Research brings hope as lifestyle adjustments aid alleviation of Alzheimer's signs in select individuals.
Maida would take a trip to her local market in San Jose, California, yet she'd struggle to recall where she had parked her vehicle. When she'd return home, she'd struggle to remember where the groceries were placed. Her husband, Paul, would occasionally find them secreted away in the garage.
An insatiable reader, Maida chose to stop devouring literature as she couldn't recollect the previous chapter or the primary characters' names.
"I thought for sure I was going mad, and the very fear of losing my mind was terrifying," she confessed to CNN's Chief Medical Correspondent Dr. Sanjay Gupta for the documentary "The Last Alzheimer's Patient."
Currently, Maida is pleased to immerse herself in short novels and help contribute to the family finances.
Mike Carver, a 71-year-old man, was diagnosed with early-onset Alzheimer's at 64 while working as a corporate executive. Doctors advised him to manage his life affairs, with the odds unfavorable. Carver eventually discovered he carried both copies of the APOE4 gene, boasting the highest documented risk for developing Alzheimer's.
These days, Carver has renewed his financial management skills and mindfully monitors investments.
"It's much like a celebratory dance," he joked. "It was jarring to show part of me as seemingly lost. Therefore, much of my self-worth has regained its footing again."
How could Maida and Carver recover what dementia had stolen from them? By taking part in the first-ever randomized controlled clinical trial that deployed lifestyle measures and confirmed improved cognitive function in individuals with mild cognitive impairment or early Alzheimer's disease.
‘A beacon of optimism’
This covert study, presented on October 14th in the European Heart Journal, comprised only 24 subjects receiving therapy and a parallel group fulfilling a control role over a five-month time frame. Not all participants indicated increase in performance. Still, for some individuals and their loved ones, remarkable revolutions occurred.
The conscious awareness abilities of most individuals in the service group remained stable, while the majority in the control group deteriorated. Ten subjects saw cognitive development improve, while a blood test revealed the receding amount of amyloid-beta, a hallmark of Alzheimer's, in said subjects.
"This study offers us hope," said Maria Shriver, a journalist and Ohio's past First Lady, who established the Women's Alzheimer's Movement at the Cleveland Clinic and provided seed money for the investigation.
"This study awards us scientific information that associations in this field have long felt instinctively; lifestyle adjustments can impact how Alzheimer's unfolds."
Although this study spanned merely five months, the findings were "overwhelming," declared co-senior author Rudy Tanzi, a Harvard Medical School neurology professor and Alzheimer's researcher.
"If you visualize a mind full of damage as a sink full of water, when you simply turn off the water tap, it'll take quite some time for the sink to gradually unload. If you desire the amyloid to fall by 20 weeks, you'll require a Roto-Rooter."
The study used a thoughtfully crafted, multifaceted, intense lifestyle intervention that tackled multiple causes of cognitive decay. Those participants who poured the most energy into these lifestyle adjustments observed the greatest advances.
"There was a significantly positive correlation between adherence to lifestyle modifications and observed cognitive enhancement," Ornish, the creator of the Ornish diet and lifestyle medicine program, founder, and president of the nonprofit Preventive Medicine Research Institute elucidated.
"I would plead this as a genuinely positive, introductory undertaking, a commencement point for further studies," enthused Dr. Suzanne Schindler, an associate neurology professor from Washington University School of Medicine in Missouri, who acted as a passive observer in the study.
"I wish we could design a method like this for everyone, not just people with mild cognitive impairment or early-stage Alzheimer's."
‘Consume well, Move more, De-stress and embrace connection’
The lifestyle upgrade Ornish designed — "eat well, move more, de-stress, and foster love" — has been showcased before. In 1990, Ornish conducted the first randomized trial to demonstrate that heart disease could be inversely impacted by nothing more than diet, exercise, stress reduction, and social support.
Notable research has since determined these four-part strategies can reduce circulating glucose levels in patients with diabetes, stifle elevated heart disease risk, chill depression, and decrease "bad cholesterol."
"How can these same four lifestyle adjustments thwart, and at times reverse, a range of the most common and aggravating chronic diseases?" Ornish inquired.
"It's because they all share various underpinning biological processes: ongoing inflammation, oxidative damage, alterations in the microbiome, changes in gene expression, and numerous additional diversities."
"We often wonder how our daily decisions impact our health, specifically our heart and brain. What we eat, how we deal with stress, the amount of exercise we get, and the level of love and social support we receive can activate or suppress various mechanisms.
Dean Ornish, a well-known doctor, questioned why this lifestyle intervention wouldn't work on early Alzheimer's or other forms of dementia. He remarked, "If our patients didn't improve at all, that would be a crucial finding, but it's necessary for people to know. But if we found that we could slow, stop, or even reverse the progression of Alzheimer's disease, that would be a significant finding as well."
To answer this question, Ornish and faculty from other leading academic institutions started recruiting patients for a new study. However, the pandemic hindered the study's progress, but the team discovered they could provide the intervention through video conference calls.
This was a game-changer as previously, individuals needed to live near hospitals or clinics that offered the program. Now, anyone can participate regardless of their location, even in areas with limited access to healthy food or rural areas.
Fifty-one individuals were chosen for the study and divided into two groups: one group followed a vegan diet, engaged in daily exercise, practiced stress management, and attended online support groups for 20 weeks, while the control group didn't. A nutritionist held hour-long video classes on diet, while a psychologist led just as long group sessions three times a week where participants shared their feelings and received support.
