Kabran Chapek, nd: Successful Progression of Diet-and-lifestyle Therapies for Cognitive Impairment

Kabran Chapek, nd, is a licensed naturopathic physician. He studied human biology at the University of Kansas followed by naturopathic medicine at Bastyr University in Kenmore, Washington. With an interest in the mental health care field, he received his clinical psychiatric experience from 2007 to 2013 while treating patients with severe mental illness in a partial hospital program as part of a multidisciplinary team.

Since 2013, Dr Chapek has been a staff physician at the Amen Clinics, a world leader in treating different types of depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD) using a sophisticated brain-imaging technology called single-photon emission computed tomography (SPECT). Dr Chapek has extensive experience in the assessment of the aforementioned mental health problems as well as severe anxiety, psychosis, eating disorders, addiction issues, dementia, sensory processing disorders, autistic spectrum disorder, and traumatic brain injuries.

Dr Chapek is the founding president of the Psychiatric Association of Naturopathic Physicians, an affiliate group of the American Association of Naturopathic Physicians. He is actively using the MEND protocol created by neurologist Dale Bredeson, md, for treating Alzheimer’s disease.

Integrative Medicine: A Clinician’s Journal (IMCJ): It seems that recently, there have been some programs and research indicating that diet and lifestyle have got a lot more impact than we initially thought on the trajectory of Alzheimer’s disease. Can you speak to what those findings are?

Dr Chapek: Yes. In the past 5 to 10 years, the National Institutes of Health is pouring millions of dollars into research because there is a tidal wave of Alzheimer’s disease coming. There are 5.3 million Americans who have it now, and by 2050, that number is going to triple. Currently, 1 in 2 people will have some form of dementia by age 85, and it is the third-leading cause of death in older adults, after cardiovascular disease and cancer. It is a huge problem, and it is going to bankrupt Medicare if we continue like this.

There are no standard treatments in the conventional world for Alzheimer’s disease, but in the past 5 years or so, there has been research into the different causes of Alzheimer’s disease. There are silos of researchers. Everybody has a theory, and each seems to be right, but there is no unification. But Dale Bredesen, md, a neurologist out of UCLA, has recently been able to provide some groundbreaking research that unifies the different theories of Alzheimer’s disease and puts them together related to the amyloid beta precursor protein, or APP, which is basically a measure of neuronal plasticity.

Neurons either grow or they die, and it is like a switch. There are trophic factors, or growth factors, and antitrophic factors, which trigger programmed cell death. It all comes down the APP gene, which carries the code for APP. Each of the different researchers is looking for something different. To one group, metals, aluminum, and mercury are what cause Alzheimer’s. For a different group, it is mycotoxins. With a different group, it is elevated blood sugars. Another group thinks that it is APOE4, a gene that is a huge risk factor. Others feel it is inflammation. But in fact, it is all of those things. All of these different routes will lead to Alzheimer’s, but there are different causes, and they all affect this APP gene. They can turn it on and it causes degeneration—cell death that is actually amplified. Dr Bredesen calls it prionic cell death—or the gene can promote growth, and reversal of degeneration, based on this APP switch.

Back to your question, one of the key modulating factors of this APP protein that turns it on and off is diet and exercise. In the work of Dr Bredesen, he has talked about a comprehensive program to hit as many pieces that affect this APP gene as possible in order to reduce this bias towards cell death.

IMCJ: Do you think that that fragmentation was one of the major hurdles that stood in the way of a breakthrough?

Dr Chapek: Absolutely. I think that is exactly right. It was a lack of collaboration. Science is very competitive. That is where I think naturopathic medicine, functional medicine, and integrative medicine, if you have that perspective—you can see the big picture and how it is all fitting together. Dr Bredesen started looking at what the common factors are and how they fit together. It is more of a holistic perspective.

Say you will treat a patient who comes in having memory problems or having been diagnosed with Alzheimer’s or early Alzheimer’s. You test and find high levels of heavy metals. For example, say they have high mercury. You do chelation, their memory significantly improves, and so a functional medicine doctor or naturopathic doctor says, “Hey, I figured out what causes Alzheimer’s, it’s heavy metals.” But the next patient comes in with a similar presentation—memory problems—and the primary care doctor’s diagnosis is early Alzheimer’s. So a test for heavy metals is ordered. Hmm, they do not have highly elevated levels of mercury or lead, so what is the cause? For them, maybe it is something else.

I had a patient who, upon testing, had a number of factors. He had prediabetes and he also had a history of mold exposure in his home, but we did not know this at the time. For our memory program workup, we assess and do some lab work. He had elevated transforming growth factor β-1 levels at 26 000. A normal level is less than 2382. We also did genetic tests that demonstrated susceptibility to mold toxicity, or not able to process mycotoxins out of his system—so if he gets exposed, he is going to be more susceptible.

