The official KetoFLEX 12/3 diet “is part of an overall protocol developed over thirty years of research by Dale Bredesen, M.D. to support brain health and address the biochemical imbalances that can lead to cognitive decline.”
KetoFLEX 12/3™ is a therapeutic high-fat, adequate-protein, low-carb food plan that reverses common underlying causes of dementia and other chronic diseases, best suited for the non-athletic/sedentary, older adult population. KetoFLEX™ eating will alter your metabolic state from running predominantly on glucose to generating ketones as a major source of fuel. The KetoFLEX™ dietary template described below should be personalized to best suit each individual. After 1-12 months on a strict KetoFLEX™ diet, most people will benefit from liberalizing their diet (see “Over the Long Term” considerations below) while still maintaining or even improving the gains in energy, mood, cognition, blood sugar stabilization, and other biomarkers made with KetoFLEX™ eating.
KetoFLEX 12/3™ in a nutshell:
- ample non-starchy colorful vegetables, nuts, seeds, avocados, herbs, pasture-raised eggs, wild-caught fish/seafood, mushrooms, non-polluted water, and olive oil
- some non-tropical fruit, grass-fed meats, pasture-raised poultry, legumes, coconut, ghee/butter, starchy vegetables, and coffee/tea
- minimal processed foods (i.e. flour), added sugar, high-glycemic fruit, gluten-free whole grains, dairy (small amounts if well tolerated), gluten (none if intolerant), pesticides/additives, and high-mercury fish
- consume food within a 12-hour or less window during the day for an overnight fast that promotes mild ketosis
- finish eating 3 hours before bedtime
- focus on nutrient-dense, high-quality whole foods; limit processed foods labelled “keto”
- lots of healthy fats to support nutritional ketosis
- over the long-term, individuals with dyslipidemia and/or with the ApoE4 allele may be advised to limit their intake of saturated fat, including coconut products, dairy/butter/ghee, fatty meats, and supplemental MCTs (Medium Chain Triglycerides)
Dr. Bredesen describes this diet for preventing and treating cognitive decline in both his 2020 and 2017 books (references below). KetoFLEX™ emphasizes a variety of seasonal non-starchy vegetables, adequate protein, and generous amounts of healthy fats. Plant foods with a low glycemic index/load that have ample fiber and phytonutrients are highly preferable to the high-glycemic, carbohydrate-laden processed foods that dominate the standard American diet.
Since Dr. Bredesen’s book doesn’t provide KetoFLEX™ recipes or meal plans, I provide my own extensive food lists, in-store and online grocery shopping guides, recipes, and diet resources to everyone I coach, as well as meal plans upon request. If you subscribe to Apollo Health’s PreCODE™ or ReCODE™ programs, you’ll receive online access to “Nutritional Guidelines” and additional resources for KetoFLEX™. You can explore some KetoFLEX-aligned recipe books here.
The “Keto” in KetoFLEX™
“Keto” refers to a nutritional strategy to get the body in a state of ketosis, fueled in part by ketones. “FLEX” refers to metabolic flexibility to run on a combination of ketones and glucose in contrast to how most Americans primarily rely on glucose all the time. Ketosis is a normal metabolic state that healthy people occasionally enter when burning fat for fuel due to short supply of carbohydrates (and glucogenic amino acids). Carbohydrates from incoming food and stored glycogen can drop with time-restricted eating, fasting, extensive exercise, and restriction of consumed carbohydrates.
To promote ketosis through time-restricted eating, meals are timed”12/3“, such that eating stops at least 3 hours before bedtime and the overnight fast lasts at least 12 hours. Up to a 16-hour overnight fast AKA an 8-hour time-restricted feeding window works well for most people. Thereby, pay attention to the timing and not just the composition of your KetoFLEX™ diet.
Chose carbohydrate foods with a low glycemic index and load. KetoFLEX™ eating avoids simple and processed carbohydrates including “whole grain” bread, gluten-free pasta, juice, soda, rice, rice cakes, and baked goods. Also, note that KetoFLEX™ is lower in meat, total protein, and saturated fat than many popular ketogenic diets. People with cognitive decline on the Bredesen ReCODE Protocol™ are usually advised to try a therapeutically ultra low carb version of the KetoFLEX™ diet to get them into a sustained state of mild ketosis. The KetoFLEX™ dietary therapy was designed especially for older adults at risk for or reversing dementia. Note that pregnant women, high-intensity athletes, children, and people with certain conditions might be better served with a different diet and macronutrient profile.
Why KetoFLEX™?
