Dr. Sanjay Gupta Reads From AARP-Supported Book 'Keep Sharp'
CNN's chief medical correspondent details and debunks the impact that certain foods have on the brain
Sanjay Gupta, M.D., is a neurosurgeon and CNN’s Emmy Award–winning chief medical correspondent. His latest book, Keep Sharp: Build a Better Brain at Any Age, published by Simon & Schuster in cooperation with AARP, is based in part on the work of the Global Council on Brain Health convened by AARP. In this audio clip, Dr. Gupta reads Chapter 7, "Food for Thought," in which he takes on the great plate debate. The book is available to purchase here.
'KEEP SHARP' CHAPTER 7: "FOOD FOR THOUGHT"
“The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.” —Mark Twain
Mark Twain’s humor is timeless. His quip about health may still be partly true today, more than a century later. But Twain’s witty observation carries a hidden truth: knowing what to eat for good health can be bewildering even by modern standards. I am amused by the number of diet books and related material that come out each year, often on cue around the “new year, new you” campaigns. Yet there is endless confusion about the ideal way to fuel your body — whether the goal is (“effortless”) weight loss, preventing heart disease, boosting brain function, or something else entirely.
Think about your own experience. How many times have you wondered: Paleo, keto, gluten free, low carb, low cholesterol, pescatarian, low fat, vegan? Those are just a small slice of the diets that have been reported over the past couple of years. Doctors seldom discuss nutrition with their patients. Once again, consider your own experience. When was the last time your doctor spent time with you going over your dietary choices and making science-backed suggestions? In a 2017 article published in JAMA, Dr. Scott Kahan of Johns Hopkins and Dr. JoAnn Manson of Harvard address the problem of this important subject getting left out of the conversation during office visits. The consequence, they say, is that “patients receive most of their nutrition information from other, and often unreliable, sources.” They cite that only 12 percent of office visits include counseling about diet. So if your doctor has had this talk with you (and you were honest in your replies to questions), consider yourself lucky.
About once a year, a compelling new protocol gains the spotlight, often backed by a weak or dubious hypothesis and cherry-picked science — what’s called “data dredging.” This helps explain why we read so many contradictory nutrition headlines. Today red wine, coffee, and cheese are found to be protective against dementia (and heart disease and cancer), and tomorrow another pair of studies pronounce that they do the opposite. Which brings me to the question I set out to answer: What is the best possible diet for my brain? Does it exist? Can it exist? Would Mark Twain wish he’d lived in the twenty-first century?
To get at the core of this issue, I spent countless hours with experts all over the country and synthesized a great deal of information because there is no consensus on the answer to this question. Nailing down any sort of conclusion is like trying to throw a blunt dart with a bad arm and hit a moving target. I was in fact astounded at how contentious the debate about diet can be (and the comical fact that the word die is within this four-letter word). Many of the foremost experts on the brain disagree on answers to basic questions that I thought would be straightforward and uncontested. Is gluten harmful to the brain? Are ketogenic diets hyped? Do “superfoods” for the brain truly exist (and just what qualifies as a “superfood”)? Is there a time and place for supplements and vitamins to make up for dietary flaws? As the late Senator Daniel Patrick Moynihan put it, “Everyone is entitled to his own opinion, but not to his own facts.” That statement couldn’t ring truer when it comes to the plate debate. The problem, however, is we don’t have all the facts. The experts themselves can’t even agree on the difference between opinion and fact.
For starters, I am comfortable saying this: We do have evidence that how you fuel your body can go a long way toward protecting your brain. That conclusion sounds simple but has been based on decades of research that has finally borne fruit. Dr. Manson has stated, “I’ve been impressed by the compelling evidence that nutrition and lifestyle drive down the risk of the major chronic diseases in the United States — type 2 diabetes, cardiovascular disease, cancer, and down the line [think dementia]. The evidence for this has reached a critical mass.” Her passion for getting the message out encouraged her to move away from a focus on clinical practice to one on population health and prevention research in an effort to address the risk factors of chronic disease rather than just disease management.
You can breathe a sigh of relief: I’m not talking about following a particular branded diet. I’m referring to a way of eating — a dietary style with general guidelines. This seems to make the biggest difference in health both short term and long term. When Sara Seidelmann, a cardiologist and nutrition researcher at Brigham and Women’s Hospital in Boston, looked at the eating habits of more than 447,000 people around the world, she found that no matter where you live or what your daily diet is like, avoiding entire food groups or restricting certain foods under the thinking you can game your way into good health is not an ideal approach. It might work for a while, but it could also backfire and hasten your death. Her advice, published in 2018 in the Lancet, echoes some unsexy, old advice: everything in moderation. I will add another reminder as well: We are all different, and getting to an ideal way of eating for you may be a little (or a lot) different than it is for someone else. Part of the solution is figuring out what really fuels you in the best way without digestive issues or food allergies. If you focus more on what you should eat instead of what you shouldn’t eat, you will end up fueling with good calories and naturally avoid the bad ones.
Say good-bye to following strict dietary protocols that are unrealistic and challenge your willpower. I titled this chapter “Food for Thought” for good reason: You’ll be given a general framework for creating meals that satisfy your preferences while staying on a path that fosters brain health. Besides, if you worry too much about “eating right,” you’ll raise your anxiety and increase cortisol levels, which would be more dangerous than the benefits of the “right diet” for brain health! Food should be a source of nutrition, yes, but it should also be a source of enjoyment. I go out of my dietary lane from time to time and have no guilt when I do. Guilt is bad for the brain, and too much of it makes you lose your sharpness.
What makes this area of medicine so tricky and controversial is that nutrition studies generally are limited. It’s very difficult, if not impossible, to conduct traditional studies on diets using a randomized, controlled design. These investigations cannot be compared to pharmaceutical studies because we cannot use a true placebo group to study essential nutrients. We can’t deprive people of certain nutrients they need to live just for the purposes of conducting a study. Also bear in mind that foods contain a staggering number of different biomolecules. If we find associations between a particular type of food and a health effect, the exact molecules that produce the desired effect are difficult or impossible to isolate because of the complex composition of foods and potential interactions among nutrients. Plus, there are underlying genetic factors to consider in consumers themselves. There’s also the practical issue of basing a nutritional study on people’s honest recollections of what they ate (Do you remember what you had for dinner last Tuesday? Will you confess to that decadent chocolate dessert last night?), as well as controlling for lifestyle (How many times did you break a sweat last week? Did you smoke any cigarettes? How many?). All of these variables and more can factor into the diet equation.
