Dr Rupy: Today we're going to be reviewing early signs to detect dementia, as well as food and lifestyle that can potentially prevent dementia. Now, why are we talking about this today? Well, the estimated total societal cost of dementia in 2019 in the US was over a thousand billion dollars. And with the number of people suffering dementia set to increase by 300% globally over the next 20 years, this is something that we need to address as early as possible. Now, we have many examples of successful cognitive agers. I don't want to suggest that if you live longer, you're going to have to succumb to dementia. There are plenty of people who have lived vibrant lives well into their 80s and 90s. And there is a clear influence with lifestyle habits. And I want to lean into these, the evidence that we have available for us, so we can all engage in these habits, whether that be nutrition strategies, brain health strategies that include lifestyle and exercise as well. So the key questions we're going to review today are: what are the some of those early warning signs of dementia and Alzheimer's? What are the foods I should avoid to help prevent dementia and brain decline? What are some of the favourite foods of mine that are brain boosting that we have evidence for that we should start to add to our diet every week? The common lifestyle habits that can improve brain health, and any supplements that I may recommend to help boost brain health and prevent decline. I also talk through a day in the life of a successful brain-healthy day, utilising all of these different habits to make it a lot more accessible and practical for you, the listener. This podcast is also going to be available on YouTube like all of our podcasts, and on YouTube, you'll be able to see some of the diagrams that I'm going to be talking through. Now, I am going to be talking through them, so you'll still get the gist on the audio version of the podcast, but if you are interested in some of those visuals, then check them out on the Doctor's Kitchen YouTube channel. You'll be able to check it out by just hitting the link in the bio as well. And if you're interested in other brain-healthy foods, you're like, what else, what other brain-healthy recipes that I should be engaging in? What are some of those brain-healthy ingredients that Dr Rupy is talking about in this podcast that I can slip into my weekly diet? Well, if you head to the Doctor's Kitchen app and you click brain health as your health goal, we will give you a ton of recipes that are brain-healthy, and they hit all the different criteria that I'm talking about in today's podcast. They include some of those brain-boosting foods, they include some of the attributes of what makes a healthy diet brain-healthy as well, and some of those proven ingredients and dietary strategies that I talk through the evidence for today as well. So if you haven't tried the Doctor's Kitchen app, you can check it out with a 14-day free trial. There's also a free version as well if you don't want to see all the recipes. And we're going to be adding so much more learning content and materials to enrich the experience of our app users. So if you want to support the podcast, you want to support the Doctor's Kitchen, download the Doctor's Kitchen app. It's so easy. You can get it on Google, Apple, and you can also get it on your desktops now as well as other devices like iPads. On to my podcast, all about brain health, brain foods, and brain-healthy lifestyles. I really hope you enjoy this.
Dr Rupy: Today we're going to be reviewing early signs to detect dementia, as well as food, lifestyle and supplements, plus many more things to prevent dementia. Now, dementia is a syndrome where there is significant impairment to brain function, affecting memory, thinking and the ability to carry out everyday activities. It gradually starts after years of progressive neurocognitive deficits and it's driven by multiple genetic and environmental factors. The key types are Alzheimer's, this is the most common type of dementia, characterised by the presence of amyloid plaques and tau tangles in the brain. You've got vascular dementia that's caused by reduced blood flow to the brain, often following strokes and other blood vessel issues. You've got Lewy body dementia, that's marked by abnormal protein deposits called Lewy bodies in the brain. This actually leads to symptoms that are similar to Parkinson's. There's frontotemporal dementia that involves the degeneration of frontal and temporal lobes of the brain, affecting personality, behaviour and language, and mixed dementia, which is a combination of two or more different types of dementia, such as Alzheimer's and vascular dementia. Now, Alzheimer's, like I said, is the most common form of neurodegenerative dementia which affects primarily the aged population. In fact, 5 to 6% of those aged over 65 and up to 30% of those aged 85 and over. And so for the purpose of this episode, we're going to focus mainly on Alzheimer's dementia. Now, the WHO estimates that more than 55 million people today worldwide have dementia, but by 2050, the number is going to increase to 130 million. It's already the seventh leading cause of death and a major cause of dependency and disability globally. But prevention is feasible. Not all older adults develop dementia, and that's why I'm going to talk to you about early signs of dementia for you to look out for, as well as those prevention strategies. Now, if you notice any of these early signs in yourself or someone you care about, it's a really good idea to book an appointment with your doctor for a full assessment. Dementia affects everyone differently, and the first signs are often relatively mild and not always easy to notice. So here are these five early signs that I want you to be thinking about. Broadly, you can categorise these into cognitive, psychological, behavioural, physical, and there are some novel signs that I'll also talk you