Book Review: The Alzheimer's Antidote

Alzheimer’s Disease (AD) is generally viewed as an unstoppable disease with a cause that is too complex to understand or prevent. Amy Berger, author of The Alzheimer’s Antidote, counters that AD may not be as enigmatic as commonly believed. Medical literature often refers to AD as “Type 3 Diabetes” and like most chronic diseases, it is related to chronically elevated insulin. Berger is far too nuanced and too practical to claim bulletproof treatment or prevention of this dignity-robbing disease. However, her approach of using a ketogenic diet and other lifestyle modifications is an important step towards improving cognition in AD-afflicted people. Some of the same tactics can also mitigate the risk of developing AD in the first place.

This is the only way I could make the review any more glowing.

Berger postulates that the defining factor of AD is the brain’s inability to properly fuel itself via glucose. The good news is that brains unable to properly metabolize glucose can still metabolize ketones. Ketones are produced by the liver when one eats a very-low-carbohydrate diet, so Berger promotes this ketogenic way of eating (along with other ketone-boosting interventions) to improve cognition in a person suffering from AD.

The book highlights the work of Dr. Dale Bredesen. In contrast to the disappointing results from drug-based AD treatments, Bredesen’s work has been largely successful. His ketogenic approach has allowed many of his severely AD-impaired patients to go back to work and lead their normal lives. Berger shares his quote: “AD is not a mysterious, untreatable brain disease-- it is a reversible, metabolic/toxic, usually systemic illness with a relatively large window for treatment.”

Berger discusses brain health from many angles, and she spends lots of time underscoring the value of cholesterol for a healthy brain. She is highly critical of the idea of cholesterol-lowering medications (statins) and calls out the fact that people who take them have increased risk of brain fog, cognitive impairment, depression, hormonal imbalances, diabetes, low libido, infertility, and memory loss. Furthermore, antacids (e.g. Pepto-Bismol) and proton pump inhibitors (e.g. Prilosec) can lead to brain-atrophying vitamin B12 deficiency. With common usage of these drugs and with common diets being nutrient-poor and insulin-spiking, it is no wonder that we are seeing cognitive decline in people earlier than we used to.

The Alzheimer’s Antidote pushes back against a common idea that beta-amyloid plaques are a driving factor in Alzheimer’s. Rather than disease causes, these plaques are effects: the plaques build up when an enzyme that could degrade them instead is too busy degrading excessive insulin. Long before beta-amyloid plaques show up in the brain, decreased brain glucose metabolism can be detected in PET scans (including in people just in their 30s and 40s). Berger also downplays common concern about the APoE4 gene variant. While APoE4 carriers do have an increased AD risk, focusing on genetics distracts from the root cause of elevated insulin levels.

For AD sufferers, for AD caregivers, and for anyone who cares about maintaining cognitive health, this book is a terrific resource. In a a practical, compassionate, and realistic manner, it teaches the reader how to implement a low-carb diet to improve cognition. It also makes the case for lifestyle practices like exercise and intermittent fasting. Berger’s work gives plenty of “why” and lots of "how" but it ultimately provides something else even more important: hope.

If you want to see a heartwarming real-life example of Berger's approach, see here. That video is what inspired me to finally read this book.

While you will find Berger's name in several of my favorite podcasts, I think one of her best interviews is here on the Peak Human podcast.

The Power of Nutrition

For anyone wondering why someone would become interested in, fascinated by, or obsessed with nutrition, check out this Tweet:

7 months ago my Mom, who has #Alzheimers, could barely walk. Eating #keto, she lost 23 lbs, gained sharpness & mobility. Share this video of my Mom dancing, she'll smile knowing she can give others hope. Tx :- ) @TuitNutrition @DietDoctor1 @tednaiman @Nutradvance @bigfatsurprise pic.twitter.com/c5cYBSV3gq

— 50 Fitty (@50Fitty) January 14, 2019

Things like this are why people like me are so passionate about nutrition. And about the potential of keto. 😃😃😃

