Survivors: In Their Own Words
First-person stories of patients recovering from Alzheimer’s disease — and how they did it.
“The day has come. Alzheimer’s patients are now recovering. And this momentous shift has not been brought about by the development of a meaningful pharmaceutical intervention, but rather, by the multifaceted, personalized approach developed by Dr. Bredesen. The First Survivors of Alzheimer’s takes us beyond the scientific validation of this program and reveals the depth of the personal narrative of those brave and pioneering individuals who chose to participate in this vanguard, iconoclastic approach to their illness that challenged them and their loved ones to their very cores, and rewarded them with recovery.”
David Perlmutter, MD, FACN
A discussion with Dr. Dale Bredesen about this new book on sale now.
Dick Benson:
To start off and for this interview, can you explain from the 30,000-foot level what the Bredesen Protocol is all about?
Dr. Bredesen:
The basic point here is very straightforward. Alzheimer's has been an untreatable disease. And so, if we're going to try to treat this previously untreatable disease, why would we do it in a blind fashion by just giving a drug that has nothing to do with what's actually causing it? Our research showed that this is a multifactorial disease, that there are many potential contributors. And for each person, we want to identify the contributors and target those with a precision medicine type of approach. So, the 30,000-foot view is simply to identify what's causing it and treat those things. And I know for people who study functional medicine and integrative medicine, that's not a surprise. Root cause medicine is very understandable. However, as you know, it is not the standard of care at memory centers throughout the world.
People are coming in every day for memory issues and their evaluation does not include the various factors that are actually causing the decline; nor does the treatment address the factors that are causing the decline.
There's not, even in a best case scenario, improved cognition or even stabilized cognition from pharmaceutical treatments. What was suggested as a positive, as a benefit, was that in some cases they seem to slow the decline. In contrast, we just posted in medRxiv our recent clinical trial, in which we actually saw people improve their cognition, not simply slow the decline. So that's the fundamental difference between going downhill more slowly and going uphill. The approach, as I say, is to identify and treat.
Now, what we found is there are 4 major groups of inducers of Alzheimer's disease. Alzheimer's, at its heart, is an insufficiency. Just as a deficiency of vitamin C causes scurvy, Alzheimer’s is an insufficiency, a complex insufficiency. There is a plasticity network within your brain, and it requires certain things to function normally. This is an interesting network, and it requires certain things in your brain. And then as you get these degenerative conditions what happens is that there is a chronic mismatch and you have an insufficiency in 4 different areas, any of which can contribute to the decline.
The first is inflammation, anything that is contributing to inflammation. That could be a leaky gut, chronic sinusitis, a poor oral microbiome with poor dentition. It can be a systemic infection, often undiagnosed chronic infections. Any of these things can contribute.
The second group is anything that creates toxicity, and this can be inorganics, organics or biotoxins. So of course, there has been a lot of press on the relationship between air pollution and cognitive decline, but also heavy metals like mercury may contribute. It can also be organics, things like toluene or benzene. Or it can be biotoxins, such as trichothecenes, ochratoxin A or gliotoxin. These all essentially create drag, increased requirements on the system.
The third group is energy. If you don't have enough energy to support this neural plasticity network, it starts to involute, and that relates to cerebral blood flow, oxygenation, mitochondrial function and ketones. You've got to have something to burn for energy, of course. And so, again, if those things are suboptimal, you increase your risk for Alzheimer's disease.
The fourth group is trophic support. So, that's growth factors like nerve growth factor and brain-derived neurotrophic factor (BDNF). It's hormones, things like estradiol, testosterone, progesterone, pregnenolone, thyroid, so forth and so on. And then nutrients like vitamin D, vitamin B12, and related nutrients.
So, those are the 4 major groups that contribute to cognitive decline. And everybody who's got Alzheimer's or pre-Alzheimer's is on the wrong side of that balance.
They've either got too much toxicity or too much inflammation, often several of these things. And so, unfortunately, human physiology is complex. You've got to look at these things, identify them and then you've got to get things back on the right side of the equation. The whole point of our protocol is simply to look at these different variables. To look at all the potential contributors, identify them and then treat them. And of course, this includes things like creating metabolic flexibility and insulin sensitivity.
So, many people have Alzheimer's in association with insulin resistance. It's one of the most common contributors. There are around 80 million people in the United States with insulin resistance. And of course, there are genetic increases in risk. But 95% of people have sporadic Alzheimer's, not truly familial Alzheimer's. The most common genetic risk, the ApoE4 gene, only changes your risk, just like a change in your lipid profile for cardiovascular disease.
So, that's the 30,000-foot view of what we're trying to do with the protocol. And we've just posted the clinical trial in which we had very good results.
Dick Benson:
So, in listening to what you have to say, it's really no different than people who are facing other chronic health issues like heart disease. What your protocol comes down to is diet, lifestyle, environment and things like that.
