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Dr. Nally’s Dementia Protocol

My medical practice is located between the Sun Cities, the beautiful retirement communities on the North West side of the Phoenix Valley.  Over the years my practice has grown with a predominantly large number of patients over 55 years old.  It is a wonderfully diverse group of very dynamic and intelligent people.  Yet, something that has bothered me for many years is the significant risk these patients have for dementia.  One of the most disturbing parts of my job, over the 22 years of my practice, is to see these vibrant patients’ progress down the road to Alzheimer’s dementia. 

To date, there have been over 400 failed clinical drug trials for the treatment of Alzheimer’s Dementia and only a few drugs that showed any mild success at slowing the progression of the dementia. The current medical literature estimates that 30% of these patients will die of Alzheimer’s type dementia.  This statistic has played out in my practice until I started applying the principles of correct diet and lifestyle modification. 

Four Stages of Dementia

There are four stages or phases of dementia that start 20 years before a person ever reaches the diagnosis of dementia. That is important, because this disease can be stopped in it’s tracks:

  • Phase 1 – asymptomatic – abnormal CSF and abnormal PET scans.
  • Phase 2 – Subjective cognitive changes (may last 10 years), symptoms without abnormal cognitive testing. 
  • Phase 3 – MCI – (Mild cognitive impairment) – abnormal cognitive testing, normal activities of daily living (ADLs), 5-10% convert to dementia each year
  • Phase 4 – Final phase of Alzheimer’s disease, ADL’s affected, diagnosis made 20 years after initial biochemical changes.

I’ve been closely following Dr. Dale Bredesen and his protocols in treating and preventing dementia.   To my delight, the following protocols have been very effective at delaying, preventing and actually reversing dementia in my patients.

So, to help you, I’ve written out my protocol (adapted from Dr. Bredesen’s protocol) for dementia treatment and prevention below.

Fat Burning

First, burning fat is crucial. The brain can use two fuels, glucose and fat, but it works better on fat.  Alzheimer’s is associated with a decrease in glucose utilization. A three-pronged approach to begin burning fat includes:

Addressing Insulin Sensitivity

I cannot emphasize this enough. Controlling blood sugar and insulin excess is foundational. Abnormal insulin production dramatically effects the thyroid and all of the sex hormones. Restoring function of the pancreas through diet and the use of Berberine 500 mg twice daily.  If you are diabetic, tight control of blood sugar and using appropriate medications that do not stimulate over production of insulin is essential.

Insulin resistance must be improved (lowering fasting insulin to < 5 ng/dL) and restoring the normal insulin sensitivity is key. This can take up to two years to improve with the correct diet.  Insulin at the correct levels is a key growth factor for neurons.

Insulin sensitivity can be restored by the following:

Health Support

Third, it is important to optimize all nutrient, hormone, and trophic (growth factor) support. This support means we can create resilience, optimize our immune systems, support our mitochondria, and begin to rebuild our brains’ synaptic networks.

Low levels of trophic factors (growth factors) such as vitamin B1 (thiamine), vitamin B12, vitamin D, testosterone, estrogen, and nerve growth factor are all associated with cognitive decline.

Other necessary nutrients for optimal cognitive function include vitamin C, vitamin E, vitamin K2, omega-3 fats, choline, and other neurotransmitter precursors, key metals such as zinc, magnesium, copper, and selenium.

Optimum hormone levels are critical for making and maintaining synapses. Optimal nutrition and lifestyle will lead to optimal hormone production for many of us. Ketones from the diet or used exogenously have been powerfully helpful.

However, other patients will need to support optimal brain function by achieving the healthiest levels of thyroid, pregnenolone, estradiol, progesterone, testosterone, DHEA, and cortisol. These are checked through your doctor and are levels that I monitor every 3-6 months with my patients.

Reducing Inflammation

Fourth, we want to optimize the way the body uses inflammation. It’s important to allow the body to increase inflammation when it’s actually necessary, but also to resolve inflammation when it’s no longer needed. 

Dr. Nally emphasizes minimizing inflammation without a purpose, which is often referred to as “chronic inflammation.” Amyloids often associated with Alzheimer’s disease are part of our body’s inflammatory response. 

Leaky gut is the most common cause of chronic inflammation. This can be caused by:

  • Stress
  • Alcohol
  • Excessive sugar intake 
  • Processed foods
  • Aspirin and related anti-inflammatories
  • Soft drinks with the crappy sweeteners
  • Excessive use of  Proton Pump Inhibitors (PPIs) (used to treat reflux or heartburn)
  • Other damaging agents

We need to know the status of our gut health.

