CHAPTER 5

B IS FOR BLOOD FLOW

UNLOCKING THE KEY TO LIFE

Yes, exercise is the catalyst. That’s what makes everything happen: your digestion, your elimination, your sex life, your skin, hair, everything about you depends on circulation.

JACK LALANNE

JIM: MARKERS OF MEMORY PROBLEMS

Jim, 61, was a successful businessman whose life started unraveling because of memory loss and erratic behavior several years before he came to our clinic just outside Washington, DC. Throughout his life, Jim had struggled with a short attention span, distractibility, and restlessness. He said he was unable to sit still and was “always on the go.”

Family and friends told Jim he likely had ADD (attention deficit disorder). He was dyslexic and didn’t learn to read until the sixth grade. Jim excelled at football and played for 10 years (middle school, high school, and college) as a linebacker, one of the worst brain-damaging positions. As a young adult, he drank heavily and smoked cigarettes and marijuana. Despite his many challenges, Jim was an outstanding businessman who owned seven automobile dealerships.

Two years before Jim came to see us, he was involved in a serious car accident in which he lost consciousness and stopped breathing three times. First responders used a defibrillator to restart his heart. During his hospital stay, he told us, he was not evaluated for a concussion. However, his memory deteriorated even more afterward, and his behavior became uncharacteristically erratic. He withdrew from his family and started having an affair, which led to a legal separation from his wife. He also described forgetting things he had asked his employees to complete, and so he ended up asking them more than once. He started drinking vodka martinis and said he “was probably drinking more than he should.” He became more anxious and had trouble sleeping, so his doctor prescribed Xanax and Ambien. Jim’s father had developed severe memory problems in his early seventies, which progressed to a diagnosis of Alzheimer’s disease. Given his family history, Jim worried that he could be exhibiting early signs of dementia.

When we first saw Jim, he was overweight and had high blood pressure and high cholesterol. His sugar intake was “higher than it should be,” and his fasting blood sugar, HbA1c, ferritin, homocysteine, and C-reactive protein were all high. His vitamin D level was low. His cognitive testing showed significant memory problems, and his brain SPECT scan showed marked overall decreased blood flow, the number one predictor of serious memory problems in the future.

JIM’S BRIGHT MINDS RISK FACTORS AND INTERVENTIONS

BRIGHT MINDS	JIM’S RISK FACTORS	INTERVENTIONS
Blood Flow	Severe low blood flow on SPECT, hypertension, three episodes where Jim stopped breathing after being knocked unconscious	Exercise, diet, ginkgo biloba, and other supplements
Retirement/Aging	High ferritin (iron) level	New learning exercises
Inflammation	High CRP and homocysteine	Diet, omega-3 fatty acids EPA and DHA, vitamins B6 and B12, and folate
Genetics	Father with Alzheimer’s
Head Trauma	Ten years playing football; motor vehicle accident with loss of consciousness
Toxins	History of significant alcohol and marijuana use	Stopped drinking alcohol
Mental Health	ADD; Xanax for anxiety	Medication for ADD; discontinued Xanax
Immunity/Infection Issues	Low vitamin D	Vitamin D3 supplements
Neurohormone Deficiencies	Low testosterone	Testosterone, weight training, supplements, and no sugar
Diabesity	High HbA1c and fasting blood sugar; obesity	Weight loss and improved blood sugar control with the Memory Rescue Diet
Sleep Issues	Sleep issues since motor vehicle accident; Ambien for insomnia	Sleep strategies to replace Ambien

JIM’S “BEFORE” BRAIN SPECT SCAN

Overall low blood flow

SPECT SCAN AFTER NINE MONTHS

Overall improvement

The cognitive testing and scan really got Jim’s attention. He did everything his psychiatrist, Lantie Jorandby, MD, asked him to do. He stopped drinking, changed his diet, started to exercise, and took medication for ADD as well as and targeted supplements to support his brain. These changes, along with strategies to improve Jim’s sleep, made it possible for Dr. Jorandby to take Jim off Xanax and Ambien. Nine months later he felt much better and his cognitive test scores and brain SPECT scan were markedly improved. Jim’s wife wrote to Dr. Jorandby, “Thank you for all of your help. I believe you and the Amen Clinics saved Jim’s life, our marriage, and our family. We are extremely grateful.”

