Anjali: Because of my mother's dementia diagnosis, I have made a very conscious effort to include lots and lots of green leafy vegetables in my day-to-day eating, and I would like to say that I'm now obsessed with leafy vegetables. Jay: That's Anjali Gupta. She's obsessed with a lot more than just green, leafy vegetables. She's cooking up a cornucopia of brain-healthy foods to reduce the risk of dementia in her family. You'll meet Anjali in a moment. Allison: Welcome to Defy Dementia, a podcast for anyone who has a brain. Jay: This podcast series is all about living in ways that keep your brain healthy, and reduce your risk of dementia, because dementia is not preordained by genetics. Our genes do play a role, but there are other risk factors, like loneliness, social isolation, or hearing loss. Allison: And research suggests that if we make healthy changes to those lifestyle risk factors, we could reduce dementia cases worldwide by at least 40%. Jay: Today on the show, how some simple and inexpensive changes to your diet could have big benefits for your brain. Allison: I'm Allison Sekuler, president and chief scientist at the Baycrest Academy for Research and Education, and the Center for Aging and Brain Health Innovation. Jay: And I'm Jay Ingram, I'm a science writer and broadcaster, I've been writing and speaking about dementia for more than a quarter-century. Allison: Join us as we defy dementia, because you're never too young or too old to take care of your brain. Many of us struggle with diet and nutrition. It can be hard to change what we eat and how much. On top of that, there's so much debate on things out there, like vitamins and the pros and cons of various diets. Jay: But there's mounting evidence that diet is a key way to reduce your risk of dementia. And so, on the menu today, on Defy Dementia, we have the latest expert information on brain-healthy foods, and some straightforward and surprising dietary rules of thumb for you. Allison: But right now, some food for thought, courtesy of our first guest, Anjali Gupta. Anjali is a caregiver to her mom who's living with dementia, and we take you right now to Anjali's kitchen in Mississauga, Ontario. Jay: Recently, Anjali invited our producer, Ben, into her kitchen. Anjali: I'm going to add a little bit of garam masala. You want to smell this, Ben, and see? Jay: To record her making lunch for her husband, Sanjay. Anjali: He is a quiet guy. He does his work, I do my own things. My life is perfect. Jay: Anjali is 65 years old. She immigrated to Canada from India at the age of 38. She's a registered dietician, now retired. She spent more than four decades advising people on how to eat more healthily. Anjali: I really like to make red lentils, because they're very easily available in every supermarket. So, you guys, [foreign language 00:03:23]. Speaker 4: [Foreign language 00:03:25]. Jay: Anjali puts her own twist on Indian vegetarian dishes so that they're especially healthy for the brain. Today, she's making a red lentil curry, called dal, stir-fried potatoes with dill leaves, eggplant and potato curry with green bell peppers. The air is full of spice. On the stove top, the dal bubbles away. It's colored bright yellow with specks of red pepper. Anjali slices some greens. Anjali: This is cilantro, coriander, and this is going to go in the tempering of the dal that I'm making, the red lentils. It has nutritional value, as well as it adds a lot of flavor, and because it's green, it has, again, the benefit of green, leafy vegetables. Because of my mother's dementia diagnosis, I have made a very conscious effort to include lots and lots of green, leafy vegetables in my day-to-day eating, and I would like to say that I'm now obsessed with leafy vegetables. When I'm cooking these potatoes, the stir-fried potatoes, which we call Pot Sukhe Aloo, they are cooked a little bit differently. My spin on this recipe is that I've added additional dill leaves in it, and in substantial amounts, and also tomatoes. And because they both have color, like green and red, which is antioxidant, it's good for brain health, and also the fiber, which is good for gut bacteria. Let's start. Speaker 5: Thank you. Anjali: So go ahead. Speaker 5: Rice goes down first, correct? Anjali: Yeah. Jay: And no surprise, brain healthy food is also delicious. Speaker 5: No, this is really, really good. I love the intensity of the dill and the potatoes, it's great. Speaker 4: That's good. Allison: And Anjali Gupta joins us now. Anjali, my mouth is absolutely watering, that sounded delicious. But before we talk a little bit more about healthy brain food, I'm wondering if you can talk a little bit more about your mother, because you mentioned that she was diagnosed with dementia, and I'm wondering, what was it like for you when you first learned about that diagnosis? Anjali: When we first found out about my mother's diagnosis, we were all very shocked, very sad, very puzzled. But at the same time, we were also a little bit relieved, because we now felt that at least now we know why she's doing what she's doing and why her behavior has changed. But at the time, she lived in India, and now she lives in Hong Kong with my brother, and that's where the accurate exact diagnosis came from. Allison: Yeah. And how is she doing now? Anjali: She's doing fine. My brother, just recently I was talking to him, he told me that she's in stage three. So she does not recognize me or anyone. Her behavior has changed a lot, she's very agitated, very