If you think dementia is an inevitable part of growing old, think again. It turns out there is a lot you can do to keep your brain healthy and prevent cognitive decline no matter what your age. Since a healthy brain is one that can learn, remember, pay attention, process information from our senses, solve problems, make decisions, communicate, support mobility, and regulate emotions, you can see why it is essential to do everything within your power to maintain brain health.
To figure out what works and what doesn’t when it comes to maintaining brain health, doctors and scientists from the American Heart Association (AHA) and American Stroke Association (ASA) advisory group teamed up to review 182 published scientific studies. Their findings were published on September 7, 2017 as an AHA/ASA Presidential Advisory titled, “Defining Optimal Brain Health in Adults.”
According to Philip Gorelick, MD, MPH, a vascular neurologist and the chair of the Advisory’s writing group,
“Research summarized in the advisory convincingly demonstrates that the same risk factors that cause atherosclerosis [narrowing or blockage of large blood vessels called arteries] are also major contributors to late-life cognitive impairment and Alzheimer’s disease.”
The relationship between blood vessel and brain health
The brain is highly dependent on adequate and consistent delivery of energy substrates, particularly oxygen and glucose, via the blood vessels that perfuse the brain. Of course, a healthy heart is necessary to pump the blood to the brain and to the lungs where it picks up oxygen. The flow of blood to and within the brain is tightly regulated so that active areas of the brain receive more blood flow and the brain is preferentially perfused even when blood pressure drops.
So you can readily understand that conditions that damage blood vessels (or the heart) will have deleterious effects on the brain. We know what many of those conditions are because of a huge body of scientific literature on factors that prevent heart attacks and strokes. So, it is not a leap of faith to say that following the guidelines that keep your heart healthy should help keep your brain healthy as well.
The Advisory group notes that “although the RCT [randomized clinical trials – the gold standard in medical research] evidence to prevent cognitive decline and dementia is still incomplete and evolving, the observational epidemiological evidence [weaker evidence because it cannot prove cause and effect] for modifiable risk factors is substantial.”
Because brain health is so crucial and because there is a huge body of evidence about factors that maintain vascular health, everyone should interpret the Advisory recommendations to follow what they call Life’s Simple 7 as a call to action that should not be ignored.
Life’s Simple 7
The American Heart Association calls the seven strategies “7 small steps to big changes”—and, indeed, they have been shown reduce heart attacks, strokes, and as noted above, observational evidence suggests they may help preserve cognition. That is certainly big.
Here are the strategies:
Things you can do on your own:
- Be physically active on a regular basis
- Eat a healthy diet
- Achieve a healthy weight
- Don’t start smoking or quit smoking (you may need medical help with the quitting part)
Things you may need medical help to achieve:
- Manage high blood pressure
- Normalize lipids (they say control cholesterol, but it is more complicated than that)
- Keep blood sugar in the normal range
Let’s explore each of these in more detail
It isn’t completely clear what target activity goals should be, but the recommendations found in the 2015–2020 Dietary Guidelines for Americans are a good place to start. They recommend that adults should do at least 150 minutes a week of moderate intensity activity or 75 minutes/week of vigorous intensity aerobic exercise. You don’t have to do it all at once but can divide it up into increments of 10-15 minutes spread throughout the day. Once you have mastered this, amp it up. There is no upper limit. Incorporate physical activity (walking, biking, hiking, swimming, running) into your daily routine so that it starts to feel strange if you have a sedentary day. Track your progress in some way using a digital tracker, such as Fitbit, or just plain old pen and paper.
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We have written extensively on this. A healthy diet is balanced, moderate in calories, and primarily fresh (not processed foods). Following a Mediterranean-style eating pattern is recommended. In fact, it is the one diet that has actually be proven to improve cardiovascular outcomes. As Dov Michaeli MD, Ph.D writes in his review of the subject:
“The results [of the definitive study] were startling. Compared with the group on the low-fat diet, the 2 groups on the Mediterranean diet had a 30% reduction in heart attacks and stroke (from 6.5% to 4.5%) over a period of 5 years. In fact, the study had to be terminated early, at about 5 years, because the results were so significant it became unethical to continue with the low-fat group.”
Achieve a healthy weight
Anyone who has ever tried to lose the extra weight knows that this one is not simple. Evolution (survival of the fittest) has helped to ensure that all animals have a very strong drive to seek and eat food to maintain sufficient energy stores to support survival. Humans have multiple, redundant mechanisms (hormones, gut factors, brain factors, and more) that make us feel hungry, crave food, and store energy as fat. It doesn’t want to give that up easily. There are some things that can make weight loss easier though:
- Find a buddy or engage the whole family in the healthy eating journey and accept the fact that this is a journey without end. Losing weight until you reach a goal and then slipping back into your old habits means slipping back into your old jeans, too.
- Never shop hungry and purge the fridge and pantry. If your favorite fattening food is not in easy reach, you have to find a substitute—make sure it is a healthy one.
- Track your progress, be consistent. A recent study showed that slow and steady wins the race when it comes to dieting. If you are measuring your weight on a regular basis, you will be able to get yourself back on track more quickly.
- Practice portion control. Eat slowly so your body’s satiety mechanisms can kick in. Use salad plates instead of dinner plates for every meal, prepare smaller portions or put the excess in the fridge before you sit down to eat.
- Cut back or cut out the alcohol. Those carbs go right into belly fat and the “buzz” can make you more susceptible to making bad food choices.
There are only a few of many small changes that you can make to slowly, but surely, achieve and maintain a healthy weight.
For most adults, quitting smoking is very hard, but it can be done and there is help available. Here is a review of Drugs for Tobacco Dependence that may help you stop smoking. It is from my favorite evidence-based source of reliable information about drugs and therapeutics, The Medical Letter (a huge thank you to them for making this article available outside of the subscription paywall).
High blood pressure, normalize lipids, and blood sugar
I am going to talk about these all together as they all may require help from your doctor, including, in many cases, prescription medications. The Advisory group researchers point out in their paper that the strongest evidence tying these strategies to brain health is for what they call primordial prevention—that means never getting these risk factors in the first place. That is why they call for people to start following the first four recommendations in childhood. Once you have high blood pressure, for example, treatment to goal can reduce the risk of stroke and cardiovascular events, but they say in the paper “that risk is not as low as for those who have maintained untreated BP [blood pressure] <120<80” (read as less than 120 systolic over less than 80 diastolic).
The bottom line
So, there you have it. These 7 simple (and not so simple) strategies can have big payoffs: fewer heart attacks, fewer strokes, and better brain health. Because the evidence suggests that it is never too early to incorporate Life’s Simple 7 into your daily life, you should get started now. In fact, don’t do it alone. Get everyone in the family engaged! You are never too young or too old to make Life’s Simple 7 the way you lead your life.
Patricia Salber, MD, MBA
Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.
Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.
She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.
She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.
She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.
Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.
Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.
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