Uh oh ... MIND Diet Good, Mediterrnean Diet Maybe Not so Helpful?

In Beating the Dementia Monster we discussed the three favored diets for brain health: the DASH diet, the MIND diet, and their granddaddy, the Mediterranean diet.  On December 17, 2018 I posted two articles about studies correlating diet with the development of AD -- one a Finnish study and the other a British study.  The Finnish study failed to find cognitive improvement over a two year period from an improved diet that correlated with the Mediterranean diet and the DASH diet.  The researchers discussed the MIND diet, but they did not evaluate the potential of the MIND diet in their study. 

The British study found remarkable improvement in hippocampal volume that they correlated with improved diet over an eleven year period.  It was difficult to understand from the methodology in the British study what their favored diet resembled -- Mediterranean, DASH, or MIND.  They scored people's food intake based on the Alternative Healthy Eating Index, which favored green leafy vegetables over carbohydrate-rich foods -- among several other factors.  I could not find a way to correlate the information in the report with any particular diet.

Now there's an interesting new study in the current issue of Alzheimer's and Dementia; the Journal of the Alzheimer's Association.  The study is "MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study."  It acknowledged studies in the US that correlated diet with brain health, but posited a need to determine if the results of American studies can be generalized outside of the US.  For example, in Australia.

The conclusion was that they can, but ... the study failed to find a correlation between cognitive improvement and the Mediterranean diet after 12 years.  On the other hand, it did find a substantial correlation for the MIND diet.  Note that the Finnish study we discussed in one of my December 17 posts also found no correlation between cognitive improvement and the Mediterranean diet after two years.  It did not evaluate the MIND diet.

I've always treated the three diets as essentially co-equal with respect to brain health because they all knock out the carbs and red meat while favoring green leafy vegetables, fish, and poultry.  But maybe I should fashion my eating more after the MIND diet than the Mediterranean diet.  I already do to a certain extent.  I eat blueberries every day and one slice of whole grain bread that I would not otherwise be eating.  But I do eat some plain cream cheese for snacks which is not on the MIND menu, even if it might be on the Mediterranean menu.  And I don't eat beans, but maybe I should.

This article from the professional journal Today's Dietician compares the Mediterranean and MIND diets without finding much difference in comparative outcomes.  (It does cite research that found favorable outcomes for both diets.)

The other thing hanging out there in my mind is how well the studies supporting these diets have been controlled for exercise.  From what I can see, only the research supporting the MIND diet claims to have controlled for exercise, and some have criticized how well that was done.  Do people in Australia who follow the MIND diet get more exercise than people who follow the Mediterranean diet?  It may seem like a silly question, but when questions like these are probed we sometimes get surprising answers.

Exciting News on the MIND Diet

We have been waiting for news on the big MIND diet study (the MIND Diet Trial) being pursued by Rush University, the Harvard TC Chan School of Public Health, and Brigham and Women's hospital.  We have written about this study several times, and we discussed it in Beating the Dementia Monster.  We expected it to be the definitive study of the power of diet intervention to affect the course of Alzheimer's disease.  We had hoped to see some results by April of this year, but, probably due to covid-19, we haven't seen anything yet.

In the absence of the Mind Diet Trial results, another large study was published on September 14 in the Journal of Alzheimer's Disease.  While different in design from the Mind Diet Trial, it is a very credible study of 597 people who had died, many with evidence of dementia.  With their consent and cooperation, the study tracked the eating habits of these people over a number of years, tested their cognition, and then evaluated their brains in subsequent autopsies.  The results provide additional support for the MIND diet as one way of limiting the advance of Alzheimer's disease.

The study used data from the Rush Memory and Aging Project which has been ongoing for many years.  Their analysis of study data controlled for age, sex, education, APOE4 status, late-life cognitive activities, and total energy intake.  

The study data was very dependent on self-reporting of dietary habits, and there was concern that dementia could have affected the quality of this data.  Each participant was scored with respect to their adherence to the diet, so that these compliance scores could be compared to their cognitive test scores and other measures.  The concern was that people suffering from advancing dementia might not accurately record what they ate.  The researchers did a credible job of showing this was not a factor.

So what did they find?

According to the published research, "a higher MIND diet score was associated with better global cognitive functioning proximate to death, and neither the strength nor the significance of association changed substantially when AD pathology and other brain pathologies were included in the model ... The MIND diet-cognition relationship remained significant when we restricted our analysis to individuals without mild cognitive impairment at the baseline [when the study began] or in people diagnosed with postmortem diagnosis of AD..."

