Dementia Hope

Dementia is one of the biggest global problems, both in societal and economic terms, and is already out of control, rising rapidly, with an ever-increasing number of new cases each year. The current estimate is 60 million globally, predicted to rise to 150 million by 2050. At present, the estimated annual cost is $1.3 trillion, predicted to rise to, up to, $4.8 trillion by 2050. Hospitals are seeing up to 25% of their total number of beds taken up by patients suffering from dementia, for whom an alternative level of care is being sort. Alternative care that is not readily available. Care packages are being proposed for people who need 24-hour care. The present situation is unsustainable and will soon be overwhelming.

The current understanding, is, there is no cure for dementia and no effective treatment. It's statement of resignation as to what is seen as an inevitable outcome, by governments and health care providers; one that has been accepted by society.

In my view, research should have taken a few steps back long before now, to look at the broader perspective. It's got buried in the fine detail at molecular and genetic level, as to what causes the formation of amyloid plaques and tau tangles in the brain, which cause Alzheimer's, and how to remove these, or stop them from forming. A similar approach has been taken to the causes of other types of dementia. All commendable, and scientifically very important, but surely, we should have been looking for a biological way of turning the tap off?

My name is Graham Ratcliffe. I have a science background, graduating from Durham University, where I studied entomology and neurobiology. I remained at Durham to undertake postgraduate research, receiving a Masters by thesis. The research I undertook, and its findings, have been referenced and quoted by those researching both veterinary and forensic science for over 40 years.

My early-stage dementia began at the age of 66, forgetting familiar names, what an object was called, simple things like a kettle, where I'd put, or last seen, something, asking a question I'd already asked several times before, forgetting I'd left something turned on, or that I'd left cooking in the oven, a condition that got progressively worse over a six-month period. I kept making excuses to myself, I was in denial, that was until one particular episode shocked me to the core, into both realising, and accepting, this was early-stage dementia. It felt as though individual facts, or memories, were being randomly plucked from my brain. The frightening thing was I knew it was getting worse, yet all I could do was put this progressive memory loss down to getting older.

I hadn't mentioned it to my friends, although I'm sure they knew something was wrong by the puzzled looks I was getting. I didn't want to tell anyone. When I forgot a name, or what an object was called, I used all means to fill the gap in my memory. I'd go through my email contact list, lists of names, or items for sale on the Internet, hoping the name, or word, might leap out at me, all avenues were pursued. Once found, I'd repeat it over and over, time and time again throughout that day, trying to fix the memory back into my mind.

I looked on the Internet to see if there was a cure, if there was anything I could do to reverse what was happening to me. I knew before I looked what the answer would be.

The answer came back, 'There is currently no cure for dementia, as the damage to the brain cells cannot be reversed'.

This was followed by a list of pharmaceutical drugs that might help me manage the disease as it got progressively worse, advice on how to keep myself safe, and how to avoid falls; a depressing read.

Nothing I read offered me ANY HOPE at all, just a long slide into oblivion, that might be slowed down a bit if I took a cocktail of drugs!

This I was not willing to accept; there had to be something I could do. By nature, I'd always been a strongly independent person, with an ability to sort matters out for myself, whenever I could, but this was rapidly beginning to look like an impossible challenge.

Through a short sequence of events, in which fate and serendipity more than played their part, I went onto a gluten free diet, which complemented the otherwise reasonably healthy diet I was already on. It was a relatively random choice, no more than somewhere to start my life-long journey in search of some hope, which I knew was destined to become no more than a long list of disappointments and failures. The choice of where to start was based solely on a conversation I'd had several years earlier, with a friend, at a summer BBQ.

When I say gluten free that didn't mean rushing out and stocking up on gluten free products. Mostly it was buying fresh produce that was naturally gluten free, and cutting out the modest number of processed foods I usually bought, which contained wheat, barley or rye. Over the next few months my memory slowly improved, within a year, so did my mental acuity; the transformation was nothing less than miraculous.

I need to clarify here, a gluten free diet cuts out all proteins found in wheat, barley and rye. In wheat, these are Gluten, Amylase-Trypsin Inhibitors (ATIs) and Wheat Germ Agglutinin (WGA), in barley and rye they are Gluten and Amylase-Trypsin Inhibitors (ATIs) only. (WGA) is specific to wheat. All of these I'll mention in more detail later on.

I did drop the gluten free diet, when my friend came across from the United States, for a trip together to the West Coast of Scotland. I dropped the change, because I thought if I stuck with it, it might make our time together more complicated, with having to cater for my diet. After we returned from Scotland, my friend flew back home. My condition had regressed, not back to square one, but I was forgetting names, having awkward conversations when I couldn't remember a particular word, trying to skirt the conversation around it, as I had done before.

However, dropping the dietary change only affected one particular food. It had been, if you like, a laboratory experiment, which confirmed that gluten was indeed the root cause of my memory loss. I went back to the diet I was using before the trip, and in time my memory began to recover.

