aging, dementia, mentalhealth

Can Dementia be Prevented by Diet and Lifestyle?

Protecting ourselves against dementia may mean doing what comes naturally: an active life with whole foods, time in nature, and community engagement.By ROBIN JACOBS

delay-dementia01As we grow older, many of us begin losing sleep over the looming possibility of developing Alzheimer’s or other forms of dementia. Ironically, both sleep problems and anxiety increase our risk profile for developing these conditions. Especially if we’ve cared for a parent or other relative with dementia, we want to feel like we have the power to change our own fate. While pharmacologists have not yet developed the miracle pill to banish all fears for good, recent research reveals what we can do to significantly lower our risk. And guess what: every one of these changes will improve our quality of life starting right now.

Around every corner, a flashy web page promises to reveal the five (or ten, or twelve) “magic foods” to boost brain functioning and prevent dementia. Often the list is composed of perfectly healthy components of a balanced diet, such as blueberries, walnuts, or spinach, alongside some more recently celebrated ingredients like chia seeds, turmeric, and coconut oil. What’s missing, though, is the big picture. Anxiously adding in a few servings of these super-foods-of-the-moment is not in itself a magic bullet. If we’re caught in a stressful, over-scheduled, or sedentary routine with no room for active time outside, unhurried preparation of a wholesome meal, or fun outings with friends, something needs to change.

delay-dementia02The evidence is in: our minds, by and large, are only as healthy as our bodies. Much as western thought likes to place a dividing line between the cerebral and the physical, in fact our brains depend upon the same blood vessels, nutrients, blood sugar levels, and hormones that course through our limbs. For much of our adult lives, we can “get away with” neglecting our bodies and expecting our minds to continue doing what they do best: solving problems, generating ideas, communicating, and multitasking. But as the signs of aging creep up upon us — at first slowly, subtly, and then in a seeming avalanche — the illusion breaks down.

The diseases widely associated with dietary and lifestyle factors — including type 2 diabetes, obesity, cholesterol imbalances, heart disease and metabolic syndrome— are all significant risk factors for dementia. Everything your doctor tells you about taking care of your heart, arteries, and blood sugar will serve you well in your quest for lasting brain health.

As your arteries stiffen, brain plaque is building simultaneously, suggests a new study which persuasively associates arteriosclerosis with Alzheimer’s.  Another study shows that low LDL (“bad”) cholesterol and high HDL “good” cholesterol are linked to lower accumulations of amyloid brain plaque. These are simply correlations: we might not know exactly why these associations exist, but they’re worth paying attention to. Exercise and diet improvements are key in managing both healthy arteries and good cholesterol balance.

And it’s not just the condition of your blood vessels, but what’s in your blood — specifically, sugar levels. Japanese researchers found that a diabetes diagnosis heightened dementia risk in their sample population. Metabolic syndrome, often thought of as a precursor to diabetes or stroke, raised incidence from 4.1% to 7.2% among a group of nearly 5000 women during a 4-year period. Metabolic syndrome is essentially a clustering of several factors, including abdominal obesity, high blood pressure, low “good cholesterol” (HDL), high triglycerides, and high fasting blood sugar. Not surprisingly, metabolic syndrome is strongly associated with lack of physical activity. In addition to exercise, cut back on sugar and other high glycemic foods (especially refined flours) which can contribute to development of metabolic syndrome and type 2 diabetes.

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It’s never too late to get active — outside!

Increasing exercise may be the single most self-protecting thing you can do. A group of older adults who walked briskly 3 times a week actually increased their brain volume in a single year, while those who abstained lost volume! In a study of 1740 individuals over 65, those who exercised 3 or more times per week had less incidence of dementia (13 per 1000) than those who didn’t (20 per 1000). So if you’re an older adult, and you think you might be too “set in your ways” to start new habits, reconsider.

You don’t have to join a gym — though for some, the staff and peer support available at exercise facilities helps in maintaining a new routine. In fact, getting outside can potentially double your benefits: expose your sunscreen-free limbs to the midday sun (for about half the time it takes your skin to begin to sunburn) while you’re out there for your daily dose of vitamin D. Older adults with particularly low vitamin D levels may be doubling their chances of dementia, and even moderately low levels indicate a major risk increase. Natural sunlight is still the most reliable way to improve your D levels. The darker your skin, the longer you need to expose your skin for adequate vitamin D production; the farther you live from the equator, the harder it is to get adequate D from the sun alone during winter (in the northern states, even if you can stand to bare your skin outside in winter, D production will be negligible). When sun is not an option, The Vitamin D Councilrecommends a supplement of 5000 IUs of D3 per day for adults.

It can be as simple as a brisk walk every morning after breakfast. You may be surprised that the exercise increases your energy for the next task at hand.  Gardening is another fulfilling (and rewarding) form of exercise, if you find yourself breathing more rapidly and experiencing a rise in your body temperature while wheelbarrowing, digging, or raking. It makes intuitive sense that daily time in nature, well known to boost physical and mental health across the board, also provides a gentle healing stimulation to the brain.

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Make it social

When you go for your brisk walk to the park, call a friend or two to join you! In a 28-year study on adult male twins, researchers found that a twin who engaged in frequent social stimulation (such as family outings, visiting with friends, club activities and hobbies) actually reduced their dementia risk, even if they carried a known high-risk Alzheimer’s gene. Common retiree favorites like bingo, volunteering for political or church groups, and even attending sports games or restaurant dates contributed toward a 70% decrease in cognitive decline in one older adults study.

