Patrick Holford is the author of 46 books on nutrition and lifestyle factors for wellness. He is also the founder of a charity, Food for the Brain Foundation, and the voluntary director of the Alzheimer’s Prevention Project.

He joins James on this episode to showcase the foundation’s resources for reversing cognitive decline and preventing Alzheimer’s disease. They discussed targeted nutrition approaches and other tools available to patients and practitioners on the foundation’s website.

Listen to the full episode to learn more about:

  • Which nutrient deficiencies correlate with poorer cognitive function
  • How to reduce the risk of developing Alzheimer’s disease through supplementation
  • The success rates of targeted nutrition therapy for reversing cognitive decline—and how nutrition therapy can be more successful than pharmaceuticals
  • Cognitive function data collected from 377,000 participants via the foundation’s test


Preventing Alzheimer’s with Functional Medicine | Ep 289


James Maskell: Lifestyle Matrix Resource Center offers clinical programs and educational tools that help increase patient acquisition, compliance and retention, so clinicians can grow and scale their practices. Learn more about membership opportunities and schedule a free practice consultation at lifestylematrix.com/membership.

Hello and welcome to the podcast. This week we feature Patrick Halford, and we’re going to be talking about the fact that Alzheimer’s is preventable. And I know you probably know that if you listen to this podcast and you’ve followed the Functional Forum here for the last few years. This has been a topic that’s come round and round again.

But, interestingly, and the reason why I wanted to share this podcast is that there is a campaign that is kicking off on November 1 to not only announce to the world that Alzheimer’s is preventable, but actually with a reasonable plan to get millions of people into an initial testing phase to identify what might be causing their reduction in cognition and a plan to improve that. It’s a big vision. It’s really exciting. They’ve got a lot of great pieces, and I would encourage you to participate if you can. Check out foodforthebrain.org, and check out all of the socials.

We’ll have all the details in the show notes but really interesting half an hour. I think there’s really good clinical information in here for you if you’re a practitioner. But, more than anything, I think at the Evolution of Medicine, we’ve tried to show that things are moving in the right direction and there’s progress towards this root-cause, lifestyle-first approach in medicine. And I think Patrick’s doing a great job of bringing together communities for that combined and unified vision. So, enjoy.
So, a warm welcome to the podcast, Patrick Halford. Welcome Patrick.

Patrick Holford: Thank you. Very good to be here.

James Maskell: When I got your email and the first thing that I saw, it just said, “Alzheimer’s is preventable.” And I think for many of the community that are listening to this, they know that because they’re treating patients in their community, doing different protocols on it. But I think it’s time that the general public knew because there’s been efforts to get the word out there. And I guess what really attracted me first was that this was sort of like a public education effort first. So, do you want to just give us a bit of background on how you got into it and a little bit about that?

Patrick Holford: Yeah, certainly. I mean, I wrote a book back in 2000 on homocysteine, and I described homocysteine as the biggest breakthrough potentially of the century. And got to meet a wonderful man called Professor David Smith, who was the professor of pharmacology at Oxford University. He was the Vice Dean of the medical school at the time. And it was his group that had found out in effect what Alzheimer’s was in terms of shrinkage of the medial temporal lobe, the hippocampal region, and then developed the scan, which is now used globally. So, I’m sure your listeners know. But basically, if you start to lose your cognitive abilities, it’s called mild cognitive impairment. Generally, now, it’s called pre-dementia as well. If it’s worse, it’s called dementia. But you can only diagnose Alzheimer’s, which is two thirds of dementia, by doing a scan effectively of the medial temporal lobe.

These guys developed that. They then found homocysteine was incredibly high in these regions of the brain, and they then did the first ever double-blind controlled trial, giving B vitamins in high dose. We’re talking 500 microgram of B12, 20 milligram B6—that’s not so high—800 microgram of folic acid. And what they got was 53% less shrinkage.

