Wednesday, August 15, 2018

Instant Pot Baby Zucchini With Mushrooms And Bell Peppers On Banza Pasta

Zucchini makes a great topping for Banza Pasta!

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Two Birds with One Stone!
Our new strict gluten-free diet often leaves us wanting for pasta and Banza Pasta fits the bill. Also, having a easy and delicious recipe to use our abundance of summer zucchini comes in quite handy! 

As we are eating for brain health, besides avoiding gluten, we want to lower our carbs. Banza, made mostly from garbanzo beans, has way less carbs and much more fiber and protein than regular pasta.

Cooking Zucchini in an Instant Pot
Cooking zucchini in an Instant Pot can be tricky. If you don't release the pressure and uncover immediately, the zucchini can turn to mush. The trick with these delicate vegetables is to use LOW PRESSURE and only cook for ONE MINUTE! (For other vegetables, see Cooking Vegetables in your Instant Pot.)

Pick or purchase small zucchini so that you can cut them into small circles. The integrity of the circles will also keep the zucchini from overcooking.

I know some of you cook your pasta in the Instant Pot, but I do not recommend doing that with Banza or other bean pastas. Bean pasta needs lots of water and will foam up a lot during cooking. Without sufficient water, it will get gluey.

         *                     *                        *                        *

Instant Pot Zucchini with Mushrooms and Bell Peppers
Vegan, Gluten and Dairy Free
[makes 6 servings]

Large soup pot for the pasta
Instant Pot for the zucchini 

Salt for the pasta water
1 tablespoon avocado oil
1/2 small onion, diced
1 red bell pepper, diced or thinly sliced
4 cloves garlic, sliced
8 ounces crimini mushrooms, sliced
2 pounds small zucchini, sliced in 1/2 inch rounds
1/2 cup fresh basil, chopped
1/2 teaspoon salt
1/4 teaspoon black pepper
1/8 teaspoon red pepper flakes
2 ounces of Banza rotini per person*

* One box will make 4 servings. This recipe will make enough zucchini for 6 servings. I don't recommend making more pasta than what you will consume as it doesn't keep well. So if you are cooking for two, make 1/2 the box and save the rest of the zucchini for another night. It also makes a great side dish. One box of Banza is enough for 4 (2-ounce) servings.

Start boiling water in a large soup pot on the stove for the pasta. Salt the water according to the directions on the Banza box.

Press the SAUTE button on your Instant Pot. Heat the oil and then add the onion, bell pepper, garlic and mushrooms. Cook until they soften, about 3 minutes. Press the OFF button.

Stir in the zucchini, basil, salt, pepper, and red pepper flakes. Secure the lid and set the Instant Pot for 1 minute at LOW PRESSURE.

While the zucchini is cooking, cook the pasta according to the directions on the box. It takes about 7 minutes but test it at 6. Use a big pot as it foams up quite a bit. Scoop off the foam with a spoon and discard. When done, drain and set aside.

When the zucchini is done, IMMEDIATELY release the pressure. Carefully remove the cover so that the water on the lid doesn't dump back into the pot. Discard the water on the lid.

Stir the zucchini and test with a fork. (If it's not done, just place the cover back on the pot for another minute but don't turn it back on.)

Remove the inner pot from the Instant Pot and place on the counter to keep the zucchini from over cooking. 

Divide the pasta into individual bowls and spoon the zucchini mixture over the pasta and serve.

Save left over zucchini for another night. It makes a great side dish.

Tuesday, August 07, 2018

The Prevention And Reversal Of Alzheimer's
Making Sense Of Bredesen's ReCODE and Sherzai's NEURO Protocols

My take on these two approaches to Alzheimer's prevention.

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Fear of Alzheimer's 
Did you just take the ApoE test and find out that you have one or more ApoE4 gene? Or maybe you're too afraid to take the test but someone in your immediate family is suffering or lost their lives from this disease. Or are you or a loved one losing your short term memory, forgetting names, struggling to remember a word, have difficulty putting together a sentence or repeating stories over and over. Some of this is normal as we age but it could also be the beginning of cognitive decline and, ultimately, Alzheimer's Disease (AD.) 

My last post described the overall risks of getting AD depending on what ApoE genes your have. Unfortunately we discovered that my husband Doug had two ApoE4 genes, putting him in the highest risk category. Knowing that, I've been in full research mode. Before I get into what I have learned and how we are going to tackle this challenge, let me define epigenetics - because it will give us all hope!

Our genes contain the instructions of how we carry out our life functions. Epigenetics controls how the cells read these instructions and whether certain genes will become active or silenced. Epigenetics is a combination of your lifestyle and your environment which can turn these genes on or off throughout your lifetime. For example - your diet, toxins that you are exposed to, how much you exercise or sleep, your hormone levels, whether or not you are getting the proper nutrients, your level of stress - all these things can determine whether the bad genes you inherit will manifest themselves into disease.

