In Part I of this series, we looked at the symptoms and likely causes of chemo brain and based on this and supporting research, the positive impact exercise and learning will have on improving and retaining your cognitive function. In Part II, we look at other lifestyle factors that will also help you ‘make the most of what you’ve got’ – We’ll look at:
There’s a whole host of interest in how diet affects cognitive performance in all age groups and how it influences degenerative conditions such as cancer, heart disease and dementia. The findings from many studies seem to be converging on a number of key principles, so eating well to help your brain will not be in conflict with eating well to ward of cancer, heart disease, diabetes etc. This list isn’t exhaustive but the top reoccurring themes seem to be:
- Eat a low GI diet and avoid added sugar (1).
- Eat plenty of fruit and vegetables of all colour groups to ensure you get all the flavanoids nature offers. And based on recent research, plenty means a minimum of 4 servings of vegetables and 3 servings of fruit a day. (See a round up of the research here: Call to make 5 a day fruit and veg into ‘7 a day’ – Health News – NHS Choices.)
Increased flavanoid consumption, particularly a greater intake of the subgroup anthocyanidins (found in purple foods such as berries – strawberries, blueberries, cranberries, red and black grapes, black beans, lentils, red cabbage, red onions, aubergine etc) is associated with reduced cognitive decline (2).
Flavonoids are a class of metabolites widely distributed in plants often responsible for giving the plant its colouring. Research is demonstrating that it is these chemicals that may be responsible for the many health benefits of a diet high in vegetables and fruit.
- Eat plenty of sources of omega 3 fatty acids such as oily fish, nuts, seeds and avocado. (Omega 3 oils are vital for nerve growth and good vascular health)
- So is the cocoa bean including dark chocolate 😋 (And why dark? To avoid the high proportion of sugar to cocoa in milk chocolate. A couple of tablespoons of cocoa powder can be added to savoury dishes such as chilli, cacao nibs can be added to breakfast for added sugar-free crunch)
- Get enough minerals particularly zinc and iron from healthy sources in your diet. Both are essential for optimum brain function.
- Zinc is important in the synthesis of neuronal membranes. Studies point to the possible association of zinc deficiency and ADHD (3) which is characterised by inabilities to concentrate and pay attention. Good dietary sources are: spinach, pumpkin seeds, nuts, seafood such as prawns, mung beans, mushrooms etc
- Iron is involved in the production of neurotransmitters and also the myelin sheath protecting nerve fibres. (The birth of new cells in the brain – called oligodendrocytes that I mentioned in Part I, are heavy users of iron.) Good healthy sources: sardines, seafood, pumpkin seeds, nuts, dark leafy greens, whole grains, tofu, cocoa and dark chocolate (min 70% cocoa)
- Vitamin D is a steroid hormone vital in calcium and phosphate absorption and in recent studies, several associations between low levels of vitamin D and neurological disorders such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, as well as depression etc have begun to surface. Food sources are secondary to the quantities your skin makes in sunlight. However, if you live in the northern hemisphere you should take a supplement in the winter when the sun isn’t strong enough for your skin to make its own. This is even more important if you are dark skinned and live in a cold or temperate climate as it is hypothesised that lighter human skin evolved to make more of the poorer sunshine as early humans migrated away from the equator. With increasingly sedentary lifestyles (not many of us toil the fields in the open air all day any more) we get insufficient sunshine to make vitamin D. Recommendations depend on the latitude you live at. As an example you should supplements between October and April if you live as far north and further than Leeds in the UK (approximately 53 degrees latitude). Googling vitamin D winter and your nearest city’s latitude is likely to help you find your ‘Vitamin D winter’.
- How much supplement to take? This is interesting – the value ‘needed’ seems to increase with each new study identifying a new relationship between minimum blood serum levels and another disease. Some researchers have tested high doses on people over long periods of time with no ill effects (10,000ug a day) – See more in Anna Coussens’ essay below.
Neurotransmitter: a chemical messenger released at the end of a nerve fibre when a nerve impulse arrives effecting the transfer of the impulse to another nerve fibre, a muscle fibre, or some other structure.
- Vitamin E is essential for normal neurological function. Good sources are nuts and seeds, avocado, leafy greens, asparagus, kiwi fruit, broccoli, sweet potato, oily fish.
- Choline is essential for the production of neurotransmitters and studies suggest a significant number of adults consume less than recommended. You need more the more alcohol you consume and the more endurance exercise you do. Good sources of choline are soy – especially lecithin granules, wheat germ, cod, broccoli, cauliflower, chicken, tofu, amaranth, quinoa, eggs, kidney beans, almonds.
