Perhaps when you were in your teens and twenties, you rarely cooked and instead lived “off the land”—grabbing food on the run (even from drive-throughs) and consuming dorm cafeteria fare or whatever you could microwave. Despite making these poor food choices, you may have powered through whatever you were facing, whether it was a final exam, an athletic event, or early years at a first job. Over time you may have realized that you didn’t perform well after eating junk. The pounds around your waistline started adding up, and you wanted to look and feel better. Perhaps you stopped eating fast food daily. You started to grocery-shop. You learned how to use the stove. Your behaviors changed and matured—in part, because your body was beginning to revolt!
You got a message from your brain, an old saying that turned out to be true: You are what you eat. When you eat well, you perform well, mentally and physically. When you eat poorly, you can’t think sharply, and your energy plummets.
Whether your current diet is fairly healthy or in need of an upgrade, if you want to improve your brain performance and halt memory loss, you will benefit tremendously from eating the 12 Smart Foods. These heart-healthy foods help control blood sugar, the key to a better brain, and can easily form the basis of flavorful, nutrient-rich meals and snacks. Study after study, including results from my own clinic, has found that these foods are most closely associated with improved cognitive function.
2. Other vegetables (except potatoes)
3. Omega-3-rich seafood (or a long-chain omega-3 supplement)
4. Olive oil and other healthy cooking oils
5. Nuts and other healthy fats
6. Berries and cherries
7. Cocoa and dark chocolate
8. Caffeine sources (green tea and coffee)
9. Red wine
10. Herbs and spices
11. Beans
12. Fermented foods
Ideally, you should eat each of these foods daily, but you may have good reasons for saying no to some of them. You may be allergic to dairy or tree nuts, or you may not tolerate beans well. Perhaps you have an aversion to the taste and smell of wild salmon and sardines. You may not like coffee or drink alcohol. The point is that you don’t have to eat from all these groups every day, but try to eat as many of these foods as you enjoy and can realistically fit into your lifestyle.
If you want a younger brain, eat your greens (spinach, kale, broccoli, Brussels sprouts, Swiss chard).
Eating one cup of green leafy vegetables every day will make you, on average, eleven years physiologically younger than someone who skips them. These delicious greens are packed with fiber, vitamin K, folate, potassium, flavonoids (antioxidant and anti-inflammatory compounds), and carotenoids (valuable plant pigments). They decrease inflammation system-wide, and because they provide fiber with little to no sugar, they improve blood sugar control. Green leafy veggies are fantastic for your brain, arteries, bones, and waistline.
Plants create pigments (chemical compounds characterized by specific colors) in part to protect themselves from the damaging ultraviolet rays of the sun. When we consume these pigments, they offer us protective benefits that help decrease the biochemical process of oxidation (which results in aging) within our cells.
Beyond leafy greens, other rainbow-colored vegetables are loaded with protective pigments (particularly nitrate-rich beets, as well as carrots, fennel, artichokes, peppers of all colors, red and yellow tomatoes, butternut squash, and more). Eating more of them will slow cellular aging (including brain cells), improve blood pressure, enhance cholesterol and blood sugar profiles, lower cancer risk, and improve gastrointestinal function. They are also good for your skin and bones. Aim to eat at least 3 cups of vegetables every day. (The recipes in Chapter 10 will make that easy.)
Plant nitrates are converted to nitrites, which form nitric oxide, the master regulator of blood flow control and artery inflammation. So vegetables rich in nitrates improve blood pressure and blood flow, boost aerobic athletic performance, and increase blood flow to the neocortex, which enhances cognitive performance. Vegetables that are particularly packed with nitrates include beets, arugula (also called rocket), spinach, celery, and most forms of lettuce. (An important note on terminology: Vegetable-based nitrates are not the same as nitrosamines, which are also commonly called nitrates and are added to deli meats and bacon to extend their shelf life. As I’ll explain in Chapter 8, nitrosamines are toxins that can give you cancer and Alzheimer’s disease, so don’t confuse them.)
Fresh-pressed vegetable juices are popular, but if they are made with fruits (or with added sugar), they are not good choices. High-quality green juices made from pure, organic vegetables are a good source of vitamins and minerals, but whole vegetables are preferable because of their superior fiber content. Freshly prepared juices have higher nutrient content than bottled juices that are weeks or months old. Enjoy fresh-pressed, vegetable-only juices, but do not consider them a substitute for whole vegetables.
Beets Get Your Blood Pumping (in more ways than one)
Aphrodite, the Greek goddess of love, ate beets to increase her beauty and sexual appeal—which is why they came to be known as an aphrodisiac. The Romans agreed and ate them before going to battle and to the bedroom. (They even depicted beets in frescoes decorating the walls of a brothel preserved in Pompeii.) There is more to the secret potent power of beets than myth and legend; there is science. Beets are a particularly rich source of nitrates, and they are excellent for improving blood pressure and blood flow, including the all-important blood flow required for erectile function. I recommend them to my patients to enhance blood pressure as well as sexual function.
Savvy athletes, particularly elite runners and cyclists, binge on beet extract drinks to up their aerobic performance. In the future, beet juice and beet extract beverages could overshadow popular sports drinks at high-level sporting events! For non-athletes, beet juice provides more sugar than most people need, and the average person should rely on eating beets or taking more expensive beet extracts that don’t contain sugar.
As for brain function, the news is very promising. Beets are reported to increase blood flow to the neocortex and have the potential to offset stressful events that shunt blood flow to the midbrain, the survival center. In a study performed in Australia, researchers randomly chose forty men and women for a placebo group and a group that consumed beet juice with 5.5 mmol of nitrate. Those in the nitrate-enriched group had a significant improvement in cerebral blood flow and modestly enhanced cognitive performance.
As generations of mothers have said, eat your beets! Try them roasted and tossed with fresh spinach, with a bit of organic goat cheese and walnuts. (See the recipes on this page and this page.)
For more than 100,000 years, humans have eaten cold-water seafood from rivers, lakes, and oceans. Cold-water fish, shellfish, and seaweed have been an integral part of our nutrient and protein intake. One distinctive nutrient that comes uniquely from seafood, including fish, shellfish, and the algae and plankton they consume, is long-chain omega-3 fats. Studies in humans have shown that greater long-chain omega-3 intake correlates with better brain function, reduced risk for dementia, lower beta-amyloid levels, higher total brain and hippocampal volume, and lower carotid IMT scores. Based on this evidence, I recommend that you eat a five-ounce serving of omega-3-rich seafood at least twice a week, or take a high-quality fish oil supplement. I personally eat at least two to three servings of wild salmon or sardines each week, plus I take 1,000 mg of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) daily. (For more information on fish oil supplements, see Chapter 5.)
Like humans, fish can’t produce these essential omega-3 fatty nutrients themselves, but plankton and algae can. Plankton and algae manufacture these highly flexible fats so that their cell walls remain supple when exposed to cold water. Mussels, oysters, and shrimp consume plankton and store more omega-3 fats, little fish eat the shrimp, and bigger and bigger fish consume smaller fish, accumulating these essential fats. Typically, the colder the water and the higher a species is on the food chain, the greater its omega-3 content.
There are different kinds of omega-3 fats, characterized by the length of their molecular “chain”—short, medium, or long. Medium-chain omega-3 fats come from land plants and are not the same as long-chain omega-3 fats from cold-water fish, although they are frequently marketed as the same substance. Medium-chain omega-3 fat sources—such as flaxseeds, soy products, and walnuts—are healthy, but the fats do not have the same anti-inflammatory properties and don’t prevent cardiac arrhythmias. Nor are they concentrated in the brain, as long-chain omega-3 fats are. This last point is of particular importance with regard to brain health.
The brain consists mostly of fat, and nearly 40 percent of it is in the form of long-chain omega-3s. Most researchers estimate that we can convert 2 to 7 percent of medium-chain omega-3 fats into long-chain omega-3 forms, but that isn’t nearly enough to meet what is recommended. The majority of health benefits related to omega-3 fats come solely from two long-chain sources.
The most studied and important long-chain omega-3 fats are DHA and EPA. DHA has more anti-inflammatory and triglyceride-lowering capacity than EPA, but both DHA and EPA are beneficial, and both forms occur in natural fish oil.
If you are a vegetarian and don’t consume shellfish or fish, seaweed food sources have the same long-chain omega-3s. You will need to have a seaweed salad several times per week, or take a seaweed source of DHA, to meet your long-chain omega-3 needs.