Low blood flow in the brain is the number one predictor of future memory problems and Alzheimer’s disease and how quickly your brain will deteriorate.[70]

Blood is the channel that supplies cells with nutrients and clears toxins. To keep our brains sharp and healthy for as long as possible, it is critical to protect our blood vessels. In fact, brain cells don’t age as quickly as once believed; research shows it is the blood vessels supporting our neurons that age.[71]

Noting that 20 percent of the body’s blood flow is used by the brain, I often tell patients, “Whatever is good for your heart is good for your brain, and whatever is bad for your heart is also bad for your brain.” Not only that, but if you have blood flow problems anywhere, you probably have them everywhere.

Case in point: Commercials for drugs that treat erectile dysfunction, such as Viagra, Levitra, and Cialis, are now commonplace on television. Just as this condition is rapidly increasing in men, so are brain problems. When I wrote The Brain in Love in 2007, I realized I had overlooked the connection between the two. Now I say, “Whatever is good for your heart is good for your brain is good for your genitals. And whatever is bad for your heart is bad for your brain and bad for your genitals. It’s all about blood flow.” Circulation goes down in both organs, not one or the other. Sexual dysfunction and low blood flow are also increasingly problems in women.

Forty percent of 40-year-old men have erectile dysfunction, according to the Massachusetts Male Aging Study, which likely means that 40 percent of 40-year-old men also have brain dysfunction. The rate rises to an alarming level in older men: The same study reported that 70 percent of 70-year-old men had erectile dysfunction, which likely means that 70 percent of 70-year-old men likely also have brain dysfunction.[72]

Besides erectile dysfunction and a loss-of-oxygen experience (like a near drowning or heart stoppages, as in Jim’s case), there are several other vascular or blood flow risk factors:

• Cardiovascular disease, including:
  1. a. atherosclerosis (hardening and narrowing of the arteries)
  2. b. high LDL or total cholesterol
  3. c. heart attack
  4. d. atrial fibrillation
  5. e. hypertension or prehypertension
• A stroke or transient ischemic attack (TIA)
• Exercising less than twice a week and/or a slow walking speed

The Blood Brain Barrier: Don’t Let Yours Leak

No discussion of blood flow to the brain is complete without mentioning the blood brain barrier (BBB), the protective membrane between blood vessels and brain tissue. The BBB acts as a gatekeeper, allowing nutrients like water, oxygen, glucose, vitamins, and hormones to cross into brain tissue and ushering out waste products like carbon dioxide. The BBB also protects the brain from toxins, infections, and allergens.

Although this protective layer is only a single cell thick, the cells forming it are tightly connected into a strong barrier. However, age, high blood pressure, trauma, inflammation, lack of oxygen, and other assaults can fray or damage the cell connections. When that happens —when the connections become “leaky” —disease is much more likely to occur because unwanted substances, like toxins, can cross into the brain.

BLOOD BRAIN BARRIER

Likewise, certain infections, such as syphilis and Lyme disease, can cross the BBB, which may be why they often are associated with cognitive and emotional problems. Some researchers suggest that gluten and milk proteins can also disrupt this barrier.[73] As we age, the BBB first becomes leaky in the area of the hippocampus,[74] which may be a big reason memory issues are much more common as we grow older. See page 71 (“Prescription to Reduce Your Brain Blood Flow Risk”) for ways to help strengthen the BBB.

BLOOD FLOW RISK FACTORS EXPLAINED

Cardiovascular diseases

Given how important blood flow is to the brain, heart and blood vessel disease is a major risk factor for memory decline. Let’s look at each potential contributor.

