Dis­rupt­ing de­men­tia

A lead­ing Amer­i­can neu­rol­o­gist claims Alzheimer’s dis­ease can be stopped in its tracks — and even re­versed. But will fol­low­ing his pro­to­col which in­cludes di­etary and life­style changes make a last­ing dif­fer­ence, asks He­len O’Cal­laghan

Irish Examiner - Feelgood - - Cover Story -

ALZHEIMER’S — a di­ag­no­sis that plunges peo­ple into de­spair, a liv­ing death sen­tence that re­lent­lessly robs the abil­ity to com­pute and com­pre­hend, to con­verse, and to con­nect with ev­ery­thing that makes us hu­man and life mean­ing­ful.

Now a US medic, an in­ter­na­tion­ally recog­nised ex­pert in mech­a­nisms of neu­rode­gen­er­a­tive dis­ease, is show­ing that men­tal de­cline ev­i­dent in early Alzheimer’s dis­ease can be stopped in its tracks — and even re­versed, so peo­ple can once again live a cog­ni­tively healthy life.

“I’m the first to pub­lish data show­ing re­ver­sal of cog­ni­tive de­cline in Alzheimer pa­tients,” says Dr Dale Bre­desen, speak­ing to Feel­good from Los An­ge­les and cit­ing his two re­search pa­pers pub­lished in 2014 and 2016. While much of med­i­cal sci­ence con­sid­ers Alzheimer’s to be a sin­gle dis­ease, Bre­desen de­scribes it as con­sist­ing of three dif­fer­ent sub-types.

He has just pub­lished his

book, The End of Alzheimer’s, The First Pro­gram to Pre­vent and Re­verse Cog­ni­tive De­cline, a New York

Times best­seller. For him, Alzheimer’s is a re­sponse to three dif­fer­ent pro­cesses in the body: In­flam­ma­tion, sub­op­ti­mal nu­tri­tion, and exposure to tox­ins.

He says his wife, a fam­ily prac­ti­tioner, out­lined her views on Alzheimer’s 30 years ago — and he should have lis­tened.

“She said we’d find it would have to do with nu­tri­tion, sleep, ex­er­cise, and use of the brain. Be­ing a sci­en­tist, I laughed and said ‘no, we’re go­ing to find one re­gion of one mol­e­cule that holds the se­cret that will al­low us get one drug’.”

Now he un­der­stands that Alzheimer’s is a process with many in­puts. “When you look at the bio­chem­istry of most peo­ple with cog­ni­tive de­cline, they’ll typ­i­cally have between 10 to 25 dif­fer­ent con­trib­u­tors that will need to be ad­dressed if they’re to have op­ti­mum out­comes.”

Bre­desen’s 2014 pa­per in­cluded three case stud­ies from among 10 pa­tients who’d fol­lowed a per­son­alised pro­gramme, largely based on diet and life­style in­ter­ven­tion. All had ei­ther mem­ory loss as­so­ci­ated with Alzheimer’s, mild cog­ni­tive im­pair­ment, or sub­jec­tive cog­ni­tive im­pair­ment. Nine showed cog­ni­tive im­prove­ment within three to six months — the one per­son who didn’t had very lat­estage Alzheimer’s.

One case in­volved a 67year-old with a de­mand­ing job who’d had pro­gres­sive mem­ory loss for two years. Her job re­quired travel and pre­par­ing an­a­lyt­i­cal re­ports — she was about to quit be­cause she could no longer

an­a­lyse data or pre­pare the re­ports. She’d read one page and have to start again be­cause she’d for­get what she’d just read. She was no longer able to re­mem­ber num­bers, had trou­ble nav­i­gat­ing fa­mil­iar roads, mixed up her pets’ names, and for­got where light switches were.

She took on some el­e­ments of Bre­desen’s rec­om­mended pro­gramme, per­son­alised for what was driv­ing her cog­ni­tive de­cline. Th­ese in­cluded elim­i­nat­ing all sim­ple car­bo­hy­drates/gluten/pro­cessed food; in­creas­ing in­take of veg­eta­bles/fruit/non­farmed fish; stress re­duc­tion through yoga; up­ping sleep to seven/eight hours nightly; fast­ing for min­i­mum 12 hours between din­ner and break­fast and for at least three hours be­fore bed­time; and ex­er­cis­ing for at least 30 min­utes, four to six days a week. She also took daily sup­ple­ments in­clud­ing vi­ta­min D3, fish oil, and CoQ10.

