Practical Dietary Recommendations for Patients at Risk, Diagnosed With Alzheimer Disease
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 how dietitians can effectively translate the latest research on diet and Alzheimer disease into practical dietary recommendations for individuals at risk or diagnosed with Alzheimer disease, including the nuances of individualized nutrition needs. This is episode two of a four-part podcast series on Alzheimer disease.
Additional Resource:
- Amos Institute. Accessed October 5, 2023. https://amosinstitute.com/our-founder/
- The Institute for Functional Medicine. Accessed October 5, 2023. https://www.ifm.org/
- KetoFLEX 12/3. Apollo Health. Accessed October 5, 2023. https://www.apollohealthco.com/ketoflex-12-3/
Listen to episode one 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.
TRANSCRIPTION:
Speaker 1: Hello and welcome to Nutrition 411: 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 Nutrition 411, 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, and we are going to take a deep dive into evidence-based practice and talk about Alzheimer's disease and the latest research. So the last episode, we discussed the latest research and the link between dietary choices and the development of prevention of Alzheimer's disease. Dr Amylee, what would you say? If you had to sum up that conversation in one or two sentences? What are the key takeaways?
Amylee Amos:
I think the key takeaways from the last episode are that nutrition matters, with regards to our cognition and the development, or lack thereof, of Alzheimer's disease. And the diet to prevent Alzheimer's, while it's based in something that most RDs are very familiar with, which is the Mediterranean diet, it's highly nuanced. And in the case of high-risk individuals, should be implemented by somebody who is very familiar with all of the research in this realm.
Lisa Jones:
I agree. It sounds like a good plan.
Amylee Amos:
Yeah.
Lisa Jones:
That's where we're talking about the referring out. So yes, please do that. And nutrition does matter. And it's interesting because the other day, somebody was talking about, "Oh, the Mayan diet," and they're like, "What's that again?" And they're like, "Isn't that just the diet that you just eat blueberries?" They just, for some reason, associated blueberries with the Mayan diet. And they thought that's all they had to do, was just check off eating blueberries every day and they were following the Mayan diet. But of course, it's more complex than that.
Amylee Amos:
Definitely. Yes. My gosh. If only it were that easy, right?
Lisa Jones:
I know, right? Everybody would be doing it. I do want to know, and I'm sure our audience and dietitians want to know, how can they effectively translate the latest research on diet and Alzheimer's disease into practical dietary recommendations for individuals who are at risk or diagnosed? And then the second part of that is how could they take into consideration the nuances of individualized or personalized nutritional needs that you were talking about earlier?
Amylee Amos:
Well, certainly it's a heavy question and that's a big conversation. I think in terms of translating the latest research, in my opinion, the most important thing to do as new studies pop up all the time ... You see clinical trials that say, "This food is beneficial for cognition. This food is harmful." We always need to first take a step back and say, "What does the nutritional epidemiology show us? What do the long-term health outcome studies show us first?" because that shows us what's going to happen in the long-term for the average person. So we need to pair that with the data from clinical trials, with the new theories that develop. And when we're making dietary recommendations, we don't want to make a dietary recommendation that might be in line with the newest clinical trial, but not in line with the vast literature, the nutritional epidemiology. That's I think, a really important first step is always to remember what we know from all of that, to remember what we know from the centenarian studies.
There's a lot of talk right now about the blue zones and things like that. While that might not be the end all be all, we do need to look at that kind of information. That is helpful in translating all of the newer information. When we couple that with the centenarian studies, that gives us a better picture of what we're looking at. So an RD should always make sure that they're taking all of the different areas of research into account when they're going to make a nutritional recommendation. With regards to the nuances, the fact is there are so many nuances. So we talked a little bit last time about the genetic risk factors for Alzheimer's, such as APOE4, and that is, in itself, a nuance. If somebody carries APOE4, we're going to do things differently.
There are different things to look out for like, for example, their blood lipids. If you were to give an APOE4 carrier too much saturated fat, which might help them get into a state of mild ketosis, which they might perform a little bit better cognitively ... If you've given them too much saturated fat, while it might help in the short-term, it could be detrimental in the long-term because we see their blood lipids skyrocket with too much of that. So it's very important to take into account the full patient in front of you.
And that is a functional approach, right? We're looking at a systems biology approach. So we're not just trying to help their brain, even though, of course, we are trying to help that as well. We're trying to make sure that all of these body systems are working in line, which can be very difficult. So that's kind of part of why for an RD who's maybe interested in this, has a patient that they're working with on another condition, and then just feels like they're getting in the weeds, that might be a time to refer out and have somebody who does this all the time work with them.
