Podcast: How Do I Keep My Brain Healthy?

Dr. Sonja Blum: There’s a long standing line of research that links exercise and the health of the hippocampus, which is a brain structure core to our memory. The hippocampus is a rare place in the brain where we actually get new neurons that are born, it’s called neurogenesis. And so exercise supports that process as well through excretion of certain hormones in the brain.

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

A recent study projected that dementia cases will double by 2060. With the risk of dementia on the rise, what are some things we can do to protect our brain health? This week we’re joined by Dr. Sonja Blum, the Director of Memory Disorders and cognitive neurology at NewYork-Presbyterian and Weill Cornell Medicine.

Dr. Blum shares some lifestyle tips that help build a strong foundation for brain health starting at a young age. She also discusses the science behind why habits like eating healthy, exercise, and a good night’s sleep can benefit your brain.

Courtney: Dr. Blum, thank you so much for joining us today.

Dr. Sonja Blum: Well thanks for the invitation.

Courtney: So Dr. Blum, I think brain health is a big concern for so many of us as we age. And I’d love to talk to you about what we can control when it comes to brain health. What are some key lifestyle factors we can all take to protect our brains?

Dr. Sonja Blum: Absolutely. There are some key concepts. So for example, in terms of the diet, we know that combination of Mediterranean and DASH diets, what we call the mind diet, which potentially reduces the risk of dementia and Alzheimer’s. This type of diet focuses on plant-based foods and limiting processed foods. The diet emphasizes consumption of leafy green vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, all those good things. A lot of those really overlap with Mediterranean diet as well.

So, there’s been a lot of back and forth on alcohol consumption. For a long time in the context of how the Mediterranean diet was conceptualized, a little bit of wine, in particular red wine, is considered good and protective. However, the more we know about alcohol, there are a lot of questions. It seems like the increase in cancer risk and recent studies have shown that any consumption of alcohol increases cancer risks, at least a little bit.

So at the very least, we say no more than very minimal alcohol consumption and really minimizing processed foods and artificial sweeteners and colors and flavors.

Courtney: What about exercise?

Dr. Sonja Blum: For exercise there are specific guidelines considered optimal for brain health. Everything can be done with modifications, depending on ability and health. When we talk about cardiovascular exercise, the intention is not to imply that everybody will be running 5Ks and jogging in the park, which is not realistic for everybody.

But, the overall recommendation is at least three times a week, around 45 minutes. The exercise program has to be personalized, but it has to include a mix of cardiovascular and strength training. The cardiovascular is called zone two training. It’s a great way to build aerobic endurance and increase brain blood flow. It benefits both the heart and the brain. The goal is to achieve about 70% of your maximum heart rate for about 45 minutes. This can be done through jogging, using a stationary bike, or a treadmill.

For those who have issues with arthritis in the knees, even chair exercise or just using the upper body or even rowing machine to really get the heart pumping.

Courtney: Is there any way to briefly describe the science behind this, like feeding our brain or why exercise is helping our brain?

Dr. Sonja Blum: So we know that exercise is linked to preservation and optimization of our heart health and our blood vessels. This is really important because when we have issues with our blood vessels in our heart, it can translate into silent strokes or other blood flow related issues that injure the brain over time. Having that blood flow adequately going through the brain tissues is clearance as with any other organs – getting the nutrients and the oxygen into all of the branches of the circulatory system.

We wanna get that blood flow everywhere and to have good nutrition delivered to all the tissues, and to have that clearance of material that needs to be recycled.

There’s a long standing line of research that links exercise and the health of the hippocampus, which is a brain structure core to our memory. The hippocampus is a rare place in the brain where we actually get new neurons that are born, it’s called neurogenesis. And so exercise supports that process as well through excretion of certain hormones in the brain. We really love exercise for the brain. It helps in preservation of good brain health.

Courtney: I appreciate this description. That’s very motivating to go for a run. I imagine mental health might have to do with brain health, too? So could we talk about the role of social engagement when it comes to brain health?

Dr. Sonja Blum: Yes. Neurogenesis and – and the health of the hippocampus is also, it’s not just exercise, but it’s what we call an enriched environment. And that really takes many forms. And as a human, socialization is a big part of that enriched environment, meaning that you are exposed to conversations, people, ideas, communication, having to speak, having to listen, having to coordinate that social structure. It helps the brain do work that keeps it alive and awake. The brain continuously needs to, sort of, process in order to stay vibrant. This includes social interaction.

Mental health and depression, anxiety. When these issues become significant, it can have a real impact on brain function and on memory, attention, and a lot of other cognitive functions. It’s important to have treatment for anxiety and depression. If it goes untreated, it can affect cognitive function, brain health in various ways.

