processed

hyper-processed foods filled with refined sugars that spike insulin levels beyond a healthy limit), our cells adapt by reducing the number of receptors on their surfaces to respond to insulin. In other words, our cells desensitize themselves to insulin, causing insulin resistance, which allows the cells to ignore the insulin and fail to retrieve glucose from the blood. The pancreas then responds by pumping out more insulin. So higher levels of insulin become needed for sugar to go into the cells. This creates a cyclical problem that eventually culminates in type 2 diabetes. People with diabetes have high blood sugar because their body cannot transport sugar into cells, where it can be safely stored for energy. And this sugar in the blood presents many problems—too many to mention. Like a shard of glass, the toxic sugar inflicts a lot of damage, leading to blindness, infections, nerve damage, heart disease, and, yes, Alzheimer’s. Throughout this chain of events, inflammation runs rampant in the body. I should also point out that insulin can be viewed as an accomplice to the events that unfold when blood sugar cannot be managed well. Unfortunately, insulin doesn’t just escort glucose into our cells. It’s also an anabolic hormone, meaning it stimulates growth, promotes fat formation and retention, and encourages inflammation. When insulin levels are high, other hormones can be affected adversely, either increased or decreased due to insulin’s domineering presence. This, in turn, plunges the body further into unhealthy patterns of chaos that cripple its ability to recover its normal metabolism. 4 Genetics are certainly involved in whether or not a person becomes diabetic, and genetics can also determine at what point the body’s diabetes switch gets turned on, once its cells can no longer tolerate the high blood sugar. For the record, type 1 diabetes is a separate disease thought to be an autoimmune disorder—accounting for only 5 percent of all cases. People with type 1 diabetes make little or no insulin because their immune system attacks and destroys the cells in the pancreas that produce insulin, so daily injections of this important hormone are needed to keep blood sugars balanced. Unlike type 2, which is usually diagnosed in adults after their bodies have been abused by too much glucose over time, type 1 diabetes is typically diagnosed in children and adolescents. And unlike type 2, which is reversible through diet and lifestyle changes, there is no cure for type 1. That said, it’s important to keep in mind that even though genes strongly influence the risk of developing type 1 diabetes, the environment can play a role, too. It has long been known that type 1 results from both genetic and environmental influences, but the rising incidence over the last several decades has led some researchers to conclude that environmental factors could be more instrumental in the development of type 1 than previously thought. SAD BUT TRUE More than one hundred eighty-six thousand people younger than age twenty have diabetes (either type 1 or type 2). 5 Just a decade ago type 2 diabetes was known as “adult-onset diabetes,” but with so many young people being diagnosed, the term had to be dropped. And new science shows that the progression of the disease happens more rapidly in children than in adults. It’s also more challenging to treat in the younger generation. What we’re beginning to understand is that insulin resistance, as it relates to Alzheimer’s disease, sparks the formation of those infamous plaques that are present in diseased brains. These plaques are the buildup of an odd protein that essentially hijacks the brain and takes the place of normal brain cells. And the fact that we can associate low levels of insulin with brain disease is why talk of “type 3 diabetes” is starting to circulate among researchers. It’s all the more telling to note that obese people are at a much greater risk of impaired brain function, and that those with diabetes are at least twice as likely to develop Alzheimer’s disease. This statement is not meant to imply that diabetes causes Alzheimer’s disease, only that they both share the same origin. They both spring from foods that force the body to develop biological pathways leading to dysfunction and, farther down the road, illness. While it’s true that someone with diabetes and another person with dementia may look and act differently, they have a lot more in common than we previously thought. In the last decade, we’ve witnessed a parallel rise in the number of type 2 diabetes cases and the number of people who are considered obese. Now, however, we’re starting to see a pattern among those with dementia, too, as the rate of Alzheimer’s disease increases in sync with type 2 diabetes. I don’t think this is an arbitrary observation. It’s a reality we all have to face as we shoulder the weight of soaring health care costs and an aging population. New estimates indicate that Alzheimer’s will likely affect 100 million people by 2050, a crippling number for our health care system and one that will dwarf our obesity epidemic. 6 The prevalence of type 2 diabetes, which accounts for 90 to 95 percent of all diabetes cases in the United States, has tripled in the past forty years. No wonder the U.S. government is anxiously looking to researchers to improve the prognosis and avert this catastrophe. And in the next forty years, more than 115 million new cases of Alzheimer’s are expected globally, costing us more than one trillion dollars (in today’s dollars). 