In 2018, these complexities triggered the retraction of a seminal study published in 2013 in the prestigious New England Journal of Medicine that endorsed a Mediterranean-style diet, which you’ve no doubt heard about over the years as being beneficial. Among the first studies to shine a positive light on Mediterranean-style diets, which are rich in olive oil, nuts, plant proteins, fish, whole grains, fruits and vegetables, and even wine with meals, was the PERIMED (Prevención con Dieta Mediterránea) research project conducted in Spain in the mid-2000s and published in the Annals of Internal Medicine. It concluded that such a dietary style could lower cardiovascular risk factors. The 2013 study showed people aged fifty-five to eighty who ate a Mediterranean diet were at lower risk of heart disease and stroke — by as much as 30 percent — than those on a typical low-fat diet. In 2018, the authors of the 2013 study published a reanalysis of their data in the same journal following criticism about their methodology. Although there were flaws in their original study, mainly due to the limitations of controlling for factors I already mentioned, their overall conclusion remained the same. Plenty of other studies have also shown that people who adhere to a Mediterranean-style diet enjoy greater brain volume as they age compared to their counterparts who don’t eat that way.
Dr. Martha Clare Morris is a professor of epidemiology at Rush University in Chicago and director of the Rush Institute for Healthy Aging, as well as a founding member of the Global Council on Brain Health. She is doing pioneering work to find effective dietary protocols to prevent Alzheimer’s disease. In 2015, she published the MIND diet for healthy brain aging, based on years of research into nutrition, aging, and Alzheimer’s disease. It was followed by her book Diet for the MIND. Her research focuses on studies that live up to the scientific method as much as possible despite the inherent limitations of nutrition studies. When I spoke with her about her study, she was excited that her investigations are among the first to show the effects of diet on the brain. Although she acknowledged the limitations of nutrition studies, she believes we are finally able to make data-driven suggestions about what we should be eating.
The MIND diet was created by taking the basics of two popular diets — the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) — and modifying them to incorporate science-supported dietary changes that improve brain health. MIND is a catchy abbreviation; it stands for Mediterranean–DASH Intervention for Neurodegenerative Delay. And there’s nothing surprising about the diet: thumbs up for vegetables (especially green leafy ones), nuts, berries, beans, whole grains, fish, poultry, olive oil, and, for those interested, wine; thumbs down on red meats, butter and stick margarine, cheese, pastries and other sweets, and fried or fast food. What might surprise you is how well this diet works. In her reasonably well-controlled study on this diet over ten years of nearly a thousand people, she showed it could measurably prevent cognitive decline and reduce the risk of Alzheimer’s disease. People who had the lowest third of MIND diet scores (meaning they followed the diet less) had the fastest rate of cognitive decline. People who had the highest third of scores had the slowest rate of decline. The difference between the highest third and lowest third in cognitive decline was equivalent to about seven and a half years of aging. I’ll take back seven and a half years of aging, and I am sure you would as well. People who were in the highest third of MIND diet scores had a 53 percent reduction in the risk of developing Alzheimer’s, and those who had the middle third of scores for following the MIND diet still enjoyed a 35 percent reduction in the risk of developing the disease.
So despite the challenges in conducting nutrition studies, we do have data to show the direct impact of nutrition on the brain and we are arriving at the best ways to feed it. We have enough evidence between outcomes in human clinical trials, mouse models, and epidemiological studies to make certain assertions with confidence. And I know that deep down you already knew that eating muffins every morning for breakfast with a mochaccino probably wasn’t going to get you where you really needed to go. Diets may seem confusing, but food isn’t.
MYTH: Superfoods like kale, spinach, nuts, and seeds will protect your brain.
TRUTH: The term superfood has no medical meaning whatsoever. Although it implies that a food provides health benefits, it’s a marketing term the food industry uses to sell more product. Some foods with the superfood halo on them can be supergood for you, such as fresh blueberries and a handful of omega-3-rich macadamia nuts, but be careful about claims that they do some thing specific for the brain. And there are “superfoods” sold out there that are anything but; juice drinks made with 100 percent fruits are mostly sugar and are stripped of what made those fruits super to begin with: fiber
WHAT’S GOOD FOR THE HEART IS GOOD FOR THE BRAIN
Over the course of my career, I’ve witnessed a sea change in how we view the relationship between diet and brain health. Once the science spoke and doctors listened, the mantra became, “What’s good for the heart is good for the brain.” That statement doesn’t paint the whole picture, but it’s not a bad place to start. Common conditions influenced by diet such as elevated blood pressure, high cholesterol, and diabetes harm both cardiovascular and cognitive health. Because you are reading this book, you probably already know that, especially if you suffer from any of these conditions. But separately, and more precisely, we can also say that a heart-healthy diet is a brain-healthy diet. Recent studies evaluating the incidence of dementia among large groups of people over several decades have found decreases in dementia occurring simultaneously with improvement in cardiovascular health. The 2017 AARP Brain Health and Nutrition survey, released in early 2018, also found that significantly more adults age fifty and over without heart disease rated their brain health/mental sharpness as “excellent” or “very good” compared to those with heart disease. The connection between the heart and brain goes far beyond the fact that the brain receives blood from the heart. It is important to remember, however, that the brain functions uniquely, and often separately, from the rest of the body. There is even a barrier — the blood-brain barrier — that acts like a gated door: Only certain molecules crucial to neural function are allowed into the brain from the blood. This is what makes the brain independent to some degree.
My search for more insights into diet and brain health specifically took me to neurologist Dr. Richard Isaacson, the director of the Alzheimer’s Prevention Clinic at Weill Cornell — a groundbreaking prevention clinic that’s on the cutting edge of medicine in the field of brain health. He is also the coauthor of The Alzheimer’s Prevention and Treatment Diet. Initially, the dean of the medical school thought Isaacson was crazy to establish a “prevention” clinic because Alzheimer’s disease had always been considered unpreventable. But times — and the thinking — have changed. Clinical trials are cropping up around the world now to study lifestyle interventions that have protective effects in people who are at an increased risk for cognitive decline and dementia. One, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, or FINGER Study, led by Dr. Miia Kivipelto, also a founding governance member of the Global Council on Brain Health, was completed in 2014 and reported that a two-year combination therapy that targeted things like a healthy diet and exercise found that these strategies can indeed help preserve cognition. In the United States, the Alzheimer’s Association is heading the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER), which also involves a two-year clinical trial. And in New York, Dr. Isaacson is making his own splash in these previously uncharted waters.
