A Plant-Rich, Nutrient-Dense, Low Glycemic, Mildly Ketogenic Diet with At Least a 12 Hour Overnight Fast Can Help Slow, Stop and Sometimes Reverse Cognitive Decline in Alzheimer’s Disease
Improving Dementia Due to Alzheimer’s Disease
with the Ketoflex 12/3 Dietary Approach.
What is It and How Do You Do It?
Rammohan Rao PhD, C-AP, RYT
Apollo Health, 855 Mahler Road
Burlingame, CA 94010
ram@ahnphealth.com; info@ahnphealth.com
www.ApolloHealth.com
KetoFlex 12/3 Diet Plan
1.800.450.0805
– Chief Scientist at Apollo Health which uses a precision-medicine, systems-based,
multi-therapeutic approach to reverse Dementia due to Alzheimer’s disease.
– Over 25+ years of research and teaching experience in Neuroscience
and has published 70+ peer-reviewed papers in scientific journals, including chapters in several textbooks.
– Board-Certified Ayurveda Practitioner, a Registered Yoga Teacher
and teaches Ayurveda and Yoga at the California College of Ayurveda.
– Best-selling author “Good Living Practices-The best from Ayurveda, Yoga and Modern Science
For Achieving Optimal Health, Happiness and Longevity.”
Interview Questions and Answers…
Kirk Hamilton: Thank you for coming on the show. Can you tell us about your educational background and how you came to combine neuroscience with Ayurveda and yoga? What got you interested in the connection between diet and cognitive health?
Rammohan Rao: After completing my PhD in neuroscience in India in 1992, I came to the United States for a postdoctoral fellowship at Mayo Clinic. I worked there for about five years on various aspects of the brain, including neurotransmitters, memory loss and Alzheimer’s disease.In 1999, I joined Dr. Dale Bredesen at the Buck Institute as a Research Associate Professor of Neuroscience. We studied Alzheimer’s disease using fly, worm, mouse and rat models and investigated the mechanisms involved in the disease.
My interest in yoga began while I was working at the Buck Institute. I practiced yoga in the evenings and eventually completed teacher training and became certified. In the early 2000s, my wife had a chronic health condition and was interested in Ayurveda. That led me to the California College of Ayurveda, where I completed a four-and-a-half-year program followed by a six-month internship. In 2008, Dr. Halpern invited me to join the faculty, and I have taught Ayurveda and yoga there since then.
KH: How did your Ayurvedic background influence the KetoFlex approach?
RR: In Ayurveda, one of the first principles students learn is that chronic conditions should be addressed through the gut. The gut is given a great deal of importance.
The KetoFlex Diet evolved from the observation that cognitive decline involves multiple biological problems, including insulin resistance, impaired neuronal fuel availability, mitochondrial dysfunction, inflammation, vascular issues, nutritional deficiencies, impaired cellular housekeeping and impaired trash-removal mechanisms.
The diet is intended to influence these mechanisms simultaneously rather than simply produce ketones. Nutrition is one part of a larger multi-modal or multi-therapeutic intervention to prevent or treat cognitive decline.
KH: What exactly does KetoFlex 12/3 mean?
RR: “Keto” refers to ketosis—the ability to use fat as a source of fuel. The brain and heart can switch between sugar and fat as sources of energy. One of the striking features of Alzheimer’s disease is that the brain becomes less efficient at using glucose as fuel.
“Flex” refers to metabolic flexibility—the ability of the brain to move efficiently between glucose and fat-derived fuels.
The “12” refers to a minimum fasting period of 12 hours between the last meal of the day and the next morning’s meal. Around the 12- to 14-hour fasting window, the brain begins switching toward fat metabolism and producing ketone bodies.
One of those ketones is beta-hydroxybutyrate, or BHB. BHB is known to induce neuroplasticity, reduce inflammation and trigger the release of BDNF, or brain-derived neurotrophic factor. It helps strengthen and nourish the brain.
KH: Do people need to measure their ketones every morning if they are following the 12- to 14-hour fasting schedule?
RR: For people who don’t experience memory loss, historical studies show that a 12- to 14-hour fast triggers the release of ketone bodies, so there is generally no need to measure them every day.
If someone is doing the right things and still experiencing memory loss, then measuring ketone levels can be useful. In some people, the levels may not be sufficient to trigger the desired benefits, and they may need to fast for a little longer.
There are devices that measure acetone in the breath and BHB in the blood. Devices such as Precision Xtra and Keto-Mojo can measure both glucose and ketone bodies. These can provide objective feedback, but I would not call measurement an absolute requirement for everybody. The broader goal is metabolic health and metabolic flexibility—not simply chasing a ketone reading.
KH: Why is the three-hour period before bedtime important?
RR: The “3” refers to stopping food at least three hours before bedtime. Circadian rhythms play an important role, and there is constant communication between the brain and the gut.
