and Optimal Brain Healt
Earl Mindell, RPh, MH, PhD
Introduction: Why You Need a Memory Supplement, 1
1. Drugs That Can Cause Memory Loss and Reduce Cognitive Function, 9
2. The Mediterranean Diet: How Diet Can Impact Memory and Cognition, 27
3. Vitamin, Mineral, and Herbal Supplements for Better Brain Function, 41
4. Brain Supernutrients, 49
5. Stress, Sleep, Socializing, Exercise, Learning, and Your Brain, 59
About the Author, 92
Introduction: Why You Need a Memory Supplement
Today, 4.5 million Americans and 35 million people worldwide are impacted by age-related memory and cognition problems. By 2050, the number worldwide is expected to climb beyond 115 million. Fifteen new cases of dementia are diagnosed every minute.
Human life expectancy has increased by about eight years in only five decades. Dementia is becoming a serious problem because we are living longer life spans than ever before, and the diseases that once did us in before we experienced loss of memory and decreased thinking ability are no longer life-threatening. More people survive well into their eighties and beyond than ever before. They want to live full, involved, independent lives, which requires good cognitive function.
Dementia is chronic and progressive. Its future in crease here in the United States and in other countries— especially developing countries—stands to wreak havoc on the ability of younger generations to manage its economic and caregiver impact.
The good news is that there is a lot we can do to forestall the brain changes that lead to cognitive decline. We know a great deal about the factors that most strongly influence brain aging. And you’ll be surprised to learn how many very commonly prescribed medications—drugs being taken by the majority of those over seventy years old in some parts of the world—may be contributing to the epidemic of premature cognitive decline. Exercise is particularly potent here—only an hour a week appears to cut the risk of Alzheimer’s disease in half.
Before we begin looking at solutions, let’s take a look at the most common memory and cognition issues people tend to face as they age.
This is a catchall term describing any form of cognitive decline. The most common cause of age-related dementia is Alzheimer’s disease, but it can also be triggered by one or more small strokes, which can cause cumulative damage that has symptoms like those of Alzheimer’s. The only way to know for sure whether dementia is specifically of the Alzheimer’s variety or is due to other causes is to actually look at an individual’s brain tissue postmortem, like Dr. Alzheimer did with his first patient (see below).
ALZHEIMER’S DISEASE (AD)
In 1906, Bavarian physician Alois Alzheimer identified the first defined case of what he called “presenile dementia.” The patient gradually lost her ability to form and retain short-term memories, and developed other symptoms too, including agitation. After her death, Dr. Alzheimer dissected her brain and found deposits of a substance called beta-amyloid, along with neurofibrillary tangles, or clumps of damaged neurons, in a part of the brain called the hippocampus. This was the first documented case of the disease that now is responsible for 60 to 80 percent of dementia cases.
Most people who develop AD are sixty-five or older, but up to 5 percent of people who have the disease fall into the category of “early onset”—they begin to have symptoms in their forties or fifties.
Alzheimer’s disease is a progressive disease that worsens over time. On average, a person can expect to live between four and twenty years following the point at which his or her symptoms become obvious. Life expec tancy for someone with AD also depends on the person’s overall health and the presence or absence of other health conditions. Alzheimer’s disease is the sixth leading cause of death in the United States.
Modern medicine does not have a cure for AD. Medical treatments do exist, and they vary in effectiveness. Research into both alternative and mainstream therapies is ongoing, as are investigations designed to help create preventive programs or to slow down the progression of the disease once it is diagnosed. Sometimes, the best that can be done is to improve quality of life for the person with AD and to help keep caregivers’ responsibilities manageable.
The risk of AD is substantially increased by several of the same activities and factors we know to increase risk of heart disease and cancer:
- Physical inactivity increases risk of AD by 82 percent.
- Depression increases risk 65 percent.
- Hypertension (high blood pressure) in midlife increases risk by 61 percent.
- Obesity in midlife increases risk by 60 percent.
- Smoking increases risk by 59 percent.
- Diabetes increases risk by 46 percent.
The damage that ultimately leads to AD symptoms begins to develop a decade or more before those symptoms appear. Damage seen in AD involves inflammation, oxidative stress, loss of mitochondrial resources, and insulin resistance in brain cells (also called neurons). Together, these factors contribute to creating atrophy and damage in nerve cells crucial for learning and short-term memory.
I’ll go into more detail about all these factors later in this book. The important basics, for now, are that all of these factors are strongly influenced by diet and lifestyle. It is theorized that the buildup of amyloid, a protein substance, in the brain—the thing believed to gum up the works in AD—is actually a part of an immune response gone awry. Modern unhealthy diets depleted of crucial nutrients “trick” the body into sending overblown immune defenses to tissues where they end up doing more harm than good.
Diets high in sugars, other refined carbohydrates, and unhealthy fats, and low in whole plant foods push blood sugar balance in an unhealthy direction, setting the stage for type 2 diabetes (which is expected to be diagnosed in nearly half of adults in the United States in their lifetimes). Type 2 diabetes and its precursor, insulin resistance, lead to chronically high blood sugars and insulin levels. This, in turn, worsens every physiologic circumstance that contributes to AD. People with diabetes who control their blood sugar, eat a really healthy diet, and exercise can do a lot to slow cognitive decline and delay a potential AD diagnosis.
SENIOR MOMENTS: AN INEVITABLE PART OF AGING?
You forget the name of a lifelong friend. You miss an appointment. You can’t remember your ATM PIN number. You go upstairs to get something, then can’t remember what you had planned to get. You misplace your car keys. “Senior moment!” you say. But how do these moments really feel?
Depending on how much your mental acuity means to you, you might experience a chuckle of recognition, a shock of real fear, or some combination of the two. If you aren’t sure whether this is a harbinger of more serious memory and cognition problems, your feelings might be more along the lines of mortal terror.
Let me allay any fears you might have that “senior moments” are linked to AD or other kinds of dementia. Scientists have traced these lapses in memory or thinking back to a decline in a specific protein in the brain called RbAp48. Levels of this protein in the hippocampus, the same part of the brain impacted by AD, decline as we age. Minor senior moments that don’t interfere significantly in your day-to-day life are not likely to suggest dementia setting in.
