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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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November 29 2017

Why Aren’t We Talking About the Cognitive Health Crisis?

By Mark Sisson
65 Comments

Inline_Cognitive_Health_CrisisIf you look at the latest stats, you might assume there’s no cognitive health crisis. The overall number of dementia cases are going up, but that’s because the aging population is growing. Older folks are living longer than ever before, so there are more people around who can develop dementia. Dementia and Alzheimer’s rates are dropping in the Western world. Politicians, those archetypical paragons of cognitive aptitude, are hanging around in office longer than ever. Technology, science, and other fields that require large amounts of cognitive ability are progressing.

But broad trends and large numbers are just statistics. However reassuring they are to public policy analysts, they mean nothing to the individual suffering from cognitive decline. They’re too abstract. Your grandpa no longer knowing who you are? That’s real. You, personally, don’t want to lose your cognitive abilities as you age. You, personally, don’t want to see the people you love get Alzheimer’s. Individual cases matter to those individuals and their loved ones. And it’s still happening more than it should.

Maybe more than any other disease, severe cognitive impairments have the potential to unravel families. They’re not one and done. They drag on. They aren’t “lethal” in the normal sense. People with Alzheimer’s can lead long lives, the latter halves of which can get very difficult for everyone involved. There’s an entire body of literature devoted to studying the effects of Alzheimer’s on families and caregivers and discovering effective methods for mitigating the damage done. You don’t get that so much with other diseases.

Yet for whatever reason, Alzheimer’s doesn’t get enough attention. Sure, it’s mentioned. People are aware it exists. They can probably name the general symptoms. But it doesn’t seem as pressing a concern as something like cancer, diabetes, or heart disease.

One reason is that cognitive diseases are really scary to consider. Most other diseases affect what we consider to be the peripheral tissues. Heart disease is about the heart. Kidney disease affects the kidneys. Cancer can strike anywhere, but it’s usually in an organ or bone. Most diseases leave our personhood intact. We’re still us, even when we’re riddled with tumors or on dialysis. But with something like Alzheimer’s, we disappear. We forget who we are. We forget where we live, how old we are, and the name of that stranger hovering over us with a concerned look on her face. People define themselves by their intellect; our superior mind is what sets us apart from the rest of the animal kingdom. When that goes, what’s left? No one wants to think about that.

Another reason is that the conventional take on Alzheimer’s and other cognitive disorders is that we are helpless in the face of it. Most of the drugs have failed. Even the chief executive of Alzheimer’s Research UK accepts as “fact that there are no treatments to slow or stop the diseases behind dementia.” When the authorities are throwing up their hands and giving in, what is a lay person supposed to do but despair and stop thinking about it?

That has to change. There are legitimate treatments available. The problem is that the treatments aren’t “take this pill and call me in the morning.” They require lifelong commitments to healthy living, eating, and exercising.

In the most promising study I’ve seen, researchers had Alzheimer’s patients undertake a dramatic diet, exercise, and lifestyle shift. Bear in mind that this was a case study, or rather ten of them involving ten subjects, not a clinical trial involving hundreds. Still, the results were striking. Here’s what each subject did:

  1. Eliminate all simple carbs and follow a low-glycemic, low-grain (especially refined grains) diet meant to reduce hyperinsulinemia.
  2. Observe a 12-hour eating window and 12-hour fast each day, including at least three hours before bed.
  3. Stress reduction (yoga, meditation, whatever works for the individual).
  4. Get 8 hours of sleep a night (with melatonin if required).
  5. Do 30-60 minutes of exercise 4-6 days per week.
  6. Get regular brain stimulation (exercises, games, crosswords).
  7. Supplement to optimize homocysteine, vitamin B12, CRP levels.
  8. Take vitamin D and vitamin K2.
  9. Improve gut health (prebiotics and probiotics).
  10. Eat antioxidant-rich foods and spices (blueberries, turmeric).
  11. Optimize hormone balance (thyroid panel, cortisol, pregnenolone, progesterone, estrogen, testosterone).
  12. Obtain adequate DHA to support synaptic health (fish oil, fish).
  13. Optimize mitochondrial function (CoQ10, zinc, selenium, other nutrients).
  14. Use medium chain triglycerides (coconut oilMCT oil).