For people who have glucose problems or memory loss, late-night eating without a three-hour gap can keep glucose and insulin elevated at a time when the body is preparing for sleep. Finishing food at least three hours before bedtime extends the fasting window, reduces late postprandial glucose exposure and helps synchronize metabolism with sleep and circadian rhythms.
KH: What happens in the brain during sleep that makes sleep so important for cognitive function?
RR: Sleep is a very active physiological period. During deep sleep, the lymphatic system associated with the cerebrospinal fluid system becomes active and helps remove dead cells and toxic material that has accumulated in the brain.
Sleep also helps remove information that is considered “noise,” making room for better synaptic connections. Memory consolidation occurs during sleep, allowing important information to be stored and consolidated.
Another important process is neuroplasticity. During sleep, the brain is rewired and new neuronal branches become stronger, improving connections between neurons. That is why good-quality and adequate sleep are so important.
KH: What happens when someone eats too close to bedtime?
RR: When you go to sleep with a heavy stomach, digestion is still occurring. Sleep can be disrupted, and the N3 and REM stages can become disrupted.
When sleep is disrupted, memory consolidation is affected, “trash” removal from the brain is affected and the removal of unnecessary information is affected. These processes can accumulate over time when sleep habits are not appropriate.
KH: Let’s talk about fats and animal foods. Is KetoFlex a high-animal-fat ketogenic diet?
RR: The concern about saturated animal fat is legitimate. But the KetoFlex Diet recommended at Apollo Health is not based on large amounts of saturated animal fat. The predominant fats we emphasize are unsaturated fats.
We emphasize omega-3 sources, high-polyphenol olive oil, avocado, nuts and seeds. We are not talking about butter, cream, highly processed meat or large quantities of saturated animal fat.
Think about KetoFlex as a plant-rich keto diet and not a “bacon-and-butter” keto diet.
KH: What kinds of seafood, poultry and meat do you recommend?
RR: Seafood is definitely included. We recommend low-mercury, wild-caught seafood from the sea. We talk about “SMASH”—salmon, mackerel, anchovies, sardines and herring—because these are rich sources of EPA and DHA.
We also recommend poultry and eggs, preferably pasture-raised, because of their choline, B12, folate and fat-soluble vitamin content.
Red meat can be used moderately, such as approximately once a week. If someone wants to eat more, we recommend grass-fed, pasture-raised and minimally processed meat.
KH: What about vegetables? What type should make up the foundation of the diet?
RR: Non-starchy vegetables form the foundation of the diet. We emphasize plant diversity and a rainbow of colors.
We emphasize leafy greens such as kale, spinach, chard and arugula; cruciferous vegetables such as broccoli, cauliflower and Brussels sprouts; and alliums such as garlic, onions and leeks. We also include mushrooms, herbs, spices, avocado and olives.
We also emphasize low-glycemic fruits, especially raw “in season fruits”, berries and nuts and fermented vegetables. The goal is food with high nutrient density, high phytonutrient diversity and low glycemic impact.
KH: What about fruits, there sugar content, glycemic effect and cognitive decline?
RR: In Ayurveda, we say to eat with the season, including seasonal fruits. I encourage people to go to farmers’ markets because farmers generally grow what is in season.
The problem today is that fruits are available throughout the year, and people can overconsume them. Fruit smoothies are another concern because they contain a lot of sugar.
For people with cognitive decline, we emphasize fruits that have a low glycemic impact. We talk about wild berries, lemons and limes and phytonutrient-rich fruits such as blueberries, strawberries, raspberries and blackberries. Approximately half a cup or less of berries is an example of what we discuss.
KH: What about beans, legumes, yams, sweet potatoes and other complex carbohydrates?
RR: We talk about resistant starch sources. These include tubers, legumes, parsnips, cassava, rutabagas, pistachios, artichokes, jicama, dandelion greens, mushrooms, leeks and green banana.
These foods can be introduced in small amounts. They provide fiber that supports gut microbial production of short-chain fatty acids, which is important for metabolic health. They may increase glucose somewhat, but they are not necessarily a major concern.
For people with significant insulin resistance or glycemic dysregulation, these can be useful low-carbohydrate food choices when used appropriately.
KH: Why does KetoFlex recommend avoiding grains?
RR: We are talking specifically about people with memory loss, Alzheimer’s disease, insulin resistance, glycemic dysregulation or impaired metabolic flexibility.
Whole grains such as rice and wheat can be healthy foods in metabolically healthy populations. We acknowledge that. But for people with insulin resistance or glycemic dysregulation, even small amounts of carbohydrate-rich whole grains may interfere with glycemic stability and mild ketosis.
That is why the KetoFlex approach de-emphasizes grains and replaces them with deeply pigmented non-starchy vegetables and other nutrient-dense plant foods. KetoFlex is a therapeutic and personalized strategy. It is not a claim that whole grains are inherently unhealthy.
