January 18, 2015

Alzheimer's Follow-up: Q&A (a.k.a. World's Longest Blog Post)


Anyone out there watch Ancient Aliens? If so, you are probably cracking up right now. If not, you’re scratching your head, because you have no idea why this is funny. (Trust me, though, it’s hilarious.)

Seriously, though, the answer is not aliens. I might not know for sure what the answers are, but I’ll provide my best guesses/hunches.

What are the questions? Here goes:

It’s no secret that I am trying to get the word out about Alzheimer’s disease as a “disease of civilization” – that is, a condition that results from the mismatch between our physiology and the modern Western diet (refined carbohydrate-heavy, vegetable oil-heavy, low in micronutrients), and the modern Western lifestyle (inadequate sleep, inadequate physical movement, too much psychological stress, loss of human emotional connections). As of 1/18/2015, the post I wrote pointing folks toward the article I wrote for the Weston A. Price Foundation, has 1470 views. Not all that many, considering the one on Vitamin J has 13,512. (If I could get Mark Sisson to include the Alzheimer’s post in one of his Sunday Weekend Link Loves, maybe it would have more, since, thanks to a reader and friend who alerted the MDA people to it, that is where the vast majority of hits came from on Vitamin J.)

But word is spreading, if slowly. (In fact, someone is launching a Kickstarter campaign to fund a documentary about preventing Alzheimer’s, called Bread Head.) More people here and there are stumbling onto my blog, and finding the Alzheimer’s article, which is nice. One such newcomer left some very good questions in the comments section. They were good enough—and my answers complex enough—that I thought it would benefit more people if I answered in the form of a blog post, where everyone would see it, versus responding in the comments section, where almost no one would.

Before we get started, though, I’d like to share a link to a study that shows mild cognitive impairment and Alzheimer’s disease are, in fact, reversible. You can find out how this was accomplished by reading the study, but the nutshell version is, they did much of what I recommend for this specific purpose: reduced carbohydrate intake, increased MCT intake & ketogenesis, reduced stress levels, increased exercise, added vitamin D, omega-3, and antioxidant supplementation, and increased sleep. As Robb Wolf likes to say, “It’s almost like this stuff actually works.”

To put everything all in one place right here, here are the comments/questions this astute reader left. My responses will follow, in the longest blog post in the history of the Internet.

You seem to make a good case of the fact that AD could well be caused by hyperinsulinism in the periphery and hypoinsulinism in CNS because of a BBB becoming insulin resistant. Glucose glycates in interstitial fluid, forming AGEs, inducing apopstosis. Okay, I get the picture. I won’t challenge this. But I do think you make some conclusions without any proofs.

First, you say that AGEs induce lipid peroxidation, thus implying that too much carbs is bad. What about exogenous AGEs formed by heating meat? I mean, I am an ‘animal protein lover’ (to say the truth, I don’t remember the last meal I had without any animal proteins), but we have to be honest and look at the whole picture.

But my main problem is not there. It’s about your conclusions and your recommendations to prevent (not to treat) AD. Ok, let’s, for the sake of the reflection, take for granted that insulin resistance is a major risk factor for AD. Then, we have to look at how to prevent IR through our lifestyle. Good, I still follow you. You make 6 recommendations which are:
1. Cut the refined carbohydrates
2. Balance your omega 6/omega 3 ratio
3. Increase cholesterol and saturated fat intake
4. Increase your antioxidants intake
5. Increase vitamins and minerals
6. Increase physical activity (or movement as you would say on your blog)

Nothing to say about 5 and 6. I’ll shut up (for those!) But as I am not the type of guy who swallows everything that is told to him without questioning, that’s what I will do for 1-4.

