Patrick Holford, Alzheimer’s Disease, Homocysteine Tests and Supplements

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”.

According to Professor Patrick Holford of Teesside University and Head of Science and Education at Biocare:

“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:

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.

Nilsson et al. 2006: Plasma homocysteine, cobalamin/folate status, and vascular disease in a large population of psychogeriatric patients.

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 17.12.07: Does Industry Sponsorship Undermine the Integrity of Nutrition Research/ and Relationship Between Funding Source and Conclusion Among Nutrition-Related Science Articles

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.

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25 Comments

Filed under Alzheimer's, B12, Brain Bio Centre, Holford, home test, homocysteine, patrick holford, supplements, vitamin B12, vitamins

25 responses to “Patrick Holford, Alzheimer’s Disease, Homocysteine Tests and Supplements

  1. LeeT

    Much as I love this blog, I do think you have been a little unfair with regard to Professor Smith. He does seem to have a rather distinguished career in Alzheimer’s research:
    see http://www.dpag.ox.ac.uk/academic_staff/david_smith so not sure why he has chosen to associate himself with Mr Holford …

  2. dvnutrix

    It is unfair to point out that Prof Smith has quite an extensive relationship with Professor Holford? Or to point out that he wrote the above quotation in 2006 and a year or so later seems to have gotten over the need for large-scale prospective RCTs to establish efficacy?

    Robert Cade had a distinguised career as developer of Gatorade yet went off to the dark side (as detailed elsewhere in this blog). Is it unfair to mention that?

    Prof Smith’s diverse opinions have excited comment before today.

  3. dvnutrix

    Prof Smith is explicitly name-checked by Prof Holford as one of the professors teaching his course “to doctors by doctors”. Consult the vastly entertaining RTE video from about 20:15 onwards (link is in tap-dancing post.

  4. LeeT

    No, all comment is fair comment when Mr H is concerned!

    Not sure when Professor Smith went over to the “dark side”. The University of Oxford’s Medical Sciences website states he was one of the founders of OPTIMA (Oxford Project to Investigate Memory and Ageing) back in 1988 and he still seems to be involved.

    At http://www.dpag.ox.ac.uk/research/metabolic_respiratory/david_smith it states:
    “A clinical trial (VITACOG) is in progress to see whether taking high doses of folic acid, B12 and B6 will slow the rate of shrinkage of the brain in the elderly with memory problems, as assessed by volumetric MRI.” One of the most concerning things about Patrick Holford is that he does not seem to back up his claims with proper clinical trials. At least Professor Smith seems to be trying to do so at one of the country’s top universities.

    According to http://www.bristol.ac.uk/clinicalsciencenorth/news/2005/cs001 the MRC gave £122,171 for a three year study back in 2005.

    It would certainly be interesting to find out more about his involvement with “Food for the Brain”. He does not mention it on his departmental biography. Mr H seems to be in the habit of exaggerating endorsement for his projects/books. Didn’t Professor Andre Tylee ask to be disassociated from FFTB? Is there any evidence that Professor Smith has publicly endorsed PH?

  5. Pingback:   Debate over widespread Alzheimer's testing by Health Tips

  6. tifosi246

    Hmm, this reminds me of a cartoon with two academics looking at a complex equation on a blackboard. There is a gap in the middle of the equation and the two parts are linked by the words “A miracle occurs…”.

    It is now clear that those two academics are Prof Smith and Visiting Prof Holford. Prof Smith, having declared the need for trials on the left hand side skips to declaring vitimin B is the answer on the right. Visiting Prof Holford will no doubt claim credit for invoking the miracle.

    Mind you, at least we get the satisfaction of knowing a miracle must have occured. As for the Daily Record, there was a press release on the left of the blackboard, a sensational headline on the right and absolutely nothing in the middle, certainly no critical thinking or checking.

  7. dvnutrix

    I am familiar with Prof Smith’s research on Alzheimer’s Disease and his good publication record.

    Professor David Smith has provided the foreword to Holford’s Alzheimer’s Prevention Plan. Profs Holford and Smith teach on the same health seminar courses organised to promote Food Is Better Medicine Than Drugs. Those look like live and on-going endorsements to me.