This way of eating alleviates many of the drivers of cognitive decline by:
- reversing insulin resistance,
- promoting metabolic flexibility,
- partially fueling the brain with ketones (especially important because glucose energy metabolism is impaired in Alzheimer’s disease),
- lowering inflammation,
- enhancing detoxification,
- shifting the gut and oral microbiome to foster better brain health,
- stimulating autophagy for removal of damaged proteins,
- stimulating mitophagy and improved mitochondrial function,
- nourishing the brain by protecting against the nutrient deficiencies associated with dementia,
- providing ample dietary building blocks for creating new nerve connections,
- protecting against nutrient deficiencies associated with brain atrophy, muscle loss, and bone loss associated with cognitive decline,
- and eliminating common food sensitivities.
Though there are alternative healthy dietary frameworks, KetoFLEX 12/3™ is singularly therapeutic for the most common biochemical and metabolic issues in adults with risk factors for cognitive decline.
Eat more brain healthy food and less processed food within a 12-hour daily window.
If you’re not used to eating this way, just take it step-by-step. If you’re feeling gung-ho, that’s terrific, but I encourage a slow transition for long-term success. Gradually allow your metabolism to adapt to burnin more fat and less sugar without dips in blood sugar. As first steps, you may want to GRADUALLY:
- reduce added sugar, processed food, and flour while increasing your intake of foods rich in healthy fats, like nuts, eggs, olives, olive oil, and fatty cold-water small-mouthed fish.
- eat a colorful array of non-starchy vegetables daily, as tolerated
- become accustomed to waiting for at least twelve hours to elapse overnight since your last bite of food…before consuming significant food (i.e. >50 calories of coffee creamer, any sugar, breakfast)
These three eating patterns are associated with significantly lower risk of common chronic diseases, including Alzheimer’s.
Everyone’s version of KetoFLEX™ will be unique.
KetoFLEX™ has “FLEX” for flexible in its name. Your KetoFLEX™ meals should be personalized to your conditions and preferences. The images below are a few examples of colorful brain food meals. These and more recipes available to all my clients and patients. Notice how a KetoFLEX™ diet looks different from popular ketogenic diets dominated by keto sports bars, Bulletproof coffees, fatty meats, keto meal replacement drinks, coconut oil, processed foods (i.e. keto waffles), tons of cheese/sour cream/butter, bacon, and “fat bombs”. These mainstream keto foods may appear in small amounts in the KetoFLEX™ nutrition plan, but are not mainstays.
If these dishes shown are not your “cup of tea”, you can develop entirely different wholesome KetoFLEX™ meals to satisfy you. If you’re worried that this way of eating won’t satisfy your sweet tooth , you may be pleasantly surprised by how your taste buds adapt over time to savor nuanced food flavors otherwise overwhelmed by added sugar. Furthermore, you can utilize a little stevia, monkfruit, or erythritol sweetener as a sugar substitute and may derive lots of pleasure from the creamy textures of a diet high in good fats.
It’s not all-or-none. Every step you make toward more brain healthy food choices is good for you. It helps to enlist the support of a partner or friend eager to eat à la KetoFLEX™. Strive for better eating without the diet perfectionism that creates stress. Note that Dr. Bredesen’s patients who reversed cognitive impairment still fudged a bit on their KetoFLEX™ diets.
If you’re having trouble, I can provide an abundance of personal support and meal/snack/grocery/restaurant planning. Coaching can be the make-or-break element that averts overwhelm, gets you taking one well-guided step at a time, and resumes your course if you veer off track.
The KetoFLEX 12/3™ blueprint requires personalization.
IPeople already experiencing cognitive decline are advised to try a fully ketogenic version of KetoFLEX™ that is ultra low carb. Initially, getting into ketosis requires attention to macronutrient ratios. Some guidance on macronutrients can be found via the link below or here. Read more about the strict ketogenic version of the Ketoflex™ via the link below or here.
KetoFLEX™ eating manifests in a diversity of ways suited to personal preferences and health considerations. Carbohydrate intake is tailored to each person’s level of glucose tolerance and physical activity. Some choose a vegetarian version for ethical reasons. Those with certain gut conditions may limit (otherwise healthy) vegetables until gut health is restored. Saturated fat intake is often restricted for those with genetic risks (ApoE4/4 status), cardiovascular disease/risk, or elevated LDLp. People with failing kidneys or fighting cancer may be advised to eat less protein. Pasture-raised eggs and nuts can be terrific choices except for those with sensitivities/allergies. Individuals taking the blood thinner coumadin/wafarin would not eat the leafy deep green vegetables usually encouraged on this diet without consulting their prescribing physician. Diabetics often see remarkable improvements on this diet, but require physician oversight and responsive adjustment of their medication as they proceed. Very thin individuals (BMI < 20) need extra attention to getting ample calories and healthy fats to avoid experiencing excessive weight loss on this diet. Other individuals may benefit from reducing FODMAPs, oxalates, phytates, nightshades, and/or lectins. Personalization is nuanced.
This webpage is only meant to be a useful starting framework. Comprehensive KetoFLEX 12/3™ diet personalization can be realized with help from well-informed and experienced practitioners. To help my clients and patients initially start customizing their diet, I provide a two-page KetoFLEX™ summary, flagging foods that may not be tolerated due to high FODMAPs, lectins, oxalates, saturated fat, histamine provocation, and potential for autoimmune aggravation.
