True confession: I’m mildly terrified of getting Alzheimer’s disease. My maternal grandmother was diagnosed at a relatively young age. Just a girl at the time, I found it profoundly disturbing to watch “LaLa”, as we called her, shrivel into the shell of her former self. With a genetic predisposition for the disease, I worried that the die was cast and there was little I could do to alter the course. Last fall, however, I began to feel differently after hearing brain health expert, Dr. Annie Fenn, speak on the relationship between diet and Alzheimer’s disease.

Annie and I were both teaching at Rancho La Puerta at the time, a wellness retreat in Tecate, Mexico. She’s a sprite of a human with a big smile and an enormous passion for using food and cooking as a gateway to better health. Based on a growing body of research, Annie explained that what we put on our plates has real potential to prevent or delay cognitive decline. Below is the first in a two-part interview with Annie. It’s longer than my typical posts, but it’s important stuff. I hope you find it as riveting as I do.

Annie Fenn diet for alzheimer's disease

Can you talk a little bit about how you came to start the Brain Health Kitchen and what you do there.

After practicing ob/gyn medicine for over 20 years, I decided to retire to spend more time with my family and pursue other interests. I went back to school — this time culinary school — and started teaching cooking classes in my community to help people eat better. I kept up with my medical journals and became fascinated by the emerging link between diet and Alzheimer’s disease. Around the same time the MIND diet study was published in 2015, my mother was diagnosed with MCI, or mild cognitive impairment. At this point, it was becoming clear to me that food had a huge impact on whether or not we get Alzheimer’s later. I decided to focus my writing and teach exclusively on Alzheimer’s prevention.

It was at that point that I created the Brain Health Kitchen Cooking School and online community in 2017 to help people eat the foods known to fend off Alzheimer’s. I partner with a cognitive health specialist in my community to give Brain Works Boot Camps, week-long dementia prevention class that includes cooking classes, brain training, lectures, stress reduction and mind/body exercises. I travel all over the U.S. and abroad to teach cooking classes and raise awareness about Alzheimer’s. In Jackson Hole, where I live, I give private classes to individuals and groups.

When we talk about dementia, most of us think about people in their 70s and 80s. Is thinking about brain health relevant when you’re younger?

Yes! We used to think Alzheimer’s disease and dementia just happened to people when they got old. Now we know that Alzheimer’s is a process that happens over decades. Amyloid protein, a key pathological feature of Alzheimer’s, starts accumulating in early mid-life. This means we need to take care of our brains starting in our 30’s and 40’s to avoid getting Alzheimer’s twenty years down the road.

I’ve heard women are more likely to get Alzheimer’s than men. Why is that?

It’s true. Two-thirds of all Alzheimer’s victims are female and it’s not just because women live longer than men. No one really knows why women are more vulnerable. We do know that women get diagnosed in later stages than men, so sometimes miss out on early interventions. One theory is that women have different (ahem, higher level) verbal skills than men, so they perform better on screening tests. Physicians are starting to develop different cognitive tests for women.

We have also just learned that pregnancy may protect against Alzheimer’s. The more months a woman is pregnant in her lifetime, the less likely she is to get Alzheimer’s. This means even early pregnancy losses may contribute to protecting women’s brains. Why? No one knows just yet, but the relationship between hormones, menopause and Alzheimer’s is starting to get serious attention. We know from brain MRIs that women’s brains become vulnerable to the onset of Alzheimer’s around the time of menopause. In fact, perimenopause, the time period leading up to menopause, may be an important window of time for women to make changes that will protect their brains for life.

We know sleep is an incredibly important factor throughout life to protect the brain from Alzheimer’s. Some postulate that women don’t get enough sleep at key times in their lives — when raising small children, going through menopause, and while pregnant.

Or maybe we are all just multi-tasking too much? Short term memory is definitely impaired when we do multiple things at once. No one knows if this also impacts our Alzheimer’s risk.

Similarly, is diet and cognition relevant for our kids?

Absolutely. As the science of nutrition and brain health explodes, we are also discovering that food choices are critical for kids and young adults too. Poor food choices are linked to anxiety, depression and ADHD. Adolescents are suffering from anxiety and depression more than ever before, and a poor diet may be part of the reason. In fact, following a Mediterranean diet was found to be an effective adjunct to therapy for clinical depression in this age group.

How much of an impact can diet have to promote brain health?