So people who inherit genes that increase their risk to get breast cancer, cardiovascular disease, and Alzheimer's have a good chance of silencing those genes by having a healthy lifestyle. On the other hand, those who inherit good genes can get all these diseases by living an unhealthy lifestyle. 

Other Risk Factors
According to the Alzheimer's Society of Canada, there are seven key modifiable, non-genetic, risk factors that account for up to half the cases of Alzheimer's disease worldwide. They are called modifiable because they are conditions that are within a person's control to change. These are:
* Poorly controlled type 2 diabetes
* High blood pressure
* Obesity
* Smoking
* Depression
* Cognitive inactivity or low education
* Physical inactivity

Reversing or Preventing Cognitive Decline
The medical community calls Alzheimer's the only leading cause of death that cannot be prevented or cured. But thankfully there are doctors who do not believe this and, in their practices, have demonstrated that cognitive decline can be reversed and Alzheimer's can be prevented, whether it be from having the ApoE4 genes or the risk factors listed above.

I studied Dr. Bredesen's book, The End of Alzheimer's, and Doug and I attended an all-day seminar by Dr. Ann Hathaway that took us into the details of his protocol. I also studied Dr.'s Dean and Ayesha Sherzai's book, The Alzheimer's Solution. I also will be referring to The Mind Diet, created by Martha Clare Morris, PhD, a nutritional epidemiologist, that is designed for brain health. In addition, I studied countless technical articles and other books, such as Dr. Permutter's The Grain Brain Whole Life Plan and Dan Buettner's Blue Zones, Lessons for Living Longer from People Who've Lived the Longest. Let's get started putting this all together!

Things They Agree On and Things They Don't
There's pretty universal agreement on the need for exercise, sleep, stress reduction, mental stimulation, good nutrition, and living a meaningful life - and not just one of these things but all of them. But whereas Dr. Bredesen's protocol relies heavily on nutritional supplementation, the Sherzais' protocol does not. And while a good diet is the cornerstone of any disease prevention program, the dietary recommendations of the various protocols, as well as the MIND diet, are quite different in certain aspects. I will cover them in detail and tell you what we have decided to do in our household.

 *   *   *   EXERCISE   *   *   *  
All the experts agree exercise and not being sedentary is key for avoiding cognitive decline as well as many other diseases and it's one of the most important things you can do for your brain. Sitting is the new smoking. Sitting at a desk all day, even after going to the gym in the morning, will wipe out much of the benefit from your workout. Prolonged periods of sitting is tied to brain atrophy as well as increased death by any cause. Yes, while you are sitting and watching TV, your brain is actually shrinking!

Exercise will get your blood flowing which will get oxygen and nutrients to the brain. It decreases blood sugar levels and insulin resistance. It also raises BDNF (brain derived neurotrophic factor) which maintains the neurons in the brain and the dendrites and synapses between them. 

Here's an exercise regimen for optimal brain as well as cardiovascular and general health.
* Set up a program of stretching, regular aerobic exercise, strength training, and balance training that are convenient for you and that you enjoy. We are fortunate enough to have the space in our home to set up some gym equipment. And it's all pointing to the TV so we can watch our programs while working out. There's nothing like walking past gym equipment to guilt you into working out!

* Do some stretching each day. Here are some stretches I found helpful. 

* Shoot for 30 minutes of aerobic exercise 5 times a week. A stroll around the block isn't aerobic. You should be a little out of breath and have a bit of difficulty having a conversation. Examples are brisk walking, swimming, bicycling (stationary or outdoor), elliptical, dancing, walking up hills, jogging, hiking, tennis, pickle ball (my personal favorite), basketball, etc. 

(High intensity Interval Training is really good. Warm up, then go 1-2 minutes as hard and fast as possible, then slow down and recover, then go again as fast as you can. Do this for the duration of your workout.)

* Twice a week or more, do strength and resistance training. Lift weights, do squats, planks and other exercises to strengthen your core, push ups, abdominal crunches, squats, etc.

* Balance is really important, especially when you get older, as many people fall and break hips and more. If you enjoy yoga, or Tai Chi, sign up for a class. To start improving your balance, just stand on one foot while watching TV or try a heel-to-toe-walk.

(Heel-to-toe-walk: place the heel of your foot in front of the toes of your other foot; both feet should be touching. Walk in a straight line while focusing on the point ahead of you - don't look at your feet.)

* Move, move, move. Don't sit for extended periods of time - sitting kills! Every 30 to 60 minutes, get up and move for 5 minutes (set a timer.) Try a standing desk or sit on a big ball instead of a chair. If you're in a meeting, stand up and stretch. If you are at work and have a question for a colleague, instead of picking up the phone, walk to their office. Just get off that chair. 

Luckily Doug and I left our high stress corporate jobs and have been farming wine grapes, fruits, vegetables, and herbs for the last ten years. Doug does a lot of work in the vineyard and is moving constantly. I am certain that has helped him avoid any cognitive decline, even with his double ApoE4 and years of heading a soccer ball. Of course he's only 59 so he has to keep up the good work!