Valuable information was learnt from the whole experience: (1) Gluten, ATIs and WGA are a major problem through the gut-brain axis. (2) My gluten free diet needed to be for life. (3) Certain stages of dementia, such as my early-stage dementia, can be reversed, certainly to a degree to be able to function normally. (4) There is a window of opportunity during early dementia. (5) There is a very good chance that the window remains open, but becomes gradually less effective as dementia advances. Nevertheless, a gluten free, healthy diet, might well turn out to be a good, and possibly the best, form of treatment for the medium and later stages of dementia.

The following is written for the situation where the person going onto the gluten free diet will both understand, and more importantly remember, what was discussed with the doctor. It is more likely, that this person will need to be accompanied by the person, or persons, looking after them, or helping with their daily routines.

A gluten free diet can make it more difficult for your doctor, and the NHS, to test you for certain medical conditions; you should discuss going onto a gluten free diet with your doctor, before doing so. It is highly likely they may want to run some routine tests, before you do. At the same time, you should show your doctor a printed-out sheet of the types of healthy foods and supplements I've suggested, or give them this website's address, so that the doctor, or a qualified dietician, can advise you more fully, with their knowledge of your medical history, and of any medications you may be taking. Your doctor is also the best person to advise you on what appropriate gentle, or moderate, exercise you might undertake.

There is a possibility you might find your doctor reluctant to engage with the idea, as the current NHS advice says there is no scientific evidence to suggest a gluten free diet would work. The reason there is no evidence, is because the research that should have taken place years ago, has not happened. It is as though a road block has been put up. If your doctor is reluctant about a gluten free diet, you should say, 'I'd rather do this with your support.' If it is likely you would not feel confident enough to say this, then you should take someone with you, who can speak on your behalf. This is not your doctor's fault, they have guidance from the NHS regarding treatment for dementia, unfortunately, the NHS guidance, in this case, is based on research that should have taken place, but has not; it is guidance based on nothing. However, the doctor can use their own professional judgement as to what they feel is best for their patient, especially when it comes to missing something out of the patient's diet; a treatment that does not involve licensed pharmaceuticals. Once your doctor has witnessed significant improvements firsthand, in patients with dementia on a gluten free diet, then your doctor will be the one recommending to other patients with dementia, that they consider going onto the same regime. Together we can change the narrative for those with dementia, but to do this we must work together and stand firm. Doctors, when they see the improvements firsthand, will join our ranks pushing for change.

I should begin by clarifying a very important point: there is no reason why we need to consume wheat, barley or rye, none whatsoever, they are not a requirement for human nutrition. We do not have a biological need for their specific plant proteins, and can live perfectly healthy lives without them. There is absolutely nothing in wheat, barley or rye that is essential — everything we need in the way of vitamins, minerals, amino acids, proteins, carbohydrates and fibre is more than provided for in a healthy diet. If anyone tells you differently, they are plain wrong.

Stop eating anything containing, or made using, WHEAT, BARLEY or RYE, which all contain gluten. These three are the main ones, but be careful — other things can contain gluten too. If you are not sure about a particular brand or product, check on the Internet, the information is readily available. Check the labels on all food products that do not specifically state they are 'Gluten Free'.

An excellent website that will give you accurate advice about the sources of gluten in both food and drinks, along with particularly good advice and gluten free recipes, is: https://celiac.org/what-is-gluten/sources-of-gluten/

AVOID SAUSAGES, BACON AND ALL PROCESSED MEATS COMPLETELY. Foods high in saturated fats should be avoided. Avoid highly processed foods. Red meats should be consumed in moderation. Refined sugar should be avoided as much as is reasonably possible. It is used in high concentrations in cakes and biscuits and other processed food; also make sure that any you do eat are 'gluten free'.

You will find some highly trusted websites advising people with dementia to eat plenty of whole grain food. They are ABSOLUTELY WRONG to make such a sweeping statement. Some whole grains, which includes all forms, and ancient varieties, of wheat, barley, rye and triticale (a hybrid cross between wheat and rye) contain gluten. If you are unsure always check on the Internet. Bread, pasta, and most, but not all, cereals, contain gluten. The advice some websites are giving is quite possibly accelerating your decline, or that of the person you are caring for. It has the 'ring' of doctors, in the 1950s and 1960s, advising their patients to take up smoking for their health.

Ask yourself this question: Does your dementia, or that of the person you are caring for, continue to get worse on the diet they are advising you follow, are there EVER any improvements?

The following are only suggestions. You should speak with your doctor before changing your current diet. Show your doctor the suggested foods below, to make sure there is nothing that might adversely affect you because of allergies, of medications you are taking, or because of medical conditions you might have.

It is important to eat healthily, a good balanced diet, with as little processed food as possible. A diet based on fresh fruit and vegetables that provides a good and appetising variety.

