Probiotics for Alzheimers ?

My only experience taking probiotics was when I had horible diarrhea on a Viking Cruise to
Cambodia.

It cleared up my diarrhea in one night.

I have had to decrease my metformin from 4,000 mg to 1,000 over the last year because of intermittent diarrhea.
I have decided to take probiotics daily to to try to increase my metformin.
Heck it might even help me lose weight.
I decided to spend $13 at SAMS rather than Mercola's $140 bottle.


This is what Dr. Dale Bredesen in his book The End of Alzheimers.

People need probiotics according to Dr. Bredesen unless they have leaky gut syndrome. 

I spoke to my Endocrinologist about Probiotics this week.

He said it helped his bowel movements.

He found Sam's to have the cheapest product.

The pharmacist suggested the Gummies below:
















The excerpts below are from The End of Alzheimers p 203






30-50 billion CFU (colony forming units)

My Sams product has only 3 billion CFUs at a cost of $13.

Here is a high price alternative






UPDATE Jan 26, 2021

I sent in a stool sample to Thryve to determine which bacteria I lack in my stool.  On sale it cost $100.  

Instructions were very clear and not messy at all. 

AZ: : "Who are they then?"

From tweet below:
"I often hear people say that a person suffering from Alzheimers is not the person they knew.
I wonder to myself - Who are they then?"






Let me clear up a myth.

"People don't change."

In Shakespearean plays it is shown how people progress in their characters.

I have changed with my Alzheimer’s disease,

I am 33 months since my diagnosis.

I try to be philosophical as I was in the epilogue of my Year One book below:

Check homocysteine level for Alzheimers ?

In The End of Alzheimer’s by Dr. Dale Bredesen advises my homocysteine should be less than 7.
If it is not I should take:
 methycobalamin 1 mg
methyfolate 0.8- 5mg
PSP 20- 50 mg
Above is also if B 12 level less than 500


My lab's range is that normal is up to 15.





l


 As you can see from my blood work below, 
I don't need more Vitamin B or folate. 
Because of my testosterone my hematocrit has been high three times.

Testosterone for Alzheimers ?

In The End of Alzheimer's  by Dr Bredesen on p 209 he advises the above: ONE and TWO

ONE
Free testosterone is low if it is less than 6 pg/ml, take more testosterone.

This test better in obese?

My free testosterone results.  They were acceptable in Dr Bredesen's criteria and in normal limits in my lab range below

TWO
Lately I have had total testosterone testing see below.

These more recent tests were lower than the 500-1000 level that Dr Bredesen would like to see.
Bredesen writes that levels less than 300 are very low.

Thus my endocrinologist and I decided to increase my 100 mg a week to 150 mg a week,
 even though normal levels are 86 to 780 ng/dL on in my hospitals lab

The endocrinolgist that fired me link 
also she didn't want me taking testosterone because my Hct and Hgb was a little high. 

I asked my urologist (a professor at KUMC that specialized in testosterone) about the risk of stroke.

The urologist was not concerned as I was on a blood thinner. 

How to improve my glucose level without adding insulin

In The End of Alzheimer’s by Dr. Bredesen advises that:
Fasting insulin should be less than 4.5
Fasting glucose should be 70-90.
Hgb A1c should be less than 5.5

Excerpts from The End of Alzheimers:



I don't disagree with DESS.
Diet (ketotic)
Exercise 150 minutes a week.
Sleep 7-8 hrs a day (with CPAP if needed)
Stress reduction (always)

on p235 I don't agree with:
Alpha lipoic acid
N-acetlycysteine
Cinnamon
Berberine
Metformin is a good idea.

The best thing to do is lose weight and then maintain that weight loss.
I have not been on insulin for many years.
I run a high Hem A1c  of 7.5

I am now trying a new strategy.
I am using a CGM (continuous glucose monitoring) to see what food raises my glucose the most.

I went to my Endocrinologist today to help me evaluate ReCODE by The End of Alzhehiers,

My Endocrinology visit today was very productive.  

He ordered a hsCRP on my request.

The lab told me my insurance might not cover it and it might be $100 out of my pocket. 

