Difference between revisions of "Bredesen Protocol"

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[http://www.buckinstitute.org/bredesenLab Dr. Dale Bredesen] of the Buck Institute for Research on Aging is a scientist who has been studying Alzheimer's disease for 30 years and has come up with a way to reverse it in it's early stages. His initial [http://www.impactaging.com/papers/v6/n9/full/100690.html protocol] involved 25 different interventions which individually don't make a big difference, but together are quite powerful. Each intervention is tweaked over time by using blood tests, etc. to measure their effect. In his initial paper, nine out of ten patients reversed their memory problems. The one who didn't show improvement was past the early stages of Alzheimer's.
==Introduction==
[https://www.drbredesen.com/thebredesenprotocol/ Dr. Dale Bredesen] has created the ReCODE protocol that involves multiple strategies to address specific health issues that contribute to Alzheimer's Disease (AD). The results of each strategy are measured by using blood tests, cognitive evaluations, and other markers of overall health improvements. Actions are tweaked over time to aim for optimal lab and evaluation results. His analogy is to think of AD as a leaky roof - there are as many as 36 leaks in the AD roof that need to be addressed to stop the problem. Not every patient will have the same leaks, and the protocol is customized based on the patient’s genetics, current health, and lifestyle.  


Dr. Bredesen has since expanded the protocol and number of patients seen and is in the process of opening up trials to the wider public through [http://www.mpicognition.com MPI Cognition]. He was previously affiliated with [https://museslabs.com/ Muses Labs]. This page sets out to explain the 25 treatments in simple enough language that untrained people suffering from Alzheimer's (or their caregivers) can begin to implement the easier ones, and work with their doctors or other labs to begin the others.
His first published paper on the protocol, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221920/ Reversal of Cognitive Decline], highlighted 10 case studies. Of those 10 people, nine showed enough improvement to return to normal life activities. Since then, several hundred people with cognitive impairment have followed the protocol, and most have seen a reversal of cognitive impairment. Dr. Bredesen is currently partnering with the Cleveland Clinic to test the protocol in a larger trial.


Here are the 25 interventions used in the Bredesen [http://www.impactaging.com/papers/v6/n9/full/100690.html protocol] to reverse mild Alzheimer's:
Although Bredesen does not see private patients, he is in the process of making the protocol available to the wider public with the help of doctors certified in the protocol through [http://www.drbredesen.com/ MPI Cognition].  His previous affiliation with [https://museslabs.com/ Muses Labs] has ended.  


1. [[Optimize diet]]


2. [[Enhance autophagy, ketogenesis]]
Bredesen’s protocol has not been tested as a preventative. That said, research has shown that amyloid-β is deposited in E4 carriers as early as their thirties, so addressing components early will likely lead to better health in aging. Members on the APOE4.Info forum who follow the protocol report improvements not only in health but also in cognition, even if they do not have an SCI or MCI diagnosis.


3. [[Reduce stress]]


4. [[Optimize sleep]]
The following list links to summaries of why each strategy is important, what you can do, and a selection of research references.


5. [[Exercise]]
==Diet Strategies==
[[Optimize diet]]


6. [[Brain stimulation]]
[[Enhance autophagy, ketogenesis|Enhance autophagy and ketogenesis]]


7. [[Homocysteine less than 6]] (earlier version of the protocol was < 7)
[[GI_health|Improve GI Health]]


8. [[Serum B12 greater than 500]]


9. [[CRP less than 1.0; A/G greater than 1.8]] (earlier version of the protocol was > 1.5)
==Lifestyle Strategies==


10. [[Fasting insulin less than 5; HgbA1c less than 5.6]] (earlier version of the protocol was Fasting insulin <7; HgbA1c <5.5)
[[Reduce stress]]


11. [[Hormone balance]]
[[Optimize sleep]]


12. [[GI health]]
[[Exercise]]


13. [[Reduction of Aß]]
[[Ensure nocturnal oxygenation|Rule out sleep apnea]]


14. [[Cognitive enhancement]]
[[Optimize mitochondrial function]]


15. [[25OH-D3 = 50-80ng/ml]] (earlier version of the protocol was 50-100)


16. [[Increase NGF]]
==Lab Tests to Track and Treat==
[[Homocysteine_less_than_6|Homocysteine]]


17. [[Provide synaptic structural components]]
[[Serum_B12_greater_than_500|B vitamins]]


