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Foods that help and harm the brain; Preventing dementia through diet

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I was fortunate enough to go to New York City at the beginning of March to attend the Integrative Health Symposium.  On the first day David Perlmutter MD (author of The Better Brain Book) spoke about the link between diet and brain health.  He touched on many aspects of this but one thing that came out loud and clear is SUGAR IS BAD FOR YOUR BRAIN.

Where there is Smoke there is Fire:

When it comes to a disease like Alzheimer’s, modern medicine often focuses on the end product of the destructive process going on in the brain.  In Alzheimer’s this is often the excess Beta Amyloid levels.   Dr Perlmutter argues that these “end products” are actually more like “smoke” we can do a lot more good for people if we stop focusing on them and instead bring our attention to the “fire” that is producing them.

His theory (and it is supported by many well done studies ) is that one of the major contributors to this disease are something called “Advanced Glycation End products”  or AGEs.  What the heck are they? Well “glycation” has to do with sugar.   In the simplest terms, these  a diverse group of molecules formed when sugar attaches to a protein or a fat.  Once formed the reaction is irreversible.   If you have more sugar circulating in your blood than is needed to meet your normal energy needs then you will make excessive AGE’s.  Over time they can build up in the tissues of the body .

Ill effects of excessive AGE’s include: wrinkles, joint aches, cardio-vascular disease, fatty liver, Alzheimer’s disease, and cancer.

Other things that cause AGE’s to be formed include:  normal aging, oxidative stress (more on this later), and inflammation in the body.  AGEs are also found in foods.  They are most highly concentrated in animal products exposed to high heat (such as grilled, fried, or broiled meat).  Those dark lines that form on grilled meat may not be the best thing for your brain!

AGEs have been known play a role in other neurodegenerative conditions such as Parkinson’s disease and also in heart disease and other chronic illnesses.  And they have been clearly linked to an increased risk for cognitive decline (memory loss, etc).

Sugar and the Brain:

Anytime you have more sugar circulating in your blood than you need to run the machinery of your body, you’ll end up making more AGE’s.  Considering that the average American now consumes 2.5 pounds of sugar per WEEK, you can see how we are setting ourselves up for chronic disease.

An article way back in 1994 had already implicated AGE’s and Alzheimer’s ds (Vitek et al.   “Advanced glycation end products contribute to amyloidosis in Alzheimer’s disease.” Neurobiology.  vol 91.  pp 4766-4700. May 1994)

Avoiding excessive sugar intake is vital for brain health.  Especially highly refined sugars because they are more likely to lead to spikes in your circulating blood sugar.

Having excessive AGE’s  increases overall inflammation in the body.  Read on to see how you can combat inflammation and oxidative stress through a healthy diet.

Oxidative stress, is fuel for the fire:

Oxidation is the process that puts rust on metal and when it happens inside of us it makes us pretty rusty, too.  Oxidation happens when harmful substances called “free radicals”  act on healthy proteins and cells.

Free radicals are atoms of oxygen with an unpaired electron. That electron does not like to be unpaired and so it will take another electron away from other molecules in the body. Free radicals cause damage this way when they steal electrons from your DNA, cell walls, LDL cholesterol particles, or structural proteins. In face these free radicals have been implicated in many health problems including: premature aging, cancer, heart disease, arthritis, memory loss, and cataracts.

Where free Radicals come from:                                                                                                                                                                             —-Some free radicals are normal byproducts of the body’s metabolism.

—–However many come from our environment:  from pollutants in the air we breathe, the food we eat, and the water we drink

—–Other sources include charbroiled meats, cigarette smoke, SUGAR, excessive stress, and sunlight exposure.

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In Alzheimer’s disease the beta amyloid that causes the destruction inside the brain is “glycolated” and “oxidized”.  One study published in Neurobiology in 1994 showed that the brains of people with Alzheimer’s  have 300% more of AGE modified beta amyloid than healthy brains. (Vitek, Michael et. al. “Advanced glycation end products contribute to amyloidosis and Alzheimers disease” Neurobiology. May 1994. Vol91: pp 4760-4770).

Glycated proteins (those changed by sugar), produce nearly 50 x more free radicals than non-glycated ones in the human body.

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Antioxidants to the rescue:

The Good News:  if high sugar diets and excessive free radicals are contributing to Alzheimer’s disease and dementia there is something you can do about it.   You can change your diet.

