Dementia is the worse aging disease you can get because there is no cure. Until recently. Dr. Dale Bredesen has used a network approach to studying dementia and has found a network solution that works to prevent and even reverse cognitive decline–including Alzheimer’s! While his techniques are not yet proven in clinical trials his protocol has helped hundreds (perhaps thousands) of patients so far. I first found his protocol online in late 2017 and was quite intrigued because it sounded so promising. Unfortunately, the online information was skimpy so I did not follow up.
Matt has been a great friend for many decades. I taught him the basics of flying, he helped me build several houses and we have continued to have a close relationship even though we seldom manage to visit very often these days. He now lives on a remote Alaskan island and travel there is by ferry, plane or boat. To get there from my home it is often a day plane trip, two if you go by car/ferry and even longer if you go by car/boat.
We stay in touch by phone. Matt has known of my intense interest in aging for a long time. Last winter he told me about the book he had just read by Dr. Dale Bredesen about stopping and even reversing Alzheimer’s and other dementias. When he mentioned Dr. Bredesen wrote it I eagerly sought it out and bought it.
The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline was even better than I had hoped, for several reasons. First is the terrific information it contained. As I read the book, I took 4 pages of notes in tiny handwriting. The book is also easy to read, a reasonable length and covers not only the whys of cognitive decline but very specific things you can do to prevent it—many of which are simple like increasing vitamin B12 consumption. Next it was only the second time I had seen an application of network theory to aging; Dr. Bredesen suggests that Alzheimer’s and other dementias are not a single disease but rather a network of things going wrong, and the failure of the network to stay within optimum parameters is the cause of the disease.
This book is not about scientific research (though there is plenty referenced in it), but a “…step-by-step manual for preventing and reversing the cognitive decline of early Alzheimer’s disease…”. Dr Bredesen’s ideas about Alzheimer’s include the thesis that it is not one disease but the end result of one of 3 different causes of Alzheimer’s:
- Inflammation (from infection or diet).
- Shortage of nutrients or hormones.
- Toxin buildup.
Any one of these three primary causes can result in Alzheimer’s disease. In his book, Dr. Bredesen addresses how to approach each type of Alzheimer’s. If you need to address cognitive decline (or, better yet, take some preventative steps) you should find a doctor who is open to new ideas and have him study the book. These ideas are not just off the cuff; Dale Bredesen is the founding president of the Buck Institute (a prestigious aging research institute) and professor at UCLA. I had read about his research years before this book was published. His book includes a list of key articles so you (or your doctor) can look them up. I don’t mean to sound like an ad (nor am I being pair or even in contact with Dr. Bredesen), but I think this book could help a lot of people.
A lot of determining what is going wrong when you get dementia is based on testing. Many of the tests are simple tests that any good clinic can order for a reasonable price. Fixing what is going wrong with you can be as simple as modifying your diet or taking a few vitamin pills to raise your nutrient levels. Some things are more complicated and the test can be very expensive–but you can get a majority of the tests for a few hundred dollars. Nor do you have to take all the tests at the same time; if you are low in vitamin B12 this month you are likely to be low next month or even next year if you don’t take steps to correct it. These issues seldom repair themselves, which is why a chronic condition leads to dementia. Our brains have a lot of ability to adopt but as you get older, eat less and absorb fewer nutrients this ability is strained and will lead to dementia if the lack of nutrients (or toxins or inflammation) are not addressed.
In this blog I have distilled some of Dr. Bredesen’s data down to a few of the easy targets you should achieve to assure your brain remains healthy into very late life. I do not address many of the underlying causes; you can read the book for those. I have focused on the easy tests and procedures so it is possible to start looking into this aspect of your health with a few simple tests. Dr. Bredesen has identified 37 factors, or network nodes, to preventing dementia. I am 60 and am concerned about my mental health, for my father was showing signs of the dementia when he was 75, and he eventually succumbed to the disease. By starting early, I hope to delay dementia for many years, if not decades.
Bad numbers–and what I plan to do about them
In April 2019 I began doing the testing Dr. Bredesen’s protocol called for. I was in Sri Lanka at the time, where testing can be very cheap. None of the tests I did were more than $45 (some, like cholesterol, were less than $3), and my total bill for the tests available (about 30) was less than $400. Naturally these will be more expensive in the US, but still less than $2,000 for the ones I took. A small price to pay for good mental health!
My goal is to assure I remain mentally healthy and starting early is key. Some neuron loss can not be reversed! I was hoping I would be within the limits he suggests, and was dismayed to discover a number of areas where I was within normal limits but outside of his. I could not test all the things he suggested; many of his specialized tests are not available there in Sri Lanka. This fall, after I return from my cruise around the world, I will do additional testing and retest some of the things I was not within Dr. Bredesen’s guidelines.
