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Maria Thomas: Hello, and welcome everybody. Good morning. Good afternoon. Depending on where you are. You've reached the brain health webinar, sponsored by Sunday health and nourishedrx.
We will be getting started in just a few minutes. Welcome to everyone who's joining us. I see the room is filling up quickly. We will start in just a few minutes. Today's webinar will be recorded. So everybody who's here or has registered will receive a recording. If you have questions today, you can place those questions in the Q&A. Or in the chat?
You can also turn on closed captioning. If you look at the bottom of your zoom screen. If that's helpful to you, you can do that.
Welcome. Everyone who's still joining. We're going to give folks just a couple of minutes to come in. I can see that the room is still filling up. You're here for a webinar on diet and dementia focused on brain health. We're so pleased to have everyone joining us today, and we will be starting very shortly.
Today's session will be recorded. So you'll receive a recording afterwards. Also, you can ask questions at any time in the Q. And a. We will try to get to as many questions as possible. We had quite a few questions submitted in advance as well, so thank you. To all of you who may have submitted questions in advance. I'm going to give it about 30 more seconds
While we're waiting. I still see, there's quite a few people joining want to remind everybody that you can use the Q. And a function at the bottom of the zoom screen to ask your questions. You can also feel free to chat if you're interested in sharing information or just telling us a little bit more about your interests. We're happy to look into the chat. You can also turn on closed captioning, if that's helpful to you at the bottom of the zoom screen.
So I have about 2 min after the hour we'll go ahead and get started. Welcome to everyone who's joined us today. My name is Maria Thomas. I am the CEO of Sunday health, one of 2 sponsors of today's webinar we are so pleased to have with us also our co-sponsor from nourishedrx.
We're here today to talk about diet and dementia, and a little bit of a spoiler for everyone there. It is possible to preserve your cognitive abilities with your diet and with your food. So there's going to be some great information shared today about that
Sunday health and nourishedrx. We are different types of companies. But we share the idea of really trying to elevate our brain health and our cognitive health more broadly by focusing on things that we have control over, one of which is our diet. And so that's today's subject.
Sunday Health. The company that I'm representing is a cognitive care medical practice. Right now. We are active in Washington, DC. Virginia and Maryland. When I say a cognitive care practice. What I mean is, we focus exclusively on memory and thinking. Dr. Doyle, who's with us today, is one of our cognitive neurologists.
But at Sunday health we really try to elevate and focus on the idea of preventing and delaying cognitive decline. And we focus really on the upstream, mild, cognitive impairment and early dementia. It's our belief that if we want to address the dementia crisis in the United States, it's very important to start early, and it's very important to focus on the modifiable risk factors of which diet and food is one. And so we're really at our mission is to help people maintain cognitive function and independence as they age.
So, as I mentioned, we're delighted to partner with our friends from Nourishedrx. Nourishedrx is a very smart food is medicine platform, and they work through health plans and providers to provide food plans and basically food to help people with chronic conditions to use food as medicine, and Kelly will tell you a lot more about that. So with no further ado, I want to introduce Kelly Chugas, who's with us from nursed. Rx. Kelly is a registered dietitian and one of our 2 panelists today. So, Kelly, I'm going to turn it over to you.
Introduction - Kelly Tsougas, Registered Dietitian
Kelly Tsougas, MS, RDN, LDN: Awesome. Hi! Everybody! As Jaritza said, I am. My name is Kelly Chugas. I am a registered dietitian with nourished Rx. My focus is really on managing chronic disease prevention and symptoms of chronic diseases. So I'm also a certified personal trainer. So we'll be your nutrition fitness and lifestyle expert. For today.
I'm also a program manager here at nourishrx. And also, as mentioned, we're a digital health and nutrition solution that helps people live healthier lives also supporting health equity. So we have a purpose driven purpose built integrated food is health program.
And these programs are centered around experiential learning where highly personalized, culturally sensitive food, nutrition, education, and coaching serve as the foundation, aiming to improve both short term and long term health outcomes and self-sufficiency. So with that, I'll turn it over to Sarah.
Introduction - Dr. Sara Doyle, Neurologist
Dr. Sara Doyle, MD: Good morning. My name is Sarah Doyle. I am a neurologist, specializing in prevention and early cognitive you know, managing early cognitive symptoms, figuring out what's going on, and then what we can do about it to help you maintain your cognitive function and independence, and you know what makes you you for as long as possible.
I currently work full time in San Antonio, and but I also am working with Sunday health, both seeing patients. And then also building out programs that can really support this this mission.
Understanding Cognitive Aging and Dementia
Dr. Sara Doyle, MD: So I wanted to spend a few minutes just as we get started to lay some groundwork about what cognitive aging is, what's normal, what's not normal? And then getting into a little bit of defining Alzheimer's disease and dementia, and then its precursor, mild, cognitive impairment, all of the things that can affect that.
And then also the what we call the modifiable risk factors, and focusing particularly the on the ones that are related to diet and lifestyle. Because your diet is such an integral part of of your daily life.
