In the past decade it has become well recognized that the millions of bacteria in the gut, collectively known as the microbiome, can influence the health of the brain, lung, heart, metabolism and the immune system. Thousands of studies have been conducted since the term was first introduced in 2001, with research shifting from an early focus on cataloging microorganisms in the human microbiome to pathogen identification and now to understanding their functional roles and how they interact with the host. Following are some of the key learnings to date, including a conversation with a leading microbiome researcher on behalf of our Well Read Patient readers. Please keep in mind that microbiome research is still in its infancy, and probiotic/prebiotic treatments are not the standard of care at this time.
What exactly is the microbiome?
Scientists define it as the sum of the microorganisms (bacteria, viruses, fungi, etc. that live in the body in healthy conditions), their genetic information, and their ecological niches. The microbiome is spread across different organs and tissues of the human body, but the most important and best studied is the gut microbiome. Studies show that under normal conditions, formation of the adult gut microbiome occurs over the first 3 years of life and is affected by events such as birth method, cessation of breastfeeding and starting solid food. Over time, it is thought that diet, drugs, age, smoking, exercise and host genetics affect the composition of the gut microbiome, and that some of these changes may contribute to metabolic, neurological, and immune disorders.
A high fiber, low animal fat diet may have beneficial effects on the gut microbiome. With this in mind, the principle of “You are what you eat” is further clarified as “You are what your gut microbes do with what you eat,” according to the European Society of Neurogastroenterology & Motility. This is precisely the area that has long fascinated Christopher Damman, MD, a gastroenterologist who has studied the microbiome’s role in health and disease for the past two decades.
“While there are many ways to consider the role microbes play in our health, most essentially they activate or transform components of food that the body can’t process by itself,” he explains. “The microbiome converts polyphenol, the colorful compounds that occur naturally in plants, and fiber, a carbohydrate prebiotic that resists host digestion, to metabolites, which are molecular byproducts of digestion. These in turn influence the mitochondria, our cells’ metabolic powerhouses, that generate most of the energy needed for the cell to function.”
Metabolites also underly the gut’s natural production of hormones GLP and GLP-1, best known for its use in weight loss and type 2 diabetes drugs like Wegovy and Ozempic. Together, with another lower gut hormone called PYY, they help coordinate the body’s response to food by regulating appetite and blood sugar.
The traditional focus has been on therapeutic use of live microbes to repopulate the gut; for some, however, says Dr. Damman, there may be more power in postbiotics. “It can be very difficult to repopulate the microbiome of individuals whose guts may resemble a bleached coral reef as opposed to a vibrant aquarium, by just increasing intake of prebiotics through whole foods. The next best approach may be to therapeutically provide the metabolites naturally produced by a healthy gut microbiome,” he says.
While the gut responds to everything in your environment, from exercise to stress levels, food appears to be disproportionately important, asserts Dr. Damman. “The key to fostering a healthy microbiome may focus on four nutrients: fiber, phenols, bioactive fats, and ferments.” To that end, he has created a tool to help guide people to microbiome-friendly choices by assigning a Nutrient Consume Score (NCS) from one to 100 for a wide range of foods. Based on an algorithm that promotes increased fiber, phytonutrients, bioactive fats and potassium, and decreased amounts of simple carbs, additives, saturated fats and sodium, NCS is available as a prototype online at Dr. Damman’s website gutbites.org. An app is in development that will enable easier use, such as scanning UPC codes at the grocery store. “I believe this is the first microbiome-focused nutrient calculator, and my intent is to have it validated scientifically and clinically before a beta release, possibly by early next year,” he says.
The takeaway from all this is deceptively simple. “We have gone on these really interesting, complex journeys intellectually, but at the end of the day, we return to our original understanding of healthy eating,” muses Dr. Damman. “As Michael Pollan (influential best-selling author and fellow at the Radcliffe Institute for Advanced Study at Harvard) says, eating mostly plant-based food, and not too much, is the way to go. All the research on the microbiome, metabolites, mitochondria, bioactives, etc. points in screaming ways right back at something we’ve known all along. We’ve evolved over centuries in concert with our microbiome and healthy whole foods that naturally regulate our appetites.”
In terms of preventing obesity, diabetes and metabolic disease, Dr. Damman maintains: “There’s no substitute for a healthy diet complemented by mindfulness, movement, and adequate sleep.”
New Tools, New Strategies for Gut Microbioma Therapy
Initially, gut microbiome therapies ranged from probiotics and prebiotics to fermented foods and fecal transplants.
