February 25, 2013

The Alzheimer's Diet! Interview & Giveaway & Mini-Review


Good luck clicking.
 Image swiped from Amazon 'cause I forgot (!) to ask for one.

Alzheimer's is one of those tragic diseases many of us don't like to think about, despite how common it is.  I know very few people whose lives haven't been touched by it in some way.

And no lifestyle intervention can guarantee a healthy brain in old age. Let's hope for a cure, pronto.

Hurry Up, 'K? Thanks!

But in the meantime, there is a lot that clever scientists have discovered about stuff that you can do to make contracting Alzheimer's less likely.

Is it worth making a few changes now, perhaps decades ahead of Possible Trouble, in order to lessen your risk?  Admittedly, it's not as sexy a goal as having six-pack abs or buns of steel. So I worry that books like this The Alzheimer's Diet: A Step-by-Step Nutritional Approach for Memory Loss Prevention and Treatment may have an uphill battle in the Diet Marketing Wars.  But it would be great if resources like this found an audience. Plus, many of these suggestions are targeted at memory boosting now, even ahead of dire diseases.

So stick around, we have an interview with the two very thoughtful authors, plus 4 copies of The Alzheimer's Diet to give away.  Note:  one copy I'm going to reserve for Canadians, even if it means confronting my laziness and shipping it myself. And another copy is specifically set aside for Cranketeers who've been participating in the monthly Goal Support Group post,  aka ¡Toma! (And there's a fresh one coming soon!)

We've got a lot to cover, so I'll keep my impressions extremely brief:

Mini-Review: Why You Might Want To Read This Book

Encouragement: After reading this book, I feel like the good news is that many health-nut Cranky Fitness readers may be doing a lot of this stuff already, and so reading it may reinforce those healthy  behaviors.

Information:  The Alzheimer's Diet does a good job of rounding up prevention as well as treatment information, including several new twists that many of us may not be aware of.

Pragmatics and Structure:  For those folks who like to have a formal plan and guidelines as opposed to a vague sense that Broccoli is Probably Good and Cheetos are Probably Not, there are lots of practical tips and resources.

Some Highlights:

Here's the part where I crib directly from promotional mailings because paraphrasing is too damn much work I'd like to make sure I'm accurate and don't misstate anything:

So here are some of the authors' "memory-boosting dietary recommendations, based on the latest scientific research and the author's clinical experience treating patients with AD and MCI."

1. Fast 12 hours at night.

If you take advantage of "early bird specials,"--having supper at the diner between 4 and 6 p.m.--you've unwittingly stumbled upon a brain health secret: the 12-hour nightly fast. If you routinely wake up at 6 a.m., try to eat your last meal by 6 p.m. the night before. There is scientific evidence that substances called ketone bodies, which are produced when there are no carbohydrates to burn for fuel, may have a protective effect on brain cells. This means no late-night snacking between dinner and breakfast.

2. Proportion your fat-carb-protein intake.

Every day, make sure you aim for 25% of your total calories from brain-healthy good fat, which includes olive oil, avocados, certain nuts, natural peanut butter, certain seeds, and certain fish. Limit your intake of bad fats (most fast foods, anything hydrogenated, dried coconut, butter, animal fats, milk chocolate and white chocolate, and cheese). Consume 30-45% of your daily calories from complex carbohydrates (fruits, vegetables and whole foods that are low on the glycemic index), and wean yourself off high glycemic carbs (sugars, high-fructose corn syrup, processed cereals and grains, anything baked, whole milk and cream, ice cream and sorbet, crackers, salty snacks such as chips and pretzels, and anything made with white flour). Finally, get the other 25-35% of your calories from high-quality lean protein.

3. Boost your brain nutrients.

Omega-3 fatty acids (DHA and EPA) are essential for memory function and brain health. Most of us don't get enough from dietary sources (such as fish), so consider high-quality, pure fish oil supplements that contain a minimum of 250 mg of DHA in each capsule, and aim for 1,000-1,500 mg of DHA daily if approved by the treating physician. Antioxidant-rich foods are also great for mental function. Some of the best are berries, kale, 100% pure unsweetened cocoa powder, mushrooms, onions, beans, seeds, sardines, herring, trout, and Alaskan wild salmon. Finally, ensure adequate intake of folic acid, B6, B12, and vitamin D in particular. If you're not eating vitamin-rich foods on a regular basis, it's good to supplement as needed in pill or liquid form.