Some of the more exciting aspects of this research suggest that restoring RbAp48 in the hippocampus could help restore cognitive function lost with the passage of time.
If you do have concerns about mental fogginess or forgetfulness indicating a more serious problem, enlist friends and loved ones to give you feedback about how forgetful you seem to them over time. Do they see a worsening of the problem? If so, something called mild cognitive impairment (MCI)—a middle ground between AD and senior moments—may be setting in. It’s sensible to get evaluated by a physician if you suspect you may have MCI.
Simple steps like getting enough sleep, engaging in healthy coping strategies in response to stress, eating well, using targeted nutritional supplementation, and keeping your brain active and engaged will help prevent senior moments from getting the best of you. So does more mindfulness—paying more intense attention to the sensory details of what is going on around you. Don’t try to multitask. Allow new memories to form more vividly as you move through your life, and engage in practices like mental rehearsal or replay of things you want to make sure you remember.
I’d also recommend going easy on yourself in terms of your expectations that you should be able to stay on top of everything this busy world throws your way. In this digital age, our day-to-day responsibilities and the number of things we’re expected to track and remember has ballooned to a point where even a sharp thirty-year-old has to struggle to manage it all.
THE BRAIN INITIATIVE
(Brain Research Through Advancing Innovative Neurotechnologies)
This book comes to you during quite an exciting time in the study of the human brain. The federal government has committed $100 billion in funding toward scientific endeavors aimed at gaining a better understanding of this miraculous and mysterious three-pound chunk of nervous system tissue.
The BRAIN Initiative is analogous to the Human Genome Project, which began in the 1980s and culminated in the early 2000s with publication of the sequencing of 90 percent of the 3 billion base pairs contained in the human genome. That project revealed an astonishing amount of information that has aided medical science in understanding, preventing, and treating human diseases, and we have every reason to expect that this concerted effort to understand the workings of the human brain will have a similar impact.
The BRAIN Initiative will enroll the best and brightest research minds across disciplines, bringing them together in collaborations that will enrich our understanding of the brain’s function and the ways in which damage occurs. It will help us broaden and deepen our understanding of the biological foundations of mental processes, which will help us understand and treat mood disorders, autism spectrum disorders, and other common issues. We’ll better understand how we think, feel, perceive, and remember, and we’ll be able to translate that understanding into more effective prevention and treatment of brain issues across the whole life span.
The sooner we begin to mindfully impact as many of these factors as possible through targeted nutrition and lifestyle changes (including replacing brain-draining prescription drugs with nutritional supplements and dietary choices that make them no longer necessary), the longer we’re likely to hang on to our mental sharpness and our precious memories, and to not create unnecessary burdens for our children and grandchildren.
Even now, so many adults who are raising their own kids have become members of the so-called “sandwich generation,” acting simultaneously as caregivers for their offspring and for their aging parents whose cognitive decline makes living on their own too risky a proposition. No one should have to be in the middle of that sandwich. It’s a terribly stressful place to be, and it can certainly increase stress and compromise health for people who are in a life stage where good health should be a given.
I, for one, hope to live at least a century in good health and with my mental faculties intact! So far, I’m staying at the top of my game, and in these pages I’ll share with you a comprehensive plan for doing the same for yourself. My advice is drawn from my lifelong work as a pharmacist, an herbal expert, and an author of dozens of books, booklets, and articles about nutritional supplements and alternatives to prescription drugs.
I’m happy to be your guide on this journey. Let’s begin.
For more information, log onto www.nowfoods.com/RememBrain-60veg-capsules.htm
CHAPTER 1: Drugs That Can Cause Memory Loss and Reduce Cognitive Function
I’m a big fan of modern medicine when it’s needed. Antibiotics, vaccines, and other modern pharmaceuticals have extended life spans, reduced suffering, and improved quality of life for countless people over the past century. And as a pharmacist and expert on alternatives to prescription drugs, I know well that modern medicine, like just about anything that’s good, is best in moderation.
Since I began writing, speaking, and learning in the 1970s, the fundamental truth of it all hasn’t changed: When we overuse or become unnecessarily dependent on drugs—or when we confuse the tamping-down of symptoms with medications with the actual rebalancing and self-care that really improve and sustain health—we’re playing a losing game. Today, prescription drugs are such a big part of most people’s lives that we tend to think they help without harming. Our trust in these products is so great that 88 percent of people aged sixty and over take at least one prescription drug on a regular basis. Over a third take five or more. Almost 45 percent of people over sixty now take prescription medicines that lower cholesterol— double the rate of use in 1999.
Drugs are designed to target very specific aspects of physiologic function. And when we go into a complex set of systems like those that make up the human body and change a single aspect, we disrupt the other parts of that system. That’s why every drug has side effects. Some of these side effects are minor; others are potentially life threatening. And the side effects of some drugs include disruption of memory and cognition.
If you are on these medications, chances are good that the doctor who prescribes them or the pharmacist who dispenses them will give you a heads-up about the possibility of these side effects. So it’s especially important for you, as an educated consumer, to know that these medicines could be impacting your ability to think and remember. It’s also important for you to know that there are natural alternatives to many of these pharmaceuticals—alternatives your doctor is unlikely to offer to you, because their mind-set tends to be that most people won’t do what is necessary to maintain or restore their health. Sadly, this is true of many folks. But since you’re reading this book to learn about natural ways to support cognitive function, I’m guessing that you are the exception to that rule.
DRUGS THAT CAN INTERFERE WITH OR CAUSE LOSS OF MEMORY: AN OVERVIEW
- benzodiazepines (antianxiety medications)
- cholesterol-lowering drugs (statins)
- muscle relaxants
- pain medications given after surgery
- sleeping pills
All of the drugs described in this chapter can create or worsen memory loss or interfere with brain function. Let’s look at what they are, what they’re prescribed for, and how you might be able to reduce or eliminate your need for them through healthier lifestyle choices and nutritional supplementation.