But these are still early days, and new approaches are continually under the microscope, including:
According to research from Nature Aging, in healthy individuals the microbiome can continue to change after age 50, in contrast with a static microbiome composition seen in people who are less healthy and die earlier. Of particular note is the finding that each person’s microbiome becomes more distinct as they age, emphasizing the ineffectiveness of a ‘one size fits all’ approach and influencing the need for personalized health therapies.
Mayo Clinic’s recently announced Gut Microbiome Wellness Index 2, a tool designed for healthcare practitioners to identify adverse changes in their patients’ gut health before serious symptoms arise. By screening a gut microbiome sample, the tool can predict with 80% accuracy or greater whether a person’s gut is healthy or trending toward a diseased state. The ability to detect shifts in gut health was tested in various clinical scenarios, including people who had undergone fecal microbiota transplantation, or had made changes in dietary fiber intake, or who had antibiotic exposure. Additional testing is in progress.
New technologies that allow physicians to more easily examine the small intestine and upper part of the colon are sure to shine a bright light on these often neglected areas of microbiome research, according to Dr. Damman. Most exciting is the recent launch of swallowable devices with compartments that open up when certain acidity levels are reached to sample the small intestine. “This could be a real breakthrough for exploring how to best help those with small intestinal bacterial overgrowth (SIBO), Crohn’s, irritable bowel syndrome (IBS) and other conditions who frequently experience significant gastrointestinal symptoms from macro nutrient-rich diets.” Future possibilities may include partnering small intestine bacteria with their preferred prebiotics and personalized combinations of prebiotics.
Is there a way to eat that not only reduces the risk of disease and promotes well-being, but is also sustainable? Could a certain diet provide enough food for the 9.8 billion people estimated to be living on earth by 2050? This was the challenge first taken on in 2019 by the EAT-Lancet Commission, comprised of top scientists from around the globe.
Combining analysis of more than 30 years of the best available nutritional studies and randomized trials with planetary boundaries for key environmental systems and processes, in 2023, the Commission found it to be “an achievable reality that would improve the health and well-being of billions and allow us to pass on to our children a viable planet.” However, cautions Walter Willett, MD, professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health and Commission co-chair: “It won’t be easy and will take the engagement of almost everyone.”
Implementing and Following the Planetary Health Diet
The basics of the Planetary Health Diet include:
No more than one serving of protein, like poultry, fish, red meat or eggs, and one serving of dairy per day. Focus on fruits and vegetables (at least five servings daily), nuts, legumes (dry beans, lentils and peas), whole grains and plant oils. “We emphasize plant-based protein sources to help prevent major health issues such as diabetes, cardiovascular disease, cancer and dementia,” explains Willett. “We also explored if there is a certain amount of red meat, for example, that that could be consumed while still remaining at low risk for disease. One serving a week (about 14 grams daily) met our criteria, but increasing to two servings weekly made a significant, and unacceptable, increase in the risk for type 2 diabetes.”
Nutrient-dense items such as nuts and legumes are also emphasized to ensure food production and consumption practices will not exceed the earth’s ecological limits. Foods sourced from animals have a relatively high environmental footprint per serving compared to other food groups which impacts greenhouse gas emissions, land use and biodiversity loss, according to the Commission.
Among major protein sources, lentils are considered the healthiest, with the highest ratio of polyunsaturated fat to saturated fat, followed by tofu, almonds and salmon.
Less healthy foods to avoid include red meat, eggs, dairy, refined grains and sugar-sweetened beverages.
Variety Through a Flexible Diet
“It really comes down to a flexitarian diet. There’s incredible variety in the ways you can put it together and keep animal sources of protein to a minimum,” says Willett. His only asterisk: “Lower vitamin B12 levels can occur when less than two servings of animal protein is consumed daily, with serious health consequences.” He recommends getting adequate amounts of the vitamin through either supplements or fortified foods.
Only a few parts of the world currently meet scientific targets for the planetary health diet, and the U.S. in particular will need to significantly decrease consumption of animal proteins. “Higher intakes of vegetables, fruits, legumes, and especially nuts and whole grains would be desirable for almost every country, preventing about 11 million deaths per year,” says Willett. “It is not a question of all or nothing, but gradually making small changes for a large and positive impact.”
The Planetary Health Diet is symbolically represented by half a plate of fruits and vegetables, and the other primarily of whole grains, plant proteins, unsaturated plant oils, modest amounts of meat and dairy, and some added sugars and starchy vegetables.
