Best foods for brain health

Research shows that the best brain foods are the same ones that protect your heart and blood vessels. A meta-analysis (a study that investigates many other studies) published in BioMed Research International found that a higher intake of fruits, vegetables, fish, nuts, legumes and cereal seemed to be associated with reduced risk of Alzheimer’s disease. A lower intake of meat, high-fat dairy, sodium (salt), sweets and refined grains was also associated with a reduced risk of Alzheimer’s disease ¹. Furthermore, these data suggest that cardiovascular disease and cardiovascular risk factors are associated with an increased risk of Alzheimer’s disease and its precursor clinical stage: mild cognitive impairment (MCI). No single food acts as a silver bullet for improving or maintaining brain health. The combination of different types of food and nutrients together in your diets likely determines health benefits. You can benefit from changing to a healthy diet at any age. However, the sooner you start the better. According to new guidelines issued by the World Health Organization (WHO), people can reduce their risk of dementia by getting regular exercise, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels ². A 2018 report from the Global Council on Brain Health ³, an independent group convened by the American Association of Retired Persons (AARP), noted that foods and diets that are good for heart health are also good for brain health, lending support to the adage, “what’s good for the heart is good for the brain.” In support of this, some recent studies evaluating the incidence of dementia among large groups of people over several decades have found decreases in the age-adjusted incidence of dementia occurring simultaneously with improvement in cardiovascular health. The Global Council on Brain Health experts pointed to large, well-designed epidemiological studies among populations in the United States, Great Britain, the Netherlands, Finland and Sweden corroborating this relationship. The 2017 AARP Brain Health and Nutrition survey found that people who often eat well-balanced and nutritious meals also reported better brain health ⁴. Among individuals age 50 and older, three-quarters (75%) who said they ate well five to seven days per week reported their brain health/mental sharpness as “excellent” or “very good.” Only about 40% of those who said they rarely or never ate well reported their brain health as high. The 2017 AARP Brain Health and Nutrition survey also found that significantly more adults age 50 and over without heart disease rated their brain health/mental sharpness as “excellent” or “very good” compared to those with heart disease (64% vs. 50%) ⁴.

Research shows that the best brain foods that protect you against dementia are the same ones that protect your heart and blood vessels, include the following:

• Green, leafy vegetables. Leafy greens such as kale, spinach, collards, and broccoli are rich in brain-healthy nutrients like vitamin K, vitamin E, lutein, folate, beta carotene and flavonoids. Research suggests these plant-based foods may help slow cognitive decline.
• Fatty fish. Many clinical and animal studies have demonstrated the importance of polyunsaturated fatty acids (PUFAs) in nerve development and neurodegeneration. Omega-3 fatty acid is a polyunsaturated fatty acid that must be obtained through dietary intake from fish as well as other types of seafood as it is not produced naturally in the human body ⁵. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential fatty acids present in omega-3 ⁶. DHA (docosahexaenoic acid) makes up 97% of the brain’s total omega-3 fatty acid content ⁶, particularly in brain regions involved in attention and memory ⁷. Docosahexaenoic acid (DHA) is involved in multiple brain functions including cell membrane fluidity, receptor affinity, modulation of signal transduction molecules, and cognitive function ⁸. Omega-3 fatty acid is important for normal cognitive development in early life and may be associated with a reduced decline in cognitive function in older adults ⁹. Recently, omega-3 fatty acids are suggested to act as recovery aids, or possibly as a prophylactic nutritional measure for concussion or mild traumatic brain injury. Animal studies and (pre)clinical studies show that DHA (docosahexaenoic acid) might have a positive effect on the outcomes of mild traumatic brain injury. However, there is a need for well-controlled studies before polyunsaturated fatty acids supplementation can be advised as a therapeutic or preventative measure against sports-related concussion ⁸. Fatty fish are abundant sources of omega-3 fatty acids, healthy unsaturated fats that have been linked to lower blood levels of beta-amyloid—the protein that forms damaging clumps in the brains of people with Alzheimer’s disease. Adults age 65 and older who ate fish once a week or more scored better on memory tests and tricky number games than those who had seafood less often. Try to eat fish at least twice a week, but choose varieties that are low in mercury, such as salmon, cod, canned light tuna, and pollack. If you’re not a fan of fish, ask your doctor about taking an omega-3 supplement, or choose terrestrial omega-3 sources such as flaxseeds, avocados, and walnuts. Plant sources of omega-3 fatty acids include flaxseed, oils (olive, canola, flaxseed, soybean), nuts and other seeds (walnuts, butternut squash and sunflower). Replacements for vegans/vegetarians exist that are not supplements, but the evidence is not as robust for plant sources of omega-3 fatty acids.
• Berries. Researchers credit the high levels of flavonoids in berries with the benefit ¹⁰. Flavonoids, the natural plant pigments that give berries their brilliant hues, also help improve memory, research shows. Berries contain a particularly high amount of flavonoids called anthocyanidins that are capable of crossing the blood brain barrier and localizing themselves in the hippocampus, an area of the brain known for memory and learning. In a 20-year study of over 16,000 older adult women (aged ≥70 years), those who ate the most blueberries and strawberries had the slowest rates of cognitive decline by up to two-and-a-half years ¹⁰.
• Walnuts. Nuts are excellent sources of protein, fat-soluble vitamin E and healthy fats, and one type of nut in particular might also improve memory. A 2015 study from UCLA linked higher walnut consumption to improved cognitive test scores. Walnuts are high in a type of omega-3 fatty acid called alpha-linolenic acid (ALA). Diets rich in alpha-linolenic acid and other omega-3 fatty acids have been linked to lower blood pressure and cleaner arteries. That’s good for both the heart and brain.
• Meat-free meals. Brain-healthy eating encourages consuming meat sparingly. Beans, lentils and soybeans, which pack protein and fiber, make a worthy substitute. They’ll keep you full and are rich in B vitamins, which are important for brain health. In one study analyzing the diets of older adults, those who had the lowest intakes of legumes had greater cognitive decline than those who ate more.
• Tea and coffee. Several studies have found an association between drinking coffee and tea and decreased risk of cognitive decline and dementia. There is plausible reason to believe that compounds in tea and coffee called polyphenols may have antioxidant benefit. However, there is no consensus on whether, and at what amounts, tea and/or coffee may be beneficial or harmful for brain health. Short-term effects of caffeine consumption from coffee and tea have been shown to increase alertness and cognitive performance, but the long-term effects are less understood. There have been several studies suggesting that those who drink coffee have better cognitive function over time than those who drink less coffee. However, it is possible that the caffeine or compounds in coffee and tea may not be the cause of improved outcomes, but rather that people who drink tea and coffee are also more likely to have higher education levels or better health, which are tied to improved cognitive performance and lower risk of dementia. While scientists are not aware of moderate tea or coffee consumption causing harm to cognitive health, if you don’t currently drink coffee and tea with caffeine, they don’t recommend that you start to do so for your brain health.

Most people with Alzheimer’s disease (over 95%) have sporadic or late-onset Alzheimer’s disease, which is a multifactorial disease in which environmental factors and genetic predisposition contribute to the pathology ¹¹. Late-onset Alzheimer’s disease has a strong genetic component, namely, apolipoprotein E (ApoE), the most widely studied genetic risk factor for Alzheimer’s disease. ApoE is produced by the liver, macrophages, and the central nervous system ¹². In the central nervous system, it is produced by astrocytes and microglia; however, neuronal expression of ApoE can be induced in response to stress or neuronal damage under certain pathological conditions (stressors and injurious agents) ¹³. The main metabolic and nongenetic risk factors include hypercholesterolemia ¹⁴, obesity ¹⁵, hyperhomocysteinemia ¹¹, hypertension ¹⁶ and type 2 diabetes mellitus ¹⁷.

The other form of Alzheimer’s disease, familial or early-onset Alzheimer’s disease, corresponds to less than 5% of the Alzheimer’s disease population and is due to mutations in any of the three following genes: (a) the amyloid precursor protein (APP) gene on chromosome 21, (b) presenilin 1 (PSEN-1) gene on chromosome 14, and (c) presenilin 2 (PSEN-2) gene on chromosome 1 ¹⁸.

Risk factors for dementia

Researchers have identified several risk factors that affect the likelihood of developing one or more kinds of dementia. Some of these factors are modifiable, while others are not. For example, some risk factors for developing dementia, such as getting older and your inherited genes, cannot be controlled. So it is important to do what you can with the things you can control, such as your lifestyle and habits.

Risk factors you can change

You might be able to control the following risk factors for dementia ¹⁹.

• Diet and exercise. Research shows that lack of exercise increases the risk of dementia. And while no specific diet is known to reduce dementia risk, research indicates a greater incidence of dementia in people who eat an unhealthy diet compared with those who follow a Mediterranean-style diet rich in produce, whole grains, nuts and seeds.
• Excessive alcohol use. Drinking large amounts of alcohol has long been known to cause brain changes. Several large studies and reviews found that alcohol use disorders were linked to an increased risk of dementia, particularly early-onset dementia. Studies also have found that drinking large amounts of alcohol appears to increase the risk of dementia. However, other studies have suggested that people who drink moderately have a lower risk of dementia than either those who drink heavily or those who completely abstain from drinking.
• Cardiovascular risk factors. These include high blood pressure (hypertension), high cholesterol, buildup of fats in your artery walls (atherosclerosis) and obesity.
• Atherosclerosis. Atherosclerosis is the buildup of plaque – deposits of fatty substances, cholesterol, and other matter – in the inner lining of an artery. Atherosclerosis is a significant risk factor for vascular dementia, because it interferes with the delivery of blood to the brain and can lead to stroke. Studies have also found a possible link between atherosclerosis and Alzheimer’s disease.
• High cholesterol. High levels of low-density lipoprotein (LDL), the so-called “bad” form of cholesterol, appear to significantly increase a person’s risk of developing vascular dementia. Some research has also linked high cholesterol to an increased risk of Alzheimer’s disease.
• Plasma homocysteine. Research has shown that a higher-than-average blood level of homocysteine, a type of amino acid, is a strong risk factor for the development of Alzheimer’s disease and vascular dementia.
• Depression. Although not yet well-understood, late-life depression might indicate the development of dementia.
• Diabetes. Having diabetes may increase your risk of both Alzheimer’s disease and vascular dementia, especially if it’s poorly controlled. Diabetes is also a known risk factor for atherosclerosis and stroke, both of which contribute to vascular dementia.
• Smoking. Several recent studies have found that smoking significantly increases the risk of mental decline and dementia. People who smoke have a higher risk of atherosclerosis and other types of vascular disease, which may be the underlying causes for the increased dementia risk.
• Air pollution. Studies in animals have indicated that air pollution particulates can speed degeneration of the nervous system. And human studies have found that air pollution exposure — particularly from traffic exhaust and burning wood — is associated with greater dementia risk.
• Head trauma. People who’ve had a severe head trauma have a greater risk of Alzheimer’s disease. Several large studies found that in people age 50 years or older who had a traumatic brain injury (TBI), the risk of dementia and Alzheimer’s disease increased. The risk increases in people with more-severe and multiple traumatic brain injuries. Some studies indicate that the risk may be greatest within the first six months to two years after the traumatic brain injury.
• Sleep disturbances. People who have sleep apnea and other sleep disturbances might be at higher risk of developing dementia.
• Mild cognitive impairment (MCI). While not all people with mild cognitive impairment develop dementia, people with this condition do have a significantly increased risk of dementia compared to the rest of the population. One study found that approximately 40 percent of people over age 65 who were diagnosed with mild cognitive impairment developed dementia within three years.
• Vitamin and nutritional deficiencies. Low levels of vitamin D, vitamin B-6, vitamin B-12 and folate can increase your risk of dementia.
• Medications that can worsen memory. Try to avoid over-the-counter sleep aids that contain diphenhydramine (Advil PM, Aleve PM) and medications used to treat urinary urgency such as oxybutynin (Ditropan XL). Also limit sedatives and sleeping tablets and talk to your doctor about whether any of the drugs you take might make your memory worse.

