How to Shape Your Brain Health and Reduce Your Risk for Alzheimer’s Disease

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Show Notes

Learn about Dr. Michelle Braun's book High-Octane Brain: 5 Science-Based Steps to Sharpen Your Memory and Reduce Your Risk of Alzheimer's at her website. 

Dr. Braun will be the guest speaker at the June 2021 class "Healthy Living with Mild Cognitive Impairment: Nutrition in Action," sponsored by the Wisconsin ADRC and Alzheimer's Association Wisconsin Chapter.

Transcript

Intro: I'm Dr. Nathaniel Chin, and you're listening to Dementia Matters, a podcast about Alzheimer's Disease. Dementia Matters is a production of the Wisconsin Alzheimer's Disease Research center. Our goal is to educate listeners on the latest news in Alzheimer's Disease research and caregiver strategies. Thanks for joining us.

Dr. Nathaniel Chin: Welcome back to Dementia Matters. I'm very excited today to have Dr. Michelle Braun, PhD, a neuropsychologist and national leader in the field of brain health. She earned her undergraduate degree in cello performance and psychology from Carroll University in Waukesha, Wisconsin, and a doctorate in clinical psychology with a minor in neuroscience from the University of Wisconsin–Milwaukee. She continued her training at Yale and Harvard and has worked for 15 years as a clinical neuropsychologist in hospitals and academia. In 2020, she published her first book, High-Octane Brain: 5 Science-Based Steps to Sharpen your Memory and Reduce your Risk of Alzheimer's. Dr. Braun, welcome to Dementia Matters.

Dr. Michelle Braun: Thank you! It's an honor to be here.

Chin: I'm excited to have this podcast with you because I'm excited to talk about your book, but I also want our listeners to know that you will be a guest speaker at our June 18th Healthy Living with Mild Cognitive Impairment class where going to talk more about nutrition in action. Before we delve into your book and its recommendations I'd like to get an overview from you on some of the common misconceptions surrounding normal aging, especially because you're a clinical neuropsychologist. What are the most common complaints you hear from patients that can be attributed to normal aging?

Braun: That's such a great question because what I have come to call ‘brain blips’ really encapsulates a lot of those complaints and questions that people have about normal aging. Really, at the top of the list is this idea that, I walked into a room and I don't know why and I forgot. We start to notice that happening just a little bit more over time, but interestingly that happens for children as well so it's important for us to normalize that a bit. We also have this phenomenon of the objects that we use most on a daily basis – our glasses, our keys, wallets, purses – where we use those so many times that our attention might not always be focused on where we put them. Misplacing objects is another really common brain blip that increases over time. I think, personally, the most frustrating and the one I hear most frustration about from people are word-finding difficulties. These are those episodes where we know that perfect word we want to say but we can't articulate it in the moment, and frustratingly those happen a bit more with age as well. Now on the flip side, I think it's also empowering to know that there are misconceptions in a negative direction as well. For example, people are often surprised to learn that with age we become better with decision-making and our vocabulary and factual knowledge improve as well. We've got that upside of aging that's really important to emphasize too.

Chin: Well, that last part I think is really important. Is that the part of your book where you talk about brain health myths and what those are? Because if you could share some more more examples with our listeners about this conception of aging and what that means and really people's misunderstanding about it.

Braun: Sure. There is a conception, a widespread idea, of aging equals decline. There is this really important research suggesting that we can imagine ourselves as the driver of a car, so to speak. We think of the car as our heredity. We think of that as the things that were established in the past. For example, our educational experiences, things that may have happened before. We can also imagine that our health, in general, is part of the car. If we imagine ourselves as the driver of that car and having the ability to engage in specific lifestyle changes that make a difference with regard to our aging, we suddenly can shift those myths and become empowered. We can take that thought process of decline and flip it, really, and talk about how can we age at our most optimal, individual level. That's actually what the high-octane brain is, is this idea of, how can I be at my personal best level of brain health given that car that was kind of given to me, and that I'm driving, and know that the research is there to support. We can all do that.

