Summary of “Keep Sharp: Build a Better Brain at Any Age by Dr. Sanjay Gupta (2021)
Introduction and self-assessment
- book is about the deep connection between the heart and the brain, but it all begins in the brain
- if brain running smoothly: better decisions, improved resilience, more optimistic attitude, physical part of body will improve. Pain tolerance will increase, need for meds decrease, ability to heal will be accelerated
- brain related impairments are increasing (47 million Americans have some evidence of preclinical Alzheimer’s disease)
- the person we marry factors greater into our longevity than our genetic inheritance does
- to preserve brain function and prevent neurodegenerative decline a good summary would be: “lead a rich, active, dynamic, complex life”
- answer the 25 questions to start
Part 1: The Brain: Meet Your Inner Black Box (covers basic facts and myths about the brain)
Chapter 1: What Makes You
- brain contains estimated 100 billion cells, or neurons, linked by trillions of connections called synapses, and billions of nerve fibres. Brain is alive, learning, changing (not static)
- not known where consciousness or self-awareness resides (but probably a confluence of factors throughout the brain)
- 73% water; many different kinds of neurons; last organ to mature (by ~ age 25)
- starts slowing down ~24, but peaks for different cognitive skills at different ages. No matter how old we are, we’re likely getting better at some things, e.g. vocabulary skills may peak early 70s
- memory: the most commonly recognized cognitive function (forms our ongoing experiences on life; gives us self/identity; make us feel alive, capable, valuable; connects past with present and framework for future; cornerstone of all learning; a learning process; every time we use our memory, we change it; it uses all our brain)
- need to pay attention to properly encode memory (if we remembered everything our system would be overwhelmed; so got to forget stuff too, and that happens at night)
- short-term memory vs long (most of us can only hold ~7 items of info in short-term); LT memory includes all the info we really know and can recall; it becomes part of us
- we often have inefficient retrieval systems; solutions need practice
Chapter 2: Cognitive Decline – Redefined
Decline can start years before any symptoms emerge; the learning: people heed the message/check their habits. Current theories/causes of cognitive decline (beyond normal aging):
- The amyloid cascade hypothesis (ACH): that beta-amyloids, or plaques of sticky protein, accumulate in the brain and destroy the essential synapses that allow brain cells to communicate; problem is they can’t support the hypothesis yet or determine whether the plaques are an effect rather than a cause of Alzheimer’s
- Genetic: certain gene abnormalities can increase beta-amyloid production and account for the early-onset Alzheimer’s that affects many members of the families that carry certain gene abnormalities
- Repeated blows to the head: a degenerative brain disease called chronic traumatic encephalopathy (CTE) has been connected to tau proteins that are responsible for stabilizing nerve cells in the brain. Multiple concussions have been linked to damaging tau buildup. Recent research in a living football player who has CTE has linked high concentrations of tau
- Blood flow abnormalities in the brain may be linked to Alzheimer’s; any factor – from smoking to high cholesterol – that affects the blood flow system to the brain is a risk. (People who have a history of high blood pressure or who have had a stroke are more vulnerable to Alzheimer’s.)
- Insulin deficiency has been linked to cognitive decline.
- Weight: as there is a link between weight and the risk for diabetes, it’s postulated that carrying extra weight is harmful to the brain; need more evidence
- Toxic substances: research is examining the connections between exposures to chemicals we encounter in our daily lives, e.g. pesticides, insecticides, substances in plastic, food additives (an example: BMAA, a neurotoxin produced by blue-green algae)
- Infections: a hypothesis is now developing that serious forms of neurodegenerative decline can stem from the body’s reaction to certain infections (Lyme disease, herpes, Zika, syphilis, rabies, even gum disease).
