Book Review: Bredesen’s “The End of Alzheimer’s”

Undoctored Program Note: There is an emerging Undoctored program
posture on cognitive decline. Be sure to see this article by Dr. Davis:
General Discussion » My notes on preventing/reversing cognitive decline/dementia

Stewardship Note: This book was released on 2017-08-23,
and should not be confused with “The End of Alzheimer’s?”
(with a question mark, by Lewis & Trempe, 2014).

Edition: 2019-12-17

TL;DR; The Undoctored Brain

This review is tailored for the Undoctored / Wheat Belly audience. If you personally follow the Undoctored program fully, Bredesen’s program (“ReCODE”) does not immediately appear to suggest a lot more that you might consider doing to mitigate AD risk. Indeed, the WB/Undoctored program has tighter targets for several key factors: carbs, gut flora, HbA1c, thyroid, Vitamin D, and inflammatory fats.

If you have risk factors (including ApoE4) or symptoms (certainly SCI or MCI), definitely look into this book. If you know someone with a diagnosed cognitive impairment, or symptoms suggestive of one, then TEoA and its ReCODE program provides yet more ammunition to get them off the diet and lifestyle that is dementing them. If you’re merely curious, as I was, TEoA is a great read.

Dr. Bredesen has developed a program that appears to work. My overall impression is that it’s at about the same stage of development, relative to the ailment it addresses, as was Dr. Davis’ TYP program a decade ago, namely: some of the ReCODE program elements might need dialing-in, some might need to be added, and some may be superfluous (but harmless). They are, however, a vast improvement over SoC, which has essentially nothing to offer (except parroting the deadly diets that probably cause AD).

On the whole, ReCODE provides actionable items with testable results, for an ailment on which Consensus Medicine™ is militantly useless today. Any of this sound familiar?: defective dogma, uninformative consensus tests, knee-jerk opposition to multi-factorial approach that is mostly diet and lifestyle, obstructive IRBs, no funding for trials, all leading to a grass-roots revolt.

The Context

A large fraction of the book is spent on the history of AD, the pointless focus on countering amyloid plaque (which we here might call the “LDL-C of AD mythology”). It explores the total failure to field any meds that can do more than slightly slow the disease. It goes on to present credible mechanisms and etiologies for the actual pathologies; and they suggest that there are three main types of AD:

1. Inflammatory (ApoE4’s at higher risk)
2. Brain nutrient deficient (ApoE4’s at higher risk)
3. Toxic (ApoE3’s at higher risk)

His thesis is that there cannot in fact be a mono-therapy (magic pill) to cure or even manage AD, because there are some 36-56 separate aspects of it that must be addressed. Any med that only targets a few of them is going to fail in a classic single-variable RCT (as they indeed have, even though some of them might actually be beneficial within a more comprehensive program).

ReCODE in a Nutshell

• Extensive testing of the kind SoC usually ignores (see more below)
   
• Ketoflex 12/3 (14-16/3 for E4)
  Minimum of 12 hour overnight fast; and no food 3 hour pre-bed.
  What exact fraction of the metabolic flexibility time is spent in nutritional ketosis is not clear, and the 5.6% HbA1c target (below) doesn’t strike me as concordant with even part-time KD.
   
• Low Carb
  There is no specific net carb target in the book (nor any discussion of PPBG or TG). There is one mention of 15 grams max. sugar per day, but it’s unclear if that’s added simple sugars, net carbs, or what. Non-starchy veggies are apparently unlimited. Although Ornish is mentioned and there’s a cover endorsement from Gundry, the program is not vegetarian, or vegan, but considerations for either of those diets is not discussed. ReCODE has some awareness of the Gluten Free™ problem.
   
• Higher Specific Fats
  Many of our standbys are endorsed (avocado, coconut oil, EVOO, etc.) Discourages dairy with no details on why (A1 vs. A2? whey fraction? lactose?). Recommends MCT, with cautions for E4s (Gundry influence here?). The argument of SatFat+ExcessCarbs=Bad I don’t think we disagree on.
   
• Low/Moderate Protein (1g/day per kg/weight)
   
• Low AGE cooking
   
• Fiber
  ReCODE is aware of prebiotics and probiotics, but provides no target on the former, and mostly defers to Perlmutter on the latter. There is a specific recommendation for a yeast: Saccharomyces boulardi. Interestingly, ReCODE does advise to not take probiotics with an uncorrected leaky gut.
   
• Hydration (no targets or metrics)
   
• Sleep hygiene
  This is a close superset of that in Undoctored.
   
• Exercise (primarily for BDNF)
   
• Sweating (for detox)
   
• Further Detox as needed
  Mercury is a big one, and the advice extends even to having amalgam fillings removed if you test at high Hg levels. Molds and mycotoxins get some attention. Ochratoxin is mentioned, but he’s missing a bet there by not being grain-free, as grains are a huge vector for that. Aluminum, despite being lodged in AD lore, is dismissed as a factor, unless it actually tests at toxic levels.
   
• Chronic Infections
  Attend to, including Lyme (but with no specific advice on that nasty problem).
   
• Stress Reduction
   
• Supplements
  A huge list, having substantial overlap with the Undoctored program. I won’t attempt to cover it. Anyone with the TEoA book can compare them to what I understand of our program advice in Supplement Central.

What I Expected to Read And Did Not

• Discussion of full-time ketogenic diet is not present. Is it more or less beneficial to people with AD? The discussion of the Ketoflex diet includes a target range of 0.5 to 4.0 mmol/L, but is that realistic with an HbA1c of 5.6%?
   
• Diet is not grain-free. Gluten avoidance advice is not universal. No mention of WGA.
   
• Leaky gut coverage is incomplete — no mention of zonulins and why they arise. No mention of a long list of other gut antagonists (chloramine, emulsifiers, etc.).
   
• Mentions Blood-Brain-Barrier, but not what causes permeability (zonulins high on that list).
   
• Omega 3: recommends 1 gram (1000 mg) DHA per day, but silent on EPA. No discussion of higher or high-dose ω3 benefits/hazards. DHA sources list fish oil, krill and algae. I guess he didn’t run the numbers on getting that much from krill.
   
• Discussion of exogenous ketones is not present. If this had been a 2014 book, I could understand that, but ExKs have been available at retail for 3 years now. Seek? Avoid? Caveats?
   
• No cautions on Omega 6 linoleic acid (beyond a target for ω6:3), and no discussion of all the things to do to correct an elevated ratio.
   
• No discussion of the recently-discovered deminimus brain lymph system. My personal suspicion is that a lot of modern brain pathologies are due to overloading this system.
   
• Advocates ubiquinol (100mg), but no discussion of why, or the statins lurking just off-stage (and people on the AD track are quite likely to also have metsyn→T2D, CVD, and “bad” lipid markers, all things that cause them to be haplessly inflicted with statins).
   
• Not fully clued-in on alternative sweeteners (mentions only stevia).
   
• No recipes, but the book was already long enough, and I suspect the related web sites get into that (and possibly some of the other oversights above — I haven’t looked yet).

Suggested Labs: “Cognoscopy”

The book recommends a battery of tests to assess status, some specific to cognition (which I won’t discuss) and some familiar to this audience. I’ll discuss a few of the latter. These are more or less in alphabetical and not priority order.

* That HDL is not mentioned is odd, as the book doesn’t specify how TC is to be raised.

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Bob Niland [disclosures] [topics] [abbreviations]