through as well. Number one is memory loss that disrupts daily life. Now, typical ageing, as we get older, it's very common to notice some changes in how you think and remember things, like being slower to find words or misplacing keys, having problems with multitasking, or just finding it a bit harder to focus. But these changes are usually pretty subtle, and importantly, they don't impact your daily life too much. Dementia often begins with progressive loss of memory, typically with the inability to learn new information, like recent life events. It's the first and main symptom of early Alzheimer's disease because it preferentially affects brain networks involved in episodic memory. So, for example, this could be forgetting the names of friends and family, forgetting appointments, or forgetting to pay bills or take medication, repeating questions and conversations. Later stages will be more noticeable, like forgetting how technology works, like the oven, microwave, or even the TV. But the early stages are going to be quite subtle, so you want to be just keeping an eye or maybe even tracking how often this occurs. The second thing that is within the cognitive realm is word-finding difficulties. So, for example, struggling to find the right word in a conversation or to follow what is being said. Frequent trouble finding the exact words to express oneself and even word substitutions using imprecise language. This is also known as anomia. The difficulty finding the right word is actually a problem with expressive language, which involves producing speech and retrieving words from memory. So struggling to find the right word in a conversation or to follow what's being said primarily relates to language processing rather than executive functioning. However, there are some overlaps and interactions between these different cognitive domains. So look out for struggling to find the right word or using incorrect language to describe a fork, for example, or something that should be quite easily recognisable in day-to-day life. The third thing is changes in mood. Now, this can be quite difficult to separate from depression, obviously, but these are subtle things that I would definitely be looking for: anger, apathy, a depressed mood, hopelessness, a loss of purpose in life, feeling confused, suspicious, fearful or anxious. The lack of initiation of thoughts or actions, like not preparing meals or struggling to participate in casual conversations. There is, unfortunately, a lot of overlap with depression, but if anyone presented with those changes, those psychological changes in mood, I'd be thinking, particularly if they're in an older age group, about an early sign of dementia. Number four is technically a behavioural symptom, but it can be quite similar to the psychological symptoms that I've just described before, and that is withdrawal from social engagement. So there could be clear shifts in one's personality. So, for example, if a normally outgoing person suddenly became more withdrawn, I'd be thinking about whether this is an early sign. It could be as subtle as losing an interest in a lifelong hobby or social activities or work, often due to difficulty keeping up with activities and conversations. This can actually precede a dementia diagnosis. So, like I said, there's obviously going to be a lot of overlap here with depressive symptoms. On the other side, they could actually be exhibiting odd behaviours, like being disinhibited, and instead of being withdrawn, being more extrovert than they used to be. So saying inappropriate things to people, eating off other people's plates, just odd little behaviours that might arouse suspicion that this could be something else that's going on. The fifth early warning sign that I'd be thinking about are falls. Now, disturbances in the ability to coordinate one's body, leading to disturbances in their gait, so the way they walk, that can be quite common across a number of different types of dementia. You may also notice changes to their voice and how they can utilise their vocal cords, something known as dysarthria. And especially if there's a new history of multiple falls, it's something to investigate. If I had a patient come into either my A&E department or clinic with a history of falls, they might not even be coming in thinking that it's dementia. They might be coming in for wound suturing or bandaging for small cuts that have been the result of a fall. That's when I'd be thinking, is dementia something that we need to rule out here? I'd definitely be looking to exclude dementia if somebody is presenting with multiple falls. Now, it can be purely physiological, it can be just from a trip, a lack of muscle, perhaps they've lost a lot of muscle because of some other insult, they might have had a long inpatient stay in hospital, but anyone who comes in with a history of multiple falls, you should be thinking about dementia and whether this needs a formal assessment. There are some novel signs that I think most people should be aware of as well. Rapid eye movement behaviour disorder, also known as RBD, acting out in dreams, such as running whilst dreaming or night terrors. The reason why this can be an early sign of dementia is because there can be changes in the brain structure. Dementia actually affects areas of the brain that control the sleep-wake cycle, leading to disruption in normal sleep patterns. There's alterations in the level of neurotransmitters like melatonin and serotonin, which regulate sleep, and these can cause sleep disturbances that can present like night terrors or odd behaviours during sleep. Because it affects someone's ability to fall into the deeper stages of sleep, it keeps them at a lower quality level of sleep that can lead them to have more vivid dreams and acting out in the middle of the night as well. So those are things that I'd be looking out for. Loss of smell can also be one of the earliest signs of dementia, often occurring before