1. Proactive Aging: Food and Lifestyle Choices Majid Fotuhi, MD PhD

2. New Discoveries 2

3. Objectives  Why does the brain shrink with aging?  Which foods increase or decrease age-related brain atrophy?  What else can be done: Brain Fitness Program 3

4. Objectives  Why does the brain shrink with aging?  Which foods increase or decrease age-related brain atrophy?  What else can be done: Brain Fitness Program 4

5. Memory Lapses Memory Lapses or Alzheimer’s? Age-Associated Memory Impairment MCI Alzheimer’s 5

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

7. 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 7

8. Overlapping Causes of Brain Atrophy with Aging Obesity Diabetes Stroke Sleep Apnea Concussion Alzheimer’s Inflammation Stress 8

9. Less Brain Volume in Patients with Sleep Apnea Am J Respir Crit Care Med 2002; 166:1382–7 9

10. Multiple Vascular Risk Factors: Worse Brain Atrophy Multiple Vascular Risk Factors No Vascular Risk Factors Hippocampus 10

11. Stress Shrinks Brain Cells in Hippocampus Stress Control 11

12. Alzheimer’s: Plaques and Tangles  Plaques: gum-like collection of a protein called Amyloid  Tangles: abnormal aggregation of a protein called Tau  Inflammation 12

13. 13 Diabetes Hypertension Obesity Sleep Apnea Head Trauma Genes Stress Brain-healthy Diet Physical Fitness Cognitive Stimulation Meditation

14. Objectives  Why does the brain shrink with aging?  Which foods increase or decrease age-related brain atrophy?  What else can be done: Brain Fitness Program 14

15. 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 15 Brain Research Volume 1280, 14 July 2009, Pages 186–194

16. Step Away From the Sugar  Increases insulin resistance  Slows cognitive performance  Reduces hippocampal BDNF levels Agrawal & Gomez-Pinilla, 2012. 16 Neurology. 2005 May 24;64(10):1704-11.

17. Trash Trans Fats  Trans fats typical found in foods such as: - Cookies, crackers, muffins, donuts - Fried foods like French fires, 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 17 Image source: Bantransfats.com

18. 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. 18 Image source: Lisabauman.blogspot.com

19. 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 19

20. More BDNF: Bigger Hippocampus 20 Erikson, PNAS 2011

21. Food That Increase BDNF Levels  Omega-3 Fatty Acids: DHA and EPA  Vitamin D Rich Foods  Cocoa  Blue Berries  Grapes  Caffeine 21

22. More DHA-EPA: Bigger Hippocampus 22 Pottala J V et al. Neurology 2014;82:435-442

23. Good sources of DHA: 23

24. Vitamin D  Associated with increases in BDNF  Low levels are linked to fatigue, cognitive deficits, and poor mood  Good sources include: - Sunlight - Milk, yogurt, & cheese - Salmon (especially wild-caught) and Mackerel - Fortified cereals - Mushrooms - Egg yolks Llewellyn, et al., 2010.; Wilkins, et al., 2006. 24

25. Cocoa  Increases BDNF levels  Improves blood flow  Prevents inflammation  Enhances memory, learning and cognitive function  Can help to prevent heart disease, high blood pressure, stroke and dementia  One ounce a day (more is not better) Spencer, 2009., Fisher et al., 2006., Reid et al.,2012 Crimini et al., 2013 25 Image source: Healthyfoodstar.com and Huffintopost.com

26. Blueberries  Strongly increases BDNF in the hippocampus  Enhances memory and motor performance  Good source of vitamins A,C and K Rendeiro, et al., 2009. 26 Image source: Huffingtonpost.com

27. Grapes  Increases BDNF  Excellent source of Resveratrol  Increases blood flow to the brain  Reduces the risk of heart attack  Darker the grape- the better Rahvar, et al., 2011. Marques, et al., 2009. 27 Image source: en.wickipedia.com

28. Wine  Source of resveratrol  Moderation is key!  Recommendations: - Women- 1 drink / day - Men- 2 drinks / day  Memory problems?— Avoid alcohol completely! Gómez-Pinilla, et al., 2008. 28 Image source: Scooppost.com

29. Coffee  Increases BDNF levels in the hippocampus  Increases attention and concentration  Increases cerebral glucose uptake  One cup a day; more is not better Moy & McNay, 2013.; Cao, et al., 2009. 29 Image source: bubblews.com

30. Food That Reduce Levels of Amyloid in the Brain  Curcumin  Walnuts  Pomegranates 30

31. Curcumin  Yellow spice commonly found in Indian foods  Reduces levels of amyloid in the brain  Reduces inflammation  Improves memory  Absorption is a problem; more research is needed Gómez-Pinilla, et al., 2008. 31 Image source: Dnndesigner.com

32. Walnuts  Reduces amyloid toxicity in the brain  Enriched with beneficial fatty acids, vitamins and polyphenols  Associated with a lower incidence of neurodegenerative disease Gómez-Pinilla, et al., 2008. 32 Image source: Ironmagazine.com

33. Pomegranates  Reduces amyloid plaques in the hippocampus  Antioxidant rich  Good source of vitamins C and K Gómez-Pinilla, et al., 2008. 33 Image source: Pomegranates.org

34. Food That Increase Blood Flow to the Brain  Tomatoes  Avocados  Beets  Vitamin B12 34 Image source: Good housekeeping.com

35. Tomatoes  Increases blood flow to the brain  Source of vitamins A, B6, and K  Reduces inflammation  Contains lycopene which prevents platelet aggregation Gómez-Pinilla, et al., 2008. 35 Image source: Thesleuthjournal.com

36. Avocado  Increases blood flow  Excellent source of Vitamin B, C and E  Reduces risk of diabetes and stroke 36 Fulgoni et al., 2013 Image source: Huffingtonpost.com

37. Beets  Increase blood flow to heart and the brain  The benefits of beets include: - Lowers blood pressure - Reduces inflammation - High in fiber and low in calories - Helps with weight loss - Improves “running performance” (more blood flow to muscles) 37 J Acad Nutr Diet. 2012 Apr;112(4):548-52. doi: 10.1016/j.jand.2011.12.002.

38. 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. 38

39. Best Brain Diet  Low Carb - No white rice - No white bread - Just a touch of cakes  High protein - 1-2 lean meats / week - 1-2 salmon / week  Lots of fruits and vegetables  Plenty of water  DHA supplements 39

40. Physical Activity and Mediterranean Diet, More Effective Together Scarmeas et al., JAMA 302 (6):627–37, 2009 Scarmeas et al, 2009 40

41. Objectives  Why does the brain shrink with aging?  Which foods can increase or reduce age-related brain atrophy?  What else can be done: Brain Fitness Program 41

42. Comprehensive Diagnostics to Evaluate Brain Health Customized Treatment Program to Maximize Brain Performance NeurExpand’s Unique Integrative Approach 42

43. Remarkable Results Hippocampus After Before 43

44. Overlapping Causes of Brain Atrophy with Aging Obesity Diabetes Stroke Sleep Apnea Concussion Alzheimer’s Inflammation Stress 44

45. 45 Diabetes Hypertension Obesity Sleep Apnea Head Trauma Genes Stress Brain-healthy Diet Physical Fitness Cognitive Stimulation Meditation

46. THANK YOU! INFO@NEUREXPAND.COM 46