Research to reality: Breaking ground in Alzheimer’s treatment

Recent research has begun to explore the idea that little can be done to slow, stop or even reverse mild cognitive impairment (MCI) or early dementia from Alzheimer’s disease (AD).

The proven approach of lifestyle interventions is entirely separate from recently approved immunotherapy drugs, such as lecanemab (Leqembi) and donanemab-azbt (Kisunla), which target amyloid plaques in the brain to slow Alzheimer’s disease but come with a host of severe side effects.

Alzheimer’s disease by the numbers

The number of Americans living with AD is increasing. According to the U.S. Centers for Disease Control and Prevention, nearly seven million Americans have Alzheimer’s disease; this number is projected to grow to 14 million by 2060. About one in nine people 65 and older (10.9%) have the disease. AD contributes substantially to the U.S. healthcare system’s economic and societal burden of illness. The total cost of treating individuals with AD and associated dementia is projected to increase from $321 billion in 2022 to more than $1 trillion by 2050.

Large-scale observational studies, such as the Lancet Commission of Dementia Prevention, Intervention, and Care, suggest that about 40% of all dementia cases are caused by one or more of 12 modifiable risk factors, such as poor diet, lack of exercise, type 2 diabetes and others.¹ Research suggests reducing or eliminating modifiable risk factors can also help reverse MCI and can help slow or reverse early Alzheimer’s disease.² Lifestyle interventions can accomplish far more than risky AD drugs.

The Ornish study

Because MCI and AD have multiple modifiable risk factors, preventing and reversing these conditions requires a comprehensive approach rather than a single drug or diet strategy.³ Dean Ornish, MD, and associates conducted a recent randomized controlled trial of a comprehensive reversal strategy.⁴  For the study, 51 patients with clinically diagnosed MCI or early AD were recruited and divided randomly into two groups: the multimodal lifestyle intervention for 20 weeks and habits and care for 20 weeks. The lifestyle interventions in the trial included:

• A whole-food, minimally processed, plant-based diet low in harmful fats, refined carbohydrates and sweeteners, plus selected supplements
• Moderate exercise
• Instruction in stress management techniques
• Support groups

Endpoints included slowing the progression of MCI or early dementia due to Alzheimer’s disease as measured by standard assessment scales and changes in biomarkers, such as plasma beta-amyloid ratios.

After 20 weeks, all 24 participants who completed the intervention program showed overall statistically significant improvement on three standard tests of cognition and function. The plasma Aβ42/40 ratio increased in the intervention group. In the control group, these markers stayed the same or decreased.

In addition to a strongly plant-forward diet, the intervention participants took several dietary supplements known to be helpful for brain health, including:

• Omega-3 fatty acids. People 65 or older who eat omega-3 fatty acids (primarily from fish) at least once a week have a 60% lower risk of developing AD.⁵
• A daily multivitamin tablet with minerals (no iron).
• Magnesium L-threonate. Mg deficiency may be a risk factor for Alzheimer’s disease, and magnesium supplementation may be an adjunctive treatment for AD.⁶
• A probiotic. The patients in the intervention group significantly improved their gut microbiome diversity.
• Lion’s mane mushroom (Hericium erinaceus). Compared to placebo, this fungus may significantly improve cognition and function in healthy people over 50⁷ and in MCI patients.⁸

The Ornish study, though it had only 51 participants, strongly suggests an intensive intervention with a near-vegan diet, moderate exercise and improved stress management can be effective for reversing MCI and early Alzheimer’s disease.

Diagnosing dementia

The hallmark of AD is tangles and plaques of beta-amyloid and tau in the brain. The amyloid plaques can be seen on a standard PET scan; the fluorodeoxyglucose (FDG)-PET shows changes in brain function and highlights areas where neurons are less active, much like a heat map of brain activity. The Amyloid-Tau-Neurodegeneration (ATN) Profile, a new blood test for Alzheimer’s disease, looks at biomarkers for beta-amyloid proteins, tau proteins and neurodegeneration.

The role of lifestyle

The central role of amyloid and tau in cognitive decline is increasingly in question, and the significant role of lifestyle factors for prevention and early treatment is becoming increasingly apparent.