many other noticeable symptoms like memory loss. This is particularly notable in Alzheimer's disease and Parkinson's disease. There's changes in the sense of smell that can be part of normal ageing, but it could also signal early Alzheimer's because the disease affects part of the brain involved in processing smells. So there's something called the olfactory system that I've just pulled up a diagram for folks who are listening to the podcast. I'm just going to describe it as a cross-section of the brain where you've got the orbitofrontal cortex at the front and your olfactory bulb is a protrusion from the centre of the brain that connects to your nose and the nasal passages. There are some cranial nerves that connect to that area, and that olfactory system is directly connected to brain areas involved in memory and cognition, such as the hippocampus. These areas are among the first to be affected in Alzheimer's disease. So changes in the sense of smell may actually be something that you want to be aware of as well. Studies actually show that 85 to 90% of people with Alzheimer's have smell problems. Plus, if someone with mild cognitive impairment, something called MCI, has a reduced sense of smell, they're more likely to progress to the advanced cognitive dysfunction and develop Alzheimer's disease as well. This means that smell tests might actually help catch Alzheimer's early, just as hearing aids could help lower dementia risk. There are some questions about whether boosting our sense of smell using smelling salts might help too. So watch out for the research on that. So now we know some of the early signs to look out for, let's review ways in which to prevent and protect ourselves from dementia so you can remain mentally sharp in your older age and even become a cognitive super-ager. Alzheimer's, like I said, is a multi-faceted condition with many different drivers, but it turns out that 40% of dementia cases are potentially caused by modifiable risk factors. So influencing these risk factors could actually influence cognitive trajectories in ageing. Now, outside of our control are non-modifiable risk factors. So these are things like age. So, like I said earlier, Alzheimer's disease affects over 5% of people aged over 65 and 30% of people aged over 85. And there are also genetic factors as well. So apolipoprotein E, which is a very easy genetic test, can give you some semblance of what your risk profile is for Alzheimer's disease. These are things that are outside of your control. But there are some things that we have some influence over. These are the modifiable risk factors. Environmental factors may actually together account for as much as a third of all dementia cases. So even if you are of an older age group, and even if you have a genetic risk, you can modify your risk of progressing to Alzheimer's disease. And there are a number of different things that are modifiable: diet, alcohol, sleep, mental and social stimulation, physical activity, smoking. There are other things like air pollution and pesticide exposure that are harder to modify, but there are still some things that we'll talk about later on that you can do with regard to that as well. The different combinations of these risk factors in different patients may activate the disease in different ways. So we don't have a clear picture as to which one will provide the biggest leverage at protection for which patient. And there's this diagram that I love from a paper that I'll describe for the folks listening, which chronicles the different environmental factors across a person's life in increments of 10 years from birth to over 80. And it just gives you an idea of the different things that you can be thinking about at different age ranges to minimise your risk of dementia at a later stage. So from 20 to 30, you want to be thinking that you want to be thinking about reducing your alcohol exposure, ensuring that you are educating yourself as much as possible, stimulating your learning faculties. An unhealthy diet is something to approach as early as possible, quitting smoking, ensuring that you're not having head trauma. And if you are going to be doing risky activities, always using a helmet. And there are a number of other modifiable risk factors that I want to describe because I want to tell you about neuroprotective habits that protect the brain and help it stay adaptable. So, neuroprotective habit number one that I think you should be thinking about every single day is to eat your daily BBGs. These are beans, berries, greens, and seeds and nuts every single day. I'm often asked a question, what are some of your favourite brain-boosting foods that I should be adding to my diet every week? And I always say BBGs. So these are rich in multiple vitamins and plant compounds that have potent anti-inflammatory and antioxidant effects, and they are tied to better cognitive function and lower risk of decline. We want to make sure that they are the foundation of many meals that we eat every single day. Berries and other colourful fruits, they're full of vitamins like vitamin C and K and polyphenols, especially a major class called flavonoids. And a higher intake of flavonoids is associated with better cognitive function and lower odds of cognitive decline. They may also lower pro-inflammatory cytokines and increase neuroplasticity. This is essential for learning and memory. There's even a suggestion that it can promote neurogenesis, that's the formation of new neurons, as well as the production of a growth factor called BDNF, brain-derived neurotrophic factor. If I was to prescribe a certain amount of berries, it would be at least an 80-gram portion of whole berries every single day. That, for example, is about seven strawberries or a handful of frozen blueberries. The second B stands for beans, and that's basically legumes. So lentils, soy-based foods like tempeh and tofu, they're a source of protein, which is super important, also