Af­ter three months all symp­toms had re­duced: she was able to nav­i­gate with­out problems, re­mem­ber phone num­bers, pre­pare re­ports, and read and re­tain in­for­ma­tion. She felt her mem­ory was bet­ter than it had been in years. When she de­vel­oped an acute vi­ral ill­ness and stopped the pro­gramme, she no­ticed a de­cline but this re­versed when she re­in­stated it.

An­other wo­man was ex­pe­ri­enc­ing pro­gres­sively se­vere mem­ory loss. She’d leave the cooker on when she went out. She for­got meet­ings, of­ten ar­rang­ing sev­eral for the same time. Her chil­dren said she’d be­come lost in mid-sen­tence and was slow with re­sponses. Af­ter five months on the pro­gramme, the 55hit year-old was able to work again, was able to learn Spanish — her chil­dren said she an­swered their ques­tions with­out hes­i­ta­tion and with nor­mal mem­ory.

“A sin­gle pill can’t ad­dress the many po­ten­tial con­trib­u­tors to cog­ni­tive de­cline, so we need a tar­geted per­son­alised ap­proach,” says Bre­desen. “One per­son might be very low in vi­ta­min D, an­other might be low on oestra­diol, one might test high for in­flam­ma­tory mark­ers. The pic­ture’s dif­fer­ent for each, so we must de­ter­mine the un­der­ly­ing mech­a­nisms driv­ing the [in­di­vid­ual’s] cog­ni­tive de­cline — or their risk for it.”

The Bre­desen Pro­to­col tar­gets phys­i­o­log­i­cal biomark­ers in­clud­ing meta­bolic is­sues, in­flam­ma­tion, tox­i­c­ity, hor­mone im­bal­ance, gut health, nu­tri­ent de­fi­cien­cies, cog­ni­tive stim­u­la­tion, as well as life­style fac­tors: Poor sleep, stress, lack of ex­er­cise. In his book, Bre­desen says pa­tients pre­sent­ing with cog­ni­tive de­cline aren’t usu­ally tested for a host of fac­tors he be­lieves im­pact neuro-de­gen­er­a­tion.

With de­men­tia a lead­ing cause of death in the US, Bre­desen says medicine’s no longer pre­oc­cu­pied with its 20th-cen­tury con­cern: What’s the di­ag­no­sis? “It’s not about what it is but why it is. Why did you get cancer, Parkin­son’s, Alzheimer’s? We must look at all the con­trib­u­tors. That will al­low us to fash­ion the op­ti­mum pre­ven­ta­tive or re­ver­sal treat­ment.”

Bre­desen rec­om­mends a ‘cognoscopy’ when peo­ple 45 so they can be told ‘look, th­ese are your great­est risks [for cog­ni­tive de­cline] and this is what you can do’. He ad­vises a sim­ple blood test to as­sess ge­net­ics and bio­chem­istry, as well as a cog­ni­tive test like the MoCA (Mon­treal Cog­ni­tive As­sess­ment) to eval­u­ate mem­ory and other cog­ni­tive abil­i­ties like or­gan­is­ing, cal­cu­lat­ing, and speak­ing. Find MoCA on­line: de­men­tia.ie/ im­ages/up­loads/siteim­ages/MoCA-Test-English_7_1.pdf

Bre­desen calls the ApoE4 gene — the strong­est known ge­netic risk fac­tor for Alzheimer’s — a “tick­ing time­bomb in the DNA”. Car­ry­ing one ApoE4 in­creases life­time risk to 30%; car­ry­ing two pushes it well over 50%. There’s a 9% risk for those with­out the gene. In a world where there’s no way back from Alzheimer’s, would you want to know whether you have it? Bre­desen finds such at­ti­tudes out­dated. He cites a so­cial net­work (apoE4.info) that’s help­ing peo­ple pre­vent their own cog­ni­tive de­cline. The group num­bers about 800, 99% are on some vari­a­tion of the Bre­desen Pro­to­col, and they’re hear­ing “re­peated sto­ries of im­prove­ment”.