A fitness instructor led online strength training and encouraged 30-minute daily walks. Meditative practices such as meditation, deep breathing, yoga, and other stress-reducing activities took up an hour every day. The program also emphasized the importance of quality sleep.
Supplements were provided to everyone in the intervention group in the form of a multivitamin, omega-3 fatty acids with curcumin, coenzyme Q10, vitamin C and B12, magnesium, a probiotic, and Lion's mane mushroom (Hericium erinaceus).
To ensure adherence to the vegan diet, all meals and snacks for both the participant and their spouse were delivered to their homes. Despite having no caloric restrictions, protein and total fat intake were kept at around 18% of the daily caloric intake. Experts suggest the average American consumes twice as much protein as they need and gets 36% of their calories from total fat.
Whole grains, vegetables, fruits, tofu, nuts, and seeds made up the bulk of this diet. Refined sugar, alcohol, and processed/ultraprocessed foods were avoided. Tanzi, who tests potential treatments for dementia on tiny organoids (composed of human brain cells that show signs of Alzheimer's), stresses the importance of a minimally processed diet.
"The gut microbiome loves the fiber from whole grains, fruits, and vegetables," Tanzi said. "My lab has shown in animals that a happy gut can induce metabolites to the brain that encourage microglial cells to devour more amyloid in the brain."
Microglial cells are responsible for tidying up synapses, taking out cellular waste, and consuming dangerous agents such as amyloid. These cells primarily work at night during key sleep stages. When neurons die due to injury, age, or diseases like Alzheimer's, microglia can become sidetracked, transforming into killers to protect the brain. This could result in a cytokine storm, leading to increased inflammation and brain damage.
To help microglia get back on track, Tanzi advises a high-fiber diet, regular exercise, and sufficient sleep. These lifestyle changes facilitate microglial cells and other amyloid-removing enzymes to resume their duties.
In fact, microbiome testing revealed two organisms that increase the risk of Alzheimer's decreased in the intervention group and increased in the control group. Meanwhile, protective microorganisms increased in the intervention group and decreased in the control group."
"As for the outcomes, while some individuals like Mike Carver and Tammy Maida experienced significant improvements, others in the intervention group didn't see positive changes. One person left the program because he couldn't give up visiting McDonald's after his daily walks."
"Throughout the five-month-long program, Mike and his wife Pat noticed cognitive improvements in addition to losing weight, reducing cholesterol levels, and experiencing lower resting heart rates. Mike's PSA levels, a prostate cancer test, looked better than ever before.
Tammy Maida's sleep improved, and she was able to resume tasks she thought she needed to give up due to Alzheimer's, like doing laundry, cooking, reading books, managing household finances, and running a small business.
She told CNN's Gupta, 'The cloud of the Alzheimer's diagnosis slowly began to lift. Honestly, I am more like my pre-Alzheimer's self than I had been for the years prior to starting Dr. Ornish's program.'"
"However, not everyone in the intervention group experienced improvement."
In a recent study, John Morris, a renowned professor of neurology and co-director of the Knight Alzheimer's Disease Research Center at Washington University School of Medicine, emphasized that the 20-week intervention period had a small sample size of only 24 individuals. Leonard Morris, who was not a part of the research, expressed his thoughts by stating, "Only 10 people out of the 24 in the intervention group showed improvements, leaving 14 others unaffected. While it's intriguing, more extensive research with a diverse population and an extended treatment duration is necessary to draw any definitive conclusions." The participants who underwent the intervention noted considerable enhancements in a blood test known as plasma Aβ42/40, measuring amyloid levels, suggesting the microglia in their brains were active. However, other amyloid tests did not reveal any significant change.
Washington University's Schindler, focusing on blood biomarkers, pointed out that not all the analyzed markers showed consistent results. "The lack of uniform improvement raises questions about the study's findings. If larger populations and longer treatment periods are considered for future research, more substantial changes might become evident," hecommented.
Cici Zerbe, one of the first recruited patients at 85 years old, was previously diagnosed with mild cognitive impairment and dementia due to Alzheimer's disease. Fearing her life would follow that of her mother and grandmother, who both suffered from the same condition, she partook in Dr. Ornish's intervention program in 2019. Now, almost five years later, Zerbe and her husband, John, living in Novato, California, continue to adhere to the program, strongly believing it has been beneficial for her condition.
Zerbe's daughter, Alicia Manzoni, remarked, "It's helped. I think it's slowed it down." Her husband also shared his appreciation, "We're very thankful. My biggest fear was she would end up in a nursing home, but now we see no such signs."
Washington University's Morris underscored that advancements in daily routines and activities are what truly matter for individuals with Alzheimer's and their families. "The true essence for them is their capabilities in carrying out their usual tasks. If a person who struggles with reading can once again read easily, this is a significant triumph," he expressed.
The leader of the study, Dr. Dean Ornish, holds hope as a vital aspect of his findings. "Frequently, individuals diagnosed with dementia or Alzheimer's are told by their doctors there is no future left for them, with the disease rapidly worsening. This news is devastating and may even contribute to its escalation. Instead, I aim to encourage people with the understanding that if they change their lifestyle, they have a good chance of slowing down the progression or, at times, even improving the condition," Ornish stated.
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Maida could incorporate wellness practices to enhance her cognitive function, such as regular physical exercise and mindfulness techniques.
As a result of the lifestyle intervention, individuals in the study showed improvements in both cognitive function and amyloid levels, highlighting the potential of wellness practices to manage Alzheimer's symptoms.
