It seems nearly all our efforts to get a handle on Alzheimer’s and dementia has been an utter failure. An estimated 6 million Americans have Alzheimer’s disease and our projected expectation is that 1 in 10 will end up developing it before death. Like all other chronic diseases, it’s accent in prevalence within our lifetime has been staggering, and like other chronic diseases, we are seemingly accepting this as normal.
Losing your mind is not a natural outcome of losing your youth. In today’s episode I am going to share what research is showing is working and what is not to prevent, and even treat, cognitive decline.
Welcome to Blasphemous Nutrition! I am your host Aimee, and I aspire to age like a mash-up of Iris Apfel and Ernestine Shephard. Chance are, if you know one of these women, you won’t know the other, and I won’t be at all surprised if both names are be unfamiliar to you. Iris Apfel passed away this year at 102, and she was a New York fashion icon for decades. If you’ve ever seen a crazy-ass looking woman with short white hair, big, thick black glasses and crazy outfits, that’s Iris. Ernestine Shephard is an 88 year old competitive bodybuilder who began lifting weights after menopause. While I’ve not waited that long, I, too want to be in my late 80s and have enough muscle to keep young hooligans thinking twice about messing with me.
Aging well is more and more a rarity in the English-speaking western world. In fact, it is so remarkable to age well and intact, that my nine-year old child remarked, “Mom, there are so many old people walking around!” the first time he visited a small European town. And this kid is not one to usually pick up on details.
Alzheimer’s diagnoses and deaths have skyrocked during our lifetimes. The focus on eliminating amyloid plaque to cure Alzheimer’s has been an utter failure. Despite decades of medication intervention, there is no alleviation of symptoms or remarkable reduction in disease progression. A more recent drug, Aducanumab, was rushed to market through an accelerated approval, despite clinical trials failing. Researchers went back and looked at other factors, changed the dose, showed a reduction in amyloid plaque – this has never been proved to have any impact on outcome – and somehow got the FDA to put it on the market, with loosened safety criteria from clinical trials – but 3 members of the FDA panel resigned after this happened. This medication costs 56K per year, most of which will be paid for by taxpayers through medicare, and that’s just all I am going to say about that. Europe has refused acceptance of the medication. That story is here and here (both sides of the bias for and against represented).
Alzheimer’s disease (AD) develops mainly because of two problems in the brain: amyloid plaques and tau tangles. Both of these problems are made worse by inflammation—the body’s response to trouble that, instead of helping, actually makes things worse. A current emerging hypothesis is that Alzheimers is a disease rooted in chronic inflammation that impacts the brain, leading to structural changes as the brain cells become damaged from chronic inflammation.
How Inflammation Leads to Alzheimer’s:
Inflammation is the body’s way of protecting itself when it senses damage or an invader, like bacteria. When there’s a problem, inflammation gets triggered to send help through various immune responses designed to kill invading pathogens and clean up damaged cells. However, in Alzheimer’s, this “help” can actually cause more harm.
In Alzheimer’s, small pieces of a protein called amyloid start to clump together between brain cells. These clumps, known as amyloid plaques, are like sticky patches of gum that jam up the normal communication between brain cells. The brain’s immune cells, called microglia, notice these plaques and try to clean them up.
But the more the microglia try and fail to remove the plaques, the more they release chemicals to call for backup, causing inflammation. Instead of fixing the problem, this constant state of alarm damages healthy brain cells, making the situation worse.
Inside each brain cell, there are structures called microtubules. These are like tiny train tracks that help transport nutrients and materials the cell needs to stay healthy. A protein called tau normally keeps these tracks straight and stable.
In Alzheimer’s, ongoing inflammation can affect tau proteins, causing them to change shape and stick together. These sticky tau proteins form tangles inside the cells, which break down the microtubule tracks. Without working tracks, brain cells can’t get the nutrients they need, leading to cell damage and death.
When amyloid plaques build up, they trigger inflammation. This inflammation doesn’t just stay put—it spreads throughout the brain, causing even more damage. It makes the tau proteins more likely to become tangled, and as more brain cells die, the inflammation keeps increasing, leading to even more damage.
