By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Burger buns, French fries, sodas, pizza, pasta, bagels, bread, cinnamon rolls, pancakes, waffles, scones, muffins, cake, chips, crackers, cereal, candy – a who’s who of carbohydrates, and a list of food items that dominates the daily diet for many millions. Add all that up, day-in and day-out, and you have a carbohydrate overload that experts say is bad for your brain…not to mention the rest of you.
One such messenger is nutritionally-oriented neurologist David Perlmutter, who has created waves in the health world with his bestselling book, Grain Brain. In it, he argues that the brain thrives on a fat-rich, low-carbohydrate diet, and, unfortunately, today’s proliferation of carbs is putting that equation at risk and destroying our brains.
Dr. Perlmutter, an old friend, conducted an exhaustive review of medical research and found ample evidence to incriminate excess carb intake as a brain-hostile practice. He warns that it’s not just your typical refined carbohydrates (namely, white flour) that are problematic, but so-called healthier whole grains can be as well. Based on his research and many years in clinical practice, he believes that the unprecedented dietary domination of cheap carbohydrates during the last century has led to overconsumption, and contributed to multiple problems including dementia, attention deficit hyperactivity disorder, anxiety, and depression. During this time we have gone from a high-fat, low carb diet to a low-fat, high carb diet.
We Have Become a Society of Carboholics!
As Dr. Perlmutter says, we need to go beyond thinking of diet as more than just how food affects the tightness of our pants. “Diets impact the functioning of our entire body…including our brain. There’s a clear cause-and-effect relationship between the food we eat and the state of our health; it’s up to us to make smart choices and increase our consumption of those foods that will keep our bodies operating optimally.”
Grains (examples: wheat, oats, rice) are carbohydrates, and carbohydrates are broken down by the digestive system into sugar; refined grains break down quicker than whole grains. But whether refined or whole, we just eat way too many of them. And often, we wash down our carb-loaded meals with sodas, which pile on more sugar and sweeteners, further increasing the onslaught of carbohydrates. Inside the body, both above and below the neck, this high tide of sugar stokes oxidative stress that leads to inflammation and tissue damage.
When I say above and below the neck, I mean that this overload is destructive in a systemic way. When the body becomes flooded with carbohydrates, the pancreas responds by spiking its insulin production (insulin is a hormone that regulates blood sugar). Over time, the body’s cells stop responding to insulin (insulin resistance), leading to weight gain, belly fat, inflammation, diabetes, cardiovascular disease, and even to a significantly increased risk of Alzheimer’s disease. All carbohydrates activate the insulin response to varying degrees.
One of the major forms of dementia – Alzheimer’s – is connected to inflammation and sugar intake. A 2013 study from the University of Washington found that higher levels of blood sugar represent a risk factor for dementia. Additionally, according to a 2012 Mayo Clinic study, a dietary pattern with a relatively high intake of carbohydrates raises the risk of cognitive impairment or dementia in elderly persons, while a high intake of fat and protein lowers the risk.
As a subplot in the carb and grain issue is the problem of gluten, a protein found in wheat, rye, and barley, and which isn’t absorbed well in the gut. Celiac patients cannot eat gluten, but many non-celiac individuals have problems with it as well. The food industry has jumped on this theme as a major sales opportunity, and today gluten-free products are everywhere. There is no shortage of gluten-free hype – the dubious claim that gluten-free food can promote weight loss is just one example.
To be sure, some people do better without gluten. But others may have sensitivity to wheat, found not just in bread, bagels, and pasta, but in multiple processed foods as a common additive. Moreover, wheat has changed drastically in recent decades due to genetic engineering. My advice is that if you have some unexplained disorder or energy deficit, avoid gluten sources, and see if it makes a difference.
During dinner recently with Dr. Perlmutter in Florida near where he practices, one of his patients came up to the table and thanked him. “You changed my life,” the man said. “I went off flour and gluten and my mind cleared up and my energy improved.”
Dr. Perlmutter’s message regarding the brain is basically the same message that I have been saying for the heart: cut down on the carbs; think low-carb, not low-fat; minimize the grains, bread, bagels, and pasta in your diet; and increase good healthy fats from extra-virgin olive oil, avocados, nuts, fish, along with a bit of saturated fat from butter and meat (preferably organic and pastured or grass-fed). Fat has long been tarnished as the enemy of health, but in recent years researchers are showing that fat is important and even essential.
This is the basis of a healthy Mediterranean-type diet.
