IS COGNITIVE DECLINE INEVITABLE?

My mind goes often to this non planet

If I knew where my mind was, I’d be able to find it. 
My mind goes to Pluto at the drop of a hat. 
What did I come into this room to get?
And where did I park my car?

As we age, we lose brain cells. That’s my story and I’m sticking to it. My mother claimed we kids were responsible for the early grey in her hair and its white was the result of the loss of brain cells, which she attributed to our wild ways driving her crazy. Neurons in the brain do die every day, but the brain grows new ones into a person’s seventies. 

Previous research suggests cognitive decline doesn’t begin before the age of 60, but this view isn’t universally accepted by scientists, much less the common public. We all have met people who’ve quit growing intellectually in their 30’s, while some have flexible minds and continue to learn new ideas and adjust their previously held thoughts when new information is presented. Some people’s capacity for memory, reasoning and comprehension skills (cognitive function) can start to deteriorate from age 45. 

Happy Birthday—Don’t return the favor.

This is why 40 was once considered “over the hill,” but folks today think of 50 as that apex. When my brother decorated my desk with dead plants and black balloons for my 40th birthday, I’m sure he meant it with tongue in cheek. However he might have been also alluding to my well known “space ranger” wandering mind. I don’t think I had cognitive decline; rather mine was more imaginative daydreaming, also known as “not paying attention.”

When I was 60, I watched a program on dementia and cognitive decline. The difference between forgetfulness and cognitive decline is the first happens occasionally and the latter affects your daily living negatively. On my recent vacation I forgot to bring toothpaste. I bought a tube at the grocery store. Cognitive decline is when you forget how to brush your teeth, you get cavities, and don’t make dentist appointments anymore. Then you lose the teeth and get dentures. Most likely someone also has to remind you to use the bubble cleaner on them and rinse them before they go in your mouth again. 
Since understanding cognitive aging will be one of the challenges of this century, especially as life expectancy continues to rise, we have to ask, what can we do to for our whole health? 

As easy as popping a pill sounds, a large recent review of studies found no solid evidence that vitamin and mineral supplements have any effect in preventing cognitive decline or dementia. The whole internet is full of health claims for this and that supplement, drink, bar, or detox tonic. While B vitamins; beta carotene; vitamins C, D or E; zinc, copper or selenium may be needed in your diet for other reasons, none of these have proved effective in preventing cognitive decline. 

How can you prevent cognitive decline? Try this combination strategy:
Four steps can improve your mental skills, even as you age—
1. following a healthy diet, 
2. getting regular exercise, 
3. socializing, and 
4. challenging your brain.

The results of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), which is the latest and most impressive study, goes a step further by suggesting that if you follow all four practices, you may even reverse lost mental capacity. The FINGER study indicated those who did so not only kept cognitive skills from declining, it also improved their reasoning skills and speed in performing mental tasks.

The volunteers were randomly assigned to two groups. One set of participants—the study group—received personal nutritional counseling, exercise instruction from physical therapists, and cognitive training. They also underwent seven medical exams during the study period. They frequently met in groups for cooking classes, cognitive training, or exercise instruction. The other participants—the control group—had three medical exams, during which they received general health advice. Both groups were given mental function tests again at the end of the study.

Dr. Scott McGinnis, a neurologist at Harvard-affiliated Brigham and Women’s Hospital and author of The Harvard Guide to Coping with Alzheimer’s Disease, says “Healthy lifestyle behaviors can benefit people of all ages. But to have the greatest impact on late-life mental function, get started early.” 

The FINGER study’s results should offer additional encouragement to pursue a healthy, active, engaged lifestyle with regular exercise, a Mediterranean diet, and challenging mental activities because these can help preserve your mental acuity. Moreover, the FINGER study reminds us it not only helps to combine these practices, but it also helps to enjoy them as we do them. 

This wasn’t a quick fix, either. The FINGER program lasted for two years and the participants stuck with it because they were enjoying themselves. They also had become friends with others in their training groups. Although the experiment was demanding, only 12% of participants dropped out. Plus, these folks worked at their exercise—attendance was over 85% at training sessions, which included three to five exercise sessions a week, as well as 10 to 12 sessions of nutrition counseling and 144 cognitive training sessions over two years.

If you’re having trouble making healthy changes, a cooking or exercise class may help you get started and open a new circle of friends. Volunteering as a tutor, joining a community choir, or working on a political campaign can offer new intellectual challenges and social engagement. The key to making lifestyle changes is in finding a way to enjoy making them—and that is often among a group of companions who are striving for the same goal. 