For proteins: lean meats, such as fish (either tinned or fresh), fish high in omega 3 is a good choice for brain health, chicken (especially skinless chicken breast) and other poultry. Beans, lentils and soya beans, all are excellent sources of protein, as are dairy, including eggs, cheese and yogurts. Eating eggs in moderation, 3 or 4 eggs per week, is very good for brain health, supplying choline, vitamins, minerals, healthy fats and antioxidants, a real brain supporting power house. Boiling or poaching eggs is the heathiest way to cook them.

Some suggestions for carbohydrates: potatoes, brown or whole grain rice, sweet potatoes, parsnips, sweetcorn, beets, butternut squash and oats. Many other vegetables also contain carbohydrates. With oats, buy those marked as 'Gluten Free', as some producers harvest, or process, wheat, through some of the same machinery, giving rise to the possibility of cross contamination.

Fresh fruit and vegetables do not contain gluten, and should be a good part of your diet, readily available in all supermarkets, with a wonderful choice available. Leafy greens are an excellent addition. Lettuce, tomatoes, radishes, cucumber and peppers, all are gluten free. Coleslaw and mayonnaise are usually gluten free, but check the label when buying ready-made, as they may contain thickeners, starches and flavouring containing gluten. You should check the labels for all store-bought ready-made products. The main approach to take is to eat each fresh produce in moderation, but with a wide variety. There are many fresh foods that are good for brain health, such as avocado, but again in moderation, such as quarter of a small avocado a couple of times a week. Blueberries, strawberries, olive oil, check on the Internet, there are numerous fresh foods that are excellent for brain health. Taking such an approach will bring significant improvements not only to brain health, but your health overall.

Probiotics should definitely be part of your daily diet, the little bottles in the supermarket refrigerated section, the ones with reduced sugar. This can be complemented with a second probiotic in capsule form, which contains a larger variety of strains. Take the two at different times of the day, but do not take probiotics with hot food or hot drinks, as this kills off the strains you are hoping to benefit from. The capsules can be broken open and the contents sprinkled onto food, for those who might have difficulty swallowing capsules, but make sure it is ONLY SPRINKLED ONTO COLD FOOD. The combination of these two types of probiotics works particularly well. A small amount of research on the Internet will tell you which two probiotics would be the best for you, or the person you are caring for. Buy the ones, not necessarily with the biggest numbers, but the ones that are science backed, have a track record, and a lot of good feedback. Discuss with your doctor, which ones would be most suitable, especially if you are watching your blood sugar levels. The probiotic capsules do not contain sugar. The probiotics are best taken first thing in the morning on an empty stomach, so they pass through the stomach quickly, or with prebiotic food, which are certain plant fibres, which the body cannot digest, but which are food for the beneficial bacteria in the probiotics you are taking, and for the good bacteria in your gut. If you are eating hot food, wait a few minutes before taking the probiotic, so you don't kill off the beneficial bacteria. Prebiotic foods are such as, gluten free oats, probably in the form of porridge, bananas, which are best slightly before they are ripe, a touch green, garlic, onions, asparagus, leeks, apples and artichokes. Prebiotics can also be bought in capsule form. Speak with your doctor regarding which types of prebiotics, either prebiotic food or capsules, and what quantity, would be suitable for you, with regards to both your medications and your health.

DO NOT UNDERESTIMATE THE IMPORTANCE OF GUT HEALTH — PROBIOTICS ARE VITAL, AND ESPECIALLY SO, FOR THOSE WITH DEMENTIA. TAKING, OR CONSUMING, PREBIOTICS WILL SIGNIFICANTLY ENHANCE THE BENEFITS YOU GET FROM TAKING PROBIOTICS. Another supplement that should seriously be considered, is glycine, a naturally occurring essential amino acid, which is readily available, and not expensive, about £15 for 1 kilo, which would last for ages. Buy the pure glycine, with nothing else added. This needs to be measured before taking, using a level quarter teaspoon baking measure, which gives a 1 gram portion. The sensible suggested daily portion is between 1g to 2g, between 1 and 2 level quarter teaspoon baking measures. You will need to work out the portion size that suits best, but keep the portions within these parameters. The glycine is best taken just before you go to bed, dissolved in a small glass of water, it has a mild sweet taste. Glycine can make you feel a little tired and is recognised to aid sleeping. More importantly, glycine is an essential amino acid for brain health. It is also known for detoxifying, removing unwanted molecules and chemicals from the body. ALTHOUGH GLYCINE IS PERFECTLY FINE FOR THE VAST MAJORITY OF PEOPLE, IT IS ESSENTIAL YOU SPEAK WITH YOUR DOCTOR FIRST, BEFORE INTRODUCING GLYCINE INTO YOUR DAILY ROUTINE. GLYCINE CAN INTEREACT WITH CERTAIN MEDICATIONS, AND IS NOT SUITABLE FOR PEOPLE WITH CERTAIN MEDICAL CONDITIONS.

Drink tea and coffee in moderation, but drink plenty of water, preferably filtered. Consider having a reverse osmosis water filter system fitted to the tap you use for drinking water. They are relatively inexpensive and remove heavy metals, forever chemicals, micro-plastics, bacteria, bacterial fragments, chlorine and many other things you'd rather not have in your drinking water.

