May 2013 Newsletter

www.serpermethod.com

www.wisernow.com

www.stilmee.com

www.joycesimard.com

www.southshoresenior.com

www.adriennemartin.com

Joanne Koenig Coste

Eric Reardon, Nutritionist

 www.fruitsandveggies.org

Senior Living Residences

www.thegreenhouseproject.org

www.alz.org

www.alz.org/manh

www.trivalleyinc.org

Anne Beecher, Massage & Stretching

WBUR Alzheimer’s Special

Ch 5 Boston Chronicle Brain Foods

One question that many have wondered is what is the difference between a Mediterranean Diet and Dr. Nancy Emerson Lombardo’s Memory Preservation Nutrition.
This newsletter is dedicated to showing both the similarities and differences and the amazing qualities of both diets.

This newsletter starts by sharing results of a ground- breaking study out of Spain about how the Mediterranean Diet dramatically reduces heart and stroke risk in vulnerable older adults.  What is unique about this study is that it is a large-scale CLINICAL TRIAL involving nearly 8,000 people.  Since brain and heart health are closely linked, this is important news.

In addition, on April 30, 2013 Neurology published a major epidemiological study, the largest yet featuring the Mediterranean Diet, and brain health. See below for our review article: University Of Alabama Study Shows Mediterranean Diet Adherence Helps Both Caucasians And African Americans Reduce Risk Of Cognitive Decline.

Related articles include one explaining why Extra Virgin Olive Oil EVOO is so brain healthy, and another about the importance of nuts and seeds for our brains.

We close with how YOU can get started making a few changes toward SAVING YOUR BRAIN! (And your HEART!)

Groundbreaking Nutrition Clinical Trial in Spain Proves Mediterranean Diet Dramatically Reduces Heart and Stroke Risk

by Nancy B. Emerson Lombardo, Ph.D. © 2013 Nancy B. Emerson Lombardo

The clinical trial involved over 7,500 adults aged 55-80 in Spain, with high cardio-vascular risk factors but no previous heart attacks or strokes nor diagnosis of cardio-vascular disease. Many participants were already on meds for cardio-vascular risk factors including high blood pressure meds (80%), statins (55%), diabetes meds (50%); blood thinners (29%). The study was funded by Spain’s national Department of Health.

Two thirds of the study participants were randomized to one of two Mediterranean Diet (Med Diet) groups and the other third to a control, “low-fat” diet.

The results were dramatic.Both Med Diet groups had 30% fewer heart attacks or strokes than the control group over the 4.8 years of study. This 30% drop is clinically relevant as well as statistically significant. The study was stopped early so the control group could begin benefiting from the Med Diet intervention.

* Source: Estruch R & Martinez-Gonzalez MA, et. al.Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med Feb 25 2013. DOI: 10.1056/NEJMoa1200303    

How did the study work?

Each group was instructed on how to implement the diet goals in their lives. They were given shopping lists, recipes and lots of coaching about how to improve their diet.

Looking more closely to the study’s report on compliance and who was eating what, they discovered that, given it was Spain, at baseline everyone was eating some version of the Mediterranean Diet already, but perhaps with unhealthy distortions, such as eating too much red meat, too many processed foods, or too many sweets, and not enough vegetables, beans, olive oil or fish. All study groups shared some of the same directions:

1) eating at least 3fruits/day,

2) at least 2 vegetable servings/day,

3)eating fish at least 3 times a week,

4)eating more beans and lentils

5)consume no more than two servings PER WEEK of sugary desserts or processed baked goods.

But the control group was encouraged to eat a low fat diet and their three servings of fish were to exclude the more fatty types, whereas the two Med Diet groups were encouraged to eat fatty fish, more olive oil and healthy fats, and were not restricted on total fats.

At the end of the study, researchers discovered that the control group had not been able to really change their diet much at all, and that two of the major changes for the two Med Diet groups was related to the study foods they were GIVEN to add to their regimen.

Med Diet Groups Were Given Free Olive Oil or Nuts

One group was given enough high quality extra virgin olive oil (EVOO) for each participant (and family members) to eat 4 Tablespoons every day.

