Tag: diet

Boost Your Brain Health with Exercise: What the Science Says

If you’re looking for a way to protect and enhance your brain health, regular exercise should be at the top of your list. Decades of randomized controlled trial (RCT) data have consistently shown that moderate to vigorous physical activity is one of the most effective strategies for maintaining cognitive function and reducing the risk of neurological and mental health disorders.

How Exercise Supports Brain Health

Exercise is not just about physical fitness—it has profound effects on brain function and resilience. Research has demonstrated that regular physical activity contributes to:

✅ Reduced Risk of Dementia & Cognitive Decline – Studies indicate that individuals who engage in moderate to vigorous exercise have up to a 30-40% lower risk of developing dementia compared to those with sedentary lifestyles. Physical activity enhances neuroplasticity, promotes new neuron growth (neurogenesis), and improves synaptic function—all crucial factors in preventing cognitive decline.

✅ Improved Stroke Prevention & Recovery – Exercise lowers blood pressure, enhances circulation, and improves endothelial function, significantly reducing the risk of stroke. For stroke survivors, RCTs suggest that physical rehabilitation incorporating aerobic and strength training can improve motor function, cognitive recovery, and quality of life.

✅ Lower Rates of Anxiety & Depression – Multiple RCTs have shown that exercise is as effective as antidepressantsin treating mild to moderate depression, thanks to its ability to regulate neurotransmitters like serotonin, dopamine, and endorphins. Regular physical activity also reduces cortisol (stress hormone) levels, improving resilience to stress and anxiety disorders.

✅ Better Sleep Quality – Exercise plays a crucial role in regulating circadian rhythms and increasing slow-wave (deep) sleep, which is essential for cognitive recovery and emotional processing. RCTs show that individuals with insomnia who engage in aerobic exercise experience significant improvements in sleep latency, duration, and overall sleep quality.

How Much Exercise is Needed for Brain Benefits?

The gold standard for brain health is a combination of aerobic exercise (such as brisk walking, cycling, or swimming) and strength training (such as weightlifting or bodyweight exercises). Research recommends:

📌 150-300 minutes per week of moderate-intensity aerobic exercise OR 75-150 minutes per week of vigorous-intensity exercise 📌 At least two days per week of strength training to preserve muscle mass and support neuroprotective benefits

The Bottom Line

Regular physical activity isn’t just about fitness—it’s one of the most powerful, evidence-based tools for maintaining brain health, preventing cognitive decline, and improving mental well-being. Whether you’re looking to sharpen memory, reduce stress, or protect against neurological disease, making exercise a regular habit is a science-backed investment in your future.

So, lace up your sneakers, get moving, and give your brain the boost it deserves! 🧠💪

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Metformin for Antipsychotic-Induced Weight Gain: What Took So Long?

Antipsychotic-induced weight gain remains a significant challenge in psychiatric practice, contributing to metabolic syndrome, decreased quality of life, and reduced medication adherence. This issue is especially concerning given the chronic nature of psychiatric illnesses requiring antipsychotic treatment. Among strategies to address this, metformin—an insulin sensitizer primarily used for type 2 diabetes—has garnered considerable interest. Below, we summarize the evidence from randomized controlled trials (RCTs) evaluating metformin’s efficacy and safety in mitigating weight gain associated with antipsychotic medications.

Evidence from Randomized Controlled Trials

  1. Meta-Analyses and Systematic Reviews
    • Multiple meta-analyses of RCTs have shown that metformin effectively reduces weight gain in individuals receiving antipsychotics. Weight reductions of 2-3 kg over 12-16 weeks have been reported compared to placebo.
    • Beyond weight loss, improvements in metabolic parameters such as fasting glucose, insulin resistance, and lipid profiles have been observed.
  2. Population-Specific Findings
    • First-Episode Psychosis (FEP): Studies indicate that metformin is particularly effective in individuals with FEP who experience rapid weight gain shortly after initiating antipsychotic therapy. Early intervention appears to yield more substantial benefits.
    • Chronic Schizophrenia: RCTs in populations with chronic schizophrenia have demonstrated similar weight-reducing effects, though results may be less pronounced compared to FEP patients.
  3. Adjunctive Lifestyle Interventions
    • Combining metformin with lifestyle interventions, such as diet and exercise counseling, results in synergistic benefits. RCTs demonstrate that this combination is more effective than metformin or lifestyle changes alone.