aggressive, she uses abusive language, and my brother finds it very disturbing because this is not how she was when she didn't have dementia. My brother is like, she uses word that we have never heard from her mouth. Allison: And he's there in Hong Kong with her, but how are you caring for her from afar? Anjali: So I basically call her every morning, which is Hong Kong's nighttime, because we are 12 hours behind. So every day, 8:30 AM, I call her, she knows that I will be calling, and then that's when I talk to her. But when I talk to her, she's all set, had her dinner, so she looks fine, and she talks fine, and the statements that she makes are very positive. So my brother always tells me that, don't think this is how she is otherwise. During the day, she's abusive, she yells, she doesn't cooperate, she will not eat, she will not go to the washroom. So yeah, it's very difficult for him, but I don't get to see that picture of her because she's very calm and collected when I call her. Jay: Well, Anjali, it's never easy dealing with dementia in the family, as you're finding out, sadly, but your mother's diagnosis though did something else. It actually changed your approach to your own health and the health of your family. Can you tell us about that? Anjali: Definitely. Since my mother has been diagnosed, I think I've become very... First of all, I'm learning a lot about dementia. When Mummy got diagnosed, I just thought, okay, so it's dementia. Now, I'm learning that how things will change as it will progress, and that is actually making me even more sad and scared than when I heard about her diagnosis the very first time. Because dementia, at that time, was just a word for us, for our family, it's not something we knew about at all. But now that I know, I'm really, really taking a lot of caution in my family and in myself for being very mindful about our eating, keeping the stress down, taking life as it comes, because I don't think this is how I was before that. Jay: And from what we've already heard, you're really interested in creating brain-healthy food as part of this response. So how easy was it to do that with a traditional Indian menu? Anjali: It wasn't very hard to modify the recipes, because a lot of brain healthy food is also part of Indian diet. The only modification that I think I have done is to use less fat in cooking, so that is one modification that I think I'll have done. And then, I very mindfully make sure that I'm eating green, leafy vegetables, berries, whole grains, and nuts and seeds, pretty much as a prescription every single day. So it's necessary that I have these things in my food every single day. Jay: Now, you've had a lot of experience as a dietician, for a long time, actually, but with respect to dementia specifically, how did you learn about what foods are brain-healthy versus not brain-healthy? Anjali: I've done a lot of research and reading since I have my mother's diagnosis, so I'm actually navigating a lot of dementia and Alzheimer's related websites, community organizations, reading research papers, and figuring out what are the things that are very important for us for brain health. So I'm definitely making sure that we eat a lot of, as I mentioned earlier, dark leafy, green vegetable, like spinach, arugula, kale, a lot of whole grains instead of the defined grains, a lot of seeds, because they will provide omega three, fatty acids, so like pumpkin seeds, walnuts, flaxseed, et cetera. And also, a lot of beans and lentils, because they're also very good for brain health, and berries, and cruciferous vegetables, like broccoli and cauliflower, Brussels sprouts, you name it. So there's a lot of variety, and you can just cook them in whichever way you want. You can steam them, you can stir-fry them, you can saute them with spices. I usually prefer to just steam them and put a little bit of lemon juice and little bit of black pepper on them so that I can actually enjoy the flavor of the vegetables, as opposed to a lot of spices. Allison: So, Anjali, you have mentioned so many different ingredients and spices, and when I heard you cooking, same thing, using a lot of different sorts of ingredients and spices, and some people might not have so much access to that sort of variety of foods, and I'm wondering if you can share some really simple, accessible brain-healthy food ideas for people. Anjali: I think what's more important is to add a variety of fruits and vegetables, and grains, and beans, and lentils, and nuts, and seeds. So it's not a prescription, as such, really, but whenever you're grocery shopping, just make sure that the vegetables that you take are colorful, and they're green, and red, and orange, and yellow, and all those colors. And to make something simple like a lentil dish, you can add a lot of vegetables in it and make it... For example, I think one of the dish that people eat here often is chili, and chili is a perfect example which can include lot of brain-healthy foods all together in one dish. And if you're really short of time, you can have the same chili for lunch and dinner, and still get everything that your body needs and your brain needs to stay healthy. Allison: And only one dish to clean at the end. Anjali: Yeah. Basically, it's not like you have to prepare a lot of different kind of foods to get brain-healthy foods in there, some can be eaten raw, some can be eaten as a snack, some can be cooked as a dish, and you will have everything that your body and your brain and your mind needs. Jay: And you know Anjali I also think people often make the mistake and assumption that Indian food has to be really, really hot and spicy, and yet, it isn't really, is it? Anjali: No, actually... And I'm very surprised, and when I first came to Canada, this is what I heard from everyone, but making food hot and spicy is up to you. Normally, the spices that is used in Indian cooking are turmeric, asafetida, coriander powder, salt, black pepper. So no, that's not the case. I think how you cook and how much of what kind of spice you put in your food is what gets the flavor, but in terms of the recipes, a lot of Indian recipes use a lot of oil, and I make exact same recipes, but I make them either literally oil free or by few drops of oil. So that is just the creativity that I am learning, and I will continue to learn, so that I can still enjoy my Indian food flavors, but keep them very, very healthy. Allison: Anjali, I am hungrier than ever listening to you, so thank you so much for sharing so much information about brain-healthy food. Jay: Yes, I echo those thoughts, and I'm even hungrier than Allison, although I haven't admitted it yet, but thank you, Anjali. Anjali: Thank you. Jay: Anjali Gupta is a retired registered dietician. She joined us from Mississauga, Ontario. Allison: Our next guest has been listening to Anjali. Dr. Thomas Holland is a physician and nutrition expert. He's a scientist at the Rush Institute for Healthy Aging at Rush University Medical Center in Chicago. That's one of the main US research centers that's investigating the role of nutrition as a risk factor for Alzheimer's disease. And he's also one of the leaders of the US POINTER trial, which is a huge ongoing study that's looking at how we might prevent dementia by making changes in areas such as diet and exercise. Dr. Holland, Tom, welcome to Defy Dementia. Thomas: Thank you so much for having me. Allison: When you were listening to Anjali tell her story, what most struck you about what she said? Thomas: One primary thing that really stood out for me is her role as a caregiver, and myself, having watched my grandmother go through the stages of Alzheimer's, the stepwise loss in cognitive abilities, it just really struck me at her dedication and her interactions with her brother. It all revolves around taking care of her mom, and making sure that they're doing what they can for her as she goes through this disease process. Allison: Yeah, and what was interesting is that, even though she had that nutritional background, she didn't stop with what she knew, she kept doing more research, and it changed how she ate herself, and how she made sure her mom ate. In your experience, as a caregiver yourself, did your experience change the way that you viewed the world? Did it influence your research? Thomas: Absolutely. And being in this ancillary role, and seeing the interactions that my dad in particular was having with his mom, it just really struck me at what we can do for our brains as we age. And from a personal perspective, I've modified how I eat and what I'm eating, how I view foods. And from a caregiver perspective, leaning into how you can modify the diet or other lifestyle factors for your loved one to either help maintain the cognition, and at the very least, slow the rate of cognitive decline, as they're fighting this specific disease. Jay: Dr. Holland, on Defy Dementia, we discuss a number of different risks that you can try and modify. What persuaded you to focus on diet? Thomas: Diet is one of those strong modifiable risk factors, that if you are consuming a standardized Western type diet, there is increased risk, whereas if you modify your diet, and you start consuming these dietary patterns like the MIND diet, Mediterranean diet, or DASH diet, there's science that tells us that it can slow the rate of cognitive decline, decrease your risk for dementia, and decrease the burden of Alzheimer's type neuropathology, like amyloid or phosphorylated tau proteins. Jay: So before we actually tackle what's going on in the brain, could you very quickly for us distinguish the North American diet from those better diets? Thomas: So from a standard American diet, or a Westernized diet, we see a lot more consumption of red meats, high fat dairy and butter, as well as fried fast foods and baked goods. All of those have a bit higher content of trans fats, and are just not as nutritious as we would like. Whereas on the other side, these really strong, healthy dietary patterns are rich in a multitude of diverse foods and food groups, being dark, leafy greens, berries, fish, extra virgin olive oil, whole wheat, nuts, just really, really healthy type foods that are diverse in the quantity and quality of minerals, vitamins, and bioactives. Allison: And can you say something about why it is that those sorts of things, the dark, leafy greens, and berries, and so on, what is it about them that makes them so good for the brain? Thomas: Yeah. So first and foremost, getting into why the dark, leafy greens and the berries are good for you. When we think about sun exposure, we know that the sun exposure of these vegetables and fruits causes the skin to thicken. A thicker skin correlates to a higher nutrient content, and that's why a high bush blueberry versus a low bush blueberry is going to be more nutritious, and why the dark, leafy greens versus the lighter leafy greens are going to be more nutritious. Allison: So when people are talking about “eat your greens”, you're really specifically