Alzheimer's - drugs or vitamins?
At Food for the Brain we are not against medication and we hope to see a successful drug discovered for health conditions, such as dementia, just like anybody else. It saddens us however to regularly see one-sided news reporting. In terms of disease modifying treatments for dementia/Alzheimer’s Disease, almost all new drug discoveries are hyped-up to be much more effective actually then they in reality are. On the other hand, a number of much more significant studies on the effects of some dietary modification or certain specific supplements on dementia/Alzheimer’s are simply ignored or mis-reported in the mainstream media. The growing emotional and financial cost of dementia (including Alzheimer’s) is so high that we cannot afford to choose sides – there is only one side and that is evidence.
In this case it is the confusing messages sent by the Alzheimer’s Research UK (ARUK). For instance a paper published in 2012 reported that B vitamins given to those with pre-dementia (mild cognitive impairment) dramatically reduces shrinkage of the Alzheimer’s brain areas and reduces further memory loss – so therefore B vitamins represent a disease modifying treatment. This study was part-funded by ARUK, however, last week we are told by ARUK’s Eric Kerran that a new drug, solanezumab is the ‘first disease modifying treatment’! (as reported on www.bbc.co.uk).
If we were to compare B vitamins with solanezumab (designed to clear out amyloid protein from the brain that can build up and contribute to dementia) the effect of solanezumab is very small in comparison to that reported with B vitamins, which mostly work through its effect on lowering homocysteine levels.
In this new drug solanezumab there’s no change in rate of brain shrinkage, which is critical if the drug is going to modify the disease process - not just marginally slow it down. There are also only very minor improvements in memory. Nevertheless, the press coverage reported a different story, “First treatment to slow Alzheimer’s disease unveiled in landmark breakthrough,” in the Telegraph and Newsweek’s title was “New drug shows promise for early-stage Alzheimer’s”, “Hugely significant…first drug actually slowing down the course of the disease …verge of a radical breakthrough.” commented another ARUK spokesman (for the full story: Policy on Alzheimer’s: sure we want a cure, just so long as it’s not cheap click here)
Considering the positive headlines, it surely creates a view that the whole scientific community agrees with the positive media’s stance, however, the press stories were printed even before the study on solanezumab itself was published! Detailed analyses of the complex results of this study by other specialists in the field have since emerged, reporting what actually happened. Margaret McCartney, writing for the British Medical Journal wrote that in one memory test, those on the drug, out of a possible score of 30, scored 1 point higher than those on a placebo. In the other two tests used the difference was also very small. In contrast, there was a virtual cessation of any further memory loss in the B vitamin study over 2 years.
Also, on a very important measure - the Clinical Dementia Rating (CDR), there was no change between Solanezumab and the placebo, which is bad news because it means no-one, actually got better. To give another comparison, the difference between the placebo group (28%) and the B vitamin group (58%) reverting to zero on the CRD was 30%. In other words B vitamin treatment doubled the proportion of people reverting to zero on the CDR according to Dr Celeste de Jager. In the drug study there is no difference between drug and placebo.
The best memory test results for the drug, the MMSE and ADAS-Cog tests, showed a 34% slowing down of decline in scores compared to those on placebo over 18 months. In the B vitamin trial, those starting with high homocysteine had a complete prevention of any further decline in episodic memory and in semantic memory over 2 years.
But perhaps the biggest difference was between the rates of brain shrinkage. Solanezumab treatments resulted in a non-significant 2% reduced rate of brain shrinkage compared to the placebo. In contrast, in the B vitamin study there was an average 30% reduction in the rate of brain shrinkage, which went up to 53% in those with raised homocysteine and 73% in those starting with good omega-3 levels that were supplemented B vitamins, compared to placebo.
Beyond the particular outcome of the solanezumab study, more and more research is indicating that amyloid plaques are not in-fact a cause in Dementia but an effect (leading to more damage).
The brain produces more amyloid protein as a response to a number of neurological conditions. This may be the results of (at least in part) poor methylation (homocysteine levels reflect poor methylation and B vitamins can effectively reduce homocysteine). The solanezumab drug reduces amyloid protein, but if fails to address the cause. A recent study conducted at the University of California has shown that omega-3 supplementation also helps the body get rid of amyloid protein and probably even more effectively together with vitamin D. So omega-3 (and possible more effective with vitamin D) can possibly do what the drug does but without the side-effects, and B vitamins help to reduce the formation of amyloid protein to start off with. Looking at it from this point of view, we already cover three disease modifiable factors, B vitamins, vitamin D and omega-3, albeit there are likely only effective in individuals with low levels.
