Beans Not Butter for Better Brains
Ever forget your keys? Where your car is parked? Who you were about to call? The fear of losing memory and the loss of control over other functions of the brain and neurologic system is a worry that many of my patients have expressed. Our brain makes us human and gives us the unique personality and skills we each have. Preserving brain and neurological function by a mindful dietary pattern emphasizing plants over animals is worthy of examination. The fact that a cauliflower looks a lot like a brain does not prove the point that a plant-based diet is the best pattern for brain health. But as you will see, it may not be a coincidence either.
Multiple Sclerosis
If you worry about your brain, then you need to know about a diet that has been studied for a common neurological disease, multiple sclerosis, or MS. MS is an autoimmune and inflammatory disease of the nervous system that can lead to severely disabling manifestations. A therapy for MS using a predominantly plant-based diet has been studied in patients followed for decades at a major university neurology clinic. This diet, constructed to be low in fat, is known as the Swank diet and is an important milestone.1
Roy Swank, MD, served as professor of neurology at the Oregon Health & Science University and passed away in 2008 at age ninety-nine. He theorized decades ago that the increased incidence of MS in northern countries might be due to decreased plant-based foods and increased animal foods. Others have implicated differences in sunshine and vitamin D production, but Swank thought otherwise. In addition, he noticed that in Norway, people who lived in fishing communities were eight times less likely to develop MS than those who lived in the mountains where meat was the main dietary component. Also, Swank noted that after eating a high-fat meal, a person’s blood cells could clump together and be able to block circulation in capillaries. He hypothesized that these clumps were blocking the tiny blood vessels in the blood-brain barrier and leading to inflammation and lesions in the central nervous system. His theory was that if you cut out the fat (saturated fat), you eliminate the clumps of blood cells. No more clumping might mean no more blockages and no more inflammation. This could mean that MS lesions would stop occurring.
Professor Swank embarked on studying a diet plan that was low in saturated fats from dairy and meat while high in fruits and vegetables. It was not a vegan diet, though red meat was not permitted the first year of care. Swank reported a decrease in the frequency and severity of MS attacks. He continued to add patients and followed up with them over thirty-four years of this nutritional treatment,2 a remarkable length of time for a study! The greatest benefit was seen in those who began the diet early in their MS course. After deaths from non-MS causes were excluded, a startling 95 percent survived and remained physically active. The patients who increased their saturated fat intake over time had a striking increase in average disability and death. Swank later tracked down patients on his diet after fifty years and reported on thirteen of them who continued to do well and had youthful appearances.3 He concluded that MS was probably due in part to saturated fat.
The actual mechanisms of the Swank diet on ameliorating the symptoms of MS are unknown, but theories have been proposed.4 Whatever the exact mechanism, the Swank diet has been hailed as an effective, if not the most effective, treatment in the literature.5 A shortcoming of the work in MS patients pioneered by Dr. Swank was the absence of brain MRI data on his patients, as the technique was not available when his studies began.
Recently Dr. John McDougall teamed up with the Department of Neurology of the same university Dr. Swank served at for years.6 Patients were monitored on a diet that had either 15 percent of calories from fat or 40 percent from fat. Compliance was high, and there was far more weight loss and decline in blood cholesterol measurements in the lower-fat cohort. Although it was hoped that brain MRI studies done before the diet and after a year on the diet would show clear improvements, the MRI results at the end of the year did not differ significantly. Overall, the study group was probably too small and the study time period too short to provide any imaging conclusions; thus, further work will be needed. While we don’t yet know how saturated fat harms the brain in patients with MS, thanks to Swank’s comprehensive research we do know that a plant-based diet helps MS in some manner.
CASE STUDY
Taming MS with Plants
I met Sarah because of some skipped and racing heartbeats she was experiencing now and then. After an evaluation that showed a healthy heart and normal laboratory studies, she was able to eliminate the problem by reducing her caffeine intake and using some supplemental magnesium at night as a sleep aid.
