n-free diet, he was transformed. His

When I diagnosed his sensitivity to gluten and he adopted a gluten-free diet, he was transformed. His depressive symptoms evaporated, and he returned to peak performance on the court. MENTAL STABILITY THROUGH DIET All this talk about gluten’s insidious connection to common psychological disorders no doubt raises questions about gluten’s role in virtually every ailment that involves the mind, from the most common mental disorder in America—anxiety, which affects approximately forty million adults—to complex afflictions such as schizophrenia and bipolar disorder. So what does the science say about gluten and our more perplexing mental illnesses such as schizophrenia and bipolar disorder? These are complicated maladies for which genetic and environmental factors are in play, but study after study demonstrates that people with these diagnoses often show gluten sensitivity as well. And if they have a history of celiac disease, they are at much higher risk of developing these psychiatric disorders than anyone else. What’s more, we now have documented evidence that mothers who are sensitive to gluten give birth to children who are nearly 50 percent more likely to develop schizophrenia later in life. The study, published just last year in the American Journal of Psychiatry, adds to a growing body of evidence that many diseases that show up later in life originate before and shortly after birth. The authors of the study, who hail from Johns Hopkins and Sweden’s Karolinska Institute, one of Europe’s largest and most prestigious medical universities, stated the facts beautifully: “Lifestyle and genes are not the only factors that shape disease risk, and factors and exposures before, during, and after birth can help pre-program much of our adult health. Our study is an illustrative example suggesting that a dietary sensitivity before birth could be a catalyst in the development of schizophrenia or a similar condition twenty-five years later.” 42 If you’re wondering how in the world they managed to make this connection, look no further than the details of their analyses, which entailed a look at birth records and neonatal blood samples of children born between 1975 and 1985 in Sweden. About 211 of the 764 kids examined developed mental disorders later in life characterized by a significant derangement of their personality and a loss of touch with reality. The team measured levels of IgG antibodies to milk and wheat in the blood samples to figure out that the “children born to mothers with abnormally high levels of antibodies to the wheat protein gluten were nearly 50 percent more likely to develop schizophrenia later in life than children born to mothers with normal levels of gluten antibodies.” 43 This association remained true even after the scientists ruled out other factors known to increase the risk of developing schizophrenia, such as the mother’s age during pregnancy and whether the child was born vaginally or via C-section (by and large, genetic factors and environmental impacts in utero weigh much more heavily into one’s risk for schizophrenia than environmental factors encountered later in life). But children born to mothers with abnormally high levels of antibodies to milk protein didn’t appear to be at an increased risk for psychiatric disorders. The authors added a fascinating historical note to their paper as well. It wasn’t until World War II that a suspicion about the connection between psychiatric disorders and maternal food sensitivity started to surface. U.S. Army researcher Dr. F. Curtis Dohan was among the first scientists to notice a relationship between postwar Europe’s food scarcity (and, consequently, a lack of wheat in the diet) and considerably fewer hospitalizations for schizophrenia. Although the observation couldn’t prove the association at the time, since then we’ve had the benefits of long-term studies and modern technologies to verify the case against gluten. Studies have also shown that a low-carb, high-fat diet just like the one I outline in chapter 7 can improve symptoms of not only depression but also schizophrenia. One woman who has been chronicled in the literature, known by the initials CD, had a complete resolution of her schizophrenia symptoms when she adopted a gluten-free, low-carb diet. 44 She was first diagnosed at the age of seventeen, and experienced paranoia, disorganized speech, and daily hallucinations throughout her life. Before adopting a low-carb diet at the age of seventy, she’d been hospitalized multiple times for suicide attempts and increased psychotic symptoms. Medication failed to improve her symptoms. Within the first week on the new diet, CD reported feeling better and having more energy. And within three weeks, she was no longer hearing voices or “seeing skeletons.” Over the course of a year, CD also lost weight, and even when she cheated once in a while by eating pasta, bread, or cake, her hallucinations never returned. A FIX FOR THE COMMON HEADACHE? I can’t imagine what it would be like to suffer from daily headaches, but I’ve treated many patients who’ve shouldered the weight of that kind of suffering throughout their lives. Take, for example, a sixty-six-year-old gentleman whom I first saw in January of 2012. I’ll call him Cliff. Cliff had endured thirty long years with pretty much the same