Top Brain Health Stories of 2019: What we learned about food, supplements, and intermittent fasting
Throughout 2019, brain health was constantly in the news. Researchers tackled key questions pertaining to Alzheimer’s and other dementias, like: How does a woman’s exposure to estrogen impact her dementia risk? Should we eat more mushrooms and less meat? Should we avoid eggs? Are we getting closer to diagnosing Alzheimer’s with a blood test? And, is there finally good evidence that intermittent fasting protects memory and brain health?
I highlighted many of these stories in my monthly newsletter. (You can subscribe here if you haven’t already.) Now, looking back, I am blown away by how many of these published papers provide key takeaways for optimizing brain health in real life every day. In fact, there is so much important information here that I’m rolling out these summaries in 3 separate posts.
To start, we’ll talk about the most impactful studies pertaining to what we eat, intermittent fasting, and supplements for brain health, summarized below. Next, I’ll share the key findings in lifestyle interventions, including exercise, sleep, and the emerging data on how environmental pollutants link to dementia. Finally, we will look at the latest advances in medicine: new information about why women are more vulnerable to Alzheimer’s, new data about blood pressure, and a cutting-edge model for a personalized medicine approach to those at risk.
Looking ahead to 2020, I’ll also give you tips on how to use this information to keep your brain healthy now and for many years to come.
The last decade of Alzheimer’s research
First, a little background. At the beginning of the last decade, Alzheimer’s was viewed as a disease of the elderly that begins late in life.
Now we know that Alzheimer’s starts 20 to 30 years before symptoms are apparent. And, numerous studies show that paying attention to health at mid-life impacts whether or not Alzheimer’s happens down the line.
Back then, the concept that we could prevent Alzheimer’s was not generally accepted.
Now we know that 60% of all Alzheimer’s cases can be reduced by following a brain-healthy diet and lifestyle. Even more remarkable: a brain-healthy diet and lifestyle reduces 32% of the Alzheimer’s cases related to having a risk gene for the disease (e.g. an APOE4 allele).
There was also very little awareness of the plight of women and their vulnerability to Alzheimer’s just ten years ago.
Now we know that women’s brains differ physiologically from men’s, and that researching these differences will help elucidate how to prevent and treat the disease in both men and women.
Finally, back in 2000 the concept of eating to prevent Alzheimer’s hardly existed. Very few nutrition studies addressed the impact of food on neurodegenerative diseases.
Now we know that certain dietary patterns can slow down the aging of the brain. And, that certain types of foods (primarily the ultraprocessed ones) can accelerate brain aging, aka cognitive decline leading to Alzheimer’s and other dementias. The ongoing MIND diet trial hopes to replicate its original results that showed a reduced Alzheimer’s risk of as much as 53%. This randomized, placebo-controlled, blinded clinical study compares the MIND diet head-to-head with another diet. Look for results sometime in 2021.
You could say that researchers were more successful this past year honing in on how to fend off Alzheimer’s than finding a cure or discovering one causative factor. That’s probably because Alzheimer’s is not caused by one thing and it won’t be “cured” by one drug. In the past decade, our understanding of Alzheimer’s evolved to look more like a disease in which chronic inflammation is the underlying insult, triggered by a varied array of factors that start at mid-life, or even earlier in some cases.
Brain-Healthy Food
What’s the best diet for brain health?
I am a huge advocate for the Mediterranean way of eating and its brain-health specific spin-off, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet—a hybrid of Mediterranean and DASH (Dietary Approach to Stop Hypertension). The 2020 U.S. News and World Report agrees. Based on advice from a panel of health experts, U.S. News ranked 35 of the most popular diets based on nutrition, ease, and whether they are proven safe and effective for reducing health risks. The Mediterranean, DASH, and MIND diets ranked in the top 5 best diets overall, as well as the easiest to follow.
The Take-Away for Brain Health: I appreciate the expert opinions that support certain diets as standing the test of time for prevention of chronic diseases, especially Alzheimer’s. To be honest, though, I don’t love the word “diet.” For me, it connotes deprivation, an attempt at weight loss, and a short-lived fling with changing one’s way of eating. What I do love is an approach to eating that’s more of a lifestyle as in the case of the Mediterranean diet, which has been proven to fend off heart disease and dementia and contribute to healthful longevity in numerous studies. It incorporates exercise, socializing, and sharing meals with family and friends. It also includes all the foods I love to eat so that I never feel like I’m “on” a diet, well, because I’m not. Studies have also shown that going on and off diets is not good for you and could be harmful in the long run to your cardiovascular system and metabolism.
Are eggs beneficial for the brain?
Eggs have never been more controversial as they were in 2019 after a study published in JAMA in March found a strong association between eating eggs and heart disease. By analyzing data from 6 separate studies, investigators found that the more eggs people ate, the higher their risk of heart attack, stroke, and death. But how accurate is the study? The researchers based their data on one dietary questionnaire given at the beginning of the study which spanned up to 31 years. That’s one dietary assessment over more than 30 years. And, what does this have to do with brain health?
