CHAPTER 14: D IS FOR DIABESITY: REVERSE THE EPIDEMIC THAT’S DESTROYING BRAINS, MINDS, AND BODIES

As your weight goes up, the size and function of your brain go down.[585]

CYRUS RAJI, MD, PHD, ASSISTANT PROFESSOR OF RADIOLOGY, WASHINGTON UNIVERSITY

My wife and I saw you on Facebook and decided to give your program a try. We knew we had to make some changes for our family. My wife has Hashimoto’s disease [neurohormones]. My daughter has polycystic ovarian syndrome [neurohormones] and struggled with moodiness, and I had not felt great about myself in a long time.

We made a commitment as a family to do what you said and give it two weeks. If it hadn’t been for my wife pushing us, I would have quit. I admit we struggled with cravings for the first few days. After one week the cravings were gone! In fact, real food started to taste delicious. I was surprised how much the flavor was magnified in a carrot. I never noticed before. After two weeks on the program, we couldn’t have been happier. We all felt fantastic and had each lost between 10 and 12 pounds [diabesity] and no longer thought about quitting. Each week on the program gets better and better, and we feel more energetic [blood flow] than ever! In fact, I can’t remember the last time I have ever felt this wonderful. I lost 20 pounds after four weeks. People tell me that my skin looks great. I am more confident, more energetic, and I sleep so much better.

Now we are all mentoring our family and friends to live this way. Both my wife and daughter had struggled with weight loss in the past in spite of exercising twice a day at times. My wife has lost 24 pounds since she started eating this way, and her skin is also more vibrant. My 18-year-old daughter has lost 22 pounds and feels happier and much more confident. As soon as they started eating according to your food rules, they were able to exercise a fraction of the time and get more results. What you eat matters!

One of the amazing things we’ve noticed is how many other people ask us for help after seeing our family’s transformation. My mother, who lives with us after suffering several strokes [blood flow], is now eating this way. Her moods and energy are much better. She is more social and no longer isolates herself to her room as much. My mother-in-law, who suffers from fibromyalgia [immunity/infection], also reports less pain and is able to walk more easily. Even our two younger sons, who don’t seem to have much interest in learning about our new lifestyle yet, are eating better without even realizing it because we no longer have junk food in the house. We know this will have a long-term effect on their health. As a family we are healthier and happier.

Several of my coworkers noticed the changes and have started the program. Now they are asking me a ton of questions. When you feel good, you look better. I even walk differently, and I think people notice. It’s hard not to share what you learn when the changes are so obvious.

 —Bobby L.

Diabesity is having high blood sugar and/or being overweight or obese. In the United States, it has become an epidemic that continues to get worse, with half the population affected by prediabetes (36 percent) or diabetes (14 percent),[586] 70 percent considered overweight, and 40 percent falling into the obese category. The annual medical costs of obesity alone top more than $150 billion.[587] Diabesity is destroying brains, minds, and bodies, and it’s robbing our children and grandchildren of their future. They will not be able to afford the tsunami of illness that is headed their way unless we get serious and do something about it. The increase in diabesity is one of the main reasons brain health/mental health issues are increasing. Both high blood sugar and being overweight take a toll on the brain and mind and negatively impact the BRIGHT MINDS risk factors.

Excess fat on your body is not your friend. Obesity is detrimental to brain health/mental health and is associated with a greater risk of depression, bipolar disorder, panic disorder, agoraphobia (fear of going out), and addictions.[588] Untreated attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD),[589] lower self-esteem, and poor body image[590] are also associated with being overweight.[591] Among women, increased body mass index (BMI) is also linked to a rise in suicidal thoughts.[592] Being overweight or obese also impacts your BRIGHT MINDS risk factors. For example, it has been associated with a smaller brain and decreased blood flow to the brain.[593] It produces chemicals that increase inflammation, store toxins, and disrupt hormonal function. It also makes you more susceptible to developing sleep problems, such as sleep apnea.[594]