    Smith has an clear relationship with Holford; it doesn’t look like a re-run of John Marks or Andre Tylee.

  8. dvnutrix

    Tifosi, plainly, there has been a miracle or a time-warp in and out of the multiverse where this research has been conducted and shown to show beneficial outcomes and significant clinical improvements.

    Possibly, we should be grateful that only the Daily Record was so strapped for copy that they ran this press release?

  9. Tifosi246 – I think I’ve seen the cartoon you are referring to.

  10. dvnutrix

    jdc – enjoyed that. We hazz math. We also hazz homocysteine management bill that runs between £700-100 p.a., per person.

  11. LeeT

    Thanks for the web links. Very disappointing.

    Not sure whether to be shocked that such a distinguished scientist should be so closely associated with Holford or thankful that Mr H has found some one good to take advice from.

    Presumably he’ll have to declare his links to the Holford empire and Food for the Brain project when the VITACOG clinical trial publishes its results?

    It would be great if some one influential could challenge Professor Smith on his links …

  12. heh, wonderful cartoon. Research would be so much easier if you could do that :D

  13. tifosi246

    jdc – not only is that the exact cartoon I had in mind but also your new caption is excellent. Thanks for the laugh

  14. superburger

    would you trust the Alzheimer’s advice of a man who can’t seemingly remember what year he graduated from university?

  15. dvnutrix

    Or the actual topic of his degree (plain old Psychology rather than the grander, more applied sounding Experimental Psychology).

  16. draust

    Oh Dear. David Smith does seem to have some unfortunate friends. The long-time chief research worker on Smith’s OPTIMA (Oxford Project to Investigate Memory and Ageing) back in the 80s and 90s was another old friend from the world of “integrative health” nutri-balls, “Professor” Kim “qLink” Jobst (brief bio here. Although that was before Jobst had gone completely Altie-loopy.

    I would guess the partial explanation is that David Smith, who clearly does have a long-standing interest in nutritional effects on memory and ageing, is a “mad enthusiast” type Professor – plenty of them about. Thus anyone seemingly sharing the enthusiasm might get a hearing.

    Hopefully Smith has the smarts to see through a charlatan masquerading as another enthusiast.

  17. Dr Aust, Prof Smith has a good record of scholarship and endeavour.

    Prof Smith has collaborated for some time with Prof Holford; they teach the Food Is Better Medicine Than Drugs seminar together in various places and for particular groups.

    I will be interested in the outcome of the OPTIMA trials. Until they are published, however, it seems premature to recommend supplementation. Particularly as it seems as if current knowledge indicates that it is not advisable to supplement some vitamins or minerals to people who have had cardiac incidents; the demographic for people to develop cardiac problems and (say) Alzheimer’s is remakably similar.

  18. draust

    Yes, I know several people who know David Smith, DVNutrix, and there is no hint of nutri-barminess in what I’ve heard. He has been described to me several times as “a character”.

    Anyway, he has a long-standing interest in nutritional effects, and I guess we can all agree that we would want research into such areas to be done by proper researchers (which he is) in proper Universities (ditto).

    Like you, I guess, I would only worry that David Smith will get his fingers burned with Patrick, see the kind of messages about supplementation now emerging from Holford Central. PH does quite a good job of seeming “scientific” to the unwary (this is, after all, PH’s core appeal), and perhaps even to the scientifically informed unwary. It is only once people begin to really subject PH’s stuff to a bit of “forensic” analysis that it becomes clear that PH is just another Woo-meister but with science-y go-faster stripes for camouflage. For which revealing we have to thank Holfordwatch and Ben Goldacre, inter alia

  19. He has been described to me several times as “a character”.

    Dr Aust, does any other nation use this description in such a charming and complimentary way?

    I’m currently looking in more detail at the idea of space race supplementation as an intellectual trigger for food and vitamin pills. Sadly, some of the science in the Holford output seems rather worse than that in various Andersen oeuvres.

  20. Pingback: Barefoot, Sex, Sleaze and Life’s 4 Living « Holford Watch: Patrick Holford, nutritionism and bad science

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