The GL of Your Diet Determines Your Future Dementia Risk
Glycaemic Load and Dementia Risk: What the Research Shows
by Patrick Holford

Why blood sugar and glycaemic load matter for brain health
A low glycaemic load (GL) diet is the first of Food for the Brain’s 8 Domains of brain health. Domain 1 focuses on supporting healthy blood glucose regulation by paying attention to both the quality and quantity of carbohydrate in the diet.
But what does the research tell us about glycaemic load and future cognitive health?
A large prospective study involving more than 200,000 UK Biobank participants investigated the relationship between dietary glycaemic index (GI), glycaemic load (GL) and subsequent dementia risk.
The researchers found that the relationship was not simply “the lower, the better”. Instead, dementia risk followed a J-shaped pattern according to dietary glycaemic load, while glycaemic index showed a different relationship.
The findings add to a wider body of research investigating blood glucose, insulin resistance and cognitive decline. Here we look at what the study found, what it can and cannot tell us, and how the findings relate to Domain 1 of Food for the Brain’s 8 Domains.
What did the study find about glycaemic load and dementia?
A 2025 study published in the International Journal of Epidemiology investigated the relationship between dietary glycaemic index (GI), glycaemic load (GL) and future dementia risk in 202,302 dementia-free participants from the UK Biobank.
Researchers estimated participants’ dietary GI and GL using 24-hour dietary questionnaires and examined their subsequent risk of all-cause dementia, Alzheimer’s disease and vascular dementia.
The relationship was not simply a case of “the lower, the better”. Instead, the researchers found a J-shaped relationship between glycaemic load and dementia risk.
Above a dietary GL of approximately 111, increasing GL was associated with a higher risk of dementia. After adjusting for potential confounding factors, GL above this point was associated with a 14.5% higher relative risk of dementia. Similar patterns were observed for Alzheimer’s disease and vascular dementia.
Glycaemic index showed a different pattern. GI values below approximately 49 were associated with a lower risk of dementia, suggesting that both the quality and quantity of carbohydrate in the diet may be important.
These findings sit within a wider body of research investigating how diet relates to brain health. Food for the Brain research into diet and cognitive function has also examined self-reported dietary patterns alongside cognitive test results, including the relationship between sugar intake and cognitive performance.
What does this research tell us?
The findings strengthen the evidence linking carbohydrate quality, overall glycaemic load and metabolic health with future brain health. They also suggest that looking only at the GI of individual foods may miss part of the picture, because glycaemic load takes into account both the glycaemic index and the amount of carbohydrate consumed.
However, this was an observational study, not a clinical trial. It can show an association between dietary GI and GL and subsequent dementia risk, but it cannot prove that a high-GL diet causes dementia or that lowering GL will prevent it. Dietary intake was also estimated using self-reported dietary questionnaires.
How This Research Supports Domain 1
Eating a low glycaemic load diet is Domain 1 of Food for the Brain’s 8 Domains of brain health.
The aim is not to eliminate carbohydrates, but to support healthy blood glucose regulation by paying attention to both the type and amount of carbohydrate eaten.
This UK Biobank study adds to the evidence linking dietary glycaemic load with long-term cognitive health. However, glycaemic load is only one part of the picture. Food for the Brain’s 8 Domains bring together modifiable areas of diet and lifestyle associated with cognitive health.
For practical guidance, including foods to choose, portion sizes, simple swaps and lower-GL meal ideas, explore Domain 1: Eat a Low Glycaemic Load (GL) Diet.
What is glycaemic load?
Glycaemic load (GL) estimates the blood-glucose impact of a food or diet by considering both the glycaemic index (GI) of its carbohydrate and the amount of carbohydrate consumed.
GI describes how quickly carbohydrate raises blood glucose. GL adds quantity to the equation, which means portion size matters too.
For practical guidance on lowering the glycaemic load of your diet, including foods to choose, simple swaps and examples of low GL meals, see Domain 1: Eat a low Glycaemic Load (GL) diet.
Blood sugar, insulin resistance and dementia: the wider evidence
The UK Biobank findings do not stand alone. A broader body of research has examined whether impaired glucose regulation, insulin resistance and diabetes are associated with cognitive decline and dementia.
Type 2 diabetes has consistently been associated with a higher risk of cognitive impairment and dementia. A systematic review and meta-analysis of 144 prospective studies found that diabetes was associated with approximately 1.25 to 1.91 times the risk of cognitive disorders, depending on the outcome studied. Higher fasting glucose, HbA1c and altered fasting insulin levels were also associated with increased risk in the studies reviewed. [3]
Importantly, the relationship may extend beyond people with diabetes. In a prospective study of 2,067 older adults followed for a median of 6.8 years, higher average glucose levels were associated with greater dementia risk among people both with and without diabetes. [4]
Insulin regulation may also be relevant. A 2004 prospective study led by researchers at Columbia University found that higher fasting insulin levels were associated with an increased risk of Alzheimer’s disease in older adults. [5]
Brain-imaging research provides another piece of the picture. A meta-analysis involving more than 31,000 participants found that type 2 diabetes was associated with smaller total brain, grey matter, white matter and hippocampal volumes, as well as greater brain atrophy over time. [6]
These findings do not establish that high blood glucose or insulin resistance directly causes dementia. Metabolic health is intertwined with cardiovascular health, body composition, physical activity, genetics and other factors. Nevertheless, the evidence provides an important context for investigating dietary glycaemic load as one potentially modifiable aspect of brain health.