If we back up a few years, you may recall that physicians used to recommend eating eggs sparingly, if at all. That’s because eggs contain cholesterol, and the belief was that cholesterol-rich foods contributed to raising bad cholesterol in the blood, especially LDL (low density lipoprotein), which has a strong association with heart disease. An increased risk of cardiovascular disease is also a risk factor for Alzheimer’s and other dementias. Then eggs were eggs-onerated, so to speak. Studies determined that dietary cholesterol has very little impact on blood cholesterol except in some (about 25%) who are dubbed “hyper-responders.” (Food containing trans fats, however, were proven to be a much bigger factor in raising LDL.) Even the American Heart Association stopped recommending that we limit the consumption of eggs to less than 3 per week. Then, sometime early in the last decade, the paleolithic movement hit the scene (followed by the keto craze) with a renewed enthusiasm for eating meat and eggs. Soon it became trendy to put an egg on just about everything.
Over in the brain health world, eating eggs (in moderation) was thought to support brain health because of their high choline and lutein content. Many will cite this study of over 2400 Finnish men over 22 years that shows eating eggs does not increase the risk of Alzheimer’s or dementia. The Finnish study also found that the egg eaters performed better on certain neuropsychological tests, such as executive function. The dietary assessment was a bit better, albeit not optimal, than in the JAMA study. Participants filled out a 4-day dietary log to document egg consumption at the beginning of the study.
The Take-Away for Brain Health: If you intend to continue enjoying eggs, I’d like you to cook them in a brain-friendly way. Ideally, your eggs will be cooked well enough to eliminate the risk of Salmonella (to an internal temperature of 160ºF, or so that the yolk is set but not runny.) But avoid cooking at such a high heat that the healthy fats in the yolk don’t change in structure, a process called lipid oxidation, leading to inflammatory substances. (Think gently fried, softly scrambled, medium-poached, and boiled with a soft but not runny yolk. Hard-boiled eggs have the most lipid oxidation.) How many eggs per week? We don’t have solid data to guide us. Eating 3 to 4 eggs per week is probably enough to benefit from their brain-healthy lutein and choline, and provide an inexpensive, easily available protein source.
Mushrooms emerge as brain-healthy food
Mushroom lovers were buzzing about this study from Singapore published in March in the Journal of Alzheimer’s Disease that looked at how mushroom consumption reduced the risk of mild cognitive impairment, the earliest stage of Alzheimer’s. A few years earlier, a large study out of Japan showed a similar protection from dementia with a mushroom-rich diet. In other work by Dr. Robert Beelman at the University of Pennsylvania, increased consumption of porcini mushrooms is thought to give older Italians an edge in avoiding Alzheimer’s. He examined the amounts of two antioxidants—ergothioneine and glutathione— known to promote brain health.
The Take-Away for Brain Health: Several studies now support that eating mushrooms is associated with less dementia with age. How many times a week should you eat mushrooms for a possible brain health benefit? All three studies found benefit with 2 or more half-cup servings each week. If you love mushrooms as much as I do, that’s not very difficult.
Have you tried my Portobello Bacon? This easy recipe will help you eat more mushrooms.
Supplements for Brain Health
FDA to supplement industry: Stop making false promises about Alzheimer’s
An estimated 25% of those over age 50 take a supplement with the intention of boosting brain health. There are currently so many supplement companies claiming their products will improve memory, reduce dementia risk, or treat Alzheimer’s disease that the FDA has finally started to crack down. That’s because most supplements marketed to protect your brain health and improve memory lack scientific data to support their claims.
Early in 2019, the FDA took action against 17 companies selling 58 different products claiming to prevent, treat, or cure Alzheimer’s disease. Gingko baloba, for example, has been thoroughly tested in clinical trials including the GEM (Gingko Evaluation of Memory) Study, and found to have no impact on reducing Alzheimer’s risk. Vitamin E held promise, but when rigorously studied was shown not to prevent cognitive decline, and even was harmful in some cases. Others, such as coenzyme Q10, ginseng, and various forms of coconut oil (MCTs, or medium-chain triglyceride supplements, and caprylic acid), have either been thoroughly proven to lack benefit or don’t have enough data to be recommended.
And yet, some supplements, such as vitamin D3, magnesium, and the omega-3 fatty acids EPA and DHA (aka fish oil), show promise when it comes to supporting healthy brain aging.
The case for Vitamin D3
Does vitamin D3 deficiency contribute to the risk of cognitive decline? Studies are mixed. Some find a link between low levels of D3 in the blood (between 25 to 50 nmol/l) and others do not. In this study of 4848 men and women in the U.K., only those who carry two copies of the APOE4 gene did better on cognitive function tests if they had higher blood levels of D3. So although there are other health benefits to optimizing your D3 levels, such as enhancing bone health and reducing cardiovascular diseases, only certain people may benefit from a brain health perspective.
You can get your D3 into the optimal range by taking a D3 supplement, eating D-rich foods, and getting more sun. To boost D3 in your diet, reach for salmon, herring, sardines, egg yolks, mushrooms, and canned tuna (light tuna, not white, up to 6 ounces per week.)