unrelenting headache, and he wins a gold medal for trying his best to extinguish the pain. His attempts included a litany of drugs from those designed for migraines, like Imitrex, to narcotic painkillers such as Vicodin, prescribed after consultations with top headache clinics—all to no avail. Aside from being ineffective, he found that many of these medications slowed him down significantly. Although Cliff mentioned that he thought his headaches were related to foods, he couldn’t say this was always the case. Nothing in his medical history jumped out at me, but when we discussed his family history, he said that his sister also experienced ongoing headaches and had significant food intolerances. This bit of information led me to probe a little further. I learned that Cliff had a twenty-year history of muscle stiffness, and that his sister carried a specific antibody related to gluten sensitivity that is also associated with what is called “stiff-person syndrome.” When I checked Cliff’s blood work for gluten sensitivity, several things stood out. He was highly reactive to eleven proteins related to gluten. Like his sister, he showed a strong reaction with respect to the antibody associated with stiff-person syndrome. I also noted that he was quite sensitive to cow’s milk. As with so many of my patients, I placed him on a diet that restricted gluten and dairy. After three months, he told me that he hadn’t needed to use Vicodin at all the previous month, and on a scale from 1 to 10 his worst headache was now a manageable 5 rather than a screaming 9. Best of all, his headaches no longer lingered all day; they only lasted three or four hours. While Cliff was not totally cured, his relief was substantial and, for him, very gratifying. In fact, he was so pleased with his outcome that he has allowed me to use his photograph when I present his case, now published, to health care practitioners. I’ve had plenty more patients come through my doors and leave with a pain-free head, thanks to the adoption of a gluten-free diet. One woman with a similar experience had been to countless doctors, tried innumerable prescription drugs, and undergone high-tech brain scans. Nothing worked until she met me and my prescription pad for a gluten sensitivity test. And lo and behold her villain—and cure —was identified. Headaches are one of our most common maladies. In the United States alone, more than forty-five million people suffer from chronic headaches, twenty-eight million of whom suffer from migraines. 45 Incredibly, twenty-first-century medicine remains focused on treating symptoms for what is often a fully preventable problem. If you’re a chronic headache sufferer, why not try a gluten-free diet? What have you got to lose? Big Headaches in Brief For purposes of this discussion I include all types of headaches in one category. So whether you’re dealing with tension headaches, cluster headaches, sinus headaches, or migraines, for the most part I refer to headaches as a collective basket of conditions that share the same characteristic: pain in the head due to physical and biochemical changes in the brain. For the record, migraines tend to be the most painful kind and are often accompanied by nausea, vomiting, and sensitivity to light. But a headache is a headache, and if you’ve got one, your top priority is finding a solution. Once in a while, however, I will specifically refer to migraines. An untold number of things can trigger a headache, from a bad night’s sleep or changes in the weather to chemicals in foods, sinus congestion, head trauma, brain tumors, or too much alcohol. The exact biochemistry of headaches, especially migraines, is under active study. But we know a lot more today than we ever did before. And for those sufferers who can’t nail down a reason (and thus a likely solution) for their headaches, my bet is that nine times out of ten that reason could be undiagnosed gluten sensitivity. In 2012, researchers at Columbia University Medical Center in New York finished a yearlong study that documented chronic headaches among 56 percent of people who were gluten sensitive and 30 percent of those with celiac disease (the ones labeled as gluten sensitive had not tested positive for celiac disease but reported symptoms when they ate foods with wheat). 46 They also found that 23 percent of those with inflammatory bowel disease also had chronic headaches. When the researchers teased out the prevalence of migraines, they found much higher percentages of sufferers among the celiac group (21 percent) and the inflammatory bowel disease group (14 percent) than in the control group (6 percent). When asked to explain the connection, the lead researcher, Dr. Alexandra Dimitrova, alluded to the ultimate perpetrator of all: inflammation. To quote Dr. Dimitrova: It’s possible the patients with [inflammatory bowel disease] have a generalized inflammatory response, and this may be similar in celiac disease patients, where the whole body, including the brain, is affected by inflammation…. The other possibility is that there are antibodies in celiac disease that may… attack the brain cells and membranes covering the nervous system and somehow cause headaches. What we know for sure is that there is a higher prevalence of headache of any kind, including migraine headaches, compared to healthy controls. She went on to say that many of her patients report major improvements in the frequency and severity of their headaches once they adopt a gluten-free diet; for some, headaches completely vanish. Dr. Marios Hadjivassiliou, whom I’ve referenced throughout this book, has done extensive studies on headaches and gluten sensitivity. 