Atherosclerosis, the main culprit behind cardiovascular diseases, is caused by a buildup of fatty deposits called plaques on the inside walls of arteries. As plaques get larger, arteries gradually narrow and can become clogged, restricting blood flow to areas that need it. Blood vessels also become less elastic (so-called “hardening of the arteries”), which raises blood pressure and makes the vessels brittle, more likely to break (causing strokes). People with the APOE e4 gene have an increased risk of coronary artery disease (in the arteries that feed the heart) and Alzheimer’s disease.[75] The most common risks for developing atherosclerosis are high blood LDL cholesterol levels (see below), advancing age, being male (women are more often affected after menopause), high blood pressure, diabetes, smoking, obesity, and physical inactivity. The risk is also greater in people with close relatives who had heart disease or a stroke at a relatively young age.

High levels of LDL cholesterol increase dementia risk, while high levels of HDL seem to lower it. In a four-year study of 1,037 women under 80 who had coronary artery disease, those who had elevated levels of LDL cholesterol had almost double the risk of memory loss, cognitive impairment, or dementia. But lowering LDL cholesterol into the normal range eliminated this increase in risk. One caveat: Lowering total cholesterol below 160 milligrams per deciliter (mg/dL) can increase the risk of depression and aggression. Maintaining proper cholesterol levels is particularly important for people with an APOE e4 gene.

Having a heart attack significantly increases the risk for future memory problems. That’s because damage to the heart decreases its ability to pump blood and keep blood flowing effectively.

Atrial fibrillation is a type of heart rhythm abnormality (arrhythmia) that reduces the amount of blood the heart can pump. This fluttering rhythm also allows blood clots to form, which are then pumped into the bloodstream. A-fib, as it’s commonly known, is a recognized risk factor for stroke and dementia.

Hypertension, or high blood pressure, increases the risk of memory problems. Optimal blood pressure is critical for brain health. High blood pressure and even blood pressure at the higher end of the normal range (prehypertension) is associated with lower overall brain function and blood flow to the brain.[76] According to the CDC about one-third of Americans have hypertension; another one-third are prehypertensive.[77] Being hypertensive is the second leading preventable cause of death and is associated with heart disease and stroke, other risks for memory problems. Chronically elevated pressure causes the blood vessel walls to enlarge and stiffen, making them more narrow and likely to break, much like atherosclerosis. Common causes of hypertension include genetics, being overweight, sleep apnea, and kidney disease. Hypertension can also be a side effect of oral contraceptive use.

Stroke or transient ischemic attacks

A stroke occurs when a blood vessel breaks or a clot chokes off blood supply to the brain, killing cells. The risk of developing dementia is six to ten times greater in a person who has had a stroke than in the general population.[78] Even a stroke that is caused by a clot smaller than a pencil eraser increases the risk for dementia. Having one or more strokes means blood vessels are significantly more vulnerable. However, risk factors such as high blood pressure, smoking, heart disease, and diabetes develop over a long time, meaning people generally have time to address these risk factors before it’s too late. And the benefits to the brain can be substantial. Recently, Canadian researchers reported that a stroke-prevention program in Ontario had a very positive side effect: a 15.4 percent reduction in dementia over a decade in those ages 80 and over. The program included following a healthy diet, exercising, staying tobacco-free, and taking blood pressure medication, if needed.[79]

BE-FAST is a mnemonic (memory device) to help people remember the early warning signs and problem areas associated with a stroke:

• Balance: sudden loss of balance or coordination
• Eyes: sudden loss of vision in one or both eyes
• Face: drooping on one side
• Arms: weakness; inability to raise both arms without one arm drooping
• Speech: slurred or jumbled
• Time: prompt medical help is critical; call 911

Sometimes the warning signs of a stroke last for only a few minutes before disappearing, but that does not mean the problem is resolved. Ministrokes, also called transient ischemic attacks (TIA), don’t last long or cause permanent damage, but they are a major warning sign of a greatly increased risk for more serious strokes and progressive memory problems.