- A number of the B vitamins are also essential for good neurological functioning. Good food sources are whole unprocessed foods such as whole grains, beans and lentils, potatoes, bananas, yeast extract. The reason many breakfast cereals and white bread have to be fortified (by law) with some of the B vitamins is because their high level of processing to remove the outer layers of the grain also removes this essential nutritional content.
- B12 is essential for neurological function and research suggests deficiency is linked to reduced brain volume and lower cognitive scores – The body can store it for up to a year and it is plentiful in animal food sources such as meat, fish, dairy products and eggs. However, there are no good natural sources for someone on a purely vegan diet. For this reason some soy products and breakfast cereals are fortified with it but if you are eating a vegan diet it is essential to find a good supplement or ensure one or two of your regular foods are fortified with this vitamin.
FURTHER INTEREST :
Vitamin D: This fabulous MRC essay by Anna Coussens summarises the research so you can draw your own conclusions, but I’m with the notion that if my skin can make around 25,000ug in approximately 15-30 minutes, taking 5,000-10,000ug a day through the winter seems reasonable Mill Hill Essays | MRC National Institute for Medical Research, London.
We didn’t evolve with a constant supply of food (just as we didn’t evolve to sit all day) and research into moderate fasting, such as the 5:2 fasting approach, suggests getting hungry occasionally actually does you good by improving insulin sensitivity, reducing metabolic syndrome, reducing markers for some cancers and other diseases. And in general, we know that what is good for your vascular health, is protective for your brain.
Studies have shown fasting reduces dementia in animals – human studies are just beginning, but so far the news about intermittent fasting is all good. And in cognitive testing, participants who are slightly hungry outperform those who have just eaten.
FURTHER INTEREST: For more on intermittent fasting, the following article outlines many of the research findings – Fasting may protect against disease; some say it may even be good for the brain – The Washington Post.
Some herbs and essential oils reputed for centuries to aid memory and concentration are at last attracting scientific attention with scientific studies demonstrating their efficacy:
Among them Gingko Biloba, Sage, Rosemary, Lemon Balm, etc (You can read more about this on at wikipedia http://en.wikipedia.org/wiki/Nootropic)
FURTHER INTEREST: The Mayo Clinic provide comprehensive information about the research and efficacy of a number of supplements including herbs – This link will take you to the background page on Gingko Biloba. Drugs and Supplements – Mayo Clinic.
They provide similar information for a number of herbs, supplements and vitamins
Too little sleep is associated with cognitive decline as interestingly, is too much! It would appear that 7 hours quality sleep a night is optimal for both brain and heart as researchers have found those having as little as 5 or as much as 9 are at greater risk of heart disease and cognitive decline.
Poor quality sleep resulting from disturbances caused by snoring and sleep apnea are also associated with cognitive decline so if you have sleep problems like sleep apnea, it is worth consulting your doctor and resolving the causes wherever possible.
Disturbed sleep due to stress may be helped by mindfulness (see below). And if you are stressed beware of caffeine as it exacerbates the body’s natural stress response and may be contributing to your sleepless nights.
(Jon Kabat-Zinn is Professor of Medicine Emeritus and creator of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School)
People who practice mindfulness meditation and other forms of meditation have been shown to develop increased white and grey matter in their brains (5). The potential bonus is obvious if you may have lost a bit due to chemotherapy. As it is also good for stress, immune function, cognitive focus, mood and sleep, it is an excellent lifestyle addition to anyone who has or has had cancer and now, possible chemo brain.
These physical improvements in brain structure have now also been demonstrated at the genetic level with evidence of stronger, longer telomeres on chromosomes supporting the many other health benefits enjoyed by meditators.
And why is this important? Telomeres are a tail or cap at the end of a chromosome and protect chromosomes against damage or misalignment during DNA replication (which happens whenever a new cell is formed). Shorter telomeres are associated with ageing and implicated as a risk factor in degenerative diseases such as cancer. Eventually, they shorten to a critical length resulting in chromosomal instability and loss of cell viability – so having longer telomeres is a good indicator of the viability of an organism.
Learning to be mindful: There are all sorts of resources available now, to learn and practice mindfulness for very little financial outlay. Once you understand and practice it, mindfulness can be built into the way you approach your day. Many practices teach you to focus on your breath, though there are other ways of being ‘mindful’ including using for example, sound or movement.
There’s a link below to the ‘Headspace’ website with short videos presenting the Benefits of Meditation along with the scientific support (and the opportunity to download a free 10-day trial for guided-mindfulness). Resources from Jon Kabat-Zinn are also easily found on the internet.
You may well have heard of the “Mozart Effect,” which suggests listening to classical music can make you smarter. We also know how a happy tune can lift our mood and there’s a growing body of research studying its effects on the brain.