Free radicals can be neutralized by antioxidants.  These wonderful natural defenders are abundant in many foods.  Some research has looked at using antioxidants in a pill form, as supplements, and the results have been mixed.  Some early research did show that taking vitamin C and vitamin E may help to reduce the risk of developing Alzheimer’s disease.  Other research on vitamin E has shown increased risk for other problems.  It’s complicated and so I’m not going to strongly come out for or against supplements right now.  I believe the best way to get your antioxidants is in food, the way nature intended!

Most experts agree that diet and lifestyle changes are most effective when done BEFORE any symptoms arrive.  But it’s never too late to make a healthy change.

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Foods that Help the Brain:

1) Antioxidants:   Antioxidants are most abundant in brightly colored vegetables and fruits.  Most people get more than enough fruit and not enough vegetables so keep that in mind when planning your meals.   Antioxidants are also found in coffee and dark chocolate but the research seems to indicated that for brain health you want to focus more on the ones in vegetables and fruit (though organic coffee in moderation may also have some protective effect).

Goal:  “eat the rainbow” –try to have something from each color of the rainbow every day.  There are different ways to break up these food groups.  At the conference one nutrition expert did it this way:

Blue/Purple:  (they kept this as one group b/c they share many similar phytonutrients but I would still try to get some of each).  Blueberries,  blue corn chips (organic),  Black berries, beets, eggplant, purple plums, prunes, raisins, grapes, purple kale, purple potatoes, etc.

RED:  Apples, strawberries, raspberries, red plums, tomatoes, pomegranates, red peppers, etc

ORANGE:  Winter squashes, carrots, apricots,  sweet potatoes, mangoes, oranges, bell pepper, etc

YELLOW: Bell Peppers, corn, yellow onion, yellow squash, yellow peppers, avocado

GREEN:  Broccoli, all the dark leafy greens, Brussels sprouts, artichoke, asparagus, green beans.  GREEN TEA too (there is some research showing intake of green tea can prevent demential

2) Follow a low carb/ low glycemic index diet.  Sugar is a carbohydrate; but not all carbohydrates are unhealthy.  In fact they are a great source of prolonged energy and we need them to be healthy.  But not all carbs are alike.  Some will turn quickly into sugar once you eat them and lead to quick spikes and then crashes in your blood sugar.  These are called “high glycemic index” carbs and are best avoided.  “Low glycemic index” carbs tend to be more a more complex type of carbohydrate such as a vegetable or a whole, unrefined grain.  To learn more about how to switch to a low glycemic index diet check out the following web page:

http://glycemicindex.com/index.php

3) Eat Lean Proteins:
Lean proteins such as beans, tofu, fish, are less likely to lead to the creation of excessive AGE’s.  And are less inflammatory to the body than proteins high in saturated fats.

4) Eat Healthy Fats: Omega 3 fatty acids (such as those found in fish and nuts) are anti-inflammatory to the body and essential for normal brain function.  The Omega 3 fatty acid DHA is crucial for brain function and we cannot manufacture it in the body. It must come in through our diet.  The main source of this fatty acid is fish.  If you do not eat any fish then you may want to consider taking a fish oil (or krill oil) supplement.

5) Avoid unhealthy fats, too much animal protein, and processed foods.  Some examples of foods known to be unhealthy for your brain include:

-trans-fats                              –White sugar                           –Artificial sweeteners (aspartame)                 —Chemical food additives  -hydrolyzed vegetable proteins                                        –soy protein isolates                                             —overcooked meats                 –caramelized foods             –excessively sugary foods

6) Buy organic whenever possible:
Though we don’t know exactly what the impact is of pesticides on brain function, we do know that some pesticides are neurotoxins and it seems wise to avoid those if you want to keep your brain functioning at it’s best.  It can be expensive to do 100% organic all the time.  However some fruits and vegetables are known to excessively accumulate pesticides and those are best eaten as organically grown only.  Leafy greens and berries are two examples that come to mind.  You can also check out the “dirty dozen” list put out  by the Environmental Working Group each year.  It lists the produce with the highest pesticide levels and also those with the lowest.

http://www.ewg.org/foodnews/

7) Get enough Vitamin B12: An 8 year study of people in their 70’s looked at memory and other signs of healthy brain function.  The researchers found that cognitive function declined much faster among the subjects with the lowest B12 levels.  Surprisingly these people did not have to have levels below normal to show ill effects.  Just being in the low normal group was enough.  It is certainly a good idea to have your B12 level checked at your physical and it wouldn’t hurt to take a supplement.  Most of the  multivitamins for people over age 55 add in extra B12, or you could just take it as a stand alone with 25 to 50mcg for prevention and much higher doses (500 to 1000mcg) to treat deficiency.