Safety and Tolerability

Metformin is generally well-tolerated. The most common side effects are gastrointestinal (e.g., nausea, diarrhea), which tend to subside with continued use. Rarely, lactic acidosis—a serious adverse event—can occur, particularly in individuals with renal impairment. It is crucial to monitor kidney function periodically.

Practical Considerations

  1. Dosing: Initiate metformin at a low dose (e.g., 500 mg once daily) to minimize gastrointestinal side effects, and titrate gradually to a typical maintenance dose of 1,000-2,000 mg per day.
  2. Monitoring: Regularly assess weight, BMI, fasting glucose, and lipid profiles. Monitor renal function before and during treatment.
  3. Patient Selection: Metformin may be particularly beneficial for patients who:
    • Have significant weight gain or metabolic disturbances from antipsychotic use.
    • Are early in their antipsychotic treatment course.
    • Have no contraindications, such as severe renal impairment.

Conclusion

Metformin offers a promising strategy for mitigating antipsychotic-induced weight gain, supported by robust evidence from RCTs. While not a standalone solution, it can play a critical role in a comprehensive approach to managing the metabolic side effects of antipsychotics. Clinicians should consider metformin’s inclusion in treatment plans for patients struggling with weight gain or metabolic dysfunction related to antipsychotic treatment.

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Evidence-Based Strategies to Reduce Distractions in ADHD

Managing distractions is a core challenge for individuals with ADHD and even for those without. Research-backed strategies, including environmental adjustments, behavioral techniques, and technological tools, have shown promise in helping individuals stay focused and minimize interruptions

1. Environmental Modifications

Declutter and Organize Your Space

  • Why: Visual clutter increases cognitive load and distractibility in ADHD.
  • Evidence: Studies show that simplified, organized environments improve task performance and reduce overwhelm.
  • Implementation:
    • Create a designated workspace with minimal visual and auditory distractions.
    • Use storage bins or labeled organizers to keep items out of sight.

Sound Management

  • Why: Background noise can be highly distracting for individuals with ADHD.
  • Evidence: RCTs indicate that white noise or low-level background music can enhance focus in some ADHD individuals.
  • Implementation:
    • Use white noise machines or apps (e.g., “Noisli”).
    • Experiment with instrumental music or nature sounds to find what works best.

2. Structured Task Management

The Pomodoro Technique

  • Why: Short, timed intervals of work followed by breaks improve sustained attention.
  • Evidence: Studies show that structured time management strategies reduce procrastination and improve productivity in ADHD.
  • Implementation:
    • Work for 25 minutes, then take a 5-minute break. Adjust intervals based on your focus capacity.
    • Use timers or apps like “Forest” to track intervals.

Chunking Tasks

  • Why: Breaking tasks into smaller steps prevents overwhelm and promotes task completion.
  • Evidence: Behavioral interventions involving task segmentation show significant benefits in ADHD.
  • Implementation:
    • Divide projects into 3–5 actionable steps.
    • Write each step on a checklist and celebrate small wins.

3. Technology-Based Interventions

Digital Focus Tools

  • Why: Apps that block distractions and guide focus provide real-time support.
  • Evidence: RCTs on apps like “Focus@Will” and browser extensions like “Freedom” show improvements in task engagement for ADHD.
  • Implementation:
    • Use website blockers to eliminate access to social media or other distractions during work.
    • Try ADHD-specific productivity apps like “TaskTuner” or “Asana.”

Timed Alerts and Reminders

  • Why: Timers and reminders keep individuals on track and prevent attention drift.
  • Evidence: Digital prompts have been shown to improve task adherence in ADHD.
  • Implementation:
    • Use phone alarms or apps like “Remember The Milk” for task reminders.
    • Schedule alerts for transitions or breaks.