RIGHT-SIDE FRONTAL, TEMPORAL LOBE STROKE —

BEFORE TREATMENT

Overall severe decreased activity

AFTER TREATMENT

Notice areas of significant improvement

If you’ve had a stroke or a TIA and want to rescue your memory, you must be very serious about your health. I’ve seen significant improvement in people who have had a stroke when they put their brains in a healing environment —specifically, when they followed all the BRIGHT MINDS strategies and used hyperbaric oxygen therapy (HBOT), which helps boost blood flow in the area surrounding the stroke.[80] (See chapter 19 for more on HBOT.)

Loss of oxygen

Your brain is oxygen hungry, and when it is deprived, it prematurely ages and is damaged. Sleep apnea can cut off oxygen (see chapter 15), as can near-drowning episodes, cardiac arrest, or voluntary asphyxiation, which is more common than most people know. I’ve treated a number of patients who would hold their breath as long as they could underwater, and others who would knowingly engage in autoerotic asphyxiation without realizing the damage they were doing to their brains.

Limited or no exercise

Not exercising is a major risk factor for memory loss, in large part because physical activity keeps blood vessels healthy. Exercise helps to boost a chemical called nitric oxide, which is produced in the walls of blood vessels and helps to control their shape. If blood vessel walls do not receive pulses of blood flow regularly from exercise, they begin to distort, flatten out, and limit blood flow overall. As a result, the body’s tissues, including the brain, do not receive the nutrients they need or have a good mechanism to rid themselves of the toxins that build up in the body. If the deep areas of the brain are starved of oxygen and glucose, a person will have problems coordinating his or her limbs and processing complex thoughts, as during deep conversations. Regular physical exercise is a major preventive strategy for memory loss,[81] no matter the age someone begins.

Yalla imshi. As a child, I heard those two Lebanese words a lot from my father. They mean “Let’s go” or “Hurry up.” I am the third of seven children, and we were often in a hurry to get to school, pick someone up from baseball, or go to the store. I still hear this phrase in my head and have used it once or twice with my own children. Little did my dad know how important those two words are. The faster we walk as we age, the longer we live and the sharper we think. An 80-year-old person who walks one mile per hour has only a 10 percent chance of living until 90. But if that same 80-year-old moves faster, say at 3.5 mph, he or she has an 84 percent chance of reaching 90.[82] As walking speed goes down, so do executive function and decision-making skills.[83] If you haven’t walked at a fast pace for a long time, start slowly and work your way up safely. Falls are also a major cause of memory loss.

The Miracle of Exercise

Physical exercise needs to be part of your everyday life for many reasons. For instance, it stimulates neurogenesis, the ability of the brain to generate new neurons. Research shows that, when laboratory rats are engaged in physical activity, new neurons are generated in the frontal lobe and hippocampus, which survive for about four weeks and then die off unless they are stimulated.[84] If you stimulate these new neurons through mental or social interaction, they connect to other neurons and become integrated into brain circuits that help maintain their functions throughout your life. This is why people who go to the library or take music lessons after a workout are smarter than those who work out and then veg out.

Exercise also protects the hippocampus from stress-related hormones, like cortisol,[85] which normally shrink it. Even leisurely walking has been shown to increase the size of the hippocampus in women.[86]

Many other health benefits stem from physical activity; for example, it

• helps increase the size of the hippocampus,[87] the holy grail of any memory enhancement program;
• stimulates the production of growth factors, such as BDNF (brain-derived neurotrophic factors), that nurture stem cell production;
• decreases beta-amyloid plaque formation;[88]
• improves cognitive flexibility and function;[89]
• elevates mood and focus;
• enhances the heart’s ability to pump blood throughout the body and brain, which increases oxygen and nutrient delivery;
• boosts nitric oxide production and the flexibility of blood vessels, which decreases the risk for high blood pressure, stroke, and heart disease;
• enhances insulin’s ability to lower high blood sugar levels, reducing the risk of diabetes;
• helps you maintain coordination, agility, and speed;
• increases levels of the hormone DHEA, which is critical to brain health;
• improves blood pressure;
• increases flexibility and agility;
• allows for greater detoxification through sweat;
• enhances the quality of sleep; and
• boosts immunity.