This creates a vicious cycle: inflammation leads to more plaques and tangles, which cause more inflammation, further damaging brain cells and making the symptoms of Alzheimer’s worse.
So, Alzheimer’s disease can be seen as a process where the brain’s attempt to protect itself backfires, causing a chain reaction that leads to more and more damage over time.
Why a Medication-only Approach Will Continue To Fail Us
The primary focus on Alzheimer’s research and medications has been on removing amyloid plaque. The belief was that if we removed the plaque, the brain could regain function. This has been an utter failure. We are no better off in finding a cure than we ever have been, and having recently had a family member die with Alzheimer’s, I cannot say that any success that may have occurred in slowing the decline and prolonging her life did her any favors. Quality of life continued to decline and adding extra years to that process, if it in fact did so, was more cruel than kind.
While some researchers are now looking at medications to reduce tao protein formation, i feel this may be barking up the wrong tree next door. Unless chronic inflammation is addressed through lifestyle, I am dubious that we will make any significant headway in our lifetimes.
Currently, the lifetime risk for the general population is currently 10-15%. I expect this to increase. Obviously, the older you are, the higher your risk, and 11% of those over 65 have a diagnosis and approximately 32% of those over 85 have the disease. Deaths from Alzheimers have increased by 141% in the last 20 years, a damning statistic further proving that our pharmaceutical interventions have been useless.
I don’t know about you, but i have no desire to live to be 85 if I am going to be in a home, unable to recognize my loved ones and unable to feed myself. Fuck that. I know, if you’ve watched a family member with this disease decline, you are 100% on board with me on this.
If the inflammatory roots of Alzheimers are to be corrected, we need to be looking at what is leading to the chronic inflammation in the body and put out that fire.
While there are genetic variances, most notably the APOE4 gene, that increase your risk of developing Alzheimer’s, this only serves as an early warning sign that you need to be extra diligent about staying on top of your health and feeding your brain well. Risk is modifiable irrespective of APOE4 genetic status. Comprehensive interventions addressing several risk factors can benefit individuals with either high or low genetic dementia risk. The Lancet Commission on Dementia released a new report in 2024 claiming that up to 50% of Alzheimers can be prevented by addressing modifiable risk factors. These are:
- Eliminating smoking, if you smoke.
- Staying active through walking, hiking, or any other physical activity. The body is meant to move, and move we must! Clinically I see the average step intake among my clients and patients to be about 1500-3000 steps daily. We need to be aiming for 10,000 as part of routine life.
- Keeping your brain sharp through learning new things. Low education is a risk factor for dementia, but I personally believe remaining curious and learning throughout life counts in absence of formal education.
- Avoiding high alcohol consumption of more than 12 standard drinks each week – that’s measured as 12 oz beer, a five ounce glass of wine, or 1.5 ounces of hard liquor per standard drink. Honestly, I feel it needs to be much lower than this, but I don’t sit on the Lancet Commission. Canada has recently recommended all adults limit alcohol intake to two drinks per week or less. This seems like a good idea to me!
- Maintaining normal blood pressure, with or without medication
- Keeping LDL cholesterol in check, with or without medication
- Treating any hearing and vision loss. There is an association with untreated vision and hearing loss increasing risk. I suspect this has to do with overall lack of input and stimulation to the brain. Much like an underused muscle will atrophy, our brain likely will as well if it is not adapting to new and different stimuli. This is supported by the educational link to dementia as well as those suffering from cognitive decline having less and less desire to do new things, as they are so much harder for the brain to process and adapt to as disease gets underway.
- Maintaining a healthy weight; both underweight and overweight individuals are at higher risk of Alzheimer’s.
- Avoiding diabetes or keeping it well controlled if you do have it. Chronically high levels of insulin and glucose is toxic to every aspect of the body. The brain is no exception. Those with Diabetes have a confirmed increased risk of developing dementia, up to 60% greater risk. In both diabetes and Alzheimer’s, the nerve cells in the brain may become resistant to the effect of insulin. This may lead to the build-up of amyloid and tau proteins in the brain. The link is so strong that Alzheimer’s disease is sometimes unofficially known as type 3 diabetes.