Bre­desen him­self doesn’t have the gene but fol­lows el­e­ments of his own Pro­to­col. “I fast ev­ery night for at least 12 hours, usu­ally 14 to 16. I fin­ish my last meal of the day at 7pm and I don’t have my first un­til 11am/ noon. I check with my wife whether I’m hav­ing episodes of snor­ing or sleep ap­noea, a con­trib­u­tor to cog­ni­tive de­cline. I eat a high-, good-fat, low-carb diet. I take sup­ple­ments in­clud­ing vi­ta­min D and mag­ne­sium.”

The Bre­desen Pro­to­col’s an ex­ten­sive pro­gramme call­ing for huge life­style mod­i­fi­ca­tion. Bre­desen rec­om­mends en­gag­ing help from a spouse/coach to im­ple­ment it. “Com­pared to tak­ing a pill once a day, it’s de­mand­ing. It’s de­mand­ing like a dif­fi­cult diet is. But it’s not crazy. It’s much less de­mand­ing than liv­ing in a nurs­ing home.”

The pro­gramme in­cludes a long list of sup­ple­ments. “There are some that ev­ery­body should be on that sup­port synap­tic struc­ture — like citi­co­l­ine and omega-3 fatty acids. Oth­ers de­pend on in­di­vid­ual needs. Most peo­ple are de­fi­cient in mag­ne­sium, zinc and io­dine.”

Is it safe to take such large amounts of sup­ple­ments? “Th­ese sup­ple­ments are cer­tainly safer than most med­i­ca­tions with side-ef­fects. But if you change your bio­chem­istry too much, it’s al­ways pos­si­ble you’ll run into trou­ble.”

Sup­ple­ment com­pany Cy­to­plan is col­lab­o­rat­ing with Bre­desen to bring his work on Alzheimer’s over from the US. He’s not wor­ried his work will be hi­jacked by com­mer­cial com­pa­nies. “If they make good sup­ple­ments, that’s a good thing.” He ac­knowl­edges the pro­gramme’s costly — test­ing, sup­ple­men­ta­tion, or­ganic food — but says it still costs “less than 1% of what a nurs­ing home costs”.

He and his team aren’t func­tion­ing as any­one’s doc­tor — “we’re of­fer­ing med­i­cal in­for­ma­tion” — and he gives a “yes and no” an­swer when asked if an in­di­vid­ual could pur­sue the pro­gramme with­out med­i­cal guid­ance. (He rec­om­mends work­ing with your pri­mary care provider us­ing the com­puter al­go­rithm, Re-CODE Re­port).

When Dublin-based nu- tri­tional ther­a­pist Edelle O’Do­herty-Nick­els dis­cov­ered Bre­desen’s 2014 pa­per, it was a light­bulb mo­ment. “Here was this [al­beit] lim­ited study show­ing 90% re­ver­sal of cog­ni­tive de­cline. I thought why isn’t the whole world scream­ing about this? Here was a neu­rol­o­gist work­ing in a lab for decades look­ing for a pill that would cure Alzheimer’s and now, know­ing all the un­der­ly­ing mech­a­nisms, he’d come around to a holis­tic, multi-fac­to­rial ther­apy that ad­dresses ev­ery as­pect of his pa­tients’ lives.”

O’Do­herty-Nick­els trained with Bre­desen at the Buck In­sti­tute for Re­search on Age­ing in Cal­i­for­nia (Bre­desen’s found­ing pres­i­dent) in July 2016. Since then, she’s had one client un­der­take the Pro­to­col. “We man­aged to stop his de­cline and he was in the mid­dle of a rapid de­cline. But it’s dif­fi­cult to keep peo­ple on the pro­gramme. It’s a huge life­style shift.”

She takes on­board Bre­desen’s ad­vice to iden­tify fac­tors eas­i­est for the per­son to change and work on th­ese first. “Diet’s of­ten hard­est, it needs a lot of con­tact, coach­ing, and tweak­ing.”

