Once I inform colleagues that I provide Valtrex (valacyclovir) and low-dose lithium orotate to sufferers nervous about creating Alzheimer’s, the silence within the room thickens. Somebody at all times asks, “The place’s the randomized managed trial?” That’s precisely the issue. We hold ready for excellent proof whereas the illness eats away at individuals’s brains.
I’m an internist and lipidologist who’s spent years watching the medical institution chase the fallacious villains, like ldl cholesterol, salt, and saturated fats, whereas ignoring the function of an infection, irritation, and immune dysfunction. Alzheimer’s is simply the most recent frontier on this blind spot.
The infectious speculation of Alzheimer’s isn’t fringe anymore. Research from Tufts College, Harvard, and Oxford have all discovered herpes simplex virus kind 1 (HSV-1) within the brains of older adults with Alzheimer’s pathology. Epidemiologic knowledge from Taiwan’s Nationwide Well being Insurance coverage Analysis Database confirmed that folks with HSV an infection had a 2.5-fold increased danger of creating dementia, and that these handled with antiviral medicine like acyclovir or valacyclovir had an 88 % discount in that danger. Let that sink in: an 88 % discount.
We’ve seen this film earlier than. Within the Nineteen Eighties, ulcers have been “attributable to stress” till Barry Marshall drank a beaker of H. pylori to show an infectious trigger. In cardiology, we’ve been sluggish to confess that Chlamydia pneumoniae has been remoted in atherosclerotic plaques for many years. But right here we’re once more, pretending that Alzheimer’s should be purely metabolic, genetic, or dangerous luck.
Valtrex isn’t a panacea, but it surely’s low-cost, protected, and mechanistically believable. Ongoing scientific trials are testing high-dose valacyclovir in early Alzheimer’s sufferers, however the security knowledge we have already got from many years of HSV therapy is strong. I often begin sufferers who’ve HSV-1 or HSV-2 seropositivity on 500 mg-1 g day by day. I mix that with lithium orotate 5 mg, not for temper however as a result of microdose lithium has been related to decrease dementia charges in a number of inhabitants research and should stabilize tau phosphorylation.
This isn’t reckless; it’s a type of preventive empiricism. We deal with hypertension to stop stroke lengthy earlier than the RCTs proved profit for each drug class. We give metformin to individuals with prediabetes with out figuring out which of them will truly develop diabetes. But on the subject of the mind, the place the stakes are irreversible, we freeze.
So sure, I’m bored with ready. If a affected person with a powerful household historical past or early cognitive complaints desires to behave now, I’ll provide a low-cost antiviral and lithium combo with full knowledgeable consent. The draw back is minimal; the potential upside, monumental. Sometime, the RCTs will catch up. By then, a few of my sufferers may nonetheless keep in mind my identify.
Larry Kaskel is an internist and “lipidologist in restoration” who has been practising medication for greater than thirty-five years. He operates a concierge apply within the Chicago space and serves on the educating college on the Northwestern College Feinberg Faculty of Drugs. As well as, he’s affiliated with Northwestern Lake Forest Hospital.
Earlier than podcasts entered mainstream tradition, Dr. Kaskel hosted Lipid Luminations on ReachMD, the place he produced a library of greater than 4 hundred packages that includes main voices in cardiology, lipidology, and preventive medication.
He’s the creator of Dr. Kaskel’s Dwelling in Wellness, Quantity One: Let Meals Be Thy Drugs, works that mix evidence-based medical apply with accessible methods for bettering healthspan. His present initiatives deal with reevaluating the ldl cholesterol speculation and investigating the infectious origins of atherosclerosis. Extra data is on the market at larrykaskel.com.