* a common thread is inflammation
* six types of normal memory lapse: absentmindedness; blocking; scrambling (confusing little details); fading away (brain continually cleans out older memories to make room for new ones); struggling for retrieval; muddled multitasking (at some point the number of things one can do effectively at one time diminishes)
* message: focus on brain, and everything else will follow
Chapter 3: 12 Destructive Myths and the 5 Pillars That Will Build You
Twelve pervasive myths about the aging brain:
- The brain remans a complete mystery: while a lot to learn, there have been great strides
- Older people are doomed to forget things: some cognitive skills do decline but some things improve (vocabulary; social communication; diplomacy; controlling emotions; weathering stress; finding meaning in our lives)
- Dementia is an inevitable consequence to old age: no, it’s not a normal part of aging
- Older people can’t learn new things: no, it can happen at any age; there is even the possibility of growing new neutrons
- You must master one language before learning another: children learning two languages don’t confuse the two; bilingual kids have a better generalized knowledge of language structure as a whole
- A person who has memory training never forgets: no; “use it or lose it” also applies to memory training
- We only use 10% of our brains: evolutionarily ridiculous; fMRI scans indicate much of the brain is engaged even in simple tasks
- Male and female brains differ in ways that dictate learning abilities and intelligence: no good science supports this; however women do have an advantage over men in their verbal abilities, and that could be a factor in identifying any cognitive problems I.e. diagnosing Alzheimer’s (+ it strikes more women than men)
- A crossword puzzle a day can keep the brain doctor away: no, that only helps in word finding; however there is value in doing word and number puzzles as it helps attention, reasoning & memory
- You are dominated by either your “right” or “left” brain: no; both sides are intricately codependent
- You have only five senses: no; six more senses exist, e.g. a sense of: where your body parts are, balance, pain, temperature, passage of time, your internal needs (hunger, thirst)
- You’re born with all the brain cells you’ll ever have, your brain is hardwired, and brain damage is always permanent: “pruning” and especially growth is continuous; one’s environment can influence the pruning (synapses that are “exercised” by experience become stronger; others get weaker); the brain remains plastic throughout life and can rewire itself in response to ones experience; the brain can form and reorganize synaptic connections (neuroplasticity); repeated mental states become neural traits
* the five pillars of brain health: move; discover; relax; nourish; connect (expanded on in Part 2)
Part 2: The Brain Trust: How to Not Lose Your Mind (covers the 5 major categories needed to protect/heighten brain function)
Chapter 4: The MIracle of Movement
- exercise is the single most important thing one can do to enhance the brain’s function and resiliency to disease; it is the only behavioural activity scientifically proven to trigger biological effects that can help the brain (think more quickly, clearly and focussed)
- according to the Centers for Disease Control and Prevention 80% of Americans don’t get enough regular exercise and only 23% of men and 18% of women meet the recommended requirements
- exercise improves digestion, metabolism, body tone and strength, and bone density; it reduces stress
- we can gain a lot more than previously realized from relatively low-intensity activities (walking, gardening, ballroom dancing, swimming); need at least 150 minutes/week; up to an hour/day better
- add interval training (alternate between varying levels of speed, intensity and effort) and strength training (weights, resistance bands or own body weight as resistance) into the mix
- sitting for long stretches is bad: circulation slows down and the body uses less of ones blood sugar; it negatively influences blood fats, high density lipoprotein (the good cholesterol), resting blood pressure, and the satiety hormone (which tells you when to stop eating); puts muscles into a sort of dormant state
- our genome expects and requires frequent movement (we’ve had to, to survive)
- search for alternatives to the easy way (stairs vs elevator; walk to the bank, etc.) or ways to work it in to routine (pull-up bars; weights in bedroom)
- note: strong hand grips and walking speeds have been shown to be indicators of how quickly people are aging
Chapter 5. The Power of Purpose, Learning, and Discovery: This is about active living and staying engaged through socialization and participating in stimulating activities. One’s cognitive reserve or brain resiliency is the brain’s ability to improvise and navigate around impediments it may encounter that could prevent it from getting the job done.
Recent research shows people with greater cognitive reserve (or brain resiliency – the brain’s ability to navigate around impediments it encounters that would prevent it from getting the job done) are more likely to stave off the degenerative brain changes associated with dementia (from a 2019 study). It can also help you function better for longer if exposed to life’s challenging events (chronic stress, surgery, toxins in the environment, etc.) It’s a reflection of how much you have challenged your brain over the years through education, work, other activities. This suggests that people with higher IQ (he’s careful not to suggest that being smarter will protect you from dementia), education, occupational achievements or engagement in leisure activities have a reduced risk of developing Alzheimer’s.