High blood sugar is associated with a smaller hippocampus, the seahorse-shaped structure in your temporal lobes associated with mood, learning, and memory. Anxiety and depression are two to three times higher in patients with Type 2 diabetes than in the general population.[595] High blood sugar causes blood vessels to become brittle and break, delays healing, increases the risk of stroke, and causes overall lower blood flow in the brain. In fact, diabetes has been linked to decreased blood flow on SPECT scans.[596] On top of that, high blood sugar and diabetes are also associated with increased inflammation; Alzheimer’s disease; strokes, heart disease, hypertension; and accelerated aging.[597] People with diabetes are also at greater risk for eating disorders, such as binge eating.[598] Having diabetes during pregnancy significantly increases the risk of psychosis in the children (auditory and visual hallucinations).[599]

All of the four circles play a role in the diabesity connection to brain health/mental health:

• Biological: Diabesity impacts many of the BRIGHT MINDS risk factors and vice versa, creating a vicious loop of internal dysfunction that conspires to keep the weight on and create brain health/mental health issues.

• Psychological: Diabesity can make you feel bad about yourself and cause you to think you were destined to have weight and blood sugar problems. This type of thinking makes you more likely to perpetuate the habits that leads to being overweight and to ignore other contributing BRIGHT MINDS factors, such as environmental toxins, inflammation, and neurohormonal issues. This mind-set makes you less likely to take action and change your behavior.

• Social: You could be fueling diabesity by eating unhealthy meals with your family at home, alcohol-filled happy hours with coworkers, and by using sweets as a coping mechanism to deal with stress in your relationships.

• Spiritual: If you lack purpose in life, you may not see why it’s important to achieve a healthy weight and healthy blood sugar levels.

By the way that our culture promotes unhealthy food choices and indulgence, you would think an evil ruler has gotten a hold of us and is behind all our weight issues and the diabetes epidemic.

THE EVIL RULER WOULD . . .

1. 1. Demand that high-sugar desserts be served with all school lunches as a way to boost inattention among children.
2. 2. Encourage companies to put out candy bowls and doughnuts in the break room to raise the risk of diabesity.
3. 3. Fool people into viewing sweet desserts (which spike blood sugar and contribute to anxiety and other mental health symptoms) as a “reward” for good behavior or a job well done.
4. 4. Allow unhealthy, artificially flavor-enhanced foods and drinks to be aggressively marketed as desirable (think Coke’s “Open Happiness” slogan). In fact, the evil ruler would encourage professional athletes and coaches to visibly drink Coke, Pepsi, or Gatorade (all filled with sugar, artificial colors, and preservatives) on the sidelines of games as a way of marketing these products to children and teens.
5. 5. Tell people that diabetes isn’t that bad and discourage making any lifestyle changes because there are drugs they can take for it.
6. 6. Blame genetics for the obesity epidemic, saying there’s nothing people can do about it.

THE BENEVOLENT RULER WOULD . . .

1. 1. Limit sugar-laden snacks and desserts in school lunches to promote stable blood sugar levels and healthy weight.
2. 2. Encourage corporations to serve brain-healthy snacks to employees to prevent diabesity.
3. 3. Tell the truth that drinking and eating foods that make you fat and diabetic is not a smart way to celebrate.
4. 4. Prevent food and beverage manufacturers from easily marketing products that increase the risk for diabesity.
5. 5. Educate people about the consequences of diabetes and encourage lifestyle changes —exercise and diet —to regulate blood sugar levels.
6. 6. Inform people that their DNA is not their destiny. Their daily habits can influence their genes, and it is within their power to control their weight.

As your weight goes up, the size and function of the brain goes down; which should scare the fat off everyone.

INSULIN AND THE BLOOD SUGAR-MOOD CONNECTION

In chapter 14, you learned about six of the neurohormones that influence your brain health/mental health. Here, I’ll show you how the seventh neurohormone, insulin, is related to diabesity and your mental well-being. In the body, the hormone insulin is involved in regulating blood sugar levels. Your body’s cells need sugar (glucose) for energy, but they can’t absorb it directly from your bloodstream. That’s where insulin comes in. Released by the pancreas when you eat carbohydrates, insulin is like a key that unlocks cell membranes so they can get the glucose they need from the foods you eat.