4. Behavioral Techniques

Mindfulness Training

  • Why: Mindfulness helps individuals recognize and redirect wandering attention.
  • Evidence: RCTs show that mindfulness-based interventions improve sustained attention and reduce impulsivity in ADHD.
  • Implementation:
    • Practice 5–10 minutes of mindfulness meditation daily using guided apps like “Headspace.”
    • Incorporate brief mindfulness exercises before starting tasks.

Behavioral Reinforcement

  • Why: Positive reinforcement encourages task focus and reduces distractions.
  • Evidence: Token systems and reward strategies have proven effective in ADHD-focused behavioral studies.
  • Implementation:
    • Set up a reward system (e.g., complete 3 tasks to earn 15 minutes of free time).
    • Track progress with visual aids like charts or checklists.

5. Workplace or School Accommodations

Flexible Seating and Movement Breaks

  • Why: ADHD individuals focus better when they can move or choose a seating arrangement.
  • Evidence: Studies on flexible classroom setups and “active learning environments” report improvements in ADHD engagement.
  • Implementation:
    • Use standing desks or fidget tools to incorporate movement.
    • Take brief movement breaks every 20–30 minutes.

Noise-Canceling Headphones

  • Why: Blocking environmental noise improves focus on tasks.
  • Evidence: RCTs demonstrate that noise-canceling headphones significantly reduce distractions in ADHD.
  • Implementation:
    • Use headphones during work or study sessions to minimize auditory interruptions.

6. Diet and Lifestyle Adjustments

Nutrition for Focus

  • Why: Stable blood sugar and adequate nutrition reduce mental fatigue and improve concentration.
  • Evidence: Studies suggest that diets high in protein and low in refined sugar reduce distractibility in ADHD.
  • Implementation:
    • Eat balanced meals with complex carbs, proteins, and healthy fats.
    • Avoid high-sugar snacks during focus-intensive tasks.

Exercise and Movement

  • Why: Physical activity improves attention and executive function in ADHD.
  • Evidence: A 2018 RCT found that 20 minutes of moderate aerobic exercise improved focus in children with ADHD.
  • Implementation:
    • Schedule exercise breaks or mini workouts during the day.
    • Use movement as a tool to reset focus between tasks.

7. Cognitive Behavioral Therapy (CBT) for ADHD

Why: CBT addresses thought patterns and behaviors contributing to distractibility.

Evidence: Multiple RCTs demonstrate the efficacy of CBT in improving attention and task persistence in ADHD.

Implementation:Work with a therapist trained in ADHD-specific CBT.Practice CBT strategies like identifying and reframing negative thoughts about distractions.

Conclusion

Reducing distractions in ADHD involves a combination of environmental modifications, structured strategies, and personalized interventions. These evidence-based approaches can help individuals focus, complete tasks, and thrive in daily life. By experimenting with these methods and tailoring them to your needs, you can find a system that works best for you.

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Evidence-Based Diets for ADHD: Insights from Randomized Controlled Trials (RCTs)

Diet plays a significant role in brain health and behavior, making it a promising area for ADHD symptom management. While dietary changes are not a substitute for standard treatments, several dietary interventions have shown evidence-based benefits in improving ADHD symptoms.

1. Omega-3 Fatty Acid Supplementation

  • Why: Omega-3 fatty acids, particularly EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), are crucial for brain development and function.
  • Evidence:
    • A 2018 meta-analysis of RCTs found that omega-3 supplementation improved attention and reduced hyperactivity in children with ADHD.
    • Higher EPA-to-DHA ratios (e.g., 3:1) were more effective.
  • How to Implement:
    • Include fatty fish (e.g., salmon, mackerel, sardines) 2–3 times per week.
    • Consider omega-3 supplements (1–2 grams daily with a high EPA content).