When eating out, look for gluten free options, marked GF on the menu, or ask the waiter or waitress. Fish and chips with gluten free batter, roast chicken with gluten free gravy and gluten free Yorkshire puddings. Always ask which meals on the menu are gluten free.

When making gravy, Yorkshire puddings, or for baking, be sure to use gluten free flour, which will be marked as 'gluten free', and is readily available from supermarkets. Move to gluten free products, which are now more widely available. This may all seem a little onerous to begin with, but you'll soon get to know what should be on your shopping list.

What I am advising, subject to you speaking with your doctor, is that you miss out food that contains ANY GLUTEN for twelve months, eat a healthy diet, take daily prebiotics and probiotics, daily glycine, and judge for yourself. Gentle exercise may not be part of the diet, but it will improve your gut health. You can always go back to the diet you had before, but I don't think you will. You have everything to gain and nothing to lose.

The countries that have significantly increased their wheat consumption in relatively recent times are India, China, Ethiopia, Nigeria, Indonesia and the Philippines. The countries that have seen some of the most significant rises in dementia cases, are India, China, Ethiopia, Nigeria, Indonesia and the Philippines.

The Gulf States have also seen some of the highest rate increases in dementia, which are predicted to be huge by 2050. The position here is more complicated, not least, because in some Gulf States 80% to 90% of their population comes from abroad.

Japan currently has the highest rate of dementia globally, but a relatively low wheat consumption per capita. Japan's low wheat consumption has been used before to explain, or show, that wheat consumption, and in particular gluten, is not the cause of dementia, which, unfortunately, is misleading. Japan is an unusual case, up to now.

After the second world war, Japan saw a huge influx of wheat supplies from the United States, as they struggled to feed the population post-war. With a continuation of this aid, the Japanese diet moved from a largely rice-based diet to wheat based, in a relatively short period of time. Japan did have wheat in their diet before the second world war, but this was very much in moderation, with rice as the main staple, vegetables, lean meats, such as fish and chicken, all of these are gluten free. Since the end of the Second World War, Japan has experienced a major shift from infectious diseases to chronic, lifestyle-related, conditions. Through significant advances in medicine, infectious diseases were greatly reduced; life expectancy rose from 40–50 years up to around 85 years, giving rise to a rapidly ageing population. However, with industrialisation, and the adoption of a wheat based, western, diet, cases of type 2 diabetes, obesity, ulcerated colitis and Crohn's disease rose significantly, as did the number of dementia cases. Up until around 1990, it was mostly vascular dementia, now the leading cause of dementia in Japan is Alzheimer's; although it has to be said, this shift is partly due to greatly improved cardio-vascular care.

Science appears to have largely discounted the unusually high rate of dementia in Japan being genetically driven, or due to genetic differences; my instincts tell me they are unwise to do so. With regards to India, China and Ethiopia, these three have a very long history of wheat consumption, in China's case, in the north of the country. However, Nigeria, Indonesia and the Philippines have a long history of a rice, non-gluten, based diet, and may well, in time, suffer the same high percentage of the population with dementia that we see in Japan.

The majority of dementia cases are characterised by tau proteins clumping inside brain cells to form tau tangles, and in the spaces between brain cells beta-amyloid clumps to form amyloid plaques, both at a rate that will eventually overwhelm the brain's ability to clear them. Once a brain cell has become overwhelmed internally by tau tangles, that cell will eventually die.

In my case, where cells had not been overwhelmed by tau tangles, and I had gone onto a gluten free diet, those cells, in time, would likely recover. For the small area in my brain where cells had died off, or were in the process of dying, there would be no recovery. Instead, the brain's natural defence to compensate for that loss would begin, neuroplasticity. Neuroplasticity is where the brain starts making new connections between neurons, effectively rewiring the brain, with the benefits of the 'rewiring' becoming noticeable within weeks or months. The full rewiring can take months to many years, depending on the extent of damage to the brain. In my case, after three months I was noticeably better, which kept on improving over the next year or so; a timing you would expect for moderate damage to a small area of the brain being compensated for by neuroplasticity.

In slightly more advanced dementia cases, the brain continues to use neuroplasticity to compensate for areas where cells have died, and will have a reasonable degree of success to begin with, giving that person an appearance of relative stability, for a period of time. However, with the disease widely scattered across the brain, neuroplasticity struggles to keep up with the progressive nature of dementia, and eventually becomes overwhelmed. At this point, that person's cognitive decline accelerates.

As people get older, their digestive system becomes progressively less efficient, this happens sooner in some than others; all the changes may seem small, less stomach acid, less enzyme secretion, weakening of the intestinal muscles, lower activity levels, a more sedentary lifestyle, changes to our diet, medications, but they all have an effect. Sitting around too much slows down stomach and bowel action and keeps food longer in the intestine. This causes the bowel to absorb more water from the food passing through it, leaving a drier environment, in which less helpful inflammatory bacteria grow, while beneficial bacteria, that thrive on regular movement and fibre, decline. Reduced physical activity lowers blood flow to the intestine, which is linked to a less diverse gut biome. All alter the effectiveness with which we digest food, but most importantly, they all bring about changes in the gut biome, which is, by some margin, a significant factor, and quite possibly one of the most significant factors, behind the cause of dementia.