7, 8 According to the Centers for Disease Control and Prevention, 18.8 million Americans were diagnosed with diabetes in 2010 and another 7 million went undetected. Between 1995 and 2010, the number of diagnosed cases of diabetes jumped by 50 percent or more in forty-two states, and by 100 percent or more in eighteen states. 9 THE SILENT BRAIN ON FIRE One of the most frequent questions I get at my clinic from families of Alzheimer’s patients is How did this happen? What did my mother (or father, brother, sister) do wrong? I am careful how I respond at such a heartbreaking time in a family’s life. Watching my own father wither away slowly day after day is a constant reminder of the mixed emotions that a family endures. There is frustration fused with helplessness, and anguish mingled with regret. But if I had to tell family members (myself included) the absolute truth given what we know today, I’d say that their loved one may have done one or more of the following: lived with chronic high blood sugar levels even in the absence of diabetes eaten too many carbohydrates throughout his or her life opted for a low-fat diet that minimized cholesterol had undiagnosed sensitivity to gluten, the protein found in wheat, rye, and barley When I tell people that gluten sensitivity represents one of the greatest and most under-recognized health threat to humanity, the response I hear is pretty much the same: “You can’t be serious. Not everyone is sensitive to gluten. Of course, if you have celiac disease, but that’s a small number of people.” And when I remind people that all the latest science points to the bane of gluten in triggering not just dementia but epilepsy, headaches, depression, schizophrenia, ADHD, and even decreased libido, a common thread prevails in the response: “I don’t understand what you mean.” They say this because all they know about gluten focuses on intestinal health—not neurological wellness. We’re going to get up close and personal with gluten in the next chapter. Gluten isn’t just an issue for those with bona fide celiac disease, an autoimmune disorder that strikes a small minority. As many as 40 percent of us can’t properly process gluten, and the remaining 60 percent could be in harm’s way. The question we need to be asking ourselves: What if we’re all sensitive to gluten from the perspective of the brain? Unfortunately, gluten is found not only in wheat products but also in the most unexpected products—from ice cream to hand cream. Increasing numbers of studies are confirming the link between gluten sensitivity and neurological dysfunction. This is true even for people who have no problems digesting gluten and who test negative for gluten sensitivity. I see this every day in my practice. Many of my patients reach me once they have “tried everything” and have been to scores of other doctors in search of help. Whether it’s headaches and migraines, Tourette’s syndrome, seizures, insomnia, anxiety, ADHD, depression, or just some odd set of neurological symptoms with no definite label, one of the first things I do is prescribe the total elimination of gluten from their diets. And the results continue to astound me. Researchers have known for some time now that the cornerstone of all degenerative conditions, including brain disorders, is inflammation. But what they didn’t have documented until now are the instigators of that inflammation—the first missteps that prompt this deadly reaction. And what they are finding is that gluten, and a high-carbohydrate diet for that matter, are among the most prominent stimulators of inflammatory pathways that reach the brain. What’s most disturbing about this discovery, however, is that we often don’t know when our brains are being negatively affected. Digestive disorders and food allergies are much easier to spot because symptoms such as gas, bloating, pain, constipation, and diarrhea emerge relatively quickly. But the brain is a more elusive organ. It could be enduring assaults at a molecular level without your feeling it. Unless you’re nursing a headache or managing a neurological problem that’s clearly evident, it can be hard to know what’s going on in the brain until it’s too late. When it comes to brain disease, once the diagnosis is in for something like dementia, turning the train around is hard. The good news is that I’m going to show you how to control your genetic destiny even if you were born with a natural tendency to develop a neurological challenge. This will require that you free yourself from a few myths so many people continue to cling to. The two biggest ones: (1) a low-fat, high-carb diet is good, and (2) cholesterol is bad. The story doesn’t end with the elimination of gluten. Gluten is just one piece of the puzzle. In the upcoming chapters, you’ll soon understand why cholesterol is one of the most important players in maintaining brain health and function. Study after study shows that high cholesterol reduces your risk for brain disease and increases longevity. By the same token, high levels of dietary fat (the good kind, no trans fats here) have been proven to be key to health and peak brain function. Say what? I realize you may doubt these statements because they run so contrary to what you’ve been taught to believe. One of the most prized and respected studies ever done in America, the famous Framingham Heart Study, has added volumes of data to our understanding of certain risk factors for disease, including, most recently, dementia. It commenced in 1948 with the recruitment of 5,209 men and women between the ages of thirty and sixty-two from the town of Framingham, Massachusetts, none of whom had yet suffered a heart attack or stroke or even developed symptoms of cardiovascular disease. 