Can The Bredesen Protocol Prevent Cognitive Decline from Alzheimer's Disease?
When it comes to non-pharmacological approaches, the Bredesen Protocol is one of the most talked about — although not always for the right reasons.
Dr Dale Bredesen is a neurologist who created a program to “prevent and reverse cognitive decline at any age” called the Bredesen Protocol, which is outlined in his book The End of Alzheimer's Programme.
Currently, there is no single drug that can treat Alzheimer’s, although there are some that may minimally reduce symptoms. When it comes to non-pharmacological approaches, the Bredesen Protocol is one of the most talked about — although not always for the right reasons.
Rather than the reductionist method that’s currently applied to medicine, which focuses on breaking a disease down to its individual parts then applying a treatment to “fix” that one component (e.g. anti-amyloid treatments that remove plaques from the brain), the Bredesen Protocol takes a more comprehensive approach.
The program has two arms: PreCODE for reducing Alzheimer’s risk; and ReCODE for the reversal of cognitive decline for people who are already living with Alzheimer’s disease.
The 7 Keys to the Bredesen Protocol
The Bredesen Protocol claims to take a holistic approach that incorporates discoveries of research across a multitude of disciplines that have a bearing on Alzheimer’s pathogenesis. The 7 keys to the Bredesen Protocol are as follows:
Reduce insulin resistance. According to Dr Bredesen, virtually everyone with Alzheimer’s has lost sensitivity to insulin and become resistant, “at least in the brain”. He states that fasting insulin should be <5.5 microIU/ml, haemoglobin a1c 4.0-5.3%, and fasting glucose 70-90mg/dL. He suggests reducing insulin resistance through his KetoFLEX diet (basically lots of low carb veg, some lean protein, a little bit of starchy veg), optimising key nutrients such as zinc, reducing stress, and exercising. In terms of the latter, he stresses that “exercise is one of the best ways to protect cognition and is also an important part of the protocol to reverse cognitive decline.”
Optimise nutrient, hormone and trophic (growth factor) support. He states that this will optimise our immune systems, support our mitochondria and begin to build our brain’s synaptic networks. Low levels of B1, B2, vitamin D, testosterone, oestrogen, and nerve growth factor are associated with cognitive decline. Bredesen’s view is that we shouldn’t just be bringing them to the low end of “normal”, but to ensure there is enough for the best functioning of the nervous system. Bredesen provides the target values for some vitamins and hormones on page 21 of his book, The End of Alzheimer’s Programme.
Resolve and prevent inflammation. Bredesen states that the most common cause of chronic inflammation is “leaky gut”, which can be caused by stress, sugar, alcohol, processed foods, aspirin and related anti-inflammatories, soft drinks, and PPIs used to treat acid reflux or heartburn. For those who have inflammation but no leaky gut, he recommends they consider if there is suboptimal dental hygiene, an infected root canal, chronic sinus infection, infection with a chronic pathogen such as Borrelia (Lyme disease), metabolic syndrome, or exposure to air pollution or mould toxins.
Treat chronic pathogens, if you have them. Even the brain may harbour bacteria, viruses, spiral bacteria, fungi, or parasites. He believes that our brain’s protective response to these pathogens can cause the very changes we call Alzheimer’s disease.
Identify and remove toxins. Metals such as mercury, organics like toluene and benzene, and biotoxins like mould toxins (mycotoxins) can lead directly or indirectly to cognitive decline.
Rule out sleep apnoea, and optimise sleep. If you suspect you have sleep apnoea, Dr Bredesen advises that your doctor can lend you, or you can purchase, an oximeter to check your oxygen at night. To optimise sleep he also suggests blocking blue light three hours before bed, keeping a regular sleep schedule, exercising earlier in the day, and avoiding caffeine past noon.
Socialise, and stimulate your brain. Prioritise social connection, as in actual meet-ups opposed to connecting through social media. Keep your brain active by learning a foreign language, learning to play a musical instrument, and doing challenging puzzles like sudoku and crosswords. He states that listening to music and dancing can also have a cognitive benefit.
Arguments against the Bredesen Protocol
While there is science behind many of the protocol’s individual strategies when it comes to reducing Alzheimer’s risk — including exercise, a healthy diet (although not KetoFLEX specifically), and social engagement — there’s no placebo controlled clinical trials behind the protocol in its entirety, and no science behind the claims that it can reverse existing cognitive decline. It’s all based on case studies.
Bredesen addresses this issue in The End of Alzheimer’s Programme, stating that in 2011 he proposed a comprehensive trial for Alzheimer’s disease based on the research and findings his team has made so far. He explained that the trial was denied by the US Institutional Review Board, which felt that the protocol was too complicated, and that it did not conform to the usual standard in which each trial evaluates only a single drug or treatment.
Another key issue with the Bredesen Protocol is around costs. You won’t find everything you need to implement the Bredesen Protocol in his book, and the appointments, tests, and membership fees required to implement it properly can really add up. For some people there may be additional equipment required, such as a glucose monitor or sleep apnoea equipment.
It’s also important to note that people with a genetic variant APOE4 have a significantly increased risk of developing Alzheimer's disease, and while Bredesen does discuss this in his book (and he tests genes as part of his protocol), it’s still not known with any level of certainty how much of a difference lifestyle changes can make for these people.
Final Thoughts
Dr Bredesen has provided some important information that may shift health professionals away from prescribing drugs for Alzheimer’s that make little difference, to prescribing key lifestyle changes that may actually help.
While these lifestyle changes haven’t been scientifically tested as a comprehensive program, there is clear science behind some of these interventions on their own, including exercise, social engagement and a healthy diet.
In my opinion, it’s most likely worthwhile implementing the cost-free changes that we already know can help reduce (but not eliminate) Alzheimer’s risk, without the pricey testing from a PreCODE or ReCODE practitioner.
What do you think?
Source notes: All information in the ‘7 Keys of The Bredesen Protocol’ section was obtained from The End of Alzheimer’s Programme, by Dr Dale Bredesen.
The information in this article is general in nature, and may contain errors and omissions. Always speak to a medical professional before making any lifestyle changes.
My husband, who is a physician, was diagnosed with a rare dementia, posterior cortical atrophy and small vessel disease in his brain, in October 2016. In its full progression PCA causes blindness because the brain no longer can recognize what it’s seeing. In the spring of 2017 our integrative doctor called us at home and said you need to read Dr. Bredesen ‘s book. I immediately got it and read it. By this time my husband was having serious cognitive decline and had a hard time following a conversation. He was unable to implement the protocol for himself, so I became his coach and together with our doctor we ran all of the tests and corrected his hormone level, treated him for Candida in his sinuses, chelated him from toxic levels of mercury and lead. I corrected aspects of our diet and got all the supplements we needed. We had our home tested for mold and changed all of our cleaning and person products to organic.He recovered so much of his cognition that he applied for hospital privileges again so he could fill in on Saturdays, for his colleagues. Then covid hit and it was too dangerous for him to be in a hospital. His PCA has not progressed, he still reads and functions well. He stopped driving a few months ago because it made him too anxious. He turned 80 in March. I am so grateful to Dr. Bredesen for his work. We added on photobiomodulation to the program as well as LDN. I’m always on the lookout for new information as it comes up.
Is there anything original in the Bredesen Protocol? I might have missed something in this post, but I don't remember any advice that other health educators haven't already mentioned. I'm always wary of doctors who come up with The [their last name] Protocol. It seems a bit bombastic, especially if they're not saying anything new. Regardless, it at least sounds like a better plan than going to your average physician. I appreciate your reasonable, nuanced takes.