We interview UK nutritionist Patrick Holford on latest protocol following scientific validation of online Cognitive Function Test
Just published is a ground-breaking paper that demonstrates that the Food for the Brain’s online Cognitive Function Test is on a par with laborious pencil and paper tests administered by general practitioners (GPs) and psychiatrists. The free, online test takes just 15 minutes to complete and determines early signs of cognitive decline that is almost universal in elderly people. Coupled with two simple additional steps, involving a homocysteine test and high-dose B vitamins for identified groups, Food for the Brain upholds that 50% of the population could be prevented from developing Alzheimer’s disease.
[PH] Very much so. There are certain key losses of cognitive function that are found in dementia/Alzheimer’s and our Cognitive Function Test (CFT) [http://cft3.foodforthebrain.org] contains tests for each of these. The scores for these individual parts of the test were compared to the best currently used ‘paper and pencil’ tests for these functions and produced the same results. So, the CFT is as good as any current cognitive test in use.
[RV] What are the advantages of having an online test versus the traditional paper tests?
[PH] The CFT can be done at home by anyone in their own time, just by going to www.foodforthebrain.org. This means that many more people will come forward for early screening, as opposed to having to visit a very busy GP who may not have the time or expertise on hand to run an early screening test. It also means the test can be free, which ours is.
The disadvantage is variable computer skills. We take that into account by starting with a ‘mouse click speed test’. This then adjusts how long someone has to complete the CFT. The CFT is validated for people aged 50 to 70. It is probably valid for a wider age group, but we have yet to test this. Most people under age 70, these days, have some keyboard skills. This will be even more common in future, so I predict paper and pencil tests will eventually become obsolete.
[RV] Most people over the age of 50 will sooner or later notice that their memory is not what it once was. How many people currently get tested using the conventional testing methods?
[PH] This is the big problem. The answer is virtually none in the early stages of memory decline, which is when it is easiest to prevent, or even recover, declining memory function. Most people are only tested when they have serious memory decline and they, or their partner, goes to the GP. No treatment has yet shown any reversal of the Alzheimer’s disease process, including B vitamins. This is not surprising, since the loss of cognitive function is caused by loss of brain cells. The earlier a person is aware of declining memory, the earlier they can do something about it. Hence, we recommend everyone over 50 take the CFT.
[RV] Orthomolecular medicine practitioners have always been aware of the damage that elevated homocysteine can do. And it’s fair to say you’ve been banging the drum on this in the UK longer than most. Why does the mainstream medical profession have so much difficulty appreciating the problem?
[PH] There are over 18,000 studies on homocysteine, so it isn’t a lack of science. Homocysteine also predicts heart attack and stroke, which led to some studies giving B vitamins to heart disease patients. Some of these studies showed no benefit, which led some to believe the homocysteine hypothesis was invalid. The same is true with studies giving B vitamins to Alzheimer’s patients: studies have found no benefit. These studies are, however, badly designed, because they didn’t select people with raised homocysteine in the first place. It’s like giving cholesterol-lowering statins to people with normal cholesterol. On top of that, it is probably too late to get an effect once a person has Alzheimer’s. However, there is some hope. In Paul Aisen’s study, those with early stage Alzheimer’s did respond.
However, I think the real reason why homocysteine and B vitamins aren’t being taken seriously by mainstream medicine is that, being unpatentable medicines, there’s no serious money to be made and big pharma isn’t interested. If there was a drug to lower homocysteine, you can bet we’d know about it and doctors would be prescribing it.
[RV] You’re proposing a seemingly simple strategy that could be incorporated into protocol-driven mainstream medicine rather well. It involves an online CFT, testing homocysteine in those whose test results show some cognitive impairment and then putting those with significantly elevated homocysteine levels onto high-dose B vitamins. You think this could eliminate 50% of Alzheimer’s disease cases in our population. Can you explain?
[PH] Studies already show that, if a person’s homocysteine level is above 9.5 mcmol/L, their brain is shrinking at an accelerated rate, with concomitant memory loss. Also, we know that giving high-dose B vitamins (most studies have given B6 20 mg, folic acid 800 mcg and B12 500 mcg) arrests both the accelerated brain shrinkage and memory loss that are the hallmarks of Alzheimer’s. Given that approximately one in two people over 65 has a homocysteine level above 10 mcmol/L, if all people ‘at risk’ (discovered by doing the online CFT) were tested for homocysteine, and given B vitamins if their homocysteine level was above 10, then we would expect a halving of Alzheimer’s.