Fresh vegetables and Chicken breast in Olive oil

We all make a choice in our lives. If we want good health, but don’t want to give up our television programs, we either need to pick an exercise time outside of our favorite TV shows, or hit a gym with screens. For instance, I still eat fried chicken, but only on my vacation. I eat uncured bacon on Saturdays rather than every day, and pancakes once a month. I haven’t given up my favorite foods, but I’ve put a limit on the most unhealthy ones out of respect for my body. This gives me some room for when I feel the need to self medicate with two scoops of ice cream, as when my computer died last month and I had to replace it. Making a big decision is definitely an ice cream moment for me, but I don’t need it every day anymore. 

One of my goals at Cornie’s Kitchen is to learn new skills and information to benefit the majority of persons in our world today: half of Americans and 30% of the world’s population are obese or overweight, and the cardiovascular diseases associated with obesity are increasing worldwide also. Since our children are also impacted by this health risk, we have to change our way of looking at food, exercise, time, stress, life, work, and our means of balancing the competing and complex needs in our world. 

If I can’t wave a magic wand over you, say a magic spell, or cast a potion of power over you, then at least I can help you burn through a few brain cells. They’ll grow back. Grey hair is a sign of power and wisdom.  

Joy and Peace, 

Cornie 

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Thankful for Health

As I enter yet another decade of Thanksgiving, I’m most thankful for my health. Once a person enters “senior status,” good health means “managed diseases.” My young friends often whine about the difficulty of taking a single prescription per day. I just laugh, for they don’t know what truck will hit them after age 50! Most people my age have pill minders or get theirs in daily prepared packaging ready made.

One health condition that can’t be standardized is the blood glucose reading, unless you qualify for a new 24 hour wearable monitor. Otherwise you do the stick and read at different times of the day. If you’re like me, keeping track of the blood sugar readings gives you a window into your body’s response to your food choices and your commitment to an exercise plan.

I have prediabetes, so I measure my glucose in the morning and before I go exercise. My doctor says the morning should be under 100 and the preexercise reading needs to be over 100 if I’m going for anything more vigorous than a gentle walk. I don’t yet have the high readings because for 14 years I’ve eaten a Mediterranean diet and exercised daily. I still eat around 2000 calories per day, so I’m not starving myself, since my BMR is 2060.

Would they like me to lose weight? Yes, and so would I, but my blood pressure is finally normal without medication, my arteries are clear, and my depression is in remission due to medication and lifestyle commitments. We have to pick the battles we want to fight. If our weight is fat, our bodies will metabolize food differently than if our weight is muscle. Weight bearing exercises such as walking, lifting weights, or climbing stairs, will build muscle over the long haul.

When I first started walking, I couldn’t make the whole way around a city block without stopping for breath, I was so out of shape. I set a smaller goal, mastered it, and made a bigger one. I can walk a 5K now, and even if I’m the last to finish, I still am faster than everyone who didn’t enter the race. Keep a positive attitude!

Health isn’t a number on the scale or a size of clothes into which you fit. Health is more about reclaiming your positive attitude towards food as nourishment for your body, rather than as a sedative for your emotional distress. I’ve been in this place myself. I never met a chocolate donut that wouldn’t soothe my inner angst, only to give me eater’s remorse afterwards. It was a downward, addictive spiral, for I’d eat again to feel better, only to feel icky once more.

Health is also about leaving behind the bad habits that bought on high blood pressure, high blood sugar of type 2 diabetes, and prediabetes: stress, excessive caffeine, and processed foods. These foods are the heart killer trifecta of the Standard American Diet—fat, salt, and sugars. These show up in our processed meats, dairy products, and bakery goods, not to mention our condiments and desserts.

Thanksgiving Feast and Desserts

Just as we learned negative habits, we can learn positive behaviors. We don’t have to change everything all at once, but we do need to begin somewhere, sometime. Perhaps the holidays seem to be the worst time, with all the extra cooking and treating surrounding us. If we pick one behavior each week, such as measuring our food portions this week and not eating second helpings the week of Thanksgiving, we’ll be on the way to a healthier lifestyle!

Cooking a Thanksgiving Feast

Remember the words of Paul in 1 Thessalonians 5:16-18–

“Rejoice always, pray without ceasing,

give thanks in all circumstances;

for this is the will of God in Christ Jesus for you.”

SEE SLIDES ON WHAT AFFECTS YOUR BLOOD SUGAR READINGS

https://www.webmd.com/diabetes/daily-control-17/slideshow-blood-sugar-swings

WHY IS FAT SO POPULAR?

TRUTH!!

Why do we choose the food on our plates? Some of us eat traditional foods from our childhoods, our cultures, or our homelands to connect us with our history and our stories. Others of us may choose alternative menus, to change our story line or to rewrite a troubled or fraught past. In this way, “what we eat proclaims who we are,” even as it nourishes the person we are becoming in the flesh.