47 Among his most astonishing work are the brain MRI scans that show profound changes in the white matter of headache patients with gluten sensitivity. The abnormalities are indicative of the inflammatory process. Most of these patients were resistant to normal drug treatments for their headaches, yet once they adopted a gluten-free diet, they were relieved of their suffering. Dr. Alessio Fasano, who heads the Center for Celiac Research at Massachusetts General Hospital, is a world-renowned pediatric gastroenterologist and a leading researcher in the area of gluten sensitivity. 48 When I met with him at a national conference on gluten sensitivity, where we both were speaking, he told me that it’s no longer news to him that gluten-sensitive patients, including those with diagnosed celiac disease, frequently suffer from headaches. We lamented together how unfortunate it is that this type of gluten-triggered headache is misunderstood by the general public. It has such an easy fix, yet few of the afflicted know that they are sensitive to gluten. When Italian researchers conducted a gluten-free trial experiment on eighty-eight children with celiac disease and chronic headaches, they found that 77.3 percent of them experienced significant improvement in headaches, and 27.3 percent of those who improved actually became headache-free when they maintained a gluten-free diet. The study also found that 5 percent of the kids with headaches who were not previously diagnosed with celiac were indeed found to have celiac disease; this was a much larger percentage than the 0.6 percent researchers had documented in the general kids population studied. Thus the risk of headache in the celiac group was increased by 833 percent. The authors concluded, “We recorded—in our geographical area—a high frequency of headaches in patients with CD [celiac disease] and vice versa with a beneficial effect of a gluten-free diet. Screening for CD could be advised in the diagnostic workup of patients with headache.” 49 The prevalence of migraine headache in the pediatric population is increasing. Prior to the onset of puberty, migraine affects girls and boys equally. Thereafter, females outnumber males by about three to one. Children with migraines have a 50 to 75 percent risk of becoming adult migraine sufferers, and the disease is inherited in 80 percent of cases. Childhood migraines represent the third leading cause of school absence. 50 Is it coincidence that so many of these kids with chronic headaches also have a strong sensitivity to gluten? And is it fortuity that the removal of gluten from their diets magically ushered their headaches away? No. And no. Unfortunately, many children with chronic headaches are never tested for gluten sensitivity, and they are placed instead on powerful drugs. The standard approach to treating headaches in kids includes the use of nonsteroidal anti-inflammatory medications, aspirin-containing compounds, triptans, ergot alkaloids, and dopamine antagonists. To prevent headaches, some of the drugs used include tricyclic antidepressants; various anticonvulsants including divalproex sodium; and more recently, topiramate, antiserotonergic agents, beta blockers, calcium channel blockers, and nonsteroidal anti-inflammatory medications. Topiramate, which is used to treat epilepsy, comes with awful side effects that would alarm any parent and be distressing to a child. They include weight loss, anorexia, abdominal pain, difficulty concentrating, sedation, and paresthesia (the feeling of “pins and needles,” or of a limb “falling asleep”). 51 I don’t know about you, but I wouldn’t want my kid to experience these side effects, even if they are temporary, to manage a headache that has nothing to do with what the drug was designed for. In the last few years, numerous studies have emerged to show that, for the most part, anticonvulsants don’t alleviate headaches in kids any better than a placebo. 52 In fact, leading researchers in headaches have been pressing for more studies to be done on children because few drugs have been proven useful, effective, and safe to use. The focus on drugs rather than dietary choices and nutritional supplementation sadly keeps us from addressing the underlying cause of the headache. Big Bellies Make for Big Headaches You already know belly fat is the worst, and that it raises your risk for a medley of health problems (heart disease, diabetes, dementia, to name a few). But people don’t think about their increased risk for headaches just by virtue of their waist circumference. Surprise: Waist circumference is a better predictor of migraine activity than general obesity in both men and women up until age fifty-five. Only in the last couple of years have we been able to scientifically show how strong this link is, thanks in part to researchers from Philadelphia’s Drexel University College of Medicine who mined data amassed from more than twenty-two thousand participants in the ongoing National Health and Nutrition Examination Survey (NHANES). 