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Reversing Mental Decline Part 4: Nine Immediate Steps to Prevent Dementia

We’ve covered a lot of scientific territory in this series, from the basics of Alzheimer’s to the tests used to evaluate risk. This final installment is something you can follow up on right now, regardless of where you fall on the risk spectrum.

Concerning your brain, let’s say you’re in one of these four situations:

  • There’s dementia in your family and you’ve checked your APOe gene risk and found you’re at increased risk (APOe 4/4 or 4/3).
  • There’s dementia in your family, but you don’t want to know your APOe status.
  • There’s no dementia in your family, but you’ve been experiencing some cognitive symptoms that are either so mild no one notices or you’ve had symptoms that might be interfering with your life.
  • You have none of the above, but do want your brain to function at its maximum potential for your entire (and very long) life.

Everyone listed above will benefit from following these steps to support best brain function.

Get regular physical exercise.  Yes, I know, you hear this all the time, but the data showing that exercise prevents dementia grows ever more compelling. Just last week a Swedish study showed that women who were highly fit in middle age were 90% less likely to get dementia in their later decades than those who were deconditioned or even moderately fit. 90%?! That should motivate you to walk outside several times daily, always take the stairs, and do some form of high-intensity workout. This one can be managed by people of virtually every age and ability in any location.

Tamp down the stress.  Chronic stress from any source definitely increases your dementia risk. Make life choices based on how you answer “Will the result of this choice increase or decrease my stress levels?” Planning to get engaged to a heroin addict you’re sure you can change? Pondering a well-paying job in the Trump administration? Get counseling if you need help making life-changing and potentially stress-inducing decisions.

Eat a ketogenic diet.  If you’ve read the words “going keto,” that’s how you’ll be eating. Your liver starts making specific chemicals called ketones from stored fats when it’s running low on carbs. Blood levels of ketones increase, a condition called ketosis, and your brain function improves. Read more about the ketogenic diet here. There are two steps to producing more ketones. First, switch to a low-carbohydrate, high-fat, moderate-protein diet. Second, incorporate intermittent fasting and go NPO (that’s nothing by mouth except water) for 12 hours or more every day. Finish dinner by 7 pm and hold off eating breakfast until 7 am or even later.

In addition, because gluten triggers unnecessary inflammation, avoid it. Most of us can handle dairy, but purchase high-quality (organic or grass-fed) versions of milk, cream, and cheeses. Keep saturated fats low by using high-quality grass-fed beef and pastured chicken as a condiment rather than as a main course. Eating a keto diet, you’ll learn to focus on lower-carb vegetables and lower-sugar fruits while you increase the amount of good fats you consume by eating more fish and avocados and using olive oil and other healthy fats. This is low-inflammation eating. If all this seems daunting, our WholeHealth Chicago nutritionists can help you make sense of it.

Master the art of good sleep.  It starts with a dark cool room, a quiet environment, limiting screen time, and being in bed before midnight. And since just about everyone over 45 wakes up sometime between 1 and 3 am, don’t agonize over it. Go empty your bladder, get back into bed, and meditate. Morning will come.

Make a conscious effort to reduce your body’s inflammation. Interestingly, some people can sense when they’re inflamed because they have symptoms like fatigue, general achiness, skin eruptions, brain fog, and digestive problems. Your doctor can measure your inflammation with an hsCRP test. If yours is elevated, you and your doctor will need to play detective to find the sources. The big villains of inflammation are eating a nutritionally poor diet, leaky gut syndrome, chronic infections (like Lyme disease, mold, chronic viruses such as herpes and Epstein-Barr, poor oral hygiene, and chronic sinusitis), and autoimmune diseases (like rheumatoid arthritis, lupus, and Hashimoto’s).

Get your hearing checked and your teeth regularly cleaned. Untreated hearing loss equals diminished brain function, which in turn increases dementia risks. Floss daily.

