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The Lp(a) drug that lowered the number but not the risk: what the pelacarsen trial means for you | BetterBrain
What the Lp(a)HORIZON trial found
The short version: On September 4, 2026, Novartis announced that pelacarsen, its lipoprotein(a)-lowering drug, did not meet the primary goal of its Phase 3 trial. The drug lowered Lp(a). People taking it had heart attacks, strokes, and cardiovascular deaths at about the same rate as people on placebo.
That result surprised a lot of cardiologists. It is also a useful moment to explain a marker that sits on the BetterBrain panel and on very few standard cholesterol tests.
The trial, called Lp(a)HORIZON, enrolled 8,323 people who already had cardiovascular disease and an Lp(a) level of 70 mg/dL or higher. Participants received either pelacarsen or placebo on top of standard treatment for cholesterol and blood pressure. The question was whether lowering Lp(a) would mean fewer heart attacks, strokes, cardiovascular deaths, and urgent hospital procedures.
For this drug, in this group, the answer was no. In earlier studies pelacarsen had lowered Lp(a) by as much as 80 percent, and Novartis confirmed that levels came down in this trial as well. The combined rate of cardiovascular events did not.
Full data have not been published. Novartis says the results will be presented at an upcoming medical congress, so some of what follows will get sharper over the coming months.
What is Lp(a), in plain language
Lipoprotein(a), usually written Lp(a) and pronounced "L-P-little-a," is an LDL-like particle with an extra protein attached, called apolipoprotein(a). Three things make it different from the cholesterol numbers on a standard panel.
First, your level is set almost entirely by your genes. Diet and exercise barely move it.
Second, it stays roughly the same across your lifetime, which is why guidelines recommend measuring it once rather than every year.
Third, it is common and rarely tested. About one in five people has a high level, and high Lp(a) is associated with roughly a 40 percent higher long-term risk of heart attack or stroke. Yet in one analysis of 71 million US adults, only 0.1 percent had ever been tested. The 2026 ACC/AHA cholesterol guideline now recommends that every adult have Lp(a) measured at least once.
Why Lp(a) is a brain health marker
The stroke risk is why Lp(a) matters at BetterBrain. The vessels that feed your heart are the same kind of vessels that feed your brain, and vascular damage is one of the major pathways to cognitive decline. High cholesterol in midlife is now formally recognized as a modifiable dementia risk factor, and Lp(a) is one piece of that vascular picture. That is why it sits in the Blueprint panel alongside ApoB and hs-CRP.
Why a drug can lower the number and miss the outcome
This is the question cardiology is now arguing about, and nobody has the full answer yet. Three hypotheses are getting the most attention.
The reduction may need to be bigger
Lp(a) is measured in much larger units than LDL. A Mendelian randomization analysis estimated that Lp(a) would need to fall by about 66 mg/dL to produce the same heart benefit as a standard 39 mg/dL drop in LDL. For people starting near the trial's entry threshold, an 80 percent reduction may land right around that line. Two competing drugs, Amgen's olpasiran and Lilly's lepodisiran, lower Lp(a) by more than 90 percent, and their outcome trials are expected to read out in 2028 and 2029, with others behind them.
Everything else was already well controlled
Everyone in this trial had established cardiovascular disease and was already on aggressive treatment for LDL, blood pressure, and diabetes. When LDL has been driven very low and antiplatelet therapy is standard, there may be little room left for one more lipid-lowering drug to show a benefit over five years. The genetic studies that made Lp(a) look so important reflect a lifetime of exposure. Treating someone late, after decades of arterial damage and a first event, is a different experiment.
The number may not be the thing
Cardiologist Eric Topol wrote a sharp piece pairing the pelacarsen result with the failure of an anti-inflammatory heart drug in the ZEUS trial. His argument: both trials lowered a blood marker without confirming the marker was driving disease in those particular patients. Lp(a) particles carry oxidized phospholipids, which are thought to be the inflammatory cargo doing the damage, and a standard Lp(a) test does not tell you how much of that cargo a given person is carrying. Two people with the same Lp(a) can have very different amounts of inflammation in their arteries.
None of these is proven. What is clear is that a marker being causally linked to disease, which Lp(a) is, does not guarantee that a drug targeting it will help everyone with a high level.
The honest caveats
The full data are not out. Everything above is based on a topline announcement. The event rates, subgroups, and safety data will be presented at a medical congress later.
This was a secondary prevention trial. Everyone had already had a cardiovascular event or had established disease. The trial does not tell us what Lp(a) lowering would do in people who have never had an event.
One drug, one mechanism. Pelacarsen is an antisense oligonucleotide. Other Lp(a) drugs use different mechanisms and reach deeper reductions. Their results could differ.
The genetic evidence has not changed. Hundreds of studies link high Lp(a) to heart attack, stroke, peripheral arterial disease, and aortic stenosis. A failed drug trial does not undo that.
Our takeaway
We have watched this pattern before. Raising HDL looked like a great idea until the drugs that did it failed to prevent heart attacks. Lowering triglycerides with fibrates cleared the biomarker and did not move outcomes. In each case the lesson was the same: a biomarker is a signal about your biology, and the useful question is what that signal tells you to do differently.
For Lp(a), the answer today is the same as it was last month. Your number tells you how much genetic vascular risk you are carrying. It does not, yet, tell you to take a specific Lp(a) drug, because there is not one. What it does is raise the stakes on everything else that protects your blood vessels: the ApoB you can lower, the blood pressure you can control, the blood sugar and inflammation you can manage, the fitness you can build. High Lp(a) is a reason to be more aggressive on the levers that work, and the evidence for those levers did not change on September 4.
That is also why Lp(a) stays on our panel. A failed drug trial does not make a risk factor less real. It makes knowing about it early more important, because the tools you have are the ones that need time.
What this means for you, right now
If you have never had Lp(a) measured, get it done once. It is on every Blueprint panel. If you are already a BetterBrain client, your result is in the BetterBrain dashboard with your other vascular markers.
If your Lp(a) is high, push harder on what is proven. ApoB is the number to lower, through diet, movement, and, where your physician recommends them, medications. Blood pressure, blood sugar, and hs-CRP round out the picture. A BetterBrain coach can help turn that into a small set of priorities rather than a long list.
If you have already had a heart attack or stroke, the trial's most useful lesson is what modern secondary prevention looks like: every established risk factor treated aggressively, with your cardiologist.
If you want the background, we covered how to read a cholesterol panel in Cholesterol and your brain, and why ApoB matters more than LDL in our VERVE-102 issue.
Common questions
What is Lp(a) and why does it matter?
Lipoprotein(a) is an LDL-like particle with an extra protein attached. Levels are mostly inherited and stable over a lifetime. High Lp(a) is associated with higher long-term risk of heart attack, stroke, and aortic valve disease. About one in five people has an elevated level, and most have never been tested.
Did the pelacarsen trial fail?
Yes. The Lp(a)HORIZON trial of 8,323 people with established cardiovascular disease did not meet its primary endpoint. Pelacarsen lowered Lp(a), but the rate of cardiovascular death, heart attack, stroke, and urgent revascularization was not significantly different from placebo. Full results are expected at a medical congress later in 2026.
Does this mean Lp(a) does not matter?
No. The genetic and population evidence linking high Lp(a) to cardiovascular disease is strong and unchanged. The trial tested one drug in one group of already well-treated patients. It raises questions about how, when, and in whom Lp(a) lowering helps, not about whether Lp(a) is a real risk factor.
Should I still get my Lp(a) tested?
Yes. The 2026 ACC/AHA guideline recommends every adult have Lp(a) measured at least once. Knowing your number does not change the number, but it changes how aggressively you and your doctor treat the risk factors you can move. Lp(a) is included in every BetterBrain Blueprint panel.
Can I lower Lp(a) with diet or exercise?
Not meaningfully. Lp(a) is largely set by genetics. Some medications shift it modestly, but there is no approved therapy designed to lower it. The practical strategy is to lower the risk around it: ApoB, blood pressure, blood sugar, inflammation, and fitness.
Are other Lp(a) drugs still being tested?
Yes. Amgen's olpasiran and Lilly's lepodisiran both lower Lp(a) by more than 90 percent, and their outcome trials are expected in 2028 and 2029. Oral Lp(a) inhibitors are also in development.
How is Lp(a) connected to brain health?
Through your blood vessels. Lp(a) is associated with ischemic stroke, and vascular damage is one of the main pathways to cognitive decline. Protecting the vessels that feed your heart protects the ones that feed your brain.
Does BetterBrain test Lp(a)?
Yes. Lp(a) is part of the 50+ brain-relevant biomarkers in Blueprint, alongside ApoB, hs-CRP, homocysteine, and metabolic markers. Results are reviewed with a brain health coach who helps you decide what to act on first.
One number you can measure once, and act on for decades
Everything at BetterBrain starts the same way: your health history, your lifestyle, your brain-relevant health data, and a coach who helps you make sense of it, narrow it to a few priorities, and build a plan that adjusts as you go. The only thing you decide is where you start.
If you want to begin with your data, that is Blueprint: 50+ brain-relevant biomarkers including Lp(a), ApoB, and hs-CRP, cognitive testing, and a 90-minute consultation with a brain health coach. It starts at $89 with insurance. If you would rather talk to someone first, the Coaching Program starts with the conversation and adds testing later.
The 5 Brain Health Recommendations We Make Most Often
Move your body, build strength, eat well, get enough sleep, and close your nutritional gaps. Most brain health advice comes down to some version of that list, and it is good advice for almost everyone.
But knowing what is generally good for brain health is different from knowing what will be best for yours. The highest-impact action depends on your biology. Your blood pressure, metabolic health, nutrient levels, cardiovascular fitness, sleep, genetics, and lifestyle can all change what deserves your attention first.
Still, when we looked across BetterBrain coaching action plans, five recommendations appeared again and again. Some are among the most evidence-supported things anyone can do for healthy aging. Others come up because they address nutritional gaps that are easy to identify and act on. Here are the five, what the evidence says about each, and how to tell which one matters most for you.
Summary
- The five recommendations that appear most often in BetterBrain coaching plans are strength training, omega-3s, aerobic exercise, B vitamins, and adequate protein.
- Aerobic exercise and strength training carry the broadest evidence for healthy aging. Randomized trials suggest modest cognitive benefits for both.
- Omega-3s and B vitamins help most when they correct a real gap. In people who already have adequate levels, routine supplementation has not consistently improved cognition.
- Protein supports the muscle maintenance that keeps you moving, training, and independent as you age.