Chin: Well, and that speaks to what you call three possible brain health trajectories that a person can follow in their life. Can you explain for our listeners, what are these three possible brain trajectories?

Braun: If we just take a moment right now to imagine ourselves in five years. Here we are in 2021 and we have this magic time travel ability to go to 2026 and just take a mental snapshot of what we might imagine we would look like in five years and what we might imagine we're doing in our typical daily environments, and we really crystallize that image. I like to think about the idea that all of the choices that we make from this moment on until that point are going to add up into a specific trajectory. For – in a way of simplifying it, the trajectories, there are really thousands of paths we could take but we could really conceptualize those in three different buckets, so to speak. One is the trajectory that most people will follow, which is the trajectory of normal aging where there will be normal bodily changes and normal brain-related aging changes that we all experience. The second trajectory is that of accelerated-aging where you can imagine that there would be an increased risk of Alzheimer's or cognitive impairment on that trajectory. We can talk later about how the different engagement with lifestyle factors fits into those trajectories, but the third trajectory is the most exciting for many people. That is that trajectory of optimal aging where we really can use research-based strategies to optimize our brain health over the next five years or the next ten, twenty, etc, with engagement in specific factors. That optimal aging trajectory is what I call the high-octane brain.

Chin: Well, that's a perfect segue into my next question which is, what does a high-octane brain trajectory look like?

Braun: Excitingly it means that we have the ability to make our brain younger than our chronological age, and with that ripple a number of positive benefits. The first is that there is less atrophy in the high octane brain or that optimal aging trajectory, meaning that the tissue in the brain shrinks. It shrinks for all of us at a specific level based on a number of factors but we can change the magnitude of that shrinkage with engagement. It's a brain that has less of that shrinkage. It's also a brain that has a lower risk of Alzheimer's and a slowed rate of cognitive aging. What's really neat about that is the very lifestyle factors that make that possible also just so happen to be lifestyle factors that increase well-being and happiness. It's like this really incredible home run. It's this synergistic effect that people experience.

Chin: So it's not really just a brain health trajectory, it's an overall well-being, overall health trajectory too.

Braun: Absolutely.

Chin: Now you talk about three navigational forces that influence these brain health trajectories. Can you tell us more about these?

Braun: Sure. I'd love to go back to that car analogy again because I feel like that really encapsulates not only the forces themselves, but also our interaction with those forces. The first is what we call foundational factors. Those are the components that, again, kind of happen in the past for us. That's what we inherited. That's our genetic makeup. Those are things like our family history as well. You know, many of us don't specifically know our genetic makeup, but we know our family history or some aspects of that. It also includes things like our age and our factors like biological sex, gender identity, for example, and those developmental experiences. So imagining again those things happened in the past, they kind of make up the car, so to speak. That second piece, the navigational factor related to our health, is also really crucial because as we know vascular risk factors, things like high blood pressure, cholesterol issues, diabetes etc cetera, really can modulate risk for dementia and cognitive impairment. In addition to vascular risk factors, there can be issues like sleep disorders, or epilepsy, and even other health related issues like medications. We can kind of consider all of those health related factors as navigational force two. Number one and number two, our foundational factors; and our health related factors again are the car. Factor three, which is the actual lifestyle navigational force, is the driver which is us. I imagine that as an inflection point. If we think about the power of an inflection point, it is that point of choice where we gain the greatest ability to change our future trajectory because the research is wonderfully clear that we have the ability to shape forces one and two by how we drive that car.

Chin: This speaks to this concept of epigenetics, which I know you go into in your book. Could you briefly just let our audience know – and they've heard this word before in other podcasts but – your perspective on epigenetics and the power of epigenetics?