1. What do you consider ‘refined carbohydrate’? Low GI pasta (38)? Whole baked potato (85) or even wild rice (87)? What’s the definition of ‘refined carbohydrate’? We have examples of ancestral tribes eating a good share of carbs as part of their diet and not developing AD. I personally (but I don’t know a …. about this) think that the problem with carbs is not carbs per se, but what SOME of these carbs lack: antioxidants and nutrients. Lots of carbs? I think some/most of people’s body can handle them. No nutrients and antioxidants to help regulate glucose uptake and your whole hormonal system? NOW we have a problem. Anyway, do you mean the same as I with ‘refined carbohydrate’? If so, then I don’t think we should have a nationwide recommendation to cut on carbs, simply to get them from better sources (whole foods). And yes, I do think that properly prepared grains DO offer benefits. Whole-freshly-stone-ground-organic-sourdough rye bread (GLUTEN…) is an example.

2. Balance your omega 6 / omega 3 intake. Well, again, I don’t think the problem is the amount of omega 6. I would say that the problem might be the lack of omega 3 in one’s diet (no matter how much O6 he or she gets) and the already rancid O6 found in heavily transformed or heated vegetable oils. I don’t think eating an avocado salad with nuts and olive oil dressing is bad because of O6 content. Again, just my humble opinion based on studies I’ve come across. (No, sorry, I don’t keep them in a folder for citations).

3. Increase cholesterol and saturated fat intake. Here, I must say that I would LOVE you to be right. As I said, I love meat, butter, I make my own tallow and lard. BUT, let’s look at the evidence. A 2008 meta-analysis seems to clearly show that SFAs tend to decrease insulin sensitivity (Dietary fats and prevention for type 2 diabetes: Risérus, Willett, Hu). O6 vegetable oils? Opposite! Sad, I know. Does that mean I cook with soybean and corn oils? I can’t, I don’t have those and don’t want them at home. But, evidence seems clear. Even without a caloric surplus. Even considering other lifestyle factors. Even blah blah blah… I know, really sad!

4. Increase your antioxidant intake. Again, from the (tiny) amount of things I’ve read, I’ve concluded (not definitely, I never stop challenging my own views) that antioxidants are good within foods. Not as supplements. You need to give your body the tools to build its own proper armour and use it whenever it's needed.

I know, long comment, sorry. But I would GREATLY appreciate if you could answer my five questions/comments (the one about AGEs and the 4 about insulin resistance). My wife has AD history in her family and I would like to help their parents get the best advice possible. But I’m not sure that telling them ‘Increase your saturated fat and cholesterol intake, drop these oils, cut on potatoes and move more’ is necessarily the best advice. Improvement? I guess so. BEST advice? Not convinced. I hope that together we can come to a better and clearer conclusion.

I wasn’t kidding when I said these were good questions, worthy of a deeper exploration than I wanted to leave in the comments section. I’ll address each of the four points in turn. I must say upfront, however, that most of this is just my opinion. My hunches, based on my (at times limited) knowledge of biochemistry and physiology. I certainly don’t know everything, but I feel confident in saying I know a little something more than the average person on the street. Whether that means my thoughts are worth anything at all is for you to decide.


I have already discussed in detail my thoughts regarding carbohydrate tolerance. See this post on my blog, and this guest post I wrote for Robb Wolf. Much of what I am going to say now is similar to what I said in those, except I have a bigger attitude now, hehheh.

If you are familiar with the globetrotting escapades and nutritional research of Dr. Weston A. Price, as well as the work of Dr. Cate Shanahan, author of Deep Nutrition, then you know that previous generations’ diet and lifestyle have a significant influence on the health and physiological/metabolic “fitness” of subsequent generations. (The same can be said for the work of Dr. Francis M. Pottenger, author of the famous Pottenger’s Cats. If you ask me, we are smack dab in the middle of the human version of the cat experiments, and the results are striking and undeniable. If you have no idea what I’m talking about, do a little looking into those cat experiments, and you will no longer wonder why our children are experiencing shocking levels of physiological and psychological debilitation and derangement. But I digress.)

