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Hope and Hype for Alzheimer’s

Alzheimer’s sucks! It is a relentless, devastating, cruel disease that destroys patients’ memory and personality, making them no longer the person they used to be. It leaves its victims dependent on caretakers and eventually kills them an average of 4 to 8 years after diagnosis. Ten percent of the population over the age of 65 has it; the incidence is 3% at age 65 and rises to 32% at age 85. As our population ages, millions more will be afflicted, with resultant social and financial costs for society. Already today, 15 million Americans are unpaid caretakers for patients with some form of dementia.

Alzheimer’s can be definitively diagnosed only after death, at autopsy. A substantial percentage of those clinically diagnosed with Alzheimer’s actually have other causes of dementia. As yet, there is no reliable way to make an early diagnosis, and no way to change the course of the disease once it has been diagnosed. Today researchers are developing biomarkers (spinal fluid proteins) and brain imaging methods that improve diagnostic accuracy and may eventually permit early diagnosis before the onset of symptoms. Six drugs have been approved by the FDA for the treatment of Alzheimer’s, but the drugs alleviate only some of the symptoms.1 No drug slows or stops the progression of the disease. And there is nothing that can reverse the damage.

“Awakening from Alzheimer’s”

While this is all very discouraging, scientists are diligently working to understand the disease and find an effective treatment. Others apparently think they needn’t bother. A journalist and singer/songwriter named Peggy Sarlin interviewed “cutting edge doctors” who are allegedly already successful at treating Alzheimer’s, sometimes with dramatic results. She wrote a book and produced an online video series, titled “Awakening from Alzheimer’s,” claiming that Alzheimer’s is for the most part preventable and it can be reversed in 9 out of 10 patients. Wowzers! Wouldn’t it be wonderful if that were true? Sorry, but I’m skeptical. I never rely on videos for my scientific information; they tend to be sensational, one-sided, and agenda-driven. But I gave Sarlin the benefit of the doubt and suffered through her whole series of 14 videos. I was not impressed. In each video, Sarlin interviewed a doctor at length; each had a different approach.

Dr. Mary Newport recommends coconut oil and its extract medium-chain triglyceride (MCT) oil, describing how it miraculously reversed her husband’s symptoms (a “light switch went on in his brain after the very first dose”). She claims to have 400 testimonials from others who tried it, but no controlled scientific studies. Snopes calls her claims “unproven.” On Science-Based Medicine, Steven Novella concluded that the health claims for coconut oil are all unsupported by scientific studies and make little scientific sense.2 The American Heart Association has warned against coconut oil because the evidence shows it increases the risk of heart disease.3

Dr. Joy Faber claims that pre-Alzheimer’s can be diagnosed by imaging that shows decreased blood flow in the brain. She recommends the supplements vinpocetine, acetylcholine, magnesium, and taurine to target specific brain regions. Faber claims 75% of patients who take these are better in six months, but there are no published studies to back up her claim. She also recommends gingko, CoQ10, vitamin E, and GABA. She recommends that everyone take multivitamins, fish oil, vitamin D and a mixture of 7 supplements to ward off dementia. Among her many unsubstantiated claims, Faber says statin drugs cause memory loss (actually, there is some evidence that statins may help prevent dementia) and recommends people use red yeast rice instead. (News flash! Red yeast rice contains the same statin that is in the prescription drug Lovastatin!)

Dr. Pamela Smith recommends healing an inflamed brain with anti-inflammatory supplements such as curcumin and krill oil.

Dr. David Perlmutter stresses that gut health impacts brain health. He recommends a high fat diet and warns against carbs and processed foods that promote “leaky gut syndrome,” which “spews toxins to the brain.” (Leaky gut is a hypothetical condition not recognized by mainstream medical science.)

Dr. Michael Breus claims that consistent lack of sleep greatly increases your risk of dementia. He recommends banana peel tea and a small light box.