Risk factors that can’t be changed

• Age. The risk of Alzheimer’s disease, vascular dementia, and several other dementias goes up significantly with advancing age, especially after age 65. However, dementia isn’t a normal part of aging, and dementia can occur in younger people.
• Genetics and family history. Having a family history of dementia puts you at greater risk of developing the condition. However, many people with a family history of Alzheimer’s disease never develop symptoms, and many people without a family history do. Researchers have discovered a number of genes that increase the risk of developing Alzheimer’s disease. There are tests to determine whether you have certain genetic mutations. In most cases, it is impossible to predict a specific person’s risk of Alzheimer’s disease based on family history alone. Some families with Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome, or fatal familial insomnia have mutations in the prion protein gene, although these disorders can also occur in people without the gene mutation. Individuals with these mutations are at significantly higher risk of developing these forms of dementia. Abnormal genes are also clearly implicated as risk factors in Huntington’s disease, FTDP-17, and several other kinds of dementia.
• Down syndrome. Many people with Down’s syndrome show neurological and behavioral signs of Alzheimer’s disease by the time they reach middle age. Many people with Down syndrome develop early-onset Alzheimer’s disease.

Dementia prevention

Dementia is hard to prevent, because what causes it often is not known. But people who have dementia caused by stroke may be able to prevent future declines by lowering their risk of heart disease and stroke. More research is needed, but it might be beneficial to do the following:

• Don’t smoke. Some studies have shown that smoking in middle age and beyond might increase your risk of dementia and blood vessel conditions. Quitting smoking might reduce your risk and will improve your health.
• Stay at a healthy weight. Obesity in midlife is associated with an increased risk of developing cognitive impairment and dementia. Lose weight if you’re overweight.
• Get plenty of exercise and be socially active. Physical activity and social interaction might delay the onset of dementia and reduce its symptoms. Aim for 150 minutes of exercise a week.
• Keep your mind active. Mentally stimulating activities, such as reading, solving puzzles and playing word games, and memory training might delay the onset of dementia and decrease its effects.
• Eat healthy food. A diet such as the Mediterranean diet — rich in fruits, vegetables, whole grains and omega-3 fatty acids, which are commonly found in certain fish and nuts — might promote health and lower your risk of developing dementia. The Mediterranean diet also improves cardiovascular health, which may help lower dementia risk.
• Manage health problems including diabetes, high blood pressure, and high cholesterol. High blood pressure might lead to a higher risk of some types of dementia. More research is needed to determine whether treating high blood pressure may reduce the risk of dementia.
• See your doctor for treatment for depression or anxiety.
• Stay mentally alert by learning new hobbies, reading, or solving crossword puzzles. Regularly challenging your brain with mentally stimulating activities through education, occupation or leisure is linked with lower risk of cognitive (memory and thinking skills) decline and dementia
• Stay involved socially. Attend community activities, church, or support groups. Participating in social activities and being connected with your community, family and friends is linked with a lower risk of dementia.
• Get enough vitamins. Some research suggests that people with low levels of vitamin D in their blood are more likely to develop Alzheimer’s disease and other forms of dementia. You can get vitamin D through certain foods, supplements and sun exposure. More study is needed before an increase in vitamin D intake is recommended for preventing dementia, but it’s a good idea to make sure you get adequate vitamin D. Taking a daily B-complex vitamin and vitamin C also might help.
• If your doctor recommends it, take aspirin.
• Get good-quality sleep. Practice good sleep hygiene, and talk to your doctor if you snore loudly or have periods where you stop breathing or gasp during sleep.
• Treat hearing problems. People with hearing loss have a greater chance of developing cognitive decline. Early treatment of hearing loss, such as use of hearing aids, might help decrease the risk.
• Protect your head against injury. Head injury, particularly severe injury (causing unconsciousness for an extended period of time) is a risk factor for the development of Alzheimer’s disease. Avoid head injury by taking care as a pedestrian, wearing seat belts in cars, and using protective headgear when cycling or for high-risk activities.

Best foods to eat for your brain

Research suggests the foods that are good for your heart and body may also be good for brain health and protect against dementia. Based on current evidence, nutritionists recommend that you:

• Eat a variety of foods, including fruits and vegetables, to ensure adequate nutrient intake.
• Reduce your intake of saturated fats by choosing fish, lean red meat, chicken without skin and reduced-fat dairy products. Limit butter, deep fried foods, pastries, cakes and biscuits.
• Choose unsaturated fats such as olive, canola, sunflower and safflower oils.
• Consider including foods rich in omega-3 fats in your diet, such as soy, canola and flaxseed oils, and fish.

The American Heart Association suggests these daily amounts:

• Vegetables – canned, dried, fresh and frozen vegetables; 5 servings
• Fruits – canned, dried, fresh and frozen fruits; 4 servings
• Whole grains – barley, brown rice, millet, oatmeal, popcorn and whole wheat bread, crackers and pasta; 3-6 servings
• Dairy – low fat (1%) and fat-free dairy products; 3 servings
• Proteins – eggs, fish, lean meat, legumes, nuts, poultry and seeds; 1-2 servings. Eat a variety of fish at least twice a week, especially fish containing omega-3 fatty acids (for example, salmon, trout and herring).
• Oils – polyunsaturated and monounsaturated canola, olive, peanut, safflower and sesame oil; 3 tablespoons
• Limit – sugary drinks, sweets, fatty meats, and salty or highly processed foods
• Choose foods with less salt (sodium) and prepare foods with little or no salt. To lower blood pressure, aim to eat no more than 2,300 milligrams of sodium per day. Reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further.
• Limit saturated fat and trans fat and replace them with the better fats, monounsaturated and polyunsaturated. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat.
• Avoid – partially hydrogenated oils, tropical oils, and excessive calories
• Replace – highly processed foods with homemade or less-processed options
• If you drink alcohol, drink in moderation. That means no more than one drink per day if you’re a woman and no more than two drinks per day if you’re a man.

The effect of “healthy diets” on cognition has also been studied. It has been reported that healthy eating patterns reduce the risk of dementia, while a high-fat diet and diets with a high glycemic index increase neuronal damage ²⁰. Healthy diet is not about ‘dieting’. Healthy diet is about making smart choices and having a balance of different foods and nutrients in your diet for good health and wellbeing. Healthy diet is about enjoying your food, at the same time as being mindful about what you eat. A healthy diet can help reduce your risk of heart disease, stroke and lots of other things you’d rather avoid. The good news is, healthy eating right doesn’t have to be hard, boring or require you to give up all of the foods you love. Proinflammatory diet also may increase the progression of dementia ²¹.

It has also been proven that the use of nutritional formulas, fatty acids, ginseng, inositol, probiotics, and products rich in flavonoids may delay the progression of dementia ²². On the other hand, according to Heider et al.’s ²³ systematic review and meta-analyses, supplementation of vitamin B, vitamin E, omega-3, and nutritional formulas does not improve cognitive function.

Carbohydrate

Carbohydrate (starch) is the body’s main energy (fuel) source. Starch is broken down to produce glucose which is used by your body for energy.

Starchy foods are an important part of the healthy diet. They should make up about a third of all the food that you eat. You don’t have to avoid or restrict them because they are ‘fattening’. Instead, be aware of the total amount of starch that you eat. Cutting out one food group, such as carbohydrate can cause dietary imbalance. Starchy foods include bread, potatoes, rice and pasta. Wholegrain options are healthier choices.

Fiber rich foods help your gut to function properly and have many other health benefits. Studies have shown that people who are overweight or obese tend to lose weight if they include plenty of high fiber, starchy carbohydrate in their diets.

Sugar

Sugar is a type of carbohydrate. Like starch, it breaks down into glucose, to provide energy for your body. ‘Free’ sugars are often added to foods during manufacture and include refined sugars such as sucrose (table sugar). This kind of sugar is also found naturally, in unsweetened fruit juices, and in syrups and honey.

Excess consumption of free sugars is linked to the risk of obesity, type 2 diabetes and tooth decay. Many of the free sugars that you consume, are in sugary drinks. A regular can of cola for instance, can contain the equivalent of seven teaspoons of sugar (35g). The guidance about free sugar consumption suggests a daily limit of 30g. This is equivalent to six teaspoons.

The natural sugars found in milk and in whole fruits and vegetables are not free sugars and do not need to be restricted in the same way.

Fruit and vegetables

Fruit and vegetables contain high levels of ‘micronutrients’. These include vitamins, minerals and antioxidants. Micronutrients are essential to the body’s many biochemical processes.

Fruit and vegetables are often high in fiber. They are generally low in calorie and they taste good. The current Dietary Guidelines for Americans recommends at least five portions of different fruit and vegetable per day ²⁴. Like carbohydrate, fruit and vegetable should account for about one third of what you eat, per day. Dried, frozen, tinned, as well as fresh, fruit and veg are all included. One portion of pulses (baked beans, lentils, dried peas) can also count towards your five a day.

Dietary fiber

Fiber comes from plant-based foods, including fruits, vegetables and wholegrains. Dietary fiber is the part of plants that you eat but which doesn’t get digested in your small intestine. Instead, it is completely or partially broken down (fermented) by bacteria in your large intestine. Once broken down in your large intestine, it has been suggested that dietary fibers increase the beneficial bacteria in your gut. This improves your immune system. Fibre includes carbohydrates called polysaccharides and resistant oligosaccharides. Recent research suggests that fiber should be categorized by its physical characteristics; how well it dissolves (solubility), how thick it is (viscosity) and how well it breaks down (fermentability). Some commonly known terms are described below:

• Soluble fiber including pectins and beta glucans is found in foods like fruit and oats.
• Insoluble fiber including cellulose is found in wheat bran and nuts.
• Resistant starch is a soluble fiber that is highly fermentable in the gut. It gets broken down by good bacteria to produce short chain fatty acids (SCFAs). Resistant starch is naturally present in some foods such as bananas, potatoes, grains and pulses.
• Prebiotics are types of carbohydrate that only our gut bacteria can feed upon. Some examples are onions, garlic, asparagus and banana

Fibre is essential for your gut to work normally. It increases good bacteria which supports your immunity against inflammatory disorders and allergies. A high fiber diet seems to reduce the risk of chronic diseases such as heart disease, type 2 diabetes and bowel cancer.

