Power Foods for the Brain

Neal D. Barnard, MD Physicians Committee for Responsible Medicine

Adjunct Associate Professor of MedicineThe George Washington University School of Medicine

What Matters Most?

Alzheimer’s attacks half of us by age 85.

2010 2020 2030 2040 20500

5

10

15Alzheimer's Prevalence in the U.S.

(mill

ions

)

Hebert LE. Arch Neurol. 2003;60:1119-1122

Memory ProblemsLapses

Mild cognitive impairment

• Learning, remembering • Reasoning• Visual-spatial ability• Language • Personality

Alzheimer’s disease =

APOE epsilon-4 Allele

From one parent: 3x risk

From both parents: 10 - 15x risk

Chicago Health and Aging Project

Saturated Fat

13 grams 25 grams

Alzheimer’s Risk

Add Up the Saturated Fat

2 large eggs 3.2 g 1 slice bacon 1.0 g Chicken thigh, skinless 4.7 g Whole milk (1 cup) 4.6 g DiGiorno Pizza for One 12.0 g

Total 25.5 g

Cardiovascular risk factors, Aging, and Dementia (CAIDE) study, FinlandEskelinen MH. Int J Geriatric Psychiatr. 2008; 23: 741–747.

1,341 adultsAverage age: 50Followed 21 years

Mild Cognitive ImpairmentSaturated fat per day

Low (<21.6 grams)

High (>21.6 grams)

Cardiovascular risk factors, Aging, and Dementia (CAIDE) study, FinlandEskelinen MH. Int J Geriatric Psychiatr. 2008; 23: 741–747.

1,341 adultsAverage age: 50Followed 21 years

Mild Cognitive Impairment APOEε4

Low(<21.6 grams)

High (>21.6 grams)

Saturated fat per day

Trans FatsLow:

1.8 gramsHigh:

4.8 grams

Alzheimer’s Risk

Cholesterol and Alzheimer's Risk

<198

198-2

20

221-2

4824

9+0

1

2

Serum Cholesterol (mg/dL)

Rel

ativ

e R

isk

9,844 participants in the Kaiser Permanente health plan.Solomon A. Dement Geriatr Cogn Disord. 2009;28:75–80.

Alzheimer's Risk

25.1

0

1

2

3

4

Saturated Fat per Day (grams)

Rel

ativ

e R

isk

Alzheimer's Risk

25.1

20.7

0

1

2

3

4

Saturated Fat per Day (grams)

Rel

ativ

e R

isk

Alzheimer's Risk

25.1

0

1

2

3

4

Saturated Fat per Day (grams)

Rel

ativ

e R

isk

Alzheimer's Risk

25.1

20.7

13.0

0

1

2

3

4

Saturated Fat per Day (grams)

Rel

ativ

e R

isk

Alzheimer's Risk

25.1

20.7

0

1

2

3

4

Saturated Fat per Day (grams)

Rel

ativ

e R

isk

Alzheimer's Risk

25.1

20.7

13.0 3.3

0

1

2

3

4

Saturated Fat per Day (grams)

Rel

ativ

e R

isk

?

Alzheimer's Risk

25.1

20.7

13.0

0

1

2

3

4

Saturated Fat per Day (grams)

Rel

ativ

e R

isk

Meat vs. Plant-Based Diets

Proportion remaining free of dementia

Loma Linda University, 272 participants Giem P. Neuroepidemiology. 1993;12:28-36.

Meat vs. Plant-Based Diets

Loma Linda University, 272 participants Giem P. Neuroepidemiology. 1993;12:28-36.

Proportion remaining free of dementia

What else is lurking in plaques?

Plaques

Β-amyloid protein

Cholesterol

Iron and copper

Copper

Another Culprit?

Aluminum in Drinking Water

88 county districts in Britain

Aluminum in water: Low (<0.01 mg/L) High (>0.11 mg/L)

Similar findings in France.

Martyn CN. Lancet 1989;333:61-62.Rondeau V. Am J Epidemiol 2009;169:489-96.

→ Alzheimer’s ↑ 50%

Vitamin E

Vitamin E and Alzheimer’s Risk

Risk over 3.9 years of follow-up Morris MC. JAMA. 2002;287:3230-3237

Low vit E:(4.2 mg)

High vit E:(7.6 mg)

%

Vitamin E

Walnuts Sesame seedsSunflower seedsAlmonds Pecans PistachiosFlax seed

BroccoliSpinachSweet potatoes MangoesAvocados

Food versus Pills

Foods have 8 forms of vitamin E. Chicago study: ~8 mg per day

1 ounce nuts or seeds = ~5 mg of vitamin E

Homocysteine

Folate

Vitamin B6

Vitamin B12

More Power for the Brain

B-Vitamins for Brain Power

Folate: 800 mcgVitamin B6: 20 mgVitamin B12: 500 mcg

223 people over age 70 with MCI, homocysteine ≥11.3 µmol/LUniversity of Oxford, VITACOG studyde Jager CA. Int J Geriatr Psychiatry. 2011; [Epub ahead of print]