ANTI-ANXIETY DRUGS (BENZODIAZEPINES)
“Benzos” are prescribed to treat anxiety disorders, agitation, and muscle spasms. They are also used to prevent seizures and help relieve insomnia. They work by reducing the activity of certain areas of the brain—including those parts of the brain that transfer memories from short-term to long-term storage. When benzodiazepines are added to the cocktail of drugs administered during anesthesia, they help erase any unpleasant memories a patient might have as a result of the procedure.
As is the case with most psychiatric drugs, benzodiazepine prescriptions are on the rise. They are often combined with opioid analgesics (strong painkillers that also have a tranquilizing effect) and are increasingly prescribed in primary-care practices. In a Centers for Disease Control (CDC) study involving 3.1 billion primary-care visits be tween 2002 and 2009, 12.6 percent involved prescriptions for benzodiazepines or opioids (a related drug class). During that time period, prescriptions of benzodiazepines grew by 12.5 percent a year.
The combination of benzodiazepines and opioid pain killers (see the next section for more on those medicines) poses significant risk to cognitive ability and to overall wellbeing: data show that combinations of benzos with opioids contribute to at least 30 percent of opioid-related deaths.
Benzodiazepines should be prescribed only rarely in older adults, in my judgment, and then, only for short periods of time. Because older people’s bodies take longer to process these medications, the amount of active drug may build up. This, in turn, increases risk with these medicines not only of memory loss, but also of falls, fractures, and car accidents. People on benzodiazepines are more likely to visit the emergency room; elderly people who use them have a heightened risk of falls.
Withdrawal from benzos can lead to very serious side effects. Addiction is a significant possibility with these medicines. Never try to kick them without supportive guidance from a healthcare professional.
Rising use of these drugs correlates with a steep rise in the diagnosis of anxiety disorders and insomnia in Western nations. People over age forty seem especially at risk. Fortunately, many natural alternatives exist for these issues: the herbal supplements theanine (found in green tea), valerian, passionflower, rhodiola, hops, ashwagandha, holy basil, kava, lemon balm, and chamomile; a substance called 5-HTP, which is made from the amino acid tryptophan; and omega-3 oils from fish or krill (tiny shrimp). The mineral magnesium has relaxant properties. Daily exercise—at least twenty minutes per day—will do a lot to reduce anxiety. Yoga, meditation, or slow, meditative martial arts forms like tai chi and chi kung are some of your best friends in reducing your need for antianxiety drugs. Leaning on supportive friends and family or seeking out skilled psychological coaching or therapy can also help you reduce any need for benzodiazepine drugs.
NARCOTIC PAINKILLERS (OPIOID ANALGESICS)
These medications are nervous system depressants used to relieve moderate to severe chronic pain. They calm the nervous system as well—an important part of helping people who are dealing with intractable pain, which can (of course) cause significant anxiety and interfere with sleep.
Narcotic painkillers contribute to many deaths each year, due to overdose or toxic combinations with drugs that also depress the nervous system. The pain signals blocked by these drugs, as well as the signals that move through the nervous system to elicit a feeling of anxiety, involve chemical messengers that are needed for clear thought and good memory. We can’t block these messengers without negatively impacting cognitive function.
Very serious pain may need this kind of serious pharmaceutical therapy, but if you and your doctor decide that its risks outweigh its benefits, nonsteroidal anti-inflammatory drugs (NSAIDs) may be a reasonable alternative. However, NSAIDs are less workable for people older than age fifty, who have a higher risk of gastrointestinal bleeding with those medicines. If pain is caused by rheumatoid arthritis or other autoimmune conditions, know that alternative medicine practitioners can help reduce pain with dietary, nutritional, and lifestyle programs.
CHOLESTEROL-LOWERING DRUGS (STATINS)
These drugs are used to lower cholesterol counts in people whose levels are judged high enough to increase risk of heart attack or stroke. Use of these medications in adults aged eighteen to sixty-four increased more than sixfold from 1988 through 1994.
Numerous studies show that statin drugs impair cognitive function. One 2009 study published in the journal Pharmacotherapy found that three of four people taking them had adverse cognitive effects that were linked to the medication. Ninety percent of these patients experienced demonstrable improvements in cognition—sometimes in only
a matter of days—after statin use was stopped. Since 2012, the FDA has required a labeling statement on statin drugs about potential impacts on memory and cognitive function.
When we consider the role of cholesterol in the workings of the body, this makes perfect sense. Cholesterol is a vital building block for hormones and nerve cells. The brain contains one-fourth of the body’s cholesterol! In particular, cholesterol is needed to foster connectivity between the cells that make up the nervous system. When we tamper with the body’s mechanisms for producing cholesterol and deplete brain levels of this substance, we directly impact nervous system function. More recent research correlates statin use with lowered levels of a body chemical called leptin; low leptin is, in turn, correlated with a higher risk of Alzheimer’s disease.
More and more Americans are being placed on statin drugs as prescribing guidelines shift. According to data from 2010, half of men and 36 percent of women aged sixty-five to seventy-four take statin drugs. Overall, one in four people over the age of forty-five take statins! The general notion is that these drugs carry little risk and that it’s always best to keep cholesterol as low as possible. I could write an entire book about just how crazy this is—how oversimplified is modern medicine’s attitude toward cholesterol counts and heart disease prevention—but for now, suffice it to say that there are probably millions of people taking these drugs and experiencing cloudy thinking and memory loss when they don’t even really require the medication in the first place. If you are interested in natural ways to reduce cholesterol, Chapter 2 of this book will guide you in terms of a healthful diet that tends to lower cholesterol as a natural “side effect.”
Eating fewer saturated fats and more olive oil, adding fiber from oats, barley, and vegetables and fruits, and taking fish oil supplements (1,000 to 3,000 milligrams (mg)/ day) will give you a good start. Sublingual vitamin B12 (1,000 micrograms [mcg]) plus folic acid (800 mcg) plus vitamin B6 (200 mg) daily can help keep cholesterol counts in balance. Exercise is one of the best ways to raise “good” high-density lipoprotein (HDL) cholesterol, which gives you more leeway in terms of your low-density lipoprotein (LDL) cholesterol. (What matters is the ratio between HDL and LDL, not the individual numbers.)
