Next on my recommended reading list is The Alzheimer’s Antidote by Amy Berger, MS, CNS, NTP. Based on the work of cutting-edge physician Dale Bredesen (I’ve written about his work here and here), as well as countless other brain physicians and researchers, Berger’s book includes both the scientific rationale and the practical steps for implementation of a brain-restoring ketogenic diet. She has read the work of nutritionists, bloggers, as well as the medical research, and approaches this complex subject with all the clarity and detail one could hope for.
The Scientific Rationale
Right off the bat, let me say that the science of Alzheimer’s is incredibly complex and I am going to look at only a tiny portion of what the book covers, just to give you an idea of the discussion that is more complete in the book itself. Let’s look at one part of what goes wrong as Alzheimer’s develops.
Along with the rest of our body, our brains tend to wear out with advancing age. More protected than the rest of our body, our brains have to actually age and fail in multiple ways before our precious power to remember and think starts to decline. The most dangerous change of aging, enhanced in folks with the Alzheimer’s risky gene ApoE4, is that in certain parts of our brain, the ability to use glucose (sugar) for the work of the brain’s nerve cells, our neurons, is compromised. If you add to that genetic- and age-induced shift any degree of insulin resistance or diabetes, your brain is really up a creek without a paddle. Insulin resistance hits hard in the brain.
Remember we’ve talked about that one of the hallmarks of insulin resistance is an increased level of insulin? That happens in the brain, too. There is a specific enzyme, insulin degrading enzyme (IDE), that takes care of that extra insulin, but there’s a catch. That very same enzyme would clean up any “amyloid protein (precursor to Alzheimer’s plaques)” that any brain might form over an area of aged or injured or malnourished neuron. In an optimal scenario, IDE would help clear up the amyloid protein and allow the brain to recover and actually re-grow its neurons. If IDE is busy with actual insulin, well—that takes precedence and the amyloid proteins are left in place and gradually can become plaques.
A helpful dietary strategy, therefore, is intended to lower levels of insulin both your body and your brain.
Meanwhile: your hungry brain, what can it do? Turns out the brain loves to fuel itself with ketones. Your body in general can thrive on either sugar or fat for fuel. Your brain needs fat or ketones—luckily ketones are generated by your liver from fat, in the absence of high levels of insulin. So the diet that keeps your insulin levels low is a diet low in carbohydrates, higher in fat, and that combo helps your own body to make ketones. Ketones that your body makes would be called endogenous ketones; ketones can also be taken by mouth, and those would be exogenous ketones. There are some exogenous ketone products that are not fully reliable, but a good area to watch as products are farther developed. Meanwhile, it’s a win-win (low insulin plus high ketones) to eat a low carb diet that bottoms out your own insulin levels and allows your liver to produce and your brain to enjoy home-made ketones.
Berger devotes the non-technical part of her book to both a celebration of and a defense of dietary fat, as well as describing the specific foods that will be part of your ketogenic diet. She includes strategies for concocting a low-carb ketogenic diet out in the real world: what to do at a restaurant or at a friend’s house. She acknowledges all the other real-life factors that can make or break a new eating plan: are you happy? Do you sleep? Do you exercise? See the sun? All these can be tweaked and finessed so that your overall brain health is supported, beyond the simple fuel of the ketogenic diet.
Before you think—well, practically speaking, if you need this book, you probably can’t understand it—of course you’re right. The book is written as a great guide for loved ones of the person with cognitive challenges already and an even better guide to the person who is worried about following in the footsteps of a parent or grandparent with the disease. Even if you don’t know if you have the gene, the book is practical and helpful for anyone who wants to maintain a healthy brain. After all, at least one-third of Alzheimer’s disease occurs in folks without the high risk gene. Alzheimer’s is a big deal—significantly impacting our health, the lives of patients and all their loved ones, and draining wallets both private and public. It’d be great for everyone to have just enough familiarity with the ketogenic diet that they can incorporate it at least part of the time into their life.
For the patient with Alzheimer’s, following the recommendations in Berger’s book can be truly life-changing. Folks are recovering lost brain abilities and even re-growing lost brain volume. Just one more reason to skip dessert tonight, and get off the sugar train in general!