By Dr. Mercola
Alzheimer's is an epidemic, currently affecting an estimated 5.4 million Americans. Unless there are radical changes, many experts project half of us will eventually acquire it.
Since diet is one of the root causes, diet is also a foundational prevention and treatment strategy. This is an important point, considering there are no meaningful conventional treatments for this devastating disease. Eliminating wheat, refined carbs and sugar from your diet would be a wise start due to the toxic effects they can have on your body, including your brain.
Drugs like Namenda or Aricept, which are commonly prescribed for Alzheimer's, have very limited effectiveness, and come with potentially serious side effects. But other healthy lifestyle strategies also need to come into play for a truly holistic approach.
In this interview, Dr. David Perlmutter, a board-certified neurologist and author of The New York Times best seller "The Grain Brain Whole Life Plan: Boost Brain Performance, Lose Weight, and Achieve Optimal Health," shares his insights into core strategies that will help boost brain performance and dramatically reduce your risk of Alzheimer's.
"The Grain Brain Whole Life Plan" is an extension and continuation of his previous book, "The Grain Brain: The Surprising Truth About Wheat, Carbs and Sugar — Your Brain's Silent Killers." Perlmutter's own father died from Alzheimer's — a death he has since realized was preventable, which has acted as a driving force for his work.
"To be clear, no one inherits Alzheimer's. Some of us who have relatives [with] Alzheimer's … are at increased risk. We certainly know there are some genes, the apoliprotein E (ApoE) 3, 2 and 4 genes that are playing a role in carrying the ApoE-4 allele. It does increase a person's risk.
But this is not a determinant that you will or won't get the disease. It does indicate that you have a higher risk for that disease. But the beauty of what we are talking about is you can offset that risk. You can change your destiny," Perlmutter says.
Primary Risk Factors for Alzheimer's Disease
According to Perlmutter, your diet is by far the greatest contributing risk factor. To prevent Alzheimer's, you need to focus on a diet that powers your brain and body with healthy fats, not net carbs (total carbohydrates minus fiber).
Perlmutter's book centers around the notion that your body prefers burning fat because it's efficient, and it minimizes production of free radicals and reduces inflammation. Becoming an efficient fat burner not only helps prevent Alzheimer's but also Parkinson's, coronary artery disease, diabetes, cancer and other chronic health conditions.
"It's a broad net that is thrown when we change our diet and finally get rid of the sugar and this bombardment of our physiology with carbs, the likes of which our gene array has never seen before," he says.
"It's very empowering, the notion that we can change the expression of our life code, our DNA, by making certain choices in our lifestyle, like our dietary choices, exercise, making sure we get adequate sleep, reducing stress and having good social relationships.
All of these epigenetic factors change the expression of your DNA, and can change our destiny even as it relates to Alzheimer's risk."
Why Nutritional Ketosis Is so Beneficial for Health and Brain Function
When your body burns fat as its primary fuel, ketones are created, which not only burn very efficiently and are a superior fuel for your brain, but also generate fewer reactive oxygen species (ROS) and less free radical damage. But that's not all.
"It's more than just the utility of powering our cells with fat that is the beauty of this type of diet. When you do cut your carbs and sugars, and you add in adequate amounts of healthy fat, your body does produce ketones, one of which is called beta-hydroxybutyrate.
It turns out [that's] not just an ideal fuel source for your cells to burn, but beta-hydroxybutyrate is [also] an epigenetic player. It actually has huge effects on the expression of your DNA …
[W]hen you're in mild ketosis and your body is availing itself now of this chemical beta-hydroxybutyrate, it stimulates changes in the expression of your DNA, which is positive, reducing inflammation, increasing detoxification pathways and increasing your body's antioxidant production."
Beta-hydroxybutyrate also stimulates specific receptors on cells called g-proteins. When these receptors are tagged by this beta-hydroxybutyrate during mild ketosis, it helps reduce the activation of pathways that lead to inflammation, and inflammation is a driver in most all chronic diseases, be it Alzheimer's, heart disease, diabetes or cancer.
So it's not merely about powering your cells with fat. This type of diet — high in healthy fats, moderate in protein and low in net carbs — also helps alter your metabolism, thereby paving the way for health.
The Case for Feast-Famine Cycling Opposed to Continuous Ketosis
To shift your body into fat-burning mode, you need to dramatically reduce your net carbs, as your body will typically use whatever glucose is available first. However, that doesn't mean you can never have large amounts of carbs ever again. In fact, remaining in nutritional ketosis for years on end may be ill advised.