Rooting for Vegetables
Bring the benefits of plant-forward eating to your table with seasonal root vegetables this winter. These veggies are high in vitamins and nutrients, and low in calories. Many root vegetables listed below may have anti-inflammatory, antioxidant and cholesterol lowering properties as well. Enjoy these versatile veggies:
Allium Bulbs (onions, shallots, garlic). Roast or caramelize for pizza garnishes, bread toppings and quesadilla fillings.
Avocados. At their creamy best for use in wraps, salads, and dips, including guacamole.
Belgian Endive. Chop for salads; braise whole or brush with a vinaigrette and grill for side dish.
Beets. Grate to sprinkle in salads or on sandwiches; sautee or roast with garlic and olive oil for side dish.
Broccoli/Broccoli Rabe/Broccolini. Use in pasta dishes and winter salads; puree for soup.
Brussels Sprouts. Roast for optimal flavor and serve as appetizer, side dish, even a pizza topping.
Carrots (white, yellow, purple, red and orange varieties). Eat raw with yogurt-based dip; steam, boil or roast for side dish.
Celeriac (celery root). Sub for potatoes in soups and stews; blend for creamy sauce; grate into salad.
Chayote. Add to salads; use as soup base.
Fennel. Chop raw and freeze for use in soups and stews.
Kale, Collards, Mustard and Turnip Greens. Roast or boil until tender and dress for salad while still warm.
Parsnips. Eat raw; boil lightly; roast with carrots and potatoes.
Rutabagas. Use in place of or in addition to turnips and potatoes.
Sunchokes (Jerusalem artichokes). Serve in salads; puree as base for main course; roast with olive oil for side dish.
Sweet Potatoes. Make healthy fries by quartering, drizzling with olive oil and baking at 400 degrees for 40-60 minutes; steam chunks and mash; bake whole and unpeeled.
Turnips. Bake, boil or steam like a potato; shred for coleslaw; julienne as garnish.
Winter Squash (butternut, acorn, delicata, kambocha, spaghetti and pumpkin varieties). Steam or microwave as low-calorie alternative to pasta; roast, stir fry or puree for soups.
Stay hydrated and energized this summer by refreshing yourself with generous amounts of water, nature’s best elixir. Inspire yourself to keep reaching for another sip by infusing water with fresh fruits, vegetables and herbs…no sugar or artificial flavoring needed. Have a Plant shares how:
Wash all produce and herbs before slicing and dicing.
Start with a large glass bottle or jar with a lid, add your desired ingredients and fill with cold or room temperature water.
Refrigerate for at least one hour. For a more intense flavor, refrigerate overnight. Some fruits and herbs will infuse more quickly than others. The longer it soaks, the more the flavors are released into the water.
Foster even more concentrated flavor by muddling – the process of mashing ingredients to draw out essential oils in herbs, rinds and fruits.
Extract multiple uses from the ingredients by adding more water and letting it infuse again. Make sure to drink within one day.
Experiment with sparkling, seltzer or unsweetened coconut water as the base.
Try making infused water ice cubes for your beverages with this simple technique: Half fill each section of an ice cube tray with water; add small pieces or slices of desired fruits, vegetables to each section; fill remaining space with water and freeze.
The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered a “wear and tear” condition, associated with aging. It was thought that cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving. New research shows that it is a disease of the entire joint that also causes bony changes of the joints, deterioration of tendons and ligaments and inflammation of the synovium (lining of the joint). While more prevalent in people over 50, OA can show up in younger patients, especially those who’ve experienced a joint injury such as a torn ACL or meniscus. The promising news is that according to the Arthritis Foundation, “OA is not an inevitable aging disease” and the Cleveland Clinic notes: “Age is a contributing factor, although not all older adults develop osteoarthritis and for those who do, not all develop associated pain.”
Still, currently OA is by far the most prevalent form of arthritis, affecting more than 32.5 million Americans, and primarily targeting knees, hips, hands and spine. A variety of factors contribute to the development of OA, including congenital joint deformity, family history, previous joint injury, and years of physically demanding work or contact sports. However, reducing risk is possible with attention to these modifiable factors:
Obesity adds stress and pressure to joints. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably – losing one pound takes 3 pounds off the knees.
Lifestyle. Being physically active is crucial, as a sedentary lifestyle and obesity are associated with a higher risk of OA. While sports such as football, baseball and soccer may pose a risk because of their impact on joints, most types of regular or moderate exercise can be safely done.
