Dr. Jeffrey Bland (PhD) presents a ~2019 YouTube commentary critiquing a February 2019 JAMA op-ed that dismissed lifestyle and dietary interventions for dementia as "pseudomedicine." He reviews multiple peer-reviewed studies (MIND program 2015; FINGER trial and follow-ups in Lancet and JAMA; 2017–2018 randomized/multidomain trials; imaging/biomarker work on tau/phosphorylated tau and brain-age prediction; a 2019 Scientific American piece) that report positive effects of diet, exercise, cognitive training and multimodal lifestyle interventions on cognitive function, telomere length, and reduced progression of Alzheimer’s disease, arguing these findings contradict the op-ed’s conclusions and support personalized lifestyle interventions.
Chapters
Hi, I'm Dr. Jeff Bland and have you ever had a time in your life where you've just got something stuck in your craw and you can't get rid of it and it just aggravates you? Well, such is the case for me and I'm going to be sharing it with you, so hopefully I can offload a little of my anxiety. This relates to this article that I've already spoken to in the Journal of the American Medical association that appeared in February of 2019 entitled the Rise of Pseudomedicine for Dementia and Brain Health. And you recall in that editorial, it was an op ed was authored by three neurology faculty at the University of California San Francisco Medical School, really attacking, I thought, quite aggressively, those proponents of the fact that there can be something done about the prevention and management of dementia, Alzheimer's related dementia by lifestyle intervention, particularly with diet. And this group really said there's no such thing as proven fact. And this was an anecdote and was exaggeration and was pseudoscience. And ironically they actually took off after one of their own colleagues in the department, Dr. Dale Bredesen, who as you know, has gained, I think, justifiable respect for his work that he's done in bringing to light the mechanisms that underlie how dietary intervention and multimodal intervention, as he called it, can be helpful for both the prevention and treatment of Alzheimer's. So this has been sitting in the literature and really bothering me, this op ed piece in JAMA because it seemed to be totally anti scientific to me. And then I was reminded when I saw a more recent paper in JAMA. This one appeared actually in the July 15 issue of 2019 entitled Putting the New Alzheimer's Disease Amyloid Tau Neurodegeneration Diagnostic System to the Test. And the reason this is interesting is it's a discussion of a new test for early assessment of potential risk and progression of Alzheimer's based upon the presence of tau protein and phosphorylated tau in a blood test that would give early warning assessment, in other words, prevent stage three Alzheimer's assessment. And the authors of this article were extolling the virtues of this test by saying by using this now we'll be able to much earlier understand the advantage that might occur through some interventions that people could undergo to prevent the progression of Alzheimer's. And so now we have a new test developing that couples together with intervention alternative approaches and, and that then takes us Back to the Dr. Dale Brednison quote, pseudo Medicine Approaches towards Improving Cognitive Health And I'm reminded as I went through my mental arithmetic and memory that it was a number of years ago, back when I was doing our monthly audio magazine called Functional Medicine Update, that we had the privilege of interviewing Dr. Martha Morris who, who is at the Resch Medical center in Chicago about the program that they were developing and studying there for early stage Alzheimer's and called me the MIND program. MIND was the acronym and actually they published results on this intervention trial using diet intervention in early stage cognitive Decline back in 2015 in Alzheimer's dementia Journal and showing very positive effects of intervention with lifestyle and diet intervention towards early stage progression of Alzheimer's disease. So this was to me already in the literature starting Fairly early in 2015. And then I was reminded that it was not too long after that that an extraordinary paper was published in the Lancet from an intervention trial that was ongoing in Finland, the so called finger study. This was a two year multi domain intervention trial of diet, exercise and cognitive training monitoring versus controls for cognitive decline in at risk populations for Alzheimer's disease. And this was a randomized controlled trial and you might recall the results of this were extraordinarily, I think, optimistic. And I quote the finding from this large long term randomized controlled trial suggests that a multi domain intervention could improve and maintain cognitive functioning in a risk high group of elderly people in the general population. And so this is like the multimodal program that Dr. Brednason was talking about with his distinction being a little bit more personalization, a little bit more specificity as it relates to the intervention for the individual. But here in kind of a general multi domain approach that was seen in this finished study, the finger trial to have very positive impact on reducing the progression of dementia. Then we go on and more recently see studies being published out of the finger trial group that looked at things like telomere length or telomeres which are kind of a surrogate marker for aging and age related problems and effects on the multi domain of dementia related function. And I'm now quoting from the Journal of Alzheimer's Disease, this is 2017 in a more recent paper showing that this finger intervention trial in finan led to increased length of the telomeres and also a reduction in cognitive decline, actually an improvement in cognitive function again with diet and lifestyle intervention, I'm quoting now published clinical research from academic centers demonstrating a positive effect which to me is antithetical to this quote, pseudo medicine reputation that was thrown out, I think glibly by the neurologist at UCSF in their op ed piece in JAMA. And then we go on to look at a 24 month intervention review of the prodromal Alzheimer's disease in another randomized double blind controlled trial. This appeared in the Lancet neurology issue in 2017. Again showing positive impact after two years of a multimodal intervention program in people with early stage Alzheimer's. And then more recently than that 2018 in Alzheimer's and dementia. Multi domain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of their baseline characteristics. This is another extension of the data from the FINGER trial in Finland. Does this seem like it's repetitive outcome from these types of trials? I think so. And then we go to ask the question, well, what happens if we use some of these new scanning technologies to look for injury to the brain prior to the pathological presentation of Alzheimer's? And now we're starting to see some very, very interesting studies being published out of prediction of brain age and using new scanning technologies and imaging technologies that are associated also with new informatics abilities to do advanced machine learning to actually determine what level of injury the brain has actually had well before the onset of dementia. Showing again that these techniques that can be now used to assess early stage can demonstrate positive benefit with intervention with with diet and lifestyle in the reduction of progression of cognitive decline. And then lastly, as if we didn't have enough, let's go most recently to 2019 and I now quote from Scientific American. This was a 07-16-2019 article in Scientific American entitled Alzheimer's meaning lifestyle factor are best and and only bet now for reducing dementia risk. Let me say it again. Lifestyle interventions are best and the only proven way to reduce dementia risk as contrasted to all the drugs that have been thrown in experiment against this condition that have been unsuccessful in producing positive outcome and in fact many of them have produced negative outcomes. And so if that were not enough, let's just top this off again going back to jama, the same journal that in February published the op ed piece about pseudo medicine and dementia. And now we go to July of 2019 with an article entitled association of lifestyle and genetic risk with incidence of dementia. And what do you think this article said? It says that among older adults with cognitive impairment or dementia that intervention with lifestyle and diet led to a significant improvement in their cognitive function and a reduction in the progression towards increasing dementia. And this work again has been done in a very reputable institute of medical research published in a high grade peer reviewed journal, the Journal of the American Medical association, the same journal that published the op ed piece around pseudo medicine and dementia related to lifestyle and diet intervention. Does there seem to be something wrong here as it relates to how all this fits together and how one makes intelligent decisions as to how to move forward when the media picks up on the pseudo medicine article, but doesn't really discuss extensively these more subsequent clinical intervention trial results that show lifestyle intervention and diet intervention as a positive and only way to actually reduce the incidence of dementia going forward in which there is no drug available to produce the same result. I think I'll quit here by saying I've now unburdened myself with my angst, given it over to you. What are we going to do about this? I think what we're going to do is we're going to personalize diet and lifestyle and make this successful to reduce and beat back the burden of unnecessary dementia. Sam.