These changes are part of the natural ageing process, which goes some way to explaining why dementia is significantly age related.

With changes in the gut biome the ability to digest gluten changes in a relatively small percentage of older people, a percentage that increases with the passage of time. Both lifestyle and diet are major factors in trying to maintain gut health, and thereby brain health, in old age. The gut and brain are strongly linked through the gut-brain axis.

In those affected, the gluten passes from the stomach, which has less acid, either partially digested, or relatively untouched, into the small intestine, where the reduced enzyme secretion, and the bacteria present, following a change in the gut biome, begin to struggle to break down the complex gluten molecules completely; this leaves two prolamins, gliadin and glutenin; or gliadin peptides, glutamine peptides and peptide fragments, if the enzymes and bacteria manage to break down the two prolamins a bit further; in both cases, the digestion of gluten is incomplete.

The gliadin peptides, and gliadin itself, cause low level intestinal inflammation, by binding to specific receptors on the intestinal wall, which results in zonulin being secreted, a protein that normally controls the tight gaps between the cells of the intestinal lining, to let nutrients pass through.

Amylase-Trypsin Inhibitors (ATIs) are potent immune activators; by binding to receptors on immune cells in the intestinal wall, they stimulate pro-inflammatory cytokine production, amplifying the immune responses provoked by gliadin and its peptide, worsening tissue stress and structural damage to the intestinal wall.

Wheat Germ Agglutinin (WGA), binds directly to the lining of the small intestine, causing cellular irritation and altering absorptive function.

The simultaneous action of zonulin opening tight gaps between cells of the intestinal wall (gliadin), direct immune cell activation (ATIs), and the cellular irritation (WGA), creates a multi-pronged assault on the intestinal wall, promoting permeability (leaky gut) by triggering overlapping inflammatory and cellular stress pathways.

This allows bacterial toxins and bacterial fragments of gram-negative bacteria, gliadin, ATIs, WGA and other molecules to enter the bloodstream, which promotes widespread systemic, and central nervous system inflammation. This combination, or even part of it, more than has the capability to inflame, and therefore compromise, the blood-brain barrier (BBB), leaving the brain vulnerable.

Once the BBB is compromised, it will quite possibly remain mostly in that state through structural damage, as bacterial toxins, bacterial fragments and other unwanted molecules leak through the intestinal wall and into the blood stream with every meal containing gluten, ATIs and WGA, that is eaten.

The vast majority of the population digest gluten properly, and break down gliadin and glutenin into amino acids and peptide fragments, which pass through the intestinal wall normally and into the blood stream, where they are used healthily, in normal body functions. In this case, the ATIs and WGA present in the small intestine, and which are largely resistant to being broken down, are not sufficient to inflame the intestinal lining, and increase permeability.

Heart disease, high blood pressure and type 2 diabetes/obesity, all significantly increase the risk of dementia. These chronic conditions share common metabolic pathways that heavily influence gut health. They are linked to intestinal inflammation, increased permeability, and are strongly linked to changes in the gut biome. Heart disease and high blood pressure increase the risk of vascular dementia, which often occurs as mixed dementia, with Alzheimer's also present. Type 2 diabetes/obesity increase the risk of vascular dementia, Alzheimer's, and commonly mixed dementia, where both vascular dementia and Alzheimer's are present.

Brain injury/head injury, brain infection, all bring about low-level intestinal inflammation, significantly alter the gut biome, and can often lead to Vascular dementia, Alzheimer's, and to dementia where Vascular dementia and Alzheimer's are both present. The leading cause of non-traumatic and acquired brain injuries are strokes, with 1.4 million stroke survivors living in the UK; who have a significantly elevated risk of suffering dementia, with approximately 15% developing dementia within the first year, and about 32% within five years. The majority being Vascular dementia, followed by Alzheimer's, and quite commonly as mixed dementia, with vascular damage from a stroke, combined with Alzheimer's. People who have survived a stroke frequently experience, intestinal inflammation, increased gut permeability and changes in the gut biome.

People with Lewy Body dementia and frontotemporal dementia frequently show signs of gut microbiome imbalance and low-level intestinal inflammation. A significant percentage of these two types of dementia are found as mixed dementia, where Alzheimer's is also present. Those suffering from PARKINSON'S have gut permeability and changes in the gut biome. Older DOWN'S SYNDROME have gut permeability and changes in the gut biome. Both have a significantly increased risk of developing dementia. In the case of Parkinson's, Lewy body dementia, which is often found as mixed dementia with Alzheimer's also present; and in older Down's Syndrome, Alzheimer's.