My Five-Day Fast

Or, how not eating taught me that I really can not do anything I put my mind to

The Highlights

• I fasted for five days, consuming nothing but water and salt. It was an amazing experience.
• I consistently felt more fully present, more energized, and more mentally sharp than I do on typical days. (For what it's worth, I was also engaged in a "Twitter fast" during this time, which I think also helped me be focused/present. But due to the tangible difference in how I felt, I attribute it mostly to the actual fast.)
• On top of my mind feeling sharp, my body felt terrific. Felt light, fluid. Joints felt looser (in a good way), pain-free. Skin felt very strong (there's even a specific patch of skin on my face where I got shingles a couple years ago that I swear I think the skin got stronger. Hard to articulate, but I think some healing took place there), although the skin on my hands and elbows still got very, very dry. (My hands and elbow skin get very dry every year when it gets cold)
• I didn't notice negative side effects this time (I had digestive issues on a previous 3-day fast. I didn't even poop once during this fast); I think adding sufficient salt may have been the key.
• I was able to work out every day of the fast at usual intensity. I might have dropped a bit of strength on the back half of the fast, but the difference was minor.
• I work as a software developer; I was able to work every day of the fast at (at least) normal capacity.
• My body was cold. Digestion seems to heat the body up. I even get cold when I fast for 16 hours or so on typical days, so being cold was not a surprise.
• I got a lot less sleep than normal. The last 3 nights of the fast, I got 6, 5, and 4 hours of sleep, but I still felt very energetic. I just woke up really early and was ready to get after it!
• With a couple exceptions, hunger was not a major issue.
• Not eating for a few days made me realize that a lot of time, thought, and bodily processing is tied up in eating.
• The human body is incredibly adaptive.

The Details

Two weeks ago, I decided to complete my longest fast to date. My previous longest fast was 78 hours, so just over three days. I began this fast just wanting to hit a new mark, maybe hit 100 hours, and, if I felt good enough, potentially max out at five days (according to the work of Dr. Valter Longo, five-day fasts can have some beneficial regenerative, health-building effects on the body). Did I feel good enough? You better believe it! I did the full five days.

Five days of consuming nothing but water and salt. To many people, that sounds crazy. Maybe it even sounds like torture. I assure you, it was anything but. It was a remarkable experience and overwhelmingly positive. It was truly one of the most memorable five-day stretches that I have experienced; at the risk of sounding grandiose, it truly felt like I was living on a different level.

Sunday, October 28

I woke up early and worked out: farmers walks, kettlebell swings, and burpees. My wife and I went to our favorite Indian buffet for lunch, around noon. That being said, I was done eating by 12:30 PM on Sunday October 28. When I got home, I weighed myself: 210.5 pounds. I didn't eat the rest of the day. After the Indian meal, I had nothing but water the rest of the day (not even salt).

Monday, October 29

Monday, I dropped my wife off at the airport around 5:30 AM (she travels for work), went to the gym at my office and worked out (approximately 17 hours fasted). Solid weight lifting workout. I had nothing but water all day (not even salt). After my workout, I went to work. I weighed myself when I got home: 206.5 pounds. I did 100 burpees at home after work. I went to bed at 10:30 PM, weighing in at 203.5 pounds. I felt good all day. I had a great visit with one of my best friends that evening and felt very mentally clear and energetic all day. My legs were twitchy, though-- that happens to me a decent amount even when not fasting. Normally I treat that with some combination of salt, magnesium, or mustard. I thought I'd give it a little more time, so I didn't have salt, magnesium, or mustard Monday night. (I didn't have magnesium or mustard at all during the fast.)

Tuesday, October 30

I woke up at 2:30 AM with calf cramps. I do get this occasionally anyway, and generally try to mitigate this with salt and/or magnesium. To this point in the fast, I had not consumed any salt. So I walked around, went back to bed, and got up at 5:30 to go work out before work. I weighed in at 201.5 pounds before work. I felt energized but dehydrated.