Yet the extreme carnivore fat shamers have no problem what so ever in singing the praises of a huge, fat riddled hunk of ribeye steak, preferably rare, and eagerly devoured as a testimony to their peak powers and dominance traits. They often mention bitcoin’s luster or their own wellness ventures if the conversation goes much past hello. I’ve often wondered if the inanimate aspect of the slab on the plate allows them to connect more deeply with their food than they can with an actual human being, who has feelings and might speak back. Better to devour both of these, and stay unaffected by the outer world’s complexities.

However, the world always intrudes. We find no sanctuary, for we tear down the very walls which we build about ourselves. If we choose the extreme course, we’re on a path to self destruction, unless we change our lives. The ancient Greeks were wise to say, “The middle path is safest and best.”

Our choice of menus, diets, or eating plans is also a form of tribal signaling, as we send out signs for others to recognize and to respond accordingly. Fat shaming is a negative form of signaling by those who overvalue outward appearances. Those whose bodies are overly generous in size need to disregard this crowd’s disgust. Instead, discovering their personal value and worth is more important so they can be proactive about their own health. To enjoy life, to live as well as possible, and to be a blessing to our family and the community, is important for each of us.

WHAT IS TRUTH?

With all the competing claims out in the world today, how can we know what is truly healthy for the long haul? Since anyone can get on the internet and make any claim they want, until someone gets hurt and the legal process shuts their scam down, how do we sort out these “Truth Claims?” The accepted way is a RCT, or randomized controlled trial, which enrolls a large number of persons and follows them over many years. This is the “gold standard” of science, rather than “I use it and it works for me, plus listen to these testimonials!” In between is the single paper, not published in a major journal, with only a small sample of 50 to 100 subjects studied for a brief period. (If someone still believes “all these truths are equal,” I may know a friend with a friend with seashore property in Arizona to sell you, but I’d recommend a lesson in logic first.)

The Lancet Public Health Journal, August 18, 2018, published a major prospective cohort study and meta-analysis of dietary carbohydrate intake and mortality. The study followed nearly 16,000 adults in 4 different US communities for 25 years and they added in published research results from 7 multinational prospective studies. They did some big number crunching, so if you want to read the whole paper, the link is at the bottom of the page. It is a real RCT study, and deserves space for commentary.

MORTALITY AND FAT SOURCE

As the wag says, “men live longer if they don’t mention the extra weight their sweet cake is carrying on her hips.” It must be true–Neil DeGrasse Tyson’s photo is connected to this quote (meme worthy, for sure!).

When my mother made meatloaf, it had breadcrumbs and an egg to bind it together. She laid two strips of bacon on top of the loaf in the pan so it would get extra flavoring. Today people wrap the entire meatloaf in two pounds of bacon before they grill it on the outdoor BBQ pit. That pork fat goes into the food we eat and stays in the arteries to clog those vessels. We might be able to live higher on the hog than our parents, but we won’t live longer, not even with a good medical plan.

LIFE EXPECTANCY AND INCOME

Fifty years has passed: we eat worse, exercise less, and we our life expectancy has quit increasing. Back in 1966, men and women could live on average to age 67 and 73. Now those numbers are 76 and 81 in 2016. Back in 1933, men could expect to live to age 61 and women to 65. At least we aren’t going back to those “really good old days” when life was harsh, medicine lacked modern advances, and sanitation was poor.

Today poverty often impacts life expectancy due to food deserts in neighborhoods, lack of health insurance, and low incomes. The wealthy live longer. The poor in some cities — big ones like New York and Los Angeles, and also quite a few smaller ones like Birmingham, Ala. — live nearly as long as their middle-class neighbors or have seen rising life expectancy in the 21st century. But in some other parts of the country, adults with the lowest incomes die on average as young as people in much poorer nations like Rwanda, and their life spans are getting shorter.

CHOOSE YOUR FAT WISELY

This Study of Dietary Carbohydrate Intake and Mortality explored how the source of fat affected deaths in the group. The more meat fat a person ate, the more it impacted their life span for the worse (table 2).

The low-carb group was split into two separate groups:

1. The plant-based low carbohydrate dietary score was associated with higher average intake of vegetables but lower fruit intake (appendix p 11).

2. By contrast, the animal-based low carbohydrate dietary score was associated with lower average intake of both fruit and vegetables (appendix pp 9, 10).

3. Both low carbohydrate diets were associated with higher fat intake in exchange for carbohydrate, although the plant-based low carbohydrate diet had higher average polyunsaturated fat and lower saturated fat intake compared with the animal-based low carbohydrate diet (appendix pp 9–11).