- The most common recommendations are not automatically your top priorities. Bloodwork and a full picture of your health decide where to start.
Why the same five recommendations keep coming up
Because brain health is whole-body health. Your brain does not age independently of the rest of your body: muscle, metabolic health, cardiovascular function, balance, and the ability to stay physically active are deeply interconnected with how well you age.
That is why coaching plans built from very different bloodwork still converge on some of the same actions. Two of the five below are foundational behaviors that benefit nearly everyone. Two are nutrients where common gaps can be identified with a blood test and corrected relatively easily. One supports all the others.
1. Strength training
Strength training comes up more consistently in BetterBrain coaching plans than almost anything else.
Resistance training supports strength, muscle mass, mobility, and physical function. It may support cognition too: a 2025 network meta-analysis of 58 randomized trials covering 4,349 participants found improvements in global cognitive scores among older adults who trained. These are short-term cognitive measures, not dementia outcomes, so the honest summary is modest benefit with a consistent direction. We broke down the science in more detail in what six months of lifting weights does to your hippocampus.
The brain health case for strength training is bigger than any single cognitive effect. Maintaining muscle protects the metabolic and cardiovascular systems your brain depends on, and it preserves the physical capacity to keep doing everything else on this list.
A useful general goal is to train the major muscle groups a few times per week and gradually increase what your body can do. The right starting point depends on your current fitness, health, and experience.
You can learn more about strength training on the BetterBrain App here.
2. Omega-3s
Omega-3s are fats involved in brain, cardiovascular, and metabolic health. EPA and especially DHA are structural components of neuronal membranes and play roles in inflammation and neurotransmission.
The trial evidence is genuinely mixed, and the pattern matters. Meta-analyses of randomized trials have reported modest cognitive benefits, mostly in people with low fish intake or mild cognitive impairment. The two largest trials in generally healthy adults, VITAL-Cog and AREDS2, found no cognitive benefit from supplementation.
That pattern is exactly why we prefer personalization over blanket recommendations. Someone who regularly eats fatty fish and already has healthy omega-3 status may have little reason to add a supplement. Someone who gets very little EPA and DHA through their diet may have a much clearer opportunity. We cover food sources, forms, and dosing in unlocking the power of omega-3s.
The BetterBrain approach: understand your diet and biomarkers first, then supplement when there is a reason to.
3. Aerobic exercise
Of the five, aerobic exercise has the broadest overall evidence base for healthy aging.
Regular cardiovascular activity supports cardiorespiratory fitness, blood pressure, glucose regulation, and metabolic health. Randomized trials suggest modest benefits for cognition, and observational research consistently associates higher physical activity with lower rates of cognitive decline and dementia. Observational findings show association rather than cause, but the direction is consistent across decades of research, and the cardiovascular and metabolic benefits are established on their own.
Walking counts. Cycling counts. Swimming counts. Running counts. The best form of cardio is usually the one you can keep doing consistently.
Learn more about aerobic training
4. B vitamins
B vitamins are an area with real opportunity, and context matters more here than almost anywhere else.
Vitamin B12 and folate are essential for normal neurological function, and correcting a true deficiency is important: frank B12 deficiency can cause neurological symptoms that are reversible when treated. Research in people with mild cognitive impairment has also produced interesting results. In the VITACOG trial, a randomized trial of 168 adults with mild cognitive impairment, B-vitamin treatment slowed the rate of brain atrophy on MRI, with the largest effect in participants who started with higher homocysteine.
That does not mean everyone benefits from a B-complex. Across 11 randomized trials covering roughly 22,000 participants, routine B-vitamin supplementation did not improve cognition in people who already had adequate levels.
This is another example of the importance of blood testing to understand your baseline and get a better view of what is going to impact your brain health the most.
Get started with BetterBrain bloodwork
Schedule your BetterBrain retest
5. Adequate protein
Protein might not be the first thing you associate with brain health. But healthy aging depends in part on maintaining the physical capacity to keep moving, exercising, and functioning independently, and adequate protein supports muscle maintenance, recovery, and the adaptations that come from resistance training.
How much protein someone needs depends on age, activity level, body size, health, and goals. A commonly used target is at least 0.7 grams of protein per pound of body weight daily, which works out to roughly 110 grams for a 160-pound adult, and possibly more if you are training intensely. Some experts recommend up to 1 gram per pound for strength and longevity goals, since hitting a protein target every day is hard and a higher target builds in a buffer.
Which recommendation should you start with?
The one that matches your biology, which is not necessarily the one that appears most often.
Omega-3s and B vitamins can sometimes be relatively simple gaps to correct. Strength training, aerobic exercise, and improving nutrition tend to require bigger and more sustained behavior change. Good brain health plans usually contain both kinds: quick wins, and habits you build into your life for years.
But even the most common recommendations are not automatically your top five. Someone with insulin resistance may need to focus heavily on metabolic health. Someone with low B12 needs a different plan. Someone with poor cardiovascular fitness, elevated ApoB, inadequate protein intake, or poor sleep has another set of priorities.
That is why BetterBrain starts by looking at the whole picture: your bloodwork, cardiovascular and metabolic health, nutrition, exercise, sleep, cognition, health history, and, where appropriate, genetics. Then you can take what science says about healthy brain aging and decide where to focus first.
The bottom line
The five recommendations above come up constantly because they address things that matter for almost every brain. Which of them belongs at the top of your plan is a question your biology answers.
If you have not seen your full picture yet, that is the place to start. Blueprint includes 50+ biomarkers, a consultation of up to 90 minutes with a brain health expert, and a personalized action plan ranked by impact. $89 with insurance, $399 cash pay.
Already a BetterBrain client? Open your protocol to see the science behind each technique and the recommendations most relevant to you.
Frequently asked questions
What is the best exercise for brain health?
The best-supported combination is aerobic exercise plus strength training. Aerobic activity supports the cardiovascular and metabolic systems the brain depends on, and randomized trials suggest modest cognitive benefits. Resistance training preserves muscle, mobility, and physical function, and a 2025 meta-analysis of 58 randomized trials found improvements in global cognition among older adults who trained. The most effective exercise in practice is the one you can sustain consistently.
Does strength training help your brain?
Research suggests it can. A 2025 network meta-analysis of 58 randomized trials found resistance training improved global cognitive scores in older adults. The broader case is indirect but strong: strength training preserves muscle mass, metabolic health, and physical function, all of which are interconnected with how well the brain ages. A common goal is training the major muscle groups a few times per week.
Should I take omega-3 supplements for brain health?
It depends on your starting point. Trial evidence suggests modest cognitive benefits mostly in people with low fish intake or mild cognitive impairment, while the two largest trials in generally healthy adults found no cognitive benefit from supplementation. If you regularly eat fatty fish, you may have little reason to supplement. Understanding your diet and biomarkers first is more useful than defaulting to a capsule.
Do B vitamins help memory?
Only in certain situations. Correcting a true B12 or folate deficiency is important, and in the VITACOG randomized trial, B vitamins slowed brain atrophy in adults with mild cognitive impairment, especially those with high homocysteine. But across 11 randomized trials of roughly 22,000 people with adequate levels, routine supplementation did not improve cognition. Testing your levels tells you which group you are in.
How much protein do you need for healthy aging?
Needs vary with age, activity, body size, and health, but a commonly used target is at least 0.7 grams of protein per pound of body weight daily, roughly 110 grams for a 160-pound adult. Some experts suggest up to 1 gram per pound for strength and longevity goals. Adequate protein supports the muscle maintenance and recovery that keep you active and independent.
How do I know which brain health habit to prioritize?
Start from your biology rather than from a generic list. Blood pressure, metabolic markers, nutrient levels, cardiovascular fitness, and sleep all change what deserves attention first. A comprehensive assessment that reads these together, the way BetterBrain's does, can rank actions by likely impact for you specifically, so you spend effort where it counts.

pTau-217: What the Alzheimer's Blood Test Can and Can't Tell You
pTau-217: What the Alzheimer's Blood Test Can and Can't Tell You
A simple blood draw can now flag Alzheimer's-related changes in the brain years before any symptom appears. For some people that is welcome news, an early window to act. For others it raises a harder question they are not sure how to answer: would they even want to know. Either way, the decision deserves more than a headline.
pTau-217 is the reason this is suddenly everywhere. On August 24, 2026, CNN reported that the FDA had cleared Elecsys pTau217, a new blood test from Roche and Eli Lilly, and a new study in JAMA suggests it may help estimate future cognitive risk in people who have no symptoms yet. The New York Times, meanwhile, focused on the confusion and distress these results can cause.
The test itself is not new to us. BetterBrain began offering direct-to-consumer, expert-supported pTau-217 testing in 2024. In April 2025, physician and scientist Eric Topol called it "one of the most exciting advances in neurology for decades", and that same month BetterBrain was featured in Nature's coverage of the rise of Alzheimer's blood tests. Our takeaway from that feature was as much about responsibility as access. Making a powerful test easier to get is only useful if people also get the context, guidance and support to understand the result.
What is pTau-217?
Tau is a protein found inside brain cells. In Alzheimer's disease, tau undergoes abnormal changes and can eventually form tangles that interfere with how those cells work.
The "p" stands for phosphorylated, meaning a phosphate group has attached to the tau protein. The number 217 points to the precise location where that change happened.
When Alzheimer's-related biology begins developing in the brain, levels of pTau-217 in the blood tend to rise. And although the name refers to tau, blood pTau-217 is especially good at tracking the buildup of amyloid plaques, another hallmark of Alzheimer's. Until recently, that kind of information generally required an expensive PET scan or a spinal tap.
Why pTau-217 matters for early detection
Alzheimer's-related brain changes can begin 15 to 20 years before memory problems show up, and pTau-217 may become abnormal during this preclinical period. That makes it one of the most promising tools we have for identifying Alzheimer's-related pathology before symptoms start, which is exactly when there is the most time to act.
Does an elevated pTau-217 result mean I have Alzheimer's?
No. An elevated pTau-217 result is a signal, not a diagnosis.
It suggests that Alzheimer's-related biological changes may be present and that your risk of developing cognitive symptoms is higher. It cannot tell you with certainty whether you will develop symptoms, or when. A negative result is reassuring, but it does not guarantee you will never develop Alzheimer's. It points to a lower likelihood of significant Alzheimer's-related pathology at the time you were tested.
This distinction between detection and prediction sits at the center of the current debate.
