A Glimmer of Hope for People With Alzheimer’s Disease

Way back in 1998 Dr. Dean Ornish published the results of his randomized controlled Lifestyle Heart Trial which demonstrated that intensive lifestyle changes could reverse coronary artery disease (narrowing of the arteries that supply the heart with blood) after one year without using drugs or surgery.  The lifestyle modifications included a low-fat (10% of calories from fat), whole-food vegetarian diet, moderate aerobic exercise, smoking cessation, stress management training and group psychosocial support for 5 years.  (1)

His results were truly startling. (1)

The group who stuck with the lifestyle changes for 5 years showed …

• Widening of the coronary arteries by 1.75 absolute percentage points (a 4.5% relative improvement) after 1 year
• Widening of the coronary arteries by 3.1 absolute percentage points (a 7.9% relative improvement) after 5 years

The control group, who made more moderate changes, showed…

• Narrowing of the coronary arteries by 2.3 absolute percentage points (a 5.4% relative worsening) after 1 year
• Narrowing of the coronary arteries by 11.8 absolute percentage points (a 27.7% relative worsening) after 5 years
• More than twice as many cardiac events (heart attacks, coronary angioplasty, coronary artery bypass surgery, cardiac-related hospitalizations, and cardiac-related deaths) occurred in the control group compared to the intervention group during the 5-year follow-up period.

Researchers noted that the factor that had the greatest influence on the change in the diameter of the coronary arteries was not younger age or lower severity of disease as they expected, but adherence to the recommended changes in diet and lifestyle.  This was the first scientific investigation to prove that heart disease could not only be slowed but stopped or even reversed.  (1)

Twenty-six years later, in June of 2024, another study from Dr. Dean Ornish and his colleagues was published.  This is the first randomized controlled clinical trial to attempt to determine if intensive lifestyle changes can beneficially affect the progression of already diagnosed mild cognitive impairment (MCI) or early dementia due to Alzheimer’s disease (AD).  (2)

The authors of this trial pointed out that many of the risk factors for coronary artery disease are the same risk factors that account for other chronic illnesses including dementia and AD because they share many of the same underlying biological mechanisms (chronic inflammation, oxidative stress, insulin resistance, telomere shortening and sympathetic nervous system hyperactivity among others).  It follows that the same healthy lifestyle interventions could help to ameliorate the ravages of other chronic illnesses.  A recent study strengthened this premise when it determined that the benefits of a healthy lifestyle can predominantly overcome brain pathologies (such as narrowed arteries, tau tangles and ß-amyloid load) to maintain cognitive abilities in later life. (2,3)

This trial lasted for 20 weeks.  52 men and women diagnosed with early-stage AD were randomized into two groups; a control group who were advised to make no lifestyle changes for 20 weeks, and a lifestyle modification group (the intervention group).  The control group was offered free access to this whole program of lifestyle alterations after the 20-week trial ended in order to deter them from making any changes on their own during the intervention period. (2)

The lifestyle modifications for the intervention group included;

• A whole-foods minimally-processed plant-based (vegan) diet, high in complex carbohydrates (fruits, vegetables, whole grains, legumes, soy products, seeds and nuts), and low in saturated fats, sweeteners and refined carbohydrates. This diet consists of approximately 14 to 18% of calories from fat, 16 to 18% of calories from protein and 63 to 68% of calories from complex carbohydrates.  Calories were not restricted and the participants could eat as much food as they wanted.  Three meals and two snacks per day as well as prescribed nutritional supplements were supplied to each participant and their spouse/trial partner throughout the duration of the trial.  Participants were asked to consume only the supplied food throughout the trial.
• Aerobic exercise such as walking at least 30 minutes per day and mild strength training exercises at least three times per week. Participants were provided with a personalized exercise prescription based on age and fitness level and their sessions were overseen by a registered nurse.
• Stress management such as meditation, yoga, stretching, breathing exercises for a total of one hour a day were supervised by a certified stress management specialist.
• Group support sessions of one hour on three days a week were supervised by a licensed mental health professional.
• Each participant along with their spouse/trial partner met via Zoom three times a week for four hours per session that included one hour of supervised exercise, one hour of stress management practices, one hour of a support group and one hour of lecture on lifestyle.

