Understanding Brain-Protective Dietary Patterns

Diet is a powerful and adjustable factor that you can modify to support brain health with age. The Mediterranean (MeDi) and MIND diets are two well-regarded and healthful diets that include a wide range of nutrients important to brain function. These brain-supportive nutrients work together to achieve a combined protective effect. Exciting and ongoing research into the MeDi, MIND, and other diets continues to uncover their roles as brain-protective dietary patterns.

What is a Dietary Pattern?

A dietary pattern is an important concept in the study of nutrition that considers the variety, quantity, and frequency with which specific foods and drinks are consumed. Research about single nutrients is important. However, we don’t simply eat individual nutrients – we eat a variety of foods that provide these nutrients in a complex matrix of many other nutrients. Importantly, nutrients interact with each other (they can enhance or modify the effects of each other), and these interactions determine how the overall pattern of a diet ultimately impacts our health.

Groundbreaking research into the MeDi and MIND dietary patterns give us a big-picture understanding of how those nutrients work together within whole foods to protect and maintain brain health over time.

These dietary patterns provided a powerful and innovative framework to guide the development our first product, RELEVATE.

Mediterranean Diet

There is a good chance you’ve already heard about the Mediterranean Diet (MeDi), since it’s been promoted for years as a way to decrease the risk of chronic diseases and promote healthy aging, particularly for cardiovascular health. This ancient dietary pattern wasn’t created in a lab or clinic. It’s based on the traditional lifestyle of cultures surrounding the Mediterranean Sea. Who would have thought that this ancient dietary pattern would become the topic of cutting-edge research in brain health?

What does MeDi research say for general health?

In the early 1960’s researcher Ancel Keys led a pioneering study, the Seven Countries Study, that examined the impact of diet on cardiovascular health of over 13,000 middle-aged men. The study compared natural dietary patterns and coronary heart disease outcomes in the United States, Japan, Italy, Greece, the Netherlands, Finland, and then-Yugoslavia. Despite some controversy over the original study design, this ongoing study has been vital in establishing the relationship between dietary patterns, lifestyle, and health. Long-term follow-up over 50 years has established an association between the MeDi and protection against coronary heart disease.

Since that study began, hundreds of studies on the MeDi have highlighted its wide-range of health benefits, including associations with lower risk of all-cause mortality, coronary heart disease, stroke, and some types of cancer.1,2 Several large clinical trials, including the Lyon Diet Heart Study and PREDIMED (Prevención con Dieta Mediterránea), have strengthened the association between cardiovascular health and a MeDi pattern of eating.3,4

What does MeDi research say for brain health?

More recently, researchers are recognizing the MeDi for its protective effect on brain aging. A growing body of research supports the MeDi as neuroprotective in the following ways: 1) maintains or improves cognition, 2) reduces the risk of mild cognitive impairment (MCI), 3) reduces progression of MCI to Alzheimer’s Disease (AD), and 4) may reduce risk of developing Alzheimer’s Disease (AD) or Parkinson’s Disease (PD).

Two important clinical trials studied the impact of MeDi plus olive oil, MeDi plus nuts (walnuts, almonds, and hazelnuts), and a low-fat diet on cognitive function. The PREDIMED-NAVARRA study, found the MeDi was related to better global cognition than those in the low-fat diet arm.5 The study suggested that the MeDi may lead to improved cognitive function with aging. Notably, the MeDi plus nuts arm showed improved memory as well.6

A systematic review of 31 studies further supports the MeDi link to cognitive health, plus an association with reduced risk of progression from MCI to AD.7 One of the studies included in this review was a part of the Rush Memory and Aging Project (MAP), designed to study risk factors for AD. Strikingly, researchers found that those who closely followed the MeDi had a 54% lower risk of developing AD over the course of the study!8

Still more research has associated the MeDi with delayed onset of Parkinson’s Disease (PD).9,10 Researchers had previously linked a MeDi-type diet with lower inflammation based on blood markers, and now found it also may reduce the risk of PD.10 Another study revealed that lower adherence to MeDi was linked to an earlier age of PD onset.9

Inflammation is a strongly-suspected mechanism in the development of neurodegenerative diseases. It’s hypothesized that the high antioxidant value of the MeDi diet plays a role in reducing inflammation in the brain.7 Other nutrients that are plentiful in the MeDi are also considered important for age-related brain function, including omega-3 fatty acids, monounsaturated fatty acids, certain B vitamins, magnesium, iodine, zinc, selenium, potassium, and iron.11

How to eat in the Mediterranean tradition

This pattern of eating recommends certain food groups at its core, but the beauty is it allows for flexibility in terms of flavors and foods that are local and traditional to you. The more you include core foods on a regular basis, the more brain-friendly nutrients you will get in your diet.

