During January and February I moved from an intermittent fast of 12 hours to 16 hours, to 18 hours, and then to 20 hours. As we discussed in Beating the Dementia Monster, I had been doing a 12 hour fast since early 2016. Now I have maintained the 20 hour daily fast since February 2020, with an eating window from 3 p.m. to 7 p.m. So what has been the result so far?
First let me say that I would never have embarked on intermittent fasting, especially a 20 hour fast, were the incentive not there. The incentive of preserving cognition in the face of advancing Alzheimer's disease is substantial and sufficient to keep me going. Also, I would not have been successful if I were still eating a relatively high carbohydrate diet such as I lived before I found that I needed to lose weight. Starting from the Mediterranean diet (or, in my case, the MIND diet) with relatively low carbohydrate consumption, fasting is much easier than it otherwise would have been. After all, they degree of hunger you experience between meals is very much affected by high consumption of carbohydrates.
So it's been seven months now. As I reported earlier, after two weeks on the16 hour fast, the arthritis in my neck simply disappeared. Against my doctor's counsel, I had been taking at least one ibuprofen every day. I would tell myself that today I would stop, but by 9 in the morning the pain convinced my I should just take one more. But suddenly I didn't need to take it anymore.
I told you back then that, while the pain in my neck was gone, I continued to have pain in my lower back. This was a nuisance, but it was not the continual pain that would prompt me to look for medication. Well, it suddenly occurred to me a few weeks ago that I no longer have arthritis pain in my lower back. The pain in my neck disappeared very suddenly, but the pain in my lower back faded more gradually. Nevertheless, it's gone.
This was remarkable. But my real goal was to improve my cognition, and this was promised in the research report in the New England Journal of Medicine that I discussed in January. Obviously, this would be a much more protracted slog, because the improvement would need to come from the BDNF protein rebuilding lost brain cells. Also, some doctors on the Internet speaking about Alzheimer's disease and fasting said that a 20 hour daily fast was necessary for the fast to be effective against Alzheimer's disease.
So has there been any improvement in my cognition since I began the 20 hour fast? And what measurements could I apply to even know?
In Beating the Dementia Monster, I told the story of how, after being diagnosed with Alzheimer's disease in 2015, my cognitive test scores rose steadily in 2016, 2017, and 2018. Because I was being tested so intensively by both my care team and for some drug trials, they decided to give me a break in 2019. So, while I did see my neurologist in 2019, I was not tested again until June 2020.
During this time I developed a set of tests to informally measure changes in my cognition. One thing was to see how often I would forget to lock the car door when I went into the gym or a store. I also had a set of about 50 3X5 cards with one or two syllable nouns written on them. I would review the words on five cards, and see how many of the words I could remember later.
And then I would see how fluidly I could speak in the Spanish language. I began learning Spanish when I was 59, and for many years I have been speaking two or three times per week with friends in Latin America, In so doing, I've found that my fluency fluctuates over time. I'll do quite well for a period of time, but then my vocabulary and fluency will slip for a few weeks or months.
In fact, all of these measures, and a few others, appear to fluctuate together, so I do believe that I have a sense for what is going on with my cognition.
In June 2019 I told my neurologist that something happened in April 2019 that very suddenly affected my cognition. It wasn't terrible, and I had no other symptoms, but something went wrong. My sense was that my cognition stayed at a lower level, and may have continued to decline into the summer. After reviewing my circumstances, my neurologist concluded that sleep problems were a factor, so I endeavored to improve the quality of my sleep.
I believe that the success I had in improving my sleep helped with my cognition, but it did not go back to where it was at the beginning of 2019. And then, in April 2020 (soon after I began intermittent fasting), my sense is that my cognition slipped again, although not to the extent it had in 2019.
That these two slips would both have occurred in April is not surprising to me. Since moving from Hawaii to the Pacific Northwest in 1986, I have always had trouble sleeping in the spring, usually beginning in April. Before we shift to Daylight Saving Time, the sun just comes up way too early, and the days are just too long.
When my cognition was tested in June 2020, the results were disappointing. My neurologist and neuropsychologist conferred on this, and they reviewed my circumstances. They concluded that my renewed issues were a consequence of stress, since I had been working on the new edition of Beating the Dementia Monster while taking on substantial new responsibilities. I had no reason to disagree with them, so I finished the book and pared back on my commitments. This felt really well, and I'm sure this has been helping. I, of course, continue to fight for the best quality sleep I can get. And I do think of it as fighting.
What prompted me to write this post is a strong sense that my cognition has actually improved since this summer. I seem to be doing well on each of my little tests, and I have been speaking more fluidly (and fluently) in Spanish. I have been quite pleased with my ability to recall and use words that I rarely use, and my use of various verb forms seems to be doing well.
I would not say that I have returned to where I was at the beginning of 2019, but I am confident that, were I tested today, I would do much better than I did in June 2020. I attribute this to sticking with the 20 hour fast in concert with each element of The Dementia Toolkit that I presented in the second edition of Beating the Dementia Monster.
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