Difference between revisions of "Bredesen Protocol"

Revision as of 12:50, 21 July 2022

Introduction

The protocol in this wiki is based on Dr Bredesen’s first book, The End of Alzheimer’s. With the exception of some new findings as well as some tweaks and refinements, his second book, The End of Alzheimer’s Program maintains the ReCode protocol, but presents practical information and steps to implement the protocol. Changes or new information from Dr Bredesen’s second book:

The cognoscopy now has some new tests and some biomarker goals have been refined, the table below in the resources section reflects these updated tests and values

The original 3 types of Alzheimer’s has been expanded to 6 types: Type 1 Inflammatory or hot, Type 2 atrophic or cold, Type 1.5 glycotoxic or sweet, Type 3 Toxic or vile, Type 4 vascular or pale, Type 5 – traumatic or dazed

Ketoflex 12/3 Pyramid. Source: https://www.apollohealthco.com/ketoflex-12-3/

A step by step guide on the order of events for reversing cognitive decline. From chapter two: 1.address insulin resistance 2. get into ketosis 3. optimize nutrient, hormone and trophic factor (growth factor) support 4. resolve and prevent inflammation 5. treat chronic pathogens 6. identify and remove toxins 7. rule out sleep apnea and optimize sleep

A discussion of the KetoFLEX 12/3 Brain Food Pyramid. The bottom layer, the foundation, is overnight fasting. Above that is non starchy vegetables and healthy fats. Next is prebiotics, resistant starch, and probiotics. Second from the top is animal protein and fruit. And the top of the pyramid is indulgences. For a video discussing this pyramid: Video "JG#2" from Facebook page "Dale Bredesen, MD" For a summation of KetoFLEX 12/3, see KetoFLEX 12/3 from Apollo Health

The role of oral health in cognitive decline

Detailed information about dementogens

Personalized nutritional supplements

Plan for gut health and how to optimize your microbiome and holobiome

Plus interspersed throughout the book are inspiring stories of patients who have successfully reversed cognitive decline

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.

In 2014, 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. Several hundred people with cognitive impairment have since followed the protocol, and most have seen a reversal of cognitive impairment. He published results of reversing various levels of cognitive decline in Reversal of Cognitive Decline: 100 patients, published October 2018. His book The End of Alzheimer's, published August 2017 discusses his protocol and explains many of the mechanisms of Alzheimer's.

Bredesen’s protocol has not been tested as a preventative, however in a May 2019 podcast interview, Dr Bredesen did say that he’s never had someone at risk come in for prevention and develop even mild cognitive impairment. Research has shown that amyloid-β is deposited in E4 carriers as early as their thirties, so addressing components prior to experiencing cognitive impairment symptoms will likely lead to better health and cognition 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.

Although Bredesen does not see private patients, he has made his protocol available to those seeking doctor assistance through AHNP: Precision Health. MPI Cognition, his previous affiliation, was acquired by AHNP and his prior affiliation with Muses Labs has ended.

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

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!

1) 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.

2) The visitor might want to look at this thread about the limitations of using Promethease for some of the genetic findings as recommended on this sheet.

Summary of key tests for ReCode Protocol Taken from table 1 of Dr Bredesen's second book The End of Alzheimer's Program provided for quick reference, refer to the book for specific information. If you are following his first book, note that some of the biomarkers have changed.