Here’s the deal, as I see it, with regard to carbohydrate tolerance:

Some of us are born with compromised carbohydrate tolerance. I am not trying to “blame” anyone, but some of this has to do with the fetal environment. If you don’t believe me, look into the work of Robert Sapolsky, author of Why Zebras Don’t Get Ulcers, and you will gain an appreciation for just how strong the influence of maternal hormones and physiological state is upon the offspring. The fact is, some of us start out in life already a bit behind the rest of the pack. We will likely never be able to consume the same amount of carbohydrate—or possibly even total “calories” as someone who was not born behind the metabolic curve.

We now have babies regularly being born at birth weights far heavier than in the past. We have heavier babies, and we have obese toddlers. Barring inborn genetic errors of metabolism, this was nearly unheard of a century ago. Do these toddlers just need to eat less and move more? Do they need more "willpower?" Do we need to put them on a low-fat diet and get them onto baby-sized treadmills, so they can crawl ten miles a day? Hardly. This is a HORMONAL ISSUE. In the U.S., most jarred baby food is entirely carbohydrate: pureed/mashed apples, sweet potatoes, bananas, peas, carrots, etc., not to mention the grains that tend to be early weaning foods, too: rice cereal, cream of wheat, and, not long after, Cheerios. I’m not saying these foods are devoid of nutrients (of course they’re not); I’m just pointing out that they are almost entirely carbohydrate. We are very, very far away from the times when mom (or dad) would take “real people food” – meat, vegetables, what-have-you, chew them up in their own mouth, and then put them into baby’s mouth. There never used to be “baby food.” Babies ate largely the same things adults ate; the food was just pureed or “pre-chewed,” so as to prevent choking. (Outside the small contingents of new parents raising their babies on Paleo/Primal/WAPF-type diets, very, very few Westerners are weaning their babies from breast milk onto coconut oil, gently cooked egg yolks, pureed liver, etc. Most people are giving their babies fruit juice and commercial [carbohydrate-heavy] baby food.)

Anyway, my point is, owing at least somewhat to the hormonal and metabolic environment in utero, some babies enter the world already predisposed to have glucose and insulin signaling problems, and predisposed to store, store, store energy upon consuming even a "reasonable" amount of carbohydrate.

What about adults? Some of us, of course, are born very robust, and are raised on good, natural, whole-foods diets, and do plenty of running around in the fresh air and sunlight during our formative years, so that, as we age, we tend to stay pretty robust. We can eat potatoes, rice, bread, fruit, an occasional piece of cake or handful of cookies, no problem.

Then, there are those of us who are born very robust, but after 30, 40, 50+ years of physiological and metabolic abuse at the hands of the modern Western diet (and lifestyle), we do not have the same degree of carbohydrate tolerance as someone who did not spend decades overconsuming carbohydrates and accumulating all sorts of other damage through stress, inadequate sleep, too little (or too much!) exercise, etc. There are people—and I believe I am one of them—whose metabolisms are so compromised, that they get to a point where a low-carb diet is the only way they can keep their blood glucose and insulin at healthy levels.

Through diet & lifestyle changes, some people will be able to repair themselves to the point where they can increase the amount of carbohydrate they eat. Some won’t. Some might have done so much damage for so long, that they’ve backed themselves into a metabolic corner, so to speak, and the only way to keep it from getting worse is through medication and/or a drastic diet—for the rest of their life.

I’m not saying this needs to be ketogenic. For some people, it might. For others, just keeping total carbs lowER is probably enough. And for these people—the ones who “must” keep carbs low-ish, my suspicion is that this applies to all carbohydrates, whether we’re talking about marshmallows, or potatoes, or rice, or Cadbury crème eggs, or kidney beans. But this should, of course, be individualized. People should invest in a blood glucose meter and see how these things affect them. I don’t test as often as I should, but I seem to do better with tubers than with grains. Maybe someone else will notice the opposite about themselves. (And yes, I certainly do recognize the different physiological ramifications of a large soda versus a few ounces of parsnips, or a bowl of cherries.)

