Monday, May 14, 2018

The links between yoga, breath-focused meditation and brain health

If you have practiced yoga and learned about ‘pranayama’ , or breathing to regulate the life force, or if you have practiced meditation with a focus on following your breath, you may be intrigued by the findings of a new study from Trinity College in Dublin, Ireland.  Even if you have never tried yoga or meditation this study may impel you to find your own version of intentional breathing to help you focus and relax.  

The new study, published in the journal Psychophysiology, explains for the first time some of the links between breathing and attention. Breath-focused meditation and yogic breathing practices have long been known to have cognitive benefits, including increased ability to focus, decreased mind wandering, and more positive emotions. To date, however, no direct neurophysiological link between respiration and cognition has been suggested.

The new research shows that breathing -- a key element of meditation and mindfulness practices -- directly affects the levels of a natural chemical messenger in the brain called noradrenaline. This chemical messenger is released when we are challenged, curious, exercised, focused or emotionally aroused, and, if produced at the right levels, helps the brain grow new connections. The way we breathe, in other words, directly affects the chemistry of our brains in a way that can enhance our attention and improve our brain health.
The study, carried out by researchers at Trinity College Institute of Neuroscience and the Global Brain Health Institute at Trinity, found that participants who focused well while undertaking a task that demanded a lot of attention had greater synchronization between their breathing patterns and their attention, than those who had poor focus. The authors believe that it may be possible to use breath-control practices to stabilize attention and boost brain health.
Michael Melnychuk, PhD candidate at the Trinity College Institute of Neuroscience, Trinity, and lead author of the study, explained: "Practitioners of yoga have claimed for some 2,500 years, that respiration influences the mind. In our study we looked for a neurophysiological link that could help explain these claims by measuring breathing, reaction time, and brain activity in a small area in the brainstem called the locus coeruleus, where noradrenaline is made. Noradrenaline is an all-purpose action system in the brain. When we are stressed we produce too much noradrenaline and we can't focus. When we feel sluggish, we produce too little and again, we can't focus. There is a sweet spot of noradrenaline in which our emotions, thinking and memory are much clearer."
"This study has shown that as you breathe in locus coeruleus activity is increasing slightly, and as you breathe out it decreases. Put simply this means that our attention is influenced by our breath and that it rises and falls with the cycle of respiration. It is possible that by focusing on and regulating your breathing you can optimize your attention level and likewise, by focusing on your attention level, your breathing becomes more synchronized."
The research provides deeper scientific understanding of the neurophysiological mechanisms which underlie ancient meditation practices. Further research could help with the development of non-pharmacological therapies for people with conditions such as ADHD and traumatic brain injury and in supporting cognition in older people.
According to the authors of this study, there are traditionally two types of breath-focused practices -- those that emphasize focus on breathing (mindfulness), and those that require breathing to be controlled (deep breathing practices such as pranayama). In cases when a person's attention is compromised, practices that emphasize concentration and focus, such as mindfulness, could possibly be most beneficial. In cases where a person's level of arousal is the cause of poor attention, for example drowsiness while driving, a pounding heart during an exam, or during a panic attack, it should be possible to alter the level of arousal in the body by controlling breathing. Both of these techniques have been shown to be effective in both the short and the long term.
Ian Robertson, Co-Director of the Global Brain Health Institute at Trinity and Principal Investigator of the study added: "Yogis and Buddhist practitioners have long considered the breath an especially suitable object for meditation. It is believed that by observing the breath, and regulating it in precise ways -- a practice known as pranayama -- changes in arousal, attention, and emotional control that can be of great benefit to the meditator are realized. Our research finds that there is evidence to support the view that there is a strong connection between breath-centered practices and a steadiness of mind."
"Our findings could have particular implications for research into brain ageing. Brains typically lose mass as they age, but less so in the brains of long term meditators. More 'youthful' brains have a reduced risk of dementia and mindfulness meditation techniques actually strengthen brain networks. Our research offers one possible reason for this -- using our breath to control one of the brain's natural chemical messengers, noradrenaline, which in the right 'dose' helps the brain grow new connections between cells. This study provides one more reason for everyone to boost the health of their brain using a whole range of activities ranging from aerobic exercise to mindfulness meditation."
Journal Reference:
Michael Christopher Melnychuk, Paul M. Dockree, Redmond G. O'Connell, Peter R. Murphy, Joshua H. Balsters, Ian H. Robertson. Coupling of respiration and attention via the locus coeruleus: Effects of meditation and pranayamaPsychophysiology, 2018; e13091 DOI: 10.1111/psyp.13091

 Sadja Greenwood, MD, MPH   Past issues on this blog. Feel free to leave me a message.

Monday, May 7, 2018

How Five Habits Can Make a Huge Difference

According to a new study led by the Harvard T.H. Chan School of Public Health, five healthy habits maintained during adulthood may add more than a decade to your life expectancy.  The bad news - Americans have a shorter average life expectancy — 79.3 years — than almost all other high-income countries. The U.S. ranked 31st in the world for life expectancy in 2015. This is disgraceful. It is probably due to our income inequality, racism, and lack of universal health care.  The good news – you can make a big difference in your health and life expectancy by consistently doing the things you already know are important. 

