Get tested for the APOE4 gene (e.g., via consumer genetic tests like 23andMe and then using foundmyfitness.com/genetics for a free report) to understand your genetic risk factor for Alzheimer’s, as knowing your status allows for proactive intervention.
Get a ‘cognoscopy’ (a suite of baseline biomarker tests) at age 45 or over to understand your risk factors for cognitive decline, including APOE4 status, homocysteine, inflammatory issues, nutrient issues, and toxin issues, as these can all be addressed.
Develop a personalized health program based on your specific risk factors and underlying causes of cognitive decline or risk, rather than a one-size-fits-all approach.
Do not rely on monotherapeutics for complex chronic illnesses like Alzheimer’s; instead, identify and address all contributing factors, which can be dozens, to effectively manage or reverse cognitive decline.
Follow the Ketoflex 12-3 diet, which emphasizes mild ketosis, a flexitarian approach treating meat as a condiment, and at least 12 hours of daily fasting starting three hours before bed, to improve cognition and metabolic flexibility.
Implement a daily fasting period of at least 12 hours between dinner and breakfast to allow for autophagy and brain cleansing; if ApoE4 positive, extend this fast to 14-16 hours.
Finish dinner at least three hours before bedtime to prevent high insulin levels, which can hurt cognition, contribute to insulin resistance, and promote fat storage.
Aim for mild ketosis (1.5 to 4 millimolar beta-hydroxybutyrate) through a very low carbohydrate, high good fats diet (e.g., avocados, nuts, seeds) to improve cognition.
Adopt a flexitarian approach where meat is treated as a condiment rather than the main course, and if consumed, choose pastured chicken, grass-fed beef, or wild-caught fish (avoiding large, long-lived fish high in mercury).
Consume organic foods to minimize lifelong exposure to dementogens and other toxins present in conventional food.
Stay away from large-mouthed, long-lived fish like tuna, shark, and swordfish due to their high mercury content, which can contribute to cognitive decline. Instead, opt for ‘smash fish’ (salmon, mackerel, anchovies, sardines, herring).
Monitor and optimize homocysteine levels, aiming for less than 7 (not 13), because high homocysteine is an independent risk factor for neurodegeneration and a more rapid decline in cerebral gray matter and hippocampal volume.
Monitor and optimize fasting insulin levels, aiming for less than 5, as higher levels contribute to glycotoxicity and insulin resistance, which impact cognition.
Monitor and optimize hemoglobin A1c, a marker of average serum glucose over two months, to address glycotoxicity and insulin resistance.
Monitor and optimize fasting glucose levels to address glycotoxicity and insulin resistance.
Monitor and optimize vitamin D levels to ensure they are optimal, not just within normal limits, as it is critical for supporting synaptogenesis and brain health.
Monitor and optimize levels of hormones such as pregnenolone, progesterone, estradiol, testosterone, and free T3, as they are critical for supporting synaptogenesis and brain health. Bioidentical hormone replacement may be necessary for some.
Engage in regular exercise to support brain health, as it is likely to increase brain-derived neurotrophic factor (BDNF) and contribute to overall cognitive support.
Prioritize quality sleep to support the glymphatic system, which actively cleanses the brain of waste products like amyloid plaques, and is crucial for overall cognitive health.
Actively manage stress levels, as they are surprisingly important factors influencing cognitive health and overall well-being.
Test your living environment for mold exposure using the EPA Relative Mold Index (ERMI) via services like mycometrics.com (aim for a score less than 2), and consider urinary mycotoxin tests to check for personal exposure, especially if you suspect type 3 Alzheimer’s.
If tests confirm mycotoxin production in your home or workplace, it is crucial to remove yourself from these environments to eliminate chronic exposure to dementogens.
Identify and address exposure to metallotoxins like mercury, which can contribute to cognitive decline, especially if you are a poor excreter or have dental amalgams.
Identify and address exposure to organic toxins like DDE, which can contribute to cognitive decline.
If specific pathogens like Borrelia (Lyme disease) or co-infections are present, they must be addressed as part of the protocol to reverse cognitive decline.