fibre, minerals, but they also have B vitamins, and they have polyphenols, particularly flavonoids and phenolic acids. If I was to prescribe this to people, it would be aiming for two portions of various beans and lentils and peas most days in addition to your vegetable portion. So an 80-gram portion of beans is about, again, a handful of haricot beans, could be a handful of kidney beans, could be a handful of cannellini beans, any sort of bean you absolutely like is something that you want to get into your diet every single day. Greens like spinach, kale, spring greens, these are all packed full of vitamin K, folate and polyphenols like carotenoids as well. So eating leafy greens regularly is tied to a slower cognitive decline, the equivalent of being 11 years younger compared to rarely or never eating them. And that was shown in a paper that was published in 2018 in Neurology. I would prescribe this to you every single day. You want to get at least two portions every single day of greens in your diet. A portion, again, is 80 grams, is about a handful of cooked kale or two heaped tablespoons of cooked spinach. Add it to your meals as much as possible, put it into curries, put it into casserole, put it into stews, put it on the side of a diversity bowl, or just have it as a side of whatever you're eating that day. Get greens in every single day. And the last ones are seeds and nuts. These are, again, packed full of minerals like zinc, magnesium, they have vitamin E. These have those healthy fats that are anti-inflammatory, and they have been shown to, again, improve heart health, which will improve brain health as well. So making sure that you're getting around 30 grams of seeds or nuts every single day. Again, add it as a topper, add it as a snack, have it with some yoghurt, getting seeds and nuts in every day. As long as you're not allergic, that's something that could be brain-healthy too. And overall, I know I'm talking about BBGs, but we know that a healthy lifestyle can significantly lower the risks of cognitive decline. There are observational studies that show that healthy eating patterns, like the Mediterranean diet or DASH diet, which is the dietary approaches to stop hypertension, there's also the Mediterranean-DASH intervention for neurodegenerative delay, that's MIND diets, those are all tied to lower risks of cognitive decline and Alzheimer's disease. And you can see on this image here that I'll describe for the folks listening, you have a Mediterranean-style diet that has a high amount of antioxidants, a high amount of fibre that will support your gut microbiota, lower amounts of inflammation that can reduce neuroinflammation, so that's inflammation that stems from the brain, and also reducing insulin resistance as well, which is something that is very much tied to the risk of dementia, your inability to partition glucose properly. These are all things that show a reduction in the risk of dementia. So these are things that have serious weight towards them, and we should be promoting them more, especially given that this is such a huge and growing problem for the global population. And we'll get on to all the other lifestyle factors later on, but just to sort of put an underline under this point, there was a study funded by the National Institute of Aging involving almost 3,000 older adults, and they showed that healthy lifestyle factors, including physical activity, not smoking, not drinking heavily, following this Mediterranean-style diet with all the BBGs that I've just described, engaging in mentally stimulating activities, had important benefits on cognitive health. The people who engaged in four or five of these behaviours had a 60% lower risk of developing Alzheimer's compared to those who only followed one or none. People who followed two or three of the activities had a 37% lower risk. So there's a dose dependency there. The more that you can incorporate these activities into your lifestyle, the more impact this is going to have on your disease risk. I'm also often asked, what are some of the foods that I should be avoiding to help prevent dementia and brain decline? And so the things that always come up are refined sugars and refined grains: sugary drinks, pastries, candies, white rice, white pasta, white bread. They all have the outer layers stripped away during the processing, leaving just the starchy core, which means they lack nutrients and they also can increase your risk of type 2 diabetes as well because it's just pure sugar. So, and those are things that are linked to the risk of cognitive decline and dementia as well. So these are things that you want to be removing from your diet as much as possible. Ultra-processed foods, like mass-produced bread, which fits in those two categories, most breakfast cereals, unfortunately, biscuits, instant soups, pre-packaged meals, buns and cakes, factory-made chips and fries. The research shows that a higher intake of these ultra-processed foods is tied to an increased risk of Alzheimer's disease, as they're poor in nutrients, they're rich in sugar, fat and salt, and harmful additives as well that may also be having an impact on neuroinflammation. So these are things that you want to be removing from your diet as much as possible, including processed meats. So sausages, bacon, ham, they're adding to your intake of saturated fats and additives. And the MIND diet actually recommends less than four servings a week of red meat, which includes beef, pork, lamb, which actually isn't that much. It's still enough to qualify, I think, for people's desires to have red meat. I personally don't have red meat in my diet every single week. It's a very, very luxury item, and I feel I can get my protein requirements and other nutrients from other sources that are going to be heart and brain-healthy. But four servings a week is still quite a bit in my opinion. But according to the MIND diet recommendations, they say that if you're having less than