So one of the things they're saying here is that among people who followed the MIND diet more carefully, cognition did not deteriorate to the extent expected based on the amount of atrophy of the brain found in their autopsies.  Brains atrophied, but those who adhered best to the MIND diet still hung onto an unexpected level of good cognition.  This is consistent with some of the surprises that came from the Nun Study that we discussed in Beating the Dementia Monster.  They're also saying that the MIND diet was helpful to people who already had Alzheimer's disease at the beginning of the study, but it was also helpful to people who developed the disease during the years of the study.

Their final conclusion: "[The] MIND diet is associated with better cognitive functioning independently of common brain pathology, suggesting that the MIND diet may contribute to cognitive resilience in the elderly."

Speaking as one of the elderly, I must say this is really good news, and I anticipate that these results will be supported when we hear from the MIND Diet Trial people.  I have been applying the MIND diet now for several years, and I'm sure that it's contributing to my well-being.  But don't forget the importance of the multi-domain approach!  You still need to get exercise, make sure you sleep well, stay socially active, and control your stress.  These are all important!

What's up with the MIND diet?

It's been, like, forever since we began our vigil for the results of the MIND Diet Trial.  This was a collaboration between Rush University, the Harvard TH Chan School of Public Health, and Brigham and Women's Hospital.  We were promised results by April 2021.  But what have we so far?  Not much.  I'm sure this is a casualty of covid-19, but we're not getting updates from anyone.  ClinicalTrials.gov was updated in March 2022, but I couldn't figure out what was updated.  

You will recall from Beating the Dementia Monster that the MIND diet is a modification of the popular Mediterranean and DASH diets, both of which have been correlated with improved brain health.  (MIND stands for "Mediterranean-DASH Intervention for Neurodegenerative Delay.")  There have been some important and very positive trials of the MIND diet, but the scientific consensus is that the earlier results must be replicated in a randomized trial.  That was going to be the MIND Diet Trial that we're still waiting on.

So, in the absence of single randomized controlled trial (the gold standard), what do we actually have that might still be good evidence of the superiority of the MIND diet for the brain?  My sister sent me this article documenting a review of the existing literature of what we know about the diet's effectiveness.  It's not exactly what we're looking for, but it's still pretty substantial.

The authors searched through 135 studies and found 14 articles that met their criteria for credibility.  All of the studies found the MIND diet was superior to both the Mediterranean and DASH diets when it came to brain health.  The authors specifically concluded, "All of the included studies indicated that adherence to the MIND diet was positively associated with specific domains, but not all, of cognition and global cognitive function ... in older adults. MIND diet was superior to other plant-rich diets including Mediterranean, Dietary Approaches to Stop Hypertension [DASH], Pro-Vegetarian and Baltic Sea diets, for improving cognition. Adherence to the MIND diet may possibly be associated with an improved cognitive function in older adults. MIND diet may be superior to other plant-rich diets for improving cognition." 

What sets the MIND diet apart that might explain its apparent superiority?  The best I can make of it is how the MIND diet stays away from cheese, butter, margarine, and red meat.

Of course, I haven't been waiting for the study results to decide whether to apply this diet or not.  I've been following it since 2016, and so it's just what I do.

How much has it helped me?  I have no way of knowing.  All I do know is that applying the whole Dementia Toolkit has helped me immensely.

MIND Diet and Boredom

There are two separate topics for this post -- boredom and the MIND diet.  I'm not bored with the MIND diet.

Boredom is good

In Beating the Dementia Monster, I described how I would sometimes sit on the sofa, completely uninterested in speaking with anyone or engaging in most any activity.  Different thoughts may have been running trough my head, but I wasn't interested in engaging with anyone or any thing.  You would think that this might indicate boredom, but I was definitely not bored.  I was too dulled by the disease to be bored.

That was then, this is now.

Retiring from my engineering and teaching careers has left me with quite a bit of time on my hands.  And so I have been keeping this blog, preparing a new edition of Beating the Dementia Monster, taking pictures, working at the food bank, getting to the gym, reading classics, meeting with friends, maintaining a couple of web sites, and other activities.  But these don't fill all of my time.  So I occasionally become bored, quite bored. At least, nowadays.

