise anyone, nor are the following statistics. An 80 year old is forty times more likely to die from cancer than someone in middle age, and their risk of Alzheimer's is 600 times greater. By 2030 Britain’s over-65 population is set to triple from what it was in 2016, and the over-85 population (what is referred to as ‘the oldest old’) is set to double. Caring for these beautiful people and the diseases they commonly suffer from is both resource and labour intensive. The fact that more and more people are living to an older age is something we should cherish and protect, and it is important to work out how society can best fit the needs of an ageing population whilst not neglecting the needs of the younger generations. Healthcare must successfully address the concerns of everyone in society: young or old, physically able or not. Whilst we want to maintain long life-expectancy (and by the way, there has actually been a stagnation in life expectancy in the UK in recent years), what we do not want to maintain is the trend in increasing cases of diseases such as heart disease, cancer and dementia. Survival rates for these diseases may be improving, but that still requires an enormous amount of resources, for just one portion of the population. Furthermore, it doesn’t change the fact that people are following unhealthy lifestyles that set them on a path towards diseases which are in so many cases preventable. ‘Healthy life expectancy’ (the years spent in good health) has not increased in proportion to life expectancy and therefore people are living in ill-health for longer. What we need to focus on is how to prevent disease so that people enjoy a long and healthy life, and so that resources are freed up to deliver what healthcare is really for: empowering people to live the life they want to lead.

These changes are needed not just to protect the NHS, or the health of those who would otherwise fall ill, but also the happiness and independence of the people who give up so much of their time and money to care for older or sick loved ones and relatives. Of course, love is strong. For many, being in a position of providing care to a family member is exactly where they’d want to be. But wouldn’t it be better for both the caregiver and the recipient to enjoy their relationship in other ways, and in good health? 72% of carers responding to the 2018 Carers UK's State of Caring Survey reported that they had suffered mental ill health as a result of caring, and 61% percent of respondents reported suffering from physical health issues as a result. 8 in 10 respondents said they have felt lonely or socially isolated whilst acting as a carer. People suffer from all these things outside of the sphere of caring, but what these numbers show is that becoming a carer puts huge strain on a person. This strain manifests emotionally, physically, and financially too. In the UK, each day another 6,000 people take on a caring responsibility. That is the equivalent of 2 million people a year. Amongst them around 600 people each day give up work to meet the demands caring asks of them. By no means does that suggest the other 5,400 people aren’t seriously feeling the weight of the load which has been rested upon their shoulders. Around two-thirds of UK adults can expect to become an unpaid carer during their lifetime, so this affects all of us in one way or another. Preventative healthcare is needed to help the millions of people in the UK who juggle their own dreams, needs, and struggles, with the needs of those for whom they are care-givers. These unpaid, unsung heroes save the UK economy an estimated £132 billion per year. That’s a considerable sum, and just one of many jaw-dropping figures that represent the enormous economic implications of striving to improve the quality of healthcare in the UK. In order for our public institutions to meet these care objectives, we need fewer people to fall ill with preventable disease.

How can fungi help with that ambition? Fungi can help to prevent illness, and can also help speed up recovery from illness. Let’s look at dementia and Alzheimer’s disease. From age 80, a person’s risk of having dementia is one in six, and from 85 that risk goes up to one in five. Alzheimer’s disease accounts for around two thirds of dementia cases in older people. 70 percent of people in care homes have dementia or severe memory problems and, typically, people with dementia spend longer in hospital care than those who are not experiencing severe memory loss illnesses. Dementia patients often suffer from comorbidities and are therefore in and out of hospital a considerable amount. It is estimated that, at any given time, a quarter of hospital beds are occupied by people who have dementia.

It is deeply saddening that so many people have to live out their older years afflicted by neurodegenerative disease. It doesn’t have to be this way. There are things we can do to reduce the risk of developing neurodegenerative diseases. Amongst them are better sleep health, and learning new things (creating novel neural pathways is so important for maintaining healthy cognitive function). As always, however, the focus here is fungi. Enter Hericium erinaceus. Known by friends and followers as Lion’s Mane, this remarkable fungus looks something between a friendly, shaggy-haired dog and an otherworldly formation of cascading stalactites. To some, presumably, it looks like a lion’s mane. Beyond its soft, white spines lie further enticing properties. Lion’s Mane’s active compounds, hericenones and diterpenoid erinacines, are responsible for its thrilling capacity for improving cognitive functioning and neural repair. Its brain-boosting power has garnered much attention in the relatively fungally-naive West, and we are beginning to explore its medicinal benefits in a clinical setting. Indigenous populations and Chinese herbal medicine have time-honoured relationships with medicinal fungi. We are playing catch up. These active compounds in Lion’s Mane increase levels of Nerve Growth Factor (NGF) in the brain. This aids learning and memory because NGF is essential for the survival of neurons and the strengthening of neural pathways. Alzheimer’s disease destroys neurons and leads to progressive memory loss and cognitive impairment. The polysaccharides and NGF-boosting compounds in Lion’s Mane can potentially help to prevent the disease (in people who have yet to develop symptoms) or slow the disease (in those who have already developed symptoms). In mice, Lion’s Mane has been shown to prevent neuronal damage caused by amyloid-beta plaques, which accumulate in the brain during Alzheimer’s. Its capacity for promoting cell repair and regeneration means that it can also be used to treat people who have suffered brain damage, for example in people who have suffered a stroke. In one animal study, a high dose was given to rats recovering from a stroke and helped to reduce brain injury by up to 44%. The impact of boosting cognitive performance is not just something that can be measured using brain-imaging scanners. It affects the everyday choices a person makes. An increase in neuroplasticity means that your capacity for learning new things is increased. This translates into healthier learning habits and a greater potential for protecting the brain against cognitive impairment. Improving neuroplasticity needs to happen at an earlier stage in life to play a role in disease prevention. Neurodegenerative disorders like Alzheimer's are irreversible, so once symptoms begin to appear, the question becomes how best to manage them.