What the JAMA study actually found
In July, a JAMA study of nearly 2,700 cognitively healthy older adults found that higher pTau-217 levels were associated with faster cognitive decline and a greater chance of developing cognitive impairment. Among participants with very high levels, researchers estimated a 38% risk of cognitive impairment within five years and a 78% risk within ten years.
Those numbers understandably drew attention. But they were group-level estimates from selected research cohorts whose average age was about 70, and the researchers cautioned that the ten-year figure rested on a relatively small number of people followed for that long. It is meaningful information. It is not a personalized countdown.
Are all Alzheimer's blood tests the same?
Not quite. Several are now available, and each gives a slightly different view of Alzheimer's-related biology. Some measure pTau-217 alone, others combine it with additional markers, and each laboratory method comes with its own reference ranges and cutoffs. That makes the specific test an important part of understanding the result.
The first Alzheimer's blood test cleared by the FDA, in May 2025, measures the ratio of pTau-217 to an amyloid marker. Later that year the FDA cleared Elecsys pTau181, designed mainly to help rule out Alzheimer's-related pathology. In August 2026 it cleared PrecivityAD2, which combines several amyloid and tau measurements, followed by the newly cleared Elecsys pTau217, which measures pTau-217 alone.
These FDA clearances apply to tests used as part of a broader clinical evaluation for people who are experiencing cognitive concerns. The results are meant to be read alongside symptoms, cognitive testing, health history and other clinical information.
BetterBrain uses Quest's AD-Detect pTau-217 test, a laboratory-developed assay that uses different technology from both the newly cleared Elecsys test and the ALZpath test used in many published studies. Because each platform measures pTau-217 differently, each result is interpreted using the reference range established for that specific assay. We use the reference range provided by Quest, then interpret the result alongside cognitive testing, kidney function, other biomarkers, health history and lifestyle.
What a pTau-217 result does not tell you
Here is the part of the conversation that often gets missed. We agree with The New York Times that handing someone a frightening result without enough support can cause real distress. That does not mean the test cannot provide useful information. It means the information needs a fuller picture around it.
A pTau-217 result tells us about one part of Alzheimer's biology. It does not tell us why one person with elevated pathology develops symptoms while another stays cognitively healthy for years, and it says nothing about the many other factors shaping that person's brain health.
Those other factors carry real weight. The 2024 Lancet Commission estimated that addressing 14 modifiable risk factors across life could potentially prevent or delay around 45% of dementia cases at the population level. The U.S. POINTER randomized trial found that a program combining exercise, nutrition, cognitive and social activity, and regular health monitoring improved cognition in older adults at elevated risk. And a long-term observational study found that a healthier midlife lifestyle was associated with a lower incidence of cognitive impairment across pTau-217 levels and APOE4 status. Pathology is not the whole story. The real answers come from looking at all of your numbers together.
What should you do with a pTau-217 result?
Unlike LDL cholesterol or blood pressure, pTau-217 is not a marker you improve through one clearly established intervention. It is primarily a measurement tool.
If your level is elevated, the next step is to understand the complete picture. That may include further clinical evaluation, establishing a cognitive baseline, considering confirmatory testing, assessing eligibility for clinical trials or approved treatments when appropriate, and addressing the modifiable factors that contribute to overall dementia risk. Research into using pTau-217 to monitor treatment response is promising, though there is still a lot to learn about this relatively new test.
Why BetterBrain never offers pTau-217 alone
When we started BetterBrain, we were driven by personal experiences with Alzheimer's in our own families. We learned firsthand that brain health is not about one marker or one intervention. So we do not simply order a pTau-217 test and email you the result. We think that would be irresponsible.
We pair pTau-217 with more than 50 other brain-relevant biomarkers in our Essentials Panel, a cognitive assessment and a detailed look at your health history and lifestyle. We look under the hood for modifiable risk drivers across vascular, metabolic, inflammatory, hormonal and nutritional health. A trained clinical expert then walks you through the findings, explains what they do and do not mean, and builds a personalized action plan focused on the areas where you have the most opportunity to improve. If a result calls for more evaluation, we help you identify the right clinical next step alongside your existing doctor.
The real power does not come from one blood test. It comes from combining early detection with a much broader understanding of your biology, then turning that into meaningful action. Knowledge can be powerful, but only when you know what to do with it.
Learn about pTau-217 testing with BetterBrain, or start your brain health journey to see the full picture.
Frequently asked questions
What is pTau-217?
pTau-217 is a form of the tau protein, measurable in blood, that tends to rise as Alzheimer's-related biology develops in the brain. It is particularly good at tracking amyloid plaque buildup, a hallmark of Alzheimer's disease.
Does an elevated pTau-217 result mean I have Alzheimer's?
No. An elevated result suggests Alzheimer's-related changes may be present and that risk is higher, but it is a signal, not a diagnosis. It cannot confirm whether or when someone will develop symptoms.
Are all Alzheimer's blood tests the same?
No. Some measure pTau-217 alone and others combine it with additional markers, and each laboratory method has its own reference ranges. The specific test used is an important part of interpreting the result.
Can you lower your pTau-217?
pTau-217 is not a marker you improve through one established intervention the way you might lower LDL cholesterol. It is primarily a measurement tool. The action lives in the modifiable risk factors around it, such as vascular, metabolic and lifestyle health.
Who should consider pTau-217 testing?
It is often considered by people who want early insight into Alzheimer's-related risk, including those with a family history. It is most useful when the result is interpreted alongside cognitive testing, other biomarkers, health history and lifestyle, not in isolation.
How much does pTau-217 testing cost with BetterBrain?
The pTau-217 test is $299, offered as an add-on to a Blueprint assessment. It isn't sold on its own, and insurance doesn't cover it. See the full breakdown, including where it's available, on our pTau-217 cost page.

VERVE-102: A One-Time Gene Edit for Cholesterol, and Why It's a Brain Story | BetterBrain
One shot to lower cholesterol for life: what PCSK9 gene editing means for your brain
The short version: In the Heart-2 trial, a single infusion of a gene editing therapy called VERVE-102 lowered LDL cholesterol by up to 62% and kept it down for as long as 18 months. It is a phase 1b result in 35 people with inherited high cholesterol, so it is years away from a pharmacy. The part that matters to you now is the target. High LDL in midlife is one of the 14 modifiable dementia risk factors named by the Lancet Commission, and the particle count underneath it, ApoB, is something you can measure this month.
Most people learn their cholesterol is high at an annual physical, get told to watch it, and never find out what the number is actually doing. It is doing something to your brain.
That connection is why a cardiology result got our attention. In May 2026, researchers reported that a single infusion of a gene editing medicine lowered LDL cholesterol substantially, and that the reduction held for up to 18 months. The results were presented at the European Atherosclerosis Society Congress and published in the New England Journal of Medicine.
It is early research in a small, specific group of patients. But the biology it targets is among the most studied in all of cardiovascular medicine, and it runs straight to your brain.
What VERVE-102 actually did
Heart-2 is a phase 1b trial. The interim analysis covered 35 participants, average age 52, all with heterozygous familial hypercholesterolemia, premature coronary artery disease, or both, and all already on the maximum statin dose they could tolerate.
Each received one infusion, at doses from 0.3 to 1.0 mg/kg. The results, per Lilly's May 25, 2026 release:
- PCSK9 protein fell by 51% to 88%, depending on dose.
- LDL cholesterol fell by 9% to 62%. At the highest dose, the drop was 62%, or 78 mg/dL in absolute terms.
- Reductions were sustained, with durability observed for up to 18 months after a single treatment.
- There were no dose-limiting toxicities and no treatment-related serious adverse events. Side effects were mostly low-grade infusion reactions and fatigue. All 35 participants received their full dose and none withdrew.
One infusion. Effects still holding a year and a half later.
How PCSK9 works, in plain language
Your liver clears LDL cholesterol out of your blood using surface proteins called LDL receptors. Think of them as docking ports: the more ports available, the more LDL particles get pulled out of circulation.
PCSK9 is a protein that destroys those ports. More PCSK9 activity means fewer receptors, which means more LDL staying in your bloodstream.
Here is the part that makes this target unusually well understood. Some people are born with naturally low-functioning PCSK9 genes. They have markedly lower LDL across their entire lives and substantially lower rates of heart disease, with no apparent downside. Turning PCSK9 down is not a theory. It is a protective pattern that already exists in nature and has been studied for two decades.
Drugs that lower PCSK9 have been approved for years. What is new here is the delivery. VERVE-102 uses base editing, a precise form of gene editing, to make a single change to the PCSK9 gene inside liver cells. The goal is to do once, permanently, what existing drugs do by repeated injection.
The honest caveats
This headline is easy to over-read. The careful version:
It is a phase 1b trial. That stage is designed mainly to test safety and look for early signals in a small number of people. It has not been shown to prevent heart attacks, strokes, or cognitive decline. A phase 2 trial is the next step, with enrollment planned by the end of 2026.
It is a specific patient group. Everyone enrolled had an inherited form of very high cholesterol or early coronary artery disease and needed aggressive LDL lowering despite maximum oral therapy. These are not general-population results.
Gene editing is a young field. The PCSK9 mechanism is exceptionally well characterized, which is reassuring. Making a permanent edit to a gene is still new, and the long-term safety record takes years to build. Approval, if it comes, will likely start with very high-risk patients such as those with familial hypercholesterolemia, and the price is likely to be high.
It is years away. Nobody should be adjusting their plan today on the expectation that this arrives soon.
Why cholesterol is a brain story, not only a heart story
Brain health is whole-body health, and few things connect the two as directly as lipids.
ApoB is the number underneath LDL
You have probably heard of LDL cholesterol. ApoB is the more precise measurement sitting beneath it.
Every LDL particle carries exactly one ApoB protein. So LDL-C tells you how much cholesterol is being carried inside LDL particles, while ApoB tells you how many particles there actually are. Since it is the particles that lodge in artery walls and start plaque, ApoB is the better predictor of risk. When the two numbers disagree, ApoB is the one to trust.
Among BetterBrain clients, 86% come back with a suboptimal ApoB. It is the single most commonly out-of-range marker we see, and most people have never had it measured.
The Lancet Commission added LDL to the dementia list in 2024
The blood vessels feeding your brain are subject to the same lipid-driven damage as the ones feeding your heart, and that vascular damage is one of the major pathways of cognitive decline.