If you do choose to supplement instead of eating seafood for omega-3, you should be aware that in most studies, eating fish consistently provides more benefits than supplements alone, though it is unclear why. It could be that fish provide protein as well as important minerals like selenium, or that the supplement quality is inferior to the omega-3 fats in fish.
In Chapter 5, I will tell you more about how to choose carefully from among the variety of fish oil supplements currently on the market, as well as how to choose a supplement with the right ratio of DHA to EPA. Much of what is mass-marketed and sold in drugstores or big-box chains is rancid (making it illegal in most European countries) and may be harmful to your health. Higher-quality pure supplements have been shown to benefit those with mild cognitive impairment and heart disease in multiple randomized clinical studies. (It can’t be emphasized enough that quality matters when it comes to fish oil—and all other—supplements.)
Finally, the type of fish you eat matters. Total intake is less important than the variety of fish. Choose fatty cold-water fish for maximum long-chain omega-3s—think salmon and sardines, as opposed to white fish such as cod, grouper, or tilapia. There is nothing wrong with those varieties if they’re responsibly sourced, but when it comes to omega-3 content, fatty cold-water fish are superior. Wild-caught usually contain more omega-3s than farm-raised and are less worrisome with regard to mercury and pesticide levels. (For a discussion of fish and mercury, a brain toxin, see Chapter 8.) In addition to salmon and sardines, excellent sources of long-chain omega-3 fats are herring, anchovies, mussels, oysters, sole/flounder, and trout.
If you’re looking for another reason to serve fish to your family—particularly to your children or grandchildren—keep this in mind: both adults and children experience cognitive benefits from consuming long-chain omega-3s. The lower the blood level of these special fats noted in children, the greater the benefit from consuming them—and children appear to benefit more from consuming omega-3 fats than adults. It’s never too early to start protecting the brain.
Olive oil has been a culinary star for thousands of years, adding an irresistible layer of flavor to food. It’s a staple in the Mediterranean diet—famous for decreasing the risk of stroke and heart attack and improving cholesterol profile—plus it’s packed with antioxidant and anti-inflammatory compounds. Most people have heard about its heart-healthy attributes, but it’s also well documented that people who consume more olive oil have lower rates of cognitive decline and better brain function. For this reason, I recommend one or more tablespoons a day of extra virgin olive oil.
The acclaimed Predimed-Navarra study, conducted in Spain, compared the health benefits of a standard low-fat diet with those of a Mediterranean-style diet featuring liberal amounts of olive oil (and is considered conclusive). It was designed to assess the impact of these diets on heart disease outcomes. The randomized trial assessed 522 participants for cognitive function with the Mini-Mental State Examination and a drawing test. Not only did the participants who followed the Mediterranean diet have fewer heart attacks and strokes, their brain health also improved. After 6.5 years of follow-up, more subjects in the low-fat diet group developed mild cognitive impairment and dementia than in the olive-oil-consuming group. Further, those who ate extra olive oil had higher cognitive scores than the low-fat eaters.
Like other foods that have developed well-deserved reputations for their health benefits, olive oil has become so popular that the market is now flooded with a confusing array of options, many of them bearing no resemblance to the genuine olive oil that is at the core of the true Mediterranean diet. Perhaps the biggest recent problem is that distributors are diluting or adulterating it with less healthy oils such as rapeseed or soybean oil. Make sure you buy your olive oil from a reliable vendor.
The most nutritious form of olive oil is extra virgin olive oil, the oil obtained from initially crushing the olives without damaging heat or chemicals. Virgin olive oil is obtained from crushing the olives again. Regular processed olive oil—which does not include the words extra virgin or virgin on the label—may be produced with heat or chemicals to pull out additional oil from the olives, processes that commonly damage the oil. That’s why extra virgin and virgin olive oil are preferable.
Good olive oil is not inexpensive, but it’s well worth it. If you are planning to cook with it, though, be aware of its smoke point, the temperature at which both flavor and nutrient value begin to degrade. Heat-damaged oils can also become oxidized and pro-inflammatory, undoing all the inherent health benefits. Extra virgin olive oil has a smoke point of 400°F, too low for most cooking, which is typically medium-high heat (425–475°F). Virgin olive oil will tolerate medium-high heat and is a good choice for most cooking. The difficulty is finding virgin olive oil, as most stores only carry extra virgin olive oil or regular processed olive oil.
I use extra virgin olive oil for salads, dressings, and low-heat cooking. I cook fish and vegetables with virgin olive oil at medium-high heat, not higher. Alternatively, you can use a high-heat stable oil, such as avocado oil, for the initial cooking, then reduce the heat to simmer and add extra virgin olive oil—providing flavor and nutrient value.
I’ve switched to using avocado oil for most of my medium-high-heat or high-heat cooking, which gives that sear effect to protein and vegetables. It has a pleasant neutral flavor and a high smoke point of 520°F. It is loaded with healthy monounsaturated fats. And it isn’t packed with pesticides, unlike many grain and seed oils.
Nut oils are another solid choice for cooking. In particular, I like cooking with almond oil (smoke point 430°F) and pecan oil (smoke point 470°F); both have a light, nutty flavor. (For more information on cooking fats and oils, see my website, www.DrMasley.com.) As part of the Better Brain Solution, you can safely consume a tablespoon a day of heat-stable cooking oil in addition to olive oil.
There is a widespread myth that coconut oil is great for high-heat cooking, but in fact this fat—which can be beneficial for brain health—has a relatively low smoke point, at 350°F (considered medium-low for cooking). Heating the oil past 350°F damages its delicate fatty acids, converting it into a partially hydrogenated oil—the worst of all cooking oils. The scientific reality is that coconut oil should not be heated beyond medium-low heat.
Partially hydrogenated oils were designed by the food industry to extend the shelf life of food, but they will shorten your life if you consume them. For years they were packed into almost everything we ate (as old-fashioned margarine, Crisco, and the like). They are still commonly found in processed foods and baked goods. Consuming partially hydrogenated fats will worsen insulin resistance and cholesterol profiles, increase cancer risk, and accelerate memory loss. Avoid them.
Nuts are back. After years of shying away from nuts while we overemphasized low-fat eating, we’ve restored their role as a healthy dietary fat. Nearly every study to assess the impact of nuts on health is positive. Nuts improve cholesterol and blood sugar profiles and curb hunger as they help with weight loss. One study showed that eating two ounces of almonds as a pre-dinner snack (about two handfuls) suppressed appetite and total calorie intake dropped; subjects who were asked to eat more almonds lost more weight than those who did not consume nuts. It is a myth that nuts are “fattening,” a reputation they have because they are not a low-calorie food, but their ability to suppress hunger, plus their multiple health benefits, makes their calorie intake worthwhile.
The landmark Predimed-Navarra study (mentioned on this page) followed subjects who were randomized to consume extra olive oil and more nuts, or to follow a low-fat diet. Those who ate two or more ounces of nuts (or olive oil) for 6.5 years had fewer heart attacks and strokes, lower rates of mild cognitive impairment and dementia, and better cognitive testing scores than those who followed the low-fat diet. Nuts are rich in fiber and smart fats. Since your brain is approximately 60 percent fat, you need good fat in your diet to nourish it, and nuts are one of the most brain-nourishing choices you can make.
Enjoy nuts as a snack, or chop and toss them in a salad. Put nut butters, such as almond butter, in a smoothie, and used slivered nuts as a garnish on a variety of dishes. They add flavor, a pleasant crunchy texture, and a powerful load of nutrients with each serving. Aim to enjoy one or two handfuls (1–2 ounces) of nuts every day. My favorite nuts, those with proven benefits, are almonds, pistachios, pecans, hazelnuts, walnuts, and macadamias. (You don’t see peanuts in this line-up because peanuts are a legume—technically not a nut at all—and are, gram for gram, higher in omega-6 fats than nuts like almonds. In addition, for people with food allergies, peanuts are high on the allergen list. For those who eat enough long-chain omega-3 fats, peanuts can be a healthy, satisfying snack in moderation, but they don’t have the same cognitive benefits as nuts.)
In a study of healthy college students on the campus of Andrews University in Michigan, researchers assessed the impact of daily walnut intake in 273 subjects during eight weeks. Students ate banana bread with or without walnuts; the group that ate the nuts showed a modest short-term improvement in reasoning, although without any improvement in memory. Walnuts in particular were selected as they are high in alpha linolenic acid (a building block for forming omega-3 fats), fiber, folate, vitamin E, and polyphenol antioxidants. The authors of the study think people with cognitive impairment might even have greater benefits than the students, though that has yet to be studied and confirmed.