Other important elements:
- the key is continued education in the form of reading, learning, and socializing (“use it or lose it”). This is about active living/aging; staying engaged through socialization; learning a new language, taking up a musical instrument, speed training games: any thing that demands more long-term memory
- cognitive stimulation builds a brain more resistant to stress
- sense of purpose: studies demonstrate that old people with a sense of purpose in life are less likely to develop a slew of ailments (including cognitive impairment, heart attacks, strokes, etc.);
- with a sense of purpose comes a love for life and all the experiences it offers. In Japan, especially Okinawa, where certain populations have incredibly low rates of dementia, they use the word ikigai which roughly translated means your reason for being. There isn’t even a word for retirement in Okinawa; people do different things as they get older, not necessarily fewer things. People are honoured and included even more as they age, as a sign of respect but also an acknowledgement of their experience. Gupta says delay retirement as long as possible and stay engaged. There’s power to maintaining a sense of purpose by continuing to learn, discover, and complete complex tasks.
- with a sense of purpose comes optimism (that, plus self-acceptance, vitality and positive relationships are all elements of mental well-being)
- one final concept: getting in the flow; described as being in a mental state that has one totally immersed in an activity without distraction or agitation; being deeply focused, enjoying intense energy absorbed in the activity; need to have a sense of purpose to be in the flow
Chapter 6: The Need for Sleep & Relaxation
* sleep is not a state of neural idleness; it is a stage during which the body replenishes itself; sleep habits rule everything about us; sleep controls our hormonal cycles (that all correlate with the solar day)
* six or fewer hours reduces daytime alertness by about a third; sleep needs remain constant throughout adulthood; sleep is essential for consolidating our memories and filing them away for later recall
* chronic inadequate sleep puts people at higher risk for dementia, depression, learning and memory problems, heart disease, high blood pressure, weight gain, diabetes, cancer
* sleep aids (meds, etc.) do not allow one to experience sleep as restful as natural sleep; some impair thinking and balance and some are linked to increased chance of developing Alzheimer’s
* during sleep cleansing or washing takes place (it is speculated that sleep scrubs the brain of metabolic refuse)
* the top 10 secrets to slumber:
- Stick to a schedule and avoid long naps; get up at the same time every day, weekends included
- Don’t be a night owl; best before midnight; non-REM (rapid eye movement) sleep tends to dominate sleep cycles in early part of night; dream-rich REM occurs closer to dawn; non-REM is deeper/more restorative
- Wake up to early morning light; our evolutionary biology screams about importance of mornings
- Get moving: regular physical activity promotes good sleep
- Watch what you eat and drink: avoid caffeine after lunch; don’t eat or drink for 3 hours before bed (stops need to get up to pee); alcohol disturbs normal sleep cycles
- Mind your medicines: some contain caffeine or stimulating decongestants; can they be taken earlier?
- Cool, quiet, and dark; ideal temperature: between 60 and 67 degrees F; keep feet warm, (socks?); sleep in dark and no sound; no pets
- Eliminate electronics; nearly all light contains blue wavelengths, a suppressor of the hormone needed for sleep (melatonin); paper books are better than e-readers; eschew TVs, phones, tablets, computers
- Establish bedtime rituals: engage in calming activities (stretch, read, music, bath); no arguing
- Know the warning signs: frequent snoring; trouble falling/staying asleep 3 x’s/wk for at least 3 months; persistent daytime sleepiness
* daytime R & R; we need both sleep plus daytime rest. Our mental well-being depends on this – and we know that greater mental well-being is associated with with reduced dementia risks; the reverse is true – conditions like certain types of anxiety and depression can be warning signs for cognitive decline. He’s big on meditation, i.e. being present in the moment and observing what is happening in your life. He suggests 20 to 30 minutes/day; can be yoga, progressive muscle relaxation, breathing exercises, etc. Other ideas: become a volunteer; express gratitude (it reduces depression and anxiety, lowers stress, increases happiness); practice art of forgiveness; look for laughter (it secretes “feel good” hormones such as endorphins, dopamine, and serotonin); take breaks from email/social media; establish system of awards (say a 5 minute break in a task every 1/2 hour); focus on one task at a time; choose to do the important tasks first (the marbles) and then the non urgent ones (the sand); ask every week “What goals do I need to accomplish in the next week for me to feel this week was a success?”; declutter your life (clean out stuff around you); set aside 15 minutes/day for yourself; daydream
* midlife (35 to ~55) tends to be more a downer (it straddles competing demands: aging parents/dependent children; working to maintain a career/saving for retirement)
Chapter 7: Food: what’s the best possible diet for the brain?