2. Elimination Diets

  • Why: Some children with ADHD may react adversely to specific foods or additives, exacerbating symptoms.
  • Evidence:
    • The Restricted Elimination Diet (RED), such as the oligoantigenic diet, has been tested in RCTs. A 2011 RCT published in The Lancet found significant symptom reductions in 64% of children who followed a restricted diet for 5 weeks.
    • Foods commonly eliminated include dairy, wheat, soy, eggs, and food additives.
  • How to Implement:
    • Work with a healthcare provider or dietitian to guide the process.
    • Reintroduce foods one at a time to identify triggers.

3. Additive-Free and Preservative-Free Diets

  • Why: Artificial food colorings, preservatives, and sweeteners may worsen hyperactivity in some children.
  • Evidence:
    • A meta-analysis published in Pediatrics (2012) found that artificial food coloring elimination reduced ADHD symptoms in a subset of children.
  • How to Implement:
    • Avoid processed foods with artificial dyes (e.g., Red 40, Yellow 5).
    • Read ingredient labels and choose whole, minimally processed foods.

4. Mediterranean Diet

  • Why: The Mediterranean diet is rich in nutrients critical for brain health, such as omega-3s, antioxidants, and vitamins.
  • Evidence:
    • A 2017 study in Pediatrics suggested that children who adhered to a Mediterranean diet had fewer ADHD symptoms compared to those with poor adherence.
  • How to Implement:
    • Focus on fruits, vegetables, whole grains, nuts, seeds, fish, and olive oil.
    • Limit red meat, processed foods, and added sugars.

5. Low-Glycemic Index (GI) Diet

  • Why: High-GI foods (e.g., sugary snacks) cause rapid blood sugar spikes and crashes, which may worsen hyperactivity and inattention.
  • Evidence:
    • A small RCT found that a low-GI diet improved behavior in children with ADHD by stabilizing energy levels and focus.
  • How to Implement:
    • Choose whole grains, legumes, and non-starchy vegetables.
    • Avoid sugary drinks, white bread, and refined snacks

6. High-Protein Diets

  • Why: Protein supports the production of neurotransmitters like dopamine, which is often dysregulated in ADHD.
  • Evidence:
    • Some studies suggest that protein-rich breakfasts improve attention and reduce impulsivity during the day.
  • How to Implement:
    • Include protein-rich foods (e.g., eggs, yogurt, lean meats, nuts) in each meal.
    • Avoid skipping breakfast to maintain consistent energy levels.

Micronutrient Supplementation

  • Why: Nutrient deficiencies (e.g., zinc, magnesium, iron) are linked to ADHD symptoms.
  • Evidence:
    • RCTs show that zinc and magnesium supplementation improves hyperactivity and impulsivity, particularly in children with low baseline levels.
    • Iron supplementation benefits those with low ferritin levels.
  • How to Implement:
    • Have nutrient levels tested by a healthcare provider.
    • Include nutrient-rich foods like spinach (iron), nuts (magnesium), and seafood (zinc).

Recommendations

  1. Prioritize Whole Foods: Focus on unprocessed, nutrient-dense foods.
  2. Limit Sugars and Additives: Avoid foods with high sugar content, artificial sweeteners, or additives.
  3. Monitor Responses: Keep a food and symptom journal to identify potential triggers or improvements.
  4. Consult Professionals: Work with a dietitian or healthcare provider to ensure nutritional adequacy and tailor dietary changes to individual needs.

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Inflammation: The Hidden Culprit Behind Your Mental Health Struggles

Over the past several years, a growing body of research has highlighted the role of inflammation in the development and progression of psychiatric disorders. A key biomarker frequently used in these studies is C-reactive protein (CRP), which can be measured through a simple blood test. For precise results, it’s important to order the ultra-sensitive CRP test when conducting this in a lab setting.

Recent findings from JAMA Psychiatry have revealed varying mental health trajectories for individuals with low-grade inflammation throughout childhood. Persistently elevated CRP levels, particularly peaking around age 9, were linked to an increased risk of developing psychosis, severe depression, and insulin resistance in adolescence and early adulthood.

This research suggests that a simple blood test could potentially identify children at higher risk for serious mental illnesses and cardiometabolic issues later in life, offering a window for early intervention.

