"Julie! Hi! How have you been?" she asked. Gee, 49, stared blankly at her. A few uncomfortable seconds passed.
"I have no idea who this woman is," Gee* thought. She felt herself slipping into a sort of cognitive abyss.
"Remember, our sons went to school together?" the woman said. "We did playground duty together?" Gee's mind was dark. She began to panic.
"I tried to act like I sort of knew who she was, became visibly upset and just left the store," she said, recalling the scenario years later. "It was horrible, just terrifying."
That painful interaction was the first sign of Gee's early stage Alzheimer's disease, which genetic tests later confirmed.
Her memory lapses mounted: Gee would find herself, for a few seconds at a time, forgetting where she was while driving familiar roads. She would walk away from conversations with her husband mid-sentence. She would be reading and unable to relate, moments later, even a shred of what she had just read.
The idea of a long, painful descent into Alzheimer's was too much to bear. Gee's initial fear after her diagnosis metastasized to hopelessness.
"I seriously considered suicide," she said.
Hope for a hopeless diagnosis
affects as many as 5 million Americans. It is the sixth leading cause of death in the United States, and there is no cure.
Yet a very small study out of UCLA is offering a glimmer of hope for those with what is often a hopeless diagnosis. Nine out of the 10 patients involved in the study, who were in various stages of dementia, say their symptoms were reversed after they participated in a rigorous program. The program included things like optimizing Vitamin D levels in the blood, using DHA supplements to bridge broken connections in the brain, optimizing gut health, and strategic fasting to normalize insulin levels.
A few months after starting the extreme program, patients in the study, aged 55 to 75, noticed their cognition had either improved or returned to normal. Only one patient, a 60 year-old female who was in the late-stages of dementia when she began the program, continued to decline.
The results, published this fall in the journal Aging, support the idea that addressing the many contributing factors of Alzheimer's disease as a group, rather than one at a time, could potentially reverse the disease's early progression, said study author Dr. Dale Bredesen, director of the Mary S. Easton Center for Alzheimer's Disease Research at UCLA.
Those factors include 36 potential deficiencies, imbalances and sources of inflammation.
"Each one of these things contributes a small piece of the puzzle," said Bredesen. "It's like a roof with 36 holes in it. Some people have a big hole in, say, exercise, and maybe a smaller hole in another area."
The 10 patients in the pilot study underwent a battery of tests, including having their blood drawn and brains scanned, and had neuropsychological evaluations. Bredesen said that most of the study participants had between 10 and 24 problems that needed correcting.
The effect of focusing on so many targets at once runs counter to what Bredesen said is a prevailing — and flawed — notion of identifying single targets to treat a disease caused by many factors.
"Drug companies tend to come up with a really good patch for one hole," said Bredesen, founder and CEO of the Buck Institute. "It's not a surprise they don't work."
Peter*, a patient in Bredesen's pilot study, was 69 years old and had been struggling with progressive memory loss for 11 years when he began the program.
Around age 58, the normally bright and unflappable medical professional found he was losing his ability to recognize faces. An ability to quickly add up columns of numbers was eluding him. He would be midway through a book before it dawned on him that he'd already read it.
"One day I went to my locker at the gym, and I could not remember the combination," said Peter. "I stood there, worked on it in my mind, and couldn't remember. Finally, I cut that thing off."
About a year later, Peter had a brain scan that indicated a pattern of damage consistent with Alzheimer's disease.
"I thought, 'Crap, I'm going to lose my driver's license in two or three years. I'll be a burden in five,' " he said.
For years, he hid his symptoms as best he could while mentally preparing for his inevitable decline. By the time he was introduced to Bredesen's program last year, he was considering giving up working.
The study outlines some of the changes Peter implemented: Eliminating simple carbohydrates and processed foods from his diet; taking probiotics and coconut oil; rigorously exercising; and sleeping as close to eight hours as he could. He added herbs and a raft of supplements to his diet, along with several other changes.
Between four and six months later, he said, his acuity with numbers and faces returned. And, at age 71, he continues to work.
"I would say I'm in better shape now, all the way around, than I was a few years ago," said Peter. "I think I'm about as good as I've ever been."