This is no longer a fringe position. In its 2024 update, the Lancet Commission on dementia prevention added high midlife LDL cholesterol as one of 14 modifiable risk factors, based on cohort studies covering more than a million participants plus a Mendelian randomization meta-analysis of 27 studies. The Commission attributes 7% of preventable dementia to high LDL alone, and links nearly half of dementia cases to the 14 factors combined.
High cholesterol in your forties and fifties is now formally a brain risk factor, not only a heart one.
If you carry APOE4
People who carry an APOE4 variant tend to run higher LDL, and APOE4 is the strongest common genetic risk factor for Alzheimer's disease. That combination is one reason lipid management is a core part of what we do, and one reason knowing your genotype can change what you prioritize rather than just giving you something to worry about.
The bigger picture
Between therapies like this one and the medications already on the shelf, the tools for managing cardiovascular disease are getting very good, and they will keep improving. But adding years to your life is only worth so much if your brain is not working well for those years. That is the conversation most people are not having yet, and it is the one that matters most to us.
What this means for you, right now
You do not have to wait for a therapy that is years away. The target itself, your lipid health, is measurable and movable today.
- Get ApoB tested, not just standard cholesterol. A routine lipid panel gives you total cholesterol, LDL, HDL, and triglycerides. ApoB counts the particles actually driving damage and is rarely ordered unless you ask for it. It is one of the most informative single markers for both heart and brain health.
- Treat lipids as a lifelong number, not a yearly one. The PCSK9 story works precisely because it lowers exposure over decades. Risk accumulates the same way. Small, steady improvements compound in your favor, and starting earlier is worth more than starting perfectly.
- Use the levers you already have. Diet, regular movement, and, where your physician recommends them, proven lipid-lowering medications all work today. Statins and existing PCSK9 inhibitors are not placeholders waiting for gene editing. They are the current standard of care.
- Look at the whole vascular picture. ApoB, Lp(a), triglycerides, blood pressure, and HbA1c interact. One number in isolation rarely tells you what to do first.
ApoB is one of the 50+ biomarkers in the BetterBrain panel, alongside homocysteine, hs-CRP, Lp(a), HbA1c and the rest of the vascular and metabolic markers. See everything we test.
Common questions
Is PCSK9 gene editing available now?
No. VERVE-102 is in phase 1b trials. A phase 2 trial is planned to begin enrolling by the end of 2026, and broad availability is years out. If it is approved, the first patients are likely to be people with familial hypercholesterolemia or other very high-risk conditions.
What is the difference between ApoB and LDL cholesterol?
LDL-C measures the amount of cholesterol carried inside LDL particles. ApoB measures the number of those particles, because each one carries exactly one ApoB protein. Two people can have the same LDL-C with very different particle counts. When the two disagree, ApoB is the better predictor of cardiovascular and cerebrovascular risk.
Does lowering cholesterol reduce dementia risk?
The 2024 Lancet Commission identified high midlife LDL cholesterol as one of 14 modifiable dementia risk factors and attributes 7% of preventable dementia to it. That is an association drawn from large cohort and genetic studies, not proof that lowering LDL prevents dementia in any individual. What is well established is that lipid-driven damage to blood vessels is one of the major pathways of cognitive decline, and that the vessels feeding your brain are affected the same way as the ones feeding your heart.
Should I get an ApoB test?
ApoB is not part of a standard lipid panel and usually has to be requested. It is most informative if you have a family history of early heart disease or dementia, if your LDL and triglycerides do not line up, if you carry an APOE4 variant, or if you simply want a clearer read than total cholesterol gives you. Discuss it with your physician or your Brain Health Coach.
Does BetterBrain test ApoB?
Yes. ApoB is included in the BetterBrain biomarker panel, which covers 50+ markers selected for their connection to brain health, across metabolic, cardiovascular, hormonal, inflammation, and nutrient categories. Blueprint is $89 with insurance and $399 without, and includes a cognitive assessment and an up-to-90-minute session with a Brain Health Coach who turns the results into a personalized action plan.
The bottom line
A one-time gene editing infusion produced large, durable reductions in LDL cholesterol in an early trial, by copying a protective genetic pattern that already exists in nature. It is not available, it is not proven to prevent anything yet, and it will not be in a clinic near you for years.
What is available is the target. Your lipid numbers are one of the few brain risk factors you can measure precisely, act on immediately, and improve over decades. Whatever arrives in five or ten years, the decades in between are the ones you protect now.

Fasting Insulin and Brain Health: The Metabolic Marker Most Physicals Skip
Key takeaways
- Fasting insulin usually moves before fasting glucose. Glucose tells you the result. Insulin tells you the effort behind it.
- In BetterBrain's dashboard, optimal fasting insulin is below 6 mcIU/mL. The fair range runs from 6 to 19.6.
- Higher fasting insulin has been associated with roughly double the Alzheimer's risk in adults 65 and older, with the strongest association in people who did not have diabetes.
- Metabolic syndrome has been associated with a 24% higher risk of young-onset dementia, with a dose response as components accumulate.
- These are observational findings. They establish association, not cause.
- Most standard panels stop at glucose and HbA1c. Fasting insulin is inexpensive and is included in BetterBrain's Essentials panel.
For most people, metabolic health shows up as one line on a lab report. Fasting glucose, 94 mg/dL, flagged normal, nothing to discuss, see you next year.
That reading is accurate. But fasting glucose is also one of the last things to change. Your body can spend years quietly working to hold that number in range, and the work it does to hold it is where the brain story actually starts.
What is fasting insulin?
Fasting insulin measures how much insulin your pancreas is releasing to keep your blood sugar steady after an overnight fast.
Insulin is the hormone that moves glucose out of your bloodstream and into your cells. A fasting insulin test tells you how much of that hormone your body needs to hold a normal blood sugar level while you are not eating. A low number means your cells are responding easily. A higher number means your body is working harder to reach the same result.
In your BetterBrain dashboard, the optimal range for fasting insulin is below 6 mcIU/mL. Above 6, and into the fair range of 6 to 19.6, the picture starts to shift.
The distinction that matters: glucose tells you the result, insulin tells you the effort behind it.
Why your glucose can look normal for years
When cells stop responding well to insulin, the pancreas compensates by producing more of it. Glucose can stay in range through that entire process, sometimes for years, while insulin climbs in the background.
This is why a single normal glucose reading is an incomplete picture. It is a true measurement of an outcome, not a measurement of how much work went into producing that outcome.

Fasting insulin can rise years before glucose looks abnormal.
What the research says about insulin and the brain
Older adults: Alzheimer's risk roughly doubled
In a study published in Neurology, researchers tracked 683 adults aged 65 and older for nearly 3,700 person-years. Alzheimer's risk roughly doubled among people with hyperinsulinemia, and the association was strongest in people who did not have diabetes.
That last detail is the important one. The association was not explained by diabetes being present.
Midlife: the same pattern, six years later
In the ARIC cohort, adults aged 45 to 64 had fasting insulin measured at baseline. Six years later, higher baseline insulin predicted greater decline in delayed word recall and verbal fluency.
The authors described insulin resistance as a potentially modifiable midlife risk factor. That phrase matters because it points at what you can do about it.
A note on complexity
Very low fasting insulin has also been associated with risk in some long follow-up studies, so the relationship is not a straight line. This is exactly why we read insulin alongside glucose, HbA1c, and the rest of the domain rather than treating any single number as a verdict.
What is actually happening in your brain
Your brain is roughly 2% of your body weight and uses about 20% of your resting energy, almost all of it from glucose. Getting that fuel where it needs to go depends on insulin signaling working.
A systematic review of 23 imaging studies covering 5,308 participants found that insulin resistance was associated with reduced glucose uptake in the brain across 22 of 23 studies. The regions involved, the parietotemporal cortex, posterior cingulate, and precuneus, are the same areas that show reduced metabolism in Alzheimer's disease. Some of those associations appeared in people who were cognitively normal at the time of scanning.
Cells that respond poorly to insulin have a harder time pulling in fuel. Consequently, the parts of your brain with the highest energy demand are the ones affected first.
Metabolic syndrome and dementia risk: when the components stack
A 2025 study in Neurology followed nearly 2 million Korean adults aged 40 to 60 for an average of 7.8 years.
Metabolic syndrome, defined as three or more of excess belly fat, high blood pressure, elevated fasting glucose, elevated triglycerides, and low HDL, was associated with a 24% higher risk of young-onset dementia. Each component added to the effect, and participants with all five had roughly 70% higher risk.
Two things worth noting: the association was stronger in people in their 40s than in their 50s, and stronger in women (34%) than in men (15%).
This is observational research, which establishes association, not cause. It is one national population, and the researchers could not account for APOE status. What it does establish clearly: the direction of the effect, a dose response across components, and earlier timing than most people assume.
The metabolic health domain: which markers we read together
When we assess metabolic health at BetterBrain, it is one of the ten health domains we track. We read a group of markers together rather than checking any one off in isolation:
GroupMarkersWhat it tells youGlucose controlFasting glucose, HbA1c, fasting insulinHow easily your body manages fuelLipid loadTriglycerides, ApoBHow much lipid your system is carryingLiver stressALT, ASTHow much metabolic work your liver is absorbingNutrient statusVitamin D, B12, folateWhether you have the raw materials to make and use energy
Any one of these can look unremarkable on its own. Read together, they tell you something a single value can't: whether your body is handling fuel comfortably, or working hard to look like it is.
What you can do
Test your fasting insulin, not just glucose. Most standard panels stop at fasting glucose and HbA1c. Fasting insulin tends to move first, it is inexpensive, and it is included in the 50+ biomarkers in the BetterBrain Essentials panel.
Move after you eat. A short walk in the hour after a meal meaningfully blunts the glucose rise. This is one of the higher-return habits in the metabolic domain because it costs almost nothing. One BetterBrain client liked the idea enough to build a free app for it, called Exercise Snacks for Health & Wellbeing.
Build meals around protein and fiber before the starch. Same food, different order, measurably flatter glucose response. Vegetables and protein first, then the carbohydrate portion.
Finish eating three to four hours before bed. Late meals land against a window when insulin sensitivity is at its lowest. Moving dinner earlier is one of the easiest and most impactful techniques to manage glucose spikes.
Retest and see it move. Fasting insulin and triglycerides respond within weeks. HbA1c takes two to three months to reflect a real change. Knowing which to watch first keeps you from concluding too early that nothing is happening.
Frequently asked questions
Can you have insulin resistance with normal blood sugar?
Yes. When cells stop responding well to insulin, the pancreas compensates by producing more of it, which can hold glucose in the normal range for years. Fasting glucose is typically one of the last metabolic markers to change, which is why a normal reading does not rule out insulin resistance.