The new study, published in the journal Circulation, aimed to quantify how much healthy lifestyle factors might be able to boost longevity in the U.S.  Data came from Harvard Chan researchers and colleagues looking at 34 years of data from 78,865 women and 27 years of data from 44,354 men participating in, respectively, the Nurses’ Health Study and the Health Professionals Follow-up Study. The researchers looked at how five low-risk lifestyle factors might impact mortality:
1. not smoking
2. keeping a low body mass index (18.5-24.9 kg/m2)
3. doing at least 30 minutes or more per day of moderate to vigorous physical activity
4. having a moderate alcohol intake (for example, up to about one 5-ounce glass of wine per day for women, or up to two glasses for men) 
5. keeping a healthy diet.

Women and men who checked all five boxes had an average life expectancy that was 14 years and 12 years longer than the life expectancy of people with none of those healthy habits. And the researchers found a dose-response relationship, meaning that for each healthy habit a person adopted, life expectancy increased.   As you can see – these are very large numbers.

Researchers also found that American women and men who maintained the healthiest lifestyles were 82 percent less likely to die from cardiovascular disease and 65 percent less likely to die from cancer when compared with those with the least healthy lifestyles over the course of the roughly 30-year study period. For study participants who didn’t adopt any of the low-risk habits, the researchers estimated that life expectancy at age 50 was 29 years for women and 25.5 years for men. But for those who adopted all five, life expectancy at age 50 was projected to be 43.1 years for women and 37.6 years for men. In other words, women who maintained all five healthy habits gained, on average, 14 years of life, and men who did so gained 12 years, compared with those who didn’t maintain healthy habits.

Compared with those who didn’t follow any of the healthy lifestyle habits, those who followed all five were 74 percent less likely to die during the study period. The researchers also found that there was a dose-response relationship between each individual healthy lifestyle behavior and a reduced risk of early death, and that the combination of all five healthy behaviors was linked to the most additional years of life.

“This study underscores the importance of following healthy lifestyle habits for improving longevity in the U.S. population,” said Frank Hu, chair of the Department of Nutritionat Harvard Chan School and senior author of the study. “However, adherence to healthy lifestyle habits is very low. Therefore, public policies should put more emphasis on creating healthy food, built, and social environments to support and promote healthy diet and lifestyles.”
Other Harvard Chan School study authors included Yanping Li, Dong Wang, Xiaoran Liu, Klodian Dhana, Meir Stampfer, and Walter Willett.

Let’s look at the healthy habits realistically.  They are sensible and well known, but not easy for many people. 
1. Quitting smoking can be hard and should be done early in life.  Vaping is not the answer as it has its own hazards, including nicotine dependency and toxins in the vaping liquid.  For help to quit smoking the Centers for Disease Control has a good website and a line to call for advice – 800 784 8669.  Your primary care provider should also be a good source of help.

 2. Find your body mass index at your doctor’s office or at
 Achieving a healthy weight may be difficult if you are overweight and have tried dieting without success. Some plans being advertised on TV are quite costly.  Weight Watchers is considered one of the most effective because of its healthy diet and group support.  The book The Ultimate Volumetrics Dietby Barbara Rolls at Pennsylvania State University provides a healthy diet that works with minimal hunger.  Visit the National Weight Control Registry to read about over 10,000 people who have successfully lost weight and kept it off, and find out about their techniques. 

3. Doing 30 minutes or more per day of moderate to vigorous physical activity may be hard for sedentary people.  Check with your primary care provider first.  Find friends to go on regular walks with you, join a gym that is friendly and has trainers to give sound advice, exercise to stimulating music that you love (for me its Cajun and Zydeco).  Plan ways to put the half hour  into your day – breaking into 2x15 or 3x10 is OK. Wear a ‘Fitbit’ or similar device if that helps you.  Do chair exercises in a class or in front of television if standing is too difficult.

4. Having a moderate alcohol intake can be hard for regular drinkers.  Much of our social life centers around alcohol – people who drink enjoy the taste of wines, beer and whiskey/gin/ rum and also like the feelings of relaxation and the ‘buzz’. At social gatherings it is easy to exceed a one drink level for women and two drinks for men. You should be extra careful if you are taking medications that do not mix well with alcohol or have a condition, such as high blood pressure, that is worsened by drinking.  Do not drink if you are going to drive a car or operate any machinery.  Do not drink if you are pregnant, or planning to become pregnant.  For many good ideas about moderating your alcohol use, go to the NIH website ‘Rethinking Drinking’.

5. Keeping a healthy diet is the fifth habit that will help you.  On this website, go to the upper left corner and type in ‘The Mind Diet’.  You will find a detailed description of what healthy foods to eat, and which others to avoid.  People who don’t use the internet can look at The Ultimate Volumetric Diet by Barbara Rolls or the Mind Diet Cookbook by Kristin Diversi.

