Threading The Needle

In June of 2013, my mother was diagnosed with Frontoemporal Dementia (FTD). I was crushed on multiple levels. My mom’s father, my grandfather, suffered a 10-year decline with FTD. For those unfamiliar, being witness to the ravages of FTD-I would strongly argue- is harder on the family than the patient. You see the essence of the victims of FTD dissolve. My grandfather, functionally-speaking, was the equal of a dependent newborn at the time of his death-unable to speak, dress himself, toilet himself, or interact in any meaningful way with anyone.

It had barely been 15 years after my grandfather’s passing when we found out my mother was now facing the same road. My mother. Before I met my wife Jess, it’s no stretch to say my mother was the woman closest to me, one of my closest confidants.

Distraught, I didn’t know where to turn or what to do. There’s no cure for FTD. There’s not even a drug  to slow down the progression of the disease.

I was angry, too. What really pissed me off was that my mom was healthy. She ran or walked for exercise every day, practiced some Yoga, always maintained a normal body weight, ate clean. It’s not fair.

About a month later, in July of 2013,  I was struggling to get a handle on my own health. My family history of dementia hung like a fog in my daily thoughts. Additionally, my biggest present health concern was figuring out how to reign in my constantly rising-cholesterol levels. Towards that end, I had spent the last 18 months taking a medication by the name of Pravastatin. My cholesterol was lower across the board-total cholesterol, LDL (the “bad”), and HDL (the “good).

Only problem was, I felt hollow inside.  I was flat emotionally-nothing moved me. I was next to non-responsive in terms of my libido. In short, life sucked, even with those “healthy” cholesterol numbers.

Then I came across an article that, thinking back on it now, was the catalyst for improving my personal health and my prospects for remaining healthy, while completely changing my outlook on medicine and my role in the field.

The article was The Straight Dope on Cholesterol, by Dr. Peter Attia. For those of you not wanting to put your science hard hats on right now, I can summarize those links for you in three sentences:

  1. No cholesterol equals no life.
  2. Saturated fat is the only type of fat that raises good cholesterol.
  3. Cholesterol is the building block for the constant regeneration of nerve tissue in the brain.

(As Linda Richman would say: “Talk amongst yourselves”)

Being the self-experimenter that I am, I came up with two ideas I wanted to put to the test:  first, my body’s high circulating cholesterol was a compensatory mechanism to feed my brain the vital nutrient it needed to thrive. Second, instead of avoiding fat in my diet, actually dialing up the fat-while cutting out sugar, breads, pastas, and the like-could actually improve my cholesterol numbers and my overall health.

Within three months I learned some pretty important lessons that I’ll try to unpack for you now. Some of these lessons were simply observational, while others were confirmed with advanced cholesterol and genetic testing that I’ll discuss briefly here and then do a deep-dive into at a later date.

1. I am “sensitive” to wheat and cow’s milk.

Not in touchy/feely sort of way. And not in a “grab the Epi pen!” type of way, either. More in the skin breakout, waking up in the middle of the night in a cold sweat, and spending extended parts of my day in the bathroom sort of way.

2. I am a cholesterol hyper-absorber.

Most folks absorb a maximum of 10 to 15 percent of the cholesterol they eat. How special am I? My body absorbs about 85 percent of the cholesterol I eat. Overachiever Alert: after 3 months of following a ketogenic diet my total cholesterol was 314 mg/dL (for reference, anything over 240 mg/dL is considered “high”).

3. I am an ApoE 4/4.

Again, I’m sorry if it comes off like bragging, but I am special. Only 1-2% of the population is an ApoE 4/4 (ApoE status is gained genetically from your parents-you get one allele from you mom and your dad). What do we win for our unique station in life? A 20-fold increase in the probability of the onset of heart disease AND dementia! Plus, just for playing, the lipoprotein particles in an ApoE 4/4’s cerebrospinal fluid are deficient in their ability to carry cholesterol across the blood/brain barrier into the brain to help regenerate myelin-the covering around nerve fibers that accelerates their transmissions.

4. My mom wasn’t as “healthy” as I previously thought.

We always knew that my mom’s side of the family had a strong sensitivity to dairy products. Mom actively avoided dairy like the plague. What we didn’t know at the time is that wheat, at a molecular level, has proteins that look like a mirror image of dairy proteins. And Mom ate wheat, those “healthy whole-grains” for nearly every meal of the day.

Mom also didn’t sleep well. I didn’t know it at the time, but came to find out she had used the sleep drug Ambien for over 10 years. If you read my post on sleep then you already know what that means-Mom hadn’t actually slept in over 10 years.

So to sum up: I don’t handle wheat or milk well and despite my ability to absorb as much cholesterol as 8 normal people combined would, my genetic predisposition makes it hard to get that cholesterol where it needs to go. And my mom’s outwardly looking “healthy” lifestyle actually predisposed her to falling into the disease process she’s now fighting with.


My experiment didn’t end after 3 months. Rather, 3 years later, I continue to study, refine, and tweak my approach to eating and lifestyle modification.

Here’s what my diet and lifestyle practices look like today:

FOOD: Meat and fish(order of preference is local/wild-caught>organic>conventionally raised), tons of veggies (minimum 2 cups per-meal), 1-3 servings of fruit per-day, and fats (order of preference monounsaturated>polyunsaturated>saturated). Sound simple and boring? You need to learn how to cook, son!

EXERCISE: 3 days per-week of mixed-modal strength training (body weight, barbell, dumbbell, unconventional heavy objects, etc.) with an additional 2 days per-week of high-intensity training and steady-state cardio. Why weights with just a little bit of cardio? The more muscle mass you maintain the better your body can deal with insulin. We’ve seen research implicating insulin resistance in the brain as one of the early drivers of neuro-degeneration (a.k.a., losing your marbles). Too much cardio could actually weaken my heart muscles, hence the small weekly dose.

SLEEP: These guys wrote a pretty good summary of the importance of sleep and how to get it here.

STRESS MANAGEMENT: Prayer, journaling, and learning not to freak out when I eat something that’s not good for me or miss a day of exercising. My goals have nothing to do with perfection or immortality (there can be only one!). Does that mean I never sweat the details of how I eat, move, sleep, and deal with stress? Absolutely not. There are days and even weeks where I can’t get over the hump and stop thinking about how I can optimize my health to keep my brain from melting out of the side of my head or my heart exploding out of my chest.

I continue to travel further down this road of preventive medicine, looking for ways to improve my health and fitness and that of my patients and clients in every way I can. Just not to the degree that it interferes with our ability to enjoy our families and life in general. If, in trying to improve my well-being or yours,  we lose sight of a good measure of faith, hope, and love, then I’ve missed the mark and you’ve missed the point.

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