Today I watched Episode 05 of Alzheimers – Science of Prevention, a groundbreaking documentary series, featuring David Perlmutter, MD, board-certified neurologist and #1 NYT bestselling author, along with leading experts in the field of brain health. For my notes on Episode 04, click here.
This fantastic series reveals the powerful ways we can decrease our chances of developing Alzheimer’s disease. According to Wikipedia, Alzheimer’s is a chronic neurodegenerative disease that usually starts slowly and worsens over time. It is the cause of 60–70% of cases of dementia.
With Alzheimers reported to be the fastest growing epidemic among the aging, I want to know what I can do now to optimize my brain health long-term. I took copious notes while watching this episode and want to share these important insights from the series with you below.
For full access to this series, as well as for bonus interviews not included in the free series, check out access to the series here.
Episode 05 Notes:
Your Brain’s Destiny Is In Your Hands.
The effects of elevated blood sugar on the body and brain
Diabetes is a condition where the body has difficulty maintaining normal blood sugar levels. By far, the most common form of diabetes is Type 2 diabetes. And this is a disease that is strongly related to inflammation and relates to dietary choices. Many of the things that cause and worsen diabetes may actually be closely linked to the development of Alzheimers disease. In fact, this idea is so important that many now refer to Alzheimer’s as Type 3 diabetes.
It turns out that several of the key problems involved in diabetes like inflammation, toxic levels of blood sugar level and problems with the hormone insulin are very much involved in Alzheimers disease as well. And this is very important because it means that understanding the diabetes disease process, we can also potentially lower our risk for developing Alzheimers disease.
Diabetes is, be definition, the body’s inability to manage a lot of carbohydrate. When you eat too much carbohydrate, blood sugar rises too high. Your body can’t handle it, can’t metabolize it. Type 2 Diabetes is not primarily a genetic disease. How do we know this? Because there have been populations that have existed around the world for centuries that have had virtually no diabetes. This epidemic has exploded in the last 50 years, in lock step with the obesity epidemic, but also with a whole range of processed foods, especially processed carbohydrates. – David Ludwig, MD
If you have Type 2 diabetes, you have more than double the risk for Alzheimers because you have both the inflammatory piece and you’ve got the piece of the insulin resistance. – Dr. Dale Bredesen, MD
If you have Type 2 diabetes, your risk for developing Alzheimers increases 2-4 fold. And Type 2 diabetes is considered a lifestyle disease. Rock bottom, too many processed carbs and simple sugars and an overly sedentary lifestyle. This is a condition that is by and large preventable. And today in the USA, 50% of people have either diabetes or pre-diabetes. And Alzheimers disease shares striking similarities with Type 2 diabetes in the brain, so much so that Type 3 diabetes has been coined to describe Alzheimers disease. – Max Lugavere, Author of Genius Foods
We know that high blood sugar, even slightly high blood sugar, increases your risk of heart disease and Alzheimers even if you don’t have diabetes. So managing your blood sugar and keeping it in a normal range or optimal range is really essential if you want to promote health and longevity and prevent Alzheimers. – Dr Mark Hyman
Now we recognize that even before you get to the diabetic level, you start to get varying degrees of risk to injury due to sugar causing damage. – Jeffrey Bland, PhD
Alzheimers: aka, “Type 3 Diabetes”
I created the term Type 3 diabetes because at the time I was studying insulin effects on the brain and for a completely unrelated reason we developed a model to see what would happen if you were to knock out insulin from the brain, prevent it from being there. And I was expecting to see what we find an alcoholic brain to see, but instead we looked at the brain and it looked just like Alzheimers. And it was at that point that we stopped all research and just focused on whether or not Alzheimers could be a kind of diabetes. We looked at the human brain and what we found was that there were features of Type 1 diabetes which means there wasn’t much insulin there. And as the disease got worse, you had less and less insulin in the brain. At the same time, you had an insulin resistance which is what you see in Type 2 diabetes. So they were both going on at the same time. So we said, let’s call it Type 3 diabetes. – Suzanne de la Monte, MD, MPH
Blood sugar is a key biomarker of health & longevity
Blood sugar is one of the most important biomarkers of health. What I see in my patients is that they start to develop a problem with insulin signaling. And as insulin starts to get out of whack, their blood sugar rises. It’s one of the most important indicators of longevity, your health span where you feel like you’re in your prime. And it’s also one of your most important indicators of your risk of Alzheimers disease. So we believe that up to 60% of cognitive decline is related to how you handle blood sugar.