The Cornell dean took a gamble on Dr. Isaacson, impressed by his credentials at such a young age (he was barely thirty when he pleaded his case for his clinic), and was willing to let him “do the screening thing.” Now Dr. Isaacson oversees teams of people who build tech applications, assist with his research programs, and develop new methods of cognitive testing. In late 2018, his work made the cover of Alzheimer’s & Dementia, one of his field’s most prestigious journals and the flagship journal of the Alzheimer’s Association. The following year, his seminal study was presented at the annual conference for the Alzheimer’s Association and published in the same journal. This study made mainstream headlines for good reason: he has demonstrated that people can delay the progression of cognitive decline due to the aging process by two to three years, on average, through simple lifestyle interventions and even if they have a family history of Alzheimer’s disease. “Alzheimer’s disease begins in the brain decades before the first symptoms of memory loss, leaving ample time for people at risk to make brain healthier choices,” he reiterated to me. “Our study showed that people can be proactive and work together with their doctors to not only improve cognitive function, but also reduce their Alzheimer’s and cardiovascular risk. On average, people received twenty-one different recommendations that were personalized for them. Considering the results of this study, along with the totality of prior evidence, people should feel empowered to take control of their brain health starting today. One in three cases of Alzheimer’s may be preventable if that person does everything right, and I believe that individualized management is our most promising way forward in the fight against Alzheimer’s disease.” His methods are stirring a revolution in brain medicine. Unlike his predecessors, who didn’t consider dietary effects on the brain, Dr. Isaacson “prescribes” certain foods to his patients because he knows that nutrition matters. And he sees a difference in patient outcomes. He also prescribes other basic lifestyle strategies such as exercise, sleep, and stress management — which I will describe in detail at the end of part 2. I truly believe he’s setting a new model for tackling brain health and disease in the twenty-first century. People who were diagnosed with MCI at the start of this study and who followed at least 60 percent of the recommendations showed cognitive improvement.
Dr. Isaacson takes a novel approach to traditional ways of managing the disease and likens his methods to how we prevent and treat other chronic diseases such as hypertension and diabetes. Preventing — and treating — dementia requires a personalized plan for each individual because no single patient is the same. While patients may look similar in symptoms and pathology, the forces driving their disease and their individual risk factors can be very different, so what works for one person may not help the next. His philosophy is in line with the tenets of what future medicine will be for all of us: precision medicine whereby we are given specific, comprehensive protocols and prescriptions tailored to our physiology and needs. Customized care takes into consideration our genes, environment, and lifestyle. Isaacson likes to focus his efforts on prevention because he knows the disease starts decades before there are any outward signs. To support his mission, he has launched free online courses at AlzU.com that laypeople (and doctors) can take to educate themselves about brain health and learn about ongoing research that’s translated for a general audience. In part 3, I share more details about his astonishing results from his interventional studies. Dr. Isaacson is among the first scientists to document the beneficial effects of lifestyle habits on the risk for cognitive decline and lessening symptoms. Best of all, he’s revealing improvements in as little as eighteen months after he puts patients on his programs — some of whom are in their twenties with no obvious signs of cognitive problems but who want to stack the deck in their favor so they may be able to avoid dementia entirely as they get older.
Dr. Isaacson has focused much of his practice on reducing risk (both he and his brother were inspired by their family’s health history to become neurologists). The experience that really struck Isaacson involves his Uncle Bob. When Isaacson was three years old, he fell into his aunt’s pool and sank to the bottom. Uncle Bob, who was in the navy at the time, jumped in and rescued him. When Isaacson was in high school and applying to medical programs, Bob was diagnosed with Alzheimer’s disease at age seventy. Isaacson was crushed and kept wondering if he could develop a treatment to help the man who had once saved his life. His mission in life was set.
Dean Ornish’s mission is not too different. At his Preventive Medicine Research Institute in the San Francisco Bay Area, he and his colleagues, including Dr. Bruce L. Miller, director of the UCSF Memory and Aging Center, are conducting randomized, controlled clinical trials to determine if the progression of early to moderate Alzheimer’s disease can be reversed by a comprehensive lifestyle medicine program — without drugs, devices, or surgery. At the heart of his protocols is diet, among other basic (noninvasive, inexpensive) changes anyone can make. Dr. Ornish has long been a proponent of dietary interventions to treat, and sometimes reverse, a wide array of chronic diseases such as coronary heart disease, type 2 diabetes, early-stage prostate cancer, high blood pressure, elevated cholesterol levels, and obesity. The author of multiple best-selling books, including his latest UnDo It!, he has been a pioneer in the field of lifestyle medicine and has now set his sights on tackling Alzheimer’s disease. He believes we are at a stage of scientific evidence very similar to where we were forty years ago regarding coronary heart disease. In other words, epidemiological data, anecdotal clinical evidence, and animal studies show that Alzheimer’s disease may be prevented or slowed by making comprehensive lifestyle changes.
The whole idea of preventing Alzheimer’s or even mitigating symptoms after a diagnosis is a twenty-first-century concept. After hearing from researchers all over the world, I believe such an achievement is within our grasp, and it likely starts with how we fuel our bodies. What you eat could very well be one of the most influential benefits to your brain health now and in the future. After all, you eat every day and how your body responds to what you put in your mouth ultimately influences your entire physiology — all the way up to your brain.
While no single food is the key to good brain health, a combination of healthy foods will help secure the brain against assault, and it is never too early to begin. Think about it. The food you eat in your youth can start to lay the groundwork for protecting your brain in your later years.
It should come as no surprise that the typical Western diet — high in salt, sugar, excess calories, and saturated fats — is not brain-friendly. As the research concludes, a plant-based diet that is rich in a variety of fresh whole fruits and vegetables, particularly berries and green leafy vegetables, is associated with better brain health. I know you have heard that countless times, and you may be getting a little numb to it. Me too. But there are a few simple statistics I often share with my patients to make the point, like this one: “Increasing fruit intake by just one serving a day has the estimated potential to reduce your risk of dying from a cardiovascular event by 8 percent, the equivalent of 60,000 fewer deaths annually in the United States and 1.6 million deaths globally.”
The good news is that exceedingly small shifts can have a tremendously outsized effect. Who can complain about reaching for a juicy apple or a sweet handful of blueberries? Remember, we’re talking about a style of eating, not a rigid eat this, not that strong-arming directive. Only 10 percent of Americans get the recommended number of fruits and vegetables a day. In 2018, it was reported that more than a third of us eat fast food daily. At least one meal a day comes from a pizza box or a drive-through. And here was a surprise: Fast food intake rises with income.
