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This is a forum copy of the transcript for the video at: Advanced Topics library: Preventing Cognitive Decline & Dementia: Nutrition Factors That page also has an extended narrative, not repeated here.
For why this is here, see this revised Reply in an earlier transcript thread.
Transcript:
The Undoctored approach to diet, to prevent cognitive decline, is going to follow much of the rest of the program. That is, we follow the Undoctored lifestyle to reverse, or minimize risk for Type II diabetes, and obesity, and heart disease, and autoimmune diseases, and hundreds of other conditions. I think, it should be the same, therefor, to prevent cognitive decline.
You’re going to encounter resistance, perhaps from your primary care doctor, other doctors, dietitians, because they still believe that a low-fat, low-saturated-fat lifestyle is the key. They were misled by the initial reports that a higher total cholesterol is associated with higher risk for dementia. What they failed to recognize is that higher cholesterol is also associated with the ApoE4 gene, and the ApoE4 gene, that generates a higher cholesterol, is a very substantial risk factor for dementia.
So the low-fat diet trials that have been conducted have shown no improvement in cognition — no protection from dementia. And likewise, the statin drug trials, the prospective clinical trials (3 of them) that used high doses of statin drugs to reduce cholesterol, had no impact, at all, on cognitive function, nor on preventing dementia. So I think it’s pretty clear: the low-fat, cut-your-fat, or even take statin drugs for prevention is dead.
If there is some confusion about diet, it’s the Mediterranean Diet. There have been some observational studies that suggested that a Mediterranean lifestyle might be beneficial, but there’s finally a prospective treatment trial (the best kind of data we can get), called the Predimed trial, in which several thousand people engage in a Mediterranean-like diet (that is: more fish, more whole foods, vegetables, nuts, and lots of olive oil). In this case, in the Predimed trial, these people were asked to drink an extra liter (about a quart) of extra virgin olive oil per week, along with a handful of nuts per day.
There was indeed a modest reduction in dementia over several years, compared to a low-fat diet. But as we often have to remind ourselves in the Undoctored lifestyle program, if one lifestyle factor is less harmful than another, it doesn’t necessarily mean it is the ideal solution. All we can say from the Predimed data is that a Mediterranean lifestyle, augmented with olive oil and nuts, is better than a low-fat diet. It doesn’t necessarily mean it’s the ideal diet. It might be the ideal diet, but I don’t think it is, but it’s at least better than the low-fat diet. It gives you another reason why the low-fat diet is clearly dead.
Cutting carbohydrates is much more relevant. The data on cutting carbohydrates is much more relevant to the Undoctored lifestyle, because it was originally thought that cutting carbohydrates would impair cognition, brain health, because many people believe that sugars and carbohydrates were essential for brain function. Well, that’s been disproven time and time again. If you cut carbohydrates; if you compare a low carbohydrate diet with a low-fat diet, there is no impairment of cognition, and there is no excess risk for dementia or cognitive decline. That’s settled. You do not need carbohydrates for brain function. That’s clear.
We’re also new starting to see clinical trials examining ultra-low-carb or ketogenic diets. That’s where we’re starting to see actual improvements in cognition. We only have two small clinical trials so far, in which carbohydrates were slashed to very low levels. Compared to low-fat diets, there is indeed an improvement in cognitive measures between 6 to 12 weeks. We don’t have any data showing any kind of imaging of the brain that’s improved. That’s not been done yet. But we have two small trials that have demonstrated improved cognition with a ketogenic-type lifestyle.
We’re also seeing new data coming out showing that anything that raises blood beta-hydroxybutyrate (that is ketones) improves cognition, both in people with mild cognitive impairment and in early dementia. So it appears that people who increase their blood levels of ketones have better mentation; have better cognition, and are protected from dementia.
I believe that in the Undoctored approach, the best solution is that last one, that is to slash carbs dramatically. We don’t have to be ketotic of course, because recall that being ketotic all the time, 365 days per year, may not be a good idea, because of some undesirable developments with long-term ketosis. But being intermittently ketotic I think is a good idea.
Certainly supplementing with MCTs (medium chain triglycerides) increase your blood levels of beta-hydroxybutyrate, is a good idea. There’s some detailed further in our written discussion [below the video on the Advanced Topics page] on our dietary approach to preserving cognitive health in the Undoctored program.