We tested his urine. He had very high levels of mycotoxin in his urine, and so we started him on a protocol. He had been a pilot for 40 years, and his memory was much better than average. He was a fighter pilot, so at one time he had very good focus, but now his wife could not leave him alone. He was making financial decisions that were costing them huge amounts of money. He was also losing things. He really had noticed a significant problem, and so we put him through a protocol, which included sweating, supplemental NAC, a number of other nutrients, and intensive exercise.

Also, every morning his habit was to eat 2 full chocolate donuts and a cup of coffee. That was his thing. He had done that since he was 20, and he was now 66. I said, “You know, this is a key factor to your health. This is basically causing Alzheimer’s disease—this dietary problem, this prediabetes. We know that glucose will damage the insulin receptors, or it will cause insulin resistance, which results in elevated blood sugar that will cause damage to the brain.” That convinced him to stop, and after about 2 months, he had significant improvement to the point that he was back to good functioning. His brain scan showed a toxic pattern and also a pre-Alzheimer’s pattern, like his brain was headed towards dementia.

At our clinic, we do brain imaging called single-photon emission computed tomography, known as SPECT. That is one way to assess that someone is headed towards Alzheimer’s disease. We also do labs and cognitive tests that clinicians can do in the office. The Self-Administered Gerocognitive Exam, referred to as SAGE, is a pencil-and-paper test. It takes 10 to 15 minutes. The patient does it on their own, you can review it, it can be repeated, and it’s 79% sensitive for mild cognitive impairment or early Alzheimer’s, as compared a full neuropsych workup. So it is something that clinicians can add to their practice immediately, because we need to start screening for this.

IMCJ: Dr Bredesen’s work has got dozens of discrete actions in his protocol. If I understand it correctly, he thinks there is a tipping point for each patient. So adherence does not have to include all 36 items, just enough of them to turn the balance in the right direction. Is that accurate?

Dr Chapek: Absolutely. He calls it a roof with 36 holes in it, and that is really true. Medications may fill one hole, heavy metals may fill one hole, and diet may be another. If you get enough of those holes patched, you will stop enough of the leaks, and your cognitive decline will reverse and go the other way. That is what I have seen to be true as well. You need to address diet. It has got to be a low-carb, healthy fat, towards a ketogenic diet with intermittent fasting, going 12 to 16 hours without food to let the insulin receptors reset. It has got to be vigorous exercise: 30 to 60 minutes, 4 to 6 days a week. We have got to address sleep, particularly to rule out sleep apnea.

This is where the clinician comes in. A good naturopathic doctor or functional medicine doctor is going to be skilled at picking out the low-hanging fruit and starting with that. After a comprehensive lab screen if there is not much to do, you may need to go deeper and screen for heavy metals, mycotoxins, and other infections like Lyme, and go to the next level. Then if you hit enough of those pieces, the preponderance of positive change will push that APP protein back in the right direction, switch off the neuronal degeneration and programmed cell death, and reinitiate cell growth, regeneration, and connection again. A key piece of that is hormones, which are growth factors. There are 5 or so different types of etiologies to Alzheimer’s disease.

IMCJ: You have mentioned heavy metals several times. What role do toxins like heavy metals or persistent organic play in the development cycle of cognitive impairment?

Dr Chapek: Specifically, the toxic type is type 3, so it is inflammatory and atrophic, which is the lack of hormones, glycotoxic, which is kind of a combination of types 1 and 2, and then type 3 is toxic. I would say a good amount of the patients are this type, and they are more difficult to treat, typically, because it involves more workup. It is harder to get the toxins out, and it is another level more than just diet and exercise. You have to do things to actually remove them.

The toxins often disrupt the hormonal systems, so they cause atrophic lack of growth. We know that heavy metals affect the hormonal system and disrupt the endocrine system, and they cause inflammation. Because they are actually affecting multiple systems, they are making that APP protein turn towards cell death and degeneration until you get them out, sort of like a thorn in the side of the biochemistry.

IMCJ: Most integrative clinicians are fairly familiar with the concept of heavy metal toxicity, chelation, and some of the challenge testing that surrounds the heavy metals. When it comes to persistent organic pollutants, what steps can be taken to remove those from the body?

Dr Chapek: My go-to is sweating. I actually like the protocol with niacin, exercise, sweating, and charcoal. This was used for 9/11 first responders and Gulf War veterans to remove their toxic exposures. When the Twin Towers happened, the first responders rushed in and had huge exposures to chemicals. They would do these protocols to remove the toxins, where one man, for example, started sweating out purple sweat. They analyzed it, and it was manganese coming out. This particular man had a tremor and was diagnosed with Parkinson’s. After the protocol, he didn’t have a tremor anymore. It was manganese toxicity, which was removed through sweating.

As trained by Walter Crinnion, nd, I have used sweating through a sauna or a steam room, or some form of sweating to successfully remove all forms of toxins, like solvents and heavy metals. I have had patients with high levels of lead who were not able to do chelation for one reason or another. They do this protocol 3 times a week. After about 6 months, significant reductions after provoked urine—using dimercaptosuccinic acid, or DMSA—high off the charts lead reduced back to normal levels, or close to normal levels.