CHECKUP FOR BLOOD FLOW ISSUES

Blood pressure

Here are the numbers you should know:

• Optimal
• Systolic 90–120
• Diastolic 60–80
• Prehypertensive
• Systolic 120–139
• Diastolic 80–89
• Hypertensive
• Systolic > or = 140
• Diastolic > or = 90

If you have diabetes or chronic kidney disease, you should have a target blood pressure below 130/80.[90] However, blood pressure that is too low can also be a problem.

• Hypotensive
• Systolic < 90
• Diastolic < 60

Lab tests

• Complete Blood Count (CBC): This blood test checks the health of your blood, including red and white blood cell counts. Low red blood cell count (anemia) can make you feel anxious and tired and can lead to memory problems. It may indicate internal bleeding or a vitamin or iron deficiency, among other causes. Enlarged red blood cells may mean you are drinking too much alcohol. A high level of white blood cells may indicate infection. Check with your health-care provider for treatment suggestions.
• Lipid Panel: Cholesterol and triglyceride (fat) levels in the blood are also important, especially because they can negatively affect blood delivery to the brain. Cholesterol that is either too high or too low is bad for the brain. Higher cholesterol later in life has been associated with better cognitive performance[91] and a decreased risk of dementia.[92] Normal levels are:
  • Total Cholesterol (135–200 milligrams per deciliter [mg/dL], yet a level below 160 has been associated with depression, suicide, homicide, and death from all causes, so the optimal level is 160–200 mg/dL)
  • HDL (>/= 60 mg/dL)
  • LDL (<100 mg/dL)
  • Triglycerides (<150 mg/dL)

  Knowing the particle size of your LDL cholesterol (your health-care professional can order this test) is important because large particles are less toxic than smaller particles. If cholesterol is a concern for you, I recommend two books: The Great Cholesterol Myth by Stephen Sinatra, MD, and Jonny Bowden, PhD, and What Your Doctor May Not Tell You about Heart Disease by Mark Houston, MD.

FROM THE BRAIN WARRIOR’S WAY LIVE CLASS

“I finally got myself to the lab to get my lipid test done, and my doctor actually messaged me and told me she was really happy with my numbers, all my numbers. She said, ‘Whatever you are doing, keep doing it!’ I’m proud of myself. And thank you, Dr. Amen and Tana [Amen]; I couldn’t have done it without you too! These numbers were much worse before I started your program.”

Balance test: how long can you stand on one foot?

Throughout life, your eyes, ears, muscles, brain (especially your cerebellum), and nerves work together to keep you upright, balanced, and steady on your feet. But as you age, your balance tends to become less dependable, especially if you don’t engage in regular coordination exercises. Unsteady footing makes it difficult to engage in any habitual physical activity, putting you at greater risk for cardiovascular disease. Poor balance and an unsteady gait are also associated with a higher incidence of falls and memory problems.[93]

A simple way to check your balance is called the static-balance test. How long can you stand on one leg with your eyes closed before you lose your balance? Follow these simple instructions to find out.

1. Enlist the help of someone who has a watch or timer.
2. Stand barefoot on a flat, hard surface. Stand close to something to grab on to, or ask your partner to stand close to steady you in case you start to fall.
3. Close your eyes.
4. Lift one foot off the ground about six inches, bending your knee at a 45-degree angle. (Use your left foot if you’re right-handed; your right foot if you’re left-handed).
5. Ask your partner to start timing.
6. Keep still for as long as you can without jiggling, teetering, falling, or opening your eyes.
7. Repeat the test three times, add up the results, and divide by three to get the average. Then check your time against the chart below.

• Balance Time: Balance-Based Age
• 4 seconds: 70 years
• 5 seconds: 65 years
• 7 seconds: 60 years
• 8 seconds: 55 years
• 9 seconds: 50 years
• 12 seconds: 45 years
• 16 seconds: 40 years
• 22 seconds: 30–35 years
• 28 seconds: 25–30 years
  

  PRESCRIPTION TO REDUCE YOUR BRAIN BLOOD FLOW RISK

The Strategies

The strategies below can help support your overall blood flow and improve your cholesterol levels and blood pressure.

