Alzheimer's Disease
and other Dementias

Unless your doctor says that supplementation is contraindicated, Dr. Weyrich recommends that ALL patients, especially patients with Alzheimer's or dementia, take a supplement containing the B vitamins (see below) in their methylated forms and avoid all vitamins that have the synthetic (folate, folic acid) forms. The product that Dr. Weyrich personally uses is "Country Life Coenzymated B" (take one daily). Talk to your doctor to determine what is best for you.

As discussed below, several different B vitamins are essential for healthy brain and nerve function. There are tests for adequate vitamin B status, but insurance coverage may be a problem for some of the better, but more expensive, tests. A clinical trial of an appropriate vitamin B supplement is generally more cost-effective than testing for deficiency. B vitamins are water-soluble, and generally, excess intake is excreted in the urine, leading to low risk of overdose toxicity. Excess B-vitamin supplementation's most notable side effect is that the patient's urine turns bright yellow, which is harmless. In addition, vitamin B3 may cause flushing ("hot flashes"), which can be mitigated by careful dosage adjustment and other strategies.

Vitamin B12 is one of the interventions used by [Bredesen2014  🕮 ]. This vitamin is essential for nervous system health and protects against Alzheimer's Disease [Hooshmand2010  🕮 ] and cognitive decline [Tangney2009  🕮 ]. Unfortunately, the patient's ability to absorb vitamin B12 tends to decline with age; this situation is further exacerbated by patients taking prescription or over-the-counter antacid preparations such as H2-blockers and Proton Pump Inhibitors. Vegans are particularly at risk for vitamin B12 deficiencies since vitamin B12 is only found in animal products, [Pacholok2011].

In addition, excessive supplementation with folic acid (Vitamin B9) can create a relative deficiency of vitamin B12 and thereby accelerate cognitive decline [Tangney2009  🕮 ].

In some cases, proper consideration of diet and food sensitivities can eliminate the need to take B12-depleting drugs.

In order to assure adequate B12 status, sublingual administration of the methyl form of B12 is recommended. In some cases, vitamin B12 injections may be indicated. A commonly used vitamin therapy used by naturopathic medical doctors is called the "Myer's Cocktail"; some allopathic doctors also prescribe what they call a "banana bag" IV injection, which is similar but lower in dose.

Vitamin B9 is essential for nervous system health and works synergistically with vitamin B12. Unfortunately, many commercial vitamins, supplements, and "enriched" food products are made with a synthetic form of the vitamin called "folic acid." In many individuals, the body can convert this inactive synthetic folic acid into the active form "5-methyltetrahydrofolate" (5-MTHF). However, some people have a genetic deficiency preventing synthetic folic acid from being converted into 5-MTHF. For these people, taking folate may be harmful (blocking necessary enzymes), so taking the more natural 5-MTHF is necessary. Again, it is possible to test for Vitamin B9 deficiency or the genetic defect; however, clinical trial of an appropriate 5-MTHF supplement is generally more cost-effective than testing for deficiency or genetic polymorphisms.

Vitamin B6 is also essential for nervous system health. Again, vitamin B6 is available in both synthetic and methylated forms; the methylated form is sometimes more effective.

Vitamin B5 is required for the synthesis of the neurotransmitter Acetyl Choline. Deficiency of this neurotransmitter has been associated with Alzheimer's Disease. It is also necessary for the synthesis of the energy metabolism intermediate acetyl-CoA.

Vitamins B2 and B3 are also known as riboflavin and niacin. Both are essential cofactors for energy metabolism. Since the brain has a high metabolic rate, these two vitamins are essential for proper brain function.

This is one of the interventions used by [Bredesen2014  🕮 ]. Serum Vitamin D (also known as calcifediol, 25OHD, or 25(OH)D) concentrations have been shown to be 1.4 standard deviation units lower in Alzheimer's disease cases compared to cognitively healthy controls [Annweiler2013  🕮 ] [Evatt2008  🕮 ]. If renal disease prevents the conversion of 25OHD into the bioactive form calcitriol (1,25(OH)D), the patient must be supplemented with preformed calcitriol.

Several authors have discussed the benefits of the ketogenic diet for treating a variety of neurological conditions: [Achanta2017  🕮 ] [Augustin2018  🕮 ] [Hertz2015  🕮 ] [Maalouf2009  🕮 ] [Newport2023] [Watson2015] For general information on the ketogenic diet, please see: Ketogenic Diet

A low-glycemic diet is one of the interventions used by [Bredesen2014  🕮 ]. This diet is suggested because Alzheimer's disease is sometimes called "Diabetes of the Brain." The low-glycemic diet helps reduce insulin resistance.

