By Jerome Burne
The obvious problem with the recent government announcement that doctors will be paid for diagnosing people with dementia, is that there is no approved form of treatment. This is because research funding has all concentrated on finding a drug that will slow the disease down or even stop it in its tracks.
At least that is what most people, doctors especially, believe. In fact there is a new and radical treatment (apart from high dose B vitamins ) The report of an early successful trial has just been published. Entitled “Reversal of cognitive decline; A novel therapeutic program”, published in the journal Aging, it describes some remarkable results.
The patients had all complained of growing problems with their memories and thinking ability. For just over half of them things had got so bad that they had had to stop working. But after six months taking combinations of various compounds, all of the six who had stopped work because of their declining memory were able to go back to work.
The program they were on was developed by Dale Bredesen, Professor of Neurology and Director of the Mary S. Easton Center for Alzheimer’s Disease Research at UCLA (University of California Las Angeles).
A big trial is unlikely to happen
‘Alzheimer’s is a complex disease affected by sleep, diet, even exercise,’ he says. That’s why he developed a protocol called MEND – Metabolic Enhancement for NeuroDegeneration – which is a ‘novel, comprehensive and personal approach to treating memory loss’.
Everyone agrees that what is needed now is a large scale, randomised, blinded trial to confirm the benefits. However the shocking truth is that it’s perfectly possible that such a trial will never happen. The big randomised trial showing dramatic benefit from high dose B vitamins has never been followed up.
The problem is that the compounds used weren’t drugs but diet, supplements, herbs and exercise – so little in the way of profit. And to complicate things further different patients got different combinations depending on their problems.
Running a “gold standard” randomised controlled trial of that package was described by other doctors as ‘a major challenge’. But given the scale and seriousness of the problem wouldn’t a more useful response be to say if our current method of testing treatments can’t handle this lets develop another one? The situation, as everyone also agrees, is desperate.
The woman who was planning suicide
Dr Bredesen’s package is a challenging life-style transformation that’s hard to stick to but the patients were all highly motived. They already had serious symptoms and there was nothing else on offer. All had previously had a scan to check that they had the pattern of brain shrinkage found in Alzheimer’s.
One was a 67-year-old woman who had been planning suicide when she began the program because she was developing the same problems her mother, who had died with Alzheimer’s. She couldn’t remember phone numbers or what she had just read and she navigating even familiar roads was becoming impossible.
The changes she made were dramatic and would have significantly boosted the health of anyone. She transformed her diet. Out went simple carbohydrates, gluten and processed foods, which were replaced with a lot more vegetables and fish. She started taking exercise, meditating and doing yoga. Her supplement regime included B vitamins, vitamin D, fish oil, Co-Q10, melatonin and HRT.
Within six months all her symptoms had vanished. Nine patients on similar regimes saw a noticeable improvement in memory. Only one patient, who was in the late stages of Alzheimer’s, didn’t benefit. Some patients have been followed up for two and a half years and the memory improvements have been maintained.
A radical new approach to Alzheimer’s
But Bredesen’s research doesn’t just hold out hope to millions of patients who feel abandoned; it suggests a radical new approach to understanding and treating the disease.
Over the past few decades genetic and biochemical research has shown that as Alzheimer’s develops there are all sort of damaging changes going on in the intricate network that underlie the metabolic system that keeping our bodies working. There are changes in compounds controlling inflammation, the control of fat and energy becomes less efficient, regulation of calcium is altered and so on.
‘That suggested that a broader-based therapeutic approach, rather than a single drug that aims at a single target, may be feasible and potentially more effective for the treatment of cognitive decline due to Alzheimer’s,’ Bredesen says.
The complete failure to develop any drugs for Alzheimer’s convinced him that researchers’ basic understanding of the disease was wrong. His laboratory has found evidence that the underlying problem is not a build-up of plaque that had to be cleared away – the drug approach – but that the normal process that destroys and creates brain cells has become unbalanced.
Plaque doesn’t need to be destroyed
Normally we have to build cells to make memories but we also have to destroy them to allow irrelevant information to be forgotten. But in people with Alzheimer’s, the forgetting process has become too active. It’s similar to what happens in osteoporosis where the bone starts being broken down faster than it is build up. So what you need to do is get that destruction and renewal process working in sync again.
This involves getting plaque doing its job properly again. ‘It has a normal function in the brain,’ says Bredesen. ‘It’s part of the forgetting system but it had got out of control. You don’t want to destroy it but to make less of it.’
Many of the multiple dietary changes and supplements in the program target the compound that makes amyloid – APP (amyloid precursor protein). Research shows it can be affected by many natural compounds and processes such as the hormones melatonin and oestrogen, vitamin D, the spice curcumin and exercise.
But the studies have also found that none of them are particularly effective on their own. So Bredesen’s idea was to combine them and give different combinations to different patients depending on what was happening to their system. The result of this early trial suggests that he is very much on the right track.
We can’t afford to get this one wrong
Bredesen says the program’s downsides are its complexity and that the burden falls on patients and caregivers to follow it. In the study, none of the patients was able to stick to the entire protocol. Other elements, in addition to the diet and exercise regimes already mentioned, include optimizing oral hygiene using an electric flosser and electric toothbrush, fasting for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime and exercising for a minimum of 30 minutes, four to six days per week.
The good news, though, are the side effects: ‘These include improved health and an improved body mass index, a stark contrast to the side effects of many drugs,’ he says.
If there was genuine political commitment to finding an effective Alzheimer’s treatment and if the drug companies grip on research budgets could be loosed in the interests of a genuine public health program, Bredesen’s work could give rise to a whole new research program.
‘We need to answer key questions’ he says. ‘ Such as the degree of improvement that can be achieved routinely, how late in the course of cognitive decline reversal can be achieved, whether such an approach may be effective in patients with familial Alzheimer’s disease, and last, how long improvement can be sustained.’
We can’t afford not to.