Now, the biggest discovery in a way that is just catching on and didn’t happen for a few years was they then looked back at the group, and they had blood samples from the start, and they looked at the omega-3 status. What they found, which is an incredibly important discovery, is that the third who had the lowest omega-3 and the lowest total had no benefit of the B vitamins. But the third in the highest total of omega-3 had not 53% less shrinkage, but 73% less shrinkage, which by the way takes it down to the level of people who have no cognitive decline at all. They had no further memory loss.

And at the end of the one year in this group of people, 30% had a clinical dementia rating of zero. In other words, they would not be diagnosed with dementia at all. And to put this in context, the best drug has produced 2% less shrinkage and absolutely no clinical dementia benefit.

Now, I said to David Smith at the time, “Now what?” And he said, “I hope within five years it’s standard NHS, National Health Service, policy.” And I said, “What would the policy be?” And he said, “Everyone over 50 needs to be tested on a cognitive function test, which is what they do in memory clinics. Because we know this test picks up subtle changes at least 30 years before a diagnosis.” “Then what?” “If not good, go to the doctor, get your homocysteine measured. If above 11 micro mol/L, because that’s the level where you see accelerated brain shrinkage, supplement the B vitamins, particularly B12. It’s largely a malabsorption issue. Not a diet issue, but a malabsorption issue. And we know that three in five people over 60, if tested, are B12 deficient in their blood but not in their diet.

Now, he said, “It may take five years.” I said, “I’m going to say 10.” Now we’re 10 years on and absolutely nothing has changed. So, what I did at the time was to get permission from the people who developed the different aspects of the cognitive function test to digitize it and make it freely available to all, which we did around 2015. And we’ve tested 377,000 people since then, so we’ve got real data.

And in 2013, when the G8 Summit was happening in London and dementia was on the agenda, we managed to get 45 minutes in the G8 Summit. What we did was to contact 113 of the world’s leading Alzheimer’s experts from all the different countries to pummel their health ministers who were attending. And we actually got a discussion.

Now, back then, in 2013, the statement which was published in the top Alzheimer’s journal was that at least half of the risk is preventable. We know that less than 1% is caused by genes. People get very confused about ApoE4, then they talk about if you have ApoE4, you’ve got 20% more risk. But that’s a relative risk. The absolute risk is about 4%, and you know that you can modify it. There’s epigenetics. So, ApoE4 doesn’t cause Alzheimer’s. If you do the right things, you can eliminate that risk, but less than 1% is caused by genes.

And here we are, I mean, even back over seven years ago, NIH did a very nice study of all the studies at the time, and they attributed 22% of the PAR, the population attributable risk, to raised homocysteine and lack of B vitamins and 22% to omega-3s and lack of seafood. Now, of course you can’t combine the two because there’s a bit of crossover, but, even then, it was pretty clear that at least a third of the risk for Alzheimer’s was down to two very simple things, which is B vitamins and omega-3, which is so easy to change.

James Maskell: Yeah, that’s great. Well look, I know what it’s like to sort of be on the coal face for a decade, and we’re more out to decades and trying to get it done. So, tell me a little bit about this, what’s happening in November, and why you think we got a shot at sort of getting some traction where maybe no traction has happened?

Patrick Holford: Well, there are really three pieces to this. So, we started… When we started to have a few hundred thousand people doing the test, we then started to research a questionnaire effectively to look at the risk factors. And we did research with University College London on this. And eventually, about a year ago, we produced what’s called a dementia risk index questionnaire, dementia risk index questionnaire. And by the way, we made a decision to exclude anything you cannot change. So, if you’ve had a head injury or you had very poor education when you were young, this increases your risk. You can’t change it.

So, on the dementia risk index questionnaire, which is split into eight areas, which we can talk about, B vitamins being one, omega’s being another. If you score a 100%, you are doing everything possible to increase your risk. And if you score 0%, you’re doing everything possible to reduce your risk. And we now have a team of some 10 leading experts, and you’ll know them, like Dr. Robert Lustig. He’s our sugar man, for example. David Smith at Oxford: he’s our B vitamin man. And so on. So, we’ve got experts in each area.

