“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
— Buckminster Fuller
The Study that Changed Everything
In July of 2024, while at a conference in Chicago, I was back in my hotel room (answering portal messages, action plans, more portal messages…) when I came across a paper that I knew was going to permanently shift how I understood aging and chronic disease. The paper that I read was on the AMBAR (Alzheimer’s Management by Albumin Replacement) Trial. It was a phase 2b/3 multicenter, randomized, double blind, placebo control trial with 347 patients that evaluated Therapeutic Plasma Exchange (TPE) with albumin replacement as a potential treatment to slow progression of patients with mild to moderate Alzheimer’s disease.
Therapeutic Plasma Exchange is a mechanical detox process that has been around for over 50 years with decades of safety data. Using a machine, very similar to kidney dialysis, it separates blood into plasma and cells, discards the plasma and then replaces it with albumin. Traditional use of TPE has been neurological disorders like Guillain–Barré syndrome, Myasthenia gravis, transplant rejection, drug overdose, and TTP to name a few. In lay terms, the researchers in the AMBAR study wanted to see if they could slow down Alzheimer’s disease by cleaning the person’s blood. They did this intensively for six weeks then monthly low volume plasma exchange for 12 months.
What floored me is what the study demonstrated:
- In the mild to moderate population, this procedure slowed cognitive decline by 52% on the ADCS-ADL Functional scale and showed a trend towards 66% less decline on the ADAS-Cog cognitive scale compared to placebo.
- In patients with moderate Alzheimer’s disease they showed 61% less functional and cognitive decline compared to the sham procedure group. Neuroimaging analysis from the same trial demonstrated that TPE with albumin replacement was associated with less metabolic decline and fewer deleterious structural changes in subcortical brain regains compared to controls.
The proposed mechanism connecting TPE to cognitive benefit was based on the idea that amyloid-beta protein exists in equilibrium between the brain and plasma. Removing plasma amyloid beta through TPE creates a concentration gradient that draws amyloid from the brain tissue into the blood stream (peripheral sink hypothesis). But the benefit likely extends beyond that. By removing pro-inflammatory cytokines, oxidized proteins, and other neurotoxic factors from the plasma (Long Haul Covid, mycotoxins, microplastics, metals, Lyme and coinfections), TPE reduces the inflammatory burden on the blood brain barrier, decreases neuroinflammation and creates conditions that support neurogenesis.
TPE differs in what we in Functional and Integrative medicine have done to date by attempting to physically remove toxins with binders, chelators, PEMF, HBOT, Red light, sauna and colonics (for the brave). These all depend on the liver, kidney and stool to eliminate toxins, which in the sensitive patient population that I usually see often causes “Herxheimer” reactions like headache, fatigue, brain fog, skin issues, high blood pressure, mood changes, hormone imbalances, and nausea.
Image credit to Dr. Ryan Bentley, MD, PhD, DC
The Fishbowl Analogy
Here’s the simplest way that I’ve heard to explain it (Thank you to Dr. Ryan Bentley, MD, PhD, DC, for both the image and description!): Think of your blood like a fishbowl. The water is your plasma and fish are your cells. Over time, that water gets murky, filled with inflammatory proteins, auto-antibodies, toxins, and cellular debris that accumulate faster than your body can clear them.
TPE works by removing that old plasma and replacing it with clean, healthy albumin. We’re not adding something new to your system (supplements, hormones, binders, medications, cool peptides). We’re taking out what shouldn’t be there. Your plasma is not just a passive carrier fluid. It is a dynamic signaling environment that communicates instructions to every cell in your body. Plasma contains over 10,000 different proteins, each with specific functions, and the composition changes dramatically with age. Pro-inflammatory cytokines like IL-6 and TNF-alpha increase two to fourfold between age 30 and 70, oxidized LDL increases by 300%. Advanced glycation end products accumulate steadily. These are not just markers of aging. They are drivers of it.