Chronic inflammation with or without a leaky gut may also be caused by periodontitis, gingivitis from suboptimal dentition, or an infection of a root canal in your mouth.

In fact, chronic periodontitis, an inflammatory condition of the gums, may be a direct link to Alzheimer’s disease.

Other causes include chronic sinus infections, or ongoing infection with pathogens such as Borrelia, or metabolic syndrome (insulin resistance, high blood pressure, high triglycerides, and inflammation, often accompanied by obesity).

There are also cases of chronic inflammation due to ongoing exposure to air pollution or mold toxins. Determining the root cause of inflammation is just the first step.

Next, the inflammatory agent or cause should be removed. Once that’s resolved, preventing further inflammation is essential. Several excellent anti-inflammatory alternatives to drugs (NSAIDs) include curcumin, fish oil or krill oil (omega-3 fats), ginger, and cinnamon.

Treating Pathogens

Fifth, we must treat chronic pathogens. Chronic undiagnosed infection can be a contributing factor in cognitive decline. It needs to be identified and targeted. We all live with more than a thousand different species of microbes.

Even the brain may harbor bacteria, viruses, spiral bacteria, fungi, or parasites. Our brain’s protective response to these pathogens causes the very changes we call Alzheimer’s disease. The goal here is to reach and maintain a balance of these microbes.

Addressing Toxin Exposure

Sixth, we emphasize the need to identify and remove toxins. Metals such as mercury, organics like toluene and benzene, and biotoxins like mold toxins (mycotoxins) can lead directly or indirectly to cognitive decline.

Optimizing Sleep

Dr Nally’s Protocol necessitates ruling out sleep disorders and optimize sleep. The amount of oxygen saturation in our blood as we sleep can plummet, which affects our brain’s optimum functioning. Oxygen saturation can be a significant contributor to cognitive decline.

Thankfully, it’s also easily addressed. A dental device APAP or CPAP device can improve oxygen intake through the night. On the other hand, simply reducing inflammation or weight can improve many people’s oxygen saturation and cognition.

That’s why it’s necessary to have a personalized program implemented by a qualified practitioner based on individual lab and other testing results. 

Identifying and targeting the various contributing factors, even down to genetics, with a plan for removalresilience, and rebuilding can tip the scale in preventing and even reversing Alzheimer’s disease. Early identification and treatment show the greatest promise.

This protocol is based on 40 years of research and the Amyloid Hypothesis, which has found that beta-amyloid accumulates and finds its way into synaptic clefts. This protein interferes with synaptic communication. 

The amyloid then collects, forming plaques that activate enzymes. This leads to the formation of neurofibrillary tangles (NFTs) inside the neuron. NFT formation activates immune cells called microglia surrounding plaques, promoting microglial activation and local inflammatory response and contributing to neurotoxicity.

The Six Alzheimer’s Subtypes Identified by Dr. Bredesen

  • Type 1 Alzheimer’s disease is inflammatory, or hot
    • Ongoing or chronic inflammation puts you at greater risk for developing Alzheimer’s
  • Type 2 Alzheimer’s disease is atrophic, or cold
    • Sub-optimal levels of nutrients, hormones, trophic factors (cell growth factors like NCF, nerve growth factor) increases your risk for Alzheimer’s disease.
  • Type 1.5 Alzheimer’s disease is glycotoxic, or sweet
    • High blood sugar or high fasting insulin levels increase your risk for Alzheimer’s disease. It is termed Type 1.5 because it has features of both Type 1 and Type 2. High cholesterol may also come into play.
  • Type 3 Alzheimer’s disease is toxic, or vile
    • Exposure to toxins such as mercury, toluene, or mycotoxins (made by certain types of mold) leads to an increased risk for Alzheimer’s disease. Although we all experience this exposure to a greater or lesser degree, the key is to minimize it by identifying and removing or minimizing exposures.
  • Type 4 Alzheimer’s disease is vascular, or pale
    • If you have cardiovascular disease, you are at an increased risk of Alzheimer’s disease. Vascular leakiness is one of the earliest changes identified in Alzheimer’s disease.
  • Type 5 Alzheimer’s disease is traumatic, or dazed
    • A history of head trauma — from accidents, falls, or repeated sports-related head injuries — increases your risk for Alzheimer’s disease.

Most patients with Alzheimer’s disease have more than one type and present multiple risk factors.

