Nutrition Essentials: How Diet Can Reduce Your Risk of Alzheimer’s Disease with Kasia Rothenberg, MD, PhD

Podcast Transcript

John Horton:

Hey there and welcome to another Nutrition Essentials podcast, an offshoot of our popular Health Essentials Show. I'm John Horton, your host. By the time I finish this sentence, statistics say that someone somewhere in the world will be told they have Alzheimer's disease. That's a life-changing diagnosis delivered every six seconds around the globe. Now, age, genetics and family history, risk factors we cannot change are considered the driving forces behind this form of dementia, but that doesn't make us powerless when it comes to limiting cognitive decline. Research suggests that up to 40% of dementia cases may be attributable to eight modifiable risk factors with one of those being diet. So today, we're going to take a closer look at how what we eat affects brain health. As always, we have registered dietitian, Julia Zumpano with us to talk about the issue from the nutrition aspect. To learn more about Alzheimer's, we brought in an expert from Cleveland Clinic's Lou Ruvo Center for Brain Health. Julia, who's our guest?

Julia Zumpano:

We're joined today by Dr. Kasia Rothenberg, who specializes in geriatric psychology. She's a part of a large team at the Cleveland Clinic working to treat people with neurodegenerative disorders such as Alzheimer's. One piece of that process is diet. I'm looking forward to talking to Dr. Rothenberg about how eating certain foods may increase our chances of staying mentally sharp as we get older.

John Horton:

Oh, it should be a fascinating discussion, Julia. So, let's get started.

Dr. Rothenberg, thanks so much for joining us on the Nutrition Essentials Podcast to explore this connection between diet and Alzheimer's disease.

Dr. Kasia Rothenberg:

Well, thank you for having me. It's extremely important to put as much attention as possible to Alzheimer's disease nowadays.

John Horton:

Well, I could not agree with you more. And Dr. Rothenberg, when we met ahead of time to chat, one thing you emphasized is that there are no definites when it comes to preventing Alzheimer's. I mean, this is an incredibly complex disease with no simple solution. So, I guess spoiler alert for everyone, there's no magic food to keep the disease away.

Dr. Kasia Rothenberg:

Yes, indeed. What I really wanted to come from this podcast is that we are not advocating for one fruit or one type of a diet or even one intervention. We really want people to know that it's extremely complex situation, and we have to really look holistically at the person with condition, or even if we take a step back and try to protect ourselves from going into the process, we have to look at whole thing more holistically.

John Horton:

Well, yeah, and that's what I was going to ask you to explain a little more. I mean, I think a lot of us all we're familiar with it and we kind of know what the effects are, but I don't know if a lot of people really know what's happening inside your head to bring that on. So, can you kind of give us a little Alzheimer's 101 to get us started?

Dr. Kasia Rothenberg:

Correct. So, Alzheimer's disease is, it's a condition which we call multifactorial, and here comes the trick. When we say multifactorial, that means that really we don't really recognize one reason. So, we know that there are multiple different reasons which cause this problem. There's another trick with Alzheimer's disease that it's a disease which comes with aging. So, per definition, we know that the condition develops for long, long, long, long time. And so, what we capture in clinically, what we see, memory loss, some difficulty navigating, changing the way people think, et cetera, et cetera, it's just the end of a process. And of course, everybody is extremely interested how to recognize, how to capture the problem earlier. And we know that really to capture problem earlier, we will have to go back like 20, 30 years. So, that's why the difficulty. We don't know when the process starts. We know that there are multiple different things which put people on the trajectory. That's why it's extremely hard to say, well, how to stop it, how to prevent it.

John Horton:

Well, then I know genetics and family history is a huge part of it, too. Correct?

Dr. Kasia Rothenberg:

Yeah, there's definitely genetic component. Some people are prone for Alzheimer's disease. We always ask about family history, so we know that the condition runs in families, but it's not that there's a genetic condition. So, once again, we can't point to one gene which is responsible for the process. Now, we know, as well, that we may have those genes which prone us for a process, but concomitantly, we may have some protective genes. So, once again, another piece of a puzzle. When we talk about Alzheimer's disease, of course, people learn about this condition from media, and there's a lot of buzzwords, amyloid flux, tau protein, all those things. Indeed, when we look at Alzheimer's disease from a descriptive perspective, indeed when we look at the brain, we see certain type of the pathology. So, those Alzheimer's disease related plaques, which like clumped proteins or some tau protein, which is inside neurons.

