I was speaking to a group of elders interested in end-of-life issues, some of whom are caretakers for people with dementia. They were interested in Alzheimer’s reversal, generally speaking, for some of their clients. After a few general questions, Nan turned to me and said she wanted to get practical, "Given that this is an epidemic we’re all facing, what can we do to avoid dementia?"
I would recommend the following steps to everyone, not only likely to prevent Alzheimer’s but to improve your health in almost every other way. For each step, I’ll give a “what to do” and then in italics, the “how” to accomplish that step.
- Know your ApoE status. We all have two ApoE genes, numbered two through four. If we’re fortunate, they are some combination of E2 and E3. Less fortunate would to be have one or two copies of E4. One copy increases your risk by a factor of two, two copies by a factor of five or five. (Clearing the age of 65, one in six of us will develop dementia, one in three with one copy of E4, and something like nine in ten of those with two E4’s.) There are two ways to learn your ApoE status: you can have your genetics tested through 23andMe.com ($99 raw data and ancestry or $199 adds some other medical info). You can run your raw data through Promethease.com for $5 to query the risk of Alzheimer’s or other diseases. 23andMe can only “read” ApoE status about 90% of the time; the other 10% of folks need the second option, namely: you can ask your doctor to order a lab test for it. Medicare will pay for the test once in your lifetime; other insurances are unpredictable. Knowing your status will inform how thoroughly you should pursue the remaining steps.
- Optimize your blood sugar and metabolism. We all develop a bit of insulin resistance (pre-pre-diabetes) as we age, and it’s deadly for the brain which develops insulin resistance to a greater degree than the rest of the body. In the brain, insulin resistance interferes with normal housekeeping. Aging brains all face challenges, and might develop a bit of amyloid plaque. A healthy brain can actually clean up the amyloid IF there is no significant insulin resistance. If you have a waistline greater than half your height, or lab tests showing a fasting insulin over 7 or a hemoglobin A1C over 5.6, you definitely have insulin resistance (IR). You can reverse by eliminating all sweet drinks (soda, juice), sweet foods, and starchy carbs (bread, pasta, root vegetables, and rice.) Feast instead on the protein you need for strength (red meat, cold-water fish, eggs, and poultry), abundant non-root vegetables (leafy greens, broccoli, cauliflower, and more), and wise fats (avocado and olive oil are safe for everyone, dairy fats and coconut oil are safe for most, inflammatory for some ApoE4 folks.) Check your blood ketones and aim for a level in your blood of 0.5-5.0 mmol/L using blood testing strips and meter.
- Sleep allows the brain to recover from the past day and to prepare for the next. Our fast-paced life, with sleep crunched between a great late movie and an early breakfast, has short-changed us on necessary sleep time. For a healthy brain, regular and adequate sleep hours are essential. Make bedtime and waking time a set routine, leaving enough time for 7-8 hours of good sleep. Enhance sleep by avoiding all food for at least three hours before bed and avoiding all electronic screens for at least two hours. Know your personal caffeine tolerance: I can have weak caffeinated tea at lunch, but anything after that, even a decaff coffee, will interfere with my sleep. Keep your bedroom cool, completely dark, and free from electronics; turn off the wi-fi router at night. Get up at the same time every day, eat breakfast and get some morning sunlight. Supplement with night-time melatonin and tryptophan (I prefer 5-hydroxy tryptophan) if needed. Chat with your doctor for chronic sleep problems, a sleep study may be needed to identify sleep apnea or other sleep challenges.
- Work out both your body and your brain, pushing beyond set routines and into new areas of strength. Body workouts should include moving your body steadily for 30-60 minutes daily (walk, cycle, swim, dance), and a couple times a week push the pace (e.g., add 30 sec. interval bursts into your walk) and add a bit of heavy lifting (push-ups require no equipment!) Consult a trainer at your gym or a physical therapist if you are quite out of shape. Mind workouts can be crossword puzzles or number puzzles, so long as you keep increasing the difficulty. Online brain training programs work well for some, such as BrainHQ (actually shown to improve dementia symptoms) or Lumosity . Brain HQ has been better researched, but choose the one you are more likely to keep doing!
- Optimize your hormone status, including pregnenolone, thyroid, estradiol (one of the three estrogens), and progesterone. Both genders need some amount of all the hormones, though they make less pregnenolone with advancing age. Men tend to make all their necessary hormones throughout life, though men with insulin resistance or obesity or other health challenges might make too little testosterone or too much estradiol. Women stop making estradiol and progesterone at menopause, and both hormones are critical for optimal brain function and other health concerns. Pregnenolone is available over the counter, but replacing other hormones must be done by a knowledgeable physician, using bio-identical hormones (estradiol, testosterone and most importantly progesterone.) When it is not possible to connect with such a physician, it would be wise to optimize all the other hormones, specifically by checking and replacing thyroid and pregnenolone to optimal levels. Again, a knowledgeable physician is needed for this as well.
- Rest your brain properly, not achieved by a good relaxing evening in front of the tube. While enjoying television or a movie may serve another purpose, specific brain relaxation offers a particular value. Encourage good brain health with some form of meditation, guided or spontaneous. You can read here for some tips about being your own meditation teacher. Other good alternatives include the guided meditation available at Headspace.com, transcendental meditation (TM) available through TM teachers, or Dr. Bredesen’s favorite, the Neural Agility track available here.
I realize I did a bit of cheating to simplify the list to just six steps! Take your time and prioritize, alternate a step that would be easy for you with one that would be challenging. I'd like to hear from you if you have questions, challenges and successes with these suggestions!