Eating a range of dietary fiber can:

• Improve the diversity of your microbiota
• Improve constipation and lactose intolerance
• Enhance immunity
• Reduce inflammation in your gut

For example, high quality randomized controlled trials have shown that eating oat bran leads to lower blood pressure and lower total cholesterol.

Benefits of a high-fiber diet:

• Normalizes bowel movements. Dietary fiber increases the weight and size of your stool and softens it. A bulky stool is easier to pass, decreasing your chance of constipation. If you have loose, watery stools, fiber may help to solidify the stool because it absorbs water and adds bulk to stool.
• Helps maintain bowel health. A high-fiber diet may lower your risk of developing hemorrhoids and small pouches in your colon (diverticular disease). Studies have also found that a high-fiber diet likely lowers the risk of colorectal cancer. Some fiber is fermented in the colon. Researchers are looking at how this may play a role in preventing diseases of the colon.
• Lowers cholesterol levels. Soluble fiber found in beans, oats, flaxseed and oat bran may help lower total blood cholesterol levels by lowering low-density lipoprotein, or “bad,” cholesterol levels. Studies also have shown that high-fiber foods may have other heart-health benefits, such as reducing blood pressure and inflammation.
• Helps control blood sugar levels. In people with diabetes, fiber — particularly soluble fiber — can slow the absorption of sugar and help improve blood sugar levels. A healthy diet that includes insoluble fiber may also reduce the risk of developing type 2 diabetes.
• Aids in achieving healthy weight. High-fiber foods tend to be more filling than low-fiber foods, so you’re likely to eat less and stay satisfied longer. And high-fiber foods tend to take longer to eat and to be less “energy dense,” which means they have fewer calories for the same volume of food.
• Helps you live longer. Studies suggest that increasing your dietary fiber intake — especially cereal fiber — is associated with a reduced risk of dying from cardiovascular disease and all cancers.

Good sources of dietary fiber include:

• Pulses (like lentils and peas) and beans and legumes (think navy beans, small white beans, split peas, chickpeas, lentils, pinto beans)
• Fruits and vegetables, vegetables such as carrots, broccoli, green peas, and collard greens; fruits especially those with edible skin (like pears and apples with the skin on) and those with edible seeds (like berries)
• Nuts—try different kinds (pumpkin seeds, almonds, sunflower seeds, pistachios and peanuts are a good source of fiber and healthy fats, but be mindful of portion sizes, because they also contain a lot of calories in a small amount!)
• Whole grains such as:
  • Quinoa, barley, bulgur, oats, brown rice and farro
  • Whole wheat pasta
  • Whole grain cereals, including those made from whole wheat, wheat bran and oats

Choose fiber rich foods from a variety of sources including wholegrains, fruit and vegetable, nuts and seeds, beans and pulses. When you read food labels check for the grams of fiber per serving or per 100g. Foods that are naturally high in fiber and contain at least 3 grams per 100 gram are often labeled as a “good source,” and foods labeled as “excellent source” contain more than 5 grams of fiber per serving.

Depending on your age and sex, adults should get 25 to 31 grams of fiber a day ²⁵. Older adults sometimes don’t get enough fiber because they may lose interest in food.

• Men over the age of 50 should get at least 38 grams of fiber per day.
• Women over the age of 50 should get 25 grams per day.
• Children ages 1 to 3 should get 19 grams of fiber per day.
• Children between 4 and 8 years old should get 25 grams per day.
• Girls between 9 and 18 should get 26 grams of fiber each day. Boys of the same age range should get between 31 and 38 grams of fiber per day.

You may wish to see a dietitian if you:

• are unsure about how much and/or what types of fiber you currently have in your diet
• suffer with constipation or diarrhea (e.g. irritable bowel syndrome [IBS])
• have a condition which can restrict your fiber intake (e.g. inflammatory bowel disease)

Keep in mind that if you haven’t been eating a lot of foods high in fiber on a daily basis, it’s important to increase your intake slowly to allow your body to adjust. A sudden increase in eating foods high in fiber (especially foods with added fiber or when using supplements) can cause gas, bloating or constipation. Be sure you are drinking enough water too, because fiber needs water to move through your body.

Protein

Protein is vital. It is your body’s main building block. Animal products such as meat, fish, eggs and dairy are good sources of dietary protein. Meat and fish also provide your body with a form of iron (heme), which is easy to absorb. Fish also contains essential fatty acids (e.g, Omega-3).

Protein also comes from foods of plant origin. Pulses, nuts, and seeds are all high in protein. Pulses are a very good meat alternative, whether or not you are vegetarian or vegan.

Cutting back on consumption of red meat (beef, lamb, goat, pork) especially, is better for your health and for the environment: current advice is to have no more than 300g of red meat per week. Try to avoid processed meats such as bacon, salami, hot dogs, ham. Consumption of these cured meat products has been linked to a much higher risk of certain gut cancers.

Dairy

Dairy products and calcium-fortified alternatives are your body’s main source of calcium, which is necessary for the growth, development and maintenance of healthy bones and teeth. Dairy products and alternatives are also a source of protein. Milk, cheese, cream and milk-based sauces and yogurts can have a high saturated fat content. Fat reduced options are recommended, and small quantities.

Fats

Fats also known as lipids, is an essential nutrient (a primary storage form of energy, a kilojoule-dense nutrient) your body need for energy and to help your gut absorb vitamins A, D, E and K from foods. Fat has twice as many calories as proteins or carbohydrates. There are nine calories (37kJ) in every gram of fat, regardless of what type of fat it is. Fats are more energy-dense than carbohydrates and proteins, which provide four calories (17kJ) per gram. Dietary fat also plays a major role in your cholesterol levels. You need some fat in your diet but not too much. There are different types of fats, some are “good” and some are “bad”, however, you should try to avoid “bad” fats. When it comes to dietary fat, what matters most is the type of fat you eat. Contrary to past dietary advice promoting low-fat diets, newer research shows that healthy fats are necessary and beneficial for health.

Healthy fats are unsaturated. They keep cholesterol levels within a healthy range, reduce your risk of heart problems and may be good for the skin, eyes and brain. Unsaturated fats are the best choice for a healthy diet.

Unhealthy fats are saturated and trans fats, which can raise levels of ‘bad’ cholesterol and increase the risk of heart disease. Multiple studies have linked high levels of saturated fat with cognitive decline. A diet that is higher in unsaturated fats and lower in saturated fats is linked to better cognition.

• Saturated fats such as butter, solid shortening, and lard. Eating foods that contain saturated fats raises the level of cholesterol in your blood. High levels of LDL cholesterol (low-density lipoprotein or “bad” cholesterol) in your blood increase your risk of heart disease and stroke. The American Heart Association recommends aiming for a dietary pattern that achieves 5% to 6% of calories from saturated fat. For example, if you need about 2,000 calories a day, no more than 120 of them should come from saturated fat. That’s about 13 grams of saturated fat per day ²⁶.
• Trans fats also known as trans fatty acids or “partially hydrogenated oils”. These are found in vegetable shortenings, some margarines, crackers, cookies, snack foods, and other foods made with or fried in partially hydrogenated oils. By 2018, most U.S. companies will not be allowed to add partially hydrogenated oils to food.

“Bad” fats, such as artificial trans fats and saturated fats, are guilty of the unhealthy things all fats have been blamed for—weight gain, clogged arteries, an increased risk of certain diseases, and so forth. Large studies have found that replacing saturated fats in your diet with unsaturated fats and omega-3 fatty acids can reduce your risk of heart disease by about the same amount as cholesterol-lowering drugs. Since fat is an important part of a healthy diet, rather than adopting a low-fat diet, it’s more important to focus on eating more beneficial “good” fats and limiting harmful “bad” fats. For good health, the majority of the fats that you eat should be monounsaturated or polyunsaturated. Eat foods containing monounsaturated fats and/or polyunsaturated fats such as canola oil, olive oil, safflower oil, sesame oil or sunflower oil instead of foods that contain saturated fats and/or trans fats.

For years you’ve been told that eating fat will add inches to your waistline, raise cholesterol, and cause a myriad of health problems. When food manufacturers reduce fat, they often replace it with carbohydrates from sugar, refined grains, or other starches. Your body digests these refined carbohydrates and starches very quickly, affecting your blood sugar and insulin levels and possibly resulting in weight gain and disease ²⁷. But now scientists know that not all fat is the same. Research has shown that unsaturated fats are good for you. Healthy fats play a huge role in helping you manage your moods, stay on top of your mental game, fight fatigue, and even control your weight. These fats come mostly from plant sources. Cooking oils that are liquid at room temperature, such as canola, peanut, safflower, soybean, and olive oil, contain mostly unsaturated fat. Nuts, seeds, and avocados are also good sources. Fatty fish—such as salmon, sardines, and herring—are rich in unsaturated fats, too. You should actively make unsaturated fats a part of your diet. Of course, eating too much fat will put on the pounds too. Note also that by swapping animal fats for refined carbohydrates—such as replacing your breakfast bacon with a bagel or pastry—won’t have the same benefits. In fact eating refined carbohydrates or sugary foods can have a similar negative effect on your cholesterol levels, your risk for heart disease, and your weight. Limiting your intake of saturated fat can still help improve your health—as long as you take care to replace it with good fat rather than refined carbs. In other words, don’t go no fat, go good fat.

Healthy-eating tips:

• Use olive oil in cooking.
• Replace saturated fats with unsaturated fats; for example, use avocado, tahini, nut or seed butter instead of dairy butter.
• Eat fish, especially oily fish, twice a week.
• Consume legume- or bean-based meals twice a week.
• Snack on nuts or add them to your cooking.
• Throw avocado in salads.
• Choose lean meats and trim any fat you can see (including chicken skin).
• Use table spreads that have less than 0.1g of trans fats per 100g.

Saturated fats

Saturated fats are fat molecules that are “saturated” with hydrogen molecules. Saturated fats are normally solid at room temperature. Saturated fats occur naturally in many foods — primarily meat and dairy foods (butter, cream, full-fat milk and cheese). Beef, lamb, pork on poultry (with the skin on) contain saturated fats, as do butter, cream and cheese made from whole or 2% milk. Plant-based foods that contain saturated fats include coconut, coconut oil, coconut milk and coconut cream, cooking margarine, and cocoa butter, as well as palm oil and palm kernel oil (often called tropical oils). Saturated fats are also found in snacks like chips, cakes, biscuits and pastries, and takeaway foods. Consuming more than the recommended amount of saturated fat is linked to heart disease and high cholesterol.

The American Dietary Guidelines recommend that:

• men should not eat more than 30g of saturated fat a day
• women should not eat more than 20g of saturated fat a day
• children should have less

For people who need to lower their cholesterol, the American Heart Association recommends reducing saturated fat to less than 6% of total daily calories. For someone eating 2,000 calories a day, that’s about 11 to 13 grams of saturated fat ²⁶.

Examples of foods with saturated fat are:

• fatty beef,
• lamb,
• pork,
• poultry with skin,
• beef fat (tallow),
• meat products including sausages and pies,
• lard and cream,
• butter and ghee,
• cheese especially hard cheese like cheddar,
• other dairy products made from whole or reduced-fat (2 percent) milk,
• cream, soured cream and ice cream,
• some savory snacks, like cheese crackers and some popcorns,
• chocolate confectionery,
• biscuits, cakes, and pastries

In addition, many baked goods and fried foods can contain high levels of saturated fats. Some plant-based oils, such as palm oil, palm kernel oil, coconut oil and coconut cream, also contain primarily saturated fats, but do not contain cholesterol.

