Art Courtesy of Katrien Deblauwer
A New Approach to Treating Alzheimer’s
For decades, scientists have searched for a cure for Alzheimer’s disease. While important, promising discoveries have been made, there is still no cure. And many doctors are now turning to an array of alternative therapies to help their patients. Dr. Dale Bredesen, a specialist in neurodegenerative diseases and the author of The End of Alzheimer’s, has developed his own strategy for potentially preventing and perhaps even reversing some cognitive decline. He calls it the Bredesen Protocol, and it’s a personalized therapy designed to identify, target, and remove a range of factors that may negatively impact brain health.
The protocol, which continues to be refined, is gaining traction: Bredesen told us that more than 200 of his personal patients have experienced significant improvements while on it, and there are over 3,000 individuals currently trying it. Bredesen and his team have trained over 1,000 physicians across the US and ten other countries to administer this innovative therapy. We spoke with Bredesen to learn more about his protocol, supporting research, and the steps we all can take to make our brains a little healthier.
(For more on Alzheimer’s on goop, see “Why Alzheimer’s Affects More Women Than Men.”)
A Q&A with Dale Bredesen, MD
While there are a variety of influences that can impact neurodegenerative decline, we initially identified thirty-six metabolic factors and have discovered more since. The many possible contributors fall into the following major groups: inflammation-related, hormone-related, nutrient-related, toxin-related, and vascular-related. Based on our research and clinical work so far, we believe Alzheimer’s disease may be a protective response to three different types of insults. Here are our theories:
Type 1: Inflammatory or “hot” Alzheimer’s may result from any number of inflammatory conditions, including a prolonged exposure to infectious pathogens, imbalances in fatty acids, sugar-damaged proteins, having the ApoE4 allele (Alzheimer’s gene), or other stressors that cause chronic inflammation. As a result of the ongoing inflammatory response, the protein that is characteristic of Alzheimer’s disease—beta-amyloid protein—can collect and form plaques in the brain.
Type 2: Atrophic or “cold” Alzheimer’s may result from a loss of trophic/nutritional support, hormonal imbalances in the endocrine system, a lack of key nutrients, a loss of nerve growth factor, or insulin resistance.
Type 3: Toxic or “vile” Alzheimer’s may result from toxin exposure, such as heavy metal exposure (mercury or copper), exposure to biotoxins, or exposure to pesticides or organic pollutants, for example.
We believe that these three categories can form the basis for Alzheimer’s disease and can arise independently or in combination. It’s important to distinguish which subtype one has or is at risk of developing, since each subtype has its own optimal treatment. The best responses occur when each factor is tested and treated. We work by removing the contributing factors—preferably all of them in each of the three categories—that are causing our brains to defend themselves. Each individual should have a personalized optimal treatment addressing all contributing factors.
While we’re all vulnerable to all of the triggers, some of us may be more sensitive to certain insults than others. Because we have no definitive way of knowing which one or two or three might assault our brains, it’s important to reduce your risk across the board—which means decreasing inflammation, increasing supportive compounds, and reducing exposure to neurotoxic substances.
While in recent years there has been an increased discussion to explore and test combination therapies for Alzheimer’s disease, the conventional approach has been to look for a monotherapy—a single drug—that cures the disease. Over 400 drugs have failed in clinical trials that have cost billions of dollars, and there is still no truly effective treatment for Alzheimer’s.
If you look at HIV, it took three drugs to have a truly effective treatment, and Alzheimer’s is even more complex. It may take ten or more parts of a targeted program to have a significant impact on Alzheimer’s. When we look at the underlying molecular basis of Alzheimer’s, we see thirty-six different contributors. It’s not about a silver bullet; it’s about silver buckshot that targets the many contributors.
As part of our program, we evaluate 150 different parameters—using blood tests, imaging, and cognitive testing—to identify any factors that may be contributing to cognitive decline. We then use a computer-based algorithm to determine the risk for each of the three subtypes of Alzheimer’s and generate an initial protocol for either the prevention or the potential reversal of cognitive decline. Of course, the final decisions are up to the physician and patient.
These protocols are personalized programs, designed to address all risk factors through a variety of steps, including:
Specific nutrition regimens—we use a plant-based ketogenic regimen called Ketoflex 12/3.
Exercise programs—aerobic and strength training.
Brain training to enhance your brain’s neuroplasticity.
Sleep—seven to eight hours per night is important, and it’s critical to make sure you don’t have sleep apnea.
Hormones, if indicated.
“Meditation on steroids”—this is an audio program targeted to brain physiology.
Specific synaptic support—for example, with nutraceuticals, etc.
Health coaching, helping you to optimize your personalized program, and if indicated, specific medications.
Since clinical trials are designed to evaluate a single variable, such as one drug, this sort of comprehensive approach is difficult to test. Unfortunately, the clinical trial system isn’t designed to best address how various diseases work, especially complex chronic illnesses such as Alzheimer’s. And our first proposed comprehensive trial, submitted in 2011, was rejected. It will be critical going forward for clinical trials to include comprehensive programs, since such programs may increase the efficacy of drugs when used in combination. With that said, in order to demonstrate the efficacy of the protocol, we’re in the midst of conducting a clinical trial.
Dr. Bredesen’s Brain Health Tips
There are many things you can do to improve your overall brain health. It’s important to remember that each of us is vulnerable to a variety of triggers that may endanger our brains. Luckily, though, there are many things you can do to reduce your chances of all of them. A few things I recommend are:
Check your ERMI (Environmental Relative Moldiness Index) scores in your home.
The ERMI score is critical to determine whether you may be exposed to any indoor molds or to mycotoxins. This test was developed by the EPA and is available online at Mycometrics.com. It’s a simple process of collecting samples in your home and sending them in, and then you get your results.