Now, not all carbohydrates are created equal. Complex carbohydrates (such as vegetables, quinoa, and fruits) help keep insulin working effectively and stabilize blood sugar levels. However, simple sugars (such as cookies, candies, and sodas) as well as highly processed carbohydrates (such as bread, pasta, and crackers) require the pancreas to pump out large amounts of insulin and can cause blood sugar levels to soar. If there’s too much sugar in your bloodstream, insulin signals your body to shuttle it to the liver for storage, which can eventually lead to fatty liver disease in some people. Another consequence of high insulin levels is that the body switches from breaking down and flushing dietary fat from the body to storing that fat, which over time can lead to weight problems. One of the main consequences of chronically eating a high-sugar diet and being obese is a decrease in insulin’s ability to regulate blood sugar, leading to prediabetes and diabetes.

How do insulin and blood sugar levels affect your mind? Eating sugar or refined carbs causes blood sugar levels to spike and, subsequently, causes them to crash. This roller-coaster effect can impact your moods and mental well-being. Research shows that high-sugar diets and blood sugar issues are associated with:

• Anxiety[600]
• Depression[601]
• Schizophrenia[602]
• Irritability[603]
• Anger[604]
• Addiction to sugar[605]
• Trouble concentrating[606]

If you want to get your brain right, it is imperative to get your food right. Eliminating sugar and other refined carbohydrates from your diet can help regulate your body’s production of insulin, stabilize blood sugar levels, and facilitate the fat breakdown process. It can also prevent the depletion of chromium, a mineral required by insulin receptors. In a fascinating study,[607] researchers from the University of Illinois looked at the nutrient levels of patients and compared them to scans of their brains and measurements of executive function (planning and impulse control) and intelligence. Improved executive function was associated with higher levels of omega-3 fatty acids, lycopene, carotenoids, vitamin D, and vitamins B2 (riboflavin), B9 (folate), and B12 (cobalamin). The brain functioned better with higher levels of omega-3s and carotene; and omega-3 levels were associated with higher intelligence.

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Eliminating sugar and other refined carbohydrates from your diet can help regulate your body’s production of insulin, stabilize blood sugar levels, and facilitate the fat breakdown process.

 

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Diabesity Risk Factors
(and the Four Circles They Represent)

• High fasting blood sugar levels, prediabetes, or type 1 or type 2 diabetes[608]

• Being overweight or obese[609]

• Aging (retirement/aging)

• Family history of the disease (genetics)

• Alcohol abuse (toxins)

• Exposure to environmental toxins (toxins)

• Being sedentary (blood flow)

PRESCRIPTIONS FOR REDUCING YOUR DIABESITY RISK FACTORS
(AND THE FOUR CIRCLES THEY REPRESENT)

The Strategies

The good news is that you can significantly lower your risk factor of diabesity.[610] As with all of the BRIGHT MINDS risk factors, you’ll need a long-term perspective and lifestyle habits you can feel happy about and maintain for the rest of your life.

1. 1. Care about your weight and blood sugar levels. As part of caring, you must know your important numbers, including BMI, waist-to-height ratio, fasting blood sugar, hemoglobin A1c (HbA1c), and fasting insulin level. (See chapter 17.)
2. 2. Avoid anything that increases the risk of diabesity.
   
   • Limit or avoid foods that increase the risk of diabesity. These include:
     • High caloric foods
     • High-glycemic, low-fiber foods (pasta, bread, white potatoes, rice, and sugar), which also promote inflammation
     • Processed foods
     • Artificial dyes, sweeteners, and food additives
     • Potentially allergenic foods (everyone is different), such as gluten, dairy, corn, and soy

     Note: In a disturbing study, children of women with the highest gluten intake (20 g/day or more) versus those with the lowest gluten intake (less than 7 g/day) had double the risk of developing Type 1 diabetes over a follow-up period of 16 years.[611]

   
   • Avoid the mind-set of diabesity. These are beliefs and thoughts you tell yourself that increase the risk you will never truly get healthy, such as:
     • “Everything in moderation,” which is generally the thought just before you are going to eat something that will hurt you.
     • “Live a little; you deserve it.” Funny, but this is the thought of early death. It should be rephrased as “Live a little shorter.”
     • “I just want to have fun.” But who has more fun? The person with the healthy brain or the one with the troubled brain? No question —the person with the healthy brain.
     • “I want what I want when I want it” is a four-year-old’s mind-set, but this thought underlies why most people do not get healthy. We need to be good parents to ourselves and be firm about engaging in good behavior if we want to end mental illness.
     • “But I always do it this way” is another common thought that tells you that your habits are destroying your mind.
   