Some of us have been so compromised, for so long, that we just cannot—EVER—go back to eating the same amount of carbohydrate that someone else can—someone who was never compromised in the first place. We have created some degree of permanent roadblock. Other people haven’t. But I also think this can happen over time. Think of all the people who eat whatever they want, because they feel they can “get away with it” – meaning, they remain thin. They don’t have any outward sign that their diet is wreaking havoc, because they don’t become overweight. But these are the people who, at 50 or 60 years of age “all of a sudden” are diabetic, or “all of a sudden” have heart disease. Or “all of a sudden” start showing signs of mild cognitive impairment (the precursor to Alzheimer’s). Do we really think these things happened overnight?

What else might influence carbohydrate tolerance?

How about genetics? Let’s take an Inuit man, give him a pair of swimming trunks, and drop him off in Hawaii. Is he going to thrive on coconut, pineapple, and papaya? If we take a Polynesian woman, give her a bunch of nice, warm fur coats, and drop her off in the Arctic Circle, is she going to thrive on seal meat and marine blubber? I think they’ll survive, but THRIVE?  That, I don’t know about. There is no doubt:  we can all survive at ketogenic levels of food intake, and we can all survive on large amounts of grains and beans. But thrive? Feel our best? Be in optimal health? I don’t know. (I’ll refer you again to my post on the carb controversy. Please do not tell me that I, Amy, can look and feel my best, get and remain lean, and be in my best state of health, by consuming lots of fruit and starchy tubers, because that’s what the Kitavans do. I AM NOT A FREAKING KITAVAN, thankyouverymuch.

And please don’t go telling a Pacific Islander he/she can be in optimal health by consuming little to no carbohydrate, and instead, eating lots of milk, yogurt, cheese, beef, caribou, and elk. Their metabolic ancestors were not dairying people, nor would they have been consuming the types of animal foods more prevalent near the Arctic Circle.

People seem to agree that the number of copies of AMY1, the gene that codes for human salivary amylase (the enzyme that begins converting starch to glucose in the mouth) influences people’s carbohydrate tolerance. This seems pretty non-controversial, though it’s a fairly complicated issue. See the following articles for more on this, if you’re interested: 

Based on variance in lactase gene persistence, skin pigmentation, and possibly even eye color, we know (or, rather, we think/believe) that the environment really does have an influence on how genes are expressed. So, looking back at the amylase gene thing, why doesn’t anyone ever mention variance among human beings in the number of copies of genes that code for enzymes involved in ketogenesis or gluconeogenesis? Isn’t it possible that evolution and dietary environment have conditioned some groups of people to be better able to thrive at ketogenic levels of food intake for long periods of time, while other groups really do “require” more carbohydrate to be their best? What about genes that code for any of the other enzymes involved in digestion & metabolism? Could these influence the different proportions of macronutrients people thrive on? I don’t think research has been conducted yet in this area, but my suspicion is YES.

Also: Seriously, why do people get so up in arms over this damn carbohydrate stuff? Just because someone else says they “need” more carbohydrates than you do, why does that threaten your precious little ketogenic worldview so much? Why do you care what anyone else eats? And vice-versa: if someone claims they feel like a total physical and intellectual badass on less than 30g of CHO a day, why argue with them? Like Liz Wolfe says, “Eyes on your own plate!” Unless someone is claiming that the way THEY eat is the way YOU need to eat—and the only way all of humankind should eat, who gives a you-know-what what anyone else is chowing down on? Call me crazy, I JUST. DON’T. GET. IT. If your life is so hunky-dory that you have nothing more significant to concern yourself with than how much butter or how many sweet potatoes someone ELSE eats, then you, my friend, are damn lucky. Go get your pastured pork, your biodynamic cauliflower, put your blinders on, and leave the rest of us the hell alone.

2. AGEs (Advanced Glycosylation End Products)

The commenter asked about AGEs. I am far less concerned about consuming pre-formed AGEs as they occur in food than I am of their being created endogenously. (For those of you who don’t know what I’m talking about, AGEs come in many forms in food, but the clearest example I can give you is charred meat, like when something is grilled/barbecued, or “blackened,” Cajun-style. AGEs also form inside the body. These internal AGEs are basically glucose glommed onto any protein--coronary arteries, a bunch of pancreatic cells, etc. Think of leaving a lollipop on a car dashboard on a hot day. The sugar melts onto everything, gets sticky, and then hardens, right? Kinda sorta the same in the body, when blood glucose levels are chronically elevated. All that sugar has to go somewhere, and sometimes, it binds to whatever physical structure is nearby, forming an AGE. And then those hard & crusty AGEs bond with other hard & crusty AGEs, making cross-linkages, and generally wreaking havoc. To use the precise scientific term, this is bad news.