The big question remains: how should we address this low-grade inflammation? My first recommendation is to focus on lifestyle modifications, particularly dietary changes that reduce inflammation, such as adopting a Mediterranean diet. Additionally, I believe chronic stress is a major contributor to inflammation. In modern American society, stress reduction is often overlooked, but finding effective ways to manage stress is crucial to mitigating long-term health risks.

Link to the article: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2822343

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The ketogenic Diet For Mental Health

The ketogenic diet, primarily known for its benefits in weight loss and managing conditions like epilepsy, has been increasingly explored for its potential impact on mental health, including psychiatry. While research in this area is still emerging, some studies suggest that the ketogenic diet may offer benefits for certain psychiatric conditions. 

  1. Mood Disorders: Some research indicates that the ketogenic diet might have a positive impact on mood disorders such as depression and bipolar disorder. The diet’s ability to stabilize blood sugar levels and regulate neurotransmitters like serotonin and dopamine could contribute to mood improvement.
  2. Anxiety: The ketogenic diet’s effects on GABA (gamma-aminobutyric acid), a neurotransmitter that helps regulate anxiety, have been of interest to researchers. By increasing GABA levels, the diet may have an anxiolytic effect, potentially reducing symptoms of anxiety.
  3. Cognitive Function: Ketones produced during ketosis are an alternative fuel source for the brain. Some studies suggest that ketones may provide more efficient energy for brain cells, leading to improved cognitive function and clarity of thought. This could have implications for conditions such as ADHD and cognitive impairment.
  4. Neuroprotective Effects: Ketones have been shown to have neuroprotective properties, which could be beneficial in neurodegenerative disorders like Alzheimer’s disease and Parkinson’s disease. By providing an alternative energy source for the brain, the ketogenic diet may help protect against neuronal damage and promote brain health.
  5. Inflammation: Chronic inflammation has been linked to various psychiatric disorders. The ketogenic diet has anti-inflammatory effects, which could potentially reduce inflammation in the brain and mitigate symptoms of conditions like schizophrenia and PTSD.
  6. Gut-Brain Axis: Emerging research suggests that the gut microbiota plays a crucial role in mental health. The ketogenic diet can influence the gut microbiome, potentially improving gut health and modulating brain function through the gut-brain axis.

While these findings are promising, it’s essential to approach the use of the ketogenic diet in psychiatry with caution. More research, including large-scale clinical trials, is needed to fully understand its efficacy, safety, and long-term effects on mental health conditions. Additionally, the ketogenic diet may not be suitable for everyone and should be implemented under the guidance of healthcare professionals, especially for individuals with pre-existing health conditions or those taking medications.

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Omega-3 Fatty Acids and Mental Health

Omega-3 fatty acids are reported to help with several physical and mental health conditions. 

They are termed essential because they cannot be produced by the body and must come from the diet. 

In fact, I use 1000 mg of omega-3 fish oil daily as part of my own supplement routine.

How Do Omega-3s Work:

Omega-3’s coat neurons, increase cell membrane fluidity, have neuroprotective properties, and the most well-established mechanism is an anti-inflammatory action. They directly affect arachidonic acid metabolism because they displace arachidonic acid from membranes and compete with it for the enzyme that catalyzes the biosynthesis of thromboxanes, prostaglandins, and leukotrienes involved in the inflammatory process thus reducing the formation of these products. 

Indications For Omega-3 Use In Psychiatry:

In mental health the most well-established use of Omega-3s is for the treatment of depression. It’s been looked at as a primary treatment as well as augmentation. The results aren’t that great when Omega-3s are used as stand-alone therapy. As augmentation they have an effect size of 0.5 to 0.6.

Given our previous talks about inflammation and depression, people with high inflammatory biomarkers may respond better to Omega-3 treatment. 

Omega-3s And Schizophrenia:

Maybe the most interesting data comes from studies of Omega-3 use in schizophrenia. It seems to work best when started early in the illness when the first signs or symptoms appear. There also seems to be a reduction in white matter changes on imaging studies. 

