Nutrition411: The Podcast, Ep. 28

The Impact of Dietary Choices on Alzheimer Disease Prevention

Lisa Jones, MA, RDN, LDN, FAND

This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.

In this podcast episode, Lisa Jones interviews Amylee Amos, PhD, RDN, IFMCP, about research that suggests a potential link between dietary choices and the development or prevention of Alzheimer disease and how dietitians can integrate this knowledge into their practice to support cognitive health in their clients. This is episode one of a four-part podcast series on Alzheimer disease.

Additional Resource:

Listen to episode two of this four-part podcast series here.

Listen to episode three of this four-part podcast series here.

Listen to episode four of this four-part podcast series here.



Speaker 1: Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietitian and nutritionist Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.

Lisa Jones: Hello and welcome to Nutrition411, the podcast where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics.

Today's podcast is part of a series of short episodes on diet and Alzheimer's disease. I have the privilege of speaking with Dr. Amylee Amos, who received her PhD from Saybrook University in integrative and functional nutrition. She has a master's of science from the University of Southern California in nutrition, health span and longevity. She's a registered dietitian, nutritionist and completed certification in functional medicine through the Institute for Functional Medicine. Please welcome Dr. Amylee.

Dr Amylee Amos: Thank you.

Lisa Jones: Hi. Wow, that's an impressive bio and I'm so looking forward to this conversation and all your knowledge about Alzheimer's disease. So I know your bio does not do you justice, so do you want to tell a little bit more about yourself and how you got to be where you are today outside of the bio?

Dr Amylee Amos: Sure, absolutely. So at USC doing my master's, I had some really great opportunities to study with some really brilliant people. So I got to work with Valter Longo, who's doing absolutely cutting edge research on health span and longevity. Then for my final master's capstone project, I worked with Dale Bredesen, who is really the leader in the functional medicine movement to prevent and reverse Alzheimer's disease. So, I've been fortunate in my training to work with some really great people.

Then my interest in the functional medicine model just had really skyrocketed and that's why I went on to pursue my PhD, and since then have taken part in some pilot studies where we're working with a group model to make it more cost-effective, and we've seen some really wonderful results in terms of improvements in cognition using this model in people with mild cognitive impairment.

Lisa Jones: Oh wow, what an amazing opportunity that is. Then your institute, which you're going to I'm sure talk about throughout the different episodes when we discuss these questions, and then we're also going to link that in the show notes so people can go and find out more information. So, fantastic.

Again, super excited you're here.

Dr Amylee Amos: Thank you.

Lisa Jones: We are going to dive right into episode one, which is talking all about uncovering the latest research and trends in dietetics. The first question I have for you, Dr. Amylee, is what research findings suggest a potential link between dietary choices and the development or prevention of Alzheimer's disease? And how can dietitians integrate this knowledge into their practice to support cognitive health in their clients?

Dr Amylee Amos: Yeah, absolutely. So the research is vast, actually. There's so much research showing us the connection between diet and cognitive impairment, dementia, Alzheimer's. In particular when we're talking about specific diets, there's a lot of research on the Mediterranean diet, which probably won't surprise anyone listening. We have research about the Mediterranean diet as it relates to pretty much all of the chronic diseases of aging, and Alzheimer's is no different here.

So, we have a lot of correlational research showing reduced risk of cognitive impairment and improved cognitive function when closely following a Mediterranean diet pattern. There's quite a few clinical trials with long-term follow-up that support the Mediterranean diet for improved cognitive function, so we've got lots of research on the Mediterranean diet.

We also have a lot of research on the MIND diet, which probably many people listening have heard of. For anyone who hasn't, that's the Mediterranean-DASH Intervention for Neurodegenerative Delay, so basically it's a combination of the Mediterranean diet and the DASH diet. What we've seen with that is the MIND diet's been independently associated with better cognitive function and lower risk of cognitive impairment in older adults. Some research has shown that it might be more predictive of cognitive decline than the Mediterranean diet alone.

I should say for those who don't know, the MIND diet is a bit more specific than the Mediterranean diet is. Also, to give kind of both sides, there was a recent study that came out just this year on the MIND diet that didn't show improvement compared to calorie restriction, although they looked specifically at high risk overweight participants, so there's a couple other nuances in there that might explain why that was.

But lots of research on the Mediterranean diet, lots of research on the MIND diet, and then just now we're starting to see some of the preliminary research on the KetoFLEX 12/3 diet, which is the diet that's been spearheaded by Dale Bredesen, which is, again, very similar to the Mediterranean diet pattern, but it just gets a little bit more specific with things like some time-restricted eating and getting the individual into a very mild state of ketosis.

So not at all what we're thinking of with a traditional ketogenic diet, but just a bit heavier on the dietary fats, the good sources of mono and polyunsaturated fatty acids, and a little bit lower on some of the starchier carbohydrates.

So that's a newer diet, we don't have any long-term data on that, but again, it's unsurprising to see that it would be helpful as well, because it's so similar to a Mediterranean diet pattern. So, those are the diets that we look at with regard to Alzheimer's.