If your insulin level goes too low, you actually increase your liver's production of glucose. If the liver's production of glucose isn't suppressed by insulin, you'll end up with high blood sugar even if you're eating virtually no carbohydrates.
In my book, "Fat for Fuel," I recommend feast-famine cycling instead of continuous ketosis for this reason. By periodically pulsing higher carb intakes, consuming say 100 or 150 grams of carbs, opposed to 40 to 60 grams per day, your ketone levels will actually dramatically increase and your blood sugar will drop. In addition to that, insulin — while required for lipogenesis (the production of fat) — is also needed for the production of protein.
When you're in extreme nutritional ketosis and drive your insulin level down to really low levels 24/7, you will not have adequate amounts of insulin to manufacture protein. This precedes wasting, as you start to lose muscle mass, which is not a healthy state.
Beware of Eliminating Healthy Carbs
Perlmutter also warns against abstaining from fiber-rich carbs. These prebiotic foods nurture the healthy bacteria in your gut, because when you eliminate these foods you can negatively affect your microbiome. This is why I continuously stress the importance of reducing your NET carbs, meaning only the sugar-based carbs that have little to no fiber. Remember, vegetables are carbohydrates, and those you can eat without limit.
"It's important that those carbohydrates remain part of the program, especially fiber-rich foods that are rich in prebiotic fiber: jicama, chicory root, dandelion greens, garlic, onions and leeks," Perlmutter says. "I think that is a big player in terms of why people have such an issue when they go into full-blown ketosis."
Exercise Rejuvenates and Regenerates Your Brain
"The Grain Brain Whole Life Plan" covers not only diet, but also an array of other lifestyle factors that are important for optimal neurological health, including exercise, sleep and stress management. Perlmutter recounts an event that showed him just how impactful stress and emotions can be — and conversely, the healing impact of positive emotions like gratitude. This personal story is also in his book.
Besides addressing your emotions and stress, exercise is another very important strategy. Certain exercises are particularly good for increasing brain-derived neurotropic factor (BDNF), which has potent rejuvenating effects on both your muscles and your brain. High BDNF levels have also been correlated to a dramatic reduction in Alzheimer's risk. As noted by Perlmutter, BDNF "does nothing short of help you grow a new brain."
"It turns out that any aerobic exercise will do this. This was just published several months ago — a new study done by Dr. Kirk Eriksen at UCLA. The conclusion was that regular participants in aerobic exercise, whatever their age have a 50 percent reduced risk of Alzheimer's. That's an important statement. They can garden, they can walk, they can swim, bike — whatever it is that gets their heart rate up. They demonstrated these profound changes on brain scans … "
Raising BDNF Through Natural Means May Be More Effective Than Stem Cell Therapy
Turmeric can also raise BDNF, as can the animal-based omega-3 fat DHA. DHA is not really a fuel like other fats but, rather, a structural component of your cells. It actually integrates into your cell membranes, and it's the only fat known to do that and not burn as fuel like virtually every other fat that you eat.
When you consider that 50 percent of the fat in your brain is DHA, the importance of this omega-3 fat becomes more readily recognizable. DHA also acts as a COX-2 inhibitor and a powerful anti-inflammatory. According to Perlmutter, recent research also suggests whole coffee fruit concentrate (also called coffee cherry) is one of the most powerful ways of raising BDNF.
"When you pick a coffee bean, it's not actually the bean you're picking. It's the berry. The bean is the center part. The seed is what you make your coffee out of. But the rest of the fruit then undergoes an extraction process and makes this whole coffee fruit concentrate that now has been shown to dramatically raise BDNF levels. You'll be able to buy that, I suspect, in the health food store pretty soon," he says.
"But I want to emphasize that the best thing you can do if you want to raise BDNF levels and therefore grow new brain cells, is to … buy a new pair of sneakers [and] become active … That turns on your body's production of BDNF [and] helps you grow new brain cells …
When we turn on the growth of our new brain cells by exercise and increasing BDNF, that increases the growth of stem cells exactly where they need to be in the brain's memory center. There are companies that do stem cell therapy for neurodegenerative conditions around the globe … The challenge with stem cell therapy is getting those cells to where they need to be and then hoping they differentiate into the type of cells needed.