Do food-source AGEs that pass through the GI tract, from mouth to anus, and do not directly interact with the rest of the body, have the same detrimental effects as the ones that form inside us, and lock onto arterial walls and neurons? (Remember, items inside the GI tract are considered “outside” the body.) My guess—and it is just that—my guess—is no. (When we eat blueberries, we don’t turn blue. The pigment from, say, raspberries, doesn’t make itself known through our skin. Our bodies have ways of processing things that come into them, and I suspect the external AGEs don’t have the same pathological end points as the ones that are created endogenously, largely as the result of chronically elevated blood glucose.) If you’re about to tell me about carotenosis, wherein the skin turns orange when freaky people eat ridiculously large amounts of carrots and other carotene-containing foods, yes, this happens. That is an extreme example of people being weirdos, and I don’t think it applies to non-wacko people eating grilled food.

I enjoy a good barbeque. I don’t love blackened things, but a little sear on the outside of a steak can be yummy, not to mention how a quick grilling can transform mundane vegetables into delicious morsels (like zucchini and eggplant). I don’t eat charred meat en masse, every day. In fact, I eat it pretty rarely, but I do eat roasted vegetables very often, and the Maillard reaction, which creates the browning on them, results in AGEs, and I. Do. Not. Care. And I’m sure as heck not going to avoid grilled burgers at a 4th of July BBQ.

If someone is especially concerned about consuming pre-formed AGEs, no problem. They can cook everything low & slow: steam, use a slow-cooker, boil gently, etc. Don't let anything they cook ever turn brown or...*gasp*...black. You can also marinate foods pre-grilling in antioxidant-rich herbs, like rosemary or cilantro, which supposedly reduces the formation of AGEs. Me, I'm gonna enjoy some grilled & roasted food, with some steamed & boiled food, some raw food, and while I'm at it, I'm also gonna try and enjoy my life.

Omega-3 and Omega-6

The commenter brought up a good point about the omega-3/omega-6 issue. Is the problem with the modern diet that the ratio of 6 to 3 is so heavily skewed in favor of 6, or is it the absolute amount of 6, regardless of its ratio with 3?

I don’t know. (*Hangs head in shame.*)

Sorry. I am a nutritionist, not a clairvoyant. (But hey, at least you know I’ll never BS you.) I’m not saying no one knows; only that I don’t. But based on what I do know about the biosynthesis pathways for eicosanoids (the fatty acid-based signaling molecules derived from n-6 linoleic acid and n-3 alpha-linolenic acid, as well as the elongation of n-3 eicosapentaenoic acid [EPA]), here is what I suspect. Just my speculation:

The n-3/n-6 thing is a numbers game. They compete for enzymes in these pathways. (This much is not my speculation. They do compete for the same enzymes.) I think it’s important to aim for a ratio of 6-to-3 of no more than 5:1. (Yes, this is higher than some of the Paleo literature recommends. If you can get yourself more in the neighborhood of 3-4:1, then GREAT. But considering the standard American diet is upwards of 20:1, then a ratio of 5:1 or, really, even 6 or 7:1, would still be a huge improvement, and would likely go a long way toward cooling inflammation and improving all the other gnarly things that 20:1-ish ratio is associated with. [IN MY OPINION.])

The ingestion of pre-formed EPA, DHA, AA, and other elongated fatty acids probably has an effect, too. (If you are ingesting pre-formed DHA, then you don’t have to worry about the conversion from ALA. Same with arachidonic acid.) But even then, there are still conversions that take place further along the pathway, as you can see in the diagram:

Graphic courtesy of the Weston A. Price Foundation.