We see that when we look at the tissue, when we look at the brain. But all those marks, hallmarks are the part of a process. The essence of the condition is that our neuronal cells, our brain is not working properly, and those neurons which make us alive, make us do everything, think, walk, talk, etc, stop working properly. They produce all those false proteins. Eventually, they stop working and fall apart. So, when in the end of a process or somewhere on the trajectory, when the process is extremely advanced, we look at the brain, and we see atrophy. We see shrinkage.

John Horton:

So, all these factors that we've talked about so far, age, genetics, family history, as we said, are all things we can't change, which is kind of a bummer. But as I was reading up on this ahead of time, I saw that there are a lot of modifiable risk factors that research seems to show can have a pretty big impact on whether or not Alzheimer's advances very far. Is this something that you've seen a lot of?

Dr. Kasia Rothenberg:

Yes, absolutely. Absolutely. The moment when we learn about what Alzheimer's disease like superficially is all about, obviously all the attention went how to remove those proteins, how to stop those proteins from forming, how to modify those signs and symptoms. But now, we know a little bit more about the fact that we have to intervene early. We have to help people build up the base. We have to help people build up their resilience to certain conditions. And once Alzheimer's disease is one of them-

John Horton:

And that is why we're here today to talk about building up that base and looking at that very specific modifiable risk factor, which is diet. So, from everything that I read, it sounds like the choices we make at the grocery store and at our kitchen table can have a pretty big impact on brain health and cognitive function.

Dr. Kasia Rothenberg:

Oh, absolutely. So, I'm very happy that I have dietician here with us.

Julia Zumpano:

Hi.

Dr. Kasia Rothenberg:

Hi, Julia. It's extremely important to look at a diet, and this is kind of surprising that only now we start really paying attention to that, given the fact that we are what we eat, correct? We eat every single day. We need to eat to build our body, to build our mind. This is kind of embedded in everything. We have to build from what we eat.

Julia Zumpano:

Absolutely. And I think that as you mentioned, we need to start early and making these healthy food choices as early as possible or really end in positive outcomes long term. As you mentioned, this doesn't happen overnight. You see progression over time. So, we just need to feed our bodies and our minds these foods that we know that are going to be nourishing to them. Unfortunately, the standard American diet, and now it's expanded throughout the world, we're consuming way too many processed foods, chemicals and dyes and artificial sweeteners and things that we know wreak havoc on our whole body, including our mind, and it does not promote positive cell growth and can degenerate function of your brain, as well as other organs in your body. So, it's very important that we start as early as possible and make changes to really help support our health. We heard about all the different kinds of diets that could be helpful, but in the end, it's really just following more of a whole foods based diet, clean-based diet with minimizing all of these added ingredients and unnecessary preservatives that can be avoided.

Dr. Kasia Rothenberg:

I love that. And let me take a step back and offer some of my private look at the diet. It'll explain immediately why I am paying attention to food right now, even though I am trained as a pharmacologist, I am a physician, I am a person who is intervening with medication, this and that. So, this concept of healing or helping people with a diet, it's not really my piece of pie. And being an Eastern European, I grew up in the culture where we have a good approach to food, maybe not necessarily about the quantity and quality of food, but how we eat. And this is what I noticed being even more important than the specifics about content of our diet, our approach to feeding, the philosophy of feeding ourselves approach to food, all the culture around food.

For example, what's shocking to me is that people do not eat at the table. They do not eat sitting down. They don't concentrate on eating. We inhale tons of fast foods, of calories of something which is really not really healthy, on the go, and this is probably where we should start, like we approach food. What does it mean not only to eat healthy, but what is that process? Is that process important?

