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Are there Bredesen / ReCode skeptics?

Posted: Wed Sep 12, 2018 10:42 am
by Grandkid
Hi! new user that read the primer!

I've had 3 grandparents pass away with dementia and one confirmed with AD. My parents are understandably exhausted after over a decade as caregivers and want distance from anything to do with AD. I'm trying to learn what I can to help them prevent or delay AD, because with them in their mid 50's, they still have time to make meaningful changes. I have a strong lay person's understanding of the science behind AD and am currently reading "The End of Alzheimer's". There are a lot of posts on ReCode and the Bredesen protocol on here with mostly positive sentiments. Upon picking up the book, I started with a "this has to be too good to be true", but the protocol isn't an easy "one size fits all" magic bullet and makes general sense to me. Bredesen admits his theory of AD is outside the mainstream, so I'm wondering if there's a good article / commentary challenging the protocol and his research. I'm not an expert and am hoping to remove my rose-colored, hope-filled glasses by overlaying a few expert perspectives.

Thanks in advance, hopefully I'm not duplicating a previous post.

PS- My testing kit is in the mail... I've intended to get tested for a while and pulled the trigger today.

Re: Are there Bredesen / ReCode skeptics?

Posted: Wed Sep 12, 2018 12:49 pm
by Fiver
Hi Grandkid,

Oh, yeah. There are skeptics. Just watch the video clip of Dr. Bredesen visiting Dr. Oz on his show. Or talk with just about every family doctor or cardiologist my mom ever saw. And, in my mom's case, they might have been right - it was almost certainly too late and she wasn't willing to adopt big changes. Heck, I still have ups and downs and doubts about whether the program, which might help some others, will help me. And I think it is good to be long as we are open to new ideas and new data. Also, there is what Dr. Bredesen says about it: "It's not alternative medicine, it's NO alternative medicine".

Having said that, there certainly is good evidence that:

(1) some cases of dementia are triggered by toxins, infections, stress, diabetes, etc. And it is just logical that fixing the underlying problem would help.

(2) healthy lifestyles can help prevent dementia, or slow it down, or delay it's development. And many of these interventions fall under the category of "just being generally healthy" - they help prevent diabetes, CVD, cancer, depression, etc.

Here is one example I sometimes re-read when I have doubts. It is one of those large clinical trials looking at different types of lifestyle changes, including dietary changes. And it sure seems to have helped this population of E4s, which is very encouraging. See bolded part at the bottom.

Effect of the Apolipoprotein E Genotype on Cognitive Change During a Multidomain Lifestyle Intervention: A Subgroup Analysis of a Randomized Clinical Trial

Alina Solomon, Heidi Turunen, Tiia Ngandu, Markku Peltonen, Esko Levälahti, Seppo Helisalmi, Riitta Antikainen, Lars Bäckman, Tuomo Hänninen, Antti Jula and 10 others



IMPORTANCE: The role of the apolipoprotein E (APOE) ε4 allele as an effect modifier in lifestyle interventions to prevent cognitive impairment is still unclear. OBJECTIVE: To examine whether the APOE ε4 allele modifies the previously reported significant cognitive benefits of a multidomain lifestyle intervention (prespecified subgroup analysis). DESIGN, SETTING, AND PARTICIPANTS: The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was a randomized clinical trial in 6 centers across Finland (screening and randomization performed from September 7, 2009, through November 24, 2011; intervention duration, 2 years). Data analysis was performed from August 1, 2015, to March 31, 2016. The study population was at-risk older individuals from the general population. Inclusion criteria were age of 60 to 77 years; Cardiovascular Risk Factors, Aging, and Dementia risk score of at least 6 points; and cognition at a mean level or slightly lower than expected for age. Individuals with dementia or substantial cognitive impairment and conditions that prevented cooperation or safe engagement in the intervention were excluded. APOE genotype data were available for 1175 of the 1260 participants. INTERVENTIONS: Participants were randomly assigned in a 1:1 ratio to a multidomain intervention group (diet, exercise, cognitive training, and vascular risk management) or a control group (general health advice). Group allocation was not actively disclosed to participants, and outcome assessors were masked to group allocation. MAIN OUTCOMES AND MEASURES: Primary outcome was change in cognition measured through a comprehensive neuropsychological test battery. Analysis was based on modified intention to treat (participants with at least 1 postbaseline assessment). RESULTS: A total of 1109 participants (mean [SD] age, 69.3 [4.7] years; 514 [46.3%] female) were included in the analysis: 362 APOE ε4 allele carriers (173 intervention and 189 control) and 747 noncarriers (380 intervention and 367 control). The APOE ε4 carriers and noncarriers were not significantly different at baseline (except for serum cholesterol level). The difference between the intervention and control groups in annual neuropsychological test battery total score change was 0.037 (95% CI, 0.001 to 0.073) among carriers and 0.014 (95% CI, −0.011 to 0.039) among noncarriers. Intervention effect was not significantly different between carriers and noncarriers (0.023; 95% CI, −0.021 to 0.067). CONCLUSIONS AND RELEVANCE: Healthy lifestyle changes may be beneficial for cognition in older at-risk individuals even in the presence of APOE-related genetic susceptibility to dementia. Whether such benefits are more pronounced in APOE ε4 carriers compared with noncarriers should be further investigated. The findings also emphasize the importance of early prevention strategies that target multiple modifiable risk factors simultaneously. TRIAL

Re: Are there Bredesen / ReCode skeptics?

