But I bet nothing in here is a protocol, just guidelines. I demand protocols, not just guidelines that MIGHT WORK. Does no one understand the difference?
The NEURO Plan and Brain Health
Last year a book written by neurologists Dr Dean Sherzai and Dr Ayesha Sherzai generated a massive amount of interest in the UK press, including a long review news article in The Saturday Times and a serialization in The Daily Mail.This level of interest could be a reflection of the nation’s concern with Alzheimer’s disease, with many individuals and families touched by the condition through the experiences of loved ones, friends and colleagues.
Shutterstock | Kateryna Kon
Dementia is now the leading cause of death in the UK, with Alzheimer’s disease being the main form.Sherzai and Sherzai’s research builds on and adds to the increasing range of evidence that lifestyle and dietary changes can seriously reduce the risk of Alzheimer’s. Their book outlines the NEURO plan – suggesting that this could reduce the risk of Alzheimer’s disease by up to 90%. NEURO stands for - nutrition, exercise, unwind, restore and optimize, sharing many similarities with Cytoplan’s Brain Health Program and The Bredesen Protocol (the latter was developed by another Professor of Neurology in California, Professor Dale Bredesen)
The NEURO plan involves:
Nutrition
The focus of the nutrition step is a wholefood, plant-based diet. Animal products are discouraged, and B vitamins and omega 3 fats are advocated alongside antioxidants from vegetables and appropriate amounts of fiber.Exercise
The exercise step involves being active throughout the day and not just relying on short bursts of activity at the gym (though it is understood that any exercise which raises the heart rate and improves muscle strength is of benefit). Exercise has anti-inflammatory benefits, helps ensure oxygen and nutrient delivery to the brain as well as stimulating an increase in a brain peptide called brain derived neurotrophic factor (BDNF), which helps with repair and maintenance of neurons as well as new neuron production.Unwind
Managing stress is a vital part of the NEURO plan with the book advocating activities such as slow, meditative walking, music, yoga or meditation to help relax the mind and body. Stress is known to cause damage to the brain – for example, chronically elevated cortisol levels (the stress hormone) can destroy neurons, trigger inflammation, affect insulin resistance, increase blood pressure and negatively affect the gut – all things which are important for maintaining good brain health.Restore
The restore step specifically refers to maintaining a good sleep pattern and getting the right amount of sleep. Lack of sleep is associated with brain shrinkage as a result of the activation of microglia – the brain’s immune macrophage cells. It can also cause decreased concentration, attention and focus as well as low mood and an increased risk of stroke. Beta-amyloid plaques, part of the pathology of Alzheimer’s, are broken down during sleep.Optimize
Undertaking complicated activities which challenge multiple functions is important as this results in an increased cognitive reserve. This could include activities like learning a new language, playing a strategic game such as chess or bridge, social interaction or learning to play a musical instrument.All of the considerations above are present within Professor of Neurology, Dale Bredesen’s approach – ‘The Bredesen Protocol’. There are some differences within the detail, though this is likely related to the patients that each study has worked with.
The Sherzais suggest that they had mostly been working with people with early stages of brain impairment – subjective cognitive impairment (SCI) or mild cognitive impairment (MCI); while Professor Bredesen had been working principally with people with MCI or who have advanced to mild or moderate Alzheimer’s disease.
Both Professor Bredesen and the Sherzais cite the importance of healthy fats and vegetables, but the NEURO plan has a more prominent emphasis on wholegrain inclusion and does not recommend the use of coconut oil, while The Bredesen Protocol recommends this for patients with a diagnosis of Alzheimer’s in order to help them produce ‘ketones’ which the brain is able to use as fuel.
While both plans suggest that red meat should be limited, the NEURO plan also suggests limiting chicken and eggs because of concerns around the saturated fat content, favoring the inclusion of pulses and beans as an alternate source of protein.
Other key differences exist in that Professor Bredesen advocates a more extensive use of supplements to support nutrient status (because the brain has substantial energy and micronutrient requirements), to reduce inflammation and to optimize gut health - a central priority area.
Of note is that the Sherzais’ memory clinic is in California, and it is very close to two distinctly different communities – a community in San Bernardino which has high rates of chronic disease coupled with poor access to health care, and the generally healthy population of Seventh Day Adventists in Loma Linda.
