Alzheimer’s Symptoms Improve After Intensive Lifestyle Changes

Vegan diet, exercise and stress reduction made a difference in small study

Marlene Cimons,

AARP

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En español

Published June 07, 2024

people doing various exercises on a track

Giulia Calistro

Intensive lifestyle changes — eating minimally processed plant-based foods plus frequent exercise, stress reduction and support groups — may reduce the symptoms of mild cognitive impairment and early Alzheimer’s disease, according to a newly released study.

“This is important because most people diagnosed are told it can only get worse,” says Dean Ornish, M.D., the well-known lifestyle medicine advocate who directed the randomized controlled clinical trial, regarded as the gold standard in human research. “It’s a devastating diagnosis. When you lose your memories, you lose everything. You lose hope. These findings may give many people new hope and new choices they didn’t have before.”

The Alzheimer’s disease burden already is large and expected to grow in the coming years. In 2023, as many as 6.7 million Americans were living with Alzheimer’s disease. This number is predicted to reach nearly 14 million by 2060, according to the Centers for Disease Control and Prevention.

Previous studies have suggested that healthy habits contribute to preventing dementia, including research that advocates the Mediterranean diet, an eating plan that emphasizes healthy fats, whole grains, fruits, vegetables, seeds and nuts. But this study is believed to be the first to demonstrate improvements among people already diagnosed with the condition.

The peer-reviewed study, published June 6 in the journal Alzheimer’s Research and Therapy, was led by Ornish, founder and president of the Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco, in collaboration with leading scientists and neurologists from several other academic medical centers, among them, Harvard Medical School, Duke University and the University of California, San Diego.

The study enlisted 51 participants and divided them into two groups, one that adopted the drug-free lifestyle intervention program for 20 weeks, and a second comparison group that followed their usual habits and treatments, including medications they might be taking. Two dropped out and were excluded from the analyses.

The program required commitment. The diet is vegan: a minimally processed plant-based diet low in saturated fats, refined carbohydrates, alcohol and sweeteners, with mostly fruits, vegetables, whole grains and legumes, plus selected supplements, including a multivitamin; moderate aerobic exercise and strength training for at least 30 minutes a day; stress management with meditation, stretching, breathing and imagery, for one hour a day; and one-hour support groups for patients and their spouses or study partners, three times per week. All the meals were sent to patients’ homes to encourage compliance.

At the end of the study period, the researchers found “statistically significant” differences between the two groups as measured by four standard tests that assess cognition. The majority — but not all — of the intervention patients showed improvements, while the control group did not.

Simply put, 10 people in the intervention group improved, seven were unchanged and seven were “minimally” worse, Ornish says. In the control group eight were unchanged, 17 worsened, he says. None showed any improvement. The more the patients changed their lifestyle in the prescribed ways, the greater was the beneficial impact on their cognition and function. “To show improvement, people had to make really big changes,” Ornish says. “It works in both directions: If they stop doing it, they lose a lot of the benefits.”

Several dementia researchers not involved in the study said they were impressed with the results, but pointed out that the study population was small and not very diverse – a limitation Ornish acknowledges — and that the study duration was short.

“I would like to see a larger and more diverse study population — 10 times this size would be the next step — for at least 12 months,” says JoAnn Manson, M.D., professor of medicine at Harvard Medical School. But Manson, author of studies suggesting the beneficial cognitive impact of taking a daily multivitamin, called the approach “very promising.”

Paul E. Schulz, M.D., director of the Neurosciences Neurocognitive Disorders Center at UTHealth Houston, agreed, saying the results were “really interesting,” but probably needed further study. As a scientist, “you say ‘I’ll do 50 people and see if there’s an effect,’” he says. “If there is, I’ll look further.”

Ornish says he is not planning a larger study but intends to validate the findings by collecting data over a long period of time from everyone who participates in the program.

In daily life, some of the changes were dramatic, he said. Several patients who couldn’t get through a book or movie because they kept forgetting what they’d read or seen, reported they were now able to do so and could remember much of it. One patient, in fact, said it would take him weeks to read a book, but he now could do it in three or four days, and retain what he read.

Two other patients said they regained their ability to manage their personal finances. “I feel like I’m me again — an older but better version of me,” one said.

Schulz, the UT Health neurologist, praised the program as a risk-free, inexpensive intervention, with no side effects — unlike those from existing Alzheimer’s drugs – which was consistent with advice he already gives his patients. “The biggest downside is getting people to actually do it,” he says.

Andrew Budson, M.D., chief of cognitive behavioral neurology for the VA Boston Healthcare System, said he’s been telling patients for more than a decade to exercise, eat unprocessed foods and reduce stress. “This study is quite exciting to me,” he says. “The bottom line is whether you want to reduce your risk of Alzheimer’s disease or slow the decline if you already have it, now you know what to do: Eat a diet of whole foods, exercise regularly, manage stress and get the support you need.”

In addition to bettering cognition and function, the intervention group also showed improvements in certain blood-based biomarkers, including the Aβ42/40 ratio, a measure of amyloid, a naturally occurring protein that disrupts cell function when abnormal levels build up in the brain and clump together to form plaques.

Researchers theorized that the amyloid moved out of the brain and into the bloodstream in the intervention group, while worsening in the control group. The scientists also found differences between the two groups in gut microbiome microorganisms that could be protective against Alzheimer’s or raise its risk.

Ornish couldn’t say which of the components had the biggest impact, only that the combination was efficacious. “We know there is evidence to support the benefits of each of these interventions and the side effects are good ones,” he says. “I’m confident in recommending all of them.”

The study used the same regimen as that of the Ornish nine-week online program to reverse progression of heart disease, an approach recognized as effective and covered by Medicare and some insurance plans. (The program costs “about $154 an hour for 72 hours” and takes place online “in real time with instructors, although people can do this on their own,” he said.) Based on these study results, Ornish says he is asking insurers to extend coverage to include early stage Alzheimer's.

The regimen offers an improved quality of life to people with early signs of Alzheimer’s. “I’m so inspired by this,” Ornish says. “How often in life do we have the opportunity to give hope to many people in the area that matters most?”

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