Guide
The Bredesen Protocol in the UK: your questions answered
The Bredesen Protocol takes two to three months to set up, and the first honest reading of whether it is working comes at around six months. ReCODE is the same programme. Choose a practitioner on professional registration, protocol training, objective measurement and the absence of any promise of reversal.
How long does the Bredesen Protocol take to work?
Setting it up takes two to three months, from the first consultation to a finalised programme. Some blood markers change within weeks, but the first honest reading of whether cognition is holding or improving comes at around six months, when cognitive testing is repeated.
This is the usual sequence:
- Weeks 0 to 3A free discovery call, then the first appointment, usually available within two to three weeks.
- Month 1A three-hour initial assessment and a cognitive baseline. Testing is ordered, with a written estimate first. Changes to sleep, eating times and exercise start straight away, because they do not depend on the results.
- Month 2 to 3Results, including neuroimaging. A two-and-a-half-hour follow-up brings everything together and finalises a written programme.
- Weeks to monthsMeasurable change in the blood markers that drive decline, such as fasting insulin and homocysteine, often within the first few weeks of treatment.
- Month 6Cognitive testing repeated. This is the first point at which it is fair to judge whether the programme is working, and a focused repeat blood panel is usually due.
- Year 1Reviews about every three months, and a repeat panel about every six months, adjusting as results change.
- BeyondA long-term way of living rather than a course of treatment, reviewed less often once things are stable.
What the result looks like matters as much as when it arrives. I do not promise to reverse Alzheimer's disease. The aim is to halt further progression. Some people improve, most often those who start early; some hold steady; some continue to decline. In the published studies, improvements in cognitive test scores were typically a few points on a thirty-point scale. In a condition expected to progress, not progressing is a result.
Adherence is one of the biggest influences on all of this. The programme asks a lot of diet, exercise, sleep and supplements over months, usually with a partner or family member involved.
Is the Bredesen Protocol the same as Apollo Health’s ReCODE?
Yes. They are the same programme under different names, not competing protocols. Dr Dale Bredesen first described it as MEND in 2014. It is now delivered as ReCODE for people with symptoms and PreCODE for prevention, through Apollo Health, the company that trains practitioners in it and runs the patient platform.
| Name | What it is |
|---|---|
| Bredesen Protocol | The name most people use for the whole approach. |
| MEND | Metabolic Enhancement for NeuroDegeneration. Bredesen’s original name for it, in the 2014 paper. |
| ReCODE | The current programme for people with cognitive symptoms, from subjective decline to early Alzheimer’s. |
| PreCODE | The same approach for people without symptoms who want to lower their risk, for example because of family history or ApoE4. |
| Apollo Health | The company that trains practitioners in the protocol, keeps the practitioner locator, and runs the ReCODE subscription and app. |
| KetoFLEX 12/3 | The diet the protocol uses: mildly ketogenic and plant-rich, with at least twelve hours of overnight fasting and three hours between the last meal and sleep. |
If you are on the programme with me, the ReCODE subscription is paid directly to Apollo Health. It gives you your results laid out against the protocol’s target ranges, your care plan, an app to track progress, recipes and educational material. The programme names are Bredesen’s own and are not a claim I make about outcomes.
What kinds of provider can help with cognitive decline?
There are four broad routes, and they do different jobs. Most people are best served by more than one of them working together, rather than choosing between them.
| Provider | What it does well | What it does not do |
|---|---|---|
| NHS memory clinic | Establishes whether dementia is present and of what type, following NICE guideline NG97. Free, and the route to NHS specialist care. | Rarely asks what is driving decline in your case. Waits can be long and follow-up sparse. |
| Private neurologist or memory clinic | The same diagnostic job, faster, with access to newer blood biomarkers and specialist imaging. | Usually diagnostic rather than a programme of treatment for the contributors. |
| Doctor-led Bredesen practice | Looks for the specific contributors in one person, treats them, and can prescribe, interpret the full workup and recognise when something needs a neurologist. | Costs more than the NHS route, and the protocol’s overall evidence base is still uncontrolled. |
| Practitioner-led Bredesen practice (nutritional therapist or health coach) | Often strong on the diet and lifestyle side, and on the day-to-day support the programme needs. | Cannot diagnose or prescribe, so medical parts of the workup and treatment need a doctor elsewhere. |
Whichever you choose, the criteria are the same. Ask what the person is registered to do, how they will measure change, what outcome they expect for you, and how they will work with your GP and memory clinic. For a fuller comparison of doctor-led and other clinics, see how to choose a functional medicine clinic.
How do I choose a Bredesen practitioner in the UK?
Check professional registration and protocol training separately, then ask how they measure progress and what they expect for someone like you. Training tells you about the method; registration tells you what someone is licensed to do.
- Professional registration. A doctor should be on the GMC register, which takes two minutes to search. Mine is GMC 4419909.
- Protocol training. Ask which Apollo Health course they completed and when. Apollo Health’s public practitioner locator shows practitioner types by area rather than names, so ask Apollo Health to confirm if you want to check.
- Who orders and interprets the workup. Including ApoE, neuroimaging and any newer blood biomarkers. If it is someone other than the person you see, ask how they work together.
- How progress is measured. A cognitive baseline and repeat testing at set intervals, not an impression.
- What they expect for you. A promise of reversal is a warning sign. UK advertising rules exist because that promise gets made.