- Treating sleep apnea and getting assessed if you think you may be at risk. Both lack of oxygen to the brain if one has apnea and lack of restful sleep, the time the body and brain has to clean up shop, make everything in your body run better. Poor sleep also makes weight loss harder and increases the risk of cardiovascular disease as well as dementia.
- Preventing a Traumatic Brain Injury as best you can through diligent use of a helmet when riding bikes, motorcycles, horses, skateboards, and other things which go faster than we do; and avoiding using your head in fútbol (American or otherwise). I would also advise staying clear of douchebags who have violent proclivities as an additional good way to reduce a risk of TBI.
- Social isolation is a higher risk later in life. As Gen X and Millennials begin to age, it will be important for us to stay social! Finding a peer group you enjoy being around is important to our emotional and physical health.
But That’s Not All!
While a healthy lifestyle is critical in avoiding dementia, once it begins to develop, all hope is not lost, despite what our current medical interventions have thus failed to accomplish.
In 2014, a utterly groundbreaking clinical study was published by Dale Bredesen and his team, showing for the first time that early onset dementia could be not just slowed, but reversed using dietary and lifestyle interventions. Since that time, a handful of researchers and dedicated clinicians are working closely and deeply in multi-modality clinical trials and showing time and time again that with early intervention, the brain can heal. It needs nutrients and it needs a radical shift in lifestyle to heal, but it can be done.
Here is what the body of research is currently showing is important:
Because AD is a systemic, complex disease, there is no one single remedy that can solve it.
- Reducing insulin if insulin levels are elevated in important.
- Increasing omega 3 fatty acid intake is part of every successful clinical trial.
- A nutrient-dense diet rich in produce and limited in carbohydrates. Most interventional studies are utilizing a ketogenic diet, as this supplies energy to the brain in the form of fats when its ability to utilize carbohydrates is compromised.
- Elimination of alcohol.
- Maintaining high oral hygiene to reduce harmful bacteria that can travel through the body and damage both the vascular system and the brain.
- Data from large systematic review and meta-analysis suggest that higher adherence to the Mediterranean Diet is associated not only with the reduced risk of developing mild cognitive impairment (MCI) and AD but also reduced risk of progression from MCI to AD (Singh et al., 2014). Likewise, a combined dietary approach of Mediterranean Diet and the DASH diet for hypertension, referred to as the MIND diet (enriched with neuroprotective berries and green leafy vegetables), which was altered with brain health in mind, is also positively correlated with slower cognitive decline (Morris et al., 2015a, 2015b) and reduction in the incident AD (Morris et al., 2015b), outperforming the Mediterranean diet, according to some research. The focus of berries and green leafies is the key differentiator here. This research suggested that consumption of leafy greens daily and berries more than twice a week do facilitate preservation of memory beyond the benefits that may be offered by wither the Mediterranean diet or DASH diet alone.
- Resveratrol is a polyphenol produced by grapes, apples, raspberries, blueberries, plums, peanuts and, most famously, red wine. Scientific reports point to neuroprotective properties of this polyphenol by eliminating oxidative free radicals, reducing inflammatory cytokines and boosting production of anti-inflammatory IL-10. While resveratrol has been the reason people go to wine and consider it a healthy beverage, I would argue that the systemic impact of alcohol on the body and brain are not worth choosing wine when the whole grapes and other dark berries will suffice.
- Increase activity and oxygen to the brain through exercise and breathing activities. This supports brain health through the positive impacts of oxygen on the brain and production of a compounds called BDNF, or Brain-Derived Neurotrophic Factor, a protein that plays a crucial role in the development, maintenance, and survival of neurons in the brain. It is also responsible for some of the mood-enhancing impacts of exercise.
