Top Brain Health Stories of 2019: What we learned about alcohol, exercise, and sleep
In my last post, I summarized the most important scientific findings of 2019 that changed how we eat, what we eat, and the supplements we take for brain health. Now let’s take a look at what we learned about how alcohol intake, exercise, and sleep impact the risk of Alzheimer’s and dementia. I’ll also share insights from a landmark study that showed how powerful it is to combine brain-healthy lifestyle factors.
Alcohol: How much is too much for the brain?
The benefits of moderate alcohol intake is ingrained in many brain-healthy dietary patterns. The Mediterranean diet includes 1 to 2 glasses of wine each day, with food, and in the presence of family and friends. The Blue Zones includes “wine at 5” as one of their strategies for longevity. And, in the MIND diet study, 5 ounces of red wine (a not-quite-half-full glass) each day is included as its own brain-healthy food group. Not only has moderate drinking been shown to be part of a brain-healthy lifestyle, many studies have documented that drinking small amounts of alcohol may be better than not drinking at all. One large study of older adults showed that those who drank 1 to 6 drinks each week had less dementia than those who drank none.
If you enjoy red wine, there’s more good news. Red wine is thought to be especially brain-healthy because it possesses resveratrol, a potent antioxidant, and flavonols, compounds that help make blood vessels more elastic and healthy. Studies still haven’t teased out if it’s the red wine itself or the social interaction that comes with sharing wine with friends that’s good for the brain. In the Rancho Bernardo study of 1,344 healthy middle-aged men and women in a close-knit, social community, moderate drinkers in a social setting were 2 to 3 times more likely to make it to 85 without cognitive impairment, when compared to heavy drinkers or those who did not drink at all. And it didn’t matter if they drank wine, beer, or spirits; all types of alcoholic beverages, such as beer and spirits, demonstrated the same degree of brain health benefit.
In the last few years, however, the tide has been turning away from moderate drinking for brain health towards drinking even less than one glass a day. Red wine was dropped as a brain-healthy food group in the MIND diet study’s next phase—the ongoing MIND diet trial, a randomized, placebo-controlled study with results due in 2021. In a 2019 study in the Journal of the American Medical Association, minimal alcohol intake (defined as zero to 1 drink per day for women, or zero to 2 drinks per day for men) is one of the 5 lifestyle factors shown to reduce dementia risk. And in a large study published in the Lancet, researchers concluded that no level of alcohol consumption improves health.
The effects of alcohol on brain health are notoriously difficult to study. But, as we are starting to learn, there may be subgroups of people who should be careful not to drink above these minimal guidelines, or should not drink at all. And all researchers agree that heavy drinking increases the risk of Alzheimer’s.
Heavy drinking in women increases risk of Alzheimer’s
Heavy drinking is on the rise in women, especially alcohol use disorder (AUD) which is characterized by compulsive alcohol use, loss of control over alcohol intake, and withdrawal when not using. In a study presented at the Alzheimer’s Association International Conference (AAIC) in July (Baharik et al), the impact of heavy drinking on dementia was assessed in female veterans. In more than 4,000 female veterans, those with AUD over the age of 55 were 3 times more likely to be diagnosed with dementia after just 3.6 years than those without AUD. Is this population of women, all of whom are veterans, especially vulnerable? More research is needed.
Drinking any amount of alcohol may increase the risk of Alzheimer’s in APOE4 carriers
APOE4 is a risk gene for Alzheimer’s, meaning those who possess one or two copies have heightened risk of developing Alzheimer’s in the future. Now we have several studies that have looked at how drinking alcohol impacts APOE4 carriers. In one study, both light and moderate alcohol consumption was associated with improvement in learning and memory in those who do not carry APOE4 risk gene. But in those who carry one or two copies of APOE4, learning and memory declined. Other studies have shown a linear relationship between the amount one drinks and the risk of Alzheimer’s in APOE4 carriers. Those carriers who drank only once or twice each month had a great risk of Alzheimer’s than those carriers who never drank.
The Take-Away for Brain Health: Although small amounts of alcohol may protect some people from dementia, more than a minimal amount quickly becomes detrimental. Heaving drinking increases the risk of Alzheimer’s, as does binge drinking at midlife.
If you are a carrier of one or two copies of the APOE4 risk gene, guidelines for minimal to moderate drinking may not pertain to you. Carriers seem to be especially vulnerable to the detrimental effects of alcohol on the brain, and we don’t know what level of drinking is safe. The best advice for carriers of the APOE4 risk gene for Alzheimer’s may be to not drink at all.
In any case, the impact of alcohol on dementia risk is more pronounced in women than men. Also, even though The Mediterranean diet and the Blue Zones celebrate wine as part of a healthy lifestyle, you don’t have to drink any alcohol at all to be brain healthy!
Exercise
Staying active over 70 is linked to less cognitive decline
Studies have long-supported that engaging in regular, vigorous physical exercise (e.g. a minimum of 150 minutes of aerobic exercise each week) reduces the risk of Alzheimer’s and other dementias. A paper presented at the AAIC in July (not yet published) underscored just how important it is to stay active beyond the age of 70. According to the study, active people in their 70’s were less likely to accumulate amyloid plaque (an inflammatory protein seen in those with Alzheimer’s). And, the exercisers with amyloid had less cognitive decline than their sedentary peers.
In other words, even though these over-70 athletes accumulated amyloid in the brain, they were less likely to show signs of Alzheimer’s.