The other group of participants was given 1 oz/30 gram packets of nuts (a mixture of walnuts (1/2 oz) and almonds and hazelnuts(1/4 oz each)).

The EVOO group increased their olive oil consumption by 50 grams, the NUTS group increased their olive oil consumption by 32 grams. The EVOO group increased average daily nut consumption to .9 servings/week and the NUTS group increased theirs to six 30 gram servings per week.

The other two significant increases in healthy foods were that both groups ate more fish (.3 more servings/week) and more beans and lentils (an extra .4 servings/week), as recommended by the study guidelines.

This writer has learned that the Spanish Med Diet study also included some secondary outcome measures related to cognitive or brain health; we haven’t learned just which tests were used or when the authors plan to publish those results. Stay tuned!

What are the take away messages?  

Yes, do try to adopt as many of the foods in the Mediterranean Diet as you can.

You could start with just the two biggest changes study participants made (though keep in mind most participants were already eating lots of vegetables, beans, lentils and very few sweets):

Eat:

• at least 1 oz of nuts and seeds every day, (use seeds such as flax, hemp, chia, pumpkin etc if allergic to nuts, or to mix it up since variety is heart and brain healthy)

(See related article on which nuts and seeds to eat)

• Use LOTS of olive oil. Aim for about 4 tablespoons which is ¼ cup per day, and make it Extra Virgin. (See related  article on why extra virgin olive oil is so good for our brains [2]^,[3])

What other changes toward the Med Diet could I make?

If you want to kick your Med Diet changes up a notch, then also add these elements:

• Eat fish, especially fatty fish such as salmon, sardines, tuna, at least 3 times a week.
• Eat ½-1 cup of lentils or beans 3 times/week or more often.
• Eat veggies as many times a day as you can.
• Eat a variety of fruit daily, ideally 3-5 servings.
• Minimize processed foods.
• Minimize pastries and baked and other desserts/sweets to no more than 3 times/week, preferably made “from scratch.”       (And if you also follow Dr. Nancy, chose desserts or pastries containing dark chocolate, fruit and/or spices.)

Many people ask me, “What is the difference between the Mediterranean Diet and Dr. Nancy’s Memory Preservation Nutrition® program?” To learn the answer see related article.  

To learn more:

Visit my website (for brain and heart healthy recipes as well as more ideas), as well as the website for the Spanish Med Diet study:  This website also contains, in Spanish only, shopping lists and recipes for the two Med Diet intervention groups (olive oil and nuts). http://predimed.onmedic.net/eng/ImplementationoftheIntervention/RECIPESBYINTERVENTIONGROUPS/tabid/582/Default.aspx     (Ignore the Low Fat section as that did not help people).

The cheaper processed olive oils have lost their potency; scientists believe that part of the power of EVOO is not just the healthy mono-unsaturated fats in the oil, but also all the potent antioxidants from the olives themselves…which are not present in the cheaper oils. Another recent study[2] suggests that substances in the good quality EVOO also has a direct positive effect on the brain. Among the potent anti-oxidants (also found in olives) is an anti-inflammatory polyphenol called oleocanthal, which, as demonstrated in brains of AD laboratory mice and cultured brain cells, acts to remove the A-beta protein (Aβ) from the brain by boosting production of two proteins and key enzymes believed to be critical in removing Aβ from the brain (P-glycoprotein [P-gp] and LDL lipoprotein receptor related protein-1 [LRP1]).

Yet another study published in 2011 found that people who had the highest levels of oils peculiar to olive oil had a greatly reduced risk of strokes. [3]

Also, in order not to overeat fat calories from fats, use EVOO INSTEAD of unhealthy fats such as corn oil, animal saturated fats like butter or lard, or margarines with transfats. Leave some room for brain healthy coconut and palm oils, cocoa butter, and of course all those nuts and seeds.