Sadja Greenwood MD, MPH
Leave me a comment or a question 

Wednesday, May 2, 2018

Chocolate Lovers – Read On!

New research from Loma Linda University indicates that there are possible health benefits to eating certain types of dark chocolate. The studies were recently presented at the 2018 Experimental Biology meeting in San Diego; they showed that consuming dark chocolate that has a high concentration of cacao (minimally 70% cacao) has positive effects on stress levels, inflammation, mood, memory and immunity. While it is well known that cacao is a major source of flavonoids, this is the first time the effect has been studied in human subjects to determine how it can support cognitive, endocrine and cardiovascular health.  (Flavonoids are a diverse group plant chemicals found in fruits and vegetables. Along with carotenoids, they are responsible for the vivid colors in these foods. Flavonoids are antioxidants with anti-inflammatory and immune system benefits.)
Lee S. Berk, DrPH, associate dean of research affairs, School of Allied Health Professions and a researcher in psychoneuroimmunology and food science from Loma Linda University, served as principal investigator on both studies. "For years, we have looked at the influence of dark chocolate on neurological functions from the standpoint of sugar content -- the more sugar, the happier we are," Berk said. "This is the first time that we have looked at the impact of large amounts of cacao in doses as small as a regular-sized chocolate bar in humans over short or long periods of time, and are encouraged by the findings. These studies show us that the higher the concentration of cacao, the more positive the impact on cognition, memory, mood, immunity and other beneficial effects."  
Here are the results presented during the Experimental Biology meeting:
Dark Chocolate (70% Cacao) Affects Human Gene Expression: Cacao Regulates Cellular Immune Response, Neural Signaling, and Sensory Perception
This pilot feasibility experimental trial examined the impact of 70 percent cacao chocolate consumption on human immune and dendritic cell gene expression, with focus on pro- and anti-inflammatory cytokines. Study findings show cacao consumption up-regulates multiple intracellular signaling pathways involved in T-cell activation, cellular immune response and genes involved in neural signaling and sensory perception -- the latter potentially associated with the phenomena of brain hyperplasticity.  (Greenwood’s explanation - Neuroplasticity is the brain's innate ability to adapt to training and learn new skills - from foreign languages to math, and, for an athlete, physical movement and strength. By stimulating the motor cortex during athletic training, the brain enters into a state of heightened plasticity known as "hyperplasticity," during which the brain adapts to training most effectively.)

Dark Chocolate (70% Organic Cacao) Increases Acute and Chronic EEG Power Spectral Density (μv2) Response of Gamma Frequency (25-40Hz) for Brain Health: Enhancement of Neuroplasticity, Neural Synchrony, Cognitive Processing, Learning, Memory, Recall, and Mindfulness Meditation
This study assessed the electroencephalography (EEG) response to consuming 48 g of dark chocolate (70% cacao) after an acute period of time (30 mins) and after a chronic period of time (120 mins), on modulating brain frequencies 0-40Hz, specifically beneficial gamma frequency (25-40Hz). Findings show that this superfood of 70 percent cacao enhances neuroplasticity for behavioral and brain health benefits.
(Greenwood – Many chocolate bars with 70% cacao contain about 48g in half a bar. Read the label carefully.  An Endangered Species bar with 72% cacao has 43g, 210 calories and 12 g of sugar in half a bar. Lily’s 70% cacao bars are sweetened with stevia – available at some specialty stores and on the internet. )
Berk said the studies require further investigation, specifically to determine the significance of these effects for immune cells and the brain in larger study populations. Further research is in progress to elaborate on the mechanisms that may be involved in the cause-and-effect brain-behavior relationship with cacao at this high concentration.

Take home message from these studies – while chocolate is a delicious treat with valuable properties for health, it often comes with too much added sugar.  If you eat part of a 70% cacao bar regularly, avoid other sources of sugar and satisfy your sweet cravings with multicolored fruits.   If you have an elevated blood sugar, go for the Lily’s brand and follow the dietary advice of your health care provider.
Sadja Greenwood, MD. MPH   back issues on this blog

Wednesday, April 25, 2018

Gun Violence and School Shootings

If you think you are hearing more about gun violence and school shootings, you are right. According to our Bolinas Assemblyman, Marc Levine, every day in the U.S. almost 300 people are shot in murders, assaults, suicides, suicide attempts and unintentional shootings, and almost 90 people die as a result of gun violence. According to a new study from Clemson University in South Carolina, more people have died or been injured in mass school shootings in the US in the past 18 years than in the entire 20th century. This finding was published in the Journal of Child and Family Studies.

The recent killing of 17 people at Marjory Stoneman Douglas High School in Florida is not an isolated occurrence, but part of a deadly epidemic that needs to be addressed. During the 20th century, mass school shootings killed 55 people and injured 260 others at schools especially in America's Western region. Most of the 25 shooters involved were white males who acted alone, and only nine were diagnosed as suffering from mental illnesses at the time. Sixty percent of shooters were between 11 and 18 years old.  