talking about dark, leafy greens, as opposed to a lot of people might like iceberg lettuce, which is a lot lighter. The darkness of it makes a difference in what's happening in the brain? Thomas: Absolutely. So when we have these darker leafy greens, the berries, the olive oil, or fish, intake, the nutrients found within those foods can act as anti-inflammatories and antioxidants. And so, inflammation is a normal process in our body, but inflammation can either have a higher amplitude or a chronicity to it, it can last for a long time. If there is more inflammation occurring, it can cause damage to our cells, and in particular, our brain cells, and if that happens, then we can start to see a decrease in cognitive abilities. And the same thing can happen from an oxidative stress perspective. There's a lot of cell processes that happen in our body that cause oxidative stress, and if that stress stays around and isn't taken care of, it again can cause cell damage, and if it's damaging our brain cells, again, we can see a loss in cognitive abilities. So intake of these foods that act as anti-inflammatories and antioxidants help temper the inflammatory process, and help process the oxidative stress to ensure that it's not damaging our brain cells. Jay: Anjali mentioned gut bacteria as being a component in this, and we've talked about the food, so it goes from our mouths, to our stomachs, then into our guts. What happens after that to involve the brain? Thomas: I love this question. The gut-brain axis is one of those wonderful complimentary systems. So if you think about the intake of the foods into the stomach, and into the small intestine in particular, the foods have to be metabolized, digested, and then absorbed. So the gut microbiome, the gut bacteria, if you have healthy, diverse gut bacteria, it helps break those foods down to the point that they are faster absorbed and more completely absorbed. And so, in that sense, it allows these foods that have gotten into our bodies to be absorbed into the blood, and then make their way into our various organ systems, but in this sense, thinking about it going to the brain, and helping maintain nutritional status in the brain. Allison: So it's all connected. So you can have these dark, leafy greens, and if you don't have the right gut bacteria, you're not going to extract all of the right stuff out of them to be able to get into the brain to protect you from that inflammation and that oxidative stress. And so, if you put it all together, that's what you're talking about when you talk about that gut-brain axis, right? Thomas: Absolutely. And as I tell my students, the body is awesome. Our bodies modify based on what we need. So if you are intaking a heavy red meat meal with a lot of trans fats and high fat dairy, like cheese, your gut bacteria is going to modify to be able to process that. However, if you then start intaking vegetables, your body's going to say, oh my gosh, what's happening here? These are new foods, I need to modify to be able to digest these. And your gut bacteria can actually start modifying and changing in 24 hours, but it can actually take up to 30 days for it to completely change to be able to start digesting the new foods. So I always like to tell participants of studies, give your body time to catch up. It will get to the point of being able to digest those new foods that you're intaking. Jay: So Tom, I want to ask you for a few simple tips, but I have one quick question that's been bothering me now for a few minutes. Eggplant, I cut the skin off the eggplant when I cook it. Should I not be doing that? 'Cause I know some recipes allow you to keep the skin on. Allison: That's a very thick skin. Thomas: It's a very thick skin, and can be difficult to process, depending upon how much is intake and how well it is processed, so chewing, how the stomach acid is working. So to your point, intaking the skin can be a good idea, but you need to make sure that you're doing it in a thoughtful manner. Now, for eggplant in particular, the flesh tends to hold a lot of the nutrients, being a lower to the ground food, but it's definitely reasonable to intake the skin and the flesh. Jay: Okay, so if I'm going to the supermarket, and I'm trying to remember everything you've said, do you have a couple or three tips of what I should do once I get through the doors? Thomas: So go to the fruit and vegetable area and try to fill your cart to be as colorful as possible. So when you get home and you're looking at your plate, you want it to pop, you want to have dark, leafy greens, bright red strawberries, bright blue blueberries, you want to have this diverse looking plate that is colorful. What you don't want is to have a very bland or beige looking plate. If your plate is fried food, baked goods, and some type of meat that's been cooked in a pan, and it's just looking very beige or tan, lean away from that, and lean a bit more into the bright, colorful, diverse foods that have a strong nutritional status. Jay: And again, just remind us why the color, the bright colors, the range of colors, is important. Thomas: So when it comes to the intake of these foods, if you are in this more beige category, the diversity of your nutrients is going to be quite limited. When you look at a bright, colorful plate, the diversity, the quantity and quality of the nutrients in those foods, is going to be quite high. So from that end, if you have a salad that has dark, leafy greens, carrots, tomatoes, extra virgin olive