My Take on Taking Control

Concerns about memory loss, cognitive decline, dementia, and Alzheimer’s are common and understandable. Modern healthcare has enabled Americans to live longer in a healthier body, but has done little to improve brain health. Alzheimer’s is now the third leading cause of death in the United States, right behind heart disease and cancer. For women, Alzheimer’s is more common than breast cancer, and women comprise 65% of patients and 60% of caregivers. The impact of this disease on women and those they care for is enormous. While prevalence is increasing, the good news is you actually have a great deal of control over this devastating disease.

I help patients understand how they can take control. We investigate risk factors such genetics and ApoE status, nutrient status, inflammation, and drug adverse effects. We use advanced testing to do this. Then we put together a personalized plan to improve brain health. This may include diet and lifestyle recommendations, micronutrient repletion in the form of oral supplements or intravenous infusions, exercise programs for both mind and body, acupuncture, and more. Patients can expect to feel better, sharper, and have measurable results within 6-12 months of following my protocols.

I use the following categories as developed and written by Dale Bredesen. The RECODE protocol is found in his book “The End of Alzheimer’s.” It’s a read well worth your time.

4 CATEGORIES OF REVERSABLE COGNITIVE DECLINE

INFLAMED/ HOT Patients present predominantly inflammatory symptoms. They

have elevated high-sensitivity C-reactive protein and other lab tests reflecting a chronic inflammatory state. When inflammation is activated, it alters gene transcription. Two of the genes turned “on” lead to a degradation of synapses, or the connections in the brain.

ATROPHIC/COLD This is a completely different mechanism from inflammation. In

this situation, brain function is being gradually turned off, similar to dimming the lights to converse energy. Restoring nutrients, mitochondria and hormones are critical to reversing this down regulation.

GLYCOTOXIC/SWEET This is an in-between subtype that involves both inflammation and atrophy processes, due to insulin resistance and glucose-induced inflammation. This often correlates with being overweight and improves as blood sugar control improves.

VILE/TOXIC These are patients have a history toxic exposures, possible mercury, plastics, pesticides, or smoking. Many will have chronic inflammatory response symptoms and lab tests. These patients respond to customized detoxification protocols

MY TIPS TO IMPROVE BRAIN HEALTH

Use it!

Mental stimulation matters. Learning new things promotes new neural connections. Any mentally stimulating activity should help to build up your brain. Read, take courses, and try “mental gymnastics,” such as word puzzles or math problems. Experiment with things that require manual dexterity as well as mental effort, such as drawing, painting, and other crafts.

Get physical exercise

Exercising regularly increases the number of tiny blood vessels that bring oxygen-rich blood to the region of the brain that is responsible for thought. Exercise also spurs the development of new nerve cells and increases the connections between brain cells (synapses). This results in brains that are more efficient, plastic, and adaptive, which translates into better performance.

If your physical health limits your exercise, at least do breathing exercises. Consider Superbrain Yoga or others types of low impact movement.

Get enough B vitamins in your diet

Three B vitamins, folic acid and niacinamide, are especially important for brain health and help lower your homocysteine level (which is linked to an increased risk of dementia). Whole grains such as oatmeal, brown rice, or quinoa, and leafy green vegetables such as kale and romaine are good sources of B vitamins.

Optimize your numbers

Get your blood pressure, blood sugar, and cholesterol into the optimal ranges. Know if you have oxidative stress or inflammation. There are many natural and lifestyle-based ways to address any unfavorable results.

Consider anti- inflammatory options

Observational studies suggest that long-term use of aspirin and other anti-inflammatories may reduce the risk of dementia by 10%–55%. Ask me whether other anti-inflammatories such as fish oil or turmeric (curcumin) would work for you.

Care for your emotions

People who are anxious, depressed, sleep-deprived, or exhausted tend to score poorly on cognitive function tests. Poor scores don’t necessarily predict cognitive decline in old age, but good mental health and restful sleep are important goals.

Stay social

Strong social ties have been associated with lower blood pressure and longer life expectancies.

Avoid toxic vices

Smoking tobacco, drinking excess alcohol, and eating fried, sugary or highly processed foods all lead to inflammation.

Copyright, Dr. Erica Oberg, ND, MPH, 2020

My Take on Taking Control

Concerns about memory loss, cognitive decline, dementia, and Alzheimer’s are common and understandable. Modern healthcare has enabled Americans to live longer in a healthier body, but has done little to improve brain health. Alzheimer’s is now the third leading cause of death in the United States, right behind heart disease and cancer. For women, Alzheimer’s is more common than breast cancer, and women comprise 65% of patients and 60% of caregivers. The impact of this disease on women and those they care for is enormous. While prevalence is increasing, the good news is you actually have a great deal of control over this devastating disease.