1. 1. Avoid anything that hurts vascular health. Examples include a sedentary lifestyle, caffeine and nicotine (which both constrict blood flow to the brain and other organs), and dehydration.[94]
2. 2. Seek treatment for anything that damages your blood flow. Be serious about addressing coronary artery disease, heart arrhythmias, prediabetes and diabetes, prehypertension and hypertension, insomnia, sleep apnea, and drug and alcohol abuse.
3. 3. Lose weight if your BMI is over 25. BMI, an abbreviation for Body Mass Index, is a measure of body fat that is based on a person’s height and weight. To determine your BMI, check any online BMI calculator. (The National Institutes of Health provide one at https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.) See also chapter 14.
4. 4. Spend 10 to 20 minutes a day in deep prayer or meditation.[95] Both prayer and meditation have been shown to improve blood flow to the brain, particularly in areas involved in memory and thinking skills.

Not only do prayer and meditation boost blood flow to the brain, these spiritual practices are also wonderful stress management tools.

1. 5. Strengthen your blood brain barrier (BBB). Eliminate gluten, dairy, and toxins (see chapter 16), and treat any infections (see chapter 12). Many of the supplements I recommend in the Memory Rescue program also seem to help with the integrity of the BBB, such as folate, vitamins B6, B12,[96] and D,[97] acetyl-L-carnitine,[98] alpha-lipoic acid,[99] alpha GPC,[100] curcumin,[101] resveratrol,[102] and omega-3 EPA and DHA.[103]
2. 6. Adopt natural strategies to keep your blood pressure healthy.
   • Eat more plant-based foods.
   • Limit dairy.
   • Limit salt intake (about 1,500 mg a day is recommended; no more than 2,300 mg).
   • Eat more foods high in magnesium (e.g., pumpkin seeds) and potassium (e.g., bamboo shoots, cabbage).
   • Eat more foods with blood pressure–lowering effects, such as broccoli, celery, garlic, chickpeas, spinach, and mushrooms.
   • Eliminate alcohol, caffeine, fruit juices, and sodas (including diet sodas).[104]
   • Drink water! People who drink at least five glasses of water a day have half the risk of hypertension as those who drink fewer than two a day.
   • Focus on getting seven to eight hours of sleep a night, and if you have sleep apnea, get it assessed and treated.
   • Take supplements that research-based evidence has shown to lower blood pressure:[105] These include magnesium, potassium, CoQ10, vitamins C and D, aged garlic, and omega-3 EPA and DHA.
3. 7. Take medication if you need it. At Amen Clinics we prefer to take a natural approach to health problems, but hypertension or excessively high cholesterol levels can become a crisis if not managed properly. The thoughtful use of medicine can be very helpful.
4. 8. Exercise! Regular exercise helps to boost nitric oxide and keep blood vessels open and flexible. (See “The Miracle of Exercise” on page 67 for additional benefits.) The following four types of exercise are great for your brain. Of course, you should check with your physician before starting any new exercise routines.
   • Burst training. This workout involves several surges of intense activity lasting 30 to 60 seconds, each followed by a few minutes of lower-intensity exertion for recovery. An easy way to incorporate this into your routine is to take a 30- to 45-minute walk every day. Include four or five one-minute periods to “burst” (walk or run as fast as you can), and walk at a normal pace for two to three minutes between bursts. A 2006 study at Canada’s University of Guelph found that burst training burns fat faster than continuous, moderately intensive activities. Short burst training also raises endorphins, lifts your mood, and energizes you. It also may improve the health and number of your mitochondria, the energy storehouses inside your cells.[106] Whenever you walk during ordinary activities, walk as if you are late. Seniors who walk faster live longer and have better executive function.[107] Yalla imshi!
   • Strength training. Aim to complete two 30- to 45-minute weight-lifting sessions a week, a day or two apart. One session should focus on the lower body (abs, lower back, and legs); the other on the upper body (arms, upper back, and chest). The stronger you are as you age, the less likely you are to get Alzheimer’s disease. Canadian researchers found that resistance training helps prevent cognitive decline[108] and benefits people with mild cognitive impairment.[109]
   • Coordination activities. Exercises such as dancing, tennis, and table tennis (the world’s best brain sport) increase activity in the cerebellum, which is involved with both physical and thought coordination. Although the cerebellum makes up only 10 percent of the brain’s volume, it contains 50 percent of its neurons.
   • Mindful exercise. Yoga, tai chi, and other mindful exercises have been found to reduce anxiety and depression and increase focus and energy. So although they don’t offer the same BDNF-generating benefits as aerobic activity, these types of exercise can still improve your brain health.