53 The data included a wealth of valuable information to examine, from calculations of abdominal obesity (as measured by waist circumference) and overall obesity (as determined by body mass index) to people’s reports on how often they experienced headaches and migraines. Even after controlling for overall obesity, the researchers determined that for both men and women between the ages of twenty and fifty-five—the age bracket when migraine is most common—excess belly fat was affiliated with a significant increase in migraine activity. Women carrying extra fat around their belly were 30 percent more likely to suffer from migraines than women without excess belly fat. This held true even when the researchers accounted for overall obesity, risk factors for heart disease, and demographic characteristics. Plenty of other studies show the inexorable bond between obesity and risk for chronic headaches. 54 One particularly large study published in 2006 looked at more than thirty thousand people and found that chronic daily headaches were 28 percent higher in the obese group than in the healthy controls of normal weight. Those who were morbidly obese had a 74 percent increased risk of having a chronic daily headache. When the researchers took a closer look at those who suffered from migraines in particular, overweight people had a 40 percent increased risk, and the obese had a 70 percent increased risk. 55 By this point in the book you know that fat is a hugely powerful hormonal organ and system that can generate pro-inflammatory compounds. Fat cells secrete an enormous amount of cytokines that trigger inflammatory pathways. Headaches are, at their root, manifestations of inflammation, just like most of the other brain-related ailments we’ve been covering. So it makes sense, then, that studies examining the relationship between lifestyle factors (e.g., overweight, low physical activity, and smoking) and recurrent headaches connect belly fat and chronic headaches. A few years ago, researchers in Norway interviewed 5,847 adolescent students about their headaches and had them complete a comprehensive questionnaire about their lifestyle habits in addition to a clinical examination. 56 Those who said they regularly engaged in physical activity and were not smokers were classified as having a good lifestyle status. These students were compared to those who were deemed to be less healthy due to one or more of the negative lifestyle habits. The results? The kids who were overweight were 40 percent more likely to suffer from headaches; the risk was 20 percent higher in those who didn’t exercise much; and the smokers had a 50 percent increased risk. These percentages, however, were compounded when a student could check off more than one risk factor. If a student was overweight and smoked and didn’t exercise, he or she carried a much higher risk for chronic headaches. And again, the study pointed to the effects of inflammation in fueling the firestorm. The bigger your belly, the more at risk you are for headaches. Seldom do we think about our lifestyle and diet when we get a headache. Instead, we turn to drugs and await the next pound in the head. All the studies to date, however, show how important lifestyle is when it comes to managing, treating, and permanently curing headaches. If you can reduce sources of inflammation (lose the extra weight, eliminate gluten, go low-carb and high good fat, and maintain healthy blood sugar balance), you can target and control headaches. THE RX TO BE HEADACHE-FREE Numerous things can trigger a headache. I cannot possibly list all of the potential offenders, but I can offer a few tips to end the suffering: Keep a very strict sleep-wake cycle. This is key to regulating your body’s hormones and maintaining homeostasis—the body’s preferred state of being, where its physiology is balanced. Lose the fat. The more you weigh, the more likely it is that you’ll suffer from headaches. Stay active. Remaining sedentary breeds inflammation. Watch caffeine and alcohol use. Each of these in excess can stimulate a headache. Don’t skip meals or keep erratic eating habits. As with sleep, your eating patterns control many hormonal processes that can affect your risk for a headache. Manage emotional stress, anxiety, worry, and even excitement. These emotions are among the most common triggers of headaches. Migraine sufferers are generally sensitive to stressful events, which prompt the release of certain chemicals in the brain that can provoke vascular changes and cause a migraine. Adding insult to injury, emotions such as anxiety and worry can increase muscle tension and dilate blood vessels, intensifying the severity of the migraine. Go gluten-, preservative-, additive-, and processed-free. The low-glycemic, low-carb, high–healthy-fat diet outlined in chapter 11 will go a long way to reducing your risk for headaches. Be especially careful about aged cheese, cured meats, and sources of monosodium glutamate (MSG, commonly found in Chinese food), as these ingredients may be responsible for triggering up to 30 percent of migraines. Track the patterns in your headache experience. It helps to know when you’re at a greater risk of getting one so you can pay extra attention during those times. Women, for example, can often trace patterns around their menstrual cycle. If you can define your