Dale Bresden’s book The End of Alzheimers is a best seller with a provocative title. Extravagant titles are always a red flag: please read and analyze me closely since I have made a radical claim. Unfortunately, the title is misleading: the book is not about the end to AD but about how to best avoid and manage it.

The credentials of a health or science book’s author are a good way to start a review. Dr. Bresden’s are impressive. He has been affiliated with top level research programs and compiled an extensive CV. Two decades ago he split from established academic centers to start the Buck Institute, an independent research center with excellent credentials. More recently he started MPI Cognition which had two main divisions- a program offering educational aids and a cognition dementia business which last year was acquired by AHNP Precision Health. This later business markets an expensive program based on the material in Bresden’s best seller. I asked a friend, an expert in education, about the educational aid business which he described as “great marketing with little results.” Now we have another large red flag- a “scientific” book promoting a well funded for-profit ventures.

The book itself is impressive. The author is obviously very knowledgeable about AD. The main thrust of his proposed treatment for preventing and reversing AD is the best lifestyle medicine very similar to much of what I have described in past blogs: diet which is mainly whole plant foods with very little animal products, refined grains, sugar, alcohol, processed foods; exercise; meditation; a good social network; intermittent fasting. There is no doubt that this lifestyle will help avoid or mitigate the development of clinical AD for many people.

I have big problems with some of his ancillary advice. The most glaring is a recommendation to keep cholesterol above 150. This recommendation caused me to review what I could find in the scientific literature. Much work has been done on the relationship of cholesterol levels and dementia including AD. There are some conflicting studies. Most show a strong correlation between low cholesterol and avoidance of later AD, but it is not at all certain that this is true for those whose low cholesterol is due to drugs. A few studies show that those with higher cholesterol in middle age have less AD when they get very old. Also, people over 85 who have higher cholesterol have less AD than those whose cholesterol is very low, but many frail, sick people have low cholesterol as part of a general malnutrition.

Bresden also recommends avoiding gluten seconding the advice of his friend David Perlmutter (author of Grain Brain.) As I discussed in a prior blog this advice is key for those with celiac disease (like me!), gluten allergy or sensitivity; but whole grains, including those with gluten, are otherwise well documented to be associated with better health. This caused Perlmutter to be labeled a medical charlatan by an expert in lifestyle medicine.

The other questionable, and possibly dangerous, advice in this book is that promoting and maintaining a mild ketosis is brain healthy. Bresden recommends use of coconut oil and MCT oil (a synthetic vegetable oil) to help create this ketosis. But all plant oils are toxic to blood vessels and coconut oil is probably the worst because of its very high level of saturated fat. Blood vessel health together with good amounts of all the nutrients and fiber found in whole plant foods is the key to good health including avoiding AD.