Saturday, November 2, 2019

Retrospective #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 paper in Aging began. It came to my attention from a link to that a good friend sent me. Hmmm. I wonder why? (LOL) Maybe it was because of this sentence in the abstract, “The results also suggest that cognitive decline may be driven in large part by metabolic processes.” That does interest me.
The successful trial from UCLA and the Buck Institute used a systems approach to memory disorders. 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 is what’s remarkable here. That is indeed rare among MCI patients.
“Since its first description over 100 years ago, Alzheimer’s disease [AD] has been without effective treatment,” the article begins. 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, “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, the authors say.
The 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,” the lead author analogized. So, he used a “novel, comprehensive, and personalized therapeutic program…designed to achieve metabolic enhancement.”
The “metabolic enhancement” part is what interested me. The therapeutic protocol included up to 36 suggestions for the patient to accept (or not). Patient participation in this 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 are quite another thing altogether.
Then there’s the issue of one-treatment-fits-all. The protocol required individualized testing and diagnosis, and the whole treatment protocol was one that anyone could do all or part of. Not every patient was 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. She agreed to follow 25 of the 36 “Goals,” “Approaches,” and “Rationales and References.”
Most of the goals and approaches the doctor recommended are ones that I too have either recommended or aspire to follow myself. Patient One’s included eliminating simple carbohydrates, gluten and processed foods. She also increased vegetables, fruits and non-farmed fish. She fasted a minimum of 12 hours between dinner and breakfast and for a minimum of 3 hours before 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 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 and cycling twice a week.
All 10 patients “presented” with slowly progressive memory loss over various durations, and nine of the ten 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. 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.”
Now, if I could just remember who was that good friend who suggested I read this research, and why…

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