   • Don’t fall for every advertising pitch. Here’s what I’d say about some common marketing slogans:
     • Coke’s “Open Happiness” —should be rephrased as “Open Illness.”
     • Ben and Jerry’s “Eat Away Your Feelings” —should be rephrased as “Eat Your Way to Depression.”
     • McDonald’s “I’m Lovin’ It” —should be rephrased as “I’ll Start Hating My Mind and Body.”
     • McDonald’s “You Deserve a Break Today” —should be rephrased as “You Deserve Illness Today.”
     • Lay’s Potato Chips “Betcha Can’t Eat Just One” —should be rephrased as “Bet You Can’t Eat Just One Because They Are Addictive.”
     • Trix’s “Silly Rabbit, Trix Are for Kids!” —should be rephrased as “Silly Rabbit, Trix Are for Kids Who Want to Struggle in School and Be Overweight and Sick!”
3. 3. Engage in regular brain healthy habits that decrease the risk of diabesity.
   
   • Develop a Brain Warrior mind-set.[612] As my wife, Tana, and I reveal in our book The Brain Warrior’s Way, you are in a war for the health of your brain. Everywhere you go, someone is trying to shove bad food down your throat that will kill you early. You need to be armed, prepared, and aware to win the fight for your life. In the book, we asked our readers, and I ask you here, “Are you a sheep or a sheepdog?”

     Sheep are best known for their strong flocking behavior. Sheep follow and are easily led. They go with the herd and do what the majority of the other sheep do. When one sheep moves, the rest of the flock tends to follow, even when it’s a bad idea. In Turkey in 2005, a sheep jumped off a cliff to its death, then 1,500 others followed.[613] Sheep have two speeds —graze and stampede (group think). Sheep are often annoyed by sheepdogs —they remind them that trouble may be nearby.

     Sheepdogs are serious and purpose-driven to protect their flock. They live to make a difference. Sheepdogs need training to be effective. Sheepdogs love their flock, even when the love is not returned. Sheepdogs will give their lives to protect their sheep. Sheepdogs have a major advantage: They can survive in a hostile environment; sheep cannot. When sheep get attacked, they often give in to death. When sheepdogs are attacked, they fight back and are much more likely to survive.

     Are you a sheep or a sheepdog? If you want to end mental illness, you have to develop a sheepdog’s mind-set.

   
   • Follow the BRIGHT MINDS diet (see chapter 18). “Eat right to think right” is one of the most important strategies to end mental illness. Over the years, we have developed one overriding food rule that captures all others: “only love and consume foods that love you back.” If you can get this one rule right, it will help you feel happy and vibrant for the rest of your life.

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   The most important food rule is “Only love and consume foods that love you back.”

    

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   • Lose weight slowly (if you are overweight or obese). The healthiest way to drop weight and keep it off is to lose one to two pounds a week. Here are more tips:[614]
     • Drink more water.
     • Have protein for breakfast to balance your blood sugar.
     • Add more fiber to your diet to lower the risk of Type 2 diabetes[615] and keep you feeling full longer. Brain-healthy high-fiber foods include vegetables (broccoli and brussels sprouts), berries, chia seeds, and quinoa.
     • Green tea has been shown to increase metabolism and decrease the risk of diabetes. It is loaded with antioxidants, but be careful what you put in it and only drink caffeinated green tea in small doses.
     • Don’t drink your calories. In 1980, Americans drank an average of 225 calories a day; in 2015, it was 450 calories a day. The extra 225 calories a day will put 23 pounds of fat on your body every year! Plus, the calories you drink are more quickly absorbed than those you have to chew.
     • Take saunas and eat detoxifying foods. Fat stores toxins, so it’s critical to detox when you lose weight.
     • Weigh yourself every day because research shows it helps keep you on track.[616]
     • Don’t overdo your weight loss. Being too thin is definitely not the answer. If your BMI gets too low, you can wind up with cognitive problems.[617]
   
   • Start new habits. You already have daily habits. Start new habits around the foods that promote your mental health rather than the ones that steal it. Most of us have about 20 meals we go to over and over. This week, try to add five brain-healthy meals with foods you love that love you back.
   