But anecdotal studies like this one are far from generalizable, and larger studies must be done to prove whether the program will work for more than the scant number of people in this study.
These study results should be interpreted with a lot of caution, primarily because of the small study group — and because the participants had a range of diagnoses, resulting in different interventions, James Hendrix, director of Global Science Initiatives at the Alzheimer's Association, explained in an email statement.
"Outside of a supervised research setting, no one should adopt these specific ideas to try to improve their, or a loved one's memory and thinking," he said. "We simply don't know what the effect would be."
The final straw
Not long after her memory problems began, Gee found out she carries two copies of the APOE-4 allele. Simply put, this gene hampers her brain's ability to heal itself, dramatically increasing her risk for developing Alzheimer's disease.
It was the final straw.
Gee threw herself into reading studies, gathering information and implementing any lifestyle change that might slow down her disease. Later, she said, she sought help from a well-known neurologist, Dr. David Perlmutter, who helped her to refine those changes.
As it turns out, Perlmutter's advice in many ways mirrored Bredesen's program.
Gee began by adding fish oil and other supplements to her daily regimen. In several studies, people who took the supplements performed better on memory tests and had bigger brains. She also started meditating twice daily and sleeping seven to eight hours each night; adequate sleep and exercise improve blood flow to the brain and instigate neuron generation.
Hormone replacement therapy is indicated for women who have a hormonal imbalance that may be affecting brain function, so Gee started that too.
She fasts for more than 12 hours between dinner and the next day's breakfast, making sure there are at least three hours between dinner and bedtime. The idea behind fasting, said Bredesen, is that with the break the body begins a process called autophagy, which can help destroy amyloid-beta, a problematic protein that builds up in the brains of Alzheimer's patients.
Gee has also cut out processed foods from her diet, including sugar, grains and other starches, since they can stir up inflammation in the brain. Her rule of thumb: "I don't buy any packaged, boxed or canned food."
A typical dinner for her includes mostly raw organic vegetables drizzled with extra virgin olive oil and wild caught fish. Occasionally she replaces the fish with grass-fed lean meats. She has integrated more fermented foods into her diet — research is beginning to correlate gut health with brain health.
"Piece by piece I was going down the protocol," she said. "My mental acuity improved the more (elements of the program) I began doing."
The overhaul Gee and others did would be dizzying for most people, but Gee said it had the converse effect of simplifying her life. She said cutting out so much processed and other inflammatory foods is freeing.
Within a few months of beginning the protocol she said she experienced a dramatic cognitive turnaround. Gee had been testing in the 30th percentile on an online brain training website before the program. Months afterward, she was scoring above the 90th percentile.
"Before this protocol, the notion was you were going to die with this disease," said Gee, who started a website
to provide support and hope for others in the same genetic situation. "There was a lack of specificity about what to do. Now we have this prevention protocol."
Hendrix with the Alzheimer's Association said one sound element of Bredesen's study, given the complexity of Alzheimer's disease, is its focus on addressing multiple risk factors. He cites as an example a two-year, 1,200-person clinical trial out of Finland, the results of which were presented earlier this year at the Alzheimer's Association International Conference.
Among study participants engaging in nutritional changes, physical activity, brain training, social activities and management of risk factors for heart problems, cognitive performance improved.
Bredesen stresses that identifying the culprit for early Alzheimer's symptoms must be based on a patient's specific deficits and imbalances.
He said he will continue testing his protocol on early-stage patients — including members of Gee's APOE-4 online group — to find the ideal stage of cognitive decline to introduce this program and how long improvement can be sustained.
"We are now looking at what is causing illness in order to make a big impact on it," said Bredesen, who added that many elements of his program could be implemented in asymptomatic people as a prevention strategy.
"If you're not deteriorating, it's a good idea to do what our moms told us to do: Exercise, get sleep, keep stress down and don't eat junk food."
He hopes that normalizing early stage Alzheimer's patients cognitively might provide a better platform on which to test future drug-based therapies.
"One 'silver bullet' drug doesn't work with 36 holes in the roof," said Bredesen. "The argument is maybe you need to patch some of those holes before trying another drug."