Avoid toxic metals and “bad” fats—sounds like an easy prescription so far. But we’re just getting started. There is a lot more you’ll want to do to protect yourself.
Certain critically important vitamins—nutrients that can easily be neglected—play vital roles in protecting your brain. Let’s take a look at four of them: vitamin E, folate, vitamin B6, and vitamin B12.
Vitamin E protects your cells. Specifically, it knocks out free radicals, those angry torpedoes that form, in part, due to copper and iron, as we saw in chapter 2. Vitamin E is an antioxidant. It neutralizes free radicals as they arise.
This is important for every part of your body. But it is critical for your brain. Skin cells and muscle cells can be replaced, and red blood cells and white blood cells turn over so quickly, they practically have a sell-by date. But brain cells are forever. Your ability to regenerate new ones is very limited, and there just aren’t a lot of shiny new replacement parts ready to stand in for brain cells that have died.
Every brain cell, the axon that extends from it, and the synapses that link it with other cells are fragile. Like an old stone statue in a town square assaulted day after day by air pollutants and acid rain, each brain cell is nicked and pockmarked by the microscopic attacks of free radicals. Vitamin E is a key part of your antioxidant shield.
So, does it work? Does vitamin E actually protect your brain cells? Dutch researchers analyzed the diets of 5,395 people, all of whom were fifty-five or older as the study began. They tracked how much vitamin E they were getting in foods, and they then followed them over the next decade. It turned out that those who got the most vitamin E cut their risk of developing Alzheimer’s disease and other forms of dementia by about 25 percent.1
Similarly, the Chicago researchers found that in older people followed over a four-year period, Alzheimer’s disease developed in 14.3 percent of those who had relatively little vitamin E in their diets, but in only 5.9 percent of those who got the most vitamin E.2 Here is the math: Every 5 milligrams of vitamin E in a person’s daily diet reduced the risk of developing Alzheimer’s disease by 26 percent.3
In the Dutch study, it did not matter if you had the APOE e4 allele—vitamin E was still helpful. But in the Chicago study, it seemed to work only in people who did not have the APOE e4 allele, for reasons that are not clear.
Two caveats: First, not all research teams have confirmed the protective effect of vitamin E for the brain. Second, don’t rush to the store and buy a bottle of vitamin E. Get it from foods instead. Here is why: Most vitamin E supplements have only one form of the vitamin, called alpha-tocopherol. Foods provide it, too, but they also have a second form, called gamma-tocopherol, and others as well. These various forms of vitamin E work as a team. There is no need to bother with pills, and some evidence suggests that vitamin E pills are not effective against dementia.4
What if you have Alzheimer’s already? Will vitamin E help? In 1997, a large research project found that vitamin E did seem to slow the decline of Alzheimer’s disease. Called the Alzheimer’s Disease Cooperative Study, the project enrolled people with moderately severe symptoms.5 Their average age was seventy-three, and they had had Alzheimer’s disease for about five years. By taking 1000 IU of vitamin E (alpha-tocopherol) twice a day, they were able to delay further decline by nearly two years. “Decline” meant loss of the ability to perform activities of daily living, severe dementia, institutionalization, or death.
Unfortunately, this optimistic finding was not replicated by later studies, and the role of vitamin E in Alzheimer’s treatment remains a matter of debate. So, for prevention, vitamin E–rich foods do seem to be effective, but once dementia has begun, its benefits are uncertain.
The recommended dietary allowance for vitamin E for adults is 15 milligrams (22.4 IU) per day. The amount that helped in the Dutch study was around 18.5 milligrams (27.6 IU) per day. The amount that helped in the Chicago study was just 7.6 milligrams (11.4 IU) per day.
You’ll find traces of vitamin E in broccoli, spinach, sweet potatoes, mangoes, and avocados. And there is much more in nuts and seeds, especially almonds, walnuts, hazelnuts, pine nuts, pecans, pistachios, sunflower seeds, sesame seeds, and flaxseed.
An ounce of typical nuts or seeds has about 5 milligrams of vitamin E. How much is an ounce? Pour some nuts or seeds into the palm of your hand and stop before they reach your fingers. That is about an ounce. If that’s part of your routine, it trims your Alzheimer’s risk by about one-quarter, if the Chicago findings hold.
While nuts and seeds are rich in vitamin E, they are also high in fat, which means they pack a lot of calories, not to mention some saturated fat. So I would suggest using them sparingly, focusing on the vitamin E–rich varieties mentioned above rather than peanuts or cashews, which have less vitamin E and more saturated fat.