I help patients understand how they can take control. We investigate risk factors such genetics and ApoE status, nutrient status, inflammation, and drug adverse effects. We use advanced testing to do this. Then we put together a personalized plan to improve brain health. This may include diet and lifestyle recommendations, micronutrient repletion in the form of oral supplements or intravenous infusions, exercise programs for both mind and body, acupuncture, and more. Patients can expect to feel better, sharper, and have measurable results within 6-12 months of following my protocols.

I use the following categories as developed and written by Dale Bredesen. The RECODE protocol is found in his book “The End of Alzheimer’s.” It’s a read well worth your time.

4 CATEGORIES OF REVERSABLE COGNITIVE DECLINE

INFLAMED/ HOT Patients present predominantly inflammatory symptoms. They

have elevated high-sensitivity C-reactive protein and other lab tests reflecting a chronic inflammatory state. When inflammation is activated, it alters gene transcription. Two of the genes turned “on” lead to a degradation of synapses, or the connections in the brain.

ATROPHIC/COLD This is a completely different mechanism from inflammation. In

this situation, brain function is being gradually turned off, similar to dimming the lights to converse energy. Restoring nutrients, mitochondria and hormones are critical to reversing this down regulation.

GLYCOTOXIC/SWEET This is an in-between subtype that involves both inflammation and atrophy processes, due to insulin resistance and glucose-induced inflammation. This often correlates with being overweight and improves as blood sugar control improves.

VILE/TOXIC These are patients have a history toxic exposures, possible mercury, plastics, pesticides, or smoking. Many will have chronic inflammatory response symptoms and lab tests. These patients respond to customized detoxification protocols

MY TIPS TO IMPROVE BRAIN HEALTH

Use it!

Mental stimulation matters. Learning new things promotes new neural connections. Any mentally stimulating activity should help to build up your brain. Read, take courses, and try “mental gymnastics,” such as word puzzles or math problems. Experiment with things that require manual dexterity as well as mental effort, such as drawing, painting, and other crafts.

Get physical exercise

Exercising regularly increases the number of tiny blood vessels that bring oxygen-rich blood to the region of the brain that is responsible for thought. Exercise also spurs the development of new nerve cells and increases the connections between brain cells (synapses). This results in brains that are more efficient, plastic, and adaptive, which translates into better performance.

If your physical health limits your exercise, at least do breathing exercises. Consider Superbrain Yoga or others types of low impact movement.

Get enough B vitamins in your diet

Three B vitamins, folic acid and niacinamide, are especially important for brain health and help lower your homocysteine level (which is linked to an increased risk of dementia). Whole grains such as oatmeal, brown rice, or quinoa, and leafy green vegetables such as kale and romaine are good sources of B vitamins.

Optimize your numbers

Get your blood pressure, blood sugar, and cholesterol into the optimal ranges. Know if you have oxidative stress or inflammation. There are many natural and lifestyle-based ways to address any unfavorable results.

Consider anti- inflammatory options

Observational studies suggest that long-term use of aspirin and other anti-inflammatories may reduce the risk of dementia by 10%–55%. Ask me whether other anti-inflammatories such as fish oil or turmeric (curcumin) would work for you.

Care for your emotions

People who are anxious, depressed, sleep-deprived, or exhausted tend to score poorly on cognitive function tests. Poor scores don’t necessarily predict cognitive decline in old age, but good mental health and restful sleep are important goals.

Stay social

Strong social ties have been associated with lower blood pressure and longer life expectancies.

Avoid toxic vices

Smoking tobacco, drinking excess alcohol, and eating fried, sugary or highly processed foods all lead to inflammation.

Copyright, Dr. Erica Oberg, ND, MPH, 2020

I recently read an excellent research review published in the Journal of Clinical and Translational Research summarizing the evidence for 21 nutrients for cognitive function. In total, 21 categories of nutrients and phytonutrients were studied including:

• α-lipoic acid,

• Bacopa monnieri,

• B vitamins,

• cholinergic precursors,

• vitamin D,

• vitamin E,

• Ginkgo biloba,

• ginseng,

• lion’s mane mushroom,

• N-acetyl cysteine,

• omega-3 fatty acids,

• aloe polysaccharides,

• Rhodiola rosea,

• rosemary,

• saffron,

• tart cherries,

• turmeric,

• wild yam,

• Withania somnifera,

• xanthines, and

• zinc.

The good news is that there are many nutrients with clinically significant effects on cognition in both healthy adults and people with dementia, brain injuries, or cognitive impairment. The challenge is that with so many promising therapeutics, how do you choose the ones that will be most impactful for your unique genetic and cognitive situation?

