Hints About What Can Be Done to Reduce Alzheimer's Risk

I have a simple rule of thumb: if we have known of a disease for a long time, but understand it even less well then we understand cancer, it is probably an autoimmune disease or the side effect of an immune system reaction to diet, infection, toxins or physical trauma. I am thinking in particular of two black beasts (bêtes noires) of old age: Alzheimer’s disease and Parkinson’s disease. In both of these two cases, suspecting that they may be autoimmune diseases is well within the scope of the current scholarly debate (Alzheimer’s, Parkinson’s). And the immune system process of inflammation is seen as a risk factor for Alzheimers. (On inflammation more generally, see my post “Jonathan Shaw: Could Inflammation Be the Cause of Myriad Chronic Diseases?

For those who either have or think they might have an autoimmune disease or are worried about diseases such as Alzheimer’s and Parkinson’s that might be autoimmune diseases or diseases with an important part of the causal mechanism involving the immune system, it is worth knowing about Steven Gundry’s hypothesis that leaky gut and certain foods often generate or aggravate autoimmune disorders. See “What Steven Gundry's Book 'The Plant Paradox' Adds to the Principles of a Low-Insulin-Index Diet.”

In this post, let me focus in on Alzheimer’s disease and leave Parkinson’s disease for another day. Researchers haven’t been able to provide gold standard evidence for anything as a preventative against Alzheimer’s disease. In her Wall Street Journal article “Should You Find Out if You’re at Risk of Alzheimer’s?”, Sumathi Reddy reports:

There is no advice derived from randomized-controlled trials—the gold standard in medicine—on preventing Alzheimer’s disease.

The title of Sumathi’s article alludes to these three facts:

  1. Genetic tests are getting a lot better at predicting Alzheimer’s disease

  2. They’ll get better still by adding in the effects of more genes and pinning down the effect of each gene more and more precisely.

  3. In the absence of good evidence about how to try to prevent Alzheimer’s disease, you may or may not want to know about your genetic level of Alzheimer’s risk.

But even in the absence of solid evidence, many researchers and doctors have the intuition that what is good for avoiding heart disease may also be good for fighting Alzheimer’s disease. (Cynically, I wonder a little if they say that because even if they are wrong about the effects on Alzheimer’s they won’t get in trouble for recommending those things.) Let’s look at some specific statements by researchers and doctors. In each case, let me add bold italics to emphasize the key message in each of the quotations from Sumathi’s article.

Rudy Tanzi’s Advice for Trying to Prevent Alzheimer’s Disease

But most doctors agree that regular exercise, adequate sleep and a heart-healthy diet can lower the risk. “The Healing Self,” which Dr. Tanzi wrote with Deepak Chopra, advocates for protecting the brain by focusing on sleep, exercising, learning things, controlling stress and hypertension, as well as maintaining social interaction and a healthy diet.

David Holtzman’s Advice for Trying to Prevent Alzheimer’s

David Holtzman, professor and chair of neurology at Washington University School of Medicine in St. Louis, says there is no objective data that specific strategies work aside from a 2015 study conducted in Finland that showed that elderly people who were cognitively normal or had a mild impairment maintained or increased their cognitive ability over two years with exercise, cognitive training and vascular-risk monitoring.

“Right now,” Dr. Holtzman said, “if you lead an active, heart-healthy, pro-brain lifestyle, there’s not much that we can tell somebody that they should do differently.”

Dale Bredesen’t Advice for Trying to Prevent and Fight Alzheimer’s Disease

Dale Bredesen, a professor in the department of molecular and medical pharmacology at UCLA and founding president of the Buck Institute for Research on Aging, advocates for specific changes. His protocol—which costs $75 a month—entails getting regular blood tests to track markers such as insulin resistance and inflammation, as well as following a low-carb, high-fat diet, fasting intermittently and taking supplements. Dr. Bredesen says he has published two small studies and one 100-person study showing that his protocol can reverse cognitive decline in patients with mild cognitive impairment or Alzheimer’s disease.

Dale has gotten some pushback on this. He answers that he is working toward getting more solid evidence:

But experts pointed out that his studies aren’t randomized controlled ones. Dr. Bredesen said he needs to build up anecdotal evidence to be able to do one. Many members of the ApoeE4.Info group, including Ms. Braymer, said they follow the principles of Dr. Bredesen’s protocol.

It is interesting to look at the Journal of Alzheimer’s Disease & Parkinsonism article “Reversal of Cognitive Decline: 100 Patients” that Dale Bredesen is the first author for.

Here are some informative quotations from that article, again with my emphasis added both by bold italics on the words of the article and by adding explanations in square brackets:

  • … what is referred to as Alzheimer’s disease is a protective, network-downsizing response to several classes of insults: pathogens/inflammation, toxins, and withdrawal of nutrients, hormones, or trophic [diet-related] factors.

  • This notion has led to a treatment regimen in which … a personalized program is generated … Some examples include: (1) identifying and treating pathogens such as Borrelia, Babesia, or Herpes family viruses; (2) identifying gastrointestinal hyperpermeability, repairing the gut, and enhancing the microbiome [leaky gut and a messed-up gut microbiome—the causal nexus Steven Gundry emphasizes]; (3) identifying insulin resistance and protein glycation [sugar molecules messing up proteins], and returning insulin sensitivity and reduced protein glycation; (4) identifying and correcting suboptimal nutrient, hormone, or trophic [diet-related] support (including vascular support); (5) identifying toxins (metallotoxins and other inorganics, organic toxins, or biotoxins), reducing toxin exposure, and detoxifying.

  • Here we have taken a very different approach, evaluating and addressing the many potential contributors to cognitive decline for each patient. This has led to unprecedented improvements in cognition. Most importantly, the improvement is typically sustained unless the protocol is discontinued, and even the initial patients treated in 2012 have demonstrated sustained improvement. This effect implies that the root cause(s) of the degenerative process are being targeted, and thus the process itself is impacted, rather than circumventing the process with a monotherapeutic that does not affect the pathophysiology.

Let’s hope that some of this advice for trying to prevent Alzheimer’s is right, or that better advice is coming soon.

For annotated links to other posts on diet and health, see “Miles Kimball on Diet and Health: A Reader's Guide.”

In relation to Cancer, which I mentioned at the beginning of this post, you might be interested in these:

How Fasting Can Starve Cancer Cells, While Leaving Normal Cells Unharmed