This is one of the interventions used by [Bredesen2014  🕮 ]. Medium-chain triglycerides are processed differently by the body, promote thermogenesis, and provide the brain with ketone bodies to use as an alternate fuel in the case of "Diabetes of the Brain." Dr. Weyrich recommends a trial of the prescription-only medical food Axona (caprylidene) or integrating MCT oil or coconut oil into the daily diet. Dr. Weyrich can prescribe the medical food Axona.

A low-grain Diet is one of the interventions used by [Bredesen2014  🕮 ]. This diet is suggested because many grains are high in carbohydrates and contain gluten, which may aggravate auto-immune conditions that may lead to neurodegeneration [Perlmutter2013].

A low-inflammatory diet is one of the interventions used by [Bredesen2014  🕮 ]. See also "Get an Oil Change" below.

A healthy diet contains an adequate supply of essential fatty acids and minimizes the consumption of "bad" fats that cause inflammation. Contrary to popular belief, not all fat is bad; fat is actually a vital building block of the brain. Saturated fats are NOT necessarily bad. However, modern agricultural practices can lead to many animal products containing "bad fats" that can cause inflammation. On the other hand, organic farming practices can produce very healthy animal fats.

Replace the "bad fats" in your diet with "good fats" as follows:

Bad Fat	Replace with Good Fat
Margarine and trans fats	Butter
Corn-fed beef products	Grass-fed beef products and pasture-fed chicken eggs
Omega-6-rich oils (corn, safflower, sunflower, canola, etc.)	Coconut, Palm, Olive oils, Omega-3 rich oils (Cod Liver)
Farm-raised fish (including Atlantic salmon)	Wild-caught cold-water fish (preferably smaller fish)

Note that the above advice differs from conventional medicine's the current standard of care - you must decide whom to trust.

Intermittent fasting is one of the interventions used by [Bredesen2014  🕮 ]. By fasting at least 12 hours each day (mostly at night), insulin levels may be lowered, ketogenesis and autophagy enhanced, and perhaps Aβ may be reduced.

Curcumin, the active principle found in turmeric, is one of the interventions used by [Bredesen2014  🕮 ]. Curcumin attenuates cognitive deficits, neuroinflammation, and amyloid plaque deposition in Alzheimer's diseased rat [Frautschy2001  🕮 ] and mouse [Yang2005  🕮 ] [Garcia_Alloza2006  🕮 ] models. The latter reference also reports partial regression of neuronal damage. The properties of Curcumin have been reviewed by [Aggarwal2007  🕮 ].

Dr. Weyrich notes that benefits seen in animal models do not always translate to humans, and in particular, pharmaceutical trials that directly target amyloid plaque formation in Alzheimer's Disease have not been successful and may even be counter-productive. While curcumin is reported to directly target plaque formation [Garcia_Alloza2006  🕮 ], it also has other immunomodulatory effects on inflammation, which may provide a benefit not found in the pharmaceutical agents targeting plaque formation more directly.

This is one of the interventions used by [Bredesen2014  🕮 ]. Considerable evidence suggests that controlling the inflammatory marker "homocysteine" (which is easily measured by an inexpensive blood test and can be controlled with targeted nutritional supplements) is essential not only for reducing the risk of Alzheimer's Disease [Hooshmand2010  🕮 ] but also for cardiovascular health. Elevated homocysteine levels are considered as important a predictor of future cardiovascular events as elevated cholesterol. Unlike cholesterol, no pharmaceutical drugs lower homocysteine, but over-the-counter supplements that are "Generally Regarded as Safe" (GRAS) by the FDA are effective without the toxic side effects of statin drugs.

The common diuretic hydrochlorothiazide (HCTZ) increases homocysteine levels [Westphal2003  🕮 ].

Dr. Weyrich highly recommends that all patients be tested for elevated homocysteine levels, which Dr. Weyrich can treat using nutritional methods.

Note that homocysteine is also elevated when there is renal failure [Allen1993  🕮 ].

Elevated methylmalonic acid levels, marker for vitamin B12 deficiency, have been correlated with faster rates of cognitive decline [Tangney2009  🕮 ]. The serum level of methylmalonic acid should be monitored, and vitamin B12 supplementation should be considered if methylmalonic acid is elevated.

Note that methylmalonic acid is elevated when there is renal failure [Allen1993  🕮 ].