So just to give a little bit of for those of you who are really visual like myself. This is how I think about cognitive aging. And so there's many things that are that affect our cognitive trajectory. And so that can be our genetics. And then also things that happen to us over our lives or environment. And then our experience and I take environment to be very broadly defined. So that's not only, you know, air we're breathing, but it's how much school we went to, and then things that are more in our control, which is our diet and exercise and kind of our overall health status.
Normal vs. Abnormal Cognitive Changes
So it's normal to have some changes in your cognition, as you get older. And we call that typical aging. And I'll talk about that in just a second. But then there can be some abnormal changes, and that can either fall into the category of mild, cognitive impairment or dementia. So let's talk about what typical aging looks like.
So here are normal changes in cognition. So it is normal to feel like it's just what is that word, you know. And it it comes to you. It just might take a moment longer, or it might be that actor's name, or it might be, what was the name of that restaurant we went to a couple of months ago.
It also might look like you have. It just takes a little bit more time to do something, or it takes a little bit more attention, whereas before you might be able to cook dinner at the same time that you're having a conversation, and somebody comes right in the middle and needs something from you, or asks you a question about something else. You might just feel like that throws you off a little bit more. You just need to have things quiet, you know, when you're doing something that requires more attention.
Similarly, it might be harder to do things like, you know, more quote unquote complex activities. So maybe it, you just double check submitting your taxes a few more times than you would normally or renewing your driver's license online. related to this multitasking can feel harder. So these things are normal. These things are not something that you should, just because you sometimes feel like you can't find the word that does not mean that you have. You know that you're going to get dementia next week.
But there are some things that are not normal. And so things that aren't normal are asking someone the same question multiple times a day. So if you had a conversation this morning about oh, what's our plan for later this evening? And then asking, you know, forgetting that and having to repeat that question multiple times. So that's when I start to worry about somebody's short term memory.
It also, if you're like, we said, it's normal to feel like you just need to pay closer attention to what you're doing, but having troubles like following a recipe, or having trouble doing something that you normally you know, following a conversation or finding your way to a place that's familiar to you. That's not, you know, having trouble with those things. Start to raise some red flags in my mind.
And then changing changes in your mood. So if you've never felt depressed before, but you feel like you're having trouble, or you're just not enjoying things in the same way that you did before. You're not having quite as much energy, or you're sleeping a lot, or you're not sleeping, having more anxiety. So feeling like your thoughts are racing. You're ruminating.
That doesn't necessarily mean that you have dementia. But that's not normal, and that's a reason to talk to your doctor, and then, like I talked about a little bit earlier, but getting lost, especially in familiar areas. forgetting a street name or what's that street's name, not necessarily abnormal, but frankly getting disoriented in a familiar place would be abnormal and a reason to talk to your doctor.
What is Dementia?
So then what is dementia? That's big. That's a question. I get a lot in my clinic. So dementia actually has a lot of different causes. And so we think of dementia more as a syndrome which is a loss of memory or other thinking abilities. So ability to navigate or ability to communicate, that is severe enough to interfere with your daily life. So you're needing help doing things that you normally were able to do for yourself.
And like, I said, there's multiple things that can cause. Dementia. Alzheimer's is one. It's a very common one, vascular disease. So having small strokes or big strokes, or it's kind of slowly accumulating vascular disease in the same way it can accumulate in your heart or in other organs. It can also accumulate in your brain and cause problems.
And then there's more rare forms that you may have heard of, like lewy body, dementia, frontotemporal dementia, and then other neurodegenerative diseases like Huntington's or Parkinson's disease can also sometimes cause memory impairment as well or cognitive impairment.
Making it really confusing is that most people have multiple types, or or when we look at their brains. You know. there's more than one thing going on which just clouds the picture, which is why I think it's most helpful to think of dementia as a syndrome rather than having one particular type, and it just means loss of memory or other thinking that's severe enough to interfere with your daily life.
Mild Cognitive Impairment
Now preceding this is mild, cognitive impairment. And so I think of that as an umbrella term again for having problems with your memory or thinking, but it doesn't necessarily interfere with your daily life.
So all the things I talked about on the last slide in the very early stages that can cause mild, cognitive impairment. But there's other things that are you know, not necessarily neurodegenerative disease, but they can make things a lot worse, or that they themselves can cause mild cognitive impairment. And so talking to your provider and getting a diagnosis and figuring out what I can maybe change or focus on to help. My cognition is really important. So sleep problems either not sleeping enough or not getting good. High quality, sleep, depression, and anxiety. Both can impact your memory and your attention and your processing speed, certain medications, especially pain medications or other things that you might be taking that effect that make you feel drowsy can impact your memory.
Hearing loss is one that's getting a lot of attention now, but it can lead to cognitive impairment, and and is something to get screened for and treat if you can. Excessive alcohol use can impact your brain. And then other medical conditions, like high blood pressure or heart disease, can also increase the likelihood that you'll have cognitive impairment.
Risk Factors for Cognitive Decline
So let's just before we transition to talking more about diet, let's just talk about a few other things related to diet that have been shown in many epidemiologic studies to increase the risk of cognitive impairment and dementia. And so I want you to look. There's a big smattering of things here again, some of these things are in your control. Some of these things are not but related to diet is high cholesterol, high blood pressure, physical inactivity, which again. I just kind of link with lifestyle, you know, if you're focusing on your diet, maybe you're focusing more on getting more exercise, too, or vice versa.