SO, regardless of the ratio, I think the absolute amount of 6 can probably tip the scales toward the 6 pathway.  Here’s the thing:  both omega-3 and omega-6 are essential fatty acids. BOTH OF THEM. But our requirement for them is actually very small. So I don’t think it’s wise to just eat as much 6 as you want and balance it out by loading up on 3. (This isn’t so different from telling a diabetic to eat as much carbohydrate as they desire and just take more insulin, right?)

In terms of food consumption, you really don’t need to go out of your way to get 6. It’s everywhere. Even if you avoid soybean & corn oils, and the other major sources of n-6 in the modern American diet, you'll still get plenty from vegetables, meats (especially poultry), and, of course, nuts & seeds. I eat a lot of nuts, myself, but I don’t make any “Paleo treats,” that call for cups and cups of almond flour. Even grass-fed meat will still have n-6 in it, AS IT SHOULD. (Remember, n-6 is an EFA. So stop being terrified of it already. But we are talking very small amounts anyway, since beef is mostly saturated and monounsaturated.)

As for n-3 intake, if you do not regularly consume good sources of pre-formed EPA & DHA, I do recommend supplementation, particularly if you have a high-ish intake of n-6. (Not from a giant bottle on sale at the corner drugstore, please. Get your fish oil from a reputable supplier with proper handling and storage practices.) Please know that if you are consuming “farmed fish,” it is lower in n-3 fats than wild-caught. Seriously—next time you’re at the supermarket, take a look at some packages of fresh or frozen salmon. Most of them will specify “color added.” Know why? It’s ‘cuz farmed salmon do not consume their biologically appropriate marine diet (normally containing lots of krill, which is what imparts that bright pink color naturally). In fact, some of them eat corn & soy protein pellets. *Headsmack.* For one of the best seafood purveyors out there, see the ad for Vital Choice on the right-hand side of my site.

Saturated Fat & Cholesterol

The commenter asked if I think it’s wise to tell people to eat more saturated fat and cholesterol, and they expressed some concern about a detrimental effect on insulin sensitivity as a result of saturated fat consumption. Walter Willett is one of the authors of the study they referenced. I am not going to dismiss it out of hand for that reason, but Willett is one of the kings of shady nutritional epidemiology, and making sweeping recommendations that don’t necessarily apply to all people, everywhere. There are so many problems with studies that seek to make generalizations about diet, not the least of which is confounding. Very, VERY rarely, is a single nutritional factor isolated (such as saturated fatty acids). So many of the studies that say “saturated fat is bad,” or “red meat causes cancer,” are conducted in the context of the standard American diet, with carbohydrate making up anywhere from 40-65% of total calories. How we can say that it is the saturated fat alone that is having an effect—regardless of anything else someone eats, or how they live—boggles my mind. If you look at the work of some of the researchers who are far more low-carb-friendly than Willett, you’ll see that, in the context of reduced carbs, saturated fat doesn’t seem to do anything bad at all.

Yes, these are only two articles. Yes, I am cherry-picking. Want to provide more data? Want to be more “balanced?” Start your own blog! (This is not directed at the commenter. It’s directed to everyone reading this.)  ;-)  Better yet, offer me lots of money so I can quit my day job and stay home doing nutrition research all day!

I don’t necessarily advocate eating a ton of saturated fat and cholesterol. In terms of Alzheimer’s disease prevention and potential reversal, what I am trying to emphasize is that there is no need to go out of our way to avoid these nutrients. (Yes, they are NUTRIENTS.) Many people with Alzheimer’s (or other forms of cognitive impairment) have been following the standard nutritional guidelines for decades. They come from the generation(s) where “doctor knows best,” and if doctor says you should eat only egg whites, swap butter out for margarine, ditch red meat in favor of skinless poultry, and only use fat-free dairy products, then many of these folks did exactly that. (They are not the types to question authority and buck “conventional wisdom,” as so many in the Paleo/Primal/WAPF communities tend to do.)