Here are the results (2):

After 20 weeks of lifestyle modifications, results in the intervention group showed…

• Improvement or stabilization in cognition and function in 71% of the treatment group with those who adhered most consistently to the diet and lifestyle changes showing the most benefits.
• Statistically significant differences in four standard test measures of cognition and function that are often used in assessing trials of Alzheimer’s drugs. Three of the test results showed improvement in the intervention group and one showed less deterioration when compared to the control group.
• A blood marker that is an indicator of ß-amyloid protein deposits in the brain linked to AD improved by 6.4% in the intervention group.
• Other biomarkers showed sizeable improvements in the intervention group compared to the control group. Insulin sensitivity improved to a greater extent in the intervention group as shown by lower levels of hemoglobinA1c and fasting insulin.  A marker of inflammation related to cognitive performance (glycoprotein acteyls) decreased.  LDL-cholesterol levels dropped by over 30% in the intervention group.  Levels of ß-hydroxybutyrate rose slightly.  ß-hydroxybutyrate is a ketone that can provide an energy source for the brain and is linked to reductions of ß-amyloid and Tau proteins in the brain.
• Telomere length increased in the intervention group. Longer telomeres are linked to slower rates of aging.
• Significant beneficial changes were observed in specific groups of micro-organisms making up the microbiomes of participants in the intervention group after 20 weeks which were not seen in the control group. Groups of microorganisms associated with reduced risk of AD (for example, Blautia and Eubacterium) increased with the lifestyle interventions used in this study and microorganism groups associated with the progression of AD decreased (for example, Prevotella and Turicibacter).

 After 20 weeks of making no lifestyle changes, results in the control group showed…

• No improvements in the cognitive function of any of the participants in the control group and 68% of them had worsened.
• Cognitive deterioration was observed in all four test measures of cognition and function.
• A blood marker that is an indicator of ß-amyloid protein deposits in the brain linked to AD worsened by 8.3%
• Levels of other biomarkers of cognitive function worsened including glycoprotein acetyls, LDL-cholesterol and ß-hydroxybutyrate.
• Telomere length was essentially unchanged in the control group.
• No changes in the types of microbes making up the microbiome were detected.

The researchers noted that substantial lifestyle changes were required to stop the progression of AD or to enhance cognition and function in these participants.  Depending on the test, adherence to the lifestyle changes by 71.4% to 95.6% was required to show improvements.  Less intensive interventions may not be sufficient to improve cognition and function. (2)

Anecdotally, many of the participants in the intervention group reported considerable improvements in their daily lives.  For example, after participating in this trial, some who previously struggled to read a book because they would forget what they had just read are now reporting being able to retain the information and finish a book.  Others regained their ability to handle daily tasks such as managing their finances.  Several expressed regaining their sense of identity or gaining a new lease on life.

It must be emphasized that the significance of this new research is profound.  It is extraordinary that any changes at all were detected in the participants after only 20 weeks of lifestyle alteration, especially when many of them had been living with progressing AD for years.

This clinical trial demonstrated for the first time that an intensive lifestyle intervention, without the use of drugs, markedly improved cognition and function in many patients with early dementia and AD.  It offers hope to those suffering from AD and their families and friends.  A cure for AD has not yet been discovered. However, this paper illuminates potential therapies with the ability to reduce or stop the progression of AD and, in some cases, even to reverse this dreaded disease.

What if you don’t have cognitive problems but are worried that they might be in your future?  Is there a way to prevent their development?  Watch this site for the next article in this series, “Is There Any Way to Ward Off Dementia?”

 

SOURCES:

1  Ornish, D., Scherwitz, L.W., Billings, J.H., Brown, S.E., Gould, K.L., Merritt, T.A., Sparler, S., Armstrong, W.T., Ports, T.A., Kirkeeide, R.L., Hogeboom, C., Brand, R.J. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16; 280(23): 2001-2007. Doi: 10.1001/jama.280.23.2001. Erratum in: JAMA 1999 Apr 21;281(15):1380. PMID: 9863851.

2  Ornish, D., Madison, C., Kivipelto, M., et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alz Res Therapy. 2024:16(122). Doi:10.1186/s13195-024-01482-z.

3  Dhana, K., Agarwal, P., James, B.D., Leurgans, S.E., Rajan, K.B., Aggarwal, N.T., Barnes, L.L., Bennett, D.A., Schneider, J.A. Healthy Lifestyle and Cognition in Older Adults With Common Neuropathologies of Dementia. JAMA Neurol. 2024. 10.1001/jamaneurol.2023.5491. Epub ahead of print. PMID: 38315471.