Wednesday, November 5, 2014

The Nutrition Debate #259: Cognitive Decline: Driven by Metabolic Processes?

“Cognitive decline is a major concern of the aging population, and Alzheimer’s disease is the major cause of age-related cognitive decline,” the research paper in Aging began. It came to my attention through an article at that a good friend sent me. Hmmm. Perhaps it was because of a sentence in the abstract, “The results also suggest that, at least early in the course, cognitive decline may be driven in large part by metabolic processes.” That does interest me.

What interested the journal Neuroscience was that this small, anecdotal and successful trial from UCLA and the Buck Institute used a systems approach to memory disorders. The story: “Memory Loss Associated with Alzheimer’s Reversed for First Time.” Nine of the ten participants in the study “displayed subjective or objective improvement in their memories beginning within 3-to-6 months after the program’s start. Significantly, the abstract states, “Improvements have been sustained, and at this time the longest patient follow-up is two and one-half years from initial treatment, with sustained and marked improvement.” This sustained improvement cannot be overemphasized.

“Since its first description over 100 years ago, Alzheimer’s disease [AD] has been without effective treatment,” the article states. Putting it in ‘medicalese,’ the paper states, “Neurodegenerative disease therapeutics has been, arguably, the field of greatest failure of biomedical therapeutics development.” Dale E. Bredesen, the author of the study, suggests that that is because Alzheimer’s is a complex disease, and a single, target-based pharmacotherapy approach is inadequate. Whereas, Bredesen argued, “Therapeutic success for other chronic illnesses such as cardiovascular disease, cancer and HIV has been improved by the use of combination therapies.” A new approach to treating early AD, therefore, is needed, he says.

Bredesen’s approach is based on the understanding that Alzheimer’s is initiated by an imbalance in nerve cell signaling, a biologic function that could be ameliorated by a systems type approach. “Imagine having a roof with 36 holes in it, and your drug patched one hole very well – the drug may have worked, a single ‘hole’ may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much,” Bredesen analogized. So, he employed a “novel, comprehensive, and personalized therapeutic program…designed to achieve metabolic enhancement…”

The “metabolic enhancement” part, as I said, is what interested me in particular. Bredesen’s therapeutic protocol included, apparently, up to 36 suggestions for the patient to accept (or not). This is where the rubber hits the road since patient participation in this therapeutic program is required. That’s not surprising. Prescribing a pill is one thing. Getting the patient to take it is another, and major lifestyle changes quite another altogether.

Then there’s the issue of one-treatment-fits-all. If it didn’t require individualized testing and diagnosis, and the whole treatment protocol was one that anyone could do (all or part of) without even seeing a doctor, why would one bother to go to the trouble (and expense) of seeing one? Okay, call me cynical. One thing is clear, though: not every patient was either 1) “prescribed” all “36” treatment protocols or 2) agreed to do all that he or she was found to be needing. Patient one, for example, “following an extended discussion of the components of the therapeutic program… began on some but not all the system. Table 1, which patient one followed, included 25 such “Goals,” “Approaches,” and “Rationales and References.”

And what was most interesting to me was that many if not most of the goals and approaches the doctor recommended are ones that I too have either recommended or aspire to myself. Patient one’s included eliminating simple carbohydrates, gluten and processed foods from her diet. She also increased vegetables, fruits and non-farmed fish, and to reduce stress she began yoga and meditation. She fasted a minimum of 12 hours between dinner and breakfast and for a minimum of 3 hours between dinner and bedtime, and increased her sleep to 7-8 hours per night. In addition, she took melatonin, Vitamins B12 and D3, fish oil and CoQ10. She exercised for a minimum of 30 minutes, 4-6 days per week.

Patient two agreed to 12 of the protocols, again including elimination of simple carbohydrates and processed foods from his diet, increasing consumption of vegetable and fruits and limiting consumption of fish to non-farmed and meat to grass-fed beef or organic chicken. He also followed the fasting guidelines with the goal to “increase autophagy and ketogenesis.” And he took a slew of vitamins, minerals and herbals, and exercised strenuously, swimming 3-4 times a week, cycling twice a week, and running once a week.

Altogether, all 10 patients “presented” with slowly progressive memory loss over various durations, and nine of the ten, who adhered to their therapeutic programs, saw sustained “improvement in their memories beginning within 3-to-6 months after the program’s start.”

One commenter summed it up best for me: “When people are used to relying on pills, they often rebel against taking control of their own health. They want simple solutions. Of course the benefits outweigh the hassle of embracing a multi-faceted health regime. But it amazes me (as a practitioner) how difficult it can be for people to understand this. Older people in particular are very attached to dietary habits. It’s a difficult adjustment.” But the benefits outweigh the hassle…

Now, if I could just remember who was that good friend who suggested I read this research, and why…

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