It is simple. You want to check liver enzymes before starting the protocol. You take niacin in increasing doses, starting at about 300 mg, going up to 2000 or 3000 mg. Then within 20 minutes, you are exercising for 20 to 40 minutes. Then you go in the sauna or steam room and sweat for 20 to 40 minutes or more. Some people sweat for 60 minutes to 2 hours. You have got to use a lot of electrolytes if you are doing that. Then you take 5 capsules of activated charcoal, any brand, and that will bind up any toxins coming out in the gut.

Not a lot of patients do this, but this is what the fellow did who had mycotoxins. We did that with NAC, and that is all we did to help him, in addition to the nutrients to help with Alzheimer’s and dementia, like acetyl-l-carnitine, ginkgo, NAC, fish oil, a multiple vitamin, α-lipoic acid, and phosphatidylserine. He is not done yet. Typically with Bredesen’s research, he says you expect to see results after 3 to 6 months. It should not take longer, to begin to see results or you are missing something. After beginning to see benefits many times patients will continue to experience benefits and improvements in memory past that point.

Every patient who has responded on the protocol, and continued on the protocol, has not relapsed. It is not permanent. You do have to continue on the protocol. But it is very encouraging. Training with him gave me a lot of confidence to talk with patients, because they are worried, and you are worried as a clinician. Are you going to be able to help them? Is this going to work? But based on this research, and what I have seen with patients we can be confident that yes, we do know that it works, and if you are not finding answers, and you are not getting improvement, you need to look a little bit deeper, or the patient has to work on more components of the plan.

It is hard to do. Patients really need support. We recommend getting coaches, either a life coach, or care in the home to help the caregiver, because sometimes they are burnt out. The patients who do the best are the ones who have a supportive family member, they are very active themselves, and they are very motivated if the spouse does it with them. If the spouse is like, “I’m going to keep drinking a bottle of wine a night. I’m going to eat sugar. I don’t want to give it up,” or if the patient does not want to give up sugar, they are not going to get better. It just comes down to that.

IMCJ: By attending your lecture at the Environmental Health Symposium in March, what more would an attendee learn about the specifics of how to employ the protocol?

Dr Chapek: They are going to learn what kind of lab work we do and what types of cognitive testing we perform. We use WebNeuro. There are different types of cognitive testing. I’ll talk more about the SAGE test and other types of things they can do in the office. They are going to learn about the different types and cases of each type, within Bredesen’s differentiated types. I will present case examples and what we did for treatment. I have some before-and-after SPECT scans, too.

IMCJ: Does Bredesen’s protocol typically take advantage of the SPECT scan, or is that something that you have added because you are connected with Amen Clinics?

Dr Chapek: That is because we’re connected with Amen. Dr Bredesen uses quantitative magnetic resonance imaging, or qMRI, which I will talk about, and anyone can order that. You just do a regular MRI, but you have it interpreted through a computer program that looks at the volume of different structures of the brain. You can use that as a baseline to help with assessment, but you can repeat that. He has convincingly shown improvements in hippocampal volumes, actually. He will talk about how radiologists will say, “This can’t be right, we’ve scanned 75 000 brains, and we haven’t seen hippocampal volume increase in pre-Alzheimer’s or Alzheimer’s patients, but we’re seeing this with your patients on the MRI.” No one can refute that.

SPECT imaging is just a very clear way of looking at areas of the brain that are not working, and you can see a pattern of brain in dementia 5 to 9 years before symptoms. This early stage is when you can take action and have the most effect. We are not claiming to reverse late-stage Alzheimer’s, or sometimes even moderate. It works for people who are having subjective cognitive impairment where you are noticing a difference, but upon objective testing, there is no noticeable difference. Then there is mild cognitive impairment, which is early Alzheimer’s, and even sometimes into moderate, where patients have had to stop working. Some have been able to go back to work after doing the protocol.

The last thing I would like to say is that we need more clinicians to do this—to be aware that they are the perfect people to assess and treat patients with Alzheimer’s—because it is a chronic condition, and that is where functional and naturopathic medicine excels. We need you, the clinicians who do this, to be the front line of treatment, because the standard of care may often be similar to the following circumstances: “I’m starting to have memory problems, I’m losing my glasses. I’m going to go to the doctor; they’re going to do the Mini-Mental State Examination.” Not the best as far as sensitivity for picking up changes. They do a regular MRI, which shows age-appropriate degeneration. They are going to be prescribed Aricept and told, “You’re probably going to have Alzheimer’s in 5 to 10 years. Why don’t you get your will and your things in order. We’ll see you in 6 months.”

How heartbreaking is that? How sad is that? It is not very helpful. That really needs to change, because now we know we can do something. Once you start to have symptoms, go and see your naturopathic doctor or your functional medicine doctor, who has some knowledge about these approaches, and they can actually do something. That is what is going to change. I think what Dr Bredesen is doing is going to revolutionize Alzheimer’s treatment. With the help of naturopathic medicine and functional medicine, we are going to be able to turn the tide of Alzheimer’s.