By Dale Bredesen, M.D., Chief Science Officer for Apollo Health

2023 should be a year of great progress — we are just starting our randomized controlled trial for patients with mild cognitive impairment and early dementia, there are new publications appearing that confirm our earlier reports of improvement with a precision medicine approach like ReCODE, in collaboration with Nutrition for Longevity there should soon be KetoFLEX 12/3 meals readily available and reimbursable (with great thanks to Julie and Aida), and there are now patients who have sustained their improvement for over ten years, something unthinkable in the past. 

Meanwhile, one of the early patients on ReCODE has done very well for nearly nine years now, but decided that he likes to cheat! He had a positive amyloid PET scan, a positive FDG-PET scan, a single copy of ApoE4, and a strong family history of dementia, so there was no question about his diagnosis. He had been struggling at work, but responded beautifully to ReCODE, and was able to work once again without difficulty. His metabolic parameters improved, his hippocampal volume improved, and his brain’s grey matter increased in size. 

However, he loved ice cream, so he would adjust his dietary indiscretion so that he would just develop a mild anomia (difficulty with names) — he knew this meant that more serious violations of the protocol would result in more serious symptoms, but he could prevent the advancement of symptoms by noting his own mild anomia. This ability to fine-tune shows how intimately the protocol and the underlying disease process are linked.  

His strategy reminded me of the terrible old joke about the priest who told the little boy, “You must stop masturbating, otherwise you’ll go blind.” “Don’t worry,” said the boy, “I’ll only do it ‘til I need glasses.” 

We all have our suboptimal areas, our little slips, whether it’s sweets or poor sleep or sedentary lifestyle or untreated pathogens or toxins, or something else. So let’s make 2023 a wonderful year of progress, OK? Let’s all try to improve our cognition, no matter where we are today, and focus on improving at least one risk parameter. For some of us, this will mean getting into ketosis more often (at least 1.0 mM BHB by finger stick, or at least 10 ACES if you are using the Biosense breathalyzer). For others, it will mean improving our oral microbiome (many like to use Dentalcidin and then oral probiotics, but whatever you choose, please try to minimize your pathogens like P. gingivalis and T. denticola). For still others, that will mean optimizing nocturnal oxygenation (the target is 96-98% saturation, and make sure to address this if you are falling below 92%). For still others, it will mean healing a leaky gut, treating identified pathogens or enhancing detoxification of biotoxins or doing more regular brain training, or starting EWOT (exercise with oxygen therapy). The great news is that in 2023 we have the unprecedented ability to address all of the many potential contributors to cognitive decline and risk for decline, especially if we start early, so that we can all contribute to making Alzheimer’s a truly rare disease. 2023 should indeed be a year of great progress.   

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