Since the start of the 21st century there have already been 13 incidents involving lone shooters; they have killed 66 people and injured 81 others. In less than 18 years, we have already seen more deaths related to school shootings than in the whole 20th century. One alarming trend is that the overwhelming majority of 21st-century shooters were adolescents, suggesting that it is now easier for them to access guns, and that they more frequently suffer from mental health issues or have limited conflict resolution skills.
The authors explain that such violence can be mitigated through deliberate and sensible policy and legislative actions. These include expanded background checks of potential gun owners, and a ban on assault weapons. Mental health issues among adolescent students and adults should also be addressed more thoroughly. School personnel should also implement tiered models of support and school-based mental health services to support students' social, emotional, and behavioral well-being in order to prevent school violence.
Preventative efforts not only require policy and legislative action but increased and targeted funding across federal, state, local and private sectors,, according to the authors. 
Our Assemblyman, Marc Levine, our State Senator Mike McGuire, our national Congressman Jared Huffman and California Senators Diane Feinstein and Kamala Harris are all actively in favor of gun control.  You can find their telephone numbers in the Bolinas Hearsay News Local Zone Phone Directory, so ably put together by Jenny Pfeiffer.  You can support the students nationwide who are demonstrating for gun control by working to register voters.  
Here are some national organizations to support with your donations if you are able: The Brady Campaign (honoring Jim Brady, shot and left disabled after an assassination attempt on Romald Reagan), Americans for Responsible Solutions (honoring former Congresswoman Gabby Giffords, who was shot and left disabled while giving a talk in Arizona in 2011), Coalition to Stop Gun Violence ( a group of religious, labor and educational non-profits with thoughtful stands on stopping gun violence), Everytown for Gun Safety (an organization started by former NYC Mayor Michael Bloomberg to counter the strength of the NRA and promote gun violence prevention nationwide).  Please look them up and decide how to give your support.  Any amount will be helpful.
Sadja Greenwood MD, MPH past issues on this blog

Monday, April 9, 2018

Who is Dr. Bennet Omalu?

 You are doubtless aware of the serious unrest occurring in Sacramento following an independent autopsy performed on 22 year old Stephon Clark.  The autopsy showed that Clark, who was in this grandmother’s back yard, carrying a cell phone, was shot eight times in the back by police officers. You may not know the remarkable story and credentials of the man who performed this autopsy, Dr. Bennet Omalu

 Omalu was born in Nigeria in 1968, the 6thof 7 siblings.  He entered school at 3 and went to Medical School at 16.  After doing 3 years of medical service in Nigeria, he became disillusioned with the politics of his country and looked for further training in the U.S. He completed a fellowship in epidemiology at the University of Washington, and then went to work at the Columbia University Harlem Hospital Center in New York, completing residency training in anatomic and clinical pathology.  In Pittsburgh he completed fellowships in pathology and neuropathology, gained a Master of Public Health degree in epidemiology and an MBA at Carnegie Mellon University.   Omalu became the chief medical examiner in San Joaquin County, California from 2007 to 2017. He resigned after accusing the county’s sheriff of repeatedly interfering with death investigations in order to protect police officers who had killed suspects.  Currently he is a Professor at the UC Davis Department of Medical Pathology and Laboratory Medicine. 

Omalu became interested in chronic traumatic encephalopathy  (CTE) after doing an autopsy on the Pittsburgh Steeler Mike Webster in in 2002.  He found ‘tau protein’ in the brain – that affects mood, emotions and executive functions. These findings had previously been seen in boxers.  He published his findings in the journal Neurosurgery in 2005.  The National Football League called unsuccessfully for the article’s retraction. Omalu published similar findings on at least 5 other NFL players who died in their 30’s and 40’s.  He also discovered CTE in the brains of military veterans.   In 2016 the National Football League testified before Congress that they did believe in a link between football and CTE.

A book entitled Concussion, by Jeanne Marie Laskas, was published in 2015. It was made into a riveting movie, Concussion, with Will Smith playing the part of Omalu. Omalu has written several books – his latest is Truth Doesn’t Have a Side: My Alarming Discovery about the Dangers of Contact Sports.  He defines contact sports as football, ice hockey, mixed martial arts, boxing, wrestling and rugby.  Non-contact sports include swimming, tennis, track and field, volleyball, basketball, table tennis and badminton. Soccer is all right if  ‘headers’ are banned.   Steer your children into these.

The name Omalu is a shortened version of the family name Onyemalukwube, which means “He who knows, speaks”.  Dr. Omalu became a U.S. citizen in 2015; fortunately before Trump’s restrictions on nonwhite immigrants.  He received the Distinguished Service Award from the American Medical Association in 2016 – its highest honor.  