Looks awfully familiar, doesn’t it? They weren’t messing around. They were even careful enough to include vitamin K2 with vitamin D. They had them fast. They were aware of the benefits of fats and ketones for the brain and didn’t even use a full-blown ketogenic diet to provide them.

How’d the subjects do?

First of all, they started with memory impairment from Alzheimer’s, amnesiac cognitive impairment, and/or subjective cognitive decline. They started from pretty serious deficits.

Nine of the ten patients showed subjective or objective improvements in cognitive function and performance within 3-6 months. The one failure was a person with late-stage Alzheimer’s disease.

Of the six patients who’d had to stop working due to their cognitive decline, all six were able to return to work.

In a 2.5 year followup, the patients had sustained and even improved on their results.

Note that they didn’t worry about “saturated fat” or “butter.” Only one subject stopped eating “meat.” Another switched to grass-fed beef over conventional beef. There were no mentions of sodium restriction or statin drugs.

This was published in 2014. The same researcher even confirmed that the protocol worked in ApoE4 subjects, the genetic variant that increases the risk of Alzheimer’s. Even the cynics over at Science Based Medicine were cautiously optimistic about it. Why aren’t Alzheimer’s researchers shouting from the rooftops and demanding more funding to run larger studies using this protocol?

I hate to assume the worst—that it doesn’t involve a patentable pharmaceutical—but what else can I do?

In the meantime, we have work to do. It’s going to take a lot to beat this. For one, we won’t beat it by reacting to the disease (although, as the case studies show, that can help and even reverse the disease before it’s progressed too far). We have to be proactive. We have to get sleep, sun, food, exercise, community, and every other lifestyle factor under control from day one. We have to stay abreast of the latest research into how diet and lifestyle affect brain function. What your kids do today may very well affect their cognitive health down the road. If that sounds heavy, it’s supposed to be. This is serious stuff, folks. You can’t play around with the most complex structure in the known universe: the human brain. Take no chances. Spare no expense.

And even then, it might not work. These were just case studies without placebo controls, after all. But at the very least, getting enough sleep and sunlight, learning to burn fat more effectively, eating micronutrient-rich diets, consuming polyphenol-rich spices and herbs, occasionally producing and burning ketones, optimizing our hormone panels, reducing or mitigating stress, avoiding hyperinsulinemia and insulin resistance, improving our gut health, and exercising on a regular basis is a good start that won’t hurt us.

That’s my plea for the day. Thanks for reading, folks.

Thoughts to share on how we talk about or treat cognitive health conditions? I’d like to read your feedback.

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65 thoughts on “Why Aren’t We Talking About the Cognitive Health Crisis?”

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  1. I’m actually pretty curious about how valid the term “Type III Diabetes” is for Alzheimer’s Disease. Researchers seem to like it, but it hasn’t popped in popular culture.

    1. Type III seems to have insulin resistance in common with Type II diabetes only it effects the brain function rather than glucose uptake etc.

  2. I read about this study a while back. It is very encouraging. You are exactly right when you say >> “Why aren’t Alzheimer’s researchers shouting from the rooftops and demanding more funding to run larger studies using this protocol? I hate to assume the worst—that it doesn’t involve a patentable pharmaceutical—but what else can I do?” Maybe Mark Sisson blogging about it will help.

    1. The problem might not be funding for research. There is really a lot out there that just can not be denied anymore.

      1 example: https://chriskresser.com/prevention-and-treatment-of-alzheimers-from-a-functional-perspective-with-dr-dale-bredesen/

      The problem is getting it to ‘mainstream’. Because we have to break through a trained behavior, : if there is a problem, we take a pill!
      A problem can always be solved with a pill.

      Change happens if ‘mainstream’ can go beyond that.

      Somebody else who is doing great work on this matter is of course Terry Wahls MD

    2. The time to keep quiet about this is almost over. Pythagoreans always said to keep your right hand to yourself- don’t extend help to those who will cut it off if you try to help them.
      Maybe the fit but overweight soccer-mom at weekly practice whose own mother dressed and undressed dolls and wet her pants, who degenerated into a two year old child in her later years with this disease is almost ready to hear this without punching me out/cutting of my hand.
      The soccer woman tries so hard to be fit and lose weight but it’s not happening for her. She’s still married to the mainstream lies. But that system is dying. Viva veritas.

