SECTION TWO
The NEURO Plan
Now that youâve taken the risk assessment and determined where you fall on the spectrum of dementia stages, itâs time to support the health of your brain and, simultaneously, the health of every system in your body. The next five chapters will guide you on the road to recovery and prevention, and include the most up-to-date research on the choices you make every day and how they affect your risk of developing Alzheimerâs.
As we revealed in Chapter 2, the five key lifestyle factors for preventing Alzheimerâs and cognitive decline are Nutrition, Exercise, Unwind, Restore, and Optimize. Put briefly: you need to eat well, move in the right ways, manage chronic stress, create a restful, restorative sleep pattern, and optimize brain function. While this might sound like a significant life transition, we promise you a brain-healthy lifestyle will be worth the effort. Imagine never having to worry about succumbing to Alzheimerâs disease. Imagine doing the things you love well into your seventies, eighties, and beyond. Imagine never forgetting names, losing your keys, repeating yourself, or relying on loved ones to take care of you. Imagine reversing the symptoms youâve begun to experience, and helping someone you love ease their own symptoms of cognitive decline. Weâve seen hundreds of patients use our NEURO Plan to reverse what seemed to be an imminent Alzheimerâs diagnosis.
Personalization is the foundation of the NEURO Plan. As the assessment showed, your risk for Alzheimerâs disease, dementia, and cognitive decline is as individual as your fingerprint, and your lifetime of experience has created a brain with a now unique set of challenges, symptoms, and protective factors. The only way for you to prevent Alzheimerâs is by understanding exactly what a healthy lifestyle is for you. To that end, here is how our program is designed:
The chapters begin with an in-depth discussion of each lifestyle factor (âNutrition,â âExercise,â âUnwind,â âRestore,â âOptimizeâ) and its impact on cognitive health. Weâve included the latest research, important findings from past studies, remarkable stories of patients weâve seen in our clinic, and intervention strategies youâll need in order to start the program. At the end of each chapter is the program itself, which features a self-assessment, detailed lists for daily success, best practices, strategies to overcome obstacles and propel you forward, and more. We recommend beginning with Nutrition, as it is the single most important lifestyle factor (but if the risk assessment revealed that another factor is important for you to address, please start there). Together, the NEURO Planâs five essential lifestyle programs will help you regain your health and keep your brain sharp and resilient well into old age.
3.
Nutrition
Food determines the fate of our bodiesâhow we grow, how we age, and how we die. What we eat every day creates and re-creates both our cells and their supporting structures. What we fail to eat causes deficiencies that stress and traumatize the body. Though the brain comprises only 2 percent of the body by weight, it uses up to 25 percent of the bodyâs energy, and because food is energy, our brains are especially vulnerable to each nutritional choice we make.
We can think of food as a type of environmental exposure through which we set up the potential for health or the potential for disease. What you choose to eat creates either an environment in which the brain can thrive and repair itself, or an environment that promotes decline. Some researchers have argued that Alzheimerâs is essentially a garbage disposal problem, the brainâs inability to cope with what we feed it over a lifetime. Poor nutrition damages the brain in so many ways: it causes inflammation and the buildup of oxidative by-products, clogs blood vessels, and deprives your brain of the nutrients it needs to strengthen neurons, their connections, and critical support structures.
Because of its fundamental role in sustaining and regenerating the body, food is the single greatest tool we have in the fight against Alzheimerâs. As lifestyle physicians and researchers, we cannot overstate the importance of food for brain health: it is by far the most important lifestyle factor. The dietary choices we make every day influence the prevention, delay, or progression of cognitive decline. Our clinical research has shown again and again, with patients of all ages and degrees of neurodegenerative disease, that adhering to a brain-healthy diet results in better cognition. Itâs that simple.