In addition to optimizing thyroid function (see above), vitamins B2 (riboflavin), B3 (niacin), and B5 (pantothenic acid) are components of the cofactors FAD, NAD, and CoA that are essential for mitochondrial energy production. CoQ-10, PQQ, D-ribose, and carnitine are also necessary for mitochondrial energy production.

This is one of the interventions used by [Bredesen2014  🕮 ]. Insulin resistance is characterized by normal fasting blood glucose levels but elevated fasting insulin levels or mildly elevated HbA1C levels. There are many treatments for this condition, but most involve dietary modification. [Bredesen2014  🕮 ] recommends Fasting Insulin < 7; HbA1c < 5.5.

This is one of the interventions used by [Bredesen2014  🕮 ]. Highly sensitive C-Reactive Protein (hs-CRP) is a sensitive marker of inflammation. Since inflammation plays a significant role in neuroinflammation and consequent neurodegeneration, the root cause of elevated hs-CRP should be identified and treated. Treatments aimed at directly reducing hs-CRP are not likely helpful, as they essentially "shoot the messenger" rather than addressing the problem for which hs-CRP serves as a markers. Approaches to lowering hs-CRP include (but are not limited to) Low-inflammatory and Oil-change diets (see above), curcumin, and optimizing hygiene (especially dental).

This is one of the interventions used by [Bredesen2014  🕮 ]. Low Albumin/Globulin (A/G) Ratio is a marker of inflammation. Since inflammation plays a significant role in neuroinflammation and consequent neurodegeneration, the root cause of the low A/G ratio should be identified and treated. Treatments aimed at directly increasing the A/G ratio are not likely to be useful, as they essentially "shoot the messenger" rather than addressing the problem for which low A/G serves as a marker. Approaches to lowering the A/G ratio include (but are not limited to) Low-inflammatory and Oil-change diets (see above), curcumin, and optimizing hygiene (especially dental).

While everybody does not have heavy metal toxicity, environmental toxins such as lead and mercury can cause severe disruption of mental function. Consider, for example the "Mad Hatter" syndrome caused by the mercury compounds used to make felt hats. Here in Arizona, the "Dreamy Draw" area of Phoenix (near Northern Avenue and Arizona 51) was formerly a mercury mine and was given its name because of the mental disruption observed in the miners.

There is some evidence linking statin drug use with transient memory loss (see the book "Lipitor: Thief of Memory" by NASA flight surgeon and former astronaut Duane Graveline [Graveline2006]). In fact, cholesterol is necessary for proper brain function, and the production of important hormones. Statins also suppress the body's production of the cofactor CoQ-10, which is necessary for mitochondrial energy production.

A cause-effect relationship between cholesterol and cardiovascular disease has not been proven (association does not prove causation). Nor has the possibility been ruled out that the cholesterol plaques are a marker of another disease process (such as inflammation) rather than a cause of disease per se, or even a protective response to another disease process (such as inflammation). The Naturopathic Medical principle "Find and treat the cause" (e.g., inflammation) is applicable here.

Since homocysteine and cholesterol are both independent risk factors for cardiovascular disease, it may make more sense to target reducing homocysteine using vitamin therapy instead of reducing cholesterol levels with statin drugs.

While you should never discontinue medications without discussing the matter with your prescribing doctor, there are some critical questions to ask:

1. Given my current age and life expectancy, is there any actual evidence that continuing statin drug therapy will allow me to live longer (reduce all-cause mortality)?
2. Given my current age and life expectancy, is there any actual evidence that continuing statin drug therapy will slow the progression of my dementia?

It is doubtful that the prescriber can cite an actual clinical trial that answers either of these questions in the affirmative. However, there is "expert opinion" that will say yes, but remember that in the past "expert opinion" has recommended replacing butter with trans-fat-containing margarine, which is now known to be terrible advice.

Note that the above advice differs from conventional medicine's current standard of care - you must decide whom to trust.

This is one of the interventions used by [Bredesen2014  🕮 ]. In an 18-month study, individuals at genetic risk for Alzheimer's Disease (who are positive for the apolipoprotein epsilon 4 (ApoE4) and who engaged in (self-reported) physical activity are protected from hippocampal atrophy, while those with similar genetic risk who did not engage in physical activity experienced a 3% decline in hippocampal volume over the same period [Smith2014  🕮 ].

This is one of the interventions used by [Bredesen2014  🕮 ]. Forty hours of computerized brain training yielded a statistically significant improvement in generalized measures of memory and attention over a control group. The magnitude of the effect sizes suggests that the results are clinically significant [Smith2009  🕮 ].