Doug and I have dedicated a room for the gym equipment we have collected throughout the years. And it faces the TV !

 *   *   *   SLEEP   *   *   *  
Another topic that the experts agree on is sleep. To prevent cognitive decline, 7 to 8 hours of high quality sleep is required. Here's why:

* During deep sleep, the brain removes toxins and other debris from the brain, including the amyloid associated with Alzheimer's. Picture the janitor sweeping the offices at night. If they had their hours cut short, the offices would get dusty and the garbage cans would overflow. That's what happens to your brain without enough sleep.

* Sleep is when memories are consolidated and learning happens. So if you are studying for an exam, it's better to sleep than to stay up all night studying. I remember when I was in engineering school, I worked on a statics and dynamics problem for hours and just couldn't solve it. I went to sleep and when I woke up, I had the answer worked out to two decimal points!

* It's when our brain cells accomplish "autophagy" or "self eating" and recycles damaged cellular components. 

* Sleep is when BDNF (brain-derived neurotrophic factor) repairs the brain - neurons actually regenerate during sleep. 

People who are chronically sleep deprived are generally chronically ill. Unfortunately sleep medications, such as Ambien, Valium, Benedryl, and others can increase your risk for cognitive decline, cause daytime sedation, and can increase your risk of falls.

Here are a dozen tips on getting a good night's sleep from the book, Why We Sleep, by Matthew Walker:
1. Stick to a sleep schedule - go to bed and wake up at the same time each day, even on the weekends.

2. Don't exercise too late in the day - not later than 2 to 3 hours before bedtime.

3. Avoid caffeine and nicotine. Drinking coffee late in the day can disturb your sleep as it could take 8 hours to wear off.

4. Avoid alcohol before bed. It may help put you to sleep but it may rob you of your REM sleep and may impair your breathing.

5. Avoid eating before bed (part of the Bredesen Protocol that we will discuss later has you fasting 3 hours before bedtime.)

6. Avoid medicines that delay or disrupt your sleep (i.e. some allergy medications, etc.)

7. Don't take naps after 3:00 PM.

8. Relax before bed. Read or listen to music and give yourself time to unwind.

9. Take a hot bath before bed.

10. Keep your bedroom dark, cool, and gadget-free. Keep the clock out of site. Get a comfortable bed and pillow.

11. Have the right sunlight exposure. Daylight is very important in regulating sleep patterns. Get at least 30 to 60 minutes a day of natural sunlight, preferable in the morning.

12. Don't lie in bed awake anxious because you can't sleep. Get up and do something relaxing until you feel sleepy.

Besides the above recommendations from Walker's book, I also learned that taking vitamin D at night could disturb your sleep so if you are supplementing with vitamin D, take it in the morning. It is inversely related to the sleep hormone, melatonin, so it can disrupt your sleep if taken at night.

If you think you may have sleep apnea, get treated immediately as it may lead to cognitive decline. Weight loss is often effective. Using a CPAP machine (continuous positive airway pressure) or a dental device that moves your lower jaw slightly forward to open your airway can help. See your doctor for other ways of treating this serious and sometimes fatal condition. 

Other ways to address insomnia include Indica strains of cannabis, bright light therapy, and melatonin. With melatonin, sometime less is more. Start with a 300 microgram dose. You can go up to about 5 milligrams or more if needed. Always use a time-released formula. (Warning: Melatonin can cause short-term depression in some people. It does that to me.)

 *   *   *   STRESS   *   *   *
Chronic stress is our body's physical and mental response to long-term emotional pressure. Depending on how we handle chronic stress, it can do a great deal of damage, especially to the brain. When under this type of unrelenting stress, cortisol levels rise, blood glucose levels spike which may lead to insulin resistance.

According to Drs. Sherzai, prolonged and uncontrolled stress could cause:
* Anxiety and depression - both of which are risk factors for Alzheimer's.

* Impaired immune function - which can mean a build up of metabolic by-products in the brain. 

* Increased inflammation in neural tissue.

* Impairment of neuron growth in the frontal lobe, a brain region that controls concentration, attention, decision making, judgement, and memory formation.

* Increased oxidative by-products that can significantly damage brain cells and tissues.

* Shrinking of the brain which leads to impaired hippocampus-dependent memory.

* Increased beta-amyloid, a contributing factor for Alzheimer's.

* Altered gene expression.

* Weight gain - a risk factor for heart disease, cancer, and dementia.

* Increased heart rate and blood pressure - both vascular risk factors that promote cognitive decline. 

* Disrupting healthy lifestyle behaviors. Stress can cause you to make poor dietary choices, smoke, take drugs, or drink in excess - all things that can negatively effect the brain.

Handling stress is tough. It's easy to say, "unwind, relax ..." but it's another to really learn to do it. I personally am terribly at this - so is Doug. We are on high speed from the minute we wake up until we drop in bed. Our decades in our high stress tech jobs probably destroyed most of our brain cells. Luckily, our new life is much less stressful and hopefully most of those cells grew back. 