What is a good fasting insulin level?
In BetterBrain's dashboard, the optimal range for fasting insulin is below 6 mcIU/mL, with a fair range of 6 to 19.6. Reference ranges vary between labs, and fasting insulin should be interpreted alongside fasting glucose and HbA1c rather than on its own.
Is fasting insulin included in a standard blood panel?
Usually not. Most standard panels stop at fasting glucose and HbA1c. Fasting insulin generally has to be requested specifically. It is included in BetterBrain's Essentials panel of 50+ biomarkers.
Does insulin resistance affect the brain?
Research as associated insulin resistance with reduced glucose uptake in the brain. A systematic review of 23 imaging studies covering 5,308 participants found this association in 22 of the 23 studies, in the parietotemporal cortex, posterior cingulate, and precuneus. Some of those associations appeared in people who were cognitively normal at the time of scanning. These are observational findings.
How quickl can fasting insulin improve?
Fasting inslin and triglycerides can respond within weeks. HbA1c reflects roughly two to three months of glucose exposure, so it takes longer to show a real change. Knowing which marker moves first prevents you from concluding too early that nothing is working.
What is metaolic syndrome?
Metabolic synrome is defined as having three or more of the following: excess belly fat, high blood pressure, elevated fasting glucose, elevated triglycerides, and low HDL cholesterol. A 2025 study of nearly 2 million adults associated it with a 24% higher risk of young-onset dementia, with risk increasing as more components were present.
The bottom line
Metabolic health is not a number you pass or fail. It is a set of markers that move together, and it is the domain where what you do this month shows up in your labs this quarter.
If you have not seen your full metabolic picture, that is a good place to start. Blueprint includes 50+ biomarkers, a consultation of up to 90 minutes with a brain health expert, and a personalized action plan ranked by impact. $89 with insurance, $399 cash pay.
Already have your results? View your metabolic markers to see where you sit and which techniques your Brain Health Coach recommends first.
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How to Personalize Your Brain Health Plan With Your Own Data
How to Personalize Your Brain Health Plan With Your Own Data
Most brain health advice is useful, but it is also designed for the average person.
Sleep more. Move often. Eat a nutritious diet. Manage stress. Build strength.
These fundamentals matter. But they cannot tell you which risk factors deserve the most attention, what may be changing in your body, or whether your current routine is producing the results you want.
Personalized brain health guidance uses your own labs, health history, sleep, activity, habits, and goals to help determine where to focus first.
BetterBrain members can now bring more of that information into My Vault, the health data home inside the BetterBrain platform. You can upload previous lab results, connect wearable data, and import relevant health context from an AI assistant such as ChatGPT, Claude, or Gemini.
All three tools are available free across BetterBrain accounts.
Why Does Generic Brain Health Advice Have a Ceiling?
General health advice tells you what tends to help people on average. It cannot tell you which intervention is likely to matter most for you.
Two people can follow the same routine and have very different needs because they begin with different:
- Biomarker levels
- Genetics and family histories
- Sleep patterns
- Activity levels
- Medical histories
- Medications and supplements
- Diets, habits, and goals
One person may need to focus on improving sleep consistency. Another may already sleep well but have an elevated cardiovascular risk marker that deserves more attention. A third may be exercising regularly but not recovering adequately.
That is why personalization matters. It helps turn broad recommendations into clearer priorities.
Research has also found that multidomain brain health interventions tailored to individual risk profiles can produce better cognitive outcomes than general health information alone. You can read the randomized controlled trial published in Nature Medicine here.
What Is Personalized Brain Health Guidance?
Personalized brain health guidance applies current research to information about your own health.
Instead of simply telling everyone that sleep is important, personalized guidance can consider:
- How much you are actually sleeping
- Whether your sleep duration or consistency is changing
- How your sleep relates to your activity and recovery
- Whether your current protocol appears to be helping
- Which other risk factors may deserve attention
Personalization does not replace the fundamentals. It helps identify which fundamentals matter most for you, where to begin, and what to monitor over time.
How Does My Vault Help Personalize Your Brain Health Plan?
My Vault brings several sources of health information together inside your BetterBrain account.
You can use it to:
- Upload previous laboratory results
- Connect sleep and activity data from a wearable
- Import relevant health context from another AI assistant
Together, these tools give BeBe, BetterBrain’s AI brain health coach, a more complete picture of your health and goals.
Upload Past Lab Results and Track Changes Over Time
A single laboratory result is only a snapshot. The trend often provides more useful context.
If you have previous results stored in a patient portal, computer folder, email, or paper file, you can upload them to My Vault as a PDF or image. BetterBrain can extract the biomarker results and display them alongside your current numbers.
Tracking results over time can help you understand:
- Whether a biomarker is moving in the desired direction
- Whether a change is new or part of a longer pattern
- How your results respond to changes in your routine
- Whether an intervention appears to be working
- Which markers may deserve further discussion with your clinician
For example, a cholesterol result may appear acceptable when viewed alone. But seeing several years of results together could reveal that the number has been steadily increasing or improving.
Your brain health plan should respond to what is changing, not just what appeared on one test.
Link Your Wearable Data
Questionnaires capture what you remember. Wearables can capture what is happening each day.
If you use a fitness tracker or smartwatch, you can connect it to BetterBrain through the BeBe app and Apple Health. You choose which information you want to share, and you can change the permissions or disconnect the integration at any time.
Depending on your device and permissions, wearable data may provide useful context about:
- Sleep duration
- Sleep consistency
- Daily movement
- Exercise
- Heart rate
- Recovery patterns
- Changes in routine
This can make guidance more specific.
Instead of receiving another reminder that sleep is important, you may be able to see that your sleep duration is adequate but inconsistent, or that your activity has declined over the past several weeks.
The goal is not to obsess over every daily number. It is to recognize meaningful patterns that may otherwise be easy to miss.
Import Your AI Memory
Many people already use ChatGPT, Claude, or Gemini to discuss their health, routines, goals, and preferences.
You may have already told an AI assistant about:
- Your health history
- Current symptoms or concerns
- Injuries
- Medications and supplements
- Family medical history
- Exercise habits
- Diet
- Sleep
- Health goals
- How you prefer advice to be delivered
- Strategies you have already tried
You can now bring that context into BetterBrain instead of starting from the beginning.
Visit Import AI Memory inside My Vault. You will see a prompt that you can open or paste into the AI assistant you use. The assistant will organize the relevant information it knows about you. You can then review the response and paste it into BetterBrain.
The process takes about a minute.
Once imported, BeBe can begin with more context about your history, preferences, goals, and previous efforts.
How Is BeBe Different From ChatGPT, Claude, or Gemini?
General AI assistants draw from broad knowledge across an enormous range of subjects. Their responses are also largely shaped by what you choose to tell them in each conversation.
BeBe is built specifically for brain health. It is grounded in brain health research that has been reviewed and interpreted by BetterBrain’s scientists and clinicians.
BeBe can then apply that specialized knowledge to information within your BetterBrain account, including:
- Your laboratory history
- Wearable sleep and activity data
- Health profile
- Current brain health protocol
- Uploaded documents
- Coaching insights
- Imported health context
- Personal goals and preferences
The distinction is specialized brain health science combined with your personal data.
A general assistant may repeat common recommendations. BeBe is designed to help you understand how the evidence relates to your own risks, results, and priorities.
Is My Health Information Private?
Your imported information stays private to your account and is used to personalize your guidance.
You control what you upload, what wearable information you share, and whether you want to delete information later. Wearable permissions can also be changed or turned off at any time.
Only import information you are comfortable storing in your BetterBrain account.
How Do I Get Started With My Vault?
You do not need to complete everything at once.
Start with whichever option is easiest:
- Upload one previous lab report.
- Connect your wearable through the BeBe app and Apple Health.
- Import relevant health context from ChatGPT, Claude, or Gemini.
- Review your health profile and current protocol.
- Ask BeBe what patterns or priorities stand out.
All three personalization tools are available with a free Self Directed BetterBrain account.
Members who want to go further can also purchase laboratory testing through Blueprint or enroll in the BetterBrain Coaching Program.
Frequently Asked Questions About Personalized Brain Health Guidance
What is personalized brain health guidance?
Personalized brain health guidance applies scientific evidence to information about your individual labs, health history, sleep, activity, habits, risk factors, and goals. It helps identify which actions may deserve the most attention for you.
What is BetterBrain My Vault?
My Vault is the health data home within your BetterBrain account. It allows you to upload lab reports and other files, complete your health profile, record your current protocol, connect wearable data, and import relevant health context from another AI assistant.
Why should I upload previous lab results?
Previous results help establish a trend. Comparing multiple tests over time can show whether a biomarker is improving, worsening, or remaining stable.
What wearable data can BetterBrain use?
Available data depends on your device and Apple Health permissions. It may include sleep, activity, exercise, heart rate, and other daily health metrics.
Can I control which wearable information I share?
Yes. You choose which Apple Health categories to share and can update your permissions or disconnect the integration later.
What does importing AI memory mean?
Importing AI memory means asking ChatGPT, Claude, or Gemini to summarize relevant information it already knows about your health, preferences, habits, and goals. You can review that response before pasting it into BetterBrain.
Does BetterBrain automatically access my ChatGPT or Claude conversations?
No. You choose what to export, review the response, and manually paste it into BetterBrain.
How long does it take to import AI memory?
The process typically takes about a minute. BetterBrain provides a prompt that helps your existing AI assistant organize the relevant information.
Are the My Vault personalization tools free?
Yes. Uploading previous labs, connecting wearable data, and importing AI memory are available across BetterBrain accounts, including free Self Directed accounts.
Does BeBe replace a doctor?
No. BeBe provides educational brain health guidance and helps you understand your data and potential priorities. It does not replace medical diagnosis, treatment, or care from a licensed healthcare professional.
Get immediate insights with a 3 minute assessment
Start nowGrey Matters: Why Brain Health Is Whole-Body Health
Gut Health: Your Second Brain
The Bottom Line: Gut health is one of BetterBrain's 10 core systems because of the gut-brain axis, a bidirectional communication system where the bacteria in your gut directly influence brain function. Your gut produces roughly 90% of your body's serotonin and communicates with your brain via the vagus nerve, immune signaling, and bacterial metabolites. While the science around gut health and the brain is early, there is mounting research in the area.