Julia Zumpano:

Yeah, I would agree with you. I mean, I'm also of Eastern European descent, so my mom had a large garden in the backyard, and we picked the vegetables and made the salad, and most of the food is made from scratch and purchased fresh within the last couple of days, and it was a family event. Everybody participated in preparing the meal, and we all sat together at a table, as you mentioned. We're never allowed to eat in any other room, but on the table. So, I do feel like we've gone away from some of those habits, those really core-based habits of being relaxed when you're eating, being involved in the food that you're consuming, whether you grow it or purchase it, prepare it, and create a lot of tradition around eating, which can increase our mental health as well, which I know some of the Alzheimer's dementia, some depression has been associated with that or negative mental health outcomes, I'm sure has a connection. So, just creating a community and more of a ritual around eating, I think, is really important.

John Horton:

Dr. Rothenberg, on that point with kind of making a meal an event, just those other aspects of it, the conversations, the habits, the traditions, does that also help cognitively just to keep all those neurons firing?

Dr. Kasia Rothenberg:

Oh, absolutely. Because obviously at this moment when we realize that it's not only about a quantity and quality of food, it's about the culture of food, it brings all the other element of building the base of protection, like socializing, exchanging, sharing, even the way we obtain food, being involved in a preparation of food, the way we live our life, how we exercise. Do we know the balance between expenditure and alimentation? Is it easy for us to find this balance between how much food we need? Well, the way we portion our food when we eat at a dinner type with others, obviously we share, we portion, we know what we put on our plate. To begin with, we have a plate. We don't eat from the box or from the back. We mix different types of food, correct? We are adding vegetables. We are sharing mashed potatoes. We are reaching for something else on the table. Absolutely. To my mind, everybody knows nowadays, it had been everywhere on media, the whole concept of blue zones.

Now, we recognize that they are those parts like cities or towns or villages in the world where people live for long, long time, relatively healthy. One of those spots is in Loma Linda, California, and now, it's not far from let's say Silicon Valley, but people in Silicon Valley, they don't live healthy to be 90, almost hundred. But somehow, people in Loma, Linda, they do. The same in Sardinia, in Greece, in Okinawa, Japan. When I was watching those scientific articles and reporting about those blue zones, and what is really common between all those places is how people eat because obviously they use naturally occurring in their regions produce, but the common thing is the fact that they eat together. They eat plants. So, we will go into that in a second probably, but they eat together. They prepare food together. They obtain food together. They share. It's at the dinner table. This way, it's extremely nourishing, not only for the body, but for the mind, as well.

John Horton:

That is such a wonderful way to put that and something, to be honest, I didn't even see our conversation going that way, but it's such a great concept to build this whole meal experience into your health in that it helps nourish your mind as you're preparing the food and putting everything together. It just makes a lot of sense. You're going to get a lot more out of making this whole meal than unwrapping a burger at the table.

Julia Zumpano:

Absolutely. I also agree that it's something you're sharing with others, right? So, that's another main theme is that you're sharing it with your family or the community, and that's priceless. It's really important to have that connection, whether you just do it once a day or up to three times a day because we are eating every day, and everything we do is better done when it's done with someone else. So, it definitely brings more joy and happiness and community, and it's been shown that people tend to eat less when they eat with others. They tend to eat slower. They tend to make better food choices. So, those also can help just in overall nutrition, whether you're trying to prevent Alzheimer's or you're just trying to stay as healthy as possible.

Dr. Kasia Rothenberg:

It really puts the whole concept, they call the whole philosophy of food and nutrition in the right place. We eat because we need to eat for our own good, for our survival. We don't eat because we are stressed out. We don't eat because we are lonely. We don't eat because well, we have nothing else to do. We don't eat because we are excited about somebody running hundred meters really fast, and we know all we can do to help him run is put a hand in a bag of chips, all those things.

John Horton:

Since you brought up diets and especially the Mediterranean region, that seems like a perfect segue to get into some of these eating plans that are kind of touted as maybe being able to help limit Alzheimer's. And obviously, one of the big ones is the Mediterranean diet. Well, we also have the DASH diet, the MIND diet and the keto diet. Luckily, we've Julia here to kind of walk us through a little bit of what all of those mean and kind of the main foods that are in them.

Julia Zumpano:

So, most of these diets are quite similar in the basis of the diet. So, the Mediterranean diet is again surrounded around those Mediterranean countries and what they normally consume, which is a lot of fresh fruits and vegetables, whole grains, fish, extra virgin olive oil, nuts, legumes. So, that's the foundation there. Some wine here or there depending on what region you're looking into.

