How To Improve Brain Health And prevent Dementia
Having spent over 25 years in the practice of health care I’ve formed the opinion that optimal health is much more than just treating or preventing disease.
And so you may be wondering why we’ve spent so much time focused on dementia in this series for improving brain health.
Well, it’s been my experience that understanding and deconstructing an endpoint disease like dementia can give us unique insight for improving health in general.
In the first article Dementia Is A Hard Way To Die, we discussed
What dementia is.
How it can affect those who have it.
The social and economic impacts it can have.
In the second article, Whence Comes Dementia?, we discussed some emerging ideas on why dementia happens, how it happens, and who’s at higher risk for developing it.
In the third article, The Genetics Of Dementia, I introduced a way for understanding hereditary diseases and provided some information to help determine if you or your loved ones may be at risk for developing dementia.
In this fourth and final article of the series I’m going to use all that we’ve covered so far to outline a strategy for not only reducing the risk of dementia, but for improving brain health in general.
The common themes that surfaced from my research into brain health are as follows:
Principle 1: It Starts Earlier Than You Think
While dementia is generally seen in older adults over 65, the disease processes begin much earlier than the symptoms appear. This means the earlier you start preventing it the higher the chance you have to avoid it.
Principle 2: You’re Not Powerless Against Your Genetics
Genetics can influence your risk for dementia but it’s not the whole story. It’s more important to understand the underlying physiological changes underlie brain disease and aging because this is what we have the most control over.
Principle 3: Dementia Is A Form Of Accelerated Brain Aging
The physiological changes that underlie brain diseases like dementia are the same as those seen in a very old brain.
These changes include:
Energy: Brain cells don’t have enough energy to carry out their unique tasks.
Sugar: High levels of circulating glucose (sugar) in the brain, caused by insulin resistance, can damage the structure and function of brain cells. Some brain researchers call this Type 3 Diabetes.
Fatty Acids: Difficulty transporting and using fatty acids like cholesterol results in less energy, sluggish cell repair, impaired circulation, and plaque buildup.
Communication: Communication breakdown between different brain regions negatively affects memory, mental agility, and critical thinking.
Leaky Brain: A “leaky” blood-brain barrier can allow chemicals, proteins, and microbes to enter the brain causing damage to the cells.
Toxic Buildup: The systems for detoxification and repair are overwhelmed allowing tangles and plaques to form.
Inflammation And Oxidation: Too much inflammation and oxidation means the brain is having problems repairing itself faster than its rate of damage.
Circulation: Poor circulation means that nutrients, fuels, and oxygen aren’t able to go where they need to. In addition, waste products and carbon dioxide cannot exit as quickly and efficiently.
The thing is, these aren’t just things seen in the brains of dementia patients.
These are some of the typical hallmarks of the aging brain. It’s just that for the person with dementia, the process of aging is accelerated.
What this means is that regardless of whether or not you develop dementia early, late, or at all, you’re most likely experiencing these physiological changes which can start in your early teens or 20’s.
While your genetics can influence how quickly your brain ages, you also have a lot of control over the health and longevity of your brain.
This recalls one of my core philosophies that
“when our behaviors are in alignment with our biological needs, we will thrive.”
An 8-Part Framework For Improving Brain Health And Preventing Dementia
You want a brain that has all the energy it needs to carry out its tasks, free of toxic buildup and inflammation, with a good blood supply efficiently bringing in the good stuff like oxygen, nutrients and fuel and getting rid of the bad stuff like CO2, toxins, etc. To do this you need to choose behaviors that optimize the physiology of your brain.
You want a brain that’s highly adaptive and able to constantly learn and incorporate new information well into old age. To do this you need to choose behaviors that optimize the function of your brain and nervous system.
The following framework is a way to safeguard your brain health regardless of your genetics by aligning your actions, choices, and behaviors with your biological needs.
Each suggestion of the framework has been chosen because
It’s shown scientifically to reduce or slow the process of brain aging.