But eating well means eating real food — not popping pills and supplements. While we all like the idea of a pill with the micronutrients neatly packaged in one swallow, that approach is not effective and not really possible. That bottle with broccoli on the label doesn’t really have broccoli in a pill. The evidence shows that micronutrients such as vitamins and minerals offer the greatest benefit when consumed as part of a balanced diet because all those other components in healthy food allow the micronutrients to be well absorbed and do their job better. Think of this as an “entourage effect.” While there may be some star players, they don’t work as well without the entourage of other ingredients. In other words, getting your B vitamins from eggs and your omega-3 fatty acids from fish trumps taking vitamins and supplements alone.
Changing your diet in an effort to optimize your brain will take some time, I realize — and it should. Most of us have a general idea of what’s good for us, and what we like and don’t like. I kept a food journal a few years ago to figure out what worked best for me. Fermented foods like pickles are a secret weapon for me but maybe not for you. I occasionally snack on them to boost my productivity. Find what works for you and make it part of your routine. In chapter 9, I offer food plan ideas so you know how to build in the right kinds of foods throughout your day and individualize the plan for you. One thought I share now is to aim for seven different-colored foods (real food — not jelly beans) every day. This usually has the impact of giving you all you need in terms of macro and micro nutrients. It may be a little harder than you think. Quick: Can you name seven different-colored foods?
Over the past several years, I have focused on creating a style of eating that I can easily maintain even when I’m on the road, but it does require planning and commitment. You should strive to do the same, which might require learning new methods for grocery shopping and finding the best, freshest foods for you and your family that meets your budget. What you should do immediately, however, is stop the external attack on your brain. Reducing your intake of sugar and artificially sweetened beverages, fast-food meals, processed meats, highly salty foods, and sweets is no longer a gentle suggestion; it is a mandate. Stop buying foods that a gardener or farmer (or your great-grandmother) wouldn’t recognize. When you replace potato chips and processed cheese dip with nuts or carrots and hummus, you lower trans fats and saturated fats while still having a satisfying snack. This is an easy one and it turns out to be incredibly helpful to your brain.
According to that same 2017 AARP Brain Health and Nutrition survey, adults age fifty and older who get the recommended amount of fruits and vegetables in a typical day report significantly better brain health, compared to those who do not get the recommended amount (70 versus 61 percent).15 The survey found that the more fruits and vegetables men and women consume, the more likely they are to rate their brain health higher. Of those who said they don’t eat any vegetables, fewer than half (49 percent) considered their brain health as “excellent” or “very good.”
MY GUIDE TO GOOD EATING
With the diversity in cultural practices and lifestyle habits around the world, there are many ways to approach dietary choices. I know my three daughters eat differently and have a different palate than I do, but we all take the extra time to eat real food instead of grub out of a box or a bag or a bottle. No single food acts as a silver bullet for improving or maintaining brain health despite the superfood halo that some foods get. Remember, it’s the combination of foods and nutrients in our meals (the entourage) that likely determines health benefits. To make this as easy and memorable as possible, I’ve summarized my guide to good eating for the brain using the SHARP acronym.
S: Slash the Sugar and Stick to Your ABCs
You can’t argue against the fact that all of us would do well to reduce our sugar intake. It’s the easiest way to gravitate toward healthier foods in general and limit the amount of processed junk. The average American consumes 163 grams of refined sugars (652 calories) per day, and of this, roughly 76 grams (302 calories) are from the highly processed form of fructose, derived from high-fructose corn syrup. My guess is that a lot of this sugar intake comes in liquid form — soda, energy drinks, juices, flavored teas, and the like — or we eat it in processed food products. When I eliminated added sugars from my diet after I did a 60 Minutes piece on how toxic sugar can be to the body, I missed it for a minute, and now have no problem avoiding foods that are typically full of sugar (not to mention other mindless ingredients). It was a win all around. My weight remains stable even during the times when I am not as active, and there is little question how much a high-sugar diet affects the “length of my cognitive day.” I can’t stay productive as long if I am eating sugar, as the inevitable crash happens.
Sugar intake is related to brain health in a wide variety of ways — too many to detail without probably inducing boredom. Nevertheless, I offer a few reasons why sugar in excess can be so toxic to the brain, and it boils down to our relationship with blood sugar control.
In part 1, I covered how Alzheimer’s can now be considered type 3 diabetes, whereby the brain cannot use insulin normally. I also noted that gaining control of blood sugar equates supporting brain health; multiple well-designed studies have found that people with high blood sugar had a faster rate of cognitive decline than those with normal blood sugar — whether or not their blood sugar level qualified as diabetes. High blood sugar can be stealthy in people who are of normal weight, but for those who are obese, it’s practically a given. Not only does the excess fat make people insulin resistant, but the fat itself releases hormones and cytokines, proteins that lead to a rise in inflammation, create a slow burning fire in the body and brain, and worsen cognitive deterioration.
When you follow your ABCs (more on this shortly), you will automatically be slashing your sugar consumption and reducing your risk for blood sugar imbalances, insulin resistance, and dementia. I’m not asking you to nix sugar entirely; we all love a little sweetness in our lives. But cutting back on volume and being choosier about our sugar sources is the shift to make. Sugar from a milk chocolate–based candy bar or fruit juice is not the same as sugar from dark chocolate or honeydew melon. When you need to add a touch of sweetness, try a pinch of natural stevia, a drizzle of honey, or a tablespoon of real maple syrup.
And what about artificial sugars? Sorry, but they are not a good replacement. While we like to think we’re doing ourselves a favor by replacing refined sugar with substitutes like aspartame, saccharin, or even seminatural products like sucralose, these are not ideal. The human body cannot properly digest these, which is why they have no calories, but they must still pass through the gastrointestinal tract. For a long time, we assumed that artificial sweeteners were, for the most part, inert ingredients that didn’t affect our physiology. But in 2014, a landmark paper, which has since been widely referenced, was published in Nature proving that artificial sweeteners affect gut bacteria (microbiome) in ways that lead to metabolic dysfunction, such as insulin resistance and diabetes, contributing to the same overweight and obesity epidemic for which they were marketed to provide a solution. These are the same conditions, as you know now, that increase risk for brain decline and serious dysfunction. Try to avoid these sugar substitutes. In general, reducing refined flours and sugars — real and artificial—is a good idea. This means eliminating or severely limiting chips, cookies, pastries, muffins, baked desserts, candy, cereals, and bagels. Watch out for products labeled “diet” or “lite” or “sugar free” because that usually means they are sweetened artificially. Remember that the best foods don’t come with nutritional labels or health claims. They are the whole, real foods you find around the perimeter of a grocery store.
Let’s get to those ABCs. It’s a method to discern the top-quality foods, the A-listers, from the ones we should include (B-list) or limit (C-list). The Global Council on Brain Health, in its 2019 report Brain Food: The GCBH Recommendations on Nourishing Your Brain, described the most brain-healthy diets from around the world and provided a useful framework for foods to encourage and those to limit. Later in this chapter, I’ll give you some ideas for meal-making so you can see how these ABCs work in real life; it’s similar to the Mediterranean-style diet.