	Critical Tests	Target Values	Comments
Inflammation, protection, and vascular	hs-CRP	<0.9 mg/L	Systemic Inflammation
	Fasting insulin Fasting Glucose Hemoglobin A1c HOMA-IR	3.0-5.0 μIU/mL* 70-90 mg/dL 4.0-5.3% <1.2	Glycotoxicity and insulin resistance markers *For those who are insulin sensitive, with fasting glucose <90 mg/dL, fasting insulin of < 3.0 is still a healthy range
	Body mass index (BMI)	18.5-25	Weight (lbs) x 703/height (inches)₂
	Waist to hip ratio (women) Waist to hip ratio (man)	<0.85 <0.9
	Homocysteine	≤7μmol/L	Reflects methylation, inflammation, and detox
	Vitamin B₆ Vitamin B₉(folate) Vitamin B₁₂	25-50 mcg/L (PP) 10-25 ng-mL 500-1500 pg/mL	Improve methylation and reduce homocysteine
	Vitamin C Vitamin D Vitamin E	1.3-2.5 mg/dL 50-80ng/mL 12-20 mg/L
	Omega-6 to omega-3 ratio	1:1 to 4:1 (beware that <0.5:1 may be associated with bleeding tendency)	Ratio of inflammatory to anti-inflammatory omega fats
	Omega-3 index	≥10% (ApoE4+) 8-10% (ApoE4-)	Proportion of anti-inflammatory omega-3 fats
	AA to EPA ratio (arachidonic acid to eicosapentaenoic acid ratio)	<3:1	Ratio of inflammatory AA to anti-inflammatory EPA
	A/G ratio (albumin to globulin ratio) Albumin	≥1.8:1 4.5-5.4 g/dL	Markers of inflammation, liver health, and amyloid clearance
	LDL-P Small dense LDL Oxidized LDL	700-1200nM <28 mg/dL <60 ng/mL	LDL-P is LDL particle number
	Total cholesterol HDL cholesterol Triglycerides TG to HDL ratio	150-200 mg/dL >50 mg/dL <150 mg/dL <1.1
	CoQ10	1.1-2.2 mcg/mL	Affected by cholesterol level
	Glutathione	>250 mcg/mL (>814 μM)	Major antioxidant and detoxicant
	Leaky gut, leaky blood-brain barrier, gluten sensitivity, autoantibodies	Negative
Minerals	RBC-magnesium	5.2-6.5 mg/dL	Preferable to serum magnesium
	Copper	90-110 mcg/dL
	Zinc	90-110 mcg/dL
	Selenium	110-150-ng/mL
	Potassium	4.5-5.5 mEq/L
Trophic Support	Vitamin D	50-80 ng/mL	(250H-D3)
	Estradiol Progesterone	50-250 pg/mL 1-20 ng/dL (P)	Women; age dependent
	Pregnenolone Cortisol (AM) DHEA-S (women) DHEA-S (men)	100-250 ng/dL 10-18 mcg/dL 100-380 mcg/dL 150-500 mcg/dL	Age dependent
	Testosterone Free Testosterone	500-1000 ng/dL 18-26 pg/ml	Men; age dependent
	Free T3 Free T4 Reverse T3 TSH Free T3 to reverse T3 Anti-thyroglobulin antibodies Anti-TPO	3.2-4.2 pg/mL 1.3-1.8 ng/dL <20 ng/dL <2.0 mIU/L >0.02:1 Negative Negative
Toxin-related	Mercury Lead Arsenic Cadmium	<5 mcg/L <2 mcg/dL <7 mcg/L <2.5 mcg/dL	Heavy Metals
	Mercury Tri-Test	<50th percentile	Hair, blood, urine
	Organic toxins (urine)	Negative	Benzene, toluene, etc.
	Glyphosate (urine)	<1.0 mcg/g creatinine	Herbicide
	Copper to zinc ratio	0.8-1.2.1	Higher ratios associated with dementia
	C4a TGF-β1 MMP-9 MSH	<2830 ng/mL <2380 pg/mL 85-332 ng/mL 35-81 pg/mL	Associated with inflammatory response
	Urinary mycotoxins	Negative	May include contributions from inhalation, ingestion, and infection
	BUN Creatinine	<20 mg/dL <1.0 mg/dL	Reflects kidney function
	AST ALT	<25 U/L <25 U/L	Reflects liver damage
	VCS (visual contrast sensitivity)	Pass	Failure associated with biotoxin exposure
	ERMI test	<2	Mold index from building
	HERTSMI-2 test	<11	Index of most toxic molds
Pathogen-related	CD57	60-360 cells/μL	Reduced with Lyme
	MARCoNS	Negative
	Antibodies to tick-borne pathogens	Negative	Borrelia, Babesia, Bartonella, Ehrlichia, Anaplasma
	Antibodies to Herpes family viruses	Negative	HSV-1, HSV-2, HHV-6, VZV, EBV, CMV
Neurophysiology	Peak alpha frequency on quantitative EEG	8.9-11 Hz	Slows with cognitive decline; useful for following progress
	P300b on evoked response testing	<450 ms	Delayed with cognitive decline; useful for following progress
Other Tests	MoCA (Montreal Cognitive Assessment)	28-30
	Nocturnal oxygen saturation (SpO2)	96-98%	Affected by living at high altitude
	AHI (apnea-hypopnea index)	<5 events per hour	>5 indicates sleep apnea
	Oral DNA	Negative for pathogens	P. gingivalis, T. denticola, etc.
	Stool analysis	No pathogens or dysbiosis
	ImmuKnow (CD4 function, indicated by ATP production)	≥525 ng/mL	Indicates function of helper cells of the cellular arm of adaptive immune system

Abbreviations used in the above table: AA – arachidonic acid AHI – apnea-hypopnea index ALT – alanine aminotransferase AST – aspartate aminotransferase BMI – body mass index BUN – blood urea nitrogen C4a – complement split product 4a CD57 – cluster of differentiation 57 CMV – cytomegalovirus CoQ10 – coenzyme Q10 (ubiquinone) DHEA-S - dehydroepiandrosterone sulfate DNA – deoxyribonucleic acid EBV – Epstein-Barr Virus EEG – electroencephalogram EPA – eicosapentaenoic acid ERMI – Environmental Protection Agency relative mold index HERTSMI-2 – Health Effects Roster of Type-Specific Formers of Mycotoxins and Inflammagens – 2nd version HHV-6 – Human herpesvirus 6 (A and B) HOMA-IR – homeostatic model assessment of insulin resistance Hs-CRP – high sensitivity C-reactive protein HSV-1 – Herpes simplex virus 1 HSV-2 - Herpes simplex virus 2 LDL – low density lipoprotein MARCoNS – mulit antibiotic-resistant coagulase negative Staphylococcus MMP-9 – matrix metalloproteinase-9 MoCA – Montreal Cognitive assessment MSH – alpha-melanocyte stimulating hormone P300b – positive wave at 300 milliseconds (event-related potential), component B PP – pyridoxal phosphate RBC – red blood cell SpO2 – peripheral capillary oxygen saturation T3 – triiodothyronine T4 – throxine TG – triglycerides TGF-β1 – transforming growth factor beta-a TPO – thyroid peroxidase TSH – thyroid-stimulating hormone VZV – varicella zoster virus

