Riley, a new patient to me, was alarmed by changes he had observed in himself.
“For a couple years, I’ve had to write down every meeting. Just two years ago I could remember a much busier schedule. Now I set multiple reminders for a weekly meditation meeting or a golf date. When I had a near-miss while driving, my wife became alarmed.”
Riley had been vigorous all his 76 years but was haunted by the memory of his father’s story. “He had the same complaints at my age. Within a year, he was hospitalized for Alzheimer’s and died a few years after that. I don’t want that story.” Conventional medicine has made no significant improvements in the course of the disease since the time of Riley’s father.
In simple conversation, Riley had no apparent problems. On cognitive testing conducted in the office, we determined that this West Point graduate and former high school and college teacher had “less than average” performance in memory testing. On his MRI, the memory-storing part of his brain was atrophied. None of our findings surprised him. They just frightened him.
It turns out Riley had read The End of Alzheimer’s by Dr. Dale Bredesen. This book lays out practical steps for fighting Alzheimer’s. Eager for support, he had approached two physicians for help only to be met with chuckles and the confident twofold assertion that Alzheimer’s was caused by plaque and that the tool to remove that plaque had yet to be found. Then Riley heard from a friend about an exciting project.
Precision Medicine and Cognitive Health
Riley and 24 other individuals with cognitive impairment characteristic of early Alzheimer’s were admitted to a prospective trial in which three physicians (including myself) applied Precision Medicine principles and charted the effects. Each subject was precisely tested for physiological and toxic weak points, which were corrected as healthy lifestyle habits were encouraged and supported.
The results—recently published in the Journal of Alzheimer’s Disease—describe how 22 of the 25 showed marked improvement at the end of nine months. No other intervention for cognitive impairment has shown anything like improvement: The best that most trials hope for is a slowed rate of decline.
How did we achieve such a stellar success? Spirituality & Health readers will not be surprised to learn that our interventions consisted of optimizing the health of both body and brain. We relied on a pattern of habits including:
A plant-generous ketogenic diet
Optimizing levels of key nutrients and hormones
Exercise of body and brain
Proper sleep and brain relaxation
We analyzed a genetic risk panel to help us prioritize risks—no one can do everything perfectly—to see what factors were most important for each subject to address. Let’s see how it worked for Riley.
Our initial evaluation showed that in addition to disturbed sleep (no surprise to him!), Riley also had prediabetes, as well as low levels of key nutrients and hormones. We thought he could improve upon his sleep and exercise habits. Although we also found some issues with mold and mercury toxicity, Riley primarily started improving with three healthy steps of brain and body recovery:
Reverse prediabetes to feed your brain.
Replace deficient key nutrients and hormones to activate your brain.
Apply proper habits to train your brain.
No fancy and expensive medications, no loss of hope—Riley’s cognitive scores returned to high normal, his brain size showed improvement, and his wife was no longer worried about him!
Although Riley’s brain recovery journey was thoroughly studied and tracked by curious physicians and statisticians, the steps he took are available to anyone who is serious about optimizing brain health.
1. Feed Your Brain
One of the hallmarks of aging is a disruption of the way our body responds to the food we eat. When we eat sugars and starches, lots of glucose (blood sugar) circulates, which triggers an insulin response. Insulin’s function is to move glucose out of the bloodstream and into our cells, which are hungry for fuel. As insulin levels go up (with age, with higher carb diets), our cells stop responding, resulting in progressively higher levels of both glucose and insulin. As the body resists insulin’s signal, the patient may be diagnosed with insulin resistance, which can lead to prediabetes and type 2 diabetes.
Remember that Riley had prediabetes: His blood sugar and his insulin levels were both elevated. A body with insulin resistance can’t use glucose as a fuel, and neither can an insulin-resistant brain. His sugar-drenched brain was actually starving for fuel, unable to use the glucose.
Luckily, there is an alternate fuel to glucose. When there is not enough sugar entering cells to fuel body and brain, your body can burn fat for fuel.
You can imagine that, long ago, evolution would have favored bodies that figured this out. Survival was greatest for hunters whose bodies could create and use an alternate fuel when there was no food to be eaten. Most of us, at normal or slightly higher body weights, could survive for days, even weeks, without eating—not by choice, perhaps, but we could survive by burning stored body fat.
When our bodies are without incoming sugar, we are able to burn fat for fuel. Our muscles can burn fat for all normal purposes, and our liver can package fat into tinier particles that can access the brain, particles called ketones—in a process known as ketogenesis.
“Great,” you might say, “I’d love to burn my extra body fat!” Here’s the problem: Your body’s fat stores cannot be burned if your insulin levels are too high—insulin blocks the body’s burning of fat. Even more of a problem for brain health: High insulin also blocks ketogenesis in the liver. Before we can enjoy ketones fueling our brain, we have to:
Reverse insulin resistance. Lower carbohydrates sufficiently to lower insulin and insulin resistance (this is the thinking behind the keto diet).
Encourage the liver with fats that are particularly suited for ketogenesis. These fats are medium-chain triglycerides, or MCT oils.
Riley’s previous diet was a healthy vegetarian + fish menu—home-cooked, mostly organic food—but his meals were predominantly carbohydrates in the form of grains and legumes.
We asked him to cover most of his plate with non-starchy vegetables, fill the rest with protein, and drench it all in olive oil. In addition, he consumed MCT oils in the form of a supplement to remind his liver of its long-forgotten job of ketogenesis.