Core Foods Moderate to Low Intake Foods to Avoid

Whole Grains

Fruits

Vegetables

Legumes

Nuts

Olive oil

Fish and seafood

Poultry

Eggs

Dairy

Alcohol (wine in particular)

Red Meat

Sweets

Beyond food, the MeDi is inseparable from the lifestyle of the cultures studied: cultivating community, enjoying meals together, and being physically active. These factors are considered so important that the Harvard School of Public Health and the World Health Organization partnered with Oldways in the 1990’s to create a Mediterranean Diet Pyramid, in which lifestyle factors are at the base of the pyramid.

MIND Diet

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) dietary pattern is a recent innovation. The MIND was developed specifically to reduce the decline in brain health that comes with aging. The MIND combines two well-regarded dietary patterns – MeDi and DASH – into a powerful combination.

We’ve already covered the MeDi above. The DASH (Dietary Approaches to Stop Hypertension) diet is a first-line therapeutic diet recommended for lowering blood pressure.12 Beyond reducing blood pressure, researchers at Rush University in Chicago later discovered that the DASH diet is associated with protection of both global cognition and memory.13

MeDi and DASH, both originally identified for cardiovascular health, were coincidentally linked to brain-protective effects. Based on those observations, neuro-epidemiologist Martha Claire Morris, PhD was curious which elements of MeDi and DASH had the most evidence for brain health. Morris collected information from participants in the ongoing Rush Memory and Aging Project (MAP) study. After searching the literature to determine the foods and dietary components important to brain health, observing how often participants ate specific neuroprotective foods, and monitoring for changes in cognition, Morris and her team created the MIND diet with the intent of protecting brain health.8,14

What does the research say about MIND?

Research has linked the MIND diet with a reduced risk of cognitive decline, AD, and PD. One prospective study showed a significantly slowed rate of cognitive decline over 10 years for those who strictly followed the MIND diet. This reduced decline equated to having a brain 7.5 years younger than those with the lowest adherence to the diet!14

An impressive outcome of a prospective study assessing the effects of the MIND diet on AD risk shows that with moderate adherence, the risk of AD was reduced by as much as 35%. Those who adhered strictly to the MIND diet saw up to a 53% decrease in AD risk through the duration of the trial.8

The MIND diet has also shown promising protection against PD. A study assessing both risk of developing PD symptoms and speed of progression with the MIND diet showed that high adherence to the MIND diet was associated with slower progression of PD symptoms, as well as up to a 42% reduced risk of developing PD symptoms compared to those who didn’t follow the MIND diet.15

These are groundbreaking results.

Anything that could potentially reduce risk by 50% is a game-changer.

How to eat MIND-fully

As a hybrid of the traditional MeDi and blood pressure-lowering DASH diets, the MIND dietary pattern combines selected components of each – plus modifications based on extensive research about nutrition for aging brains. Specifically, consumption of leafy green vegetables and berries are stand outs when it comes to protecting cognitive function. The MIND does not specify any other fruits (as in MeDi and DASH), high dairy (as in DASH), nor greater than one serving of fish per week (as in MeDi).8,14

MIND Diet Core Foods MIND Diet Foods to Avoid

Green leafy vegetables

Other vegetables

Nuts

Berries

Beans

Whole grains

Fish

Poultry

Olive oil

Wine

Red meat

Butter/margarine

Cheese

Pastries and sweets

Fried/fast food

The food recommendations for MIND diet were chosen based on nutrients shown to be associated with dementia prevention in scientific literature (both animal and human studies). Eating lots of vegetables, especially green leafy vegetables, is associated with lower risk of cognitive decline. Beneficial nutrients in leafy greens include vitamin E, carotenoids, and flavonoids. Olive oil, nuts, and whole grains are also good sources of vitamin E, which has been associated with neuroprotection. Berries, a rich source of polyphenols, have been shown to improve memory in animal studies.14 In the large-scale landmark trial, the Nurses’ Health Study, higher intake of blueberries and strawberries were associated with slower rates of cognitive decline.16 Finally, omega-3 fatty acids, abundantly found in cold water fish, were shown to reduce some of the pathological hallmarks of AD (e.g., beta amyloid formation in the brain) as well as oxidative damage, even at a level of one serving a week.14