oil, that could have upwards of 100 to 120 different vitamins and minerals and bioactives in that salad. Jay: So Tom, in Defy Dementia, we like to say, you're never too young or never too old to think about reducing your risks for dementia. So in this area of proper diet, when should you do that? Thomas: You said it the most eloquent way I could think, do it as soon as you possibly can. Although there may be a ceiling effect, that you're not going to become a super brain by maintaining this diet, you may be able to maintain your cognitive abilities for a very, very long period of time. A mentor of mine told me that the best outcome is that you could be 90 to 100 years old, and you hit the slopes, and you have your cognitive and physical abilities intact, you go to the bed that night and don't wake up. Being able to maintain your cognitive and physical functioning into those older years is what we all want, and maintaining a healthy diet is going to be one of the components that helps you get there. Allison: So Tom, I remember hearing somewhere that following these sorts of brain-healthy diets can actually effectively decrease your brain age. Is that true? Thomas: Yes, we have research that shows if you maintain your diet in this higher level of intake, the MIND diet in particular, that you can decrease your brain age by seven and a half years. So to put that into context, if somebody is 67 and a half years old, and they've been maintaining their high level nutritional intake of this diet, they could effectively have the brain age of a 60-year-old. Allison: Oh, that's huge. A lot of people who might need that gain in decreased brain age don't have a lot of money necessarily, and food prices have gone up all over the world, so I'm wondering if you might have any tips for people, especially caregivers and people living on fixed incomes, how do you reach that goal of that brain-healthy diet? How do you consume brain-healthy food on a budget? Thomas: This is a wonderful question. This is something that I personally struggle with as well, and for me, what I do going into a store is I try to buy bulk. So I will go to my frozen food section, and I will buy bulk blueberries, strawberries, cherries, and kale, that's frozen. And I will take a cup of that each day, put it into a blender with water, blend it up, and I have my serving of leafy greens and my serving of my berries. And that's one quick, easy way, and my cost per shake is sub 50 cents. Jay: When we embarked on this episode, we thought that Anjali would be the cook and you'd be the scientist, now you're both. So thank you very much for this, Dr. Holland, it's really been edifying and I'm... Well, I always treated eggplants with respect, but I have more respect for them now. Thanks again. Thomas: Absolutely. Thank you so much again. Jay: Dr. Thomas Holland is a physician and researcher at the Rush Institute for Healthy Aging at the Rush University Medical Center. He joined us from Chicago. So Allison, the thing that struck me about Anjali and Tom Holland was Tom Holland's advice that when you go to the supermarket, turn right or left, however your supermarket is arranged, go straight to the fruits and vegetables, and pick the most colorful ones. And I like it, because on this podcast, we're trying to urge people to do things to help reduce their risk of dementia. But almost everybody goes to the supermarket, so we're asking them to do something once they're there, in other words, once they're doing something they already do. And I think that's going to be much easier. Allison: Yeah, I totally agree. Changing your behavior just a little bit can make a very, very big difference. And when you're there, when you're in the fruit and vegetable section, one of the things I thought was really cool was not all blueberries are created equal, not all lettuce is created equal, you want to look for the darker colors. And the other thing I thought was really interesting is, in listening to Anjali and the passion with which she's cooking in her culture, this rule of thumb, the most colorful things on the plate, the deepest colors, can work in any culture for any kind of food. So again, to your point, no matter what your normal eating patterns are, you can tweak them just a little bit and make this advice work for you. Jay: And stay away from beige. Allison: Stay away from beige, for sure. Jay: Find out more about how you can reduce the risk of dementia or slow its progression. Please visit us at defydementia.org. There, you can check out other episodes of this podcast, as well as our videos and infographics. Allison: Our podcast production team is Rosanne Aleong, Monique Cheng, Sylvain Dubroqua, our Chase producer is Ben Schaub. Production is by PodTech, Music is by Steve Dodd, and our cover art is by Amanda Forbis and Wendy Tilby. Jay: We'd also like to give a big thank you to the founder of this podcast series, the Public Health Agency of Canada. Please note, the views expressed here do not necessarily represent the views of the Public Health Agency of Canada. Allison: Your support for our podcast is greatly appreciated, so please hit that subscribe button for Defy Dementia on Spotify, Apple Podcasts, Google Podcasts, or wherever you get your pods. I'm Allison Sekuler. Jay: And I'm Jay Ingram. Don't miss our next episode of Defy Dementia, it's all about how air pollution, both indoor and outdoor, could increase your risk of dementia. We'll share lifestyle hacks that'll help clean up the air that you breathe.