Diabetes and obesity are also both linked with higher risk of having cognitive impairment and dementia both highly linked to diet, or can be managed through diet. So a lot of interconnectedness here which just really. I think, makes it exciting, especially since diet can have an impact on all of these different things.
So now we'll transition over to Kelly.
The MIND Diet: Nutrition for Brain Health
Kelly Tsougas, MS, RDN, LDN: Okay. let me mute. Okay, welcome everybody. So today, I just wanted to talk to you a bit more about the nutrition and lifestyle component when it comes to cognitive health and promoting brain health. So
the mind diet is short for Mediterranean dash, diet intervention for neurodegenerative delay. So I think mind. Diet rolls off the tongue a little bit better than all of that. But this is a diet. Well, I hesitate to use the word diet, because whenever I say that to people it, it brings up the idea of restriction. And so I want to be clear that this isn't about restriction. This is a flexible pattern of eating that emphasizes nutritious foods to promote optimal brain function and overall well-being. So limiting foods that are linked to more inflammation and vascular problems
mute me. Thank you. So the key components of the mind diet are more emphasis on brain, healthy food groups, so more foods to eat on the left hand side. Here we have leafy green vegetables.
Foods to Emphasize
Ideally, we should aim for at least 6 servings of these per week. So we're talking about spinach, kale, collard greens, all those fun things, berries, berries, we should be consuming at least 2 servings per week. Blueberries, strawberries, blackberries. All these colorful berries have polyphenols and antioxidants in them that are anti-inflammatory and can support cognitive health.
We have nuts. We should be, including 5 servings of nuts per week, like almonds or walnuts or cashews. We have beans, beans, we should be consuming at least 4 or more servings per week. So lentils, chickpeas, black beans, whole grain foods. We should be consuming at least 3 or more servings per day. So whole wheat, brown, rice, quinoa, oats, etc. whatever you like in the whole grains category. My personal favorite is oats.
fish, and poultry. We should be eating at least once a week a serving of fatty fish like salmon or trout or sardines, and then for poultry about 2 servings per week, chicken or turkey, and then olive oil is another important component of the mind diet. So we emphasize using this as your primary cooking oil. When it comes to using a brain healthy cooking oil versus other types of oil.
Foods to Limit
some food groups you should limit. So red. Meat is limited in this eating pattern, but it's no more than 3 servings per week. and you know it's really the processed red meats and things that we have a higher concern about. But you know, if you're eating a filet or some lean ground beef, those are going to be the choices you're going to want to emphasize when you do consume those butter and margarine less than one tablespoon per day on those cheese. Unfortunately, folks on this eating pattern we do recommend limiting to one serving or less of cheese per week, and then fried foods and pastries or fast foods again, really no more than once per week on those. Okay.
Additional Considerations
Some additional considerations for you on this are lifestyle factors. So we want to talk about portion, size and frequency. So you know some of the tips that I share with people about portion sizes. Using a smaller dinner plate. Make half of your plate, vegetables, and a quarter of your plate can be that lean protein, and then the other quarter of your plate can be a a starchy food like rice or sweet potatoes, or whatever your preferences for that. So you want to adjust your portion sizes like, based on your satiety and your individual needs. So learning how to tap into your internal hunger cues and recognizing when you're actually hungry versus just feeling snacky, or something like that, having a craving
talk about nutrient density. So this is the concept where we focus on minimally processed foods that deliver antioxidants, vitamins, minerals, healthy fats that support that brain function and can help reduce inflammation. So obviously a more nutrient, dense food would be like, you know, a fruit plate versus, you know, crackers, or something like that. So thinking about actual nutrient density and quality of the foods that you're eating
and then lifestyle integration as well. So diet plays a significant role in brain health. But combining this with regular physical activity and adequate sleep and stress management can further enhance the benefits that you'll receive from this
Practical Food Swaps
next. I want to talk about just some common foods that you may be eating and suggestions for some mind diet approved alternatives. So when you are in the grocery store, or putting together your plate, some of these swaps like you can, instead of red or processed meat, you pick up some poultry, some turkey breast, or some ground turkey ground chicken, or one of those fatty fish that I mentioned on the previous slide for butter and margarine, as I mentioned previously. We want to shoot for extra virgin olive oil for that high fat cream sauces, you can, instead of perhaps, like a ranch dressing, you can use an olive oil based dressing so lower in those saturated fats, and higher in the olive oil which has those anti-inflammatory benefits. So, instead of, you know, having, you know, frequent cheese consumption, the Cheddar and the melty stuff you can opt for feta or goat cheese, which are a little bit lighter and less dense. So
pastries, cookies, and sweets. I know it isn't like the exact same thing, but if you're craving a sweet treat, you may opt for fruit or berries, or maybe a smaller portion of the pastry, with some berries on top, so that you still get to enjoy a little bit of something that you enjoy, and for chips and processed snacks, unsalted nuts or seeds, popcorn is actually a pretty good choice. It's pretty high in fiber, and it's a high volume. Food. So that's a good one for promoting satiety or fullness.