Hopkins Verbal Learning Test, revised, with delayed recallUniversity of Oxford, VITACOG study de Jager CA. Int J Geriatr Psychiatry. 2011; [Epub ahead of print]

0 1 25

6

7

8

9 Memory(Delayed Recall)

Years

Placebo

6.9

5.9

Hopkins Verbal Learning Test, revised, with delayed recallUniversity of Oxford, VITACOG study de Jager CA. Int J Geriatr Psychiatry. 2011; [Epub ahead of print]

0 1 25

6

7

8

9 Memory(Delayed Recall)

B-Vitamins

Years

Placebo

6.9

7.2

5.9

6.8

Placebo B-VitaminsHcy 22 → 30, atrophy 2.5%/y Hcy 24 → 12, atrophy 0.5%/y

Brain changes over 2 years. Blue indicates contraction. University of Oxford, VITACOG studySmith AD. PLoS ONE. 2010;5(9):5(9): e12244. doi:10.1371/journal.pone.0012244

Concord Grape Juice Mild cognitive impairmentAverage age: 781 pint daily

0 1 2 330

35

40Learning

(California Verbal Learning Test)

Grape Juice

Months

Placebo

33.2

38.6

33.2

35.2

University of Cincinnati Krikorian R. Br J Nutr. 2010;103:730-4.

0 1 2 34

5

6

7

8 Recall(California Verbal Learning Test)

Grape Juice

Months

Placebo

5.4

7.2

5.0

6.0

Blueberry Juice Mild cognitive impairmentAverage age: 761 pint daily

0 1 2 3

5

10

15Learning

(Verbal Paired Associate Learning Test)

Blueberry Juice

Months

University of Cincinnati Krikorian R. J Agric Food Chem. 2010;58:3996-4000.

0 1 2 35

6

7

8

9

10 Recall(California Verbal Learning Test)

Months

Blueberry Juice

Who eats that way?

Are there extra benefits from avoiding “bad fats”?

1 gram of fat = 9 calories

1 gram of carbohydrate = 4 calories

Physical Activity

University of Illinois, 120 adultsBrisk walk, 3 times per week

Reversed brain shrinkage Improved memory

Erickson KI. Proc Natl Acad Sci USA. 2011;108:3017-22.

Dr. Barnard’s Exercise Tips

1. Arrive at airport as late as possible. 2. Carry massively heavy luggage. 3. Run for the plane.

Beginning Aerobic Exercise

Begin with 10-minute brisk walk.

Increase 5 minutes per week, up to 40 minutes.

The Bilingual Advantage

Languages protect your brain.

Delays cognitive decline by ~5 years.

Craik FI. Neurology. 2010;75:1726-9.

Mental Activity Reduces Alzheimer’s Risk

• Intellectual activities

• Documentaries, newspapers

• Crosswords, anagrams

WELLILL

Online Cognitive Training

Lumosity.comFamiliar Faces

Online Cognitive Training

Lumosity.comWord Bubbles

WordsFacts

SkillsEmotions

Slow Wave Sleep REM Sleep

Amyloid Production Falls During Sleep

But wait, there’s more….

Medications That Affect Memory

Midazolam (Versed) Cholesterol-lowering drugs Sleeping medicationsAntidepressants Antihistamines Anxiety medications Blood pressure medications Acid blockers

Medical Conditions That Affect Memory

Depression Thyroid disease InfectionsMigraines Chemotherapy Gluten intolerance

□ Avoid “bad fats” □ Avoid excess metals□ Vitamin-rich foods□ Vitamin B12

□ Physical activity□ Mental stimulation □ Sleep □ Medications

Checking our Scorecard

PCRM 2009 USDA 2011

Beginning a Healthful Diet

Step 1. Check out the possibilities

Breakfast

Lunch

Dinner

Snack

Foods to Try

Healthy Breakfasts

• Cinnamon Raisin Oatmeal• Blueberry Pancakes

• Hot Whole Wheat with Dates• Breakfast Scrambler

• Fantastic Fruit Smoothie• Whole-Grain Bagel with Jam

• Swiss Style Muesli• Slow Cooker Whole-Grain Porridge

• Orange-Pineapple Crush

Lunches and Dinners• Chunky Vegetable Chili

•Chuckwagon Stew • Seitan & Mushroom Stroganoff • Portobello Mushroom Steaks • Oven-Barbecued Tofu Steaks

• Roadhouse Hash • Sweet & Sour Tempeh

• Southern Beans & Greens • Seitan Cassoulet • Mandarin Stir-Fry

• Stuffed Vegetable Rolls • Zucchini & Herb Calzones

• Chili Bean Macaroni

Italian Cuisine

Mexican Cuisine

Chinese Cuisine

Japanese Cuisine

Fast-Food Options

Veggie delight

Bean burrito, hold the cheese

Beginning a Healthful Diet

Step 1. Check out the possibilities

Step 2. Do a 3-week test drive

Optional: Use transition foods

Resourceswww.pcrm.org

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PCRM.org

PCRM.org

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