  3. Your brain is part of your body. If you keep your body healthy it stands to reason your brain will fare better as well. Pharmaceuticals haven’t been the answer in the quest to cure Alzheimer’s. In fact, it’s entirely possible that at least some of them can cause or contribute to the problem. Nobody really knows what long-term usage of drugs actually does to the chemical balance of the brain and the functioning of the human mind. For me, that’s good enough reason to avoid them as much as I can.

    Most drugs have a dirty underbelly (commonly known as “side effects”) that manufacturers are forced by law to disclose. Unfortunately, people looking for a quick solution rarely pay much attention to those disclosures–which likely aren’t even all-inclusive–and doctors have a notoriously cavalier attitude toward what they prescribe. In reality, lifestyle/dietary changes are the only “magic” out there–not chemicals that suppress one problem while creating other more serious ones.

    1. Totally with you all. It’s a terrifying illness but it seems common, evolutionary sense: keep the gut, body and brain healthy in every other way – and be mindful.

  4. THANK YOU!!!!!!!!!!!!!!!!!! Yes I am effected by a parent who is brilliant, wonderful and fun human being slowly degrading. Becoming more timid, sometimes angry, more forgetful and slowly slipping away from us. I had not heard of this study. Thank you.

    1. To find out more read the book ‘ The End of Alzheimers ‘ by Dr Dale Bredesen. It’s his study Mark is talking about and since then I believe he has had success with over a hundred patients and there are trials going on in America as well as the UK.

      1. There are also good youtube videos of Dr. Bredesen discussing his protocol. I suggest the one from the Silicon Valley Health institute. The structure behind the protocol will make a lot more sense after hearing his talk.

    2. I am on the exact same boat, I get it 100%. With my dad it was slow at the beginning and faster later. i am saving this article

  5. My mother had dementia for about 20 years. Later we found out that one of the symptoms of it’s onset was “falling for no apparent reason” which she would do a few times a year. Had we known then we could have maybe changed her lifestyle. She still knew us until the end just not every moment.
    To help her brain to stay calm towards the end of her journey she had to take anti-psychotics. If she didn’t take those she would run out to the street screaming, afraid that people were harming her, sad to see such a wonderful woman disappear gradually.

    1. You had a similar experience I had with my lovely mother… In her case, after 5 years, the nurologist found she had hydrocephaly plain, and she had two surgeries to add a tube to the bottom of her skull, connecting to the faringe, to drain the liquid… It was a tragic, painful situation… The doctors could not explain the origin or cause of the problem. They only said that it probably could have been less damaging if we had found help earlier – but, we were not doctors and none of the doctors had ever diagnosed it before the neurologists did when she was 70. She finally dies at 73 after a hemorragic stroke.

  6. Bless you Mark. I read this study at the time but sadly lost both link and reference. With 2 family members suffering with dementia I have done my best to remember the crucial details to assist in their care but now I have all the information I need. I am very grateful to you for this, and for shining a light on a much neglected area of care and healing.

  7. This is very interesting! Do you know if there are similar studies about autism?

    I know a couple with an autistic child and he showed great improvements in behavior when they changed his diet. They basically cut all processed food and sugar from his diet and removed cured meats with nitrates as well. One time the mom freaked out when her son got hold of a bratwurst and took a huge bite!

    This was about 18 years ago, and I believe they were on the cutting edge of using diet to improve symptoms of autism. I remember thinking that it made sense – all the chemicals and additives in processed foods can’t be good for a brain whose chemistry is already delicate.

    Great article!

    1. You might try David Perlmutter’s site. He’s a neurologist and wrote Grain Brain and Brain Maker, and advocates Dr. Bredesen’s approach to Alzheimer’s. Dr. Perlmutter has lots of info on his site/books regarding diet/ lifestyle modifications for autistic kids including the use of fecal transplants in some cases.

    1. I feel like he doesn’t really tend to comment about products — especially supplements — he doesn’t sell. I think it’s been years since he’s even mentioned squatty potty.