Fried or fast food. Just, you know, when you do have those moments right? Because life happens and we all have to, you know, run from appointments. We have those days. So if you do, just look at the menu, you can look up nutrition information in advance. Most of these places have it posted. If you're not able to do that, you know, opting for baked or grilled or steamed options, you know. Get the grilled chicken sandwich, and maybe a side salad, or some fruit or something like that.
Instead of sugary beverages. Obviously we want to emphasize water intake but unsweetened herbal teas or sparkling water are also great choices
for white rice. whole grain options, so brown rice, quinoa barley, so kind of maybe spending some time in the aisle at the grocery store and looking, and maybe experimenting with some new options. If you've never tried far or barley, pick pick it up and see see if you like it. One of my favorite things to eat is beef and barley, stew or soup. So that's a nice little way to integrate whole grains, soups, and stews, and things like that.
White bread, whole grain, or sprouted bread, are great options for that. Sometimes the sprouted breads are found in the freezer section of your grocery little pro tip there, and for pastas you can do whole grain or legume based pastas. So there's a whole emergence of these products in the supermarket now with Chickpea or lentil based Pastas. So spend some time looking at those options as well, and see what might be a better alternative for the typical refined pastas, and as far as cereals, like refined breakfast cereals and things like that, you know, oatmeal whole grain cereals. Those are going to be your best options there.
Okay?
Sustainable Implementation Strategies
Kelly Tsougas, MS, RDN, LDN: And then really one of the the most important things that I want to talk about with regard to adopting some of these changes is, how do we do so sustainably and making it realistic for ourselves. because when we make too much change all at once, we do a 1 80 a lot of times. You know we have the momentum and that motivation. But over time we realize that it's not sustainable for us. So I really want to emphasize and and do so with all of my patients that I see that we start with one small goal, and then we build from there. So
the 1st step, though, is to set clear and achievable goals right? So they're specific. They're measurable. They're achievable. They're realistic. And then once we have those set out and written out on paper and know, hey, this is what I want to accomplish. Set one small goal. So start small, and build gradually, integrate that habit into your daily routine, and monitor your progress. Any successful behavioral change intervention will often have some sort of self monitoring tool. So whether that's checking in with yourself and journaling. Or you know. however, you choose to measure your progress. That's gonna be an important component.
And I would also say, too, you know. life isn't perfect. Perfection does not exist, and that black and white thinking and perfectionist tendencies really tend to set us up for failure. So it helps if you can identify some anticipated challenges ahead of time, busy schedule stress. And then kind of think about some solutions or workarounds to those packing snacks ahead of time, etc, and be flexible. If you miss a day again, avoid that all or nothing mindset, and then just recognize this is a normal part of life. and you know, acknowledge it and then keep going. It doesn't have to be all or nothing. Right? So practice that self compassion. So these by doing these things, you know, you can build habits that are both sustainable and realistic, which you can integrate and maintain long term. So stepwise, approach and and give yourself grace. If this is a big change that you're making.
Okay?
Practical Planning Strategies
And so finally, I wanted to talk about some practical strategies. So planning ahead, right, can you perhaps dedicate a specific day each week to sit down and plan your meals, so keep a running list of recipes that you make and that you like, and then just pull from that hat each week. Once you get your kind of recipe database built out and plan a new recipe, try to try a new recipe each week and create your grocery list where you focus on brain, healthy ingredients, leafy greens, berries, whole grains, lean proteins, etc.
There's meal planning apps. Or you can do a simple like calendar meal, planner, and just print out a blank calendar and kind of write down there so you can keep track of your recipes and shopping lists. Involve people in your family, too. If you know you have a partner that you live with, or children, you know, ask them what they want to eat and and make it a family event, and get them involved in the preparation and planning
curator rotating menu pretty much covered this already. So you know, we we call it a cycle menu in the nutrition and food service space. But it's really just the same thing keeping that list and saying, You know, every Tuesday we're gonna have Taco Tuesday, and you do shrimp tacos and different variations, etc. So just kind of knowing that that day is going to be planned ahead of time can take a lot of stress off of the plate and stress management again, is super important.
So, and then adapt to your schedule. So on. On busy days have those go to recipes that are quick and nutritious. Even a simple salad loaded with, you know, leafy greens and diverse plant based foods and lean proteins or or a veggie wrap that you can just throw together real quick can be a great option. Okay?
Batch Cooking and Meal Prep
And batch cooking and prepping. this is something where you just kinda have a day each week. If you're off on Sunday, you know. Spend some time washing and chopping vegetables, cook your whole grains like your your rice or your quinoa, so you can easily just grab those and pre-portion. Your proteins, like your grilled chicken or your fish?
you can use a slow cooker or an instant pot, which is my personal favorite, because it's quick! That that can help you to make large batches of soups and stews packed with veggies and legumes and whole grains, which you can easily reheat during busy days so.
and then integrating nutrient rich foods into daily meals. So, you know, start your day with with a nutrient packed option like overnight oats that you can top with some berries and a sprinkle of nuts or seeds. Smoothies are another quick choice, so blend leafy greens and fruits, and a spoonful of nut butter, perhaps for an energizing start, if you prefer a smoothie
lunch and dinner so balanced meals with a base of whole grains like quinoa or barley, and a generous helping of vegetables, salads, and steamed or roasted vegetables, and lean proteins, and experiment with dishes mixed green salads with grilled fish or whole grain Pasta tossed with olive oil, tomatoes, and a side of steamed greens.