Here's what the experts recommend to improve your ability to deal with chronic stress:
* Practice meditation. There are many types of meditation so you may have to search to find one that is right for you. I personally cannot sit still for more than a minute so I gravitate toward meditative practices that involve movement like Qijong.

* Learn breathing exercises. Dr. Weil has some good methods for this.

* Do yoga or Tai Chi.

* Regular exercise is a great way to increase the body's ability to deal with stress. I find Zumba a better stress relief than yoga.

* Get in touch with nature. Walk in the woods or along the ocean if you have access to that. Nothing beats the silence of the woods or the sound of the ocean to melt away stress.

* Listen to music or play a musical instrument.

* Take steps to simplify your life. 

* Avoid things that stress you out. I recently gave up listening to the news.

* Avoid people and relationships that stress you out.

* Unplug and spend some quiet time away from your gadgets.

* Develop a hobby you love.

* Most of all, MAKE TIME TO DO THIS!

We are trying this product called Inner Balance by HeartMath. We just got it last week so I can't report on how well it works. But basically it's a little gadget that hooks onto your ear and provides visual feedback that let's you see your level of frustration vs. appreciation. The company claims that this little gadget will:
* Increase focus 24%
* Increase sleep 30%
* Increase calmness 38%
* Decrease anxiety 46%
* Decrease fatigue 48%
* Decrease depression 56%

If it can do anyone of these things, I will be pleased and amazed. I will have to keep you posted. 

 *   *   *   DIET   *   *   *
Here's where the experts have somewhat different approaches to prevent Alzheimer's and cognitive decline - although they all stress plant-based diets and the limitation of meat consumption. Let me present all of them to you . In some areas they are so different your head might explode, but I have evaluated them all and I'll give you my thoughts afterwards.

#1 - Dr. Bredesen's Ketoflex 12/3 Diet
This diet recommendation is from Dr. Bredesen's book, The End of Alzheimer's.  It was explained further by Dr. Ann Hathaway at her seminar on cognitive decline that we attended.

The Ketoflex protocol is based on a "ketogenic" diet and intermittent fasting. A ketogenic diet involves significantly reducing your carbohydrate intake and getting more calories from good fats. This puts your body in a metabolic state called ketosis where it starts breaking down fat to use as energy instead of carbohydrates. The premise is that the brain prefers ketones over glucose for its fuel as they are more efficient and produce fewer free radicals. 

Dr. Bredesen's ketoflex diet includes:
* A 12/3 fast (eat 3 hours before going to bed and fast for at least 12 hours from dinner to breakfast)

* Minimizing refined carbohydrates 
Avoid sugar, candy, cookies, muffins, cakes, all bread, pasta, white potatoes, grains, soft drinks (even diet ones, as they disrupt your microbiome), fruit juices, processed foods, and high fructose corn syrup.) You can eat sweet potatoes and other colored potatoes in moderation. Pure organic stevia is ok (i.e. SweetLeaf). Alcohol is a neurotoxin and should be limited to a few ounces of dry red wine with or after a meal. Those who are ApoE4 carriers do poorly with any amount of alcohol (Doug is both ApoE4 and a wine maker which turns out not to be a very good combination!)

* Eating Whole Food, Mostly Plant-Based
The majority of the diet should be made up of non-starchy vegetables with some small amount of starchy vegetables. Vegetables should be non-GMO and organic when possible, especially those on EWG's dirty dozen list. Best plants to eat are leafy greens, cruciferous vegetables, mushrooms, herbs and spices, those high in fiber. (Those with hypothyroid should always cook their cruciferous vegetables to lessen the goitrogens that suppress thyroid function.)

Whole fruits should be consumed at the end of a meal. The best fruits are wild berries, lemons, limes, tomatoes, olives and avocados. Avoid or limit tropical fruits with high glycemic indices. Avocados are the best and should be eaten at every meal.

* Eating Nuts and Seeds
Unless you are trying to gain weight, limit to a few handfuls or ounces daily. Walnuts, macadamia nuts, pistachios, pecans, almonds, brazil nuts, pine nuts, cacao, and seeds of flax, hemp, chia, sunflower, pumpkin, sesame, and quinoa are good options.

* Eating Legumes
An excellent source of protein, especially for vegetarians and vegans who are going to have a hard time on this mostly grain-free diet. To remove phytates, etc., legumes should be soaked overnight and cooked with kombu. 

* Increase Good Fats
Without grains and starchy vegetables, good fats become a key source of calories. Examples of recommended fats are:
EVOO, avocados and avocado oil, coconut, coconut oil (not recommended for ApoE4), MCT oil (only occasionally to initiate ketosis), walnut oil, macadamia oil, nuts, seeds, sesame oil, algae oil, cod liver oil, grass fed butter, ghee, cacao butter, pasture-raised organic egg yolks

* Avoid Bad Fats
Avoid all seed, grain and bean oils such as soy, corn, canola, peanut, sunflower, safflower, cottonseed, and palm kernel. Avoid all trans fat processed foods.