Avocados are another of my favorite high-fat foods. They are loaded with fiber, potassium, and monounsaturated fats, and they have a delicate taste. Enjoy them a few times a week sliced into salads. Try mixing chunks of avocado with chickpeas, cucumbers, tomatoes, and shrimp, dressed with olive oil and lemon juice, for a refreshing and satisfying lunch or dinner. (See the recipes in Chapter 10 for more ways to incorporate healthy fats into your meals and snacks.)
Many flavonoids, but especially blue, purple, and red plant pigments (anthocyanins) are associated with increased cerebral blood flow and a lower rate of cognitive decline. Berries and cherries are high in flavonoids as well as fiber. They satisfy a taste for sweetness, but without the damaging effects of increasing blood sugar levels, plus they reduce both oxidation and inflammation.
In particular, blueberries have been shown to improve cognition and to slow cognitive decline. Feeding children blueberry-rich meals improves memory and information processing, and older adults showed improved cognitive function after consuming blueberries daily for twelve weeks. Scientists have tried to clarify the mechanism in berries that improves brain function. In addition to their obvious antioxidant and anti-inflammatory properties, blueberries have been shown to reduce the production of beta-amyloid, the protein associated with Alzheimer’s disease.
Enjoy one half to one cup of cherries or berries every day. The fresh ones are delectable, when you can get them in season, but frozen varieties are wonderfully convenient and equally beneficial.
Another delicious source of dietary flavonoids is cocoa and dark chocolate. With functional MRI brain imaging, we can actually see how cocoa intake improves cerebral blood flow, in particular to the memory center of the brain, the hippocampus.
For years, I’ve recommended daily cocoa or dark chocolate, as it improves blood pressure levels as well as insulin sensitivity, and it decreases the oxidation of cholesterol into artery plaque. More recent research has also shown that eight weeks of daily cocoa intake improved cognitive testing results in older adults, especially for those with early cognitive decline. Subjects in this study drank about one cup of unsweetened cocoa daily. (If you need your cocoa at least slightly sweetened to consume it, consider adding stevia or xylitol.)
Dark, unprocessed cocoa will contain up to 10 percent of its weight as flavonoids. Be aware that Dutch processing (chemical processing by manufacturers to reduce the perceived harshness or acidity of cocoa) reduces flavonoid content. Studies measuring the benefits of cocoa for brain function carefully selected cocoa brands that provided at least 375–500 mg of cocoa flavonoids per serving, although smaller dosages still provided some benefit. (Look for brands labeled “natural” or “nonalkalized” to ensure maximum flavonoid content.)
When it comes to selecting chocolate for brain benefits, don’t confuse milk chocolate with dark chocolate. A chocolate must contain at least 70 to 80 percent cocoa to qualify as what I’d call dark chocolate. Although some may worry that consuming chocolate will worsen blood sugar control, at least the Physicians’ Health Study (which followed more than eighteen thousand physicians and dentists for more than nine years) found that eating more dark chocolate was associated with a reduced risk for developing diabetes, so something about dark chocolate helps with blood sugar and insulin regulation as well.
A tablespoon of dark, unprocessed cocoa powder has only twelve calories. Here are a few ways I get my daily chocolate brain boost. I recommend one or two ounces of dark chocolate or two tablespoons of dark, unprocessed cocoa powder per day.
• Add 1 tablespoon of cocoa powder to each of two cups of coffee each morning. This is my version of a mocha for breakfast.
• Add 1 tablespoon of cocoa powder to a smoothie. Frozen cherries, almond milk, kefir, protein powder, and cocoa powder are awesome in a smoothie and terrific for your brain, too. (See the basic smoothie recipe on this page.)
• Consume 1–2 ounces of dark chocolate after dinner.
• Melt and drizzle dark chocolate over berries, pear slices, or other fruit and nuts, allow to cool, and enjoy. (See recipe on this page.)
To achieve the benefits, noted in studies on cognitive function, from eating dark chocolate instead of cocoa, you would need to eat at least one or two ounces of dark chocolate, about half a typical dark chocolate bar. But if you like dark chocolate, it’s not so bad, right?
Over the last decade researchers have concluded that caffeine consumption from coffee and tea is harmless at levels of 200 mg in one sitting (around two and a half cups of coffee) or 400 mg daily (around four or five cups of coffee during the course of the day). Note: Throughout this section, I refer to eight-ounce cups of coffee or tea—not to smaller cups or to a double espresso from the local coffee bar.
Caffeine sources (tea and coffee, as well as caffeine tablets) have several positive actions on the brain in healthy people. Caffeine increases information processing, alertness, and concentration, and in some people it enhances mood and limits depression. It also enhances the effect of drugs used to treat migraines. Lifelong coffee/caffeine consumption has been associated with lower rates of cognitive decline and reduced risk of developing Parkinson’s and Alzheimer’s diseases. However, for people with mild cognitive impairment, adding caffeine in tablet form has almost no benefit, meaning the benefits of caffeine may not apply to people with established early memory loss. Long-term consumption appears to be protective, and benefits may take time to have an impact.
Although most studies have shown that coffee is good for your brain, there has been some debate about the ideal intake, and about whether the benefit is from caffeine itself or from the flavonoid pigments in the coffee. When researchers analyzed several studies, with a total of more than 34,000 participants, comparing coffee intake with cognitive disorders (mild cognitive impairment, Alzheimer’s disease, and dementia), they noticed a J-shaped-curve relationship between coffee consumption and the risk of developing memory loss. On the J-shaped curve, the lowest risk was in people who drank one or two cups per day, which was better than those who drank no coffee, or those who drank more. And in Japan, a study with over 23,000 adults older than age sixty-five showed a 20 to 30 percent reduction in advanced dementia in those who consumed two to four cups of coffee daily.
Several studies have shown that women display less cognitive decline than men as a result of consuming coffee. (Even decaf coffee has been shown to improve cognitive function and mood in men and women, so that cup of decaf can have some benefits, too.) If you like drinking coffee, enjoy it—about two cups per day is the right amount.
If you’re also a tea drinker, don’t exceed more than two cups of coffee and two cups of tea per day, unless the additional beverages are decaf. (If you’re concerned about caffeine jitters and wondering why coffee-drinking affects people differently, see the box “That Caffeine Buzz—Is It Good for You?”)
As promising as the science is linking coffee and brain benefits, tea looks even better. Tea provides flavonoids, caffeine, and L-theanine, an amino acid that helps cognition. Over decades, tea drinkers consistently show less cognitive decline than non-tea consumers, and as with coffee, women appear to benefit more than men.
In particular, the L-theanine in tea has special cognitive benefits. Supplied in capsule form, it has been shown to improve mental function and help achieve a state of calm, without the jitteriness that some people experience with caffeine. For millennia, monks have consumed tea while meditating for greater focus and clarity. In one study, researchers combined 97 mg of L-theanine and 40 mg of caffeine in a single tablet for one group of subjects and gave a placebo to another group. Those who took the combo showed a significant improvement in cognitive accuracy during task switching, an improvement in alertness, and less self-reported fatigue.
Getting this amount of caffeine should be easy, as a typical cup of tea has 25–35 mg and a cup of coffee has 60 mg. The challenge might be in getting this amount (close to 100 mg) of L-theanine without a supplement. Two cups of matcha green tea will do it, as matcha has 46 mg of L-theanine per cup. You would need to drink nearly four cups of black tea (which has 25 mg per cup) to get the right amount. With regular green tea, it would be hard to achieve—it has only 8 mg of L-theanine per cup, so you’d need more than twelve cups to get L-theanine’s benefits. The challenge with green tea is that when a cup from a tea bag is brewed, most of the antioxidant capacity and L-theanine don’t get into the tea; they are discarded with the solids in the tea bag. Not only is matcha green traditionally grown in the shade, which increases the leaves’ L-theanine production, but matcha is stone-ground into powder, allowing the antioxidants and L-theanine to dissolve into the tea liquid far more effectively.
If you are going to choose green tea over coffee, choose matcha to get 500 percent more antioxidant and L-theanine benefits. Matcha has a similar amount of caffeine as other teas, but only about 25–30 mg, which is half that found in a standard cup of coffee.
If you happen to avoid caffeine altogether, you will still benefit from consuming decaf tea (which has L-theanine) and decaf coffee (which has flavonoid pigments), as their benefit is only partly related to the caffeine. Unfortunately, if you are an herbal tea drinker, any benefits relating to cognitive function or the prevention of memory loss are unknown. However, many herbal teas have antioxidant and/or anti-inflammatory properties, and drinking them will likely help lower the risk for all forms of neurodegenerative conditions, including Alzheimer’s disease.
That Caffeine Buzz—Is It Good for You?