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Don’t forget about Stress:

Stress is inflammatory to the body as well.  A key part of brain health is having a healthy way of coping with stress:

–exercise           –meditate       –laugh       –be creative          –do some yoga, or tai chi      –get enough sleep  –have a massage

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Exercise :

Finding a type of exercise you enjoy is essential for overall health.  Besides helping you to cope better with stress, exercise also helps you to use up excessive sugar and makes the insulin you have circulating in your body work better.  It burns fat and the less fat you have sitting around your mid-section the less inflammation you have in your body.  If you want to minimize the amount of AGE’s in your body then regular exercise is key.

You don’t have to run a marathon either.  Just walking for 30 min 5 x a week is enough.  If that seems like too much start with shorter walks and work your way up.

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consider the impact of medications (over the counter and prescription):

In his “Better Brain Book” Dr Perlmutter goes to great lengths to discuss all the potentially harmful medications out there.  I recommend checking it out.   Also there has been some new research  recently reporting on the dangers of benzodiazepines (xanax, klonopin, valium, ativan, etc).   A prospective study looking at 1063 men and women (mean age 78) who were all free of dementia at the onset of the study.  They were followed for 15 years.  The researchers compared those who started benzodiazepine use at year 3 or later in the study to those who never took them and found a 50% increased risk for dementia in the group using benzodiazepines.

This really struck me because poor sleep is a common problem as we age and these medications are often used to help with sleep.  I think the message here is to think long and hard before taking these and to investigate more natural ways to cope with insomnia and anxiety.  Contact me if you want to learn more about how to do that for yourself.

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Helpful Links:  For those of you who want to learn more:

Dr Perlmutter on Alzheimers:

http://www.drperlmutter.com/videos/a-better-brain-alzheimers-disease-is-preventable/

Eating a low glycemic index diet:

http://glycemicindex.com/index.php

Eating Organic:

http://www.ewg.org/foodnews/

Sleeping Better:

http://www.drweil.com/drw/u/ART02037/sleep-aid

Exercise more:

http://www.hsph.harvard.edu/nutritionsource/staying-active-full-story/

Stress management tips:

https://mail.google.com/mail/?shva=1#label/stress-management/138189a64bd55677

 

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Beware of the dangers of too much calcium….

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Calcium rich foods are an important part of a healthy diet.  BUT, as always, balance is important.  Too much of a good thing is not always a good thing.  And when it comes to calcium, research is showing that too much (especially when it comes from supplements) may actually be harmful.

When I was in medical school and residency I was always told to encourage women to drink milk and eat yogurt and if they didn’t do that daily to advise a calcium supplement. The recommended doses at that time were 1000mg for pre-menapausal women and 1500mg for post-menopausal women.   In many conferences and lectures we were encouraged to just given women 1000- 1500mg of calcium in supplements to be sure they were getting enough.

I went along with that for a long time. Interestingly, in noticed that my patients often took less than I prescribed. Perhaps these women had an intuitive sense that too much calcium from supplements might be unnecessary or even potentially harmful.  I will outline some of the potential risks in this blog today.

But what about the “potential benefits?  Every pill or supplement you take into your body will offer you both potential risk and potential benefit.  It is wise to keep this in mind and to be sure you are fully aware of both sides of the equation before deciding if something will be part of your regular routine.

Let’s start with the benefits…..

1) BONE HEALTH:
Calcium is an important mineral to the body.  It is largely stored in the bones and does contribute to bone strength.  In fact 98% of the calcium in your body is located in your bones.  The rest is divided between your teeth (1%) and your blood (1%).

In women who have a low intake of dietary calcium, research has shown the taking 500mg a day of calcium citrate does improve the strength of bones in the femur, spine, and wrist.   Other research has made it clear that adding vitamin D to the calcium supplement is needed to show definite benefit in decreasing the risk of osteoporosis in post menopausal women.  The reason you need to take the vitamin D is because you need adequate vitamin D in your body or else the calcium will not be properly absorbed.