A-LIST FOODS TO CONSUME REGULARLY
>> Fresh vegetables (in particular, leafy greens such as spinach, chard, kale, arugula, collard greens, mustard greens, romaine lettuce, Swiss chard, turnip greens)
>> Whole berries (not juice)
>> Fish and seafood
>> Healthy fats (e.g., extra-virgin olive oil, avocados, whole eggs)
>> Nuts and seeds
B-LIST FOODS TO INCLUDE
>> Beans and other legumes
>> Whole fruits (in addition to berries)
>> Low sugar, low-fat dairy (e.g., plain yogurt, cottage cheese)
>> Whole grains
C-LIST FOODS TO LIMIT
>> Fried food
>> Pastries, sugary foods
>> Processed foods
>> Red meat (e.g., beef, lamb, pork, buffalo, duck)
>> Red meat products (e.g., bacon)
>> Whole-fat dairy high in saturated fat, such as cheese and butter*
*There has been a lot of noise around the debate about saturated fat. Which is worse in terms of causing heart disease: saturated fat or sugar? Saturated fat, especially from animal products, is not harmless. If you eat a lot of fatty meats, butter, lard, and cheese, your high intake of saturated fats could raise your risk for all causes of premature death, including dementia. What the research shows, however, is that replacing butter, cheese, and red meat with highly refined carbohydrates (such as white flour products and white rice) does not reduce heart disease risk. I’d rather you enjoy an artisanal cheese plate with whole-grain bread or crackers than buffalo wings dipped in blue cheese dressing or chili cheese fries. You get my point.
H: Hydrate Smartly
As we age, our ability to perceive thirst diminishes. This helps explain why dehydration is common in older people, and dehydration is a leading cause for admission to emergency rooms and hospitals for the elderly. A good rule of thumb is that if you feel any thirst, you have already waited too long. (And by the same token, if you feel stuffed, you have already eaten too much.)
One of my mantras is “drink instead of eat.” We often mistake hunger for thirst. Even moderate amounts of dehydration can sap your energy and your brain rhythm. Because our brains are not really that good at distinguishing thirst and hunger, if there is food around, we generally tend to eat. As a result, we walk around overstuffed and chronically dehydrated.
The link between hydration status and cognitive ability and mood is well recognized. Dehydration often leads to cognitive problems in older folks, which can be assessed by examining changes in short-term memory, numerical ability, psychomotor function, and sustained attention. Researchers have found that even moderate dehydration is associated with confusion, disorientation, and cognitive deficits. The degree to which thinking skills are affected is dependent on the severity of dehydration, and the extent to which observed cognitive performance and associated neural activity are reversible with rehydration is a topic of ongoing investigation. The lesson here is to stay hydrated, and the best way to do that is with water. You also can have your morning coffee or tea.
Most people get their antioxidant fix in caffeine. Several studies have found an association between drinking coffee and tea and decreased risk of cognitive decline and dementia. We don’t know exactly how or why this is the case. We know that the short-term effects of caffeine have been shown to increase alertness and cognitive performance (as well as athletic performance), but the long-term effects are less well understood. Several studies have suggested that those who drink coffee have better cognitive function over time than those who drink less coffee. But it’s possible that the caffeine or compounds in coffee and tea may not be the cause of improved outcomes; rather, people who drink tea and coffee are also more likely to have higher education levels or better health, which are tied to improved cognitive performance and lower risk of dementia. The good news is that you’re not going to do your brain any harm by drinking coffee or tea unless you’re downing copious amounts of caffeinated energy drinks in combination with your coffee (which you shouldn’t be doing anyhow). Just be sure your caffeine consumption doesn’t interfere with your sleep. For most people, it’s ideal to scale back the caffeine intake in the afternoon and be caffeine-free after about 2 p.m.
Alcohol does not count as a source of hydration, but it can be part of a healthy diet. We hear competing messages in the news about the benefits (or lack thereof) of alcohol. While there is substantial evidence that moderate alcohol consumption can have protective heart health and cognitive benefits, some studies indicate there are also adverse effects on the brain from alcohol consumption. Alcohol consumed even in moderate quantities has been linked with negative brain health outcomes in some people. And therein lies the difference: in some people. For you, a daily glass of wine may help your heart and brain function better over time, but for your friend, the opposite may be true. The trouble with alcohol is that people can slip into abusing it, gain a tolerance to excessive amounts, and establish a bad habit — or worse, addiction. There are both short-term and long-term risks associated with excessive alcohol consumption, including learning and memory problems. Any excessive intake of alcohol will have negative effects on every organ in the body. And as we age, our ability to metabolize alcohol decreases. In 2017, a report published in JAMA Psychiatry revealed a jarring trend: alcohol abuse is rising among older adults. The researchers speculate the causes to be everything from increased anxiety in general to more robust late-lifers who think they can continue the drinking habits of their youth.
The debate about the risk-benefit analysis on alcohol — and its related studies — will surely continue, but here’s what I suggest: If you don’t drink alcohol, don’t start drinking in order to protect your brain health. If you drink alcohol, don’t overdo it, because it is unclear what the beneficial level of consumption is for brain health. For men, moderation is up to two drinks a day (a drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces — one shot glass — of liquor); for women it’s one drink. While that is partly because women are physically smaller, more alcohol puts women at higher risk for breast cancer as well. Ideally, choose red wine mostly because it does contain polyphenols, micronutrients that may act as antioxidants that affect blood pressure and are not typically contained in spirits or beer.
A: Add More Omega-3 Fatty Acids From Dietary Sources
We hear a great deal these days about the benefits of omega-3 fatty acids — the brain-nourishing gems from seafood, nuts, and seeds. Unfortunately, the American diet is extremely high in another type of omega — the omega-6 fats, abundant in the corn and vegetable oils used in so much processed, fried, and baked food. The result is that we consume a disproportionate amount of omega-6 fats. According to anthropological research, our hunter-gatherer ancestors consumed omega-6 and omega-3 fats in a ratio of roughly 1:1. Today the average American eats a disproportionate amount of omega-6 fats compared to omega-3s: anywhere from 12:1 to 25:1 omega-6 to omega-3. As you might guess, that’s mostly because we eat too much omega-6, while at the same time our intake of healthier, brain-boosting omega-3 fats has dramatically declined from evolutionary norms.