Ideally, you want your ERMI score to be less than two. Any higher and it’s considered potentially harmful, since some molds produce toxins that are damaging to your body.
Some people are resistant to molds, so if you’re curious where you fall, you can do a background test called HLA-DR/DQ, which assesses your genetic background to see if you’re more or less sensitive or to them.
Follow a plant-based ketogenic diet.
This helps improve brain function, reduce insulin resistance, and increase trophic support. We recommend doing a Ketoflex 12/3 diet, which is more or less a plant-rich no-grain, no-dairy, high-fat, medium-protein, low-simple-carb diet. Through this diet, we’re trying to drive the biochemistry of each person toward the biochemistry that is most supportive of your brain’s function, and least supportive of Alzheimer’s.
The brain uses glucose or ketones to support its function. As you get older, your brain seems to function better when using ketones, which may help offset Alzheimer’s or pre-Alzheimer’s disease. Insulin resistance and high blood sugar levels have been shown to be contributing factors of cognitive decline. Ketosis occurs when our bodies enter a state of fasting, which helps decrease blood sugar levels and increase insulin sensitivity.
You also have an anti-Alzheimer’s effect with a plant-based diet since refined sugars, carbs, and processed foods are all inflammatory agents. Vegetables also aid in detoxification and are high in antioxidants and phytonutrients. We’ve found that when people are able to make this dietary switch and incorporate periods of fasting, some have been able to go off of medications they relied on, like statins, blood pressure medication, and diabetes medications.
Consider adding MCT oil to your diet.
MCT (medium-chain triglycerides) is an oil made up of fatty acids, and it’s found naturally in some foods. Coconut oil is a form of MCT oil but has been found to cause inflammation in some people and may not be absorbed as well as MCT. To improve brain function and have an anti-Alzheimer’s effect, you want to find a way to generate ketones.
There are three ways you can generate ketones: by producing it on your own by breaking fat down in your body; by taking MCT oil; or by taking ketone salts or ketone esters. If you’re able to generate ketones naturally, you may not need MCT oil. An MCT oil can help induce mild ketosis, but it may affect your cholesterol levels, so it’s important to check your levels before starting. That will help you establish a baseline level and measure any effect.
Practice intermittent fasting.
This may be helpful in removing the amyloid proteins associated with Alzheimer’s. If you’re APOE4 negative, we recommend a fasting period of twelve to fourteen hours per night, and if you’re APOE4 positive, we recommend fasting for fourteen to sixteen hours.
This period can be between the time you finish dinner until the time you eat breakfast. Many people call it “window eating” where they eat their meals within an eight-hour time frame. We recommend doing this combined with the Ketoflex 12/3 diet.
Note: While practicing intermittent fasting is important for individuals over forty and for those who are overweight, it is not recommended for individuals who are very thin. Always be cautious while fasting and don’t skip out on carbohydrates.
Take probiotics, and eat foods such as kimchi, miso, kombucha, sauerkraut, jicama, asparagus, onion, garlic, and Jerusalem artichoke.
Probiotics help to optimize the bacteria in your gut—your microbiome—which in turn helps reduce inflammation and improve metabolism.
Kimchi, miso, kombucha, and sauerkraut are all food sources of probiotics. Jicama, asparagus, onion, garlic, and Jerusalem artichokes are all sources of prebiotics.
In addition to these steps, I highly recommend anyone over the age of forty get what I call a “cognoscopy.” This involves doing blood work, genetic testing, and a simple online cognitive assessment to determine any potential contributors. See where you stand and get started on active prevention. We should be able make Alzheimer’s a rare disease within the current generation. One of the biggest issues with medicine—or the old-fashioned notion—is to wait until you feel bad to go to the doctor. Complex illness, like Alzheimer’s or Parkinson’s, are going on for years before they express symptoms. Go talk to your doctor—you don’t have to wait until you’re symptomatic.
So far, we have successfully treated over 200 patients with the protocol, not including the other medical professionals I have trained who are using it with their own patients. One of the biggest challenges has been getting patients to follow the protocol in its entirety and gather the necessary information we need to understand their results. Most people who follow the program closely, which is about half of our patients, show improvement within six months, and more importantly, the improvement continues to be sustained. Some developments we have seen include improved memory, increased scores on quantitative neuropsychological testing, enhanced recognition of faces, improved ability to work, calculate, and plan, as well as improved engagement with friends and family members.
We completed a study looking at ten individuals and published four peer-reviewed papers on the protocol and its results, as well as a book. The original paper on the protocol was the first published piece to show a reversal of cognitive decline in patients with Alzheimer’s or pre-Alzheimer’s. In the second, we described the three major subtypes of Alzheimer’s, and in the third, we showed that type 3 Alzheimer’s disease may be associated with mycotoxins. In the fourth, we illustrated an additional ten patients whose scores and scans improved on the protocol. We’re starting a clinical trial in partnership with the Evanthea Foundation, which will be ongoing through 2018, and will be the first comprehensive trial addressing the many contributing factors to Alzheimer’s disease.
In general, the earlier you start the protocol, the better the results, so we encourage everyone over forty-five to have a “cognoscopy” and get on the optimal prevention program. We have seen some patients in late stages who still respond; however, if someone is already symptomatic, it’s best to seek help as soon as possible.
Dale Bredesen, MD, is an expert in neurodegenerative diseases, with a focus on Alzheimer’s. Bredesen graduated from Caltech, received his MD from Duke University Medical Center, and has held faculty positions at several universities. Bredesen developed the Bredesen Protocol with the goal of reversing cognitive decline in the future, and he is the author of the New York Times bestseller The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline.
The views expressed in this article intend to highlight alternative studies. They are the views of the expert and do not necessarily represent the views of goop. This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.