Book Title: The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline
Book Authors: Dale Bredesen
Publication Information: New York, Avery, 2017, 320 pp., $27, hardcover
This is an important book. The health benefits of lifestyle change, including nutrition, have been known for a long time. Reducing the risk of heart disease, cancer, and stroke motivates many patients, but is not enough to result in a healthier population. Avoiding and even reversing Alzheimer’s disease is another matter. No one wants their life, or their loved ones’, to end with years in dementia.
One in three Americans will develop Alzheimer’s disease or another form of dementia by age 85.1 UCLA Professor of Neurology Dale Bredesen has shown that this does not need to happen. Alzheimer’s disease and other forms of dementia are related to our nutrition and other lifestyle factors, even with the ApoE4 gene variant. This book shows that Alzheimer’s disease can be prevented and even reversed if caught early enough.
Dale Bredesen is a basic scientist and neurologist who worked in a lab studying the biology of Alzheimer’s disease for over 20 years. Like many, he was hoping to find a single biochemical solution to this debilitating disease. In his book, he explains why that is not possible. As he learned, having Alzheimer’s disease is like having a leaky roof with 36 holes. Fixing one will not solve the problem.
Fortuitously, his wife is a family physician trained in and practicing functional medicine. She told him the only solution to fixing Alzheimer’s disease is to fix the lifestyle. He decided to conduct a clinical trial using intensive lifestyle change, and improvement of cognitive decline followed. Bredesen devotes a chapter to “patient zero” whose improvement was reported in 2014.2
Since then, Bredesen has shown improvement or reversal of cognitive decline in over 200 patients. He reported on some of these in a follow-up paper.3 He describes how much trouble he had getting research funding for this work because he was not proposing a single solution. His protocol has been developed over about 5 years of study with patients and is called ReCODE (reversing cognitive decline) the Bredesen Protocol 3.0. With this book and his websites, drbredesen.com and mpicognition.com, he is training practitioners to provide the protocol around the world.4
Starting with evaluation of the patient, Dr Bredesen recommends a thorough testing protocol that he refers to as a “cognoscopy.” This includes a volumetric MRI, genetic testing, and thorough neurocognitive testing starting with a MoCA (Montreal Cognitive Assessment).5 Extensive laboratory work is recommended, including inflammatory markers. Bredesen describes three subtypes of Alzheimer’s disease: (1) Inflammatory (hot) includes those with the ApoE4 genotypes, (2) Atrophic (cold), and (3) Toxic (exposure to chemicals and infections). These types are clarified by the testing, and some patients, especially those with ApoE4 genotypes, have a combination of types 1 and 2.
The ReCODE protocol emphasizes nutrition but also includes exercise, sleep, and stress reduction. The nutrition is at least 12 hours of daily fasting to achieve ketosis and a fasting insulin level of 4.5 or less. Fasting blood sugar should be below 90 and hemoglobin A1c less than 5.6 percent. The food choices are a low glycemic Mediterranean diet with olive oil and lots of vegetables and whole fruit. Poultry and eggs should be pasture raised, other meat is grass-fed and used as a condiment rather than a main course. Seafood should be wild and to avoid mercury and other toxins, large-mouthed fish such as shark, swordfish and tuna are to be avoided. He recommends the “SMASH” fish: salmon, mackerel, anchovies, sardines, and herring. Bredesen recommends many supplements, consistent with a functional medicine approach. I counted over 20 supplements, and Bredesen suggests a person does not need to start all of them at once.
The End of Alzheimer’s is in many ways a victory for family medicine, and should be read by faculty and residents. I read the book twice to know all the details of ReCODE, and have started using it with patients. I have patients and residents reading the book, and we plan to start a practice at Eisenhower Medical Center with an emphasis in functional medicine to complement family medicine. Several of us will get formal training in the Bredesen Protocol 3.0. Reversing cognitive decline is a game changer for medicine and belongs in primary care.
Interestingly, two neurologists at Loma Linda University, a husband and wife team, direct the Brain Health and Alzheimer’s Prevention Program at Loma Linda University Medical Center. They are also demonstrating reversal of cognitive decline with a similar lifestyle approach. The only real difference is that their diet is whole food plant-based, consistent with the Seventh Day Adventist vegan diet. All animal products are avoided. The only supplements recommended are vitamin B12 and fish oil. They also recommend cognitive exercises daily. Their book came out 3 weeks after Bredesen’s.6 More research is needed to clarify what works, but the most important thing to know now is that cognitive decline is reversible, and lifestyle change is the answer.