These activities are usually rewarding on their own, but for some introverted adults who are accustomed to spending time alone in a regular routine, it can be confusing to know how to begin. Especially in urban areas, people are turning increasingly to online forums such as Meetup.com, which offers a wide variety of user-initiated group activities, generally hosted by friendly enthusiasts who are open and welcoming to newcomers. Even activities which might be called “passive” such as going to the movies, a concert, or the theater, were found to indicate more positive outcomes.

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Keep your mind engaged

No one can definitively say why, but education lowers dementia risk by about 40%. This may indicate a “use it or lose it” tendency for your brain; attending higher education early in life may simply establish habits of intellectual engagement that tend to persist. Of course you don’t have to enroll in college to have an active, alert mind: the self-motivated will find ample opportunity to challenge oneself at home and at work, by grappling eagerly with knotty problems, reading books that push one’s understanding, and engaging in lively debates at the dinner table.

Keep it novel: try learning a new musical instrument, or a foreign language. If you’re used to crosswords, try switching to Sudoku; if you’re a chess master, try bridge. Don’t worry about excelling at the new challenge, just enjoy the process. Neuroscientist Art Kramer jokes that “the best advice might be to join a book group that walks and drinks red wine [for the antioxidants] while talking about the book”. Social, intellectual, physical — and hopefully fun! Experiment with a combination that suits your interests and personality. If you enjoy it, you’re much more likely to stick with it.

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Plan your meals for simplicity and nutrition, not overindulgence

We all have the best intentions to eat moderately and wholesomely, but our schedules, stress-level, and cultural conditioning can sabotage our efforts. As we age, our bodies simply require less calories, and those who adjust and naturally curb their intake suffer less cognitive impairmentthan those who overeat. To increase satisfaction while lowering consumption, savor your food slowly and mindfully — or with an interesting companion or stimulating book! But beyond “everything in moderation”, what specifically should we eat? Fortunately, it’s not complicated. It turns out that many of the simple whole foods which have justly gained praise in recent years will help you maintain your brain health too. We like to focus on the neighborly and sustainable: grow what you can, and support your local farmers and fishers.

Beans and legumes regulate blood-sugar and provide B-complex vitamins, which may protect against brain shrinkage. The vitamin C in citrus fruits, bell peppers, and strawberries may help prevent dementia-related brain plaque, as well as maintaining healthy blood vessels which are essential for brain health: a preliminary study showed that Alzheimer’s patients have lower C levels than their unaffected peers. Almonds are a good source of vitamin E: if you have high levels of E in your blood, your risk-level may be 25% lower.

delay-dementia07Low omega-3 levels have been linked with brain shrinkage and lower scores on memory tests. Salmon, sardines, and other low-mercury fatty fish are the simplest way to meet your omega-3 needs — also, the DHA in fish is important for your heart, which of course feeds back to your brain. Aim for 2-3 servings of fish per week to reduce your dementia risk by 50%! Some supplements such as krill oil can also fill this need for non-fish-eaters. Berries, green tea, red wine, chocolate, citrus and kale are among many wonderful foods to boost your flavonoids, which are crucial to maintaining key synaptic connections, helping to prevent the progression of any cognitive degeneration. Happily, many of these nutrients have also been investigated for their potential to inhibit cancer growth.

Coffee has made news recently for health benefits, after decades of perception as a “vice” beverage: evidence is mounting that moderate coffee consumption (around 3 small cups a day — hold the sugar, of course) can change brain chemistry to protect against degeneration. In a study of women with early dementia warning signs, those with no caffeine in their blood were far more likely to progress to full-blown Alzheimer’s than those with moderate caffeine levels.

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Make it do-able: don’t try to change each of your habits overnight. Start with one at a time and challenge yourself gently, yet steadily. All-or-nothing change — in which we set impossible goals, then despair and give up when we inevitably lapse — are a set-up for failure. Share your intentions with those close to you, so they can support your efforts: if you can get another family member on board, you may find you have a willing walking companion, or fewer junk foods tempting you in the fridge or cabinets. The more bases you can cover, the greater your health gains in all areas. Periodically, review your checklist and set new goals:

  • Exercise outdoors 3+ times per week
  • Maintain a healthy weight
  • Eat a balanced, whole-foods diet
  • Participate in regular social and cultural activities
  • Challenge yourself intellectually
  • Moderate alcohol consumption (0-2 drinks per day)
  • No smoking (Learn more about quitting)

There is no crystal ball. We can’t change our genes, and much of dementia’s progression remains a mystery. So rather than worrying, let’s make the most of our bodies’ and minds’ current abilities, with the hopes that our efforts will reward our future selves too. With most of these lifestyle adjustments, we come out ahead on enjoyment and vitality right now (you won’t miss those junky snacks for long). Fascinatingly, some elderly people have all the physical signs of Alzheimer’s in their brains, yet don’t develop symptoms: researchers wonder if some of these lifestyle factors may explain their resilience.

Think of it as an excuse to take some “safe risks” for your own health and happiness: phone an interesting acquaintance and plan a hike together. Serve an unfamiliar vegetable at dinner tonight. Dig a new garden bed in the middle of your lawn, and read up on growing raspberries, tomatoes, or asparagus. Breathe deeply and celebrate the wonders of each passing season. Start where you are.

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