It occurred to me the other day that the return of my ability to experience boredom is a relatively recent phenomenon.  It occurred to me that boredom, at least for me, arises out a sort of frustration with a lack of engaging activities.  But if I'm ambivalent about life, I'm not frustrated, and I'm not bored.

It seems to me that the ambivalence I was experiencing before was a product of AD.  Therefore, the more recent tendency to boredom indicates a retreat by the disease.

I don't like being bored, but it looks like the ability to be bored is a very good thing!

More on the MIND diet

In Beating the Dementia Monster I minimized the importance of diet in dealing with AD after reading that some researchers believed that the link between brain health and cognition may simply indicate that people who eat healthy diets also get exercise.  The idea was that research was inadequately controlled for exercise, and exercise is responsible for the better brain health of people with good diets.  I still said that diet was important, but it wasn't anything like the powerful solution that exercise was. 

In my December 17, 2018 post on the FINGR study, I noted the disappointment that a correlation could not be established between either the Mediterranean diet or the DASH diet and improved cognition.  The study acknowledged that there was such a thing as the MIND diet, but it did not evaluate it.  The study is important and seems to be forming a baseline for research on diet and brain health.  It seemed to me that this was helping confirm my minimization of diet as an important solution to AD. 

On March 6 of this year I reported on an Australian study that actually compared cognitive improvement outcomes with the Mediterranean diet and the MIND diet.  The study found no correlation between the Mediterranean diet and brain health, but it did find a surprisingly strong correlation with the MIND diet.  I was surprised, but didn't think much of it initially.

Over the past month I've been thinking about this more and more.  Maybe skipping the butter, cheese, and red meat, then adding all of the blueberries, strawberries, and almonds actually is making a significant difference. 

The University of Washington Alzheimer's Disease Research Center publishes a quarterly magazine, Dimensions.  I will review the current issue in another post, but I want to note a specific article there on diet.  The article discusses the MIND diet, and notes that there is a large study of the MIND diet in progress right now that may more clearly define its true worth in brain health.  It should be completed in April 2021.  Yes, that's a long way off, but maybe this will be the definitive study that answers most of our questions on the relationship between diet and Alzheimer's disease.   

 

The MIND Diet -- Dead and Buried -- or Reborn?

In Beating the Dementia Monster, we looked forward to what was to be the definitive study on the MIND diet. The research project was looking to recruit 600 participants, and it appeared that we could expect to see results in April, 2021. The research was a collaboration of Rush University, T. H. Chan School of Public Health, Brigham and Women’s Hospital, and the National Institute on Aging. I was very hopeful for some solid, scientific support for the validity of the MIND diet.  

And then covid happened.

Covid threw a monkey wrench into a lot of plans, including this one. In fact, if you go to the study’s web site, you’d think the research is still underway. The web site stands frozen in time. But they did finally publish the results in July 2023, and the results were disappointing. Some vegan YouTubers were a bit gleeful about this, primarily (it seems to me) because the diet allowed for consumption of some fish and poultry. 

I wrote before that I was disappointed in the quality of the study, because it was compromised by covid restrictions. In my view, some of the adjustments they made to the research protocol impaired data collection and assurance of the validity of the data. After reading the research, it didn’t appear to me that they really knew what people were actually eating with an appropriate level of accuracy. Some took the research results to indicate that the diet really didn’t work to reduce the risk of Alzheimer’s, at least not any better than the Mediterranean diet. But not me.  

So perhaps I’m vindicated in resisting the negative interpretation of the results. Recent research at the University of Hawaii (my wife’s alma mater) used data drawn from 93,000 US adults, of which 21,000 developed Alzheimer’s. The study found that adherence to the MIND diet by members of the general population resulted in a 9% reduction in Alzheimer’s risk. But those of White, Black, and Latino descent experienced a 13% reduction. However, people who improved their adherence to MIND over 10 years (including those who didn’t follow the diet closely at first) had a 25% lower risk of dementia compared to those whose adherence declined. Data for the study was drawn from the research cohort known as the Multiethnic Cohort Study which began in the 1990s. This study was also an initiative of the University of Hawaii, but its original goal was to study the demographics of cancer.  

Now, the MIND diet had not yet been formulated in the 1990s. So this is obviously a longitudinal study in which they analyzed information regarding a large population and looked for correlations between diet and the development of Alzheimer’s. The late Dr. Martha Clare Morris developed the MIND diet based on similar research that she and her team conducted. She describes her research in her book, Diet for the Mind.  