      1. Ion, while I feel the need to be judicious in comments about others’ products unless I’m full on recommending them, I don’t have a hard rule against it either. I haven’t heard of the product Mark mentioned and left the space for others to comment at will. And for the record, I still have my Squatty Potty. Glad you’re here. Grok on – M

  8. This stuff makes me crazy. Especially seeing so many friends with parents who are really struggling. It ends up ripping families apart. I’m so fortunate that my parents who are in their 80’s are actually doing most of the stuff that was done in the study. And they’re super sharp and with it. Personally, I saw a major reduction in my own anxiety, as well as an increase in focus when I went high fat/low carb. Pretty sure I have ADD,it was just not diagnosed much when I was a kid (the term was “hyperactive” back in the 70s”) but I look at it as a postivie…I’m full of ideas and energy. Eating and living this way helps me stay focused. So I have no doubt this lifestyle can help with so many cognitive issues. But sadly most people would rather just be prescribed a pill.

    1. Yes, Elizabeth! I agree. I had a similar experience; I had no idea that changing my nutrition would affect my brain functioning in such a positive way. It was an awesome bonus that I wasn’t expecting!

    2. To be fair Dale Bredesen’s protocol involves a lot of pill popping in addition to diet, yoga and fasting – it just so happens that most of those pills are not classified as drugs but supplements.

  9. The author of the study, Dale Bredesen, has written a book on the protocol, available cheap on Amazon Kindle: The End of Alzheimer’s.

  10. That’s it in a nutshell, from the 2014 paper. More recently, Bredesen’s excellent July 2017 book “the end of Alzheimers” lists 36 levers to delay or relieve Alzheimer’s. Many are obscure supplements. He recommends first doing a cogniscopy (mental and physical evaluation) to measure levels.

    The jist is that AD is the body’s protective mechanism to insults of modern life. The solution is to remove as many insults as possible, in other words: move in a primal direction.

    1. Go back to Nature…

      My thanks for the succinct appraisal. I like the expression ‘insults of modern life’. I may have to borrow this 🙂

  11. I have a somewhat lengthy experience to share related to this article. My grandmother had Alzheimer’s. She was definitely moderate to advanced decline. After learning about this study in the past two years, we found a functional medicine doctor for her.

    The functional medicine doctor was following this same protocol that you described from the study. She ran a bunch of labs, including B12, folate, Vitamin D, etc and made recommendations for daily supplementation along with lifestyle changes.

    My grandmother was in the memory care center, so the lifestyle changes were not feasible for her. The facility was unwilling to change their menu or kitchen offerings which was quite disappointing to say the least. They would serve cookies, cakes and soda to the memory care residents for snack time. This is standard practice for senior care facilities, so unless you are living with an Alzheimer’s patient where you can prepare the meals yourself, or are swimming in money, there’s not a lot that can be done currently until the industry changes its ideas about food.

    They facility was also not willing to walk with her for 15 mins a day to help her get exercise, despite the physicians orders. So exercise was also not possible as part of a regular routine for her.

    However, we started the daily supplements from her functional medicine doctor (Vitamin D, zinc, folic acid, probiotics, fish oil, etc) and after about 2.5 months there was a SIGNIFICANT improvement in her cognitive function.

    Her mood was stable and improved, she was much more social and much happier. She was able to do some things by herself that she had been unable to do for years (like change the thermostat on her own, get a sweater if she felt cold, have a meaningful conversation, use the bathroom without guidance). If you have a loved one with dementia, you can recognize what a huge amazing accomplishment these small things were, even though it doesn’t sound like much on paper.

    Her short term memory did not show signs of improvement, but overall it was clear that her brain was working a lot better even with this simple supplementation. We were correcting some nutritional deficiencies that she could have been suffering from for years, maybe even decades.

    Her general practitioner did not approve of the supplements and was unwilling to assist with prescription refills for the vitamins, despite seeing the significant improvements. We had to work exclusively through the functional medicine dr to implement these changes. I wish we had been able to implement more of the program components, but our hands were tied in many ways. I can only imagine what kind of other improvements she would have experienced if she were eating right and getting exercise every day.

    Alzheimer’s patients are typically unable to advocate for themselves and the cause, so thanks for helping to get the word out there. It really is heartbreaking to see how Alzheimer’s slowly destroys people. I hope that everyone can make some of these lifestyle changes and hopefully avoid going through the same experience. Prevention, prevention, prevention.