ANIMAL FATS VS. PLANT FATS

People choosing an animal-based diet had an overall, higher, total protein intake. Five foods differed most significantly between the highest and lowest quantiles of animal-based and plant-based low carbohydrate dietary score (appendix p 9):

1. The animal-based low carbohydrate diet had more servings per day than did higher carbohydrate diets of beef, pork, and lamb as the main dish; beef, pork, and lamb as a side dish; chicken with the skin on; chicken with the skin off; and cheese (appendix p 10).

2. The plant-based low carbohydrate diet had more servings per day of nuts, peanut butter, dark or grain breads, chocolate, and white bread than did higher carbohydrate diets (appendix p 11).

3. Both low carbohydrate diets were lower in average regular soft drink intake (appendix pp 10, 11)

DEATH BY GIANT RIBEYE STEAK

Exclusionary diets, unless for medically necessary reasons, are not the best choice. Just because we want to jump off a cliff doesn’t mean we should do this! Someone who wants to eat only white food, as my child did for a time, is going through a phase. An adult who won’t eat anything white is missing out on some food groups, or doesn’t want to spend the time learning about food. If we have time saving machines all around us, why don’t we have the time to care for our embodied selves in this spare time? Do we value our work more than the worker? This devaluation of people is a slippery slope to other ills, not only to self harm but to disparagement of others or outright hatefulness.

1. In the ARIC cohort and in meta-analysis, increased consumption of animal-based protein and fat instead of carbohydrate was associated with a significant increase in all-cause mortality (table 3). Eat more animal fat and die sooner.

2. Alternatively, increased consumption of plant-based protein and fat instead of carbohydrate was associated with a significant decrease in all-cause mortality (table 3). Trade animal fats for healthier plant fats from nuts and seeds, such as olive oil. Use in moderation.

3. The animal and plant-based findings were consistent for cardiovascular and non-cardiovascular mortality (appendix pp 3, 4). Both heart disease and other diseases are made worse by animal fats. Let’s eat leaner, greener, and add more plants into our menus.

4. Similarly, in the meta-analysis, mortality increased when animal-derived fat and protein were substituted for carbohydrate, and decreased when these substitutions were plant-based (table 3). Eating more plants would do us better.

THE SWEET SPOT

The model for carbohydrate caloric intake is about 50% of total calories per day. It seems to be a sweet spot for life expectancy. In the diabetes world, most of us work to control our blood glucose readings by diet, so many of us will reduce our carbohydrates until they’re minimal at best. We may get good readings on our glucose meter, but what about our heart health? We don’t have a home health test for this. Since people with diabetes also have high rates of heart disease, we need to think of our whole body as one interconnected system, and not focus only on one symptom. We are complex and wonderful, so finding a balance for our finely tuned instrument is important.

ALL CARBS ARE NOT EQUAL

What carbohydrates we choose are another factor. If we think a bag of potato chips is equal to a baked potato in calories and nutrition, we have another think coming. Learning to read nutrition labels might cure us of this delusion. In the meantime, avoiding the snack aisle at the grocery store can keep us from bringing this ersatz food product into our home.

In “Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association Clinical,” the trials that used polyunsaturated fat to replace saturated fat reduced the incidence of cardiovascular disease. In contrast, trials that used mainly carbohydrates to replace saturated fat did not reduce CVD.

CHOOSE CARBS WISELY

However, the types of carbohydrate-containing foods were often unspecified and typically included sugar and other refined carbohydrates to maintain energy balance. When carbohydrates from whole grains replace saturated fat, evidence from prospective observational studies indicates reduced CVD. The two best interventions for menu modification are DASH and the Mediterranean Diet.

LIFESTYLE MODIFICATION

The other way we can help keep our blood sugar in range is lifestyle modification. This is the most difficult of changes most of us have to make. Exercise, meditation, journaling, adjusting recipes, cooking meals, making menus, and setting a bedtime or wake up schedule all seems like too much at once. Of course it is! And if it were easy, everyone would be doing it, no one would blog about it, and there’d be no great 25 year long studies to tell us not to wrap two pounds of ground beef in two more pounds of fatback bacon.

Actually, Aristotle, the Ancient Greek philosopher, spoke about the “golden mean.” Moral behavior is the mean between two extremes: at one end is excess, and at the other deficiency. Find a moderate position between those two extremes, and you’ll be acting morally, or rationally. This was his goal in life.

If we were to pick only one of these lifestyle modifications per week to work on, then in the next, do another one the best we can, and do on in the following weeks. Soon we’d all be more comfortable with the routine, and all of us would be doing them all without even realizing it. This is how you sneak in your learning! Before you know it, you have a transformed life. No one waved a magic wand over you, but you grew into your grown up shoes slowly but surely.

Best wishes for a better life, with more exercise and more joy!

Love, Cornie.

The Lancet Public Health Journal, August 18, 2018

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2818%2930135-X/fulltext

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association | Circulation

https://www.ahajournals.org/doi/10.1161/CIR.0000000000000510