Dr. Vincent Fortanasce has developed a unique program of his own, the TEAM protocol, based on stimulating the hippocampus by doing things that are novel and emotional. He says 75% of patients improve with a combination of isometric exercise, olfactory and gustatory stimulation, music, photos, asking about old memories for 2–4 hours a day (!), and tactile stimulation (human touch or touching with a soft object). He says if you can get them to cry, you have succeeded. He recommends numerous dietary supplements and wine. He claims 3 out of 4 patients “re-wire” their brains and improve significantly, but he has published no studies.

He has figured out what causes Alzheimer’s: mainly obesity, along with lifestyle factors (sedentary, stress, lack of sleep, diet with trans fats and high fructose corn syrup, and lack of exercise). He says the average child sleeps less than six hours a night, a laughable claim.

Dr. Pamela Smith says a ketogenic diet can help reverse Alzheimer’s and is “perhaps the most important health discovery in the last 10 years.” (I don’t think so!) She does multiple non-standard lab tests and prescribes combinations of supplements, probiotics, and hormones. She recommends everyone take multiple supplements to prevent dementia.

Dr. Fred Pescatore focuses on glutathione, inflammation, and a nearly unknown probiotic, ME3. He says sugar is an “anti-nutrient” that depletes nutrients. He worries about toxins in the environment; he says there are over 700 toxins in a newborn’s cord blood. He recommends Alpha GPC and Blue Ness, mushroom extract, and green tea extract (he sells supplements).

Dr. David Katz says we can slash the risk of Alzheimer’s by 80% through diet and lifestyle changes.

Dr. Perlmutter thinks gluten is a major cause of cognitive loss.

Dr. Dale Bredesen proclaims The End of Alzheimer’s in Our Time with the Bredesen Protocol, which he calls the first effective treatment for reversing cognitive decline. It is a personalized, comprehensive therapeutic program involving multiple modalities designed to achieve metabolic enhancement for neurodegeneration. He has published a report of ten patients,4 with three case studies and a summary table that merely lists the other seven patients. Only half of them were diagnosed with Alzheimer’s; the others had mild cognitive impairment or subjective cognitive impairment. The case studies describe a complicated individual regimen. For example, one case was treated with fasting, a limited, mostly vegetarian diet, probiotics, coconut oil, strenuous exercise (swimming, cycling, running), melatonin, numerous herbs and vitamins, DHA and EPA. Nine patients had “subjective or objective improvement;” the tenth had advanced Alzheimer’s and failed to improve. He now claims to have treated 100 patients. The treatments are based loosely on his hypotheses about causation, with no clear rationale for the combination of interventions.

Bredesen thinks the amyloid deposits that characterize the disease are not the problem, but rather a protectant that kills microbes and fungi and protects from inflammation like from sugar. And he believes chronic Lyme disease (which doesn’t exist) is a critical factor.

His method looks at over 100 parameters: copper to zinc ratio, estradiol to progesterone ratio, vitamin D status, stress level, HSCRP, IL6, TNF alpha, etc. He says, “Most people don’t do well with gluten,” and says everyone should fast 12–16 hours at night to clean out the brain.

No Consensus, Just Hype and Slick Marketing

One of the doctors interviewed said there is an emerging consensus. I think you can see that there is no consensus at all, except that most experts agree that a healthy diet, exercise, adequate sleep and other lifestyle factors are important for general health and well being. Their promotion of a high fat diet (especially coconut oil) conflicts with the American Heart Association’s warnings against it. Many of them practice so-called “integrative” and “functional” medicine, which are basically excuses for doctors to make things up as they go along and pick from a smorgasbord of unproven treatments.

Let’s say you are impressed by the video interviews and want to prevent or treat Alzheimer’s. Where would you start? Which of the different recommendations would you adopt? All of them? Some of them?