Dr. Bredesen:
Certainly, it has to be adapted to how the brain works. People often say, what's good for the heart is good for the head. Well, yes, to a point. There are some situations in which there are some slight differences. But you're right in general. So yes, you have to look at what the things are that are actually driving this. And making some cases, there are specific pathogens found in the brains of patients with Alzheimer’s. If you look at the neuropathological studies, they have shown Porphyromonas gingivalis from the mouth, the oral microbiome; Treponema denticola, again from the oral microbiome; Herpes simplex, of course from the lip; various molds from the sinuses. For example, HHV-6A, which is thought to come in through the sinuses, although that is not known for sure, but also various fungi. All sorts of things that can be found in your brain when you have Alzheimer's disease.
If you look at the amyloid that has been vilified in this disease, the amyloid is actually part of the innate immune system. So, it's part of your response to these insults. Just as with COVID-19 you have this ongoing inflammation; the big difference, of course, is that in COVID-19 it's much more acute, and in Alzheimer's it's much more chronic. So, in COVID-19, people are dying of a cytokine storm, whereas with Alzheimer's, they're dying of cytokine drizzle. It's very slow over years and years and years. So again, you have time to figure it out. I should point out one of the most important things for people to realize is that the nomenclature has actually hurt us: when you get this disease, you go through 4 stages. The first stage is pre-symptomatic, in which you can already see changes on PET scans if you look, or in the spinal fluid, but you're still asymptomatic.
Then the second stage is SCI, subjective cognitive impairment, which could be called early Alzheimer's disease. By definition, that means that you're still scoring in the normal range on cognitive testing, but you know something's wrong. It's just that something is not quite right, not the same as before. And often your spouse and your co-workers may notice it as well.
Then the third of the 4 stages is called mild cognitive impairment. Well, it's unfortunately got this label of mild. And so, the doctors will send you home and say, "You have mild cognitive impairment, not a lot to do, come back next year." No, that is the third of 4 stages. It should be called advanced stage Alzheimer's disease. And by the way, the SCI, the second stage, on average lasts for 10 years. So, we have a tremendous window of opportunity to treat. If people would just get in early. But they often ignore it. When they finally go in — with MCI by definition — they are now scoring abnormally on cognitive tests. But they haven’t lost their activities of daily living. So, when you tell a person they have mild cognitive impairment, that’s like saying to them, you have mildly metastatic cancer. It’s a late stage of the underlying process, it’s an emergency. You should absolutely be treating it, preferably long before that. But if you haven’t treated it until then you really need to jump in with everything. And what’s happening is doctors are just sending people home and saying, “Yeah, you know there’s not a lot to do. Come back next year. We’ll see how you’re doing.”
And then of course, the fourth stage is full-on Alzheimer’s. And, by definition, then you’ve lost or begun to lose your activities of daily living. That’s really the end stage of Alzheimer’s pathophysiology.
Now it is known that this process begins about 20 years before a diagnosis. And so, what we used to think of as a disease of your 60's, 70's and 80's, is really a disease of your 40's, 50's, 60's and sometimes even your 30's. And so, you can look at these things early and the reality is that virtually nobody should get this disease. This is something that you can pick up early. People should be on prevention. We recommended everyone who's 45 years of age or older, get a cognoscopy. Which is simple, 3 things: it's getting some basic blood tests, looking at the very things that you and I just talked about. Second, a simple online cognitive screen. And then third, if you have symptoms already — thus, it's not purely for prevention — you should get an MRI with volumetrics.
The reality is that Alzheimer’s should be a rare condition! It's a problem because people don't address it early enough. We could all make a huge difference. Alzheimer's is now optional. If you want to make sure you don't get it, simply get on prevention. When you're 45, get a cognoscopy, get on prevention. Or if you develop the earliest symptoms, please don't wait. People will often say, "Oh, I'm not that bad yet." Well, that's the problem. People wait too long, often because they think there's nothing that can be done. So, you're right, there are things that are important in many complex chronic illnesses, from heart disease to cancer, to chronic renal failure and chronic liver disease. These all boil down to looking at the right things, knowing what to look for, and with these chronic illnesses, you have a relatively large window of opportunity.
In Robert Lustig's book, Metabolical, he talks about some of these issues, and how it's amazing that doctors are often looking at the wrong things, then writing prescriptions, when in fact they need to be understanding what is actually driving the problem. Which is exactly what we're doing with the brain and cognitive decline: looking at what is actually driving the process.
Dick Benson:
And do you think from the practitioner's standpoint that they struggle in how to treat patients with memory decline?
Dr. Bredesen:
Yes. The entire medical system is set up for 20th century diseases. It's not set up for 21st century diseases, which are non-communicable chronic illnesses, typically complex chronic illnesses. And so, number 1, we're not trained for this situation in medical school. We’re trained to ask what is it, what's the diagnosis, and then write a prescription. We need to change the what to the why. In other words, everything now should be "Why?" But again, the entire system is set up against this. Number 2, there's every reason to write a prescription — there's support from the drug companies. The drug companies are the ones doing the trials. When a recent drug, Aduhelm™ was approved for Alzheimer's, the Alzheimer's Association was given $1.4 million by the company that made the drug, and said it was a good drug — the opposite of what the expert panel from the FDA said.