The take home messages for readers of this column – Protect your brain and your children’s brains from repeated blows to the head.  Insist that soccer be played without  headers. The brain is what makes you – you. Keep it safe.
Watch the movie Concussion if you haven’t seen it.
Sadja Greenwood, MD, MPH   past issues on this blog

Sunday, April 8, 2018

Phthalates – what are they, and what you can do to avoid them

Phthalates are chemical substances widely used in plastics to increase their flexibility, transparency, and durability.  They are of concern because recent studies have shown that they may affect human health by being endocrine disruptors.  This means that they may affect the fetus during pregnancy, and my also be implicated in reduced fertility, obesity, diabetes, endometriosis and some cancers.  There is concern that the development of the male fetus and male fertility may be especially affected.  
A recent study from the University of California in Berkeley and San Francisco, and George Washington University,found that people who ate out more regularly tended to have significantly higher levels of phthalates in their urine.  Researchers looked at people consuming food from restaurants, cafeterias, fast-food locations, or other dining establishments. They analyzed data on 10,253 people who were 6 years and older that was collected from 2005 to 2014 as part of the National Health and Nutrition Examination Survey (NHANES). This data included phthalate concentrations from their urine samples and the frequency at which they ate out versus at home. Those who regularly ate out had 35% higher phthalate levels than those who did not. This difference was even higher for adolescents: 55%. The culprit didn't seem to be the core ingredients of the food, but possibly something involved in the preparation of the food. For example, the study revealed that eating sandwiches (including cheeseburgers) prepared outside the home was associated with higher urine phthalate levels compared to eating sandwiches prepared at home. Many eating establishments use plastic containers, machine parts, packaging, and other items to handle, process, and store food. Phthalates are chemicals used in many plastic items to help them become more flexible. Therefore, phthalates may be leeching from all of these plastic items into the food that subsequently goes into your mouth.   
Here are some ways to decrease your exposure to plastics, according to the Natural Resources Defense Council . You can’t eliminate all plastic, but you can take some easy steps to reduce your plastic use. Swap plastic food storage containers with glass or stainless steel; if you do keep plastic ones, don’t use them to store fatty foods, and never microwave them. Replace plastic bags with reusable lunch bags, and plastic cling wrap with beeswax-coated cloth. Choose hard wood blocks and cotton baby dolls over plastic ones. In short, anytime you’re in the market for something plastic, research whether safer alternatives exist. Canned foods can make meal prep a breeze, but those cans are likely lined with BPA to keep them from corroding. Even cans labeled “BPA-free” may use a similar chemical that hasn’t been proved any safer. Choosing fresh, frozen, or dried foods (like beans) that aren’t packaged in cans is a smart preventive measure. Aseptic “brick” cartons or glass packaging are both better than cans.  Finally – eat at home!
Sadja Greenwood, MD, MPH

Tuesday, March 6, 2018

The Mind Diet – Rush University Medical Center

Rush University Medical Center dates back to March 2, 1837, when Rush Medical College received its charter. The college is named for Benjamin Rush, a signer of the Declaration of Independence and a Pennsylvania physician, who counted George Washington among his patients. He became a medical and humanitarian leader after the Revolutionary War. He was also a social activist, a prominent advocate for the abolition of slavery, for scientific education for the masses— including women—and for public medical clinics to treat the poor.

The Mind Diet, created by researchers at Rush University Medical Center, may help substantially slow cognitive decline in stroke survivors, according to preliminary research presented on Jan. 25 at the American Stroke Association's International Stroke Conference 2018 in Los Angeles. The findings are significant because stroke survivors are twice as likely to develop dementia compared to the general population.

The MIND diet is short for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay; it is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Both have been found to reduce the risk of cardiovascular conditions such as hypertension, heart attack and stroke.

"The foods that promote brain health, including vegetables, berries, fish and olive oil, are included in the MIND diet," said Dr. Laurel J. Cherian, a vascular neurologist and assistant professor in Rush's Department of Neurological Sciences. "We found that it has the potential to help slow cognitive decline in stroke survivors." Cherian is the lead author of the study, which was funded by the National Institute of Aging. "I was really intrigued by the results of a previous MIND study, which showed that the people who were most highly adherent to the MIND diet cognitively functioned as if they were 7.5 years younger than the least adherent group," Cherian said. "It made me wonder if those findings would hold true for stroke survivors, who are twice as likely to develop dementia compared to the general population." "The Mediterranean and DASH diets have been shown to be protective against coronary artery disease and stroke, but it seems the nutrients emphasized in the MIND diet may be better suited to overall brain health and preserving cognition."  Cherian said that studies have found that folate, vitamin E, omega-3 fatty acids, carotenoids and flavonoids are associated with slower rates of cognitive decline, while substances such as saturated and hydrogenated fats have been associated with dementia. "I like to think of the MIND diet as a way to supercharge the nutritional content of what we eat. The goal is to emphasize foods that will not only lower our risk of heart attacks and stroke, but make our brains as resilient as possible to cognitive decline.”  Cherian cautions, however, that the study was observational, with a relatively small number of participants, and its findings cannot be interpreted in a cause-and-effect relationship.