Lisa Jones:
Yeah. Because as I'm listening to what you were saying, I think especially if you were somebody that's relatively new in the field, or a dietitian that recently graduated, and then they're trying to apply this and you get a patient that has Alzheimer's disease or a client, and you're like, "Where do I start?" And a lot of times, dietitians are very process-oriented. So the fact that you said, "Okay, the first thing you're going to do is you're going to look at different areas of research," that's really helpful. It's kind of like what's the step-by-step that somebody could follow? Because if we're going to have a first patient, everyone's going to have a first patient. There's the first patient that you work with. And the process, I think, really helps. At least, I know for me, that did a long time ago. But I'm not a new dietitian anymore. You kind of need that process.
But I think specifically in the area that you specialize in, it just sounds overwhelming. So what would you recommend? Say, somebody that's new and wants to do what you do. We know what the first step is. What is the second thing that they now do?
Amylee Amos:
Probably get a mentor.
Lisa Jones:
Okay.
Amylee Amos:
For what you're describing. So somebody new who wants to do this, though, if this is the goal for them ... which is wonderful, we need more RDs doing this ... I would seek out someone who does this all the time, who specializes in this area, who's going to be willing to partner with them on their first couple of patients until they kind of feel more confident. Which as we talked a little bit about last time in our last episode, that's quite common in certain areas. That's pretty common in RDs who specialize in eating disorders. They'll mentor RDs who want to get into that area because that's a very safe way of getting your feet wet that's also in the best interest of the patient. So I would recommend, if that's something you really want to do, find a mentor who's going to work with you on that. And then eventually, you can go off on your own once you feel more comfortable.
Lisa Jones:
Yeah, that is the best advice. Get a mentor. And I think that's applicable in any setting, but specifically this one with so many nuances and trying to provide that personalized or individualized nutritional care that you're doing.
Amylee Amos:
Absolutely. I agree.
Lisa Jones:
Thank you for that. Is there anything else that you can think of that they should keep in mind? So they're going to be looking at the different areas of research. And also, do you have additional advice on that? If there's somebody relatively new, or someone that maybe transitioned from another type of career into doing this and they're like, "Where do I start with the research?" do you have any advice? Back in the day, where did you start with the research?
Amylee Amos:
Yeah. I mean, obviously start attending the right kinds of conferences. So for this area, certainly, functional medicine. The Institute for Functional Medicine was where I did my postgraduate training and certification, which was wonderful. A very, very comprehensive training. So whether you do the training or at least start attending the conferences, and some free lectures that you can find online that are through these types of institutes so that you know they're coming from a quality source, I would start there. And then something that was really helpful for me was kind of joining up with like-minded people, getting on group text message threads. And then as new research comes out, people are sharing on those types of threads. We're sharing and collaborating, discussing. That's a good way to make sure you don't miss anything big. For example, if you were just recently a student and perhaps you had peers in your cohort that had similar interests, join up on a group where you share information that you hear. That would be a great way to kind of get started.
Lisa Jones:
Yes, because that's another thing. That's a really good tip. Because a lot of times, especially if you're someone that's more generalized and you have your hands in different pots, it's so hard to keep up with everything.
Amylee Amos:
It is. It really is.
Lisa Jones:
So if you have it right there and somebody's sharing it, then you're kind of like, "Oh, I've heard about that," or, "I've seen it. Now I could just go back to where I've heard about it and find out more about it," before you speak on it. Because obviously, the more knowledgeable we are, the better.
Amylee Amos:
Absolutely.
Lisa Jones:
Thank you. Is there any additional advice that we haven't discussed yet that you want to add to this conversation?
Amylee Amos:
I think that really sums it up. Just that it is so important. No matter what you are working in, as clinicians, we have to keep up with the science. And that's where it becomes a problem, probably less so for the newer RDs who are feeling fresh. But for those of us who have been doing this a while, it's easy to become complacent and to feel very comfortable with the recommendations we've always made and the cookie cutter approach becomes very easy. We have a responsibility as clinicians to be up with the most current research. That doesn't always mean changing everything you do based on the newest research. But knowing what it is, following along so that when the time comes where a change in interventions does need to occur, we're ready to do that and we know that that time has come.
Lisa Jones:
Yes, most definitely. And you've inspired me to go do more research on the Ketoflex Spare Three Diet. Did I say that right?
Amylee Amos:
Yeah. The Ketoflex 12/3, which again, this is very new. No long-term research yet, just some pilot studies. But that's where it starts, right? So we've got to make sure we're staying on track and seeing where it goes. So far, it looks very, very promising in terms of both the data that we have and just the theories behind the different mechanisms. Makes a lot of sense. But future studies are already in the work, so we'll see.
Lisa Jones:
Yes, looking forward to finding out more about that. And if there's any links or anything you want to share, too, with the audience, let us know. That would be helpful too.
Amylee Amos:
Sure. Sure thing.
Lisa Jones:
All right. Well, thank you for that wonderful conversation in our deep dive into evidence-based practice.
Amylee Amos:
Thank you.
Speaker 1:
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