Fatty fish is a wonderful source of omega-3 fatty acids (especially salmon, mackerel, and sardines), and even wild meat like beef, lamb, venison, and buffalo contain this healthy fat. Plant sources of omega-3 fatty acids include flaxseed, plant-derived oils (olive, canola, flaxseed, soybean), nuts, and seeds (chia seeds, pumpkin seeds, and sunflower seeds). Food sources — not supplements — are the best way to obtain omega-3 fatty acids. In fact, fish oil supplements have come under scrutiny lately due to mixed results in studies. Although fish oil supplements have been billed as an easy way to protect the heart, lower inflammation, and improve mental health, the evidence is far from definitive and compelling (and yet Americans spend more than $1 billion a year on over-the-counter fish oil).
In January 2019, for example, Harvard researchers reported in the New England Journal of Medicine that omega-3, also known as marine n-3, fatty acid supplements did nothing to reduce the likelihood of a heart attack in men fifty and older, as well as women fifty-five and older who did not have any risk factors for cardiovascular disease. Other studies have also shown that taking too much fish oil, which is easy to do with supplements, can have surprisingly negative side effects, such as higher blood sugar levels, increased risk of bleeding due to effects on blood clotting, as well as diarrhea and acid reflux (heartburn).Unless you have a true deficiency, I’d rather you get omega-3s from foods, not supplements. You would be hard-pressed to overdose on fish and walnuts! And remember, nearly all the studies that link omega-3 to brain health have largely been done on food sources, not supplements. That fact alone speaks volumes.
The impact of omega-3 fatty acids on the brain has been extensively studied, and there is a wealth of information on the link between omega-3 fatty acids and healthy brain aging. Studies examining the role of omega-3 fatty acids have widely considered them together as a whole rather than looking at the specific types of omega-3 fatty acids: EPA (eicosapentaenoic acid), ALA (alpha-linoleic acid), and DHA (docosahexaenoic acid). DHA is the most prevalent omega-3 fatty acid in the brain and has been shown to play an important role in the maintenance of neuronal membranes, and fish as well as algae have plenty of it. No surprise, then, that in large-scale surveys, those who typically eat fish or other seafood every week report better brain health than those who never eat fish or seafood.
I think it’s safe to say we all would do well to eat more fish. In some regions of the country, fish can be less expensive than meat. Just be sure you know where your fish is coming from. Avoid fish from polluted waters or places where the mercury content in the fish can be too high. Mercury is a heavy metal that can harm the brain and is not easily eliminated from the body. A good resource to check is the Monterey Bay Aquarium’s Seafood Watch website (www.seafoodwatch.org). The site can help you choose the cleanest fish (wild or farmed) that are harvested with the least impact on the environment.
MYTH: Supplementing your diet with vitamins, omega-3 fish oil, and vitamin D is a good thing. It will help make up for dietary flaws.
FACT: Supplements do not take the place of real food, and some can be harmful. The supplement industry is woefully unregulated; supplement manufacturers do not have to test their products for effectiveness or safety. While there are some quality supplement makers with a solid and ethical track record, use should be considered on an individual basis under a doctor’s recommendation.
Let me talk about supplements more broadly, beyond the fish oils. A basic rule is that when you eat right, you shouldn’t need to supplement. While taking a multivitamin a day might confer a placebo effect (you think it’s actually doing you some good or somehow making up for nutritional deficits), they are probably not going to help you prevent any illness or brain decline unless you truly have a nutrient deficiency. Although nutrient deficiencies in the Western world are extremely rare, some neurologists recommend certain supplements based on a patient’s individual circumstances and biology. Most of us are eating a fortified diet. Even fresh mushrooms now come “fortified” via irradiation with vitamin D. Researchers, including Pieter Cohen at Harvard, have pointed out that even with a standard American diet, we are probably not likely to be broadly deficient in most vitamins, thanks to fortification. The problem is more the quantity of what we are eating, not the deficiency.
When I worked on a film about the supplement industry, I was stunned at just how unregulated it is. Thus far in 2019, the Food and Drug Administration has issued twelve warning letters to companies that were illegally marketing fifty-eight dietary supplements with claims to prevent, treat, or cure Alzheimer’s disease or other serious conditions. Supplement makers don’t have much of an obligation to prove their product is safe or effective before taking it to market. And as Dr. Dean Sherzai of Loma Linda University and the author of The Alzheimer’s Solution explains, it is actually harder than you think to take the “good” stuff out of food and put it into pill form. While you may be able to get the active ingredients isolated and even synthesized, real food is made up of a multitude of molecules, and we have only begun to scratch the surface in defining what they all do. Some seemingly inert molecules may help the active ingredients travel through the body, acting as vehicles. Other molecules may help unlock receptors, allowing the molecules to activate their targets. As I mentioned earlier, it is referred to as the entourage effect and helps explain why real food is always going to be a better option than a supplement.
Keep in mind that most studies that look at the utility of supplements rely on self-reporting of both usage and symptoms. It leaves a lot of room for interpretation and bias. It is part of the reason we get constantly conflicting studies — one day, it is a great savior and the next, it has no benefit. If you contemplate supplementing, do so under the supervision of a doctor. This area needs to be personalized.
MYTH: Taking supplements marketed for boosting brain health, such as ginkgo biloba, coenzyme Q10, and apoaequorin (a protein from jellyfish) is a great way to prevent dementia.
TRUTH: We’d all love to think we can maintain our cognitive powers by popping a few pills a day. These antidementia supplements are backed by some clever advertising and are often sold by major retailers, giving them the hue of total legitimacy. But they are not backed by science. No known dietary supplement improves memory or prevents cognitive decline or dementia — no matter what the manufacturers claim in bold promises that you see on the internet, in newspaper ads, and on TV. These supplements are often promoted by testimonials that appeal to people worried about brain health. Don’t be fooled. Spend the money you’d waste on supplements on something that will help your brain: a good pair of walking shoes or a new pillow for a good night’s sleep.
R: Reduce Portions
You’ve heard this lesson before: Portion control is a potent skill and a potent preventive strategy in any health-related goal. We Westerners love our gigantic plates and heaps of food. Look no further than Thanksgiving dinner or the spread on Super Bowl Sunday (as a nation, we eat more food on Super Bowl Sunday than any other day of the year). Occasional overindulgence won’t kill you (or your brain), but every day in between, we have to diligently watch our caloric intake. All the experts I spoke with for this book mentioned portion and calorie control. It’s a given in any brain wellness conversation.