Living with Osteoarthritis
Unfortunately, there is no cure for OA, and managing symptoms such as joint stiffness, tenderness, swelling, and popping or crackling can become increasingly difficult over time. While seeking a pill to alleviate discomfort is a natural reaction, consider trying alternative solutions to help break the cycle of chronic pain.
“The longer the brain processes pain, the more hypersensitive it becomes to pain,” explains Rachel Welbel, MD, a physiatrist who is extensively trained in physical medicine and rehabilitation and sports medicine. “The brain, now constantly on high alert, may respond to non-painful sensations as if they are painful. Poor diets and stress can increase chemicals in the brain that reinforce this response, prolonging the pain cycle.”
Reflecting a more holistic and multi-faceted approach to managing pain, she says: “Opioids are almost never the answer.” Instead, she recommends lifestyle modifications, treatments and medications that help tackle pain in a variety of ways.
Lifestyle Modifications, Treatments and Medications for Osteoarthritis
Weight management. Obesity is not only a leading risk factor for OA, but adds to the pain for those with the condition. Body fat produces proteins called cytokines that cause inflammation, and in the joints, can alter the function of cartilage cells. Shedding even a few pounds can make a difference: losing just 10% of your body weight can cut arthritis pain in half, and losing another 20% can reduce the pain by an additional 25% or more, and may slow or even halt progression of the disease.
Exercise and movement. “Exercise is key to living well with OA,” says Welbel. “While resting aching joints may bring temporary relief, lack of movement ultimately leads to more discomfort. The focus is not on weight loss but on minimizing pain and maximizing strength.” Plan on 150 minutes of light to moderate exercise each week. She recommends working with a physical therapist who can analyze your joint biomechanics and suggest exercises to strengthen muscles and improve range of motion while reducing stiffness and pain. “In addition, exercise is a natural mood elevator,” says Welbel. “Walk, swim, or try mindfulness-based, stress-reducing exercise such as yoga and tai chi.”
Anti-inflammatory diet. Increasing consumption of fruits, vegetables, whole grains, legumes and fish, while reducing consumption of red and processed meats, refined grains, and sugar-containing beverages and foods, may play an important role in reducing pain associated with inflammation from OA, says Welbel. Try incorporating into your diet fatty fish; herbs and spices such as garlic, turmeric and cinnamon; yogurt and other fermented foods; and healthy fats such as avocados, extra virgin olive oil and walnuts.
Supportive devices. A cane or walker can help lighten the load on your joints, decrease pain, and reduce your risk of falling. Intermittent use of a knee brace may be helpful for added stability, especially if walking on uneven surfaces. Foot orthotics such as arch supports and metatarsal pads may reduce foot pain.
Medications. Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) may help joint pain and stiffness for some. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also used to relieve pain, including OTC medications such as Advil or Aleve, or Celebrex, a prescription medication with a somewhat lower risk of ulcers and upper gastrointestinal bleeding than other NSAIDs. Topical NSAIDS such as Aspercreme and other creams or patches containing ingredients such as capsaicin, menthol or lidocaine can help.
Injections. Corticosteroids injections may provide temporary relief for acute flare-up of OA pain in knees and finger joints, but effectiveness can vary, and you must wait at least 3 to 6 months to repeat an injection in a specific joint if needed. Viscosupplementation involves injection of a gel-like substance containing hyaluronic acid, which acts as a lubricant in the fluid between bony surfaces and is decreased in OA joints. Research results for significant pain reduction or improved function are not yet convincing, but there appear to be a number of patients with mild to moderate knee OA who report symptom relief.
Supplements. Research results are mixed, but we note some of the more well-known supplements with the caution that these are not recommended to be used alone as treatments for OA. Glucosamine and chondroitin sulfate, naturally occurring compounds found in healthy cartilage, may help reduce joint pain and stiffness, and have been available in the U.S. and Europe for several decades. Other supplements such as tart cherry and turmeric may help reduce OA symptoms for some.
Other promising but not yet proven treatments. Platelet-rich plasma (PRP) injections and stem cell therapy have been used to treat pain of mild to moderate knee OA, but evidence of effectiveness is mixed, and these are still considered experimental. Elements of Eastern medicine, including herbs and acupuncture, may help control OA symptoms, but have not yet been confirmed in large clinical studies.
A Generation of Joint Replacements
When diet and exercise modifications, supportive devices, medications and injections no longer sufficiently ease the pain of OA, a hip or knee replacement may be recommended. The number of people opting for this surgery increases each year, now totaling more than 790,000 knee and 450,000 hip replacements annually.