Unsaturated Fats

If you want to reduce your risk of heart disease, it’s best to reduce your overall fat intake and swap saturated fats for unsaturated fats. Unsaturated fats are in fish, such as salmon, trout and herring, and plant-based foods such as avocados, olives and walnuts. Liquid vegetable oils, such as soybean, corn, safflower, canola, olive and sunflower, also contain unsaturated fats.

There are 2 types of unsaturated fats: monounsaturated and polyunsaturated. Unsaturated fats help reduce your risk of heart disease and lower your cholesterol levels.

• Polyunsaturated fats such as omega-3 and omega-6 fats are found in fish, nuts, and safflower and soybean oil.
• Monounsaturated fats are found in olive and canola oil, avocado, cashews and almonds.

Monounsaturated fats have one (“mono”) unsaturated carbon bond in the molecule. Polyunsaturated fats have more than one (“poly,” for many) unsaturated carbon bonds. Both of these unsaturated fats are typically liquid at room temperature.

Eaten in moderation, both kinds of unsaturated fats may help improve your blood cholesterol when used in place of saturated and trans fats.

Polyunsaturated fats

Polyunsaturated fats are simply fat molecules that have more than one unsaturated carbon bond in the molecule, this is also called a double bond. Oils that contain polyunsaturated fats are typically liquid at room temperature but start to turn solid when chilled. Olive oil is an example of a type of oil that contains polyunsaturated fats.

There are 2 main types of polyunsaturated fats: omega-3 and omega-6. Oils rich in polyunsaturated fats also provide essential fats that your body needs but can’t produce itself – such as omega-6 and omega-3 fatty acids. You must get essential fats through food. Omega-6 and omega-3 fatty acids are important for many functions in the body. A deficiency of essential fatty acids—either omega-3s or omega-6s—can cause rough, scaly skin and dermatitis ²⁸.

Polyunsaturated fats can help reduce bad cholesterol levels in your blood which can lower your risk of heart disease and stroke. Polyunsaturated fats also provide nutrients to help develop and maintain your body’s cells. Oils rich in polyunsaturated fats also contribute vitamin E to the diet, an antioxidant vitamin most Americans need more of.

Foods high in polyunsaturated fat include a number of plant-based oils, including:

• soybean oil
• corn oil
• sunflower oil

Other sources include some nuts and seeds such as walnuts and sunflower seeds, tofu and soybeans.

Omega-6 fats are found in vegetable oils, such as:

• rapeseed
• corn
• sunflower
• some nuts

Omega-3 fats are found in oily fish, such as:

• kippers
• herring
• trout
• sardines
• salmon
• mackerel

The American Heart Association also recommends eating tofu and other forms of soybeans, canola, walnut and flaxseed, and their oils. These foods contain alpha-linolenic acid (ALA), another omega-3 fatty acid.

Polyunsaturated fats (PUFAs) are frequently designated by their number of carbon atoms and double bonds. Alpha-linolenic acid (ALA), for example, is known as C18:3n-3 because it has 18 carbons and 3 double bonds and is an omega-3 fatty acid. Similarly, eicosapentaenoic acid (EPA) is known as C20:5n-3 and docosahexaenoic acid (DHA) as C22:6n-3. Omega-6 fatty acids (omega-6s) have a carbon–carbon double bond that is six carbons away from the methyl end of the fatty acid chain. Linoleic acid (LA) known as C18:2n-6 and arachidonic acid (AA) known as C20:4n-6 are two of the major omega-6s.

The human body can only form carbon–carbon double bonds after the 9th carbon from the methyl end of a fatty acid ²⁹. Therefore, alpha-linolenic acid (ALA) and linoleic acid (LA) are considered essential fatty acids, meaning that they must be obtained from the diet ³⁰. Alpha-linolenic acid (ALA) can be converted into eicosapentaenoic acid (EPA) and then to docosahexaenoic acid (DHA), but the conversion (which occurs primarily in the liver) is very limited, with reported rates of less than 15% ³¹. Therefore, consuming EPA and DHA directly from foods and/or dietary supplements is the only practical way to increase levels of these fatty acids in the body.

Alpha-linolenic acid (ALA) is present in plant oils, such as flaxseed, soybean, and canola oils ³¹. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are present in fish, fish oils, and krill oils, but they are originally synthesized by microalgae, not by the fish. When fish consume phytoplankton that consumed microalgae, they accumulate the omega-3s in their tissues ³¹.

Some researchers propose that the relative intakes of omega-6s and omega-3s—the omega-6/omega-3 ratio—may have important implications for the pathogenesis of many chronic diseases, such as cardiovascular disease and cancer ³², but the optimal ratio—if any—has not been defined ³³. Others have concluded that such ratios are too non-specific and are insensitive to individual fatty acid levels ³⁴. Most agree that raising eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) blood levels is far more important than lowering linoleic acid (LA) or arachidonic acid levels.

Currently, most clinicians do not assess omega-3 status, but it can be done by measuring individual omega-3s in plasma or serum phospholipids and expressing them as the percentage of total phospholipid fatty acids by weight ³⁵. Experts have not established normal ranges, but mean values for serum or plasma phospholipid eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) among U.S. adults not taking omega-3 supplements are about 3%–4% ³⁵. Plasma and serum fatty acid values, however, can vary substantially based on an individual’s most recent meal, so they do not reflect long-term dietary consumption ³⁶.

It is also possible to assess omega-3 status via analysis of erythrocyte fatty acids, a measurement that reflects longer-term intakes over approximately the previous 120 days ³⁷. The “omega-3 index” proposed by Harris and von Schacky reflects the content of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) in erythrocyte membranes expressed as a percentage of total erythrocyte fatty acids ³⁸. This index can be used as a surrogate for assessing tissue levels of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) ³⁹. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) typically comprise about 3%–5% of erythrocyte fatty acids in Western populations with low fish intakes. In Japan, where fish consumption is high, erythrocyte eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels are about twice those of Western populations ³¹.

Table 1. Alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content of selected foods

Food	Grams per serving
	ALA	DHA	EPA
Flaxseed oil, 1 tbsp	7.26
Chia seeds, 1 ounce	5.06
English walnuts, 1 ounce	2.57
Flaxseed, whole, 1 tbsp	2.35
Salmon, Atlantic, farmed cooked, 3 ounces		1.24	0.59
Salmon, Atlantic, wild, cooked, 3 ounces		1.22	0.35
Herring, Atlantic, cooked, 3 ounces*		0.94	0.77
Canola oil, 1 tbsp	1.28
Sardines, canned in tomato sauce, drained, 3 ounces*		0.74	0.45
Mackerel, Atlantic, cooked, 3 ounces*		0.59	0.43
Salmon, pink, canned, drained, 3 ounces*	0.04	0.63	0.28
Soybean oil, 1 tbsp	0.92
Trout, rainbow, wild, cooked, 3 ounces		0.44	0.4
Black walnuts, 1 ounce	0.76
Mayonnaise, 1 tbsp	0.74
Oysters, eastern, wild, cooked, 3 ounces	0.14	0.23	0.3
Sea bass, cooked, 3 ounces*		0.47	0.18
Edamame, frozen, prepared, ½ cup	0.28
Shrimp, cooked, 3 ounces*		0.12	0.12
Refried beans, canned, vegetarian, ½ cup	0.21
Lobster, cooked, 3 ounces*	0.04	0.07	0.1
Tuna, light, canned in water, drained, 3 ounces*		0.17	0.02
Tilapia, cooked, 3 ounces*	0.04	0.11
Scallops, cooked, 3 ounces*		0.09	0.06
Cod, Pacific, cooked, 3 ounces*		0.1	0.04
Tuna, yellowfin, cooked 3 ounces*		0.09	0.01
Kidney beans, canned ½ cup	0.1
Baked beans, canned, vegetarian, ½ cup	0.07
Ground beef, 85% lean, cooked, 3 ounces**	0.04
Bread, whole wheat, 1 slice	0.04
Egg, cooked, 1 egg		0.03
Chicken, breast, roasted, 3 ounces		0.02	0.01
Milk, low-fat (1%), 1 cup	0.01

Footnotes: *Except as noted, the U.S. Department of Agriculture (USDA) database does not specify whether fish are farmed or wild caught. **The USDA database does not specify whether beef is grass fed or grain fed.

Essential Fatty Acids

Essential Fatty Acids such as omega-3 oils are ‘essential’ because your body can’t make them and you have to obtain them from your food. Essential Fatty Acids are found in the skin of white fish but also in the flesh of oily fish such as fresh and tinned salmon, mackerel, sardines and fresh tuna. Advice for fish eaters is to have one portion of oily fish, and one portion of white fish per week.

Essential Fatty Acids can also be found in some plant oils such as flaxseed, rapeseed and soya but there is not as much in these oils as there is in fish and seafood.

Omega-3 fatty acids

Omega-3 fatty acids (omega-3s) are a type of polyunsaturated fat and have a carbon–carbon double bond located three carbons from the methyl end of the chain (see Figure 6). Omega-3 fatty acids, sometimes referred to as “n-3s,” are present in certain foods such as flaxseed and fish, as well as dietary supplements such as fish oil. Omega-3 fatty acids are especially beneficial to your health. Omega-3s play important roles in the body as components of the phospholipids that form the structures of cell membranes ²⁸. There are different types of omega-3s: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are found in fish and algae and have the most health benefits, while alpha-linolenic acid (ALA) comes from plants and is a less potent form of omega-3, although the body does convert ALA to EPA and DHA at low rates. Alpha-linolenic acid (ALA) contains 18 carbon atoms, whereas eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) are considered “long-chain” omega-3s because EPA contains 20 carbons and DHA contains 22 ³⁹.

Docosahexaenoic acid (DHA), in particular, is especially high in the retina, brain, and sperm ³¹. In addition to their structural role in cell membranes, omega-3s (along with omega-6s) provide energy for the body and are used to form eicosanoids. Eicosanoids are signaling molecules that have similar chemical structures to the fatty acids from which they are derived; they have wide-ranging functions in the body’s cardiovascular, pulmonary, immune, and endocrine systems ²⁹. Higher concentrations of EPA and DHA than arachidonic acid tip the eicosanoid balance toward less inflammatory activity ⁴⁰.

Research has shown that a diet rich in omega-3 fatty acids may help to:

• Prevent and reduce symptoms of depression, ADHD, and bipolar disorder.
• Protect against memory loss and dementia.
• Reduce the risk of heart disease, stroke, and cancer.
• Ease arthritis, joint pain, and inflammatory skin conditions.
• Support a healthy pregnancy.
• Battle fatigue, sharpen your memory, and balance your mood.