Do you need to drink at least two cups of coffee before you’re firing on all cylinders, or are you wired after just one? People metabolize caffeine differently. About half the population are “fast” caffeine metabolizers, meaning their caffeine blood levels naturally decrease promptly after consuming their coffee or tea. The other half are “slow” metabolizers—their caffeine blood levels jump and stay high longer after consumption. How you break down caffeine is a genetic trait and can be measured with genetic testing—or you may know simply based on how coffee or tea impacts you. (I like drinking coffee and feel lucky to be a fast metabolizer.)
When scientists studied the impact of caffeine consumption on heart disease risk, they noticed that in the whole population, consuming zero to three cups of coffee daily had no cardiac risk, but consuming four cups or more increased the risk by 30 percent. Yet when they controlled the analysis for caffeine metabolism, the results looked very different. Fast metabolizers who consume one or two cups per day have less heart disease risk than those who consume no coffee. (Those flavonoid pigments in coffee are good for you.) They had to consume more than four cups daily to show even a small risk. Fast metabolizers who consumed two to four cups of coffee per day also had better blood pressure and blood sugar control than non-coffee drinkers.
The slow caffeine metabolizers’ results are eye-opening, as spikes in blood caffeine levels that persist are a concern. Slow metabolizers who consume four or more cups of coffee daily have a 400 percent greater risk for a cardiovascular event. Slow metabolizers do fine with one or two cups per day, but clearly they should not exceed a second cup. Not only do they show an increased risk for cardiovascular events, but the extra coffee increases their blood pressure and blood sugar levels as well.
Caffeinated beverages may disturb sleep and cause insomnia, especially for slow caffeine metabolizers. It may also raise anxiety in highly sensitive people. If caffeine impacts your sleep or anxiety, avoid it. Caffeine does not seem to lead to classic dependence, although some people experience withdrawal headaches for a few days when they suddenly stop caffeine intake, which feel much like an intense migraine. If you drink coffee or tea regularly and want to assess how you would feel without it, I suggest you wean slowly and stop your intake over a couple of weeks, not all at once.
If you are not sensitive to caffeine, then a daily coffee and/or tea intake can be part of a healthy diet for adults of all ages. If you feel better avoiding all sources of caffeine, you might consider taking an L-theanine supplement, as it has known cognitive benefits without any established significant side effects.
The greatest benefit derives from consuming one or two cups of coffee or three or four cups of tea per day, and not more. If you currently exceed this amount, either cut back, or be safe and ask your doctor to check your caffeine metabolism status, which is a measure of your CYP1A2 activity (the liver enzyme that metabolizes caffeine). Most likely your health insurance won’t cover this type of testing.
I enjoy drinking a couple cups of coffee in the morning, and I drink a cup of matcha in the early afternoon. The evidence suggests that I’m making a smart choice for my brain and my heart. I have to limit myself to two or three cups of caffeine per day, because if I drink more, even as a fast metabolizer, I won’t sleep well at night. I also look for organic brands, to avoid the pesticides used by large coffee and tea growers.
Moderate alcohol intake has complex biochemical neuroprotective and anti-inflammatory properties, and worldwide, multiple studies consistently show that those who consume alcohol in moderation experience less cognitive decline than those who have no alcohol intake. Red wine, a classic complement to the Mediterranean diet, has the most beneficial effect. Moderate consumption is described differently in various studies, but generally it is one to three servings per day for women and two to four servings per day for men. (A serving is 5 ounces of wine.) If you are wondering why men get larger servings, it’s because generally men are bigger, distributing the alcohol over a greater body size; in addition, due to the effects of estrogen and progesterone, women metabolize alcohol more slowly. Even if a woman and a man of the same size drink the same amount, the woman will experience a higher blood alcohol level over a longer period of time.)
One serving of beer is 12 ounces, and one serving of distilled spirits is 1.5 ounces. Sorry, beer and hard liquor lovers—most studies that show cognitive benefits from alcohol reveal most of the benefit comes from wine, especially red wine. I think four drinks a day for most people is a considerable amount of alcohol (likely excessive), and more than that—particularly with beer and hard liquor—is associated with an increased cancer risk, so use your discretion. Overindulging in any form of alcohol will undo its benefits.
In one study, New York City residents older than sixty-five who drank wine (but not beer or liquor) had larger brain volumes, indicating less brain shrinkage, than those who didn’t drink. (Women had one serving per day and men had one or two servings.) Whether they had the Alzheimer’s-related ApoE4 gene or not, they showed the same benefit.
In Australia, researchers studied people age sixty-five to eighty-three who had a Mini-Mental State Examination score of less than 23 out of 30 (indicating mild cognitive impairment). Those who had two to four drinks a day over six years had less cognitive decline than those who were abstainers or used alcohol infrequently.
A study in the Netherlands tracked people age forty-three to seventy over five years. Those who drank two or three servings of red wine per day showed less cognitive loss than those who abstained or who drank more than three servings per day.
In France, researchers assessed alcohol intake in 3,088 middle-aged adults and measured their cognitive function thirteen years later. Women who consumed one or two servings of wine and men who had two to three servings had better cognitive function than those who had none or who had it infrequently. Again, heavy drinking showed worse cognitive function.
The consensus from multiple studies shows that even after controlling for other health factors (weight, diet, education, and various health issues), those who drink moderately, especially red wine, have less cognitive decline than those who don’t drink at all and those who drink too much.
Red wine seems to be key. Though several studies showed some benefit from all alcohol intake, they showed substantial and additional benefits from red wine compared to beer or spirits (and wine, beer, and liquor contain varying percentages of alcohol). Something in red wine, apart from alcohol, benefits the brain—likely the red grape pigments, the polyphenols, and the nutrient resveratrol, found in the skins of dark grapes. Multiple studies with red grape juice have not found these benefits as consistently, likely because the sugar in grape juice offsets the benefits noted in red wine.
Red wine has not only brain benefits but other benefits as well—better digestion, decreased arterial plaque formation, decreased inflammation, and better blood sugar control and insulin sensitivity. For all these reasons, I recommend daily consumption of one or two servings of red wine with dinner.
Although the benefits seem clear, some people have good reason to avoid all alcohol. Not everyone likes it; nor can everyone enjoy a glass or two of wine and simply stop. For some, a few drinks leads to excess, and excessive alcohol is bad not only for your health but for families and job performance as well. If you do not wish to drink, for whatever reason, don’t start. Instead, consume other red-purple plant pigments (red grapes, blueberries, cherries, and other berries) and consider taking a resveratrol supplement daily, discussed in Chapter 5.
Seasoning your food with herbs and spices elevates it to another level—not only because of their great taste but because of their extraordinary health benefits. Fresh or dried, herbs and spices can add a kick of flavor plus a blast of antioxidant and anti-inflammatory properties. If you want to slow aging, protect your brain, and have fewer aches and pains, simply eat more of these wonderful plants.
The best-known mainstays of a Mediterranean diet are olive oil, heaps of vegetables and fruits, and even red wine—yet the diet’s distinct spices and herbs likely have just as many benefits. Italian herbs and fine herbs—rosemary, thyme, oregano, sage, basil, marjoram, tarragon, chervil, chives, and parsley—are used throughout Mediterranean cuisine. They are loaded with medicinal properties, and eating them lowers inflammation, reduces oxidation, and slows aging. They also taste fantastic when combined with food.
Rosemary has been called a brain-boosting herb. Animal studies in mice and rats have shown that it slows cognitive decline and helps maintain memory. In Italy’s southern regions, some locals eat rosemary-infused foods at nearly every meal. In one area near Naples, researchers have noted a very high rate of people who live into their nineties, with surprisingly low rates of dementia. I consider rosemary a terrific culinary herb; I grow it in my garden and cook with it several times a week.
Don’t limit your palate to Mediterranean cuisine when you’re searching out healthful, fabulous flavors. In southern India, where curry spices are used in abundance, you will find one of the lowest rates of Alzheimer’s on the planet. Curry spices have amazing anti-inflammatory power. Eating them decreases joint pain, lowers cancer risk, and helps prevent memory loss. A typical blend of curry spices would include coriander, turmeric, cumin, and fenugreek and may also include chili pepper, ginger, garlic, fennel seed, caraway, cinnamon, clove, mustard seed, cardamom, nutmeg, and black pepper. The potential varieties are nearly endless, and they don’t have to be spicy hot.