- There is a direct connection between the gut and the brain via the vagus nerve. It is currently believed a back and forth communication system exists between the gut microbiota and the brain, potentially influencing cognitive functions and the development of neurodegenerative diseases such as Alzheimer’s disease (AD). Associations between anxiety depression, and poor gut health are well established in the research, and the relationship between gut health and dementia has garnered significant interest in recent years, particularly through the concept of this “gut-brain axis.” An imbalance in gut microbiota can lead to increased gut permeability and systemic inflammation, which can negatively impact the blood-brain barrier, causing what some call “leaky brain”, which then can promote neuroinflammation through the introduction of inflammatory cytokines into the brain, eventually contributing to neurodegeneration. At this point in research, numerous animal studies support the role of gut microbiota in cognitive function and AD, but there is a substantial lack of human clinical trials. While gut dysfunction may play a role for many, addressing gut health alone is unlikely to resolve most cases of early cognitive decline.
Dr. Heather Sandison, a mentee of Dale Bredesen, conducted an additional clinical trial after his research came out, which was published in 2023. In just 6 months, 74% of participants demonstrated cognitive improvements. They utilized Dale Bredesen’s approach and put 23 people through a very individualized and intensive treatment plan. 17 of the 23 noted improvements. These results echo Dr. Bredesen’s research showing improvements in 84% of participants over a 9 month time period in a 2022 publication.
In these studies, all participants were given nutrition, movement, and stress reduction education and support. Exercise was recommended based upon baseline fitness levels and they were encouraged to increase and vary their routine, such as adding strength training if only walking, or beginning to walk if sedentary. For stress reduction, a chanting style of meditation, mindful acts of kindness and/or daily prayer practice were recommended.
Nutrition recommendations that yield these results included a ketogetic diet high in low carbohydrate produce and fats, 12 hour overnight fasts, Organic produce, wild-caught low-mercury fish (salmon, mackerel, anchovies, sardines, and herring), and consumption of organic, pastured eggs and poultry, organic dairy, and 100% grass fed meats were encouraged. Participants were asked to eliminate alcohol, processed foods, and all grains during the trial. Self-reported diet diaries were collected monthly and blood ketone levels were measured at clinical and research visits to confirm adherence.
The supplement regimen was fierce. In Sandison’s clinical trial, baseline nutrition and brain supportive supplements included multiple vitamins and minerals, adaptogenic herbs, amino acids for cognitive focus, omega-3 fatty acids, probiotics, coQ10, and various polyphenols.
As each research participant had a full work-up, they were assessed for overall toxic burden, for mold or heavy metals, as well as hormonal health, a sleep assessment to test for apnea, history of TBI, digestive health, and tested for various infectious diseases, such as HPV or lyme disease. These factors were considered in their treatment plan, with additional supplements and therapies added if needed. While not all improvements in the Sandison trial reached statistical significance, improvements were made across all measurements of concentration, memory, reasoning and verbal ability, with memory improvement being the strongest and most significant improvement observed. [Concentration:+7.1% (p = 0.16), Memory:+10.6% (p < 0.01), Reasoning:+4.7% (p = 0.17), and Verbal Ability:+4.8% (p = 0.22)]
What is emerging from this research is a multi-modality plan to reverse early-stage cognitive decline. These are small clinical trials, but if these results are repeated over and over again we will have high quality evidence gathering strength of efficacy, and this will outperform anything Big Pharma comes up for us over the next 20 years.
Based on the existing evidence, an unprocessed diet high in lots of vegetables is a foundation of this plan. These foods are high in fiber, nutrient-loaded, and have loads of polyphenols and antioxidants that help the gut by regulating the intestinal barrier, supporting beneficial microbiome which then supports neurotransmitter health and reduces brain inflammation and provides necessary components to repair DNA damage. A diet high in omega-3 fats from low-mercury seafood, and keeping a modest to lower carbohydrate intake is a good start to prevent cognitive decline. Once mild cognitive impairment is beginning, pulling carbohydrate back further and relying more on fats to supply the brain with energy appears crucial, as well as addressing all the contributing factors that were assessed in these clinical trials, such as untreated HPV, nutrient deficiencies, mold exposure, gut health, hormone health, and sleep quality.