What was more interesting about Sarah was that she also had MS. She was diagnosed in 2001, about twelve years before I met her. She had been experiencing some changes in her vision. She also felt tingling in her left leg and arm, which she imagined was a pinched nerve, perhaps from an old high-school volleyball injury. When she began to feel some burning in her leg and an overall fatigue, she knew she needed an evaluation. Her primary care doctor ran routine testing that was unrevealing, but a neurologist performed a battery of tests and imaging that was consistent with the diagnosis of MS—a diagnosis she did not want to hear at age forty-four.
A family member residing on the West Coast was familiar with the work of Dr. Swank. He suggested to Sarah that she read his book, The Multiple Sclerosis Diet Book, and study his work. At the time, Dr. Swank was still alive, and Sarah decided to travel from Michigan and meet him in his clinic. She was impressed with his conviction that she could control the disease by adopting the diet he had prescribed to patients for decades. She not only adopted the very low saturated fat guideline, she decided to opt out of all animal products as much as she could and develop skills to create delicious plant-based meals for her and her family.
She is convinced her decision paid off. Within six months of changing her diet she felt her energy was back to normal and the tingling and burning had resolved. She continued to follow up with her local neurologist, who concurred with her stability over the years as he monitored the MS. She never was put on medications for the MS. She does not need any assistance in her daily activities of caring for a new grandchild. She has not needed a walker or wheelchair. She is also no longer having palpitations. 
Stroke
Have you ever known anyone who had a stroke? Do you have a fear of a stroke? Some strokes are minor, but a major stroke can be life altering and lead to serious disabilities. The Adventist Health Study looked twice at the effect of a vegan diet and stroke.7 One study was called the Adventist Mortality Study (looking at deaths), and one was the more recent Adventist Health Study analysis. Members of the Seventh-day Adventist community who followed a vegan diet by consuming only plant-based foods had between a 7 and 35 percent lower rate of cerebrovascular disease (stroke syndromes) than the meat-eating omnivores in the study.
There are many possible reasons why this might be, such as the lower blood pressure, lower cholesterol, and reduced rate of type 2 diabetes in vegans. Obesity is also less frequent in vegans, and the associated sleep apnea, atrial fibrillation, and possible emboli (clots traveling from the heart to brain) may be reduced by following a WFPB diet. Whatever the exact reasons, the lower stroke risk in the Adventist vegan groups is important data.
Alzheimer’s disease affects in excess of 5 million Americans, and it is expected to triple in frequency in coming decades. It is likely something you fear and want to avoid. Although there are several factors known to contribute to the risk of developing Alzheimer’s disease—including family history, head trauma, hypertension, obesity, diabetes, and high cholesterol—the possibility that diet plays a role has been considered. Plant-based diets deserve some serious consideration as a preventive strategy.
Over twenty years ago, an early phase of the Adventist Health Study examined the relationship between dementia and diets rich in animal products.8 The study reported on 272 study subjects living in California who were “matched” for age, sex, and zip code. All subjects were enrolled in the Adventist Health Study, so they had filled out extensive dietary questionnaires. The people who ate meat (including poultry and fish) were more than twice as likely to become demented as their vegetarian counterparts. Not only was dementia less common in those who did not eat meat, but its onset in those who did develop it tended to be delayed. It is certainly better to develop dementia late in life as opposed to early, yet never developing it is the goal.
If you are wondering why the Plant-Based Solution might protect the brain from dementia, there are two theories. One relates to eating greens and their content of folate (notice folate, a B vitamin, and foliage, or greens, share a common root). Folate is naturally found in whole foods. Folic acid, which is used to supplement foods like cereals, is synthetic.
In the first theory, recall from chapter 5 a process in the body called methylation, which regulates homocysteine, an amino acid that can cause arteries feeding the brain to malfunction. Bad arteries can lead to “bad” brains, and vascular dementia is a major cause of dementia. Better arteries from plant-based diets rich in folate may ward off dementia. Methylation is involved in controlling the activity of genes and the proteins that they control. A common genetic defect in methylation, called a MTHFR defect, is found in as many as 50 percent of people and is severe in perhaps 10 percent. The genetic defect in methylation can lead to cells not functioning normally and to the accumulation of homocysteine. You can ask your doctor for blood tests that determine both the status of the MTHFR gene inheritance and homocysteine levels in the blood to guide the replacement of folate not only with food-based folate but with additional B12 and B6 vitamins too, which are involved in methylation.
