For decades, scientists have struggled to solve the puzzle of Alzheimer’s disease. Most of the focus in the pharmaceutical field has been on trying to reduce the presence of clumps of protein in the brain called amyloid, which have long been associated with progression of the illness. Overall, the resulting drugs have shown a modest slowing in the rate of disease progression, along with a risk of bleeding in the brain and other side effects.

This past June, an international group of investigators reported for the first time that a lifestyle intervention can, in the short run, not only halt the progression of early Alzheimer’s but also lead to improvements in patients’ cognitive abilities. The study was published in Alzheimer’s Research & Therapy, one of the premier journals in the field. The lead author, Dr. Dean Ornish, is a clinical professor of medicine at the University of California, San Francisco, and the founder and president of the Preventive Medicine Research Institute, a nonprofit based in Sausalito, California. You may already be familiar with Dr. Ornish’s research, which has shown that extreme low-fat, vegan diets, along with exercise, stress reduction, and other lifestyle changes, can positively impact and possibly even reverse heart disease and other chronic conditions.

The new study included 51 adults identified as having early Alzheimer’s disease. Half were assigned to the lifestyle intervention and half received usual care, and the primary outcomes were the scores on four standard tests of cognition and function. The researchers analyzed the effects 20 weeks after the start of the study (and later will publish the results after 40 weeks).

Here are excerpts from our interview with Dr. Ornish about his study and its implications.

Wellness Letter: What is the current situation with Alzheimer’s treatments?

Dean Ornish: Billions of dollars have been spent over the last 20 years to develop a drug that can help improve cognition and function in people with MCI [mild cognitive impairment] or early dementia due to Alzheimer’s disease. Only three drugs have been approved for this group, and all three only slow the rate at which people get worse. But getting worse more slowly is still getting worse.

This situation tends to take people’s hope away. They’re told, “I’m sorry, Mr. Jones or Mrs. Smith, you’ve got early Alzheimer’s disease. The drugs can only slow it down a little bit. Get your affairs in order. If there’s anything you want to do, do it soon, because you don’t have a lot of time left.” That’s why the suicide rate in the first month after being diagnosed is seven times higher than in the general population.

WL: Given that background, what is the significance of your study?

DO: This is the first randomized trial showing that a lifestyle intervention can reverse the progression of early-stage Alzheimer’s disease in many people. Not every patient got better, but we found that after 20 weeks, there were statistically significant differences between the intervention and the control groups in cognition and function. Rather than just slowing down the rate at which people were getting worse, we actually showed that their cognition was improving. Next we’ll be publishing the results after 40 weeks of the lifestyle intervention.

The intervention is the same one we’ve been studying for more than 40 years and that is outlined in my books. It includes several components—a whole-foods, plant-based diet; moderate exercise; meditation and other stress management techniques; and social support [see box at end]. To reduce it to its essence, there are four parts—eat well, move more, stress less, and love more. But it’s not that one plus one plus one plus one equals four—it’s more like they equal 10. There’s a synergistic effect that comes from doing all of these things at the same time.

WL: Previously you’ve looked at the effect of this intervention on heart disease. How is that connected to Alzheimer’s?

DO: People used to view heart disease the way they view Alzheimer’s today—that the best you could do was slow down the rate at which patients got worse. In our past research, we found that if you make changes in a lot of things at the same time, patients’ heart disease could get a bit better after a month, better than that after a year, and even better after five years, whereas the participants in the control group got worse and worse during the same period of time.

We know that what’s good for your heart is good for your brain because they are both affected by a lot of the same underlying biological mechanisms, like chronic inflammation, oxidative stress, changes in the microbiome, and gene expression. And each of these mechanisms is directly influenced by what we eat, how much exercise we get, how we respond to stress, and how much love and social support we have.

WL: In addition to heart disease, what other conditions have you investigated before turning to Alzheimer’s? 

DO: We found these same lifestyle changes could often reverse the progression of type 2 diabetes, high blood pressure, high cholesterol, and obesity. When it comes to gene expression, these changes can turn on the genes that keep you healthy while turning off genes involved in the biological mechanisms that drive these chronic diseases.

We also found for the first time that these lifestyle changes could lengthen telomeres. [Telomeres are structures found at the ends of chromosomes, and shorter ones are a marker for aging.] That is, these lifestyle changes may reverse aging at a cellular level. Now we’re showing that they can often improve cognition and function in people with early-stage Alzheimer’s.

WL: Can you describe what practical differences this made to people in the study?

DO: The benefits were clinically significant, and there was a dose-response correlation between the degree of lifestyle change and the degree of changes in cognition and function testing. Some participants had struggled to read a book because they would read a paragraph and then forget what they read and need to read it over again, or they couldn’t follow the plot of a movie, or they couldn’t cook because they would forget to turn the burners off. And many saw changes in these areas. One guy said, “I’m back to reconciling our finances, I keep up to date on our investments.” These kinds of changes also affected how they viewed themselves and improved their sense of self-worth.

In addition, our intervention led to differences in amyloid. The drugs that have been tested are designed to pull the amyloid out of the brain. In our trial, amyloid markers improved in the group that made lifestyle changes and got worse in the control group. And there was a dose-response correlation between the degree of lifestyle change and the degree of change in the amyloid markers.

WL: What do these findings mean for patients?

DO: One lesson is that people can have a sense of hope, and that can be self-fulfilling, as can despair. If you feel like you’re only going to get worse, it’s almost like the brain starts to shut down as an adaptive response to such horrible news, and you don’t do the things that might make you better. But it takes big changes to reverse a chronic disease. It’s hard.

Medicare is going to spend $5 billion just on one Alzheimer’s drug, lecanemab, that only slows down the rate of getting worse and has serious side effects. I’m hoping that they will eventually decide to cover this lifestyle intervention for people with early Alzheimer’s in the same way that they’re already doing for heart disease.

WL: What about prevention of dementia? Do your findings have implications for that, too?

DO: Yes, definitely. Some of the new artificial-intelligence-enhanced diagnostic technologies can pick up the likelihood of someone developing Alzheimer’s up to 10 years before it becomes clinically apparent. But a lot of people say, “Why would I want to know? Why would I even want to know about the genes that predisposed me to get Alzheimer’s? If there’s nothing I can do about it, it’ll just make me crazy.”

But now we have evidence that a lifestyle intervention can often improve early Alzheimer’s in some people, and the approach may be equally and perhaps even more powerful in helping to prevent it. As with many things, you don’t need to make such big changes in order to prevent something as you do to reverse it. So I’m hoping that can be a great motivator for those with a family history of Alzheimer’s to begin making these changes.