When you eat, your blood sugar goes up with some foods more than others. Insulin is like an escort which takes that blood sugar and puts in in three different places – inside your muscles, inside your liver, or inside your fat. SO I think of insulin like a bodyguard. If you’re a perfect hormonal specimen – if you’re someone who hasn’t struggled with your insulin being out of whack, then you do a really good job at this. You spend the most of your blood sugar after you’re done eating to your muscles. What happens is, for various reasons, sometimes the foods you eat (have) too many refined carbs, sometimes due to stress, sometimes because you took antibiotics and it made your microbiome out of whack, insulin no longer serves this really important function. It becomes an overwhelmed bodyguard. So that’s also known as insulin resistance. That’s when your cells become numb to insulin. So it’s much harder to get that blood sugar that’s elevated in your blood after eating, inside the cell. Insulin resistance is a state of inflammation which is associated with many other conditions – things like diabetes, metabolic syndrome, alzheimers disease.– Sara Gottfried
Insulin resistance occurs not just inside the body with diabetes but it also occurs on the outside of the brain called the blood-brain barrier. And that blood brain barrier is a special lining that protects the brain and is very picky and it chooses what’s going to get into the brain and what’s not going to get into the brain. And if you have a healthy blood brain barrier, only the right things go in. Unfortunately, one of the things that needs to go in is insulin And if you eat too many of the wrong carbohydrates too often, you damage those insulin receptors on the brain that escort insulin into the brain. And when those become damaged and fewer in number, it’s harder and harder for insulin to get into the brain. The brain becomes insulin resistant and the inside of the brain will become lower and lower in insulin. A high carbohydrate, especially the wrong types of carbohydrates can damage the brain at any age. So we now see people with high insulin levels and insulin resistance even in childhood. This didn’t use to be very common but now unfortunately it is. So now we have young children with obesity and Type 2 diabetes. And as soon as you have insulin resistance, you have insulin resistance of the blood-brain barrier likely already occurring. So it’s really important to start as soon as you can to change your diet. The risk for Alzheimers disease starts long before a person has Type 2 diabetes. By the time you have Type 2 diabetes, your blood sugar is completely out of control, your insulin is no longer able to keep your blood sugar in a normal range. It’s the high insulin levels not the diabetes that damage the brain. – Georgia Ede, MD
Stop Eating Packaged, Processed Foods
Today we are inundated with packaged processed foods that our bodies just don’t know what to do with. And it’s driving insulin resistance which is the cornerstone of type 2 diabetes. We know that insulin resistance in the body is closely related to the metabolic health of the brain. There’s this misconception that if you are thin, you are metabolically healthy. We tend to think of obesity as something that is exclusive to people who are actually obese, but that’s not true. Chronically elevated levels of insulin can precede a diagnosis of diabetes by a decade. – Max Lugavere
We know that if you get pre-diabetes, you get pre-dementia, or called mild cognitive impairment or MCI. We know that the mechanism in the brain that is driving some of the inflammation has to do with insulin resistance which is driven from eating too much sugar and starch. We know that sugar is highly inflammatory and that Alzheimers is an inflammatory disease. So we have all these linkages that when put together make it very clear that a diet high in starch and sugar is bad for you. And the bigger your belly, the smaller your brain is actually what the science shows. – Dr Mark Hyman
Alzheimers is an inflammatory disease. High blood sugar drives inflammation.