4. Eat whole foods, Mediterranean style.

A brain-healthy Mediterranean-style diet includes fruits and vegetables, lean protein (fish, chicken, and turkey); low-fat yogurt and cheeses; and grains, nuts, and seeds. Stay away from red meat and processed foods. Get in the habit of eating whole foods. What are whole foods? They're foods that have only one ingredient--for example, strawberries, broccoli, or barley. If you must have a convenience (manufactured) food on occasion, find those packaged, canned, and frozen items with the fewest ingredients--especially ingredients that you readily recognize and understand.

5. Enjoy coffee and pure cocoa.

Good news for coffee lovers! Caffeinated coffee, 1-3 cups early in the day, may be beneficial over time to your brain. Studies done in Europe over several years demonstrate that men who drank coffee regularly for many years showed less of a decline on memory tests than those who did not drink coffee. More good news: An exciting new study released August 2012 showed that patients with mild cognitive impairment who had regular intake of the strong antioxidants found in pure dark cocoa powder had improvement in memory function.

And Now Crabby Interviews the Authors With Persnickety Questions!

Crabby:  I was intrigued by the idea that something as simple as eating dinner early and fasting for 12 hours before eating again could help brain function and weight management, by putting the body in 'mild ketosis.' But how do we square this with research saying breakfast eaters lose weight more easily than breakfast skippers? Shouldn't the "skippers" be in mild ketosis too? Or have those studies been contradicted?

Patient Authors: In our opinion, there is not definitive evidence that breakfast eaters lose more weight or have an easier time losing weight than skippers. We have read studies “proving” that, but there are just as many solid studies saying it makes no difference. Generally speaking, food choices are less healthy when people are extremely hungry, but it really comes down to total caloric intake vs. expenditure for the day (regardless of when the food is consumed). Overnight fasting can lead to the natural production of ketone bodies by the body (during the latter stages of a ‘mini-fast’) which can provide an alternative fuel source for the brain. This alternative energy source is basically a “cleaner-burning” fuel and may potentially have some neuroprotective benefits to the brain cell. Overnight fasting can also be associated with decreased overall caloric intake, which based on recent research from the Mayo Clinic, can also reduce risk of developing dementia.

Crabby: You recommend a low-carb, low glycemic style of eating, yet with the health benefits of a Mediterranean diet. Hooray! Unless I misunderstood, you suggested working gradually down to a total carb count of about 65 grams a day. (Edited later to note: should be 75g).  And just to clarify: Is this net carbs or does it include fiber? I'm hoping net?

I love the fact that you include all kinds of healthy low glycemic carbs like veggies and fruit and beans and whole grains as well as non or lowfat dairy. Much nicer than a typical low carb plan. But really, can you have all this stuff and still end up under 65 grams of carbs? For example, an apple and one slice of my favorite whole wheat bread, 1/4 cup hummus and a glass of nonfat milk and blam, I'm over the limit for the day. Are there any tricks to staying this low and still getting to eat "Mediterranean"? Or did I misunderstand your carb target?

Patient Authors: Great point. As the foundation of the Mediterranean diet is traditionally plant-based foods that do contain carbs, it can be difficult to eat a traditional Mediterranean and low-carb diet at the same time. Individuals may consider a Mediterranean-style diet, which is tweaked to lower carbohydrate intake according to the recommendations in The Alzheimer’s Diet 9-Week Diet Plan.

Here, lowering the total carbohydrate intake takes precedence over making sure the largest proportion of the diet is from fruits and vegetables. As with everything, it’s a balance but in Week 9 of The 9-Week Diet Plan we suggest that individuals may want to lower their carb intake to 75 g/day or less if tolerated and approved by physician (very important to note that all changes in diet must first be approved by the individual’s physician). 75 (or even 65) g/day still leaves a fair amount of room for (good) carbs and is much less restrictive than the original very low-carb (ketogenic) diets that may call for less than 20-30 g/day. For individuals already experiencing memory loss, data suggests that more significant carbohydrate reduction may be necessary to have a positive effect on memory function. In terms of reducing risk in those people who have not yet experienced memory decline, a less restrictive plan may also be suggested (e.g., higher intake of fruits and veggies).

In clinical practice we have also found that setting a target goal of 75 g/day or less most often leads to a reduction in carbohydrate intake from a patient’s prior (average) intake, while also being reasonable enough to ensure adherence.

Those are net carbs by the way, but we should point out that there is not yet agreement as to just how low a low-carb diet needs to be in order to experience brain health benefits. In creating our targets, we balanced the suspicion that there may be an inverse dosage effect of carbohydrate intake on brain health (the lower carb the diet, the greater the memory protective effects may be) with the fact that very low-carb eating can be risky (particularly for diabetic patients), not to mention extremely difficult to maintain.