10 Since then, the study has added multiple generations stemming from the original group, which has allowed scientists to carefully monitor these populations and gather clues to physiological conditions within the context of myriad factors—age, gender, psychosocial issues, physical traits, and genetic patterns. In the mid-2000s, researchers at Boston University set out to examine the relationship between total cholesterol and cognitive performance, and they looked at 789 men and 1,105 women who were part of the original group. All of the individuals were free of dementia and stroke at the beginning of the study and were followed for sixteen to eighteen years. Cognitive tests were performed every four to six years, evaluating things like memory, learning, concept formation, concentration, attention, abstract reasoning, and organizational abilities—all the features that are compromised in patients with Alzheimer’s disease. According to the study’s report, published in 2005, “There was a significant positive linear association between total cholesterol and measures of verbal fluency, attention/concentration, abstract reasoning, and a composite score measuring multiple cognitive domains.” 11 Moreover, “participants with ‘desirable’ total cholesterol (less than 200) performed less well than participants with borderline high total cholesterol levels (200 to 239) and participants with high total cholesterol levels (greater than 240).” The study concluded that “lower naturally occurring total cholesterol levels are associated with poor performance on cognitive measures, which placed high demand on abstract reasoning, attention/concentration, word fluency, and executive functioning.” In other words, the people who had the highest cholesterol levels scored higher on cognitive tests than those with lower levels. Evidently, there is a protective factor when it comes to cholesterol and the brain. We’ll be exploring how this is possible in chapter 3. The research keeps coming from various labs around the world, flipping conventional wisdom on its head. As I write this, researchers with Australian National University in Canberra just published a study in the journal Neurology (the medical journal of the American Academy of Neurology) showing that people whose blood sugar is on the high end of the “normal range” have a much greater risk for brain shrinkage. 12 This ties directly into the story of type 3 diabetes. We’ve known for a long time that brain disorders and dementia are associated with brain shrinkage. But knowing now that such shrinkage can happen as a result of blood sugar spikes in the “normal” range has tremendous implications for anyone who eats blood sugar–boosting foods (i.e., carbohydrates). So often my patients will tell me that they are fine because their blood sugar is normal. But what is normal? The lab test may indicate that an individual is “normal” by established standards, but new science is forcing us to reconsider normal parameters. Your blood sugar may be “normal,” but if you could peek into your pancreas, you might be aghast at how much it’s struggling to pump out enough insulin to keep you on an even keel. For this reason, getting a fasting insulin test, which is done first thing in the morning before eating a meal, is critical. An elevated level of insulin in your blood at this time is a red flag—a sign that something isn’t metabolically right. You could be on the verge of diabetes, already depriving your brain of its future functionality. The Australian study involved 249 people age sixty to sixty-four who had blood sugar in the socalled normal range, and who underwent brain scans at the start of the study and again an average of four years later. Those with higher blood sugar levels within the normal range were more likely to show a loss of brain volume in regions involved with memory and cognitive skills. The researchers even managed to factor out other influences, such as age, high blood pressure, smoking, and alcohol use. Still, they found that blood sugar on the high end of normal accounted for 6 to 10 percent of the brain shrinkage. The study suggests that blood sugar levels could have an impact on brain health even for people who do not have diabetes. 13 Blood sugar and insulin imbalances are epidemic. Within the next decade, one in two Americans will suffer from diabesity—the term now used to describe a range of metabolic imbalances from mild insulin resistance to pre-diabetes to full-blown diabetes. The hardest fact of all to accept is that a breathtaking 90 percent of these people will not be diagnosed. They will carry on and come to learn of their predicament when it’s far too late. My mission is to interrupt such an unfortunate destiny. We want to focus not on calling all the king’s horses and all the king’s men, but on coaxing Humpty