A 2010 report from the Institute of Medicine (IOM) found that most Americans get more then enough calcium from diet to maintain healthy bones.  The only group who did not seem to be taking enough in through diet was girls aged 9 through 18.  This may be why research published in 2011 in Osteoporsis Int showed improved bone strength in a group of girls aged 9 through 13 who took calcium 800mg  PLUS vitamin D  (400mg) for 6months.

In contrast, many post-menopausal women may be taking too much calcium if they take high dose supplements.

2) OTHER  POTENTIAL BENEFITS:

Other potential benefits of calcium supplementation include: reducing PMS,  slightly lowering blood pressure, slightly improving cholesterol levels, and possibly preventing polyps in the colon.  Some favorable research does exist for each of these conditions.

There was a time when calcium was reported to aid in weight loss but follow up research proved that was not true.

3) DEATH AND HEART DISEASE:
There was a study with white, postmenopausal women published in the Archives of Internal Medicine in 2011 that showed a 3.8% reduction in risk of death over a 22 year period in the women who took up to (but not over) 900mg per day in supplements.

Another recent study published in the Journal of the American Medical Assn this year followed a large group of men and women for 12 years and showed a decreased risk of death from heart disease with increased calcium intake (from all sources combined), up to a total of  about 1200mg per day.

Remember that is 1200mg from BOTH food and supplements.  Taking 1000mg a day in supplements is very likely to put you well over this and into a much higher range of calcium intake.  This is important to realize because excessive calcium intake appears to carry with it some pretty concerning risks.  Read on to learn more….

The Risks of calcium supplementation: 

1) HEART DISEASE:
In addition to the findings that some calcium intake may be protective to the heart research is showing that too much calcium (especially from supplements) may be doing just the opposite.

In recent years medical research has certainly shown that we have good reason to be cautious.  In 2010 a study in the British Medical Journal showed an increase in heart attacks in women taking high doses of calcium.  Interestingly this risk was NOT seen when the women took both calcium and vitamin D.  So there are still a lot of questions about what is really going on here.

Still that same study mentioned above, the one published this year in JAMA, showed that in men taking more than 1000mg a day of calcium in supplement form, there was a significantly increased risk for death from heart attack over the 12 year period studied.    This finding was not seen in the women in that study but other studies have shown some association between heart disease in calcium supplementation for both men and  women if  they  were already taking in more than 805 mg of calcium from foods.  Fortunately there was NO association between dietary calcium and an increased risk for heart attack.  The problem seemed to come from combining a moderate to high amount of dietary calcium along with the supplements.

More recently the British Medical Journal published a 19-year study conducted in Sweden that showed a significantly higher risk of Death in women with high calcium intake (especially if it came from supplements).  Women in the group taking >1400mg of calcium per day (from diet and supplements) were 40% more likely to die during the trial period compared to women in the group taking in 600mg to 1000mg per day(Michaelsson, BMJ 2013).

Some experts have theorized that there is a high spike of calcium in the blood following ingestion of a supplement and speculate that this “burst” of calcium may increase the risk for the calcium to deposit in the arteries leading to increased risk of developing plaques/ blockages in those arteries.  We still don’t know.  But there are enough questions re: safety to make it clear that more is not better when it comes to your calcium pills.

2) PROSTATE CANCER:  Here’s a quote from the Harvard School of Public Health on this issue:

“A diet high in calcium has been implicated as a probable risk factor for prostate cancer. (17) In a Harvard study of male health professionals, men who drank two or more glasses of milk a day were almost twice as likely to develop advanced prostate cancer as those who didn’t drink milk at all. (18) The association appears to be with calcium itself, rather than with dairy products in general: A more recent analysis of the Harvard study participants found that men with the highest calcium intake—at least 2,000 milligrams a day—had nearly double the risk of developing fatal prostate cancer as those who had the lowest intake (less than 500 milligrams per day). (19)”

More research is needed.  But until that time it seems wise for men to limit their calcium intake.  Most experts agree it is best for men to get their calcium from food and to keep their total intake to <2000mg per day.  If a man does take a supplement most experts advise to keep it to 500mg or less.

3) KIDNEY STONES:   Research has shown that there can be an increased risk of kidney stones from calcium supplementation, especially with doses 1000mg or over.  Fortunately there has not been any problem found from dietary calcium so if you have a history of  kidney stones you can still feel safe to get your calcium from food.

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OTHER FACTORS TO CONSIDER IN CALCIUM BALANCE:

So the question remains, is there benefit to taking calcium supplements?  The answer depends on you.  Do you follow a very acid diet?  Is your dietary intake of calcium low?