Fish the best source of omega-3 (high in EPA and DHA):

• Anchovies
• Herring
• Salmon
• Mackerel
• Sardines
• Trout
• Tuna
• Mussels
• Oysters
• Halibut

Vegetarian sources of omega-3s (high in ALA):

• Algae such as seaweed (high in EPA and DHA)
• Eggs (small amounts of DHA)
• Flaxseeds and flaxseed oil
• Chia seeds
• Canola and soybean oil
• Walnuts
• Mayonnaise
• Edamame
• Beans (refried, kidney, etc.)
• Brussels sprouts
• Kale
• Spinach

Fish is a good source of protein and omega-3 fatty acids, which are good for your heart. Research has shown that omega-3 fatty acids can reduce your risk of heart disease and stroke. A 2020 Cochrane review ⁴¹ of 86 randomized controlled trials published between 1968 and 2019 found that 0.5 g/day to more than 5 g/day omega-3 fatty acids for 12 to 88 months in a total of 162,796 participants reduced serum triglyceride levels by about 15% and slightly decreased rates of cardiovascular mortality and coronary heart disease events. However, the omega-3 fatty acids supplements did not affect all-cause mortality, cardiovascular events, stroke, or arrhythmia. The authors of several earlier meta-analyses and systematic reviews, as well as a 2016 report from the Agency for Healthcare Research and Quality, concluded that omega-3 fatty acids supplements do not appear to significantly reduce the risk of most cardiovascular events ⁴². Many of these analyses ⁴³, however, but not all ⁴⁴, did find that omega-3s reduce the risk of cardiac death.

The American Heart Association recommends eating 2 servings of fish (particularly fatty fish) per week. A serving is 3.5 ounce (100 g) cooked, or about ¾ cup of flaked fish. Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are high in omega-3 fatty acids. For people with existing coronary heart disease, such as a recent heart attack (myocardial infarction), the American Heart Association recommends approximately 1 gram/day EPA plus DHA, preferably from oily fish; however, supplements could also be considered under the direction of a physician ⁴⁵. The American Heart Association does not recommend omega-3 supplements for people who do not have a high cardiovascular disease risk.

While omega-3s are best obtained through food, there are many omega-3 and fish oil supplements available. A typical fish oil supplement provides about 1,000 mg fish oil, containing 180 mg EPA and 120 mg DHA, but doses vary widely ⁴⁶. If you need to substantially lower your triglycerides, your doctor may recommend prescription fish oil, which has been concentrated to contain about 900 mg of EPA plus DHA per capsule. Cod liver oil supplements provide vitamin A and vitamin D in addition to omega-3s. For strict vegetarians or vegans, as well as obtaining ALA from food sources, look for capsules containing DHA and EPA extracted from algae, the original source of omega-3s for fish. Although seafood contains varying levels of methyl mercury (a toxic heavy metal) ⁴⁷, omega-3 supplements have not been found to contain this contaminant because it is removed during processing and purification ⁴⁸.

Some types of fish may contain high levels of mercury, PCBs (polychlorinated biphenyls), dioxins and other environmental contaminants. Levels of these substances are generally highest in older, larger, predatory fish and marine mammals.

The benefits and risks of eating fish vary depending on a person’s stage of life.

Children and pregnant women are advised by the U.S. Food and Drug Administration (FDA) to:

• Avoid eating those fish with the potential for the highest level of mercury contamination (such as shark, swordfish, king mackerel or tilefish).
• Eat a variety of fish and shellfish that are lower in mercury (such as canned light tuna, salmon, pollock, catfish).
• Check local advisories about the safety of fish caught by family and friends in local lakes, rivers and coastal areas.

For middle-aged and older men and postmenopausal women, the benefits far outweigh the potential risks when the amount of fish eaten is within the recommendations established by the FDA and Environmental Protection Agency.

Eating a variety of fish will help minimize any potentially adverse effects due to environmental pollutants. Five of the most commonly eaten fish or shellfish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish. Avoid eating shark, swordfish, king Mackerel, or tilefish because they contain high levels of mercury.

Cholesterol

Dietary fat plays a major role in your cholesterol levels. Cholesterol is a type of fat, a wax-like substance that your body needs to function properly that comes from foods such as eggs and is also found in your blood mostly made by your body in your liver. In and of itself, cholesterol isn’t bad. But when you get too much of it, it can have a negative impact on your health. The 2 main types of cholesterol are:

1. “Good” cholesterol or HDL (high-density lipoprotein) cholesterol. “Good” HDL cholesterol has a positive effect by taking cholesterol from parts of the body where there’s too much of it to the liver, where it’s disposed of.
   
2. “Bad” cholesterol or LDL (low-density lipoprotein) cholesterol.

High levels of LDL cholesterol (low-density lipoprotein or “bad” cholesterol) can increase your risk of heart disease. The key is to keep your LDL levels low and HDL high, which may protect against heart disease and stroke. High levels of LDL cholesterol (low-density lipoprotein or “bad” cholesterol) can clog arteries and low HDL (high-density lipoprotein or “good” cholesterol) can be a marker for increased cardiovascular risk. However, eating foods that contain any type of cholesterol won’t actually raise your body’s cholesterol levels. Rather than the amount of cholesterol you eat, the biggest influence on your cholesterol levels is the type of fats you consume. Eating saturated or trans fats is far more likely to give you high cholesterol. So instead of counting cholesterol, it’s important to focus on replacing bad fats with good fats.

LDL (bad) cholesterol

LDL (low-density lipoprotein) cholesterol is considered the “bad” cholesterol, because it contributes to fatty buildups in arteries (atherosclerosis). This narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease. Your body naturally produces all the LDL cholesterol you need. Eating foods containing saturated fats and trans fats causes your body to produce even more LDL — raising the level of “bad” cholesterol in your blood.

HDL (good) cholesterol

HDL (high-density lipoprotein) cholesterol can be thought of as the “good” cholesterol because a healthy level may protect against heart attack and stroke. HDL carries LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body. But HDL cholesterol doesn’t completely eliminate LDL cholesterol. Only one-third to one-fourth of blood cholesterol is carried by HDL.

Trans fats

Avoid trans fat. Trans fats also known as trans fatty acids or “partially hydrogenated oils”, are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid, so they ‘behave’ like a saturated fat. There are two broad types of trans fats found in foods: naturally-occurring and artificial trans fats. Naturally-occurring trans fats are produced in the gut of some animals and foods made from these animals (e.g., milk and meat products) may contain small quantities of these fats. Artificial trans fats (or trans fatty acids) are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.

Trans fats increase the levels of ‘bad’ LDL cholesterol and decreases the levels of ‘good’ HDL cholesterol in your body, which increases your risk of developing heart disease and stroke. Trans fats is also associated with a higher risk of developing type 2 diabetes. Trans fats can be found in many foods such as in butter, margarine (in small amounts), deep-fried and processed foods like doughnuts, cakes and pastries. Baked goods, such as pastries, pizza dough, frozen pizza, pie crust, cookies, biscuits, and crackers also can contain trans fats.

Since 2006, the FDA has required trans fat content to be listed on the Nutrition Facts panel of packaged foods. In recent years, many major national fast-food chains and casual-dining restaurant chains have announced they will no longer use trans fats to fry or deep-fry foods.

The American Heart Association recommends that adults who would benefit from lowering LDL cholesterol eliminate trans fat from their diet.

To find the amount of trans fats in a particular packaged food, look at the Nutrition Facts panel. Companies must list any measurable amount of trans fat (0.5 grams or more per serving) in a separate line in the “Total Fat” section of the panel, directly beneath the line for “Saturated Fat.” This means if a food package states 0 grams of trans fats, it might still have some trans fats if the amount per serving is less than 0.5 g. You can also spot trans fats by reading ingredient lists and looking for the ingredients referred to as “partially hydrogenated oils.”

Salt

Salt or sodium is a mineral that’s essential for life. Table salt is a combination of two minerals — about 40% sodium and 60% chloride. Salt or sodium is regulated by your kidneys, and it helps control your body’s fluid balance. It also helps send nerve impulses and affects muscle function. High levels of salt in your diet can increase blood pressure. High blood pressure is known as the “silent killer” because its symptoms are not always obvious. It’s one of the major risk factors for heart disease, the No. 1 killer worldwide. Ninety percent of American adults are expected to develop high blood pressure over their lifetimes. Because high blood pressure is an important risk factor for stroke, and strokes are detrimental to cognitive health, excessive salt intake is harmful for your brain health. There is a well-established relationship between consuming high levels of sodium and risk of stroke. In Japan, a public health education intervention in the 1960s showed the effectiveness of dietary interventions to reduce sodium intake. A 50% reduction in salt in the diet was associated with an 85% reduction in mortality caused by stroke.

Most of the salt that you eat is added to processed foods. More than 70% of the sodium you consume comes from packaged, prepared and restaurant foods. The rest of the sodium in the diet occurs naturally in food (about 15 percent) or is added when we’re cooking food or sitting down to eat (about 11 percent). Current recommendations from the Dietary Guidelines for Americans are to limit sodium intake to 2,300 milligrams (mg) a day, which amounts to about one teaspoon of salt. The American Heart Association recommends an ideal limit of no more than 1,500 mg per day for most adults. On average, Americans eat more than 3,400 milligrams of sodium each day — much more than the American Heart Association and other health organizations recommend. Because the average American eats so much excess sodium, even cutting back by 1,000 milligrams a day can significantly improve blood pressure and heart health. One estimate suggested that if the U.S. population dropped its sodium intake to 1,500 mg/day (1/2 teaspoon salt), overall blood pressure could decrease by 25.6%, with an estimated $26.2 billion in health care savings. Another estimate projected that achieving this goal would reduce cardiovascular disease deaths by anywhere from 500,000 to nearly 1.2 million over the next decade.

Here are the approximate amounts of sodium in a given amount of salt:

• 1/4 teaspoon salt = 575 mg sodium
• 1/2 teaspoon salt = 1,150 mg sodium
• 3/4 teaspoon salt = 1,725 mg sodium
• 1 teaspoon salt = 2,300 mg sodium

The body needs only a small amount of sodium (less than 500 milligrams per day) to function properly. That’s a mere smidgen — the amount in less than ¼ teaspoon. Very few people come close to eating less than that amount. Plus, healthy kidneys are great at retaining the sodium that your body needs.

Best diet for healthy brain

The typical, contemporary Western diet (high in salt, sugar, excess calories, and saturated fats) is not good for the brain. Eating a heart-healthy diet benefits both your body and your brain. In general, best diet for brain health is lower in saturated fats. Research in the area of the relationship between diet and cognitive functioning is somewhat limited, but it does point to the benefits of three diets in particular: the DASH (Dietary Approaches to Stop Hypertension) diet, the Mediterranean diet and the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay diet). A plant-based diet that is rich in a variety of fruits and vegetables, particularly green-leafy vegetables and berries, is associated with better brain health. Specific foods (such as olive oil), and particular nutritional supplements (including phenolic compounds like curcumin and quercetin) that may prove effective for Alzheimer’s disease prevention. These diets can help reduce heart disease and may also be able to reduce risk of dementia.