patterns, you can better understand your unique headache and act accordingly. The idea that we can treat—and in some cases, totally eliminate—common neurological ailments through diet alone is empowering. Most people immediately turn to drugs when seeking a solution, oblivious to the cure that awaits them in a few lifestyle shifts that are highly practical and absolutely free. Depending on my patients’ unique circumstances, some of them need more short-term support for managing certain conditions, and this can come in the form of psychotherapy or even supplemental medication. But by and large many of them respond positively to simply cleaning up their diet and expelling nerve-racking (literally) ingredients from their lives. And those who do require additional medical help often find that they can eventually wean themselves from pharmaceuticals and welcome the rewards that a drug-free life has to offer. Remember, if you do nothing else recommended in this book but eliminate gluten and refined carbohydrates, you will experience profound positive effects beyond those described in this chapter. In addition to watching your mood brighten up, you’ll watch your weight go down and your energy soar in just a few weeks. Your body’s innate healing capacities will be in high gear, as will your brain’s functionality. PART II GRAIN BRAIN REHAB Now that you’ve gotten a panoramic picture of “grain brain,” which actually encompasses more than just grains and includes virtually all carbohydrates, it’s time to turn to the ways in which you can support the ideal health and function of your brain. In this section of the book, we examine three key habits: diet, exercise, and sleep. Each of these plays a significant role in whether or not your brain thrives or begins to falter. And with the lessons gleaned in this part, you’ll be fully prepared to execute the four-week protocol outlined in part 3. CHAPTER 7 Dietary Habits for an Optimal Brain Hello, Fasting, Fats, and Essential Supplements I fast for greater physical and mental efficiency. —PLATO THE SIZE OF OUR BRAIN IN COMPARISON to the rest of our body is one of the most important features distinguishing us from all other mammals. An elephant, for example, has a brain that weighs 7,500 grams, dwarfing our 1,400-gram brain. But its brain represents 1/550 of its total body weight, while our brain weighs 1/40 of our total body weight. So we can’t make any comparisons about “brain power” or intelligence just based on brain size alone. It’s the ratio of brain size to body size that’s key when considering the brain’s functional capacity. 1 But even more important than our impressive volume of brain matter is the fact that, gram for gram, our brain consumes a disproportionately huge amount of energy. It represents 2.5 percent of our total body weight but consumes an incredible 22 percent of our body’s energy expenditure at rest. The human brain expends about 350 percent more energy than the brains of other anthropoids like gorillas, orangutans, and chimpanzees. So it takes a lot of dietary calories to keep our brains functioning. Fortunately for us, though, our large and powerful brains have allowed us to develop the skills and intelligence to survive extreme conditions like food scarcity. We can conceive of and plan for the future, a uniquely human trait. And having an understanding of our brain’s amazing abilities can help inform the ways in which we can optimize our diet for a healthy, functioning brain. THE POWER OF FASTING One critical mechanism of the human body that I’ve already covered is its ability to convert fat into vital fuel during times of starvation. We can break down fat into specialized molecules called ketones, and one in particular that I’ve already mentioned—beta-hydroxybutyrate (beta-HBA)—is a superior fuel for the brain. This not only provides a compelling case for the benefits of intermittent fasting to, as contradictory as this may seem, nourish the brain, but also serves as an explanation for one of the most hotly debated questions in anthropology: why our Neanderthal relatives disappeared between thirty and forty thousand years ago. While it’s convenient and almost dogmatic to accept that Neanderthals were “wiped out” by clever Homo sapiens, many scientists now believe that food scarcity may have played a more prominent role in their disappearance. It may be that the Neanderthals didn’t have the “mental endurance” to persevere because they lacked the biochemical pathway to utilize fat to feed the brain. Unlike other mammals’, our brain can use an alternative source of calories during times of starvation. Typically, our daily food consumption supplies our brain with glucose for fuel. In between meals, our brains are continually supplied with a steady stream of glucose that’s made by breaking down glycogen, mostly from the liver and muscles. But glycogen stores can provide only so much glucose. Once our reserves are depleted, our metabolism shifts and we are able to create new molecules of glucose from amino acids taken from protein primarily found in muscle. This process is aptly named gluconeogenesis. On the plus side, this adds needed glucose to the system, but on the minus side, it sacrifices muscles. And muscle breakdown is not a good thing for a starving huntergatherer. Luckily, human physiology offers one more pathway to power