Professors Patrick Holford and David Smith chose the Daily Record to announce their remarkable findings that Alzheimer’s Disease is preventable with just a “few simple diet and lifestyle changes”.
I may be new to Holford Watch but I am familiar with the Holford Test-Em Dose-Em style of Jeopardy. If the answer is, “Dose them with B vitamins” the question must have been, “What do you do after testing someone’s homocysteine levels?”. And, what do you know, I think it has slipped its way into this article, masquerading as a “simple blood test”.
“The chances are that the risk of Alzheimer’s can be identified early with a simple blood test and corrected with large amounts of B vitamins. However, this simple test is hardly ever done.” In Britain we run 20,000 home tests a year. In Germany it’s over two million.
It’s a homocysteine test, the measurement that Holford believes is a crystal ball for our health. It looks like Holford Watch has dealt with Holford’s dubious interpretation of homocysteine research on several occasions:
- Never Mind the Research Quality, Feel the Fear: Justifying Homocysteine Tests
- Homocysteine: Helpful or Hoax Asks Patrick Holford
- How Relevant Are Holford’s Claims About Homocysteine Levels? Part 1
- How Relevant Are Holford’s Claims About Homocysteine Levels? Part 2
Currently, it seems like there is no clear clinical evidence to support the notion that lowering raised homocysteine levels actually results in a significant clinical outcome. Even at a recent homocysteine conference, the general consensus was:
The results of ongoing randomized controlled intervention trials must be available before screening for and treatment of hyperhomocysteinemia can be recommended for the apparently healthy general population.
As recently as 2006, Smith wrote this about a role for B vitamins in preventing AD:
Large-scale randomised trials of homocysteine-lowering B vitamins are needed to see if a proportion of dementia in the world can be prevented.
So, if these haven’t been done, is it appropriate to advocate testing and supplementation? Is Smith leading a multiverse existence where he is writing the above in 2006, yet in 2007, he is confident enough to claim that, “Alzheimer’s is a preventable disease, not an inevitable part of ageing”. Presumably, somewhere, in a multiverse as yet unknown, this research has been done or what lies behind what would otherwise seem to be a volte-face?
There is no research to substantiate the efficacy of controlling your homocysteine levels in the prevention of Alzheimer’s Disease (among many others). Tweaking and maintaining your homocysteine at the level advocated by Holford will cost between £700-£1000 per annum, for tests and supplementation. That may be a rather large price to pay for something for which there is no strong evidence, particularly when the evidence that does exist seems to indicate that the homocysteine level may not be relevant for diagnostic purposes. See, e.g., Nilsson et al, 2007: Elevated plasma homocysteine concentration in elderly patients with mental illness is mainly related to the presence of vascular disease and not the diagnosis.
The findings imply that elevated plasma tHcy concentration in elderly patients with mental illness is mainly associated with the presence of vascular disease and is not related to the specific psychogeriatric diagnosis.
We were also able to confirm our previous finding that there was no association between dementia of Alzheimer type (AD) and plasma tHcy level or metabolic cobalamin/folate deficiencies.
So, it doesn’t look like there is sufficient evidence to support Holford and Smith’s optimism. It is disappointing that they were not challenged about these claims, but this is what happens when you promote your science by press release rather than peer-reviewed journals.
Update 05.12.07: Nature offers The Ghost of Research Past which is an instructional overview of popular nutritional beliefs that persist although clinical trials have long since contradicted observational studies that suggested a clinical benefit (explored more fully in Tatsioni, Bonitsis and Ioannidis).
Update 19.12.07: Patrick Holford discusses Alzheimer’s Disease with Tom Warren. We encounter the usual culprits of food allergies and candida to which the stock response is testing and supplements. However, the, to me, novel twist was Warren’s riff about the culpable status of amalgam fillings.
If you have chronic disease, especially schizophrenia, Alzheimer’s, dementia and other neurological disorders such as multiple sclerosis that your physician does not know the underlying cause for and you are not getting well, look in your mouth. If you have a mouth full of fillings this may be the problem.
For those who don’t have access to the full report, it concludes with a reassurance that
[t]he Brain Bio Centre at the Institute for Optimum Nutrition offers comprehensive diagnostic testing and optimum nutrition based treatment for dementia and Alzheimer’s.