• Dietary Approaches to Stop Hypertension (DASH) diet
  • The DASH diet aims to reduce blood pressure by:
    • Eating foods that are low in saturated fat, total fat and cholesterol, and high in fruits, vegetables and low-fat dairy.
    • Consuming whole grains, poultry, fish and nuts.
    • Decreasing your intake of saturated fats, red meats, sweets, sugared beverages and sodium.
• Mediterranean diet
  • The Mediterranean diet incorporates different principles of healthy eating that are typically found in the areas bordering the Mediterranean Sea.
    • Focusing on fruit, vegetables, nuts and grains.
    • Replacing butter with healthy fats, like olive oil.
    • Limiting red meat.
    • Using herbs to flavor food rather than salt.
    • Eating fish and poultry at least twice a week.
• MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay diet)
  • The MIND diet is similar to the DASH diet and the Mediterranean diet ⁴⁹.

The research found that high scores in all three diets were associated with a reduced risk of Alzheimer’s disease, but the MIND diet was the only diet in which even moderate adherence was beneficial. The MIND diet was also associated with a slower decline in global cognition, the equivalent of being 7.5 years younger in age cognitively. However, all of these studies are still observational, making it very difficult to confirm whether the benefits are caused by the diet or by other characteristics shared by the people who choose these foods. More research could help determine which of these diets has the most potential benefit for brain health. In the meantime, take note of the basic characteristics that they share: high levels of fruits, vegetables, fish, and legumes and low levels of processed foods, red meat, sweets, and sugars.

Many clinical and animal studies have demonstrated the importance of polyunsaturated fatty acids in neural development and neurodegeneration. Omega-3 fatty acid is a polyunsaturated fatty acid that must be obtained through dietary intake from fish as well as other types of seafood as it is not produced naturally in the human body ⁵. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential fatty acids present in omega-3 ⁶. DHA (docosahexaenoic acid) makes up 97% of the brain’s total omega-3 fatty acid content ⁶, particularly in brain regions involved in attention and memory ⁷. Docosahexaenoic acid (DHA) is involved in multiple brain functions including cell membrane fluidity, receptor affinity, modulation of signal transduction molecules, and cognitive function ⁸. Omega-3 fatty acid is important for normal cognitive development in early life and may be associated with a reduced decline in cognitive function in older adults ⁹. Recently, omega-3 fatty acids are suggested to act as recovery aids, or possibly as a prophylactic nutritional measure for concussion or mild traumatic brain injury. Animal studies and (pre)clinical studies show that DHA (docosahexaenoic acid) might have a positive effect on the outcomes of mild traumatic brain injury. However, there is a need for well-controlled studies before polyunsaturated fatty acids supplementation can be advised as a therapeutic or preventative measure against sports-related concussion ⁸.

Mediterranean diet

“Mediterranean diet” is a generic term based on the traditional eating habits in the countries bordering the Mediterranean Sea ⁵⁰. There’s not one standard Mediterranean diet. At least 16 countries border the Mediterranean. Eating styles vary among these countries and even among regions within each country because of differences in culture, ethnic background, religion, economy, geography and agricultural production ⁵¹. However, there are some common factors. Mediterranean diet is low in saturated fat and high in fiber ⁵².

A Mediterranean-style diet typically includes:

• plenty of fruits, vegetables, bread and other grains, potatoes, beans, nuts and seeds are eaten daily and make up the majority of food consumed;
• olive oil as a primary fat source, may account for up to 40% of daily calories; and
• small portions of cheese or yogurt are usually eaten each day, along with a serving of fish, poultry, or eggs.

Fish and poultry are more common than red meat in the Mediterranean diet. The Mediterranean diet also centers on minimally processed, plant-based foods. Wine may be consumed in low to moderate amounts, usually with meals. Fruit is a common dessert instead of sweets.

Main meals consumed daily should be a combination of three elements: cereals, vegetables and fruits, and a small quantity of legumes, beans or other (though not in every meal). Cereals in the form of bread, pasta, rice, couscous or bulgur (cracked wheat) should be consumed as one–two servings per meal, preferably using whole or partly refined grains. Vegetable consumption should amount to two or more servings per day, in raw form for at least one of the two main meals (lunch and dinner). Fruit should be considered as the primary form of dessert, with one–two servings per meal. Consuming a variety of colors of both vegetables and fruit is strongly recommended to help ensure intake of a broad range of micronutrients and phytochemicals. The less these foods are cooked, the higher the retention of vitamins and the lower use of fuel, thus minimizing environmental impact.

The Mediterranean Diet is associated with a lower incidence of mortality from all-causes ⁵³ and is also related to lower incidence of cardiovascular diseases ⁵⁴, type 2 diabetes ⁵⁵, certain types of cancer ⁵⁶, and neurodegenerative diseases ⁵⁷. The Mediterranean diet is now recognized as one of the most healthy food patterns in the world.

Year after year, the Mediterranean diet comes out on top in the U.S. News and World Report annual ranking of best diets. The Mediterranean diet is also touted as one of the healthiest by many health organizations and dietitians ⁵⁸.

A Mediterranean-style diet is a healthy dietary pattern that:

• emphasizes vegetables, fruits, whole grains, beans and legumes;
• includes low-fat or fat-free dairy products, fish, poultry, non-tropical vegetable oils and nuts; and
• limits added sugars, sugary beverages, sodium, highly processed foods, refined carbohydrates, saturated fats, and fatty or processed meats.

This style of eating can play a big role in preventing heart disease and stroke and reducing risk factors such as obesity, diabetes, high cholesterol and high blood pressure. There is some evidence that a Mediterranean diet rich in virgin olive oil may help the body remove excess cholesterol from arteries and keep blood vessels open.

The Mediterranean Diet is characterized by ⁵⁹:

1. An abundance of plant food (fruit, vegetables, breads, cereals, potatoes, beans, nuts, and seeds);
2. Minimally processed, seasonally fresh, locally grown foods;
3. Desserts comprised typically of fresh fruit daily and occasional sweets containing refined sugars or honey;
4. Olive oil (high in polyunsaturated fat) as the principal source of fat;
5. Daily dairy products (mainly cheese and yogurt) in low to moderate amounts;
6. Fish and poultry in low to moderate amounts;
7. Up to four eggs weekly;
8. Red meat rarely; and
9. Wine in low to moderate amounts with meals.

Here are some things you can do to switch from a traditional Western-style diet to a more Mediterranean way of eating.

• Dip bread in a mix of olive oil and fresh herbs instead of using butter.
• Add avocado slices to your sandwich instead of bacon.
• Have fish for lunch or dinner instead of red meat. Brush it with olive oil, and broil or grill it.
• Sprinkle your salad with seeds or nuts instead of cheese.
• Cook with olive or canola oil instead of butter or oils that are high in saturated fat.
• Choose whole-grain bread, pasta, rice, and flour instead of foods made with white flour.
• Add ground flaxseed to cereal, low-fat yogurt, and soups.
• Cut back on meat in meals. Instead of having pasta with meat sauce, try pasta tossed with olive oil and topped with pine nuts and a sprinkle of Parmesan cheese.
• Dip raw vegetables in a vinaigrette dressing or hummus instead of dips made from mayonnaise or sour cream.
• Have a piece of fruit for dessert instead of a piece of cake.
• Use herbs and spices instead of salt to add flavor to foods.

DASH diet

DASH stands for Dietary Approaches to Stop Hypertension is similar to a Mediterranean-type diet ⁶⁰. DASH diet is an eating plan that is based on research studies sponsored by the National Heart, Lung, and Blood Institute ⁶¹. The DASH diet is a lifelong approach to healthy eating that’s designed to help treat or prevent high blood pressure (hypertension). The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium and eating foods that are low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and low fat dairy foods ⁶².

DASH Diet is a flexible and balanced eating plan that helps you create a heart-healthy eating style for life.

The DASH diet eating plan requires no special foods and has no hard-to-follow recipes. It simply calls for a certain number of daily servings from various food groups to provide your daily and weekly nutritional goals. The Dietary Approaches to Stop Hypertension (DASH) diet recommends ⁶³:

• Grains and grain products: 7–8 servings per day, more than half of which are whole-grain foods
• Fruits: 4–5 servings per day
• Vegetables: 4–5 servings per day
• Low-fat or non-fat dairy foods: 2–3 servings per day
• Lean meats, fish, poultry: 6 or less servings or fewer per day
• Nuts, seeds, and legumes: 4–5 servings per week
• Added fats and oils: 2–3 servings per day
• Sweets: 5 or less servings per week
• Salt (sodium): 1,500 milligrams (mg) sodium lowers blood pressure even further than 2,300 mg sodium daily.
• Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel and palm oils
• Limiting sugar-sweetened beverages and sweets.

The DASH diet eating plan includes vegetables, whole grains, poultry, fish, and nuts, and has low amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium, calcium and magnesium, as well as protein and fiber. The number of servings depends on the number of calories you’re allowed each day. Your calorie level depends on your age, sex, the amount of lean body mass (muscular, athletic, average or overweight), height and, especially, how active you are. Think of this as an energy balance system—if you want to maintain your current weight, you should take in only as many calories as you burn by being physically active. If you need to lose weight, eat fewer calories than you burn or increase your activity level to burn more calories than you eat.

The DASH dietary approach has been shown to lower blood pressure, but little has been published regarding weight loss ⁶⁰. In fact, a systematic review and meta-analysis on observational prospective studies on the effects of Dietary Approaches to Stop Hypertension (DASH)-style diet, showed that the DASH diet can significantly protect against cardiovascular diseases, coronary heart disease, stroke, and heart failure risk by 20%, 21%, 19% and 29%, respectively ⁶⁴, ⁶⁵.

Blood pressure is usually measured in millimeters of mercury (mmHg) and is recorded as two numbers—systolic pressure (as the heart beats) “over” diastolic pressure (as the heart relaxes between beats)—for example, 120/80 mmHg. Both numbers in a blood pressure test are important, but for people who are age 50 or older, systolic pressure gives the most accurate diagnosis of high blood pressure. Systolic pressure is the top number in a blood pressure reading. It is high if it is 140 mmHg or above ⁶⁶.

High blood pressure is blood pressure higher than 140/90 mmHg and prehypertension is blood pressure between 120/80 and 139/89 mmHg. Prehypertension means that you don’t have high blood pressure now, but are likely to develop it in the future unless you adopt the healthy lifestyle. High blood pressure is dangerous because it makes your heart work too hard, hardens the walls of your arteries, and can cause the brain to hemorrhage or the kidneys to function poorly or not at all. If not controlled, high blood pressure can lead to heart and kidney disease, stroke and blindness.

Being overweight or obese increases your risk of developing high blood pressure. In fact, your blood pressure rises as your body weight increases. Losing even 10 pounds can lower your blood pressure and losing weight has the biggest effect on those who are overweight and already have hypertension. Overweight and obesity are also risk factors for heart disease. And being overweight or obese increases your chances of developing high blood cholesterol and diabetes—two
more risk factors for heart disease.

The original DASH trial ⁶⁷ consisted of 459 subjects with systolic blood pressures <160 mm Hg and diastolic blood pressures between 80 and 95 mm Hg. For three weeks, all participants were fed a control diet low in fruits, vegetables, and dairy products, and with a fat content typical of an American diet (37% of daily caloric intake). During the following eight weeks, the participants were randomized to one of three diets: the control diet, a diet rich in fruits and vegetables, or the DASH Diet.

The DASH Diet was not low in sodium (salt), but still reduced blood pressure. A meta-analysis of 56 randomized, controlled trials that included over 3,500 participants did not support universal sodium restriction, but instead only recommended dietary sodium restriction in the elderly ⁶⁸.