And so, now, people do two things. One, they do the cognitive function test, which is not a questionnaire. They get an actual measure of their cognitive function. They then do a questionnaire, and it not only gives them a single number between a 100% and zero, but it splits it into eight domains. And it’s a cog, it’s called cognition. So, they’re eight cogs. And if you’re doing well on a cog, like B vitamins, it’ll be green. And if you’re doing badly on a cog, like light, low carb/GL, you score red.

And then the third piece of the equation, which is what we’re launching on November the 1st, but there’s a few other things happening around there as well, is an app. And what the app does, it’s called cognition, is that here you are now making the invisible visible. You can see the areas that are going to have the biggest impact, and you’re then shown your two weakest links, so to speak. So, maybe you’ve got two reds, and you pick one. And then for the next month you’re going to go through a sequence of personalized, interactive emails, WhatsApps, texts, things to watch, things to do, groups to join, things to report.

For example, we have assistant professor Tommy Wood from Washington University. He’s absolutely brilliant on the kind of active-body-type front. So, people will be counting their steps and reporting back and given targets and all sorts of stuff because active body is one of the pieces.

And in this way, of course, conventional science is very sort of reductionist, and it likes to measure one thing, in this case, cognitive function and have one intervention, and in this case, reducing your dementia risk index. And we want to have at least a million people in this grassroots campaign so we can look at the correlation of what happens over time as you reduce your dementia risk index.

Now, inside the black box of that dementia risk index, eight factors. So, it’s very functional, if you like. There’s active body, active mind, sleep and calm, which is really stress. There’s healthy gut. There’s antioxidants, B vitamins, sugar, omegas, vitamin D, and so on.

So, the point is that—and this is really the fundamental principle—I mean, I studied with Linus Pauling and Dr. Abram Hoffer. We’re all different. We are not the same. So, it’s absolutely critical that a person has this sort of personalized journey because…

James Maskell: Well, one of the reasons I really like this… So, obviously, we featured leading experts in this space over the years on our platform. And, obviously, from what you said earlier, this world has so much more to offer than the drugs that have been offered over the last year. For many reasons, obviously, one of the most recent reasons we saw was that the end point of the drug trials was off and fraudulent. So, you see the Bredesens and the Perlmutters and the Tanseys of the world really going at it. And obviously all the work that you guys are doing over there in the UK.

One of the things that appealed to me about the cognition app when I saw it is that it’s not a black box. There’s some parts of this Alzheimer’s work where it’s a black box. You’ve got to take this special test, and you can’t get access to this information without it. And I think the way you laid it out there with the eight sort of causes are quite simple. And then if anyone can take the test and it’s free, and then they can start working on their two biggest causes. It’s sort of empowering.

I mean, I come from a family like my grandmother on my father’s side, Alzheimer’s. My mother towards the end definitely lost a lot of cognitive function. I’d say my dad is certainly like precognitive decline at 84 right now but, otherwise, very healthy. So, you got to keep it as simple as possible. How much thought went into designing care for a population that it’s not that easy to get compliance or adherence?

Patrick Holford: You mean in older people and so on?

James Maskell: People with cognitive decline. They have to remember to do something.

Patrick Holford: Well, I mean, we had…

James Maskell: The foundation of the medicine is that people have to participate.

Patrick Holford: Our sort of prime minister, a few years ago, Cameron, had a big campaign to make Britain dementia friendly. And our campaign is to make dementia unfriendly—I mean, Britain dementia unfriendly. We have to tackle this much, much, much earlier. It’s true. We’ve done some work in care homes where we get the homocysteine down, we give omegas, and people are more stable, and they decline kind of less quickly and so on.

But the thing with Alzheimer’s, and I think we can have lots of talks about stem cells and all the rest of it, but by the time you’ve got holes in your brain, at the time you’ve got that medial lobe shrinkage, there’s no going back from that. You may improve somewhat.

So, unlike type II diabetes, which we know we can reverse, I think what’s really getting everyone excited and scared because here we have Alzheimer’s. In the US, it costs $200 billion. That’s what it’s costing. It’s going to cost a trillion dollars by 2040. We’re going to have 12 million people with this disease. It’s absolutely massive. We’ve just got to stop that happening. And the best time to stop that happening is in the forties, fifties, sixties, seventies, Yes, you can do something in the eighties, perhaps nineties. But really we want to start early.