This raised the important question; can we prevent schizophrenia? 

Vienna Study:

There was a study published in nature communications that looked at outcomes in the prevention of psychotic disorders in Vienna. 

They started with 12-week trial with omega-3s which proved to reduce the risk of progression to a psychotic disorder in young people with subthreshold psychotic states for a 12-month period compared to placebo. 

They then completed a long term follow up of the study to show that brief intervention with Omega-3s reduced the risk of progression to a psychotic disorder and psychiatric morbidity. 

A year after the Omega-3 treatment only 5% converted to schizophrenia, compared to 28% in the control arm. Seven years later the rates of conversion to schizophrenia were 10% Vs 40% with most of the patients being retained in the study. 

Side Effects of Using Omega-3:

There are very few risks to adding omega-3 fatty acids to existing psychiatric treatments. Fish burps are a common occurrence and can be mitigated with enteric coated capsules or refrigerating the capsules. Omega-3 can increase bleeding time and require careful monitoring if the person is scheduled for surgery or taking anticoagulants. Keeping doses at 1000 mg/day is advised for this population. 

Sources of Omega-3:

You can use a supplement, or you can consume fish like salmon, herring, or anchovies two times per week to get an adequate dose. 

Ensuring the EPA to DHA ratio is 2:1 (EPA: DHA) or pure EPA is essential when selecting a product. Consumerlabs.com to help ensure the purity and potency of the product is accurate. 

The cost of adding an Omega-3 supplement to your treatment is $8 to $30 per month depending on the specific product. 

There is very little downside to increasing your consumption of Omega-3 fatty acids either from whole food sources or as a high-quality supplement. 

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Why Psychiatrists Don’t Use Lifestyle Medicine to Treat Psychiatric disorders

My clinical experience indicates that most psychiatric disorders would benefit from the use of lifestyle medicine. As a member of the American College of Lifestyle Medicine, I’ve used lifestyle interventions to treat many of my patients. It’s an underutilized and undervalued part of health care in general and these are my thoughts about why that is the case. 

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Medication Side Effects: Doctor I’m Gaining Weight!

One of the biggest challenges we face in the field of psychiatry is medication adherence. A large portion of the people fail to get better either because they do not start the medication, or do not take it as prescribed. One of the most common reason cited by patients for stopping medication is weight gain. In this article I will detail the approach I take to weight management for patients on psychiatric medications. 

Initial Visit: 

Weight management is a discussion that should happen between the patient and clinician at the first meeting. It’s important to use primary prevention (preventing the onset of weight gain) if possible. We always obtain some objective measures such as height, weight, and calculate the BMI on the initial visit and subsequent visits. Additional tests that may be ordered include HBA1C, fasting blood glucose, and lipid profile. This is where I will take the opportunity to discuss the importance of diet and exercise. For people with little diet or exercise experience I will keep the information very basic. The discussion will center around eliminating processed foods, calorie containing beverages, increasing fruit and vegetable intake, and making good choices when shopping at the food store. I have several handouts with food choices on them that help guide the patient when making food choices at the grocery store. I also recommend patient’s keep a food diary or track their food intake on a mobile app such as my fitness pal. This will help us to understand more about the patient’s eating habits and identify potential areas for improvement. I will build on diet interventions and monitor progress with the food diary or app at each visit. I do not recommend a specific diet, as it’s far more important for the patient to pick something they can be consistent with, and there are multiple ways to achieve weight management goals. At this time the closest diet we have that I’m comfortable recommending is the Mediterranean diet. There is some good evidence that the Mediterranean diet can have an antidepressant effect which is an added bonus.

Exercise

Exercise is the next area to address. I like to ask some screening questions about what type of physical activity the patient engages in, and how much experience they have with fitness/athletics. I will then ask them to track their exercise over the subsequent weeks prior to returning for follow up visit. On the initial visit I will recommend they begin a basic walking program of at least 30 minutes per day preferably seven days per week. This is a simple thing to incorporate on a daily basis, and does not require any special equipment or gym membership. We can improve on this routine and incorporate resistance training on a case by case basis. 

