What Is The Bredesen Protocol? An Evidence-Based Review

The Bredesen Protocol is a comprehensive, multi-pronged, and personalized approach to preventing or slowing down cognitive decline associated with Alzheimer’s disease. 

This protocol is as popular as it is controversial. Of course, when it comes to controversy around new or alternative treatment methods for chronic illness, problems tend to arise when we’re looking for a black and white answer to a complicated question. 

One of the most common and obvious questions about any treatment (especially a new or trendy one) is “does it really work?”, and this may not make for splashy headlines, but the answer is almost always “it depends”. 

But I don’t say that to dismiss the question. Alzheimer’s is one of the scariest and most pervasive chronic illnesses of our time, and we owe it to ourselves, our loved ones, and our society to try to understand as much about it as we can.

Consideration of the Bredesen Protocol is an important part of this, so let’s break it down, from the strategies and possible benefits of the approach to the controversy and what the research says. 

What Is The Bredesen Protocol?

The Bredesen Protocol is an approach to Alzheimer’s prevention that centers around the multifactorial nature of the disease. 

There are seven key strategies to the Bredesen Protocol: 

1. Nutrition
2. Exercise
3. Sleep
4. Stress
5. Brain stimulation
6. Detox
7. Supplementation 

If you’re thinking that these sound pretty similar to the central components of a functional medicine approach to health in general, you’re right. The protocol gets into many more specifics, but broadly speaking, we’re talking about whole-person centered, root-cause based, precision medicine that harnesses the power of diet and lifestyle choices. 

More specifically, the protocol zeroes in on factors that can damage the brain and those that may help to protect it. Exposure to damaging triggers is reduced, while steps are taken to rebuild the neural network and strengthen the brain’s natural capabilities. 

Some of the more specific steps and strategies that make up the Bredesen Protocol include: 

Optimizing fat burning by eating a low-carb, fiber-rich, plant-filled diet, fasting for at least 12 hours overnight, and exercising for at least 30 minutes, five times per week. 

Removing chronic pathogens including bacteria, viruses, parasites, or fungi, certain kinds of which may contribute to cognitive decline.

Reducing chronic inflammation by identifying and limiting exposure to root causes, and supporting the body’s anti-inflammatory capabilities through diet, nutritional supplements, and other strategies. 

Addressing insulin sensitivity, which has been linked to the development of Alzheimer’s, in part by optimizing nutrient consumption, reducing stress, and following a 12/3 fasting protocol (fasting for 12 hours overnight, and finishing all meals at least 3 hours before bedtime). 

Minimizing toxin exposure as much as possible, in part by identifying types and sources of exposure. 

Improving sleep with an emphasis on oxygen saturation. Suboptimal oxygen intake at night, as can occur with sleep apnea and other disorders, may contribute to cognitive decline.

Optimizing nutrient and hormone levels, beginning with testing to identify imbalances or insufficiencies. Diet and lifestyle changes are first steps in correcting any imbalances, with targeted supplements recommended if needed.  

History

The protocol was developed by Dr. Dale Bredesen, a neurologist with more than 30 years of experience studying the mechanisms behind neurodegenerative diseases, cognitive decline, memory loss, and Alzheimer’s. 

In 2014, Dr. Bredesen published a paper entitled Reversal of Cognitive Decline: A Novel Therapeutic Approach, outlining for the first time this new, multi-step protocol (1). The protocol has become quite popular since then, and a few small studies have recently observed promising cognitive benefits for individuals who follow its steps (2, 3) 

Fundamentally, the Bredesen Protocol recognizes that multiple different environmental and genetic factors can contribute to the development of Alzheimer’s and that the exact combination of these factors varies from person to person. 

The approach involves testing to identify individual risk factors, and the implementation of several holistic strategies to support brain health into older age. 

Criticisms 

Let’s take a look at some of the main criticisms around the Bredesen Protocol. 

1. Lack Of High-Quality Evidence

Most criticism of the Bredesen Protocol relates to the fact that research on the method is limited, and the papers that have been published and cited as evidence to date are primarily observational case studies or series’. 

Some of the papers Dr. Bredesen has authored on the protocol have been published in journals that don’t necessarily have the most rigorous standards for review, and are missing important information related to study methodology and limitations (4). 

My response: While it’s true that research is somewhat limited because of the multifactorial nature of this approach, it’s also true that no system in the body operates in a vacuum. Trying to treat a single symptom of a disease with a single treatment modality is one reason modern medicine tends to fail many of those it’s trying to help.