Investigate and address leaky gut, as it is a common problem that contributes to chronic inflammatory conditions, including cognitive decline.
Utilize gut health tests such as Genova’s GI Effects, Doctor’s Data stool analysis, or Cyrex Array 2 (for leaky gut/LPS response) and Array 3 (for gluten/gliadin sensitivity) to assess and address gut health.
Consider supplementing with omega-3s and antioxidants, along with vitamin D, as they have been shown to improve amyloid plaque phagocytosis and cognition, and are involved in resolving inflammation.
When seeking omega-3 benefits, prefer consuming whole fish (e.g., ‘smash fish’) over isolated DHA supplements, as fish provide additional protective antioxidants and nutrients that may be more effective, especially for ApoE4 carriers.
Ensure adequate intake of synapse precursors like DHA and citicoline to support synaptogenesis and maintain a large network of synapses.
Incorporate regular sauna use into your routine, especially if you have type 3 Alzheimer’s or high toxic burden, as it helps detoxify the body by eliminating toxins like cadmium, mercury, and BPA through sweat, and contributes to resilience.
After sauna use or sweating, immediately shower with a non-emollient soap (e.g., Castile soap) to wash away toxins released in sweat and prevent their re-penetration into the skin.
Consider and address any history of head trauma as a contributing factor to cognitive decline.
Investigate and address any vascular compromise as a contributing factor to cognitive decline.
When interpreting lab results, aim for optimal biomarker ranges rather than merely ‘within normal limits,’ as standard reference ranges may not reflect physiological optimum for health and cognitive function.
Cultivate metabolic flexibility, allowing your body to efficiently switch between burning carbohydrates and fats for fuel, which is beneficial for brain health and reduces reliance on glucose.
Reduce your intake of simple carbohydrates, as human organisms are not designed to consume the high amounts typically found in modern diets, and excess sugar acts as a toxin.
If you have known risk factors like ApoE4, be proactive in trying lifestyle and dietary interventions to prevent cognitive decline, even if you currently have good health markers.
Continuously monitor cardiovascular biomarkers such as LDL particle number and size, and triglycerides, to ensure that dietary and lifestyle changes are beneficial for both heart and brain health.
Before attempting to remove amyloid plaques (e.g., with antibodies), first identify and address the underlying causes of their production, as amyloid is a mediator and protectant, not the sole cause of Alzheimer’s.
Actively support the resolution phase of inflammation, not just addressing the inflammatory triggers, to prevent chronic inflammatory states that contribute to cognitive decline.
Understand your personal ‘mixture’ of Alzheimer’s subtypes (inflammatory, atrophic, glycotoxic, toxic) to tailor the most effective treatment protocol, as most people have a combination of contributing factors.
Optimize trophic support for your brain by ensuring appropriate levels of hormones (e.g., through bioidentical hormone replacement if needed) and brain-derived neurotrophic factor (BDNF) to counteract atrophic processes.
Initially use MCT oil or coconut oil to help raise ketone levels and transition to a ketone-based metabolism for the brain.
If ApoE4 positive, after 1-2 months of using MCT oil to establish ketosis, transition to more monounsaturated and polyunsaturated fats to maintain heart health while supporting cognition.
Be aware that transitioning to a ketogenic diet can cause ‘keto flu’ if ketones aren’t adequately raised while carbs are lowered; it takes a few weeks to convert to a fat-based metabolism, and exercise can help during this period.
If you have a very low BMI and are on the Ketoflex 12-3 diet, liberalize your diet about once a week with more carbohydrate-related foods like sweet potatoes to prevent unwanted weight loss.
Monitor and optimize your HSCRP levels, a marker of inflammation, as part of addressing inflammatory issues contributing to cognitive decline.
If ApoE4 positive, monitor your LDL particle number (LDLP) and aim to keep it below 1,000, adjusting your intake of MCT oil, monounsaturates, and polyunsaturates to balance heart and cognitive health.
Take personal responsibility for your longevity and health by actively seeking data, understanding your body, and making informed lifestyle choices.