Aug 19 2010

Alzheimer’s and Diet

The pattern is depressingly common – take a disease that is not currently cured by science-based medicine. Claim that doctors “don’t care”, or are ignoring treatments that do not make them money, or there is a conspiracy of silence headed by “Big Pharma.” Then offer a snake-oil alternative based upon anecdotal evidence. Sometimes faith and God are thrown in for good measure.

Nita Scoggan fits this mold nicely. She is promoting herself as a “health and happiness coach” and using her husband as anecdotal evidence of the power of her nutritional advice. The story is now being promoted by other low-carb gurus, including Jimmy Moore.

The story is a great example of why anecdotes are so problematic. We are told that Nita’s husband, Bill, was diagnosed with Alzheimer’s disease, but she cured him with diet and nutrition, specifically coconut oil and a low carb diet. The problems with this story begin with the diagnosis. Scientific medical trials always include what are called inclusionary and exclusionary criteria – this is to make sure that subjects actually have the disease that is being studied. This is critical because apparent remissions may be due to the fact that the person never had the alleged disease in the first place.

In fact, it is almost certain that Bill never had the diagnosis of “Alzheimer’ disease” (AD) to begin with – this is because doctors do not usually make this diagnosis. The diagnosis of “Alzheimer’s disease” is based only upon a brain biopsy (or autopsy after death), but brain biopsies are rarely done to diagnose dementia. Instead, we diagnose “Alzheimer’s type dementia,” which means that someone has dementia of a type compatible with AD and other causes have been ruled out – it is a diagnosis of exclusion, and a clinical diagnosis. But that diagnosis is only as good as the thoroughness of the workup to rule out other causes. In addition there are disorders that can mimic AD unless a careful assessment is made.  Even in the best circumstances, there will be the occasional misdiagnosis simply due to the limitations of our ability to diagnose AD.

So the first question we have to ask is – did Bill actually have AD or something else that was reversible? We cannot know, and we are not given sufficient information to make this judgment. It is even possible that Bill had a nutritional dementia – there are some vitamin deficiencies that produce dementia that can mimic AD, like B12 deficiency. So there will be some patients who improve with supplementation. This is not a “miraculous nutritional cure” for AD, but rather just treating a nutritional deficiency that causes dementia (but not AD).

Another common disorder that mimics AD is what is called “pseudodementia” – this means that the brain is not functioning well, but there is no biological damage. This can be cause by sleep deprivation, or depression. Pseudodementia is 100% reversible because there is no permanent damage to the brain.

So it is possible, even probably, that Bill never had AD and his anecdote is therefore not relevant to AD.

But I also don’t buy the claim that he is improved. He may be, but the videos are not impressive. You may notice that Bill says very little during these videos – Nita does almost all of the talking. He does relate some historical tales – exactly the kind of long term memory that is selectively preserved in many dementias – but does not give evidence that he does not have some impaired cognition. It may just be their personalities and relationship that cause Nita to do almost all the talking – but this is also a very typical dynamic for a couple where one member has impaired cognition. I am not making any judgments about what Bill has or does not have from this evidence, just pointing out that if the point of the videos was to convince us that Bill is better, they failed utterly.

Finally we are told that a very low carb diet and coconut oil can cure AD, but doctors are just not interested because it does not make them money. This is naive and insulting, of course. First – treating dementia is not a money-maker for doctors. It is just about the least lucrative disorder that neurologists treat. From a purely selfish point of view, we would love to be able to cure AD with a simple dietary change. And, I think that most doctors are not heartlessly selfish and would actually like to help their patients with dementia. In fact we routinely diagnosis and treat B12 deficiency, so if AD were a deficiency of saturated fats why wouldn’t we treat it the same way?

In the end, simplistic conspiracy theories are not compelling – the scientific evidence will determine how AD is treated. If anyone can provide compelling (i.e. not anecdotal) evidence that coconut oil helps AD then we will all prescribe it. So far there is no such evidence – only self-promoters selling anecdotes and conspiracies. A PubMed search on coconut oil + dementia or Alzheimer’s disease yielded exactly zero results. Google searches yield only promoters – no evidence. I also find it very telling the the promoters don’t link to any actual published evidence – they probably would if it existed.

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