and then, as far as snacks, so make sure you keep easy, healthy snacks on hand so pre-portioned servings of nuts, fresh fruits, veggie sticks with hummus, or whole grain crackers with a bit of cheese. Nuts are one of those foods that it's pretty easy to go overboard on, so that's why I recommend the pre-portioning on that. Nuts are healthy fats, but we still need to be mindful of our portion sizes on those, and a portion size of nuts is about fits in the the palm of your hand. That's about a 1 ounce serving
so, having these things can be readily available, can reduce the temptation to go, grab some processed foods when hunger strikes. So those are pretty much my tips here.
Q&A Session
Maria Thomas: Thank you so much, Kelly. Some great tips there, and really appreciated how you acknowledge that everybody's a little bit different. We have good days, and sometimes we have bad days, and just try to keep moving on. So appreciate that attitude. And Dr. Doyle also thank you for laying the foundation with some definitions and differences between dementia and Alzheimer's, and mild cognitive impairment. So just to repeat for folks who may have joined late, everybody who registered for this webinar will get a recording. We've had a number of questions in the chat about that. You will receive a recording as well as a summary of the slides and the material. But for now we are going to go to questions, and I'm going to kick off one to you, Kelly. What are your thoughts on G. I'm never sure how to pronounce it, so you can correct my pronunciation as well. What are your thoughts on G instead of butter, and maybe you can even tell us what G is, and then also also wanting to know your views on intermittent fasting or eating within a certain window, and fasting with intake of water or tea during the fasting period.
Question: Ghee vs. Butter and Intermittent Fasting
Kelly Tsougas, MS, RDN, LDN: so ghee is just clarified. Butter. Right? So you've heated it up and the clear part of the butter kind of separates to the top, and then the more solid particulate matter kind of settles to the bottom, more frequently used in like East Asian cuisine, and things like that. As far as from a nutritional standpoint. It's not any in any way really superior to butter. You're still going to have the same saturated, fat content. It's it's a solid at room temperature still, which indicates that it is a saturated fat. So I still, you know, using it in moderation and cooking, just like you would with butter, but I know there are certain communities out there who just throw it in their coffee like it's a you know, coffee creamer. So I I don't recommend that approach, but you know it. All things in moderation. Right?
That was just.
Maria Thomas: And the other question was about fasting or intermittent fasting.
Kelly Tsougas, MS, RDN, LDN: Intermittent fasting. Sure. So really, the thing with intermittent fasting right is like with any any lifestyle, change or diet recommendation. Is it sustainable for you right. The reason why we see benefit for intermittent fasting in some people is because they can they reduce their calorie intake by decreasing their feeding window. Right? So it's a shortened period of time in which you're eating. So you're eating fewer calories. Right? That's the that's really where the evidence lies in intermittent fasting as far as benefit again. I don't. I don't see any benefit to intermittent fasting over a more balanced approach where we're including lean proteins and healthy fats and eating in a more balanced manner, like that kind of ensures that you're getting adequate macronutrient balance as well. So when you restrict yourself to that window. You you're consuming fewer calories overall. Are we getting a balanced diet in that way? Those are sort of my concerns with intermittent fasting, but it works great for some people. It's not a routine recommendation that I make, though.
Question: Dr. Dean Ornish's Program for Heart Disease Prevention
Maria Thomas: Thank you so much, Kelly. We have a lot of questions coming in about very specific food items. So I'm going to come back to some of those, as I see. There's some repeats, but I want to direct a question to you, Dr. Doyle. We have a question in the Q. And a section which thank you. To all of you who are submitting your questions there, we do prefer you to submit them there. The question is, what are the pros and cons of Dr. Dean Ornish's program for reversing heart disease on preventing dementia. So, as you're answering that question, Dr. Doyle, perhaps you could 1st say what that program a little bit about what that program is for heart health, and then its relevance to dementia.
Dr. Sara Doyle, MD: Yes, absolutely, really timely and relevant question. Dr. Dean Ornish has been he's out in San Francisco, I believe, and he is a been working for the last few decades on heart health and preventing heart disease through diet interventions. I would say that the cardiologists are like 30 years ahead of the neurologists. So it's a good rule of thumb to say, what's good for your heart is good for your brain, but not. But and the brain still deserves its own clinical trial. And so Dr. Dean Ornish has now developed a program specifically for brain health, which does include a diet component, has a few things that are specific. We talked a lot about healthy fats over the course of in the last few minutes, and so Omega focus on Omega 3 S as part of that. But then there's these other aspects of lifestyle, including exercise and socializing and cognitive stimulation that have gone into this to this specific intervention, and a paper recently came out looking at the effect on cognitive scores of people who, you know, adopted this kind of intensive lifestyle intervention that includes a specific diet. So we could probably include, or it's probably an easy Google to look up that paper or coverage of that paper. That kind of summarizes its findings, but certainly a lot of what is informing brain, healthy diets. stems from the heart, healthy diets with some more focus on or, as everything is iterative, you know. I think we've the pendulum has swung, and now we think a little bit more or less about low fat, and more about which fats or hypertension is not just losing weight, but it's also reducing salt and other things that are like that. So really good question, really timely.