In all of the above conditions, the intestine has low-level inflammation and there are changes in the gut biome. It is highly likely these people have a problem digesting gluten, brought about by changes in the gut biome, allowing gliadin, gliadin peptides, glutenin, glutamine peptides, peptide fragments, bacterial fragments, bacterial toxins, and other molecules to cross the intestinal lining and into the bloodstream.

A gluten free, healthy diet, supplemented with daily prebiotics and probiotics, and daily glycine, is an important potential treatment for ALL forms of dementia, because Alzheimer's is often present: Vascular dementia (heart disease, high blood pressure, and obesity/diabetes), dementia caused by brain injury/head injury, which includes strokes, brain infections, Lewy Body dementia, which includes Parkinson's, Frontotemporal dementia and Alzheimer's.   Amongst other conditions, Schizophrenia, Major Depressive Disorder (MDD), Anxiety Disorders,  Chronic Kidney Disease (CKD), Obesity, depression and psychological distress, sleep disturbances, untreated hearing loss, social isolation and loneliness, all frequently experience intestinal inflammation, increased gut permeability, changes in the gut biome, and all carry an increased risk of Alzheimer's. I suggest you read section 12 next, where I will set out exactly what causes Alzheimer's, which is about 60-70% of all dementia cases globally.

The notable increase of ulcerative colitis and Crohn's disease in Japan is of particular interest. As a consequence of the inflamed intestine and significantly increased permeability that is present in both of these conditions, bacterial fragments, bacterial toxins, and other molecules will be passing into the bloodstream, and have the ability to compromise the BBB. However, there has not been a significant increase in young-onset dementia in Japan, which tells us that bacterial toxins, bacterial fragments and other molecules are not causing dementia, rather they are part of the pathway by which it might occur. It also tells us that these people must be digesting wheat, barley and rye properly at a younger age, into amino acids and beneficial peptide fragments. Research has found markers in these two conditions for the BBB being compromised and neuroinflammation.

Type 2 diabetes: High blood sugar levels and oxidative stress, damage tight junctions in the intestinal wall, increasing permeability; it also alters the gut biome by reducing the level of beneficial bacteria and increasing harmful bacteria.

The number of cases of ulcerative colitis, Crohn's disease and type 2 diabetes have risen significantly in the Japanese population, as has obesity, with Japanese people developing type 2 diabetes at a much lower body mass index (BMI), driven primarily by insufficient insulin secretory reserve, controlled by the INS gene. Yet none of these conditions have caused a noticeable increase in young-onset dementia, even though they are all known to increase the chance of dementia. However, all three are known to suffer dementia earlier and have a faster cognitive decline, which points the finger even more firmly at wheat, barley and rye.

Studies from Japan show that Japanese people with early-stage dementia have gut biome imbalances and compromised intestinal barriers.

With gliadin, gliadin peptides, ATIs and WGA increasing the permeability of the intestinal wall, and bacterial fragments, bacterial toxins and other molecules compromising the BBB, I looked more broadly at the partial digestion of wheat, barley and rye to see which other molecules, resulting from the partial digestion of gluten, would be crossing the BBB and into brain cells. Although gliadin, gliadin peptides, glutenin, glutamine peptides, ATIs, WGA, bacterial fragments and bacterial toxins should be categorised under the golden rule of 'never rule things out completely', the stand out, prime candidates, are immunogenic peptides and oligopeptides, these are peptide fragments that directly result from the partial digestion of gluten.

Immunogenic peptides and oligopeptides can easily cross a compromised BBB. Certain amyloidogenic oligopeptides can adopt beta-sheet conformations and act as templates, structural ''seeds''.  When they contact normal host proteins, or protein fragments, such as beta-amyloid, they trigger conformational changes, a structural shift in the shape of this molecule, without breaking its chemical bonds, which turns the functional, healthy protein fragment, beta-amyloid, into rogue, aggregated structures; in Alzheimer's, amyloid plaques. Amyloidogenic oligopeptides result from the partial digestion of gluten in wheat, barley and rye. Immunogenic peptides provoke local immune responses and oxidative stress in glial cells, which impairs the brain's ability to clear toxic aggregates and worsens protein misfolding.

Immunogenic peptides and oligopeptides frequently act as epitopes. The epitope is a specific part (a molecular sequence) of an immunogenic peptide or oligopeptide, a molecular target recognised by the immune system, that triggers an inflammatory response. This immune reaction creates reactive chemical molecules that damage nearby neurons and glial cells, causing oxidative stress, which impairs normal cell signalling, energy production and waste removal. In simple terms, the chronic inflammation and cellular stress, caused by invading epitopes, disrupt the brain cell's internal maintenance systems. This breakdown in protein balance makes the brain cell's native proteins, which include tau, the precursor to tau tangles, far more likely to misfold, clump together, and form toxic aggregates over time; in Alzheimer's tau tangles.

