A Natural Approach to Cognitive Health

What if  Dementia and Alzheimer’s Disease could be reversed? Would it surprise you if this could actually be done? You’re probably thinking that if this were true, you would have seen this on the news or read about it in a newspaper. But the fact is, researchers at the University of California Los Angeles, UCLA,  reported success in reversing symptoms of Alzheimer’s back in 2014 in a journal article was called “Reversal of cognitive decline: A novel therapeutic program”  The lead researcher Dr. Dale Bredesen describes his journey with patients and the comprehensive protocol he uses to help those with dementia in his 2017 book  The End of Alzheimer’s Disease.   We will discuss his recommendations.

Alzheimer’s disease is now the third leading cause of death in the United States and the most common form of dementia recognized by doctors. If you know anyone with dementia or cognitive impairment, please share this article.  It contains a lot of information and may be overwhelming for many—following the suggested recommendations will require a team effort and support of friends and family.

A colleague of mine, Dr. Wes Youngberg, who is a practicing clinical nutritionist and lifestyle medicine specialist in Temecula, California, has been working with Alzheimer’s patients one-on-one, using the Dr. Bredesen protocol.  Dr. Youngberg shared the following testimonial with me.

What is Alzheimer’s Disease?

Alzheimer’s disease is a brain disorder that generally affects older adults. The condition was named after Dr. Aloysium “Alois” Alzheimer (1864-1915).  Dr. Alzheimer was a psychiatrist who in 1906 diagnosed dementia in a woman who had died from a strange mental illness. He then published the findings.  In 1912, this form of dementia was named Alzheimer’s disease. 

Alzheimer’s disease usually affects those 60 years of age and older. Less than one percent of the cases occur prior to this age. Up to one in 10 people after age 80 are at risk for developing Alzheimer’s disease. Scientists have broken Alzheimer’s disease into three stages: early onset, late-onset, and familial related. 

Symptoms of Alzheimer’s Disease 

• Memory loss, recent memory affected, long-term memory remains (Amnesia)
• Trouble remembering the names of things (Anomia)
• Misusing objects due to not being able to identify them when in hand (Apraxia)
• Trouble with words and difficulty expressing oneself through speech (Aphasia)
• Executive function impaired difficulty making decisions (Agnosia)

Risk Factors of Alzheimer’s Disease

• Older age 
• Diabetes/Pre-diabetes
• Heart disease
• Tobacco use
• Diet">Diet">Diet">Diet">Diet">Diet low in fruits and vegetables
• High blood pressure
• Depression
• Physical Inactivity
• Down’s Syndrome
• History of head trauma and brain concussion
• Family history – 25 percent of the cases appear to be genetic, having the apolipoprotein E-e4 (APOE-e4) gene

Current Approaches to Alzheimer’s Disease

The current approach to cognitive impairment, dementia and Alzheimer’s is severely limited.  Scientists have discovered at least 36 things that contribute to Alzheimer’s disease, yet currently, conventional medical doctors focus on just two. Physicians rely on two classes of pharmaceutical drugs to treat memory loss:

• Cholinesterase inhibitors donepezil (Aricept), rivastigmine, and galantamine 
• N-methyl-D-aspartate (NMDA) receptor antagonist memantine (Namenda)

In 2014, Dr. Bredesen introduced his protocol in his sentinel paper Reversal of cognitive decline: A novel therapeutic program. His approach was unique and, of the original ten patients with dementia, nine improved after following his protocol. Six of the patients who stopped working due to memory issues were able to return to work full time. Dr. Bredesen’s approach addressed all 36 abnormalities.  

Dr. Bredesen’s approach has been helpful for those with mild to moderate Alzheimer’s disease, pre-Alzheimer’s disease, Subjective Cognitive Impairment (SCI) and Mild Cognitive impairment (MCI). 

He identified the following important components. It is advised that one do as many of them as possible in order to get the best outcome for your brain. 

Diet

• Minimize simple carbohydrates – Avoid breads, pastas, processed foods, sugars, and fast foods.  Consume a more plant-based diet. Eat wild, non-farm-raised fish, but no more than once per week.  If you consume meat, use grass-fed, hormone-free beef, turkey and chicken.
• Fast 12 hours each night, including no food for three hours prior to bedtime. Example, if you go to sleep at 10 PM,  do not eat between 7 PM  and  7AM.