Braun: I'm so glad you asked that because that's such an exciting area. It's really been a burgeoning frontier. I think this is really an x-factor for Alzheimer's research because epigenetics says to us – I like to think of it as a dance. Our genes are one partner in the dance. We are the second partner. As we know when we think about dancing and in a partnership, those movements are influencing one another. So epigenetics uses something called DNA methylation, DNA being one of the core ways in which our genetics are expressed and communicated. The research shows that by engaging in specific behaviors we can turn on or off our genetic factors through that phenomenon of DNA methylation. That's basically just a fancy way of saying that what we do makes a difference in how our genes are expressed. With Alzheimer's, in particular, why I think it's an x-factor is because, as we know, 99% of cases of Alzheimer's are not genetically caused. So while there may be a genetic risk, we have really clear evidence suggesting that the lifestyle factors that make a difference make a difference to the same or greater extent for individuals who have a genetic risk. Furthermore, what's even more exciting is that 1% of individuals who do have genetically-caused Alzheimer's who will develop it research shows that they can actually back up the timeline of symptom expression by 15 years or more, and interestingly actually decrease the level of cellular abnormality by exercise, for example. What I love about the concept of epigenetics is along that whole continuum, even on that edge where we're talking about that 1% of genetically-caused Alzheimer's, we still see epigenetics make a huge difference.

Chin: That is really profound and powerful. Of course then that leads into, what are these health behaviors that you've written about? So the high octane brain incorporates five key lifestyle factors, all of which are evidence based. You have a really nice acronym for them called EXCELS. So can you explain briefly – because we'll go into more of the details later on – but explain to us what are these five factors that make up EXCELS?

Braun: Sure. The five factors that make up EXCELS really are, as you mentioned, the heart of the book because then the question after we learn that this is possible, that we have the power to shape our trajectory, it becomes a question of now, how do we implement that? I really wanted to create an acronym that provided a user-friendly way of referencing back. EXCELS.  E-X-C-E-L-S – the EX is for exercise. We'll go into, as you mentioned, some of those details but I really have that as the foundation based on a number of factors. C is for consume healthy food. E is for engage and learn. L is for lower stress and boost well-being. S is for sleep for brain power.

Chin: And based on your book it does seem like you're recommending a certain approach to these lifestyle changes, starting with exercise and ending with sleep, doing all of them at a certain sequence. How did you come to that order?

Braun: Well, that's really such a great question because that was a huge component in this book and writing this. Really, I went back and forth on that because as we know trying to compare research across studies, et cetera, is really a challenge. What I wanted to have as my leading edge was having there be a system that truly was helpful to people in making change. I let that really be the leading edge, what we know about the science of motivation. What I had observed clinically over the years was when I would talk about these multiple factors, there would be a bit of a dilution of the information, almost a little overwhelming. Like, well how can I do all of those things? So I really wanted to be able to provide a stepwise program that people could follow. I went back to that research again and I said, ‘okay if I have to compare these and really give somebody a method to follow, where is the easiest entry point, possibly, that also has the greatest research support?’ That's where we start with exercise. Surely, exercise, in part, has the greatest support because we've known about it for the longest. Of course there's more research on it, whereas sleep on the other end of the spectrum is really much more of a burgeoning area. By definition, there just isn't as much research. It's important to know while these are research-based, based on the strength of the available research and integrating the WHO guidelines – World Health Organization guidelines – that we do always have to tailor these. For example, if we know somebody has a particular issue with sleep we wouldn't wait until step five to address that. We're always tailoring these for each individual.

Chin: And I'm really appreciative of that last part too, because I wasn't sure if I've been doing it incorrectly by recommending sleep ahead of time. You're right, so the personalized medicine approach. You did mention exercise has the most evidence and it is a really profound lifestyle change. In regards to that, what do you tell your patients, though, about its benefits to brain health, and in particular how do you recommend someone start a new exercise plan if they have not already been a regular exerciser?

