A Basic Brain Protection Plan, © 2006 by John Smart
(This article may be excerpted or reproduced in its entirety for noncommercial purposes.)
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Overview

Those of us who are sufficiently wealthy and foresighted have health plans, insurance plans, even annual vacation plans. So what's your brain protection plan? How are you taking care of the part of you most responsible for your sense of self and its effectiveness in the wider world? Here's my plan, and I hope you find it useful.

Disclaimer

This article is not medical advice. Take this information to your physician. You should always seek expert medical advice before starting any new drug or supplement regimen.

Article

The following are the most important steps I've discovered to date, dietary and nondietary. Your feedback is appreciated. I list them first in brief, then follow with notes on each.

Most Recommended Dietary Steps
1. Curcumin (900-1800 mg, or 1-2 capsules/day). Good source: Life Extension Foundation [1]. For best absorption take with some type of fat (milk, plant, or animal fat, or a fatty acid like the fish oil below).
2. EPA+DHA Omega-3 Fatty Acids (from Fish Oil) (1200-3600 mg, or 7-10 capsules/day). Good source: Regular strength fish oil capsules from any source. Costco's [2] Kirkland brand capsules are particularly affordable. If you are a strict vegetarian, you can use algal DHA instead, but not flax seed or canola oil. These are great oils for your diet, but they contain only ALA, and you need DHA as well for your brain.
3. A multivitamin (one/day) with Folate, Niacin, Vitamin E, Vitamin C, and a good range of other important vitamins and minerals. Good source: Twinlab Daily One [3].
4. Pisceterian or Vegetarian Diet. Minimize saturated fats (eliminate dairy and almost all meat) and unsaturated trans fats (partially hydrogenated oils in many overprocessed foods). Eat small amounts of cold water fish (salmon, albacore tuna, lake trout, halibut, mackerel, and sardines) which are rich in DHA/Omega-3 fatty acids, or go totally vegetarian if you can (as long as you know what to eat to get protein and nutrients, and are taking the appropriate supplements).

Special Case Dietary Steps
5. Ibuprofen (200-400 mg, or 1-2 capsules/day, liquid softgel). Over the counter drug.
6. A statin (lovastatin or atorvastatin, 20-40 mg or 1-2 tablets/day). Prescription. or Niacin (1000mg/day) OTC.

Both of these last two substances have side effects and should should only be used under the advice of a physician. Consider them particuarly if you suspect early Alzheimer’s ($1,000+ neuroimaging tests are available for this if you want one, ask your doc), or if you are “Apo E” gene positive (ask your doc about the genetic test for this as well). Ibuprofen is hard on the stomach for most people and so should ideally be taken only intermittently, in low doses, and with recovery periods.

Most Recommended Non-Dietary Steps
7. Sleep. Get your eight to nine hours a day. Take afternoon naps if you need them, particularly as you age.
8. Bad Stress Avoidance. Low level of cyclic stress, balanced with full recovery, is good. Dis-stress, however, is bad. Know the difference.
9. Exercise. Get sustained aerobic exercise however you can, do it in moderation every day, and keep it up for life.
10. Education Get an enriched mental environment however you can, in moderation every day, and keep it up for life.

Notes - Dietary Steps
1. Curcumin. This is the active ingredient in turmeric, Indian yellow curry spice. Asian Indians have only 25% of the age-adjusted Alzheimer’s and dementia rates of other countries. Greg Cole, PhD and others have done research to show that this is primarily due to curcumin, a major ingredient in the Indian diet.

Curcumin is lipophilic and crosses the blood-brain barrier. It is a powerful antioxidant and anti-inflammatory, and has mild anticancer effects. But it's most amazing and still little known ability is that it crosses from the bloodstream into the brain, binds to Alzheimer’s-causing amyloid plaques, and helps your immune system clear them out.

While human trials are still early with this supplement, compelling evidence already suggests (see Curcumin: A Powerful Brain Protection Supplement, John Smart, 2005 [4]) that this supplement will turn out to be even more effective than DHA/Omega-3 fatty acids at general cognitive protection and Alzheimer’s protection. Curcumin has been taken for centuries by millions of Asian Indians, and has been well studied for safety by US researchers.