The implants, made of plastic, metal or ceramic, are traditionally kept in place with bone cement, which is gradually being replaced by newer cementless and porous titanium systems to improve bone fixation and durability. Also on the rise is computer-assisted surgery to increase placement accuracy of the prosthetic components, and patient-specific implants using 3D printing technology. The combination of modern materials and advanced surgical techniques have extended the durability of most implants to 20 years, a marked improvement over the previous standard of 10 to 15 years.
Recovery time has also changed for the better. With rehabilitation to regain strength and motion, normal activities can usually be resumed within weeks to months. Most importantly, the majority of patients are highly satisfied with the results, reporting minimal to no pain and significantly improved function and quality of life. However, outcomes can vary and potential complications should be discussed before proceeding.
Additional breakthroughs may be on the horizon: researchers at Duke University start trials this spring of a hydrogel-based cartilage substitute that may prove more durable than natural cartilage…stay tuned!
Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.
Except for dedicated thespians, saying “break a leg” is most definitely not a harbinger of good luck. More than 10 million Americans are living with osteoporosis, a condition of low bone mass that results in increased risk of bone fracture, sometimes even from a minor fall or pressure from a big hug. Over 1.5 million osteoporotic fractures occur annually, and 1/3 of women and 1/5 of men over 50 will experience an osteoporotic bone fracture in their lifetime. The good news is that reliable diagnostic testing and treatments are available, which we share below.
Who’s at Risk for Osteoporosis?
Osteoporosis is sometimes referred to as a “silent disease” because it is painless unless a fracture occurs, so people often are unaware they have it until that happens. Post-menopausal women are at highest risk, in part due to the decline in estrogen levels. Estrogen, and to an even greater extent, testosterone, are hormones that help ward off osteoporosis, which is why it is not as common in men. Others at risk include those with autoimmune diseases such as rheumatoid arthritis and celiac disease, those with high parathyroid or thyroid levels and certain other chronic diseases.
Medications including corticosteroids, proton pump inhibitors and certain antidepressants and anti-seizure medications may increase risk of bone thinning. Inherited factors may affect risk, such as race (more common in Caucasians and Asians), body shape and size (smaller/thinner individuals more at risk) and family history of osteoporosis. Physical activity level and diet play a role, placing those who are sedentary and/or have a diet low in calcium at higher risk. Cigarette smoking and higher alcohol intake are also risk factors.
How Osteoporosis is Diagnosed
A bone density measurement test is the best way to diagnose osteoporosis, using the DEXA (dual energy x-ray absorptiometry) scan of hip and spine. The severity of decrease in bone mass is determined by your T-score: Between -1.0 and -2.5 is defined as osteopenia, when bones are weaker than normal, while -2.5 or less indicates osteoporosis.
Osteoporosis Medications
A number of medications are available to treat osteoporosis.
Bisphosphonates to slow the breakdown and removal of bone are typically tried first. Fosamax, used most, is a weekly pill often taken for 5 years followed by a “drug holiday.” The IV bisphosphonate Reclast is generally continued for three years.
Evista is a daily pill for post-menopausal osteoporosis that protects against bone loss and also reduces the risk of breast cancer in high-risk women.
Prolia is injected every 6 months to slow breakdown and removal of bone and help increase bone density. It should not be discontinued once started or must be followed by another medication if stopped.
Evenity is injected once a month for a year to increase new bone and reduce breakdown and removal of bone.
Forteo and Tymlos are drugs that help build bone for people at high risk of fracture. These are injected daily for two years.
Managing Osteoporosis
Peak bone mass is achieved by age 25-30 years, but at any age, a healthy lifestyle can aid in strengthening bones. Focus on eating a balanced diet rich in vitamin D and calcium (see sidebar), and remember that exposing the body to natural sunlight increases production of vitamin D. Eliminating tobacco use and limiting alcohol is strongly recommended to promote maximum absorption of calcium and vitamin D. Taking fall prevention measures is crucial: consider that 95% of hip fractures are caused by falls.
Aim for 30 minutes of weight-bearing and muscle strengthening exercises on most days:
Walk or run on level ground or a treadmill
Dance
Climb stairs
Lift weights without straining your back
Sit-to-stand exercises: start with an elevated seat height, and progress to a lower chair as you get stronger
Strengthen thighs: stand against a wall and slide down into a slight knee bend, hold for 10 seconds and repeat a few times
Tai Chi: combines slow movements, breathing exercises, and meditation
Nourishment Know-How for Bone Health
For optimal bone health, a daily intake of 1200-1500 mg of calcium and 400-800 IU (international units) of Vitamin D is recommended for adults. In many cases, supplementation may be appropriate.