So, everything is stacked against what should be done. We should be asking "Why?" Another thing, doctors don't have enough time. They're told they have a certain number of minutes to see a patient. You don't have time to get into all the nuances of what actually happened. And then, we're taught to prescribe a drug and everything you read is about this next drug. Everyone knows about the new drug for Alzheimer's. Nobody knows about all the cases of people actually getting better, because everything is pushing toward the next drug, the next drug prescription or something that's going to be a way to make money.
The entire system is backward. When it comes to cognition, we need to look upstream. We need to spend more time. We need to understand what's at the root here. You know, it's going to take you more time and effort to get to an answer now that there's a whole team that can be involved. So, the entire medical system needs to be set up in a different way to get optimal outcomes in these chronic complex illnesses.
Dick Benson:
It's easy for you to talk to people who practice Functional Medicine, but how do you go to a clinic of conventional practitioners and how do you explain this problem or issue to them?
Dr. Bredesen:
That's exactly the problem. They have anointed themselves the experts and they're not interested in hearing anything that is progressive. The current medical system is set up for old-fashioned diseases and thus is out of date. And if you look at the history of medicine, as you know it's about tradition and permission. You look at the history of medicine and everything from when Paracelsus was saying, "Hey, diseases can come from toxins." And he was ridiculed. When you had Lind saying, "Hey, scurvy, you need to use citrus." And was ridiculed for that.
So, there's been one after another, after another. Medicine has a horrible history of not advancing when there are new things needed. And so, my hope has always been to see more Silicon Valley in medicine —Silicon Valley is about disruption. And so, I was hoping at some point, Silicon Valley would jump in and say, "Hey, how can we reconfigure medicine?" But of note, what Silicon Valley has done so far is just hire people who are part of the medical establishment. So, that doesn't make the problem better. And so, yes, you're right. This is, unfortunately, the bloodiest revolution in history. We're now up to about 18% of our GDP going toward healthcare, and we are a very sick country because of this failure to make changes.
Dick Benson:
In your new book, do you go into other things besides just talking about those survivors?
Dr. Bredesen:
Half of the book, the first 7 chapters, are from the survivors themselves. I wanted to have a voice from the survivors because it's been so compelling for me to see and hear these wonderful stories they have told me over the years, "Here's what happened. Here's what's going on with my family." And I found these stories so heartwarming. And to hear in one of the stories, from Julie, about her son crying when she first got the diagnosis, she told him about it and he said, "Mom, I don't want you to die," then having her getting back on track, and his getting married with her at the wedding, as brilliant as ever — these are beautiful stories from the survivors. So, that's half of the book, and the other half addresses related issues.
There is a chapter on the parallels between COVID-19 and Alzheimer's. There's a chapter on how to enhance normal cognition. As you know, so many of us feel like, well yeah, I have normal cognition, I don't have Alzheimer's. True, but you still may have sub-optimal cognition and you could be doing much better if you would follow some of these same principles. So, there's a chapter on that, and there's a chapter on the future of medicine and then a chapter on wearables. Wearables have, as you know, been such an increasingly large part of what we're all able to do to optimize health. So that we really do have the ability to see these chronic illnesses coming long before they ever hit us, which is a huge issue. And how do we address that? So, the book is broken down essentially into those 2 halves.
Dick Benson:
And from the standpoint of the book, is it focused more toward consumers or patients who are going to be facing Alzheimer's or for practitioners or both?
Dr. Bredesen:
The stories are for everyone. I just thought they're such touching stories, and then the other part of the book is for practitioners, but it's written in such a way that everyone can understand it. We find that more and more things that have been identified are critical, from the oral microbiome and nocturnal hypoxemia and various dental abscesses that may not have been diagnosed, to various pathogens, such as HHV-6A, that hadn't been recognized before. So yes, we're understanding better and better what is required to get best outcomes.
Dick Benson:
This is probably the last thing that baby boomers are going to have a big impact on since many of them now are getting to the age where they're going to be facing Alzheimer's. Do you think that they may react differently and take things more into their own hands and control it a little better?
Dr. Bredesen:
Yes, and I think that the baby boomers are now in that period in which they are the ones getting Alzheimer's, unfortunately. But to me, the challenge, and I think now it's absolutely possible, that this will be the last generation in which Alzheimer's is really a worry. So that future generations, for example our daughters, getting on appropriate prevention when they're relatively young, they're already making sure that they don't have insulin resistance. They're already making sure that they have metabolic flexibility. They're already making sure that they don't have a leaky gut, that they don't have gluten issues, dairy issues, things like that. So, things that in my generation, and I'm just ready to turn 70 next year, my generation, this was not something that people did. And even for my medical colleagues, this was not something that was typically done. So, I think that things are changing dramatically. And so, my hope is that in future generations, absolutely, this should be a rare problem.
Dick Benson:
Thank you very much for your time. For additional information about this new book visit:
https://www.apollohealthco.com/book/first-survivors-of-alzheimers/
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