Question: Modifiable Risk Factors
Maria Thomas: Dr. Doyle, is it fair to say that, addressing the modifiable risk factors, the the slide that you had up early in this webinar are, you know, important and relevant to preventing and delaying cognitive decline.
Dr. Sara Doyle, MD: Yes, absolutely so there was a the 1st paper actually on this or big paper that got a lot of splash came out in 2017, and it's since been updated in 2020, and then again in 2024. And this is the Lancet Commission on dementia Prevention. But gathering data from studies, global studies. Really? Then, looking at the house. looking at a lot of different things. keeping these things under good control, or if theoretically, we could eliminate all depression, all traumatic brain injury, all high cholesterol, all air pollution. We would probably be able to prevent about 40% of dementia cases.
that's very fancy statistics, but it just means that there's a there's a bulk of, you know. There's still a lot of things we don't know right? The flip side of that is like 60% is still an unknown, which is some combination of genetics, or how genes are expressed, or other things, maybe other modifiable things. Maybe we don't yet know about
but I think it stands to say that, or it's becoming more recognized that there are modifiable risk factors that everyone there's within that list, I'm sure everyone be like, oh, there's a few things on there that maybe I could work on some of the things are out of your control, you know, air pollution. But if you're somebody who's really interested in policy or really interested in your kind of local environment, you know, that's something that that you could potentially focus on. But you know, exercise and diet, and, you know, controlling your blood pressure, controlling diabetes, really paying attention to how your mood is and how you're feeling. All can make a really big difference in terms of your own risk of dementia. And then also, you know, if you're here on behalf of a loved one on theirs as well.
Question: Specific Foods - Yogurt, Sauerkraut, Olive Oil
Maria Thomas: Thank you so much, Dr. Doyle Kelly. We have a number of questions about specific foods. I'm going to try to group them. There are several questions about yogurt. There's a question about sauerkraut. There's also a couple questions again about olive oil and olive oil and butter, and if there are other oils you would recommend. So yogurt, sauerkraut, olive oil, or other oils, you would recommend.
Kelly Tsougas, MS, RDN, LDN: Okay? So I will start with the olive oil question. And that is a great question. I the other cooking oil that I like to use is avocado oil. and that is because of its smoke point and its stability under heat. So they're they're a little bit different. So avocado oil can handle a higher temperature threshold, so it. It has the highest smoke point about 520°F. So this makes it really good for high heat cooking like frying right? So
olive oil is good right when we use it in salad dressings and lower heat like extra virgin olive oil. We kind of have a temperature threshold around 3, 75 before it will begin to oxidize right and break down. So we don't want that. So lower heat for the extra virgin olive oil. Regular olive oil is a little bit higher smoke smoke point, I want to say, around 400 420 degrees. But avocado oil may be a better choice for higher temperature. Cooking?
so that answers that question. Sauerkraut. super great food, love it. It is a prebiotic food, so it is fermented and has a great great benefit on gut health. If it is a food that you can tolerate right. Sometimes prebiotic fibers can make us a little bit gassy, so my caution there, too, would be, you know, start small and work your way up. But sauerkraut is a great food to integrate, you know, leafy green, but in fermented format so definitely go go crazy with your sauerkraut, but work your way up to it.
Let's see what was the other.
Maria Thomas: Yogurt.
Kelly Tsougas, MS, RDN, LDN: Yogurt
So yogurt's a great food it is, you know, high protein, particularly if you get a strained variety like Greek yogurt has some probiotic benefit. Maybe not as like robust as yogurt companies would like you to believe, because most commercially prepared yogurts have a shortened ferment time where we see a lot of the beneficial probiotic activity. And there's a big link between your your gut health and your brain function. So we have the gut brain access. Right? So nurturing your gut. Health is is indeed a an important part of a brain, healthy lifestyle and and diet plan. So I would just say to, you know
a lot of yogurts with the fruit on the bottom, or the added sugars like, check your food labels right now. We have, labeling requirements that have food, manufacturers labeling how much added sugar is put into a product. So that's different from naturally occurring sugar. So lactose is the naturally occurring sugar and milk. So obviously, it's going to have some sugar in it. If it's got fruit in it, there's going to be some naturally occurring sugar from the fruit. But it's it's really the added sugars that we want to avoid, and yogurts can be really guilty of that. So, checking your nutrition labels and avoiding those higher sugar options. And I would say, probably you know, I choose lower fat options because it is dairy, and so the the animal based fats are always going to be a more saturated type of fat. So but you do need some saturated fat in your diet. So having some, you know, 2%, 1% low. Fat yogurt is is perfectly fine, and a great protein source too.
Question: Protein and Eggs
Maria Thomas: Speaking of protein, Kelly, there are a few more questions about meat and also eggs. So one specific question is, if you, if you take meat out of your diet, or red meat out of your diet, and you eat only, or all meat out of your diet, you eat only fish and veggies. How do you know if you're getting enough protein? And then a related question is, can you talk about eggs? And is it okay to eat eggs?