What we see with the endogenous stem cell therapy, in other words, BDNF brought on by exercise, coffee fruit and turmeric, is that that's exactly what happens. Those stem cells grow where they are needed. They develop into fully functional brain cells and they migrate to areas where they are needed as well."
Other Important Benefits of Exercise
Besides boosting BDNF and promoting neuroplasticity, exercise also increases an important metabolic signal called peroxisome proliferator-activated receptor gamma coactivator (PGC-1α), which increases mitochondrial biogenesis. The PGC-1α pathway regulates both mitochondrial activity and mitochondrial replication. This is important, as your brain is the most mitochondrially-dense organ in your body.
"It turns out that mitochondria do more than just help us produce energy and power our cells," Perlmutter explains. "Mitochondria are actually involved in determining which cell lives or dies … This is mitochondrial therapy.
We're now looking upon Alzheimer's and Parkinson's as acquired mitochondropathies or mitochondrial diseases that can be acquired by exposure to toxins, like we see with Parkinson's, or just direct toxic effects on mitochondria based upon diet. For example, a high sugar diet is toxic to mitochondria.
Here is yet a third benefit to aerobic exercise that has just been published. It now looks as if those who engage in aerobic exercise have a wider diversity of gut bacteria. The more exercise you do, the more diverse are the organisms that live in your gut. That correlates with better health, reduced inflammation and a more balanced immune system. I think we've given out three very powerful reasons that people need to engage in aerobics."
An important and fascinating side note here is the findings of Dr. Dale Bredesen, a UCLA researcher who, by leveraging 36 different healthy lifestyle parameters, was able to reverse Alzheimer's in 9 out of 10 patients. This included the use of exercise, ketogenic diet, optimizing vitamin D and other hormones, increasing sleep, meditation, detoxification and eliminating gluten and processed food.
His work was published in the journal Aging in 2014. You can download the full-text case paper online, which details the full program.1 According to Bredesen, "The results … suggest that, at least early in the course, cognitive decline may be driven in large part by metabolic processes," which is exactly what Perlmutter is suggesting.
How Light Affects Brain Function
Interestingly, research shows people living in northern latitudes have higher rates of death from dementia and Alzheimer's than those living in sunnier areas, suggesting vitamin D and/or sun exposure are important factors. I recently interviewed Dr. Lew Lim about the use of near-infrared light as a treatment for Alzheimer's, known as photobiomodulation.
About 40 percent of the rays in sunlight is near-infrared and when that light hits your skin it causes your body to create the powerful antioxidant in your mitochondria which radically reduces oxidative stress and free radicals. Near-infrared light is also thought to work by interacting with cytochrome c oxidase (CCO) — one of the proteins in the inner mitochondrial membrane and a member of the electron transport chain. CCO is a chromophore — a molecule that attracts and feeds on light.
In short, sunlight helps your cells make the best use of whatever food they have, and improves the generation of energy (ATP). The optimal wavelength for stimulating CCO lies in two regions, red at 630 to 660 nanometers (nm) and near-infrared at 810 to 830 nm.
Photobiomodulation also improves oxygenation to your cells. One of the ways it does this is by releasing nitric oxide (NO) back into your body after being exposed to red and near-infrared rays. NO is a vasodilator that helps relax your blood vessels, lower your blood pressure and improve vascular health. When you deliver red and infrared light to the mitochondria, it also promotes synthesizing of gene transcription factors that trigger cellular repair, and this is as true in the brain as anywhere else in your body.
While daily sun exposure is likely your best option, followed by specialized technology such as near-infrared treatments, other devices emitting the near-infrared spectrum may also be beneficial. Lim has invented a photobiomodulation device for neurological health and the treatment of dementia, but if you're on a budget, you could use a near-infrared (850 nm) security light from Amazon.
I position it over my head for brain health. As noted by Perlmutter, vitamin D is also crucial, and vitamin D is, of course, another important effect derived from sensible sun exposure.
Sauna
Dementia is related to the accumulation of unfolded proteins in the brain like beta amyloid and tau proteins. Sauna is one of the best ways to increase heat shock proteins which help to refold the proteins. But you have to make sure to make sure the sauna is hot enough. Most all of the research documenting sauna benefits comes from Finland, which uses traditional saunas where the temperatures range from 160 to 200 degrees Fahrenheit.
Most far infrared saunas simply don't get that hot, But you can determine if the sauna is hot enough for you by using the following strategy.