Lisa Jones: So that one, the last one you mentioned, I'm familiar with the first two, the Mediterranean and the MIND. Then my question is, it's so hard to keep up with all these different diets that are new on the scenes, especially if you're not somebody that this is the area that you study and this is ... Say you're a practitioner and you kind of see a broad range of patients or the general population, do you have any recommendations for how somebody in that situation can keep up with all this research? 'Cause this is the first I'm hearing of the KetoFLEX.

Dr Amylee Amos: Yeah, definitely. So I think the main takeaway should be for any kind of nutrition professional or healthcare professional in general, the most important thing to know and to stress to your patients is that diet matters with regards to our cognition. That's the main thing, because unfortunately there's still a lot of nutrition misinformation out there, that when it comes to Alzheimer's disease, people tend to think it's genetic determinism, so to speak, and that if you've got the gene, you're going to get it. It's not that simple at all, nutrition absolutely plays a role.

So I think if this is not an area that an individual specializes in, they're not looking to kind of get into the weeds on this and they just want to help, just very general help for all of their patients, I think a Mediterranean diet is great for the average person, for the average person who's at normal risk of developing Alzheimer's disease.

From there, if you had a patient with very high risk, and we can talk about those genetic risk factors if you'd like, then it might make sense to look a little bit deeper to look into the biochemistry that's occurring there, and possibly refer out to somebody who does this all the time. That might be a better option than trying to learn about all of the new research in these different diets.

Lisa Jones: Yes, and I love what you said, the diet does matter. I also think that's a great takeaway, but as well as referring out. If it's not your area of expertise, we are so well-connected these days to other dietitans, that you can easily find somebody to refer it out to to help you. So, that's an excellent-

Dr Amylee Amos: Absolutely, yeah. I think with certain types of patients, as RDs we're really comfortable doing that. With eating disorders, for example, at least in my network of RDs who don't work with eating disorders, we're ready and very wanting to refer out to people who specialize, because it's such a unique patient base, that it's important to do that.

I think it's good to do that as well with other conditions, and I think with someone with a very high risk of Alzheimer's when we can get really, really nuanced with the diet, it does make sense to do that as well. But then at the same time, for just your average patient, relatively normal risk, but wants to avoid Alzheimer's, any RD can counsel in the Mediterranean diet and that would be a good starting point.

Lisa Jones: Yes, that's a great starting point. You mentioned earlier about talking more about the genetic predisposition. Could you talk more about that?

Dr Amylee Amos: The primary gene variant that we're looking at is APOE4. So for anyone who's not familiar, we all have two copies of APOE, and they can be any combination of APOE2, three, and four. APOE2 appears to be protective against Alzheimer's, APOE3, which is by far the most common appears to give you a neutral risk, and APOE4 is the high risk for sporadic or late-onset Alzheimer's disease. Although again, late-onset, and early onset, are not nearly as black and white in those terms as people like to think, so you can get late-onset Alzheimer's much earlier than most people think

So, APOE4 is a test that has become far more common. It used to only be tested by some functional cardiologists and people like that because it's also a risk factor for cardiovascular disease. It's a lipoprotein, so that makes a lot of sense. But now companies such as direct-to-consumer genetic testing companies like 23andMe, test for APOE and will tell an individual whether or not they carry zero, one, or two copies of APOE4. So, now a lot more people know what their variants are.

This is an extremely well-studied variant, so what we do is leverage that information, we leverage what we know about this genetic variant to help personalize the diet and lifestyle further.

So of course Alzheimer's, is a highly complex chronic disease. Even just in terms of genetics, this is polygenic etiology, as well as many other modifiable lifestyle factors. So it's not to say that just because an individual has APOE4 means that they'll get Alzheimer's, and it doesn't mean that just because you don't have APOE4 that you won't get Alzheimer's, it's far, far more complex than that. But that's certainly the strongest genetic risk factor that we know of right now for sporadic onset, so that's what we would be looking at.

Lisa Jones: Well, I think that makes it kind of like you mentioned the 23andMe. If somebody went on their own and they had that done and then they're trying to interpret the results, I think back to what you were saying, refer to somebody that specializes in it to tell you what the results actually mean, 'cause you can be misinterpreting it and assuming things that may not be kind of what you were just saying, right?

Dr Amylee Amos: You're absolutely right. In fact, I mean, I work with that patient that you just described all the time. Someone who has found out they carried this variant, they're absolutely petrified, because often they've had a parent or loved one suffer from Alzheimer's disease and they think, "This is it. I've got it too, and this is my future."

That doesn't have to be the case. As I said, we can use the information. It's not something to be fearful of, but rather it's kind of a knowledge is power type of situation. So we use the information, we use everything that's known about this variant to further personalize the diet.

Lisa Jones: Yes, personalized nutrition.

Dr Amylee Amos: Yep.

Lisa Jones: I like it.

Dr Amylee Amos: Exactly.

Lisa Jones: Well, thank you Dr. Amylee for coming on and talking about the latest research with us today.

Dr Amylee Amos: Absolutely. Happy to be here.

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