four servings a week, you're still adhering to that lifestyle. And another very big issue that I again, I don't think gets enough attention is alcohol and heavy drinking over time. Heavy drinking is absolutely tied to an increased risk of dementia, but I feel that the lowest dose that is permissible is something a lot lower than government guidelines today. So government guidelines are 14 units per week for women and 21 units per week for a man. Opt for less than a unit a week. That's what the latest research seems to be suggesting. There has to be some allowance for the conviviality and the social element of drinking, but purely from a chemical standpoint, there is no dose of alcohol above a unit a week that has been shown to be beneficial whatsoever. So, and even the one unit a week isn't of benefit, it's of zero harm. So I think alcohol really needs to be addressed as something to significantly reduce if we're serious about reducing the risk of dementia. Neuroprotective habit number two, add extra brain-friendly ingredients. I love these ingredients. I have them every week, if not a couple of times a week, certainly in the case of extra virgin olive oil. Eating about seven grams of olive oil, so a tablespoon of olive oil daily has been linked to 28% lower risk of dying from dementia-related causes. Extra virgin olive oil, like we've discussed many times on the podcast, is one of those super ingredients that just has so many different benefits for so many different conditions. Dementia now being one of them. Probiotic-rich foods, so things like yoghurt, kefir, sauerkraut. In older adults with and without dementia, probiotic supplementation has improved cognitive function compared to controls. Plus, the fermented dairy is also tied to a lower risk of type 2 diabetes and improved gut health, which again, in turn, can lower the risk of dementia as well. Spices, especially turmeric. Its main active compound is curcumin, which may lower inflammation and oxidative stress, disrupting the formation and accumulation of amyloid plaques in the brain that is pathognomonic of Alzheimer's. In some studies, these are funded, but some studies suggest that curcumin supplementation can actually improve memory and attention, although there might be problems with bioavailability and crossing the blood-brain barrier. We definitely need more research to confirm the best dose, but a couple of teaspoons of turmeric in your food is definitely going to be adding to the anti-inflammatory impact of your diet. One for the chocolate lovers like myself, dark chocolate and cacao powder have flavonoids, specifically flavanols like epicatechin, that can improve blood flow to the brain, lower inflammation, and feed the gut. It has a prebiotic effect. And in human trials, consuming quality dark chocolate, so we're talking 75% and above with minimal sugar and no extra ingredients, or cacao powder can improve participants' mental skills, verbal fluency, which is the ability to come up with words, and memory as well. So I'm a big fan of good quality dark chocolate. If you want to learn more about dark chocolate, just type in Doctor's Kitchen chocolate and all the research will come up for that. Fatty and oily fish is something I try and get into my diet a couple of times a week. They're a big source of DHA and EPA, these long-chain omega-3 fatty acids. They also have things like iodine and choline, which support brain function and lower brain inflammation. And in cohort studies, people who eat fish regularly have a lower risk of dementia. And controversially, eggs. So eggs are a major dietary source of choline, which is involved in the synthesis of brain chemical messengers such as acetylcholine. There was a cohort study of 2,490 men from Finland who found that participants with higher egg intake had a lower risk of dementia and performed better in cognitive tests. For heart health, the evidence suggests eating up to seven eggs a week, so that's an egg a day. So I personally like to mix up different plant-based proteins like cooked beans, scrambled tofu, chickpea with eggs as part of my protein sources. And there is some controversy around that because we are looking at observational studies, there's going to be a lot of limitations, and also we need to personalise it to the individual. So somebody with high cholesterol, I'd actually advise not having eggs in the diet because there is evidence that it can increase the cholesterol markers that put you at more risk of cardiovascular disease, which in turn can impact dementia. But if you do not have high cholesterol, then eggs is something that you could potentially add to your diet for those extra benefits to your brain. But again, it's really up to the individual. There are many ways in which to get plant-based proteins into your diet. Neuroprotective habit number three, get sweating and work your muscles. There are many studies that support exercise or physical activity as a protective lifestyle factor. And according to two meta-analyses of prospective studies, regular physical activity can reduce the risk of developing dementia by about 20 to 28% and Alzheimer's by up to 45%. I've got a diagram here that I'm not going to describe for folks listening because it is quite complicated, but I'll just explain how exercise might protect the brain. It improves blood flow to the brain, so bringing oxygen-rich blood to the regions of the brain that are responsible for thought creation, memory, etc. It increases the antioxidant and inflammatory processes in the brain, anti-inflammatory processes in the brain. It lowers the production and increases the removal of beta-amyloid, which may have a positive impact on symptoms. And beta-amyloid is something that can be increased in Alzheimer's disease. It also increases the production of brain-derived neurotrophic factor, something that we mentioned earlier before when it came to berries. This is sometimes referred to as brain fertiliser. It basically