And I think the important message really is there’s a lot of people… I mean, the youngest age of dementia now I think is 25. There’s a lot of people in their forties who are already are feeling, let’s say, forgetful. They’re just noticing they’re not as sharp as they used to be. They’re not thinking quite so well. So, I think that a lot of people get kind of clues, things in their forties and their fifties, certainly in their sixties, where they’re a bit worried.

And they’ve watched… I mean, I filmed Linus Pauling, I think the last person to do so before he died in his nineties, filming him on his lipoprotein (a) theory, which we now know is so incredibly important. Abram Hoffer was on my scientific advisory board, Professor Abram Hoffer. He treated 6,000 people successfully with schizophrenia. He stopped work two weeks before his death. Four days before his death, he told his friend, I’m not feeling very well. Two days before his death, he went to hospital. He didn’t have any disease as such. His organs just closed down. He died without drugs, without pain, in his mid-nineties with two weeks off work.

So, we absolutely have no need whatsoever to get to the end of our life with half a mind. I mean, that’s terribly important to realize. I mean, one could say that physically it’s quite hard to get to the end of your life fully functional. It’s hard to maintain that muscle mass when you’re in your nineties and so on. But, mentally, there is no reason to have cognitive decline. This is not a natural consequence of the aging process.

And what’s really interesting now, we’ve seen the total failure of all the amyloid drugs and the cheating of the FDA to try and at least get a little bit of money flow. What we know is that homocysteine actually raises P-tau. That’s the other kind of target. They’re saying, “Okay. Well, forget about amyloid drugs. Now let’s look at phosphorylated tau.” And it’s actually the homocysteine that does that.

Last week, there was an amazing study just out, and what it looked at was homocysteine cognitive function and micro-cerebrovascular dysfunction. In other words, the breaking down of those micro blood vessels. Now, you know what an odds ratio is. Well, those who had raised homocysteine had a ten-fold increased risk of cognitive function and a 17-fold increased risk of microvascular degeneration.

What I’m starting to realize now is when we hear about gray matter and white matter, those neurons, the body of the neuron is the gray matter and the dendrites, those 10,000 on average tentacles that reach out to others, which is largely an electrical signal traveling down an insulated cable. So very, very high in fat. It’s white because it’s fat. That’s basically it. And the membrane of a neuron is made of phospholipids attached to DHA. I mean, over 90% of the structural fat of the brain is omega-3 DHA. But the attachment cannot happen unless you’re doing methylation, and you won’t do methylation unless you’ve got the B vitamins. And I would say that at least half, I mean, I’m just giving a figure, of the methylation homocysteine problem is very simply to do with malabsorption of B12, lack of stomach acid. And as we pile in the omeprazole, the PPIs, metformin, of course, inhibits B12 absorption, so do diuretics. So, a lot of the polypharmacy is just channeling people right into this mess. And, of course, B12 is so safe, it’s so cheap and so on.

So, yeah, it’s harder to get people to lose weight, it’s harder to get people to exercise, it’s harder to get people to deal with stress and sleep and so on. But it’s incredibly easy to take B12 or omega-3. And I think those two factors have got to be at least a third of the power and certainly the ones with the most evidence at this point in time.

James Maskell: Absolutely. Well, look, I think everyone in our community… I think there’s great information, and I’m excited for it. Give everyone an idea because, when it came across my desk, I guess one thing I was impressed by was just how many different organizations have got involved. And I know the UK landscape quite well, and now we’re in the US as well. But it seems like where, maybe, let’s say, the World Council for Health and the Public Health Collaborative and BANT and the lifestyle medicine groups can’t really agree on that much. They all agree this is something they need to be behind. Right?

Patrick Holford: Well, it’s true. I mean, really to be honest, in terms of contacting organizations, it’s me and my computer, and we’ve had now 48 organizations sign up in under 14 days. And I hope by the time this podcast comes out, we should have the Soil Association. We’re moving into the ecological sector. We should have the National Association of Head Teachers. So, it’s going into education. We’re now talking to some major players in the psychedelic research area. They’re very, very fascinated.