Table Tennis, Tennis, and Other Sports That Boost Longevity

To get the biggest benefit from exercise, pick up a table tennis or tennis racquet and get moving. A 2016 study published in the British Journal of Sports Medicine[110] that tracked more than 80,000 adults for nearly a decade found that those who played racquet sports, such as tennis, table tennis, badminton, or squash, had the lowest risk of dying during the study compared to other exercisers. In fact, they had a 47 percent lower chance of dying from all causes compared to those who didn’t play racquet sports and were 56 percent less likely to die as a result of cardiovascular disease (blood flow problems).

Table tennis is my favorite sport for the brain, because it is one of the fastest racquet sports, with balls flying close to you at speeds of up to 60 miles per hour. Table tennis’s demanding visual and spatial requirements, together with strategy and aerobic exercise, offer powerful brain benefits. A study of 164 Korean women age 60 and older showed that table tennis improved cognitive function more than dancing, walking, gymnastics, or resistance training.[111] Other research suggests table tennis may help with ADHD.[112]

If racquet sports are not your thing, get in the water: Swimmers were 28 percent less likely to die for any reason and 41 percent less likely to die of cardiovascular disease than other exercisers in the British study. Or try Zumba or aerobics —those who did were 27 percent less likely to die of any cause and 36 percent less likely to die of cardiovascular disease.

The Nutraceuticals

• Ginkgo biloba extract[113] has been shown to help cerebral blood flow and memory. In fact, the prettiest brain SPECT scans I see often belong to people who are taking this Chinese herb concentrate. The typical adult dose is 60 to 120 mg twice a day. I recommend starting at the lower dose for several weeks and then increasing to the higher amount to determine at which dosage your focus, energy, and memory are sharpest.

For better blood flow, consider taking 60 mg of ginkgo biloba twice a day.

• Cocoa flavanols[114] have been shown to boost blood flow to the brain, promote healthy blood pressure,[115] and improve some cognitive functions,[116] even in those who are sleep deprived.[117] I recommend one piece of sugar-free, dairy-free dark chocolate every day. Being the grandson of a candy maker, I was so excited about this finding that I made our own sugar-free, dairy-free, gluten-free, non-GMO chocolate bar called Brain in Love, which tastes amazing and has nine grams of fiber (www.brainmdhealth.com/brain-in-love-chocolate-bar-case).
• Omega-3 fatty acids can increase blood flow;[118] decrease brain atrophy;[119] increase working memory,[120] executive function,[121] and mood;[122] and decrease inflammation.[123] The active omega-3s are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). The reliably effective daily dose seems to be well above 1,000 mg (1 gram) per day of EPA and DHA. I recommend that most adults take 1.4 grams or more in about a 60/40 EPA/DHA ratio. (Check out more detailed information on the Omega-3 Index on page 102.)
• Green tea catechins (GTC —especially epigallocatechin gallate, or EGCG) have been shown to increase blood flow,[124] improve blood vessel tone, and help manage blood pressure.[125] An analysis of a group of studies indicates taking GTC daily lowers the risk of stroke.[126] GTC has also been shown to help improve cholesterol management[127] and blood sugar regulation.[128] Daily consumption of GTC may improve depression[129] and significantly lowers the risk of cognitive decline, especially for females and those at genetic risk for Alzheimer’s.[130] A note of caution: I recommend not taking more than 600 mg a day.
• Pycnogenol, a standardized extract of flavonoids from the bark of the maritime pine (Pinus pinaster), is a powerful antioxidant and anti-inflammatory that protects the circulation and also the brain —especially the endothelium, a delicate single layer of cells that line the blood vessels and regulate their functioning.[131] The most intensively researched of all the nutraceuticals, Pycnogenol has shown benefits for memory, attention, and other cognitive functions in both students and the elderly. An effective dose ranges from 30 to 150 mg per day and occasionally much higher since Pycnogenol is very safe to take.[132]
• Resveratrol at 75 mg a day can increase blood flow to the brain.[133]
• Probiotics may lower LDL cholesterol, blood pressure, inflammatory markers, blood sugar levels, and BMI,[134] according to researchers who have found accumulating evidence of probiotics’ benefits. For more information, see page 106 in chapter 7.