Lifestyle

• Reduce stress – Many of us have financial, job, family, and relationship stress. Minimize your stress by listening to music, practicing yoga, meditating and/or praying daily.
• Optimize sleep – Try to get eight hours each night.  If you have sleep issues, ask your doctor to check you for sleep apnea. Supplement: Melatonin 0.5 mg each night, titrate up to 10 mg if needed.   
• Exercise – At least 150 minutes per week. Exercise daily for at least 30 minutes, five days per week. Exercise increases Brain-Derived Neurotrophic Factor (BDNF), a protein which helps the brain make new nerve cells. If you have heart disease, ask your physician before starting an exercise program.  
• Stimulate your brain – It’s easier than it sounds. Brain stimulation occurs during activities like reading, word puzzles, crossword puzzles or Sudoku. Take it a step further and learn a new language as this protects against dementia. Recommended websites to help improve cognitive function include BrainHQ.com and Lumosity.com. Consider language programs using smartphone applications. 

Blood Tests

Blood tests can provide your doctor with useful information. Make sure you receive a copy of your blood results. While many of your results may be in the “normal” range, they may not be in the optimal range. The following blood tests should be considered as part of a dementia evaluation.

• Apolipoprotein E-e4 (APOE-e4) – Genetic test can be done with a blood test. Twenty-five percent of the population has one copy of the gene. These people are 2-3 times more likely to develop Alzheimer’s while those with two copies of the gene are 5-6 time more at risk.
• Vitamin B6 (60-100 nmol/L is optimal) – Also known as pyridoxine. Low normal blood levels can be problematic while levels over 110 nmol/L can also be a problem.  
• Vitamin B12  (> 500 pg/ml is optimal ) – Also known as cyanocobalamin. Plays an important role in keeping nerves healthy. When low, some develop numbness and tingling in their legs. Memory difficulties can occur. Methyl-vitamin B12 is preferred by many but regular vitamin B12 can also be taken.
• Folic Acid (10-25 nanograms/ml is optimal) – Supplementing with methyl-folate is preferred.
• Homocysteine ( < 7 µmol/L is optimal) – Homocysteine is an amino acid that if elevated, increases the risk for heart attacks, strokes and dementia. Elevated levels occur with vitamin B12 deficiencies and in those with MTHFR gene mutations. The goal is a blood level less than seven although most laboratories consider 11 or less normal.  Treat elevated levels with vitamin B12,  methyl-folate and/or  TriMethylGlycine (TMG).
• Cardiac C-Reactive Protein, CRP  (< 1 mg/L ) – A marker of inflammation. This protein is made in the liver when an inflammatory process is occurring. A diet rich in generous servings of fruits and vegetables can help lower inflammation. Omega-3 fish oil supplementation can help lower CRP. Inflammation is frequently due to chronic infections, gum disease, high sugar diet, a leaky gut, and exposure to toxins.  
• Fasting Insulin (Optimal < 7 mIU/L) – An elevated insulin is an indicator that the body is working harder than it should to control blood sugar (glucose). Before a person develops type 2 diabetes or pre-diabetes, they have elevated insulin levels. The body breaks down insulin, using a chemical called Insulin Degrading Enzyme (IDE). Scientists have shown that this enzyme also breaks down amyloid-beta, the abnormal protein found in the brain of those afflicted with Alzheimer’s. Therefore, those with elevated insulin have more amyloid-beta protein in their brains.
• Hemoglobin A1C  (< 5.5 %) – The HgA1C is a test a physician orders to measure a person’s average blood sugar level over a three to four month period. It measures the percentage of hemoglobin, or red blood cells, which have a sugar molecule attached.  A level of less than 5.5 percent indicates that there is no diabetes or pre-diabetes present. If your level is more than 5.5 percent,  then diet changes, exercise and weight loss is needed.
• Fasting Glucose ( < 90 mg/dl or  <5.0 mmol/L) – Most labs report glucose (sugar) being normal when it is  99 mg/dl (5.5 mmol/L) or less. A fasting glucose level between 100-125 mg/dl  (5.5 -7.0 mmol/L ) is considered pre-diabetes while a fasting blood glucose level of 126 mg/dl (>7.0 mmol/L) or more is diabetes. If your level is elevated, diet changes, exercise, and weight loss is needed.
• Hormone balance – Optimizing hormones is important. Thyroid hormones include TSH (<2.0 microIU/ml is optimal), Free T3, and Free T4. Sex hormones include estradiol, progesterone, testosterone, DHEA and cortisol.
• Vitamin D – (50-100 ng/ml  or 125 nmol/L to  250 nmol/L is optimal). Ask your doctor to check your vitamin D 25-OH blood level. Most labs report normal being 30 ng/ml to 100 ng/ml (75 nmol/L-250 mmol/L). Read more about the other health benefits of vitamin D.
• Optimize Copper: Zinc ratio – Copper and zinc ratio is important, and both mineral tests can be measured, using a simple blood test. Low blood levels of zinc and too much copper is a risk for dementia, according to a study in the Journal of Alzheimer’s Disease.  The optimal copper-to-zinc ratio, according to Dr. Bredesen is 0.8-1.2. The optimal zinc blood levels are 90-110 mcg/dl.
• Heavy metal toxicity – Person with dementia should have a baseline blood test for mercury, lead, and cadmium.  Depending on one’s occupation or community in which they grew up, some may have higher risk. If your levels are elevated, discuss detoxification options with your healthcare provider.