As for the type of nuts and seeds to eat in your pursuit of the Mediterranean Diet and following Dr. Nancy’s Memory Preservation Nutrition® program, choose your favorites so you will indeed eat them every day. The three used in the study are especially terrific, because walnuts are rich in the plant form of omega-3’s and almonds in vitamin E, and different healthy fats. Hazelnuts are popular in Europe and have complementary nutrients. But ALL nuts, including the lowly peanut, are power houses of potent nutrients that help us in a myriad of ways. For example, among popular nuts eaten in the U.S., cashews have the second highest amount of Omega 3’s (.22 gram/ounce), after walnuts and the less common butternut. Hazelnuts, Brazil nuts and peanuts have smaller but significant amounts of Omega 3’s.

In fact eating a variety of nuts and seeds is the way to go. Other human clinical trials have shown how a various nuts lower cholesterol, help lower blood sugar, and both walnut and almonds in studies with mice improved brain health including reduction of A-beta. And in none of the human clinical trials testing health benefits of nuts did the participants eating extra nuts gain weight compared to control groups. So despite the high fat and calorie content, the nuts maybe replacing less healthy foods, or their super-healthy ingredients help prevent weight gain.

For more information on nuts see our web-page table listing some nutrients in various nuts.

Among seeds, flax seeds, which must be ground to be bio-available, have good amounts of Omega-3’s as do chia seeds and hemp seeds (the same type of hemp from which rope, fabric and paper can be made, a distant cousin* of the marijuana plant). Many other seeds also have brain and body health benefits including pumpkin seeds, squash seeds, pepitas, sesame seeds (used to make Tahini, an ingredient in hummus), and many others.

(* Very distant.  You can’t get high on hemp seeds and they are legally imported shelled, usually from Canada)

The primary difference is that the Mediterranean Diet relies on certain foods (e.g. olive oil) that are available and popular in countries that ring the Mediterranean. The Memory Preservation Nutrition program relies on strategies that can be applied to ANY country or ethnic cuisine. It gives guidance for choosing brain healthy foods from among all those available to a particular person in a particular place.

Some descriptions of the Mediterranean Diet also fail to address the negative role of sugar and white grains and starches. although the Predimed Diet did limit sweets. Historically people following the traditional Med Diet ate so many healthy foods they balanced out the white bread and white pasta or white rice that traditionally constituted part of the cuisine. Sweets were typically a rare treat, not eaten every day. Today, sweets and processed foods are more prevalent even in the Mediterranean countries, and the quality of the meat and poultry has also begun deteriorating though not to the egregious degree as in the US. In the US most “industrial” farm animals and poultry are fed mainly cheap grains, not allowed to free range and thus are devoid of Omega 3’s and other nutrients obtained from grass and green vegetation, and are so vulnerable to illness that they are dosed with antibiotics and other medications.

To learn more:

Visit my website (for brain and heart healthy recipes as well as more ideas), as well as the website for the Spanish Med Diet study: http://predimed.onmedic.net/eng/Home/tabid/357/Default.aspx   This website also contains, in Spanish only, shopping lists and recipes for the two Med Diet intervention groups (olive oil and nuts).

Recipes: http://predimed.onmedic.net/eng/ImplementationoftheIntervention/RECIPESBYINTERVENTIONGROUPS/tabid/582/Default.aspx      (Ignore the Low Fat section as that did not help people).

Remember you don’t have to give up your favourite foods – just eat less if a food is not good for you, and a LOT less if they are sugary, white rice, flour or starchy, loaded with transfats, or too much salt. And find which of the healthy foods you like best and eat more of them.

Variety is important so we urge you to keep trying new foods that are on the heart and brain healthy list. (Some examples are contained in my recipes on the website). Remember there are 100s of “super foods” for the brain and body, so you are sure to discover plenty that you find delicious.

“There can be a misperception that eating healthfully means giving up your favorite foods,” said registered dietician and Academy of Nutrition and Dietetics President Ethan A. Bergman. “The ‘Eat Right, Your Way, Every Day’ 40^th Anniversary National Nutrition Month theme (for March, 2013) encourages consumers to include the foods they love as part of a healthful eating plan that is tailored for their lifestyles, traditions, health needs and, of course, tastes.” See www.eatright.org

Dr. Nancy suggests this simple key: learn

• which of your current favourite foods are unhealthy and eat less (or much less!) and
• which are healthy and eat more of them.