Curry powder is a spice mix of varying ingredients based on South Asian cuisine. Curry powder and the very word curry are Western inventions and do not reflect any specific South Asian food, though a similar mixture of spices used in India is called garam masala. The word curry is derived from the Tamil word kari meaning “sauce, relish for rice,” although most people think of it as the essence of South Indian food. Curry-like mixtures have been used in South India for almost four thousand years. (Chili pepper spices, now essential to any curry powder, are relatively recent additions to the mix as chili peppers were brought to South Asia from the Americas in the sixteenth century.)
The best-known individual curry spice with brain benefits is turmeric, a yellow, ginger-like plant. Turmeric plays an essential role in curry spice blends. A variety of studies using turmeric have suggested that it slows cognitive decline and benefits cognitive function. The challenge is that it is generally poorly absorbed, and the quantities needed to show a benefit are big: you’d have to eat about three heaping tablespoons of turmeric every day. When I lived and worked as a volunteer in various hospitals in India, including a leprosarium near Calcutta, I likely ate this amount daily. I ate curry-flavored meals for breakfast, lunch, and dinner. But that was then, and this is now. I once tried to add a tablespoon of turmeric to yogurt and eat that three times per day, thinking, Okay, this is good for me, but I confess I didn’t get past the first serving, let alone three per day.
Fortunately, the benefits of turmeric are also available as a supplement, called curcumin (discussed in Chapter 5). The brain benefits of turmeric can be replicated by taking one curcumin capsule daily, without any meaningful side effects, apart from occasional stomach distress noted with higher dosages.
Garlic and ginger have additional anti-inflammatory benefits. Chili pepper spices, derived from any number of chilies containing the ingredient capsaicin, help rev up your metabolism. Cinnamon improves blood sugar control and improves insulin sensitivity.
My challenge is to use more spices and herbs every day, and I encourage you to do the same, at least two teaspoons of dried spices or two to three tablespoons of fresh herbs daily.
David’s Better Brain (and Body) Story: Adding the Right Foods
David was fifty years old and felt awful. Obese, struggling with type 2 diabetes, and depressed, he couldn’t think straight. As an accountant, he was having more and more trouble focusing on tasks at work, and felt like his brain was beginning to fail him, just as his body had. His doctor recommended bariatric surgery and a slew of medications to take beforehand—for high blood sugar, cholesterol, and high blood pressure. Disheartened and unenthusiastic about the prospect of surgery and reliance on medications, he got motivated…and it started in the kitchen, at the grocery store, and on his plate.
David isn’t one of my patients, but he did show up at my clinic months after his doctor suggested the surgery, wearing two pairs of jeans—at the same time. He wore a size 34 pair, and over that he had on his old jeans, size 48. This happy, smiling stranger had shown up to thank me.
It turns out that after rejecting surgery, David knew he had to do something to reduce his dangerous weight, repair his brain, and save his life. He went online and found my books—Ten Years Younger and The 30-Day Heart Tune-Up. His wife agreed to cook recipes from the books, and he took the leftovers to work for lunch, cutting out the junk and focusing on the core foods I recommended. While those books focused on foods for their anti-aging properties and their cardiac benefits, they are similar to the ones I recommend here for better brain health—foods like clean protein, fiber, red wine, nuts, and dark chocolate.
Within a month, David told me, he knew he didn’t need the surgery. Instead, he added many of the same dozen foods featured in this book, and he cut out cereal, bread, crackers, and all beverages with sugar. He also started going for a walk twice a day, before and after work.
During the first month, he noticed that he had much more energy and slept better, and his wife noted a big improvement in his romantic performance. He enjoyed the foods he was eating and felt satisfied with his new meals and snacks. The biggest change was that he felt mentally sharper all day long. He was not just getting his work done on time but feeling like he could do more. His boss noticed his improved job performance as well, and he was promoted.
David kept losing about fifteen pounds per month. Uncomfortable with the physician who had thought drug therapy and weight-loss surgery were the only answers, he found a new doctor, who was almost as happy as he was with the results: David’s blood sugar, cholesterol, and blood pressure were all back to normal. David had simply added the right foods and avoided the bad ones. What you choose to eat, and what you leave out of your diet, truly has a dramatic impact on your mind and body.
Beans are a tremendous source of nutrients, as they are likely the best source of fiber you can achieve from one serving of food. They are loaded with vitamins and minerals, such as mixed folates, magnesium, B vitamins, and potassium. They have the highest oxidation-blocking score of any food ever tested, meaning that they effectively fight destructive oxidation in cells—think of it as internal rusting—that can lead to accelerated aging and disease, including memory loss.
Best of all, eating a half-cup serving of beans improves blood sugar control and decreases insulin secretion, as the carbs in beans are absorbed slowly. We have known for decades that eating legumes can even improve blood sugar control and insulin production when consumed with other carbohydrates, such as rice and bread. Legume intake also helps with weight control.
Yet some people don’t tolerate beans. Beans contain lectins, a compound that about 10 percent of the population cannot break down and digest. The result isn’t merely gas—it’s intestinal pain and discomfort, enough to turn you off from this otherwise amazing food. But there is a work-around. You can remove lectins from uncooked beans by soaking them in water a couple of times (commonly called sprouting, although you don’t need to wait until sprouts actually appear). Simply soak beans overnight in water, drain and rinse in the morning, soak again for up to eight hours, and rinse one last time before cooking. This will markedly shorten the cooking time (a boon on a weeknight), and the beans will absorb and remove most of the lectins during this initial sprouting process. It will also decrease the common gassy effect from eating beans, too.
Canned beans are convenient and nutritious (though you can’t remove lectins if that’s an issue for you), and most supermarkets carry a terrific variety. Choose pintos, chickpeas (garbanzos), cannellini (white) beans, butter beans, lentils, or any bean or legume you enjoy; if you buy canned beans, be sure to purchase BPA-free cans. Soaking dried beans and cooking them from scratch is economical and easy, although it takes time. Aim to eat at least one-quarter to one-half cup daily.
A tsunami of research now connects the gut microbiome—the complex community of trillions of microorganisms that live in the digestive tract—to the brain. Have you noticed that when you know something isn’t right, you get that “gut feeling”? That you develop “butterflies in your stomach” before a first date or a big interview? And how about “stomach rumbling” when you are stressed out? All these are everyday examples of the extraordinary gut-brain connection, a relationship that impacts your cognitive function.
Several books have explored this link, including The Mind-Gut Connection by Emeran Mayer, M.D., and Brain Maker by David Perlmutter, M.D. (the best-selling author of Grain Brain). Interviewing both of these internationally renowned physicians for this book made me even more aware that the gut communicates with the brain like no other part of the body.
Most of us have always had an inkling of the gut-mind connection (those butterflies!), but scientists have been slow to focus on it. Yet there are more microbes in our gut than there are cells in our entire body. The connection between the mind and the gut is bidirectional: the gut talks to the brain and the brain talks to the gut every minute of our lives, and the microbes living in our gut have a major influence over the quality of this exchange. When our gut-brain communication is off balance—due to diet, antibiotic use (which kills off valuable bacteria and other microbes), stress, or lifestyle—we experience physical and mental health issues, including depression, anxiety, fatigue, weight gain, and digestive problems. Recent studies have shown that a diverse, healthy biome improves cognitive function and decreases risk for depression, anxiety, and cognitive decline.
In 2015 I co-chaired the American College of Nutrition’s symposium “Translational Nutrition: Optimizing Brain Health,” attended by scientists and clinicians from around the world. I was amazed how much research connects a healthy gut microbiome to brain function, and how an abnormal gut microbiome balance is associated with an increased risk for neurological problems, including Alzheimer’s disease, Parkinson’s disease, attention deficit disorder (ADD), and autism.
The needless use of antibiotics has harmed our gut microbiome (see the box “Antibiotics and Gut Health” ), but so have acid-blocking agents (heartburn medications); it turns out that stomach acid is essential to a healthy microbiome. Some people may have a serious medical problem requiring the use of an acid-blocking drug (to name a few: Prilosec, Nexium, Omeprazole, Ranitidine, Zantac, and Lansoprazole). But in my clinical experience, far too often people overuse these microbiome-disrupting medications because they smoke tobacco or overindulge in coffee and alcohol, causing avoidable heartburn. If you are currently taking this type of medication, talk to your doctor about how you could safely avoid this drug class altogether.
We need a strong, balanced gut microbiome to detoxify chemicals, metabolize our own hormones, and control inflammation. A healthy gut microbiome depends on two primary factors:
• Fiber. Gut-healthy microbes eat primarily fiber—so you need to eat fiber from vegetables, fruits, beans, and nuts to keep your microbiome well fed and alive.