This class of drugs was once used only to treat seizures, which are most often caused by epilepsy. But as has happened with so many medications, there’s been a significant amount of cross-condition “creep” in their usage. Today, they’re used to treat bipolar disorder and other mood disorders, mania, and nerve pain. Between 1999 and 2009, use of these medications nearly doubled in the United States, from 3.1 percent of the total population to 5 percent—about 15.2 million people. The memory-dampening impact of these drugs has to do with their mode of action. They prevent seizures by suppressing signals that move within the central nervous system. Any drug that depresses the movement of signals in the brain is likely to also reduce ability to think and remember.
People with epilepsy may be able to switch to a drug called phenytoin, which seems to have less impact on memory than the drugs listed above. Chronic nerve pain treated with antiseizure meds may also respond to an antidepressant called venlafaxine, which may help clearer thinking prevail.
If mood disorders, bipolar disorder, or mania are the issues being treated, these have been shown to respond well to natural therapies, in particular high-dose fish oil. Most people in treatment for these issues end up switching their medications around periodically as their brains adjust and the medicine becomes less effective or causes more side effects. If memory loss and/or foggy thinking are issues with these drugs, talk to your doctor about ways to work with alternative medicines, natural therapies, talk therapy, or a combination of treatment approaches.
Tricyclic antidepressants (TCAs) are older medications— the first antidepressants developed, in fact, back in the 1950s. Newer antidepressants have largely replaced them, but they are still prescribed in some cases of depression that don’t respond to newer drugs. They are also prescribed for anxiety disorders, eating disorders, obsessivecompulsive disorder, and chronic pain, and are also used to support people who are attempting to quit smoking. Women with severe menstrual cramps and hot flashes may also be prescribed these medications, which work by blocking the binding of neurotransmitters to receptors.
Among adults using TCAs, about 35 percent report some memory impairment. About 54 percent report difficulty with concentration. Lowering the dose or switching to more modern, more selectively acting antidepressants— selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs)—can help restore better memory and thinking ability.
An important note: depression itself should not go untreated. It can be a serious issue that interferes with relationships, work, and overall quality of life. In addition, depression is a risk for cognitive decline and for Alz heimer’s disease. The more intense the depression, the higher the risk of cognitive decline.
Now, this may bring up fear and frustration for those who believe the party line that depression is strictly a biochemical issue, something that strikes certain people and that is a chronic and largely incurable—if sometimes manageable—condition. That’s another point I could go on about for roughly 100 pages, and this isn’t the space or the time for that. For now, let me assure you that in most cases of depression, cure is possible. You may have to go outside the box of what the mainstream says you need, but it is almost always available. Genetics are not destiny here. The interplay of “nature” (genetic inheritance and biological tendencies) and “nurture” (environment, learning, ways of talking to ourselves and relating to others, choices about self-care and spiritual practice) is much more complex than the peddlers of biopharmaceutical therapies would like you to believe.
PARKINSON’S DISEASE DRUGS (DOPAMINEAGONISTS)
Let me begin by saying that Parkinson’s disease has to be treated, and that these medications are our best bet at this point in holding the symptoms of this progressive illness at bay. Difficulties with memory and cognition are relatively minor concerns for people coping with this illness. However, dopamine agonists are increasingly being prescribed for restless legs syndrome (RLS) and to people with certain kinds of pituitary tumors.
Parkinson’s disease is characterized by a deterioration of the part of the brain that produces the neurotransmitter dopamine. These drugs work by activating signaling pathways for this neurotransmitter. When we impact those pathways, we also impact movement (especially fine motor control), motivation, the way pleasure is experienced, and learning and memory.
The drugs levodopa and carbidopa may be good alternatives to dopamine agonists for people with Parkinson’s disease. They convert to dopamine in the brain. Carbidopa is used with levodopa because it reduces side effects, especially nausea. For those taking dopamine agonists for restless legs syndrome, and who notice impacts on memory and thinking ability, try avoiding caffeine, alcohol, and nicotine. If you use antinausea drugs (prochlorperazine or metoclopramide), antipsychotic drugs (haloperidol or phenothiazine derivatives), antidepressants that raise active levels of serotonin in the body (SSRIs), or cold and allergy medicines that contain sedating antihistamines, you should know that these can cause RLS symptoms. Daily exercise, increased sexual activity (orgasm increases dopamine and other opiates in the body that have been shown to help relieve RLS!), drinking more water, using progressive relaxation exercises, and taking supplemental magnesium may all help relieve this uncomfortable and mysterious condition.
HYPERTENSION DRUGS (BETA-BLOCKERS)
These are some of the oldest drugs still commonly prescribed. They’ve stood the test of time and are overall pretty darned safe and effective for their usual indications: high blood pressure (the most common indication), congestive heart failure, abnormal heart rhythms, chest pain, and migraines.
Beta-blockers work to reduce blood pressure and heartrate by blocking the actions of what we call beta-adrenergic agonists: norepinephrine, epinephrine (aka adrenaline), and others. In reducing the activity of those messengers, we also reduce the transmission of messages throughout the nervous system, and that can slow things down enough in the brain to impact thinking ability and memory.
Calcium channel blockers, another type of blood pressure–lowering medication, are also quite safe, time-tested, and effective, and they tend to impact memory and thinking ability less. For those using beta-blockers to treat glaucoma, another drug called a carbonic anhydrase inhibitor may be a better bet.
Even the folks at the Mayo Clinic agree that lifestyle changes and nutrition can take the place of medications for managing blood pressure. A healthful diet, focused stressreduction strategies (yoga, meditation, guided visualization, or spiritual practice), and regular moderate exercise are good foundations. Losing weight around your midsection, if it’s accrued there beyond forty inches (for men) or thirty-five inches (for women), will help drop high blood pressure too. Reducing dietary salt, drinking alcohol only moderately if at all, cutting back on caffeine, and ensuring that you have supportive relationships with family and friends also will help keep blood pressure numbers below the threshold requiring medication.
Ironically enough, at least one study has found that beta-blockers prescribed for hypertension may help prevent Alzheimer’s disease (AD). This may have to do with the role of hypertension in creating microinfarcts, or tiny strokes, that can reduce brain function and memory over time. Controlling high blood pressure is clearly integral to AD prevention. What the study did not spell out, however, was whether controlling high blood pressure without medications would have an equal effect. We do know that exercise and good nutrition help stave off both hypertension and AD.
