How to Bring Back Your Brain
The big problem is that so many people still think that nothing can be done to reverse dementia.
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“I don’t think I’ve ever mentioned that my father and his father both had Alzheimer’s disease—or something,” Helen began. “We called it ‘Old-Timer’s Disease.’ Maybe I should do some of those brain tests you talk about.”
Helen had been my patient for years, and she followed my website for guidance between annual appointments. She said she had become worried that her brain “isn’t what it used to be.” She continued to work as a therapist without problem, but now had to add her own personal appointments to her work schedule. “I completely forgot a lunch date—I never do that!”
So we took five minutes to perform a MOCA test—an excellent and reliable cognitive test that anyone can learn to administer online. Her results were 26 out of 30—still “normal” but lower than I would have expected. Next, we arranged for some lab tests, which revealed that she carried the so-called Alzheimer’s gene ApoE4, which increases her risk. She also had borderline elevations in blood sugar and fasting insulin as well as low levels of several critical hormones and suboptimal amounts of several crucial brain nutrients. All things considered, I was delighted.
Before you think I was cruel in my delight, let me explain a few key points about dementia. Most people still think there’s nothing to be done about dementia because decades of Alzheimer’s research have yielded drugs that offer only brief periods of improvement and no overall impact on the expected course of the disease. But the failure of pharmaceuticals is only half the story. The more important half of the story goes like this:
Brain deterioration starts years before symptoms emerge.
Our brains are great strategists through a feature called neuroplasticity: If we suffer any loss of brain cells, the remaining networks pitch in and find alternate pathways to accomplish the work of the brain. So it’s important not to ignore any signs of cognitive decline.
Dementia can be slowed or reversed, particularly when identified early.
A variety of tests can now help identify the sources of neurodegeneration in its earliest stages and fix it. Various factors—denial, fear, and the mistaken belief that nothing can be done—often prevent people from seeking help when it will be most helpful.
There are several types of dementia, and the easiest to reverse are those that arise when an ApoE4 patient has improper sugar handling, low hormones, and low nutrition.
That’s why I was delighted with Helen’s results. She had sought attention for early symptoms not late ones, and her lab results were all consistent with the easiest kinds of dementia to reverse. Six months later, we didn’t even bother to retest. “Well, it’s really quite amazing: It’s subtle, of course, but I can just tell that the lights are back on,” she said.
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The Common Thread
You already know that Alzheimer’s isn’t the only way that brains can lose their abilities. Football trauma, strokes, or Parkinson’s disease all impair brains’ activities. What you may not know is that there are different causes of Alzheimer’s, categorized as different types of the disease. For a complete rundown, read The End of Alzheimer’s, by Dale Bredesen MD. Most of my patients have read some or all of it, and some consider it their bible.
Dr. Bredesen has shown that the one constant metabolic thread that runs through almost all Alzheimer’s cases is insulin resistance (IR), which tends to grow worse as we age and is toxic in the brain. Insulin resistance in the body can lead to type 2 diabetes. In the brain, insulin resistance is why Alzheimer’s is sometimes called type 3 diabetes.
The first problem created by insulin resistance in the brain is essentially starvation—what we may experience as brain fog. Our brain can run on two fuels: glucose or ketones. Insulin resistance can render the glucose fuel almost useless within our brains, and ketones only arise when our body switches from burning glucose to fat. A diet rich in carbohydrates, as well as the standard advice to eat six small meals a day, blocks the liver from turning fat into ketones for the brain. The brain-related result of insulin resistance is that your body tends to get fat—especially around the midsection—while the brain is not properly fed.
The second problem is that the insulin that isn’t used tends to accumulate—and excess insulin appears to be inflammatory. Such inflammation can be painful in your knees, clog your arteries, and fog your brain. Additionally, excess insulin is perceived by the brain as litter. A designated enzyme, insulin degrading enzyme (IDE), is primarily tasked with insulin cleanup, which would be great except that IDE also has a secondary job, which is to clean up accumulating amyloid beta protein, one of the components of brain degeneration central to Alzheimer’s. So excess insulin may lead to amyloid buildup.