   • Exercise! Research shows that working out improves blood sugar levels and weight. Strength training is a must. Compared with women who reported no strength training, women engaging in any strength training reduced the incidence of Type 2 diabetes by 30 percent.[618] Any type of regular movement matters, even walking,[619] but walk as if you are in a hurry.[620] (See chapter 5 “B Is for Blood Flow.”)
   
   • Check with your physician to see if other treatment is necessary. Depending on your personal numbers and your genetic risks, you may be able to improve your health without resorting to taking medication.[621]

1. 4. Take nutraceuticals that help balance blood sugar. Your physician or integrative health-care professional can help determine which of these will work best for you.
   • Omega-3 fatty acids EPA and DHA.[622] By now, you know that this supplement will help you with many of the BRIGHT MINDS risk factors; that’s why I recommend it to all my patients. It helps to maintain proper insulin signaling in the brain, counteract nonalcoholic fatty liver, and decrease the risk of metabolic syndrome.[623] (Metabolic syndrome is defined as having at least three of the following risk factors: high fasting blood sugar levels, abdominal obesity, high triglycerides, low HDL cholesterol, and high blood pressure.) In a large study in older adults, the diabetes risk was 43 percent lower among those with the highest blood concentrations of omega-3 fats compared with those with the lowest concentrations.[624] In a well-designed placebo-controlled trial in overweight type 2 diabetics, supplementing with the omega-3 fatty acid EPA significantly decreased serum insulin, fasting glucose, HbA1c, and insulin resistance.[625] (Check out information on the Omega-3 Index in chapter 7, which will let you know if you’re on the right track toward omega-3 protection.)

     Dose suggestion: The effective daily dose seems to be 1,400 mg or more with a ratio of approximately 60/40 EPA to DHA.

   • Chromium as chromium picolinate can help regulate insulin, which boosts the metabolism of glucose and fat. Chromium picolinate also helps decrease carbohydrate cravings and binge eating, thus impacting both blood sugar and weight.[626] Some research shows that chromium picolinate significantly lowers HbA1c in type 2 diabetics.[627]

     Dose suggestion: The typical recommended adult dosage is 200–1,000 micrograms (mcg) a day.

   • Cinnamon[628] offers a bouquet of benefits for those at risk of diabetes. It’s been shown to lower fasting glucose levels and HbA1c and improve insulin sensitivity.[629] This sweet and savory spice also lowered cholesterol and improved working memory in older prediabetic[630] adults, while improving blood flow to the prefrontal cortex.[631] Plus, it has been shown to decrease abnormal tau protein aggregation, thought to be one of the major contributors of Alzheimer’s disease. Not only can cinnamon help your blood sugar levels, but it can also spice up your love life.

     Dose suggestion: The typical dose for blood sugar control is 1–6 grams a day as a supplement. Use the spice liberally. If you are taking medication to control your blood sugar, talk to your doctor before taking supplemental cinnamon, as it may have an additive effect and lower blood sugar too much.

BRIGHT MINDS: DIABESITY

STEPS TO CREATE MENTAL ILLNESS . . . AND MAKE MY NIECES, ALIZÉ AND AMELIE, SUFFER

1. 1. Don’t care about your weight or blood sugar levels.
2. 2. Engage in habits that increase the risk of diabesity.
   • Don’t bother weighing yourself.
   • Don’t get your blood sugar levels or HbA1c levels checked.
   • Eat a high-sugar, low-fiber diet.
   • Eat a lot of processed foods.
   • Skip meals and make up for it by eating twice as much at the next meal.
   • Overeat on a regular basis.
   • Adopt a diabesity mind-set that allows you to stay overweight and sick.
   • When you want to lose weight, go on a crash diet to drop pounds fast.
   • Be a couch potato.
3. 3. Avoid the strategies that reduce the risk for diabesity.

STEPS TO END MENTAL ILLNESS . . . AND KEEP MY NIECES, ALIZÉ AND AMELIE, HEALTHY

1. 1. Care about your weight and blood sugar levels.
2. 2. Avoid anything that increases the risk of diabesity.
3. 3. Engage regularly in healthy habits that reduce the risk of diabesity.
   • Weigh yourself daily.
   • Get your blood sugar and HbA1c levels checked at least once a year.
   • Consume a BRIGHT MINDS diet.
   • Add more fiber to your meals.
   • Adopt new daily habits to replace the habits that steal your mental health.
   • Get moving! Engage in strength training and cardio exercise on a regular basis.
   • Consider supplements that support healthy blood sugar levels.