SLEEPING AIDS (NONBENZODIAZEPINE SEDATIVE-HYPNOTICS)
Ambien, Lunesta, Sonata: the brand names have such a soothing, melodious ring. But these so-called “Z drugs,” used to treat insomnia and mild anxiety, have some serious downsides. They can cause amnesia or cause people to behave very strangely while asleep. Sleepwalking? Yes— but also try sleep-eating, sleep-drinking, sleep-cooking, or sleep-driving. Ambien has been a rising problem in traffic stops; it’s one of the top ten substances found in the bloodstreams of people who are arrested for traffic violations. There is a confirmed link between these dangerous behaviors and drugs like Ambien, with that drug leading the field as the most popular among those wielding prescription pads (26.5 million prescriptions were written for this drug alone in this country in 2012). Packaging information must warn users of the possibility of these kinds of side effects. These drugs are particularly potent when combined with alcohol.
Although these medicines are molecularly distinct from benzodiazepines, they act on the same physiochemical pathways and alter activity of the same chemical messengers. Addiction, withdrawal, and loss of memory and cognitive function are all possibilities with ongoing use of these medications. If you are using these drugs and want to stop, please do so with guidance from your doctor, as withdrawal symptoms can be significant.
Getting enough sleep—good quality sleep—is an issue for many folks over the age of fifty. Following the natural cycles of light and dark in your waking and sleeping, refraining from caffeine after noon, not drinking too much alcohol (it might relax you to sleep, but it is likely to jolt you awake as it wears off in the middle of the night), and getting daily exercise will all help. Keep the bedroom dim and use it only for sleep and sex—no glowing screens in the boudoir. Even a small amount of light at night can disturb sleep. Use progressive relaxation or meditation techniques to help you relax in the evening if anxiety keeps you awake.
The best natural sleep aid, by far, is melatonin, a hormone made in the pineal gland in the brain. Supplementing in doses from 3 to 10 mg before bedtime can help reestablish healthy sleep patterns. Animal research even suggests that melatonin can help reduce the risk of age-related memory loss. It is an antioxidant that reduces the accumulation of oxidative byproducts in the body—and those byproducts are part of the plaques that form in people with Alzheimer’s disease. At the moment, we don’t know for sure that it is safe to use every day—there is some concern that supplying the hormone through a supplement could reduce the body’s natural production—but using the supplement two or three nonconsecutive days per week is believed to be safe.
INCONTINENCE DRUGS (ANTICHOLINERGICS)
Anticholinergics are most often used to treat a condition variously known as “overactive bladder” and “urge incontinence”—a sudden, extreme urge to urinate that can mean not getting to the bathroom in time. Drugs in this class work by blocking the action of a chemical messenger called acetylcholine, which (among many other things) prevents involuntary contractions of muscles that control the flow of urine. The brain uses acetylcholine to activate learning and memory. In 2006, a study of oxybutynin (brand name Ditropan) found that using this drug impacts memory at a level comparable to about ten years of cognitive aging. The study’s author said it this way: “We transformed these people from functioning like sixty-seven-year-olds to seventy-seven-year-olds.” (Another oxybutynin product, Oxytrol for Women, is sold over the counter.)
Of all the drugs in this class, darifenacin (brand name Enablex) seems least likely to impair memory or cognitive ability; so, if you require an incontinence drug, see if you can get your physician to prescribe this one. Be sure your physician has ruled out any other possible reason for your urge incontinence: a bladder infection is one possible cause, and some medicines (blood pressure drugs, diuretics, or muscle relaxants) can cause side effects that resemble overactive bladder.
Once these are ruled out, I’d recommend trying some simple lifestyle changes, such as cutting back on caffeinated and alcoholic beverages, drinking less before bedtime, and doing Kegel exercises to strengthen the pelvic muscles that help control urination. As a last resort, try adult diapers, pads, or panty liners. As uncomfortable as these might make you, modern versions are thin and comfortable and give complete insurance against embarrassing accidents.
ANTIHISTAMINES (FIRST GENERATION)
The best known of these over-the-counter and prescription drugs is Benadryl (diphenhydramine). This medication was once the go-to remedy for allergy and cold symptoms, and its sedative effects are pronounced—as many parents will tell you, a little Benadryl is a handy thing for a child who’s too sick to sleep. Antihistamines like these are also used to prevent dizziness, motion sickness, nausea, and vomiting. In rare cases, they have been recommended to help relieve anxiety or insomnia.
This class of drugs works by blocking the production of histamine, the chemical that causes allergic reactions. Unfortunately, the action of other body chemicals is blocked in the process, including that of chemical messengers/neurotransmitters called acetylcholine and serotonin. This reduces activity in centers where learning and memory happen. These medicines also appear to reduce the absorption of vitamin B12 in the stomach, and B12 is important for alertness and for good nervous system function.
Today, these medicines are not often used to treat allergy symptoms, as nonsedating antihistamines like loratidine and cetirizine are available by prescription and over the counter. These nonsedating medicines are generally far better tolerated, especially for older adults.
CHAPTER 2: The Mediterranean Diet: How Diet Can Impact Memory and Cognition
If I were to put my recommendations about what to eat to improve and preserve cognitive function in as brief a sentence as possible, I’d say, “Eat a Mediterranean diet.”
THE MEDITERRANEAN DIET
The Mediterranean diet is comprised mostly of colorful vegetables (especially leafy greens); some fruit; lean protein (mostly fish, with some other meats—which the Mediterranean food pyramid places at the same level of consumption as sweets, meaning that they should be eaten rarely); some nuts and seeds (especially walnuts); whole grains; and dairy products in moderation, primarily as unsweetened yogurt and cheese. The diet is rich in legumes (beans), seeds, herbs, and spices; red wine is a hallmark of this diet as well. Refined sugar, unhealthy hydrogenated fats, fatty cuts of meat, butter, dishes dripping with cheese, and processed foods made with white flour do not make much of an appearance here.