How Excess Blood Glucose Can Affect the Brain
What happens if you consume far more glucose than the body needs?
A can of sugary fizzy drink contains around 35 grams of sugar. That is roughly nine times more glucose than the total amount normally circulating in your bloodstream.
This excess is toxic. It damages blood vessels and the tissues they supply. Diabetes is diagnosed precisely because excess sugar damages the kidneys, eyes and nerves. The brain is no exception.
“The brain needs more energy than any other organ, so it contains the most mitochondria. Sugar damages mitochondria,” says Professor Robert Lustig, Professor of Neuroendocrinology at the University of California, San Francisco.
What Does HbA1c Tell You About Blood Sugar?
The simplest way to assess your long term blood sugar exposure is to measure HbA1c.
HbA1c measures the proportion of haemoglobin that has glucose attached to it (glycated haemoglobin), providing an indication of average blood glucose levels over the previous two to three months. An HbA1c of 6.5% (48 mmol/mol) or above is one of the thresholds used in the diagnosis of diabetes.
Some research suggests that cognitive risk may increase at HbA1c levels below the threshold used to diagnose diabetes. For example, higher HbA1c has been associated with faster cognitive decline in longitudinal studies, while one study in adults aged 80 and over found HbA1c of 5.4% or above was associated with decline in memory function. [7,8]
HbA1c is such a strong indicator of blood sugar resilience that it is included in Food for the Brain’s 5-in-1 DRIfT home blood test kit.
What Does This Research Mean for Your Diet?
The research does not show that there is one ideal glycaemic load for everyone, or that lowering GL will prevent dementia. However, it adds to evidence suggesting that the quality and quantity of carbohydrate we eat, and their effect on blood glucose, may be important for long-term brain health.
In practical terms, a lower GL way of eating means choosing fewer refined and rapidly digested carbohydrates, while favouring foods that have a gentler effect on blood glucose, such as beans and lentils, non-starchy vegetables, whole fruits, nuts and seeds.
For practical guidance, food swaps and examples of lower GL meals, see Domain 1: Eat a low Glycaemic Load (GL) diet.
What to Do Next
If you want to put the principles of a lower glycaemic load diet into practice, there are three useful next steps.
Learn how to lower the glycaemic load of your diet.
Use practical guidance on carbohydrate choices, portions, meal combinations and lower-GL foods. Explore Domain 1: Eat a Low Glycaemic Load (GL) Diet
Test your blood sugar resilience.
HbA1c provides an indication of your average blood glucose levels over the previous two to three months. It is included in Food for the Brain’s DRIfT 5-in-1 home test, alongside other key brain health markers. If your HbA1c is elevated, diet and other lifestyle factors may form part of an appropriate strategy for improving blood glucose control.
Check how your brain is functioning now.
The free Cognitive Function Test takes around 20 minutes and provides an objective snapshot of memory, attention and processing speed.
Make changes, then retest.
Follow the recommendations for three months, then consider retesting HbA1c to track changes in blood glucose control.
Measuring relevant markers can help you track changes over time.
References
- Novau-Ferré N et al. Glycemic index, glycemic load, and risk of dementia: a prospective analysis within the UK Biobank cohort. Int J Epidemiol. 2025.
- Wasserman DH. Four grams of glucose. Am J Physiol
- Xue M, Xu W, Ou YN, Cao XP, Tan MS, Tan L, et al. Diabetes mellitus and risks of cognitive impairment and dementia: a systematic review and meta-analysis of 144 prospective studies. Ageing Research Reviews. 2019;55:100944.
- Crane PK, Walker R, Hubbard RA, Li G, Nathan DM, Zheng H, et al. Glucose levels and risk of dementia. New England Journal of Medicine. 2013;369(6):540–548.
- Luchsinger JA, Tang MX, Shea S, Mayeux R. Hyperinsulinemia and risk of Alzheimer disease. Neurology. 2004;63(7):1187–1192.
- Zhang T, Shaw M, Cherbuin N. Association between type 2 diabetes mellitus and brain atrophy: a meta-analysis. Diabetes & Metabolism Journal. 2022;46(5):781–802.
- Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing. Diabetologia. 2018;61:839–848.
- Katsumata Y, Todoriki H, Higashiuesato Y, et al. Metabolic Syndrome and Cognitive Decline Among the Oldest Old in Okinawa: In Search of a Mechanism. The KOCOA Project. Journal of Gerontology: Medical Sciences. 2012;67(2):126–134




