CONFERENCE The Role of Nutrition in Dementia Prevention and Management March 26 - 27, 2015

[LA18]

Thanks Martha and Julie for all the great information! I was actually wondering whether staying in ketosis would potentially reduce what’s left of my brain’s ability to utilize glucose and am relieved to learn that this (“use it or lose it”) isn’t an issue. After reading this thread, I’m seriously considering trying benfotiamine (or sulbutiamine?).

[Stavia]

I wonder when others decide to break their overnight fast?

I start getting hungry and a hunger headache around 16 to 18 hours. I listen to my body.

Rep ask d me if eating knocks me out of ketosis. It didn't today. 0.4 before lunch (salad, 2 eggs, nuts, half a cup of berries) and still 0.4 2 hours afterwards and before dinner. An hour after dinner down to 0.2 (chicken, and a *gasp* whole potato.) I reckon it'll go up overnight to the 0.4 again. The potato was extremely unusual. Spiked my glucose to 114 *double gasp*.
Lol I'm very relaxed about it.

[TheBrain]

So how do I begin the process of going into mild ketosis? Feel free to link me to other similar dicussions.

I can't eat much at one time because of early satiety (presumably due to as of yet unresolved digestive issues). I need to eat protein with every meal or snack. I eat dinner between 8-9 pm and wake up hungry in the middle of every night. If I don't eat a snack of about 300 calories (and then take Klonopin), I won't fall back to sleep.

On rare occasion, I have gone as long as 9 hours of fasting, but I don't know why.

I am hanging out at 106 pounds at 5'1". To date, my lipids have been fine, but I haven't had them tested in three years but will soon.

I eat a couple of Tbs of coconut oil nearly every day, as well as some EVOO and nuts (almond butter and macadamia nuts). I eat two slices of bacon every day and occasionally have a Tbs of ghee. I am sensitive to egg yolks, so I don't eat eggs.

I'd appreciate any suggestions or links. I feel lost.

[RichardS]

Alysson - May I ask what are your "unresolved digestive issues"? Do you suspect any problems with nutrient absorption? Perhaps your body is not making full use of the calories you are taking in.

Also, how is your fiber intake? Depending on the nature of the "digestive issues" you may want to look into resistant starch (aka RS) which many people report helping with satiety and sleep. RS tends to keep BG good, and I have read reports of people trying to maintain ketosis while adding RS having success. However, depending on what digesting problems you have, it is possible that increasing fiber and or RS would need to be done carefully. Are you sensitive to FODMAPs?

[TheBrain]

Alysson - May I ask what are your "unresolved digestive issues"? Do you suspect any problems with nutrient absorption? Perhaps your body is not making full use of the calories you are taking in.

Hi Richard,

Thanks for your troubleshooting help and suggestions. I have wondered if my body wakes me up at night to eat to prevent me from starving to death.

• * I do suspect I have problems with nutrient absorption. Stool tests have shown malabsorption, as well as low pancreatic enzymes. I take HCL supplements and pancreatic enzymes, but I haven't had testing lately to see what my status is now.
  
  * I believe I have leaky gut, something I’ve been trying to resolve for years. I have a lot of food sensitivities, including gluten and dairy. At this point, I suspect I have zonulin up-regulation (caused by prior gluten consumption), which might only be solvable by Rx meds (if and when they become available).
  
  * I also suspect I have delayed gastric emptying and slow motility, the cause of which I could only guess. Maybe it’s from my hypothyroidism. I’m taking thyroid meds for it, but I still have symptoms of hypothyroidism, such as being cold all the time.
  
  * I also have chronic constipation, and I take magnesium every day (and a Blue Ocean Minerals supplement, which is a good source of magnesium) to keep things moving (possibly a result of the slow motility).
  
  * I’ve also had chronically low levels of good gut bacteria, though I’ve made some progress with this from eating fermented vegetables and coconut yogurt.

Also, how is your fiber intake? Depending on the nature of the "digestive issues" you may want to look into resistant starch (aka RS) which many people report helping with satiety and sleep. RS tends to keep BG good, and I have read reports of people trying to maintain ketosis while adding RS having success. However, depending on what digesting problems you have, it is possible that increasing fiber and or RS would need to be done carefully. Are you sensitive to FODMAPs?

Fortunately, I'm not sensitive to FODMAPs. I couldn’t guess how many grams of fiber I eat every day. I should track that, but I know in the past when I have dramatically increased my fiber intake, it has never helped. (I don't mean to be gross, but imagine what's it's like trying to pass an intact head of cauliflower.)

Adding RS sounds like it's worth looking at seriously. My gut bacteria would probably jump up and down with joy. I did check that out at one point, and it seemed like potatoes were the main option, but I’m sensitive to them. I do eat sweet potatoes regularly, but I don’t know how they compare. Green bananas don't appeal to me, but I would eat them if they would help me progress.

