[music]

Heather Reisman:
Hi, I’m Heather Reisman, and this is Well Said, a podcast on the art and science of living well. Our subject today: Alzheimer’s.

[music]

Heather Reisman:
Alzheimer’s, a disease which impacts many, has long been one of the most terrifying diagnoses a person can get. It presages a relentlessly debilitating decline, a loss of self, and the understanding that not much can be done.

Our guest today says, “Not so fast” and maybe not so necessary for so many of us to begin with. Dr. Dale Bredesen is an internationally renowned researcher and an expert on neurodegenerative diseases, including Alzheimer’s. He is a professor at UCLA, a founding president and CEO of the Buck Institute for Research on Aging, and now the chief science officer at Apollo Health. He is also the author of The New York Times and Indigo bestsellers The End of Alzheimer’s and The End of Alzheimer’s Program. Today we talk to him about the foundational thinking in those books, as well as his newest book, The First Survivors of Alzheimer’s.

In his latest book, Dr. Bredesen shares actual stories from real patients who have followed his protocol and totally improved cognitive function and quality of life.

I just have to say, I have been looking forward to this discussion. And thank you so much for being with us, Dr. Bredesen.

Dr. Dale Bredesen:
Thank you so much, Heather. Great to talk to you.

Heather Reisman:
Fabulous. So of course we’re going to spend time today talking about your books, but before we dive into the newest one, I want to start by taking a step back. What percentage of the population ends up being diagnosed with Alzheimer’s or a related life-altering neurodegenerative disease before 85?

Dr. Dale Bredesen:
Yeah, great point. About 15 per cent of people will die from Alzheimer’s.

Heather Reisman:
If you’re between 50 and 60, I’m just curious, what per cent of the population between 50 and 60 might be diagnosed with Alzheimer’s or a form of dementia?

Dr. Dale Bredesen:
You know, this is a great point, because when I was training as a neurologist, way back in the 1980s, we never saw people in their 50s who had Alzheimer’s disease. It’s becoming one of the most common things we see now. And indeed, the epidemiologists have published that, in fact, it is clearly on the rise in the younger people.

The second thing that I should point out is we also now know that the biochemical changes associated with Alzheimer’s in the brain begin about 20 years before a diagnosis. So you can show by spinal fluid analysis, you can show by PET scan analysis, that there are abnormalities associated with Alzheimer’s—what, again, we used to think of as a disease of the late 60s, 70s, 80s—is really a disease of the 40s, 50s, 60s which is diagnosed 20 years later.

So this has been one of the problems, as you know, because everything has been backward, because people have said since there’s nothing we can do about it, let’s not look for it. It’s now the opposite. We need to look more and more closely—beginning with let’s not wait so long.

Heather Reisman:
I think I’m hearing you say by the time the symptoms of Alzheimer’s are obvious, or present themselves, a person might have already had Alzheimer’s for 10 or 20 years.

Dr. Dale Bredesen:
That’s correct. Now, what I’m saying is when you get a diagnosis of Alzheimer’s. And again, this is one of the problems. There are four general phases. And it’s—it’s a little bit like saying, “Imagine we had all the cancer researchers looking for cures but they didn’t call it ‘cancer’ until it was widely metastatic.” That’s the problem with Alzheimer’s; we have people studying this at a very, very late stage.

So the first stage is, again, where you have no symptoms. And that typically lasts several years by itself. You’ll then have mild symptoms for about 10 years; and that is called SCI, Subjective Cognitive Impairment, really should be called Earliest Stage Alzheimer’s, because it—it is already now the second stage. You know there’s something wrong but, by definition, you are still testing in the normal range in your cognitive assessments.

The third stage, out of four, is called Mild Cognitive Impairment. And that has actually hurt us because people will say, “You know, it’s mild. Come back next year. You’re not that bad yet.” So that’s a time when we actually should be calling that Relatively Advanced Stage Alzheimer’s disease, because we need to jump on it then and actually make sure that we take care of it.

And then the fourth is Alzheimer’s, where you’re losing the activities of daily living.

So again, we want to get people in the SCI—if not for prevention then at least at the SCI or, at very latest, early MCI stages. And there’s a lot we can do then.

Heather Reisman:
Let me ask you, Dr. Bredesen, how much of getting Alzheimer’s, or a related kind of dementia, is strictly in our genes? And how much is potentially lifestyle-related and therefore something we can take action on to avoid?

