In June 2016 a team from the Buck Institute of Ageing published the results of a small case series that used a technique called Metabolic Enhancement for NeuroDegeneration (MEND) to treat people with various stages of Alzheimer’s disease.
According to the authors of the study, the results are ‘unprecedented‘. But is this description warranted? Neuroscientist Dr Olivia Hibbitt takes a sceptical look at MEND.
What is MENDTM?
MEND is one of those increasingly common ‘therapies’ that seems to go straight to market and only after trademarks and cost centres are set up do we start to see scientific ‘evidence’ supporting the use of them.
There is very little information around about what exactly the MEND protocol does and the marketing material from the Muses corporation is suitable vague and peppered with a healthy dose of jargon and buzzwords. It is apparently a holistic approach to Alzheimer’s that assesses each individual for genetic, metabolic, behaviour (work, support network), cognition and, using this information a treatment program is developed. According to the marketing website: Protocol + Behaviour = change
This can be said for essentially every condition known to man, so this is not really in dispute. The website and the published paper have very little information on the protocol other than saying that patients included were on it. So whether the MEND protocol specifically plus behaviour really equals change is another question entirely!
The MEND study details
A great deal of caution needs to be taken when interpreting the results of this study. As a case series, this study is considered a low level of evidence.
Case studies have their place in science and often they are an important ‘first look’ that leads to more complete information. Here the case reports are used to see if there are measurable changes in Alzheimer’s symptoms associated with the MEND protocol.
The results presented here probably suggest that the MEND protocol does deserve some more investigation.
However, before you sign up for what is probably very expensive therapy there are a number of things this study cannot tell us.
- For starters, it’s impossible to assess whether the changes observed in the people participating had anything to do with MEND itself. To see this there would need to be a control group. Data obtained from a series of case studies are difficult to assess.
- Secondly, it appears that the MEND protocol is highly individualised and comprised of multiple, one might even say myriad, interventions. Trying to isolate the effect of these interventions to see if there really is a causative relationship could prove exceptionally difficult.
- Furthermore, the size of the study, 10 cases in total, while not usual for case series, is an issue when interpreting the data with respect to the rest of the population. Perhaps the effect on Alzheimer’s symptoms in these individuals was due to MEND. But maybe it was just the effect of having someone help them get healthier. Or maybe it was just pure random chance that symptoms improved in these people.
- There are also some red flags with this study. This study is not listed on the clinicaltrials.gov website. In 2016/17, there really is no excuse not to list trials. Even case series on this website, or similar, and the reference number should be listed in the paper. There also appears to be no ethics application associated with this publication, something that is a concern for clinical trials.
- Further to this, there appears to be no consistency with how the extent of Alzheimer’s symptoms has been assessed. In some people, the standard mini-mental state exam has been used, in others reports come from family. Both of these may be valid measures of effectiveness, but to understand how an intervention is having an effect there needs to be standard measurements that act as endpoints.
- In addition, while this study does have some promising results the tendency for the authors to overstate claims of effectiveness is troubling.
Does MEND reverse Alzheimer’s?
WELL, no conclusions can really be made from this study other than a series of dietary, lifestyle and pharmacological interventions may have an effect on health, including on Alzheimer’s disease. Which is not particularly revolutionary!