In my many years in practice, I increasingly recommended to patients that they reduce their carbohydrate and sugar intake. When they did, I often saw improvements, and not just for heart health and weight loss. Diverse conditions such as psoriasis, gut problems (dysbiosis), and neurological problems improved as well.
Personally, I cut down dramatically on my pasta, which I used to eat daily. Now, it’s only a few times a month. The grandkids enjoy my pasta, so I make it for them when they come over, but I only use gluten-free pasta or an organic, non-GMO ziti or thin spaghetti from Italy. As far as bread and bagels are concerned, I only eat them on a rare occasion. I will have a bagel maybe a few times a year covered with Nova Scotia lox and cream cheese. That’s pure enjoyment I don’t want to deny myself.
Here are some guidelines for carb reduction:
- Try to limit your carbs, as much as possible, to low-glycemic index (GI) items. This well-known index ranks carbohydrate foods on a scale from 0 to 100 according to how fast they raise blood sugar levels after eating. Foods with a high GI rating are rapidly digested and absorbed, and cause marked fluctuations in blood sugar levels. This carb class includes items like pizza, potatoes, rice, puffed wheat, instant oatmeal, and baguettes, to name a few. Hours after intake, you may feel spaced-out, confused, and have trouble focusing; you may become fatigued and irritable. Those are common signs of hypoglycemia – low blood sugar. After an initial sugar high, the insulin kicks in, and drops the blood sugar level down. Eating large quantities of high-glycemic index carbohydrates is associated with an increased risk of diabetes, and diabetes is associated with a higher risk of Alzheimer’s.
- Eat foods that contain fiber. Foods higher in fiber tend to be lower-GI foods as they they digest and absorb more slowly, produce only gradual rises in blood sugar, and thereby help put the brakes on insulin and deter insulin resistance and diabetes.
- If you desire grains, my favorites are amaranth, buckwheat, and quinoa. They have a low GI rank. Try, like me, to avoid wheat as much as possible, whether refined or whole.
- Avoid soda like the plague. It is junk food with no nutritional value. Sugar laden soft drinks are the leading source of added sugars in the diet. Stay away from them altogether! They will generate a sugar-insulin response. There’s another danger lurking in many drinks and food items – fructose, a common sweetening additive. Researchers have found harmful oxidizing agents called advanced glycation end-products (AGEs) present in significant concentrations in Alzheimer’s disease. These sugar-protein molecules damage neurons. Fructose is ten times more reactive as glucose in inducing AGEs, implicated also in diabetes, atherosclerosis, end-stage renal disease, and rheumatoid arthritis.
- Get yourself a copy of Dr. Perlmutter’s Grain Brain Cookbook, which provides recipes and practical strategies for getting around the dietary grain traps. Some of his innovative examples include: eggs Benedict with zucchini pancakes, artichoke dip, grilled Parmesan tomatoes, and cauliflower “couscous.” He also offers some novel snack and dessert ideas such as curried almonds, coconut-cashew bars, chocolate-hazelnut truffles, and lemon soufflé pudding, just to name a few.
- Remember that lifestyle, and not just diet, can help protect your brain. Regular exercise can help reverse insulin resistance and significantly reduce the risk of diabetes among high-risk individuals.
- Have a look at my video and article on “the awesome foursome.” CoQ10, carnitine, magnesium, and D-ribose are four supplements that can help increase the energy production of cells, including brain cells.
- Perlmutter, David. Grain Brain. (Little, Brown and Company, 2013).
- Roberts RO, et al. Relative intake of macronutrients impacts risk of mild cognitive impairment or dementia. J Alzheimer’s Dis, 2012; 32(2):329-39. Published online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494735/
- Crane PK, Walker R, Hubbard RA. Glucose levels and risk of dementia. N Engl J Med, 2013; 369(8):540-8. Published online at http://www.ncbi.nlm.nih.gov/pubmed/23924004
- Harvard Health Publications. Glycemic Index and Glycemic Load for 100+ Foods. Published online at http://www.health.harvard.edu/diseases-and-conditions/glycemic_index_and_glycemic_load_for_100_foods
- Seneff S, Wainwright G, Mascitelli L. Nutrition and Alzheimer’s disease: The detrimental cost of a high carbohydrate diet. Euro J Int Med, 2011. Published online at http://people.csail.mit.edu/seneff/EJIM_PUBLISHED.pdf
- Sasaki N, et al. Advanced glycation end products in Alzheimer’s disease and other neurodegenerative diseases. Am J Pathol, 1998;153(4): 1149–55. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853056/
- Perlmutter, David. The Grain Brain Cookbook. (Little, Brown and Company, 2014).
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