Braun: I'm so glad you asked that because I get so excited about exercise, in particular. I know you and our other colleagues do too because we're just so moved by the strength of the research. Part of the challenge I have experienced is communicating that excitement because of this saturation effect that I think happens with folks. Most people, if you stop them on the street and you say what do you think you could do to improve your health, they'll say exercise and diet. So in some ways when we say those things they go, ‘I already knew that’. The question then becomes how do we communicate this in a poignant way that moves the heart and that is salient. I really have tried experimenting with many, many ways and I've come to this. I see people light up much more when I say, “I'd like you to take your thumb and curl it and just look at it for a second. I want you to imagine that that curled thumb shape structure is about an inch and a half in under each of your ears and towards the center of your brain. It is sitting there as your memory switchboard. It is the place that within milliseconds takes in new information, packages it, and sends it off. It's an amazing organ and it's called the hippocampus. Would you like to learn how to grow that area? Would you – wouldn't it be great if you could make that area denser and faster?” And then they say, “yes,” and I will talk about the idea that exercise, cardiovascular exercise, is really the only proven strategy we have to increase the density of that area through growth factor. Of course exercise impacts the brain overall, but research is really clear that it is preferentially targeting that hippocampus which is where Alzheimer's most often begins, and also targeting some of those frontal circuits. We think – I call the hippocampus park place, and I call the frontal lobe boardwalk. I say, you know, if you had to choose two areas of the braid that you wanted to strengthen, we would have those at the top of the list. Guess what? Cardiovascular exercise does that. Getting back to your other point, I often will reframe the word exercise into movement with joy. I'll call it ‘movement with joy’. What do you do that gives you joy when you move? That opens up a whole new conversation where we start talking about dance and I love walking and hiking in nature. I love archery. You know, various things we wouldn't necessarily conceptualize as exercise out of our ways of thinking about being in a gym on a treadmill, which is not how most cultures move with joy or most people move with joy. Then when it comes to, when we distill what that movement with joy is, then we talk about – how often are you moving with joy? How often is that happening? Can we maybe increase that just by a minute or two? Having there be an intentional celebration of those small successes is key, as well making sure people involve people or animals in doing those activities if they like. In other words, broadening the idea of exercise, again, making it tailored and joyful.

Chin: And I was actually going to ask you, is exercise a dirty word or should we be using other terms, and I really like movement with joy or physical movement or activity. That makes perfect sense, and like you said incrementally increasing one's ability to do it. We're not going to be able to cover all the five EXCELS factors today in the podcast. However, Dr. Braun has agreed to do a book club discussion with a Q&A this fall for Wisconsin ADRC’s newest program, the Mind Readers Book Club. And so I'm going to ask our audience listeners, please check our website for more details on this upcoming event as we will be asking more questions relating to the remaining factors. As I came up with the questions for today, Dr. Braun, I have many more that I know that our host will be asking you as well. To end, I would like to delve a little further into the healthy eating. Your chapter in this is so well done and I'm hoping you can highlight some of what you call the “top takeaways” in your book. What diet do you recommend for brain health and why?

Braun: This is such a hot area. I recommend the MIND diet for brain health, which is a Mediterranean and DASH diet influenced diet. It's important for listeners to know that the Mediterranean diet and the DASH diet have randomized controlled trials supporting their effectiveness for brain health, so those are wonderful as well. What's interesting about the MIND diet is that in some research you can see that it's twice as effective in protecting against cognitive decline. What I always love about trying to impart these techniques is how practical is it. We're in the clinic trying to change lives and I like the idea that the MIND diet is successful even with partial dietary compliance. For example, people who followed it for four years at full compliance had a 53% reduced risk of Alzheimer's, which is amazing, but even people who followed it partially for that amount of time had a 35% reduced risk. We really want to have those diets that lend themselves to real life, that are practical, and where people can actually see improvement.

Chin: And I think it's probably safe to say that you probably follow the MIND diet, at least partially?

Braun: Yes.

Chin: You know, I wonder for our audience, to something personal. What have you found to be the biggest struggle in following the diet?