The DASH Diet reduced systolic blood pressure by 5.5 mm Hg and diastolic blood pressure by 3.3 mm Hg, as compared with controls. Subgroup analysis showed that African Americans and those with hypertension had the greatest reduction in blood pressure ⁶⁷ . The DASH diet results might be applied to a larger group due to the heterogeneous population: half of the participants were women, 60% were African American, and 37% had household incomes of <$30,000 per year. One limitation of applying the DASH Diet to the general population is that the study was carried out in a very controlled setting, where all the meals were prepared for the subjects, and thus no comments may be made regarding attrition rates for the diet.

By following the DASH diet, you may be able to reduce your blood pressure by a few points in just two weeks. Over time, your systolic blood pressure could drop by eight to 14 points, which can make a significant difference in your health risks.

Salt or sodium is a mineral that’s essential for life. Table salt is a combination of two minerals — about 40% sodium and 60% chloride. Salt or sodium is regulated by your kidneys, and it helps control your body’s fluid balance. It also helps send nerve impulses and affects muscle function. High levels of salt in your diet can increase blood pressure. High blood pressure is known as the “silent killer” because its symptoms are not always obvious. It’s one of the major risk factors for heart disease, the No. 1 killer worldwide. Ninety percent of American adults are expected to develop high blood pressure over their lifetimes. Because high blood pressure is an important risk factor for stroke, and strokes are detrimental to cognitive health, excessive salt intake is harmful for your brain health. Most of the salt that you eat is added to processed foods. More than 70% of the sodium you consume comes from packaged, prepared and restaurant foods. The rest of the sodium in the diet occurs naturally in food (about 15 percent) or is added when we’re cooking food or sitting down to eat (about 11 percent). The American Heart Association recommends no more than 2,300 milligrams (mg) a day and moving toward an ideal limit of no more than 1,500 mg per day for most adults. On average, Americans eat more than 3,400 milligrams of sodium each day — much more than the American Heart Association and other health organizations recommend. Because the average American eats so much excess sodium, even cutting back by 1,000 milligrams a day can significantly improve blood pressure and heart health. One estimate suggested that if the U.S. population dropped its sodium intake to 1,500 mg/day (1/2 teaspoon salt), overall blood pressure could decrease by 25.6%, with an estimated $26.2 billion in health care savings. Another estimate projected that achieving this goal would reduce cardiovascular disease deaths by anywhere from 500,000 to nearly 1.2 million over the next decade.

Here are the approximate amounts of sodium in a given amount of salt:

• 1/4 teaspoon salt = 575 mg sodium
• 1/2 teaspoon salt = 1,150 mg sodium
• 3/4 teaspoon salt = 1,725 mg sodium
• 1 teaspoon salt = 2,300 mg sodium

The body needs only a small amount of sodium (less than 500 milligrams per day) to function properly. That’s a mere smidgen — the amount in less than ¼ teaspoon. Very few people come close to eating less than that amount. Plus, healthy kidneys are great at retaining the sodium that your body needs.

Table 2. Daily Nutrient Goals Used in the DASH Studies (for a 2,100 Calorie Eating Plan)

Total fat: 27% of calories	Sodium: 2,300 mg*
Saturated fat: 6% of calories	Potassium: 4,700 mg
Protein: 18% of calories	Calcium: 1,250 mg
Carbohydrate: 55% of calories	Magnesium: 500 mg
Cholesterol: 150 mg	Fiber: 30 g

Footnote: 1,500 mg sodium* was a lower goal tested and found to be even better for lowering blood pressure. It was particularly effective for middle-aged and older individuals, African Americans, and those who already had high blood pressure. The American Heart Association recommends no more than 2,300 milligrams (mg) a day and moving toward an ideal limit of no more than 1,500 mg per day for most adults. On average, Americans eat more than 3,400 milligrams of sodium each day — much more than the American Heart Association and other health organizations recommend. Because the average American eats so much excess sodium, even cutting back by 1,000 milligrams a day can significantly improve blood pressure and heart health.

Abbreviations: g = grams; mg = milligrams

[Source ⁶⁹ ]

MIND diet

MIND diet is short for Mediterranean-DASH Intervention for Neurodegenerative Delay diet ⁴⁹. The MIND diet is similar to two other healthy meal plans: the DASH diet and the Mediterranean diet. Morris et al. ⁴⁹ originally devised the MIND diet and found that the diet can slow cognitive decline over an average of 4.7 years in adults aged 58–98 years old. Interestingly, recent research found that the MIND diet and not the Mediterranean diet, protected against 12-year incidence of mild cognitive impairment and dementia in older adults ⁷⁰. Also, a large observational study with older adults found that longer adherence to the MIND diet was associated with better verbal memory ⁷¹. The MIND diet promotes 10 healthy foods (Leafy greens, other veg, nuts, berries, fish, poultry, olive oil, beans, whole grains, red wine) and limits 5 other foods (red meat, butter, cheese, pastries and sweets, fried foods). While previous research shows that higher consumption of vegetables are associated with lower risk of cognitive decline ⁷², the strongest association was observed for higher intake of leafy greens ⁷³. Previous research on cognitive function or dementia do not observe protective effects for overall fruit consumption ⁷⁴. However, berries were shown to slow cognitive decline, particularly in global cognition and verbal memory in older adults ⁷⁵.

The MIND diet has 15 dietary components, including 10 “brain-healthy food groups” ⁷⁶:

• Green leafy vegetables (like spinach and salad greens): At least six servings a week
• Other vegetables: At least one a day
• Nuts: Five servings a week
• Berries: Two or more servings a week
• Beans: At least three servings a week
• Whole grains: Three or more servings a day
• Fish: Once a week
• Poultry (like chicken or turkey): Two times a week
• Olive oil: Use it as your main cooking oil.
• Wine: One glass a day
  • You AVOID:
    • Red meat: Less than four servings a week
    • Butter and margarine: Less than a tablespoon daily
    • Cheese: Less than one serving a week
    • Pastries and sweets: Less than five servings a week
    • Fried or fast food: Less than one serving a week.