Vitamin D is a good example. Normal limits for vitamin D are 30-100 ng/mL; Dr. Bredesen recommends 50 to 80. Vitamin D is almost the only ‘medicine’ I am currently take (I also take a statin). In spite of this I was outside of Dr. Bredesen’s vitamin D guidelines at 36 ng/mL. So, I increased my dosing from 2,000 to 3,000 IU. Dr. Bredesen provides an interesting little calculator for calculating how much you should take and this is about half of what his calculator recommended, but summer dosing is different (especially in Alaska). Also, I was going to be on a cruise around the world and expected to get a lot of sun. I increased my dose in spite of expecting a lot of sun because I wanted to assure getting into the higher end of Dr. Bredesen’s range before the long, dark Alaskan winter (where I live the sun is only up a few hours in December). In the fall I will test again to see where I am and then base my dosage next summer on that–especially since I am getting a lot of sun, which causes your skin to produced vitamin D for you. Testing again in November and February should yield dosing for the dark Alaska winters.
Free T3, a thyroid hormone, is another example where my numbers were low. The recommended T3 is 2 to 4.4 pg/mL. At 3 it seems like I should be fine, but Dr. Bredesen recommends 3.2 to 4.2, so I am not optimum. Iodine supplementation can sometimes cure this issue, but I am close to being normal so I will recheck this in the fall to see how I am doing and then develop a treatment based on that. Especially since another thyroid hormone, free T4, at 1.3 is (barely) within his limits of 1.3 to 1.8 and well within ‘normal’ limits of 0.9 to 1.7.
My last thyroid hormone Dr. Bredesen discusses is TSH. He recommends less than 2 microU/mL, and mine is 1.86. So mine is well within the normal recommended levels of 0.3 to 4.2 and also fits his recommendations as well.
At 5.49 ng/mL my testosterone is right in the middle of normal recommended values of 2.5 to 8.4 ng/mL. But Dr. Bredesen’s recommendation is 6.5 to 15, so mine is very low (note: Dr. Bredesen also recommends these levels for women). Testosterone can be fixed by increasing exercise. Since I do not like taking drugs, I have been attempting to fix this with exercise, increasing my daily average exercise I get from 200 calories burned per day to 500. In the fall I will re-test and see if I had succeeded, or if I need to take supplements. There is also a chance that Sri Lanka measurements are done differently, giving different values, than in the US. Before I look for a cure beyond exercise, I will have it re-tested.
At 473 pg/mL, my vitamin B12 level is fine as far as normal limits go (197-771 pg/mL) but low for what Dr. Bredesen recommends: a minimum of 500 pg/mL. Vitamin B12 comes only from meat products (or manufactured). If you are not a vegetarian it is fairly easy to get more by eating clams, fish, crab, beef, fortified cereal, fortified tofu, dairy, cheese, eggs and, best of all, liver. I ate a small amount of liver a week or so ago and my nutrition log showed the liver provided enough B12 for a week (I log all my food I eat and calculate my nutrition levels). This is because animals store vitamin B12 in the liver. I plan to eat liver once a month to see if I can raise my vitamin B12 to at least 600 pg/mL. B12 is a vitamin that has a long half-life in the body (meaning the body uses it very slowly, so the amount you have in your body turns over slowly). If you ate a lot of vitamin B12 one month you would be fine for several months with very little.
Folate is another B vitamin (B9) that Dr. Bredesen considers necessary for optimum brain health. He recommends you keep your blood levels of folate between 10 and 25 ng/mL. At 13.8 mine is fine, though probably it would be wise for me to eat a few more green vegetables. Again liver is a good source, so eating more liver will also help my folate levels.
My fasting glucose levels came back fine. Dr. Bredesen recommends 70-90 ng/mL (normal is 65-110) and mine is 83 ng/mL. My insulin levels, however, are quite a bit too high according to him. He says they should be less than 4.5 microU/mL and mine are 15, which is in the middle of what is considered normal (2.6 to 24.9). For people with high insulin he recommends the ketoflex diet, so called because it results in your body burning fat rather than carbohydrates for energy, and when you do that you produce ketones. One way to get yourself on a ketoflex diet is to skip eating for more than 12 hours, at which point your body has pretty much burned all the carbohydrates you have available and so you start burning stored fats for energy. Since I fast on a regular basis I think perhaps I should increase my fasting from 1 day a week to perhaps 2 and then test myself again. I should also probably cut out some of the carbohydrates I eat–a lot of my energy comes from bread and potatoes which are not good for lowering insulin!
My total cholesterol is 148, which is pretty good by normal standards. Not so for Dr. Bredesen’s protocol, though only a little low since he recommends 150 as a low. Interestingly, low cholesterol is correlated with cognitive decline. He says that when total cholesterol is less than 150 it is correlated with brain shrinkage! He suggests this might be because cholesterol is so important for cell membrane structure. However, he does have other cholesterol targets you should achieve, primarily related to LDL. My HDL cholesterol is low at 47; normal recommendations are more than 60 and Dr. Bredesen recommends more than 50. So I am not too worried about my total cholesterol, but plan to study cholesterol a bit better to see if there is some happy medium; I think cholesterol is a lot more complicated that people think, for there are good indications that keeping LDL really low will extend lifespan. Related are triglycerides (another fat), which is recommended to be less than 150. Mine, at 125, are fine.