Then, the DASH diet stands for Dietary Approach to Stop Hypertension, and it is also more heavily plant-based. It's a higher carbohydrate-based plan, little lower in protein, but still includes protein. It's a little bit more abundant in dairy than the Mediterranean diet is, and it does limit fats a little bit more. But still the key to the DASH diet is high plant-based food, so fruits, vegetables, and grains.

And the, the MIND diet is a combination of those two. It's a combination of the concepts of the Mediterranean diet with a little bit of the concept of the DASH diet, so it kind of mends the two together. And of course, it encourages certain foods like polyphenols and antioxidants that support brain health, omega-three fatty acids, so it's taking it an extra level to kind of really push those nutrients that are going to support brain health.

And lastly, the Keto diet is the one that's probably the most different of the four. And the Ketogenic diet is where you are consuming a majority of your calories from fat. Carbohydrates are very low, and protein is moderate to low depending on the plan, but it is mainly fat-based, so you're consuming up to 80% of your calories from fat. So, that is shown to improve metabolism. Ketones can be an energy source and helps really decrease inflammation. It increases different aldosterone levels. So, there is a lot of great benefit to the ketogenic diet. It's been shown to help with decreasing seizure activity, and it is foundationally, like I said, high fat, moderate protein, and then you do get your carbohydrates only from vegetables alone.

John Horton:

It sounds like all of these are very heavy on vegetables, fruits, whole grains, just, I mean everything we kind of associate with good, healthy eating.

Julia Zumpano:

Absolutely. Yeah. The keto doesn't have fruit in it, of course, because we're creating ketosis extremely low in carbohydrate. Most fruits are avoided except small to moderate amounts of berries. But yeah, they're all mainly whole food based, so none of them allow processed foods in their core reasoning. Of course, we can infiltrate processed foods into any diet and try to justify it, but the foundation is limiting or avoiding processed foods, added sugars, really looking at whole core real food ingredients is the foundation.

John Horton:

And obviously, there is a ton of information on all of those diet plans. We could do shows on each one of them. So, for our listeners, if you're looking for more information, we'll have some links to articles attached to these wherever you're finding this podcast. And you can also go to health.clevelandclinic.org and find just a boatload of information on all of those diet plants. So, just if you want to learn a little more, it's there for you. So, Dr. Rothenberg, I know you wanted to make a point in particular about folks being careful not to be lured to certain foods on promises that they'll solve Alzheimer's or just suddenly reboot your memory.

Dr. Kasia Rothenberg:

Oh, absolutely. And that's why we both, me and Julia, we go into this kind of a concept of diet or variety and not to focus ever on one thing. Why I am kind of so particular about it, because I see it in the clinic. People would ask me, "Do you think that pomegranate juice, it's good for me?" I even noticed it in my own family. Well, we've visited my husband's family, and I saw that they add blueberries to everything. And the concept is blueberries are good for us. Absolutely, they're good for us, but it's not the diet. Correct? It's not the produce that we should be eating.

Now, there is even a little bit of dangerous simplification here because if we focus on one, we are avoiding the essence of a healthy diet, which is variety. Variety, in general, it's a spice of life, and it's definitely a spice of a healthy diet. And this is what it's common between all those various "healthy" diets, variety. Two things, mostly plants, but different various plants. So, saying that we know that tomatoes are rich antioxidants, and they're good for us, and they go heavily into Mediterranean diet, but if we eat only tomatoes, we are not going to cover what we need to cover.

Julia Zumpano:

I couldn't agree more, Dr. Rothenberg. I always say that, "Eat the rainbow." So, we want a food from every color of the rainbow every day if you can. So really, variety is essential. I also challenge my patients to buy a new fruit or vegetable every time you go to the grocery store. Try something new. I think we all get into the traps of eating the same. So, it's really important to add variety. Essential. I completely agree.

John Horton:

And Julia, I take it this also, we want to emphasize here that people should not be drawn to fad diets that kind of pop up with a lot of promises, and you just need to kind of focus on these sound eating plans that you can do for years and years and years.

Julia Zumpano:

Absolutely. Fad diets very rarely have any clinical data that supports their use. They're usually designed to produce an outcome very quickly, so they're very restrictive, and they're not sustainable, and oftentimes not healthy. So, we want to focus on really whole foods as Dr. Rothenberg beautifully mentioned. Majority of your foods coming from plants, and you want to add variety as much as possible and minimize processed foods. So, it's really very simple.