The second theory relates to another gene, the ApoE gene. We inherit one ApoE gene from each parent. There are three ApoE gene types called E2, E3, and E4. The ideal inheritance is called ApoE3/3, which means each parent gives the favored ApoE3 gene and represents a low risk of cardiovascular disease and dementia. However, many people inherit one or two ApoE4 genes, with the combination ApoE4/4 (both parents gave an ApoE4 gene) raising the risks of both cardiovascular disease and dementia. A simple blood test can determine this. In individuals with one or two ApoE4 genes, diets high in saturated fats are more likely to raise cholesterol and injure arteries. Diets low in saturated fat are recommended for this group to protect the brain and heart.
If you follow the Plant-Based Solution by eating a healthy WFPB diet, it will be naturally low in saturated fats (because it will omit cheeses, full-fat dairy, chicken, red meats, and other common sources of saturated fats). Whether you know your ApoE status or not, the Plant-Based Solution will be a brain-friendly choice for this reason.
Test Your Brain Health
Ask your doctor for the following tests that assess whether you are at higher risk for stroke, heart disease, and dementia.
MTHFR: This mouthful stands for methyl tetrahydrofolate reductase, an enzyme that is in every cell in the body and required for proper metabolism. The enzyme activity is determined by what genes we inherit from our parents. Each of our parents may donate a normal gene, so we get the normal, or “wild,” type. If one parent donates a normal gene and one an altered gene, this enzyme and the process of controlling our metabolism (called methylation) work at only 40 to 50 percent efficiency. Finally, if both parents donate an altered gene, we are homozygous for the MTHFR gene, and we may methylate, or control our metabolism, at only 10 percent the normal efficiency. All of this can be assessed by a simple blood test and will reveal whether we are at higher risk for heart disease.
Homocysteine levels: Homocysteine is an amino acid that cycles with its pal methionine in the same methylation cycle in which the MTHFR enzyme is active. If we inherit altered MTHFR genes, our homocysteine level may rise and cause arteries to malfunction and increase the risk of stroke. This is another lab test. Elevated levels can be corrected with B complex vitamins.
ApoE gene blood test: This blood test assesses whether your parents donated normal versions of the gene called ApoE or an altered one. The most normal is when both parents donate the ApoE3 copy, which is ApoE3/3. This is the lowest risk for stroke, heart attack, and Alzheimer’s. More concerning is if you inherit one or two copies of ApoE4, thereby being ApoE4/4. This increases the risk of stroke, heart attack, and dementia. It also suggests the need to decrease saturate fats in the diet (something we all should be doing) and limit alcohol intake.
Seven Guidelines to Prevent Alzheimer’s Disease
By now you know I admire the work of Dr. Neal Barnard of the Physicians Committee for Responsible Medicine. Along with co-authors, he has developed guidelines to prevent Alzheimer’s disease using diet and lifestyle based on available scientific studies.9 These are:
1. Minimize your intake of saturated fats and trans fats by avoiding dairy products, meats, and certain oils (coconut and palm oils).
2. Eat vegetables, legumes (beans, peas, and lentils), fruits, and whole grains in place of meats and dairy products as primary staples of the diet.
3. Get your vitamin E from seeds, nuts, green leafy vegetables, and whole grains; vitamin E is a preferred antioxidant for brain health.
4. Consume a source of vitamin B12 daily. Blood levels of vitamin B12 should be checked regularly.
5. Avoid iron and copper in over-the-counter supplements if a multivitamin is being used.
6. Consider minimizing exposure to aluminum by choosing cookware, antacids, baking powder, and other products that are free of added aluminum.