The 14 videos were free online but each episode was only available for 24 hours, so it was easy to miss one. Never mind: they sell the videos and Sarlin’s book. I was bombarded with email offers for the books and videos, and for all kinds of supplements, blood type quackery, diets, “an incredible herb that can literally reverse memory loss in one hour,” a cancer cure (“one spoonful a day cures cancer”), and even lithium (a potentially dangerous psychiatric medication). One message said, “this is the last time I’ll bug you.” I received eight more emails in the following two weeks.

Conclusion: False Claims, False Hope

Let’s face it: the claim that Alzheimer’s is for the most part preventable and it can be reversed in 9 out of 10 patients is simply not true. I fervently wish it were, but harsh reality intrudes. Such claims are cruel and not supported by any credible science. We can’t reliably prevent Alzheimer’s, but we can adopt a healthy lifestyle. We can’t slow or stop the disease, but we can manage the symptoms to maximize patients’ quality of life.

Videos such as those done by Peggy Sarlin offer false hope. The real hope lies with researchers who are working hard to develop treatments and better ways to diagnose and prevent the disease and who understand the necessity of controlled experiments—research scientists who don’t just collect hypotheses, uncontrolled observations, and patient testimonials and throw everything but the kitchen sink at patients. END

About the Author

Dr. Harriet Hall, MD, the SkepDoc, is a retired family physician and Air Force Colonel living in Puyallup, WA. She writes about alternative medicine, pseudoscience, quackery, and critical thinking. She is a contributing editor to both Skeptic and Skeptical Inquirer, an advisor to the Quackwatch website, and an editor of sciencebasedmedicine.org, where she writes an article every Tuesday. She is author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon. Her website is SkepDoc.info.

References
  1. http://bit.ly/2qaSPKj
  2. http://bit.ly/2zIxI3B
  3. http://bit.ly/2s9il2Z
  4. https://bit.ly/2fbeADa

21 Comments

  1. Bruce Robinson says:

    With all the billions of dollars being spent on health care, and with such a large percentage of elderly people experiencing Alzheimer’s, it would seem reasonable for the federal government to divert a bit of money to fund a series of a dozen or so clinical trials to evaluate each one of these claims. Then, instead of searching after a non-existent cure, people will be more likely to seek medical help and at least obtain medications to relieve some of the symptoms.

  2. Jonathan Hand says:

    As Dr. Hall mentions, a significant percentage of dementias diagnosed as AD are not actually AD. For those caused by things such as microvascular dementia or small strokes, a heart healthy diet (i.e., low sodium, low saturated fats, lots of fruits & veggies) could be considered preventative. My grandmother had a TIA and, to the casual observer, she seemed pretty much the same afterward but I could tell that she had really lost her mental edge.

  3. David Reid says:

    The surprising thing is not that there are those out there hawking bogus remedies — the billion-dollar supplements industry is full of that — but that doctors who should know better (they do hear of peer review in med school, don’t they?) are doing it (and without apparent remunerative motives). Bad science. In any case, hope springs eternal , as in this article http://bgr.com/2018/01/01/alzheimers-treatment-drug-type-2-diabetes-research/

  4. sittingbytheriver says:

    Thank you, Harriet, for another excellent article. What shocks me the most is the designation “Dr.” before the name of each of these practitioners who claim success in treating Alzheimer’s.

  5. Jim says:

    In the last 20 years I have seen many hypotheses as to the cause of Alzheimer Dementia. Aluminum, genetics, vascular change, collagen or other deposition, lack of antioxidants, the list goes on and on. With no consensus on cause, or really what the process is (are the changes they see a result or a cause, for example) how can we generate consensus on treatment or prevention? While some research shows that those with dementia may do slightly worse on statins, which don’t add much after age 75 anyway. At younger ages statins do enough to prevent vascular changes that I am using one. Exercising the brain does improve function some in the specific modes exercised, but in the long run has not been shown to improve the actual process, and the meds are like driving with a tailwind– a little better mileage, but no change in the engine. And don’t think the “doctors” promoting these things have no vested interest in the product or concept.

