A grain of salt

(Knowing what I know, Part 4)

“Knowing what you know about Alzheimer’s disease, what do you do differently in your own life?”

I’ve been slowly making my way through my responses to this question in a series of posts, so far covering advance care planning, physical exercise, and cognitive activity. Today I’m feeling ready to tackle The Big One. “Big” in that I know it’s what most people are seeking when they ask me questions about preventing dementia: What should I eat?

There is currently no known way to prevent Alzheimer’s disease or other types of dementia. Lots of anecdotal evidence, sure. And many books for sale on the topic, yes. You don’t need to send me the Amazon links. There is, however, credible research about the impact of diet on risk, and I do make some personal choices accordingly.

What I do

Lots of plants. I’ve still never heard advice that I like more than Michael Pollan’s: “Eat food, not too much, mostly plants.” And when it comes to brain-healthy eating, this simple guideline holds. Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) is a well-researched method that combines the principles of the traditional diets of Mediterranean cultures and Dietary Approaches to Stop Hypertension (DASH). You can read more about it here. Large-scale, long-term studies demonstrate that the MIND diet, which emphasizes whole grains, vegetables, fruit, nuts, seeds, and legumes, decreases normal age-related cognitive decline and reduces the risk of developing Alzheimer’s disease. I don’t follow the MIND diet explicitly, but strive to eat a vegetable at every meal and at least two servings of fruit per day – and more when I can. We’ve belonged to the Community Supported Agriculture (CSA) program of a local farm for many years, and I enjoy the challenge of using up every item in the delivery, which keeps us eating a variety of seasonal produce year-round.

Plenty of fat. Extremely low-fat diets are sometimes recommended for individuals with heart disease, but the brain requires dietary fat, and plenty of it. Stick with fats that come from plants, though, and you can keep both your heart and your brain healthy. I try to have a small handful of mixed nuts daily, and mostly use oils and cooking fats that come from olives and seeds. It would be better for my health to cut down on dairy, and we happily drink and use nut milks now. But cheese and butter bring me gustatory joy, and I have stopped fighting with myself over them. Instead I try to remain mindful of both portion sizes and the pleasure they bring.

Some fish. We aren’t vegetarians, but eat primarily vegetarian at home, because we enjoy legumes and vegetables, and I enjoy creative, improvisational cooking with them. Happily, it’s also cheaper, better for the environment, and healthier than cooking with meat. I make a point, however, to try and prepare fish at home at least one night per week, because the omega-3 fats found in fatty, cold-water fish are associated with cardiovascular health and decreased inflammation, both of which contribute to better brain health. Also: we like it. Two servings of fish per week are generally recommended, and sometimes I’ll treat myself to a second serving in the form of a tin of sardines or anchovies, but if I get in a serving per week, I call it good.

Only a little sugar. Sugar intake is clearly linked to many forms of inflammation, and its role in dementia risk is under investigation. But it’s unquestionably bad for our health. I’m more of a crunch and salt gal, but I will never turn down my neighbor’s delicious fresh baked chocolate chip cookies, or a slice of cake on someone’s birthday. And I do love pie. I mean I really, really love pie. I don’t care for soda, but I do enjoy cocktails, beer, and wine, so I try to be careful about how much sugar I take in that way. (More on that subject later.) The deal I generally make with myself is that I’ll have either an alcoholic drink or a dessert daily, but not both. Except on special occasions. I’m sure that would make a dietician cringe, but that’s about as strict as I can get about these things.

What I don’t do

Supplements and superfoods. “Superfoods” is a marketing term, and I see no benefit in loading up on specific fruits, vegetables, nuts, fish, or bacteria. If it came from a plant that isn’t poisonous to humans, then it’s probably pretty super. By eating what our CSA delivers throughout the year, and what’s cheapest and nicest-looking at the market each week, I’m taking in a variety of micronutrients. If lab work revealed a vitamin or mineral deficiency, I’d certainly adjust my diet accordingly, and consider supplementation with a doctor or pharmacist’s guidance. But in the absence of any known deficiencies, supplementation is unnecessary. Let’s expend more effort on healing the soils in which we grow our food to make it more nutritious, and less on the manufacture of supplements, nutraceuticals, and “medical foods.”

Keto. The ketogenic diet is a method of fasting through a high-fat, very low-carbohydrate diet, which forces the organs to metabolize ketone bodies instead of glucose. It’s been demonstrated to have some anti-inflammatory and neuroprotective effects, but there is not sufficient evidence of a protective effect against dementia to justify the downsides, which include gastrointestinal problems, weight loss, and hyperlipidemia. I stick to ways of eating that allow for a wide range of nutritious – and enjoyable – food, the maintenance of a stable weight and cardiovascular health, and adequate energy for the types of activity I enjoy.

What I’m still not sure about

Intermittent fasting. I’ve read several articles on the subject, and still don’t know where I land on this. The idea is caloric restriction that produces the state of ketosis described above, generally accomplished by either scheduling intermittent days of extremely low caloric intake (a few hundred calories per day, two days per week), or restricting the window of time during which one eats in a 24-hour period (between 6-8 hours). A healthy, balanced, and varied diet is generally encouraged by proponents of intermittent fasting, though, so I don’t completely object to it in principle.

Coffee. There’s ample evidence that moderate caffeine consumption, in the form of coffee or tea, has several beneficial health effects. But of course it’s a stimulant, and because sleep is so essential to good brain health, I’m cautious with it, even though the smell of a freshly-brewed pot of coffee is often what gets me out of bed in the morning. I could easily drink more, but limit myself to two cups of coffee in the morning, and sometimes a cup of green or black tea in the early afternoon. Life without coffee, I figure, would probably make me marginally more healthy – but significantly less happy.

Alcohol. The research here is murky, and layered with so many social and personal issues that I admit it’s hard to be clear-eyed about the data. Ethanol is poisonous to humans, and even light drinking is known to significantly increase the risk of several different types of cancer – to say nothing of its addictive properties, and personal and social consequences. Dementia prevention research consistently touts the risk-reducing effects of light-to-moderate alcohol intake (a daily glass of red wine with dinner is consistent with the MIND diet), but articles are always careful not to encourage anyone to start drinking alcohol for its health benefits. “It’s better not to drink alcohol, but since you’re probably going to … ” Unlike those two morning cups of coffee, alcohol is something that I can be happy and functional without drinking daily, but it’s such a longstanding social habit that it does require I make a conscious effort not to drink. I limit myself to a few drinks a week now, in the interest of brain and general health, and that dessert-or-a-drink deal I cut with myself usually does the trick. But the need to cut deals with oneself about alcohol is something that gives me pause, and I can’t say I’m at peace on this one.

In summary, I try to keep my practices around food and drink as simple and straightforward as possible. But I’m inclined to overthinking, and it’s not always easy. I read and learn what I can, making changes that incorporate new information when it seems reasonable, but always taking it with a grain of salt. Or a nice healthy herb or spice substitute.

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Do you eat for brain health? Or are you trying to? I’d love to hear your thoughts, strategies, questions, and arguments.