As my patients know, the key to my successful treatment protocols is starting with an accurate and in depth lab tests that help me understand what nutritional and metabolic pathways are relevant to the individual in question. So before starting a new handful of supplements, consider updating your micronutrient testing (if you are an existing patient, you may call my office to request this and we’ll follow up to discuss the results.)

In the meantime, here are a few highlights on the research paper.

Ginseng

One well-studied botanical medicine that I have under-utilized is Ginseng. Eight well-done human studies have found consistent improvement on tests of memory, focus, and cognition. While a number of species of ginseng were tested, it appears Panax ginseng dosed between 800mg-4g is most effective.

Lion’s Mane

Lion’s Mane mushroom (Hericium erinaceus) has been getting a lot of press for good reason. Check it out at the La Jolla Farmer’s market! You can prepare it just like a crab cake! While there were only 2 lion’s mane studies reported in the review, they showed significant improvement in standardized cognitive testing in only 12-16 weeks.

Alpha Lipoic Acid

Antioxidants are the cornerstone of any brain health protocol because of their critical roles in quenching damaging free radicals. One of my favorites is alpha lipoic acid. This antioxidant readily crosses the blood brain barrier and increases acetylcholine. At least 3 clinical studies have shown meaningful stabilizing performance on standardized cognitive testing, and consistent slowing down of progression. Alpha lipoic acid was dosed at 600mg per day in all 3 trials.

B Vitamins

B vitamins are not antioxidants, but they have been shown to have an important impact on brain health. In a study of nearly 200 people with Mild Cognitive Impairment (MCI), a B vitamin combination of 0.8 mg folic acid, 0.5 mg B12, and 20 mg B6 per day was given for 2 years (those are not big doses). After 2 years, Executive function was maintained in the B vitamin group compared to placebo and in those with baseline homocysteine above the median value (11.3 mmol/L), global cognition (MMSE), episodic memory (Hopkins Verbal Learning Test–delayed recall), and semantic memory (Category Fluency) improved in the B vitamin group compared to placebo. Imagine what results might have been seen if they used optimal doses or improved routes of administration such as intravenous B vitamins.

Choline

I was also happy to see that some of my tried and true favorites continue to gather more research support. Choline precursors – citicholine, phosphatidyl serine, phosphatidyl choline, lecithin – continue to demonstrate their role in improving/slowing cognitive decline. These specialized fats are critical to the structure of the brain and neurotransmitters. Choline can be easily tested from whole blood samples which can guide us in determining whether or not adding more of these nutrients can be expected to improve function.

That’s just a snapshot of the 21 nutrients summarized in this research review. I encourage you to check it out, or bring me questions or your personal experiences about cognitive improvement with nutrients!

Mental fitness is a concept used to help us enhance our thought patterns and overall mental and cognitive well-being. Just as the body can be strengthened through physical exercise, our minds too can be made more resilient through conscious training and healthy lifestyle practices. By developing an awareness of our thoughts, feelings, and behaviors, we can become more confident and capable in the world.

Everyone has experienced feeling overwhelmed, stressed, and helpless amidst the pressures of daily life, and many people have found this especially true over the last two years. It is when we let these types of thoughts dominate that we run into problems. Feeding into negative beliefs will only make them occur more frequently, as the brain forms neural pathways that become reinforced. The practice of mental fitness is about rewiring the neural pathways that don’t serve us, so that we experience positive thoughts more often than negative ones, and supporting our mental and cognitive health daily.

Instead of responding to challenges emotionally, which often leads to frustration and defeat, mental fitness allows you to step back and respond in a way that is calm, rational, and positive. It also helps to improve our cognition, brain health and memory for years to come.

Ways You Can Optimize Your Mental Fitness

Achieving peace of mind and optimal brain health may sound easier said than done, but there are many small changes and practices that you can add to your routine to keep your brain in top shape.

1 – Sleep

Getting enough sleep not only prevents illness, it also significantly improves your mental health and cognitive functioning. Make sure that you are getting at least seven to eight hours of sleep every night so that your brain functions optimally.

2 – Exercise

Physical fitness is closely connected to mental fitness; you cannot achieve a healthy mind if your body is not performing properly. This is also true the other way around, as poor physical health may also impact mental health. The benefits of leading an active life are well documented. Physical activity increases the flow of oxygen to the brain and releases endorphins – our happy hormones. These so-called “happy chemicals” will help relieve stress and improve your mental state.

3 – Mindfulness

The ability to recognize when a thought is negative or unhelpful is crucial to developing mental fitness. Take the time to step back from your negative thoughts and question their validity. You can then reframe them to more positive ones that serve you and your goals. These can take some retraining, and it’s often useful to talk with a healthcare professional.