Braun: As a native Wisconsinite, I have founded a struggle to minimize cheese consumption. One of the takeaways of the MIND diet, which is sort of surprising and it's a bit different than a lot of the fad diets, is its focus on minimizing saturated fat because saturated fat has a number of negative impacts on tissue which we definitely will go into during the talk I give. That's been a struggle for me. So what I've tried to do – and I was able to chat with Dr. Martha Claire Morris who with her team created the MIND diet and she gave me some really tailored suggestions. She said, you know, let's imagine cheese as a compliment to a dish as opposed to a main part of a dish. Also having cheese that – you know, we enjoy cheese; you can have lower fat cheese too. I've really tried to shift that for myself.

Chin: And so, how should people get started when they're interested in making these dietary changes towards a MIND diet? Then, what do you think are the most important aspects of the diet and things? And really a third question. What are the key things to avoid, as far as just generally?

Braun: What I love about MIND, which is again different than Mediterranean and DASH, is there are ten foods that are emphasized as brain healthy foods. What's different is there are five foods that are emphasized as brain-deflating foods, and so it's so helpful to know what we want to minimize overtly. I really look at the superstars, again, with this eye towards how do we make this doable for most people. I tell people, if you can just add one serving of dark green, leafy vegetables a day that actually was associated with decreased brain aging at a rate of 11 years over a period of ten years, which is amazing. Then I focus on the berries as well because that's really the second most powerful food. We're looking at that two to three times per week. So those are the superstars. I emphasize if you can get the superstars in, then we can move on to the next parts of it. Again, with this idea of that's how people change, it is incrementally. They're not necessarily going to take on the whole diet. Then also emphasizing, on the flip side, trying to minimize the saturated fat.

Chin: And what is your response when patients ask you about supplements and brain health?

Braun: I tell them that we would absolutely love it if there was a supplement we could stand behind and that there has been a feverish look into whether supplements make a difference. Unfortunately, the research consistently shows that there is no benefit to brain health from supplements unless an individual is nutrient deficient in a specific nutrient or vitamin, which is really the minority of people because food is really the source that we want to focus on for nutrients. The other thing that I highlight is that there is no FDA approval for supplements. One really stark and kind of funny way of putting that into perspective is there is this dog food called Purina Bright Mind, which is made for senior dogs and the amount of clinical trials that Purina had to go through to show that that dog food actually helped cognition in older dogs was far greater than any type of proof that supplements have to offer for people. If we put it in those terms, I think people really understand how unregulated that industry is.

Chin: Lastly, where do you stand on alcohol consumption and brain health?

Braun: It's interesting to look at the research here because it's a little counterintuitive. Basically it suggests that people who have – women who have one drink a day, men who have one to two drinks a day, have a lower rate of dementia or Alzheimer's than people who don't drink at all. It's unclear exactly why that's the case, although some leading research suggests perhaps it's because of the positive effect that small amounts of alcohol could have on cardiovascular health. What I always like to talk about is that it's sometimes challenging to have that small amount. Anything over that is toxic to the brain. If you're sure that you can kind of stay within those minimal levels that could potentially be helpful, but I also, again, come back to that tailoring. We know a number of individuals that may have some challenge controlling alcohol consumption or who had difficulty with alcohol in the past. We would want to be very careful about having them follow that recommendation and that may not be a good recommendation for them. I also tell people that the research on this, in my opinion, isn't strong enough to suggest that somebody who doesn't drink or prefers not to drink suddenly start picking up alcohol use to enhance brain health. I mean, there's definitely a consistent finding but it is more of a minimal finding.

Chin: I wish we had more time but since we don't, I'm going to leave us with that answer. So thank you, Dr. Braun, for your time today and all of your insights.

Braun: Thank you so much.

Outro: Please subscribe to Dementia Matters on Apple Podcasts, Spotify, Podbean, or wherever you get your podcast. And rate us on your favorite podcast app; it helps other people find our show and lets us know how we're doing. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health and the Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Rebecca Wasieleski and edited by Bashir Aden. Our musical jingle is "Cases to Rest" by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments email us at dementiamatters@medicine.wisc.edu. Thanks for listening.