While my albumin level, at 4.37, was a bit less than Dr. Bredesen’s recommended level of 4.5, my albumin/globulin ratio of 2.12 was more than his minimum of 1.8 so I am not worried. Unfortunately correcting these is not covered in the book so I will have to do a little research.
My glycosolated haemoglobin was fine at 4.7%, less than Dr. Bredesen’s recommended 5.6% maximum.
Morning cortisol should be between 10 and 18 mcg/dL in the morning. Unfortunately the Sri Lanka lab results had two issues. First, I measure in the early afternoon, when cortisol has usually declined significantly. Secondly, they measured in nanomoles per liter and I have not converted between the two. Thus, my number is meaningless except for general health; I just know it is within the right range for Sri Lanka (mine was 163 nmol/l and their recommended afternoon reading is 74-291). I will re-test this in the fall—and this time in the morning.
DHEA sulfate was also measure differently in Sri Lanka, in ug/mL rather than the mcg/dL Dr. Bredesen uses. When I converted, I came out with a crazy number (9,400 mcg/dL), so I suspect there is some error going on like different measurement protocols. For now, I am satisfied with my number of 0.94 ug/mL, but just because it is in the recommended Sri Lankan range of 0.06 to 4.58 ug/mL doesn’t mean it fits Dr. Bredesen’s protocol. So, this is another on my growing list of things to re-check. Dr. Bredesen wants to see levels of 400-500 mcg/dL in men (for women her recommends 350-430 mcg/dL).
Estradiol level should be between 50 & 250 pg/ml, progesterone between 1 and 20 ng/ml with a ratio of 10:100…and Dr. Bredesen says “optimize to symptoms”. My estradiol level could not be checked and the recommended progesterone values in Sri Lanka (0.05 to 0.15 ng/ml) are so different that (again) I think their measurement protocols are different. Another thing to test this fall!
C-reactive protein, which is a measure of inflammation, should be less than 0.9 mg/L in the high-sensitivity test. Unfortunately, the test in Sri Lanka was not the high sensitivity one, so my value of 2.1 is not useful for me, other than it is less than their recommended 8 maximum value that they recommend!
Another measure of inflammation is the ratio of omega-6 to omega-3 in your red blood cells. He says it should be less than 3 but more than 0.5. Unfortunately, this was not a test the hospital in Sri Lanka had so I don’t know what my value is.
Vitamin E is something I could not have checked in Sri Lanka either. I used to have a lot of trouble keeping my vitamin E consumption levels above the RDA, but since I started eating a margarine that is rich in it and having more sunflower seeds, I have managed to keep my consumption above the RDA. This fall I will have it tested to make sure my consumption is keeping it within Dr. Bredesen’s recommended 12-20 mcg/ml.
There are a few things you can do without testing. Having a reasonable weight has a large impact on cognitive health. Dr. Bredesen says your waist should be less than 35 inches if you are a woman and less than 40 inches if you are a man. Your BMI is also easy to calculate and there are many calculators for it online (google BMI calculator); all you need is your weight and your height. Low visceral fat status is what you are trying to achieve, so what you want is a Tanita score of 1-12; if you are over this you are carrying too much fat. This can be measured with a body composition analyzer.
Comments, conclusions and additional tests:
Just a quick comment on normal vs abnormal values. Since I did my blood tests in Sri Lanka their normal values may not match ours, whether from different test procedures (for example sedimentation vs color reaction), different kinds of values (micromolar vs mg/mL) or other factors could affect my Sri Lanka tests. The values that were within their normal range and their normal range encompassed Dr. Bredesen’s advice I assume matched US protocols. Where their normal are widely different I assume that there is an underlying reason for the difference and my numbers, normal by Sri Lankan values, just can’t be compared to his values. These tests will need to be re-done at some point to verify I am within his recommended values. But as a first pass at doing these measurements, I can see it is urgent I finish the testing in the US to assure my brain has the right mix of nutrients, no inflammation and no toxins.
There were a number of values which I could not get measured in Sri Lanka. Here is a table of the remaining ones I did not review above:
|Vitamin E||12||20||mcg/mL alpha-tocopherol|
|Copper||30||mcg/dL free copper (not bound in ceruloplasmin)|
|Red blood cell magnesium||5.2||6.5||mg/dL|
|Thiamine (B1)||20||30||nmol/l serum thiamine|
|Apnea-hypopnea index||5||events per hour (prefer 0)|
There are also a number of things he talked about that are too complex to go into here:
- Leaky gut
- Blood-brain barrier permeability
- Gluten sensitivity
- Genetics: ApoE4 status
Your doctors can investigate these if they feel it is needed. The End of Alzheimer’s has a discussion of each of these if you want more information.
Not an ad!
While this blog may seem like an advertisement for The End of Alzheimer’s it is not. I just think this is such a good book that anyone interested in maintaining their mental health into old age should read it. After all, mental health is the most important part of successful aging.
The notes I took when I read this book.