• Bacteria. If you haven’t always eaten an abundance of fiber, you likely need to restore some healthy bacteria to rebuild your microbiome. The best way to do that is to eat a diet rich in fermented foods, which naturally are packed with multiple strains of valuable gut-healthy bacteria.
Fermented foods include, among others, sauerkraut, pickles, kimchi, kombucha, miso, tempeh, yogurt, and kefir. (You’ll find the last two items in the Mediterranean-style diet, where fermented foods come from the dairy category.) If you aren’t likely going to eat fermented foods daily, then taking a probiotic supplement would be another good option, which I’ll expand upon in Chapter 5. Feed your gut—to fuel your brain!
Even a short course of antibiotics can wreak havoc on your gut microbiome, killing billions of healthy bacteria and leading to an overgrowth of potentially toxic microbes. I am not suggesting that you avoid antibiotics for, say, pneumonia or an infected wound. Yet far too often antibiotics are prescribed for colds or minor infections when they are absolutely not needed. A single course of antibiotics can disrupt your gut microbiome for more than one year and, by changing the balance of gut microbes, cause you to gain substantial weight. Before you accept a prescription for an antibiotic treatment, clarify with your physician if you could safely do without it, even if it requires a follow-up visit.
Adding the 12 Smart Foods to your daily diet will help you think more sharply and save your brain from decline, at the same time giving you satisfying, flavorful options to indulge in when you choose your meals and snacks. There are, however, some foods you should eat in moderation or avoid entirely, as they have the potential to hurt you in many ways. Some are obvious (nobody will recommend that you eat more partially hydrogenated fat), but others will be surprising, especially with regard to brain health.
Let’s begin with the least controversial and most toxic substitute to avoid—any form of trans fat, also called partially hydrogenated or hydrogenated fat. For nearly twenty years, I have referred to these dangerous fats as “embalming fluid,” an apt term because consuming them essentially embalms your insides—that’s as bad as it sounds. The food industry creates trans fats in much the same way chemists create plastic. Manufacturers heat oil, such as vegetable oil, add noxious chemicals such as nickel, and pump in hydrogen gas to stiffen it. When you eat hydrogenated fat, you are in turn hardening your tissues, including your arteries and your brain. It’s like being injected with liquid plastic.
Partially hydrogenated fats are almost fully saturated with hydrogen, a process that destroys most of the healthful chemical bonds that make fats delicate and flexible. Don’t let the word partially fool you into thinking that’s somehow better than all-out hydrogenated. Fully hydrogenated fats have no healthy double-bonded structures left within them; the hydrogenation process obliterates them. Partially hydrogenated means they are nearly 100 percent hydrogenated.
Why would the food industry do this? The answer is pretty simple—profits. Foods prepared with partially hydrogenated fats last for decades on the shelf, so they almost never go bad, and you can sell them forever. Because of hydrogenated oils, cookies and crackers, frozen pizza, and boxed rice pilaf won’t go rancid. On the other hand, healthy fats have a far more limited shelf life (not the multiple years–plus of many hydrogenated fats), and products containing them must be thrown away after their sell-by date. Some locations have banned food with trans fats (restaurants in a number of states can no longer use them), and recently passed federal legislation will, I hope, eventually phase them out of our food supply. It’s way overdue. Still, be aware that many baked goods, foods that come in boxes and cans, and numerous highly processed foods still contain these nasty compounds.
Avoiding them is fairly simple: read the ingredient list. If you see the words hydrogenated or partially hydrogenated (even if the nutrition label indicates zero grams of trans fat), return that item to the shelf and buy something else. Dining out is trickier, but you can ask what type of fat a restaurant cooks with. If you hear the words partially hydrogenated or mention of a restaurant-grade oil called phase vegetable oil, ask them to use another oil, such as virgin olive oil, or you should go somewhere else.
Another way to avoid hydrogenated fats is to avoid fried food, especially when you are eating out (and especially in fast-food restaurants). Many fats may start out healthy or harmless, flexible and clean, but when they sit in a fryer all day and then are heated to high temperatures, they become damaged and dangerous. As we saw on this page, even many healthy fats—including olive oil—can be destroyed and transformed into hydrogenated fat when heated for a prolonged time and above their smoke points. If you must fry a food, then at least use a healthy fat, like high-heat-tolerant avocado oil. Cook quickly at high heat, and don’t reuse the oil.
Toxic fats originate in feedlots, among animals who are typically fed grains sprayed with pesticides and the chemical glyphosate (the active ingredient in the weedkiller Roundup), or given up to six different growth hormones to fatten them up before they are slaughtered for market. Over time, chemicals and hormones are concentrated in the animal fat. Eat a cut of meat or poultry from a feedlot-raised animal, or an egg from a factory-farmed chicken, and you eat a load of toxins. Something similar occurs with dairy products when cows and sheep are fed toxic grains and injected with hormones to increase milk production. The milk fat used to make cheese, butter, yogurt, or other dairy foods, as well as the milk itself, may be loaded with residual pesticides, chemicals, and hormones.
I’ve had a few colleagues challenge me with statements like “But those toxins only cause cancer, not dementia or heart disease.” To which I say, isn’t cancer bad enough? As it turns out, many of the harmful chemicals in toxic fats block insulin sensitivity, leading to diabetes and elevated blood sugar, thereby upping the risk for heart disease and dementia.
The solution is straightforward. If you buy animal protein and dairy, buy “mostly” products that are clean, as in grass-fed, or only organic-fed, and from animals that are not given hormones. Look for terms like pasture-raised and wild, as well as grass-fed and organic, and try to purchase products that come from smaller farms and producers as opposed to the food giants. Unfortunately, such marketing isn’t a 100 percent guarantee that your food is clean, but at least it is a very good start. As for dairy, if you cannot find grass-fed and pasture-raised, at the minimum opt for organic.
Since elevated blood sugar is the #1 cause of dementia and heart disease, avoid sugar—especially added sugar—and refined carbs if you want to improve blood sugar and insulin control. How high your blood sugar rises after a meal is fairly predictable (and is explained more thoroughly in Chapter 4), particularly if you know whether you’ve consumed actual sugar—but that’s where it gets a bit murky. Here is a partial list of alternative names for plain old sugar: organic cane juice, syrup, glucose, fructose, high-fructose corn syrup, cornstarch, cane products, fruit juice, sucrose, and dextrose—it’s all just added sugar. And the more of these names you see in the ingredients list, the worse that item is for you (even if it’s organic).
Don’t be fooled by agave, either. Agave is often marketed as a “health food” because consuming it doesn’t raise blood sugar levels, but agave is nearly pure fructose, which is stored in your liver as fat, basically turning your liver into pâté. Fatty liver is one of the causes of insulin resistance, which leads to disabling memory loss. Skip the agave.
Chemical sweeteners give you a sweet taste without any calories, but they have little upside beyond that. Some of these sweeteners kill off the healthy microbes living in your intestinal tract, disrupting the gut microbiome and causing a variety of serious health problems, ranging from weight gain to neurological injury to elevated blood sugar. Sucralose (found in Splenda) is really chlorinated sugar. Consider that we use chlorine to kill bacteria in public water supplies. In lab animal studies, aspartame (what NutraSweet and Equal are made from) has been reported to increase the risk for certain cancers, in particular leukemia and lymphoma. Furthermore, a natural calorie-free sweetener (even the plant-derived stevia, or the alcohol-based xylitol) will likely stimulate your appetite and cravings, causing you to eat more later and gain back some of the calories you were trying to avoid.
To make this message sweet and short: avoid most sweeteners, including the blue, yellow, and pink packets—aspartame (NutraSweet and Equal), sucralose (Splenda), and saccharin—as they all have the potential to harm your gut microbiome and/or raise your risk for other health problems. If you feel you must use a sweetener, consider natural options that don’t adversely impact your gut, like stevia, erythritol, and xylitol, but don’t overdo it. Erythritol and xylitol in excess can cause an unexpected reaction—diarrhea—and as mentioned above, even these natural sweeteners can spike your appetite and cause you to overeat.
For many of us, celebratory foods are an important part of our family culture and ethnic heritage. We share them with others as we mark holidays, birthdays, weddings, anniversaries, and other major milestones. My goal is to keep you in good enough health so that you can enjoy life and have decades ahead filled with those special moments—the occasional high points in life that may call for a splurge at the table. That is why the most realistic and important focus with regard to food should be on the everyday: what you eat for breakfast, lunch, and dinner, including workdays, when you want to be mentally sharp.
With that in mind, let’s look at a few food categories that fall into the “in moderation” category (including foods that often show up on those special occasions) and practical ways to navigate them.
