|Dr. Marsha Nunley, MD
Functional Medicine Doctor
Cognitive Decline Expert
The advancement of modern medicine and technology has made our lives easier. Our struggle for survival is much less challenging than that of our ancestors. A longer life span does have some drawbacks, however. Our bodies tend to lose function as we age. Aging leads to a rise in dementia and Alzheimer’s disease.
New and exciting studies show that a functional medicine protocol can lead to a slow down and even prevention of dementia.
Dr. Dale Bredesen, M.D., an expert in dementia and Alzheimer’s disease, has developed the Bredesen Protocol which is a functional medicine approach to prevent and treat Dementia. The goal of functional medicine is to give you the tools to take control of how you age.
What is Alzheimer’s?
Alzheimer’s is part of a broad spectrum of dementia related to brain functioning, characterized primarily by memory loss. It can rarely occur on an early age, late-onset dementia is much more common. Alzheimer’s is a primary diagnosis for most types of dementia.
Prevention is the key to Alzheimer’s. Once things have advanced, it is difficult to get back what you have lost.
Focusing on early warning signs can help stop or slow the disease progression. Memory loss is a big red flag but there are other more subtle symptoms you need to be cognizant of.
Early Symptoms of Alzheimer’s
Early symptoms are very mild and the patient or their family members might have gotten used to covering them up. Very often family members will cover for patients cognitive deficient. For example, when you ask someone today’s date, their spouse would answer them.
Sleeping more can be an early symptom of Alzheimer’s, as can waking up later or taking more afternoon naps. People with early symptoms may have difficulty focusing. This can cause them to lose interest in things they once enjoyed like reading books or watching TV. A general loss of interest, apathy and depression can all be early symptoms of Alzheimer’s. Another sign to watch for is poor facial recognition.
Is This Just A Senior Moment Or Something More Serious?
We all experience what they call “senior moments” from time to time. You lose your train of thought or can’t find your car keys, this may be normal occasionally. But, if you have some of the above mentioned early warning signs, it might be time to see a functional medicine doctor.
Many of the common symptoms of Alzheimer’s can fit more than one disorder. “Brain fog”, for example, can be a common symptom women tend to experience during menopause due to hormonal changes. A functional medicine doctor can help you determine if this is a senior moment, hormone deficiency, or early stages of dementia.
To determine if there is a problem, you need to know why these events are occurring. Could it be a senior moment, or could it be the early stages of dementia? This is where a functional medicine doctor can help.
Multiple Screening Methods for Alzheimer’s
In general, we start with a detailed history from both the patients and family members that includes medical history, symptoms, and other issues. Depending on results of the basic screening, more extensive testing may be needed.
These may include some of these well-known tests:
- Self-Administered Gero-cognitive Exam (SAGE)
- The Alzheimer’s Questionnaire (AQ)
- Montreal Cognitive Assessment (MoCA)
The screenings are very simple, just a series of questions and tasks. For example, many people with Alzheimer’s have trouble with clocks. So we ask them to draw a clock and show where 10:00 is. Or we might give them a list of words to memorize, then ask them what the first three words were. Some screenings such as the VCS Test (Visual contrast sensitivity) are available online and can be done at home.
It’s important to note that these are not screenings for intelligence. Alzheimer’s is the loss of memory and focus, it does not mean diminished intelligence.
After the screenings, indicative lab tests are ordered to asses other causes of cognitive problems like toxins, hormones and infections. If there are other underlying issues, we need to address those first to see if the problem is solved or not.
The Importance of Family Involvement
Family involvement is very important for implementation of the protocol and ongoing support for the patient. Family members may be essential for helping keeping track of medical information, medication schedules, meal planning, lifestyle changes and other vital parts of the treatment plan.
What Is The Bredesen Protocol?
Developed by Dr. Dale Bredesen, M.D., an expert in dementia and Alzheimer’s disease, the Bredesen Protocol is a functional medicine approach to treating cognitive issues.
You’ve got 36 holes in your roof.
Imagine you have a roof over your head with as many as 36 different holes (representing the 36+ possible causes of dementia). You might not be able to plug all of these holes and stop them from leaking, but you start with those that make the biggest impact.
With Alzheimer’s you need to get to work early plugging the holes before the house is already flooded. There is generally no one cause of Alzheimer’s, but a combination of risk factors that vary from one person to the next based on lifestyle and genetics.
You Are What You Eat: The Bredesen Protocol Diet
Diet and lifestyle changes are the heart of the Bredesen Protocol. The food you eat, the portion sizes and the timing of meals can all have a big impact on the progression of dementia and Alzheimer’s disease.
With the Bredesen diet, the main focus is on cutting carbohydrates and processed foods. These foods are then replaced with vegetables, healthy fats, protein, and other whole foods. The keto diet which may be difficult to sustain is appropriate to some, but not all dementia patients.
It is important to tailor the diet to each patient and their needs. People who are diabetic have a higher risk factor for dementia so we need to watch blood sugar more carefully. People who have poor gut health need special dietary considerations as well. That’s why the diet should be modified to fit the patient.