Here's why inflammation from the gut matters: An imbalanced gut microbiome can create problems through multiple pathways. First, it can trigger systemic inflammation that crosses the blood-brain barrier, creating the neuroinflammation that is linked to Alzheimer's disease. Second, it can impair nutrient absorption. If your gut isn't properly absorbing omega-3 fatty acids or vitamin B12, your brain is starved of essential building blocks.
This means chronic digestive issues like bloating, constipation, or irregular bowel movements aren't just gut problems. They're early warning signs of processes that can potentially impact cognitive function over time.
Evidence informed solutions:The best way to address gut health is on an individualized basis. For people with chronic digestive issues or diagnosed gastrointestinal disorders, more intensive interventions might be needed, such as elimination protocols, comprehensive stool testing, or working with a gastroenterologist.But for people with slight disturbances or occasional issues, evidence-based dietary approaches can be helpful:
- Control sugar and refined carbohydrate intake, as these feed harmful bacteria and create inflammation.
- Increase prebiotics, which are essentially fiber from vegetables, whole grains, and legumes that feed beneficial bacteria.
- Add probiotics through fermented foods like yogurt, kimchi, sauerkraut, and other cultured foods.
- Follow a Mediterranean-style diet rich in diverse plant foods, which naturally supports a healthy, diverse microbiome.
- Minimize processed foods, which often contain additives that can disrupt gut bacteria.
The gut-brain connection illustrates perfectly just one way that whole-body health is brain health.
Oral Health and the Inflammation Pathway
Bottom Line: The health of your mouth can be a significant indicator for your overall well-being, including your brain health. Periodontal disease, a severe form of gum disease, sits within our inflammation domain because it's fundamentally a story about chronic systemic inflammation and how it creates pathways to neurodegeneration.
Here's how it works: Periodontal disease is associated with increased levels of systemic inflammation throughout your body. This isn't just localized gum inflammation. Research has found that the bacteria commonly involved in periodontal disease, particularly Porphyromonas gingivalis, can enter the bloodstream and potentially make its way to the brain. Once there, these bacteria can trigger inflammatory responses and potentially impact brain health.
A 2020 study published in the Journal of Alzheimer's Disease found that periodontal disease is closely associated with Alzheimer's risk in older adults. While a direct causative relationship between periodontal disease and Alzheimer's has not been definitively established, several studies have shown that people with periodontal disease are more likely to experience cognitive decline over time.
What makes this particularly relevant is how preventable it is. The bacteria don't just appear overnight. They build up over months and years of suboptimal oral hygiene. The inflammation compounds. The damage accumulates.
But the good news is that simple, evidence-based interventions are both straightforward and accessible, and make a meaningful difference.
- Brush twice daily, ideally with an electric toothbrush, for 2 minutes each time.
- Floss twice daily to remove bacteria from areas your toothbrush can't reach.
- Get routine dental cleanings every 6 months, which removes tartar buildup and allows your dentist to catch early signs of periodontal disease.
These are all low effort, low cost, and supported by high-quality evidence.
Mental Health & The Bigger Picture
Why Whole-Body Health Matters
Why this matters: Mental health is one of our 10 core domains because disorders like depression and anxiety don't just affect mood, they have measurable impacts on brain structure and long-term cognitive outcomes.
The Science: Chronic stress from unmanaged mental health conditions elevates cortisol, which at high levels is neurotoxic and damages the hippocampus, your brain's memory center. This stress also drives systemic inflammation through the same pathways we've discussed with oral and gut health. Depression in midlife has been linked to nearly double the risk of dementia later in life.
The bottom line: It's important to emphasize that while we're only touching the surface of mental health's importance here, it is the perfect example of why holistic health matters. You could be doing everything else right: eating well, exercising regularly, taking your supplements, managing your physical health conditions. But if your mental health is suffering, the rest of your health will suffer too.
Chronic stress, anxiety, and depression create ripple effects across every system in your body: they disrupt your sleep, suppress your immune function, drive inflammation, impair your gut microbiome, reduce your motivation to exercise, and directly damage brain structures critical for memory.
The Bigger Picture: This is why BetterBrain assesses 10 health domains. Inflammation from your gums, neurotoxic compounds from your gut, stress hormones from chronic anxiety: these aren't isolated problems. They're all pathways that converge on your brain and shape its trajectory. Mental health, oral health, and gut health are just three examples of how every system in your body connects to cognitive function.
This is also why so many of our members report feeling better overall, not just cognitively sharper, as a result of their BetterBrain interventions. When you reduce inflammation, optimize your gut microbiome, manage stress effectively, improve your sleep, and move your body regularly, you're not just protecting your brain. You're improving your energy, mood, metabolic health, and overall well-being.
As you think about your goals for the new year, remember that taking care of your brain means taking care of your entire body, and taking care of your body means taking care of your brain. They're inseparable!
Grey Matters: 90% of us aren't getting enough of this brain nutrient
FEATURED BIOMARKER
Omega-3 Index: What Your Blood Reveals About Your Brain
What it is: The Omega-3 Index measures the percentage of EPA and DHA in your red blood cell membranes. It reflects your omega-3 status over the past 2-3 months (similar to how HbA1c reflects blood sugar over time). An Omega-3 Index of 8% or higher is considered desirable for heart and brain health; most Americans fall between 4-5%.
Why it matters for your brain: DHA is one of the primary structural components of your brain's cell membranes, and EPA plays a powerful anti-inflammatory role. Together, they support everything from neurotransmission to neuroplasticity.
The research is compelling and continues to grow. A large meta-analysis of 48 longitudinal studies involving over 103,000 participants found that dietary omega-3 intake was associated with an approximately 20% lower risk of dementia and cognitive decline. In the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort, long-term omega-3 supplement users showed a 64% reduced risk of Alzheimer's disease. And a dose-response meta-analysis of 58 randomized controlled trials published in Scientific Reports found significant improvements in attention and processing speed with omega-3 supplementation.
The APOE4 connection: If you carry the APOE4 gene variant, omega-3s may be especially relevant for you. Research suggests that APOE4 carriers may have more difficulty transporting DHA into the brain, which means they may benefit from higher intake, ideally started before cognitive symptoms appear.
How to improve it:
- Eat SMASH fish regularly. Salmon, Mackerel, Anchovies, Sardines, and Herring are the richest food sources of EPA and DHA. Aim for at least two servings per week. (Tilapia, shrimp, and clams are good protein sources but are not meaningful sources of omega-3s.)
- Supplement strategically. BetterBrain recommends fish oil with 1-2g of DHA daily, taken with food, from a reputable third-party tested brand. If you're vegetarian or vegan, algal oil supplements provide EPA and DHA directly from the original marine source.
- Monitor your levels. Your optimal dose depends on your starting point, your genetics, and your diet. Tracking your Omega-3 Index through blood testing takes the guesswork out of supplementation.
BetterBrain Tip: Low omega-3 levels are one of the most common findings among our members, and one of the most actionable. In fact, fish oil supplementation is one of the first techniques our coaches recommend. Many members see meaningful improvement in their omega-3 ratio within 90 days of starting a targeted protocol.
Check your omega-3 levels with BetterBrain →
BETTERBRAIN HACK
The SMASH Strategy: Making Omega-3 Rich Foods Easy
Getting enough omega-3s from food alone is absolutely possible, but it takes some intention. The acronym SMASH makes it simple to remember the best sources: Salmon, Mackerel, Anchovies, Sardines, and Herring.
The science: Not all fish are created equal when it comes to omega-3 content. A 3-ounce serving of wild salmon delivers roughly 1,500-2,000 mg of EPA and DHA combined. Sardines pack around 1,600 mg along with impressive amounts of protein (22g), vitamin D, B12, calcium, and selenium. Meanwhile, popular choices like tilapia or shrimp contain only a fraction of those levels.
Quick wins to try this week:
- Sardine lunch hack: Grab a tin of sardines packed in extra virgin olive oil. Pair with whole grain crackers and your favorite hot sauce. It's one of the easiest, most nutrient-dense lunches you can assemble in under two minutes.
- Salmon prep day: Bake a couple of salmon fillets on Sunday. Use them throughout the week in salads, grain bowls, or alongside roasted vegetables. If you're looking for a new recipe, here's an awesome from coach Erika that we featured in a previous newsletter.
- Anchovy upgrade: Melt anchovies into pasta sauces, salad dressings, or olive oil for a savory umami boost. They dissolve completely, so even anchovy skeptics tend to enjoy them this way.
- Frozen is fine: Don't overlook frozen fish. Flash-frozen fish is often fresher than what's sold at the counter, and wild-caught frozen salmon is widely available and more affordable.
A note on mercury: You may wonder about heavy metals in fish. The SMASH fish are all smaller, shorter-lived species that accumulate far less mercury than large predatory fish like tuna and swordfish. Eating SMASH fish multiple times per week is both effective and safe.
BetterBrain Insight: Combining omega-3 intake with B vitamin supplementation may enhance the benefits. Research suggests that DHA supplementation works best when paired with adequate B vitamin levels, particularly for slowing brain atrophy. This is why BetterBrain looks at the full picture of your nutritional biomarkers, not just one nutrient in isolation.
If eating SMASH fish multiple times a week isn't realistic for your lifestyle, or if your Omega-3 Index is still below target after dietary changes, supplementation is a simple and effective next step. Our go-to pick is Carlson's The Very Finest Fish Oil, which delivers 1,600 mg of omega-3s per serving, is third-party tested for purity and potency, and comes in a natural lemon flavor that makes it easy to take daily.
Content Corner
The Form of Omega-3 May Matter for Your Brain
A clinical trial underway at the University of Cincinnati is investigating something fascinating: not just whether omega-3s help the brain, but which form of DHA is most effective at actually reaching it.
Bottom line: Standard fish oil supplements deliver DHA in a form called TAG-DHA (triglyceride-bound). But emerging evidence suggests that LPC-DHA (lysophosphatidylcholine-bound DHA), the form naturally found in fish, may be significantly more effective at crossing into the central nervous system. The trial is comparing the two head-to-head in 153 older adults with mild cognitive decline, measuring DHA levels directly in cerebrospinal fluid for the first time.
This research is still in progress, and we want to be clear that standard fish oil supplements remain well-supported by the existing evidence base. But it's an exciting example of how the field is moving beyond "do omega-3s help?" toward "how do we optimize their delivery to the brain?" We'll be watching this one closely and will share results when they're published.
Also worth noting: a December 2025 narrative review highlighted the particular importance of omega-3s for postmenopausal women, given the loss of estrogen's neuroprotective effects. The authors recommended monitoring omega-3 levels and integrating supplementation into public health strategies for women after menopause.