Pick One BRIGHT MINDS Diabesity Tiny Habit to Start Today

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1. I will immediately stop drinking my calories.
2. When I eat lunch and dinner, I will add one serving of a colorful vegetable.
3. At each meal, I’ll make sure to include some high-quality protein and fat to stabilize my blood sugar and reduce cravings.
4. When I want to lose weight, I will do it slowly so I can develop lifelong habits.
5. When I take my daily shower, I will weigh myself because it will keep me honest and motivated.
6. I will take omega-3 supplements daily.

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[585] Cyrus A. Raji et al., “Brain Structure and Obesity,” Human Brain Mapping 31, no. 3 (March 2010): 353–64.

[586] Andy Menke et al., “Prevalence of and Trends in Diabetes among Adults in the United States, 1988–2012,” JAMA 314, no. 10 (2015): 1021–29.

[587] “Adult Obesity Facts,” Overweight and Obesity, Centers for Disease Control and Prevention, last reviewed August 13, 2018, https://www.cdc.gov/obesity/data/adult.html.

[588] Gregory E. Simon et al., “Association between Obesity and Psychiatric Disorders in the US Adult Population,” Archives of General Psychiatry 63, no. 7 (July 2006): 824–30.

Nancy M. Petry et al., “Overweight and Obesity Are Associated with Psychiatric Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions,” Psychosomatic Medicine 70, no. 3 (April 2008): 288–97.

[589] H. C. M. Byrd, C. Curtin, and S. E. Anderson, “Attention-Deficit/Hyperactivity Disorder and Obesity in US Males and Females, Age 8–15 Years: National Health and Nutrition Examination Survey 2001–2004,” Pediatric Obesity 8, no. 6 (December 2013): 445–53.

[590] Michael Hinck, “How Obesity Can Affect Your Teen’s Self Esteem,” Health Beat, Jamaica Hospital Medical Center, September 26, 2014, https://jamaicahospital.org/newsletter/how-obesity-can-affect-your-teens-self-esteem/.

[591] Zhang Xue-Yan et al., “Obese Chinese Primary-School Students and Low Self-Esteem: A Cross-Sectional Study,” Iranian Journal of Pediatrics 26, no. 4 (August 2016): e3777.

[592] Kenneth M. Carpenter et al., “Relationships between Obesity and DSM-IV Major Depressive Disorder, Suicide Ideation, and Suicide Attempts: Results from a General Population Study,” American Journal of Public Health 90, no. 2 (2000): 251–57.

[593] Cyrus A. Raji et al., “Brain Structure and Obesity,” Human Brain Mapping 31, no. 3 (March 2010): 353–64.

Kristen C. Willeumier, Derek V. Taylor, and Daniel G. Amen, “Elevated BMI Is Associated with Decreased Blood Flow in the Prefrontal Cortex Using SPECT Imaging in Healthy Adults,” Obesity (Silver Spring, MD) 19, no. 5 (May 2011): 1095–97.

Mark Hamer, G. David Batty, “Association of Body Mass Index and Waist-to-Hip Ratio with Brain Structure,” Neurology 92, no. 6 (February 2019): e594–600.

[594] Alan R. Schwartz et al., “Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches,” Proceedings of the American Thoracic Society 5, no. 2 (2008): 185–92.

[595] J. M. Zanoveli et al., “Depression Associated with Diabetes: From Pathophysiology to Treatment,” Current Diabetes Reviews 12, no. 3 (2016): 165–78.

A. M. Castellano-Guerrero et al., “Prevalence and Predictors of Depression and Anxiety in Adult Patients with Type 1 Diabetes in Tertiary Care Setting,” Acta Diabetologica 55, no. 9 (September 2018): 943–53.

[596] Hirokatsu Niwa et al., “Clinical Analysis of Cognitive Function in Diabetic Patients by MMSE and SPECT,” Diabetes Research and Clinical Practice 72, no. 2 (May 2006): 142–47.