Get Screened and Get Optimized

In our office we screen for dementia with regular labs looking at all the factors above, MRI scans and a yearly COGNITRAX mental status test.  This is covered by insurance and by Medicare.  In fact, they recommend it yearly with your annual wellness visit.

Second, we perform autonomic nervous system testing yearly that looks for metabolic causes of inflammation and stress.

The key markers that I have found essential to balance in this population are:

  • HS-CRP
  • HbA1c
  • HOMA-IR
  • TG:HDL ratio
  • small dense LDL particle
  • Fasting Insulin
  • Homocysteine
  • Vitamin D
  • MRI with grey matter volume measurements

This multi-factorial seven tiered approach has been tremendously effective the delaying and treating progressive dementia. If you have any risk for dementia, get in to your doctor and get your brain checked. Or, call my office and schedule a comprehensive dementia evaluation.

Dr. Nally’s Twenty Two Tough Truth’s

Sunday’s are my day of rest, . .  . if a physician ever really rests? I’m sitting out under the stars very late on this Sunday evening, into the wee hours of Monday morning.  (It’s our turn for flood irrigation at 2 o’clock in the morning).  But, I appreciate these times of solitude.  It is on Sunday’s that I’ve been able to work on twenty two life lessons (tough truths) that make life better. I do my best to treat Sundays as a “sacred” or “holy day,” a day of rest from my temporal labor, to contemplate the word of God, to pray & meditate, to participate in public worship and focus on where I am at in my personal spiritual development.

Yes, I know.  I’m a physician; and yet, I believe in God.

No, it is not a contradiction.  (I can already see my in-box filling up with agnostic castigation.)  Friends of mine claim atheism or agnosticism.  Yet in the day to day trenches of life, I find there is no real atheism. There is no such thing as not worshiping.  When it comes down to it, we all worship something.  We each have the choice of what we worship.  Worship being defined as giving adoration, reverence or homage to someone or something.

We have the choice of worshiping the God, a god (however you may define god), spiritualism, truth, ethical principles, nature, football, money, your body, someone else’s body, power, fame, etc.  You and I know this on a basic level, we just have to come to grips with what it is we hold on a pedestal, and to which we “pay homage.”

There comes a point, when one deals with life and death on a daily basis, that a person must question the very existence of God, and come to terms with who or what we actually pay homage.  I’ve sincerely asked that question . . . I’ll leave that story for another time.

It’s during my Sunday afternoons, that I’ve been able to contemplate and attempt to re-apply the “tough truths” of life that seem to challenge me.  So, instead of sharing some bacon with you this evening, I thought I’d share twenty two of the truths that I am working on improving in my life. (Though . . . they’re almost as good as bacon!)

Twenty Two Tough Truth’s that I’ve Learned & Had to Re-Learn in Life:

  1. There is much about life over which we have absolutely no control. You cannot control everything that happens in life, but you can control how you respond.  Your response is your greatest power.  “The joy we feel has little to do with the circumstances of our lives, and everything to do with the focus of our lives.” (Russel Nelson)
  2. It’s not about the cards you’ve been dealt, it’s about how you play the hand. (Randy Pausch)
  3. W. C. Fields said, “Smile first thing in the morning and get it over with.”  My expectations often make me utterly unhappy.  Happiness is letting go of what you assume your life is supposed to be like right now, and sincerely appreciating it for everything that it actually is. 
  4. In mortality, we will always be incredibly imperfect.  If you wait until you’re perfect before you share your stories, ideas, talents and gifts with the world, no one will ever hear from you.
  5. A moment spent worrying is a moment wasted. Worrying will NEVER change the outcome.  Do more, worry less. Train your mind to see the lesson in EVERY situation, and then make the very best of it.  Liberating ourselves from our fears, automatically gives people the ability to do the same around you.  
  6. The best lessons often come from the very hardest days.  If you are having a hard day, stand strong, there is a lesson here.  Sometimes you have to experience a low point in life to learn a good lesson you couldn’t have learned any other way. 
  7. Success easily gets to our heads, and failure easily gets to our hearts.  Our true character is usually revealed at our highs and lows.  Be humble at the mountain top, steadfast in the valley’s and faithful in between. 
  8. We often confuse being busy with being productive.  What you pay attention to grows.  So, focus on what truly matters and let go of what does not. “You are the average of the five people you spend the most time with.” (Jim Rohn)
  9. More money left un-managed just creates more problem.  Yes, we need money to live.  Earn it. Save it. Invest it. But, avoid spending money you haven’t earned, to buy things you don’t need, to impress folks you don’t even know. Manage your money so it doesn’t end up managing you. 
  10. Most of us don’t need more to be happy – we need less.  When things aren’t adding up in life, begin subtracting.  Life gets much simpler when you clear away the physical and mental clutter that makes it complicated. 
  11. Our fancy gadgets (phones, computers, tablets, radios, etc.) often get in our way and dehumanize us.  We all need to learn to be more human again.  Don’t avoid eye contact.  Don’t hide behind the gadgets.  Smile often.  Ask about people’s stories . . . And, then, listen.
  12. We don’t always get what we give.  You will end up sadly disappointed if you expect people will always do for you as you do for them.  Not everyone has the same heart you do. 
  13. Most arguments we have with one another are pointless.  Be selective in your battles. Peace in this moment may be better than being right. You actually don’t need to attend every argument into which you’ve been invited. “You will never reach your destination if you stop and throw stones at every barking dog.” (Winston Churchill)
  14. I’ve never met a strong and confident person with an easy past. Be grateful for your scars.  Be thankful for the emotional muscle and physical strength you gain from standing against the winds of life.
  15. The only way to completely avoid pissing people off is to do nothing of importance. 
  16. The true definition of “Hell” is to meet the person you could have become on your last day on earth. 
  17. Just because you fell off the ketogenic wagon today, doesn’t give you license to drag it into the woods, set it on fire and use the insurance money to buy Twinkies
  18. “You only live once, but if you do it right, once is enough.” (Mae West)
  19. Ignoring your passion in life creates anxiety.  Ignoring the anxiety, creates panic and hopelessness. Never ignore what moves you. Mold your work around the lifestyle that brings you passion, don’t mold your passion around your career. 
  20. The human body tends to move more or less in the direction of your expectations.  This is why it is so important to know that the attitudes of confidence and determination you feel and hold are just as much a part of your treatment program as medical science and technology.
  21. The hottest places in Hell are reserved for those, who in times of great moral crises, maintained their neutrality. (paraphrased from Dante Alighieri)
  22. A man would do well to carry a pencil in his pocket, and write down the thoughts of the moment.  Those thoughts that come unsought after in the moment are commonly the most valuable, and should be secured by recording them, . . . because they seldom return.  (Brigham Young)

Over the years, I’ve carried a leatherbound little notebook with me and I write down thoughts or quotes I hear into that little note book.  Among these thoughts and quotes I’ve collected, I’ve found that on Sundays, I can let my mind chew on them.

One of the things that I’ve learned over the years is that observing a weekly “day of rest,” or “holy day,” is that this behavior is one of the most important safeguards to health and wellness.  I’ve learned this from my personal experiences during periods when I didn’t observe the “day of rest” and periods where I have closely guarded that “day of rest.”  I’ve found that observing the Sabbath has truly become a “delight” as spoken of by the Old Testament prophet, Isaiah.

Science Demonstrates Importance of Day of Rest

What is fascinating, is that science has recently demonstrated how this works.  In early 2000, Marcus Raichle from Washington University demonstrated that the human brain demands 20 percent of the body’s energy and uses only 5-10 percent more when solving calculus problems, reading a book (or this blog post, for that matter) or writing a letter.  However, they noticed that some areas of the brain became notably less active when concentrating on a mental challenge, but fired synchronously when laying flat in an MRI scanner, allowing their thoughts to wander (1).

This was confirmed by a number of other researchers who noted that there was a coordinated communication between diverse areas of the brain when people were “resting.” This mysterious coordination between different parts of the brain during “daydreaming” has become known as the default mode network (DMN).  In the last few years, we’ve learned there are actually five different “resting state networks” that coordinate vision, hearing, movement, attention & memory. However, the DMN is the most researched and appears to be the most important.

Dr. Immordino-Yang reviewed the research on the DMN and found that downtime is an opportunity for the brain to make sense of what it has recently learned. It is during this “day of rest” that the mind coordinates unresolved tensions, conversations we had earlier in the week, re-writing verbal blunders, and practicing standing up to those that intimidate us.  Our minds shuffle through the neglected to-do lists and post-it notes on the mental refrigerator of our brain, searching for solutions and answers.  It moves back and forth through childhood scenes and futuristic adult hopes and dreams. It is during this time that our brain looks at the moral connotations of our performance with others (3).