Life Extension Foundation (LEF.org) sells a formula with bioperine pepper added, which gives it better bioavailability than the other commonly available formulations. You can get Super Curcumin with Bioperine from LEF.org for $15 for a bottle of 60 capsules. At the recommended 1-2 capsules/day this is a 1-2 month supply, or 25-50 cents a day, which is quite affordable. Sabinsa [5] sells a patented C3 curcuminoid complex that apparently also has good bioavailability and is used by medical researchers in their studies. You'd have to call them about price if you are interested, as they don't have online ordering.

According to Dr. Sally Frautschy, PhD, another leading UCLA Alzheimer’s researcher, each 900 mg capsule is roughly equivalent to eating about five curry dinners. To get good absorption, which is a problem with this supplement, you should take each capsule with a meal or drink that has milk, plant, or animal fat in it, or take it with your daily fish oil supplement.

Before you start it, try to take a memory test like Cognicheck [6] ($20) to get a sense of your mental baseline. Take the test again three months later and see if there is any change. Record your daily impressions in a dairy as well, if you keep one. I’ll bet you’ll be surprised, as I and others have been, that your periodic slow periods are much less frequent once you are taking it on a daily basis. They may even disappear over time.

2. EPA+DHA Omega-3 Fatty Acids (from Fish Oil). Neurons, unlike other cells, contain over 60% of their dry weight in the form of long chain polyunsaturated fatty acids (LC-PUFAs). 90% of these are either DHA, a major main component of fish oil, or a close cousin called Arachidonic Acid (AA). It is hard for mammals to make PUFAs from other dietary fats, and these special brain-protecting substances are found in highest concentration in fish, shellfish, organ meats, and wild game, all of which humans ate larger amounts of back when we had a preagricultural diet, more than 20,000 years ago.

Eating meat has its own hazards, and should be minimized in a healthy modern diet, but as this article on PUFA's and neurological disorders [7] notes, it is also true that our modern diet is PUFA-scarce, and a consensus is emerging that we are evolutionarily optimized to a high-PUFA diet.

Fish oil has an excellent safety profile and is known to be valuable for a wide range of diseases of aging (heart, joints, etc.) in addition to the brain. We keep discovering new ways that fish oils protect the brain, and in recent years we have proven that DHA both slows the age-related buildup of amyloid in the brain and also makes neuroprotectin D1, a substance that protects neurons from early cell death [8].

Enteric coated fish oil capsules will dissolve slower and lower in your GI tract than ordinary ones, so you won't have fishy burps after you take them. But if you can find regular capsules that don't give you burps, or if you can tolerate the occasional burp, it is probably best to use the regular (and cheaper!) capsules instead. That's because regular capsules will break down quickly in your GI tract, so they will solubilize the curcumin faster, which means more of it (a small but significant amount) will be able to "partition" out of your gut and into your bloodstream.

The American Heart Association [9] recommends 1 gram of Omega-3's a day ("preferably from fatty fish, not supplements") if you have coronary heart disease, and 2 to 4 grams if you need to lower your triglycerides. They propose you can take up to 3 grams a day without physician assistance. Coincidentally 3 grams/day is what a number of longevity physicians, like Steve Harris M.D. of the Life Extension Foundation, recommend for daily supplementation.

If you buy your fish oil from a major producer like Costco.com and their Kirkland brand, three grams grams a day works out ten of the regular strength capsules, or seven of the extra strength ones. Costco sells regular strength capsules for $9 for a bottle of 400, each giving 180 mg of EPA, and 120 mg of DHA Omega-3 fatty acids. At the recommended ten capsules a day this is a 40 day supply and 23 cents a day, which is quite affordable.

3. Multivitamin with E, C, Niacin and Folate. Vitamin E and C together have been shown in some studies to slow cognitive impairment, but studies with both E and C alone do not show this. Niacin stabilizes HDL levels and low HDL cholesterol is strongly associated with poor memory. Folate has also shown mild prevention of cognitive impairment, and is an excellent supplement for expectant mothers, as it reduces neural developmental defects in unborn children. It's hard to find vitamin supplements that really cover the spectrum that you need. According to a number of longevity physicians, if you are only going to take one, Twinlab's Daily One (without iron) is one of the better multivitamin and multimineral supplements.