18. [[Optimize antioxidants]]
[[CRP_less_than_1.0;_A/G_greater_than_1.8|Inflammation]]  


19. [[Optimize Zn:fCu ratio]]
[[Fasting_insulin_less_than_5;_HgbA1c_less_than_5.6|Insulin sensitivity]] (insulin and blood glucose)


20. [[Ensure nocturnal oxygenation]]
[[Hormone_balance|Hormones]]


21. [[Optimize mitochondrial function]]
[[Optimize Zn:fCu_ratio|Zn:fCu ratio]]


22. [[Increase focus]]
[[25OH-D3 = 50-80ng/ml|Vitamin D]]


23. [[Increase SirT1 function]]
[[Exclude heavy metal toxicity|Rule out heavy metal toxicity]]


24. [[Exclude heavy metal toxicity]]
[[Optimize antioxidants]] ??


25. [[MCT effects]]


26. [[Inhalational Alzheimer's]]
==Brain Strategies==
[[Brain stimulation]]


[[Reduction of Aß]]
[[Cognitive enhancement]]
[[Increase NGF]]
[[Provide synaptic structural components]]
[[Increase focus]]
[[Increase SirT1 function]]
[[Inhalational Alzheimer's]] (editing note: update to types of AD)
==Resources==
'''Lab tests:'''
[[Lab testing information]]
[[Lab testing information]]