John Horton:

Dr. Rothenberg, you had mentioned people coming into the clinic with ideas in their head that they found online or in talking with people that you kind of need to talk with them about a little bit. Are there any other kind of eating or diet related myths related to Alzheimer's that you routinely have people ask you about?

Dr. Kasia Rothenberg:

We as a society, we love those abbreviations. We love simplifications. We love buzzwords. When we squeeze it out, people may understand it like, "Well, I have to eat a lot of fat." Or, "Coconut oil is good for me." So, what does it mean? How does it translate into everyday diet? Well, that, "On the top of what I had for dinner, I am eating free full spoons of coconut oil or something like that. Or peanut butter." No, no, no, no. The oils, essential oils embedded in a diet are. Coming with certain food. This is the essence of what is good for us. We have to be careful how we implement what we hear on the news.

Julia Zumpano:

I couldn't agree more. I think most of my job as a dietician is debunking myths that are out there in the media all the time every day.

John Horton:

So, Dr. Rothenberg, when people do come in and they have these questions, are there certain foods that you recommend that they gravitate toward and ones maybe that they should stay away from?

Dr. Kasia Rothenberg:

Yes, yes. From all the diets that we discussed, from all the healthy eating approaches that we discussed, I definitely start the discussion with my patients about eat food. I encourage them to eat food as natural as possible. I encourage them to keep good eating habits to eat like three meals a day. I encourage them to implement a little bit of keto or intermittent fasting approach, which in my mind means do not eat at night. Stop eating at least three hours before. In terms of a content, I do believe that the whole concept of MIND diet, it's the most inclusive and the easiest to advise or recommend to most of my patients. And how so? Because even when we look at abbreviation MIND, it's not about human mind. It happens to sound like a human mind. But in fact, it was Mediterranean intervention into neurodegenerative delay. This is the extension of abbreviation, Mediterranean intervention to neurodegenerative delay. And in fact, MIND diet grew out of DASH diets, so there's not huge difference here.

John Horton:

I want to touch on something that you brought up there too, which was skipping meals. And I know one of the things that's big with brain health and maybe the development of Alzheimer's is being malnourished. It seems like almost as much the flip side of being overweight. So, it seems like you really need to find a healthy balance where you're routinely nourishing your body and feeding your body and not going too far to either side.

Dr. Kasia Rothenberg:

Oh, absolutely. And well, he opened Pandora box because at this moment we will have to really give a full picture, bring all the other interventions like exercise, expenditure, mental activities, et cetera, et cetera. But yes, we know from scientific data that both extreme malnourishment and over nourishment are a risk factor for many neurodegenerative conditions. But let's start with basics. First of all, we have to provide our body with essentials. And first on my list in terms of advising relatively geriatric population, people older, is good, essential amino acids, protein. Many, many people who do not eat regularly, who lost the capacity or capability of preparing their own meals, they may be malnourished in terms of proteins. Slight digression, vegetarian diet may be very hard to implement when people do not cook for themselves or don't know enough about produce. So, amino acids, protein, it's the essence. We have to provide our body with building blocks, and it's not that easy.

It's not that easy. We have to think about it. So, eliminating meat may be tricky here. Eliminating dairy may be tricky here. So, this is first thing. Sometimes, we have to eliminate certain things. There are conditions, neurologic conditions included, which call for some form of elimination. The first on the list being migraine headaches. We know that certain foods feed into headaches like biogenic amines. So, there are some elimination diets that we use on daily basis in neurology and psychiatry. There is even the whole concept of diet, which would help recovery from depression. And it's a combination of elimination, paying more attention to specific nutrients. But those are very, very tricky things, and I would leave it to a specialist. The other example of those elimination are preferentially using one type of a food would be epilepsy. But we have to remember that here we are talking about a disease, a condition which needs, well, we use food here as a way of mitigating symptoms.

John Horton:

Dr. Rothenberg and Julia. We've talked about amino acids and proteins. Why are these so important for brain health?

Dr. Kasia Rothenberg:

First thing which comes to mind is neurotransmitters, most of our neurotransmitters. So, the chemicals which make our brain work come from amino acids.