Medication Choice

The next step in the process is to make a medication choice that limits the potential for weight gain. Most psychiatric medications cause weight gain. This is an unavoidable fact. Avoiding the use of medications with the highest propensity of weight gain including Clozapine, Olanzapine, and Mirtazapine is good planning on the physician’s part. It’s important to note that it’s not always possible to avoid these medications. Medications such as Aripiprazole which are considered to be weight neutral, from clinical experience are not weight neutral at all. It’s important for the clinician to make good choices if weight gain is a potential issue that will interfere with treatment.

Medication For Weight Management

My last line of defense against weight gain which often comes too late is medication management. I like to start with Metformin extended release 500 mg daily after the largest meal. This is to test the patient’s tolerance for the medication. The goal is to titrate to 2000 mg/day in divided doses. A B12 level should be checked once per year as Metformin has been known to reduce levels. There is evidence in the literature from a Meta-analysis of all RCTs supporting the use of Metformin for antipsychotic induced weight gain. The important thing to remember is to start the medication at the earliest signs of weight gain, or even before the onset of weight gain in high risk patients. The patients most likely to benefit are those who are younger, more recently started on antipsychotics, overweight but nor obese, and those that had rapid weight gain. 

The second medication I will talk about is Topiramate There is evidence from RCTs to support the use of Topiramate for antipsychotic induced weight gain. There is greater weight loss with Topiramate over placebo, with a mean decrease of 2.8 kg. The effective dose for the medication is 100 to 200 mg/day depending on the patient’s tolerance. Getting to an effective dose can often take some time with this medication.

Final Points

Weight management discussions begin day one when medications are going to be used. Prevention is the first line option with lifestyle modification including diet and exercise. Medication choice also plays a big role. When initiating medication being mindful of the propensity for weight gain, and using medications that are weight neutral if possible, can help. If these measures fail, there are a few options backed by research evidence which can be used but I believe lifestyle modification is the best option. 

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What Can We Do to Help Prevent Alzheimer’s disease (AD)

Introduction

The other day I had a conversation with a friend, and the topic of Alzheimer’s disease (AD) came up. My friend’s opinion was basically why would I want to know I have a disease that results in steady decline in function, and lacks any disease modifying treatments? This is in large part true, there have been multiple clinical trials of both symptomatic and disease modifying drugs that failed to produce adequate results. However, this is a very limitted view and neglects the benefits of focusing on modifiable risk factors and primary prevention. We know approximately 1/3rd of AD cases are due to modifiable risk factors, and the implementation of lifestyle modification early may prevent or delay the onset of AD. 

Modifiable Risk Factors

Common modifiable risk factors for AD include hypertension, hyperlipidemia, diabetes, obesity and smoking. Management of these risk factors as early as possible may offer a preventative approach for AD. Equally important are lifestyle modifications such as physical exercise, diet, mediation/mindfulness, and social activity.

Physical Activity

Physical inactivity has a significant influence on the development of AD. Twenty-one percent of AD cases are attributable to physical inactivity. There is a significant number of studies in the literature that indicate physical activity is neuroprotective. We know one of the areas in the brain affected by physical activity is the hippocampus which is involved in memory. Exercise leads to increased neurogenesis and neuroplasticity in the hippocampus. Other benefits of exercise on the brain include increased blood flow, modulation of inflammatory markers, and increased brain-derived neurotrophic factor (BDNF). The exact definition of adequate exercise varies in the literature. Any activity that is sufficient to increase heart rate and can be sustained for 30-60 minutes is my definition. A basic example would be brisk walking for 30-60 minutes. Physical activity two times a week beginning in middle age is associated with reduced risk of AD. Aerobic exercise is associated with additional cognitive benefits including improved processing speed, attention, and memory in adults with mild cognitive impairment. This recommendation is especially important for ApoE4 carriers, as exercise is associated with reduced amyloid deposits. 