And what I find really intriguing, for example, I was talking to The Vitamin D Council and the lovely Carol Bagley at the Grassroots Healthcare Foundation, is they’ve got thousands of people. They know their vitamin D status, both in blood. They know what they’re supplementing. And all they have to do is pour them in this funnel, and now they’ll know their cognitive function. So, suddenly you can research the correlation between blood vitamin D and the cognitive function. I mean, it’s really interesting.

So, we’re going to squeeze in a question for the Soil Association about percentage of food eaten organic. We can look at correlations in organic and cognitive function. I think the psychedelic guys would like us to put a question in on that. And then we could look at… There’s so much possibility for looking at associations. And I think that’s important.

And, at the end of the day, I don’t know, my strong sense because I’ve been sitting staring at incredibly good research of brain scans on undeniable evidence. I mean, we had one of the big pharma guys come to us and said in relation to the B vitamins, “If this was patentable, this is a multi-billion dollar drug. End of story.” But we can’t patent it. So, basically, they got to kill it.

So, the point is that I don’t think that any of our major healthcare organizations are about to do this kind of thing. So, it really is up to us. But the point is, when we’ve tracked a million people over 10 years with all the necessary measurements, we’ve not only helped a million people, and we think that conservatively we can reduce both the risk by at least 30% and the incidents of dementia by at least 30%. And then you kind of have the evidence. You really have everything that anyone could ever need.

On November the first, all our wonderful top scientists, but also others, like David Perlmutter, are getting together and doing very short, snappy presentations on each of the areas. We’re doing this virtually. Obviously, we would like loads of practitioners to come and check in because it’s the best way to get up to date. But we’re going to record it all because it’s kind of a training. And we’d then like to give that training to all the different schools, the naturopaths, the nutritionists, the functional medicine doctors. We’ve got the British Society of Lifestyle Medicine very much involved.

So, what we got to do here is to break down some barriers. Barrier one, it’s in the genes. Barrier two, I don’t want to take the test because there’s nothing I can do about it. That’s the second barrier. Barrier three is: How do we trust this? Where’s the science? We’ve got that. So, we need to break down these barriers and get people engaged.

My dream is that everyone contacts everyone they know over 50, maybe even over 40. It’s sort of a chain letter kind of thing. But when we’ve got a grassroots group, I mean, we are just at the edge. I think we will look back in a couple of years’ time and say what we’re doing is so basic because as AI starts to really develop, our ability, and of course for any practitioner, we know this is the issue. The issue is: How do you change someone’s behavior? Actually, how do you shift them to a whole different way of operating, thinking, functioning, eating and so on?

And ultimately, that is the biggest challenge. But we are in a digital age, and things are moving very, very fast. And, of course, my belief is that this is like the first step. People need people to guide them. So, the next step is the army of practitioners, functional medicine doctors. Over here, we have nutritional therapists and so on.

And I think one of the reasons why so many organizations have really jumped together and the thing that is so exciting is that it’s got a bit of everything in it. Stress, sleep, exercise, diet, nutrients and so on. And I think that it’s possible around this topic of preventing Alzheimer’s that we can bring a lot of groups who don’t always talk to each other. We are all so siloed. You can see that in the conferences. Hopefully, we can bring a lot more of these groups together.

James Maskell: Yeah, I mean, that’s something that we’ve wanted to do all the way through with the Evolution of Medicine. And I guess just on that, I mean this is kind of interesting to our community. When you go to the Lifestyle Medicine Association, and you say, “Hey look, the evidence on B vitamins is really clear.” How does that go across to an entity in general, like in the US, that are kind of anti-supplement? They get all the lifestyle stuff, but they’re just like, “No, we don’t really think supplements are the way.” But it’s like, if B vitamins was a patentable drug, it would be a billion-dollar industry. So, how do you cross that chasm?

