Alzheimer's Disease and Dementia - Metabolic Enhancement
Dr Dale Bredesen, MD
|Dr Dale Bredesen|
Dr. Bredesen is internationally recognized as an expert in the mechanisms of neurodegenerative diseases such as Alzheimer's disease.
Dr. Bredesen works at UCLA in the laboratory for Neurodegeneration Research. Dr. Bredesen also works at the Buck Institute for Research on Aging, as its founding President and CEO.
Dr Bredesen believes that until tested we are all have high risk for getting Alzheimer's disease, so he suggests that at 45 or 50 we should have a comprehensive metabolic profile done. That will include ApoE status, insulin resistance, tests for inflammation, tests for hormone and vitamin deficiency, and tests for toxicity.
The MEND Process
For the last six years Dr Bredesen has been developing the MEND process, Metabolic Enhancement for Neurodegeneration. The basic idea was that he would test for many metabolic functions and correct as many as possible. Bredesen believes that there are over 1000 possible agents that might be causing brain injury. In response the brain produces amyloid plaques and tau as a protective process for the whole brain. The result of much trial and error, is The Bredesen Protocol.
The Bredesen Protocol for Alzheimers
The current protocol tests for at least 150 micronutrients, hormones and toxins. The result of this complex testing is processed by a computer programme that suggests a protocol for treating each patient. This programme tries to identify the "holes" that need to be plugged.
Over the next ten years or so practitioners will be trained to offer this treatment generally. The Institute of Functional Medicine has taken on the training task, and at the end of 2017 over 1000 specialists from seven countries had been trained. These practitioners will be able to offer a full range of tests, to use the computer programme and to get the advantage of sharing experience other practitioners, in working with thousands of patients.
You, Your Doctor and Our Community
In the meantime there's still a lot each of us can do. Essentially work with your doctor, to be as healthy as you can be. Dr Bredesen has told us some of the essentials. The ketogenic diet, exercise, sleep and stress reduction. That's a fair bit to do that doesn't need medical expertise. We can make sure we do those things well. Dr Bredesen says, "We should imagine that the roof has 36 holes in it. You have to find those holes and patch every one of them. If you attend to your diet, exercise, sleep and stress, many of those holes will be plugged, and the balance will tip in your favour."
Until now there has been little incentive for medical doctors to order tests for people getting dementia. It was unclear what to test for. There was no treatment protocol. Now we know that if people are metabolically "fit" the brain responds and also improves it's function. Hence, there is a purpose in extensive evaluations of hormone status, nutritional status, toxicity status, metal status (copper, zinc, magnesium), gastrointestinal permeability, iodine , vitamin B12 and insulin resistance. Several thyroid tests are suggested. This is familiar territory for your doctor, so begin to pick your way through the tests and try to re-create optimal values, if the system is found wanting.
The patient and the patient's family also have a big task. The brain will clear the amyloid plaques and tangles, to repair itself most efficiently if it's in mild ketosis, as it was when you were being breast fed. That means eliminating sugar from the diet and also eliminating all the obvious carbohydrates. You need to eat a very-low-carbohydrate high-fat diet, like the Banting diet. You need to learn about ketones and how they support the brain.
Over time we can find more of those holes and create a positive feedback loop that will stop decline and start recovery. For instance toxins may be found that may require treatment. The addition of more fat to your diet will improve the supply of micronutrients available to your system. If you don't feed yourself properly you can't succeed.
"Reversal of Cognitive Decline"
American College of Nutrition: Published on 5 Jan 2016
Insulin Resistance, Metabolic Syndrome, and the Banting Diet
There are many benefits of lowering carbohydrates in your diet, the first is weight control, the second is reduced inflammation. For Alzheimer's disease, eating very-low-carbohydrate, Banting Diet, means that your brain is always using ketones for most of it's energy requirements. Because of insulin resistance, the glucose to ATP energy pathway is broken, so the supply of ketones is critical.
Insulin is a hormone, it is the key that opens body cells walls so glucose can enter the cell. But if there is excess insulin, it also drives inflammation in the brain. When you are in ketosis, the amount of insulin you need is tiny, and your insulin sensitivity will increase.
The difference between a ketogenic vs. a non-ketogenic diet, is that ONLY in ketosis are there enough ketones available, for your brain to switch metabolism and use ketones while conserving glucose, which should be in short supply. The main ketone is ß-hydroxybutyrate, which should be present in the blood serum at 0.5mmol/dl to 4mmol/dl. Unless you are exercising or fasting, levels between 0.5mmol/dl and 1mmol/dl are normal.
Dr Bredesen says that, "Alzheimer's is a metabolically driven disease. We do many tests - with healthy people it's likely that there will be three or four abnormal results. For people with Alzheimer's there are always more than ten obvious abnormalities, and sometimes in excess of 25. To restore brain function we should not be content with scores in the normal range (two standard deviations). We should imagine that this patient is young and strive to move test result closer to the optimal result for a young person."
"Most people believe that they eat a "healthy diet." None of the people who develop Alzheimer's do. That's easy to show. Look at their blood tests. You might think you eat well, but the blood chemistry doesn't lie. If you are insulin resistant, if you lack iodine, vitamin B12, or vitamin D, or if you have high inflammation, your diet needs attention. Besides almost nobody who first attends our clinic is in ketosis. If you are going to repair your brain being in mild ketosis is essential. A ß-hydroxybutyrate reading of 0.5mmol/dl and 1mmol/dl is fine. We must fight against insulin resistance."
"We know that these dietary requirements are essential. We've had people leave our clinic, apparently fully recovered, but if they stop following the protocol, Alzheimer's soon returns. The solution is to get back to the protocol."
"Dale Bredesen discusses the metabolic factors underlying Alzheimer's Disease"
The IHMC: Published on 1 Jun 2016
Types of Alzheimers Disease
"We've identified five types of Alzheimer's. There are three that everyone should know about."
Type One: Caused by inflammation in the body. Sugar and excess carbohydrate in the diet, dietary vegetable oils, leaky gut problems, and things like herpes, bacteria and fungi.
Type Two: Caused by a metabolic failure to supply essential support. Simple lack of energy because of insulin resistance, lack of essential amino-acids or micronutrients, or malfunction of some hormones. The brain can't get the nourishment it needs, and it starts to shut down piece by piece, to protect the whole.
Type Three: Caused by exposure to toxins. These people are unrelated to the ApoE4 genetic risk. The toxin is often a metal, but it could be mould, or some organic chemical. Identifying the toxin and removing it is valuable. We think many of these toxins have been in the body for many years stored in the bones, and safe. As muscle mass declines, the bones also lose structure and the toxin is released.