The MIND

For Prevention of Cognitive Decline

Sarah Lopes, dietetic intern Any ideas?

Can you name some foods you think may be “brain-healthy” foods?

Can you name some foods you think may be on the list to avoid?

Have you read about this topic in the news? Background on Alzheimer’s disease

Alzheimer's is a type of which impairs or alters memory, thinking and behavior. This is a progressive disease, meaning that symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily life. The most common early symptom of Alzheimer's is difficulty remembering newly learned information.

Approximately five million Americans are affected by Alzheimer’s disease. Alzheimer's is the sixth leading cause of death in the United States. Those with Alzheimer's live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.

Current treatments for Alzheimer's cannot stop the disease progression, but they can temporarily slow the worsening of dementia symptoms. The MIND diet was developed using the available research on and brain health to prevent or delay onset of symptoms. What is the MIND diet?

Mediterranean-DASH Diet Intervention for Neurodegenerative Delay

Essentially combines the and the DASH (dietary approaches to stop hypertension) diet with some additional specifications based on available research. The Mediterranean diet

This diet is well-established as a means of reducing risk of heart disease and lowering LDL cholesterol.

A large study which examined the dietary habits of more than 1.5 million healthy adults found that following a Mediterranean diet was associated with a reduced risk of death, whether related to cardiovascular disease or otherwise. This diet is also associated with a reduced incidence of cancer, Parkinson's disease, and Alzheimer's disease. Key components of the Mediterranean diet

Primarily plant-based foods (fruits, vegetables, whole grains, legumes and nuts) Not a low-fat diet, but healthy fats such as are preferred (also canola) Fish is the predominant animal protein Poultry comes second and is grouped together with eggs and strictly limited; less than once a week (“meats & sweets”) Rely on herbs and spices for flavor, not heavy salt Also: ● Regular physical activity is considered part of the “diet” ● Enjoy socially (with family and friends) ● Drink red wine in moderation (optional). Limit of 5 oz per day for women or for men over 65. Limit of 10 oz per day for men under 65. Old USDA

DASH diet

Dietary Approaches to Stop Hypertension. This diet was originally designed to lower blood pressure.

Ranked overall best diet for 7th year in a row by US News & World Report, January 2017. Also ranked best for subcategories diabetes, heart health, and healthy eating. This diet has also been used for weight loss and lowering cholesterol.

The DASH diet is described as a plant-focused diet which is rich in fruits and vegetables. It also incorporates nuts and seeds and mostly whole grains. Protein is supplied by low-fat and non-fat dairy, lean meats, fish, and poultry. It is high in fiber and low to moderate in fat, and fats are heart-healthy. Herbs, spices and other flavorings are encouraged in place of added salt. Added sugars are discouraged.

The Dietary Guidelines for Americans recommend the DASH diet as a model for healthy eating for everyone. Type of food Number of servings Servings on a for 1600 - 3100 2000 Calorie diet Calorie diets

Grains and grain products 6 - 12 7 - 8 (include at least 3 foods each day)

Fruits 4 - 6 4 - 5

Vegetables 4 - 6 4 - 5

Low fat or non fat dairy foods 2 - 4 2 - 3

Lean meats, fish, poultry 1.5 - 2.5 2 or less

Nuts, seeds, and legumes 3 - 6 per week 4 - 5 per week

Fats and sweets 2 - 4 limited DASH diet pyramid Old USDA food pyramid DASH diet pyramid The MIND diet

“The diet is styled after the Mediterranean and DASH diets but with modifications based on the most compelling findings in the diet-dementia field.” The MIND diet

This diet was designed by nutritional epidemiologist Dr. Martha Clare Morris and her research team at Rush University Medical Center to prevent or delay onset of memory loss and difficulties with mental tasks associated with Alzheimer’s disease.

The team followed the food intake of 923 seniors for up to 10 years (average 4.5 years). Diet was assessed using a 154-item food questionnaire. A total of 144 participants developed Alzheimer's disease by the end of this study period. The MIND diet

Outcomes of the Mediterranean diet, DASH diet, and MIND diet were all evaluated, with consideration of the degree of adherence. All three diets, when closely followed, offered significant protection against Alzheimer’s. The Mediterranean diet lowered Alzheimer’s risk by 54%, the MIND diet by 53% and the DASH diet by 39%.

"Modest" adherence to the MIND diet still lowered risk by 35%, whereas the difference in risk was “negligible” for the Mediterranean diet or DASH diet. The MIND diet Certain food components have been directly linked to improved neurological function or reduced Alzheimer’s biomarkers in the brain. According to Dr. Morris, the MIND diet is comprised of foods containing nutrients shown to slow cognitive decline, lower risk of Alzheimer’s, decrease amyloid in the brain or neuron loss in animal studies, or decrease oxidative stress and inflammation.

These nutrients include tocopherol ( E) and the omega-3 fatty acid docosahexaenoic acid (DHA), B- such as folate, and vitamins C and D, all of which have been found in multiple studies to help neurons cope with aging. The MIND diet has 15 dietary components

10 “brain-healthy food groups:”

● Green leafy vegetables ● Other vegetables ● Nuts ● Berries ● Beans ● Whole grains ● Fish ● Poultry ● Olive oil ● Wine Green leafy vegetables

Several prospective studies have linked high consumption of vegetables with slower cognitive decline. More specifically, 2 studies conducted in the United States found that the greatest cognitive protection was associated with intake of at least six weekly servings of green leafy vegetables.