The easiest ways to gain control of your portions and calories are to prepare meals yourself at home, measure accurately, and don’t go back for seconds. You know what you’re putting into the meals you cook and have better control over ingredients and portion sizes. The research also speaks: Frequently cooking at home does indeed lead to better diet quality and improved health and weight. One thing we often don’t think about, however, is cooking methods and their impact on nutrition. For example, there are benefits of slow, low-temperature cooking such as sautéing as compared to fast, high-temperature cooking such as frying. Frying can generate harmful chemical compounds that may promote inflammation and harm brain health. When possible, turn to boiling, poaching, steaming, or baking. This is yet another reason to cook more at home: You get to decide which method to use. We tend to gravitate toward fried and grilled fare when we’re eating out. At home, however, in addition to controlling for cooking methods, you can also avoid those mystery oils, sauces, and added ingredients. If time is an issue and you can splurge a little, take advantage of the increasing volume of home grocery delivery services.
How about fasting? Intermittent fasting has come back into the spotlight in recent years as a method of reducing calorie consumption, another subject matter I encountered a lot when I was researching this book. There are two common approaches to fasting. One is to eat very few calories on certain days, then eat normally the rest of the time. The other involves eating only during certain hours and skipping meals for the rest of each day. I know a lot of fellow doctors who eat just two meals a day and go for extended periods of time without eating. They will fast overnight from dinner until lunch the following day, thereby fasting for twelve to sixteen hours straight. This helps reduce their overall caloric input (unless, of course, they’re consuming huge portions when they do eat). Although large, long-term studies on the benefits of fasting are still lacking, there is some evidence in animal models that it can slow the progression of certain age-related diseases and boost memory and mood. It also has been shown to improve insulin sensitivity, a good thing in the name of metabolism and, ultimately, brain health.
Dr. Mark Mattson is a professor of neuroscience in the Johns Hopkins School of Medicine and also serves as chief of the Laboratory of Neurosciences at the National Institute on Aging. He has devoted much of his life to studying the brain and the effects of cutting caloric intake by fasting up to several days a week. In laboratory experiments, Professor Mattson and his colleagues have found that intermittent fasting, which in his definition means limiting caloric intake at least two days a week, can help improve neural connections in the hippocampus while protecting neurons against the accumulation of those dangerous amyloid plaques. According to his theory, fasting challenges the brain, forcing it to react by activating adaptive stress responses that help it cope with disease. From an evolutionary perspective, this makes sense. One thing we know is that when fasting is done correctly, it can increase the production of brain-derived neurotrophic factor (BDNF), a protein I defined earlier that helps protect and strengthen neural connections while also spurring new growth of brain cells. Physical exertion and cognitive tasks can also trigger higher levels of BDNF.
Fasting is not for everyone (it can take some getting used to (sort of like exercise if you’ve been sedentary), but I’ll give you some ideas in chapter 9 should you want to try it and have checked with your doctor. I’ve tried it several times, and after the first time, it becomes much easier than you might think.
P: Plan Ahead
Put another way, don’t get caught starving and resorting to junk food (simple carbohydrates, lack of fiber, and saturated fats). Food is all around us, especially the junky kind. When hunger strikes and we’re not prepared, well-ingrained animal instincts will push us in the wrong direction. We will gravitate toward whatever is quick, tasty, and satisfying (hello, cheeseburger, fries, and soft drink).
Once or twice a week, try to plan your main meals in advance and grocery-shop accordingly. Aim to build more fiber into those meals, including whole fruits and vegetables (for fruits, bananas, apples, mangoes, and berries rank high on the fiber content; for vegetables, the darker the color, the higher the fiber content); beans and legumes; whole grains; and seeds, including wild and brown rice. I haven’t talked much about fiber, but it’s key to brain health because it changes the overall chemistry of a meal. When you lack fiber, the carbohydrates you eat will get absorbed more quickly, thereby raising glucose and insulin levels and potentially increasing inflammation. Fiber intake has long been shown to help prevent depression, hypertension, and dementia through a variety of biological pathways. It also has been tied to successful aging in general. There are two types of dietary fiber: soluble and insoluble. Soluble fiber dissolves in water, which turns it into a type of gel that lowers cholesterol and glucose levels; it’s found in oats, peas, beans, apples, carrots, and citrus fruits like oranges. Insoluble fiber can’t dissolve — it’s the roughage that keeps the other digestive fluids moving through your intestines. This type of fiber is found in nuts, whole grains, wheat bran, and vegetables like green beans. It’s the tough matter that’s not broken down by the gut and absorbed into the bloodstream (it stays intact as it moves through the digestive system).
There’s no easier way to consume more fiber than to plan meals ahead, focusing on adding more fibrous plants to the plate and avoiding the fiberless fare from eating out at generic restaurants or out of a box.
Organic? Grass Fed?
Contrary to reports in the media, we have no good proof that eating organic foods provides any more nutrition than conventionally grown foods. Most people concerned about organic versus conventional are thinking about how pesticides, herbicides, and trace amounts of hormones and antibiotics can potentially have adverse health effects, even if that has not been adequately proven. When people ask me if it’s ideal to eat purely organic, I say that given the current science, in general it’s not necessary. But if you’re concerned about chemical exposures due to traditional farming practices, try not to buy produce that’s on the Dirty Dozen list, published each year by the Environmental Working Group (EWG). This list is based on U.S. Department of Agriculture findings of conventionally grown foods most likely to contain pesticide residues: strawberries, spinach, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, potatoes, and sweet bell peppers. Fruits and vegetables with thicker skins tend to have fewer pesticide residues, because the thick skin or peel protects the inner flesh. Remove the skin or peel, as you would with a banana or avocado, and you’re removing much of the residue. The EWG puts out another list of foods, too, called the Clean 15: avocado, sweet corn, pineapple, cabbages, onions, sweet peas, papayas, asparagus, mangoes, eggplants, honeydews, kiwis, cantaloupes, cauliflower, and broccoli.
When you want to occasionally splurge on a good steak, grass-fed beef is a better alternative to conventionally farmed cattle. Grass-fed beef, which comes from cattle not fed grains like corn, has a different composition as a result. It has less total fat, more heart- and brain-healthy omega-3 fatty acids, more conjugated linoleic acid (another type of healthy fat), and more antioxidant vitamins, such as vitamin E. Another strategy that works for me is not keeping meat at home; I consume it only when I’m eating out. This helps me stick to a more plant-based diet low in red meat.
Spice It Up
The fare of my Indian heritage is rich in spices. Turmeric in particular is considered one of the seven essential Indian spices, and it’s not only a darling in traditional Indian cooking but is gaining star status in research circles as well. Curcumin, the main active ingredient in the spice turmeric, which is the substance that gives Indian curry its bright color, is currently the subject of intense scientific inquiry, especially as it relates to the brain. It has been used in traditional Chinese and Indian medicine for thousands of years. Lab studies have repeatedly shown that curcumin has antioxidant, anti-inflammatory, antifungal, and antibacterial activities, although we don’t know exactly how it exerts these effects. Its powers have attracted the interest of research scientists around the world, including epidemiologists searching for clues to explain why the prevalence of dementia is a lot lower in communities where turmeric is a staple in the kitchen.