The Mediterranean diet is the superstar of all healthpromoting diets. It’s got every ingredient known to help prevent or reverse all age-related conditions, from heart disease to type 2 diabetes to dementia—and yes, the risk of even some kinds of cancer can be reduced with adherence to a Mediterranean diet. A study involving over 1.5 million adults demonstrated that following this diet reduced the risk of death from heart disease and cancer, while also reducing the risk of Parkinson’s and Alzheimer’s diseases.
Based on all the available evidence about food as medicine to maintain mental sharpness and prevent Alz heimer’s disease or other types of dementia, the Mediterranean diet appears to cover all the bases. Its preventive impact against stroke has recently been confirmed by a study of thousands of Spaniards, published in the vaunted New England Journal of Medicine. Ministrokes, also known as microstrokes, are known to be a major player in age-related damage to the brain that robs us of memory and cognitive ability, and if we can help prevent those with diet, we should. This diet will do just that.
That being said, let’s look at a few important rationales for my recommendation, and a few points to be aware of in the specific quest to promote better brain function. What characteristics of the Mediterranean diet explain its positive impact on brain health and function? Here are the main points to recognize.
The Mediterranean Diet Is Anti-Inflammatory
The body has a delicately balanced set of mechanisms for fighting infection and healing injury. Inflammation is one part of that immune response. When you hurt a joint, it becomes hot, swollen, and painful as healing immune factors are drawn to the site. That’s one kind of inflammation, and it usually resolves when the healing process is complete. A fever is a full-body inflammation that happens as the immune system launches an attack against a pathogen. Allergies and autoimmune diseases represent imbalanced inflammatory responses, and in those cases, inflammation does more harm than good. Modern diets and lifestyles (high stress, little physical activity, too little sleep, and diets that promote inflammation) create a state of lowgrade, chronic inflammation in the body and the brain. Over time, this does damage to tissues that prematurely ages them and can set the stage for age-related conditions like dementia. Inflammation within blood vessel walls is a major contributor to stroke.
Our bodies make both inflammatory and anti-inflammatory chemicals. The foods we eat provide the building blocks for the making of those chemicals (primarily fats), and they impact the biochemical pathways that modulate inflammation. The upside of this is that inflammation can be impacted strongly through diet. The Mediterranean diet provides the body with potent nutritional factors—in particular, antioxidants and healthy fats—that have this antiinflammatory effect.
The Mediterranean Diet Is High in Antioxidants
In Greece, where the Mediterranean diet is standard fare, people consume an average of six or more servings of anti oxidant-rich, highly nutrient-dense vegetables and fruits each day. Their rates of dementia are lower than those in the United States (as are rates of the disease across central and eastern Europe: overall prevalence in the United States as of 2009 was about 6.5 percent of the population older than age sixty had some form of dementia—far ahead of the approximately 4.8 percent prevalence seen in those parts of Europe).
When the cells that make up our bodies metabolize fats, carbohydrates, or proteins to produce energy, they also produce a kind of “exhaust” known as free radicals. These submicroscopic particles can damage fats, proteins, and cholesterol. Our bodies have natural antioxidant defenses designed to “quench” these renegade particles, but we also need dietary antioxidants to maintain a healthy balance. High oxidative stress (chronically high, un-”quenched” free radicals) is linked to all kinds of outcomes no one wants, including most of the age-related diseases.
The brain is especially vulnerable to damage by free radicals. It is one of the most highly metabolic parts of the body—in other words, it uses more oxygen—and it also has low levels of antioxidant enzymes that are the body’s natural protection against free radical damage.
Diets low in antioxidants are firmly linked to heightened risk of dementia. Antioxidants are most abundantly found in nutrient-dense plant foods; in general, the more brightly colored the food, the higher the antioxidant content. The Mediterranean diet is built mostly from these foods. Case closed.
HOW ABOUT SUPPLEMENTATION?
Supplementing antioxidants, anti-inflammatory factors, and other nutrients found in healthy foods may help support optimal brain function throughout life. I’m a big fan of nutrient supplementation, but it has to be done wisely, according to the latest research. At one time, it was standard practice to take megadoses of individual vitamins and minerals; today, we know a lot more about how to create a balanced intake of these nutrients without the potential long-term dangers of overdoing it or taking nutrients in the wrong balance. In Chapters 3 and 4, I’ll go into depth about how to supplement with these factors to create additional antioxidant and antiinflammatory insurance against dementia and related issues.
The Mediterranean Diet Is Nutrient-Dense and Relatively Low in Calories
Animal studies have found that reducing caloric intake has much more than a slimming effect. Eating about a third less than one would naturally want to eat translates to the retardation of many aging processes; the delay of onset of most of the diseases associated with old age; and the lengthening of life span. Does this work for humans? Yes! Clinical trials investigating food restriction in healthy adults have shown significant drops in body weight, blood pressure, and blood sugars over periods ranging from two to fifteen years. This doesn’t guarantee the dramatic impacts seen over the much shorter life spans of calorically restricted rats, but overall it looks like a very promising avenue for anyone interested in avoiding premature aging and loss of cognitive function.
The catch with the low-calorie diet is, of course, that eating this way could mean being hungry all the time. This has been found to cause no small amount of crankiness in those who attempt to restrict their caloric intake. And the best way to find middle ground here is to eat plenty of food, but to ensure that it is highly nutrient-dense: more nutrient bang for each caloric buck.
Whole foods rich in fiber and nutrients are inherently more satisfying than junk foods that are engineered to get you to eat much more of them than you need. Think of it this way: a head of broccoli is loaded with fiber and nutrients and only about 200 calories. A small bag of chips will have easily that many calories, much more fat, and a lot fewer antioxidant vitamins and minerals.
If you eat according to the dictates of the Mediterranean diet, your caloric intake will be well below what it would be if you ate a standard American diet. You won’t need to worry about counting calories, and you’ll still get all the benefits of a highly nutritious, low-calorie diet.
The Mediterranean Diet Is Low Glycemic
According to the American Diabetes Association, nearly 26 million American children and adults have diabetes; 79 million have prediabetes (a condition I’ll explain more in a moment); and 1.9 million are diagnosed with diabetes each year. Most of these people are diagnosed with type 2 diabetes, also known as adult-onset diabetes—a form of diabetes created by an unhealthy diet high in refined carbohydrates and the overweight/obesity that often results from such a diet. Why does this information show up in a book about ways to preserve memory and cognition? Be cause type 2 diabetes is a major risk factor for Alzheimer’s disease and other types of dementia.