The Take-Away for Brain Health: Don’t stop exercising just because you are over 70. Find an activity you enjoy, preferably while socializing with others, and keep at it. Work towards a minimum of 150 minutes of aerobic exercise each week. Balance your workouts with strength training twice weekly, along with restorative activities like gentle yoga and stretching.
Lifelong exercise reduces dementia risk by 60%
Results from the Shanghai Aging Study, those who exercised at a moderate to vigorous level were 45% less likely to get dementia over the next five years. Another study of 1,288 adults (as part of the Washington/Hamilton Heights-Inwood Columbia Aging Project) suggests that those who have exercised vigorously since their teenage years were 60% less likely to develop dementia. Even if study participants didn’t begin exercising until after age 50, they still were half as likely to get dementia than those who reported never being physically active.
The Take-Away for Brain Health: Exercise begun early in life is best; but late-starters (after age 50) can still expect a 50% reduction in Alzheimer’s risk. Physical activity and good vascular health may protect against Alzheimer’s even in the presence of amyloid plaque in the brain.
Put another way, exercisers build more resilient brains, meaning they are less likely to show signs of Alzheimer’s even if they become riddled with amyloid.
Sleep
While we sleep, the brain goes into a clean-up cycle
Earlier in the decade, sleep researchers discovered that getting enough high-quality sleep is key to fending of Alzheimer’s. That’s because the brain filters and flushes out certain by-products of metabolism into the cerebrospinal fluid during sleep. One of these toxins—amyloid protein—accumulates in the brains of Alzheimer’s victims. A new study published in the journal Science in November now shows how the brain waves of sleep help wash the brain of amyloid. Neural oscillations during deep sleep cause fluctuations in blood flow. This in turn brings coordinated waves of cerebrospinal fluid that flushes out toxins.
Social jetlag
In another study published this year, losing just one night of sleep in young, healthy men resulted in the rise of tau protein, a biomarker for Azheimer’s. This disruption in a regular sleep schedule is sometimes called “social jetlag.” In the past, this type of sleep disturbance was thought to be just a nuisance. Now we know that even a minor variation in your sleep schedule changes the chemistry of your brain.
Sleep medications may be protective for some, yet increase dementia risk for others
What about taking medication for sleep? In new data presented at the AAIC in July (and part of an ongoing study), researchers found that sleep medications may impact men and women differently. And, they found differences between races. In more than 3,000 healthy, dementia-free men and women over 70, those who took sleep medication “often” or “almost always” were 43% more likely to develop dementia compared to those who reported “never”, “rarely”, or “sometimes” taking sleep medications. In this study, white men were more impacted by sleep medications than women or black men.
Another paper presented at AAIC of 3,656 over 65 looked at whether sleep medications impact the Alzheimer’s risk of men and women differently. The men who used sleep medication were 3.6 times more likely to develop Alzheimer’s disease. For the women, it depended on whether or not their sleep was impaired to begin with. In women without sleep disturbances, taking a sleep med gave them a four-fold greater risk for developing Alzheimer’s. But if they had sleep problems, using the meds reduced their risk by 35.2%.
The Take-Away for Brain Health: Sleep is a powerful tool to slow down the aging of your brain. Avoid “social jetlag” by aiming for regularity in your sleep schedule, going to bed and getting up at the same time each day. Make getting enough sleep a priority. Most experts recommend giving yourself a “sleep opportunity” (or time spent in bed waiting to sleep or sleeping) of 7 to 8 hours each night.
If you’re not sleeping well, see your physician to figure out why. Both men and women should be cautious about using sleep medications since they are associated with an increased Alzheimer’s risk. Researchers are just now teasing out the differences between how sleep medications affect men and women differently. For better sleep, try non-medical strategies. Besides regularity, avoid screens at night, keep your bedroom cool, soak in a hot tub right before bed, and get mentally prepared for sleep an hour before bedtime. And don’t forget to take a look at your diet to make sure what you eat and drink aren’t keeping you from getting a good night’s sleep.
Researchers are just now teasing out the differences between how sleep medications affect men and women differently.
The power of combining brain-healthy lifestyle habits
This study, published in July in the Journal of the American Medical Association, looked at how a favorable lifestyle impacts Alzheimer’s risk. Following a brain-healthy diet and other lifestyle factors reduced risk by as much as 60% in those without a genetic mutation for Alzheimer’s. In those who possess one or two copies of the APOE4 risk gene, brain-healthy lifestyle habits reduced risk by 32%.
Conversely, investigators found that individuals at the highest risk had both a genetic risk factor and an unhealthy lifestyle; they were almost three times more likely to develop dementia within 8 years than those who followed a favorable lifestyle.
This was the first study to show that a brain-healthy lifestyle can reduce Alzheimer’s risk in those with genetic risk factors.
The 5 brain healthy lifestyle factors? Not smoking, exercise, minimal alcohol intake (as defined above), cognitive stimulation, and a brain-healthy diet. Researchers found that if a participant adopted one more low-risk lifestyle factor, whatever their current number of factors, their risk of Alzheimer’s decreased by an additional 22%.
The Take-Away for Brain Health: Adopting 4 or 5 brain-healthy lifestyle factors reduces Alzheimer’s even in those with genetic risk. This study highlights the importance of following multiple brain-healthy lifestyle practices that add up to a huge reduction in risk. And, that upgrading your lifestyle by adding just one more brain-healthy practice could yield a whopping 22% reduction in risk.
In the third installment of Top Brain Health Stories of 2019, we will look at the latest advances in medicine: new information about why women are more vulnerable to Alzheimer’s, new data about how pollution impacts dementia, and a cutting-edge model for a personalized medicine approach to those at risk.
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