Kelly Tsougas, MS, RDN, LDN: Yeah. well, I would say, if you're being mindful about incorporating, you know a lean protein source with each meal, you're probably getting enough protein you know, if you're just eating, you know, processed foods. And you know, Mac, and cheese and things like that, you know that that's where you would be concerned. And also, you know where routine checkups come into play. Right, you know, making sure you're getting your lab values monitored and things. But, generally speaking, the American diet has plenty of protein, and even if you take out red meat and poultry
as far as the eggs go, I I like eggs. They're a really great source of a very important nutrient for brain function. They have choline in them. So we have a neurotransmitter. Dr. Sarah can probably speak a little bit more to this, too, as well. But acetylcholine is the most abundant neurotransmitter in the brain. So eggs are a very, very great source of choline.
and very important even when I'm working with prenatal clients. Hey, moms, I want to make sure you're getting adequate choline, because it's also very important for fetal brain development. So eggs are good, I would say to you know, if you have dyslipidemia or hyperlipidemia, you know. Don't have like 5 eggs per day, maybe have just one or 2, just because of the saturated fat content of them. But I think eggs are a good protein source in general.
Question: Timing of Dementia and Screening
Maria Thomas: Thanks, Kelly and Sarah. I am going to flip it back to you. Feel free to comment on eggs if you want to start off on that. But there are a few questions, Sarah, that I'm going to try to group together for you that relate to the timing of getting dementia. And when is it too early or too late? So let me just read a couple of them. Are there any proactive slash preventative testing that can be done or is cognitive, decline something that you have to wait till you start seeing changes to have testing done. Similarly, a question about is dementia a gradual process. And what is the average age of getting dementia? So these are all sort of related to the timing of getting screened, and also the nature of different dementias, but feel free to start with eggs if.
Dr. Sara Doyle, MD: All really good questions. I was actually heartened to hear Kelly talk about eggs, because I I do enjoy eggs, and I think they're a good source of protein, and I know they had a pretty bad time in the media maybe 20 years ago, and people are very anti egg, but I think we've got more nuance on the subject now, and it's, you know, eggs in moderation. Good protein source. And yeah, acetylcholine is one of the most abundant neurotransmitters. And it's actually the neurotransmitter that one of the medications that's frequently prescribed for cognitive impairment and dementia so donepazil or aricept and its cousins increase the amount of acetylcholine that's there. And it's 1 of the key neurotransmitters for your memory circuit. So
I don't think we can go so far to say that having 2 eggs a day will prevent your dementia. But I think for those of us who internalize the fear of eggs, I think we can liberate that a little bit. And then for so timing of dementia. So for most people, dementia or cognitive impairment and dementia comes on in later life, and if you read the textbooks, later, life will be defined as 65, and later
editorially. And this is truly just my opinion, I think, as we all live better and are living longer, I think. Probably I I would say it's more common that in your seventies, or maybe even your early eighties is when the bulk of the population. So thinking about that bell curve, if you develop cognitive impairment, that's usually when most people start to notice some changes early onset dementias. much more rare. And we typically define that as like before age 60, and that more frequently has, like a genetic component to it. And so when I see someone in the clinic who is maybe in their fifties and noticing some memory changes, and I ask them about their family history. And they say, Yes, you know, my mom or my dad started having memory issues in their, you know. fifties or even early sixties. I start to think about. Oh, maybe we should do some genetic testing, because this might be more genetically linked than environment linked. Not that it's not still relevant to to focus on. But I would say that that's early onset. Dementia before age 60 is much more rare, and usually you have a family history of it. Remind me of the last question I forgot.
Maria Thomas: Was about screening and screaming.
Dr. Sara Doyle, MD: It's.
Maria Thomas: Yeah, screen time. Or should you wait until you have symptoms.
Dr. Sara Doyle, MD: Okay, this is also a really good question. And I think where the practice is ahead of the guidelines, because currently the United States preventive services. Task force does not recommend screening for most people. If you're above a certain age. I I believe it's above 80, they do recommend it but and the point it, or and the reason that they give that recommendation is that for so long there hasn't been any real action, you know if you do detect a deficit, you know, even if you can diagnose exactly what it's from. You know, there are not a lot. Maybe this is changing now of medications, you know pharmaceuticals to treat that or reverse it. And we didn't really know a lot about lifestyle interventions either.
I think the practice now is shifting towards. you know, early detection is important for a lot of different reasons. One there is still it. It is still valuable to focus on lifestyle things. So even if you know, you're starting to notice like, yes, I'm having memory problems. I repeat my I repeat stories, or I repeat questions, or you know I do. the things that we were talking about of, like that might actually be a sign. And you get tested. And there are some deficits. That is still a reason to look at your sleep, to look at your diet, to look at exercise, to look at your mood, and how you're, you know, interacting with people doing things that you enjoy. So
that is. Still, I think there's more action now than we thought there was before. I think also, too, there's value in and advanced care planning, too. That's outside of the scope of this talk. But I think there's value to that, too, for people who have absolutely no symptoms or just want to know. I think there's also value in getting a baseline.
