Introduction

In part 1 of this article, we talked about how important it is to address high blood pressure, eat an anti-inflammatory diet with lots of plant based, whole, unprocessed foods, get regular exercise, protect your hearing, pursue lifelong learning, practice intermittent fasting, and choose lower temperature cooking methods when preparing meals. These are all good ways to keep your brain healthy.

Research Studies

Promising research findings have emerged in recent years. Here are some examples.

• When older adults have done regular moderate aerobic exercise for six months, their hippocampus has gotten measurably bigger. 
• In what is known as the MIND Diet Study, participants ate a diet that is a combination of the Mediterranean and DASH diet. It included eating leafy greens such as kale, spinach, and lettuce each day, plus at least one other vegetable, 5 servings of nuts per week, berries (blueberries, strawberries, raspberries, and blackberries), 3 servings of whole grains per day, extra virgin olive oil as the primary cooking oil, poultry twice a week, legumes in at least 4 meals per week, and fatty fish at least once a week. Things that were limited in the MIND diet were red meat, butter/margarine, cheese, pastries and sweets, and fried and fast foods. After 12 years of follow-up, the people who most closely adhered to the MIND diet had a more than 50% reduction in any measurable cognitive impairment. (I would recommend eating more vegetables than participants in this study did.)
• Thirty retired NFL football players who had brain damage and cognitive impairment were entered into a six-month intervention trial that involved weight loss, a high dose of fish oil, a high potency multivitamin, and a brain enhancement supplement. They improved significantly after a six-month period, a sign that even when someone has suffered cognitive decline, there may be hope for improvement.

Aim for a “Low Normal” Hemoglobin A1c

Both diabetes and impaired glucose tolerance (prediabetes) are associated with a significantly increased risk of dementia. I think people sometimes mistakenly get the message that they are not really at risk until they have diabetes itself, which just isn’t the case.

There tends to be some small shrinkage of our brain over the years, even in healthy people. The Hemoglobin A1c (HbA1c) test is commonly done to screen for diabetes. It is a measure of glycated hemoglobin, that is sugar stuck onto your hemoglobin molecule. 

When it comes to minimizing annual loss of brain volume, people with a “low normal” HbA1c do better than those with a “high normal” value, and significantly better than those with prediabetes. It is probably best for our brain to be in that low normal range for our HbA1c.

Steps you can take to lower your HbA1c include choosing low glycemic index/low glycemic load carbohydrates, eating more fibre, weight loss, getting 7–9 hours of sleep per night, lowering chronic stress, practicing intermittent fasting, quitting smoking, and getting exercise. (Anyone with diabetes should not make changes to their diet without working beside their health care provider, so as not to end up with hypoglycemia or low blood glucose.)

Reduce Chronic Stress

None of us are going to lead a life free of stress. The kind of stress I am really worried about is chronic stress. People who are in this situation will be generating a lot of cortisol, which is a stress-related hormone. We know that chronic stress and high levels of cortisol are very bad for your brain. Stress can actually lead to brain shrinkage, or atrophy, and it can directly impact your cognitive functioning.
Something we can all do to lower stress is a daily mind-body practice such as meditation, yoga, breath work, self-hypnosis, or guided imagery. And if your personal circumstances are causing you chronic stress, seeing a good counsellor would be a wise idea.

Lose Weight 

We know from a Lancet Commission study and many other studies that obesity is a risk factor for dementia. Losing weight is not as simple as eating less and walking more. To lose weight it is important to really stay away from processed carbohydrates, reduce chronic stress, build a robust microbiome, and reduce exposure to environmental chemicals. Environmental toxins are actually considered to be obesogens, something that unfortunately is not getting any attention, but is a real risk factor.

Supplements

I recommend a good quality, balanced multivitamin/ multimineral. Why? Because you want to ensure you are getting enough vitamin D, B12, iodine, all the B vitamins, etc. Also, if your diet is low in omega-3 fatty acids, consider taking a good quality, high potency fish oil supplement. High potency means at least 600mg EPA + DHA per capsule. Look for a fish oil that has a five-star rating on this website:  https://certifications.nutrasource.ca/certified-products.

What About Labs?

If you are going to ask your family physician to do a few labs related to brain health, here are the ones I would recommend.

HbA1C (Hemoglobin A1c):
Is it in the sweet spot for brain health? (i.e. in the low normal range)

Vitamin B12:
People over the age of 65 are at higher risk of vitamin B12 deficiency. B12 deficiency can start to mimic having some cognitive decline, so we want to be certain that we have a good level of B12 that is in an optimum range of at least 400 pmol/L.

Thyroid Function:
Be sure your thyroid is functioning OK.

High Sensitivity C-reactive protein:
This is a marker of inflammation. Ideally it should be less than one.

Conclusion 

I think it is clear that, yes, we can absolutely reduce the risk of dementia, and there really should be, in my view, more public health messages around this.

Can the brain repair itself? Yes, at least partially.
When should we start? As soon as possible!

The material in this article was prepared by Dr. Louise Gagné. Louise practiced medicine in Saskatoon for over 35 years and completed a Fellowship in Integrative Medicine at the University of Arizona with Dr. Andrew Weil. She taught nutrition and integrative medicine at the University of Saskatchewan for 15 years. This article was sourced from both her spoken and written words in a presentation she made at the University of Saskatchewan. Dr. Gagné passed away in 2023, but her exceptional knowledge continues to be shared. To access part one of this article, please go here in the May/June 2025 issue.