Patrick Holford: Well, the very strange thing, and I mean this literally. I mean, I’ve contacted, let us say, 80 organizations. We have 48 signed up. We’ve had three refusals. And the others haven’t responded yet. And we’ve not hit any barriers like that. I mean, sometimes I’ve had conversations where people say, “Yes, of course Alzheimer’s is preventable. It’s down to what you eat and all the rest of it.” And I said, “Well, actually, it’s a little bit more than that.”

So, I think what I kind of love is that the whole principle of ortho molecular medicine, functional medicine, that we’re not the same. We don’t all need the same amount of a nutrient and that you can test function. So, homocysteine obviously is the test for the function of methylation. And as Professor David Smith says, “The optimal level of a nutrient is simply the level that corrects the symptoms.”

And what we have found out, which is really quite useful, is that the vast majority—I mean, probably 98% of people who are B12 deficient—can actually correct it with high oral supplementation. There’s a few that do need injection. But what we’ve learned now is that when you put in 500 microgram or so, a little more does cross and you don’t need that much.

So, this lovely idea that there isn’t really a relevant RDA, you have to test function and then dose accordingly. I think it’s very possible that this will also open up those kind of non-believers of supplements because the case for vitamin B12 is just phenomenally clear. You really can’t argue with it.

James Maskell: I agree. Well look, I think it’s amazing work. I’m really excited to support it. So, for all the practitioners who are listening, when November 1 comes around, where do they need to go? Where can they sign up? How can they get their patients or their family members to do the test online? And how do we get to that million mark and make the impact that you’re looking for?

Patrick Holford: Well, just go to foodforthebrain.org. It’s all there. My advice for all practitioners is do the test yourself. Because until you know what it’s like, you can’t tell other people. Already, it will show you your risk. It will show you those eight factors. You can’t join cognition yet because it’s in sort of beta test phase. We may secretly sneak it out sometime in October, but we know the official launch is November the 1st. So, take the test, find out what it’s like.

And we have actually, under organizations, there’s a section of content that you can use. We’ve done some really cool one-minute animations on how to build the brain, how to fuel the brain, talking about ketones, and how to protect the brain. There’s a lot of resource there that you can share freely with your community. Education is absolutely key.

Come to the master class. We’re going to open up booking for that on September the 1st. It’s very inexpensive, like 20 pounds, $25. So, everyone’s donating their time, myself included, on this whole project.

So, what has been so cool is these top scientists, like Professor Jin Tai Yu at Fudan University, Shanghai, whose meta-analysis of 396 trials, half of which are RCTs. I mean, it’s simply the best piece of prevention research in the world. They’ve all jumped on board because they know there is only one way forward, and that is to prevent Alzheimer’s. It is preventable. We have to do it in a multifactorial functional medicine way.

James Maskell: Beautiful. Well, it’s really great to have you on here. If you go into the show notes, I’m going to put all the details there about the campaign and how you can get involved and where to go. But Patrick, thank you so much for leading the charge on this. I’m very excited about it personally, professionally, and also just exciting to see. I think, in a certain way too, the sort of collapse that’s happening in the NHS is possibly offering an opportunity for progress that was not possible before because there was, like, it wasn’t too bad. Right now, we see that we need to do chronic disease differently. We can’t just have people showing up at GPs in the ER. We have to treat the cause. We have to find innovative ways of supporting patients, and I think this is a good starting point to introduce them to this whole world of root-cause, lifestyle-first approach, which is wonderful.

Patrick Holford: And I think as you know, there’s a little secret in here, which is exactly the factors that are driving Alzheimer’s, these eight factors. They’re the thing that’s driving everything else as well.

James Maskell: Yeah, exactly. Yeah, no, you improve one thing, you’ll improve everything. Well, thanks so much for being here. This has been the Evolution of Medicine podcast. Check out the show notes for more information about the campaign. Go to foodforthebrain.org. You can also check out all of the different social channels. But I’m excited to share that Alzheimer’s is preventable. I think if you’re listening to this, you already know that, and I’m excited for Patrick and his community to really be taking this out to the masses. I hope for massive press and look forward to seeing the progress of the campaign.

This has been The Evolution of Medicine podcast. I’m your host, James Maskell. Thanks so much for tuning in, and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.

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