The powerful combination of immunogenic peptides and oligopeptides cause native proteins, and protein fragments, in the brain, to misfold and clump, forming amyloid plaques and tau tangles. This comes about when the change in the gut biome leaves that person no longer able to digest gluten properly, leading to the partial digestion of gluten and the release of immunogenic peptides and oligopeptides into the blood stream, where they cross the BBB and into the brain. The problem is, this has been happening for quite some time before any symptoms appears, during which time the brain has been compensating. At the time symptoms appear, THE TIPPING POINT, the formation of amyloid plaques plateaus, or slows down, while the formation of tau tangles and brain cells dying off, accelerates. The ONLY effective treatment is a GLUTEN FREE DIET, to dramatically slow down, or stop, the formation of amyloid plaques and tau tangles, this combined with PREBIOTICS AND PROBIOTICS to reduce the inflammation of the intestinal wall and improve gut health significantly, along with daily glycine to aid the glial cells in clearing misfolded proteins and dead brain cells, which will take quite some time. No other treatment will work as well as this, in fact if you don't take gluten out of the diet, no other treatment will work at all. THIS IS EXACTLY HOW THE PARTIAL DIGESTION OF GLUTEN CAUSES ALZHEIMER'S. I need to add a word of caution here, gluten may, or may not be, the only driver of Alzheimer's. The approach needs to be, a gluten free diet, rebuild gut health through prebiotics, probiotics and a healthy diet, and aid the brain's recovery with supplementary glycine. From my own experience, both my memory and mental acuity have improved both continually and significantly, as I've stayed with the treatment, so the outlook looks promising.

Both the studies below have been quoted numerous times, as definitive proof that gluten is not a risk factor for Alzheimer's disease in the general population.

1. Swedish study – Columbia University

Title: Risk of Dementia in Patients with Celiac Disease: A Population-Based Cohort Study.

This study examined 8,846 people aged 50 or older with confirmed coeliac disease and compared them with 43,474 controls from the general population.

Participants were followed for a median of 8.4 years.

It found no statistically significant overall increase in dementia among coeliac patients.

It did not measure participants' gluten consumption, establish their adherence to gluten-free diets or compare those consuming gluten with those on a gluten free diet. Consequently, this study cannot establish that gluten consumption is harmless to the brain or that it does not contribute to Alzheimer's disease in the general population.

Columbia University went further in its public explanation, suggesting that concerns about gluten-related cognitive symptoms leading to dementia could largely be set aside, which is all the more surprising, as the Swedish study was designed to investigate the consequences of coeliac disease, not the consequences of consuming gluten, or of a gluten free diet , within the general population.

2. JAMA Network Open study (2021)

Title: Long-term Intake of Gluten and Cognitive Function Among US Women

The investigators examined 13,494 women, with an average age of approximately 61, when they underwent their cognitive assessment.

Dietary information was collected between 1991 and 2015.

Cognitive assessments were conducted between 2014 and 2019.

Researchers were assessing cognitive performance at approximately 61, not following the women into their 70s and 80s to establish whether they subsequently developed Alzheimer's disease, an important distinction when interpreting the study's conclusions about Alzheimer's risk. It is quite plausible for someone aged 61 to have a normal cognitive assessment, but still have Alzheimer's developing.

This study investigated whether different levels of gluten consumption were associated with cognitive performance in 13,494 women, who had not been diagnosed with coeliac disease. It found no significant association between estimated gluten intake and cognitive test results.

Importantly, even the lowest gluten-consumption group continued to consume substantial quantities of gluten.

This means the investigators were principally comparing differing levels of gluten consumption, rather than comparing a gluten-free population with a gluten-consuming population. Indeed, the researchers explicitly acknowledged that their dietary assessment was insufficiently sensitive to identify people following a gluten-free diet. They stated that their conclusions should not be extrapolated to that population. Consequently, this study cannot establish that eliminating gluten has no neurological benefits, or that long-term gluten consumption cannot contribute to Alzheimer's disease.

Overall conclusion

Both studies provide useful evidence, but neither answers the fundamental question of whether consuming gluten increases Alzheimer's risk compared with avoiding gluten.

The first investigates diagnosed coeliac disease rather than gluten exposure. The second investigates cognitive performance rather than Alzheimer's disease, and does not adequately compare consuming gluten with a gluten free diet.

It would therefore be scientifically unjustified to use either study as proof that gluten is not a risk factor for Alzheimer's disease in the general population.

Broadly, the current explanation is:

(1) Ageing is the single biggest risk factor for dementia, because underlying brain-damaging diseases take many years to develop and manifest symptoms.

(2) Older brains experience a natural decline in cell repair, mitochondrial dysfunction, genomic instability, and a reduced ability to clear out toxic proteins like amyloid and tau.

(3) Ageing frequently brings stiffer arteries, reduced cerebral blood flow, and a higher cumulative risk of micro-strokes or high blood pressure, that compromise brain resilience.

(4) Weakening immune system and chronic, low-grade, inflammation make neural tissue more vulnerable to progressive degeneration.

(5) Older adults are more prone to risk factors, such as diabetes, hearing loss, or cardiovascular strain, which amplify cognitive vulnerability.