From my perspective, Americans as a nation take “treats” for granted, particularly when it comes to sweets, but sweets have taken a quantifiable toll when you look at rates of diabetes, heart disease, and dementia. We’re swimming—and drowning—in a sea of sugar.
Our love of sweets started out naturally enough. It’s a taste humans have enjoyed for eons. Breast milk, the first food for many infants, naturally contains the milk sugar lactose—humans are exposed to sweet before they taste savory. Early humans would get some honey from a beehive, for instance, or lick sugary sap from a rare tree, or chew a sweet-tasting plant. It wasn’t often, and it was nice when we found it. Eventually we figured out how to manufacture sugar from sugar beets and sugar cane, though for centuries sweets were still a rarity reserved for the rich. That changed, of course, but it’s unlikely anyone would have predicted today’s astronomical levels of sugar consumption. The average American consumes twenty teaspoons of sugar every day and nearly sixty-six pounds per year. We’re pouring it into our food supply, and it’s damaging our bodies, hearts, and brains.
If your blood sugar and insulin levels are elevated, then avoid all forms of added sugar for at least thirty days. Often that will bring your insulin and blood sugar back into control.
If they are well controlled (fasting glucose less than 95 mg/dL and insulin less than 5 μIU/mL), then I think it’s fine for you to have the occasional treat. Just use common sense—and remember the definition of treat. If you have it regularly, it’s not one.
Given what we know about chemical sweeteners and their impact on the microbiome, I’d use a natural agent rather than a chemical one, so on occasion, if you have normal blood sugar control, then a bit of maple syrup in your oatmeal, honey in your tea, or a sweetener like xylitol, stevia, or erythritol is okay. Unless you are a long-distance athlete and you can tolerate much more sweet intake than most of us, just keep it to an occasional use, as in a few times per week. If that seems unrealistic, and you are going to take something sweet daily, then pick honey, and limit it to a teaspoon per serving, and not more than a couple of teaspoons per day. Honey acts as a probiotic with up to ten to fifteen gut-healthy bacterial species, and if you eat local honey it can help you with pollen allergies. Therefore, if you have well-controlled blood sugar and you want to use an occasional sweet in your food or beverages, make honey your top choice.
Most people report that gradually reducing their sugar intake is much easier than trying to do it all at once. And from a health perspective, if it is a choice between sugar or organic half-and-half in your coffee, choose the organic half-and-half.
The topic of saturated fat is one of the most controversial in this book, especially when we are talking about brain health. If you ask ten doctors about the risks and benefits of consuming foods high in saturated fats, you will likely get ten different answers. From a heart perspective, the evidence is pretty clear. Eating clean saturated fat from animal protein and dairy isn’t bad for your heart—but I can’t say it’s good for you, either. The evidence from multiple randomized clinical trials says it is neutral, meaning that clean meat and dairy won’t improve your heart health, but they won’t necessarily hurt you. If you want to avoid heart disease, it is vastly more important to focus on cutting your sugar intake than to worry about clean saturated fat.
During expert interviews for this book, I asked my colleagues, neurologist and author Dr. David Perlmutter and Dr. Daniel Amen, the brain health expert, psychiatrist, and author, about saturated fat and the brain. Neither was concerned about cognitive decline with saturated fat intake, because they both focus on eating the right saturated fats, in the right way.
The challenge is that the more saturated fat average Americans eat, the higher their risk for Alzheimer’s disease. To appreciate why this might be, you have to consider the type of saturated fat that people are eating and what else they eat with it. The issues that link saturated fat intake with dementia and brain diseases are revealed with these questions:
1. Do you consume excess saturated fat when you have insulin resistance?
2. Is the saturated fat clean or loaded with toxins?
3. Do you consume saturated fat by itself or with sugar and/or flour?
First, as pointed out by Rush University professor Martha Clare Morris, Ph.D., epidemiological studies show that eating foods high in saturated fat likely increases the production of beta-amyloid in the brain, the protein associated with an elevated risk for Alzheimer’s. Even worse, if someone is insulin resistant, then the enzyme that would normally remove beta-amyloid is busy removing excess insulin; thus especially for them, eating extra saturated fat may raise levels of beta-amyloid in the brain. This may be even more important for people with an ApoE4 genotype, as they already have trouble removing cholesterol from the bloodstream. For them, limiting extra saturated fat to a moderate intake might make good sense.
Because of this link, for the average person, Dr. Morris and most national organizations recommend following a Mediterranean-like diet and, as with the DASH plan, eating more vegetables and fruits and limiting the intake of saturated fat. With this approach, you don’t have to give up saturated fat entirely; rather, just eat it in moderation.
Second, as discussed earlier, many sources of saturated fat have toxins and hormones that worsen blood sugar control, leading to insulin resistance, which damages brain cell function and triggers cognitive decline. Most saturated fat consumed in America today is dirty (the animals were fed pesticides or given hormones). There are no studies that compare clean saturated fat with dirty saturated fat and their respective impacts on memory loss (or even cancer), but based on what we do know, my position is this: if you eat animal protein, make it clean, not mean protein that hurts your brain and your health. I’m confident most of my medical colleagues would agree with that approach.
Third, as several studies show, when you combine saturated fat with refined carbs (such as sugar and flour), there is a much greater increase in inflammation than you get from eating either item alone. A study at the Veterans Affairs Medical Center studied twenty older adults with both normal cognitive function and early cognitive decline, comparing their diets and measuring beta-amyloid production in cerebrospinal fluid (the fluid that surrounds the brain). Those consuming a diet high in saturated fat and sugar had much more beta-amyloid production than those who ate a low-fat, low-sugar diet.
Americans typically eat saturated fat in the worst way possible for their brains: in cheese and crackers, butter and bread, steak and baked potato, burger on a bun, macaroni and cheese, frosted cupcakes, French fries (starch fried in fat), and of course, ice cream. You may be thinking, “Wait, cheese is fat, but crackers are salty,” or, “The bun on the burger isn’t sweet,” but the white flour in both (whether it’s gluten-free or not) as well as the starchy potato behave in your body the way table sugar does (as we’ll see in Chapter 4).
A note on cheese: Cheese by itself, especially if eaten in moderation as in not more than one or two ounces per day, likely has a neutral impact on health. It is a decent source of calcium, and fermented cheeses act as a beneficial source of probiotics. To me, the issue with cheese is whether it is loaded with pesticides and hormones or is clean. If you eat cheese, choose minimally processed and organic varieties.
We simply don’t have randomized clinical studies to answer the question, “Is there a healthy way to eat more saturated fat?” So we have to make the best guess as to what to do. When we lack evidence, my tendency as a physician who still sees patients most days of the week is to be cautious, not cavalier. So until we have studies that assure us that clean sources of saturated fat intake are safe for your brain, I’m going to advise this: Eat clean saturated fat in moderation, not to excess. And truly, that isn’t so restrictive, as you could still have a couple of servings of foods with saturated fats each day.
Many health experts in my professional circle follow a Paleo eating plan (which aims to replicate how humans ate 20,000 to 70,000 years ago), and they will claim that you can eat all the extra saturated-fat-rich foods you like. But in truth, we don’t come close to living like cavemen and -women anymore, and we live much longer, too. Sure—as long as Paleo followers have great blood sugar and insulin control, eat only clean animal protein, and don’t combine saturated-fat-rich foods with carbs that raise blood sugar levels, then I’ll admit that extra saturated fat may be just fine.
But until we know for sure, for the average American, especially for those with an ApoE4 gene, eating more saturated fat is associated not only with suffering from memory loss but also with dying younger and with a higher mortality rate. I’d rather be frank and share the latest information available, to help you make the best decision for yourself.
Saltiness is one of the five types of taste, and our bodies require some amount of salt in our diet. For people who don’t get iodine from eating seafood or from taking a multivitamin with iodine, iodized salt provides this essential mineral. The Better Brain Solution program provides salt in moderation to make your food taste delicious, but not enough to cause problems for those who are salt sensitive.
For years we have asked people to lower their salt intake, in particular those with high blood pressure, thinking that most people were sensitive to it. However, we now know that it is more effective to limit sugar than to cut back on salt for better blood pressure control. The average American consumes about 3,500 to 4,000 mg of salt daily. Many health organizations recommend that people limit their sodium intake to not more than 2,500 mg daily—there are 2,325 mg of sodium in one teaspoon of table salt.
Who needs to limit their salt intake?