* Minimize proteins
Use animal protein sparingly, as a condiment and not as a main course. Vegetarians and vegans can get sufficient protein from vegetables, nuts, seeds, tempeh, and beans but may be deficient in omega-3, vitamin B12, vitamin D, and choline - all critical for brain health. 

DHA omega-3 is especially critical to reverse cognitive decline as it is one of the most important fats for the brain. DHA helps promotes new brain cells and protects existing ones. Wild-caught SMASH fish (Salmon, Mackerel, Anchovies, Sardines, and Herring) are a great source of DHA and are low in mercury.  Avoid high mercury fish such as tuna, swordfish, and shark. 

Eggs are an excellent source of choline, critical to the development of the neurotransmitter that is responsible for memory. Always select organic, pasture-raised eggs.

* Avoid Inflammatory Foods
Avoid grains and dairy as much as possible as they can be inflammatory and can create "leaky gut." Chronic inflammation can trigger autoimmune and neurological disorders. A1 cows in the U.S. produce an inflammatory protein while A2 cows, sheep, and goats do not. ApoE4's should avoid all dairy of any kind. Organic bone broth can help heal leaky gut. 

* Eat Probiotics and Prebiotics
Probiotic and prebiotic foods help optimize your microbiome. The brain and the gut are intricately connected so feeding your microbiome has enormous consequences and benefits. 

* An Example Ketogenic Breakfast
 - 4 to 5 cups of organic, non-starchy vegetables
 - Sweet potato wedges
 - 2 pasture raised, organic eggs lightly cooked to preserve choline
 - Fermented vegetables
 - Bone broth 

* An Example Lunch or Dinner
 - 5 or more cups of organic, non-starchy, lightly cooked or raw vegetables
 - A small serving of wild caught Alaskan salmon
 - Liberal use of good fats like avocados, olives, nuts, seeds, and EVOO

#2  -  Dr's. Sherzai's NEURO PROTOCOL
These diet recommendations are part of the NEURO protocol that is from their book, The Alzheimer's solution. Their predominantly vegan diet differs from the Bredesen protocol in that it promotes a high consumption of grain, allows sweet fruit, discourages the consumption of eggs, dairy, and meat, and is non-ketogenic.

Foods that are Beneficial on NEURO PROTOCOL
* Fresh and frozen vegetables of all kinds

* Mushrooms: portobello, shiitake, cremini, and oyster

* Whole grains: quinoa, brown rice, barely, rolled oats, wheat berries, bulgur, barley, 100% whole wheat bread and tortillas, whole-grain pasta from brown rice, quinoa and whole wheat

* Sea vegetables

* Fruits: Avocados, all berries, lemons, limes, papaya, watermelon, peaches, nectarines, apples, plums, oranges, kiwi, pears, pineapple, grapes, bananas, mangoes.

* Nuts: Almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pistachios, walnuts

* Seeds: Flax, chia, sunflower, pumpkin

* Beans and lentils: Black beans, black-eyed peas, kidney, navy, cannellini, chick peas and lentils

* Plant protein: Tofu (organic, sprouted), seitan, tempeh

* Oil, in small amounts: Avocado, canola, grapeseed, olive, safflower, and sunflower

* Nut milks (almond, cashew, hemp, oat, rice and soy), coffee, green and herbal tea

* Spices: Turmeric, cloves, Ceylon cinnamon, coriander, black pepper, saffron, cumin, ginger, mustard, allspice, curry

* Plant sweeteners: Date sugar, erythritol, stevia

Foods to Eliminate on the NEURO PROTOCOL
* Sweets: sugar, syrups, all soda, juices, ice cream

* Processed junk foods

* Sugary cereals

* Cookies, cakes, cereal bars, baked and packaged goods

* Chips, crackers, and other salty snacks, buttery popcorn

* Any bread products that aren't 100% whole grain

* All dairy and eggs

* Meats, processed meats, and poultry: Fish, especially those high in omega 3, is a better choice of animal protein. Select wild salmon, mackerel, anchovies, sardines, and herring. But they prefer you get your protein from beans, tofu, tempeh, or seitan.

* Alcohol: They prefer you eliminate completely but 2 glasses per week is probably ok.

* Tropical oils like coconut and palm should be replaced with evoo, safflower, or sunflower.

This diet was developed by nutritional epidemiologist Martha Clare Morris and her colleagues at Rush University Medical Center. It borrows concepts from the Mediterranean diet and the DASH diet (a diet to address hypertension) to create a food regimen with brain-boosting benefits that promotes cognitive health. 