I told my Doc I had hurt my back 2 months ago in Poland and it had not cleared up.
He found it might be covered with lumbar back pain. 
As an infectious disease Doc we would do CPR to look for osteomyelitis. 
Dr Bredesen advises getting hs-CPR and it should be less than 0.9.

Mine was higher than this.
I think it was due to my back pain from muscle inflammation.
My prior tests have not been elevated. 
I will check on it in 4 months.

I had a patient with very high hsCRP.  It was after she had her teeth cleaned.

I am surprised with all the items listed by Dr Bredesen for inflammation I was surprised he did not list chronic gingivitis or bad teeth.

As an Infectious Disease specialist I would be consulted for fever of unknown origin.  I would find these country people with very bad teeth. In Idaho I was friends with a dentist who went into ENT. 
He happily wound take the patient with no insurance to the OR and pull out all their bad teeth. 



CPR  is not often used by family Doctors as it it consider non-specific. (many things can raise it)

However in infectious disease this is the test that we used to decide whether to stop long term antibiotics in the treatment of osteomyelitis.


In The End of Alzheimers, Dr Bredesen says to treat hs-CRP if greater than 1.0 on p 235.

Dr. Bredensen advises specialized pro-resolving mediators for one month (SPM)

I can't find in the book what SPM is?

I will simply baby my back with stretches and exercise for a few months and check it again

Check Vitamin levels of B12 and Folate and TSH according to THE END of Alzheimer’s

On p 167 of Dr Dale Bredesen's book The End of Alzheimers he advises having a high level of folate at 10-25.
At this point I don't want to take any more supplements and I believe my level is normal.



Dr Bredesen Advises B12 levels to be 500 to 1500.



I doubt I will take B12 supplements as I eat a high meat diet. I have consistently had normal levels over the years. 




Dr Bredesen advises TSH level on p 168 that TSH should be less than 2.0 
Again my TSH is less than 4.0.   That is in normal range. I discussed this with my endocrinologist. 
I am not going to take thyroid.

Vitamin D for Alzheimer’s ?

In The End of Alzheimers by Dr. Dale Bredesen advises a high level of vitamin D.

Vitamin D: target level 50- 80

I did not take any supplemental vitamin D for 3 months while I was traveling from July 16, 2019 to Oct. 8, 2019.

Thus I repeated my Vitamin D level after taking 2-4,000 units since Oct 8.



Since 2013 my vitamin D levels have been in normal range. 
I will now maintain an intake of 4,000 units a day to get to the 50 range as Dr. Bredesen suggests.  
I do this to prevent going below the normal level of 30 and it is inexpensive and something I have believed in for health for a long time. 
In my geriatric practice I would check my patients while on 1,000 units a day after I did a loading dose.  To my surprise they would be low in Vitamin D after winter.  Thus in my book the Tubby Theory from Topeka I increased their daily dose to 2,000 mg a day. See excerpts below.





When I published my recommendation above for Vitamin D3 2,000 IU a day in 2010 my Lipid mentor admonished me for advising such a high daily dose.  I based my therapy on clinical experience.  I was one of few Doctors doing follow up Vitamin D levels.  Time has proven my initial experience to be true. 

New trial on Vitamin for Alzheimers. 





I purchased subscription to Examine.com link
and I was not disappointed

Excerpts from their article below.

I took Dr. Breseden's challenge and obtained some of the tests he advises.

In The End of Alzheimers by Dr. Dale Bredesen on p 167  he advises:
LDLp 700 to 1,000
HDLc greater than 50
Triglyceride less 150 fasting
I actually have done much better than this with low dose Lipitor or atorvastatin

October 11,2019

This lab is after being off Niacin and Lovaza since Aug 3, 2019
This lab is done while on Lipitor 10 mg and Zetia 10 mg after traveling for 3 months.
LDLc 46 is as low as PCSK9 drugs achieve.
NonHDLc  is 69 and TG 117 non-fasting

10-28-19 lab result on bottom of blog
I did better with half the dose of atorvastatin
LDLc 37
nonHDLc was 54
I had TG non-Fasting 87  after 17 days
 on Lovaza 4,000 mg and Niacin 1,000mg and lower dose of Atorvastatin 5mg
These are extremely low levels while on Low carbohydrate high fat diet



Traditional Lipid panel in past.