  6. Dave S. says:

    Bruce, it takes far more than “a bit of money” to evaluate even one of the smorgasbord of claims. For a claim to be worth the expenditure of an expensive clinical trial, there has to be a biologically plausible rationale for a beneficial effect, and preferably evidence of effectiveness in animal models of the disease. Otherwise, you’re just squandering taxpayer dollars throwing good money after bad, just as NCCIH has been doing (w/ virtually nothing to show for it) for years.

  7. Paul Bredderman Sr says:

    I think prevention is a better approach.

    Where are the epidemiological studies — to at least determine relative weights to the associations with Alzheimer’s, and to determine historical trends in different regions of the World?

  8. Beth Ayers says:

    This nation generally needs to change its focus from treating catastrophic illnesses to preventing illness by promoting wellness. The amount of money saved on hospitalizations, medications, and lost productivity would make it possible to fund research into diagnosing, understanding, palliating, and even curing some of these devastating diseases. And this promotion of wellness should include replicable studies of the claims of quacks and scaremongers to discredit those that are worthless, and save another huge amount of money. Public education is desperately needed, starting with school-age kids.

  9. Dave S. says:

    Beth, if replicable studies were all it takes to vanquish goofy quack claims, homeopathy would have long since disappeared. But instead it is thriving. The NCCIH has been testing quack claims for years, has not found any benefit of even one of them (the last I heard, anyway), and yet the claims persist and Americans buy them. I agree education may help, but it’s up against the siren song of true belief in simple answers to complex problems.

  10. BillG says:

    For decades my mother took about 10-supplements a day – B-vitamins, fish oil, herbs. etc., had a good diet, didn’t smoke, and had a occasional glass of wine.
    My father followed the exact diet and supplement regimen. When she died, she had advanced dementia (or Alzheimer’s.)
    My fathers is now 93, lives at home and has an intact mind. What does that tell me? Not much as small samples and anecdotes are almost worthless.
    Genetic? Environment? You tend to lean toward genes but it could also be a combination of both.
    Meanwhile and to state the obvious, stay away from quacks who want to monetize with no evidence.
    Thanks Dr. Hall

  11. ACW says:

    Well, I certainly don’t think Fortanasce’s recommendations could hurt … though I doubt they’d do anything about Alzheimer’s. A health-promoting lifestyle including eating a better diet (which can include vegetarian or vegan, or ‘organic’, as long as it emphasizes variety and balance, and generally shuns junk), at least moderate exercise, sufficient sleep, mental stimulation, and emotional and social ties may not prevent or delay Alzheimer’s (or any other form of dementia), but they’re worthwhile ends in themselves and adopting those habits should be ‘well, like, duh’. The rest of the doctors surveyed sound like either crackpots or con artists.

  12. John Richardson says:

    Thanks for your research…

  13. Dr. Phillip Shaffer says:

    For Bruce Robinson:
    One thing about getting grant money is that you have to write a grant that cites supporting literature that the proposed research has theoretical plausibility and you need to cite preliminary research that indicates there is a reasonable likelihood that the hypothesis you are testing is true, and that your research will be successful. If none of this exists, your likelihood of getting grant funding is pretty much zero.
    Beyond that, researchers have to get published to have a career, and for the most part, negative research is not publishable. So, presume you somehow get funding to investigate the hypothesis that sugar in low doses will permit people to fly. When you prove it does not, you will not be able to get it published in a reputable journal. You will then have a very short and anonymous career.
    And, I don’t know if you have noticed, but even when some improbably claims are tested and they are found to be wrong, it pretty much does nothing to persuade the faithful that they were mistaken.

  14. Beth K says:

    Thank you, Dr. Hall.

    It seems there are quack cures for about everything that worries people both from the wing-nuts and moon-bats. They both combine their favored quackery with whatever conspiracy theories they prefer, and selling you cures “that your doctor will never tell you about”. That’s because they are quite simply unproven and non-medical cures.