What Foods to Eat on the MIND DIET
* Green leafy vegetables: 5 servings a week minimum

* Nuts: 5 servings a week

* Berries: 2 servings a week minimum

* Beans: 3 servings a week minimum

* Whole Grains: 3 servings a day

* Fish: 1 serving a week minimum

* Poultry (chicken or turkey): 2 servings a week minimum

* Olive oil as the primary oil used

* Wine: 1 glass a day maximum

What Foods to Limit on the MIND DIET
* Red meat: no more than 4 servings a week

* Butter and margarine: no more than 1 tablespoon daily

* Cheese: no more than 1 serving a week

* Sweets: no more than 5 servings a week

* Fried or fast food: no more than 1 serving a week

Dr. Bredesen's Ketoflex diet is an extremely difficult diet to implement, especially for vegetarians and vegans who depend on grains as a mainstay of their diet.

What I like about the Ketoflex diet is the 3/12 fasting. We've been doing that for several months now and it has kept us from snacking before bed, has improved my sleep, and is quite easy to do. It's extremely beneficial for the body to take a break from digestion and for the brain to form memories and clean up toxins. ApoE4's should extend the fast to 14 hours or more.

With respect to the actual Ketoflex diet, I've never been a fan of ketogenic diets. I tried going Paleo for about a week and it just didn't agree with me. The extremely high fat content and almost complete avoidance of grains and starchy vegetables was nearly impossible. That said, I agree that grains should be minimized and gluten-containing grains should be completely avoided. I also agree that we need lots of really good fats but not to the extent used in this diet. 

This diet might be appropriate for those who already are in cognitive decline and need to do something drastic. Feeding the brain ketones might be what is needed to reverse cognitive decline and prevent it from progressing into Alzheimer's. But people who do not have one or two ApoE4 genes or any other significant risk factors, can do a lot to prevent cognitive decline without this drastic a protocol.
In addition, the Ketoflex diet can cause severe weight loss.

Drs. Sherzai's NEURO diet recommendations are very good for the most part - especially for those who want to or are able to follow a vegan diet although it will require supplementation of several key nutrients (I will discuss later.) They don't rule out the addition of some animal products, like the low mercury SMASH fish, but they do encourage a completely plant-based diet. 

I disagree with their recommendation to consume wheat and other gluten-containing grains and foods, such as seitan. I also completely disagree with their recommendation to use omega-6 oils such as safflower and sunflower oils as they create a suboptimal omega-3 to omega-6 balance. I would also avoid canola (it's usually GMO). 

Although I agree that eliminating dairy is a good thing, I don't agree that good pasture raised organic eggs should be eliminated since they are an excellent source of choline, critical for brain health.  

The Mind Diet is a good start. I especially agree with its focus on green leafy vegetables, berries, beans, nuts, EVOO. I'm happy (as an Italian living on a vineyard, not necessarily as a nutritionist) that they allow a glass of wine each day. Their inclusion of healthy fish and poultry makes this diet easy for most to follow. 

Where I disagree is their recommendation of 3 servings of whole grains per day with no mention of avoiding gluten. For Alzheimer's prevention, I would not recommend gluten-containing grains and 3 servings a day of any grain may be a bit excessive and inflammatory.

I think the MIND diet is far too liberal by allowing a tablespoon of butter every day. Why would you need that much saturated fat when you could use EVOO? They also allow up to 4 servings of red meat a week and up to 5 servings of sweets per week. Red meat, if consumed at all, should be much more limited - maybe once a month. And then it should organic and grass fed. Sweets should be eliminated completely (ok, maybe have a piece of cake on your birthday.) You can include lots of healthy desserts or raw fruits so why allow for a sweet almost every day? And why even allow a single trip to a fast food restaurant?  

For the general public, the MIND diet is a vast improvement, even with its generous allowances, but it isn't strict enough to reverse cognitive decline and it certainly isn't enough for ApoE4 people or those with other risk factors to significantly reduce their risk of Alzheimer's.

We took the best ideas of the three diets and ended up with the following diet to prevent cognitive decline: (Note, this is not a ketogenic diet.) As we learn more or if Doug or I develop additional risk factors or begin to show signs of mild cognitive decline, we will modify.

What to Eat:
* Green Leafy Vegetables: Eat 1/2-cup cooked or 1 cup raw every day if possible, but at least 5 times a week..

* Other Vegetables: 5 to 7 servings each day: Mostly non-starchy but allowing sweet potatoes and some other colorful root vegetables.

* Fruits: Focus on berries and try to eat 1/2-cup serving every day but at a minimum, 3 times a week. Eat one other seasonal whole fruit daily if desired, but not fruit juices. Eat fruit after a meal to prevent rise in blood sugar. 

* Beans: One 1/2-cup serving each day, if possible, but at least 5 servings a week - especially if you are a vegetarian or vegan. Organic tofu is ok unless you are allergic to soy or have hypothryroidism as it contains goitrogens which suppress thyroid activity.

* Gluten-free Whole Grains: One to two (1/2-cup) servings per day: Quinoa, gluten-free oatmeal, and/or rice (GABA, haiga, or black forbidden rice). Millet is ok unless you have hypothyroidism - it contains goitrogens which suppress thyroid activity. 