In addition, one can begin adopting one by one additional DELICIOUS healthy foods. Springtime is a good time to experiment. One great source just might be traditional ethnic foods fixed traditional ways with wholesome ingredients, from our own family traditions, or borrowed from others.

Brain Healthy Snacks at Work or School

At the Office – Or in your lunch bag in the car if you are on the go…

• Nuts, seeds or trail mix, ideally in single serve packs
• Fruit
• Avocadoes*
• Peanut butter
• Whole grain crackers
• Low sodium soup
• Canned sardines, wild salmon or tuna

* Store whole avocadoes along with a dinner knife and spoon, and maybe a little sea salt. No refrigeration please! When avocado is ripe (slightly soft when touched) cut in 1/2 the long way with the knife. Then separate the two halves, leaving the seed in one half. After adding just a hint of sea salt on the top, scoop out spoonfuls from the other half…i.e. you eat it right out of the shell. What could be easier! The other half will keep another day to eat later…or if really hungry, eat up that one too.

If you have access to a refrigerator or use a ice pack in your lunch bag, add these to your list:

• Vegetables cut up “to go”
• Jicama (a crisp and slightly sweet root vegetable) peeled, sliced and served on a salad with lime vinaigrette or chopped for a crunchy addition to salsas; or, cucumbers, including Armenian for extra crunch!and
• Gazpacho (a cold tomato-based raw vegetable soup) made with spinach or cucumbers.
• Greek yogurt
• Stuffed grape leaves (yummy!)
• Olives
• Tabouleh
• Hummus
• Guacamole – you can buy prepared at Trader Joe’s or elsewhere, fresh or frozen.
• Hard boiled eggs
• Low fat cheeses such as mozzarella, provolone or goat cheeses
• Snack ready veggies such as baby carrots, sugar snap peas, miniature sweet peppers,…or if you have time to cut them up, celery sticks, cucumber or pepper slices

Healthy Drinks:

• Water
• 100% fruit juice especially dark colored ones
• Coconut water (instead of sugary sports drinks…does  a better job of balancing electrolytes)
• If access to a blender: green smoothies, adding in leafy greens, avocados, nuts, seeds(especially flax, chia, hemp) or any combination to the usual fruits.

Sweets:

• Dark chocolate, at least 60-70% of more cocoa solids- many delicious brands out there; do your own taste test and find your favourite. (Check my February e-newsletter for some of my favourites, and more about chocolate’s fascinating history)
• Trader Joe’s Dark Chocolate covered almonds
• Healthy snack bars such as Budibars™  
• Cookies and desserts made with brain healthy ingredients and recipes (check out my website, brainwellness.com)
• This one can be used for breakfast, dessert or as a snack:

Greek yogurt parfait made with berries or cut up fruit, cinnamon, a dash of coconut sugar or Truvia, a tablespoon or more of hemp heart seeds (or chopped nuts, chia seeds).

Neurologist Georgios Tsivgoulis, MD, who is on the faculty at both University of Alabama and the University of Athens, in Athens, Greece, led this important special purpose analysis of existing data in the REGARDS study at the University of Alabama, a study originally designed to assess risk factors for Stroke in the so called “stroke belt” of the southern U.S. (REGARDS is a prospective, population-based, cohort of over 30,000 individuals age 45 and older, enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003-2007). Dr Tsivgoulis excluded from the larger sample base, participants with history of stroke, impaired cognitive status at baseline, and/or missing data on Food Frequency Questionnaires (FFQ). The resulting number of people was 17,478 participants for his Med Diet study data base, with an average age of 64.  He applied the MeD diet strategy developed by another Greek MD working in the US, Nicholas Scarmeas MD who innovated the idea of applying a point system to be able to assess how closely any person’s food intake followed key elements of a Mediterranean style diet, regardless of their ethnicity or geography. People in the study were scored 0-9 points using data in their FFQ’s.