Dr. Dale Bredesen:
Ninety-five per cent of this is modifiable. And by that what I mean is only five per cent of people get this as a familial Alzheimer’s disease. But for the other 95 per cent, the vast majority of us, this is sporadic Alzheimer’s. Your genes can give you an increased risk—just as they do for cardiovascular disease—but they are not your fate.

So there is a tremendous amount you can do about it. And I mentioned in the books, the idea of the “36 holes in the roof” tells people, yes, there are many different contributors. You know, this is the beginning of a new era of network disorders—whether you’re talking about frontotemporal dementia, ALS, Alzheimer’s, these are network disorders that have multiple things. So this is now the era of systems biology and looking at all the different pieces.

Heather Reisman:
You note that what we eat has a big impact on brain health. Can you expand on this for us, expand on how what we eat impacts our risk of getting Alzheimer’s?

Dr. Dale Bredesen:
Of the “36 holes in the roof” that we talk about, food is arguably and—and nutrition arguably the most important one of all. And yes, starting with sugar. But beyond that, what you eat is so critical in a number of ways.

Second thing is: are you getting yourself into an energetically positive state? What happens with people with cognitive decline, they have the worst of both worlds. They’ve lost the ability … Your brain responds to two major things: it responds to glucose; it responds to ketones. Those are the ketones coming from fats. So you’ve basically got two. It’s—it’s a little bit like a Prius. You’ve got two ways to go. Right?

Now imagine that the Prius, your brain, is no longer responding to either one. So as you become insulin-resistant and you’re feeding yourself with more and more sugar, you now don’t respond to the glucose but you’re also not making ketones. So you want to have both. And that is specifically called “metabolic flexibility”—the ability to go back and forth. You’ve got your Prius now working on electric and gas.

So we want to retrain our brains, because so many of them have lost that ability to be responsive to both the ketones and the glucose.

Heather Reisman:
So what does this actually mean for me for breakfast, lunch, and dinner?

Dr. Dale Bredesen:
Whatever you want to do that achieves the following biochemical parameters. Number one: you want to have a low-carb diet. Specifically low simple carbs. You want to have virtually no sugar—as low in sugar as you can and other, you know, other simple carbs.

Second thing: you want to have the ability to get good fats and generate ketones.

Then you want to have the phytonutrients, which is why we suggest a plant-rich—it doesn’t have to be plant-exclusive.

Then you want to detox, and you want probiotics and prebiotics so that you are getting your gut to help you. Again, we think of ourselves as single organisms, you know, when we’re about a trillion different organisms together. We’re kind of like the man o’ war with all the different organisms working together.

Heather Reisman:
Can you just tell us, in laypeople’s terms, what is our microbiome?

Dr. Dale Bredesen:
Yes. And of course we have microbiomes in our sinus, in our mouths, but the one that’s talked about most, of course, is the gut microbiome. So especially in your colon, you have many, many millions—somewhere toward, you know, a trillion or so—organisms. As is often pointed out, you are more, you know, non-human organisms than you are human when you come to cell count, actually. You have viruses there. You have bacteria there. You have fungi there. You have all these different things that are working together.

So when things are going well, these are all working together to improve your neurotransmission, to improve your blood pressure, to improve your mood—all these things. When things are going poorly, you actually have the wrong type of microorganisms, and that’s associated with depression, and with Alzheimer’s, and with Parkinson’s, and many things like that.

Heather Reisman:
So, what I hear from you feels to me like it’s just a clarion call for us to embrace leading-edge science and take control of our well-being early, to build our chances of never getting Alzheimer’s. That’s pretty exciting.

Let’s turn a little bit now to the experience you’ve have had with the people who have already been diagnosed. Perhaps you could start by telling us the story of Kristin, who was your very first patient on the Bredesen Protocol.

Dr. Dale Bredesen:
Great point. And we had only done this, you know, in the laboratory. When she approached me, I mean, I hadn’t seen a patient in 20 years. We had been working on mice with “mouseheimer’s,” ah, flies with “alzfleimer’s,” and cells for years and years. And I got a call saying would I—would I see this person. And I said, “Look. I don’t know if there’s anything I can do.”

We had been turned down to do the first clinical trial. And actually we just posted the clinical trial a few months ago: 84 per cent of the people actually improved their scores. So we’re very excited about that.