Additionally, we asked him to stop eating at least three hours before bed and to refrain from eating again until 13–14 hours had elapsed. A resting digestive system confers optimal rest upon the brain. He increased protein consumption through eggs, some soy, and even some iron-rich chicken livers. He supplemented generously with olive oil and checked his blood (by finger-stick) to verify that he was making ketones.
2. Activate Your Brain
Once well-fueled, Riley’s brain was almost ready to get back in shape. Our bodies and our brains work best when nutrients and hormones are optimal.
I mentioned chicken liver above because it is perhaps the most iron-rich food and Riley’s iron levels stayed stubbornly low despite supplements. His wife declined support in only this one aspect of his new diet, so Riley learned to cook, bumping up his iron levels with sautéed chicken livers and even chicken liver paté.
Other nutrients that should be optimized for the brain to thrive include:
Vitamin D, aiming for levels of 40–70 ng/mL
Omega 3s from either wild fish (less mercury) or fish oil, especially the omega 3 referred to as DHA (docosa-hexaenoic acid)
Sufficient B vitamins to optimize the level of homocys-teine at 5–7 mcmol/L
Magnesium, entering the brain best in the form of magnesium-l-threonate
… and almost every other vitamin as well!
Once Riley’s nutrient needs were identified, we addressed his hormone levels. Hormones—thyroid, cortisol, and pregnenolone, and all the sex hormones—also contribute to the normal function of the brain. We were able to optimize most—not quite all—of his hormones. Optimizing hormones is a complicated topic, and requires a bit more finesse than replacing low levels of iron or vitamin D.
As an example, though, let’s talk about pregnenolone. Pregnenolone is a hormone made from cholesterol and can act either as a brain steroid itself or it can be transformed into progesterone (a “female” hormone found in men and women) or other hormones. In the brain, pregnenolone has been found to enhance memory, learning, mood, and cognitive function.
The normal levels of pregnenolone range from 33 to 245 ng/dL, easily tested at any clinical lab. The brain how-ever, prefers levels of 80–120 ng/dL, or even a bit higher. Amazingly, pregnenolone is one of the two hormones (with DHEA) that are available over the counter. (If you want to try this out for yourself, you should check with your own physician about this generally safe intervention.)
3. Train Your Brain
I have saved the best for last. Training your brain can be challenging to do correctly, but it can be done by anyone. While feeding and activating your brain might involve interaction with labs and physicians, you can work on your own brain’s fitness with a minimum of outside support.
The principles of training apply equally to your brain and your body. There are three steps:
Challenge: Working out, especially when it’s hard!
Rest: Take times of rest; sleep adequately and regularly.
Restore and recover: Recovery allows a rested body or brain to work again.
Challenging the brain starts with mental work that you might find enjoyable—what’s your favorite? Word games, crossword puzzles, sudoku, jigsaw puzzles—all have their place in exercising familiar muscles in your brain.
As any athlete knows, getting in shape also involves doing things that are harder, outside your comfort zone. If your memory is slipping, an important brain exercise for you will be training your memory. For the trial, we used the online program BrainHQ, which has been well documented, on its own, to improve brain performance in those who use it regularly. The program is smart: It learns where you can be pushed and where you need the challenge to be a little easier.
Half-hour sessions, three to six days a week, can make a big difference. Riley jumped into the challenge, putting in the time and steadily building his expertise.
We also asked Riley to develop a regular exercise routine, working with a personal trainer in three areas:
Gentle aerobic exercise, such as walking, swimming, biking—anything that can be done daily for 30 minutes or more at a level of exertion where you are able to maintain a conversation.
Intervals: Start with an aerobic activity that can be intensified. After you’ve warmed up 5–10 minutes, pick up the pace as much as you can for 20–30 seconds at a time, in a high intensity interval. Repeat 6–12 times, just two to three times a week. (Bonus: Helps reverse insulin resistance!)
Strength: Two days of the week, find a safe way to develop strength. Lift or carry something heavy, or turn up the resistance on the machines at the gym. (If this is new to you, seek out the help of an exercise trainer or physical therapist.) (Bonus: Increased muscle mass contributes to a longer, healthier life!)
Rest starts with an optimal night of sleep. Riley was not so great in following my encouragement to get to bed earlier, but he did manage 7–8 hours of sleep and was easily able to stick to the prescribed 13–14 hour overnight fast. Rest also includes days off from intense exercise, easily included in the regular exercise routine described above.
Recovery is the consequence of rest. For the study, we trained recovery as well, indicated by heart rate variability. HeartMath is an app that asks you to breathe regularly while an earpiece measures your heart rate variability, noting when you’re paying attention and when your busy mind has wandered! Riley was among several subjects who were meditators before the trial, but he added HeartMath. He thought it a bit too easy as a practice but enjoyed watching his heart rate variability.
When all the results were tallied, we found that for 22 of the 25 subjects, all the outcome measures revealed improvement. They had statistically significant improvement in their cognitive tests, in the estimation of their loved ones, and in the brain measurements on their MRI. (The three who did not recover significantly were affected by the pandemic, which interfered with compliance in areas like exercise participation or relief from exposure to mold in the home.)
The results are the first Alzheimer’s trial to show improvement of impaired cognition—from any intervention. Diet and lifestyle changes outperformed other trials with expensive pharmaceutical interventions.
I should clarify that there were some side effects: Many subjects resolved issues of diabetes, prediabetes, metabolic syndrome, obesity, and hypertension. Even the spouse of one subject also reported an apparent cure of his rosacea, as he ate gluten-free with his wife!