According to the Alzheimer’s Association, over five million Americans are living with Alzheimer’s disease (AD), increasing to 16 million in 30 years. In Pennsylvania, an 18.5 percent increase in diagnosis is estimated in people aged 65 and over in the next eight years. The cost of caring for those with Alzheimer’s and other dementias is estimated to total $259 billion this year, increasing to $1.1 trillion (in today’s dollars) by mid-century. Nearly one in every three seniors who dies each year has Alzheimer’s or another dementia.
Why is the rate of Alzheimer’s disease increasing so dramatically? Research shows that several factors contribute to late onset AD (over age 65, the most common form). These include older age, genetics (especially carrying the APOE4 allele), family history, a history of head trauma, midlife onset high blood pressure, obesity, diabetes, and high cholesterol. Delving deeper, Americans are living longer, but over 65 percent of adults are overweight or obese and diabetes rates are climbing (over a third have diabetes or prediabetes). What is good or bad for the heart is also good or bad for the brain.
What are the common lifestyle factors influencing the heart and brain? Diet, exercise, sleep, and mental acuity are the most prominent and, fortunately, modifiable factors.
In the past, the majority of diet research focused on individual nutrients. However, with this approach it is difficult to show much difference since we don’t eat single nutrients. Past research has shown there is not enough data to support reduction or prevention of AD by omega-3 fatty acids, antioxidants, or B vitamins by themselves, such as in supplement form. However, some research has shown low levels of vitamin D are associated with higher risk of AD.
However, in the last several years there has been renewed study in eating patterns to support brain health. The Mediterranean diet, first named in 1993 but eaten for over 4,000 years in the 22 countries of the Mediterranean region, has shown great promise in promoting and maintaining brain health. Studies in Spain that began in the early 2000s and continue today have demonstrated declines in heart attacks and strokes and improved cognition when participants were following Mediterranean eating patterns. Longer life, less diabetes and fewer cancers, and lower rates of childhood obesity are also seen. The diet focuses on consumption of more vegetables, fruits, whole grains, beans, nuts, seeds, olive oil, water, and fish and shellfish; smaller amounts of cheese, yogurt, and poultry; and least amounts of red meats and sweets. A moderate amount of red wine is included. This eating pattern also includes little processed foods, so overall it is lower in sodium and sugar, as well as saturated and trans fats. It is higher in fiber, potassium, antioxidants, and healthy fats compared the typical Western diet. The research is so compelling about the healthfulness that this eating pattern has now been recognized and recommended in the newest 2015–2020 U.S. Dietary Guidelines.
Published in 2015, research from Rush University in Chicago has combined elements from the Mediterranean diet and the DASH diet (Dietary Approaches to Stop Hypertension, developed in the early 1990s by Harvard researchers), called the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet. The goal is to prevent AD. They tested over 900 Chicago-area seniors over four and a half years. The longer people had followed the MIND diet patterns, the less risk they appeared to have for AD. The study found the MIND diet lowered Alzheimer’s risk by about 35 percent for people who followed it moderately well and up to 53 percent for those who adhered to it rigorously.
Consume greens, berries, and nuts frequently to help improve mind health.
The MIND diet outlines 15 dietary components to follow.
Ten “brain-healthy food groups”:
- Green leafy vegetables—daily
- Other vegetables—daily
- Nuts—five times per week
- Berries—twice per week (½ cup)
- Beans—every other day (½ cup)
- Whole grains—at least three daily
- Fish—at least weekly
- Poultry—twice per week
- Olive oil—use as main cooking oil
Five “Unhealthy Food Groups”:
- Red meats—fewer than four servings per week
- Butter and stick margarine—less than 1 tablespoon per day
- Cheeses—less than one serving per week
- Pastries and sweets—fewer than five per week
- Fried or fast food—none
While the MIND diet research is compelling and promising, more research is needed to replicate the results. With the exclusion of most dairy foods, calcium and vitamin D will likely need to be supplemented or replaced by fortified soy products. It is unclear why low- or nonfat dairy products are not included. If you consume dairy products and/or eat out frequently, this diet could be a challenge to follow.
Leading neurobiology researchers published a set of recommendations in 2014 summarizing their ideas for lifestyle changes to prevent AD, with the first two strongly diet related:
- Minimize saturated fats and trans fats.
- Vegetables, legumes, fruits, and whole grains should replace meats and dairy products as primary staples of the diet.
Additionally, physical activity, sleep, and how you use your brain are included:
- Do aerobic exercise equivalent of 40 minutes of brisk walking three times per week.