Noteworthy about this new research is that adherence to the diet had relatively little effect on Americans of Asian and Native Hawaiian descent. Positive results were seen in White, Black, and Latino populations. The researchers speculated that this may be because the ethnic foods of Asian and Native Hawaiian cultures was already somehow protective of the brain. And you’re looking for the difference in outcome between what people normally eat and a specialized diet. But if both diets are protective of the brain, you won’t see anything that suggests the MIND diet improved anything. But … as they always say ... more research is necessary.  

The new research hasn’t been published, but it was to have been presented at NUTRITION 2025, the conference of the American Society for Nutrition, this past Monday, June 2, in Orlando. I presume all went according to plan.

Diet for the Mind

In Beating the Dementia Monster, we discussed the MIND diet.  Research had found reduced incidence of AD among people who followed the Mediterranean and DASH diets, and the MIND diet was said to be an improvement on these.  In fact, in my post of March 6, 2019, I cited research that found no cognitive improvement with the Mediterranean and DASH diets, but improvement with the MIND diet.  But I have never gone back to the source when speaking to the MIND diet.  (I have, however, been following the MIND diet myself for about two years.)

This weekend, I finally read Dr. Martha Clare Morris's book, Diet for the Mind.  It was Morris who created the MIND diet to explicitly include nutrients known to support brain function.  In her book she describes the thought processes that went into its development and discusses the research that led to her formulation.  The second half of the book was devoted to recipes developed by her daughter.  The book answered a lot of my questions about the diet and the logic behind its composition.

One thing I wondered about was her exclusion of red meat, since I understood from the Wikipedia and Dr. Mark Hyman's book, Food: What the heck should I eat, that saturated fat, especially saturated fat from red meat, had been effectively ruled out as a nutrition issue.  Hyman had cited several studies that discounted cardiovascular risk due to intake of saturated fat.  But Morris cited research that claimed the opposite. She called one of the most important studies "seriously flawed."  So the MIND diet rules out red meat and keeps saturated fat to a bare minimum.  Hyman, nevertheless, discourages meat consumption in general.

Morris points out that her diet is the subject of a large study intended to definitively establish the place of the MIND diet as an effective weapon in the battle against neuro-degenerative diseases.  Is it a game-changer?  Results are due out in April 2021.

And it gets worse ... or does it?

I've remarked before that, when I speak on the diet aspects of the Dementia Toolkit, I hear groans ... notably, when I talk about avoiding sweets, cheese, butter, and margarine.  In her book, Diet for the Mind,  the late Martha Clare Morris says that American pizza is one of the worst things you can eat, at least with respect to brain health.  (This is different from pizza you might find in Italy.)  Aside from all of the cheese, most pizza toppings will include "ultraprocessed foods" like pepperoni.  We wrote previously about ultraprocessed foods.

So there's some new research about ultraprocessed foods.  The researchers used data derived from the Nurses' Health Study and the Health Professionals Follow-up Study to dig deeply into the influence of ultraprocessed foods on the development of dementia.  This gave them access to the experiences of 130,000 people over periods as long as 43 years.  

Of the 130,000 people, 11,173 developed dementia.  So what did they eat, and what did they not eat?

One finding was that people who ate one-quarter serving or more of processed red meat daily had a 14% greater risk of dementia.  But they also found that substituting nuts and legumes for processed red meat was associated with a 20% lower risk of dementia as well as fewer years of cognitive aging.

This research has not yet been published, but here's an article about it.

We continue to see research on the Mind Diet we discussed in Beating the Dementia Monster.  In reality, it doesn't seem to be the game-changer it originally promised.  So maybe that cheese is OK after all, especially if you're a guy.

A new study was just published in the journal, Neurology, about benefits of adherence to the Mind Diet.  It was entitled, "Association of Adherence to a MIND-Style Diet With the Risk of Cognitive Impairment and Decline in the REGARDS Cohort."  While the study found that, overall, greater MIND diet adherence was associated with decreased risk of cognitive decline, this was almost entirely among female subjects.  It also found that black subjects experienced better improvement than white subjects when they adhered more strictly to the diet.

A question I had was, what diet did they compare against?  Did the control group live on pizza and ice cream, or did they eat something more like a Mediterranean diet?  (Which wouldn't be much different from the MIND diet.)