4. Diet. The ideal Alzheimer’s prevention diet is “Pisceterian” (a word you don’t hear often), mostly vegetarian with fish as the only animal protein, and only in low amounts. Especially good fish are cold water ones high in DHA/Omega-3 fatty acids like salmon, albacore tuna, lake trout, halibut, mackerel, and sardines. Add lots of vegetables, including dark ones like broccoli, kale, and spinach, and lots of fruits, including dark ones like blueberries and red grapes.

Stay away from saturated fats, which means all meat except the cold water fish in small amounts and all dairy including milk, cheese and eggs. Cheese is nice but isn’t worth it, either to you or the animals. Free the cows, chickens, geese, deer, duck, pigs, dogs, sheep, and other close cousins you may currently be dining on or otherwise exploiting. If you can go fully vegetarian by all means do so, but I’ve tried several times and have always found I need a some animal protein once a week or so, to feel healthy, which I take in the form of fish. This may be my old habits or it may be a legitimate need that is currently not being met by my "amateur" approach to a vegetarian diet. If you have difficulty being mostly vegetarian, read a great book on nutrition and health, like The China Study, by T. Colin Campbell, 2005 [10], and you’ll have the information you need to stay on track. If you want help with your food choices and a plan for making the move, try Being Vegetarian for Dummies, by Suzanne Havala, 2001 [11].

Avoid the usual suspects like smoking and alcohol (except red wine in small amounts), and "bad" stress (know the difference). If you are already a non-read-meat eater that prefers soy milk, cheese, tofutti etc. over dairy you should find the switch away from chicken and turkey to fish isn’t too hard to make. You can find albacore tuna almost everywhere, and wild salmon is gaining in popularity. A bit harder is cutting down the total animal protein we eat. We need a whole lot less of it than exists in the typical American diet, and we pay for that with our obesity and poor health.

5. Ibuprofen. When taken in low doses long term, with interspersed with drug-free recovery periods, this drug can significantly lower your Alzheimer’s risk and delay its onset, according to a number of studies [12]. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen keep a lid on inflammatory mechanisms of your immune system, so they stop it from overreacting to amyloid plaques and tangles, so they grow slower in an aging brain. But long term use of ibuprofen can cause stomach upset and nausea in 10-20% of people, and high dose use may increase stroke risk so take it low dose, on a full stomach, and with a doctor’s supervision, and take a month or more off every few months as a safety factor.

There are new profens in the pipeline (e.g., flurbiprofen/flurizan) that apparently don’t cause stomach upset and have shown the same ability to prevent cognitive decline in animal models, so you may be able to switch to a better profen a few years from now. Unfortunately however, new designer pharmaceuticals, like the Cox-2 drugs, often also have unanticipated negative side effects that take years to discover, so it might be best stick to the tried and true ones until long term (10 year+) studies have been done.

6. Statins or Niacin. Statins like lovastatin (Mevacor) and its successors can significantly reduce Alzheimer’s risk according to a number of studies [13], though other studies have found no effect [14], so this is still a controversial topic. They appear to work by several pathways, including lowering blood cholesterol, which greatly reduces heart disease risk, which is the number one killer of American. They also lower the production of amyloid precursor protein (APP) in the brain, and lower your immune system’s overreaction to amyloid buildup.

These drugs are quite hard on your body, especially your liver. The first version of these was isolated from a poison produced by a fungus, Red Rice Yeast. See this article for a brief "hidden history" [15] of lovastatin's development. Few people realize this commonly used drug is a plant poison. As poisons they will harm your liver to some degree, will cause myositis in up to 5% of users and over the long term can, very rarely, cause severe problems like rhabdomyolysis.

With all these potential drawbacks, you would think these aren't worth the risk, but statins are still considered relatively safe by most physicians, and have been in use for almost 30 years by tens of millions of people, so the safety profile of the older ones is particularly well known. Most docs think that with appropriate supervision their potential problems can be headed off long before they become major issues, but here again, opinions differ. Statins will occasionally raise your liver enzymes as an early warning sign that your body is having problems metabolizing them, and that needs to be monitored by your physician with periodic blood tests. Because of the way statins change your body's cholesterol production machinery, if you need to get off of them you need to do it slowly, using a drug taper (decreasing dose schedule) prescribed by a physician, because your cholesterol levels will often shoot up to unhealthy levels afterward, in compensation, if you don't do a long and careful taper.

If you want to get the Alzheimer's prevention effect of lower cholesterol but don't want to use a statin there are less effective options available, such as high-dose (1000mg/day) niacin (get the non-flushing formulation). You should only use niacin under a doctor’s supervision.