The Role of Intermittent Fasting
Have you ever noticed that after eating a large meal you feel sluggish and tired? That isn’t a chemical reaction, your body literally needs to divert blood flow from the brain to the gut in order to process that meal. Digestion is one of the most labor intensive processes your body goes through. So eating smaller meals and restricting feeding times can allow your gut to digest food properly. Fasting also gives your body the opportunity to cleanse itself of all the waste and toxins it accumulates throughout the day.
Start of easy with a 12 hour fast that happens mostly while you sleep. You can stop eating at 7 PM and not eat again until 7 AM. Then graduate to an 18 hour fast where you don’t eat until around lunch time. A few times a week you can even extend that to a 24 hour fast so that effectively you are only eating every other day. It all depends on your risk factors and personal health goals.
An Alzheimer’s patient that is also overweight or has diabetes would benefit the most from 24 hour fasting. It has been shown to be a key factor in weight loss for people that struggle with other metabolic conditions. As always, work with your doctor to figure out what the best fasting schedule is for you.
Foods to Eat
Most people like to keep it simple and need a meal plan or food list to follow. Here are some of the healthy foods recommended by the Bredesen Protocol.
- Dark leafy green vegetables
- Low glycemic fruits such as blueberries, strawberries and raspberries
- Healthy fats like wild caught salmon, coconut oil, olive oil, nuts, seeds and ghee
- Small amounts of lean meats
- Eggs (egg yolks are high in choline, an important nutrient for brain function)
- Black coffee and tea (you can have 3-4 cups a day, coffee is rich in antioxidants and can promote brain function and focus). Make sure you are drinking black coffee and not adding a lot of extra sugars and flavors.
Dark green vegetables should take up to 75% of your meal plate. Use meat sparingly, think of it as a condiment you are adding for flavor. Using the palm of your hand as a guide, estimate 3 to 4 ounces at most. Use berries and nuts as a sweet, yet healthy dessert. Remember to keep portion sizes small so you can digest easily between meals.
Sample meal: A large serving of raw or cooked green vegetables, with olive oil based dressing, 2-3 eggs, wild caught salmon, and a few berries and nuts for dessert. Keeping meals simple and delicious can help you stay on track with this whole food based diet.
Foods to Avoid
There are many foods to avoid on the Bredesen Protocol, including:
- Processed foods
- High carb foods (exception – low glycemic fruits)
- Limit grains
- Avoid alcohol
- Limit saturated fat
The Role of Supplements in Treating Alzheimer’s
Supplements are necessary for dementia and Alzheimer’s, especially, targeted supplements. This means you get everything you need without taking too many supplements. Your lab work will help determine what you are deficient in, so it’s not a one size fits all situation.
As we get older, we don’t digest food as well so there is more chance of deficiency. Luckily we can target these deficiencies with a combination of supplements. The B vitamins are very important as they are essential for proper brain function. There are others we recommend as a part of the protocol for various cognitive functions as well.
Basic Supplements for Brain Function:
- B vitamins
- Vitamin D
- Fish oil or Omega 3s
- Key minerals (especially magnesium and calcium)
- Lion’s mane extract
As part of the Bredesen protocol you may find yourself taking supplements daily. In addition to the general supplements listed above, you may get additional supplements depending on your personal circumstances. If you are allergic to eggs then you want to get a choline supplement to make up for it. This is just one example of how we tailor the supplements needed to each patient.
The stronger your family history of dementia is, the earlier you need to start taking the supplements. If your grandmother or your father had late stage dementia then you need to start prevention early. Start filling your holes to avoid the flood.
Lifestyle Changes Are Part of the Bredesen Protocol
We are facing an epidemic of increased incidents of dementia and Alzheimer’s due to our lifestyle. We are living longer and that means we have to place a greater emphasis on health. We didn’t used to live into our 70’s and 80’s and beyond, so if we’re going to start living that part of our lives we need to do it in a functional manner.
Beyond Diets: Lifestyle Changes You Need To Make Now To Prevent Dementia
Here are a few of the lifestyle changes that need to be made to help preventing dementia:
- Brain Games – Your brain can function normally well into old age. Studies have shown that brain games increase reaction time and cognitive slowing as you age.
- Exercise – When it comes to exercising later in life we can all take the advice of Ruth Bader Ginsburg. Sitting on the Supreme Court; at almost 90 years old, she still keeps an active exercise routine. It doesn’t matter what you do, the important part is to keep moving. You can walk, lift weights, stretch, or do just about anything you enjoy.
- Get Social – According to the book Blue Zones by Dan Buettner, people who live in one of the seven areas of the world with the longest life span, also had a reduced rate of dementia or Alzheimer’s. One of the key characteristics of these locations are the strong social ties of the population. Many live in small tight-knit communities where they are involved with extended family, friends, church groups and the overall community. Staying connected to others may help the brain also stay active.
The Bredesen Protocol and Alzheimer’s Prevention
The most important thing to remember is that prevention through lifestyle changes is the key to avoiding dementia and diminishing its effects. Using the Bredesen Protocols as guidance towards a healthy diet, exercise, and other lifestyle enhancements can help reduce the worldwide epidemic of Alzheimer’s.
Dr. Nunley sees patients in her clinic located in San Francisco, California, and also offer video consultations.