The good news is that the body can be reminded to produce less insulin with a change of diet, fasting between meals, adequate sleep, and regular exercise. A great way to provide necessary fuel for an aging brain is to follow a ketogenic diet with long breaks between meals and a 13-hour or more overnight fast. Your liver will feed your brain with ketones and you may suddenly notice that the fog lifts.
Healing Brains with Ketones
Ketones were first used therapeutically in the 1920s as a treatment for epilepsy in children, and its effects were achieved through fasting diets or very-low-carb, high-fat diets. The patients not only lost weight, many of them also lost their seizures! The diet fell into disuse as better-tolerated medications became available. However, a recent study in the journal Neurology reported a significant reduction in epileptic seizures in just under a third of patients, often within days or weeks after starting a ketogenic diet.
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The Variable Threads
When I first meet with a patient I always look for signs of insulin resistance, but I also interview them carefully about the likelihood of each of three contributing factors.
1. Inflammation: Patients who have a chronic problem with inflammation or a highly inflammatory diet (high in trans fats or omega-6 fats, common in the Standard American Diet, SAD) are not only at greater risk for heart disease and cancer, they are also at greater risk for inflammation in their brains. We identify these type 1 inflammatory patients on routine tests (hsCRP, serum globulin) and more specialized ones (Interleukin-6 and Tumor Necrosis Factor). An MRI will frequently show shrinkage of different parts of the brain, especially the memory-gathering hippocampus. ApoE4 patients have more trouble handling brain inflammation than the more common version, ApoE3. (Dr. Bredesen estimates that one out of four Americans carry one copy of the ApoE4 gene.)
Treatment of the inflammation can include dietary subtractions (no more deep-fried food, vegetable oils, and perhaps gluten) and additions (omega-3-rich fish, olive oil) as well as supplements specific to each patient’s situation and laboratory results. Often these patients have the quickest response to treatment.
2. Deprivation: As well as fuel, the brain needs optimal amounts of hormones and nutrients to keep neurons healthy, and to optimize the communication between brain cells. We identify these brain problems by low levels of hormones (estradiol, testosterone, progesterone, pregnenolone, cortisol, and thyroid) as well as vitamins and minerals (especially D and the B vitamins, zinc, and magnesium). MRI findings will resemble those of the type 1 patients. (Occasionally, the degree of malnutrition is severe and these patients do not have insulin resistance; rather, they have low insulin, and require more careful dietary management.)
Replacement of lost brain nutrients is managed through supplements and prescription hormones, based on individual history, lab results, and preference. Lifestyle measures (sleep, exercise, and stress reduction) also help with hormone balancing. Improvement in these patients is likely to be slower, but it should be steady and predictable if cognitive function has not declined too far. (Patients with MOCA scores as low as 13 can have a good outcome of stabilizing or reversing what once was a steady decline.)
3. Toxicity: When patients have atypical cognitive complaints—a lost ability to organize, prioritize, or calculate, rather than short-term memory loss—I question them more closely about possible sources of brain toxins. Long-term effects of viral infection like herpes, tick-borne infections, or heavy metal or mold toxicity can impair the normal function of the brain. They may show up in the form of depleted zinc, imbalanced hormones, and perhaps high levels of heavy metals or markers of brain inflammation (MMP-9, TGF-beta 1, and others) or viral infection (specific viral antibodies).
ApoE4 patients are actually a bit more resistant—up to a point—to the effects of these toxins, so an early onset of toxicity-related symptoms is more likely to occur in an ApoE3 patient. Toxicity on MRI shows as atrophy of unusual parts of the brain (hippocampus can be fine, but gray matter may be small) or inflammation scattered through the white matter of the brain.
Treatment for these patients starts with identifying and removing the provocations of inflammation while simultaneously boosting the body’s own depleted immune reserves.
Repairing a Tapestry
The brain is an intricately woven tapestry that we do not fully understand, and so are its many forms of degeneration. And that complexity is compounded by the variations among different individuals. But none of that means that it is impossible to identify the sources of degeneration—and to slow or reverse the damage. The prescribed diet, lifestyle, and supplements may be a change from one’s previous habits, but they can restore vitality and ease to an aging body and brain. —Deborah Gordon MD