Saturated fats and cholesterol are critical parts of human physiology and metabolism. If someone prefers to cook with olive oil, rather than tallow, no problem. But they don’t have to order the egg white omelet at the diner, or buy fat-free yogurt and reduced fat cheese, for cryin’ out loud.

There might be one situation in which I would actively encourage slightly increased consumption of cholesterol and saturated fat, and that is in attempting to reverse Alzheimer’s disease that is somewhat severe and longstanding. When we have a person whose brain is damaged and starving to death, we need to feed and nourish it. I don’t think it would be a terrible idea for this person to have a (full-fat) coconut milk smoothie with a couple raw egg yolks mixed in. A sat fat/MCT and cholesterol infusion! This person should also probably be eating vegetables sautéed in lard, bacon fat, or coconut oil. This person’s brain is suffocating, and we’ve got to open a window and let some air in for it, STAT.

(Again, only my opinion. One thing I can tell you will NOT improve severe dementia is f*$#ing crossword puzzles.)


The last point the commenter wanted me to address is antioxidants. I do not think loading up will-nilly on antioxidants is a good idea. Oxidation is one of the processes by which our immune systems neutralize invading pathogens. So we do want some oxidation to occur, at the right times, and in the right places. In fact, we can’t really have “zero” oxidation. After all, the number one source of free radicals (pro-oxidants) in the human body is the human body itself. (See this post about reactive oxygen species, in the cancer series, for more details.)

I totally agree with the commenter's point: I think, for someone whose brain is NOT starving to death, the best sources of antioxidants are from foods. (This will almost certainly ensure that one does not “overdose” on them.) And certainly, even Alz patients should make an effort to consume antioxidant-rich foods, beverages, and spices: green tea, coffee, berries, leafy greens, cod liver oil, turmeric, rosemary, etc. But for someone who IS battling Alzheimer’s, this may not be enough. Supplements are just that – supplemental to a good diet. By themselves, they’re not enough to bring about much change. But combined with a better diet and better lifestyle habits, they can have a synergistic effect. For the most part, for a healthy person, I would not recommend antioxidant supplements. But for someone in the throes of severe Alzheimer’s? Yes, I would be comfortable with doing so. (That said, supplemental antioxidants would probably be my last priority in the list of other things I would deem more important and more effective, starting first and foremost with a low-carb diet.)

I believe in the strategic use of supplements—be they antioxidants, omega-3s, vitamins, minerals, or dessicated glandulars. There can be a “ramping up” period, during which we try to make someone’s body replete with whatever the substance is. (Assuming they needed more of it in the first place.) This is a “therapeutic dose,” and it’s usually pretty aggressive. We want to get the levels up to where we want them, relatively quickly. (Although not so quickly that we overwhelm somebody’s system and induce some other sort of problem.) After that, we dial things back to a “maintenance dose,” which is lower, and may be titrated even lower over time, as the person’s own body heals and repairs, and generally starts doing what it needs to do all on its own. (With certain conditions, of course, lifelong supplementation and/or pharmaceutical medication might be warranted, but in general, the goal should be to get to NONE NECESSARY. And maybe, on occasion, if things get a little off track, they can start up the supplements again as a short-term band-aid, until they get a handle on their diet & lifestyle again.)

One last point: I would like to emphasize what I stressed in my post on Robb Wolf's site: the diet and lifestyle strategies that I think might--MIGHT--reverse Alzheimer's are not necessarily required to prevent it from occurring in the first place. Setting off a bug bomb in your house will kill your insect infestation, but there were probably much less drastic ways you could have prevented the infestation from occurring in the first place, capice?

And, finally, since so much of this is not settled, and is really only my guesses and intuition, I’ll leave you with this thought:

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.


  1. Hi Amy,
    I first want to thank you for the (really) quick and detailed response you have provided to me and to every single reader of your blog. It's much appreciated.

    You once again prove how balanced and nuanced you are in your approach to diet and health. Most of what you wrote rings sound and true to me (then again, I'm no more knowledgeable in this domain than you!) When I'll have more time time (you know, I also have a full-time job and I don't spend every damn minute of my life on PubMed!), I hope I can provide you more detailed thoughts and questions on the issues we've put forward. The time and energy you spend replying me at deserves it.