    In the current atmosphere that borders on paranoia, the market is very open to any snake oil anyone can come up with. And, with a slick enough marketing campaign that convinces a “critical mass” of your claims, questioning them becomes akin to heresy.

    Doctors are not immune. The optometrist I saw a few months ago tried to sell me “eye vitamins” which would prevent and cure macular degeneration. These were the AREDS formulation. Moreover, the particular formulation sold by that eye clinic would not be covered by my insurance – which WILL pay for supplements prescribed by a physician if prescribed to treat a diagnosed condition.

    I have diabetes and see an opthomologist every year for diabetic retinopathy detection. He noted early stage cataracts, and recommends a “watch and wait” approach, says I do not have macular degeneration, and tells me that if I eat the recommended foods in my diabetic diet, that those “eye vitamins” will not help, and may increase risk for certain cancers.

  15. Barbara Harwood says:

    Medical science has been so good at curing diseases that would have killed most people at a much younger age, we are now living with the end result. I am reminded of something out of “Gulliver’s Travels” in which the parents of a new baby were informed that the child was an immortal, but despaired at the thought. The child would live out a normal lifetime and just continue living with the infirmities of old age. Once we cure Alzheimer’s, what else will be hiding around the corner?

  16. Angela A Stanton PhD says:

    I was reading Dr. Hall’s commentary with interest. She always adds some spice to the material. However, I found that this time she missed both the spice and also scientific knowledge. One would expect an MD who comments with criticism to do her homework before doing so.

    Two topics grabbed my attention as being incorrect:
    1) Leaky gut syndrome is not an accepted field of area
    2) coconut oil is not recommended by the AHA (true but completely erroneous and I would have expected a double-check on this highly controversial subject–if for nothing else because of the controvert it represents.

    To help Dr. Hall educate herself, let me offer a few starter articles on leaky gut syndrome from respectable academic journal publications:

    1: Mechanisms of Disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases
    Alessio Fasano & Terez Shea-Donohue
    Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 416–422 (2005)
    doi:10.1038/ncpgasthep0259
    01 September 2005

    2: Front Immunol. 2017; 8: 598.
    Published online 2017 May 23. doi: 10.3389/fimmu.2017.00598
    PMCID: PMC5440529
    PMID: 28588585
    Leaky Gut As a Danger Signal for Autoimmune Diseases
    Qinghui Mu, Jay Kirby, Christopher M. Reilly, and Xin M. Luo,

    3) Front Cell Neurosci. 2015; 9: 392.
    Published online 2015 Oct 14. doi: 10.3389/fncel.2015.00392
    PMCID: PMC4604320
    PMID: 26528128
    Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders
    John R. Kelly, Paul J. Kennedy, John F. Cryan, Timothy G. Dinan, Gerard Clarke, and Niall P. Hyland

    Now topic 2, that MCT oil as in saturated fat as per the AHA. There are hundreds–if not thousands–of articles that show that fats (saturated or otherwise) are not connected to heart disease. In fact, the so greatly feared cholesterol is made from carbohydrates. Most importantly though, it is not even cholesterol that causes the biggest concern, since many studies conclusively show no correlation (or association) of cholesterol at all with heart disease. There is some correlation with triglycerides (not cholesterol) and HDL–so so called good cholesterol (also not a cholesterol) and both of those improve (triglyceride reduces and HDL increases from a reduced carbohydrate diet with increased fat–fat of any kind).

    In fact, when the AHA released its warning against coconut oil, it became the laughing stock of the whole academic field to the point that the USDA felt obligated to ask for commentaries from the public about what THEY think the 2020-2025 Dietary Guidelines should contain. And that is because the AHA has much to gain from keeping people eating the very things that make them sick.

    I would have expected Dr. Hall to pay attention to the dynamics of science so long that she wishes to write about it. I would also expect her to step out of her MD shoes and step into the shoes of a researcher if she wishes to write an article criticizing those who try to get out of under the stronghold of dogmatic “evidence-based science” that has yet to have a single clinical trial prove it correct.