Or is it? We all know we should eat âhealthy.â We know that vegetables are a better choice than cake, that we should avoid sodas and sugary drinks and anything called âfast food.â Most of us know that the steady increase in our consumption of processed foods over the past fifty years has led to an epidemic of obesity, heart disease, and diabetes. But many of us donât understand the direct connection between food and the brain. As we stated in Chapter 1, there is an assumptionâperpetuated by scientists, researchers, and even doctorsâthat the brain is too complex to be influenced by our daily actions, that itâs somehow not part of the physical body. Many of our patients accept that diets heavy in saturated fat contribute to cardiovascular disease. Alcohol consumption poisons the liver. Studies have proven that smoking causes lung cancer. Yet most patients have trouble accepting that the cognitive symptoms theyâre experiencing could be the result of something as simple as food. Clearly articulating the connection between food and brain health is the main goal of this chapter and the personalized plan that follows. As weâll argue in the coming pages, the brain is damaged exponentially by poor nutritional choices, more so than all other bodily systems given how hard it works, how much energy it consumes, and how much waste itâs responsible for clearing. This chapter will prove that cognitive health is intrinsically linked to overall health, and when we fail to nourish our bodies, we also fail to nourish our brains. The inverse is true as well: giving our bodies the right foods protects and strengthens our brains.
Nutrition is unique in that it creates more anxiety and confusion than any other lifestyle factor in the NEURO Plan. With all of the overwhelming and contradictory information about nutrition, it might seem nearly impossible to come up with a plan that you feel confident is contributing to your overall health, let alone your brain health. One website tells you to cut out carbohydrates. Your doctor, in a hurried appointment without much time for questions, says you should eat less meatâbut how much is âlessâ? Then you read a book that says some, but not all carbohydrates, are essential. A good friend tells you that fat is now considered healthy. A magazine article claims that vegetarian diets donât provide all the protein you need. Despite your frustrations and your very busy life, you do the best you can. You adopt a heart-healthy diet. You try to lose weight. You make a concerted effort to eat more vegetables and buy fewer prepackaged foods, and hope that will be enough. If youâre in the midst of this struggle yourself, youâve come to the right place. This chapter offers a clear, science-based approach to brain-healthy eating that has helped our patients prevent and reverse the debilitating symptoms of cognitive decline. Though current research points to an ideal diet for brain healthâa whole-food, plant-based, low-sugar diet with little meat and dairyânumerous studies have also proven that incremental steps toward brain-healthy eating have tremendous benefits. Please keep this important concept in mind as you read. The goal is not necessarily to eat perfectly for the brain but to figure out the best, most sustainable diet for you based on verified research and your unique circumstances.
Evelyn
The unfortunate reality when it comes to nutrition is that few of us are eating in a way that maximizes the health and resilience of our brains. When we encounter patients who know they have a poor dietâfast food, pizza, pastries, prepackaged desserts, and soda, one of the most common offendersâour work is fairly straightforward. These patients accept that their diet has some room for improvement and is likely affecting their health. More often than not, however, we meet people whoâve done their own research on nutrition and have made conscious decisions about what to eat every day. Theyâve read books and articles and consider themselves well informed. They go vegan, Paleo, or gluten-free. They think their diets are healthy, that theyâre making the right nutritional choices for their bodies, and yet theyâre still experiencing cognitive decline and other health issues. In these cases, our work as physicians is twofold: we first need to inform these patients as to why their chosen diet isnât supporting their cognitive health, and then show them how to adopt the dietary patterns that are proven to protect the brain against decline and disease.
Take Evelyn, for instance. She came to see Ayesha after experiencing depression, anxiety, and memory impairment. The memory decline had taken place over a two-year period but had accelerated recently. Evelyn was a sixty-one-year-old attorney whose work required her to travel frequently, meet many new people, and engage in high-energy conversations. She had always been authoritative, in control, and extremely capable. But lately she felt a nagging sense of confusion and exhaustion. She was more irritable than sheâd ever been. She was second-guessing her decisions, tacking notes on her refrigerator so she wouldnât forget meetings and phone calls. She lost her first house key, then her second house key, which she later found in the freezer. Remembering names had always been a source of pride for Evelynâshe knew that learning peopleâs names was one of the most powerful skills in business. But in the past few months sheâd forgotten the names of two important clients. Then there was a big presentation she gave to a group of colleagues from London. She prepared diligently, as she always had. Despite the stress and anxiety she felt, Evelyn knew how to stay both focused and calm. The presentation got off to a great start, but about halfway through she blanked and couldnât find her place. She struggled through her notes and, after a very tense minute, regained her composure. A few minutes later it happened again: a total blank. Evelyn had never experien...