It can improve cognitive abilities and mental performance.
Since we could dedicate an entire series to each part of the framework, I’m going to provide you with enough information and resources to get you started on applying this framework for brain health to your own life.
A good and effective way to apply this framework to your life:
First- read through each one.
Second - critically assess which one you struggle with the most.
Third - commit to making small gradual changes in one area of your life.
As a health consultant I’ve found it’s most effective to really focus on one main area of health improvement at a time remembering that the goal isn’t perfection and immediate success but creating a set of long-term behaviors that are most in alignment with your biological needs.
This requires time, patience, and some trial and error to figure out what works best for you.
1. Sleep
By far the most important thing we can do for the health of our brain is to optimize our sleep quality. Of course we all have occasional bad nights of sleep due to stress, illness, a new addition to our family, or while traveling. If you value the health of your brain, and the rest of your health for that matter, then sleep needs to be a top priority.
I define good sleep as between 7-9 hours of uninterrupted sleep where you wake up feeling refreshed. My recommendation is for all my clients to shoot for this goal 6 out of 7 days per week.
For some people (the lucky ones) this isn’t too hard. For others (like me) this can be a real challenge. The pace and balance of our lives, our daily habits and our environments aren’t very supportive for good sleep unless we take an active role to change them. In order for this to happen, good sleep has to be priority #1.
When you sleep well, your brain repairs itself, detoxifies waste products, and reduces inflammation. It also organizes and integrates your experiences and knowledge from the day. This helps build and reinforce brain connections that aids with memory, recall, focus, agility, and problem solving.
When you don’t sleep well, especially for multiple nights in a row, waste products build up, inflammation runs rampant, and the brain can’t repair itself fast enough to keep up with the heavy demands placed on it.
Beta amyloid, the brain plaque associated with Alzheimer’s disease, has been shown to increase by as much as 5% in the brains of healthy people after just one night of bad sleep (1).
One of the first steps you can do is take an online sleep assessment to see how well you’re sleeping and if you could use some improvement. Assessments like these are scientifically validated and can give you some good insight about your sleep.
To learn more about how to optimize your sleep I’ll point you to Dr. Matt Walker, an expert on sleep and sleep optimization. His book Why We Sleep is THE guide to help you understand your own sleep patterns, sleep need and how to get the best sleep of your life.
2. Stress
After good sleep, I can’t think of any lifestyle change more important than reducing and managing your stress.
As I’m sure you’re aware, stress has become one of the most harmful factors affecting our health today. It’s known to contribute to almost every disease from cancer to heart disease. It’s also at the core of many brain diseases like dementia.
One of the problems with addressing stress is that general recommendations often fail to help people. We all deal with stress differently and what may seem stressful to one person can feel completely unthreatening to another person.
In addition to contributing to poor sleep, stress itself has many of the same negative effects that poor sleep does. Poor sleep plus high stress is a one-two punch to the brain and can even mimic the symptoms of a concussion.
As with sleep, I recommend taking an online stress assessment to determine your level of stress.
This article and podcast episode by Dr. Rhonda Patrick is a good place to begin learning about stress and how you can overcome it in your life.
3. Physical Exercise
Aside from sleeping better and reducing our stress, the absolute best thing we can do for our brain health is to exercise regularly.
Dr. Peter Attia, a world-renown longevity expert is quoted in his book as saying, “exercise is by far the most potent longevity drug.”
The problem is almost everyone knows they should be exercising. But, there isn’t a lot of good, evidence-based information about exactly what exercises to do, how much, and how often.
The reason is that, like diet, everyones’ individual needs and preferences are different so there is no one-size fits all approach.
Peter Attia has an extensive collection of articles and podcasts that go into this exact topic. His book Outlive is also a great resource to start creating your own fitness for longevity plan.
Another book and resource that gives actionable advice and activities to improve your physical fitness is Built To Move by Kelly and Juliet Starrett. Instead of giving you general fitness advice, Built To Move shows you how to build a fitness routine that supports and fits into your life with an emphasis on fitness for all stages of life.