I initially wanted to get to at least 48 hours without even having salt during the fast, but during my workout I was feeling a little light-headed (and had twitchy/crampy legs). As I learned from The Salt Fix, consuming sodium helps with these symptoms, and that was very true in this case. So at 6:10 AM in the middle of my farmers walk/kettlebell swing workout, I had some salt with water (I was not going to mess with hyponatremia, anyway). I finished the workout (41 or 42 hours fasted), then I went to work and had another good day. I continued feeling sharp and alert. I didn't record whether I did my 100 burpees before or after work that day. Anyway, I did them. I was worried that I was going to have some gastrointestinal issues (read: diarrhea) Tuesday, but I upped my salt intake and no issues came to pass. (On my previous 3-day fast, I did have some GI issues starting around the 48-hour mark.) Throughout the rest of the fast, I made sure to consume salt in plentiful amounts to replenish the sodium lost via exercise.

I experienced very little hunger all day. Occasionally I would get slightly hungry but it quickly passed.

Wednesday, October 31

I woke up at 3 AM Wednesday and felt raring and ready to go (and weighed in at 203 pounds). I did some comedy writing exercises for a couple hours, then I went in to the office gym and worked out. I felt amazing and, 66 hours fasted, set a new personal best for weighted pull-ups. This improvement in pull-ups was very unexpected. The thing I was most worried about with the prolonged fast was breakdown of muscle mass. After my lifting workout of pull-ups, machine rows, rear delt pulls, and barbell upright rows, I went to work. During the work day, I wrote in my phone notes: "10/31 continue to feel terrific, so much mental clarity, elevated mood. It's amazing how much energy the body must use to digest food based on the increased clarity I feel." Seriously, I felt amazing. Even compared to my baseline, which I tend to think is pretty good/energetic.

I talked to my mom on the phone Tuesday evening. And then I talked to my wife on the phone while waiting for trick-or-treaters to come. No trick-or-treaters came, and that's probably just as well (they would have been disappointed coming to the lame house handing out toys instead of candy).

I don't remember if I did 100 burpees after my morning lifting workout or after getting home. Probably after I got home. Anyway, I did them. Also, I weighed myself at 7 PM: 204.5 pounds

Just like the day before, I experienced very little hunger all day. Occasionally I would get slightly hungry but it quickly passed.

I went to bed around 9:00.

Thursday, November 1

Once again, I woke up really early (2:00 AM) and felt energized. More comedy writing exercises. I had a great time doing this. And I was excited-- I was preparing to do open mic stand-up that night (for just the second time in my life).

Then, around 6 or 6:30 AM, it was time to hit the gym. Time for some hex bar deadlifts, 90 hours fasted. Two quick warm-up sets, then one set of trying to pull 365 pounds as many times as I could. I got 12 reps that day, basically in line with where I was when I last did that workout five days earlier. Afterwards, I tried to test out my vertical jump (my legs typically feel springy after hex bar deadlift), and I was an inch or two below my typical jump. That made sense, as my legs did feel a bit fatigued; some combination of no food and low sleep was likely the cause. But I felt terrific overall.

Then, it was time to shower up and head to another day at the office. At the start of the work day, I had my strongest hunger signals of the week. My body was craving food, especially for about the first hour after working out. But. . . even then, it passed. Throughout the work day, I took notes in my phone saying things like "Fasting is the truth" and "Felt chipper as fudge all week" (only I didn't say fudge). So. . . I was feeling goooooood.

After work, 100 hours fasted, I did 100 burpees.

Then, I prepared a little more for doing open mic comedy. . . I went up at about 9:30 PM (105 hours fasted) and did five minutes of stand-up. Compared to my first time doing it about two months earlier, it went really well. I had a great time; I got some decent laughs from a way-too-friendly crowd. Don't worry, I still bombed on some of my punchlines. I'm just glad my fast wasn't broken by crowd members launching tomatoes at me. Anyway, I was really, really excited about how well it went. It capped off a great day. I got home and went to bed around 11 PM.