We know that having higher blood sugar drives inflammation. And it does this through a number of mechanisms. Number 1 is essentially creating creme brulee in your brain, not the creamy stuff but the crusty stuff. When proteins and sugars interact to create damaging crust that literally clog up your brain and they do this by activating receptors they call AGE or “ages” and this is because you have too much sugar and it combines with the proteins and leads to this consequence of severe brain damage through this process called glycation which is what you see with creme brulee or crust on a bread – these are all proteins and sugars interacting to create damage. So what’s fascinating is that your hemoglobin which is a protein can also be affected by too much sugar sugar combines with the hemoglobin to become glycate, we call it hemoglobin A1C. And that is a marker of your risk of diabetes and of course, even Alzheimers.- Dr Mark Hyman
Inflammation is ravaging our health. What it does is it creates damage to proteins and cells, it creates free radicals and we call it oxidation. No one knows what that is. That’s when your car rusts or your apple turns brown. Imagine that happening in your body, it’s rancid fat in your blood, it’s rancid fat in your brain, it’s oxidized, damaged chemicals that cause huge havoc in your body, it’s the single final pathway for aging, for all sorts, whether it’s cancer, diabetes, heart disease, and it’s really prevalent for brain disorders. So getting a hold of inflammation, getting a hold of oxidative stress, getting a hold of free radicals, is a critical step in creating a healthy human and a healthy brain. – Dr Mark Hyman
Inflammation may be the most important concept to grasp as you listen. Inflammation is the entire cascade that occurs in the body. Inflammation is the root cause of chronic disease. – Sara Gottfried, MD
Inflammation is a biologically ancient pathway which serves a critical protective function. If you cut your arm or it gets infected. Inflammation is the body’s response to bring immune cells to kill the invading bacteria and begin the process of wound healing. Inflammation in that setting is self-limiting. It goes away as the body repairs its tissues. Another related problem is chronic inflammation. Not acute but chronic inflammation. And especially the kind that takes place in the body. In the lining of the blood vessels and the organs. This process is initiated importantly by aspects of our lifestyle – poor quality diet, too much processed foods, other environmental insults. And when this type of inflammation sets in and become chronic, it begins to damage the body’s internal organs, the lining of the blood vessels and even the brain, setting the stage for Type 2 diabetes, heart disease, and neurodegenerative diseases like Alzheimers. Chronic inflammation of the body can start in a variety of ways – poor diet, lack of exercises, stress, and one the key factors related to inflammation is insulin resistance – especially related to fat cells. When fat cells start growing taking in extra calories, for a period of time the body can handle it just fine metabolically. But at some point, fat cells begin to undergo a transition – they go from a nice, calm metabolic state to inflamed. White cells rush in, and the adipose tissue with this inflammation begins to spew out chemicals that spread inflammation throughout the body. When that inflammation goes to blood vessels, it can promote atherosclerosis. When it goes to the pancreas, it can affect the production of insulin, setting the stage for Type 2 diabetes. When it goes to the brain, it can set the stage for Alzheimers and other neurodegenerative diseases. – David Ludwig, MD
There are many ways in which elevated blood sugar is associated with inflammation. First of all, inflammation will elevate blood sugar. But it’s a vicious cycle because the elevated blood sugar will cause damage to tissues which will then aggravate inflammation. – Leo Galland, MD
We need to worry about inflammation to the brain because inflammation is very damaging. And almost every brain disease you can think of is driven by inflammation. It doesn’t mean that your brain is red, or swollen or sore, it’s inflammation on a microscopic level. These unnatural food products, what they do is they cause the cells of the body to release lots of little SOS signals and distress signals, and free radicals that are really damaging – and they run around and damage DNA and proteins, and left to their own devices, they can actually kill cells from the inside out. So if that keeps going and going you can actually have shrinkage of parts of the brain. – Georgia Ede, MD