Posted: Wed Sep 12, 2018 1:34 pm
by Grandkid
Thanks Fiver - I just watched the Dr. Oz appearance, which gives me an idea of how the broader community might approach Bredesen's research. The "no alternative medicine" quote combined with the study provides a very good perspective though. The Bredesen protocol does align with the risk factors and prevention techniques of a lot of other research out there. It seems like consequence of what you're saying is that the worst case scenario is that following the protocol is likely going to help; the magnitude of the benefit is up for debate, but there's little to no harm in trying. Does that seem fair?

Re: Are there Bredesen / ReCode skeptics?

Posted: Wed Sep 12, 2018 2:01 pm
by Fiver
I look at Dr. Bredesen's RECODE protocol as one among several similar plans. There's a good amount of overlap for most protocols. Each person would tailor a protocol to their situation. And it's likely to be a process of phasing in lifestyle changes and seeing how you feel, and what the lab numbers tell you.

And you've identified the main challenge. Population studies can tell us how groups of people respond but not how any one person will respond. And while there are some useful markers to assess your personal progress in terms of general health, there aren't many to tell you directly that a protocol is working against AD.

So, yes, I think there is an element of playing the odds. Most of the suggestions would likely improve overall health - lowering other health risks. So, it's just a personal decision.

I recommit every time I visit my mom.

Re: Are there Bredesen / ReCode skeptics?

Posted: Wed Sep 12, 2018 5:11 pm
by CarrieS
Welcome Grandkid! Your love of family is so evident in your post. My grandmother passed from late onset AD and my mother passed from earlier onset AD (probably due to herpes simplex) so I do understand being exhausted from the impact of the disease on our lives. If I knew then what I know now, you bet I'd be learning as much as possible to help my mother and taking steps to improve her life as much as I could. I appreciate how you are reaching out and looking to learn all about AD, current research and possible prevention. I believe that you will find this site to be a wealth of information and support.

Here are a few tips on getting the most out of this community. How To Get The Most Out Of The website is chock full of tips to help you navigate, search and post. If you haven't found it yet, the Primer is a wealth of information as well.

Re: Are there Bredesen / ReCode skeptics?

Posted: Thu Sep 13, 2018 8:14 pm
by Kenny4/4
I follow his guidelines.
I am skeptical as I am of all things, the alternative is a doctor that says " We have nothing. I'm sorry."
Bredesen has been a researcher so whatever he is recommending is at the very least a very well educated guess.
Can he permenently reverse full blown Alzheimer's? I don't think so.
Can he delay Alzheimer's? My guess is Yes.
Can he prevent Alzheimer's in some before they die from another disease? I hope.

Re: Are there Bredesen / ReCode skeptics?

Posted: Fri Sep 14, 2018 3:12 pm
by mike
My hope is to slow things down enough that I'll still be me by the time the cure comes. I've been hearing a lot about the ability to repair genes with CRISPR, and Apoe4 seems like it would be a good choice to work on - really just one point to repair to get to Apoe3. ... ngle-gene/

Re: Are there Bredesen / ReCode skeptics?

Posted: Fri Sep 14, 2018 4:57 pm
by BeKindToYourMind
I'm so glad someone else asked this question! I am always skeptical of programs that are based on research done on very small sample sizes. When I first started reading Bredesen's stuff a couple years ago, he had only published a couple papers on the same 10-20 participants. I thought that he jumped the gun on writing a book about his findings when his research was in such early stages with so few participants.

Having said that, I look forward to learning the results of larger clinical trials. Further, as Fiver said above, the ReCode paradigm seems to be looking at many known biomarkers for disease risk and treating them appropriately on an individualized basis. This seems like a reasonable approach to reducing stress on the body and potentially improving a person's chances of improvement. I do want to see a larger study confirming this outcome. I think it is more likely that people in the early stages of cognitive decline, such as subjective cognitive impairment and maybe mild cognitive impairment, would experience noticeable benefits from ReCode than those with advanced cognitive impairment and full-blown Alzheimer's disease. I think that's what Bredesen's preliminary studies showed. (But we can't be to confident in those results with such a small sample size.)