Genetic testing shows that about 25 percent of people are sensitive to salt, almost 30 percent are minimally sensitive, and 45 percent are hardly impacted by salt intake at all. (Salt sensitivity means that increased salt intake increases blood pressure levels.) Being insulin resistant increases your salt sensitivity. The good news is that following The Better Brain Solution program will make you less salt sensitive so that you can enjoy a bit of salt without unhealthy consequences. People with high blood pressure, heart problems, and advanced osteoporosis may benefit from limiting their salt intake to 2,500 mg daily and should discuss it with their doctor. Recent studies have shown that people without bone loss or hypertension could enjoy a little extra salt without any harm.
For the rare person diagnosed with congestive heart failure or Ménière’s disease (a disorder of the inner ear’s balance center), limiting salt intake to not more than 1,500 to 2,000 mg daily is clearly a benefit. This may be about 2 to 4 percent of the population. For these individuals, I’d ask that they cut the salt content in my recipes by 30 to 50 percent, to ensure that they stay below 2,000 mg per day.
The goal for the recipes in The Better Brain Solution is to help people keep their salt intake moderate and consume close to the 2,500-mg-per-day limit. Adding extra herbs and spices to recipes provides an abundance of flavors, complementing the intended moderate food saltiness, to ensure you and your family love the meals you prepare.
Gluten is a protein found in wheat, rye, and barley. Every time you eat one of these three grains, you’re consuming gluten. Wheat flour is by far the most prevalent source of gluten, used to make thousands of processed foods. It’s a challenge to avoid gluten, but for gluten-sensitive individuals, it’s essential.
Twenty percent of all Americans are gluten sensitive, meaning that if they consume this substance, they can initiate an autoimmune disease, including disabling and deadly ones like multiple sclerosis and inflammatory bowel disease.
An autoimmune disease means your body makes antibodies that attack and damage your own tissues. In the case of gluten sensitivity, your immune system “sees” the gluten protein and treats it like a foreign invader, making antibodies that attack the perceived enemy. Normally, the immune system’s protective response is beneficial, but with an autoimmune disorder, many of these antibodies get confused and wreak havoc on your gut lining, joints, thyroid, sinuses, and even your brain.
When you have gluten sensitivity, you essentially have an autoimmune disease. Eating gluten even once has the potential to cause your immune system to attack your tissues for the next twenty to thirty days. You may eat gluten only once every two weeks, yet you may have symptoms all the time, because the antibody attack is relentless. The symptoms of gluten sensitivity include: gastrointestinal issues such as bloating, gas, and abdominal pain; brain fog; anxiety; depression; achy joints; sinus congestion; fatigue; weight gain or resistant weight loss; eczema and psoriasis rashes.
You could have all of these symptoms or merely one or two. I was surprised to discover that half of people with gluten sensitivity have no gastrointestinal issues but other systemic issues instead. At my clinic, anyone with any of these chronic, unexplained symptoms deserves laboratory testing or a gluten-free elimination diet trial for a minimum of three or four weeks. I wish it were simple, but the reality is that laboratory testing and going gluten-free are complicated; see the Resources section at www.DrMasley.com for details.
Gluten sensitivity is very serious. When you hear the term, don’t confuse it with something annoying but not life-threatening like lactose intolerance. The good news is that the improvements in gluten-sensitive people who go gluten-free are really amazing.
Even people who are not gluten sensitive might benefit from giving up gluten. Absolutely no critical nutrients for your body are to be found in gluten products, most of which come in the form of bread, crackers, pretzels, and pancakes. The main thing you give up by not eating gluten is calories. Furthermore, the wheat grown on North American farms today is not the wheat that was grown fifty or a hundred years ago. It has been genetically modified and is more likely to cause gluten-related problems than before. People who are not truly gluten sensitive may nonetheless be intolerant of gluten and might feel better by avoiding it.
Mary’s Better Brain Story: Gluten
Mary Beth was fifty-seven years old when she first came to see me, more than a decade after her diagnosis of multiple sclerosis (MS). Despite consulting several neurologists and trying a series of the latest available drugs, her symptoms were progressing. Her brain function seemed sluggish as she was increasingly forgetful, and she had tingling sensations down the left side of her body and some early signs of facial drooping. Her latest neurologist had ordered an MRI scan, confirming classic signs of MS. The medications were not working. When her neurologist indicated there wasn’t much more he could do, she visited me.
In addition to her MS symptoms, she also had joint aches, marked fatigue, chronic sinus congestion, and bloating. That combination of symptoms made me think of gluten sensitivity, and I ordered a gluten antibody panel. Her tests were strongly positive for gluten antibodies, including transglutaminase-6 IgG, which is associated with brain antibodies and major neurological symptoms.
I asked Mary Beth to follow my program, add a dozen brain-protecting foods and extra nutrients (outlined in Chapter 5), and totally avoid all sources of gluten. Within a month, the tingling was disappearing, her memory and mental acuity were dramatically sharper, her energy greatly improved, and the joint aches had resolved. By five months, all her neurological symptoms had disappeared. At two years she has had no relapse of any neurological issues (totally symptom free), her energy and cognitive function are great, and as a bonus, she lost more than twenty-five pounds. I am convinced that if she had not started my Better Brain Solution, her symptoms would have progressed, and by now she would be disabled.
One simple way to build meals around the 12 Smart Foods is to follow a Mediterranean-inspired diet. The heart-healthy benefits of the Mediterranean diet—famous for its generous use of olive oil, Mediterranean herbs and spices, and red wine, and for the longevity of its adherents—are well documented, but it offers impressive cognitive benefits as well. The overall diet is rich in plant foods and light on animal protein, and it is characterized by an abundance of bioactive phytonutrients, beneficial plant compounds, with antioxidant and anti-inflammatory properties.
This diet dates back to the early Greeks and Romans, but several decades ago nutrition scientists noted that people living along the Mediterranean basin had lower rates of cardiovascular disease and lived longer than other populations, including Americans. Today a typical daily Mediterranean diet includes five servings of vegetables, two or three servings of fruit, one or two servings of beans, five servings of fat (nuts, olive oil, seeds), one or two servings of fermented foods (like yogurt and raw milk cheese), an abundance of herbs and spices, and one or two servings of whole grains.
There is seafood three or four times per week, poultry two or three times per week, and red meat typically less than once per week. Its followers drink water, coffee, tea, and red wine. And in recent times, they have added cocoa and dark chocolate.
Many studies have linked the Mediterranean diet to overall longevity, but its impact on the brain is particularly striking. In one study of healthy elderly people (the average age was eighty, and they showed no signs of dementia), researchers analyzed diet and brain size. They discovered that individuals who ate more fish and less meat—consistent with the Mediterranean diet—had higher brain volume, a significant finding suggesting that memory loss and dementia are linked to brain shrinkage.
A hallmark of the traditional Mediterranean diet is a leisurely, pleasurable way of eating with friends and family, with fresh foods that are local and seasonal. Meals are heavily plant-based: animal protein is served in small portions or as a condiment, vegetarian dishes are drizzled with olive oil, and herbs play a major role at the table. The diet comes with an active lifestyle that is much more robust than that of most Americans. This was, after all, the diet of farmers, fishermen, olive growers, shepherds, laborers, and people who worked the land and sea.
The Japanese, famous for their longevity and low rates of Alzheimer’s, also have a notably healthy diet that is worth mentioning here as it also features many of the 12 Smart Foods. At first glance, Japanese and Mediterranean cuisines may not appear to have much in common, but they are more similar than different: both have an abundance of vegetables and fruits, and more seafood than meat; both use herbs and spices in abundance, as well as legumes. The Japanese have fermented foods at most meals (miso soup, pickled vegetables, and natto), and although they eat less fat, they eat many smart fats such as nuts and fatty cold-water fish. Like a Mediterranean meal, a Japanese dinner is often a slow-paced, enjoyable affair that includes a moderate amount of alcohol. (The Japanese also walk much more than Americans do.)
The 12 Smart Foods show up consistently in the diets of healthy, long-lived people with sharp brains. Eat these foods more often—ideally, every day—to enhance your brain performance and fend off cognitive decline.
Now, let’s move on to Step 2, for more ways to achieve optimal brain function and avoid the number one cause of memory loss.
Foods to Enjoy
These quantities are intended as a general guide, not to force you to measure and quantify everything you eat.
Foods to Moderate
| Whole grainsacid.* | Optional, up to 3 servings per day |
| Butter | Optional, grass-fed, 1–2 Tbsp. per day |
| Cheese | Optional, organic, 1–2 oz. per day |
| Red meat | Optional, grass-fed, 10–12 oz. per week |
| Natural sweets (honey, maple syrup) | Optional, 1–2 servings per week |
*Choose whole grains with a medium-to-low glycemic load (as explained in Chapter 4), and consider going gluten-free.