Looking Further into TPE
After the AMBAR paper, I dove into how this is being applied in the Long Haul Covid population. This is something that has flooded my practice since 2021 with some of the sickest patients that I have ever seen. Reading the case report authored by Dobri Kiprov MD, who is also co-author on the Buck Institute trial with 30 years of clinical apheresis experience, that described a 68 year debilitated man with lung opacity, fatigue, physical and cognitive weakness, loss of smell and lymphocytopenia return to normal activities and work after rounds of TPE was even more evidence that I needed to check into this procedure.
A few months after that hotel room discovery, I was on a plane to Nashville, accompanying one of my patients for their first TPE procedure. And the day of the procedure? We were front row at the Grand Ole Opry.
I tell you that not just because it’s a good story, but because I want you to hear this clearly: this is not a scary procedure and it is not debilitating.
For the right patient, it is life-changing.
Bringing TPE to Hudson, Wisconsin
After my second patient made the trip to Nashville, I had a very clear thought. You know me and my opinions, so it will come as no surprise when I say: I thought I could do it better in regards to prepping someone for the procedure and their after care.
Not just the procedure itself, but the whole experience. Here’s what I mean:
- Attention to detail, precision medicine. We’ll be supporting you based on your personal constitution, toxic burden, inflammatory markers, genetic vulnerabilities, nutritional status, state of your limbic system, both before and after the procedure. This will be done in a way that’s fully integrated with your existing care plan: Patient specific, not “protocol specific.”
- More accessible pricing. TPE runs anywhere from the high $5,000’s to $13,000 per session across the US. That’s not including the cost of travel, nutritional IVs, lodging and lab testing. We’re committed to bringing Midwest pricing to our patients.
- Your own team. You’ll be working with practitioners who have known you for years, not providers you’re meeting for the first time in another state.
- Accessible location. Whether you live in Minnesota or Western Wisconsin, Hudson is a beautiful destination for health (More details coming soon!). Out of state patients only have a 25 mile drive from the Minneapolis-St. Paul airport.
- Private. The rooms that we are administering the TPE in are private, single occupancy with TV and peaceful views of the St. Croix River
Who Would Benefit from TPE?
The ideal candidate is going to be a symptomatic patient with high toxin burden who has exhausted other therapies or wishes to detox faster. TPE is able to remove toxins without over taxing the immune system. According to Paul Savage MD of MD Lifespan, TPE reduces circulating toxins by 40 to 60% on average with some toxins reduced up to 90% relative to the population upper percentiles. Long-term monitoring also shows sustained toxin reduction and improved markers like inflammation, oxidation, telomere length, and disease markers.
Patients that would not be good candidates for this therapy are those with confusion, severe asthma, seizure risk, recent heart attack/stroke or under the age of 18. Those people would be better suited in the hospital setting.
If you’ve been wondering whether this could be part of your care plan, I want to give you the chance to ask me directly. My marketing team has been nudging me to do a webinar…. so we’re doing a webinar. Stay tuned for the day, time, and how to register to ask Susie, Lisa, and I all of your TPE-related questions. In the meantime, I’ve linked several papers below detailing the research on TPE if you’re interested in reading the science.
More details on our new Hudson clinic and the full team coming soon. As always, feel free to reach out through your patient portal or give us a call with any questions.
Papers Supporting TPE
01 | The AMBAR Study: A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer’s disease: Primary results of the AMBAR Study. Read the full paper here.
02 | TPE & Long COVID: Case Report: Therapeutic and immunomodulatory effects of plasmapheresis in long-haul COVID. Read the full report here.
03 | Tissue Rejuvenation: Rejuvenation of three germ layers tissues by exchanging old blood plasma with saline-albumin. Read the full report here.
04 | Real World Study: A real-world study on the safety and efficacy of therapeutic plasma exchange in patients with Alzheimer’s disease. Read the full report here.