- How they work with the NHS. Letters to your GP and memory clinic, and referral when something else is found.
- What it will cost in total. Not just the consultation fees. You should have a written estimate before any test is ordered.
Cognitive decline rarely comes alone. Sleep apnoea, insulin resistance, gut problems and post-viral fatigue are common alongside it, and a practitioner who can assess and treat those in the same programme will usually get further.
How can I tell whether an approach to cognitive decline is evidence-based?
Look for an honest account of the evidence, objective measurement, and no promise of reversal. A clinic that cites the Lancet Commission and the FINGER trial, and works with your memory clinic rather than around it, is on firmer ground than one leading with testimonials.
| Reassuring | Warning sign |
|---|---|
| Says plainly that the Bredesen studies are small and uncontrolled | Presents the protocol as proven |
| Aims to halt progression; describes improvement as possible, not expected | Promises reversal, or leads with dramatic before-and-after stories |
| Repeats cognitive testing at set intervals | Judges progress by impression alone |
| Tests to answer specific questions, with an estimate first | Runs large fixed panels on everyone |
| Uses existing NHS results and imaging rather than repeating them | Repeats everything in-house |
| Refers on when something needs a neurologist | Treats every case as suitable |
| Uses supplements to correct specific findings | Builds the plan around a product range |
The evidence itself, briefly. Bredesen’s papers from 2014 to 2018 and a 2022 trial by Toups and colleagues all reported improvement in most participants, but none had a control group, so they cannot rule out placebo, selection or chance. The individual parts of the programme rest on firmer ground: the 2024 Lancet Commission estimated that addressing fourteen modifiable risk factors could prevent or delay around forty-five per cent of dementia cases, the FINGER randomised trial showed a multidomain lifestyle programme protected cognition, and the VITACOG trial showed B vitamins slowed brain atrophy in people with raised homocysteine. The early Alzheimer’s guide sets this out in full.
What does the Bredesen Protocol cost in total?
Around £10,000 to reach the point where you can properly act on a treatment plan. That covers the initial consultation, the laboratory workup, neuroimaging, and the follow-up where everything is brought together and the plan is finalised.
After that, the ongoing costs are:
- Reviews about every three months in the first year, at £525 each.
- A focused repeat blood panel about every six months, much smaller than the first.
- Supplements, typically around £400 to £500 a month, with a wide range depending on what your results show.
- Apollo Health’s ReCODE subscription, paid to them directly.
Every figure is an estimate until I have seen your history, and I give a written estimate before any test is ordered. The fees page has the detail.
Common questions
How long does the Bredesen Protocol take to work?
Setting it up takes two to three months. Some blood markers improve within weeks, but the first fair judgement of whether cognition is holding or improving comes at around six months, when testing is repeated. After that it is a long-term way of living, reviewed every few months.
What is the difference between the Bredesen Protocol and the Apollo Health protocol?
There is none. ReCODE, delivered through Apollo Health, is the current name for the Bredesen Protocol for people with symptoms; PreCODE is the version for prevention. Apollo Health trains practitioners and runs the patient platform.
What criteria should I use to select a UK practitioner for the Bredesen Protocol?
Check professional registration (the GMC register for a doctor) and Apollo Health training separately. Then ask who interprets the workup, how progress is measured, what outcome they expect for you, how they work with your GP and memory clinic, and what it will cost in total.
How do I tell whether a clinic’s approach to cognitive decline is evidence-based?
It should describe the evidence honestly, including that the Bredesen studies are uncontrolled; measure cognition at set intervals; refer on when needed; and never promise reversal. Citing the Lancet Commission and the FINGER trial is a good sign. Leading with testimonials is not.
What criteria should I use to choose a provider for cognitive health support?
Decide first what you need: a diagnosis, which an NHS or private memory clinic provides, or a programme to address what is driving decline, which a Bredesen-trained practitioner provides. Then check registration, measurement, expected outcomes and how they work with your other doctors.
Can the Bredesen Protocol be done remotely?
Much of it can, and I see patients online across the UK. Examination and blood tests need to happen in person or locally, and I will tell you which parts at the outset.
How much does the Bredesen Protocol cost in the UK?
With me, around £10,000 to reach an actionable treatment plan, covering the initial consultation, laboratory workup, neuroimaging and results follow-up. Ongoing costs are reviews, a repeat panel about every six months, supplements and a ReCODE subscription.
Sources
- Bredesen DE. Reversal of cognitive decline: a novel therapeutic program. Aging 2014;6(9):707-717.
- Toups K, Hathaway A, Gordon D, et al. Precision medicine approach to Alzheimer’s disease: successful pilot project. Journal of Alzheimer’s Disease 2022;88(4):1411-1421.
- Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 2024;404:572-628.
- Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention (FINGER): a randomised controlled trial. Lancet 2015;385:2255-2263.
- Smith AD, Smith SM, de Jager CA, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment (VITACOG). PLoS ONE 2010;5(9):e12244.
- NICE. Dementia: assessment, management and support for people living with dementia and their carers. NICE guideline NG97, June 2018.
- Apollo Health. ReCODE.
Written and reviewed by Dr Andrew Greenland, MBBS, MRCSEd, FRCEM, FMCP-M, a practising hospital doctor and certified functional medicine practitioner. Registered with the General Medical Council, number 4419909(verify). This guide is general information and not a substitute for individual medical advice.
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