Sarah, 61, came to my clinic convinced she had early Alzheimer's. Forgetting words mid-sentence. Couldn't focus through meetings. Walking into rooms and forgetting why. Her mother had died from Alzheimer's at 68. Sarah was terrified she was next. I ran the full workup: Cognitive testing: normal for age. Brain MRI: no concerning findings. Biomarkers: no evidence of Alzheimer's pathology. But something was clearly wrong Then I looked at her labs: A1c: 6.1% (prediabetic) Blood pressure: 148/92 (hypertension) LDL: 156 (elevated) Body weight: 42 pounds over healthy range Sleep: 5-6 hours, poor quality Her brain wasn't failing. Her body was failing her brain. I prescribed something no pharmaceutical company makes: Lose 25 pounds over 6 months. Walk 30 minutes daily. Mediterranean diet. Sleep 7-8 hours nightly. Manage stress actively. Sarah looked disappointed. She wanted a pill. A diagnosis. Something medical. Not "eat better and exercise." That felt too simple. Too much like failure. But she agreed to try. Three months with a health coach. Daily accountability. Structured program. Here's what happened: Month 1: Lost 8 pounds. Sleep improved to 7 hours. Brain fog "maybe 10% better." Month 2: Lost another 7 pounds. A1c dropped to 5.8%. "I can think again during afternoon meetings." Month 3: Lost 6 more pounds. Blood pressure 128/84. "I haven't felt this sharp in 5 years." Six months later: Lost 23 pounds total. A1c: 5.4% Blood pressure: 118/76 LDL: 112 Sleep: 7.5 hours average Cognitive complaints: resolved. Sarah didn't have dementia. She had metabolic dysfunction causing reversible cognitive impairment. Fix the metabolism. Fix the brain. This isn't rare. I see it constantly: Sarah asks me now: "Why didn't my last doctor tell me this?" Because we're trained to diagnose disease, not reverse dysfunction. We're good at spotting Alzheimer's. Terrible at recognizing reversible metabolic cognitive impairment. The difference matters enormously. One is progressive and irreversible. The other responds to lifestyle intervention within months.

My posts on alcohol get a lot of engagement. Lots of questions. Lots of pushback. Here's the deeper dive you asked for. The data keeps getting worse for alcohol and brain health. Even moderate drinking. What we know now: 7+ drinks per week associated with brain atrophy on MRI. 14+ drinks per week: significant white matter damage. No amount appears protective despite earlier studies claiming benefits. The "French paradox" was mostly confounded by other factors. How alcohol damages the brain: Direct neurotoxicity - ethanol kills brain cells. Oxidative stress - generates free radicals that damage DNA. Inflammation - chronic low-level brain inflammation. Thiamine deficiency - disrupts energy metabolism in neurons. Disrupted sleep architecture - prevents brain waste clearance. All accelerate cognitive aging. The dementia risk: Heavy drinking (21+ drinks/week): dramatically increased risk. Moderate drinking (7-14/week): modest increased risk. Light drinking (1-6/week): unclear, possibly slight increased risk. No drinking: baseline risk. The dose-response is pretty clear. More alcohol = more risk. But what about the studies showing benefits? Confounding. Non-drinkers in those studies included former heavy drinkers who quit due to health problems. Made non-drinking look worse than it was. When you separate lifelong abstainers from former drinkers, the protective effect disappears. Alcohol provides zero cognitive benefit. What about red wine and resveratrol? Resveratrol in wine: too low to have biological effect. You'd need to drink 1,000 bottles to match the dose used in mouse studies. The benefits attributed to wine are likely from: Healthier overall lifestyle of wine drinkers Mediterranean diet (not the wine itself) Social connection during meals Can be achieved without alcohol. The question I get most: "So I should never drink?" I'm not saying that. I'm saying understand the tradeoff. Social enjoyment vs brain health. Personal values vs risk tolerance.

University of Vermont just published a vascular dementia breakthrough. Identified why brain blood flow fails in dementia. And how to potentially fix it. The problem: Reduced cerebral blood flow is a major contributor to dementia. Especially vascular dementia and Alzheimer's. Brain tissue needs constant blood supply. When circulation drops, cells die. Cognitive function declines. What they discovered: A lipid molecule called PIP2 normally keeps blood vessel channels regulated. Controls Piezo1 channels in endothelium. When PIP2 is present: channels work normally, blood flow is healthy. When PIP2 decreases: Piezo1 channels become overactive, vessels constrict, blood flow drops. In dementia: PIP2 levels dramatically reduced. The experiment: Restored PIP2 in animal models with vascular problems. Blood flow normalized. Vessel function improved. Gives us specific molecular target. New drug development pathway. Why vascular health matters: Vascular dementia: 15-20% of all dementia Mixed dementia (Alzheimer's + vascular): another 20-30% Nearly half of dementia has vascular component. Even "pure" Alzheimer's: vascular health influences progression. Better blood flow = better amyloid clearance. The heart-brain connection: What's good for your heart is good for your brain. Hypertension damages cerebral blood vessels. Atherosclerosis reduces blood flow. Diabetes impairs vascular function. High cholesterol affects brain circulation. All midlife cardiovascular risk factors = later dementia risk. Managing vascular risk in midlife: - Control blood pressure (target <130/80) - LDL cholesterol <100 mg/dL - Prevent or manage diabetes (A1c <5.7%) - Maintain healthy weight - Don't smoke - Exercise regularly - Mediterranean diet These aren't just heart disease prevention. They're dementia prevention. The timeline: Vascular damage accumulates over decades. Silent at first. Small vessel disease. Microinfarcts. White matter changes. Reduced perfusion. By age 70: damage is extensive if risk factors uncontrolled.

Who are you when nobody else is watching? When you let go of should? When you don't dial yourself down to make others comfortable or turn it on to keep them approving? What if your main goal for 2026 was to be the you-est you that you could be, what would that look like? I'm not suggesting you should be her all the time. She may need to be tempered or managed to create what you want in life. But most importantly, I want YOU to know who she is intimately. Because knowing her will allow you to love her bigger and better. Because pretending to be someone else is exhausting and lonely. AND because she has some interesting and valuable things to offer us all. Not everyone will love her like you do. That's OK. Because the ones that do....they are your people. Find your people this year. I'm in. Are you? Have a very Happy New Year! I love you all, Jocelyn P.S. If you like Thursday Thoughts, visit me at Instagram.com/justjocelyncoaching.