Selected sources with calcium and/or Vitamin D:
Dairy products
Calcium- and vitamin D-fortified foods and beverages (soy or almond milks, cereals, cheese)
Dark green, leafy vegetables
Fish such as salmon, trout, mackerel, tuna, sardines
Egg yolks
Sesame or chia seeds, figs, almonds
Fall Prevention Measures for Those with Osteoporosis Include:
Avoid ladders, step-stools and roof work
Eliminate tripping hazards like throw rugs, obstacles or cords on the floor
Be careful around pets and leashes
Use good lighting, night lights, update glasses and eye care to optimize vision
Stay fit with regular strengthening and balance exercises
Wear non-slip shoes
Install handrails and grab bars in the bathroom
Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.
Harkening back to ancient civilizations, the concept of food as medicine represents one of today’s most cutting-edge approaches to prevention and disease management. Inspired by the intricate connection of mind and body wellness, a small, special group of diets have made their way into the mainstream offering benefits far beyond short-term weight loss. Among them are DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium and magnesium; the Mediterranean diet for heart health, emphasizing fish, fruits, and vegetables, with olive oil as the main source of fat; and combining both, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which shows real promise in helping its adherents preserve cognition and reduce the risk of dementia.
Launched in 2015 by researchers at Rush University Medical Center, the MIND diet encourages selecting foods from categories that include leafy greens and vegetables, legumes, fish and seafood, poultry, nuts and berries, while limiting high fat, high sugar and processed foods. Longitudinal observational studies showed the rewards of shifting to this healthier way of eating, with a 53% reduction in the risk of dementia for seniors who rigorously followed the diet, and somewhat surprisingly, a 35% risk reduction even for those who followed it only moderately well.
“This is my favorite feature,” says Jennifer Ventrelle, MS, RD, lead dietitian for the MIND Diet Intervention to Prevent Alzheimer’s Disease at Rush, “you don’t have to be perfect! It’s not necessary to eat from every preferred category to achieve your goals.”
Although it’s not intended as a reducing diet, Ventrelle says people who follow it naturally lose weight by focusing on the preferred categories of foods. “It’s too difficult for many people to consider banishing all sweets or giving up red meat forever, so we haven’t eliminated these foods but allow them with limited frequency and close attention to portion sizes,” she explains.
Additional research pointed to a host of other benefits associated with eating MINDfully for older adults: slower cognitive decline and progression of Parkinsonian signs in aging, and reduced risk of functional disability, depressive symptoms, metabolic syndrome, cardiovascular disease and all-cause mortality. “The literature continues to grow, with new studies that point to the key role diet plays in preventing cognitive decline,” says Puja Agarwal, PhD, nutritional epidemiologist and assistant professor of internal medicine at Rush.
But it is the gold-standard randomized controlled trial begun several years ago by Rush and Harvard School of Public Health that may ultimately establish a causal relationship between diet and dementia. More than 600 participants at higher risk for Alzheimer’s disease – overweight, suboptimal diets and a history of dementia in the family – were enrolled in the study designed to directly measure whether following the MIND diet versus a low-fat diet can prevent neurodegenerative ills – results are expected by the end of 2022. According to Agarwal, who is fully aware of its significance at a time when more than 6 million people in the U.S. are living with Alzheimer’s disease, a number expected to double in the coming decades. “We don’t have a cure for these diseases, so prevention strategies are essential. We’re hoping for intervention trial results for the effect of MIND diet in protecting the brain to further establish the role of diet in healthy aging.”
What a day of meals on the MIND diet might include*:
BREAKFAST Greek Yogurt Parfait: ½ cup whole grain, high fiber cereal, ½ cup berries, ½ cup low-fat Greek yogurt, 2 tbsps (raw, unsalted) walnuts, almonds or pecans.
LUNCH Whole Wheat Turkey Wrap: 1 tortilla wrap + 3-5 oz turkey breast lunchmeat or carved white meat + 1 slice reduced fat cheese + lettuce, tomato and veggies of choice.
3-Bean Salad: Mixture of kidney beans, black beans, chickpeas, red onions + 1 tbsp extra-virgin olive oil + 1 tsp balsamic vinegar + Italian seasoning mix such as oregano, parsley, basil, etc.
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