Friday, November 2

Up at 3 AM: 204.5 pounds. More comedy writing exercises. I was still amped from my positive experience the night before. Around 5:30 AM, time for the gym. Farmers walks, kettlebell swings, and burpees. I did fail a few steps early on my final set of farmers walks, so maybe I was losing a bit of physical strength by this point. But anyway, I got the workout in. Then I went to work, had a normal work day until lunch time, at which point it was my turn to help on my company's Meals on Wheels delivery route. We finished the route at about 12:30, basically the exact 5-day mark of the fast. I drove towards my house, grabbed some food from the grocery store, and went home to cook it.

Friday I never got as hungry as I was on Thursday after my morning workout, but I definitely felt hungry from time to time and I was looking forward to eating. I was so excited to chow down that I forgot to weigh myself one final time. Plus, I had to quickly get my lamb chops cooked to avoid cast iron sizzling being a distraction on a 1:30 PM conference call. You know, work responsibilities and stuff.

Yum. The lamb chops (and a couple cans of sardines) were delightful. They tasted great, they didn't interrupt the work call, and the fast was complete.

I ended up eating a lot that night. I didn't think to weigh myself until the next morning (after probably eating about 5000 calories since breaking the fast and after an hour or so of open gym basketball Saturday morning): 205 pounds.

A Few More Notes to Recap

Even compared to baseline, I just felt so alive and in-the-moment that week. My mood was very elevated. It was a very memorable week. To my knowledge, no one I talked to even knew I was even fasting except for a few friends at work who I talked to about it (and my friend who I hung out and talked about it with that Monday). I think my performance at work and my social interactions were at least as good as normal, probably better.

I talk about these types of energy, mental clarity, and body-feel-good benefits from my typical way of eating (largely carnivorous, ketogenic, Paleo-ish, low-carb, low-omega-6, intermittent fasting) a lot and I believe they are real. But I'll be damned if there wasn't a marked difference going from that to how I felt during the fast.

I found the weight changes interesting, as it goes to show how weight on a scale isn't always that meaningful. It fluctuates a lot. Despite eating 0 calories between 10:30 PM Monday and 3 AM Friday, I gained 1.5 pounds. A lot of this likely has to do with hydration, sodium intake, and water retention.

I did my first 24-hour fast about a year prior to this 5-day fast. That experience (and the resulting mood elevation, lessening of joint inflammation, etc.) was one of the key moments that made the power of nutrition feel real to me. It shaped how I thought about food and and it helped get me interested in learning more and more and more about health and nutrition. I now know I have a lot more to learn, but this five-day experience was another incredibly powerful experience for me. All of my experiences fasting: from starting out with 12-hour eating windows, to 1-day, to 3-day, to 5-day fasts. . . have been very good for building self-confidence and self-discipline. Being able to control my intake of food made me feel like I could establish self-control in other areas of my life as well. (Somehow, it helps build self-control despite the fact that the self-discipline didn't feel difficult once I decided to fast because the fasting felt so good.)

Admittedly this experience was better than my previous three-day fasting experience (which I also found overwhelmingly positive). During my three-day fast (about six months prior), I got pretty antsy waiting for the fast to end; I went to bed early the last night so I could fall asleep and then wake up and eat a steak-and-eggs breakfast. Plus I got diarrhea during the 3-day fast but not during this 5-day one. This time, I had no intense desire to rush to break the fast and no diarrhea.

With that, I'm done writing about diarrhea. Anyway, fasting was fun. Do you have comments? Questions? Do you have any experiences with fasting? Let me know in the comments section. Thanks for reading.

Note 1: Despite my positive experience and reflections, I am not encouraging anyone to try any kind of prolonged fasting without proper medical supervision. Especially if taking any medications and/or if one struggles with disordered eating. Not everyone is metabolically ready for fasting; it is not risk-free.

Note 2: I record my weight throughout this week because I found the fluctuations to be interesting, not because I had a goal to lose weight. I did this to see what it would be like, to build up a little self-discipline, and to potentially kick off some healthful regenerative processes in my body; I had no desire to lose weight (although I knew that some weight loss would occur).