[RichardS]

Adding RS sounds like it's worth looking at seriously. My gut bacteria would probably jump up and down with joy. I did check that out at one point, and it seemed like potatoes were the main option, but I’m sensitive to them. I do eat sweet potatoes regularly, but I don’t know how they compare. Green bananas don't appeal to me, but I would eat them if they would help me progress.

If internet discussion forums and blog comments are to be believed, many who are sensitive to potatoes can tolerate raw potato starch. YMMV. If you go this route, start low and increase slowly. I was only sensitive at higher doses like 2 tbsp/day.

Sweet potatoes have a much lower level of RS. Green bananas doesn't have to mean purely green. The studies on them described them as having green at the tips. That said, there is a huge range of RS estimates for green bananas - almost certainly related to the amount of "greenness". Beans have RS and other fermentable starches. Parboiled rice has a moderate amount but those who are glucose sensitive should probably track BG. My BG response is good with parboiled rice, but I've never had BG problems.

[Julie G]

Apologies for being slow on reporting about the conference. I’ve been swamped with many distractions. One concept that I was repeatedly struck by was this assertion that sarcopenia, a loss of muscle mass that accompanies aging, DRIVES neurodegeneration. Several speakers referred to this concept. Agnes Flöel, who touched upon CR & CR mimetics, even asserted that CR would NOT be an appropriate strategy for AD prevention due to the subsequent sarcopenia. There seemed to be a consensus that we should increase protein intake starting around age 50 to avoid sarcopenia.

All of which led me to question the strategies many of us are practicing. Could we be doing harm by restricting protein and calories. I know I’ve been in a catabolic state for the past several years. Cognitively, I feel very sharp, but (with my BMI barely hovering at 18) I have definitely lost muscle mass. I’ve recently focused more on weight training daily (in addition to walking/running) and have slightly increased my protein intake. I feel good- a little stronger.

FWIW, Dr. Flöel made a convincing case for the use of CR mimetics in her talk. She has found that 200 mg of resveratrol combined with 320 mg of quercetin provided very similar benefits without the sarcopenia that can accompany CR. She also asserted that the cognitive benefits of CR disappear during maintenance re-feeding stages; whereas mimetics can be maintained indefinitely.

Effects of Resveratrol on Memory Performance, Hippocampal Functional Connectivity, and Glucose Metabolism in Healthy Older Adults
http://www.jneurosci.org/content/34/23/7862.ful

[aphorist]

There are several recent papers which draw the connection between frailty and future incidence of alzheimer's.

Downsizing of lean body mass is a key determinant of Alzheimer's disease

Lean body mass (LBM) encompasses all metabolically active organs distributed into visceral and structural tissue compartments and collecting the bulk of N and K stores of the human body. Transthyretin (TTR) is a plasma protein mainly secreted by the liver within a trimolecular TTR-RBP-retinol complex revealing from birth to old age strikingly similar evolutionary patterns with LBM in health and disease. TTR is also synthesized by the choroid plexus along distinct regulatory pathways. Chronic dietary methionine (Met) deprivation or cytokine-induced inflammatory disorders generates LBM downsizing following differentiated physiopathological processes. Met-restricted regimens downregulate the transsulfuration cascade causing upstream elevation of homocysteine (Hcy) safeguarding Met homeostasis and downstream drop of hydrogen sulfide (H2S) impairing anti-oxidative capacities. Elderly persons constitute a vulnerable population group exposed to increasing Hcy burden and declining H2S protection, notably in plant-eating communities or in the course of inflammatory illnesses. Appropriate correction of defective protein status and eradication of inflammatory processes may restore an appropriate LBM size allowing the hepatic production of the retinol circulating complex to resume, in contrast with the refractory choroidal TTR secretory process. As a result of improved health status, augmented concentrations of plasma-derived TTR and retinol may reach the cerebrospinal fluid and dismantle senile amyloid plaques, contributing to the prevention or the delay of the onset of neurodegenerative events in elderly subjects at risk of Alzheimer's disease.

http://www.ncbi.nlm.nih.gov/pubmed/25380591

[Rshircliff]

I have lost muscle mass which has me concerned...I look like I am wasting away. I have a BMI of 20.6 and consume 2000 cal a day, mostly plant based. I don't think that qualifies for CR does it? I just can't afford to lose more weight.

[RichardS]

Effects of Resveratrol on Memory Performance, Hippocampal Functional Connectivity, and Glucose Metabolism in Healthy Older Adults

Full text: http://www.jneurosci.org/content/34/23/7862.full

That looks like a solid paper to me showing the benefit of resveratrol in humans using easily obtainable supplement doses (200mg). That's been my dose for a few months which was intended to help lower oxLDL. It was great to see the positive correlation between the functional MRI measures in the hippocampus and the verbal memory measures. That is rare for an herbal intervention for improving memory. I was disappointed that for all the effort and expense that went into this study, they only had a single cognitive measure, but what they did test improved with resveratrol compared to placebo and that improvement was reflected in the MRI measures.

HbA1C and leptin improved relative to placebo as well. I need to read more on why it might help.