7. Schedule aerobic exercise for at least forty minutes three times per week. Brisk walking can suffice.
Science Corner: Smile but Don’t Say Cheese
If you follow a WFPB diet, will you feel happier and less depressed? Wouldn’t that be a nice side effect of eating healthier? A study of thirty-nine omnivores suggests this may be true, perhaps through a healthier GI track (the microbiome).10 The subjects were fed one of three meal patterns: (1) meat, fish, and poultry as an omnivorous diet; (2) a diet with fish three to four times a week but no meat or poultry; or (3) a vegetarian diet free of meat, fish, and dairy. At baseline and at the end of two weeks, assessments of mood states as well as measures of stress, anxiety, and depression were performed. After the study period, the vegetarian group demonstrated several measures of mood scores not seen in the other diets.
While it is not entirely certain why these changes might occur, the authors described differences in dietary fatty acids, like lower levels of arachidonic acid, an inflammatory compound, in the vegetarian group. Don’t worry, be happy, go vegan.
Parkinson’s Disease
Over a decade ago a hypothesis was presented that plant-based diets may reduce the risk of developing Parkinson’s disease.11 Studies suggested diets higher in animal fat were associated with a higher risk of Parkinson’s disease while fat derived from plants, like avocados, did not raise the risk. Therefore, WFPB diets, free of animal fats, offered a hopeful approach.
A bizarre twist on this hypothesis was published about the same time that related to bowel frequency. The study, which analyzed more than 6,700 men free of Parkinson’s disease as to their bowel frequency and then followed them for twenty-four years, suggested a link.12 Subjects with the lowest bowel movement frequency (less than one a day) had four to five times the risk of Parkinson’s disease compared to the group with the highest frequency of bowel movements (more than two a day). Even after adjusting for exercise, laxatives, and servings of fruits and vegetables per day, the risk of infrequent bowel movements persisted.
Vegans are good at a lot of things, but they are very good at bowel movement frequency.13 Compared to omnivores, a study of over 20,000 subjects identified the vegan diet as an independent factor with higher bowel movement frequency. While it is premature to state that eating a WFPB diet is a proven path to prevent or reverse Parkinson’s disease, the data is mounting, and the interest in using the nutrients in fruits and vegetables for neuroprotection is growing.14
Plant Rant
Do you think most patients with multiple sclerosis ever hear about the results of the Swank diet? Are they ever told that there is fifty years of data on a diet plan that may calm their disease and improve their clinical course? As in heart disease and cancer therapy, full disclosure of the impact of dietary interventions on disease course and prognosis is rarely presented. This is a huge omission and an ethical concern. The times are changing slowly but for the positive, and there is hope that lectures will more routinely incorporate the power of the Plant-Based Solution in medical education. Protect your brain by spending time in your garden, farmers markets, and produce aisles.
THE PLANT-BASED PLAN Prepare Beans and Grains for the Week
One way to save time during the week is to make one big batch of brown rice or quinoa and a big batch of beans that you can eat all week. Sure, you can buy canned beans, but you may like homemade ones better. Use the precooked beans, rice, and quinoa for the recipes in chapter 15, or add a big spoonful of each to a salad or soup.
Brown Rice: Bring 4 cups of water to a boil. Add 2 cups of rinsed rice. When it reaches a boil, reduce heat, cover, and simmer for 45 minutes, or until rice is cooked through and all the water is absorbed. Turn off heat and let rest for 10 minutes. Fluff with a fork and serve, or allow to cool and then store in the refrigerator or freezer. Makes 4 cups of rice.
Quinoa: Bring 4 cups of water or vegetable broth to a boil. Add 2 cups of rinsed quinoa. Cover, reduce heat to low, and simmer for 15 minutes or until tender and the water is absorbed. Fluff with a fork and serve, or allow to cool and then store in the refrigerator or freezer. Makes 4 cups of quinoa.
Beans: In a large pot, combine 10 cups of water and 3 cups of dried beans, rinsed. Heat to boiling. Remove from heat and cover. Let sit for 1 hour. Simmer partially covered beans for 2 to 4 hours (chickpeas may take 4 hours and smaller beans will be quicker) until soft. Keep an eye on them—you may have to add more water. There is no need to presoak beans. (To save time, consider using a pressure cooker—beans will cook in less than an hour.) Makes 6 cups of beans. Refrigerate (or freeze) in 1½-cup portions, which is roughly the quantity in one 15-ounce can.