She was in­volved with Cy­to­plan in host­ing the Ir­ish In­te­gra­tive Health­care Con­fer­ence last June (Man­ag­ing De­men­tia: Are Nu­tri­tion and Life­style the Key?) with Dr Ran­gan Chat­ter­jee (BBC

Doc­tor in the House) and Dr Pa­trick Han­away (MD at Cleve­land Clinic Cen­tre for Func­tional Medicine). Th­ese doc­tors will lead two clin­i­cal stud­ies into the Bre­desen Pro­to­col in Bri­tain next year.

Ac­tion Against Alzheimer’s (Cy­to­plan’s pre­ven­ta­tive pro­gramme, in­cor­po­rat­ing all Bre­desen’s find­ings) prac­ti­tioner-train­ing took place in Septem­ber in Stil­lor­gan. Fifteen prac­ti­tion­ers from around Ire­land at­tended. They’re un­der­go­ing an ap­praisal process with Cy­to­plan be­fore be­ing li­censed to de­liver a pub­lic talk about Alzheimer’s and se­ries of eight work­shops, cover­ing all el­e­ments of the Bre­desen Pro­to­col.

The Alzheimer So­ci­ety of Ire­land has reg­u­larly called on the Govern­ment to adopt pub­lic health ap­proaches to re­duce de­men­tia preva­lence, which af­fects 55,000 in Ire­land. The so­ci­ety points to a re­cent study in The Lancet. “[It] high­lights key fac­tors that cause dam­age to the brain in­clud­ing hear­ing loss, obe­sity, and smok­ing. Preven­tion and health pro­mo­tion pol­icy has to start in­clud­ing de­men­tia. Cur­rent health pro­mo­tion in Ire­land ig­nores mod­i­fi­able risk fac­tors for de­men­tia.”

Con­sul­tant psy­chi­a­trist and di­rec­tor of the Mem­ory Clinic at St James’s Hospi­tal Prof Brian Lawlor says there are no pub­lished con­trolled in­ter­ven­tion tri­als us­ing the Bre­desen Pro­to­col that demon­strate ef­fi­cacy, only a small case se­ries re­port­ing on 10 peo­ple. “The idea of im­prov­ing sleep, diet, ex­er­cise, so­cial and cog­ni­tive ac­tiv­ity, low­er­ing stress, and ad­dress­ing de­men­tia risk fac­tors is sen­si­ble — we rec­om­mend it to pa­tients. How­ever, I’d be very cau­tious in stat­ing there’s ev­i­dence this ap­proach can ‘pre­vent or re­verse cog­ni­tive de­cline’ — the data to sup­port this claim is sim­ply not there at the mo­ment.”

Bre­desen says the data ex­ists: “We’re writ­ing up the next 50 case stud­ies now.”

Alzheimer’s is a dis­ease that’s killing many, he says. “Are you re­ally go­ing to tell peo­ple there’s noth­ing to be done when there’s hope now that was never there be­fore? It’s easy to be con­ser­va­tive un­til Alzheimer’s strikes you or your fam­ily. We have 1,000 peo­ple on the Pro­to­col with very clear ev­i­dence of im­prove­ment. We’ve trained more than 600 prac­ti­tion­ers from seven coun­tries and all over the US.”

For Bre­desen, this is not a time to hold back — in true pioneering spirit, he has set him­self a bold goal: “We want to make de­men­tia the rare dis­ease that it should be.”

Ac­tion Against Alzheimer’s pub­lic talks in Dublin: Wed­nes­day, Oc­to­ber 18, and Thurs­day, Novem­ber 9, both 6.30pm (con­tact: edelle@cy­to­plan.co.uk, rem­e­dy­clinic.ie, or 01-6855 832); Mon­day, Novem­ber 6, 10am (con­tact info@river­holis­tic.ie or 018310888).

The End of Alzheimer’s, Dr Dale Bre­desen, Pen­guin House, €15.74.

Dr Dale Bre­desen: Pro­to­col costs less than 1% of a nurs­ing home costs.

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