helps create neurons in the hippocampus, which is involved in memory as well. It improves sleep, mood, and lowering stress as exercise, lowers blood pressure, lowers cholesterol, lowers blood glucose, all of which can help your heart as well as your brain. So you get it, your brain is going to be more efficient, more plastic, more adaptive, the more exercise you do. Now the question is, what type of exercise? And the answer is a combination of aerobic and strength training. As a minimum, the aerobic training that you want to be doing is 30 minutes a day of walking, so just getting your steps in. Again, as a minimum, mild strength training exercises focusing on the larger muscle groups in your legs, three times per week. We also want to get to a place where we're challenging the body. So if these are too easy for you, you want to increase the resistance and increase the time and the speed at which you do the aerobic and mild strength training exercises. And a lot of people struggle to keep an exercise regime. The way I like to think about it is that it is a daily hygiene habit. So just like I wouldn't leave the house without brushing my teeth, I wouldn't skip an exercise, even something as simple as stretching or just doing some press-ups before I leave the house. I always do an exercise regime in the morning, and I treat it as a must-do part of my day, so it becomes automatic and is as essential as my other routines. And if you're struggling to start, just think about the ways in which you can introduce exercise into your daily routine. So instead of sitting down and taking a call, go for a walk taking the call, or do a walking meeting, or instead of taking the train somewhere, try and walk there. Just always thinking about little ways in which to introduce those exercise habits. Neuroprotective habit number four, prioritise your sleep. Sleep disturbances have been linked to a higher risk of all-cause dementia and clinically diagnosed Alzheimer's disease in multiple studies. Researchers have found that those who regularly sleep fewer than five hours per night were twice as likely to develop dementia compared to those who slept six to eight hours per night. Why does this occur? Well, during sleep, the brain gets rid of the biochemical debris that accumulates during the day. And a few bad nights might not do any harm, but over time, so two to three days a week over many weeks and months, the debris can accumulate. And those sleep disturbances that lead to that debris accumulation have been have been linked to more beta-amyloid deposition, so that's the the proteins that are involved in Alzheimer's disease, low activation of these clearance pathways, a higher risk of metabolic problems and cardiovascular disease. So your ability to regulate sugar in your bloodstream is diminished, and you have this low-grade inflammation that potentially raises the beta-amyloid deposition burden, leading to Alzheimer's disease and further sleep disturbances. So it is something that is quite stark and quite clear, but there is an uncomfortable truth in that we can't just automatically fall asleep. We have lots of other impacts on the reasons as to why we can't sleep. It could be things outside of our control, as well as things within our control. So defining good sleep is very personal, but generally it is seven to eight hours every single night. It involves regularity, so going to bed and waking up around the same time, even on weekends, and the quality of your sleep as well. I personally use a sleep tracker to determine the quality and what impacts my quality, but that's not for everyone. I don't think you need to track your sleep every single night, but getting a good idea of what impacts your sleep and making changes around that and actually monitoring the data that is produced from a sleep tracker to determine new habits, I think is a useful exercise. So for me, I know that having alcohol or eating too late close to bedtime is not a good idea, and that can disrupt my sleep. And because I'm practising neuro habit number four, prioritising my sleep, that's something that I've taken on me to change in terms of when I choose to eat and whether I choose to have alcohol in the evenings or not. And in reality, look, it can be challenging, but finding what works for you is a practice that I think is going to be worthwhile. We can treat sleep like a sport, you know, and my biggest tip is to prep for sleep rather than just throwing yourself into bed and expecting to fall asleep straight away. You really got to prepare for it. So the things that I do are, like I said, avoiding eating three hours before bedtime. I avoid caffeine after 12:00 p.m. and I do not drink alcohol in the last six hours of my day. I have a shutdown routine with meditation, sometimes gentle yoga-based poses, stretching, progressive relaxation, breathing exercises. Sometimes I do listen to soothing music with no lyrics. Sometimes it can be imagery to increase as in visualisation to increase that sense of relaxation. I remove electronics, especially from the bedroom, something that I've struggled with in the past. And I optimise my sleep environment. So I make sure that it is a cool, dark and quiet environment. And I've done that with sleep masks, a temperature regulator in the bedroom, and if I need to, I'll use noise-cancelling earbuds. Neuroprotective habit number five, challenge your brain and nurture your social network. So research finds that people who engage in mentally stimulating activities tend to have lower rates of cognitive decline. So for example, we see cognitive benefits in people who have played an instrument, even for a few years, and the risk of dementia in old age was actually found to be lower in people with cognitively stimulating jobs than in those with non-stimulating jobs as well. Now, if you don't have a cognitive stimulating job, I'm not saying you need to change your vocation, but think about other ways in which you can