My granny blinked behind her glasses as she drove us to her home after school, trying to conceal her panic. It was 1975. I was seven years old, and she was fifty. Granny wasn’t sure where to turn her Oldsmobile Cutlass Supreme next. The distance between the school bus stop and her home was only five miles, but we were lost.

When my grandmother’s memory and then her personality drained out of her due to Alzheimer’s disease, I didn’t know that women are at double the risk of Alzheimer’s compared with men. I didn’t recognize that her risk began in her forties, at the time that was taking caring of me after school because my parents both worked full time. Now I understand that her cognitive decline was probably due to issues related to her blood sugar, fondness for drinking two or three martinis every night, and loss of estrogen associated with perimenopause and menopause.

I went to medical school because I wanted to help people. When I was 21 and my beloved grandmother was in a nursing home unable to recognize me, I got clear about my “why.” I wanted to cure Alzheimer’s disease.

At Harvard Medical School, I learned the wretched news about Alzheimer’s disease. Not only was it miserable for the patient, caregivers, and family—but the lack of treatment made the medical training grim. Neurologists were beaten. Their mantra was, “Diagnose, and adios,” because there was no reliable way to prevent or treat it. I chose instead to go into gynecology. Since then, more than 99 percent of treatments for Alzheimer’s have been total failures. Currently approved medications fail to stop or slow the progress of the disease. Of the four Alzheimer’s drugs on the market that may reduce memory loss and confusion, they do it only for a limited time.

But as a gynecologist, I discovered another approach. It’s called personalized lifestyle medicine, and it acknowledges that all chronic disease—including Alzheimer’s disease, cancer, diabetes, high blood pressure, and cardiovascular disease—stems from inflammation that begins years, maybe decades, before the diagnosis. So the strategy is to work upstream and systematically with lifestyle changes—the way you eat, move, think, and supplement—in order to prevent the inflammation and therefore the diagnosis. (Inflammation, which I think of as a frat party gone wrong, starts in your brain in your forties, like it did with my grandmother.) In mainstream medicine, the old school idea is that there’s a pill for every ill, but that hasn’t worked in Alzheimer’s. But there is a multi-dimensional approach, which ultimately has pleiotropic effects, meaning that it is simultaneously capable of producing multiple benefits—it lowers inflammation, increases brain metabolism and connections between nerve cells, increases remembering and decreases forgetting, and may even reverse cognitive declines. Lifestyle medicine serves as the basis of the work of my friend and colleague Dale Bredesen MD, who has improved or reversed early Alzheimer’s disease in a series of one hundred patients. He describes Alzheimer’s as a disease where you have 36 holes in the roof. You need to patch all of the holes to see improvement.

In my medical practice, I do not take care of patients with Alzheimer’s disease. Instead, I take care of women aged 35 and older who are noticing the earliest signs of cognitive issues, like the forgotten keys or appointments, the stopping mid-sentence because they can’t find the word they are looking for. They don’t have 36 holes in their roof, they have three or five. Together we patch the holes, they feel better, and we may have dodged a diagnosis in their future.

In my new column, I’ll be writing about my experience with helping women care about their brains much earlier—ideally in your thirties, forties, and fifties. I’ll describe what has been most effective based on which holes you may have in your roof.

Here’s today’s tip. One of the best ways to stave off a scary diagnosis like Alzheimer’s is to pay attention to your blood sugar. Know your fasting blood sugar, a simple test that most patients undergo once every year or two. The average for 95 percent of the population is less than 100 mg/dL. But I don’t want you to be average, I want you to live long and well with a healthy brain clear of debris and deposits. Starting at age forty, blood sugar climbs about 10 points per decade, unless you are actively doing something about it. Rising blood sugar is responsible for 60 percent of cognitive decline. Make normalizing your blood sugar a top priority by doing the following.

• Know your numbers, including fasting blood sugar and hemoglobin A1C (a three-month average of your blood sugar)
• Keep your blood sugar from rising too high by avoiding sugar and foods that trigger inflammation for you, which may include gluten and dairy, among others. Follow an elimination diet, such as the one found in my new book, Younger.
• Limit alcohol. The latest research shows there is no safe level, especially for women. Alcohol is a brain toxin and increases the risk of many cancers, including breast.
• Exercise a minimum of thirty minutes per day, and ideally an hour. Perform high intensity interval training to make your cells hungry for glucose, so that the glucose can be pulled out of the blood stream to feed your muscles.
• Meditate, pray, or find some other way to objectively witness your experience so that stress doesn’t raise your cortisol (stress hormone) and drive up blood sugar.
• Optimize your levels by keeping fasting blood sugar 70 to 85 mg/dL and hemoglobin A1C < 5.
• To learn more about personalized lifestyle medicine for the prevention of Alzheimer’s, read my book Younger.

If you remember nothing else from this column, know that rising blood sugar leads to metabolic inflexibility, which decreases plasticity of the nerve cells, particularly in the hippocampus, the part of the brain involved in memory consolidation and emotional regulation. So the trick is to stay metabolically flexible with lots of connections between nerve cells in the brain. Pay attention to holes in your roof and patch them early, starting with your blood sugar. My granny didn’t, but you can.

Dr. Sara Gottfried is a Harvard-trained MD, bestselling author, and leading expert on hormones. For more information, click here: www.saragottfriedmd.com/