Notes - Non-Dietary Steps
This article was intended primarily to summarize dietary advice, so I have only a few words to say about non-dietary steps. If you want more, read a good book like Making a Good Brain Great, by Daniel Amen, M.D., 2005 [16]. Dr. Amen was a keynote speaker at ASF's Accelerating Change 2005 conference [17], and he had fascinating insights to share on how unconscious our culture is with regard to protecting our brains.

7. Sleep. Do your best to get your eight to nine hours a day. Take afternoon naps if you need them, particularly as you get older. Read a good book like The Promise of Sleep, by William Dement, M.D., 2000 [18], to understand how important it is to your health to get regular full sleep.

8. Bad Stress Avoidance. Low levels of cyclic stress, balanced with full recovery, is good. Other types of stress are generally bad. For more on dealing with bad stress, try Stress Management for Dummies, by Allen Elkin, PhD, 1999 [20], a book filled with great tips on how to recognize and let go of unhealthy stress in your life.

9. Exercise. In moderation, cardiovascular and non-cardio exercise are one of the healthy types of stress, and both can have a profoundly beneficial effect. The benefits of cadiovascular exercise are many, but may not be obvious if you've been out of practice for a while (in other words, you will likely feel worse before you feel better), so go slow at first, with multiple mild sessions a day until you can handle intensive 30+ minute excercise intervals. Once you are in shape, the cognitive benefits of a good cardio workout will be particularly noticeable for several hours after each exercise session. A book like The Power of Full Engagement, by Loehr and Schwartz, 2004 [19], provides a great description of healthy stress, and demonstrates the endurance-building benefits of the stress plus full recovery (post-exercise nap and rest) cycle.

10. Education. With regard to Long term epidemiological studies show significant preventive effects of lifelong learning. With regard to education, read Aging With Grace, by David Snowdon, 2002 [21], for a great account of the Nun study and what it says about healthy living, including the strong correlation between a low rate of Alzheimer's and high linguistic ability. That will keep you reading the morning paper I'll bet!

I hope you live long and with great health and wisdom!

Feedback? Reach me at johnsmart{at}accelerating{dot}org.

References
1. Life Extension Foundation, lef.org. "A nonprofit organization, whose long-range goal is the radical extension of the healthy human lifespan."
2. Costco.com. A national deep discount retailer.
3. Twinlab. A leading manufacturer and marketer of high quality, science-based, nutritional supplements.
4. Curcumin: A Powerful Brain Protection Supplement, John Smart, 2006
5. Sabinsa.com. Manufacturer and supplier of high-quality fine chemicals, phytonutrients, and organic intermediates.
6. Cognicheck. Providing adults with an affordable means to screen aspects of their memory/cognitive processes online.
7. "Polyunsaturated Fats and Neurological Disorders," C. Leigh Broadhurst, Ph.D. from Nutrition Science News, Sept. 2000, Vol.5, No.9.
8. “Scientists discover how fish oil protects the brain,” Karen Pallarito, HealthDay, 2005.
9. "Fish and Omega-3 Fatty Acids," website guidelines, American Heart Association (April 2006).
10. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health, by T. Colin Campbell, 2005.
11. Being Vegetarian for Dummies, by Suzanne Havala, 2001
12. "Novel therapeutic opportunities for Alzheimer's disease: focus on nonsteroidal anti-inflammatory drugs," Townsend, et. al., FASEB J. 2005 Oct;19(12):1592-601.
13. "Association between statin use and Alzheimer's disease," Zamrini et. al., Neuroepidemiology. 2004 Jan-Apr;23(1-2):94-8.
14. "Statin therapy and risk of dementia in the elderly," Li et. al., Neurology. 2004 Nov 9;63(9):1624-8.
15. "The hidden origin of statin drugs," Shane Ellison, April 2005, Newswithviews.com.
16. Making a Good Brain Great, Daniel Amen, M.D., 2005.
17. Accelerating Change 2005. A technology futures conference produced by the Acceleration Studies Foundation.
18. The Promise of Sleep, William Dement, M.D., 2000.
19. The Power of Full Engagement, by Loehr and Schwartz, 2004.
20. Stress Management for Dummies, by Allen Elkin, PhD, 1999.
21. Aging With Grace, by David Snowdon, 2002.