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The End of Alzheimer's and Cognitive Decline

A few months ago--as part of my ongoing quest to investigate and uncover the roots of my own ongoing health issues--I sent away for my 23andme results. I wasn’t so interested in the ancestry as I was the genetic health risk report, which tells you if you have genetic variants associated with certain health risks, such as the BRCA gene for breast cancer. And so it was that I discovered I carried one gene variant (from one parent) for late onset Alzheimer’s.

At almost the same time, I came across a brilliant book, written by Dale Bredesen, MD called The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline. This extraordinary book quickly affirmed the substantially elevated risk associated with carriers of one or two variants of the Alzheimer’s ApoE4 gene. In the next breath, however, the book reveals the revolutionary program called ReCODE developed by this doctor and his team that according to this author is both preventing and reversing mild to moderate stages of Alzheimer’s as well as its precursors of general cognitive decline--in literally hundreds of patients! This article is essentially a short synopsis of this book. This article is for you, If you are:

  • someone who is suffering from cognitive decline yourself, or observing these changes in a loved one

  • someone who is currently a caregiver for, or who has experienced the loss of, a loved one to Alzheimer’s

  • someone who at any age discovers that they are a carrier of the ApoE4 gene, or

  • someone who wants to spread the word of hope to anyone like those listed above.

As of today, in the world of conventional or Western medicine, there is no cure for Alzheimer’s, and not even anything that reliably prevents or slows its progression. Alzheimer’s is not only fatal; for years and sometimes decades it robs its victims of their very humanity and terrorizes their families. Memories, capacities for thought, the ability to live full and independent lives, is gone as these individuals descend into a mental abyss where they no longer recognize their world or anyone in it. We have all known, met, or been caretakers of those with Alzheimer’s and directly experienced the toll that it takes.

Some facts about Alzheimer’s: of 244 experimental drugs tested from 2000 to 2010 only one--memantine--was approved in the treatment of Alzheimer’s. Its effects are modest at best. Alzheimer’s is the only one of the 10 most common causes of death, for which there is no treatment. Alzheimer’s strikes an estimated one in nine Americans 65 and older, or 5.2 million Americans. Globally 160 million people will be diagnosed with Alzheimer’s by 2050. About 75 million Americans carry either one or both of the ApoE4 gene variants. A single gene carries a 30 percent increased risk, and a double gene a 50-90 percent increased risk (depending on the study). Those who don’t carry the gene can also develop Alzheimer’s or significant cognitive decline, but this occurs in only about 9 percent of this population.

So what causes Alzheimer’s? And why is science, so successful in advances in other areas such as cancer and heart disease, failing so miserably when it comes to Alzheimer’s? Bredesen argues it is because they are approaching Alzheimer’s with a “one size fit all” mentality, and failing to see that it is a far more complex illness. In fact Bredesen and his researchers identified as many as 36 factors driving the Alzheimer’s process!

Seemingly rock solid evidence in lab rats shows Alzheimer’s is caused by accumulation in the brain of sticky synapse-destroying plaques made of a protein called amyloid-beta. These studies indicate that intervening in the steps of amyloid-beta production, or destroying these plaques would be an effective way to treat. All studies to date have therefore been focused on developing a drug toward this end. The compounds created in many cases did a great job of removing the plaques, or of blocking enzymes required to produce amyloid-beta. But the patients either didn’t get better, or got worse. What this means is that amyloid-beta is not the most significant factor in whether or not one develops Alzheimer’s, and that there must be other factors present that are actually driving the process.

Two conditions--Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI)--are stages of mild to moderate cognitive decline that are often present for years before full-blown Alzheimer’s appears. To date, no treatment exists to keep people with symptoms of SCI and MCI from progressing, much less to prevent them from developing at all. But these forms of cognitive decline, as well as Alzheimer’s-related dementia and Alzheimer’s, are showing great improvements--and even complete reversal if caught early enough--with Dr Bredesen’s program that I mentioned above, called the ReCODE protocol.

So what are some signs of the onset of SCI and MCI? How would you recognize if you or a loved one was starting down a path of cognitive decline, so that you could actually do something about it? Some typical signs include: facial blindness (difficulty recognizing and remembering faces), decreasing mental clarity (especially later in the day), decreasing interest in reading, an inability to follow or engage in complex conversations, an inability to follow movies with complicated plots, decreasing ability to recall what one has heard and read, decreasing vocabulary, mixing up words, difficulty remembering to-do lists and and appointments, sleep disruption, no mental boost from caffeine, and trouble speaking foreign languages one was once proficient in.