If other known risk factors – lack of antioxidants, low omega-3, high sugar and glycaemic load diet, smoking and lack of social, mental and physical activity – were also addressed, even more cases of Alzheimer’s could be prevented.
The projected number of people with Alzheimer’s by 2050 is 100 million worldwide. Even a small one-year delay in disease onset would result in 9.2 million fewer cases globally by 2050, and would save billions in costs to society. Just think of the financial saving of halving Alzheimer’s incidence. Already, in the UK alone, Alzheimer’s disease costs around £25 billion a year.
[RV] What doses and forms of B12, B6 and folate have been shown to work?
[PH] There are two main pathways for lowering homocysteine, and improving methylation, which is a critical process for brain and body health. The main one involves vitamin B6, B12 and folic acid. There is another homocysteine-lowering enzyme system in the liver, which requires zinc and TMG (tri-methyl-glycine). Naturally occurring ‘folate’ in food is rich in these ‘methyl’ groups, required for methylation. They are also found in fish and eggs. All of these nutrients, and foods, have been shown to lower homocysteine.
The most effective doses have been 20 mg of B6 (ten times the RDA), 800 mcg of folic acid (four times the RDA) and 500 mcg of B12 (200 times the RDA). Some people also benefit from supplementing a methylated form of either B12 (methylcobalamin).
Most good homocysteine-lowering formulas contain all of these. Some also contain N-acetyl-cysteine (NAC) or glutathione, because homocysteine can also be processed to produce glutathione. If this pathway is satisfied by supplementing glutathione or its precursor NAC, then more homocysteine is turned into the ‘good guy’ called S-adenosyl methionine (SAM), which actually does all the ‘methylation’. High homocysteine means you are bad at methylation.
Online Cognitive Function Test in the comfort of your home — or this?
[RV] Briefly, what’s the key mode of action for these B vitamins?
[PH] Methylation is how our bodies and brains micro-adjust our body and brain chemistry. It is needed to make neurotransmitters and hormones, repair DNA and turn on and off genes, for energy, for building joints and bones, for detoxifying – in fact, for just about everything. There are about a billion methylation reactions every few seconds. It is how, for example, you can produce adrenalin in 0.2 of a second when encountering an emergency. Even a child’s school grades can be predicted by knowing their homocysteine level, or level of folate or B12. If homocysteine accumulates, it damage the brain, the bones, the arteries. So, these B vitamins are helping to keep just about every part of your body healthy.
[RV] From an evolutionary perspective, do you think that we’re now consuming less B vitamins than our ancestors did, or are we seeing symptoms of aging that weren’t previously apparent because we're living longer? Or have our environments become more toxic and we're just not methylating sufficiently well these days — what do you think is really going on?
[PH] For sure we are consuming less B vitamins. Not only are they refined out of food, but also we are actually eating less than our highly physical ancestors due to cars and modern conveniences. A more toxic environment also ‘consumes’ more nutrients. Stress depletes B vitamins. But the critical B vitamin is B12. The reason such high supplemental levels are needed is largely due to decreasing absorption with age. Common medications, especially the antacid ‘PPI’ drugs – the ‘prazoles’ – and the diabetes drug metformin, interfere with B vitamin absorption. Coffee promotes its excretion, as do diuretic drugs. Lack of zinc means you can’t make enough stomach secretions, which are critical to B12 absorption. Decreased consumption of vegetables, fish and eggs, which describes a major difference between today’s diet and that of our ancestors, also means less methyl groups. It may be a combination of these factors.
It is a fact of life that the older you get, the less efficient your cell function becomes. So, even the healthiest need more nutrients as they age to keep well.
[RV] Do you have any safety concerns regarding long-term use of high-dose B vitamins, especially folic acid, at the 800 mcg level you are proposing?