How can you determine the air temperature of your sauna? You can get an analog thermometer that goes up to 180 degrees F. for about $10 on Amazon. Once you know the temperature of your sauna, you will be able to correlate it with the biologic reactions that indicate you have achieved a high-enough core body temperature.
The first and most important criteria is to make sure you are sweating enough. The easiest way to do this is to accurately measure your naked body weight before going into the sauna and then re-weigh yourself naked when you get out.
One pint of water (sweat) equals 1 pound. Depending on your size, you should lose 1 to 2 pints during the therapy. The most I have lost is 4 pints of water, which is half a gallon or two liters of water. This was before I had the temperature dialed in as that is too great a water loss. Ideally, you'll want to lose between 1 and 2 pints of water (a drop of 1 to 2 pounds of bodyweight) during a session.
One of the things you can do about one hour before your sauna is drink a quart of water. It's best to add some electrolyte to the water.
The other biologic parameter you can measure is your body temperature. You can use a simple oral thermometer to measure your temperature before and immediately after the sauna. Your temperature should increase by 3 to 5 degrees F. If you meet the temperature and sweat criteria, your sauna is hot enough to detox and generate heat shock proteins.
My absolute favorite sauna is one you make yourself by using the Sauna Space panel that cost about $1000. You can easily convert a far IR sauna to this and get all the benefits of the extra near IR light. You can look at my landmark comprehensive article on my Substack channel.
The Importance of Sleep
Sleep is another factor that can play a significant role in your brain health, as your brain can only detoxify and clean itself out during deep sleep.
"We look at the correlative studies that are really quite profound in showing that interrupted sleep, dropping out of restorative sleep, and even full-blown sleep apnea have strong correlations to risk for Alzheimer's disease. There are multiple reasons for that. We know that, for example, if you measure inflammatory markers, like C-reactive protein and others, they correlate quite nicely to tumor necrosis factor alpha, with the degree of abnormality of a person's sleep," Perlmutter says.
"We recognize that the brain undergoes some fundamental housekeeping during the course of sleeping. It's not like everything shuts down. That's when the brain tidies up. That's when we are activating what's called the brain's glymphatic system to help clear debris.
[Recent] research … [also] indicates that during sleep, the brain may undergo what's called synaptic pruning. What that means is we spend our whole day making new connections between brain cells, but we rely upon the fact that during sleep, we reduce some of those connections because they may not be necessary. We don't overrun the hard drive here with all these connections that are not necessarily important for us.
I talk about, in my new book, all types of ideas people can pursue to improve their sleep … So many watch the 11 o'clock news, which these days are enough to keep anybody awake, then wonder why they can't sleep … Again, it's trying to emulate the fact that we would go to sleep when the sun went down and wake up when the sun came up. It's desperately important. It's a very important lifestyle choice right there with eating and exercise."
Not only will late-night TV watching prevent you from falling asleep quickly by shutting down the production of melatonin — a potent antioxidant and hormone that triggers sleepiness — the type of programming you choose to watch will also affect your brain health. As noted by Perlmutter, "if you bombard yourself with all the stuff going on around you, the world does look like a very dark and scary place. That raises your cortisol level. That's toxic to your brain's memory center. That sets the stage."
You can somewhat mitigate the negative impact of artificial lights and electronic screens in the evening by wearing blue-blocking glasses. I put on my orange-colored glasses as soon as the sun sets.
"Again, it's important from a genetic perspective because our ancestors' genomes were honed to be perfectly responsive to that environment. We have that same genome today and we have to do our very best to emulate that [ancient] environment and cater to it — get enough sleep, be physically active, and eat a diet that doesn't have much sugar or [net] carbs in it."
Social Interaction
Besides exercise, sleep and sun exposure, another no-cost practical strategy that can benefit your brain health is improving your social interactions. There are so-called "blue zones" around the world where people have better health and live longer. What do they do differently than other folks? A healthier diet is one thing, but they also tend to be more physically active and socially involved.
"They have networks. These are societies in which the elderly, for example, are integrated and are valued and remain an active part of their communities," Perlmutter explains. "This has, from a chemical perspective, a profound effect on lowering cortisol and raising other things in the body, for example like oxytocin, which happens to be called the love chemical.
I would suspect that in humans, there are probably even changes seen in the gut bacteria in the microbiome … [T]here was an interesting report [showing] … the level of beta-amyloid correlated with changes in gut bacteria. When there were no gut bacteria, there was actually less of the beta-amyloid produced in this genetically modified rodent, as opposed to when there was a standard gut bacteria.