    I was greatly disappointed in Dr. Hall’s commentary at this time. I hope she prepares better for her next commentary!

  17. Nonie sanders says:

    In order to get funding for scientific research we need to get celebrities involved. Look how quickly we got money for AIDS research once Elton John and a few other big-time celebrities got involved and started giving concerts. Since our rock ‘n’ roll stars are aging too maybe they will start funding some of this research.

  18. George says:

    Angela A Stanton PhD: You quacks were gonna show up sooner or later, eh? If you were REALLY a PhD of any kind, your criticism would be more sophisticated and nuanced with gentle suggestions for further review instead of your nasty response. And, your references would not include something that was published “online”. But I will leave it to others, more qualified than I, to tear you apart.

  19. Harriet Hall, MD says:

    I don’t think it’s true that the American Heart Association has become a laughingstock. Did you read the article I cited by Steven Novella? He offers a balanced view.
    Intestinal permeability is an accepted subject of research; the “leaky gut syndrome” is something else entirely; it is not accepted by mainstream science and it provides a very questionable explanation for a wide variety of symptoms and conditions.

  20. Peggy Heppelmann says:

    Dr. Hall seems unaware of research that supports the positions of many of these doctors and how that research indicates there are multiple interrelated causes of adult delayed onset Alzheimer’s. She criticizes Pearlmutter and Bredesen for recommending low refined carbohydrate diets with plenty of high quality fat. A recent paper from the Framingham study, found that people with high cholesterol in their 40s had a 40% lower incidence of Alzheimer’s in their 80s. A Mayo Clinic study of healthy elderly done 4 or 5 years ago found that the quartile with the highest fat intake and lowest carbohydrate intake had a significantly reduced risk of developing dementia over the course of the study, compared to the quartile with the lowest fat, highest carbohydrate increase. People with type 2 diabetes have an increased dementia risk. The enzyme IDE has the dual role of breaking down insulin and clearing beta amyloid from the brain. Hyperinsulinemia creates an IDE deficiency which contributes to accumulation of beta amyloid. Low carbohydrate high fat diets are likely to be therapeutic for people facing this issue. Multiple important studies on the recently discovered glymphatic system show the role of the glymphatic system in removing waste from the central nervous system. The glymphatic system has been found to be 90% more active in sleeping subjects than awake subjects. It is not a stretch to suggest that sleep is critical for clearing waste products from the brain and preventing Alzheimer’s. Recently beta amyloid plaques have been found to contain lipopolysaccharides, LPS,(outer shells from bacteria.) Beta amyloid has been identified as a component on the innate immune system, and there is increasing evidence that beta amyloid production increases in response to pathogens and LPS which are able to get through the blood brain barrier. First LPS has to get through the gut barrier. “Leaky gut” is no longer a theoretical concept. Leaky gut can now be directly measured by the amount of LPS in the blood stream. Studies show that dietary agglutinin damages the intestinal lining increasing blood levels of LPS. Some probiotics repair the gut lining decreasing blood LPS levels. Fecal transplant in mice can increase or decrease LPS levels depending on the microbe mix. Here’s a link to a recent paper on LPS and Alzheimer’s. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591429/
    I don’t think Dr. Hall is familiar enough with recent Alzheimer’s research to be credible on this subject. We have spent billions of dollars on research on the beta amyloid hypothesis of Alzheimer’s using a genetically modified mouse with a mutation that effects less than 5% of human Alzheimer’s patients. All of the doctors that Dr. Hall is criticizing are looking at the tiny percentage of research that is exploring other causes of Alzheimer’s and pointing to Alzheimer’s being a preventable disease. We should be cheering these doctors and all researchers doing work in these areas.

  21. Loren Petrich says:

    15. Barbara Harwood — those are the Struldbrugs of Luggnagg. For the first 70 or so years of their lives, they lead a normal sort of life, growing old in the usual fashion, but they continue on living in a state of aged decrepitude.

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