Other research demonstrates that the mind solves very tough problems during this period of rest and day-dreaming.  You may have experienced something like this when you solve a problem while in the shower.  (I hate to admit it, but many of my problems get solved in the shower.)  When the mind isn’t actively working or learning something new, it can accumulate, memorize and rehearse recently learned skills, actually transcribing them onto new brain matter (4).  Recent research demonstrates that this recording of new memory and skill, called “sharp-wave ripples” actually occurs more often during “rest periods” than during sleep (5).

Meditation and the Day of Rest

Meditation and/or prayer have been shown to strengthen connections between regions of the DMN.  Those that observe a day of rest with meditation develop a more intricate wrinkled cortex, the outer layer of the brain that gives us the ability to perform abstract thought and introspection.  Meditation appears to increased both the volume and density of the hippocampus, the area of the brain essential for memory storage and the frontal cortex that allows us to control or rein in emotions.  Fascinatingly, meditation and observance of a “day of rest” slows the natural “wilting” of the brain regions required for sustained attention that normally withers as we age (6, 7, 8, 9).

How soon does observing a rest day or “keeping the Sabbath” become effective?  A number of studies show that noticeable changes occur within a couple of weeks.  More importantly, daily meditation has been show to be more effective in the long run than the total hours of meditation over one’s lifetime (10,11).

As a physician and a clinical hypnotherapist, I personally use and recommend daily meditation.  If you want a free copy of my self-guided meditation program for relaxation and weight loss, CLICK HERE.

Now, what I want to know, is does bacon intake during the rest day have any effect on the hippocampus, frontal cortex or wrinkle cortex?  I guess we’ll have to wait for that research to be completed.  In the mean time, check out my membership page to see what we do know about the use of fat and cholesterol does to help attention and energy.

References:

1. Raichle ME, MacLeod AM, Snyder AZ, Powers WJ, Gusnard DA, Shulman GL. “The maturing architecture of the brains default network.”  Proc Natl Acad Sci U S A. 2001 Jan 16; 98(2):676-82.
2. Moussa MN, Steen MR, Laurienti PJ, Hayasaka S.  “Consistency of Network Modules in Resting-State fMRI Connectome Data” PLOSone. 31 Aug, 2012. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0044428.
3. Immordino-Yang MH, Christodoulou JA, Singh V. “Implications of the Brain’s Default Mode for Human Development and Education.” Perspectives on Psychological Science. 29 Jun, 2012. 7(4): 352-364.
4. Payne, JD. “Learning, Memory, and Sleep in Humans.” Sleep Medicine Clinics. Mar 2011. 6(1):15-30.  https://www.sciencedirect.com/science/article/pii/S1556407X10001220.
5. Perlow LA, Porter JL. “Making Time Off Predictable – and Required.” Harvard Business Review. Oct 2009. https://hbr.org/2009/10/making-time-off-predictable-and-required.
6. Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness meditation improves cognition: Evidence of brief mental training.” Consciousness and Cognition. Jun 2010. 19(2): 597-605. https://www.sciencedirect.com/science/article/pii/S1053810010000681#]
7. Luders E, Kurth R, Mayer EA, Toga AW, Narr KL, Gaser C. “The unique brain anatomy of medication practitioners: alterations in cortical gyrification.” Front Hum Neurosci. 29 Feb, 2012. online. https://www.frontiersin.org/articles/10.3389/fnhum.2012.00034/full
8. Pagnoni G, Cekic M. “Age effects on gray matter volume and attentional performance in Zen meditation.” Neurobiology of Aging. 28(10): 1623-1627. https://www.sciencedirect.com/science/article/pii/S0197458007002436
9. Luders E, Toga AW, Lepore N, Gaser C. “The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter.” Neuroimage. 15 Apr 2009. 45(3) 672-678. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184843/
10. Chiesa A, Clati R, Serretti A. “Does mindfulness training improve cognitive abilities? A systematic review of neurpsychological findings.” Clinical Psychology Review. 1 Dec 2010. 31: 449-464.  http://psy.fgu.edu.tw/web/wlchou/perceptual_psychology/class_pdf/Advanced%20Perceptual/2011/2011week15_HaoChen_paper.pdf
11. Chan D, Woollacott M. “Effects of level of meditation on experience on attentional focus: is the efficiency of executive or orientation networks improved?” J Altern Complement Med. 2007. Jul-Aug. 13(6): 651-657. https://www.ncbi.nlm.nih.gov/pubmed/17718648.