KH: What is your view of ghee and coconut oil?
RR: Ghee is clarified butter. In Ayurveda, ghee is considered a revered and nourishing fat. Apollo Health does not strongly recommend ghee, but we do not say no to ghee in the same way we would say no to butter, cream or rich-fat milk.
Coconut oil is a saturated fat from a plant source, while ghee is a saturated fat from an animal source. Both are saturated fats, and both can be nourishing.
At Apollo Health, we initially emphasize avocado and olive oil because people are trying to build metabolic flexibility. Once someone is metabolically flexible and doing well with insulin, glucose and memory, there is no reason they cannot take coconut oil or ghee.
KH: Do you recommend periodic prolonged fasting, such as a fasting-mimicking diet or water fasting?
RR: If someone is fasting for 14 to 15 hours every day between the last meal and the next morning, they are already creating metabolic flexibility and are already in a fasting mode.
I would not suggest extreme fasting patterns. There may be a role for longer fasting in selected individuals, but fasting longer does not automatically mean it is better.
For most people, we emphasize a daily fasting window of 12 to 14 hours. If an extended fast or fasting-mimicking diet is considered, it needs to be individualized and supervised.
We specifically caution against prolonged fasting in underweight individuals because of concerns about sarcopenia and bone loss. Aggressive fasting can be counterproductive.
KH: What are your personal eating and fasting habits?
RR: I have three meals. I usually have a very light breakfast, such as fruit or avocado. Around 11:30 or 12, I have a small midday meal with a lot of vegetables. Then I have supper with a lot of vegetables and less grain.
My wife and I try to finish our evening meal by 6:30, or 7 at the latest. We usually go to bed around 10 or 10:30, giving us about a three-and-a-half-hour gap. We then break our fast after about 15 hours.
Before I eat in the morning, I usually do 30 minutes of yoga, followed by either a walk around the neighborhood or time at the gym. I combine fasting with exercise.
KH: How much sleep do you usually get?
RR: Usually I get seven hours of sleep. I go to sleep by 10 or 10:30 and get up by five. I am an early riser.
KH: What glucose and fasting-insulin levels do you look for?
RR: For fasting insulin, we look for approximately 3 to 5.5. If someone is maintaining metabolic flexibility, there is no reason for insulin to be very high.
For hemoglobin A1c, at Apollo Health we look for less than 5.5.
For people with early memory loss, a family history of Alzheimer’s disease or especially a copy of APOE4, we recommend adopting the KetoFlex principles more rigorously. If someone has no memory loss, there is no need to be as restrictive.
KH: What is the main message you would like people to take away about KetoFlex 12/3?
RR: The main message is that KetoFlex Diet is not a rigid diet or a one-size-fits-all prescription. Diet is an important aspect, but it is not the only one and should not be used in isolation.
Alzheimer’s disease and dementia are complex disorders involving metabolism, inflammation, vascular function, mitochondrial health, gut-brain health and many other processes. KetoFlex 12/3 attempts to address several of these pathways through a dietary approach involving low glycemic nutrition, mild ketosis, meal timing and metabolic personalization.
Nutrition is part of a larger multi-domain approach that includes physical activity, sleep, stress management, and cognitive and brain stimulation. The evidence is encouraging, but we also need to be humble. At the end of the day, we need to bring all of these approaches together to sustain the benefit we are looking for.
KH: Thank you, Ram. I appreciate your time and your enthusiasm. I hope we can have you back to talk specifically about Ayurveda and cognitive function.
RR: Whenever you call me, I’ll be there. I think this is a great message because both of us are interested in making sure that people do the right things. At the end of the day, it is not just about memory loss. Nutrition, sleep and exercise are beneficial for many of the problems we have, and Ayurveda has talked about these things for a long time.
KH: One last question: Are you a coffee or tea drinker?
RR: Neither, although I can have coffee or tea. I’m not dependent on a morning cup of coffee. If I have coffee or tea, I don’t usually take it completely black because it is too astringent for me and creates some problems.
I like to add a little A2 milk and a little sweetener. Sometimes I’ll have coffee or tea instead of breakfast, and sometimes I’ll have something like avocado or fruit. It’s either one or the other.
KH: Thank you, Ram.
RR: Thank you so much.