Dr Bredesen's research

Books

Dr Bredesen's first 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

Dr Bredesen's second book, The End of Alzheimer's Program: The First Protocol to Enhance Cognition and Reverse Decline at Any Age, published August 18, 2020. His first book laid out the science, this book updates his program and provides "how to" advice to implement the science of his program. Amazon link to this second book

Social Media

Facebook Page: Dale Bredesen, MD includes a library of videos where Dr Bredesen discusses numerous subjects related to his research and findings.
Twitter: Dr Dale Bredesen

Videos and interviews

Videos are available on the AHNP Cognition website https://www.ahnphealth.com/science.html
There is a long, but very good STEM Talk interview with Dr Bredesen available on YouTube, Published on Jun 1, 2016 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 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 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) AHS16 - Dale Bredesen - ApoE4 Mechanistics
Dr Gundry's interview with Dr Bredesen, published on Aug 21, 2017 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, 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. Dr Perlmutter and Dr Bredesen
Dr Rhonda Patrick interview with Dr Bredesen, posted October 1, 2018. This link not only provides a video to the interview, but also a written summary, transcript, glossary, and a timeline to go directly to a specific discussion point with supporting links. Dr. Dale Bredesen on Preventing and Reversing Alzheimer's Disease
Presentation given by Dr Bredesen at the Center for Discovery, published on Oct 22, 2018 The Complexity Gap & 21st Century Medicine
Interview with Dr Bredesen posted May 2019, during which he cites a few updates to the protocol as cited in his book The End of Alzheimer's. Dr Dale-Bredesen and the End of Alzheimer's, How You can prevent it, and hope for all degenerative disease Differences noted:

He cites 6 types of Alzheimer's: (1) inflammatory (2) atrophic (1.5) glycotoxic (3) toxic (4) vascular and (5) traumatic. Vascular and traumatic are new since publication of his book
In his markers for glycotoxicity, he cites fasted insulin of 5.0 (his book cites 4.5) or lower and HbA1c 4.5 to 5.2 (the book cites less than 5.6)
Dr Bredesen said that the Big Four to avoid are: grains, simple carbs, dairy, and lectins. Pro-inflammatory lectins have been added since publication of his book.
He added another mold/mycotoxin to his list: Wallemia. The big 5 molds are now: Stachybotrys, Aspergillus, Penicillium, Chaetomium, and Wallemia.

Interview with Dr Bredesen, conducted by Dave Asprey of Bulletproof Radio. Posted Oct 28, 2020. This interview promotes and discusses Dr Bredesen's second book, "The End of Alzheimer's Program. You Can Prevent and Even Reverse Cognitive Decline – Dr. Dale Bredesen with Dave Asprey : 753
Facebook live talks (recorded): "Special Considerations for ApoE4 Carriers" (March 12, 2021) and "Special Considerations for ApoE4 Carriers Part 2" (March 25, 2021) with Dr Dale Bredesen, Dr Ram Rao and Julie Gee. These recorded videos can be found on Dr Bredesen's facebook page, Dale Bredesen, MD - Facebook page click on the VIDEO link to find the talks.

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:

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

This paper addresses the common criticism that the original paper only covered a small number of patients. This paper documents improvement in cognition of 100 patients treated by several different physicians thus providing further support for a randomized, controlled clinical trial of the protocol and overall approach:

Reversal of Cognitive Decline: 100 Patients, published October 2018. https://www.omicsonline.org/open-access/reversal-of-cognitive-decline-100-patients-2161-0460-1000450.pdf

This paper set to determine whether a precision medicine approach implementing Dr Bredesen's Protocol to address Alzheimer's disease and mild cognitive impairment, in which potential contributors to cognitive decline are identified and targeted therapeutically, is effective enough in a proof-of-concept trial to warrant a larger, randomized, controlled clinical trial.

Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project, published 4 July 2022, https://content.iospress.com/articles/journal-of-alzheimers-disease/jad215707

ReCODE: A Personalized, Targeted, Multi-Factorial Therapeutic Program for Reversal of Cognitive Decline published September 29, 2021

https://www.mdpi.com/2227-9059/9/10/1348/htm?fbclid=IwAR11GJ1h2SL7XLythJ2-J78Vcguy2N5GP0av2PoiEyCC9os5HqqsgVJLFXo