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TEN GOOD RULES FOR REVERSING COGNITIVE DECLINE
Memory loss, cognitive impairment and Alzheimer’s disease afflicts one in ten Americans over age 65. However, evidence from medical science shows this can often be reversed. Listed here are safe interventions that improve brain function, with the most promising saved for last. All these interventions practiced together give the best outcome and each has the potential to significantly improve a person's life.
1.
Sleep Well
Ensuring good sleep is critical. A good night’s sleep improves memory and provides an opportunity for the brain glymphatic system to reduce toxic substances that build up during the day. A regular schedule that allows for 7-9 hours of sleep each night is optimal. A cool, dark sleeping environment is best. Obstructive sleep apnea (OSA) severely interrupts sleep, preventing the normal restorative processes that occur with deep sleep which are necessary for the brain to work optimally. Diagnosing OSA requires a sleep study which often can be provided in someone’s home using telemetry. If present, OSA can be treated with a dental appliance or a CPAP machine. Although the process can be tedious, when OSA is successfully treated the results are often life changing.
2.
Optimize Nutrition
The importance of essential nutrients becomes especially important with age. Fish consumption (presumably because of omega-3 fat) as well as sun exposure (presumably because of vitamin D) are well established healthy behaviors that reduce the risk of Alzheimer’s dementia. Supplements can provide vitamins (e.g., D, B's, C) and trace minerals (e.g., Li, Se, Si, Zn, Cu, Fe), and essential fats (DHA and EPA) that can help prevent cognitive decline. Probiotics and fermented foods like plain, whole fat Greek yogurt can help optimize and give diversity to the microbiome. There may be additional benefits from eating fish and being in sunlight which cannot be obtained by supplements.
3.
Walk Outdoors
Surrounded by foliage and trees, a daily forty minute walk outdoors can stimulate new nerve growth in the hippocampus and reverse memory decline. Working in a garden may provide critical benefits. A physically active lifestyle, which may also include weight training, aerobic exercise, and racket sports can improve executive function, processing speed, and overall brain health.
4.
Be Social
Engaging with a large social network, novel activities, dancing, and diverse mental stimulation can improve cognitive function as it improves mood. Loneliness increases the risk of dementia by one-third. Meaning and purpose in life can deepen through social engagement, offering protection against dementia.
5.
Learn New Skills
Brain activities improve cognition and can make for a fulfilling life. Learning a new language or musical instrument, reading, writing or participating in discussion groups can keep the brain active. Play games that require concentration and strategy or work puzzles to help prevent cognitive decline.
6.
Avoid Toxins
Minimizing the exposure to toxins is a fundamental strategy to improve health, especially brain health. Food additives, mold, industrial seed oils, pesticides, aluminum, heavy metals, and other unhealthy elements of the modern lifestyle are hard to avoid. Insisting on organic food from local sources can mitigate some of these issues. Quitting smoking yields many benefits, including better memory.
7.
Minimize Alcohol
Alcohol is a neurotoxin, and drinking is a common cause of early cognitive decline. Many people find it hard to drink at the recommended healthy level of less than one drink a day. Fortunately safe medications such as naltrexone can dramatically help eliminate alcohol craving and consumption, especially if eliminating drinking entirely is not their goal. (See: TenGoodRules.org )
8.
Question Pharmaceuticals
Prescription medications can be lifesaving, but they can also cause dementia. Medications intended to help insomnia, anxiety, agitation, and depression are more likely to impair cognitive function in older people. Such medications, as well as antihistamines, steroids, opioids and anti-seizure drugs often contribute to memory loss and dementia. Further, medications tend to accumulate in the body with age, and combinations of drugs can make this problem acute.
9.
Get A Thorough Check-Up
Medical and dental care can sometimes have remarkable benefits. Effective treatment of depression, deficiency conditions (such as pellagra) or metabolic disorders (such as thyroid disease or diabetes) can sometimes result in dramatic improvement in brain function. Proper treatment of meningitis, lyme, and urinary tract infections can dramatically improve cognitive ability. Regular dental care can also help prevent progression of cognitive decline by reducing gum disease, periodontitis, and the accompanying systemic inflammation. Hearing or vision problems can interfere with healthy intellectual stimulation, but when these problems are addressed, brain function can improve.
10.
Increase Ketones To Fuel The Brain
One of the key features of the cognitive decline that occurs with age is that the brain has less energy because it no longer uses glucose efficiently. The lack of energy available to the brain cells that results contributes to both the cause and progression of dementia. Ketones provide an alternate source of energy for brain cells, and this can be maximized when someone is in ketosis. Ketosis is the process that occurs when the body's energy source is shifted from molecules of blood sugar, (i.e., glucose) to three small fat molecules called ketones: Beta hydroxybutyrate (BHB), acetone, and acetoacetate.
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Ketones and Ketosis
Ketones are a more efficient brain fuel than glucose, so when ketones in the blood increase, the brain has more energy ... and it works better. As a result, the cognitive decline often found to occur at age 60 - and even Alzheimer’s dementia - can be reversed by ketones. Practical and proven ways to increase the supply of ketones and achieve a beneficial state of ketosis to improve cognition, memory, and concentration include:
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Fasting, (avoiding all calories), stimulates autophagy and ultimately improves the energy available to the brain by optimizing mitochondria, the powerhouse of the cell. Even intermittent fasting of 12 hours a day or more can help
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Exercise that is prolonged, especially when fasted.
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Following a very low carbohydrate, ketogenic diet which provides more than 80% of calories from fat and protein. This diet eliminates all grains, starches, and fruit, and especially sweets and sweet drinks. Some high fat and protein dairy (e.g., Greek yogurt and cheese) can be beneficial if consumed in moderation.
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Consuming medium chain triglycerides (MCT) throughout the day (e.g., 30-75g/ daily). MCTs are saturated fats 6 - 12 carbon chains in length, and their shorter length allows these molecules to be rapidly absorbed and converted to ketones. Coconut oil is a natural source of these fats while MCT oil is a more concentrated source. Coffee made with added MCT ("keto or bulletproof coffee") is a popular way to increase blood ketone levels.
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Consuming ketone monoester throughout the day. BHB and ketone formulations developed for military service members are now available commercially. Ketone monoester is a convenient method of increasing blood ketone levels. These drinks can be taken throughout the day as a food supplement without need to change the regular diet.
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The body is always making ketones but on a typical diet, the levels are insignificant, i.e., below 0.5 mmol/L. Ninety minutes of intense exercise can boost blood BHB to 1–2 mmol/L. Fasting for 12–16 hours can raise BHB levels to 0.6 mmol/L while fasting for 2 days can raise BHB to 1–2 mmol/L. Following a low carb, high fat ketogenic diet will raise ketone levels above 2 mmol/L, but this adaptation can take days or weeks. Consuming MCT oil or ketones (e.g., BHB) can rapidly raise ketone levels between 0.5 mM - 1 mM for perhaps 4 hours, and this even occurs on a typical diet. Combining these methods maximizes the effect on blood ketone levels. Because the degree of ketosis is related its benefit, measuring blood, breath, or urinary ketones can be useful and is relatively easy to do.
The typical way to achieve ketosis is by minimizing carbohydrates and other sugars in the diet. A healthy ketogenic diet focuses on healthy organic sources of protein and fat and minimizes sweets and other carbohydrates:
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Healthy fats: Avocado, coconut oil, avocado oil, walnut oil, olive oil.
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Fish and seafood: Especially fatty fish like mackerel, trout, sardines, and salmon.
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Nuts and seeds: almonds, pecans, walnuts, flaxseeds, pumpkin seeds, chia seeds
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Meats: grass finished and fed beef, organs, game meat, lamb, bison.
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Eggs: pastured or omega-3 whole eggs
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Dairy: Whole fat Greek yogurt, grass-fed butter, heavy cream, unprocessed cheeses - cheddar, goat, blue, or mozzarella
The key to ensuring a good level of blood ketones is to limit carbohydrates to less than 20 to 50 grams per day. Carbohydrates from breads, crackers, rice, potatoes, and sweets should be avoided completely. Any carbohydrate containing vegetable should be low in starch and highly nutritious, e.g., spinach, kale, asparagus, avocados, and zucchini. Avoiding fruit can be difficult but this is an important feature of a successful ketogenic diet. However, since fermentation removes sugar, fermented fruits and vegetables contain fewer carbohydrates. Fermented food can be highly nutritious, and the living microbes that accompany even small amounts of these foods help create a healthy gut microbiome.
Inducing ketosis gradually and staying well hydrated minimizes the fatigue, headache, and irritability of the “keto flu”, a common transient problem that can occur when people initially enter ketosis.
Recent studies (See references) illustrate the science behind the above recommendations. One study listed shows that cognitive function is improved by ketosis and another provides convincing examples of the benefit of ketosis.
Disclaimer
This information is intended for educational purposes only and is not intended to diagnose or treat any illness. Nothing in this document should be taken as a basis to initiate treatment without guidance from a physician. No guarantees of benefit or the absence of harm can be offered, and use of the information provided is solely at your own risk.
The image above shows brain DHA uptake using a PET method I developed at NIH.
Dr. John C. Umhau MD MPH CPE FASAM CDR (ret)
July 29, 2025
Selected References