Type 2 diabetes is diagnosed when a person’s blood sugars stay too high over time. The cells lose sensitivity to the hormone insulin (a shift known as insulin resistance), which is supposed to move sugars from the bloodstream into the cells to be “burned” as fuel. High blood sugar is damaging to the body in many ways: it creates greater oxidative stress (more free radicals), accelerates inflammation, and directly damages the walls of arteries. The pancreas produces more and more insulin to try to overcome insulin resistance; this is also an unhealthy situation, since insulin in too-high concentrations is harmful to the insides of blood vessels. In prediabetes, insulin resistance has begun and sugars have started to rise, but they are below the threshold of a diabetes diagnosis. Still, microscopic damage to blood vessels is happening, particularly if antioxidant intake is low—a setup for potential strokes or heart attacks later on.
Type 2 diabetes and prediabetes both create excess inflammation and free radicals, both of which are bad news for brain function. Fortunately, these conditions both respond very well to changes in diet and lifestyle that reduce excess pounds and bring lots of nutrient-dense whole foods into the body. The Mediterranean diet is a great fit for this. It is low glycemic, which means the foods it contains do not create the blood sugar peaks and valleys that set the stage for prediabetes and diabetes.
Someone who is working to reduce blood sugars can modify the Mediterranean diet to eliminate any higherglycemic foods. White bread, pasta, potatoes, and all but a few fruits (low-glycemic fruits include apples, stone fruits, cherries, and blueberries) can behave a lot like sugars in the body, and should be avoided by those with diabetes.
The Mediterranean Diet Is Made Up of Whole Foods, Especially Vegetables
The research is conclusive: a diet rich in vegetables—about as much as one would consume in the Mediterranean diet—reduces risk of dementia. Fruit is okay in small amounts here, but vegetables are the real key. Fruit is high in sugars, which can be an issue. I’ll say more about that later in this chapter.
A vegetarian or vegan (no eggs or dairy) diet has been found to reduce risk of dementia. One study involving nearly 2,300 California residents found that those who ate any meat at all—including poultry and fish—were more than twice as likely to develop dementia than those who were vegetarians. When past meat consumption was factored in, the difference in risk widened even further, demonstrating a nearly threefold increase in risk for those who had been long-term meat-eaters. That’s a pretty enormous difference in risk profiles, and worth noticing. Vegetarianism and veganism appear to be more protective for men than for women. Most other studies comparing vegetarian to high-meat diets demonstrate protective effects against dementia.
Most likely, the key factor in the vegetarian diet is the abundance of vegetables, fruits, whole grains, beans, nuts, and other foods that bring protective vitamins, minerals, phytochemicals, fats, and other compounds into the body. If you want to enjoy a few chunks of chicken, a filet of salmon, or even some range-raised, grass-fed beef with your abundant plate of plant foods, there is little chance that this will get in the way of the protective effects of those vegetarian delicacies. If you are consuming plenty of vegetables, it’s fine to enjoy small servings of meat, dairy, or egg thrown in, if that helps you make the whole thing more satiating and delicious. Of course, if you’re willing to try being vegetarian, you’ll be going one step further to protect your health as you age.
The Mediterranean Diet Is Very Low in Refined Sugars and White Flour
The Mediterranean diet emphasizes whole grains and contains very little refined sugar. For our purposes, sugars and white flour are the same: they are rapidly metabolized and cause blood sugars to spike. A surge of insulin from the pancreas drops those blood sugars back down—sometimes so quickly that low blood sugar (hypoglycemia) results. Next comes a craving for more sugars or refined carbohydrates, and the cycle begins anew. Even mild hypoglycemia can make a person absentminded, forgetful, and spacey. Over time, being in this cycle sets the stage for insulin resistance and type 2 diabetes.
This cycle has the impact of accelerating inflammation, creating extra free radicals, and causing glycation: a binding of sugars to proteins that stiffens and ages tissues before their time. Chronic consumption of sugars and white flour crowds out other more nutritious foods from the diet, too, robbing the body of vital nutrients potentially supportive of good brain function. Go easy on the grains and choose whole versions—brown rice, whole barley, sprouted-grain breads and crackers—and avoid sugar as much as possible. You’ll find you won’t crave it after going cold turkey for a few days.
How about artificial sweeteners? Avoid them like the plague. Shifting your diet away from sweet tastes will only help you appreciate the more refined flavors of healthier foods. Aspartame, one of the more commonly used artificial sweeteners, has been found to be an excitotoxin, a substance that overstimulates neurons (nerve and brain cells), exciting them literally to death. The jury’s still out on the safety of these fake sugars, so avoid them. One exception is a plant-derived sweetener called stevia, which seems to be fine when consumed in moderation.
The Mediterranean Diet Is Very Low in Trans Fats
Trans-fats are oils made solid and shelf-stable through a process called hydrogenation. The food industry thought of this as a good plan, but it turns out that these fats that industry built are among the most toxic fats around. They accelerate the inflammation we know to be bad for the circulatory system and bad for the brain.
The evidence that trans fats are dangerous is strong enough that the U.S. government created stricter labeling practices for processed food makers, but they can still use these fats and say the product contains 0 grams perserving if they keep it to below half a gram per serving. My suggestion is to avoid all foods that include hydrogenated or partially hydrogenated oils in their list of ingredients.
The Mediterranean Diet Is Rich in Polyunsaturated and Monounsaturated Fats, Especially Omega-3 Fats
Where trans fats accelerate inflammation, the Mediterranean diet is especially rich in anti-inflammatory fats and neutral fats. Omega-3 fats are found in fatty fish like sal mon, mackerel, sardines, and anchovies, and most experts agree that it’s a good idea to include fish in your diet two to three times a week. Hundreds of research studies have been published supporting omega-3s’ preventive impact against heart disease, stroke, and some kinds of cancer.
Tuna is an acceptable source, but please stick with chunk light tuna, which is higher in fat and is less likely to contain high levels of neurotoxic mercury. Freshwater fish are likely to contain higher levels of mercury as well—not something you want to consume if you’re concerned about the health and function of your gray matter.
