Goal: Optimize diet: minimize simple carbohydrates (CHO), minimize inflammation.
Approach: Patients given choice of several low glycemic, low inflammatory, low grain diets.
Rationale: Minimize inflammation, minimize insulin resistance.
Simple carbohydrates (see more on carbohydrates) are foods that rapidly break down to glucose in the blood. Examples include sugar, honey, candy, syrup, juice, cereal, soda, white bread, instant oatmeal, junk food, and most foods that come in a box in the center aisles of the grocery store. Over time, too many simple carbohydrates can lead to insulin resistance, a precursor to diabetes.
Insulin is the hormone produced when you eat carbs, telling your body to take glucose out of the bloodstream. High blood glucose and fructose causes those molecules to stick to places they shouldn't be, aging your body. The higher your blood glucose levels, the more insulin your pancreas has to produce to take it out of the bloodstream. The cells of your body get accustomed to the high insulin levels and start ignoring it, leaving high levels in the blood stream. Once that happens you become insulin resistant. Over time, insulin resistance can turn into diabetes. Diabetics have higher rates of cancer, heart disease, and stroke as well as Alzheimer's.
Low glycemic foods take longer to break down to glucose in the blood. Good examples of low glycemic foods are green vegetables, non-starchy vegetables, beans, and lentils. Lower glycemic fruits such as berries, lemons, limes, tomatoes, and avocados are best, and go for the whole fruit, not juices. Whole wheat bread, undercooked pasta, potatoes, brown rice, and corn are examples of carbohydrate rich foods that break down a little more slowly, but they are not recommended by Dr. Bredesen. Generally, he recommends that foods with a glycemic index lower than 35 should make up the bulk of your diet. Overall, low glycemic foods tend to be unprocessed and whole foods. The more protein, fat, and fiber a food contains, the less glycemic the food is likely to be.
Insulin is also produced when you eat protein, telling your body to take amino acids out of the bloodstream. The protocol recommends limited animal protein; one should choose mostly wild caught fish in 2-3 ounce servings a few nights per week.
Beyond glycemic load, research shows that more people are sensitive to gluten-containing grains, like wheat and rye, than is commonly thought. Some argue that everyone is sensitive, to some degree. Foods containing gluten include bread, pasta, noodles, crackers, cereal, pancakes, tortillas, beer, most processed foods, even sauces and cosmetics. Oats is often listed as a grain to avoid because it is often cross-contaminated with gluten during processing.
Inflamation is the body's way of repairing injuries. As we get older, our bodies become more and more inflamed due to dietary and environmental toxins as well as other health-related assaults. Dietary inflammation can be triggered by trans fats, gluten, other grains, and dairy, causing "leaky gut" where the intestinal tract develops small holes that allow fragments of food and/or bacteria to enter the bloodstream. These can trigger an immune response by our bodies. Overall, grains and dairy are not recommended by Dr. Bredesen because of the potential for inflammatory response. Cyrex labs is an example of a company that has good tests for gluten sensitivity.
Foods with trans fats have recently been outlawed because they are linked to increased inflammation and poor health outcomes. Another fat, omega-6 oil, is more inflammatory than omega-3. Most processed food is loaded with soybean oil and other inexpensive omega-6 oils and should be limited. Some omega-6 is necessary in the diet; however, the Standard American Diet provides way too much in the form of processed foods.
The fat profile of animal protein you eat is also affected by the food they eat. Conventionally raised animals are typically given high omega-6 diets of corn and soy. The protein produced contains a higher amount of omega-6 fats. Grass fed meats, poultry, and eggs provide a better omega 3:6 ratio.
Dr. Bredesen recommends healthy oils from avocados, nuts, seeds, and olive oil. He feels MCT oil can help to improve insulin sensitivity, but he recommends switching to the healthy oil list once insulin resistance improves.
Dr. Bredesen also recommends eating detoxifying plants, including cilantro, cauliflower, broccoli, cabbage, kale, radishes, Brussel sprouts, turnips, watercress, kohlrabi, rutabaga, arugula, horseradish, maca, rapini, daikon, wasabi, bok choy, avocado, artichokes, beets, dandelions, garlic, ginger, grapefruit, lemons, olives, and seaweed. These help sequester and eliminate toxins from the body.
Recent research has suggested a modified Mediterranean diet is associated with lower rates of dementia. Check out the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. Do note, that ApoE4 carriers on this forum often report being sensitive to grains and legumes, but this whole-foods focused diet can provide a good outline.
Although not specifically included in the Bredesen Protocol, a diet that a number of ApoE4 forum members have adopted that is low carbohydrate and anti-inflammatory, characteristics that the ReCODE Protocol calls for, is Dr. Gundry's Diet Evolution. The third stage is the one you want. Here is his list of safe and forbidden foods. Apoe4 carriers should limit animal based fat.
Another diet option is the Wahls Protocol.
Insulin Resistance, for ideas on improving your insulin sensitivity.
Inflammation & LPS, for background on why diet and it's relationship to leaky gut are important.
Omega-3 fatty acids, for more on why Omega-3s, from eating fish or taking fish oil, are important.
Return to Diet Strategies.