Considering all this, and that omega-3 and B vitamins to reduce homocysteine levels have with minor-no side effects and solanezumab (a monoclonal antibody drugs which has to be given by injection every few weeks) is associated with haemorrhage (which occurred in a small percentage of people on this study), we find it odd that news, even from respected organisations such as ARUK, can be so unbalanced in favour of drugs. Again we are not against medication but the growing emotional and financial cost of dementias is so high that we cannot afford to choose one over the other, and neither should we have to. In an ideal world solanezumab would have been tested also in conjunction with omega-3, B vitamins, and vitamin D to learn what the best possible outcome is.
One option for now is to try Food for the Brain’s validated free online Cognitive Function Test (only takes around 15 minutes) which also works out your preventable risk factors and gives you a personalised report of key changes to reduce your risk of dementia.
11th August 2015
'B12 memory study is bad science' written by Patrick Holford
A study published last week, which was rejected by the British Medical Journal, claims that vitamin B12 supplements don’t work for preventing memory decline. One of the authors of the study, published in the American Journal of Clinical Nutrition, is Robert Clarke, who has already published a number of previous papers on the same topic. All of them have concluded that B vitamins are ineffective for dementia prevention, and all have been criticised for bad science and for making the same classic errors.
This study involved 191 people with no memory problems or concerns about cognitive problems. They were described by the authors as being relatively healthy and highly functioning, but with low blood B12 levels. Half the group were given placebos and half were given B vitamins. There was no change in their cognitive function after a year. Neurological tests also showed no change. That’s the gist of it.
So, if the memory of those in the placebo group, who started with good cognitive function, didn’t get any worse why would anyone expect those in the B12 group to respond any differently? If the study had been long enough for the memory of some of those in the placebo group to get worse then the trial might have shown if B12 could help prevent it. But with no change in the placebo group, you know the study is either too short, has the wrong people (eg. without memory issues), using too low a dose or that the memory tests are not sufficiently sensitive.
But there is more that is seriously flawed in this research. The researchers tell us the starting (baseline) homocysteine levels and cognitive function scores of the participants. So it seems to me it would have been sensible and useful to have reported on any difference between those starting with high homocysteine versus low homocysteine, or in those starting with worse cognitive function scores.
I know that reviewers have asked for these calculations to be included in Clarke’s previous studies but, once again, these essential sub-group analyses have not been done. I did contact the lead author, Dr Alan Dangour, to ask why not. He informed me that they were prohibited from doing so, under the ‘Consort’ guidelines (which stands for the ‘Consolidated Standards for Reporting Trials’, giving researchers a set of guidelines for conducting good quality research) given that they had not pre-specified these analyses when they originally designed the trial. The Consort guidelines, however, do allow for relevant post hoc sub-group analyses to be done, since they are so central to the issue being researched I do not understand why they have not been done. The authors say they ‘have clear plans for the conduct and publication of such analyses’ but do not say what they are.
The net result is that the paper is meaningless. It simply shows that supplementing extra B12, if your memory is good, won’t make it better. It’s like finding no benefit from giving insulin to healthy people and concluding it wouldn’t benefit diabetics. Yet Oxford University sent out a press release ensuring the media will pick it up and run more fallacious “no benefits from B vitamins stories”. The detailed and expert criticism of the trial’s failings no doubt will be published in due course but will inevitably be ignored and so the myth will be perpetuated.
As a result people with raised homocysteine levels will be put off supplementing B12 when there is good evidence that it can help reduce the rate of brain shrinkage and memory loss in those with memory problems and raised homocysteine levels. What is still not nailed down is whether it can help prevent dementia in those without memory problems. This study contributes no useful information at all to that question since it was far too short and no-one in the placebo group was anywhere near the diagnosis of pre-dementia.
It has been funded by the UK government. Why are we taxpayers paying for research that is clearly a total waste of money when there is a desperate need for funding for good quality prevention research?
If you would like to see a summary of evidence for B12 and lowering homocysteine in the context of dementia prevention see www.foodforthebrain.org/hcyevidence.
6th July 2015
The effects of dietary supplementation on nutrient status in children with Autism Spectrum Disorder
A recently published article assessing the effects of dietary supplementation on nutrient status in children with Autism Spectrum Disorder (ASD) highlights some important considerations when supplementing with a multivitamin and mineral (MVM) supplement. One of the conclusions of the study was that even when a child takes a MVM some deficiencies were not corrected, such as calcium and vitamin D, whilst other vitamins and minerals may lead to levels above the Upper Limit, such as folate, copper and vitamin A. This was particularly true when a child is on a gluten-free and casein-free (GFCF) diet, owing to the fact that these children are more likely to take a MVM.