4. Food
As a professionally trained nutritionist and nutrition researcher I know that food can be one of the most sensitive, and hotly debated subjects in healthcare. To be clear I’m not a proponent of any one way of eating. There are however some common principles that apply scientifically to brain health and dementia so I’ll keep it simple with a “Eat More” and “Eat Less” list of foods and beverages to include or avoid in your diet.
Eat Less:
Sugar
Alcohol
Fast food
Deep-fried food
Processed food
Cured and processed meats (sausages, salamis, etc)
Trans Fats (margarines and vegetable shortenings)
Vegetables contaminated with microplastics and pesticides
High-sugar fruits (dried and canned fruits)
Eat More:
Eggs
Fatty fish high in omega-3 fatty acids
Olive oil
Nuts high in omega-3 (walnuts, pecans, etc)
Protein: If from animal sources get 1g/pound of bodyweight per day. If from plant sources get 1.5g/ pound of bodyweight per day.
Vegetables, especially cruciferous veggies like broccoli, kale, and cauliflower
Low-sugar fruits (fresh blueberries, cherries, and most citrus)
High-fiber beans and legumes
For a complete list of high-sugar and low-sugar foods here’s an online glycemic index. A high-sugar fruit is any that has a glycemic load (GL) of > 4.
5. Mental Fitness
While a lot of people know about the importance of physical fitness, fewer are aware of how important mental fitness is. So what exactly is mental fitness? The best way to understand it is by using physical fitness as an analogy.
For example in order to gain more strength, muscle mass, mobility, or aerobic fitness your body has to adapt to specific stresses placed on it. If you want stronger legs you need to increase the weight or resistance your legs can press. This will cause strength adaptations in the muscles of your legs.
If you want to improve your ability for problem solving, attention, memory recall, and overall mental agility you need to do activities that challenge your mental abilities. The fancy name for this is neuroplasticity.
Just like our bodies are built to move, our brains are built to solve problems. When we don’t have good enough or interesting enough or challenging enough problems to solve our mental capacities wane and we’ll often create our own neurotic problems for ourselves.
One way to take a holistic approach to your own mental fitness is to play more games. I don’t mean crossword puzzles or solitaire, but games that completely absorb you…games that require your full attention and challenge your problem solving abilities. I call these immersive games.
One kind of immersive game is your work or job. If you’ve chosen a profession or business you love, that constantly challenges your problem solving skills, where you get into states of flow and complete absorption in your tasks, this is a kind of immersive game.
I think the rush toward retirement for many people is a bad idea. The evidence is clear that cognitive abilities drop off significantly within even a few years of retirement. But, not everyone loves their work so this suggestion isn’t for everyone.
Another way to improve and safeguard your cognitive abilities is by playing video games. Newer video games are often adaptive, increasing the challenge or complexity as you gain competence and experience. A recent article in the Handbook of Clinical Neurology demonstrates the benefits of some video games to improve neuroplasticity in players.
One more way to keep your brain running on all cylinders is to improve reading speed and comprehension. Reading is a meta skill because you can use it to learn more things, including how to read better. Jim Kwik is a good resource for all things related to learning and has a course called Kwik Reading that can help you improve your reading speed and comprehension.
6. Emotional Fitness
The importance of emotional health for brain health cannot be overstated. In many cases it’s difficult to distinguish between a brain disease like dementia and psychological conditions like depression and anxiety because the symptoms are so similar.
We are currently living in a time where mental health has become an epidemic. Over the past 10 years life expectancy in the US has steadily declined for the first time in 100 years. This isn’t due to COVID or even an increase in cancers, heart attacks or motor vehicle accidents. The reduction in life expectancy is caused by increases in suicides, opioid overdoses, and alcohol-related fatalities, collectively called diseases of despair.
As I mentioned earlier, one of my core health philosophies is that to be ultimately healthy and vital our behaviors and environments need to be in alignment with our biological needs.