The calcium in your bones does play a role in keeping your bones strong but it also has another function.  It is critical to maintaining a healthy acid-base balance in the blood.  Your blood must keep within a very narrow pH range.  Going just a little bit too high or too low will lead to dire health consequences.   If your pH begins to drift out too much into an “acid” range then the bones release calcium into the blood to buffer the excess acids.

This is key to understand because the standard American diet is one that drives the body toward an acid state.  In fact the amount of calcium you take in may not be the only thing we need to focus on when it comes to bone health.  Equally important is reducing the amount of high acid foods and getting enough alkaline foods.  Acid forming foods include: Soda (regular AND diet),  meat,  dairy (yes, dairy!), white sugar, processed foods, trans-fats.  Alkaline foods include: fruits and vegetables, beans, herbs).  High salt intake can also trigger the kidneys to excrete calcium and lead to weakening of bones (http://www.jacn.org/content/25/suppl_3/271S.full)

Loss of calcium through the urine goes UP when diets are high in protein and sodium.  In fact it has been shown that vegans (people who eat no animal protein) have low excretion of calcium in their urine and vegetarians lose less than omnivores. (Breslau, J. of Clincal Endocrinology and Metabolism. 1988)

Furthermore, calcium absorption will be increased and excess loss decreased by:

–Keeping your vitamin D level in the normal range

–Avoiding excess animal protein (have some vegetarian meals if you can)

–Limit your intake of sodium to less than 2400mg per day (read labels!)

–Eat more fruits and vegetables, they help keep the blood more alkaline.  (aim for 7-9 servings/day)

–Avoid excessive caffeine and alcohol (both have been linked to accelerated bone loss)

–Avoid white sugar and simple carbohydrates (they push the blood in the acid direction)

Also there may be foods that are particularly protective.  One researcher looking into this and according to the textbook on Integrative Medicine:

“Muhlbauer described 25 plant foods as bone resorption inhibitory food items (BRIFI). These include garlic, rosemary, Italian parsley, sage, thyme, parsley, dill, onion, arugula, prune, fennel, orange, leek, yellow boletus, wild garlic, field agaric, red cabbage, celeriac, red wine, and lettuce.[51] In addition to effects on acid-base balance, the benefits of plant foods also appear to be related to the pharmacologically active compounds they contain. Certain specific monoterpenes,[52] flavonoids, and phenols[53] may be responsible for the observed beneficial effects on bone.”

Keeping these foods in your diet will likely slow your loss of calcium and therefore decrease your need for supplementation.

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GETTING CALCIUM FROM FOOD:

And of course including plenty of dietary sources of calcium helps, too.  I’m going to include a link to a table here to guide you but bear in mind adding up the “millgrams” of each of these is only part of what will keep your bones healthy.

Some foods may be more “bioavailable” meaning that the body is better able to absorb the calcium they contain (this is likely true for dark greens).  Also some people may be better able to absorb calcium.  Pregnant women have been shown to be better able to absorb and maintain calcium in their systems during this time.  They still need to take in calcium but they don’t need to take in more than their non-pregnant peers.

For those who like hard numbers the following recommendations currently exist:

For those ages 1-3: 700mg/day, ages 4-8: 1000mg/day,  ages 9-18:  1300mg /day,  ages 19-50:  1000mg/day,  ages 51- 70: 1000mg/ day for men and 1200mg/day for women, ages >71: 1200mg.

Here’s that link that lists the specific calcium content in foods:

http://www.ucsfhealth.org/education/calcium_content_of_selected_foods/index.html

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CALCIUM FROM SUPPLEMENTS:

If you do take supplements then bear the following in mind:

–Do not take more than 900mg/day in supplements.  Looking at the research suggests that a max of 500mg is  enough.

–Be sure to take vitamin D with your calcium so it can be absorbed

–Calcium citrate is better absorbed and can be taken with or without food.  This type of calcium may be a better choice for people with low stomach acid.  Calcium carbonate is less expensive but less easily absorbed so it is better to take with meals.

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Additional References:

Naturadatabase.com Calcium monograph

Rakel, David MD.  Integartive Medicine, 3rd ed

Harvard school of public health web site:  http://www.hsph.harvard.edu/nutritionsource/calcium-full-story/#calcium-from-milk

consumerlab.com : product review of calcium supplements