Study co-author Martha Clare Morris, ScD, a Rush nutritional epidemiologist, and her colleagues developed the MIND diet based on information from years of research about what foods and nutrients have good, and bad, effects on the functioning of the brain. The diet has been associated with reduced Alzheimer's risk in seniors who adhered to its recommendations. Even people who moderately adhered had reduced risk of AD and cognitive decline.

Rush, in Chicago, is currently seeking volunteers to participate in the study, which aims to show whether a specific diet can prevent cognitive decline and brain changes with age. From 2004 to 2017, Cherian and colleagues studied 106 participants of the Rush Memory and Aging Project who had a history of stroke for cognitive decline, including decline in one's ability to think, reason and remember. They assessed people in the study every year until their deaths or the study's conclusion, for an average of 5.9 years, and monitored patients' eating habits using food journals.

The researchers grouped participants into those who were highly adherent to the MIND diet, moderately adherent and least adherent. They also looked at additional factors that are known to affect cognitive performance, including age, gender, education level, participation in cognitively stimulating activities, physical activity, smoking and genetics. The study participants whose diets scored highest on the MIND diet score had substantially slower rate of cognitive decline than those who scored lowest. The estimated effect of the diet remained strong even after taking into account participants' level of education and participation in cognitive and physical activities. In contrast to the results of slower decline with higher MIND diet score, stroke survivors who scored high on the Mediterranean and DASH diets, did not have significant slowing in their cognitive abilities. "This is a preliminary study that will hopefully be confirmed by other studies, including a randomized diet intervention study instroke survivors," say the authors. "For now, I think there is enough information to encourage stroke patients to view food as an important tool to optimize their brain health."

 The MIND diet has 15 dietary components, including 10 "brain-healthy food groups" and five unhealthy groups.
Foods to enjoy include
1) green leafy vegetables – 2 cups raw or one cup cooked, daily.
2) Berries – at least 2 cups a week.  Bananas count as a berry.
3) Vegetables and fruit – at least one serving daily -2 cups raw vegetables or one cup cooked, one cup fresh fruit or ½ cup dried.  An apple equals one cup.
4) Nuts  - almonds, pecans, walnuts et al. 1-2 ounces at least 3 times a week
5) Whole grains – 3 servings a day.  Oats, quinoa, spelt, rye, brown rice, whole grain pasta, buckwheat, 100% whole grain bread.
6) Seafood – at least one serving a week of salmon, sardines, trout or other seafood you enjoy.  4-6 ounces.
7) Beans – a serving every other day – fresh or cooked.  Wash canned beans to eliminate extra salt.  Unsweetened non-dairy milk: soy, almond, cashew or rice milk.
8) Poultry – at least 2 four  ounce servings a week, skin removed.  Poultry provides protein and vitamin B12, iron and zinc, important for cognitive health. 
9) Olive Oil – Use as primary oil for cooking and for salads and cooked vegetables.  Olive oil has many anti-oxidant and anti-inflammatory properties.  Use low to moderate heat when cooking with olive oil.  Grapeseed oil is also good for cooking and can be used at higher heat.
10) Wine – one 5 ounce serving of wine – containing alcohol or not. Wine has micronutrients such as resveratrol that help prevent degenerative diseases.  Red or purple grape juice may have same effects of wine on health – to be verified.

The diet also specifies limiting intake of the designated unhealthy foods
1) Red meat – beef, lamb, pork and duck – limit intake to 3 ounces less than 4 times per week. Look for lean, organic an/or grass fed options.  Avoid all cured and processed meats.
2) Pastries and Sweets – less than 5 servings a week – such as one small cookie.  Try to enjoy whole fruit instead.
3) Butter and stick margarine – Avoid any fat that is solid at room temperature, including palm oil, coconut oil and other shortenings.  No hydrogenated oil.  Limit butter to less than 1 ½ teaspoons daily.
4) Full-fat cheese – limit to 1.5 ounces, less than once a week.  Try low or no fat options, or vegan cheese.
5) Fried or fast food – limit to one small serving of fries twice a month at most.

Greenwood’s addenda:  1) Studies from Oxford University and elsewhere have shown that levels of vitamin B12 decrease with age and low levels can affect leaning and memory adversely.  B12 is only found in animal food.  Supplements are advisable in vegans and older people.  50 micrograms a day should suffice.
2) Alcohol use disorders are the most important preventable risk factors for the onset of all types of dementia, especially early-onset dementia, according to a nationwide observational study of over one million adults diagnosed with dementia in France.  Red or purple grape juice my have the same effects as wine on health – to be verified.
3 ) A cookbook based on the Mind Diet by Kristin Diversi is published by Ulysses Press: The Mind Diet Cookbook

Sadja Greenwood, MD, MPH   Past issues at

Monday, January 8, 2018

Children may Benefit from Omega 3 Fatty Acids in Fish

 According to a new report from the University of Pennsylvania, children who eat fish at least once a week sleep better and have IQ scores that are 4 points higher, on average, than those who consume fish less frequently or not at all. These findings were recently published in Scientific Reports, a Nature journal.