For example, research has shown that listening to music while exercising boosts cognitive levels and verbal fluency skills in people diagnosed with coronary artery disease (and coronary artery disease has been linked to a decline in cognitive abilities). Improvement in verbal fluency more than doubled after listening to music compared to that of the non-music session.
Whilst the enhancing effects of listening to music are possibly short-lived it’s likely that the temporary brain arousal it induces contributes to overall brain stimulation which slows cognitive decline. If listening to music may be something you are not in the habit of doing consider switching to a classical music station whilst doing another task.
Music and Cognitive Abilities http://gopher.nypl.org/sites/default/files/music_brain.pdf
Ever wonder why you sometimes have to eat when you’re doing something difficult at work?
Human beings have been chewing things other than food for centuries – probably forever -(the ancient Greeks chewed the resin of the mastic tree) so there’s been much speculation amongst psychologists about the function it may serve. There are now a number of studies that demonstrate that the action of chewing temporarily raises alertness, cognitive performance and mood – perhaps because there’s a temporary change in blood flow when your jaw muscles are first activated (6).
The effect only lasts about 20 minutes so if you are working on something for a longer period or perhaps taking exams, remove the gum after 20 minutes, rest your jaw for say 20-30 minutes and then try a fresh piece. (I can’t find any experiment looking at this)
Last but not least, many studies have shown the link between social interaction (or a lack of) and increased risk of dementia in older age. One of the reasons for this is that being social requires complex brain activity – listening and understanding, reading faces, situations etc. Another major factor is likely to be the positive effects it has on mood. In one study, just 10 minutes of social intersection was shown to have a significant impact on cognitive performance! (7)
If after a period of illness your social circle and level of activity has dwindled, it is a good idea to seek ways to improve your contact with others be it by getting out more to meet up with friends or by phone or Skype.
In “Chemo Brain Part I” we confirmed the phenomenon of some cognitive loss in many people who have undergone chemotherapy. However, broader scientific research is highlighting a variety of other lifestyle factors that contribute to our ability to build and maintain our cognitive function. Last week we looked at exercise and learning.
This week we draw further hope and can take a variety of initiatives to further support our brain function by making changes to other lifestyle factors including diet, eating patterns (such as intermittent fasting), learning mindfulness, listening to music and making sure we interact with others on a daily basis.
We should make an effort to get enough quality sleep and can get further temporary boosts for tough thinking challenges by chewing a bit of gum after a cup of coffee – oh and don’t forget to add a bit of rosemary oil to your daily moisturiser !
Finally, I am often asked what supplements are around with the herbs and minerals we have taken a look at. Whilst I am not qualified to comment on their efficacy, I personally seem to benefit from Vega’s “BRAINFUEL” Formula, which I find I need to have with a decent breakfast as it contains zinc which can make you feel a little nauseous on an empty stomach. (Please remember to take advice about supplements if you have blood clotting disorders or are on medications that may interact with them.)
NEXT TIME IN PART III: A PERSONAL REVIEW OF MY OWN ‘CHEMO BRAIN’ AND STRATEGIES FOR DEALING WITH THE CONSEQUENCES.
(1) Barnes, J.N., and Joyner, M.J., (2012) Sugar highs and lows: the impact of diet on cognitive function The Journal of Physiology, 590, 2831.
(2) Elizabeth E. Devore, Jae Hee Kang, Monique M.B. Breteler and Francine Grodstein. Dietary Intake of Berries and Flavonoids in Relation to Cognitive Decline. Annals of Neurology; Published Online: April 26, 2012
(3) Dodig-Curković K, Dovhanj J, Curković M, Dodig-Radić J, Degmecić D. (2009) The role of zinc in the treatment of hyperactivity disorder in children Acta Medica Croatica 63(4):307-13
(4) Tangney C.C., Aggarwal N.T., Li H., Wilson R.S., Decarli C., Evans D.A., Morris M.C.(2011) Vitamin B12, cognition, and brain MRI measures: a cross-sectional examination. Neurology. 77(13):1276-82.
(5) Hölzel, B.K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S.M., Gard, T., and Lazar, S.W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research; 191(1): 36–43
(6) Smith, A., (2010) Effects of chewing gum on cognitive function, mood and physiology in stressed and non-stressed volunteers. Nutritional Neuroscience 13(1):7-16.
(7) Ybarra O., Burnstein E., Winkielman P., Keller M.C., Manis M., Chan E., and Rodriguez J. (2008). Mental exercising through simple socializing: social interaction promotes general cognitive functioning. Personality and Social Psychology Bulletin. 34(2):248-59.