1. Use of supplements. Even many critics of the Bredesen Protocol acknowledge that some of its components are likely to be helpful, including exercise, mental stimulation, and eating a healthy, anti-inflammatory diet. However, the use of supplements as a component of the protocol is more controversial. This ties in with the first area of criticism: the supplements recommended as part of Dr. Bredesen’s method have not (or not yet) all been proven to prevent or reverse Alzheimer’s (though some have been shown to have benefits for various pathologies associated with Alzheimer’s, such as reducing inflammation).  
2. Cost. Again, this criticism ties in with the first two, with the concern being that patients may be spending potentially large sums of money on a protocol that hasn’t been proven to work. The cost of the Bredesen Protocol is not exactly the same for everyone, but some components, like testing and optional supplements, as well as the fees associated with working with a clinician trained on the protocol, can add up. Unfortunately, insurance coverage is limited for treatments and tests that fall outside of the conventional medicine paradigm. However, if we can prevent or slow cognitive decline and other chronic illnesses associated with aging, we are likely looking at substantially lower costs of care over the course of a lifetime. 

Ultimately, when it comes to the question of evidence or “proof" in the healthcare field, especially outside of the realm of single purpose pharmaceutical drugs or treatments, the answer is not always simple. 

Are observational studies the gold standard in scientific research? No. Does that mean the Bredesen Protocol doesn’t work? Also no. Can we conclusively say that the Bredesen Protocol prevents Alzheimer’s across the board? Again, no. 

The nature of a multifactorial chronic disease like Alzheimer’s and a multipronged treatment approach like the Bredesen Protocol make large-scale, randomized, placebo-controlled clinical trials (the gold standard in medical research) very challenging. 

With that said, many of the individual components of the protocol have been shown to improve cognition, reduce the risk of cognitive decline, memory loss, or Alzheimer’s, and/or reduce disease states or biomarkers associated with Alzheimer’s including inflammation, insulin resistance, oxidative stress, gut dysbiosis, and beta-amyloid plaques. 

The Benefits Of Following The Bredesen Protocol

Small studies with human participants have found that Bredesen may indeed help to slow, prevent, or even reverse cognitive decline associated with Alzheimer’s disease. However, these studies are limited for the reasons I discussed above, and all decisions you or your loved ones make about treating or seeking preventative care for Alzheimer’s disease should be made in conjunction with a healthcare provider.

There is no single “cure” for Alzheimer’s, and research that has focused on developing one drug to prevent or treat the condition has been largely unsuccessful. (5, 6) 

However, several simple diet and lifestyle factors may help to prevent or slow cognitive decline and memory loss, and the Bredesen Protocol centers and emphasizes these strategies. For example: 

Anti-inflammatory diets like the Mediterranean and MIND diets have been shown to reduce β-amyloid load (7) and other pathologies associated with Alzheimer’s, and reduce Alzheimer’s risk. (8)

Regular exercise has been shown to improve cognition and reduce the risk of Alzheimer’s by around 45% (9)

Getting enough sleep helps to protect the brain from damage and has been shown to reduce the risk of cognitive decline and dementia (10). 

Cognitive engagement and stimulation can help to reduce the risk of memory loss and dementia (11). 

One of the main benefits of the Bredesen Protocol is that it provides a detailed, comprehensive, step-by-step framework, merging several strategies for as much cognitive support and protection as possible but with less overwhelm.  

The Takeaway 

As great as it would be if there were one magic pill that could prevent or reverse Alzheimer’s, the reality is that it’s a complex, multifactorial disease that requires an equally multifaceted preventative approach.

While research on the Bredesen protocol as a whole is limited, the program is based on a massive body of research into the causative factors behind Alzheimer’s and the strategies that might help to prevent it or slow its progression. Future studies will hopefully help to tell us more about the effectiveness of the protocol. 

As of now, this is one of the best options we have in terms of a cognitive support protocol that considers the whole person, addresses multiple root causes, and centers diet, lifestyle, and individuality – all pluses in my book. 

Ultimately though, this is a personal choice to be made alongside your loved ones and a trusted practitioner.

Looking For Personalized Support? 

If you’re looking for more guidance when it comes to supporting your memory and cognitive function as you get older, or if you or someone you know has been diagnosed with Alzheimer’s or cognitive decline, we are here to help. Reach out to our functional medicine clinic for a telehealth consultation to get started.