As a ReCODE™ practitioner, I work with your doctor to personalize the KetoFLEX™ diet for you, tailor the diet to your taste buds, and bring awareness to any blind spots in how well your eating aligns with your goals. Coaching helps you identify and focus on all good stuff that you can eat, keeping in mind a positive vision of how healthy eating will indeed help you optimize brain health and age well.
Coaching helps to guide, simplify, accelerate, and ease the transition, especially to a fully ketogenic version of KetoFLEX 12/3™. Coaching support helps you get comfortable with new KetoFLEX™ eating habits and iterate on the diet until you’re feeling your best. Support also keeps you from falling off the wagon until you find your groove. After an upfront investment of effort and time to transition to new eating patterns, KetoFLEX™ can become easy to maintain.
Food can be exceptionally powerful brain medicine.
Consider a trial of the therapeutic KetoFLEX™ diet to experience the benefits for yourself. A gradual, initial ramp up may take adjustment and professional support. Check in with your body after clocking a full month of honestly sticking to the aforementioned KetoFLEX™ principles at least 80% of the time. Most people clearly feel better after four weeks of following a well-formulated KetoFLEX™ food plan. If not, you may need a functional/naturopathic/integrative medicine practitioner playing detective to figure out why—i.e. poor digestion, gut dysbiosis, other bowel conditions, misinterpretation in applying the dietary principles, anxiety, or less common conditions. An experienced practitioner can troubleshoot and suggest discontinuing KetoFLEX™ when appropriate. KetoFLEX™ works is powerfully therapeutic for most people, but some individuals may ultimately need a different dietary approach.
After 2-6 months on a well-formulated, personalized KetoFLEX™ diet, I most commonly observe
- substantial fat loss in people who were overweight
- reports of feeling more cognitively clear
- key biomarkers, especially fasting insulin and Hba1c, come closer or within optimal range
- normalization of previous blood sugar excursions in people who were pre-diabetic
- reduction of medication prescribed for diabetics, under doctor’s supervision
- resolution of chronic constipation and/or diarrhea
- improvements in other issues, like skin conditions, joint pain, and autoimmune symptoms
Over the Longer Term
After 2-12 months of optimizing health with KetoFLEX™ eating, its time to methodically experiment with liberalizing your diet toward a more balanced way of eating. Long-term health is often better served by replacing some of the fats and oils (often 70% of caloric intake) with more diverse and nutrient-dense foods. Observe whether you can maintain energy, mood, cognition, blood sugar stabilization, bodyweight, and biomarker gains when departing from strict KetoFLEX™ guidelines. Additional protein-rich bison, beef, lamb, and/or elk may help you avoid sarcopenia, anemia, and nutrient deficiencies. Notice if your body responds positively to ample meat intake. If so, please disregard the ideological castigation of ancient, nourishing sources of human nutrition. Attenuating vegetable intake below very high KetoFLEX™ recommendations may help you avoid oxalate-related complications (i.e. kidney stones, pain syndromes) and small bowel obstruction. After months of successful KetoFLEX™ implementation, you may discover that you’ve restored metabolic flexibility such that you can enjoy more seasonal fruit without sacrificing ideal glucose regulation. Seasonal fruit is an ancestral human food that has historically coincided with vigorous health. Overall, a more balanced whole food diet is more accommodating for participation in social events. Your long-term brain healthy eating plan should find ways to include communal and/or celebratory social eating that psychologically nourishes your brain.
Intermittent periods of ketosis can be attained through time-restricted eating, exercise, fasting, a 5-day fasting-mimicking diet, and/or temporary periods of low carbohydrate intake, rather than through constant carb restriction. Overall health can be boosted by occasional bouts of both feasting as well as fasting, by cycling between anabolism and catabolism. Staying in continuous ketosis for years is probably not ideal for most people, but may be necessary for treating mild cognitive impairment or dementia.
Each individual develops a maintenance diet to serve up optimal brain health and well-being. People with cognitive impairment are likely to need to maintain a stricter dietary pattern to prevent further decline than people at the stage of prevention. Rational people pursuing preventative health strategies would be wise to continue to avoid eating ultra-processed products associated with poor health in order to reduce their risks of chronic disease.
The experience of greater wellness, stable energy, and cognitive clarity can feed your motivation to make brain healthy eating your new normal. For most folks, a trial of the therapeutic KetoFLEX 12/3™ diet recovers more robust health and is well worth the investment. I hope you too will discover greater nourishment without calorie counting to feel and perform your best.
*Consult your doctor before changing your diet.
References: Dale E. Bredesen, “The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline“, 2017
Dale E. Bredesen, “The End of Alzheimer’s Program: The First Protocol to Enhance Cognition and Reverse Decline at Any Age“, 2020
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