'''Supplements:'''
[[Supplement ordering]]
[[Supplement ordering]]
'''Tracking results:'''
Our member "optimize" made a Google spreadsheet using the recommended Cognoscopy test values in The End of Alzheimer's. This spreadsheet is a simple table to help you track your latest test results, with values flagged as "high", "low", or "in range". It's intended as a quick way to organize test results, and see at a glance where to make improvements.
The link to make your own copy of the spreadsheet for your private use is here: https://goo.gl/8t2dxi
Please note! The copied spreadsheet will let you type in the white areas, but this may cause errors in the formulas. If you accidentally type in a white area, hit "ctrl-Z" a few times to remove the typing, or download a fresh copy of the spreadsheet.
'''Summary of key tests for ReCode Protocol'''
Taken from Dr Bredesen's book '''''The End of Alzheimer's'''''  provided for quick reference, refer to the book for specific information
{| class="wikitable sortable"
|-
! Genetics!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || ApoE || Negative for Apo#4 || Whole genome, exome, or SNPs || Saliva or blood
|-
|}
{| class="wikitable sortable"
|-
! Blood Tests!! Critical tests !! Target values !! Optional tests!! Comments
|-
| Inflammation vs. cellular protection || Hs-CRP || <0.9|| IL-6, TNFalpha||
|-
| || Homocysteine || <7|| ||
|-
| || Vit. B6, B12, folate || 60-100 (B6) 500-1500 (B12)10-25 (folate)|| ||
|-
| || Vit. C, D, E || 1.3-2.5 (C) 50-80 (D) 12-20 (E)|| || Vit. D is measured as 25-hydroxy-cholecalciferol
|-
| || Omega-6: omega-3 ratio||0.5-3.0|| ||
|-
| || A/G ratio (albumin:globulin ratio)||≥  1.8 > 4.5 (albumin)
|| ||
|-
| || Fasting insulin, glucose, hemoglobin Atc||≤ 4.5 (fasting insulin) 70-90 (fasting glucose) <5.6 (A1c)
||Neural exosome studies (p-tau, AB42, REST, cathepsin D, and IRS-1 phos. Ratio) ||
|-
| || Body mass index (BMI)||18-25|| ||
|-
| || LDL-p or sdLDL or oxidized LDL||700-1000 (p) <20 (sd) <60 (ox) || ||
|-
| || Cholesterol, HDL, triglycerides||>150 (cholesterol) >50 (HDL) <150 (TG) || ||
|-
| || Glutathione||5.0-5.5 || ||
|-
| || RBC thiamine pyrophosphate||100-150 || ||
|-
| || Leaky gut, leaky bloodbrain barrier, gluten sensitivity, autoantibodies||Negative || ||
|-
|}
{| class="wikitable sortable"
|-
! Trophic support!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || Vit D.|| 5-80|| ||
|-
| || Estradiol (E2), progesterone (p) || 50-250 (E2) 1-20 (p)|| ||
|-
| || Pregnenolone, cortisol, DHEA-sulfate || 50-100 (preg) 10-18 (cort) 350-430 (DHEA, women) 400-500 (DHEA, men)|| ||
|-
| || Testosterone, free testosterone || 1500-1000 6.5-15 (free)|| ||
|-
| || Free T3, free T4, reverse T3, TSH || 3.2-4.2 (fT3) 1.3-1.8 (fT4) <20 (rT3) <2.0 (TSH) Ft3:rt3 ≥20|| ||
|-
|}
{| class="wikitable sortable"
|-
! Toxin related!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || Mercury, lead, arsenic, cadmium || <5, <2, <7, <2.5, respectively ||<50th percentile (Quicksilver) ||
|-
| || Copper:zinc ratio ||0.8-1.2|| RBC zinc; ceruloplasmin ||
|-
| || C4a, TGF-B1, MSH ||<2830 (C4a) <2380 (TGF-B1) 35-81 (MSH)|| MMP9, VEGF, leptin, VIP, ADH, osmolality || If abnormal, add MARCoNS culture and VCS testing
|-
| || HLA-DR/DQ || Benign HLA-DR/DQ || ||
|-
|}
{| class="wikitable sortable"
|-
! Metals Excluding those listed above!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || RBC-magnesium || 5.2-6.5|| ||
|-
| || Copper, zinc ||90-110 (both)|| ||
|-
| || Selenium ||110-150|| ||
|-
| || Potassium || 4.5-5.5|| ||
|-
| || Calcium || 8.5-10.5|| ||
|-
|}
{| class="wikitable sortable"
|-
! Cognitive performance!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || CNS Vital Signs, BrainHQ, or equivalent || >50th percentile for age, improving w/ practice || Novel object recognition ||
|-
|}
{| class="wikitable sortable"
|-
! Imaging!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || MRI w/ volumetrics || Hippocampal, cortical valume percentiles steady (or increasing) for age, >25th  percentile || ||
|-
|}
{| class="wikitable sortable"
|-
! Sleep!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || Sleep study || AHI <5/h || ||
|-
|}
{| class="wikitable sortable"
|-
! Microbiomes!! Critical tests !! Target values !! Optional tests!! Comments
|-
| || Gut, oral, nasal || No pathogens || ||
|-
|}
==Dr Bredesen's research==
'''<big>Book</big>'''
Dr Bredesen's book, '''''The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline''''', published August 22, 2017.  [https://www.amazon.com/End-Alzheimers-Program-Prevent-Cognitive/dp/0735216207/ref=sr_1_1?ie=UTF8&qid=1501354240&sr=8-1&keywords=bredesen Amazon link to Dr Bredesen's book]
<big>'''Videos and interviews'''</big>
* Videos are available on the MPI Cognition website [http://www.mpicognition.com www.mpicognition.com]
* There is a long, but very good STEM Talk interview with Dr Bredesen available on YouTube, Published on Jun 1, 2016 [https://www.youtube.com/watch?v=HS7VZydS8HI Episode 12 Dale Bredesen discusses the metabolic factors underlying Alzheimer’s Disease]
* Presentation given by Dr Bredesen at the Integrative Healthcare Symposium (IHS) Pre-Conference - Feb. 24, 2016 in Midtown, New York City [https://vimeo.com/173061978 IHS 2016 -Cognitive Health: Dawn of the Era of Treatable Alzheimer’s Disease]
* 36 Holes in the Roof, comes with a very nice illustrative video, published Mar 25, 2015 [http://www.clinicaleducation.org/resources/reviews/36-holes-in-the-roof-the-dawn-of-the-era-of-treatable-and-preventable-alzheimers-disease/ 36 ‘Holes in the Roof’ The Dawn of the Era of Treatable and Preventable Alzheimer’s Disease]
*Dr Bredesen's presentation at the Ancestral Health Symposium in August 2016 (AHS16) [https://www.youtube.com/watch?v=s86wpaF-7XI&list=PLbhWKPDKXIEBBybYcY_jUQGE7S0KLgH5S&index=47 AHS16 - Dale Bredesen - ApoE4 Mechanistics]
* Dr Gundry's interview with Dr Bredesen, published on Aug 21, 2017 [https://www.youtube.com/watch?v=p6lkRXaQKwk&feature=youtu.be Dr. Steven Gundry interviews Dr Dale Bredesen about "The End of Alzheimer's"]
* Dr Mercola's interview with Dr Bredesen, with a fair discussion of ApoE4, Published on Aug 25, 2017, [https://www.youtube.com/watch?v=qrQyxWP-S2s&feature=youtu.be Dr. Mercola Interviews Dr. Bredesen About ReCODE Protocol]
* Dr Perlmutter, author of "The Grain Brain" interviewed Dr Bredesen on Dec 4, 2017. Dr Bredesen also took questions from the audience. [https://www.facebook.com/DavidPerlmutterMd/videos/1770871056278647 Dr Perlmutter and Dr Bredesen]
<big>'''Dr Bredesen's Papers'''</big>
* The first version of Dr Bredesen’s protocol (which is similar to the above) can be found in his paper: '''''Reversal of cognitive decline: A novel therapeutic program''''', published September 2014, https://www.ncbi.nlm.nih.gov/pubmed/25324467
Subsequent papers of Dr Bredesen do not address his protocol, but further examine his findings. They include:
* '''''Metabolic profiling distinguishes three subtypes of Alzheimer's disease''''', published in August 2015, https://www.ncbi.nlm.nih.gov/pubmed/26343025
* '''''Direct Transcriptional Effects of Apolipoprotein E''''' published January 2016, Dr Bredesen is co-author.  https://www.ncbi.nlm.nih.gov/pubmed/26791201
* '''''Inhalational Alzheimer’s Disease: An unrecognized – and treatable epidemic''''', published February 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789584/
* '''''Transcriptional Effects of ApoE4: Relevance to Alzheimer's Disease''''', published September 2017. https://www.ncbi.nlm.nih.gov/pubmed/28879423

