1. Diet and Your Brain Majid Fotuhi, MD PhD Howard County Library System Ellicott City, MD September 30, 2014

2. New Discoveries 2

3. “This book may be the most important you’ll ever read. Certainly, what Dr. Fotuhi teaches in this book has changed my life.” Michael Roizen, M.D. Chairman of the Wellness Institute- The Cleveland Clinic 3

4. “Dr. Fotuhi has summarized the latest discoveries that show how we can grow our brains bigger and stronger…” Mehmet Oz, M.D. The Dr. Oz Show 4

5. Objectives  What happens to our brain with aging?  Best Nutrition for a Healthy Brain  How to reverse age-related brain atrophy?  Brain Fitness Program 5

6. Short-term: Hippocampus Long-term: Cortex Cortex Hippocampus 6

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8. Beautiful Neurons in Hippocampus 8

9. With Aging, Hippocampus Atrophies Faster than the Rest of the Brain  Hippocampus shrinks by about 0.5% per year after age 50  That is the reason memory lapses become more frequent after age 50 9

10. What Causes Atrophy in Hippocampus? Obesity Stroke Sleep Apnea Concussion Alzheimer’s Diabetes Hypertension Stress 10

11. Alzheimer’s: Plaques and Tangles  Plaques: gum-like collection of a protein called Amyloid  Tangles: abnormal aggregation of a protein called Tau  Inflammation 11

12. Brain is a Highly Vascular Organ Zlokovic et al. Neurosurgery 43(4), 877–78, 1998 12

13. Obesity Shrinks the Brain  Associated with reduced brain volume Ward, et al., 2005  Slows cognitive function Debette, et al., 2011  Brains of overweight and obese individuals appeared 8 and 16 years older, respectively Raji, et al., 2010 13 Brain Research Volume 1280, 14 July 2009, Pages 186–194

14. Multiple Vascular Risk Factors Shrink the Brain, Especially the Hippocampus Multiple Vascular Risk Factors No Vascular Risk Factors Hippocampus 14

15. Stress Shrinks Brain Cells in Hippocampus Stress Control 15

16. Depression Shrinks the Brain  The number of days of depression is associated with the severity of hippocampal atrophy Sheline, et al, (1996). PNAS, 93(9);3908-13.  Depression is associated with impaired memory, executive function and processing speed Egger et al, (2008). Psychiatry Research: Neuroimaging; 164(3): 237-44) Sheline, (1996). PNAS, 93(9);3908-13. 16

17. Why do we forget names?  Hypertension  Diabetes  Alcoholism  Depression  Heart failure  Obesity  High cholesterol  Head trauma  Aging  Poor sleep  Too much work  Information overload  Too many responsibilities  Fatigue  Poor attention  Poor diet  “Can’t do it” mentality 17

18. 18 Diabetes Hypertension Obesity Sleep Apnea Head Trauma Genes Stress Brain-healthy Diet Physical Fitness Cognitive Stimulation Meditation

19. Objectives  What happens to our brain with aging?  Best Nutrition for a Healthy Brain  How to reverse age-related brain atrophy?  Brain Fitness Program 19

20. Obesity Shrinks the Brain  Associated with reduced brain volume Ward, et al., 2005  Slows cognitive function Debette, et al., 2011  Brains of overweight and obese individuals appeared 8 and 16 years older, respectively Raji, et al., 2010 20 Brain Research Volume 1280, 14 July 2009, Pages 186–194

21. Step Away From the Sugar  Increases insulin resistance  Slows cognitive performance  Reduces hippocampal BDNF levels Agrawal & Gomez-Pinilla, 2012. 21 Neurology. 2005 May 24;64(10):1704-11.