our brains. When food is no longer available, after about three days, the liver begins to use body fat to create those ketones. This is when beta-HBA serves as a highly efficient fuel source for the brain, allowing us to function cognitively for extended periods during food scarcity. Such an alternative fuel source helps reduce our dependence on gluconeogenesis and, therefore, preserves our muscle mass. But more than this, as Harvard Medical School professor George F. Cahill stated, “Recent studies have shown that beta-hydroxybutyrate, the principal ketone, is not just a fuel, but a superfuel, more efficiently producing ATP energy than glucose. It has also protected neuronal cells in tissue cultures against exposure to toxins associated with Alzheimer’s or Parkinson’s.” 2 Indeed, Dr. Cahill and other researchers have determined that beta-HBA, which is easily obtainable just by adding coconut oil to your diet, improves antioxidant function, increases the number of mitochondria, and stimulates the growth of new brain cells. In chapter 5 we explored the need to reduce caloric intake in order to increase BDNF as a means of stimulating the growth of new brain cells as well as enhancing the function of existing neurons. The idea of substantially reducing your daily calorie intake does not appeal to many people, even though it’s a powerful approach to not only brain enhancement, but also overall health. But intermittent fasting—a complete restriction of food for twenty-four to seventy-two hours at regular intervals throughout the year—is more manageable, and I recommend and outline a fasting protocol in chapter 10. Research has demonstrated that many of the same health-providing and brain-enhancing genetic pathways activated by caloric restriction are similarly engaged by fasting, even for relatively short periods of time. 3 This is counter to conventional wisdom that says fasting lowers the metabolism and forces the body to hold on to fat in a so-called starvation mode. Much to the contrary, fasting provides the body with benefits that can accelerate and enhance weight loss, not to mention boost brain health. Fasting not only turns on the genetic machinery for the production of BDNF, but also powers up the Nrf2 pathway, leading to enhanced detoxification, reduction of inflammation, and increased production of brain-protective antioxidants. Fasting causes the brain to shift away from using glucose as fuel to using ketones manufactured in the liver. When the brain is metabolizing ketones as fuel, even the process of cell suicide (apoptosis) is reduced, while mitochondrial genes are turned on, leading to mitochondrial replication. Simply put, fasting enhances energy production and paves the way for better brain function and clarity. Fasting in spiritual quests is an integral part of religious history. All major religions promote fasting as far more than a ceremonial act. Fasting has always been a fundamental part of the spiritual practice, as in the Muslim fast of Ramadan and the Jewish fast of Yom Kippur. Yogis practice austerity with their diets, and shamans fast during their vision quests. Fasting is also a common practice among devout Christians, and the Bible has examples of one-day, three-day, seven-day, and forty-day fasts. WHAT FASTING AND KETOGENIC DIETS HAVE IN COMMON What happens when you substantially reduce your carbohydrate intake and derive more of your calories from fat? I just finished explaining the benefits of fasting, which stimulates the brain to turn to fat for fuel in the form of ketones. A similar reaction takes place when you follow a diet low in carbohydrates and rich in healthy fats and proteins. This is the foundation of the Grain Brain dietary protocol. Throughout our history we sought fat as a calorie-dense food source. It kept us lean and served us well in our hunter-gatherer days. As you already know, eating carbohydrates stimulates insulin production, which leads to fat production, fat retention, and a reduced ability to burn fat. What’s more, as we consume carbohydrates we stimulate an enzyme called lipoprotein lipase that tends to drive fat into the cell; the insulin secreted when we consume carbohydrates makes matters worse by triggering enzymes that lock fat tightly into our fat cells. As I’ve also described, when we burn fat as opposed to carbohydrate, we enter ketosis. There’s nothing inherently bad about it, and our bodies have been equipped for this activity for as long as we’ve roamed Earth. Being in a mild ketosis state is actually healthy. We are mildly ketotic when we first wake up in the morning, as our liver is mobilizing body fat to use as fuel. Both the heart and the brain run more efficiently on ketones than on blood sugar, by as much as 25 percent. Healthy, normal brain cells thrive when fueled by ketones. Certain brain tumor cells, however, can only use glucose as fuel. Standard treatment for glioblastoma, one of the most aggressive types of brain tumor, is surgery, radiation therapy, and chemotherapy. But quite honestly, results from these approaches are fairly dismal. Taking advantage of the fact that glioblastoma cells can only use glucose, and not ketones, Dr. Giulio Zuccoli of the University of Pittsburgh School of Medicine reasoned that a ketogenic diet might actually prove effective in treating glioblastoma along with traditional treatments. 