Alzheimer’s is like having ‘a leaky roof’

You have to be careful about hyperbole. This is why I was somewhat sceptical when I first came across a book called The End of Alzheimer’s, by Dr Dale Bredesen.

Despite his credentials (he is an esteemed neurologist in the US, actively involved in Alzheimer’s research for decades), the claim of finding a cure for this condition when so many others have failed seemed a little far fetched.

The title of the best-selling book at least grabbed people’s attention.

Among experts in the field, its reception has been more lukewarm, however. The main criticism of the claims was that they were based on interventions that had not been subjected to the usual research rigor and might be inaccurate or misleading.

To be fair to Dr Bredesen, his approach is by its nature difficult to study, as it is based on the hypothesis that Alzheimer’s develops for a number of different but potentially connected reasons. As he puts it, Alzheimer’s is like having a leaky roof.

There are multiple holes and there is no point just plugging one if the water continues to leak through the others.

So, you must do multiple things to address the separate issues. If you then have a positive result, which of these  things is responsible? It can be tricky.

I do think there is validity in this idea, however. Certainly, we know that there are a number of different processes associated with Alzheimer’s disease, including inflammation, disturbed metabolism (such as insulin resistance, high blood sugar and high cholesterol), problems with blood flow, and a decline in nutrient supply and hormones with age. To give yourself the best chance of avoiding the condition, you need to minimise the impact of these processes, and this is what the so-called Bredesen Protocol aims to do.

The protocol involves an assessment of your specific issues (through blood tests, predominantly) and the institution of regular exercise, a mildly ketogenic diet (with a 12-hour daily fast and no eating for three hours before bed), optimising sleep and stress, and the use of targeted supplements to improve inflammation or metabolic health, eradicate infection or address nutritional problems.

This year will see the formal release of results of the Evanthea study, which is a randomised controlled trial based on the Bredesen Protocol, but some information is already available – and it is encouraging.

The trial involved 73 adults in mid- and later-life who already had memory problems. Over a period of nine months, some of the participants received standard medical care, and the others were put through an intensive, personalised program that involved blood-sugar control, sleep quality, inflammation, exercise, nutrition, hormone balance, infections and toxin exposure.

Those who had undergone active treatment showed clear improvements in several areas of cognition (such as memory and processing speed) – not just less decline than the standard medical care group, but actual improvements. This is very unusual for Alzheimer’s trials.

Physical health also generally improved, though the brain did not show any significant structural changes.

The authors claim that the effect size of the intervention – how much the participants improved – was manifold that of the new disease-modifying drugs that became available in 2025.

There are a number of caveats with the trial results. But in an era where mainstream medical approaches to Alzheimer’s yield underwhelming results, this is an optimistic development and I am watching this space closely.

 Kailas Roberts is a psychogeriatrician and author of Mind Your Brain: The Essential Australian Guide to Dementia, available at bookstores and online. Visit yourbraininmind.com or uqp.com.au