stimulate yourself during the day. So try any mentally stimulating activity to build up your brain: read, take courses, try brain workouts like word puzzles or math problems, experiment with things that require manual dexterity as well as mental effort. So that's drawing, painting, other crafts. These are all things that could develop that neurological plasticity and lower atrophy of the brain. There's also studies that suggest that greater social participation in midlife and later life is tied to 30 to 50% lower risk of dementia risk, although some of this may not be causal. I would highly recommend you try and do activities with others. Not only is it fostering that sense of community and that sense of protection against loneliness, but it may also have a beneficial effect on that brain plasticity and preventing against dementia. So I want you to pay attention to those foundational neuroprotective habits, but there are some add-ons as well, like supplements, for example. So there are some key supplements that have been studied for dementia and cognitive health, including omega-3 fatty acids. Having high levels of omega-3 in the blood is associated with a lower risk of dementia and Alzheimer's disease. So I'm actually a fan of taking long-chain omega-3 fatty acids, EPA and DHA, around a gram. I'd try and get it from a reputable source as well and ensure that it is third-party tested because unfortunately, a lot of omega-3 supplements are contaminated. So I wouldn't buy it from the cheapest seller on Amazon. I would get it from a reputable source that actually has the credentials that show that it is third-party tested. B vitamins, namely folic acid, vitamin B12 and vitamin B1, these have been shown to reduce the risk of dementia, but you can get these B vitamins from different types of foods as well, namely nuts, greens and even fatty fish as well. So BBGs, it really goes back to BBGs, and that's what you can get from your diet. I would also recommend lowering your body burden where you can. Pollutants, pesticides, toxic chemicals, heavy metals, these can raise the likelihood of developing dementia over time. So I personally try and limit chemical exposure where I can. I try and choose organic or low-pesticide produce. If you can't choose a higher price item, then certainly wash produce thoroughly, that can also help. And if you're buying from small local farmers, they might use organic practices even if they aren't officially certified. So don't hesitate to ask them about their farming methods as well. When I cook with produce, I opt for stainless steel, glass or ceramic methods. I don't use any non-stick pans unless I'm making pancakes, and I try and also limit plastic containers and bottles as well. In addition, I use natural cleaners, particularly in the home environment. So wherever we are exposed to chemicals that are synthetic, I try and avoid the harsh chemicals where possible, just to again lower that body burden. We are exposed to multiple different chemicals throughout our day. It is unavoidable in an urban living environment like many of us live in. So I'm not expecting everyone's body burden to plummet to zero, but the more we can do by being a lot more cognisant about the personal care products, the cleaning products and the produce that we consume in the home, the better for our overall dementia risk. Another thing is protecting your head. So avoiding activities that put you at risk of head injury and always wearing a helmet when doing an activity where there is a risk of head injuries, like biking, skiing, riding a horse, motorcycle riding, climbing as well. These are great social activities, so I wouldn't ever say you should never do those, but you want to protect your head as much as possible so you limit trauma to your head that has a clear relationship with dementia risk. Another thing is eating on time. So time-restricted feeding or TRF or TRE, time-restricted eating, that's emerged as a means of synchronising our sleep-wake cycles, our circadian rhythm, which is commonly disrupted in Alzheimer's disease. And there is some emerging evidence that suggests that these dietary interventions hold promise for promoting cognitive function and mental well-being in ageing populations. The preliminary evidence suggests that these time-restricted feeding methods can produce neuroprotective effects on cognition and reduce neuroinflammatory markers related to Alzheimer's disease in humans. To date, there aren't any studies investigating the effects on time-restricted feeding on sleep disturbances and patients with Alzheimer's disease, but it stands to reason that, like I was saying earlier with my prioritising sleep schedule, if you're going to be eating regularly at a certain time, you're going to have less disruption to that sleep-wake cycle that could manifest as a lower risk of dementia because you're improving the quality of that sleep that is essential for keeping your brain protected. Another intriguing idea and practice is challenging your senses. So, just like I said, hearing aids can reduce the dementia risk, there are some researchers now exploring whether boosting our sense of smell could also help as well. So this idea is called environmental enrichment, and it's been studied in animals for a while, and it involves putting them in a larger, more stimulating space, which stimulates neuroplasticity that improves their human-like neurological symptoms. And recently, there's been some promising research on humans. There was a small industry-funded study, so I just want to highlight that was a funded study that found that smelling strong scents regularly at night improved memory in older adults after six months. Now, aside from smelling scents, other interventions aimed at enriching people's sensory environments, such as dancing, have been associated with cognitive improvements in older people as well. So this might be something that you want to try, even though it is early