* SMASH Fish (Wild caught salmon, mackerel, anchovies, sardines, and herring) and shellfish: Minimum of two 3-ounce servings per week. Vegetarians and vegans can substitute additional beans, nuts and seeds but must supplement with DHA, vitamin D, and B12.

* Poultry (chicken or turkey - optional): Organic, pasture raised, two 3-ounce servings per week. (Except for ApoE4's who should avoid all poultry.) Vegetarians and vegans can substitute additional beans, nuts and seeds but must supplement with vitamin B12. Pescatarians can substitute additional servings of SMASH fish and shellfish.

* Eggs: Organic, pasture raised, average of one per day, if you are not allergic.

* Good fats: Cook with organic avocado oil. Use organic extra virgin olive oil (EVOO) liberally on salads and vegetables. May use organic, pasture raised ghee on occasion (except for ApoE4's who should avoid all dairy.) Eat 1/2 to 1 avocado each day if desired.

* Nuts and seeds: Especially those high in omega-3 such as chia, flax, hemp seeds and walnuts. Include at least one handful daily.

* Mushrooms: Shiitake, lion's mane, maitake, crimini, oyster, and others. Eat freely.

* Sea vegetables: Enjoy seaweed salad but avoid those with food coloring. Add kombu to soups and use when cooking beans and grains. 

* Fermented vegetables: Enjoy every day - even a bit at every meal!

* Coffee, green, and herbal tea. Those with caffeine should be consumed early in the day.

* Wine: no more than a glass a day. Skip some days. If you don't currently drink, don't start.

* Spices: Use freely, especially turmeric, saffron, ginger.

* Dark chocolate: A daily piece of 72% cacao or higher.

* Sweeteners: stevia

What to Avoid:
* Sugar and sweets - read labels

* Dairy including milk, cheese, butter, ice cream

* Gluten

* Processed foods

* Junk foods and fast foods

* Fried foods

* Red meat more than once a month (must be organic, pasture raised)

* Omega-6 rich oils such as sunflower, corn, safflower and soybean oil

* Beer (contains gluten), hard alcohol

 *   *   *   SUPPLEMENTS   *    *    *
The MIND diet doesn't discuss supplements and the Sherzai's believe nutrition should come from food. The only supplements they recommend are vitamin B12 and omega-3 that are lacking in a vegan diet.

The Bredesen ReCODE protocol, on the other hand, recommends quite a few supplements. However, he recommends lab tests to determine the need for some of the supplements.  This is some of what he recommends but I strongly suggest you read the details in his book, or see a physician trained in the Bredesen protocol, before you take all these pills.

Dr. Bredesen recommends:
* Curcumin (or turmeric) - 1 g, twice per day, eat with good fats

* Ashwagandha - 500 mg, twice per day with meals

* Bacopa monnieri - 250-500 mg, twice per day with meals

* Gotu kola - 500 mg once or twice per day, for alertness and focus

* Magnesium threonate - 2 g per day, take at night

* Ubiquinol - 100 mg

* PQQ - 10 to 20 mg

* Resveratrol - 100 mg

* Nicotinamide riboside - 100 mg

* Omega-3 - 1 g of DHA and .5 to 1 g EPA

* Liposomal glutathione - 250 mg twice per day

* Probiotics and probiotics - If leaky gut, heal gut first

* Vitamin D and vitamin K2 (MK7) - Target D level of 50 - 80

* Mixed tocopherols and tocotrienols - 800 IU - Target vitamin E level of 12 - 20

* Bioidentical hormones - work with doctor to optimize thyroid, adrenal, and sex hormones.

If homocysteine is over 6 and if B12 is less than 500 take:
  * Methylcobalamin - 1 g per day
  * Methylfolate - 0.8 to 5 mg per day
  * P5P (pyridoxal 5-phosphate, the active form of vitamin B6) - 20 to 50 mg per day

If fasting insulin is greater than 4.5 or fasting glucose is greater than 90, or hemoglobin A1C is greater than 5.5., take:
  * Alpha-lipoic acid - 100 mg per day
  * N-acetylcysteine - 500 mg per day
  * 1/4 teaspoon per day cinnamon
  * Berberine - 300 to 500 mg, three times a day or metformin

If zinc is greater than 80 or copper:zinc ratio is greater than 1:3, take:
  * Zinc picolinate - 25 to 50 mg
  * Alpha-lipoic acid - 100 mg per day
  * N-acetylcysteine - 500 mg per day
  * P5P - 50 mg per day
  * Manganese - 15 mg per day
  * Vitamin C - 1 to 4 g per day

This is a LOT of supplements. If you or a loved one are already in mild cognitive decline or the beginning of Alzheimer's, you should get in touch with a doctor who has been trained in the Bredesen protocol and work with them.