“We consistently found that people living a healthy lifestyle [the Seventh Day Adventist community] had a much lower prevalence of dementia. By contrast those who lived unhealthy lifestyles got dementia more often and it usually emerged earlier in life” [they say, referring to the neighboring, typical modern community of San Bernardino].
Loma Linda is regarded as one of the healthiest places on Earth. A third of its residents are Seventh-Day Adventists, whose faith is very much connected to health and wellbeing. The community is active, vegetarian and spiritual with strong family and community ties – all of which can help improve stress and wellness. The community tends to live an average of 7-9 years longer than average and, perhaps most importantly, they are living longer with less chronic disease when compared to the general population.
Loma Linda is noteworthy as it is one of the five areas in the world designated as a ‘Blue Zone’. Dan Buettner – in his book of the same name – describes Blue Zones as areas of the world where communities live well and live longer (well into their 90s or even 100s), and where there are lower rates of chronic diseases.
Blue Zones have been identified in Ikaria in Greece, Okinawa in Japan, Sardinia in Italy, Loma Linda in California and Nicoya in Costa Rica. Within his book, Buettner identifies a range of lifestyle and dietary characteristics that are shared by all these communities. The people living in Blue Zones tend to:
- Move naturally. Activity is part of daily life and about much more than going to the gym – regular movement is within the fabric of their day-to-day activities
- Maintain a diet that is mainly plant based with meat treated as a ‘side dish’ and generally not eaten every day. The diet is likely based on wholefoods, while processed foods are avoided
- Stop eating before they are full. The Okinawans call this Hara Hachi Bu – which means that they stop eating when 80 % full rather than 100 %. Other research has also linked restricted carlorie intake to anti-aging benefits and longevity;
- Drink red wine in moderation. This means just one small glass daily, though it is worth noting that contrary to what is generally reported in the press, research has shown that there is no benefit to mortality from moderate drinking – ‘all-cause mortality’ increases in line with alcohol consumption and with alcohol there is no safe dose, even though a small amount of red wine may reduce the risk of certain specific diseases like heart disease
- Have a purpose in life. This means that these people know their reason for waking up in the morning and feel fulfilled by this
- Take time to relax
- Participate in a spiritual community
- Make family a priority
- Be surrounded by others who share in their Blue Zone values
Multi-Modal Approaches to Alzheimer’s
Both the Sherzais and Professor Bredesen’s approaches consider the range of biological mechanisms that are involved in the development and advancement of Alzheimer’s disease. Historically, drug therapy and monotherapies (single agent drug therapy) for neurodegenerative diseases have often failed because they do not cater for the multifactorial nature of these conditions.There exists a range of studies which support each of the elements noted above around cognitive health, though less of these tend to take on board a multifactorial approach. One study that has is the FINGER Study – that is, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability.
This research, published with The Lancet in 2015, consisted of a multi-domain approach to preventing the cognitive decline of elderly people at risk within the general population of Finland. This large, long-term trial illustrated that this type of multi-domain intervention could maintain or even improve cognitive functioning.
The central hypothesis within this trial was that undertaking simultaneous changes within several risk factors would result in a protective effect on cognition within elderly people between 60 and 77 years of age who may be at risk.
Participants within the study were divided into 2 groups. A control group of 565 people received regular advice around their health, with the intervention group of 554 receiving extra intervention such as being advised to adopt a plant-based diet that is high in omega 3 fatty acids, advice around resistance and aerobic exercise training, social activities and a cognitive training program. The intervention group also received vascular risk monitoring.
After a two-year period, the intervention group showed a considerably higher cognition score – the primary outcome – and additional outcomes around BMI, processing speed, executive functioning, physical activity and dietary habits.
References are available on request.
The Brain Health Program
The Brain Health Program has been designed to provide individuals with the knowledge and practical tools required to optimize wellbeing, memory and mood. The Program includes six interactive workshops, led by qualified Nutritional Therapists, which include talks, activities and discussion to show individuals how to make, and sustain, lifelong food and lifestyle choices to protect and promote the health of the brain. The workshops cover topics such as nutrition, optimizing gut health, stress management, improving sleep, physical activity and brain training.The Brain Health Program is suitable for anyone wishing to learn how to support their mental health and wellbeing and reduce their risk of cognitive decline.
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