No one really knows if we can “prevent” Alzheimer’s. But we do know that a certain diet can delay the onset of the disease by many years. If we can put off getting Alzheimer’s for 5 to 10 years, say by pushing it off to age 90 instead of 80, we have basically prevented it. Nutrition is just one aspect of fending off Alzheimer’s. Ideally a brain healthy lifestyle also includes getting enough of the right types of exercise; good quality and quantity sleep; building up cognitive reserve; and reducing stress. There is now good data that all of these things are important to keep the brain healthy throughout our lifespan. We want our brainspan — the number of years our brain is functioning at a high level — to match our lifespan. That’s the goal.

Based on the research, what foods should we be eating on a regular basis for brain health?

The MIND diet study that came out in 2015 describes 10 brain healthy food groups and 5 brain unhealthy ones. MIND, which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay, is a spin-off of the Mediterranean diet made more specific for brain health.Researchers found that following the MIND diet for 4.5 years yielded an Alzheimer’s risk reduction of 53%. Also, those that followed the MIND diet less rigorously, about half the time, still had a risk reduction of 37%. These findings make sense given the large body of data that says eating a Mediterranean diet leads to a longer, dementia-free life.

When I teach Brain Health Kitchen cooking classes, I emphasize eating from 10 brain healthy food groups:

Berries

Nuts

Leafy Greens

Fish

Chicken

Vegetables

Beans

Whole Grains

Olive Oil

Red Wine (yes, red wine is a brain healthy food group!)

But this should be qualified by saying small amounts of red wine, enjoyed with food and in the company of others. The MIND diet specifies 5 ounces of red wine daily as contributing to brain health. That’s a small glass of wine! Those who drink small amounts daily have less Alzheimer’s risk than those who drink more or not at all.

What’s Special About These Foods?

Alzheimer’s disease is an inflammatory disease caused by many different pathways. We still don’t know the exact cause, or the most dominant pathways, but inflammation is the core process that leads to nerve cell death, brain shrinkage and ultimately Alzheimer’s. These foods are anti-inflammatory, nutrient dense, fairly low in saturated fats, and packed with antioxidants known to combat brain aging.

All these foods are low on the glycemic index, too. That means they are low in sugar, high in fiber, and won’t spike blood glucose and insulin levels. Some experts think Alzheimer’s results from chronically elevated glucose and insulin levels. Diabetics, for example, are at increased risk of Alzheimer’s. A recent study showed that even those with mildly elevated fasting blood sugar, one that is considered pre-diabetic, have double the risk of getting Alzheimer’s.

Certain nuts are high in monounsaturated fatty acids and the whole food form of vitamin E, all crucial for brain health. That’s why my cooking classes teach people how to swap out dairy products (which are thought to be inflammatory to the brain) for nut milks, creams and cheeses. We bake with nut flours, such as almond and hazelnut flours, instead of processed white flour, which is pretty much robbed of all its nutrition.

Olive oil is also an important part of the brain healthy diet. It is the only oil recommended in both the MIND diet and the Mediterranean diet. Not only does high quality olive oil contain mostly mono- and polyunsaturated fats, it is high in polyphenols, potent antioxidants that help combat brain aging. It also provides a conduit to absorb the fat-soluble vitamins A, D, E and K, all of which are important for brain health. I use extra virgin olive oil for almost everything I cook, including baked goods. For high heat cooking, I use avocado oil.

Berries are its own food group in the MIND diet study and the only fruit recommended. High in fiber, low in sugar, berries are packed with anthocyanins — the pigment that makes them blue, black, or red. Anthocyanins help scrub the brain of amyloid protein.

It’s important to eat a wide variety of colorful vegetables. Nutritionists like you have been telling us for years to “eat the rainbow.” This is important for brain health because plant pigments — the molecules that give veggies all their vibrant colors — are specific antioxidants that help prevent amyloid plaque for building up in the brain. So we want to eat a large variety of plants to have all of these antioxidants working for us. 

Fish is a complicated one — eat too much and the wrong types and we can increase our exposure to toxins such as mercury, known to be bad for the brain. But fatty fish are so good for the brain because they provide lean protein and omega-3 fatty acids, especially in the form our bodies cannot produce. All the SMASH fish are a good bet:

Salmon (wild-caught)

Mackerel

Anchovies

Sardines

Herring.

In my classes, I am always sneaking anchovies into sauces and soups, converting anchovy-avoiders into anchovy-lovers.

Stayed tuned for Part Two of this interview, which will cover the foods to minimize in your diet, how to connect with Annie and her work, and a few of her favorite brain-healthy recipes. Stay tuned for that next week.