    And be proactive in seeking out a functional medicine doctor if you can. It was very discouraging that her GP was so dismissive.

    1. Thanks so much for sharing this Warsh, and thanks to Mark for a very critical and potentially life-altering article.

  12. Wow this strikes a chord with me … I saw the gradual downfall of my dad early, I could not have any influence on him (I am used to this with other people, but this is my dad!)

  13. I am at risk for blood clots (bad valves in my leg veins). Would Vitamin K2 affect my clotting risk?

    1. Cathy I’m not a medical professional (which I assume you have consulted with on this) but my two cents worth … vitamin K2 is very important for protecting your blood vessels from calcification and it does have a blood thinning effect. In addition to stuff you already know (eating healthy, exercising, staying hydrated, good night’s sleep) other supplements / food that help with blood clots are garlic, curcumin, green tea. They all can cause the blood to thin so if you’re on any medication you should check with your allopathic physician or holistic practitioner.

    2. If you are on blood thinners, do not increase your Vitamin K intakes without consulting a physician.

  14. I came across research about brain health and how to promote it while reading Grain Brain. My focus though was managing my Type 1 diabetes through diet, not brain health. Knowing what I know now, I’m doubly happy with my diet and lifestyle changes: my body and brain are both benefiting! It is fascinating how much of our health is affected by what we eat. I wish researchers were shouting it from the rooftops too!

  15. I saw a webinar recently that had a study done in Israel that had people in nursing homes take cannabis oil orally and they said that they had improvements. This needs to be looked in to more.

  16. Amy Berger’s new book Alzheimer Antidote is a great resource.

  17. I’d like to see an article on Neurofeedback therapy, which relates to this topic, and many more that our primal community care about.

    I know you’ve discussed the Bulletproof 40 years of zen lab, but that’s just one version of the therapy, which has shown a great deal of success.

    There are practitioners everywhere using standard protocols for all types of brain related issues, and for performance optimization.

  18. This scourge is not going away soon unfortunately. So many monied interests. I too had a father that faded away. If we think that is bad, I would think that having our mates (wives,husbands, partners,friends) getting this disease would be even worse, if that’s even possible. At least this community is giving it a good fight. And fight on we will.

  19. Wonderful data Mark, as usual, thanks! Already got the link sent to some relatives struggling with issues of that kind, it seems so difficult for all, a lot of affected people won’t want to recognize or admit the issue neither which easily leads to conflict. The title of the article got my attention and is so true, I hear a lot about it from people around me in the last few years but the media / scientific coverage really don’t seem to follow the need for help here, thumbs up for putting a spotlight on that one!

  20. Dr. Richard Issacson is doing this at NY Presbyterian Hospital. I am part of a longitudinal study for the prevention of Alzheimer’s. My last set of blood work and cognitive assessments were off the charts good. But it is hard work, like most things that are worthwhile!

  21. Alzheimer’s disease, which develops slowly over decades of poor lifestyle choices, won’t be cured with a pill; therefore there is no incentive for Big Pharma to spend the money to do the types of research that we should be doing. They can’t make any money by people changing their lifestyles to eat less processed food, do intermittent fasting, exercise more, get adequate sleep, etc.. So it really falls to each individual to do your own research, and make smart lifestyle choices, which will go a long ways toward reducing the risk of developing cognitive diseases as you age.

    1. And think of the impact on the manufactures of pseudo foods, and the “ethical” drug industry, if people started eating correctly. I said correctly because so called “healthy eating” as most people think of it is not healthy.

      As the cliche goes, “Beware of alleged foods that make health claims.”.

  22. I am a Social Worker for Older Adults, and nothing scares them more than losing their brain vitality and ability to decide for themselves. I completely agree with everything you wrote and yet, find that most people do not or can not implement all of these suggestions – especially people who have already lost some of their brain bandwidth. There is a new company that I just signed on for that addresses the BRAIN/GUT axis and I invite readers (and Mark), to check it out:
    http://ltl.is/AOaEo

  23. Our team (Stony Brook University + Massachusetts General Hospital/Harvard Medical School) has just received significant funding to conduct a fairly large-scale study on the impact of ketosis and exogenous ketones in preventing dementia. Will start recruiting subjects (ages 18-79) in the next few months.