Keep your hormones (thyroid, adrenal, sex hormones) at healthy levels. You may have to apply pressure to your doctor for cooperation on this, but “borderline hypothyroid” is not normal. For women, long-term sex hormone replacement (starting at the onset of menopause) definitely reduces dementia risks. Ask your doctor for bioidentical hormones. You’ll be taking a molecule that’s completely identical to the one your ovaries were producing. Read more about bioidentical hormones replacement here. Because there’s an increased risk of breast cancer theoretically with any hormone replacement (1.2 times the average risk), annual mammograms are mandatory. Bioidenticals are not owned by Big Pharma, so all the studies testing the risks of hormone replacement have used the pharmaceutical Premarin. No one has performed a head-to-head study comparing the risks of Premarin with those of bioidenticals.

Keep your exposure to chemicals very low. If not you’re not buying organic, which is ideal, wash fruit and veggies thoroughly. Most of what you’ll eat on a keto diet are whole foods, but if you’re buying a food with a label, read it closely. If you can’t pronounce something or if it’s another word for sugar, don’t eat it. Challenge the necessity of any drugs you’re prescribed. More than three quarters of Americans over age 50 are taking one or more prescription drugs, most of them prescribed to treat the consequences of unhealthful lifestyle choices.

Challenge your brain endlessly. Watch less TV and check your phone less often. Read more books, take some evening courses, join a choir, create art or write in a journal, and learn something new, like a foreign language or a musical instrument. Consider using one of the brain-fitness websites, such as brainhq.com.

Here’s a list of the basic nutritional supplements that most researchers, including Dr. Bredesen of The End of Alzheimer’s, consider most helpful for maintaining optimal brain health (all are available in our Apothecary):

  • A high-potency multiple vitamin, with or without iron (with iron is only for menstruating women), such as Multiplex by Integrative Therapeutics.
  • Vitamin D 5,000 IU daily
  • Resveratrol Ultra–High Potency (by Integrative Therapeutics) 175 mg, one daily.
  • Citicoline (by Jarrow) 250 mg, twice daily.
  • Neuro-Tone by Douglas Laboratories, two tablets twice daily.
  • SPM Active (ultra high-potency fish oil for inflammation), one capsule twice a day.

This list will likely be longer if you’re following the Bredesen Protocol (ReCODE) for restoring cognitive function and you’ve had some abnormal test results.

Last week’s Health Tip listed the blood tests recommended in Dr. Bredesen’s book, which look for what he calls the 36 “holes in the roof” that, if left unrepaired, potentially increase your risks of advancing from mild subjective cognitive impairment (SCI) to mild cognitive impairment (MCI) to actual dementia. He points out that among patients with either SCI or MCI, fully 20% of test results are outside the ideal normal range. Common abnormalities include high homocysteine, early diabetes, borderline hypothyroidism, and low vitamin D or B-12.

Whether or not you want to check your genetic risk with an APOe test is up to you. However, if you’re experiencing any memory issues, best get started on the lifestyle changes ASAP.

Be well,
David Edelberg, MD

Leave a Comment

  1. Sharon Schwartz says:

    Can you begin bioidentical hormones at 70

  2. Dr E says:

    There are positives and negatives about starting hormones late in life. A low dose of bioidenticalsis likely quite safe. I would suggest them if APOe status placed you at Alzheimer risk

  3. Angie Lindsay says:

    My father in law has Alzheimer’s. He lives in Springfield, IL. I’ve been reading about Dr. Bredesen and when I googled doctors nearby, your practice came up. I’m wondering what you would recommend we do about my father in law. He’s only 76. Is there someone he could see in Springfield who is willing to find underlying causes or should we bring him up to Chicago to see you? He’s just on so much medication and he’s getting worse. Thanks for your help!

  4. Dr E says:

    I would suggest contacting the Bredesen staff and asking if someone is trained in your area

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Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.


• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

• Painful sore throat
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• Fever

FLU (Standard seasonal flu)
• Fever
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• Sudden onset over few hours
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• Sore throat
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• Muscle aches, sometimes quite severe
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• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
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