New Study Shows Lifestyle Changes Can Reverse Alzheimer's Symptoms
The year was 1990. Dr. Dean Ornish’s Lifestyle Heart Trial results has just been published in the British medical journal, The Lancet. The conclusion: After just one year of lifestyle modifications—such as a whole food diet, stress management, aerobic exercise, smoking cessation, and group support—coronary artery disease could be reversed.
Subjects were in the randomized control trial for five years (1986-1992). The study involved 48 patients with mild to severe coronary heart disease. After one year, cholesterol dropped 24.3%, LDL fell 37.4%, plaques regressed 11%, and the function of the heart pumping blood improved without the use of drugs.[i]
This was unorthodox to put it mildly. To reverse heart disease without the use of drugs or other medical interventions was completely unfounded until this study.
Fast forward to 2024. Dr. Ornish has done it again. Just as his Lifestyle Heart Trial reversed heart disease with specific intensive lifestyle modifications, his latest trial concluded mild cognitive impairment due to Alzheimer’s disease can be reversed with lifestyle interventions. In a randomized controlled clinical trial “comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with mild cognitive impairment due to Alzheimer’s Disease”[ii] In other words, what was thought to be impossible, is possible. This is Dr. Ornish’s second randomized controlled clinical trial that had groundbreaking and unprecedented outcomes.
Alzheimer’s disease is a progressive brain disorder. According to the Alzheimer’s Association, 6.7 million people over the age of 65 in the US have Alzheimer’s disease, and that number is predicted to increase to 13.8 million by 2060. Amyloid beta plaques and tangles in the brain form inside the brain’s neurons and destroy the neurons and their connections, resulting in memory loss and ultimately the inability to do simple tasks.
The lifestyle interventions used in this latest trial were like those used in Ornish’s Lifestyle Heart Trial – a minimally processed plant-based diet low in harmful fats, carbohydrates, and sweeteners (14-18% of calories from fat, 16-18% protein, 63-68% mostly complex carbohydrates, and unrestricted calories) and specific supplements. Other interventions were moderate aerobic exercise of at least 30 minutes a day, mild strength training three times a week, stress management using yoga, meditation, and breathing techniques, and a support group lead by a mental health professional that met one hour three times per week.
Fifty-one Alzheimer’s patients with mild impaired cognition participated (26 in the intervention group who followed the guidelines and 25 in the control group who did not make lifestyle changes) and had an average age of 73 1/2 years. In the intervention group, three of the four measures testing cognition and functionality saw statistically significant improvements in cognition and function. The control group experienced a worsening in three of the four measures over the 20 weeks. The fourth measure saw less deterioration in the intervention group than in the control group. The study found the better the patients’ adherence to the interventions, the greater the improvement. Depression scores saw no difference between the two groups. Previous studies that have been done testing cognition and functioning have not been as extensive or intensive as this study, and therefore may have seen only a slowing of cognition and functionality rather than a reversal. Ornish’s latest trial concluded it may be necessary to use more intensive multimodal lifestyle interventions as were done in this study to see a reversal of these conditions. Of the 24 participants in the intervention group ( 2 dropped out), 10 showed improvement, 7 were unchanged, and 7 worsened. Perhaps this is reflective of the degree of adherence by the participants the study concluded. Those whose conditions improved were able to resume some activities Alzheimer’s had prevented them from doing. Eight were unchanged in the control group who made no lifestyle changes and 17 worsened.
Improvements were also noted in A1c, insulin, glycoprotein acetyl (an inflammatory biomarker), LDL cholesterol, and 𝛃-Hydroxybutyrate (cell signaling) in the intervention group.
One other thought derived from this study was it may take less extensive lifestyle changes to prevent mild cognitive impairment than it takes to improve it. So, let’s keep up our WFPB diets along with exercise and practicing stress reduction techniques!
Interestingly there was another positive outcome of this study resulting from the interventions. Researchers found an increase in gut bacteria that are known to lower the risk of Alzheimer’s disease. In addition, there was also a decrease in the number of bacteria known to increase the risk of Alzheimer’s. Amazing!