22. Trash Trans Fats  Trans fats typical found in foods such as: - Cookies, crackers, muffins, donuts - Fried foods like French fries, chicken nuggets - Chips and other snack foods  Increase the risk of cardiovascular disease -Increases LDL (bad cholesterol) -Decreases HDL (good cholesterol)  Linked with brain shrinkage Agrawal & Gomez-Pinilla, 2012 22 Image source: Bantransfats.com

23. Alcohol Shrinks the Brain  Alcoholics shows significant brain atrophy Jacobson, 1986. Mann, et al., 1992.  Heavy drinking is associated with learning and memory problems Nixon, et al., 1995.  Women appear to be more susceptible to damage Hommer, et al., 2003. 23 Image source: Lisabauman.blogspot.com

24. Three Types of Food for Reversing Brain Atrophy with Age 1.Increasing levels of a healing protein: BDNF - BDNF helps with growth of new brain cells 2.Reducing levels of toxic amyloid in the brain - Too much amyloid kills brain cells 3.Increasing blood flow in the brain - Reducing risk of stroke is the best way to keep your brain young 24

25. More BDNF: Bigger Hippocampus 25 Erikson, PNAS 2011

26. Food That Increase BDNF Levels  Omega-3 Fatty Acids: DHA and EPA  Vitamin D Rich Foods  Cocoa  Blue Berries  Grapes  Caffeine 26

27. More DHA-EPA: Bigger Hippocampus 27 Pottala J V et al. Neurology 2014;82:435-442

28. Omega-3 Fatty Acids: DHA 28

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30. Good Sources of DHA: 30

31. Foods That Reduce Levels of Amyloid in the Brain  Curcumin  Walnuts  Pomegranates 31

32. Foods That Increase Blood Flow to the Brain  Tomatoes  Avocados  Beets  Vitamin B12 32 Image source: Good housekeeping.com

33. Vitamin B12  Improves blood flow to the brain  Low levels are linked to smaller size of hippocampus  Increases cognitive function and processing speed  Reduces risk of inflammation, stroke and heart attack Ho, et al., 2011.; den Heijer, et al., 2003.; Firbank, et al., 2010. 33

34. Mediterranean Diet 34

35. The MIND Diet: Mediterranean + Low Salt Makes Your Brain 7 ½ years Younger  Berries  Nuts  Apples  > 3 servings of bean  Olive Oil  1-2 servings of fish/week  Low in trans-fats  Junk food (zero)  <4 servings of meat/week  Low in cheese and butter Presentation by Martha Claire Morris, Alzheimer’s conference, Denmark 2014 35

36. Physical Activity and Mediterranean Diet, More Effective Together Scarmeas et al., JAMA 302 (6):627–37, 2009 Scarmeas et al, 2009 36

37. Objectives  What happens to our brain with aging?  Best Nutrition for a Healthy Brain  How to reverse age-related brain atrophy?  Brain Fitness Program 37

38. 6 Steps to Grow Your Brain 1. Get Fit 2. Tease Your Memory 3. MIND diet 4. Sleep Well 5. Focus Your Mind 6. Start Today 38

39. 1. Get Fit: Hippocampus Grows Bigger with Exercise Erikson, PNAS 2011 39

40. Draganski et al. J Neurosci 2006; 26:6314–7 2. Tease Your Memory: Hippocampus Grows Bigger with Memorization Training 40

41. 3. MIND Diet 41

42. 42 4. Sleep Well: Hippocampus Grows Bigger with Treatment of Sleep Apnea Canesa, American Journal of Respiratory Medicine, 2011

43. 5. Focus Your Mind: Hippocampus Grows Bigger with Meditation Holzel, Psychiatric Research, 2011 43

44. 44 6. Start Today : Hippocampus Grows Bigger When You Start Early

45. Objectives  What happens to our brain with aging?  Best Nutrition for a Healthy Brain  How to reverse age-related brain atrophy?  Brain Fitness Program 45

46. Brain Fitness Program Goals Short Term  Think faster  Remember more  Improve efficiency of problem solving  Sharpen focus  React quicker  Enhance self esteem  Brighten mood Long Term  Help to regrow brain cells in hippocampus  Establish a brain healthy lifestyle change that results in lifelong benefits  Reduce risk of dementia in late-life 46

47. BFP: Evaluating &Treating All Causes of Cognitive Impairment in Elderly 47 Medicine Neurology Psychology

48. Improvement in Memory 49

49. Remarkable Results 50 Hippocampus After Before

50. Sustained Benefits 51 Hippocampus Volume (cm 3 ) 8.6% increase in HC volume = brain that is approx. 16 years younger

51. 51 Diabetes Hypertension Obesity Sleep Apnea Head Trauma Genes Stress MIND Diet Physical Fitness Cognitive Stimulation Meditation