4 And, in fact, he published a case report of treating a glioblastoma patient using a ketogenic diet with impressive results. If a ketogenic diet can prolong the life of a cancer patient, what can it do in a healthy individual? A purely ketogenic diet is one that derives 80 to 90 percent of calories from fat, and the rest from carbohydrate and protein. Certainly this is extreme, but again, recognize that ketones are a far more effective fuel for the brain. In 1921, when the Mayo Clinic’s Russell Wilder developed the ketogenic diet, it was basically an all-fat proposition. In the 1950s, we learned about medium-chain triglycerides (MCTs), which act as precursors in the body for beta-HBA and can be consumed through coconut oil. The diet protocol outlined in chapter 10 honors the main ketogenic principles of significantly reducing carbohydrates to the point that the body is pushed to burn fat while increasing dietary fat and adding nutrients to increase production of beta-HBA. You’ll limit your consumption of carbohydrates to just 30 to 40 grams a day during the four weeks, after which you can increase that amount to 60 grams. The degree of ketosis that you’re able to achieve can actually be measured with ketone test strips, which are typically used by diabetics and available at all pharmacies. They simply require a drop or two of urine and provide immediate information as to the level of ketosis that you’ve achieved. Look for trace to small levels of ketosis in the neighborhood of 5 to 15; most ketone test strips such as Ketostix use color charts, and light pink usually indicates the presence of small, trace amounts. This means that your body is effectively using ketones as energy. If you follow my protocol, you can expect to become slightly ketotic after approximately the first week on the plan, and you may want to test yourself to see this effect. Some people feel better at higher levels of ketosis. SEVEN BRAIN-BOOSTING SUPPLEMENTS “The high-carb diet I put you on twenty years ago gave you diabetes, high blood pressure, and heart disease. Oops.” I love a cartoon that offers a nugget of wisdom in a matter of eyebrow-raising seconds, the time it takes to absorb the image and caption. The one above caught my eye years ago; I only wish more doctors were as smart as cartoonist Randy Glasbergen. Given all the science we’ve accumulated since this cartoon was first published in 2004, we can add “and set you up for brain disease” to this caption. The painful reality in today’s doctoring world is that you’re not likely to get a lot of useful advice about staving off brain disorders during an office visit to your internist. Nowadays, you get fewer than fifteen minutes (if that) with a doctor who may or may not be trained in all the latest knowledge about how to preserve your mental faculties. What’s more disturbing is that many of today’s physicians, originally trained decades ago, don’t have a firm grasp of nutrition and its effects on your health. I don’t say this to pooh-pooh my industry; I’m merely pointing out a truth that’s largely a consequence of economics. My hope is that our next generation of doctors will be better equipped to swing the pendulum to the side of prevention rather than focus so much on treatment. Which brings me to my recommended supplements. (here for exact dosages and instructions on when to take each of these daily.) DHA: As I mentioned earlier, docosahexaenoic acid (DHA) is a star in the supplement kingdom. DHA is an omega-3 fatty acid that represents more than 90 percent of the omega-3 fats in the brain. Fifty percent of the weight of a neuron’s plasma membrane is composed of DHA. And it’s a key component in heart tissue. I could write an entire chapter on DHA alone, but I’ll spare you that level of detail. Suffice it to say, DHA is one of the most well-documented darlings in protecting the brain. I often ask doctors in my lectures what they think the richest source of DHA is in nature. I hear all kinds of answers—codliver oil, salmon oil, anchovy oil. Some guess flaxseed oil or avocados, but those don’t contain adequate DHA. The richest source of DHA in nature is human breast milk. Which explains why breast-feeding is continually touted as important for the neurologic health and long-term performance of a child. Plenty of high-quality DHA supplements are available today, and there are more than 500 food products that are enriched with DHA. It doesn’t really matter whether you buy DHA that’s derived from fish oil or from algae. Opt for the algae-derived variety if you’re a strict vegetarian. Resveratrol: The magic behind the health benefits of drinking a glass of red wine a day has a lot to do with this natural compound found in grapes, which not only slows down the aging process, boosts blood flow to the brain, and promotes heart health, but also curbs fat cells by inhibiting their development. You can’t get enough resveratrol in that glass of wine, though. Hence the need to supplement with higher doses to reap the benefits. Because this so-called miracle molecule protects cells against a remarkable range of diseases, it’s frequently touted as an assistant in the body’s immune and defense system. Within the last decade we’ve come to learn just how this is possible, thanks largely to the work of Harvard’s Dr. David Sinclair, who discovered the supplement’s ability to activate certain genes called sirtuins, which affect longevity. 