4 – Doing new things

Being adaptable and open to change is a major component of mental fitness. Find new ways to challenge yourself and your mental fitness will grow with the world around you. This could be as simple as taking up a new hobby or trying a new food. Studies on Alzheimer’s have found that engaging your brain in different ways helps support brain cells and strengthen neural connections. Variety will increase your brain’s vitality.

5 – Playing!

Many fun recreation activities help keep your brain active. Doing puzzles and playing games have a positive effect on mental fitness. It increases problem solving skills and can help keep the brain sharp. Many physical activities, including dancing and tai chi, have cognitive benefits since the brain must work to remember steps or movements involved.

6 – Active listening

Sometimes, we listen merely to respond, but the type of listening that mental fitness requires is slow and thoughtful. Deep listening will increase your knowledge and your capacity to reason and relate to others.

7 – Spend time in nature

If your stress levels have been high lately, you may benefit from adding at least 20 minutes of outdoor time into your daily routine. Think of it as a “nature pill” for your well-being. Studies have shown that connecting with nature and “forest bathing” can significantly lower stress hormones.

8 – Reading

Even if you only spend 15 minutes a day doing it, reading can be a highly beneficial activity to aid your mental fitness. Visualizing the action on the pages will help you relax and ignite your imagination. Reading also strengthens connections in the brain and improves memory and concentration.

9 – Meditation

Learning to calm your mind and hone your thoughts will significantly increase your mental fitness and help you manage stress. Spend a moment taking in your surroundings and focusing on your breath with no distractions. It will likely be challenging at first, but your mind and body will thank you for it. Many apps and websites can guide you through the basics of meditation.

10 – Foods and Supplements

Many essential nutrients play a role in supporting mental fitness. Vitamin D, for example, helps protect against depression and anxiety disorders. Studies show that a lack of omega-3s in the diet has detrimental effects on cognitive function and has been associated with chronic inflammation, potentially contributing to depression symptoms. Magnesium is also a key player in mental health, as this mineral helps to regulate many key neurotransmitters involved in mood regulation. Magnesium deficiency has been associated with anxiety, ADHD, fatigue, and low libido.

Focus on a natural, whole foods diet with a variety of fruits and vegetables, quality protein and healthy fats. Avoid or limit alcohol as it can alter communication pathways in the brain, as well sugar and processed foods which are oftentimes contributors to impaired cognitive skills and self control.

Like any physical exercise, mental fitness requires a bit of discipline to create a routine. The good news is that science has shown that our brains are elastic and can be trained just as any muscle can to become stronger. With just a few small but meaningful changes, you can adjust your mindset to get more clarity while supporting your brain health for years to come. And, don’t be afraid to reach out – we can help!

Sources

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Briguglio M, Vitale JA, Galentino R, et al. Healthy Eating, Physical Activity, and Sleep Hygiene (HEPAS) as the Winning Triad for Sustaining Physical and Mental Health in Patients at Risk for or with Neuropsychiatric Disorders: Considerations for Clinical Practice. Neuropsychiatr Dis Treat. 2020;16:55-70. Published 2020 Jan 8. doi:10.2147/NDT.S229206

Robert S. Wilson, Tianhao Wang, Lei Yu, Francine Grodstein, David A. Bennett, Patricia A. Boyle, Cognitive Activity and Onset Age of Incident Alzheimer Disease Demential Neurology Aug 2021, 97 (9) e922-e929; DOI: 10.1212/WNL.0000000000012388

Centeno RPR. Effect of Mindfulness on Empathy and Self-Compassion: An Adapted MBCT Program on Filipino College Students. Behav Sci (Basel). 2020;10(3):61. Published 2020 Feb 27. doi:10.3390/bs10030061

Hunter MR, Gillespie BW, Chen SY. Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers. Front Psychol. 2019;10:722. Published 2019 Apr 4. doi:10.3389/fpsyg.2019.00722

Maraz A, Király O, Urbán R, Griffiths MD, Demetrovics Z. Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS One. 2015;10(3):e0122866. Published 2015 Mar 24. doi:10.1371/journal.pone.0122866

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Effatpanah M, Rezaei M, Effatpanah H, Effatpanah Z, Varkaneh HK, Mousavi SM, Fatahi S, Rinaldi G, Hashemi R. Magnesium status and attention deficit hyperactivity disorder (ADHD): A meta-analysis. Psychiatry Res. 2019 Apr;274:228-234. doi: 10.1016/j.psychres.2019.02.043. Epub 2019 Feb 19. PMID: 30807974.