Revision as of 15:25, 25 March 2018

Introduction

Dr. Dale Bredesen has created the ReCODE protocol that involves multiple strategies to address specific health issues that contribute to Alzheimer's Disease (AD). The results of each strategy are measured by using blood tests, cognitive evaluations, and other markers of overall health improvements. Actions are tweaked over time to aim for optimal lab and evaluation results. His analogy is to think of AD as a leaky roof - there are as many as 36 leaks in the AD roof that need to be addressed to stop the problem. Not every patient will have the same leaks, and the protocol is customized based on the patient’s genetics, current health, and lifestyle.

His first published paper on the protocol, Reversal of Cognitive Decline, highlighted 10 case studies. Of those 10 people, nine showed enough improvement to return to normal life activities. Since then, several hundred people with cognitive impairment have followed the protocol, and most have seen a reversal of cognitive impairment. Dr. Bredesen is currently partnering with the Cleveland Clinic to test the protocol in a larger trial.

Although Bredesen does not see private patients, he is in the process of making the protocol available to the wider public with the help of doctors certified in the protocol through MPI Cognition. His previous affiliation with Muses Labs has ended.


Bredesen’s protocol has not been tested as a preventative. That said, research has shown that amyloid-β is deposited in E4 carriers as early as their thirties, so addressing components early will likely lead to better health in aging. Members on the APOE4.Info forum who follow the protocol report improvements not only in health but also in cognition, even if they do not have an SCI or MCI diagnosis.


The following list links to summaries of why each strategy is important, what you can do, and a selection of research references.

Diet Strategies

Optimize diet

Enhance autophagy and ketogenesis

Improve GI Health


Lifestyle Strategies

Reduce stress

Optimize sleep

Exercise

Rule out sleep apnea

Optimize mitochondrial function


Lab Tests to Track and Treat

Homocysteine

B vitamins

Inflammation

Insulin sensitivity (insulin and blood glucose)

Hormones

Zn:fCu ratio

Vitamin D

Rule out heavy metal toxicity

Optimize antioxidants  ??


Brain Strategies

Brain stimulation

Reduction of Aß

Cognitive enhancement

Increase NGF

Provide synaptic structural components

Increase focus

Increase SirT1 function


Inhalational Alzheimer's (editing note: update to types of AD)


Resources

Lab tests: Lab testing information


Supplements: Supplement ordering


Tracking results: Our member "optimize" made a Google spreadsheet using the recommended Cognoscopy test values in The End of Alzheimer's. This spreadsheet is a simple table to help you track your latest test results, with values flagged as "high", "low", or "in range". It's intended as a quick way to organize test results, and see at a glance where to make improvements.