Inflammation both contributes to and is a result of insulin resistance in the body. So again in terms of a diet that’s going to mitigate your insulin resistance and inflammation, by eating the right foods, focusing on fiber, veggies, nutrient dense whole foods, you’re going to go a long way toward mitigating inflammation in the body, and thus helping your body better process glucose which is going to promote insulin sensitivity which is the inverse of Type 2 diabetes which is going to help minimize your risk for developing alzheimers. – Max Lugavere
Shrinkage of memory of the brain can happen earlier than shrinkage in most other parts of the brain. The memory center of the brain is called the hippocampus. And the hippocampus is where memories are formed. The hippocampus is especially vulnerable to big spikes and peaks in blood sugar and it’s really sensitive to the same types of forces that cause diabetes – so high blood sugar and high insulin levels. The reason for that is because the hippocampus needs more insulin than the rest of the brain does. The more sugar you eat and the higher your insulin levels are, the less insulin gets into the brain and it starves the hippocampus of energy. – Georgia Ede, MD
Diabetes accounts for 67% of all cases of Alzheimers disease. – Lisa Mosconi, PhD, Women’s Brain Initiative, Weill Cornell Medical College
How to improve insulin sensitivity & protect your brain health
Reduce your intake of simple carbohydrates. Optimize your microbiome. Make sure you don’t have a leaky gut. Virta has had very good results with a ketogenic diet. We recommend a plantbased ketogenic diet. Having a keto diet helps you to improve your insulin sensitivity. Literally, you’re burning fats instead of burning simple carbohydrates. – Dale Bredesen
There are strategies for insulin resistance that are very simple. Insulin resistance is primarily about eating processed foods, refined carbohydrates and vegetable oils. So, if you can eat whole foods, real food – meat, seafood, fruit, poultry, vegetables, – if you do that, it will be very unlikely that you would develop insulin resistance. People who have insulin resistance will need to eat a low carb diet. Look at how big you are around the middle. If you have a lot of extra belly fat, it’s often a sign of insulin resistance. Avoid all processed foods, refined carbohydrates, and the seed oils. – Georgia Ede, MD
There are a number of ways to take care of your insulin glucose relationship. One of the most important is exercise. The food you eat can raise your blood sugar. Stress can raise your blood sugar. And we know that exercise can help you manage your blood sugar. So what exercise does is it makes your muscles hungry for glucose. So if we get back to the definition of health and wellness, it is absolutely essential that you are exercising regularly, that you have a lot of physical movement. So that you’re making your muscles hungry for glucose. – Sara Gottfried, MD
The first step in avoiding chronic inflammation is to be physically active, and eat a really healthy, well-balanced diet.
Fasting: A powerful way to fight insulin resistance
Fasting sensitizes the cells of the body to insulin so it’s an insulin sensitizer. – Valter Longo, PhD
Fasting is a promising tool we have to fight insulin resistance. It helps our cells by restoring insulin sensitivity. And making it easier for cells to use fuel. I recommend exploring fasting as way to improve your blood sugar as well as insulin levels. – Dr David Perlmutter
Thank you, Dr. David Perlmutter and experts featured in this series for sharing your life-changing knowledge, practical tips and habits to help us optimize our brain health. It’s incredibly empowering and inspiring to know that we have more control over our cognitive health than statistics suggest.
Practical ways to make changes today:
- Dramatically reduce your intake of simple sugar and refined carbohydrates
- Optimize your microbiome
- Consume a lower carb or ketogenic diet that is focused on ample amounts of plant foods and fiber
- Exercise regularly
- Consider fasting
- Get good quality sleep
You Can Reverse Diabetes & Cognitive Decline
The body has tremendous recuperative potential, if given the chance. It may take more work and diligence one the disease has developed, but I’ve seen as a clinician, advanced cases of Type 2 diabetes, go into remission with major lifestyle changes. – David Ludwig, MD
I’ve seen the reversal of diabetes, the reversal of cognitive decline, through making these changes, such as through intermittent fasting, going keto green and incorporating incredibly beneficial stress management techniques. – Anna Cabeca, DO