Physical activity should be a recommendation for all patients without major health concerns preventing physical activity. The earlier in life a patient begins an exercise routine the better. Some of these studies have looked specifically at starting exercise routines in middle age, but there is no reason to wait. The physical and cognitive benefits of exercise are beneficial regardless of age. It’s much easier to begin training when you are young and healthy. If you build healthy lifestyle habits earlier in life, they are likely to last as you age. Guidelines for regular exercise can be found on the American Heart Association or American College of Sports Medicine websites. 

Meditation

Meditation or mindfulness is a topic that is beginning to get more attention in the medical literature. Chronic stress is believed to effect brain structures involved in memory and may contribute to AD. Psychological stress increases oxidative stress and telomere shortening which could contribute to the neuronal loss seen in AD. Meditation has emerged as a possible way to reduce the stress associated with daily life. The techniques of mindfulness involve directing one’s attention to the present moment to reduce the stress associated with constant thinking and worrying. Randomized controlled trials (RCTs) have shown significant improvements in overall well-being and attention. Improved executive function and reduced inflammatory processes implicated in AD. Additional research and larger RCTs are needed to improve the evidence base. Given the data we currently have there is no reason to not begin mindfulness practices. The techniques are relatively simple and can be learned from a variety of sources. If you are looking for low cost options for learning mindfulness, YouTube has a variety of guided mediations available. I personally like Headspace for beginners because it provides a solid foundation, has a variety of meditation courses, and allows you to track your progress. There is a fee for access to all the courses, but the first 10 sessions are free. Whichever route you choose, spending 10-15 minutes per day practicing mindfulness will lead to a happier and healthier brain. 

Diet

A great deal of research has been conducted over the last several years on the role of diet with respect to cognition. People with high calorie diets, specifically those high in fat are at higher risk for AD. Traditional western diets high in processed carbohydrates, simple sugars, and saturated fatty acids can impact the hippocampus and memory. When Japan transitioned to western diet the incidence of AD increased. Lower calorie diets with lower saturated fat content are linked to lower oxidative stress, decreased Beta amyloid burden, and decreased inflammation. One diet with proven benefits for preventing AD is the Mediterranean diet. This diet is rich in fruits, vegetables, whole grains, olive oil, and fish. There is moderate intake of low-fat dairy products and low intake of red meat, saturated fats, and sugar. Most of the data supporting the reduce risk of AD with this diet comes from epidemiological studies. Studies have shown combining this diet with exercise further reduces the risk of AD. The Mediterranean diet is associated with better cognitive function and reduced cognitive decline. This is one specific example, but the basic principles can be applied without the need to adhere to one specific named diet. 

Some specific foods you may want to add to your diet to prevent AD include fresh berries which have the highest amounts of antioxidants among the fruits. They are also low in calories and work well in diets where weight loss is a goal. Green leafy vegetables and tomatoes have the highest nutritional value when it comes to brain health amongst the vegetables. Foods high in omega-3 fatty acids are considered to be helpful in supporting brain function. The omega-3 fatty acid most important in brain function is docosahexaenoic acid (DHA), which is mostly found in fish. The anti-inflammatory and antioxidant properties of DHA are thought to be responsible for its role in preventing AD. Patients with diagnosed AD are known to have low levels of DHA. Omega-3 fatty acids recommendations from the American Heart association for adults is to eat fish rich in omega-3s two or more times per week. If using a supplement 1-3 grams per day is an adequate dose. Over 3 grams per day, you should consult with your doctor before moving above 3 grams per day. 

Finally, curcumin which is derived from turmeric has anti-inflammatory, antioxidant, and anti-amyloid properties. There is low bioavailability of the curcumin lead to mixed results in the initial trials. A new more bioavailable form called Theracumin demonstrated positive results in a randomized double-blind placebo-controlled study on memory, attention, and amyloid plaques in older adults without dementia. 

Conclusion

While there is no guarantee that lifestyle modification alone will prevent AD, there are some promising studies indicating it plays a role in the development of this disorder. Most of these interventions are things patients can implement in their lives immediately. They will not only improve cognitive function and lower the risk of developing AD, but it will improve and potential reverse other diseases of lifestyle. 

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