This holds true for our psychological, emotional and spiritual health. When we’re out of alignment with psycho-emotional needs we will often suffer. When we’re out of alignment long enough, we’ll get sick.
Chronic emotional health challenges like major depression, anxiety, and PTSD can have lasting negative impacts on the brain and often predispose people to early onset dementia.
There are many ways to look at emotional health and we could spend an entire series on just this one topic so I’ll distill it down to what I believe to be the 3 most important things.
In my 25 year health care career I’ve spent much of it working in the fields of pain medicine, addiction medicine and mental health care. In almost every case where someone was suffering emotionally there were three factors that influenced their emotional fitness:
Safety
Connection with others
Self love and self respect
Safety - They often felt unsafe in general due to a current crisis, or from the impressions and memories of a past trauma. Once the person felt safe again, much of their emotional suffering became easier to bear. What it takes for one person to feel safe will often be different from another person.
The key factor is if a person is in a physically or psychologically unsafe situation, they need to get out of it. This could be a job, a relationship, a living situation, etc. Once they’re out of the unsafe situation, healing and repair can begin. There are a lot of therapies that people can use to remind their nervous system how to feel safe and balanced again. A few of these include:
Counseling
Breathwork
Mindfulness meditation
Neurofeedback
Medications
Psychedelic-assisted therapies
It’s my very strong opinion that for someone to be emotionally fit they need to spend most of their time being safe and feeling safe.
Connection With Others - It’s undeniable that we’re social creatures. Even the most introverted people still want and need connection with at least one other person. It’s no wonder that chronic loneliness is associated with all-cause mortality.
Unfortunately in this post-COVID era, loneliness and social isolation are more rampant than they’ve ever been. I have some theories about this which I may write about in another article but suffice to say that I’ve noticed it becoming increasingly difficult to get my social needs met. When I talk with other friends and colleagues about this matter, many of them agree, but nobody has any good solutions.
Being social requires effort and planning and the millions of shows, movies and other distractions available to us on demand often make that effort seem larger than it needs to be. I have no suggestions for you to be more social other than figure out what you need, make the effort, and you won’t regret missing the most recent episode of your favorite show.
Self Love And Self Respect - We have all had those people in our lives who are difficult to be around…they just rub us the wrong way. But, what happens when the person who grates on your nerves is you? Another theme I’ve seen at the core of why many of us suffer emotionally is a disconnection from our own self love and self respect.
CEO and investor, Kamal Ravikant wrote a book called Love Yourself Like Your Life Depends On It. In it the author shares about a very hard and dark time in his life where he learned to love himself unconditionally. This didn’t happen by accident but by intentional practice. As he felt and experienced more self love, his current challenges and past traumas faded into the background and he was able to unlock a degree of emotional fitness he had never experienced before. Here is a short summary of key points from the book.
Like all the other parts of my 8-Part Framework For Improving Brain Health, this short discussion about emotional fitness is far from adequate to do the topic justice. Hopefully though you’ll walk away with an understanding that:
Emotional health is critical for brain health.
Many people struggle with their emotional health for many different reasons, so if you’re struggling, you’re not alone.
There are things you can do to improve your emotional health.
7. Supplementation
Before we start with this discussion I want to be clear that I’m not a huge proponent of so-called nootropics. The reason for this is that most drugs and supplements marketed to improve mental abilities, do so only in the short-term, and often with hidden long-term consequences.
My supplementation approach for brain health focuses mostly on supporting the structure and function of the brain for the long term. The suggestions I give most of my clients in this regard have a direct influence on the physiological changes that underlie brain disease and aging such as:
Energy and metabolism
Inflammation and oxidation
Detoxification and repair
Networks and connection
Circulation
The following supplements can help support these 5 key physiological functions that keep the brain healthy. Here I’ll provide a short description of the benefits of each supplement.