In 2018, a study conducted at UCLA led by Dr. Gary Small, a top physician and researcher on the aging brain that I introduced earlier, hit the media for its stunning results: People with mild memory problems who took 90 milligrams of curcumin twice daily for eighteen months experienced significant improvements in their memory and attention abilities. They also had a boost in mood. This was a well-designed, double-blind, placebo-controlled study that involved forty adults between fifty and ninety years old. Thirty of the volunteers underwent PET scans to determine the levels of amyloid and tau in their brains at the start of the study and after eighteen months. (Tau proteins, you will recall, are a microscopic component of brain cells that are essential to neuronal survival. But when they undergo chemical changes, they can become damaged, altered, clumped up, and thus harmful.) After the trial, the brain scans showed significantly fewer amyloid and tau signals in regions of the brain that control memory and emotional functions than those who took placebos. As of right now, there aren’t any approved medications that can reliably do the same thing. The researchers are embarking on a follow-up study with a larger number of participants.
Turmeric is one of many spices that can lend flavor to dishes. It’s one of my favorites, and we use it a lot in my home. In addition to classic spices and herbs, seasonings and condiments are often part of meals. They can be a source of flavor and nutrition, but a note of warning: They can also be combined with sugar, salt, saturated fats, and other ingredients we’d do well to limit. This is especially true when it comes to certain condiments, prepared sauces, and salad dressings. Read the labels.
The Gluten Debate
I’m pretty sure you’ve heard about gluten or, more precisely, the gluten-free diet. Gluten is the main protein component of wheat, rye, and barley. It’s found in many foods, including breads and pastas, cookies, muffins, and breakfast cereals (and it’s often the reason these foods have a delectable, chewy texture). You’ve also likely heard about people avoiding gluten for a variety of reasons, from losing weight to supporting intestinal health. A gluten-free diet is the only proven treatment for celiac disease, an immune-based disease affecting nearly 1 percent of the U.S. population. In people with celiac disease, dietary gluten triggers an immune reaction that results in intestinal damage. These people must avoid gluten, or they can suffer serious health consequences such as abdominal pain and diarrhea and even nonintestinal symptoms like headache, osteoporosis, and fatigue. Anecdotally, many patients with celiac disease report that when they are unintentionally exposed to gluten, they develop recurrent symptoms that often include transient cognitive problems, including word finding and memory difficulties. This phenomenon, often referred to as “brain fog,” is not well understood, and the mechanism by which gluten triggers these cognitive symptoms is unknown.
In addition to those with celiac disease, there are also people who describe symptoms including “brain fog” who improve on a gluten-free diet and yet do not have celiac disease. These people are said to have nonceliac gluten sensitivity. Because there is no definitive test to diagnose this condition, it’s usually made after a test for celiac disease produces a negative result. Despite popular claims that gluten contributes to cognitive problems in the general population, there is no evidence to suggest that gluten has an effect on mental function in people without celiac disease or nonceliac gluten sensitivity. Given the principle that what is good for the heart is good for the brain, I should note that diets high in gluten have not been linked to heart attack risk. In fact, a low-gluten diet, if it is low in beneficial whole grains, could pose an increased risk of coronary heart disease. I also add that people who claim to feel much better when they go gluten-free tend to clean up their diets in ways that do in fact benefit them but have nothing to do with the gluten aspect. They eat wholesome, fresh foods. They engage more in other healthy habits like exercise. And they see outcomes like weight loss and more energy that motivate them to keep doing what they’re doing.
You do not have to go gluten free if you don’t have celiac. The key is to choose gluten-containing foods carefully. Avoid gluten-containing refined flours found in white bread, crackers, chips, and pastries because they are not doing you much good, and move instead toward more fibrous, whole-grain foods that boost heart and, in turn, brain health.
Feeding Your Brain
• Using smaller plates is an effective method for controlling portion sizes.
• Eat fish (not fried) at least once a week.
• Look at the sodium content in prepared foods you are eating. Baked goods such as bread, canned soups, and frozen foods are typically high in salt, and you might not realize there is a lot of salt in what you are eating.
• Choose frozen vegetables and fruit, which are typically low in salt and high in essential nutrients, when you’re creating fresh meals instead of buying frozen, ready-to-eat meals.
• Eat a wide variety of different colored vegetables. The nutrients that give green bell peppers, for example, their color are different from those that give red or orange bell peppers their hue. When you “eat a rainbow” of vegetables, you eat a more diverse array of nutrients, many of them brain-friendly antioxidants. Try to add new vegetables to your diet, and experiment with new ways of cooking and preparing them.
• Use vinegar, lemon, aromatic herbs, and spices to increase flavor in food without increasing salt content. • Check the labels of spice blends to determine if they contain salt.
• Use mono- and polyunsaturated fats in cooking, such as extra-virgin olive oil, canola oil, safflower oil, and sesame oil. For high-heat cooking, try avocado oil.
• Steer clear of partially hydrogenated oils. That’s code for trans fats, which are fading out of the food supply but still find their way into lots of processed foods; fried foods like doughnuts; baked goods such as cakes, frozen pizza, and cookies; and margarines and other spreads. Trans fats raise your harmful (LDL) cholesterol levels and lower your good (HDL) cholesterol levels. Eating trans fats increases the risk of developing heart disease, stroke, and type 2 diabetes. All of these diseases can harm the brain and increase your risk of cognitive decline.
• Prepare meals at home. This gives you more control over the salt, sugar, and fat content than if you buy prepared meals or food from restaurants.
My final word of dietary wisdom is floss. Dr. Gary Small added this tidbit to our interview, and it’s worth sharing here. Flossing — and brushing — your teeth twice daily removes food debris and bacteria buildup that can ultimately lead to gum disease and increased risk of stroke. The connection to the brain? Gum disease entails inflammation. Periodontitis is an infection of the gums, the soft tissue at the base of the teeth, and the supporting bone. As the natural barrier between the tooth and gum erodes, bacteria from the infection have an entry into the bloodstream. Those bacteria can increase plaque buildup in the arteries, perhaps leading to clots. Hence, flossing is now a good-for-brain habit.
Audio excerpt courtesy of Simon & Schuster Audio from 'KEEP SHARP' by Sanjay Gupta, M.D., read by the author. Copyright © 2021 by Sanjay Gupta, M.D. Used with permission from Simon & Schuster, Inc.
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