If you have a tendency to overdo it with nuts and seeds—you tear open a pack and pretty soon you’ve eaten the whole thing—try this: Use them as an ingredient, rather than as a snack food that you might eat all by itself. Sprinkle them on your salad or into a sauce. That way you’ll be less tempted to go back for more.
| Vitamin E–Rich Foods6 | |||
| GAMMA-TOCOPHEROL | ALPHA-TOCOPHEROL | ||
| Black walnuts | 8.1 | Sunflower seeds | 7.4 |
| Sesame seeds | 8.0 | Almonds | 7.3 |
| Pecans | 6.9 | Almond butter | 6.9 |
| Pistachios | 6.4 | Hazelnuts | 4.3 |
| English walnuts | 5.9 | Pine nuts | 2.6 |
| Flaxseed | 5.7 | Brazil nuts | 1.6 |
| Amounts are listed in milligrams per ounce. | |||
Vitamin E is not the only important nutrient. Three other vitamins are being studied for their role in protecting the brain. Let me tell you what they do.
There is a small, destructive molecule that circulates in your bloodstream, called homocysteine (pronounced ho-mo-SIS-teen). At high levels, it is linked to risk for heart attacks and strokes. It also affects the brain. Exactly how it does its dirty work is not entirely clear, but some have suggested that, among other things, homocysteine works in combination with copper and cholesterol to damage brain cells.7
Where does this nasty actor come from? Well, you don’t inhale it, you don’t drink it, and it does not come from food. It is actually created within your body. As your cells build protein, homocysteine is a temporary by-product made along the way.
That’s where vitamins come in. They help you get rid of it. Specifically, three B vitamins—vitamin B6, vitamin B12, and folate—work as a team to eliminate homocysteine. If you are low in any one of them, it will tend to build up in your bloodstream.
In the Netherlands, researchers conducted a study to see what folate supplements could do to boost memory and cognition overall.8 They invited a group of volunteers to participate. They were healthy, between fifty and seventy years of age, and free of any major memory problems, but they all had high homocysteine levels on blood tests. Everyone was asked to complete some basic cognitive tests. For example, they were given a list of fifteen words and asked to recall as many as they could twenty minutes later. They were asked to name as many animals as they could think of in one minute. The researchers measured their reaction times.
Then, half the volunteers were given folate supplements of 800 micrograms per day. The other half were given a placebo—a dummy pill that had no folate in it at all. Every year for the next three years, they were tested again.
The placebo group ended up getting no benefits, needless to say. But for the folate group, homocysteine levels promptly fell, from around 13 micromoles per liter to around 10. Their memories improved, and they were thinking measurably more quickly compared to participants who did not get folate.
Note that the people in the Netherlands were within the range of what we would consider normal mental functioning. Even so, folate made a noticeable difference.
Researchers at Oxford University went a step further, testing folate, vitamin B6, and vitamin B12 in older people who were having memory problems that were sufficient for a diagnosis of mild cognitive impairment.9 As you will recall, that means they had significant forgetfulness but were otherwise fine for the moment. The researchers gave everyone a set of cognitive tests. Then, over the next two years, the participants started a daily regimen that consisted of 800 micrograms of folate, 500 micrograms of vitamin B12, and 20 milligrams of vitamin B6, all of which are well above the recommended dietary allowances for these vitamins and more than one would typically get from foods.
The effects were remarkable. High homocysteine levels fell sharply, and many people found their memory improving significantly. Accuracy on testing was improved by as much as 70 percent. And brain scans showed that the B vitamins also helped protect against brain shrinkage over time.
Can these three vitamins prevent Alzheimer’s disease? That is not so clear. But studies of Alzheimer’s patients have shown that many have had excess homocysteine levels, suggesting that it is critically important to get the vitamins that eliminate it.11,12
Once people have been diagnosed with Alzheimer’s disease, vitamin supplementation has been disappointing. In a recent US study involving 409 people with mild to moderate Alzheimer’s disease, B6, B12, and folate supplements showed no benefits for the group as a whole. However, focusing on those whose symptoms were mildest, the vitamins did seem to slow cognitive decline over an eighteen-month period compared with people given a placebo.13
Overall, these studies suggest that folate, B6, and B12 help lower homocysteine, and that helps protect your memory. But before you start loading your shopping cart with supplement bottles, let me share some important caveats:
First, it is likely that benefits of vitamin supplementation will show up in people whose homocysteine levels have been too high as opposed to people with normal homocysteine levels.8,14 It is easy for a doctor to check your homocysteine level. A value over 15 micromoles per liter is too high, and some clinicians would call for a more conservative cutoff of 13. If you are in the normal range, it is not necessary to get heroic amounts of these vitamins in your diet. Rather, you just want to make sure you’re not missing them.