I do want to say that simply tossing some of these together or using a kitchen-sink approach is not advised. While most of these supplements are very safe, it’s critical to get the correct form, dosage, timing and combination in order to have the most favorable effect.
Here’s my one obvious pitch in the article…this is exactly what I do for my clients, among many other things.
If you’re looking to work with someone to personalize a health, performance and longevity strategy for you, including customized supplement protocol, click this link.
Ok, here’s the supplement list:
Alpha-lipoic Acid: A potent anti-oxidant that helps with energy metabolism in brain cells.
Omega-3 Fatty Acids: Concentrates from fish oils and flax oils that are high in fatty acids called docohexanoic acid (DHA) and eicosapentaenoic acid (EPA) are excellent for reducing inflammation and oxidation, improving cellular repair and circulation.
N-Acetyl-Cysteine: An amino acid that supports detoxification and protects the blood-brain barrier:
Nrf2 Modulators: Broccoli sprout concentrates provide high doses of sulforaphane which improves detoxification, circulation, and protects the blood-brain barrier.
Phosphatidyl-Choline: This essential nutrient is currently being studied as a treatment and preventative for Alzheimer’s disease. It’s been shown to improve cellular repair and detoxification in the brain as well as support the production of a brain chemical called acetylcholine which is responsible for focus, attention and communication between different parts of the brain.
Phosphatidyl-Serine: This amino acid has been shown to improve sleep and reduce stress by reducing the stress hormone cortisol. It is also being looked at as a preventative for Alzheimer’s disease, especially in combination with omega-3 fatty acids.
While there are hundreds of supplements that influence brain activity, my approach is to focus on long-term supplementation with compounds that have a positive long-term effect on the brain.
Compounds like caffeine, L-theanine, alpha-GPC, and huperzine-A can be fun to experiment with but to my knowledge don’t provide any long-term benefits without potentially negative side effects.
A simple example is caffeine which can make you feel more productive but can also negatively impact your sleep, which is critical for brain health.
With the exception of phosphatidyl-serine, most people don’t experience any noticeable, immediate effects from the supplements listed above.
It could also be said that most people don’t feel the gradual physiological changes associated with reduced metabolism, detoxification, and circulation, and cellular repair in their brain.
Again, the supplements listed above are intended for long-term use and long-term protection for brain health and prevention of brain diseases like dementia.
8. Medicine
I’ve put this one last because I strongly feel that if a person applies the other 7 parts of the framework to their life, they’ll accomplish 90% of what it takes to have a healthy braiin.
In this short discussion I won’t review any specific medications but instead emphasize the importance of working with a skilled medical provider to take care of your total health.
I encourage all my clients to take advantage of the medical and diagnostic resources available to them such as:
Blood work
Imaging
Genetic tests
Prescription medicines and medical procedures if necessary
If you have chronic insomnia, high blood pressure, high blood sugar or any number of conditions that can reduce your overall health and quality of life, they will also impact the health of your brain.
You can work closely with your medical team to determine your physiological and genetic risks for diseases and in a holistic way, systematically reduce those risks while increasing the quality of your life and health.
Some people have unfortunately had negative experiences with their health care and have lost some trust in the doctors and professionals they relied on.
I’d encourage those people to not toss the baby with the bath water. The medical system in the US, while greatly flawed, is still one of the best in the world. Healthcare in the US shines in its ability to provide highly effective interventions once someone has a disease.
Where it fails is its ability to keep people healthy and free from disease in the first place. Medicine still has a lot to offer as long as you know how it fits into your overall health strategy.
This is where consultants like me come in. I can help you assess your physiological and genetic risks for most diseases of aging, including dementia, and will work with you and your doctors to create a holistic strategy to improve all aspects of your health.
If you’re interested in learning more click this link.
That’s All Folks!
I hope you’ve enjoyed this series on brain health and dementia prevention! I also hope I was able to bring it all together for you in this final article so you can start taking immediate action toward a healthier brain.
If you’re interested in reading the other articles in the series, here's an index with links.
Additional References: