My grandma died ten years before her heart stopped beating. 

Once her Alzheimer’s took root, the person she once was slowly and agonizingly withered away over what should have been her golden years.

On paper, she lived to the esteemable age of eighty-five.

But in reality, you could argue that her life would have been better if she did not have to suffer through ten years of full-blown Alzheimer’s.

Our goal, highlighted in the green line in the graph below, is to maintain as high a quality of life as possible—in the realms of physical, mental, and emotional health—and then painlessly drop dead with little to no time spent in a state of disease or serious impairment.

Quite ambitious, yes.

But it’s a shoot for the moon, land among the stars kind of thing.

My grandma’s life, on the other hand, represents a worst-case scenario.

She managed to live a fairly long life, but roughly 14% of it was in a disease state.

As you can see in the purple line above, her decline in health was much more gradual, meaning she had more years where her physical, mental, and emotional health were significantly diminished.

In her day-to-day life, that impairment translated to no travel, no exercise, no time spent with friends, an inability to savor quality time with family, and so on.

In short, she wasn’t able to do the things she loved or be with the people she loved in a meaningful way for the last 10 years of her life.

Alzheimer’s disease, and other neurodegenerative diseases (Lewy body dementia, Parksinson’s, Huntington’s, and Lou Gehrig's Disease or ALS), are the most disheartening and downright depressing of the Four Horsemen Diseases (the other three being heart disease, cancer, and metabolic diseases).

And unfortunately, our current medical system can’t do much, if anything, to help or cure those with Alzheimer’s and other neurodegenerative diseases.

So, our best and only option is prevention.

The Alzheimer’s Prevention Plan

First, Principles: Four Principles for Preventing Cognitive Decline and Neurodegenerative Disease

The following four principles must inform any preventative tactics we deploy.  

Principle #1: If it’s good for your heart, it’s good for your brain

Low apoB concentrations, low inflammation, and low oxidative stress are critical to both heart and brain health.

Our efforts here should be pointed toward lipid health and metabolic health.

Both are immensely complicated topics, but here is a quick and dirty overview. 

Lipid Health

You want to get apoB and LDL-C concentrations as low as possible, as early as possible*.

• Target apoB concentration: 20 to 30 mg/dL

• Target LDL-C concentration: 10 to 20 mg/dL

This will drastically lower your risk for not just neurodegenerative diseases like Alzheimer’s, but also for cardiovascular disease. 

The first catch is that just about everyone will require a prescription from their doctor for some sort of lipid-lowering therapy (i.e., statins, ezetimibe, PCSK9 inhibitors, etc.) to reach these target concentrations. 

The second catch is that your doctor will think you are out of your mind for trying to drive your apoB and LDL-C this low.

Our current medical system, evidenced by our lackluster approach to assessing cardiovascular disease risk, is more concerned with late-stage intervention than proactive prevention.

*The target concentrations stated above are from Chapter 7 of Outlive by Dr. Peter Attia.

Metabolic Health

Building and maintaining strong metabolic health will help you fight both inflammation and oxidative stress.

A chronic caloric surplus, for example, leads to the development of visceral fat (fat that lives around your organs) and insulin resistance which both promote inflammation.

There aren’t any secrets here.

Maintain a healthy body weight, don’t overeat, minimize hyperpalatable and overly processed foods, perform regular endurance and strength training, sleep well, and manage stress.

Principle #2: Metabolic health is crucial to brain health

Strong metabolic health not only lowers your risk for neurodegenerative diseases but for heart disease and cancer too.

To gain a deeper understanding of metabolism and to minimize your disease risk through metabolic health management, skim this article.

Principle #3: Time is your friend

Diseases of neurodegeneration are no different than the three other Horsemen in that they take years and decades to establish themselves.

For us, this is good news.

It means that if we start now, play the long game, and put the right practices in place, our efforts will compound over the years to fight, and hopefully prevent, these diseases.

Whether you’re eighteen or eighty, the best time to start is now.

Principle #4: Exercise is the most powerful tool we have

Whether your goal is to prevent disease, improve your physical health, or stave off cognitive decline, exercise is the most powerful longevity “drug” we have.

Exercise should be the foundation of any program directed at extending lifespan, slowing and reversing physical and cognitive decline, maintaining strength, energy, and vitality, and enabling us to keep doing the things we love with the people we love until we die.