10-28-19

Anit-ageing with NMN and NR?

My edited version of Scientific American article to make it easier to read link

The Rise of Pseudomedicine for Dementia: Cargo Cult Science

JAMA article 2019 link






My edited version to make reading easier link

Here are some highlights:

Some sane advice on Alzheimers. My review of the article.

My comments in purple

Real Evidence for Steps to Prevent Dementia

Any number of people want to sell you magic steps to prevent dementia.

Lumosity had to pay a two million dollar fine in 2016 because it “preyed on consumer fears about age related cognitive decline.” But that hasn’t stopped the company. It’s just being more careful about falsely promoting its game to prevent dementia.

Nonetheless, consumers are still spending an estimated $1.9 billion on brain training apps. They’re also spending hundreds of millions of dollars on useless brain health supplements.

Hacketts article from Jan. 2016 confirms this event. 

Luminosity brain games don't work link

However, if you really want to take steps to prevent dementia, the evidence is pretty clear. The best thing you can do is take real physical steps. Enjoy some healthy physical activity. Regularly and throughout the day.

Robust Evidence

For a very long-term outcome like dementia, randomized controlled studies are difficult. Nonetheless, the evidence for benefits from physical activity is robust. First of all, observational studies show a clear relationship between physical activity and better cognitive function. In addition, randomized studies show that physical activity helps with cognition for patients with dementia.

Mary Sano, an Alzheimer’s researcher, explained some basic strategies to the New York Times for protecting your brain function:

A lot of this boils down to common sense. Keep physically and socially active, eat sensibly, don’t smoke and don’t drink to excess. Treat your treatable conditions. Protect your head, which means wear seatbelts and helmets and use sturdy ladders. That’s because falls which occur frequently as we get older can be devastating to the brain.

So Don’t Waste Your Money

Brain training games don’t work. Brain supplements are expensive placebos. Staying active, both physically and socially, does work. So just do it.

It amazes me that Prevagen (from Jelly Fish) ads is still flooding the media.

Prevagen loses suit from FTC link

What I do on Dr. Dale Bredesen"s ReCODE list from The End of Alzheimer’s

I have reviewed much of the book in my blog link

I actually do much of what Dale Bredesen MD advises. 

1-I keep my LDLp below 1,000.  (LDLp is the particle count which is more accurate than LDLc)

2-I keep my systolic blood pressure under 120.

3-I also exercise 150 minutes a week

4-I have  a sleep apnea machine since 2004 and sleep 7-8 hours a day

5- He advises Magnesium threonate 2 gram a day.  I take 3,750 mg of Magnesium maleate a day which has helped my leg cramps at night tremendously.

6- I get my Resveratrol with wine

7- I get Nicotinamide riboside 100 mg in Enduracin (nicotinic acid)  2,000 mg which I take for cholesterol, triglycerides and HDLc. Both chemical are in the same molecular pathway.

8- He advises Omega 3: DHA 1g EPA 0.5 to 1.0 gram 

I take 4,000 mg of Lovaza which breaks out as:

DHA 375 x 4= 1500 mg
EPA 465 x 4 = 1860 mg

9- I take Vitamin D 2,000 to 4,000 IU a day

10- I take Citalopam for depression or rather dysphoria. 

11- I take Testosterone 100 mg IM

That leaves 20 things I don't do on Bredesen's list

The other 21 items are nostrums that have no human trial evidence. 

I think the 10 items I do is more than enough.  

Especially the following:

CURCUMIN

ASWAGANDHA

BACOPA

GOU KOLA

UBIQUINOL

PQQ

LIPSOMAL GLUTATHIONE

VITAMIN E

CINNAMON

BERBERINE

ZINC PICPLATE

HUPERZINE

Dr. Bredsen advises many tests.

I will attempt to comply to what I think might be reasonable.  I plan to do the following blood tests this week. I have already done these tests in the past. 

1-Repeat TSH

2-Repeat Vitamin D  level 

3-Repeat B 12

4-Repeat hsCRP

5-Repeat Folate 

6-Repeat Homocysteine level

I found my favorite vermouth to go with my classic Gin martini.