[PH] Firstly, and importantly, I don’t propose these high doses unless a person has elevated homocysteine, above 10 mcmol/L. I have no concerns about B6 or B12, but folic acid, in large amounts, if given to a person with pre-cancerous cells, especially in the gut (gastrointestinal polyps is an indicator of risk), can speed up the growth of these cells and precipitate cancer. However, generally, upping folic acid actually reduces cancer risk.
For these reasons, I don’t recommend taking more than 200 mcg of supplemental folic acid unless you have tested your homocysteine and found it to be elevated. Even then, if you have cancer or pre-cancerous cells, I would limit supplemental folic acid to 200 mcg.
[RV] For those who have been found to have elevated homocysteine and then go onto high-dose B vitamins, will they need to remain on them for the rest of their lives or face an increase in homocysteine and subsequent further brain shrinkage and memory loss?
[PH] Often not. Homocysteine levels tend to come down very quickly. Most people with a homocysteine of 15 mcmol/L can expect it to be below 10 mcmol/L after 3 months of supplementation. One South African man had a level of 119 mcmol/L and reduced it to 9 mcmol/L after 12 months! Our website www.foodforthebrain.org explains what to supplement based on your homocysteine level (search for ‘lowering homocysteine’). Below 7 mcmol/L, a good high-potency multivitamin will suffice. But there are some people, for example, who inherit variations of key methylation genes and just need more B vitamins, and always will. If you use our guide to how much to supplement according to your homocysteine level, you can then adjust your supplement intake as your homocysteine comes down. If, at this point, you find your homocysteine level goes up again, you've learned what level of supplementation you need to maintain a healthy homocysteine level.
[RV] What evidence is there that the reversal of brain shrinkage by those suffering raised homocysteine will be sustained long-term by taking high-dose B vitamins, for the rest of a person’s life?
[PH] So far, the well-designed studies have given B vitamins for 2 years and shown an arrest of brain shrinkage and memory loss. The next-needed study is a longer study, looking at more people with mild cognitive impairment, to follow them through to the point at which Alzheimer’s would be expected. This study is ready to roll but needs funding. It will probably take another 5 years to have an answer to this question. I am, however, very hopeful, because the evidence after 2 years is so strong. There was almost nine times less brain shrinkage among patient taking B vitamins. There is no logical reason to expect this effect to vanish. Even if it did diminish, the effect of delaying Alzheimer’s by 2 years would be very good news.
[RV] Apart from taking high-dose B vitamins, are there any other preventative strategies you think are important to protect against Alzheimer’s?
[PH] Yes, plenty! In fact, when a person does the CFT, we include other advice on Alzheimer’s prevention steps. These include eating more oily fish, specific vegetables including beans and greens rich in folate and more antioxidant-rich berries, drinking green tea rather than homocysteine-raising coffee, avoiding sugar and refined carbs by eating a low GL diet, keeping physically, mentally and socially active and lowering blood pressure. We have a downloadable leaflet at www.foodforthebrain.org/preventionsteps on all these Alzheimer’s prevention steps. These may not be as well proven as supplementing homocysteine-lowering B vitamins, but all the evidence points in the right direction.
Given that only 1% of Alzheimer’s is caused by genes, we have every reason to hope for 99% being preventable. Our charity is focusing on that goal, through research and education, but we need more money to reach more people. 170,000 people have done the CFT, but we need this number to be over a million. Any help, both in terms of funding and letting other people know about the CFT, is greatly appreciated – and thank you ANH for helping to get the word out there.
[RV] What’s the best advice you can give a person who’s over 50 and wants to do what they can to avoid Alzheimer’s disease?
[PH] Firstly, do the CFT. If you score fine, and you probably will, incorporate our Six Alzheimer’s Prevention Steps into your lifestyle. If your score is not so good, test your homocysteine and, if it's above 10 mcmol/L, supplement the right level of B vitamins. Retest again in 3 months and adjust your supplemental intake accordingly. It's as simple as that. We need to address the question of why the drug industry is spending billions of pounds, helped by our government, under the misguided illusion of finding a drug-based ‘cure’, when we already have the means to prevent Alzheimer's. This question is important not only for Alzheimer’s, but also for all primarily diet- and lifestyle-related diseases of the 21st century, including obesity, diabetes, heart disease and cancer. These are the diseases that are costing us all a fortune through taxes.
Put your money where your mouth is. That’s my advice to the government and the NHS.