The reason I mention it is because there is a big push to develop medications that can rid the brain of beta-amyloid … But how intriguing it is that those of us who are focused on the gut bacteria are now recognizing that it may play a role from such a fundamental level, in terms of the production of amyloid protein in the brain."
Is it Advisable to Eat Wheat?
I recently interviewed John Douillard, author of "Eat Wheat: A Scientific and Clinically-Proven Approach to Safely Bringing Wheat and Dairy Back Into Your Diet." In that interview, I noted Perlmutter appeared willing to embrace many of Douillard's notions, which center around the idea that there's a significant difference between whole unrefined wheat and refined processed wheat, and that once gut dysfunction has been properly healed, eating whole wheat can be very healthy.
"Let me first say that I have known John Douillard for about 25 years … I love the guy," Perlmutter says. "He's dedicated to health. I interviewed him as well and I have to say that I don't agree with him. His contention is that our ancestors ate wheat at certain times of the year, and that most people can eat wheat and some people cannot. Again, I give him every benefit of the doubt, but I told him in the interview that I don't agree with him in the nicest way I could.
The thing about wheat and other gluten-containing products … is that gluten, because of its content of another protein called gliadin, is threatening to the lining of the gut. Dr. Alessio Fasano's research at Harvard has made it quite clear that gliadin, which is found in wheat, barley and rye, causes increased leakiness or permeability in the gut of all humans … That's a surefire way to imbalance the immune system and augment inflammation in the body …
I want to tell you something very interesting as an observation. After I did that interview with Douillard, the comments on the interview were so positive … because of the fact that we disagreed but we were respectful of each other. We heard each other's side. We didn't interrupt. That certainly seems to be pretty unusual these days. I'll leave it at that. Again, I think he's a terrific guy. It's fine to disagree."
Annual Symposium for the Institute for Functional Medicine
Perlmutter is chairman of the Institute for Functional Medicine's 2017 Annual International Conference, "The Dynamic Brain," held in Los Angeles June 1 through June 3. The meeting will focus on neurogenesis and neuroplasticity allowing recovery from neural degenerative conditions.
Speakers include Bredesen, Michael Merzenich, the leading pioneer in brain plasticity research at the Buck Institute, Rudolph Tanzi, professor of neurology at Harvard, who will speak about how activity and lifestyle changes affect BDNF, Dr. Terry Wahls, who will speak about strategies to upregulate mitochondrial function and the PGC-1α pathway through diet and other lifestyle choices, and Dr. Joe Pizzorno, a naturopathic physician who will speak about toxicity and detoxification.
"I'll do the opening keynote … But also, I will focus on the emerging science of the microbiome and how that relates to this so-called gut-brain connection," Perlmutter says. Online registration for the event closes on May 30, 2017.
For more information about how to safeguard yourself against Alzheimer's and other chronic disease, I highly recommend picking up a copy of Perlmutter's book, "The Grain Brain Whole Life Plan: Boost Brain Performance, Lose Weight, and Achieve Optimal Health." He's also written three other books on the topics of eliminating grains for optimal health and optimizing brain health: "The Grain Brain," "The Grain Brain Cookbook" and "Brain Maker."
I also will be releasing a new book, "Fat for Fuel" in May, which will delve into the finer details of nutritional ketosis and its health benefits, which includes improved brain health. Incidentally, Perlmutter was one of over two dozen medical experts who helped edit the book, and I'm deeply grateful for his invaluable contributions.
"I'm really very excited for your new book. I had the opportunity to read it ahead of time and I will tell all your viewers that this is going to be a homerun. Not just in terms of being successful, but a homerun for everyone who reads it.
I want to close with a quote if I could. It's from Ralph Waldo Emerson … 'Do not go where the path may lead. Go instead where there is no path and leave a trail' … All of us are outliers clearly. You have really left a trail for so many people to follow that isn't where the path may lead. I think it's so wonderful that you've done this all these years and you continue to do it, because it's a beacon for all of us."
"Fat for Fuel" is my 10th book, but it's the only one I really had a strong desire to write. It emerged out of sheer passion and a deep-seated concern for those needlessly dying from cancer — and the same fundamental dietary intervention that treats cancer also treats Alzheimer's, diabetes and obesity.
They all have the same fundamental problem, which is mitochondrial dysfunction. The good news is this metabolic dysfunction can be avoided and reversed using simple, no- or low-cost strategies, some of which have been covered in this interview.