The confusing study of omega-3 supplements
We already know, from numerous studies, including this publication in Neurology, that eating fatty fish reduces dementia and Alzheimer’s risk. Does that mean that taking a fish oil supplement will give you the same risk reduction? The data on omega-3 fatty acid supplements vacillate between some studies showing heart and brain benefit, and others showing no benefit at all. (For example, in this study of healthy elderly without dementia, taking EPA and DHA for 26 weeks did not enhance memory or other cognitive functions.) The answer, it seems, is that only certain people may benefit from omega-3s. One theory is that omega-3s only improve the brain health of those who don’t carry the APOE4 risk gene for Alzheimer’s. That’s because the presence of APOE4 may impair the transport of DHA into the brain.
Boost your EPA and DHA levels with these foods: mackerel, salmon, oysters, herring, sardines, anchovies, caviar, and cod. Vegans and vegetarians can get omega-3s as ALAs with these foods: walnuts, flax seeds, chia seeds, soybeans, hemp seeds, algae, Brussels sprouts, and spinach.
The Take-Away for Brain Health: Is it time to toss most of the supplements touted to improve your brain health? I say yes. Supplements like these are merely a waste of money and energy, and suck up valuable time with medical practitioners that could be spent discussing evidence-based interventions for brain health. Vitamins and nutrients are best consumed through food not pills.
In the next few years, however, I predict that certain supplements will stand up to the rigor of scientific study and become part of our arsenal of fending off Alzheimer’s and other dementias. I’m especially keen on keeping an eye on magnesium, omega-3s, and vitamin D for certain subsets of people. As our knowledge of brain health evolves, supplementation will become more individualized as each person learns his or her unique risk profile.
Intermittent fasting
Trendy weight loss strategy or real brain health benefit?
In 2019, intermittent fasting (the practice of forgoing calories for large blocks of time) became a very popular weight-loss strategy. It’s also known as time-restricted eating, and until recently, only studies done on animals showed that intermittent fasting can lead to a healthier metabolism and a longer life. But now that’s started to change. In December, an article published in the New England Journal of Medicine, Effects of Intermittent Fasting on Health, Aging and Disease, reviewed the current state of evidence of fasting in human trials.
Reducing caloric intake through fasting at midlife leads to fewer cases of Alzheimer’s, stroke, and Parkinson’s disease later in life. This study suggests that caloric restriction preserves memory in elderly adults. Fasting is thought to protect brain cells, reduce insulin sensitivity, and stimulate autophagy (the clean-up of toxic substances like amyloid plaque from the brain). Animal studies suggest that fasting reduces inflammation in the brain through several different pathways, however, we still lack adequate clinical trials that prove whether an intervention of intermittent fasting can fend off cognitive decline.
The Take-Away for Brain Health: Building evidence suggests that some form of intermittent fasting is beneficial for both maintaining an optimal weight and brain health. If you want to try a fasting regimen (which I started doing about three years ago) consider not eating for a 14-to 18-hour window of time on some nights. Put another way, restrict the time that you eat to a 6- to 8-hour window each day. For me, this means having an early dinner and a late breakfast about 3 to 4 days a week. (You can still drink water, black coffee, and unsweetened tea.) Fasting is not appropriate for everyone, such as those with a history of disordered eating, so be sure to speak with your health-care provider first.
The next decade in brain health research
There is much hope going into the next decade. Congressional leaders announced this month that they have increased funding for Alzheimer’s research to 2.8 billion dollars, up $350 million from 2019. As public awareness grows about which lifestyle factors can reduce dementia risk, I believe that preventive brain-health care will result in an aging population with sharper memories, more resilient brains, and fewer instances of Alzheimer’s. For those diagnosed with Alzheimer’s, I believe there will be effective treatments. It could be a vaccine that blocks the deposition of inflammatory proteins in the brain. Or, it could be a drug targeted to a specific factor, such as amyloid protein or the bacterial toxin gingipain. Most likely, it will be a cocktail of drugs targeted to individuals based on risk factors identified with a blood test, brain scan, genetic test, or a combination of these biomarkers. Any drug regimen that’s likely to work for a complicated disease like Alzheimer’s will be best started long before symptoms set in.
Now more than ever I am motivated to demystify brain health research so that you can incorporate the latest science into lifestyle habits that will slow down the aging of your brain. I am committed to help you on this brain-healthy path with information, encouragement, support, and recipes. Yes, recipes, because I believe brain-healthy living starts at home, right in your own kitchen. And, just to be clear, it’s not that I have all the answers to what constitutes an optimal brain-healthy lifestyle. I am on this journey with you, learning right at your side. But I am committed to doing the work (which often entails poring through food science studies, epidemiological papers, animal data, basic science research, and a plethora of lay literature) that will push us all further towards building resilient brains.
I believe brain-healthy living starts at home, right in your own kitchen.
Ready for more? Check out Part 2 of our Top Brain Health Stories of 2019: What we learned about alcohol, exercise, and sleep.
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