J. F. Jimenez-Bonilla et al., “Assessment of Cerebral Blood Flow in Diabetic Patients with No Clinical History of Neurological Disease,” Nuclear Medicine Communications 17, no. 9 (September 1996): 790–94.

[597] F. Pasquier et al., “Diabetes Mellitus and Dementia,” Diabetes and Metabolism 32, no. 5, part 1 (November 2006): 403–14.

Kapil Gudala et al., “Diabetes Mellitus and Risk of Dementia: A Meta-analysis of Prospective Observational Studies,” Journal of Diabetes Investigation 4, no. 6 (November 2013): 640–50.

[598] Ewa Racicka and Anita Brynska, “Eating Disorders in Children and Adolescents with Type 1 and Type 2 Diabetes: Prevalance, Risk Factors, Warning Signs,” Psychiatria Polska 49, no. 5 (2015): 1017–24.

[599] Syudo Yamasaki et al., “Maternal Diabetes in Early Pregnancy, and Psychotic Experiences and Depressive Symptoms in 10-Year-Old Offspring: A Population-Based Birth Cohort Study,” Schizophrenia Research 206 (April 2019): 52–57.

[600] Monique Aucoin and Sukriti Bhardwaj, “Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification,” Case Reports in Psychiatry 2016 (2016): 7165425.

[601] Ibid.

[602] Malcolm Peet, “International Variations in the Outcome of Schizophrenia and the Prevalence of Depression in Relation to National Dietary Practices: An Ecological Analysis,” British Journal of Psychiatry 184, no. 5 (May 2004): 404–8.

[603] “Type 1 Diabetes Low Blood Sugar Symptoms,” JDRF, accessed August 19, 2019, https://www.jdrf.org/t1d-resources/about/symptoms/low-blood-sugar/.

[604] Peter Bongiorno, “Is There a Blood Sugar Monster Lurking within You?” Psychology Today, November 13, 2014, https://www.psychologytoday.com/us/blog/inner-source/201311/is-there-blood-sugar-monster-lurking-within-you.

[605] Belinda S. Lennerz et al., “Effects of Dietary Glycemic Index on Brain Regions Related to Reward and Craving in Men,” American Journal of Clinical Nutrition 98, no. 3 (September 2013): 641–47.

[606] “Type 1 Diabetes,” JDRF.

[607] Chris E. Zwilling et al., “Nutrient Biomarker Patterns, Cognitive Function, and fMRI Measures of Network Efficiency in the Aging Brain,” NeuroImage 188 (March 2019): 239–51.

[608] E. Duron and Olivier Hanon, “Vascular Risk Factors, Cognitive Decline, and Dementia,” Vascular Health and Risk Management 4, no. 2 (2008): 363–81.

[609] Rachel A. Whitmer, “The Epidemiology of Adiposity and Dementia,” Current Alzheimer Research 4, no. 2 (April 2007): 117–22.

Duron and Hanon, “Vascular Risk Factors.”

[610] Jaakko Tuomilehto et al., “Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance,” New England Journal of Medicine 344, no. 18 (May 3, 2001): 1343–50.

[611] Julie C. Antvorskov et al., “Association between Maternal Gluten Intake and Type 1 Diabetes in Offspring: National Prospective Cohort Study in Denmark,” BMJ 362 (September 19, 2018): k3547.

[612] Daniel G. Amen and Tana Amen, The Brain Warrior’s Way (New York: New American Library, 2016), 1, 28.

[613] Associated Press, “450 Sheep Jump to Their Deaths in Turkey,” USA Today, July 8, 2005, http://usatoday30.usatoday.com/news/offbeat/2005-07-08-sheep-suicide_x.htm.

[614] Daniel G. Amen, Memory Rescue (Carol Stream, IL: Tyndale, 2017), 235–36.

[615] Andrew Reynolds et al., “Carbohydrate Quality and Human Health: A Series of Systematic Reviews and Meta-analyses,” Lancet 393, no. 10170 (February 2, 2019): 434–45.

[616] Cornell University, “Weighing Yourself Daily Can Tip the Scale in Your Favor,” ScienceDaily, June 17, 2015, https://www.sciencedaily.com/releases/2015/06/150617134622.htm.

