Dementia: Is Gluten the Culprit?

Bret S. Stetka, MD; David Perlmutter, MD

Disclosures

January 21, 2014

In This Article

The Dementia Diet

Medscape: What type of diet or interventions do you recommend to prevent or slow dementia?

Dr. Perlmutter: The data show that individuals with lower blood sugar levels have a lower risk for dementia. Therefore, we've got to keep blood sugar low. We do so by using the time-honored dietary intervention of a lower-carbohydrate, higher-fat diet.

This is what the scientists have told us for years is the best way to lower blood sugar. If you look at the A TO Z trial,which was published in JAMA in 2007,[3] dramatic reductions in blood sugar were seen in participants on a lower-carb, higher-fat diet.

A similar article was published in NEJM in 2008.[4] This was an interventional trial demonstrating both weight loss and reduction of fasting blood sugar in individuals eating a higher-fat, lower-carbohydrate diet.

The Mayo Clinic published a study[5] in the Journal of Alzheimer's Disease in 2012 demonstrating that in individuals favoring a high-carb diet, risk for mild cognitive impairment was increased by 89%, contrasted to those who ate a high-fat diet, whose risk was decreased by 44%. Drs. Barnes and Yaffe from the University of California, San Francisco, published a study in Lancet Neurology in 2011[6] indicating that about 54% of cases of Alzheimer disease in the United States could have been prevented with attention to lifestyle changes, such as exercise, weight loss, and controlling hypertension.

This province of lifestyle modification in neurologic diseases has not been one of comfort for neurology in general. We neurologists are acting in an essentially reactionary manner. In other words, we are responding to illnesses by hoping that there are medications to treat symptoms, whereas we really ought to embrace the notion of preventive medicine, because the science is staring us in the face.

Medscape: One of the points in your book I found interesting is that you're not just talking about processed carbohydrates or sugars here, right? You believe that whole grains -- typically presumed healthy -- also increase dementia risk?

Dr. Perlmutter: Yes, they do. There's a lot of very good information provided on the glycemic index of these foods. That is a metric of not only just the elevation of blood sugar and the consequence of consuming a particular food, but actually it's also a measurement of how long the blood sugar remains elevated.

The glycemic index measures what the blood sugar is between 90 and 120 minutes after consuming a particular food. When you look at the glycemic index of whole-grain bread, for example, it's extremely high: 72-74. It's higher than that of white bread. It's much higher than that of many candy bars. It becomes a huge issue in terms of how long your blood sugar remains elevated -- that is, how long you have increased risk for glycation of proteins. It becomes a big issue that we have to reconsider these recommendations about whole grains in terms of the simple fact of looking just at the glycemic index.

Medscape: Does the same go for other grains common in health foods these days, such as flax and quinoa?

Dr. Perlmutter: Flax and quinoa (which by definition is actually not a grain) are gluten-free foods rich in fiber and healthful fat. However, they do contain modest amounts of carbohydrate, and assessing these foods by evaluating their glycemic indices will help decide how healthful they really are.

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