Second, in the United States, many foods are supplemented with folate. If you are already getting plenty, more is not necessarily better. In fact, overdoing it with folate supplements may well be harmful. In the Chicago study, getting extra folate was not helpful and, if anything, increased the risk of Alzheimer’s disease over time.15 Similarly, in a large Norwegian study, B vitamins were used in people who had recently had heart attacks to see if they could prevent recurrences. However, the study participants did not necessarily have high homocysteine levels, and B vitamins ended up doing more harm than good, boosting the risk of future heart problems by about 20 percent.16
So what’s the safe and smart way to get the vitamins you need? Let’s take them one by one:
Best sources of folate: Folate is in foods with foliage—that is, broccoli, spinach, asparagus, and other green leafy vegetables. You’ll also find it in beans, peas, citrus fruits, and cantaloupe. It is in all common multivitamin supplements, and, by law, many grain products in the United States are now fortified with it: bread, breakfast cereals, flour, pasta, and rice. The recommended dietary allowance for adults is 400 micrograms per day.
Folate is fragile. With processing and prolonged storage, the folate in foods gradually disappears. So fresh produce—and produce that is frozen quickly after harvest—is a good choice.
Best sources of vitamin B6: Whole grains, green vegetables, beans, sweet potatoes, bananas, and nuts are rich in B6. If these foods are part of your routine, you will easily meet the recommended dietary allowance. The recommended dietary allowance for B6 for adults up to age fifty is 1.3 milligrams per day. If you are over fifty, the RDA is 1.5 milligrams for women and 1.7 milligrams for men.
As you have noticed, greens and beans are good sources of both folate and B6, so you will want to be sure to keep them on your shopping list and on the menu.
Best sources of vitamin B12: B12 is in fortified products, such as breakfast cereals or fortified soy milk, in all common multivitamins, and in B12 supplements. It is also found in animal-derived products, but the absorption from supplements and fortified foods is much better.
The recommended dietary allowance for adults is 2.4 micrograms. Most supplements have more than that, sometimes much more, and it is not toxic at higher intakes. The US government recommends that everyone over the age of fifty take a B12 supplement or choose B12-fortified foods. My advice is that you not wait until you are fifty. A B12 supplement is essential for people who avoid animal products and an excellent idea for everyone else, too.
In 2009, a team of researchers in Singapore reported that people who had more vitamin B12 circulating in their blood had better memory function and better ability to pay attention. But they also found that B12 was especially critical in people with the APOE e4 gene.17 Those with the APOE e4 gene who were low in B12 did badly on memory tests. But people with the APOE e4 gene who had higher B12 levels performed much better.
So why would anyone ever run low in B12? Two reasons:
First, poor absorption. The vitamin B12 found in animal-derived products is bound to protein, and many people, particularly older people, do not produce enough stomach acid to free B12 from the foods that contain it. Acid-blocking medicines, metformin (a common diabetes drug), and stomach disorders can reduce your absorption of vitamin B12 even further.
Second, diet. If you are skipping animal products (which is a very good idea), it is essential to have supplemental B12, because foods from plants are devoid of B12, except when they are fortified with it. That said, it is easy to find in B12 supplements and fortified foods.
Bottom line: Be sure to have folate, B6, and B12 in your routine. I’d suggest emphasizing green leafy vegetables, beans, and whole grains, and also taking a supplement for B12. They will work together to eliminate homocysteine, protecting your heart and brain.
By now, you have no doubt noticed that researchers are keen on fruits and vegetables. These healthful foods are loaded with important vitamins and other nutrients, as well as being strikingly low in “bad” fats.
Fortunately, many people share the researchers’ enthusiasm. Participants in the Chicago study who got three or four vegetable servings per day slowed their rate of cognitive decline by 40 percent compared with those who got only about one serving of vegetables per day.18 Fruits and vegetables also help prevent stroke.19,20
Are some fruits or vegetables better than others? Are you better off having an apple or a serving of spinach? A team of Dutch researchers tackled that question by analyzing the diets of 20,069 healthy people and then following them for the next ten years to see which foods had the most health power. It turned out that orange fruits and vegetables had the most heart-protecting power. People who ate the most carrots, sweet potatoes, cantaloupe, butternut squash, and their botanical cousins cut their risk of heart problems by 26 percent, presumably due to the beta-carotene and other nutrients in these foods.21
When it came to preventing stroke, the real standouts were apples and pears.22 People who averaged the equivalent of an apple a day were able to cut their stroke risk by 50 percent or more.