Oats and other whole grains are rich in certain kinds of omega-6 fats that are also anti-inflammatory when incorporated into an overall healthy diet. Eating lots of sugars and refined grains can actually make these good fats proinflammatory, however, due to some complexities of the biochemical cascade that these fats go through at the cellular level.
Anyone who’s been paying attention to the health news knows that olive oil is a clear winner in terms of healthfulness. The Mediterranean diet was the one that brought this oil into the world’s cuisine, and for this, we should all be thankful.
A diet that contains moderate amounts of healthy fats is more satiating. Healthful oils in the diet nourish the skin and nerve cells—in fact, research demonstrates that omega-3s are vital for maintaining or improving nervous system function (more on that in Chapter 4) and that supplementation may be a good idea for virtually everyone who plans to live to a ripe old age with their minds and memories intact.
The Mediterranean Diet Is Rich in Both Soluble and Insoluble Fibers and Plant Sterols
Soluble fiber and insoluble fiber, both found abundantly in whole grains, beans, vegetables, and fruit, each have their own roles in reducing the risk of age-related disease. Soluble fiber reduces the absorption of cholesterol into the body by binding its precursors in the gastrointestinal tract. Insoluble fiber improves bowel function, which helps reduce the body’s reabsorption of toxins from the contents of the bowel. Plant sterols also block cholesterol absorption. They are found in healthy whole foods, including apples, grapes, and strawberries, and they are increasingly found as supplements in processed foods like buttery spreads. Getting adequate amounts of these fibers can reduce cholesterol counts by up to 5 percent.
The question that hasn’t been answered is whether reducing cholesterol will help prevent dementia. There’s definitely not adequate research support for reducing dementia using statin drugs. The majority of human data on blood and brain cholesterol counts does not support a role for cholesterol in causing Alzheimer’s disease (AD). Some studies show that lowering cholesterol with medication helps with prevention, but others show no effect. One study found that older adults who had higher LDL (“bad”) cholesterol and lower HDL (“good”) cholesterol had slightly greater beta-amyloid deposits in their brains. This study made big headlines, but it didn’t necessarily provide support for the use of statins as preventives against AD.
Here’s why. Beta-amyloid deposits are characteristic of AD, but what’s now being recognized—after decades of trying to target and prevent AD by reducing beta-amyloid—is that accumulation of this substance may just as easily be an effect of AD as a cause. And some research even shows less cognitive decline with higher beta-amyloid levels in people with AD. Some forward-thinking investigators even think it may be an antioxidant that accumulates because the brain is trying to knock out an unwanted invader, and that the invader—potentially a virus—is actually the root cause.
Now, this is definitely not license to mainline butter, bacon, and pork rinds, because a diet high in cholesterol is not so great for the body for other reasons. Foods very high in cholesterol also tend to be high in other things we don’t want in our bodies (saturated fat, toxic chemicals that concentrate most highly in fatty foods) and tend to be missing the factors that most aid prevention.
A FEW SPECIAL DIETARY TIPS FOR GREAT COGNITIVE FUNCTION
To round out your new dietary adventure, consider a few specific do’s and don’ts that aren’t part of the Mediterranean diet, but that research suggests are important for maintaining good cognitive function as we age:
Eat lots of brain-healthy “superfoods.” Walnuts, asparagus, blackcurrants, blueberries, fatty fish, ground flaxseed, kale, pumpkin seeds, radishes, red cabbage, spinach, summer squash, sweet potatoes, walnuts, watermelon: all these foods are high in B vitamins, which makes them brainfriendly dietary choices. Blueberries are particularly good for the nervous system, in that they contain a compound that prolongs neuron (nerve cell) life.
Try an exotic mushroom. Lion’s mane mushroom, which research has found to improve neuronal proteins and the entire process the body uses to build nerve cells, can be found in health food and gourmet stores, or can be taken as a nutritional supplement. This superfood also seems to have a positive impact on mood and well-being.
Consume coconut oil. Rich in medium-chain triglycerides (MCTs), coconut oil can be your second go-to oil for cooking, after olive oil. Research suggests that MCTs are not readily stored as fat and that they are easily burned to produce energy. They are metabolized to end products called ketone bodies, which provide an alternative energy source for neurons. Some research suggests that in people with mild to moderate AD, MCTs improve cognitive ability.
Eat lots of gluten-containing foods. Gluten is the major protein in wheat. Minimizing or even eliminating this substance in your diet is likely to score you big gains in brain function. For people who have difficulty digesting gluten— those with celiac disease—quitting wheat entirely has been found to drastically improve cognitive function and lift brain fog. The jury is out in terms of solid research for those who aren’t diagnosed with celiac disease, but anecdotally, I can tell you that I’ve known a great many people whose thinking, memory, and attention, as well as their overall energy, took a big leap in a positive direction when they tried a gluten-free diet, and they noticed a big backward leap when they tried eating gluten again.
Load up on nonfermented soy. While fermented soy in the forms of miso and tempeh are healthy for the body as part of an overall balanced diet, nonfermented soy foods (including soymilk, tofu, and texturized soy protein) have multiple effects on the body that may contribute to foggy thinking. Fermentation transforms soy from a thyroid-hormone-blocking, digestion-disrupting, mineral-depleting food into a healthy and easily digested food. Reducing thyroid action and disrupting the absorption and action of vital nutrients is one sure way to diminish your ability to remember, attend, and learn! It’s okay to consume nonfermented soy in moderation—a cup of soymilk here or a salad with baked tofu there is not going to make or break you—but these are not foods to eat every day.
Load up on foods high in fructose (fruit sugars). The research on this one is pretty conclusive: high dietary fructose—the main source for most modern Americans being high fructose corn syrup in sweetened processed food and drinks—is very, very bad for the brain. Dense doses of fructose have increased drastically in our diets, and that increase correlates with the similarly dramatic rise in obesity and type 2 diabetes. Both these conditions are associated with lower cognitive performance, cognitive decline, and dementia. Avoid any food sweetened with fructose and go easy on the fruit; emphasize fresh vegetables instead.
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