BetterBrain Takeaway
Omega-3 fatty acids are among the most studied nutrients in the world, with over 50,000 published research papers. The evidence consistently points in one direction: adequate EPA and DHA intake is associated with better cognitive outcomes and lower dementia risk. Yet the vast majority of us aren't getting enough. Testing your levels, eating SMASH fish regularly, and supplementing strategically are three concrete steps you can take today.
Grey Matters: Understanding APOE status + Coach Erika's Corner
Understanding APOE4 Genetics
How APOE4 carriers benefit most from specific interventions
Bottom Line: APOE4 is a significant genetic risk factor for Alzheimer's, but it's not deterministic. We've talked before about how environmental and lifestyle factors play a vital role in whether you develop the disease, and certain interventions are particularly beneficial for APOE4 carriers, and today we'll dive in deeper.
How APOE genetics work: The APOE gene has three major variants: E2, E3, and E4. Each person inherits one copy from their mother and one from their father, creating six possible genotype combinations.
The risk breakdown:
- E2/E2 or E2/E3: Lower risk (protective effect)
- E3/E3: Normal risk (baseline, this is the most common genotype)
- E2/E4 or E3/E4: Increased risk
- E4/E4: Increased risk (highest risk, earlier potential onset)
What E4 does: The E4 variant is associated with several mechanisms that increase Alzheimer's risk:
- Impairs lipid cholesterol metabolism and transport
- Reduces amyloid-beta clearance, leading to plaque buildup
- Increases inflammation leading to neuronal damage
- Causes blood-brain barrier dysfunction and vascular inflammation
Why knowing matters: the prevention advantage: Recent groundbreaking research shows that APOE4 carriers benefit even more from specific interventions than non-carriers.
A 2025 study published in Nature followed over 5,700 people for 34 years and found that closely following the Mediterranean diet lowered dementia risk by at least 35% in people with two copies of the APOE4 gene, the highest risk group.
"Not only did following a baseline Mediterranean diet reduce the probability of developing dementia by 35% in people with two APOE4 genes, but higher adherence to the diet further reduced their risk," said lead author Yuxi Liu, a research fellow at Brigham and Women's Hospital and Harvard Medical School.
The building blocks matter more than the diet label. While this study focused on the Mediterranean diet, it's important to understand our approach at BetterBrain. Following a specific diet like Mediterranean, MIND, or Paleo is less critical than understanding the underlying building blocks.
The totality of research highlights these essential components: healthy fats (especially omega-3s), micronutrients, antioxidants, sufficient protein, and fiber. Diets like Mediterranean are selectively valuable because they're rich in these protective building blocks, but you don't need to follow one specific diet perfectly. What matters most is consistently incorporating these brain-protective nutrients in a way that fits your lifestyle.
Other interventions particularly beneficial for APOE4 carriers:
- Omega-3 supplementation: APOE4 carriers have impaired brain lipid transport and DHA uptake, making higher doses of omega-3s especially important (more on this below in Coach's Corner)
- Aerobic exercise: Particularly effective for APOE4 carriers in maintaining brain volume and cognitive function
- Sleep optimization: Critical for amyloid clearance, which is already impaired in APOE4 carriers
- Lipid management: Monitoring and optimizing ApoB, LDL, and inflammation markers is especially important
- Avoiding head trauma: APOE4 carriers have worse outcomes from traumatic brain injury
- Limiting alcohol: Alcohol is particularly harmful for APOE4 carriers
The empowering reality: As Dr. Richard Isaacson, director of research at the Institute for Neurodegenerative Diseases, notes: "Genes do not have to be your destiny. If the risk of dementia in a person in the highest risk category can be cut by 35% just by following a specific diet, imagine what can be done when you work on dozens of modifiable risk factors such as exercise, sleep, stress and the like."
BetterBrain's APOE testing: APOE testing can be added on to all of our BetterBrain programs. It's a very personal choice, but many people find it very useful and empowering to know. Understanding your status allows us to tailor your prevention protocol with precision, emphasizing the interventions that will have the greatest impact for your specific genetic profile.
Coach's Corner
Omega-3 DHA, Brain-Healthy Salmon & Holiday Mindset
We're very excited to feature Erika Schwan, one of our newest additions to the BetterBrain coaching team, in our Coach's Corner this week!
About Erika: Erika Schwan, RDN, is a registered dietitian nutritionist, health coach, and trained chef with more than a decade of experience in clinical care, functional nutrition, and personalized wellness. Her work centers on individualized nutrition, mindful lifestyle practices, and evidence-informed approaches that support long-term brain health and overall well-being.
Erika's passion for optimizing brain health and advancing dementia prevention is deeply rooted in her personal experience caring for her mother, who lived with Alzheimer's disease.
Personal brain health technique: "For anyone wanting to improve their cognition, support their mental health, and reduce dementia risk, omega-3 polyunsaturated fats are crucial, especially the DHA form found in fatty fish like salmon."
Why DHA matters: DHA is an integral component of neuronal membrane structure. It increases membrane fluidity, supporting neuronal function, neuronal speed, and synaptic transmission. It also reduces neuroinflammation and protects against neurodegeneration.
The APOE4 connection: If you're an APOE4 carrier, getting this essential nutrient at higher than standard doses is even more important. Brain lipid transport and DHA uptake are impaired in APOE4 carriers, meaning you need more to achieve the same brain benefits.
Erika's omega-3 protocol: "I've taken a quality fish oil for years but recently switched to one with more concentrated DHA for increased neuroprotection. I also have a few go-to salmon recipes to ensure a steady intake of omega-3s about 2-3 times per week."
Air Fryer Salmon with Honey-Ginger Marinade
Below is one of my favorite recipes for cold weather. It's tasty, warming, and has additional anti-inflammatory support from fresh ginger. It pairs wonderfully with brown rice (or any whole grain), kimchi, and any vegetables really! I prefer roasted organic broccoli with extra virgin olive oil, a little kosher salt, fresh black pepper, and red pepper flakes for some heat.
If you haven't tried air frying salmon, I highly recommend it!
Ingredients:
- 2, 6-oz salmon filets (skin on or off, per preference)
- 1 Tbsp avocado oil
- 2 Tbsp soy sauce
- 1 Tbsp honey
- 1-inch piece of ginger, grated
- ½-1 tsp garlic, minced (to preference)
Instructions:
- Select "Fish" setting on the air fryer (or select 370°F, 15 minutes); preheat the air fryer for 5 of those minutes
- In a small bowl, whisk the avocado oil, soy sauce & honey together
- Add the ginger & garlic, whisk again
- Cut your salmon into ~1" cubes
- Place salmon & marinade in a sealable container & shake to coat
- Marinate the salmon for 20-60 minutes
- For easier cleanup, place a piece of parchment paper in the bottom of the air fryer taking care not to have the paper exceed the height of the air fryer basket
- Place your marinated salmon in the air fryer basket and cook for 10 minutes at 370°F; check for doneness
- Enjoy!
Making Space for Mental Health
"As I've moved into the holiday season, I'm aware of both the joys and stresses that can arise at this time. As someone who's lost loved ones around the holidays, I'm learning the importance of making space for mental health.
Our mental and emotional health is intricately tied to brain health and impacts so many areas of our lives like stress, sleep, appetite and motivation.
Making space for mental and emotional health can take many forms. First and foremost, working with a licensed mental health professional can be incredibly supportive and transformative. Define your support system and lean upon them at this time.
I find using an app for gratitude practice trains my brain to continue to see the good things in my life and is an easy way to reflect on what I've logged. Finding ways to ground myself in breath and nature are healing measures: a simple home yoga practice, app-guided meditations, a walk at the park, or a hike in the woods and mountains.
And finally, practicing self-compassion as we navigate the nuance of this season can help us walk with a lighter step. Wishing you and yours all the best this holiday season!"
Grey Matters: Your Brain Score, the power of connection and CBT
Product Feature
Your Brain Score
What it is: Your Brain Score is a single number that combines data from multiple assessments to give you a comprehensive view of where you stand and how you're improving over time.
What's measured?
Your Brain Score combines data across the assessments available through BetterBrain:
- The Health Profile
- Cognitive Check-Ups*
- Your blood biomarkers*
- The Mind & Body Snapshot
*Available with BetterBrain Check-Up
What makes it powerful?
Your score weighs objective measures like bloodwork more heavily, ensuring it's grounded in measurable data while accounting for your health history and how you feel.
When does the score update?
Your score will update any time you complete a new assessment. We keep a preliminary label on your Brain Score until you complete all assessments to reflect that we don't have all the information yet.
What's a normal score?
Scores go from 0 to 100, and we find that our clients have scores that fall across this entire range. In other words, all scores can be considered "normal" - it's more important to keep track of the trend.
Join BetterBrain today or update your assessments to continue tracking your Brain Score over time.
Social Connections
Evidence-Based Strategies That Work
Strong social connections are fundamental to mental and physical well-being, including brain health and dementia risk. Research shows that people with robust social networks have up to 50% lower risk of cognitive decline.
The Science: Social engagement stimulates cognitive reserve and reduces neuro-inflammation. Strong relationships buffer against chronic stress (a major dementia risk factor) while providing sense of purpose linked to better cognitive outcomes. Connected people also maintain healthier lifestyles and seek medical care sooner.
Getting Started: Small, consistent actions can compound over time. The key is quality over quantity - even one meaningful relationship can provide significant brain health benefits.
Areas to focus on:
- Improve Quality Time: Practice active listening and dedicate focused time to connect with loved ones. Put away devices and engage in deep conversation.
- Prioritize Close Relationships:Invest in regular in-person interactions with people who matter most. Schedule recurring activities with family and friends.
- Build New Connections: Join local clubs, volunteer, or take classes. Put yourself in situations where you can meet like-minded people.
- Give Back to Your Community: Volunteer for causes you care about, mentor others, or perform random acts of kindness. Helping others creates meaningful connections while providing a sense of purpose that protects cognitive health.
BetterBrain Insight: Social connections work best when combined with other brain health strategies. Many of our highest-scoring clients participate in social exercise, cooking together, or group learning activities.
You can access all of our Brain Health Arsenal techniques related to social connections on your BetterBrain dashboard here.
CONTENT CORNER
CBT: A Mental Tool for Brain Protection
Bottom line: Cognitive-behavioral therapy (CBT) can help fight dementia through two powerful paths - addressing mental health issues that increase risk and helping establish brain-healthy habits.