Numerous studies show interventions to improve lifestyle factors, such as diet and exercise status, along with interventions to improve blood flow to the brain, can help preserve cognitive function and reduce the risk of cognitive decline in older adults.⁹

Dietary interventions

Many studies have shown the value of a healthy, plant-forward, Mediterranean diet for preventing or delaying cognitive decline.¹⁰ The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet, developed by the Rush Institute, incorporates the Mediterranean diet with elements of the DASH diet to treat hypertension. This approach lowered the risk of Alzheimer’s disease by as much as 53% in participants who adhered to the diet rigorously and by about 35% in those who followed it only moderately well. This diet has also been shown to slow cognitive decline with aging.¹¹

Other research has shown the importance of diet for amyloid status. A high intake of fruits, vegetables, low-glycemic-index food, polyunsaturated triglycerides and fatty acids contributes to healthy amyloid status. Little or no alcohol intake is also associated with improved amyloid status. Adequate amounts of trace minerals, such as calcium, iron and zinc, are also crucial for healthy amyloid status.¹²

Exercise, sleep, stress reduction

Numerous other factors may play a role in preventing and reversing MCI and early Alzheimer’s disease. Regular gentle exercise, adequate sleep and stress reduction have all been shown to help prevent and even reverse early impairment.¹³

Other lifestyle improvements, such as treating hypertension and quitting smoking, are also helpful.¹⁴

Additional supplements for cognition

The essential nutrient choline is needed to produce the neurotransmitter acetylcholine (ACh), which plays a role in many brain functions, including learning, memory, thinking, motivation and arousal. Among other roles, ACh is crucial for forming short-term memory. Imbalances in ACh are a known factor that causes AD. It’s possible that choline supplementation could help delay or prevent AD.¹⁵

A study of nearly 500,000 U.K. Biobank participants aged 40 to 71 found that over 11 years, zinc supplementation was associated with a 29% reduced risk of all-cause dementia and AD. Zinc plays a central role in antioxidant production; supplementation may increase the protective effect of antioxidants on brain neurons.¹⁶

Low-level laser therapy

Robust studies have revealed outstanding clinical outcomes using low-level laser therapy (LLLT) to combat MCI and AD.¹⁷ Reduced blood flow to the brain can be an underlying cause of MCI and early dementia from AD. Improving blood flow through transcranial LLLT can help treat cognitive impairment by stimulating the neuronal mitochondria across the mitochondrial electron transport chain.

Violet light, for example, impacts complex I (where electrons enter the chain and coenzyme NADH is oxidized) and affects tau and alpha-synuclein; red light impacts complex IV (where the final steps of ATP production occur) and affects beta-amyloid plaques. In one study, elderly patients who received red light transcranial photobiomodulation showed significant improvements in critical measures of cognitive function, such as action selection and mental flexibility.¹⁸

Final thoughts

Today, cognitive impairment from Alzheimer’s disease and other causes must no longer be seen as an unavoidable part of aging. We now know that cognitive impairment can not only be treated and reversed but can also be prevented or delayed. This is an area where integrative DCs can make a real difference. Our skill set in diet, supplements, exercise therapy, non-thermal LLLT, and our trusted role as health and lifestyle coaches position us well for a brighter future that will increasingly demand our expertise.

ROBERT G. SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, is a doctor of chiropractic, clinical nutritionist, national/international speaker, author of Amazon’s #1 best-seller Inside-Out Health and founder and CEO of Westchester Integrative Health Center. He graduated magna cum laude from the University of Bridgeport College of Chiropractic and has a master’s degree in human nutrition. The American Chiropractic Association Sports Council named Silverman Sports Chiropractor of the Year in 2015. He is on the advisory board for Functional Medicine University and is a seasoned health and wellness expert on the speaking circuits and in the media. A thought leader in his field and practice, he is a frequently-published author in peer-reviewed journals and other mainstream publications and was the principal investigator in two Level 1 FDA laser studies. His book, Amazon best-seller Immune Reboot, was released in December 2022. For more information, visit drrobertsilverman.com.

References

All accessed October 20, 2024.

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