The link to make your own copy of the spreadsheet for your private use is here: https://goo.gl/8t2dxi

Please note! The copied spreadsheet will let you type in the white areas, but this may cause errors in the formulas. If you accidentally type in a white area, hit "ctrl-Z" a few times to remove the typing, or download a fresh copy of the spreadsheet.


Summary of key tests for ReCode Protocol Taken from Dr Bredesen's book The End of Alzheimer's provided for quick reference, refer to the book for specific information

Genetics Critical tests Target values Optional tests Comments
ApoE Negative for Apo#4 Whole genome, exome, or SNPs Saliva or blood


Blood Tests Critical tests Target values Optional tests Comments
Inflammation vs. cellular protection Hs-CRP <0.9 IL-6, TNFalpha
Homocysteine <7
Vit. B6, B12, folate 60-100 (B6) 500-1500 (B12)10-25 (folate)
Vit. C, D, E 1.3-2.5 (C) 50-80 (D) 12-20 (E) Vit. D is measured as 25-hydroxy-cholecalciferol
Omega-6: omega-3 ratio 0.5-3.0
A/G ratio (albumin:globulin ratio) ≥ 1.8 > 4.5 (albumin)
Fasting insulin, glucose, hemoglobin Atc ≤ 4.5 (fasting insulin) 70-90 (fasting glucose) <5.6 (A1c) Neural exosome studies (p-tau, AB42, REST, cathepsin D, and IRS-1 phos. Ratio)
Body mass index (BMI) 18-25
LDL-p or sdLDL or oxidized LDL 700-1000 (p) <20 (sd) <60 (ox)
Cholesterol, HDL, triglycerides >150 (cholesterol) >50 (HDL) <150 (TG)
Glutathione 5.0-5.5
RBC thiamine pyrophosphate 100-150
Leaky gut, leaky bloodbrain barrier, gluten sensitivity, autoantibodies Negative



Trophic support Critical tests Target values Optional tests Comments
Vit D. 5-80
Estradiol (E2), progesterone (p) 50-250 (E2) 1-20 (p)
Pregnenolone, cortisol, DHEA-sulfate 50-100 (preg) 10-18 (cort) 350-430 (DHEA, women) 400-500 (DHEA, men)
Testosterone, free testosterone 1500-1000 6.5-15 (free)
Free T3, free T4, reverse T3, TSH 3.2-4.2 (fT3) 1.3-1.8 (fT4) <20 (rT3) <2.0 (TSH) Ft3:rt3 ≥20


Toxin related Critical tests Target values Optional tests Comments
Mercury, lead, arsenic, cadmium <5, <2, <7, <2.5, respectively <50th percentile (Quicksilver)
Copper:zinc ratio 0.8-1.2 RBC zinc; ceruloplasmin
C4a, TGF-B1, MSH <2830 (C4a) <2380 (TGF-B1) 35-81 (MSH) MMP9, VEGF, leptin, VIP, ADH, osmolality If abnormal, add MARCoNS culture and VCS testing
HLA-DR/DQ Benign HLA-DR/DQ


Metals Excluding those listed above Critical tests Target values Optional tests Comments
RBC-magnesium 5.2-6.5
Copper, zinc 90-110 (both)
Selenium 110-150
Potassium 4.5-5.5
Calcium 8.5-10.5


Cognitive performance Critical tests Target values Optional tests Comments
CNS Vital Signs, BrainHQ, or equivalent >50th percentile for age, improving w/ practice Novel object recognition


Imaging Critical tests Target values Optional tests Comments
MRI w/ volumetrics Hippocampal, cortical valume percentiles steady (or increasing) for age, >25th percentile


Sleep Critical tests Target values Optional tests Comments
Sleep study AHI <5/h


Microbiomes Critical tests Target values Optional tests Comments
Gut, oral, nasal No pathogens

Dr Bredesen's research

Book

Dr Bredesen's book, The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline, published August 22, 2017. Amazon link to Dr Bredesen's book

Videos and interviews


Dr Bredesen's Papers

  • The first version of Dr Bredesen’s protocol (which is similar to the above) can be found in his paper: Reversal of cognitive decline: A novel therapeutic program, published September 2014, https://www.ncbi.nlm.nih.gov/pubmed/25324467

Subsequent papers of Dr Bredesen do not address his protocol, but further examine his findings. They include:

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