Crabby: There seems to be a movement rethinking the dangers of saturated fats if they come from grassfed animals. You guys are pretty anti-saturated fat. Do you think the "Primal" or "Paleo" diets are kind of crazypants?

Patient Authors: We have gotten some enthusiastic comments from proponents of these diets. We would not necessarily call these diets ‘crazypants,’ but based on our experience, we believe that less drastic dietary changes are more easily adhered to, and as such have taken that approach in our practice. Our guess is it may (emphasis on might) have some health benefit but that would almost certainly come from a reduction in total caloric intake, rather than something good about saturated fat.

Caloric reduction leads to a ton of health benefits in overweight and obese (and even sometimes in normal weight) individuals. This may (again may, might, could or possibly) override the potential ill effects of the increase in saturated fat. Further research is warranted to adequately answer this question, but with smaller caloric loads coming in and no simple carbs to cause rapid spikes in insulin, the body may be able to metabolize the fat sufficiently enough to protect against clogging of the arteries and other potential negative effects. If a person pays more attention to their diet and lowers caloric intake, they will also likely lose weight and experience several health benefits (including the potential for improved cognitive function).

In our clinical experience, we have found that less drastic and more balanced/comprehensive approaches are more well-studied in terms of brain health, which is described in more detail in The Alzheimer’s Diet.

Crabby: What do you think of the use of sweeteners, artificial and otherwise? Is stevia a better alternative? Are there risks to using a lot of it?

Patient Authors: Long term data is lacking when it comes to both stevia as well as other artificial sweeteners. Stevia is “supposed” to be (and truly may be) a better alternative because it is naturally rather than synthetically derived. However, it is still processed. The FDA has approved stevia-based sweeteners but again, that doesn’t necessarily mean much in terms of long-term safety. There is definitely risk associated with using a lot of it but there are risks associated with overconsumption of just about everything (in fact, people can die from drinking too much water alone). As with any sugar substitute it’s an ‘enter at your own risk’ type of thing. Some people feel that artificial sweeteners have negative long-term side effects. For example, some recent preliminary research has shown possible associations to higher risk of stroke, but further research is necessary to clarify this. Others feel that artificial sweeteners are a heck of a lot better (or less bad) for a person than sugar or high fructose corn syrup. The jury is still out here, but as mom says (and as we say in the book over and over again), “everything in moderation” may be the best advice here.

For me (Dr. Ochner), I do use stevia in moderation but don’t make recommendations one way or the other on it. We definitely recommend ingesting less sugar so, for those who still need sweets and sodas and things like that, stevia-based sweeteners may be a viable option. However, science has not yet proved the long vs. short-term benefits.

Crabby:  Thanks guys!!

And So Just Who Are These  Patient Authors? 

Harvard-trained neurologist Richard Isaacson MD is an associate professor of clinical neurology specializing in Alzheimer's disease at University of Miami Miller School of Medicine. Christopher Ochner PhD is a leading researcher on nutrition and the brain at Mount Sinai School of Medicine and the New York Obesity Nutrition Research Center. You can learn more at The AD Plan or The Alzheimer’s Diet website.

To Enter the Giveaway:

Just leave a comment below and check back next week. I think it's just U.S. and Canada, sorry.  You'll have until Friday March 4 to claim your copy if you win.

Do you guys worry about Alzheimer's?


  1. I must admit, that's a pretty strange title for a diet book!

    That said, since I do most of the recommendations, I love it, lol!

    Seriously, their suggestions are an excellent healthy lifestyle!

  2. Sounds like a healthy diet! And I like the concrete examples.

    Still curious about the 12-hour fast thing, and whether eating dinner at 10 and skipping breakfast qualifies. It seems like the answer would be yes, but I wasn't sure from the answer provided -- maybe because that hasn't been studied specifically?

    I worry about Alzheimer's -- Dad has dementia (possibly Alzheimer's, possibly something else, it's hard to say), and mom has been having a lot of memory issues lately. I know studies say that there can be ameliorative effects based on diet, exercise (physical and mental), etc. It's hard because you also hear so many stories of people who did everything "right," and still suffered from this horrible disease. (Foreign language skills are supposed to be a big benefit, and both my parents are multi-lingual.)

  3. Most interesting, especially about coconut, butter, and cheese being considered bad fat. I follow much of this already in the general high fat, low carb arena, and it's usually 14 hours between supper and breakfast.

  4. When it comes to protecting the brain, they are talking mostly right up my alley. Food should be something that looks like it grew and was harvested, then minimally processed, or like it ate real food.

    If you have to ask yourself what that food was before it got to you, it's probably not good for you.