The study found many of the risk factors for coronary artery disease – high blood pressure, smoking, depression, obesity, physical inactivity, social isolation, type 2 diabetes, chronic inflammation, oxidative stress, and insulin resistance are also risk factors for mild cognitive impairment due to Alzheimer’s.
I am going to take the liberty to say we can conclude what is good for the heart is also good for the brain.
Currently the FDA has one approved drug to treat Alzheimer’s disease. Leqembi was FDA approve in January 2023 and reduces the brain plaque in people with early stages of mild cognitive impairment or mild dementia. It reduces the amyloid plaques and slows down the progression but not the reversal of the disease. One study found after 18 months, patients taking Legembi had a 27% slower rate of cognitive decline than those who had not taken the drug.[iii] The patient receives an infusion every two weeks. However, the medication comes with a black box warning – the strongest level of caution. Side effects of the drug may include temporary swelling of the brain along with small areas of bleeding on the brain’s surface. Other side effects from the infusion may include nausea, seizures, headaches, dizziness, confusion, problems with walking, and changes in vision. According to the National Council on Aging, the medication is listed at $26,500 a year with Medicare covering 80% of the cost.
Literally while writing this article, a second drug to treat Alzheimer’s disease, Kisunla, was FDA approved. In clinical trials, Kisunla saw about a 35% reduction in the progression, but not the reversal, of Alzheimer’s disease after 18 months.[iv] Unlike Leqembi, patients are able to discontinue use of Kisunla when the plaques are reduced to a desirable level. Kisunla has side effects similar to Legembi.
Infusions are given once a month. After 18 months, 69% of the people in the Kisula study were able to discontinue treatment. Some were able to discontinue treatment sooner. The cost for treatment for 18 months is $48,696, with Medicare paying 80% of the cost.[v]
The number of people with Alzheimer’s disease is growing, to the point that despite the side effects, FDA fast-tracked approval of the two drugs that for some may slow down the progression of the disease. Even with the co-pay, both medications have high out-of-pocket costs that many patients cannot afford. As previously mentioned, both approved drugs have side effects – some of them very serious. But the thought the FDA had in approving these medications was, working with their doctors, some patients and their families can have an option to choose the medications knowing the risks vs doing nothing and watching the disease progress. It is a difficult decision to make.
For many, including those who have had loved ones struggle with this disease, we now have hope when there was none. Now one more option is available to those experiencing mild cognitive impairment, and it has has no side effects, little cost, and for the first time, can reverse this dreaded disease. Implementing intensive lifestyle interventions provides hope to families that they can continue to live a nearly normal life despite the diagnosis. That is real hope!
[i] Ornish, D, Brown, SE, Scherwitz LW, Billings JH, Armstrong WT, McLanahan SM, Kirkeeide RL, Brand, RJ, Gould, KL. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990 Jul 21;336(8708):129-133. Doi: 10.1016/0140-6736(90)1656-u.
[ii] Meglio, M. (.2024, June 20). Intensive Multimodal Lifestyle Intervention Improves Cognition and Function in Randomized Controlled Trial. Neurology Live. Retrieved from http:// www.neurologylive.com.
[iii] Adam Feurstein, et.al. FDA approves first Alzheimer’s therapy shown to clearly slow cognitive decline. STAT. July 6, 2023. Found on the internet at https://www.statnews.com/2023/07/06/leqembi-alzheimers-fda-approval-eisai-biogen/
[iv] Sims JR, Zimmer JA, Evans CD, et al; for TRAILBLAZER-ALZ 2 Investigators. Donanemab in early symptomatic Alzheimer’s disease: the TRAILBLAZER-ALZ 2 randomized clinical trial. JAMA. 2023;330(6):512-527.
[v] Lilly Investors. (2024, July 2.Lilly’s Kisunla™(donanemab-azbt) Approved by the FDA for the Treatment of Early Symptomatic Alzheimer’s Disease [Press release]. https://investor.lilly.com/news-releases/mews-release-detao;s/lilly’s-kisunlatm-donamab-azbt-approved-fda-treament-early.