Other Strategies to Improve Brain Health

• Gut Health – About 2,300 years ago, Hippocrates (460 BC-370 BC)  stated “All disease begins in the gut. Science supports this, and focusing on intestinal health is crucial if one wants to improve their overall health, especially brain health.  Consume probiotics and cultured foods daily.
• Optimize antioxidants – A colorful diet that consists of a wide range of fruits and vegetables should be consumed daily. The goal should be eight servings daily. Fruits and vegetables have different colors, which is an indicator of their antioxidant diversity.  Supplement with selenium, N-acetyl cysteine (NAC), resveratrol, and vitamin C.
• Reduction of Amyloid-Beta (Aβ or Abeta) – This protein has been found in the brain of those with Alzheimer’s disease and stopping it from forming is critical. Scientific studies have shown that turmeric can help prevent the build-up of Aβ in the brain. Ashwagandha can also help reduce Aβ deposits in the brain.
• Ensure adequate oxygen at night – Sleep apnea has become more common. Carrying excess weight is a leading cause. A person who has daytime fatigue, frequent headaches, and snores should ask their doctor to be evaluated for sleep apnea. Those with sleep apnea do not get adequate oxygen to their brain when they sleep.
• Optimize mitochondrial function – Our body’s main energy-producing cells are mitochondria. If they become damaged, they are unable to generate power or energy.   The nerve cells in our brain require mitochondria to be efficient. Supplement with Co-Enzyme Q10 and L-Carnitine to help support mitochondria. 
• Medium Chain Triglycerides – Use coconut oil when cooking and consider a coconut oil oral supplement.

Recommended Supplements for Memory

Vitamins

• Vitamin B1 (Thiamine) – 50 mg once per day
• Vitamin B6 – 20 mg once per day
• Vitamin B12 or methyl-cobalamin (B12) 1 mg (1,000mcg) daily
• Folic Acid or methyl-folate 800 mcg minimum per day
• Pantothenic Acid –100-200 mg once per day 
• Vitamin C – 1,000 mg once per day
• Vitamin D – 2,500 to 5,000 IU once per day
• Vitamin E – 400 to 800 IU once per day
• Vitamin K2 – 100 mcg once per day

Minerals

• Zinc picolinate – 50 mg minimum, once per day
• Magnesium chelate – 125 to 500 mg daily

Herbs and other Supplements

• Turmeric - 500 mg once to three times per day
• Resveratrol – 100 mg once or twice per day
• Nicotinamide Riboside – 100  mg once per day
• Citicoline – 250 mg once or twice per day
• L-Carnitine – 500 mg once per day
• Ubiquinol  (Co-Enzyme Q10) – 100 mg once or twice per day
• Ashwagandha – 500 mg once or  twice per day
• Rhodiola – 200 mg once or twice per day
• Bacopa monnierie –  250 mg twice per day
• Gotu kola – 500 mg twice per day
• Probiotics – 10 to 100 billion units daily

Summary

Cognitive dysfunction and Alzheimer’s disease is a condition that will become more prevalent over the next several decades. Everyone should undertake strategies to help prevent brain deterioration. 

As discussed above,  Dr. Dale Bredesen, of the University of California Los Angeles has developed a very comprehensive approach to help improve and in some cases, reverse,  symptoms of memory loss. For those who chose to follow his protocol, I recommend you try to follow as many of his recommendations as possible.  

Please realize that it may take some several months before improvement is noticed while others will notice some small improvements within a few weeks. 

References:

1. Bredesen DE. Reversal of cognitive decline: A novel therapeutic program. Aging (Albany NY). 2014;6(9):707-717.
2. Bredesen, Dale, E. The End Of Alzheimer’s Copyright 2017 Penguin Random House Publishing. Site accessed http://dryoungberg.com/ . 
3. National Institute of Aging. Accessed Aug. 27, 2016 https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease- fact-sheet
4. Bredesen DE, Amos EC, Canick J, et al. Reversal of cognitive decline in Alzheimer’s disease. Aging (Albany NY). 2016;8(6):1250-1258. doi:10.18632/aging.100981.
5. Exp Neurol. 2012 Jan;233(1):373-9. doi: 10.1016/j.expneurol.2011.11.001. Epub 2011 Nov 10.
6. J Alzheimers Dis. 2015;47(3):565-81. doi: 10.3233/JAD-143108.