Interview Summary…
Dr. Ramahan Rao describes the KetoFlex 12/3 approach as a plant-rich, nutrient-dense, mildly ketogenic and personalized nutritional framework intended to address multiple factors associated with cognitive decline, including insulin resistance, impaired neuronal fuel availability, mitochondrial dysfunction, inflammation, vascular issues, nutritional deficiencies, and “impaired cellular housekeeping.” He explains that “keto” refers to using fat as a fuel, “flex” refers to metabolic flexibility—the brain’s ability to move between glucose- and fat-derived fuels—and “12/3” refers to fasting for at least 12 hours between the last meal and the first meal of the next day, while finishing eating at least three hours before bedtime. Rao emphasizes non-starchy, diverse and colorful vegetables, low-glycemic fruits such as berries, nuts, seeds, avocados, olives, fermented vegetables and selected resistant-starch foods such as legumes and tubers in small amounts, while recommending avoidance of grains for people with memory loss, insulin resistance or glycemic dysregulation. He says the diet is not a “bacon-and-butter ketogenic diet” and emphasizes unsaturated fats from omega-3 sources, olive oil and avocado, while recommending low-mercury, wild-caught seafood, pasture-raised poultry and eggs, and moderate amounts of grass-fed, pasture-raised, minimally processed red meat. Dr. Rao explains that a 12–14-hour fast is generally sufficient to trigger ketone production and that routine ketone measurement is not required for everyone; longer fasting should be individualized and supervised. He also emphasizes the importance of sleep, explaining that sleep supports removal of accumulated waste, removal of unnecessary information, enhances memory consolidation and neuroplasticity. Finally, he stresses that KetoFlex is not a rigid, one-size-fits-all diet and that nutrition is only one component of a broader approach involving physical activity, sleep, stress management, and cognitive and brain stimulation.
10 Key Take-Home Points from the KetoFlex 12/3 Interview with Rammohan Rao, PhD
- KetoFlex is not simply a “ketogenic diet.”
Dr. Rao describes KetoFlex as a plant-rich, nutrient-dense, mildly ketogenic and personalized approach rather than a high-animal-fat diet. - It is not a “bacon and butter” keto diet.
The interview specifically states that KetoFlex is “not a bacon and butter keto diet.” The approach emphasizes unsaturated fats, including sources such as olive oil, avocado, nuts, seeds and omega-3-rich foods. - The goal is metabolic flexibility—not simply producing ketones.
“Flex” refers to the ability to move between glucose and fat-derived fuels. Dr. Rao explains that the approach is intended to address broader metabolic problems rather than simply generate ketones. - KetoFlex 12/3 combines nutrition with meal timing.
According to the interview, “12” refers to a minimum 12-hour fasting period between the evening meal and the following morning, while “3” relates to allowing approximately three hours between the evening meal and sleep. - The approach is intended to address multiple factors associated with cognitive decline.
Dr. Rao discusses insulin resistance, impaired neuronal fuel availability, mitochondrial dysfunction, inflammation, vascular issues, nutrition deficiencies, impaired “cellular housekeeping” and impaired “trash-removal” mechanisms. - Diet is only one part of the strategy.
A major message of the interview is that diet should not be considered in isolation. The broader approach includes physical activity, sleep, stress management, cognitive and brain stimulation, and other interventions. - Low-glycemic eating is emphasized.
For people experiencing insulin resistance, glycemic dysregulation or impaired metabolic flexibility, the interview describes avoiding grains and replacing them with deeply pigmented non-starchy vegetables and other nutrient-dense plant foods. - The approach emphasizes nutrient-dense plant foods and healthy fats.
The interview highlights foods such as vegetables, avocado, nuts, seeds, olive oil and selected seafood, particularly seafood providing EPA and DHA. - Exercise and sleep are important components.
Dr. Rao describes combining fasting with exercise and discusses maintaining an appropriate nighttime sleep window. He reports getting approximately seven hours of sleep himself. - The evidence is described as encouraging—but the approach is not presented as a guaranteed cure.
Dr. Rao calls the evidence “very encouraging” but also says there is a need to “be humble.” He emphasizes that KetoFlex is not a rigid, one-size-fits-all prescription and that sustained benefit requires bringing multiple components together.
($5.00/month or $50/year would be appreciated for this publication)
- Practice, Persistence and Patience – My Favorite. The first story of transformation that “jumped out” at me before my cancer and then the first one “sent” to me after my cancer diagnosis. A physician cures herself of a rare, life threatening sarcoma after chemo, radiation and alternative therapies had been tried.
- ”Source” the Documentary – The Science behind the practice. Highly recommended.
- Proof – Stories of Transformation (listen to a few stories of transformation from serious health problems)
- Stories of Transformation – YouTube Channel
- Research: The Science Behind Mind/Body Healing and Meditation
- Dr. Joe Dispenza’s Book: Becoming Supernatural
Falun Dafa – Truthfulness, Compassion and Forbearance
Brief Introduction to Falun Dafa
Falun Gong Misconceptions
Books & Recent Writings of Mr. Li Hongzhi
Video & Audio Materials
Take an Online Class
Kirk Hamilton PA-C
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.StayingHealthyToday.com
www.StayingHealthyToday.Substack.com
($5.00/month or $50/year would be appreciated for this publication)