* what we eat could very well be one of the most influential benefits to our brain health now/future; how we fuel our body, protects the brain
* basic: everything in moderation. We are all different. Never too early to begin
* MIND diet: a modified blend of two diets, the Mediterranean and DASH (Dietary Approaches to Stop Hypertension). Summary: thumbs up for vegetables (especially green leafy ones), nuts, berries, beans, whole grains, fish, poultry, olive oil, wine; thumbs down for red meats, butter and stick margarine, cheese, pastries and other sweets, fried or fast food
* the MIND diet (shown through a 10 year study of 1,000 people; noted in 2015 issue of Alzheimer’s & Dementia) can prevent cognitive decline equivalent to ~7 1/2 years of aging. Through simple lifestyle interventions (nutrition, exercise, sleep, stress management) it has been demonstrated that people can delay the progression by two to three years
* the typical Western diet – high in salt, sugar, excess calories, and saturated fats – is not brain friendly. We have too much artificially-sweetened beverages, processed meats, sweets
* increasing fruit intake by just one serving/day has potential of reducing dying from a cardiovascular event by 8%. Only 10% of Americans get recommended number of fruits and veggies/day. More than 1/3 eat fast food daily. Fast food intake rises with income.
* aim for 7 different-coloured foods/day
* his guide to good eating uses SHARP acronym:
S: Slash the sugar and stick to your ABCs (a lot comes in liquid form – soda, juice); to get sweet try honey, maple syrup, natural stevia; no to artificial sugars like aspartame, saccharin or even sucralose (the human body can’t digest them plus they affect gut bacteria which leads to insulin resistance and diabetes). So severely limit chips, cookies, pastries, muffins, baked deserts, candy, cereals, bagels
His A list (to consume regularly): fresh veggies; whole berries; fish and seafood; healthy fats (e.g. extra virgin olive oil, avocados, whole eggs); nuts and seeds
His B list (include also): beans and other legumes; whole fruits (in addition to berries); low sugar, low fat dairy (e.g. plain yogurt, cottage cheese); poultry; whole grains
His C list (limit consumption): fried food; pastries; sugary foods; processed foods; red meat (e.g. beef, lamb, pork, buffalo, duck); red meat products (e.g. bacon); whole-fat dairy high in saturated fat (cheese, butter); salt
H: Hydrate smartly: as we age our ability to perceive thirst diminishes; rule: if you feel any thirst, you have already waited too long. Drink instead of eat. There is a link between hydration status and cognitive ability and mood. Water is best; also morning tea or coffee. Alcohol doesn’t count as a source of hydration, but it can be part of a healthy diet. Jury is out on alcohol being healthy; for some it is; some not. Also as we age, our ability to metabolize alcohol deceases. If you do drink, moderation key, I.e. for men up to 2 drinks/day; for women one/day (a drink is 12 oz beer, 5 oz wine, red better, 1.5 oz liquor).
A: Add more Omega-3 fatty acids from dietary sources, e.g. fatty fish (salmon, mackerel, sardines); flaxseed, plant derived oils (olive, canola, soybean), nuts, seeds (chia seeds, pumpkin, sunflower). Food sources, not supplements (when you eat right you don’t need them). Know where your fish comes from (see: www.seafoodwatch.org).
R: Reduce portions. Watch caloric intake. Note: don’t fry; boil, poach, steam, bake instead. Note re fasting: it challenges the brain, forcing it to react by activating adaptive stress responses that help cope with disease. Try intermittent fasting.