Working with a qualified health professional who is skilled in assessing these risk factors or well-connected to providers who can is important. Dale Bredesen now trains providers in his methodology. It is called RECODE, and you can search for providers in your area, or those who do telehealth appointments, to find clinicians familiar with and trained in his work.
Additionally, both Dr. Sandison and Dr. Bredesen have written books about Alzheimer’s and what is known about reversing cognitive decline through their research. I strongly recommend both of these books if you have a personal interest in your own brain health and want to formulate a preventative health plan. I’m looking at doing this training myself, but can help implement what is written in Drs. Sandison and Bredesen’s books if you need support in that area.
These resources are included below.
The best thing you can do to protect your brain is to move your body, avoid alcohol and tobacco in entirety, and consume an unprocessed diet rich in green veg, berries, seafood, and other quality proteins. Healthy fats from olive oil, nuts, seeds, and cold water fish are a must – going low-fat did not do jack for our health like we were told!
Additionally, neglecting to care for other aspects of your health, such as poor sleep, gut issues, and chronic infections or metabolic and hormonal imbalances make make it harder for you to keep your brain in tip top shape, so it is important to address these aspects as well.
Finally, maintaining valuable friendships, challenging your brain with learning new things and staying engaged in the world in a meaningful way is also important to healthy brains as an elder. We are social creatures who need one another to reduce stress, stay sharp, and keep meaning in our lives.
We are all going to have areas where we are doing well, and areas which are a struggle. Shore up and build consistency in areas that you are already skilled at, and get support to improve the areas that need work!
Which areas do you feel confident in? Which areas are a struggle for you? I’d love to know where your concerns and confidence lies!
Resources to learn more:
The End of Alzheimer’s by Dale Bredesen
Reversing Alzheimer’s by Heather Sandison
https://www.alz.org/alzheimers-dementia/facts-figures
Gudala K, Bansal D, Schifano F, Bhansali A. Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies. J Diabetes Invest 2013;4:640–650
Cholerton B, Baker LD, Montine TJ, Craft S. Type 2 Diabetes, Cognition, and Dementia in Older Adults: Toward a Precision Health Approach. Diabetes Spectr. 2016 Nov;29(4):210-219. doi: 10.2337/ds16-0041. PMID: 27899872; PMCID: PMC5111529.
Szczechowiak K, Diniz BS, Leszek J. Diet and Alzheimer’s dementia – Nutritional approach to modulate inflammation. Pharmacol Biochem Behav. 2019 Sep;184:172743. doi: 10.1016/j.pbb.2019.172743. Epub 2019 Jul 26. PMID: 31356838.
Bredesen DE. Reversal of cognitive decline: a novel therapeutic program. Aging (Albany NY). 2014 Sep;6(9):707-17. doi: 10.18632/aging.100690. PMID: 25324467; PMCID: PMC4221920.
Sandison, Heather et al. ‘Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline’. 1 Jan. 2023 : 993 – 1004.
Toups, Kat et al. ‘Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project’. 1 Jan. 2022 : 1411 – 1421.
van den Brink AC, Brouwer-Brolsma EM, Berendsen AAM, van de Rest O. The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer’s Disease-A Review. Adv Nutr. 2019 Nov 1;10(6):1040-1065. doi: 10.1093/advances/nmz054. PMID: 31209456; PMCID: PMC6855954.
Hosking DE, Eramudugolla R, Cherbuin N, Anstey KJ. MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study. Alzheimers Dement. 2019 Apr;15(4):581-589. doi: 10.1016/j.jalz.2018.12.011. Epub 2019 Feb 28. PMID: 30826160.
Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA, Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015 Sep;11(9):1015-22. doi: 10.1016/j.jalz.2015.04.011. Epub 2015 Jun 15. PMID: 26086182; PMCID: PMC4581900.
Holland TM, Agarwal P, Wang Y, Leurgans SE, Bennett DA, Booth SL, Morris MC. Dietary flavonols and risk of Alzheimer dementia. Neurology. 2020 Apr 21;94(16):e1749-e1756. doi: 10.1212/WNL.0000000000008981. Epub 2020 Jan 29. PMID: 31996451; PMCID: PMC7282875.