What all these explanations are saying, is, you get dementia because you are getting old, and the older you get, the greater the chance you'll get dementia.

Gluten is widely recognised by scientists as one of the most difficult dietary proteins for the human gut to break down, at any age.

Digesting gluten, and processing wheat, barley and rye, can become more challenging as people enter their 60s, 70s and 80s, largely due to natural shifts in the ageing digestive system.

So, with all the list of reasons why the human brain declines with age, why do we expect the human intestine to keep digesting the hardest of proteins, without the possibility it would be less likely to do so? The expectations are unrealistic, not least because of the significant changes to the gut biome of older people, and the rather important fact that the gut needs certain bacteria to break down gluten, without these beneficial bacteria only partial digestion takes place.

There has been no clinical research or trial, ANYWHERE, that places patients with early-stage dementia onto a gluten free diet, to treat or reverse the condition.

Why on earth has this not been tested?

I struggle to find any justification, or logical reason, for not carrying out this basic, and quite clearly necessary, research. It's a glaring omission to virtually discount gluten, without testing it first.

The link to wheat consumption, and therefore gluten, is undeniable, the statistics and numbers speak for themselves.

This research/clinical trial ABSOLUTELY needs to be carried out.

Gluten free diets are already used by health service providers; it's a recognised treatment for other conditions, and it's a virtually risk free, almost cost free, treatment.

A gluten free, healthy, diet, combined with daily prebiotics, probiotics and glycine — which can all be bought at the supermarket, or online — turns off the tap for one of the main culprits.

This has to be the way forward to significantly reduce, and control, the number of new dementia cases, and as a potential treatment for existing dementia cases.

I'm certainly not advocating the whole population goes gluten free, as most people (99%) are absolutely fine eating gluten, except in the cases of young-onset, early-onset, early-stage, and later stages of dementia, the (1%) of the total population, which equates to approximately 8% of the population aged over 65; and includes those with dementia before the age of 65. These percentages vary between countries.

What I am advocating, is those with a diagnosis of dementia, as soon as they get that diagnosis, are placed immediately onto a gluten free diet, by the doctor, consultant or other medical professional who is attending to their health care. This would need to be alongside a dietician to advise the patient, or their family, on an appropriate gluten free, healthy diet; which should definitely include daily prebiotics, probiotics and glycine.

I am also advocating, doctors placing people, who have had dementia for some time, on the same gluten free diet, to halt, or significantly slow down (in the cases of mixed dementia) the progression of the disease, so that neuroplasticity can bring improvements to their everyday lives. That doctors place all stroke survivors onto the same gluten free, healthy diet, with daily prebiotics, probiotics and glycine, to significantly reduce the high percentage that go on to develop dementia. The treatment could well be effective for older Down's syndrome with early-stage dementia; and the same treatment may be beneficial to those with Parkinson's.

Alzheimer's, the most common form of dementia, is considered to be both progressive and irreversible.  I consider that this statement does have not to be the case, there is hope.

1. By removing gluten from my diet, the partial digestion of gluten could not take place, so gliadin, gliadin peptides, ATI's and WGA were not present to inflame the intestinal wall and increase gut permeability. In consequence, oligopeptides and immunogenic peptides, which both originate from the partial digestion of gluten, bacterial fragments, bacterial toxins and other molecules could not enter the bloodstream.

2. The probiotics are necessary to rebalance, and maintain, a healthy gut biome, which is critical in older people to maintain both gut health, and overall health. They are best taken first thing in the morning, so they pass through the stomach quickly, or at the same time as consuming prebiotic food or taking prebiotic capsules, or slightly apart if you find that more comfortable. DO NOT UNDERESTIMATE THE IMPORTANCE OF BOTH PREBIOTICS AND PROBIOTICS IN TERMS OF YOUR OVERALL HEALTH,  THE HEALTH OF YOUR GUT, AND YOUR BRAIN HEALTH.

3. The supplementary glycine is beneficial for brain health, it aids the brain's glial cells, in clearing misfolded proteins and dead brain cells, indirectly, by reducing inflammation in the brain, supressing inflammatory pathways, and as antioxidant support as a precursor to glutathione, a significant cellular antioxidant; in this role glycine helps to neutralise oxidative stress.

4. The healthy diet was essential in supplying not only the body, but also the brain and the intestine, with the nutrients they needed to maintain a healthy balance.

The reason why glial cells can't deal with the misfolded proteins that cause Alzheimer's, is they can't keep up with the progressive nature of the disease. The rate at which the proteins are misfolding, overwhelms the glial cells. The brain cells are dying quicker than the glial cells can remove the misfolded proteins, and clear dead brain cells.

If the 'tap is turned off' and the proteins stop misfolding, then the glial cells will eventually catch up and clear away the remaining misfolded proteins, and the dead brain cells. During this same period, neuroplasticity will be working to make new connections between neurons. The extent of the recovery will depend on how much damage has been done to the brain, prior to the 'tap being turned off'.