Some of the recommendations of the study (http://www.andjrnl.org/article/S2212-2672(15)00390-1/abstract), primarily aimed at dieticians and nutritionists, were that multivitamins should not be universally prescribed in children with restricted eating patterns, and that Vitamin D and calcium levels are often low even with a MVM. The author of the study commented that it is important for children with ASD to receive individual assessment for “potential nutritional deficiencies or excess and that when supplements are used careful attention should be given."
Although this research has led to some valuable conclusions and considerations there were a number of other points the authors did not mention.
Due to the common occurrence of limitations in the variety of foods a child with ASD may eat, deficiencies as well as possible excesses in selective nutrients (especially if the preferred food is high in a particular nutrient or artificially fortified) may arise. Research has previously shown that some synthetic nutrients in fortified foods (and some supplement brands) are not so well assimilated and processed by the human body, therefore, possibly acting as a burden rather than a help to address deficiencies.
When choosing a supplement we would recommend visiting your local health food shop for advice rather than using supermarket own brands - often these can have unsubstantial levels of the particular nutrient and use synthetic ingredients rather than natural ones.
At the Brain Bio Centre we can assess every client for their specific nutritional needs and create a supplement and/or nutrition programme supporting any deficiencies and imbalances. For more information on this please visit www.brainbiocentre.com or call 020 8322 9600.
18th June 2015
Omega-3 and B vitamins arrest Alzheimer’s brain shrinkage
There is no cure for Alzheimer’s. Brain shrinkage, the hallmark of Alzheimer’s, starts for many from the age of 50. But can it be prevented? Researchers at Oxford University gave 168 people over 70 with the first signs of memory loss either high dose B vitamins or dummy pills and monitored shrinkage with advanced brain scans over a two year period.
They found that those taking the extra B vitamins who started with high omega-3 levels in their blood had 70% less brain shrinkage, reaching about the same degree of shrinkage as is normally found in healthy elderly people with no memory decline. The results were reported in the American Journal of Clinical Nutrition this week (Jerneren et al.)
The least brain shrinkage in those treated with B vitamins occurred in those with both high omega-3 blood levels, an essential fat found in oily fish, and high blood levels of homocysteine at the start of the study, indicating a poor B vitamin status, especially B12. About half of people 65+ have raised blood homocysteine levels, indicating that older people need to be supplementing B vitamins. A third of the people in this study, from the Oxford area, had low levels of omega-3 and no beneficial effect from the B vitamins. It was the combination of omega-3 and B vitamins that made the difference.
This study suggests that at least one third of the British population could significantly reduce their risk of developing Alzheimer’s simply by taking in enough omega-3 fats and supplementing B vitamins.
“This is a very encouraging result.” said Professor David Smith from Oxford University who research group led the study “It means that something so simple as keeping your omega-3 levels high and supplementing B vitamins if you are at risk (with a high homocysteine level) could dramatically reduce a person’s risk. We should be screening people for the early signs of cognitive impairment and then testing their homocysteine and omega-3 status.”
In Sweden people over age 60 in memory clinics are routinely screened for homocysteine, in much the way GPs screen for cholesterol in the UK. Those with high levels are prescribed B vitamins.
“This study adds to a growing body of evidence that Alzheimer’s is largely a preventable disease. At least half the risk for Alzheimer’s is preventable, while only 1% of cases are caused by genes. We should be educating people about prevention steps and screening early for the first signs of cognitive changes.” says nutritionist Patrick Holford, from the UK’s charitable Food for the Brain Foundation which has campaigned for Alzheimer’s prevention to be taken seriously. “Less than 0.1% of UK dementia research funding is spent on prevention. It should be 50%.”
Food for the Brain offers a free Cognitive Function Test online at www.foodforthebrain.org. Two hundred thousand people have now taken the test, which not only gives the earliest indication of your memory status but tells you what to do about it. Increasing omegas from fish, nuts and seeds and testing for homocysteine, and supplementing B vitamins if needed, are two of six prevention steps. Others include eating more fruit and veg, keeping fit and socially active. The best foods for omega-3 are oily fish such as mackerel, salmon and sardines, walnuts, chia and flax seeds.
The charity hopes to reach a million people, and have just launched an educational video called ‘Alzheimer’s prevention is better than drugs’ (see below) to encourage those at risk to take positive steps to prevent this terrible disease.
20th April 2015
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