A study conducted at the University of Illinois found that lutein, a pigmented nutrient found in dark-green vegetables, helps to preserve cognitive function and mental sharpness as the brain ages. Other vegetables As mentioned previously, high intake of various vegetables has been associated with slowed cognitive decline in many studies. MIND diet researchers recommend eating at least one vegetable serving in addition to a salad every day. Nuts Nuts are a great source of both healthy fats and antioxidants. In addition of boosting brain health, nuts can also reduce heart disease risk and lower LDL cholosterol.

MIND diet researchers recommend eating nuts at least five times a week. Attention should be paid to portion size, as nuts are a high-calorie food. Berries Rich in antioxidants, berries prevent cellular damage in the brain. Some researchers also assert that compounds in berries alter brain signalling in a way that reduces inflammation and improves motor control.

Blueberries and strawberries in particular are noted for their positive effect on cognitive function. MIND diet researchers recommend eating berries at least twice a week.

Berries are the only fruit specifically recommended in this diet plan. Beans Beans are a source of B-vitamins, which play a role in the development of chemical messengers that transmit signals between nerves.

Beans are also a great source of fiber and a lean protein source.

MIND diet researchers recommend 1 cup of beans every other day Whole Grains At least 3 servings per day are recommended.

Whole grains are a staple source of carbohydrates including . Because they are digested and absorbed more slowly than refined grains, they do not spike blood sugar.

Examples include oatmeal, brown rice, and 100% whole-wheat bread. Whole Grains Consume at least once per week. Servings Fish should be baked or grilled, not fried.

Many studies have reported a link between seafood consumption and reduced cognitive decline. Specifically, omega-3 fats found in fish facilitate better transmission between synapses in the brain and less oxidative stress..

A recent study has associated fish intake with larger brain volumes in areas responsible for memory and cognition in healthy elderly people. Poultry At least 2 servings per week are recommended.

Skinless poultry is an excellent source of lean protein. Chicken in particular is also a source of choline, an essential nutrient similar to the B-vitamin family. Adequate intake of choline was linked in one study to better performance on memory tests. Olive Oil Olive oil should be the primary oil used for cooking. It contains antioxidants, oleic acid (monounsaturated), and linoleic acid (polyunsaturated).

Remember that as a dietary fat, oil is calorically dense. Wine One 5-oz glass of wine per day is recommended. MIND diet developer Martha Clare Morris states that her team did not collect enough data to differentiate between the effects of red or white wine.

In previous studies, moderate wine consumption has been shown to slow cognitive decline with age and lengthen the lives of patients already suffering from Alzheimer’s disease. Specifically, polyphenols found in red wine have shown the potential to delay or protect against dementia. Resveratrol is a polyphenol found in high concentrations in the skin of red grapes. It can also be found in berries and peanuts. The MIND diet has 15 dietary components The five unhealthy food groups: ● Red meats ● and stick ● Cheese ● Pastries and sweets ● Fried or fast food

Total servings from these 5 groups combined should be capped at 3 per week. Red Meat Red meat has higher levels of saturated fat and cholesterol than poultry, seafood, or vegetable proteins, and therefore intake should be limited. Butter or Stick Margarine

Also high in saturated fat, butter and stick margarine should be limited to no more than 1 tablespoon per day.

Olive oil is recommended instead for cooking. Cheese Cheese is generally high in calories, saturated fat, and sodium. Limit to no more than once per week.

A high-fat diet promotes inflammation in the body, including in the arteries, which can increase your chance of stroke. Multiple strokes can lead to a condition known as vascular dementia. Sweets and Pastries Added sugars can spike blood glucose, leading to an array of health problems including damage to blood vessels.

Pastries are not only high in sugar, but also contain trans fats, which raise LDL cholesterol and heart disease risk and lower HDL cholesterol. Fried or Fast Food According to Dr. Morris, the saturated fat in fried food is shown to damage the blood-brain barrier. “When it’s disrupted, it can allow harmful substances to get in and perhaps injure the brain. It can also disrupt the uptake of nutrients that are important for brain function.”

Fried food is also known to increase blood cholesterol levels. A 2014 study demonstrated that individuals with high levels of LDL cholesterol and low levels of HDL cholesterol are more likely to have a build-up of beta-amyloid proteins in their brain.

Limit to no more than once per week. Physiology of Alzheimer’s In terms of what is physically happening inside the brain, the hallmarks of Alzheimer’s disease are beta-amyloid plaques, or accumulations of protein fragments which interfere with passing of signals between nerve cells, and neurofibrillary tangles, which consists of abnormal twisting of fibers within nerve cells. In addition, the brain shrinks.

Some things to keep in mind

-The research on this particular diet is fairly limited

-Some of the prior research used as a basis for formulation of this diet was based on animal models. Animal research does not always translate to human subjects.

-Recommendations or restrictions imposed by your doctor for management of certain health conditions must take priority over this optional diet plan.

-Cheese, which is described here as an unhealthy food, is a source of calcium and protein, and some such as part-skim mozzarella are lower in fat.

-Many foods, such as milk, yogurt, eggs, and fruits other than berries are not discussed.

-If adequate dietary intake becomes an issue, following voluntary restrictions may no longer be appropriate.

-Alterations may be necessary based on allergies or doctor’s recommendations. Thank you for your time!

Any questions? References

Alzheimer’s Association

Bright Focus Foundation

Cleveland Clinic

Mayo Clinic

Morris MC, Tangney CC, Wang Y, et al. MIND Diet Associated with Reduced Incidence of Alzheimer’s Disease Alzheimers Dement. 2015 September ; 11(9): 1007–1014. doi:10.1016/j.jalz.2014.11.009.

Morris MC, Tangney CC, Wang Y, et al. MIND diet slows Cognitive Decline with Aging. Alzheimers Dement. 2015 September ; 11(9): 1015–1022. doi:10.1016/j.jalz.2015.04.011