The most advanced cognitive testing is something called neuropsychology testing, which is like a multiple hour battery of tests. It's not necessarily practical for everyone to get that done. But there are more and more tools out there, including some tech like online or tablet, based or not, pen and paper tools that either your primary care doctor may be comfortable using, or. you know, a practice like Sunday health or other neurologists who are focusing on early detection and lifestyle intervention and prevention can do with you to get a baseline because it may be completely normal. But then we know where you're at, so that if we detect something later, or if you're noticing a change later you can remeasure and see if there's been a see if there's been a difference. The reason to have a baseline is because there's so many other things that may affect. You know how you do on a cognitive test on a day to day basis? Did you sleep all the night before? Are you? Is your mind going about something else? You got family stuff going on. You got work stuff going on. You got money stuff going on. Were you sick recently, I mean, the flu and Norovirus have been just ripping through our little town here. So were you sick recently, and you know your brain's just kind of recovering from that stressor. And so you can. If you notice a change you might be able to pinpoint. Oh, maybe that's what it's from, or this is a true change in, and maybe I should get some either more advanced testing or I should or I want to, you know, refocus or or double down on. You know how I'm spending my time managing my stress, sleeping my lifestyle things like that.
Important Note About Medicare Wellness Visits and Screening
Maria Thomas: Thank you, Dr. Doyle, and we have a comment in the Q. And a. That, I think, is important to acknowledge. That is the Medicare annual wellness visit does require a cognitive screening. There's some data out from the Alzheimer's association that suggests that the number of Pcps that actually do do that screening during the annual wellness test is pretty low, but there is a requirement by Medicare during the annual wellness visit to get a cognitive screening. and you can ask for it.
Unfortunately, many Pcps don't do it. I think it's also very important to call out, and I think you mentioned it, Dr. Doyle, but I want to emphasize that if you get a screening and you do not test within the normal range. This does not mean that you have dementia in the same way that oftentimes, if one gets a mammogram, sometimes you get a call back. it doesn't mean you have cancer immediately. So a screening is simply that a screening it's an opportunity to look deeper, you know. Go deeper with an assessment, if necessary. And it's not a diagnosis. So just to call that out. I'm going to take one more question, Kelly, for you. This one is about coffee and tea. So the question is, can you tell me anything about the research on expresso and dementia, and should one drink tea versus coffee, which is better.
Question: Coffee vs. Tea
Kelly Tsougas, MS, RDN, LDN: Well, I would say coffee versus tea debate. I don't think one is particularly better over the other, only if you get more enjoyment from one over the other. So really, I think that the coffee versus tea is really what you enjoy as far as coffee and dementia risk and what the research says. Right? Like moderate coffee consumption is shown to be beneficial for cognitive health in in many studies, but it's sort of dependent on dosage, preparation, individual health factors. So
you know, caffeine sort of functions by by blocking certain receptors in your brain adenosine receptors which helps, you know, improve alertness in folks. So again, that moderate caffeine intake is linked to a reduced risk of cognitive impairment. So coffee is also rich in polyphenols. Chlorogenic acid flavonoids, and, you know, may have some anti-inflammatory and neuroprotective effects from that regard, reducing oxidative stress. So I would say, moderate coffee intake can be good but excessive caffeine intake. Obviously not not great. Right? 2 cups per day, no more than 4, you know. Then we kind of run into increased anxiety. Sleep, disturbances which can negatively affect your cognitive health. Caffeine tolerance and dependence. If you have hypertension. you know, stay closer to that lower lower level limit, since high doses can increase blood pressure, so acid reflux are going to you know you may opt, for, like a cold brew or lower acidity, coffee, as far as espresso versus.
Maria Thomas: Hey, Kelly, I'm gonna I'm gonna jump in. I'm so sorry to interrupt. But we're really coming up to the hour, and I wanna make sure that everybody knows. What's gonna happen. I'm very sorry to interrupt.
Kelly Tsougas, MS, RDN, LDN: You're good.
Closing and Contact Information
Maria Thomas: So point. But we will give folks here an opportunity to contact nourishedrx as well as Sunday health. Directly we can put up that information. I want to thank Kelly and Dr. Sarah Doyle for this incredible webinar and informative webinar a couple of quick housekeeping tools before folks drop. You will get a recording as well as a summary of what you heard today. If you want to reach Sunday health, we are focused on cognitive care. We have cognitive neurologists and nurse practitioners who can do cognitive screenings, cognitive assessments, diagnosis. This is the information that you have on the screen is how you can reach us also. Immediately after this, you're going to be receiving an email from us, asking a couple of survey questions. You can really help us out on how we did today. But also we are going to be working on, or we are working on a new brain health program through Sunday health. And we would love to have your input into that to help us shape it. So please take a moment to look at those survey questions immediately after this.
If you're interested in nourishedrx and contacting nourishedrx. You can go to their website, and their information is all available there. So I thank everyone for attending today. And hopefully, you learned something great. But if you don't take anything else away from today, it's that you do have some control over these modifiable risk factors that can really engage your brain. Health and diet and nutrition are one of 14 that we had in the presentation today. So please take care of your brain just like you take care of your heart. And with that we're going to say Thank you and goodbye.