And, it can affect sleep. Sleep is such a core part of brain health. There is this process of clearing metabolic waste that also happens during sleep. In depression and anxiety, sleep can be disrupted, and that can over time play a negative cumulative role in brain health.

Most people really do need somewhere between seven to nine hours. And that’s optimal. We really want to make sure that folks know that. A lot of stabilizing, strengthening, and integration of memory actually happens during different stages of sleep. The brain sort of quote unquote washes itself. So there is this process of clearing metabolic waste that happens during sleep.

Courtney: So sleep is really restorative for the brain. What about something like meditation?

Dr. Sonja Blum: Absolutely. And I’m glad you’re asking this question because we’re learning more about meditation. First of all, we know that meditation is excellent in terms of modifying our stress and anxiety. But also there’s been recent evidence that regular meditation is associated with slightly increased cortical thickness. We are big fans of meditation and recommend mindfulness and meditation as an integral part of brain healthy lives.

Courtney: That is so great to hear about mindfulness and meditation. I didn’t know that there was evidence backing that up. So what about other things we hear about, like brain boosters, like crossword puzzles and games? Are they effective for our brain health?

Dr. Sonja Blum: One of the interesting things about games and puzzles – there’s been a huge interest for many years in finding some game, or gaming application, that’s going to really be this amazing exercise tool for the brain. But what we found over and over again in various games is that, even if it’s exercising your memory or your attention, you actually get better and better at the game. However, it doesn’t seem to translate to a real world task in that domain of cognition. So if you got really good at this video game that is training your memory and then do a real life memory task that doesn’t seem to translate very well.

There is evidence that crossword puzzles or Sudoku, these things can contribute to, you know, so we recommend that as, kind of, a part of that. That’s okay, but it’s also not this silver bullet.

What we really find is that, you know, a life that retains complexity – that can be personalized, and individualized. Being mindful of one’s interests and staying motivated to remain engaged in physical activity that is interesting or at least palatable to you to meet those basic goals and then, you know, maintaining social connection, maintaining cognitive interest. And yes, you can throw in some Sudoku and crossword puzzles but you also want to be doing a number of different things that address the different domains of function that keep the brain going.

You wanna be doing things that are interesting to you and maintaining those interests whether it’s trying to learn some words of a new language or history class or doing a book club.

Courtney: These are great takeaways. I also love how you put that, “a life that retains complexity.”

Dr. Sonja Blum: Yes. And I think, sometimes in my work with patients, people read something or hear something and then have this take away message that, “oh, I have to do that thing.” And it’s not quite the case. You do not have to do Sudoku if you don’t like to do it, but it’s really about retaining that complexity.

Courtney: So, May is Women’s Health Awareness Month. Are women more at risk for brain diseases like dementia?

Dr. Sonja Blum: Unfortunately, yes, we do know that, for Alzheimer’s disease, the ratio is two to one. Women are much more likely to get Alzheimer’s disease than men. So for every two women to one man.

Traditionally, we have mostly studied men, in terms of cognitive aging and Alzheimer’s disease. Most of the clinical research and studies have recruited male participants. There’s been a big push in recent years to understand women’s cognitive aging and to better understand why women are more affected by Alzheimer’s disease. One of the ways this is looked at is through efforts to better understand the menopause transition, which is thought of as a potential period of vulnerability.

Research is currently undergoing here and across the world, to understand better if there are specific points of vulnerability that we could potentially intervene upon, to minimize the risk that women have.

Courtney: How often should people get their brain checked? Are there tests or assessments that might go into a visit like this?

Dr. Sonja Blum: At the memory clinic, we typically see individuals who already have symptoms. For presymptomatic individuals, so those who have normal function of memory or not feeling that anything is wrong – there aren’t recommendations for screening tests.

However, in the near future, this will probably change. We have better and better biomarkers of future risk of developing Alzheimer’s disease and related disorders. Currently, there is a lot of research underway to better predict who is on the path to develop Alzheimer’s and related diseases prior to actually developing symptoms.

And there’s also research on the way to investigate treatments that could be implemented preemptively. Currently, we’re still not there, so there isn’t a recommendation to do routine tests or screenings. But this will change in the near future as we learn more.

Courtney: Thank you so much for joining us today, Dr. Blum. I really appreciate all your tips on how we can keep our brains healthy.

Dr. Sonja Blum: You’re very welcome. Thank you for having me.

Courtney: Our many thanks to Dr. Sonja Blum. I’m Courtney Allison.

Health Matters is a production of NewYork-Presbyterian.

The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Blum’s work with patients, check out the show notes!

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