The Foods

AVOID (OR LIMIT):

• Caffeine, which has been shown to constrict blood flow to the brain
• Sugary and diet sodas, which are harmful to both your health and your brain. Sugar-sweetened sodas can raise blood pressure and cause other heart problems,[135] and diet sodas have now been linked to a higher risk of dementia, Alzheimer’s disease, and stroke.[136]
• Baked goods, which can lead to clogged arteries, hypertension, and heart failure
• French fries and other foods fried in vegetable oils
• Trans fats, found not only in some processed snacks but in many margarines and powdered coffee creamers
• Low-fiber “fast” foods
• Alcohol (I recommend no more than two to four servings a week.)

CONSIDER ADDING:

• Spices: cayenne pepper,[137] ginger, garlic,[138] turmeric,[139] coriander and cardamom,[140] cinnamon,[141] rosemary, and bergamot (which has cholesterol-lowering properties)
• Arginine-rich foods to boost nitric oxide and blood flow: beets, pork, turkey, chicken, beef, salmon, halibut, trout, steel-cut oats, clams, pistachios, walnuts, seeds, kale, spinach, celery, cabbage, and radishes. Drinking nitrate-rich beet juice has been found to lower blood pressure, increase stamina during exercise and in older people, and boost blood flow to the brain.[142]
• Vitamin B6, Vitamin B12, and folate-rich foods: leafy greens, cabbage, bok choy, bell peppers, cauliflower, lentils, asparagus, garbanzo beans, spinach, broccoli, parsley, salmon, sardines, lamb, tuna, beef, and eggs
• Vitamin E–rich foods, which widen blood vessels and decrease clotting: green leafy vegetables, almonds, hazelnuts, and sunflower seeds
• Magnesium-rich foods, which relax blood vessels: pumpkin and sunflower seeds, almonds, spinach, Swiss chard, sesame seeds, beet greens, summer squash, quinoa, black beans, and cashews
• Potassium-rich foods to help control blood pressure: beet greens, Swiss chard, spinach, bok choy, beets, brussels sprouts, broccoli, celery, cantaloupe, tomatoes, salmon, bananas, onions, green peas, sweet potatoes, avocadoes, and lentils
• Fiber-rich foods, which have been shown to lower blood pressure[143] and improve cholesterol levels[144]
• Vitamin C–rich foods: See more in chapter 12, page 200.
• Polyphenol-rich foods: See page 118 in chapter 8.
• Garlic-rich foods to lower cholesterol
• Omega-3-rich foods: See page 107 in chapter 7.
• Maca, a root vegetable/medicinal plant native to Peru, to reduce blood pressure[145]

PICK ONE HEALTHY BRIGHT MINDS HABIT TO START TODAY

1. Focus on drinking more water —blood is mostly water.
2. Avoid caffeine and nicotine.
3. Take up a racquet sport.[146]
4. Have a small piece of sugar-free dark chocolate.
5. Take ginkgo biloba.
6. Spice up your food: Add cayenne pepper.
7. Add arginine-rich foods, including beets.
8. Add vitamin E foods, including green leafy vegetables.
9. Add magnesium-rich foods, including pumpkin seeds.
10. Drink green tea.