The Brain Energy Problem That Begins Decades Before An Alzheimer’s Diagnosis
Especially if you have a maternal history of Alzheimer's.
If your mother has or had Alzheimer’s disease, there’s a good chance you inherited a brain that is more vulnerable to problems with energy metabolism.
Researchers call this brain hypometabolism.
It means the brain is not using glucose efficiently for fuel, and it’s one of the earliest and most common things seen in Alzheimer’s disease. In fact, brain hypometabolism can often be seen on FDG-PET scans years — sometimes decades — before the first cognitive symptoms appear.
This is especially important for people with a maternal history of Alzheimer’s because several major Alzheimer’s risk factors are inherited more strongly through the mother’s side, particularly those involving mitochondria, inflammation, and brain hypometabolism.
Mitochondria are the energy-producing structures inside your cells, and they are inherited almost exclusively from your mother. Your brain uses an enormous amount of energy every day. When brain cells begin struggling to efficiently access and use fuel, they become more vulnerable and less resilient over time.
Researchers have shown that cognitively normal adults with a maternal history of Alzheimer’s often have lower glucose metabolism in Alzheimer’s-prone brain regions long before symptoms begin.
That matters because Alzheimer’s doesn’t suddenly appear the day someone receives a diagnosis. The processes in the brain begin developing years earlier.
And honestly, this changes how we should think about prevention.
If brain energy problems are already silently developing in our 40s, then prevention cannot simply start when we get older or after symptoms begin.
It has to start much earlier.
While an FDG-PET scan can reveal whether someone already has brain hypometabolism, I’ve simply assumed I have it because of my maternal family history.
I actually do have 5 good reasons to believe Alzheimer’s would eventually become very likely for me if I ignored this, and other hidden risk factors. Those 5 good reasons are the 5 women in my direct maternal line who have already had it.
The good news is that brain hypometabolism is modifiable. That’s the part I want more people to understand.
The women in my family who developed Alzheimer’s knew nothing about brain hypometabolism. They had no access to the information we have today. In their lifetime, and during most of mine, Alzheimer’s prevention and reversing early symptoms of cognitive decline were considered to be impossible.
Even though researchers first began identifying abnormal brain glucose metabolism in Alzheimer’s disease back in the late 1970s and early 1980s. Even now, most people, including many physicians, still don’t understand how important this concept is for prevention.
My female relatives developed symptoms in their mid-late 60s, but the metabolic dysfunction contributing to those symptoms began much earlier.
My cousin, especially. Her cognitive symptoms actually became obvious in her 50s, and she died at age 64 after progressing to late-stage Alzheimer’s disease. That means the underlying metabolic dysfunction in her brain could have started in her 30s or 40s.
Do I think hypometabolism was the only thing contributing to Alzheimer’s in my family?
No. Alzheimer’s is multifactorial. But I absolutely believe it was one of the factors affecting all of them.
Brain hypometabolism can exist for years before obvious cognitive decline appears As time passes, there may be symptoms that are easily dismissed as stress, aging, burnout, menopause, poor sleep, or simply “having too much going on.”
Because the brain is not producing and using energy efficiently, early signs of that can show up in subtle ways. Some people also describe a vague sense that their brain “doesn’t feel as resilient” as it used to, even though standard cognitive testing is still normal.
The exciting part is this: The brain has another fuel source called ketones.
Ketones are molecules your liver produces primarily from fat when your body is no longer getting a constant supply of glucose (sugar) from food.
This naturally happens overnight while you sleep, during exercise, or when meals contain fewer carbohydrates, and there’s a longer period of time between eating.
Unlike glucose, ketones can still provide energy to brain cells even when glucose metabolism in the brain has become impaired.
In other words, ketones can help provide fuel to brain cells that are running low on energy because of impaired glucose metabolism. This is one reason ketogenic strategies are being studied so heavily in Alzheimer’s prevention and early cognitive decline.
In the paid section below, I’m going to walk through a few practical ways to begin using this information to support your brain energy without becoming obsessive or feeling like you need to change everything overnight.