One of the most challenging aspects of my practice is trying to help people recover lost brain function: even when they know they have a problem, and want help for the problem, the path of relief is not straightforward. Intelligent people are particularly adept at creating coping techniques and strategies to compensate for a decline in mental function, so it is often not noticed or addressed until cognitive decline is significant. Additionally, the first signs of a disease like Alzheimer's often include depression or other emotional changes, rendering a person unmotivated or outright resistant to changes that might be helpful. I have great confidence in the cognitive recovery program outlined by Dr. Dale Bredesen and discussed on this website here and here, but I am stymied by the difficulty in achieving full cooperation of a patient who already has cognitive decline. Although I love the freedom of my solo medical practice, it is for these patients that I wish I worked in a large clinic, with medical assistants, nutritionists, and life coaches to involve in patient care.
Which is all a very long (and confessional!) introduction to my main point: if you have any family history of dementia, or if you have any worry or dread about dementia (okay, that's now everyone), your best protection against developing dementia later in life is to start preventing it today. Research is currently thriving in both the treatment (too late!) and the prevention (glad to hear it) of Alzheimer's Disease and other dementias. A recent study, described here, specifically associates levels of an important brain substance, brain-derived neurotrophic factor (BDNF) and the prevention of mental decline. Although the relationship is strongest among individuals with Alzheimer's Disease, the correlation held as well for other forms of cognitive decline. The researchers studied elderly people from about 80 years of age until their death, and made their evaluation of brain proteins at autopsy. Cognitive function was evaluated repeatedly through the last years of the elders' lives. It turns out, that the higher their levels of BDNF, the stronger stayed their mental abilities, even if their brain showed the plaques and tangles of Alzheimers. (We have long known that it is not just the presence of these changes that confers disability. The tanges are hazards, but more crucial is the interaction of the tangles with the rest of the brain's vitality.)
So how to get higher levels of BDNF is the next question! An excellent resource on this topic is Dr. David Perlmutter, who describes another BDNF related study here, in which BDNF levels were measured in living persons. Those with the highest levels of BDNF developed memory problems at 50% the rate of those with lower BDNF levels. Perlmutter writes extensively in his books, Grain Brain and Brain Maker, as well as on his website about ways to boost brain health and specifically by raising BDNF levels. The steps to take mirror what you will read elsewhere on my site, as linked above, but let's repeat them now since we're here! There is research to suggest the effectiveness of each intervention in boosting BDNF levels.
- Exercise, specifically aerobic exercise! 20-30 minuts a day of slightly challenging consistent exercise is best.
- Take a high quality fish oil supplement with plenty of DHA. My current favorite is Barlean's, the key lime flavor!
- Spend time out in the sunshine.
- Restrict calories: about a 30% reduction seems to help increase memory function. Easiest achieved with a low-carbohydrate (high fat) diet and intermittent fasting: extend your overnight fast to include the next morning, twice a week.
- Take the low carb approach farther and follow a ketogenic diet.
- Eat a LOT of turmeric, or better yet, take a high quality curcumin supplement. The one I take is Integrative Therapeutic's Theracurmin.
While other factors may not have been researched in the arena of BDNF, you will also benefit from getting enough regular, un-medicated sleep, challenging your brain with interactive websites or learning a new language, or ....what else?, and maintaining an optimal level of vitamin D. Keep inflammation levels low: to Dr. Perlmutter this means avoiding grains altogether, but at the very least gluten should go, as well as any foods you know you react to with any allergic symptoms. Keep your immune system healthy by avoiding environmental toxins (such as antibiotics in conventional meat) and filtering the microbiome-killing chlorine out of your water. Probiotic-rich fermented foods or convenient supplements can help restore your microbiome, so long as you eat some foods (lots of vegetables) with the right kind of fiber residue to feed the probiotics.
And since we know that "everything is related," it's also true that adopting these lifestyle suggestion, you lower your risk of many other chronic illnesses.
In closing, I would encourage you to take your mental abilities seriously. Ask yourself quite specifically if you are having particular difficulty remembering recent events, finding familiar or new locations, or following complex conversations or movie plots. If the answer is yes, please ask for help: you will also have difficulty following these suggestions. If the answer is no, great! Start now with as many of the suggestions as possible: your future brain and your future doctor will both appreciate the care you have taken to keep a healthy brain!