But don’t focus just on carrots and apples. Go for the variety nature provides. As you walk into the produce section of a grocery store, you can’t help but notice the bright colors. The orange beta-carotene in carrots and sweet potatoes is a powerful antioxidant. The red color in tomatoes is lycopene—a cousin of beta-carotene and a powerful antioxidant in its own right. There are many others.
So by all means do have carrots and apples, and have many other fruits and vegetables, as well. It’s the generous variety of vegetables and fruits in your daily routine that does the trick.
While you’re in the produce section, pick up some berries. Yes, cranberry juice really does help prevent urinary infections, and blueberries may do the same. Many berry varieties contain antioxidants and other compounds that counter inflammation, and researchers have put them to the test for their effects on the brain. In a small study, researchers at the University of Cincinnati gave Concord grape juice to people with mild cognitive impairment and found that it improved their learning ability and modestly boosted short-term memory. The amount was roughly one pint of juice each day for twelve weeks.23 It was not necessary to drink it all at once; it could be divided into smaller servings.
The Cincinnati team also found benefit from blueberry juice.24 These studies were small, and it is not certain that other research studies will confirm their findings. Even so, berries and grapes are healthful foods that are rich in antioxidants with no harmful side effects.
In southwestern France, the river Garonne is flanked with vineyards that produce close to a billion bottles of wine every year. It is the wine capital of the world. In 2004, researchers in Bordeaux found that people who had a glass or two of wine each day were half as likely to develop Alzheimer’s disease compared with teetotalers.25 They were also less likely to develop other kinds of dementia, such as that caused by strokes.
Now, one might have been tempted to chalk up the findings to a local product promotion. But studies in the Netherlands and New York showed the same benefit—modest drinking cuts the risk of Alzheimer’s by about half.
Red wine is unusual in that the prolonged contact of the grape skins with the juice during fermentation lends a deep red color to the wine and also infuses it with bioactive compounds. One, called resveratrol, is being studied for antiaging and heart-protective effects. But when it comes to Alzheimer’s disease, any sort of alcohol seemed to produce the same benefit. It does not have to be wine. A modest intake of alcohol is known to help protect the heart, and it looks like it has the same effect on the brain.
But before you toast to health and longevity, let me offer a couple of caveats.
First, alcohol is not essential for health. People in Loma Linda generally avoid alcohol, because it is discouraged by the Seventh-day Adventist Church. And yet they do extraordinarily well. In fact, it may be that alcohol’s role in other populations is simply to counteract some negative effect of a less-than-healthy diet. If you’re eating well, it’s not clear that alcohol adds anything.
Second, alcohol has risks. If you’re drinking more than about one to two drinks per day, you are at risk for liver disease, accidents, social problems, and several forms of cancer. In fact, the French government has been trying very hard for years to rein in the epidemics of cirrhosis and automobile fatalities that are caused by alcohol.
Even one drink per day—if it is every day—increases a woman’s risk of breast cancer. The explanation might be that alcohol interferes with folate. It turns out that the B vitamin that is important for eliminating homocysteine is also part of the body’s anticancer defenses, and alcohol disrupts its action.
Alcohol also increases iron absorption. While that may sound helpful, alcohol can contribute to iron overload, especially if you have more than two drinks per day.26
So, as you can see, alcohol’s effects are complicated and mixed. If you drink alcohol, the best advice is to have it modestly and intermittently as opposed to every day. And be sure to include plenty of greens and beans in your regular diet to give you the folate you need.
In 2010, a team of Finnish researchers found an unusual ally in the battle against Alzheimer’s disease: coffee. Over a twenty-one-year period, they tracked the coffee habits of a group of 1,409 people. Some loved it and others avoided it, like everywhere else. But the coffee lovers came out on top, with 64 percent less risk of developing Alzheimer’s disease. Even among people carrying the APOE e4 allele, the effect of coffee was clear: a nearly two-thirds drop in their risk!27
That’s great news for coffee drinkers, needless to say. But there are two hitches. First, not every study agrees, although several previous studies did favor coffee, too. Second, only people who drank a lot of coffee—three to five cups a day—showed any benefit, and it looks like decaf doesn’t cut it.
Exactly why coffee should help prevent Alzheimer’s is still very much up in the air. Caffeine is a stimulant, of course. Coffee also contains antioxidants and dozens of other chemical compounds ready to take credit.
So far, evidence for any benefit from other caffeine-containing beverages, such as tea, is much weaker. As we saw above, tea contains traces of aluminum, which remains a consideration.
There is, of course, a downside to caffeine. It can disrupt your sleep, which, in turn, can harm your memory. It can also make you irritable and even aggravate problems with heart rhythm. Caffeine’s effects vary from person to person, so I suggest that you see how it affects you.
As we have seen in the past three chapters, protecting your memory starts with three improvements to the menu:
1. Shield Yourself from Toxic Metals
You’ll want to limit exposure to copper, iron, and zinc, and there is no reason to expose yourself to aluminum at all. With a few judicious choices when it comes to food products, cookware, multiple vitamins, antacids, and so on, you will have enormous control over these potential toxins.
2. Give Your Brain an Oil Change
We need to stop the attack of toxic fats and give your brain the traces of healthy fats it needs. That means shifting from a diet based on meat, cheese, and other animal products to a plant-based menu and avoiding the partially hydrogenated oils that turn up in snack foods and fried foods. As you choose your foods, it pays to be generous with vegetables—especially the green leafy varieties—as well as fruits, legumes, and whole grains.
Skip the cooking oils. In chapter 9, I’ll show you simple techniquee that allow you to go beyond oil-based cooking.
3. Build Your Vitamin Shield
Four vitamins are key here: vitamin E and three B vitamins.
Next, be sure to get your B vitamins:
The good news is that the diet changes that may protect your brain are remarkably similar to those that are good for your heart. And they help trim away unwanted weight in the bargain. If you happen to have high blood pressure, diabetes, or cholesterol problems, a healthful plant-based diet can help enormously. A simple set of menu changes accomplishes all of this at one time. In chapter 9, we’ll pull it all together in an easy-to-follow menu plan, followed by many recipes to get you started.
By now, you might be thinking, “A healthier diet probably would have been really good for me. But it’s too late now. The damage has been done.” Let me tell you about someone who decided not to say that.
Benjamin Spock, MD, was the world’s best-known pediatrician. His book Baby and Child Care revolutionized how parents thought about raising children and remains one of the best-selling books of all time.
He was a tall man, strong and athletic, and won an Olympic gold medal with the Yale rowing crew at the 1924 games. Graduating at the top of his class at Columbia University’s College of Physicians and Surgeons, he specialized in pediatrics and went on to study psychoanalysis for six years.
But later in life, his health began to fail. In 1991, he began to suffer from chronic lung problems—a recurrent pneumonia that he could not shake. He had had a prior exposure to tuberculosis, and accumulating fluid around his heart and lungs left him vulnerable to chronic infections that antibiotics could not clear. Around the same time, a case of serious food poisoning left him with chronic neuropathy, weakening his legs. His energy was shot.
His doctors at Boston’s New England Medical Center had no effective treatment for his worsening health problems. Essentially, they gave up. After all, Ben was in his eighties, and he should not expect miracles. Stay home, buy a wheelchair, and install an elevator, his doctors told him. You’ve lived a good life.
That didn’t sit well with Ben. It was not the implication that he ought to just wait to die that troubled him; it was when he saw the price of installing an elevator that he got steamed!
With the encouragement of his wife, Mary, he decided to try a different approach, which involved taking a long look at his diet and making some major changes. He consulted with a knowledgeable nutritionist, who felt that it was not too late to try something new. Out with the meaty, cheesy junk food, and in with the vegetables and whole grains. Mary kept him on track, preparing soup, rice, stir-fried vegetables, and many other dishes.
Within days, he started to sleep better. By the three-week mark, his strength and energy were back. By six weeks, he had lost fifty pounds of fluid and felt like a new man.
It was not always smooth sailing, however. At a restaurant one night, he was tempted by the menu and decided to “treat” himself to steak. Almost instantly, he felt sick again. His energy was gone and his sleep was disrupted—and that proved to him that it really was the healthy food that had made the difference. He got back on track and felt good again.
Shortly thereafter, he went back to the New England Medical Center—not for a medical appointment this time, but as an invited speaker—and he saw the physicians who had consulted with him before. They were stunned to see his dramatic improvement.
After these life-changing experiences, Dr. Spock began to advocate for a healthful diet. He rewrote Baby and Child Care to include information about the value of plant-based diets and getting away from meat and milk—foods he had once thought were essential for children. He worked with my organization, the Physicians Committee for Responsible Medicine, as we pushed the federal government to change its dietary policies.
Speaking with Dr. Spock in his nineties was like talking to a young man embarking on a new adventure. He had a vast knowledge, generous disposition, and a sense of purpose that never left him. Mentally clear every day of his life, he died just shy of his ninety-fifth birthday.