5 In 2010, scientists at Northumbria University in the United Kingdom published a study in the American Journal of Clinical Nutrition that discussed exactly why resveratrol can be so effective in optimizing brain function. 6 In it, they explained that they gave twenty-four students resveratrol and recorded marked increases in blood flow in the brain while they were performing mental tasks. And the harder the tasks, the greater resveratrol’s effect. Whether or not this means we all should be taking resveratrol before embarking on a serious undertaking like a test or interview is up for debate. But for now we know that we could do our brains well with the addition of a modest dose every day. And note I said modest. Although earlier research hinted that very large doses would be required to reap any benefits (doses equating to drinking hundreds of bottles of wine), newer studies clearly demonstrate that lower doses (as small as 4.9 milligrams per day) confer positive effects. Turmeric: Turmeric (Curcuma longa), a member of the ginger family, is the subject of intense scientific research, much of it evaluating the anti-inflammatory and antioxidant activities that stem from its active ingredient, curcumin. Turmeric is the seasoning that gives curry powder its yellow color, and as I mentioned earlier, it has been used for thousands of years in Chinese and Indian medicine as a natural remedy for a variety of ailments. In a report for the American Journal of Epidemiology, researchers investigated the association between curry consumption level and cognitive function in elderly Asians. 7 Those who ate curry “occasionally” and “often or very often” scored much better on specific tests designed to measure cognitive function than did people who “never or rarely” consumed curry. One of curcumin’s secret weapons is its ability to activate genes to produce a vast array of antioxidants that serve to protect our precious mitochondria. It also improves glucose metabolism. All of these properties help reduce risk for brain disease. Unless you make lots of curry dishes at home, you probably don’t get a lot of turmeric in your diet on a regular basis. Probiotics: Stunning new research in just the last few years has shown that eating foods rich in probiotics —live microorganisms that support our intestine’s resident bacteria—can influence brain behavior and help alleviate stress, anxiety, and depression. 8, 9, 10 These tribes of “good bacteria” that live in your intestines and help with digestion are enhanced and nourished by probiotics. They play a role in producing, absorbing, and transporting neurochemicals such as serotonin, dopamine, and nerve growth factor, which are essential for healthy brain and nerve function. Understanding how this is possible requires a quick lesson in the science of your microflora–gut– brain communication. 11 It’s true that your gut is your “second brain.” 12 This is an area of active, fascinating research, a large volume of which in recent years has demonstrated an intimate communication highway between the brain and the digestive system. Through this two-way connection, the brain receives information about what’s going on in your intestines as the central nervous system sends information back to your gut to ensure optimal functioning. All this transmission back and forth makes it possible for us to control our eating behavior and digestion, and even find restful sleep at night. The gut also sends out hormonal signals that relay to the brain feelings of fullness, hunger, and even pain from intestinal inflammation. In diseases and illnesses that affect the intestines, such as uncontrolled celiac, IBS, or Crohn’s disease, the gut can be a major influence on our well-being—how we feel, how well we sleep, what our energy level is, how much pain we experience, and even how we think. Researchers are currently looking at the possible role of some strains of intestinal bacteria in obesity, inflammatory and functional GI disorders, chronic pain, autism, and depression. They are also examining the role that these bacteria play in our emotions. 13 So intricate and influential is this system that the health of our gut could be a much bigger player in our perception of overall health than we ever imagined. The information processed by the gut and sent up to the brain has everything to do with our sense of well-being. And if we can support this system just by consuming the gut’s most important collaborators—healthy gut bacteria—then why not? Although lots of foods—such as yogurts and some beverages—are now fortified with probiotics, these products can often come with too much sugar. Ideally, get your probiotics through a supplement that offers a variety of strains (at least ten), including Lactobacillus acidophilus and bifidobacterium, and contains at least ten billion active bacteria per capsule. Coconut oil: As I’ve already described, coconut oil can help prevent and treat neurodegenerative disease states. It’s a superfuel for the brain and also reduces inflammation. You can drink a teaspoon of it straight or use it when you prepare meals. Coconut oil is heat stable, so you can cook with it at high temperatures. In the recipe section, I’ll give you some ideas for working with coconut oil in the kitchen