days, it is quite exciting. A really important suggestion that I have is to regularly review your medicines with your doctor. So many people, particularly those who have multiple medications, should have a yearly, at least a yearly check-in with their doctor to ensure that they're not overusing certain medications. An excessive use of some medications alone or in combination with others can affect your brain either directly or indirectly through neurotoxic effects. Now, this includes many commonly prescribed medications: muscle relaxants, antidepressants, antihistamines for allergy relief, sleep aids, drugs that treat urinary incontinence like oxybutynin, and medications for relief of cramps in the stomach, intestines and bladder. Talk to your doctor about whether any of your medications might be affecting you and your cognition and discuss the possibility of swapping to alternatives or slowly tapering off the dose if it's safe. I honestly think that keeping your own medication list up to date can make a big difference in how you feel mentally as well. So it's always something that I would encourage people to review themselves and certainly in conjunction with your personal physician. On the subject of checking in with your doctor, I would do three routine checks as a minimum. Get your hearing tested. Hearing loss can exacerbate cognitive decline, so regularly test your hearing. Check your blood pressure, that's an overall check. It's something that is symptomless in many people and can put you at risk of vascular dementia and cardiovascular disease as well. And look out for nutritional deficiencies as well. So getting a regular blood test, looking at B vitamins, looking at vitamin D, and if you can, an omega-3 index as well, that is something that you can do from the comfort of your home using a finger spot test. Get those regularly tested to prevent and ensure that you're doing everything proactively to prevent dementia. If I was to describe a neuroprotective day in the life, I would say it goes a little bit like this. You wake up at the same time every day that regulates your circadian rhythm, promotes better sleep quality and cognitive function. You hydrate, obviously, and you try and get outside as soon as possible. That sets your circadian rhythm, so you're more likely to be energetic and have a better quality of sleep later on as well. You do your morning exercise, ideally outdoors if possible, but if you can't, you do your morning exercise first thing because that is part of your daily hygiene for your brain. Ensure that at breakfast time, you're having a protein-rich breakfast with nuts and seeds or any of the other BBGs that I mentioned earlier. Getting them in early in the day means that you've ticked that box for your brain. If you're commuting to work or you have some downtime during the morning, you want to do a brain workout. So instead of scrolling on social media, solve a puzzle, do a crossword, learn a new language, knit, dance around your kitchen, anything that challenges your brain in a way that it's not used to is going to be good for that brain plasticity. At lunch, you want to make sure you're getting a side of dark leafy greens, any sort of greens as possible, so you're ticking off that BBGs. If you're going to have a snack, you can have a snack with berries. Berries, remember, have those flavonoids, those anti-inflammatory properties and those brain-boosting effects as well. If you haven't already, make sure that you're making time for your friends and your family. Have a conversation on the phone, go for a walk with someone. Walking with someone and having a chat is actually stimulating both the exercise part of the neuroprotective habits as well as the socialising part as well. So you're getting a double whammy. Try and do that as often as possible. It's something that would have been very natural for our ancestors, but it's something that is quite hard to do, particularly in urban living environments as well. When you get home, you're going to have your dinner early because you know that that's going to impact your sleep-wake cycle, it's going to improve the quality of your sleep, and you're not going to have alcohol with your dinner either. And if you can introduce some of those brain-healthy ingredients that I absolutely love, like oily fish, extra virgin olive oil, spices that are anti-inflammatory in nature, particularly turmeric, then do so at dinner time. And before you go to sleep, you're going to engage your sleep routine. This could be meditation, it could be breathwork, it could be visualisation. It's something to signal to your brain that it is time to go to bed. And that's going to ensure that you're going to have a nourishing sleep that is going to remove debris from your brain that are the normal metabolic waste products of your brain functioning, and that again in turn reduces the risk of dementia. So all these things coupled together are things that could help protect your brain against cognitive decline, but potentially also dementia as well. Essentially, everything that I've described here is very much in line with the Mediterranean diet and lifestyle pattern. So the Mediterranean way of living is not just a diet, it's also the conviviality, the social elements of of life. And it it really is a great blueprint for anyone that's looking to improve their brain health, improve the functioning of their brain. And it's something that I would lean into very much so. And even if you can just do one or two things and stack those habits on top of each other, try and do that as much as possible. So those are early warning signs as well as protective habits to ensure that you're going to lower the risk of dementia. Let me know in the comments if I've left anything out, you think I should have mentioned something. I'd love to know what your thoughts are on this and if you think I should be doing another episode on specific habits that can improve your brain health.
