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Dave loved his job as a financial analyst. He was 66 years old when he left work one day and couldn’t figure out how to get home. In the following months, his work performance declined to the point where he was asked to retire. He became more confused, felt chronically fatigued, and even the simplest tasks became very complicated. Eventually, his eyesight declined, his speech became unintelligible, and he stopped recognizing those nearest and dearest to him. Dave’s daughter had to quit her job to take care of him and now they live together in the unforgiving world of Alzheimer’s.

What is Alzheimer’s?

Sixty to eighty percent of dementia cases are Alzheimer’s, a disease characterized by the emergence of beta-amyloid plaques and tangles called Tau in the hippocampus region of the brain that controls memory. Beta-amyloid builds up between nerve cells and inhibits signaling while Tau forms inside cells and disrupts transport systems for nutrients and other essential compounds.

As beta-amyloid and Tau spread to other neural regions, affected cells die and cognition and biological functions worsen. Originally, it was thought that beta-amyloid or Tau drove the disease. Newer theories focus on genetic and epigenetic drivers as well as inflammatory processes, metabolic dysfunctions and even infections as mechanisms. Although nobody knows the actual cause(s), Alzheimer’s is increasingly thought to be the result of a combination of genetic, environmental, and lifestyle factors. (1)

The Reach of Alzheimer’s

Alzheimer’s affects 5.4 million Americans with 5.2 million of those people age 65 and older. Globally, almost 47 million people have the disease with that number projected to nearly triple to 132 million by 2050. A small percentage (less than 5%) develop Alzheimer’s in their forties and fifties but the majority are “late onset” and become symptomatic at age 65 and older. (2)

Memory loss is usually the first sign of Alzheimer’s. As the disease progresses, patients experience  symptoms like

• disorientation
• mood and behavior changes
• confusion about events, time, and place
• loss of smell
• vision changes
• paranoia
• difficulty speaking and swallowing
• difficulty walking
• loss of recognition of friends and family

The toll on caregivers is extremely high financially and emotionally and eventually those suffering from Alzheimer’s will die from the disease.

“Type 3 Diabetes” is Diabetes of the Brain

People with Type 2 diabetes, a disease characterized by hyperglycemia and insulin resistance, are much more prone to neural degeneration and memory loss than healthy people and they are twice as likely to develop Alzheimer’s. These diseases have common pathologies and share many risk factors supporting the growing theory that people with Alzheimer’s have “brain diabetes” or Type 3 diabetes. (3)

There is a very strong genetic component to Alzheimer’s and not everyone who has it will have a history of Type 2 diabetes. It is also true that not everyone who has Type 2 diabetes will go on to develop Alzheimer’s. However, Type 2 diabetes does appear to influence the development of Alzheimer’s:

1. Hyperglycemia (an excessive amount of glucose in the bloodstream) damages blood vessels and creates an excess of advanced glycation end-products (AGEs) that damage long-lived cells such as neurons. Research shows that poorer glycemic control correlates with greater cognitive deficits. In fact, chronically elevated glucose is so harmful to the brain that the damage it causes is referred to as glucose neurotoxicity. (4)

2. Hyperinsulinemia leads to insulin resistance not only in the body but in the brain as well, and a startling 80% of people with Alzheimer’s have insulin resistance. In an insulin resistant state, brain cells can absorb glucose, but lose their ability to use it effectively. There is a lot research looking at ketones and the best methods for keto-adaptation as a means to improve dementia symptoms and perhaps even reverse disease processes. (5)

3. Additional risk factors include:

• Obesity
• Metabolic syndrome
• Heart disease
• Vascular disease
• Unfavorable omega-6/omega-3 ratio
• Smoking
• Chronic stress
• Lack of physical activity
• Lack of sleep
• Alcohol abuse
• Common microbial community

The Paleo Diet and Brain Health

The majority of calories in the standard American diet come from processed foods lacking essential nutrients. We lead high stress lifestyles, get inadequate sleep, inadequate sunshine, we sit too much, and we take too many medications that contribute to the decline of the health of our microbiome. Taken together, we are left vulnerable to sickness and disease.

Our genes play a strong role in the development of disease but the study of epigenetics tells us our environment shapes how those genes are expressed. The Paleo lifestyle encourages practices that are in line with our genetic predispositions for optimal wellness and as such, acts as an epigenetic reset for our health. The diet, by placing a premium on foods with the highest nutritional value and the lowest toxic loads, is anti-inflammatory and health promoting. Although not strictly defined as such, the relatively low carb nature of the Paleo diet improves glucose tolerance, increases insulin sensitivity, and promotes weight loss.

