Chiropractic + Naturopathic Doctor • May 2019 • Brain recode

Mild cognitive impairment (MCI) is considered a pre-Alzheimer’s disease, characterized by memory problems, impaired thinking, language difficulties, disorientation in time and space, poor judgement and impaired depth perception. Approximately 10-15 per cent of those with MCI will continue on to develop dementia, according to the Alzheimer’s Society.

The tragic social and economic impact need not be highlighted as these diseases have likely touched just about everyone in some manner.

Currently there are no successful pharmaceutical solutions approved for MCI. Clinical trials on two classes of anti-dementia drugs (cholinesterase inhibitors and glutamate receptor antagonist) have been disappointing (Steiner, Bensoussan, Liu, et al, 2018). Dementia has multi-factorial contributing factors and as a result, a one cause, one cure approach is ineffective.

Alzheimer’s has been considered one of the “irreversible” dementia’s but looking at the work of Dr. Dale Bredesen, this is now being re-defined. Dr Bredesen, an expert in the area of neurodegenerative disease, is the founder and CEO of the Buck Institute for Research on Aging, and developed the ReCODE (Reversing Cognitive Decline) protocol. ReCODE addresses cognitive decline from an integrative functional medicine approach and has successfully shown the reversal of cognitive decline in both Alzheimer’s related dementia and MCI (Bredesen, Amos, Canick, et.al. 2016). Dr. Bredesen looks at the disease as physiological imbalances, a synaptoblastic:synaptotrophic imbalance due to metabolic disturbance. Not only has his protocol demonstrated to reverse cognitive decline in areas such as memory, but has actually shown to restore lost hippocampal volume, a key area showing volume loss in diseased brains. (Bredesen, Amos, Canick, et al. 2016) It is also important to understand it is difficult to successfully treat something without understanding the true cause.

There has been a shift in the understanding of the role of amyloid-beta plaques and tau tangles in Alzheimer’s disease. Although these are common traits seen in the brains of these patients, their presence is not necessarily the cause of the disease, but rather the brain’s reaction to neurotoxic effects. In fact, amyloid plaques and tau tangles may be antimicrobial, act as binders of divalent metals, and be a response to a reduction in trophic support. The presence of amyloid beta and tau tangles are therefore more of an effect and not necessarily causal. This would explain why efforts focused only on their reduction has lead to poor outcomes.

Addressing MCI or dementia involves a personalized and programmatic approach (Gustafson, 2015). Identifying and understanding the subtypes of the disease aides in directing where to start in the multiple points of repair addressing 36 metabolic imbalances – referred to as “36 holes in the roof.”

1.Inflammatory (“hot”). Includes causes leading to systematic inflammation including infections, resulting in elevated high-sensitivity C-reactive protein, low albumin:globuin ratio, high cytokine (including interleukin 1 and inter leukin-6)

2.Non-Inflammatory. Atrophic (“cold” loss of trophic support) Reduction in synaptogenesis, reduced support from sex hormones, brain-derived neurotrophic factor, nerve growth factor, insulin, vitamin D, often with increased homocysteine and insulin resistance. There is subtype noted as 1.5: Glycotoxic (“sweet”) Combines both 1 and 2 subtypes.

3.Cortical (“toxic”) An environmental toxin related subtype with chronic inflammation presenting with more general cerebral atrophy. Affects more cognitive functions but not typically memory, seen in younger patients (<65yrs), more often in women, often in APOE negative.

There are additional subtypes including vascular and traumatic have also been cited. (Bredesen, 2015). Although there are differences in these subtypes there are also unifying and overlapping causes.

The first step in this approach is identifying the subtype and then taking a wide approach, involving genetics and lifestyle factors that include diet, sleep, exercise and environmental exposures. Why is this important as a chiropractor? We have the ability to help guide and address key lifestyle areas with patients, and be a conduit for referral to ReCODE doctors, or become certified in the ReCODE protocol.

The ReCODE protocol looks at 36 metabolic imbalances. For optimal outcome all 36 points may be addressed. However, as Dr. Bredesen experienced with one of his first cases, addressing 12 of the 36 points may be enough to get over a threshold (Gustafson, 2015). An important point to remember in this program is the goal is to not only ‘normalize’ metabolic function but to ‘optimize’ metabolic function. An example of this are the optimal values to aim for in these specific areas:

The therapeutic systems look to address the 36 holes identified in the protocol first developed and published in 2014. [Table 1. Therapeutic System 1.0 (Bredesen, 2014)] (Visit canadianchiropractor.ca/brainrecode to view the chart.)

The processes are complex and interconnected, addressing the list below helps to simplify the approach in a step-by-step process for repairing the 36 holes. One step builds on the other and the threshold for improvement is individually determined.

•Reduce inflammation (use biomarkers such as hs-CRP, IL-1, IL-6, TNF alpha) •Normalize glucose and insulin

•Optimize levels of key nutrients including antioxidants, vitamins and minerals

The best way to demonstrate the protocol is by one of the published case studies in the original 2014 paper (Bredesen, 2014). Summary of Patient:

•11-year history of progressive memory loss. Lost the ability to quickly add numbers/columns in his head

•Multiple testing including PET scan and neuropsychological testing indicating progressing Alzheimer’s disease process was diagnosed

•Labs indicated various markers outside of optimal range including homocysteine, Vit. D, CRP, sex hormones, zinc, copper, thyroid hormones

•Consumed non-farmed fish, occasionally consumed grass fed beef or organic chicken

After six months on this program the patient, his coworkers, and his wife all noticed marked improvement. He reduced his weight by 10 pounds. Recognition of faces, his memory for work schedules and his ability to quickly add numbers all returned. The rapid and significant cognitive decline in the past few years halted.

Many of these action steps for repair may not be new to integrative doctors. The avoidance of processed foods, eating diet leaning towards ketogenic, reducing inflammation, sleeping, optimizing nutrients, and exercising may seem obvious to some, but the key is employing all of these things to repair the 36 holes and aiming for optimal ranges in stated biomarkers.

DR. VICTORIA COLEMAN is a graduate of the CMCC and a 25-year veteran in health care delivery both clinically and in business development. Dr. Coleman introduced and was President of Douglas Laboratories/Pure Encapsulations Canada for 14 years and served as VP of Clinical Education for Atrium Innovations. Victoria is also a Certified Functional Medicine Practitioner through the Institute of Functional Medicine. She is holds a Master’s degree in Human Nutrition and Functional Medicine.