Along with identifying 36 clear factors that contribute to the cognitive decline of Alzheimer’s, Bredesen’s research has revealed three main types of Alzheimer’s. These three distinct subtypes of Alzheimer’s include: inflammatory, trophic, and toxic. Identifying these three subtypes has created profound implications for how to evaluate, prevent and treat it. It has also meant a shift from a “one size treats all” mentality, toward an approach long recognized by Eastern medicine, such as traditional Chinese medicine and Ayurveda: that people are unique, and that the whole person must be treated instead of focusing on a generalized medication approach to a single disease.

Bredesen and his team report they have been treating hundreds of patients with SCI, MCI and Alzheimer’s since 2014 with great success. Even more success has been achieved with patients exhibiting signs of SCI and MCI before they progress to full-blown Alzheimer’s. Obviously, the earlier you start a program to slow cognitive decline, the better the outcome can be. This is true of any disease caught in the early stage, rather than at more advanced stages.

The three types of Alzheimer’s identified by Bredesen are as follows:

Inflammatory “Hot” type 1: This is the most common type, and the one that responds most quickly to the ReCODE program. Labs in people with this type show an increase in inflammatory biomarkers like C-reactive protein, Interleukin-6 and tumor necrosis factor, a decrease in the ratio of albumin (blood protein that keeps unwanted molecules like amyloid and toxins out of the blood) to globulin, and metabolic and hormonal abnormalities that point to insulin resistance.

Trophic “Cold” type 2: This type typically initiates symptoms about a decade later than the inflammatory type. There is often no sign of inflammation; instead the nutrient support for brain synapses has dried up due to declining levels of hormones (sub-optimal levels of thyroid, adrenal, estrogen, progesterone, and testosterone), reduced vitamin D, high homocysteine and also insulin resistance. This type responds more slowly than type one. It should be noted, however, that people can have both type 1 and 2 simultaneously.

Toxic type 3: This last type is the most tricky and the least likely to respond to ReCODE. This condition tends to occur in people without the ApoE4 gene, and doesn’t typically run in families. It strikes in the late forties to early sixties, often following great stress. Rather than beginning as memory loss, type 3 usually starts with difficulties involving numbers, speech or organizing. The patient loses both recent and old memories. Labs show strikingly low zinc and high copper ratios, low triglycerides, hormonal abnormalities, and high blood levels of toxic chemicals such as mercury or mycotoxins, produced by molds. Therapies are required, that can be incorporated into ReCODE, that remove these toxins from the system.

The ReCODE program is basically a functional medicine based approach that combines extensive lab testing based on a careful patient medical and environmental history, together with other appropriate tests to determine the tailored approach required by the individual.

Doctors always recommend when we reach 50 we should have a colonoscopy. Bredesen recommends getting a “cognoscopy”, evaluating all of the potential contributors and risk factors to cognitive decline. This will create a clear picture of your risk and a path to treatment--whether you are already experiencing cognitive decline or not. Tests include:

  • Genetics: find out if you have the ApoE4 gene

  • Blood tests determining inflammation levels, hormone and nutrient levels, and the presence of toxins (presence of Lyme, heavy metals, mycotoxins or mold)

  • Sleep study: if sleep apnea is suspected, this needs to be corrected. Sleep apnea is extremely common and contributes substantially to cognitive decline, including driving Alzheimer’s processes. For more information on sleep apnea, check out my article here.

  • State of Your Microbiome: Stool and/or breath tests that uncover the state of a person’s intestinal microbiome. How is your gut flora? Are there pathogens?

  • Appropriate Imaging: MRI w/ volumetrics shows the percentages of the brain that may be decreasing or staying steady. Retinal imaging of amyloid-beta, at several hundreds of dollars versus PET scans of amyloid at several thousands of dollars, is an emerging but highly informative and useful technique to determine how progressed the condition is, as well as a useful tool for monitoring progress. PET scans detect relatively large collections of amyloid; retinal scanning can reveal if amyloid is in the blood vessels or not. With retinal imaging it is possible to identify many hundreds of very small plaques, map the location of each, and follow up to see if plaques have declined.

  • Cognitive performance testing can identify and improve cognitive function. Many companies provide online training, such as Posit Science, Brain HQ, and Cogstate. Hundreds of scientific papers have shown the importance of the cognitive effects of brain training; in fact one speed processing training program called Double Decision reduced the risk of dementia by nearly 50 percent ten years after the training--far more than any drug has accomplished!

If this article has inspired you, I highly recommend purchasing a copy of Bredesen’s book for yourself, for a much more in depth discussion of Alzheimer’s, cognitive decline after 40, and effective treatments. Finding a practitioner versed in ReCODE I believe would be a necessity for those who are already experiencing the effects of cognitive decline. We live in exciting times where great breakthrough are being made--both in conventional medicine, and functional medicine. To see these two powerful approaches come together in the service of the individual is I believe the wave of the future. Then we can look at our genetic risk report with confidence and gratitude: we know what to prepare for, and exactly what we need to do to prepare.

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