And this woman—we went through, “Here are the things that we were going to try to get done in this trial. If you want to take this to your physician, please feel free.” And so when I got a call on a Saturday at my home, three months later, and she said, “I can’t believe it. I’m better than I’ve been for 20 years. I’m back at work. Everything’s great.” I was really excited. And I have to say, I—I did not think I would ever hear from her again.

And so I turned to my wife, who is a family practice physician, who actually had told me, “You know, whatever you guys find in the research lab, it’s going to have something to do with basic processes like this.” And I said to her, “No, no. We’re going to find one molecule, one domain. And there’s going to be a drug, and it’s going to fix everything.” And I just was not thinking at the network level, at that time.

Subsequently, the research showed us this is a network illness; you have to look at all these things.

So Kristin, by the way, nine-and-a-half-years out now—she started in 2012—still doing very, very well. She is now a brain health coach. And of course she has all sorts of wonderful experiences to draw on.

When you see people get better, when you’re actually attacking the things that are causing it, then they stay better.

[music]

Heather Reisman:
At the end of every episode, we like to ask our guests a few fun questions. Let’s start with this. Of all the books that you’ve read, which book or couple of books have most profoundly impacted the way you approach the world?

Dr. Dale Bredesen:
Wow. Yeah, that’s a great question. Do I get to include Dante’s Inferno?

Heather Reisman:
You sure can, if you want to.

Dr. Dale Bredesen:
You know, that—that was something that I thought was profound and interesting.

And then, I would say, another one that I found very illuminating was The Great Gatsby.

Heather Reisman:
Mm!

Dr. Dale Bredesen:
And then there was a book called “Stupor in Coma,” that was written by Fred Plum and Jerome Posner, that was about, you know, what—what caused people to become stuporous or comatose. And it was one of the best books I read in terms of understanding the brain, understanding what, you know, what makes it work.

And then, am I allowed to say one that’s crazy that nobody will believe in?

Heather Reisman:
Absolutely!

Dr. Dale Bredesen:
So, there’s a book called Surviving Death, by Leslie Kean. Have you read this?

Heather Reisman:
No, I haven’t.

Dr. Dale Bredesen:
It is absolutely fascinating. As a scientist, you know, you pick it up and say, “Wait a minute. This person is telling me there’s something after death and—and she’s going to prove it to me? Come on, this is ridiculous.” She is an investigative reporter. And she makes a case that if you’re an open-minded scientist, you just basically say, “More research needs to be done,” because clearly people are denying reality. So that—that was an absolutely fascinating book, Surviving Death.

Heather Reisman:
One last question: what brings you joy in life?

Dr. Dale Bredesen:
Basically, you know, two things: family, and laughing with family; you know, surfing. I still talk to my old surf buddy. You know, every month we catch up on what’s going on. And just, you know, those sorts of things. Exercising, running around. I love to, you know, play tennis, pickleball, stuff like that. Getting outdoors.

And the other thing is conceptual knowledge. You know, I’m basically a theoretician. I—I’m trying to understand, “Why does the brain work this way?”

Heather Reisman:
Last question and I’ll let you go to have a beautiful evening. What does purposeful living mean to you?

Dr. Dale Bredesen:
To me, purposeful living means living with goals—as they say, a goal is a dream with a deadline—having more than you kind of stumbled onto the planet. A purposeful life means trying to leave the world a better place than it was when you came in.

Heather Reisman:
Mm.

Dr. Dale Bredesen:
And you know, living with that each day.

Heather Reisman:
That’s such a beautiful thought for us to close on. Look, I could go on. But I just want to say that it is a privilege to be able to talk with you, Dr. Bredesen. And I’m grateful for all of your work.

Dr. Dale Bredesen:
Thank you so much. Let’s make this a rare problem.

[music]

Heather Reisman:
Thank you for tuning in to our conversation with Dr. Dale Bredesen. For more ideas to help you live well, including the books featured in this episode, The End of Alzheimer’s and The First Survivors of Alzheimer’s, visit indigo.ca/podcast. If you enjoyed this episode, please leave us a rating on Apple Podcasts. You can follow us wherever you listen to your podcasts.

Well Said was produced for Indigo Inc. by Vocal Fry Studios and is hosted by me, Heather Reisman.

Announcer:
The information provided in this podcast should not be relied upon by our listeners as medical advice, even where it has been presented by physicians or medical practitioners. Any information presented in this podcast is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment. The views expressed throughout this podcast represent the views of the guests and do not necessarily represent the views of Indigo.