- Have a regular sleep routine of seven to eight hours per night.
- Engage in regular mental activity that promotes new learning for 30 minutes per day, four or five times per week.
There is little doubt we can decrease the amount of adults diagnosed with AD by making lifestyle changes. The question is, will we? The costs are too great to society if we do nothing. Families today are under immense financial, emotional, physical, and mental stress when a parent or spouse is in cognitive decline from AD. For more information and support, contact the Alzheimer’s Association.To learn more about the Mediterranean diet and lifestyle, check out our “ Mediterranean Cuisine Comes to You ” program, offered in workshops throughout Pennsylvania and online, to take on your own time and pace.
Examine Your Choices
|Food||Source||What I buy||What I plan to buy/change|
|Cereal||Whole grains, nuts, berries||Frosted flakes||Oatmeal, walnuts, and berries|
My goal: Consume whole-grain cereal with nuts and berries four times per week.
Aztec Grain Salad
Serving size: makes 12 ½-cup servings
Prep time: 15 minutes
Cook time: 30 minutes
Aztec Grain Salad combines a high-protein grain called quinoa with aromatic roasted butternut squash, crisp apples, and dried cranberries to make a delicious and colorful side dish.
- 1½ cups quinoa, dry
- 1¾ cups fresh granny smith apples, peeled, cored, cubed ¾ inch
- 1¾ cups fresh butternut squash, peeled, seeded, cubed ½ inch
- 1 tablespoon canola oil
- ¼ teaspoon ground ginger
- ¾ teaspoon ground cinnamon
- ¼ cup frozen orange juice concentrate
- 1½ tablespoons olive oil
- 1 teaspoon honey
- 1/3 teaspoon Dijon mustard
- 2 tablespoons red wine vinegar
- 1/8 teaspoon salt
- 1 dash ground black pepper
- 1/3 cup dried cranberries, finely chopped
- 1/3 cup golden raisins, seedless, finely chopped
- Fresh cilantro or parsley as garnish
- Preheat oven to 400°F.
- Rinse quinoa in a fine-mesh strainer until water runs clear, not cloudy. Combine quinoa and 3 cups water in a medium pot. Cover and bring to a boil. Turn heat down to low and simmer until water is completely absorbed, about 10 to 15 minutes. Fluff with a fork. Cover and refrigerate
- Combine apples and squash in a large mixing bowl. Add canola oil, 1/3 teaspoon ginger, and ¼ teaspoon cinnamon. Toss well to coat.
- Pour apples/squash mixture onto a large baking sheet and place in oven at 400°F. Roast for 15 minutes or until squash is soft and slightly brown on the edges. Do not overcook. Remove and set aside to cool.
- In a medium mixing bowl, combine orange juice, olive oil, honey, Dijon mustard, red wine vinegar, salt, pepper, and remaining ginger and cinnamon. Whisk together to make dressing.
- In a large mixing bowl, combine quinoa, apples/squash mix, cranberries, raisins, and dressing. Toss well to combine. Cover and refrigerate for about 2 hours. Garnish with cilantro or parsley. Serve chilled.
Per ½ cup: 150 calories, 27g carbohydrate, 3g fiber, 3g protein, 4g fat, 0.5g saturated fat, 58mg sodium. Source: What’s Cooking? USDA Mixing Bowl
Alzheimer’s Association. “2017 Alzheimer’s Disease Facts and Figures.”
Annweiler, C., et al. “Higher vitamin D dietary intake is associated with lower risk of Alzheimer’s disease: A 7-year follow-up.” The Journals of Gerontology Series A, 67, no. 11 (November 2012): 1205–1211.
Barnard, N. et al. “Dietary and lifestyle guidelines for the prevention of Alzheimer’s disease.” Neurobiology of Aging 35, Supplement 2 (September 2014): S74–S78.
Martínez-Lapiscina, Elena H., et al. “Mediterranean diet improves cognition: The PREDIMED-NAVARRA randomised trial.” Journal of Neurology, Neurosurgery and Psychiatry 84, no. 12 (2013).
Morris, Martha Clare, et al. “Alzheimer’s and Dementia.” Journal of the Alzheimer’s Association (September 2015).
Office of Disease Prevention and Health Promotion. “2015–2020 Dietary Guidelines for Americans.”
Otaegui-Arrazola, A. “Diet, cognition, and Alzheimer’s disease: Food for thought.” European Journal of Nutrition 53, no. 1 (February 2014): 1–23. doi: 10.1007/s00394-013-0561-3.
Prepared by Lynn James, senior extension educator.