This is why the ‘cure’ for Alzheimer's will likely be a preventative medicine; one which stops the disease before it even begins, before the amount of amyloid plaque in the brain reaches tipping point. In the meantime, the power of preventative measures should therefore not be understated. Our lifestyle choices influence the accumulation of amyloid plaque, so we should feel empowered to be able to do something about it. The fact that we have agency in building defences that protect our brain is an inspiration. In addition to supporting brain health, Lion’s Mane is shown to reduce inflammation and oxidative stress, boost the immune system, help prevent type II diabetes and manage diabetes symptoms, and reduce risk of heart disease. In summary, Lion’s Mane is a useful tool in both preventing and managing some of the elderly’s most commonly diagnosed diseases.

Other mushrooms have been and are being studied for their brain-boosting properties and show promising health benefits in the fight against age-related neurodegenerative illnesses. Amongst them are Ganoderma lucidum (Reishi), Grifola frondosa (Maitake/ The dancing mushroom) and Sarcodon scabrosus (Bitter Hedgehog), which have been reported to stimulate neurite outgrowth and support healthy cognitive function.

With people living for longer, it is important to stay mobile for longer too. That means maintaining flexibility in the joints and being able to move without pain. For people suffering from osteoarthritis, which causes joint pain and inflammation, staying mobile becomes increasingly difficult as time goes on. Osteoarthritis is a common comorbidity of being obese, as carrying around extra weight puts strain on the joints and heightens levels of inflammation in the body. If someone’s joints hurt too much to exercise, we have a dilemma. This is not an uncommon problem. Each of the two health issues serves to reinforce the presence of the other. The NHS Digital Health Survey for England shows us that an alarming number of adults in England are putting their health at risk for being too heavy. Three quarters of people between 45 and 75 are overweight or obese; with over a third of that age group falling into the obese category. This past year has shone a light on the health risks associated with being obese. The likelihood of developing cancer, heart disease, dementia or diabetes multiplies when someone is obese. Anti-cancer fungi and fungi which help prevent and manage diabetes and heart disease will have their own essay. For now, we are going to focus on osteoarthritis and the fungi which demonstrate powerful therapeutic powers for the 8 million people suffering from osteoarthritis in the UK. With the projected increase in the population of over 65 year olds, it is likely the cases of osteoarthritis will similarly increase. In addition to the pain this condition causes, suffering from osteoarthritis makes having a fall more likely, which can be a really unpleasant and traumatic experience for an elderly individual, especially for someone living alone. Moreover, having a fall often results in broken bones and therefore hospital admissions. Reducing symptoms of osteoarthritis should be right up there on the agenda for helping the elderly enjoy a better quality of life.

Cordycepin, a compound derived from cordyceps fungi, has unique anti-inflammatory properties, according to a recent study by The University of Nottingham here in the UK. Their research looked at the effect of this compound on rats and mice suffering from osteoarthritis and found that not only was pain reduced, but the cordycepin also stopped the condition from progressing. This finding is huge, as osteoarthritis has always been understood as a chronic condition whose symptoms worsen over time. The researchers on this study were particularly intrigued by the fact that cordycepin achieves its healing effects via “a different mechanism than any other known anti-inflammatory painkiller,” which “means that medicines derived from cordycepin may help patients for whom other treatments have failed.” Here we have an unprecedented model for painkillers, and a reminder that we should be looking at fungi for powerful bio-narratives which can inspire solutions to a whole host of human problems, in the medical world and beyond.

This just goes to show how much we can learn from these incredible organisms. This isn’t about casting our established treatment methods aside and relying on fungi to save us. This is about finding novel ways of tackling the health issues which afflict today’s society. It is about funding this kind of research in proportion to the promising nature of the results gained so far, so that more human, clinical trials can be conducted. Only then will fungi be embraced by the mainstream medical community. Evidence of fungi inhabiting this planet dates back to around 715 - 810 million years ago. That’s a lot of time for a lot of evolution. The first hominids (which includes only humans and their immediate ancestors, not apes) can be traced back to around 3 and 4 million years ago. Amazingly, genetic comparisons place fungi closer to humans than they are to plants. We have the luxury of being able to consume these wonderful organisms and to pore over them in microscopic detail to uncover their secrets. When we die, it is the fungi who will consume us and work their microscopic mycelium through our decaying corpses. Allies we are in death. So, too, can we be whilst living.

P.S. The mycology of Cordyceps is pretty fascinating. Have a google to see the bizarre manner in which they grow, and check out the chapter Mycelial Minds in Merlin Sheldrake’s Entangled Life to swot up on the curious habits of these parasitic fungi.

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