Julia Zumpano:

Absolutely. I would second that. Neurotransmitters, neuromodulators, they come from these amino acids. There are nine essential amino acids. Those are found in complete proteins, mainly meat. Some plant-based foods are complete proteins, but very few are. So, you make a good point. If you are not getting enough protein, being overly restricted, like following a plant-based diet may not be for you. So, protein is essential. And I do agree as you age, as we age, we need more protein. Our muscle mass decreases just naturally. So, we need to make an effort to focus on protein. That is the primary goal. That is what I teach all my patients to focus on is are you getting enough protein? Because those essential amino acids are key. They're essential for the building blocks of all your tissues, organs, muscles. And from a side note, when you eat enough protein, you feel more full and satisfied. So, if we're eating too many carbohydrates, we're not getting that fullness or satiety, and our blood sugars are all over the place. So I do completely agree with you.

Dr. Kasia Rothenberg:

There is another little bit micro element here. Those are vitamins. When we age, we need to pay attention to certain vitamins. When we use certain medication, we have to be mindful of are we supplementing our body with enough of a vitamins. For the brain, from a brain health perspective, there's one vitamin B type, which is B-12, which we always pay attention to. And this is even the requirement first thing, before we even go into diagnosis of certain type of dementias like Alzheimer's disease, we have to check the level of those vitamins in our body. And elderly people, people who are getting older, may be depleted. And vitamins, interesting fact, vitamins are usually co factors of certain enzymes. So, they are essential for production of those neurotransmitters of building connections in our brain. If we don't have certain vitamins, our enzymes do not work properly.

John Horton:

Both of you have laid out really well how you can start working to prevent Alzheimer's and this cognitive decline early in life by just making sure you have a healthy diet throughout. I mean, no matter what your age, you can kind of start helping your older self early. But let's kind of shift a little bit and look at when you are older and maybe even you're beginning to show some early signs of Alzheimer's. How important is diet at that point in kind of controlling the disease?

Dr. Kasia Rothenberg:

Of course, it can go either way. I can give you very brief answer or very detailed answer, but a brief version is that MIND diet or MIND approach, it's both protective as well as having some form of therapeutic values. Because they had been even a study which look at people with already fully developed syndrome of Alzheimer's disease, whose diet was changed or tweaked to some extent into as close as possible to MIND diet, and they benefited a lot. The progression was slower. There were even some potentially restorative situations or elements that we were noticing in the brain, in the brain tissue. So yes, MIND diet or full Mediterranean diet is both protective as well as curative in a sense.

Julia Zumpano:

One thing I want to note on that is inflammation. So, we know inflammation can worsen any disease state, and as you mentioned, the MIND diet being one of the best, if not the best type of style of eating to follow. We know that the MIND diet is very anti-inflammatory because of the antioxidants, the polyphenols, the omega-three fatty acids, so we want to keep a focus on that. Inflammation worsens your disease states, and an anti-inflammatory diet helps suppress that inflammation. So, very key note here.

And when you mentioned about protein, I also think it's really important, and vitamins, that you consider seeing a dietitian because there's a lot of vitamin and mineral deficiencies that can lead to negative health outcomes and also present with signs of dementia. So, I think it's important to really look and look for a trusted healthcare provider such as a dietitian to help you assess your diet, help you meet all your vitamin and nutrient needs and protein needs, and really help develop a plan for you because it is hard. It's a lot to manage and think about and put together on a daily plan, and that's where we really come in.

Dr. Kasia Rothenberg:

Yeah, thank you for that. Well, it's a huge component of protective intervention like dietary intervention, limiting, harnessing, inflammation. Let me offer some simplified, of course, understanding what inflammation is. Inflammation is a tissue response to injury. And in Alzheimer's disease, those deposits, those plaques which are in the process depositing in the brain, they cause a lot of inflammation. Inflammation means swelling. Inflammation means production of all the substances, all the particles which may injure cells additionally to what was done before. So yes, we do want to harness inflammation, especially chronic inflammation. And here comes a beauty, which we didn't still talk about, which is kind of embedded in MIND diet. Processing food. All the processing foods are potentially pro-inflammatory. Frying, the way we prepare food is important as well. And of course, first thing, when we talk inflammation, we have to talk about simple sugars, refinated sugars.