Previous studies showed a relationship between omega-3s, the fatty acids in many types of fish, and improved intelligence, as well as omega-3s and better sleep. But they've never all been connected before. This work, conducted by Jianghong Liu, Jennifer Pinto-Martin and Alexandra Hanlon of the School of Nursing and Penn Professor Adrian Raine, reveals sleep as a possible mediating pathway, the potential missing link between fish and intelligence.

"This area of research is not well-developed. It's emerging," said Liu, lead author on the paper and an associate professor of nursing and public health. "Here we look at omega-3s coming from our food instead of from supplements." For the work, a cohort of 541 9- to 11-year-olds in China, 54 percent boys and 46 percent girls, completed a questionnaire about how often they consumed fish in the past month, with options ranging from "never" to "at least once per week. They also took the Chinese version of an IQ test called the Wechsler Intelligence Scale for Children-Revised, which examines verbal and non-verbal skills such as vocabulary and coding (!).

Their parents then answered questions about sleep quality using the standardized Children Sleep Habits Questionnaire, which included topics such as sleep duration and frequency of night waking or daytime sleepiness. Finally, the researchers controlled for demographic information, including parental education, occupation and marital status and number of children in the home. Analyzing these data points, the Penn team found that children who reported eating fish weekly scored 4.8 points higher on the IQ exams than those who said they "seldom" or "never" consumed fish. Those whose meals sometimes included fish scored 3.3 points higher. In addition, increased fish consumption was associated with fewer disturbances of sleep, which the researchers say indicates better overall sleep quality.
"Lack of sleep is associated with antisocial behavior; poor cognition is associated with antisocial behavior," said Adrian Raine, who has appointments in the School of Arts and Sciences and Penn's Perelman School of Medicine. "We have found that omega-3 supplements reduce antisocial behavior, so it's not too surprising that fish is behind this.

The researchers see strong potential for the implications of this study. "It adds to the growing body of evidence showing that fish consumption has really positive health benefits and should be something more heavily advertised and promoted. Children should be introduced to it early on. That could be as young as 10 months, as long as the fish has no bones and has been finely chopped, but should start by around age 2.  Introducing the taste early makes it more palatable. It really has to be a concerted effort, especially in a culture where fish is not as commonly served or smelled. Children are sensitive to smell. If they're not used to it, they may shy away from it."

Given the young age of this study group, Liu and colleagues chose not to analyze the details participants reported about the types of fish consumed, though they plan to do so for work on an older cohort in the future. The researchers also want to add to this current observational study to establish, through randomized controlled trials, that eating fish can lead to better sleep, better school performance and other real-life, practical outcomes.

For the moment, the researchers recommend incrementally incorporating additional fish into a diet; consumption even once a week moves a family into the "high" fish-eating group as defined in the study.
"Doing that could be a lot easier than nudging children about going to bed," Raine said. "If the fish improves sleep, great. If it also improves cognitive performance -- like we've seen here -- even better. It's a double hit."  

Families who are vegetarians may consider making an exception and giving their children chewable fish oil capsules. 

Dear Reader – I will be going away for a month, so my columns will not resume until late in February. Past issues are at Call me with any questions – I’m in the Bolinas Yellow pages, and you can get my cell phone from that number.   Sadja Greenwood, MD

Monday, January 1, 2018

Colon Cancer Survival Helped by Nut Consumption

 A new study sponsored by the Dana Farber Cancer Institute in Boston looked at people diagnosed with colon cancer, and found that eating tree nuts  lowered their chances of cancer recurrence. An observational study of 826 patients with stage III colon cancer showed that those who consumed two ounces or more of nuts per week had a 42% lower chance of cancer recurrence and 57% lower chance of death than those who did not eat nuts. The questionnaire was given after completion of chemotherapy in a study that began in 1996.  Stage III colon cancer is defined as cancer that has spread to surrounding lymph nodes.
 “Basic healthy eating can often be overlooked during cancer treatment. This study shows that something as simple as eating tree nuts may make a difference in a patient's long-term survival," said Dr. Daniel F. Hayes. "Nut consumption and a healthy diet are generally factors that clinicians and patients should perhaps pay attention to as they design the approach to treatment for colorectal cancer." A secondary analysis revealed the benefit of nut consumption was limited to tree nuts. Tree nuts include almonds, walnuts, hazelnuts, cashews, and pecans, among others. There was no associated reduction in cancer recurrence and death among patients who consumed peanuts or peanut butter. According to the authors, the reason may be that, being legumes, peanuts have a different metabolic composition than tree nuts
"Numerous studies in the fields of heart disease and diabetes have shown the benefits of nut consumption, and we felt that it was important to determine if these benefits could also apply to colorectal cancer patients," said lead study author Temidayo Fadelu, MD, a clinical fellow in medicine at Dana Farber Cancer Institute. "Patients with advanced disease who benefit from chemotherapy frequently ask what else they can do to reduce their chances of recurrence or death, and our study is an important contribution to the idea that modifying diet and physical activity can be beneficial."
Researchers were particularly interested in nut consumption because it has been linked to lower incidence of obesity, type 2 diabetes, and reduction in insulin resistance. These health conditions are each associated with a higher risk of recurrence and death from colon cancer. The benefit of eating nuts was consistent across known factors that can influence cancer recurrence, including patient age, body mass index, gender, and common genomic changes in the tumor.