The Power of Dietary Patterns for Brain Health

Both the MeDi and MIND dietary patterns are powerful ways to benefit your brain’s long-term health and function. This innovative research is just beginning. Today, a large-scale clinical study to further explore the benefits of the MIND diet is underway in Chicago and Boston. There are also innovative studies in-progress combining dietary patterns, exercise, and other health factors to improve brain health outcomes. One of these is the US POINTER study, which is part of a worldwide collaboration of studies that combine diet and lifestyle changes to protect the brain. Another clinical trial, the Building Research in Diet and Cognition (BRIDGE) study, is in-progress to investigate the how MeDi’s protective effects on cardiovascular health and cognitive health are intertwined. Researchers are also developing brain-protective dietary patterns through statistical modeling of dietary data collected from sample populations.10,17,18 There is much to learn in this exciting time for brain health and dietary patterns!

One of the best ways to keep your brain healthy for the long-haul is to start as soon as possible and stay as consistent as possible. We realize that change is hard. Remember that any step toward these diets can provide some benefit, and the more steps you take the closer you’ll get to your goal. So, start with small changes and add more when you’re ready.

Looking for brain-supportive meal inspiration? Visit our Brain Table to find brain-healthy recipes inspired by the MeDi and MIND diets, including the most brain-relevant nutrients.

Are you getting everything you need from your food? Visit our Homepage to learn more about how RELEVATE helps close gaps in important nutrients found in brain-protective dietary patterns.

References

1. Dinu, M., Pagliai, G., Casini, A. & Sofi, F. Mediterranean diet and multiple health outcomes: An umbrella review of meta-analyses of observational studies and randomised trials. European Journal of Clinical Nutrition 72, 30–43 (2018).

2. Sofi, F., Abbate, R., Gensini, G. F. & Casini, A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: An updated systematic review and meta-analysis. American Journal of Clinical Nutrition 92, 1189–1196 (2010).

3. Estruch, R. et al. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N. Engl. J. Med. 378, (2018).

4. Kris-Etherton, P., Eckel, R. H., Howard, B. V., St. Jeor, S. & Bazzarre, T. L. Lyon Diet Heart Study. Circulation 103, 1823–1825 (2001).

5. Martínez-Lapiscina, E. H. et al. Mediterranean diet improves cognition: The PREDIMED-NAVARRA randomised trial. J. Neurol. Neurosurg. Psychiatry 84, 1318–1325 (2013).

6. Valls-Pedret, C. et al. Mediterranean diet and age-related cognitive decline: A randomized clinical trial. JAMA Intern. Med. 175, 1094–1103 (2015).

7. Aridi, S. Y., Walker, L. J. & Wright, R. L. O. The Association between the Mediterranean Dietary Pattern and Cognitive Health: A Systematic Review. Nutrients 9, (2017).

8. Morris, M. C. et al. MIND diet associated with reduced incidence of Alzheimer's disease. Alzheimer's Dement. 11, 1007–1014 (2015).

9. Alcalay, R. N. et al. The association between Mediterranean diet adherence and Parkinson's disease. Mov. Disord. 27, 771–774 (2012).

10. Gao, X. et al. Prospective study of dietary pattern and risk of Parkinson disease. Am. J. Clin. Nutr. 86, 1486–1494 (2007).

11. Knight, A., Bryan, J. & Murphy, K. Is the Mediterranean diet a feasible approach to preserving cognitive function and reducing risk of dementia for older adults in Western countries? New insights and future directions. Ageing Res. Rev. 25, 85–101 (2016).

12. Appel, L. J. et al. A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. N. Engl. J. Med. 336, 1117–1124 (1997).

13. Tangney, C. C. et al. Relation of DASH- and Mediterranean-like dietary patterns to cognitive decline in older persons. Neurology 83, 1410–1416 (2014).

14. Morris, M. C. et al. MIND diet slows cognitive decline with aging. Alzheimer's Dement. 11, 1015–1022 (2015).

15. Agarwal, P. et al. MIND Diet Associated with Reduced Incidence and Delayed Progression of Parkinsonism in Old Age. J. Nutr. Heal. Aging 22, 1211–1215 (2018).

16. Devore, E. E., Kang, J. H., Breteler, M. M. B. & Grodstein, F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann. Neurol. 72, 135–143 (2012).

17. Kesse-Guyot, E. et al. A Healthy Dietary Pattern at Midlife Is Associated with Subsequent Cognitive Performance. J. Nutr. 142, 909–915 (2012).

18. Gu, Y., Nieves, J. W., Stern, Y., Luchsinger, J. A. & Scarmeas, N. Food Combination and Alzheimer Disease Risk: A Protective Diet. JAMA Neurol. 67, 699–706 (2010).