    Again, thanks a lot. In the meantime I will continue looking up links you put up (those I hadn't read before) and reading on different subjects that could help us get a better picture of AD prevention.

    1. Honestly, for prevention, I think it's actually fairly straightforward, simple, and non-invasive. (Not "easy," but simple...those are not the same, hehheh.) Maintain good insulin sensitivity (using whatever amount or types of carbs are "suitable" *on an individual basis*, get some sunlight, lots of fresh air, enough sleep, enough physical activity without *overstressing* the body in the absence of adequate rest & recovery. Eat real food (again, to one's individual carb tolerance...which, for some people, could certainly include grains, and could certainly include gluten!) -- in essence, be a Homo sapiens! Get the dietary & environmental inputs humankind has come to expect & require, and try to avoid prolonged exposure to the ones it *doesn't.* (She says, as she types this sitting under a light, in front of a computer screen...) In short, if we don't "break ourselves," then we don't have to find ways to repair ourselves. :) And don't forget hugs...and love...human contact. All that boring vitamin J stuff. :P

    2. Also, I hope it was clear that nothing in this post was directed specifically at *you.* (So any time I said the word "you," it was directed at the *general* you. The "royal you," as I sometimes say.) So I really (really!) hope you didn't take offense to anything I've said here. And I owe you a thank you, actually. Your questions pushed me to get my thoughts out there on a few issues I'd been meaning to tackle for a while now.

    3. Hey there,
      I found this post about AGEs from Chris Masterjohn and thought you'd be interested in it. I've only skimmed it so far, but it looks fascinating. I'll read it in full later tonight.


    4. Thanks for the link, I had already read it twice (not saying I understood and little part of it each time!) Now I must say that with my 'updated knowledge', I did understand maybe one more notion. Not bad!
      Seriously, it is indeed really interesting, I remember also reading his post on gluthatione and finding it as useful as this one. I also remember that after reading this piece I did some research and found new studies saying the opposite: that dietary AGEs do increase the amount in the blood (and not just before being evacuated in urine. I might have to look again (when I'll have time...)

      Thanks again!

  2. Excellent post, as usual. My "n of 1" experiment has shown me to be one of those people you talk about who started out normal but got metabolically broken probably by my mid-twenties. Now at 44 I eat a VLC ketogenic diet. Three times a year I have a planned cheat lasting one day. Each time my blood glucose goes up by 20-30 points and stays high for roughly seven days. I don't think I'll ever be able to increase my carb count without serious consequences. My A1C records going back a decade don't show scary numbers, so it isn't as though I was an undiagnosed diabetic. But clearly I was heading that direction.

  3. Amy
    I just found your blog (refered her by an fellow Active low carber, Liz) and was thrilled to see you passion re: Alzhiemer's. My 84 YO mom finally has a diagnosis and, at sixty-something, I am trying to avoid following in her footsteps! I read the UCLA study that managed to reverse the symptoms in 9 out of 10 patients in the study this past September and have been motivated to try and follow it on my own. I will be combing thru your blog for more help!
    thank you in advance as this is as important to me as it is to you.

    1. :-) Glad you found it. I think low-carbing is instrumental to warding off AD. It's no guarantee, of course, but there's no doubt in my mind AD is largely a brain glucose metabolism problem. Is your mother in her own home, or is she in a care facility or someplace like that? If you or another caregiver can manage her food supply (and some environmental factors), you might be able to help her a little bit, even at that advanced age.

    2. She was moved into assisted living this Fall after a health crisis. They are the best in her small town and have recieved national recognition for not using psych drugs in their memory care. BUT they could not get a two week non-dairy trail done so I have little hope that they could go low carb. Last week we got a diagnosis of pulmenary hypertension so that might bring a quick end than anticipated. kind of a good news/bad news thing I think. I can only hope to avoid AD myself at this stage.