  24. Loved this!!! My Dad has dementia, has gone through pneumonia, developed heart disease and currently has a lung infection. I live in Sydney while he’s in Ireland and it kills me that I can’t be there to integrate these things into his life. Doctors continue to prescribe more statins and I fear he’s on a rapid decline. Can you please recommend someone in Ireland that could access him, give a second opinion? Thank you for this post!

  25. Mark, you ask two very important questions – “Why aren’t we talking about the cognitive health crisis, and why aren’t Alzheimer’s researchers shouting from the rooftops and demanding more funding to run larger studies using this protocol?” And after reading your article, I’m left asking, “Why isn’t Mark shouting Dr. Bredesen’s name from the rooftops?” As the researcher who has developed the protocol to prevent/reverse cognitive decline, and is lobbying big pharma and medical institutions to fund studies (mostly without success), your readers and the public deserve to know specifically that the researcher you’re referring to is Dr. Dale Bredesen, and his website is https://www.drbredesen.com/ and his book is “The End of Alzheimer’s”. This book is chock-full of valuable interventions that all of us can take to prevent and even reverse cognitive decline, and Dr. Bredesen’s protocol dovetails very nicely with ketogenic and Primal lifestyles.

  26. Hello,
    in the village of my grandmother in croatia live a lot of old people, up to the age of 90, even 100.
    No one had ever dementia and alzheimer, no one.

    They live a simple life: eat what theygrow by them self (lot of greens, legumes, on sundays meat) and they fast 2 times a week as i know (roman-katholic).
    And they have strong social contact.

    No industrie.
    No pollutans.
    No junk food.

    Greetings from croatia (sorry for my bad englisch 🙂
    Markus

    1. Your English may not be the best, but the content of this post surely is!

  27. Exactly one year after I posted this http://forum.marksdailyapple.com/forum/the-primal-blueprint-forum-discussion/primal-research/2989035-bredesen-protocol-for-alzheimer-s (2016-11-29) at the MDA forum… just imagine what you could have done with the info in the mean time… provided you would have frequented the forum like so many still did back then.

    Please get the forum back to it’s former glory Mark. Time’s running out… and spammers are taking over. Fast and relentless. Due to having no moderators and/or spam control. It hurts to see it falling apart and all the useful information getting buried underneath the junk.

  28. Listen to interview with Daniel amen on bulletproof radio very informative
    Amen clinics

  29. I’ve known about this study and have been teaching about it as an herbalist. Doctors that I have talked to about this study say that the small size of the study limits the conclusions, that the patients were not well screened and diagnosed before the study, and that the journal in which it was published is a less-than-stellar journal (authors pay to be published in that journal). The claim about the small size of the study I find laughable. Many medical studies recruit hundreds or thousands of cases in order to gain enough strength to show even the smallest effect. This study elegantly shows dramatic effects with only 10 cases. I think the problem is that the protocol is complex and requires significant commitment, even though the authors point out that even patients who were only partially compliant got good results. It is definitely time for the medical community to recognize that MCI/AD are metabolic diseases and to act accordingly.

  30. Both my grandmother and my father had Alzheimer’s. I do not want to be the next in line. During the time we were caring for my dad, I would share what we were dealing with to anybody who would listen. Nobody offered much in the way of advice even though I knew that several of them had been through a very similar experience. Afterward, I found that even more people I know had been caregivers, but they kept silent. It made me angry that nobody wanted to talk about this issue. I think they were so traumatized by the experience that they were not willing to revisit the experience. I have spoken to many researchers and none of them are willing to discuss prevention or treatment. They’re primarily looking for ways to manage the disease. Thank you for raising this issue. We all need to speak up and push for more action.

  31. How do you get a person that has never exercised in her life to take up walking? It’s good to know that you can do something. But the mother at 79 is not going to make any changes. I was able to sneak in some NEMs which seem to have stabilized her condition together with cancer for now. But walking or eating less carbs: forget it.

    1. My mother was never a big exerciser, but I sent her out to Steve Rowe’s kettlebell gym in West Haven when she was 81 — I think that went on for two years.

  32. Perhaps neurofeedback, and other methods of brain exercise can also help those with Alzheimer’s