The article in today’s Daily Mail about B vitamins and Alzheimer’s is the story of the triumph of dogged scientific persistence – do read it first if you can because this blog would become impossibly long if I repeated all the details.
But behind it is another story of indifference and prejudice that is preventing people getting access to a treatment that could be effective and safe.
For years researchers have known that there is a link between Alzheimer’s and an amino acid called homocysteine; studies regularly found these patients had high levels. So could homocysteine be contributing to the disease or was it an innocent bystander? It’s also well known that the only way to reduce homocysteine is to increase your intake of B vitamins, so some nutritionists suggested taking B vitamins as a prophylactic.
Scientific sceptics condemned this as foolish and irrational because there was no randomised controlled trial (RCT) evidence to support it. Fair enough. But then an Oxford Professor of pharmacology, David Smith, did a top quality RCT on the idea that ticked all the boxes: it was a reasonable size and lasted for two years. This was premium grade research.
B vitamins cut brain shrinkage
The result was impressive and surprising. Those who took a very high combination of B vitamins saw a significant drop in brain shrinkage measured by a brain scan compared to those getting a placebo. Their score on memory and thinking tests stopped getting worse too.
This is where the indifference and prejudice kicked in. You might think Alzheimer’s charities would welcome the result, not least because the drug approach of targeting plaque had proved a total failure and there was little to offer patients.
However all one leading charity had to say was that the best way to protect yourself was to get B vitamins from a healthy diet. This is inadequate in so many ways; not least the fact that there is no evidence that a healthy balanced diet (leaving aside the question of what that is) is actually protective.
As for getting your B vitamins from food, quite apart from the fact that it would be impossible to get the high levels used in the trial, elderly people, the ones most at risk, are often deficient in B vitamins. This is partly because old people living alone often don’t eat so well and meals in hospitals and care homes are rarely nutrient rich. It is also because the drugs many are on such as acid blockers and the diabetes drug metformin are known to reduce availability of B12. There was simply no attempt to take any serious notice at all of what Professor Smith had discovered.
B vitamins are fraudulent
A tougher line was taken by one of the most aggressive champions of RCTs (his identity is unimportant because he speaks for a lot of people who believe they are supporting a scientific approach to medicine by ridiculing nutrition and use of vitamins).
When faced with evidence from a “gold standard” RCT did he say “OK, interesting let’s investigate”? Absolutely not. Instead he began his blog responding to the research by asserting: “B vitamins are a favourite of the fraudulent supplements industry. One of their pet propositions is that they will prevent dementia.” So not much science there either.
Even so it was a properly conducted study, with results which, if replicated, could quite possibly cut the rate people progressed to Alzheimer’s – the stated aim of most of the drug trials. Even the charity had said more research needs to be done. So did any of the funding bodies concerned about Alzheimer’s pick up on it?
Again, absolutely not. For two years Professor Smith took his academic begging bowl to top funders in the States and the UK without any success. Now it could be that the research was really flawed – as some academics hinted to me – or simply that it is a tough game, lots of promising research doesn’t get followed up on. There is no hidden agenda I was assured.
Good quality research
And so we come to the trial that that prompted today’s article (it’s important but it’s not the trial that Professor Smith was seeking funds for to show that B vitamins can actually slow or prevent the development of Alzheimer’s). It is top quality science – published in a leading journal) with a lead author who works at the Functional Magnetic Resonance Imaging Centre at Oxford. Still fraudulent?
It was part-funded by the Medical Research council. It found the reduction in brain shrinkage was better than 50% – it was 90%. It tied down the link between brain shrinkage and cognitive decline and supported the idea that homocysteine could actively damage the brain
So how has it been received? Remarkably the response of Alzheimer’s Research UK was almost identical to the first time round. First it said more research was needed, which was obvious two years ago but nothing has been done.
And the healthy diet advice was rolled out yet again along with keeping weight down and exercise. It’s the standard basic advice to deal with any chronic disease. It’s been promoted as the solution to obesity and diabetes for the last 20 years and look how well that has worked.
Professor Smith has provided good evidence for a new, specific and radical promising treatment and its implications are simply being ignored. Could it be because drugs are simply preferred to vitamins whatever the evidence? Hard to prove but a news item I found on the Alzheimer’s Research UK website lends support to the idea.
Two million for drug brain shrinkage trial
It was a report of a two million pound trial of blood pressure drug call Losartan, due to start later this year to see if it can reduce brain shrinkage and improve memory in Alzheimer’s patients. The researchers will be using brain scans and memory tests.
It’s being done at Bristol University and the researchers describe Losartan as “well tolerated” (Side effects listed on the medical site WebMD include diarrhoea, muscle cramps, dizziness, insomnia, and nasal congestion).
The proposal goes on to say that the drug could improve brain/blood flow, that brain shrinkage is known to be “strongly linked with reduced memory function” and that the “the beauty of this drug is that if it works it is already available and cheap.” Funding for the study was announced in December last year as part of the Prime Minister’s boost for Alzheimer’s research funding.
If the evidence is all that matters it is very hard to understand why two million needs to be spent on Losartan when we already have RCT evidence for treatment with a vitamin that has virtually no side effects, has been shown to reduce brain shrinkage dramatically and is available and far cheaper? Would patients really prefer to take Losartan for years rather than B vitamins which have a range of other benefits?
If this is scientific medicine it needs a radical overhaul, starting with the trial everyone agrees, theoretically, needs to be done.