Your mental health is closely linked to your brain health. Depression, anxiety, and other disorders can increase inflammatory stress in your brain and disrupt cognitive function. CBT is highly effective at treating these conditions, offering protection against dementia risk.
But CBT's benefits extend beyond mental health. Much of dementia prevention relies on addressing lifestyle risk factors like physical inactivity, poor diet, diabetes, and high blood pressure. CBT provides proven techniques for forming and maintaining the healthy habits that protect your brain:
- Cognitive Restructuring: Challenge negative thoughts like "changing my diet won't make a difference" and replace them with "every healthy meal contributes to my resilience"
- Behavioral Experiments: Start small with manageable changes like 10-minute daily walks to build confidence and momentum
- Goal Setting: Work with specific, achievable targets that feel realistic and manageable
- Reinforcement: Track progress over time to create a natural feedback loop where improvement becomes motivating
BetterBrain Takeaway: The systematic approach CBT uses to challenge thoughts and build new behaviors is the same framework that helps you successfully implement the lifestyle changes identified in your Health Profile and Brain Health Arsenal.
You can find CBT support through insurance-covered therapists, telehealth platforms like Talkspace, or self-help resources like Dr. David Burns' "Feeling Great." You can read more about this topic and access resources to get started in our Grey Matters blog post on CBT and brain health.
Grey Matters: Your hearing might be your brain's biggest risk factor
What's Actually Happening in Your Brain
When hearing loss goes untreated, your brain doesn't just struggle to process sound. It begins to fundamentally reorganize itself, and not in a good way.
The Framingham researchers used advanced brain imaging to track these changes over time. They found that hearing loss was associated with greater white matter hyperintensities (a marker of brain aging) and accelerated decline in executive function, the mental skills we use for planning, problem-solving, and staying focused.
Scientists propose three main mechanisms linking hearing loss to cognitive decline:
Cognitive load: When your hearing is impaired, your brain has to work much harder to understand speech. Think of it as working overtime just to follow a conversation, leaving fewer resources available for memory and reasoning. Studies using functional brain imaging show that people with hearing loss recruit additional brain regions, particularly in the frontal cortex, just to process what they're hearing.
Brain reorganization: The areas of your brain that normally process sound begin to shrink when they're not getting clear signals. Research shows that prolonged auditory deprivation leads to cortical reorganization, where these regions get recruited for other tasks or simply atrophy. The temporal lobes, which are critical for both hearing and memory, show particularly significant volume loss.
Social isolation: Difficulty hearing often leads people to withdraw from social situations, which compounds the problem since social engagement is itself protective against cognitive decline.
The APOE4 Connection
One of the most striking findings from the Framingham study was how hearing loss interacts with genetics. Among APOE ε4 carriers, those with hearing loss had nearly triple the dementia risk (hazard ratio of 2.82) compared to those without hearing loss. If you're a BetterBrain member and have had APOE4 testing, this underscores why protecting your hearing is especially important.
Why This Matters
The 2024 Lancet Commission didn't just identify hearing loss as a risk factor. They went further, concluding that the evidence for treating hearing loss to reduce dementia risk is now stronger than ever. Use of hearing aids appears to be particularly effective in people with additional risk factors for dementia.
The numbers are compelling: hearing aid use in patients under 70 with hearing loss reduces dementia risk by 61% over 20 years. Even across all age groups, studies consistently show a 30-40% reduction in dementia risk with hearing aid use.
This is prevention you can actually implement. Unlike many dementia risk factors that require systemic changes or are difficult to address, hearing loss is treatable with existing technology.
What You Can Do
Protect your hearing now.
The best treatment is prevention. Use hearing protection in loud environments: concerts, power tools, loud traffic. Noise above 85 decibels (common at concerts or loud workplaces) damages inner ear cells permanently. Keep personal audio below 60% of maximum volume and take quiet breaks.
Explore BetterBrain Picks for hearing protection.
We've curated high-fidelity earplugs that protect your hearing without sacrificing sound quality, including options from Hearprotek, Loop Experience, and Earos One. You can browse BetterBrain's Hearing Protection Picks here.
Get your hearing tested.
The Framingham study found effects even with mild hearing loss, levels that many people dismiss as "just part of aging." Adults with even mild hearing loss showed smaller brain volumes, greater white-matter damage, and faster cognitive decline.
Start with at-home screening.
Quick options include the Mimi Hearing Test app (gives you frequency detail and tracks trends over time) or the Johns Hopkins Hearing Number app (tests your real-world hearing in noise). Both take 5-10 minutes with headphones. Repeat monthly to watch for changes.
Get a professional baseline.
Schedule a comprehensive audiogram with an audiologist for pure-tone thresholds, speech-in-noise testing, and tympanometry. This is the gold standard for brain health planning.
Act early if you have hearing loss.
Research suggests that early hearing aid adoption provides significantly better cognitive protection than delayed treatment. The implication is clear: don't wait until your hearing loss is severe.
Use hearing aids consistently.
The protective effect comes from actually using them, not just owning them. Consistent use helps maintain the neural pathways for sound processing and reduces the cognitive effort required for everyday listening.
Talk to a BetterBrain coach.
Get personalized guidance on hearing screening, protection strategies, and next steps based on your unique risk profile.
The Bottom Line
Hearing loss isn't just about missing words. It's about protecting your brain. The evidence is now strong enough that major health organizations are calling for public health action on hearing screening and early intervention.
Ready to take action on your hearing health?
Log into your BetterBrain Portal to explore personalized hearing protection recommendations, schedule coaching, and track this critical component of your brain health plan.
New to BetterBrain?
Explore your BetterBrain options and check your insurance coverage to get comprehensive biomarker testing, personalized protocols, and expert coaching to address all your modifiable dementia risk factors, including hearing health.
Grey Matters: Sugar is hijacking your brain (but here's how to fight back)
Content Corner
Systematic Review: Sugar's Impact on Brain Function
Bottom Line: This systematic review and meta-analysis, published in the journal Nutrients, reveals that added sugar consumption consistently correlates with cognitive impairment. For those of us still struggling with sugar, seeing the research can be the reality check we need.
The stark findings (yes, they're as bad as you suspected):
- All cohort studies found significant correlations between added sugar and cognitive impairment risk
- Eight of nine cross-sectional studies showed the same pattern
- Men consuming the most sugar were 23% more likely to develop mental disorders over five years
- Higher sugar intake was linked to smaller brain volume and poorer memory performance
The key distinction: Natural fructose-containing foods (whole fruits) were actually associated with reduced cognitive impairment risk, while added sugars (high-fructose corn syrup, table sugar, etc.) were consistently harmful.
How sugar damages the brain:
- Disrupts blood-brain barrier: Allows harmful substances to enter brain tissue
- Increases neuroinflammation: Particularly in memory-critical brain regions
- Reduces brain volume: Especially in the hippocampus, crucial for memory
- Impairs glucose regulation: Causes energy crashes that affect cognitive function
For the data lovers: Many of our members have found continuous glucose monitors incredibly eye-opening. Seeing in real-time how that muffin spikes your glucose to 180mg/dL often provides the push people need to make lasting changes.
BetterBrain connection: This research validates why we include HbA1c and glucose testing in our panels. Sugar's effects on cognitive function are measurable through biomarkers, so you can actually track improvements as you work on reducing intake.
Evidence-Based Strategies:
Smart Sugar Strategy Implementation
Nutrition can be nuanced. Different people struggle with different things. Your partner might crave fried chicken, while you can't resist something sweet. We can't give you every recommendation in one newsletter, but here are a few simple, science-backed strategies to control your sugar intake to get you started.
The key is working smarter, not harder, and recognizing that timing matters as much as what you eat.
Start with your morning: Your breakfast determines your blood sugar pattern for the entire day. A breakfast built around protein (more on this below) and healthy fats (avocado, nuts, olive oil) instead of refined carbs.
The simple swap system (small changes, big impact):
- Bread: Whole grain for white (look for brands with 3+ grams fiber per slice)
- Fruit: Whole fruit for juice (even 'no sugar added' juice spikes blood sugar because it's lacking fiber. )
- Yogurt: Plain with berries for sweetened varieties
- Snacks: Nuts with dark chocolate for sweetness
Hunt the hidden sugars (they're everywhere): The real culprits aren't the obvious ones. Check condiments (ketchup has more sugar than you think), 'healthy' snacks (many protein bars are candy bars in disguise), and low-fat products (they often add sugar to replace fat).
Plan for the 3-4 PM crash: This is when willpower dies and sugar cravings peak. Many of our members swear by keeping satisfying alternatives ready: mixed nuts, apple with almond butter, or a small piece of dark chocolate (70%+ cacao).
Timing matters more than you think: Having sugar after a workout? Your muscles will use it for recovery. Having it while stressed and sedentary? Straight to fat storage and blood sugar chaos. Context is everything.
The CGM revelation: For those who love data, continuous glucose monitors have been game-changers for many of our members. Seeing how that 'healthy' smoothie sends your blood sugar to 200 and leaves you crashing an hour later often provides more motivation than any lecture about sugar's dangers.
BetterBrain insight: Nutrition is an incredibly important pillar of overall brain health, which is why all of our Brain Health Coaches deeply understand nutrition for brain health. This isn't about guilt or perfection. It's about small, strategic choices that keep your energy and focus steady all day.
Hack of the Week
The Protein-First Morning Protocol
Why consider it: Higher-protein breakfasts are linked to smaller post-meal glucose rises, greater satiety, and fewer later-day cravings in controlled studies.
The Protocol:
- Aim for 20–30 g protein within the first 1–2 hours after waking.
- If you drink coffee, have protein with or before it. Caffeine can transiently reduce insulin sensitivity in some people, especially with a carb-only breakfast.
Why protein first matters:
Protein slows gastric emptying, blunts glucose excursions, and increases satiety signals such as GLP-1 and PYY. The net effect for many people is steadier energy and fewer mid-morning sugar grabs.
Easy options:
- Hard-boiled eggs
- Plain greek yogurt plus nuts or seeds
- Protein shake with berries and milk or soy milk
- Leftover dinner protein
Tracking outcomes: Most individuals report reduced sugar cravings and improved energy stability within just 3-5 days. Continuous glucose monitoring can objectively demonstrate improved glycemic variability.
Key insight: This approach addresses the underlying cause of sugar cravings by preventing the glucose fluctuations that trigger compensatory food-seeking behavior.
You can visit our Brain Health Arsenal for more techniques on protein optimization and reducing refined carb intake.
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