This is extremely pro-inflammatory element of our diet. And all the diets which reduce amount of simple sugars, especially like artificial sugar, then are kind of proved to be anti-inflammatory. Well, now I don't want to open another Pandora's box because we didn't talk about microbiome. How does microbiome play here in this puzzle? Because everything is interconnected, type of foods, level of inflammation, variety of foods, how we digest, how we absorb, how the nutrients are going through blood brain barrier. Inflammation plays humongous role here. When inflammation is high in the brain, we may have problems with transition of nutrients between body and the brain.

John Horton:

Dr. Rothenberg, the microbiome is fascinating. Actually, we did an entire podcast on that with Dr. Lee. So, if anyone's looking for information on that, please look that one up. But Julia and Dr. Rothenberg, while I have both of you here, I want to ask one really key question. If someone is concerned about Alzheimer's risk, what is one thing they can do to improve their odds through diet?

Dr. Kasia Rothenberg:

We didn't talk a lot about how much we should eat, how to balance our caloric intake. We have a science behind eating a little bit less that we think, which may be potentially neuroprotective. So, yes. Eat food, not too much. Mostly plants. I would build this last phrase into eat a lot of various plants.

Julia Zumpano:

That's a great point. Now, I would have to say from an immediate perspective, the one thing I would really focus on is limiting sugar. So, artificial sugars, not natural sugars, but what we all know is table sugar or whatever sweetening those packaged foods or beverages. Sugar, as we mentioned, is very inflammatory. It's found in almost everything you pick up at the grocery store except whole foods. We're not talking about sugar that's naturally in fruit. We're talking about added sugars. Unfortunately, there's an enormous amount of sugar being consumed in the standard American diet, mainly from beverages and snack foods. So, that would be my one big takeaway is to reduce the sugar intake.

There was a study done just a couple weeks ago. The results were not necessarily surprising, but really fascinating to see the numbers. So, it looked at sugar intake and looked at the low nutrient diet and a high sugar intake in an older... Those people who followed this high sugar, low nutrient diet had an older epigenetic age, meaning that their internal bodies are older than those who followed a nutrient rich, low sugar diet. And just by cutting back 10 grams of sugar a day, you could gain two and a half months of longevity in your lifespan. So, just think about, on average, Americans are consuming just 50 grams of sugar in a drink. That's what the Food and Drug Administration is suggesting limit for a day. In my opinion, I think that's even still too high. But so, we really want to look at sugars, reducing just 10 grams a day to start, and then again, building upon that. So, that would be my definite answer would be sugar.

John Horton:

I think we could talk for days on this topic. Dr. Rothenberg, I think we opened up about a dozen Pandora's boxes as we went through this conversation, and I feel like we could just go on and on and on, but our time today is limited. So, before we play our walk off music, is there anything else you'd like to add regarding diet and Alzheimer's risk? And Dr. Rothenberg, why don't you get us started?

Dr. Kasia Rothenberg:

I am going to change my phrase. Eat food. Not too much. Eat variety of plants. Do not eat sugar. I totally agree.

John Horton:

Look at Julia. It's wonderful. She's already taken your advice, Julia, and building it into all the advice.

Julia Zumpano:

A catchphrase. I love it. I love it. The one thing I think we didn't extend upon was fasting, and I think there's a lot of great information that we have on our website that provides information on fasting, but that is something I would encourage any listener to discuss with their healthcare provider because I do feel like fasting can contribute to a lot of positive health outcomes, specifically from a brain health perspective, but just needs to be done properly and guided by a healthcare provider who knows how to properly guide someone in the fasting journey.

John Horton:

Well, that sounds great. I appreciate both of you giving us your time and expertise today, and thank you for a fabulous discussion.

Julia Zumpano:

Thank you so much.

Dr. Kasia Rothenberg:

Thank you very much.

John Horton:

Is it possible to prevent Alzheimer's disease through diet? Unfortunately, there's no definite yes answer to that question, but ample evidence suggests that a nutritious diet and healthy lifestyle can reduce your risk of cognitive decline. Consider that food for thought the next time you're at the grocery store.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, eat well.

Speaker 4:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.