    This is one i would read and pass along.

  5. Thanks! This was very interesting. I confess, I like my coconut oil and cheese, and I'm not keen on counting carbs, but I think there is still lots of good info to take away from this.

  6. Interesting. And I love how diplomatic they were regarding the use of "crazypants" as a descriptor. Ha!

  7. Interesting, indeed. I will cut down on cheese and butter only if my food allergies change and force me to, but I'm happy to hear about the coffee! The twelve-hour thing is something I do naturally, when my schedule doesn't interfere. I never want to eat first thing when I get up, but sometimes I have to, and sometimes I don't have twelve hours between getting home from work and getting up again.

    Mary Anne in Kentucky

  8. Well, at least it seems like a doable diet/lifestyle change unlike some of the current diets. I think counting the carbs would be the hardest part for me - not big on tracking (cause I'm lazy!). Would definitely be a plan to look into!

  9. Excellent questions, thank you Crabby. My 92 year old mother lives with Alzheimer's. She is still quite verbal, but not in the moment. I fear that I may follow her lead. The contents of this book have shed some new light on this family subject.

  10. I am really interested in this for sure since my grandmother on my mom's side at this! I certainly don't do the 12 hour fast so... BUT I do a lot of the rest. As for those super low carbs - I did a bodybuilding diet & I almost crashed my car on that diet with super low carbs. I see they qualify it though so something to read about. Thx Jan!!!

  11. My father had Alzheimer's so I am interested in this. It maybe too late for me since I am in my mid 60's but there are some steps i can take now ( if I can just remember them). ;)

  12. I spent the last year working on the dementia unit of a nursing home as a certified nursing assistant. There is no more devastating disease IMHO, not only for the patients, but perhaps especially for their families.

    Every afternoon I helped people get out of bed, sometimes with the aid of a hydraulic lift. I took them to the dining room and fed them pureed food and helped them drink thickened liquids. Then I took them back to their rooms, washed their face and hands, undressed them and put on a hospital gown or their own pajamas. I brushed their teeth and changed their briefs, carefully cleaning their bottoms and putting on skin protecting cream. Then I'd use the lift again to put them in bed and tuck around the covers, chatting softly while they started straight ahead, seemingly oblivious to everything around them. 2 hours later I'd come in to reposition them in bed so they wouldn't get bed sores, and check for any medical or comfort issues. This would continue every 2 hours throughout the night until morning when the process was repeated.

    Anything I can do now to protect brain and neurological function, I do. We need more books and research on Alzheimer's and other dementias.

  13. I have tried many ways and I think I shall add this too to my routine. It seems promising and also I think it’ll work out.

  14. Sounds like an interesting read. I follow a lot of these guidelines already (most of the time), so I'f be interested to see what this book says.

  15. I like! Another reason to go moderately low carb! I've always felt that my brain was working better when I was low carb. And maybe I'll re-embrace a small amount of goat cheese into my life!

    Funny how many diet books are out now coming up with different ways say eat whole foods, lots of veggies, fruits, lean proteins and healthy fats.

  16. Super low carbs make Geo something something...I can see the point of healthy meals with minimal processing...especially no aspartame. I often wonder though how much of dementia and alzheimers can be prevented. When you get older things just wear out and your genetic lottery ticket has a lot to do with it. I suppose you do the best with what you've been given :)

  17. I have been diagnosed with MS a few years ago, which is a disease very similar to Alzheimer in the way it affects the nerves in the brain. My symptoms have almost entirely gone away since switching to a healthy diet and avoiding too much sugar and fat.
    Although I would never quit my medication.
    But I'm quite sure that our eating habits can have a massive effect on such conditions.
    Very interesting book by the way! :)

  18. Hurray for kids that make you eat dinner crazypants early! (Boo to kids and their junk food peer pressure. (Oh please, as if my kids are the only problem.)) I also adore the authors' reaction to your use of crazypants. :)

    I'm working hard for the next month to get our family back on the whole and homemade and meal-planned path. I have done South Beach on and off which sounds a bit similar (although not so dairy restricted). I find when I keep us on it we are all so much happier. Adding "keeping my memory kicking" is a bonus advantage.

    We have been lucky to not have anyone in our family affected by Alzheimer's (the Big C is more our style). But I have friends who have. It is a horrible, cruel, devastating disease. So I'll add my voice to the "hurry up science" pleas.

    It runs rampant in my family.

  20. This sounds amazing! I'm with Miz - lots of Alzheimer's in my family and I'm terrified that's going to be me :(

  21. This is really motivational to get my sugar(carb) consumption under control.


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