Next, Tactics: Seven Tactics to Stay Sharp and Reduce Neurodegenerative Disease Risk

Tactic #1: Proper Nutrition

Our metabolism is massively impacted by how and what we eat.

Avoiding refined carbohydrates and hyperpalatable foods that we know are not good for us is a great place to start.

Beyond that, it may be beneficial to eat a Mediterranean-style diet with more monounsaturated fats (extra virgin olive oil, macadamia nuts, avocados…), regular consumption of fatty fish, and lots of fiber (38g for men and 25g for women per day).

The omega-3 fatty acid DHA which is found in fish oil supplements may also help maintain brain health.

Lastly, alcohol. Significantly cut down or just cut it out completely.

Tactic #2: Zone 2 Endurance Training 

Exercise is our most powerful combative against Alzheimer’s disease.

Steady state zone 2 endurance training strengthens our metabolic health by helping to improve the efficiency of our mitochondria—the powerhouse of our cells that produce much of our energy. 

Aim for four 45-minute zone 2 sessions per week (three hours per week total) if you can.

But if that’s too much then no worries, just do what you can.

Any amount of exercise is better than nothing.

Other than improving your metabolic health, steady state endurance exercise helps to manage high cortisol levels resulting from stress and, due to increased cerebral blood flow and BDNF (brain derived neurotrophic factor) production, provides the perfect time to think through problems you’re facing.

Tactic #3: Strength Training

Studies have shown that the greater someone’s grip strength, which acts as an excellent proxy for overall strength, the lower the risk for dementia.

One reason for this might be due to the role of muscle in metabolic health.

Glucose from the food we eat, primarily carbs, can only be stored in the liver and muscles. 

So, the more muscle we have, the more space we have to store fuel rather than letting it end up as fat or remaining in our blood.

Chronically elevated blood glucose levels damage just about all of our organs, including the heart, brain, and kidneys.

Building muscle and strength also helps fend off the inevitable loss of muscle as we age, which is critical to quality of life as a lack of strength will quickly prevent us from doing the things we love.

Tactic #4: Sleep

Poor sleep and disruptions in sleep may drive an increased risk of dementia.

Sleep, particularly deep sleep, is when our brain heals itself and cleans out the waste that can build up between neurons (nerve cells).

If poor sleep is accompanied by elevated cortisol levels that stem from high stress, your risk can be multiplied as these simultaneously contribute to insulin resistance and damage the hippocampus (part of the brain that plays a major role in learning and memory).

This highlights the importance of two of the most swept-under-the-rug health practices in Western society: sleep and stress management.

If you’re sleeping poorly, the worst thing you can do is stress about the fact that you aren’t getting good sleep.

Isolate the root of the issue, whether it be poor sleep or high stress, or both, and act on it.

Worrying has never accomplished anything.

Tactic #5: Oral hygeiene 

Good oral hygiene may reduce systemic inflammation and thus reduce Alzheimer’s disease risk.

So, floss and brush your teeth.

Tactic #6: Dry Saunas

Dry sauna use can reduce Alzheimer’s risk by about 65% and atherosclerotic cardiovascular disease (ASCVD) risk by 50%.

The recommended protocol is at least four sessions per week for at least 20 minutes per session at 179°F (82°C) or hotter.

Consult your doctor before spending time in the sauna.

Tactic #7: Other potential interventions

The six tactics above are fairly proven ways to reduce your risk for Alzheimer’s, the broader bucket of neurodegenerative diseases, and the Four Horsemen diseases in general.

But for speculative fun and to provide a springboard for your own research, here are a few other potential interventions that you may want to further investigate or discuss with your doctor:

• Higher Vitamin D levels (this is quite uncertain).

• Lowering homocysteine with B vitamins while optimizing omega-3 fatty acids. 

• HRT (hormone replacement therapy) for women in transition from perimenopause to menopause (especially if they have one copy of APOE e4). 

That’s all, folks. Thanks for reading!

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Let’s connect—If you have a question or just want to chat, I’d love to hear from you! Reply to this email, leave a comment, or find me on Twitter.

Much love to you and yours,

Jack Dixon

Credit

Some ideas in this article are based on my reading notes from Outlive: The Science and Art of Longevity by Dr. Peter Attia.

Peter’s pragmatic and data-driven approach to longevity sets this book apart from others in the field.