P: Plan ahead. Don’t get caught starving and resorting to junk food; animal instincts will push us in the wrong direction when hunger strikes. Plan your meals, i.e. build in more fibre (KEY), including whole fruits (bananas, apples, mangoes, berries) and veggies (the darker the colour, the higher the fibre content); beans and legumes; whole grains and seeds, including wild and brown rice.
Note: some conventionally grown foods are more likely to contain pesticide residues, where it is suggested they first be washed, peeled or skin removed; can also wash in water with vinegar (the Dirty Dozen: strawberries, spinach, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, potatoes, sweet bell peppers), so consider buying organic. Clean 15 list: avocado, sweet corn, pineapple, cabbage, onion, sweet peas, papaya, asparagus, mango, eggplant, honeydew, kiwi, cantaloupe, cauliflower, broccoli. Re the occasional steak, go grass-fed beef. Plus don’t keep meat at home; only consume when out. Spice: curcumin in turmeric is good for brain (dementia lower in communities where it is a staple).
Check sodium content; often high in baked goods (cakes, frozen pizza, cookies), canned soup, frozen foods. Steer clear of partially hydrogenated oils (trans fats; they raise your harmful cholesterol, LDL – and lower your good, HDL, cholesterol); they appear in doughnuts, baked goods, margarines and other spreads.
Final note: floss; protecting gums is good for brain (gum disease = increased stroke risk)
Chapter 8: Connection for Protection
- we need social connection to thrive (not just the number but the quality, type, and purpose)
- the health of one spouse is important to that of the other spouse (in first 6 months after loss of a spouse, there is a 41% increased risk of mortality of the other). Divorcees twice as likely as married people to develop dementia
- one-third of Americans older than 65 and half over 85 now living alone
- people with fewer social connections have disrupted sleep patterns, altered immune systems, more inflammation, and higher levels of stress hormones
- loneliness accelerates cognitive decline in older adults and at least 1 in 5 Americans suffers from loneliness (and feelings of exclusion lead to feelings of loneliness)
- the Rush University Memory and Aging Project has shown that those with larger social networks (particularly when centred around some sort of challenging activity) were better protected against the cognitive declines related to Alzheimer’s than the people with a smaller group of friends
- being online and connected through social media, etc. equals a greater sense of independence and happiness (vs being offline); get a computer
- good to maintain social relationships with different ages
- join a club; adopt a pet; don’t forget power of touching
Chapter 9: Putting It All Together (this is his 12 week program that incorporates his learnings)
Part 3: The Diagnosis: What to Do, How to Survive: (The third part of the book, Chapters 10 and 11, and Conclusion, are on dealing with brain diseases esp Alzheimer’s)
Chapter 10: Diagnosing and Treating an Ailing Brain
- Alzheimer’s typically begins in the brain up to 30 years before the symptoms develop
- interventions pay attention to diet, exercise, sleep, intellectual stimulation, stress reduction, supplements, and drugs where necessary (see Part 2 of book)
- stages of Alzheimer’s described
- medications; some like Benadryl (antihistamine) may increase risk of dementia; the Global Council on Brain Health does not recommend supplementation for brain health
- traumatic brain injuries can cause memory loss; preventing falls important
- long term excessive alcohol consumption causes alcohol dementia
- two approved drugs to lesson symptoms but come with their own side effects; they also lose their effectiveness as disease progresses
Chapter 11: Navigating the Path Forward
- while women are most likely be the caregivers, they are also much more likely to develop Alzheimer’s themselves (almost 2/3s of Americans who have it are women)
- the invisible second patient: caregivers of spouses with dementia are up to 6 times more likely to develop dementia than people in the general population
- toxic stress is suffered by caregivers
- dementia a “forgetfulness disorder”; but the other symptoms are a challenge to manage too: anger, agitation, mood changes, hallucinations, apathy, sleep disturbances, incontinence, wandering. “Sundowning” can happen in as many as 20% of individuals (increased confusion, anxiety, and agitation beginning late in the day)