"It should be emphasized that the authors are not suggesting that eating nuts should be considered a substitute for standard chemotherapy and other treatments for colon cancer, which have dramatically improved survival," said Dr. Hayes. "Rather, patients with colon cancer should be optimistic, and they should eat a healthy diet, including tree nuts, which may not only keep them healthier, but may also further decrease the chances of the cancer coming back."

"We need to look at the potential positive impact of nut consumption on survival at other stages of colon cancer, particularly stage IV. (Stage IV colon cancer is defined as cancer that has spread to other organs, such as liver or lungs.) Ultimately, we need to understand how nuts confer this protective effect, as well as possibly conduct a randomized, controlled clinical trial where diet recommendations are given at the start of the study to prove that tree nuts can reduce recurrence and death after treatment for colon cancer," said Dr. Fadelu.
Here’s a take-home message from this positive finding.  It’s a good idea to put nuts into your diet now – they can also help to prevent overweight, diabetes and heart disease.  Peanuts have also been found to have positive effects on our health.  If they fill you up with healthy fat, you’ll be ahead when it comes to super-sweet deserts!
Sadja Greenwood, MD, MPH

Thursday, December 14, 2017

More Good News about Coffee

 A recent paper, published in the British Medical Journal (BMJ), looked at over 200 studies on coffee drinking and health outcomes.  The work was done at the University of Southampton (England) and the University of Edinburgh.  Researchers reviewed over 200 observational studies across many countries.  Drinking coffee was consistently associated with a lower risk of death from all causes and from heart disease, with the largest reductions at 3 cups a day, compared with non-coffee drinkers.  Drinking more than 3 cups daily was not associated with harm, but the beneficial effect was less pronounced. There was less evidence for the positive aspects of decaf coffee, but it had similar benefits for a number of outcomes.  Some but not all of the studies corrected for factors that may be associated with coffee drinking, such as smoking, that may influence health outcomes.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial (uterine), skin and liver cancer, as well as type 2 Diabetes, gallstones, gout and cirrhosis of the liver. Finally, there seemed to be beneficial associations between coffee use and Parkinson’s disease, depression and Alzheimer’s.  

The authors concluded that coffee drinking seems safe within usual patterns of use, except during pregnancy and in women with increased risk of fracture.  They also wrote that there is substantial uncertainty about the effects of higher levels of intake.  It may be a trigger for rapid or irregular heartbeat in some people.  Additionally – coffee is often consumed with sugars and unhealthy fats  which may not be beneficial.

The warnings about coffee during pregnancy are based on an English and Swedish study showing that caffeine use may be associated with lower birth weight babies and an increased risk of miscarriage.    Caffeine from coffee, tea, chocolate , soft drinks and some medicines should be counted.  The authors suggest limiting caffeine use  - a cup of coffee contains about 100 mg of caffeine, while tea may have half that amount.  It may be prudent not to exceed one cup a day in pregnancy.  Avoid colas, whether sweetened with sugars or chemicals. In addition do not smoke during pregnancy and limit alcohol use to one small glass of wine once a week.  It is best to avoid alcohol completely, since studies on minimal amounts have not been done.  Binge drinking is associated with serious harm to the fetus.

Warnings against caffeine use in post-menopausal women come from a few studies looking at osteoporotic fractures and diet.  A 2001 study from Creighton University showed that a caffeine intake of more than 300 mg daily was associated with decreased bone density of the spine in women with a particular genotype influencing vitamin D receptors.   There is currently no test for this problematic vitamin D receptor.   The authors suggest that postmenopausal women at risk of osteoporosis decrease caffeine intake (no more than 3 cups daily) and use vitamin D supplements.

Ways to Avoid Overeating during the Holidays!
*Include lean protein sources at every meal – such as chicken (minimal skin), beans and fish.  Protein triggers a hormone that signals the brain to slow down emptying of the stomach.  This hormone also acts to decrease  the hunger promoting hormone called ghrelin. 
*Choose minimally processed, high fiber carbohydrates, such as whole grains and vegetables. You will feel full more quickly, and help your microbiome!
*Chew your food thoroughly, don’t gulp!  Eating more slowly allows you to know when you’ve had enough.
*Get enough sleep. Inadequate sleep is associated with increased levels of hunger and weight gain.

Sadja Greenwood, MD, MPH