The REGARDS study did not use the same cognitive measures typical in other studies designed to assess Alzheimer’s risk, but did have a basic 6-point cognitive screen, with which his team to assess incident cognitive impairment (“ICI”), over a period of 4-5 years. This enabled the study to identify 1,248 (7%) of the study population who had developed cognitive impairment (ICI) during the study period.

The study found that in healthy people, those who more closely followed the Mediterranean diet were 19 percent less likely to develop problems with their cognition, i.e. thinking and memory skills. These key findings arevstated in abstract as:

“Higher adherence to MeD was associated with lower likelihood of ICI before (odds ratio OR 0.89; 95% confidence interval 0.79-1.00) and after adjustment for potential confounders (OR 0.87; 95% CI 0.76-1.00) including demographic characteristics, environmental factors, vascular risk factors, depressive symptoms, and self-reported health status.

Another researcher had an interesting comment on the study, also published in Neurology. Mr. William Grant at the Sunlight, Nutrition and Health Research Center suggests that we need to look at the genetic factors known from other studies to be related to both risk of Diabetes, and to risk of cognitive decline. ” Differences in the prevalence of apolipoprotein E (ApoE) alleles may explain this finding. The ApoE epsilon2 (ApoE2) allele is associated with increased risk of diabetes mellitus [2] while the ApoE4 allele is associated with increased risk of cognitive impairment and Alzheimer disease (AD). [3] There is also evidence that dietary effects on AD are affected by ApoE alleles. [4] While blacks have a higher prevalence of ApoE4 than whites or Hispanics, [5] the higher rate of diabetes associated with dietary factors may counter the effect of ApoE allele. It would be interesting in future studies to identify the components diet that affect risk of cognitive impairment as well as the interactions with genetic factors. ” http://www.neurology.org/

This important study is an epidemiological study, not a clinical trial such as the major Spanish study reported elsewhere. That is, it adds to the evidence base but is not a gold standard clinical trial as required to get our U.S. Center for Disease Control to add nutrition to its planned re-launch of the Healthy Brain Initiative. It is important though in adding to the impetus to get physicians and laypeople to recognize the importance of improved nutrition in protecting our brains!

A bit of back-story from Dr. Nancy: I had the pleasure of being a reviewer for an earlier version of this manuscript, submitted over a year ago to another journal. I had suggested some revisions but urged its publication as offering unique database and perspectives; that journal ultimately rejected that version of the manuscript despite my urging its publication. I am thrilled that an even more prestigious journal has now published Dr. Tsivgoulis’s study.

Check out other reviews of this important article: medline plus

1.Tsivgoulis G, Judd S, Letter AJ, et al. Adherence to a Mediterranean diet and risk of incident cognitive impairment. Neurology 2013;80:1684- 1692. http://www.neurology.org/

2. Anthopoulos PG, Hamodrakas SJ, Bagos PG. Apolipoprotein E polymorphisms and type 2 diabetes: a meta-analysis of 30 studies including 5423 cases and 8197 controls. Mol Genet Metab 2010;100:283-291.

3. Sachdev PS, Lipnicki DM, Crawford J, et al. Risk profiles of subtypes of mild cognitive impairment: the Sydney memory and ageing study. J Am Geriatr Soc 2012;60:24-33.

4. Barberger-Gateau P, Lambert JC, Féart C, Pérès K, Ritchie K, et al. From genetics to dietetics: the contribution of epidemiology to understanding Alzheimer’s disease. J Alzheimers Dis 2013;33 Suppl 1:S457- S463.

5. Grant WB. A multicountry ecological study of risk-modifying factors for prostate cancer: Apolipoprotein E-4 as a risk factor and cereals as a risk reduction factor. Anticancer Res 2010.;30:189-199.

For brain health consultations for yourself, your family, or your organization contact Nancy for further information or to book an appointment. 978-621-1926 or email at nemerson@healthcareinsights.net.

Nancy Emerson Lombardo, PhD
HealthCare Insights, LLC
P.O. Box 2683 , Acton , MA 01720

© 2013 HCI