[617] Chun-Ju Chiang et al., “Midlife Risk Factors for Subtypes of Dementia: A Nested Case-Control Study in Taiwan,” American Journal of Geriatric Psychiatry 15, no. 9 (September 2007): 762–71.

Heidi White et al., “Weight Change in Alzheimer’s Disease,” Journal of the American Geriatrics Society 44, no. 3 (March 1996): 265–72.

[618] Eric J. Shiroma et al., “Strength Training and the Risk of Type 2 Diabetes and Cardiovascular Disease,” Medicine and Science in Sports and Exercise 49, no. 1 (January 2017): 40–46.

[619] Frank B. Hu et al., “Walking Compared with Vigorous Physical Activity and Risk of Type 2 Diabetes in Women: A Prospective Study,” JAMA 282, no. 15 (1999): 1433–39.

[620] Carl J. Caspersen and Janet E. Fulton, “Epidemiology of Walking and Type 2 Diabetes,” Medicine and Science in Sports and Exercise 40, suppl. 7 (July 2008): S519–S528.

[621] Amen, Memory Rescue, 236.

[622] Ibid.

[623] Artemis P. Simopoulos, “Dietary Omega-3 Fatty Acid Deficiency and High Fructose Intake in the Development of Metabolic Syndrome, Brain Metabolic Abnormalities, and Non-alcoholic Fatty Liver Disease,” Nutrients 5, no. 8 (July 26, 2013): 2901–23.

[624] Luc Djoussé et al., “Plasma Omega-3 Fatty Acids and Incident Diabetes in Older Adults,” American Journal of Clinical Nutrition 94, no. 2 (August 2011): 527–33.

[625] Shokouh Sarbolouki et al., “Eicosapentaenoic Acid Improves Insulin Sensitivity and Blood Sugar in Overweight Type 2 Diabetic Mellitus Patients: A Double-Blind Randomized Clinical Trial,” Singapore Medical Journal 54, no. 7 (2013): 387–90.

[626] Kimberly A. Brownley et al., “A Double-Blind, Randomized Pilot Trial of Chromium Picolinate for Binge Eating Disorder: Results of the Binge Eating and Chromium (BEACh) Study,” Journal of Psychosomatic Research 75, no. 1 (July 2013): 36–42.

[627] N. Suksomboon, N. Poolsup, and A. Yuwanakorn, “Systematic Review and Meta-analysis of the Efficacy and Safety of Chromium Supplementation in Diabetes,” Journal of Clinical Pharmacy and Therapeutics 39, no. 3 (2014): 292–306.

H. Rabinovitz et al., “Effect of Chromium Supplementation on Blood Glucose and Lipid Levels in Type 2 Diabetes Mellitus Elderly Patients,” International Journal for Vitamin and Nutrition Research 74, no. 3 (2004): 178–82.

[628] Amen, Memory Rescue, 237.

[629] Ting Lu et al., “Cinnamon Extract Improves Fasting Blood Glucose and Glycosylated Hemoglobin in Chinese Patients with Type 2 Diabetes,” Nutrition Research (New York) 32, no. 6 (June 2012): 408–12.

Paul A. Davis and Wallace Yokoyama, “Cinnamon Intake Lowers Fasting Blood Glucose: Meta-Analysis,” Journal of Medicinal Food 14, no. 9 (September 2011): 884–89.

Ashley Magistrelli and Jo Carol Chezem, “Effect of Ground Cinnamon on Postprandial Blood Glucose Concentration in Normal-Weight and Obese Adults,” Journal of the Academy of Nutrition and Dietetics 112, no. 11 (November 2012): 1806–9.

Ashley N. Hoehn and Amy L. Stockert, “The Effects of Cinnamomum cassia on Blood Glucose Values Are Greater Than Those of Dietary Changes Alone,” Nutrition and Metabolic Insights 5 (2012): 77–83.

[630] Mark L. Wahlqvist et al., “Cinnamon Users with Prediabetes Have a Better Fasting Working Memory: A Cross-Sectional Function Study,” Nutrition Research (New York) 36, no. 4 (April 2016): 305–10.

[631] Robert Krikorian et al., “Improved Cognitive-Cerebral Function in Older Adults with Chromium Supplementation,” Nutritional Neuroscience 13, no. 3 (2010): 116–22.