After studying the Bredesen protocol and Doug's specific requirements as a homogeneous ApoE4, this is what Doug takes to prevent cognitive decline in addition to his normal daily supplements:
Carlson's Vitamin D - 4,000 IU each morning
MycoBotanicals Brain Mushrooms and Herb Capsules by Host Defense - 2 per day
* Vitamin B12 - methylcobalomine, sublingual, 1 g per day
* Life Extension Super Ubiquinol with PQQ - 100 mg per day
* Jarrow Citicoline CDP choline - 250 mg per day
* Thorne ResveraCel - 2 per day, contains nicotinamide riboside, quercetin, trans-resveratrol, and betaine anhydrous
* Carlson's Super DHA - 500 mg per day
* Thorne Meriva 500-SF -  2 per day for 1 g of curcumin
* Life Extension Super R-Lipoic Acid - 1 per day for 240 mg
* Pure Encapsulations Ashwagandha - 1 per day for 500 mg 
* Vitamin K2 as MK-7 - 1 per day
* Thorne Utlimate E, containing all forms of vitamin E - 1 per day
* Life Extension Neuro Mag, magnesium L- threonate - 3 before bed
* A good probiotic and prebiotic - find in the refrigerated section of your supermarket

In addition, we take CBD (cannabidiol) tincture that I make from the non psychoactive strain of cannabis called ACDC which has strong antioxidant and neuroprotective properties. As a neuroprotectant, it can protect again brain damage and promote neuron growth. 

Supplement regimen

 *   *   *   PILLS NOT TO TAKE   *   *   *
Besides taking supplements to help prevent cognitive decline, a number of pharmaceutical drugs can impair memory and should be avoided. Some of the most common are:
* Benzodiazepines taken for sleep or anxiety. These include drugs such as:
  - Ativan, Dalmane, Valium, Halcion, Klonopin, Midazolam, Librium, Paxipam, ProSom, Restoril, Xanax 

* Prescription sedatives like:
  - Ambien, Sonata, and Lunesta

* Anticholinergics block the neurotransmitter acetylcholine and is linked to an increased risk of Alzheimer's. These drugs include:
  - Benadryl
  - The PM versions of analgesics such as NyQuil PM, or Tylenol PM.
  - Muscle relaxants such as Flexaril
  - Motion medications like scopolamine
  - Tricyclic antidepressants such as Elavil and Pamela

* Cholesterol-lowering drugs not only lower cholesterol in the blood, but also in the brain. Cholesterol in the brain is needed in order to form connections between nerve cells needed for memory and learning.
  - Statins

* Narcotic painkillers increase the risk of memory loss.
  - Opioid analgesics such as fentanyl, oxycontin, oxtycodone, demorol, hydrocodone, morphine, percocet, codeine, methadone, dilaudid, oxymorphone

* Dopamine agonists used for Parkinson's can lead to memory loss,

* Antihypertensive drugs can interfere with chemical messengers in the brain
  - Beta-blockers

* Medications that effect your gut health and microbiome can increase your risk of cognitive decline.
  - Antibiotics
  - Anti-inflammatories like ibuprofen, naproxen, 
  - Reflux medication like PPI proton pump inhibitors 

    *    *   *   BRAIN STIMULATION   *   *   *
The expression, "use it or lose it" certainly applies to the brain. Contrary to popular belief, older adults can create new neurons! So it's important to stimulate the brain by doing something that is intellectually stimulating.
* Learn a foreign language

* Take up a musical instrument

* Learn a new hobby

* Take a class or pull out your old textbooks. 

* Do Sudoku or crossword puzzles

* Do Brain Training. Some examples of this are:
  - Brain HQ - online brain-training developed by an international team of neuroscientists. 

  - Luminosity - fun brain training and mental fitness games, tests, and activities backed by science.

  - Happy Neuron - games and activities for developing memory, attention, language, executive functions and visual/spatial.

  - My Brain Trainer - an online "brain gym".

  - Braingle - A place to solve puzzles, brush up on trivia, and play games.

 *   *   *   PUTTING IT ALL TOGETHER   *   *   *
All this can seem overwhelming, especially when it involves big life changes like giving up dairy and gluten and taking lots of supplements - or finding the time to exercise, do brain games and meditative activities. It's best to take one step at a time.

Our diet was already pretty clean but we made some modifications like trying to completely eliminate gluten (we gave up dairy decades ago), eating fewer grains, eating more veggies at breakfast, eating at least 3 hours before bedtime and fasting 12 to 14 hours before breakfast.

We already took quite a few supplements but added some new ones, especially those that target the brain that were recommended by Dr. Bredesen.

For aerobic exercise, we take a brisk walk every day, work out in our gym, play pickle ball and swim but we need to make sure we do all of these things more consistently. 

We haven't done enough with stress relief or brain games. It's just so hard to find the time and we don't like sitting still. But our goal is to find the stress relief activities and brain games that we enjoy and that work for us. It's a journey but it will be worth it if we can enter into our golden years someday with a fully working brain!