This often was first choice of many opinions

I found Bianco vermouth makes the best
Classic Gin Martini to my taste

Vya Vermouth is my second favorite Vermouth to make a Classic Gin Martini

I like to add 4 garlic stuffed olives. 

The only 
Vodka maritini I like is made with Bison Grass Vodka 
from Poland link

My Amazon review of The End of Alzheimers by Dr. Dale Bredesen

Review of End of Alzheimers #9

1- Optimize diet
I have been in nutritional ketosis since 2011. 
I did this to maintain my weight loss with less hunger. 
However I eat a lot of meat.  Bredesen says to avoid meat. 

2-Enhance autophagia, ketosis
Bredesen advises fasting 12 hours a day including 3 hours before bedtime. 
I am not sure about the theory of autophagia.
But for people who can do this without too much pain I will allow it.  I just know for myself that 3 hours before sleep if the most difficult time for me to not to snack.  Too painful for me to do it 
since I am in nutritional ketosis every morning anyway.

No human trials demonstrating efficacy with Alzheimer's

3- Reduce stress.
Yoga, meditation or music.
All the above fine with me. 
I used the meditation technique from Alzheimers Association as  when I am stressed or I am trying to be patient because it is such an easy technique.  
Simply say 
Sha
Tha
Na 
Ma 
 with a finger exercise simultaneously. 
Thumb and finger shift with each word.
I think the best way to avoid stress is have fun
rather than trying to comply with such an overwhelming program such as ReCODE. 
It puts the responsibility on the patient.  Very stressful and unnecessary when there is little evidence for success. 


4- Get 7-8 hours of sleep
This is good advice especially to rule out sleep apnea. 
Not sure melatonin or tryptophan helps with sleep for all as I think it is more for circadian rhythm rather than sleep induction. 

Sleep problems can be very difficult. 
I get up 3 to 5 times a night to urinate.
Fortunately I rarely have trouble falling back asleep.
I have a memory palace where I have memorize 55 European countries.  I usually fall asleep before I get through the whole list. 

5- Exercise
I try to walk at least 5,000 steps. 
I often do not make it to 10,000 steps
Trials have shown an Alzheimer should exercise 150 minutes a week. 
20 minutes x 7 is 140 minutes. 
I usually do more than 20 minutes and I walk up steps 5-10 times a day.


 6- Brain stimulation
Not sure what this is?  Crossword puzzles or Soduka?

"The aim of this systemic review was to determine the available tests for the assessment of executive functions with ecological validity to predict individuals function."

7- Homocysteine level

I have no problem with people getting a homocysteine level. 

8- B 12 greater than 500
This included in traditional work up of dementia. 
I doubt my level is low as I eat a great deal of meat. 


9- CPR less than 1.0 
I would advise getting a hsCRP

10- Fasting insulin level more than 7 
 and Hemoglobin A1c less than 5.5

I don't think people should wait till they have memory loss.  If fasting glucose greater than 95 you probably have pre-diabetes.  Best test is 2 hour post prandial test. Best treatment is weight loss with Atkins or Low carbohydrate High fat diet. 

11- Hormone balance 
Probably good idea with Endocrinologist help. 
These labs can be confusing even to your family physician and often need to be done in a special way or timing. 
I take testosterone IM 100 mg a week since 2011 to help libido.

12- GI health

If you are concerned with this diagnosis please get confirmation confirmation from a Gastro-intestinal specialist. 




Celiac disease is not a cause of Alzheimers

13 Abeta = Amyloid

Only way to know this is to get a PET scan for Amyloid plaque

Curcumin and Ashwaganhda have no human trials decreasing Amyloid plaque

14-  Cognitive enhancement

Bacopa, Manniera and Magnesium have not be shown to improve thinking in Alzheimers patient trial.


15- Vitamin D (25OH-D3)
Get level from 50-100 ng/ml

I agree it is a good idea for the elderly to check their Vitamin D level, especially during February. 

16- increase NGF

This is interesting. Basil forebrain implants.

This mushroom is typical Chinese Herbal Medicine. 

Not enough information to advise either of these drugs. 


17- Provide synaptic structural components
Citacoline
DHA

DHA is part of the four Lovaza capsule I take
DHA 375 x 4= 1500 mg
Dr. Bredesin advises 1,000 mg a day