References

1. Nan Hu, Jin-Tai Yu, Lin Tan, Ying-Li Wang, Lei Sun, Lan Tan, “Nutrition and the Risk of Alzheimer’s Disease”, BioMed Research International, vol. 2013, Article ID 524820, 12 pages, 2013. https://doi.org/10.1155/2013/524820
2. Adopting a healthy lifestyle helps reduce the risk of dementia. https://www.who.int/news/item/14-05-2019-adopting-a-healthy-lifestyle-helps-reduce-the-risk-of-dementia
3. Brain Food: GCBH Recommendations on Nourishing Your Brain Health. https://www.aarp.org/content/dam/aarp/health/brain_health/2018/01/gcbh-nourishing-your-brain-health-report-english-aarp.doi.10.26419%252Fpia.00019.001.pdf
4. Mehegan, Laura, Chuck Rainville, and Laura Skufca. 2017 Brain Health and Nutrition Survey. Washington DC: AARP Research, January 2018. https://doi.org/10.26419/res.00187.001
5. Davis B.A., Prall B.C. The challenges of incorporation of omega-3 fatty acids into ration components and their prevalence in garrison feeding. Military medicine. 2014;179:162–167. doi: 10.7205/MILMED-D-14-00172
6. Bailes J.E., Patel V. The potential for DHA to mitigate mild traumatic brain injury. Mil. Med. 2014;179:112–116. doi: 10.7205/MILMED-D-14-00139
7. Stonehouse W., Conlon C.A., Podd J., Hill S.R., Minihane A.M., Haskell C., Kennedy D. DHA supplementation improved both memory and reaction time in healthy young adults: a randomized controlled trial. Am. J. Clin. Nutr. 2013;97:1134–1143. doi: 10.3945/ajcn.112.053371
8. Barrett, E., McBurney, M., & Ciappio, E. (2014). Omega-3 fatty acid supplementation as a potential therapeutic aid for the recovery from mild traumatic brain injury/concussion. Advanced Nutrition, 5(3), 268–277. doi:10.3945/an.113.005280
9. Jackson P.A., Reay J.L., Scholey A.B., Kennedy D.O. DHA-rich oil modulates the cerebral haemodynamic response to cognitive tasks in healthy young adults: a near IR spectroscopy pilot study. Br. J. Nutr. 2012;107:1093–1098. doi: 10.1017/S0007114511004041
10. Devore, E. E., Kang, J. H., Breteler, M. M., & Grodstein, F. (2012). Dietary intakes of berries and flavonoids in relation to cognitive decline. Annals of neurology, 72(1), 135–143. https://doi.org/10.1002/ana.23594
11. S. Chakrabarti, V. K. Khemka, A. Banerjee, G. Chatterjee, A. Ganguly, and A. Biswas, “Metabolic risk factors of sporadic Alzheimer’s disease: implications in the pathology, pathogenesis and treatment,” Aging and Disease, vol. 6, no. 4, pp. 282–299, 2015.
12. Y. Huang and R. W. Mahley, “Neurobiology of Disease Apolipoprotein E: structure and function in lipid metabolism, neurobiology, and Alzheimer’s diseases,” Neurobiology of Disease, vol. 72, pp. 3–12, 2014.
13. V. Van-Giau, E. Bagyinszky, S. S.-A. An, and S. Y. Kim, “Role of apolipoprotein E in neurodegenerative diseases,” Neuropsychiatric Disease and Treatment, vol. 11, pp. 1723–1737, 2015.
14. Z. Xue-Shan, W. Qi, R. Zhong et al., “Imbalanced cholesterol metabolism in Alzheimer’s disease,” Clinica Chimica Acta, vol. 456, pp. 107–114, 2016.
15. J. M. Walker and F. E. Harrison, “Shared neuropathological characteristics of obesity, type 2 diabetes and Alzheimer’s disease: impacts on cognitive decline,” Nutrients, vol. 7, no. 9, pp. 7332–7357, 2015.
16. R. F. de Bruijn and M. A. Ikram, “Cardiovascular risk factors and future risk of Alzheimer’s disease,” BMC Medicine, vol. 12, no. 1, article 130, pp. 1–9, 2014.
17. R. Sandhir and S. Gupta, “Molecular and biochemical trajectories from diabetes to Alzheimer’s disease?: a critical appraisal,” World Journal of Diabetes, vol. 6, no. 12, pp. 1223–1242, 2015.
18. X. Sun, W. Chen, and Y. Wang, “β-Amyloid: the key peptide in the pathogenesis of Alzheimer’s disease,” Frontiers in Pharmacology, vol. 6, pp. 1–9, 2015.
19. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. https://doi.org/10.1016/S0140-6736(20)30367-6
20. Liu Y.H., Gao X., Na M., Kris-Etherton P., Mitchell D.C., Jensen G.L. Dietary pattern, diet quality, and dementia: A systematic review and meta-analysis of prospective cohort studies. J. Alzheimer Dis. 2020;78:151–158. doi: 10.3233/JAD-200499
21. Kheirouri S., Alizadeh M. Dietary Inflammatory Potential and the Risk of Neurodegenerative Diseases in Adults. Epidemiol. Rev. 2019;41:109–120. doi: 10.1093/epirev/mxz005
22. Moreira S.C., Jansen A.K., Silva F.M. Dietary interventions and cognition of Alzheimer’s disease patients: A systematic review of randomized controlled trial. Dement. Neuropsychol. 2020;14:258–282. doi: 10.1590/1980-57642020dn14-030008
23. Haider S., Schwarzinger A., Stefanac S., Soysal P., Smith L., Veronese N., Dorner T.E., Grabovac I. Nutrientsal supplements for neuropsychiatric symptoms in people with dementia: A systematic review and meta-analysis. Int. J. Geriatr. Psychiatry. 2020;35:1285–1291. doi: 10.1002/gps.5407
24. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
25. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. https://health.gov/sites/default/files/2019-09/2015-2020_Dietary_Guidelines.pdf
26. The Skinny on Fats. https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/the-skinny-on-fats
27. Jakobsen, M.U., et al., Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr, 2010. 91(6): p. 1764-8.
28. Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, DC: National Academy Press; 2005.
29. Jones PJH, Rideout T. Lipids, sterols, and their metabolites. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014.
30. Jones PJH, Papamandjaris AA. Lipids: cellular metabolism. In: Erdman JW, Macdonald IA, Zeisel SH, eds. Present Knowledge in Nutrition. 10th ed. Washington, DC: Wiley-Blackwell; 2012:132-48.
31. Harris WS. Omega-3 fatty acids. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010:577-86.
32. Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 2008 Jun;233(6):674-88. doi: 10.3181/0711-MR-311
33. Wang C, Chung M, Lichtenstein A, Balk E, Kupelnick B, DeVine D, et al. Effects of omega-3 fatty acids on cardiovascular disease. Summary, evidence report/technology assessment no. 94. (Prepared by the Tufts New England Medical Center Evidence-based Practice Center, Boston, MA.) AHRQ Publication No. 04-E009-1. Agency for Healthcare Research and Quality, 2004. https://archive.ahrq.gov/downloads/pub/evidence/pdf/o3cardio/o3cardio.pdf
34. Harris WS, Davidson MH. RE: Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst. 2014 Apr;106(4):dju019. doi: 10.1093/jnci/dju019
35. Brasky TM, Darke AK, Song X, Tangen CM, Goodman PJ, Thompson IM, Meyskens FL Jr, Goodman GE, Minasian LM, Parnes HL, Klein EA, Kristal AR. Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial. J Natl Cancer Inst. 2013 Aug 7;105(15):1132-41. doi: 10.1093/jnci/djt174
36. Harris WS. Are n-3 fatty acids still cardioprotective? Curr Opin Clin Nutr Metab Care. 2013 Mar;16(2):141-9. doi: 10.1097/MCO.0b013e32835bf380
37. Agency for Healthcare Research and Quality. Omega-3 fatty acids and cardiovascular disease – 2015. https://effectivehealthcare.ahrq.gov/products/fatty-acids-cardiovascular-disease/research-protocol
38. Harris WS. The omega-3 index as a risk factor for coronary heart disease. Am J Clin Nutr. 2008 Jun;87(6):1997S-2002S. doi: 10.1093/ajcn/87.6.1997S
39. Metcalf RG, Cleland LG, Gibson RA, Roberts-Thomson KC, Edwards JR, Sanders P, Stuklis R, James MJ, Young GD. Relation between blood and atrial fatty acids in patients undergoing cardiac bypass surgery. Am J Clin Nutr. 2010 Mar;91(3):528-34. doi: 10.3945/ajcn.2009.28302
40. James M, Proudman S, Cleland L. Fish oil and rheumatoid arthritis: past, present and future. Proc Nutr Soc. 2010 Aug;69(3):316-23. doi: 10.1017/S0029665110001564
41. Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KH, Summerbell CD, Worthington HV, Song F, Hooper L. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2020 Feb 29;3(2):CD003177. doi: 10.1002/14651858.CD003177.pub5
42. Weylandt KH, Serini S, Chen YQ, Su HM, Lim K, Cittadini A, Calviello G. Omega-3 Polyunsaturated Fatty Acids: The Way Forward in Times of Mixed Evidence. Biomed Res Int. 2015;2015:143109. doi: 10.1155/2015/143109
43. Casula M, Soranna D, Catapano AL, Corrao G. Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: A meta-analysis of randomized, placebo controlled trials [corrected]. Atheroscler Suppl. 2013 Aug;14(2):243-51. doi: 10.1016/S1567-5688(13)70005-9. Erratum in: Atheroscler Suppl. 2014 Mar;233(1):122.
44. Agency for Healthcare Research and Quality. Omega-3 fatty acids and cardiovascular disease: an updated systematic review. 2016. https://effectivehealthcare.ahrq.gov/products/fatty-acids-cardiovascular-disease/research
45. Siscovick DS, Barringer TA, Fretts AM, Wu JH, Lichtenstein AH, Costello RB, Kris-Etherton PM, Jacobson TA, Engler MB, Alger HM, Appel LJ, Mozaffarian D; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association. Circulation. 2017 Apr 11;135(15):e867-e884. doi: 10.1161/CIR.0000000000000482
46. National Institutes of Health. Dietary Supplement Label Database. 2015.
47. U.S. Food and Drug Administration. Fish: what pregnant women and parents should know. 2014. https://www.fda.gov/food/consumers/advice-about-eating-fish
48. ConsumerLab.com. Product review: fish oil and omega-3 fatty acid supplements review (including krill, algae, calamari, green-lipped mussel oil). 2021. https://www.consumerlab.com/reviews/fish-oil-supplements-review/omega3
49. Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Bennett, D. A., & Aggarwal, N. T. (2015). MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimer’s & dementia : the journal of the Alzheimer’s Association, 11(9), 1007–1014. https://doi.org/10.1016/j.jalz.2014.11.009
50. Altomare, R., Cacciabaudo, F., Damiano, G., Palumbo, V. D., Gioviale, M. C., Bellavia, M., Tomasello, G., & Lo Monte, A. I. (2013). The mediterranean diet: a history of health. Iranian journal of public health, 42(5), 449–457. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684452
51. Castro-Quezada, I., Román-Viñas, B., & Serra-Majem, L. (2014). The Mediterranean diet and nutritional adequacy: a review. Nutrients, 6(1), 231–248. https://doi.org/10.3390/nu6010231
52. Serra-Majem, L., Tomaino, L., Dernini, S., Berry, E. M., Lairon, D., Ngo de la Cruz, J., Bach-Faig, A., Donini, L. M., Medina, F. X., Belahsen, R., Piscopo, S., Capone, R., Aranceta-Bartrina, J., La Vecchia, C., & Trichopoulou, A. (2020). Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns. International journal of environmental research and public health, 17(23), 8758. https://doi.org/10.3390/ijerph17238758
53. Sofi F., Macchi C., Abbate R., Gensini G.F., Casini A. Mediterranean diet and health. Biofactors. 2013;39:335–342. doi: 10.1002/biof.1096
54. Estruch R., Ros E., Salas-Salvadó J., Covas M.I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med. 2013;368:1279–1290. doi: 10.1056/NEJMoa1200303
55. Mitrou P.N., Kipnis V., Thiébaut A.C., Reedy J., Subar A.F., Wirfält E., Flood A., Mouw T., Hollenbeck A.R., Leitzmann M.F., et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: Results from the NIH-AARP Diet and Health Study. Arch. Intern. Med. 2007;167:2461–2468. doi: 10.1001/archinte.167.22.2461
56. Couto E., Boffetta P., Lagiou P., Ferrari P., Buckland G., Overvad K., Dahm C.C., Tjønneland A., Olsen A., Clavel-Chapelon F., et al. Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br. J. Cancer. 2011;104:1493–1499. doi: 10.1038/bjc.2011.106
57. 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. Am. J. Clin. Nutr. 2010;92:1189–1196. doi: 10.3945/ajcn.2010.29673
58. Widmer, R. J., Flammer, A. J., Lerman, L. O., & Lerman, A. (2015). The Mediterranean diet, its components, and cardiovascular disease. The American journal of medicine, 128(3), 229–238. https://doi.org/10.1016/j.amjmed.2014.10.014
59. F.B. Hu. The Mediterranean Diet and mortality—olive oil and beyond. N Engl J Med, 348 (2003), pp. 2595-2596
60. Journal of the American College of Cardiology Volume 45, Issue 9, 3 May 2005, Pages 1379-1387. Diets and Cardiovascular Disease: An Evidence-Based Assessment. http://www.sciencedirect.com/science/article/pii/S0735109705003670
61. National Institutes of Health. National Heart, Blood and Lung Institute. Description of the DASH Eating Plan. https://www.nhlbi.nih.gov/health/health-topics/topics/dash
62. National Institutes of Health. National Heart, Blood and Lung Institute. Your Guide To Lowering Your Blood Pressure With DASH. https://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf
63. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH; DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001 Jan 4;344(1):3-10. doi: 10.1056/NEJM200101043440101
64. Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L. Nutrition. 2013 Apr;29(4):611-8. doi: 10.1016/j.nut.2012.12.018. Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases–incidence: a systematic review and meta-analysis on observational prospective studies. http://www.nutritionjrnl.com/article/S0899-9007(13)00007-5/fulltext
65. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008 Apr 14;168(7):713-20. PMID: 18413553. http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414155
66. National Institutes of Health. National Heart, Blood and Lung Institute. Your Guide to Lowering Blood Pressure. https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf
67. L.J. Appel, T.J. Moore, E. Obarzenek, et al.A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med, 336 (1997), pp. 1117-1124
68. J.P. Midgley, A.G. Matthew, C.M. Greenwood, A.G. Logan. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA, 275 (1996), pp. 1590-1597
69. National Institutes of Health. National Heart, Blood and Lung Institute. Your Guide to Lowering Blood Pressure with DASH. https://www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf
70. Hosking DE, Eramudugolla R, Cherbuin N, Anstey KJ. MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study. Alzheimers Dement. 2019 Apr;15(4):581-589. doi: 10.1016/j.jalz.2018.12.011
71. Berendsen AM, Kang JH, Feskens EJM, de Groot CPGM, Grodstein F, van de Rest O. Association of Long-Term Adherence to the MIND Diet with Cognitive Function and Cognitive Decline in American Women. J Nutr Health Aging. 2018;22(2):222-229. doi: 10.1007/s12603-017-0909-0
72. Chen X, Huang Y, Cheng HG. Lower intake of vegetables and legumes associated with cognitive decline among illiterate elderly Chinese: a 3-year cohort study. J Nutri Health Aging. 2012;16(6):549–552.
73. Morris MC, Wang Y, Barnes LL, Bennett DA, Dawson-Hughes B, Booth SL. Nutrients and bioactives in green leafy vegetables and cognitive decline: Prospective study. Neurology. 2018 Jan 16;90(3):e214-e222. doi: 10.1212/WNL.0000000000004815
74. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology. 2006 Oct 24;67(8):1370-6. doi: 10.1212/01.wnl.0000240224.38978.d8
75. Devore EE, Kang JH, Breteler MM, Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann Neurol. 2012 Jul;72(1):135-43. doi: 10.1002/ana.23594
76. Diet May Help Prevent Alzheimer’s. https://www.rush.edu/news/diet-may-help-prevent-alzheimers