In its most basic form, following a Paleo diet means eating nutrient dense vegetables, fruits, meats, fish, healthy fats, nuts and seeds while avoiding grains, beans, soy, dairy, refined vegetable oils and refined sugar. In its broadest form, the Paleo diet places value on locally grown food that is produced ethically and sustainably and mimics the traditional human diet by including pastured meats and wild fish from animals that ate appropriately for their species and plant foods grown free of pesticides, herbicides, and other potential toxins. Paleo also places a premium on certain unrefined fats and oils such as coconut oil that are known to have health benefits.

In addition to diet, the Paleo lifestyle encourages sleep, play, outdoor time and physical activity and is a holistic approach based on the habits our hunter-gatherer ancestors evolved to thrive on. What is the role for Paleo in the fight against Alzheimer’s?

Research on Paleo and Alzheimer’s

In one very small recent study out of UCLA, researchers tested a personalized multi-target treatment to reverse dementia and Alzheimer’s with a diet and lifestyle protocol congruent to Paleo. The study involved 10 subjects with varying states of dementia and Alzheimer’s. Nine of the ten showed improvement in memory and remarkably, the patients who had to discontinue working were able to go back to work and those having trouble doing their jobs were able continue with improved performance. The only subject not to show improvement was the patient with late-stage Alzheimer’s. (6)

The protocols per patient were personalized, and the following example was designed for a woman who had experienced two years of progressive memory loss and who was having trouble not only doing her job but with activities of daily living as well. Three months into the study, she had experienced total recovery! She was able to adhere to the following aspects of her protocol (some were too hard to adhere to) and at the time of publication, while continuing the protocol, she had maintained her cognition for two and one-half years:

• She eliminated simple carbohydrates; gluten and processed food from her diet with increased vegetables, fruits, and non-farmed fish leading to a weight loss of 20 pounds.
• She began yoga; and eventually become an instructor!
• She meditated for 20 minutes twice per day.
• She took melatonin each night and increased her sleep from 4-5 hours per night to 7-8 hours per night.
• She took B12, D3, CoQ10, and fish oil each day.
• She used an electric flosser and toothbrush to optimize oral health.
• She reinstated hormone replacement therapy that had been discontinued.
• She fasted for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime.
• She exercised for a minimum of 30 minutes, 4-6 days per week.

Dr. Bredesen, the lead researcher of the study, reported in a recent interview with Chris Kresser that his patients have sustained cognitive improvement on their personalized protocols for as long as his program has been around, which is four years. That’s exciting! It demonstrates that Paleo-type changes in diet and lifestyle can have therapeutic value for neurodegenerative conditions. Dr. Bredesen concedes that more studies are needed but, so far, his results are very encouraging. (7)

Ketones as an Approach to Alzheimer’s Prevention

You just can’t talk about diet and Alzheimer’s and not mention ketones. Ketones are formed in the body as an alternative fuel source when glucose isn’t available. Our brains prefer glucose but function just as well on ketones in times of food scarcity, prolonged fasting, or during the application of the ketogenic diet; a very high fat, moderate protein, very low carb regimen that induces ketosis. With regard to the Paleo diet, the low carbohydrate nature of the diet creates fat adaptation and ketosis will kick in during times when carbohydrate intake is low enough for long enough. The amount of time this takes will be different for everyone and as soon as carb intake increases, as it will on Paleo, ketosis shuts down.

The ketogenic diet is well known to control uncontrolled seizures in children, and a growing body of data shows that it controls Type 2 diabetes and obesity. Researchers are now studying the use of ketones as a therapeutic tool for dementia and Alzheimer’s—diseases where glucose metabolism is severely compromised.

Brain cells have a high affinity for ketones and they appear to boost cognition in patients with memory loss. The ketogenic diet has to be very restrictive to work and can be very hard to follow for any length of time. Fortunately, medium chain triglycerides enhance ketone formation and there are several ongoing clinical trials looking at how the implementation of diet, MCT oil, and coconut oil, which contains a large proportion of medium chain triglycerides, might benefit the brains of patients with memory loss. (8)(9)(10)

The Role for Paleo in Type 3 Diabetes

Preventing Type 2 diabetes seems like a good place to start! By removing grains, legumes, and sugar, the relatively low carb nature of the Paleo diet improves glucose tolerance, increases insulin sensitivity, and promotes weight loss in patients with Type 2 diabetes. Addressing other risk factors such as getting more sleep, reducing stress, treating nutrient deficiencies, and exercising can add additional prevention.(11)

The low carbohydrate nature of the Paleo diet creates fat adaptation and ketosis will kick in when it needs to. If Alzheimer’s is present, implementing ketone-inducing strategies may be beneficial.

As previously stated, there is a very strong genetic component to Alzheimer’s and not everyone who has it will have a history of Type 2 diabetes. It is also true that not everyone who has Type 2 diabetes will go on to develop Alzheimer’s. Going Paleo and vanquishing type 2 diabetes is not a cure for Alzheimer’s, but it may be a crucial step towards reducing your risk of developing this devastating disease.