Dr Annette Bosworth, an internal medicine specialist with over two decades of experience, has shared insights into early warning signs of dementia that may be identifiable up to 15 years before formal diagnosis. Speaking on Steven Bartlett’s Diary Of A CEO, Dr Bosworth, also known as Dr Boz, examined the connection between insulin resistance and the metabolic changes that can precede cognitive decline.
Dr Bosworth, who advocates healthy Keto living and hosts the popular YouTube channel ‘Dr Boz’, emphasises that metabolic disruptions rather than cognitive symptoms mark the earliest stages of dementia. She explains that elevated insulin levels and insulin resistance can impair the brain’s ability to clear cellular waste and reduce its energy supply long before any memory lapses or confusion occur.
According to Dr Bosworth, common signs such as becoming disoriented while driving often emerge too late, as they reflect the accumulation of “brain trash” caused by prolonged metabolic dysfunction. She warns that these forgetful episodes indicate the processes underlying dementia have been ongoing for as long as 15 years, highlighting the importance of early detection and intervention.
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Supporting this perspective, research from the American Academy of Neurology points to a 15-year preclinical phase characterized by work productivity decline and midlife metabolic changes that correlate with later brain health. Persistent insulin resistance and elevated insulin levels are significant predictors of cognitive decline and dementia risk, although they are not direct symptoms.
Health bodies, including the Alzheimer’s Society, recommend controlling blood sugar levels, following a balanced diet, and engaging in regular exercise to reduce the risk of cognitive impairment. People with type 2 diabetes or systemic insulin resistance face a heightened likelihood of dementia, sometimes referred to as “type 3 diabetes” in informal discussions.
In clinical practice, Dr Bosworth monitors early biological markers such as haemoglobin A1C levels above 5.5, ongoing vitamin D deficiency, and the absence of naturally produced morning ketones rather than relying solely on cognitive assessments. Medical News Today notes that detecting metabolic and biochemical dysfunction early enables healthcare providers to implement targeted prevention strategies before memory problems manifest.
Whereas traditional testing often looks for brain plaques after damage has occurred, indicators like elevated haemoglobin A1C, prolonged vitamin D deficiency, and lack of morning ketones reveal underlying metabolic inflexibility and brain inflammation. These factors deprive brain cells of essential nutrients, accelerating the progression of dementia and Alzheimer’s disease.
This emerging understanding underscores the importance of early metabolic health monitoring as part of dementia prevention efforts, shifting the focus from late-stage symptom management to proactive intervention.