I don't have access to the actual research, but what I do see is that the control group ate a "usual diet."  Of course, what's usual in New Orleans may not be usual in Omaha.  Nevertheless, all participants, both subjects and control, were coached on diet and calorie reduction.  This seems to have modified everyone's diet, so they actually had improvement even in the control group.  And, after coaching, was that still a control group?

Here's an article on this study.

What do I think?  I think the evidence (that we've discussed before) tells us that there is a clear association between the Mediterranean diet and a reduced incidence of of dementia.  But it's not clear now how much modifying the Mediterranean diet to the MIND diet improves on this.  We have also discussed how studies that failed to confirm this about the Mediterranean diet finding relied too heavily on self-reporting of what people ate.  When actual dietary intake was more carefully regulated or observed, the benefits of the Mediterranean diet are more clearly defined.  (Are you surprised?)

How good is that Mediterranean diet anyway?

About three and a half years ago, we posted about a study that found the MIND diet might be good for brain health, but the Mediterranean diet might not be so helpful.  This seemed to deny a number of "longitudinal" studies that correlated the Mediterranean diet with a lower incidence or later onset of dementia.  

In Beating the Dementia Monster, we noted that longitudinal studies that follow a population -- correlating behaviors with the appearance of dementia -- must be carefully controlled for confounding factors.  For example, people who eat a healthy diet are much more likely to get good exercise.  So if a study of diet finds a good outcome, was it due to the diet or the exercise?  Or both?  Or some other uncontrolled factor?  Studies looking for correlation between diet and brain health have produced a range of conflicting results.  Some explain this as evidence of variation in how confounding factors (like exercise) are controlled.

Researchers are all quick to point out that, whether or not the Mediterranean diet helps with dementia, it is still profoundly important in the control of other diseases, such as metabolic syndrome.

A recent 20-year study from Lund University in Sweden, published in the journal Neurology, appeared to find that the Mediterranean diet had little influence on the incidence of dementia.  In reading the material, it appears to me that they were more deliberate in controlling confounding factors compared to other studies.

This article in Medical News Today evaluates the research and recalls the same research we cited in our 2019 post.  The upshot is that the Mediterranean diet may not help with preventing, slowing, or stopping Alzheimer's disease, but there is still plenty of evidence that the MIND diet does.  

But where is The MIND Diet Trial we discussed in Beating the Dementia Monster?  Here's what their web site says.  And according to the NIH's "ClinicalTrials.org," they have no results yet.  They were supposed to have published their results two years ago.  I'm thinking they remain a victim of covid.

There have been several promising studies of the MIND diet, so I'm sticking with it.  But the MIND Diet Trial seems to me to be so well designed that, once they can get their results out, we'll have much better confidence in it.  I'm sure it will fare better than the Mediterranean diet.

Finally - MIND Diet Trial Results

In Beating the Dementia Monster, we talked very positively about the MIND diet.  In the book, we noted that a major, hopefully definitive, trial was under way, and we anticipated that we would see results by April 2021.  But then came covid.  I stopped hearing about the trial, and updates to the trial's official web site stopped.  As you can see here, even today, the trial web site stands frozen in time, as though the trial is just getting under way.  (Be sure to click on "Study Progress.")  The FDA's clinical trials web site (which I checked periodically) showed no progress after assembling a study population.  I figured that the covid had major impact on execution of the study, and maybe it had just died.

While I was vigilant (I thought), they did actually complete the study and publish the results.  Yes, covid challenged completion of the study, but also, the results were pretty underwhelming.  So they didn't get much media buzz.  And, of course, they said nothing on their web site. 

The results were published in July 2023 (two years later than expected) in the New England Journal of Medicine.  But I only stumbled on this today.

Long story short, there was very little meaningful difference in outcomes for the two groups studied.  The study population consisted of two cohorts of about 300, cognitively normal, somewhat overweight, older people with family histories of dementia and initially poor dietary habits.  They were not trying to treat Alzheimer's, but simply measure how much decline occurred in populations with normal cognition.  They tried to keep one cohort on the MIND diet, while members of the other group were only supposed to change their eating habits to reduce their intake of calories.  For three years...

The researchers concluded, "Among cognitively unimpaired participants with a family history of dementia, changes in cognition and brain MRI outcomes from baseline to year 3 did not differ significantly between those who followed the MIND diet and those who followed the control diet with mild caloric restriction."

But the study design has its critics.  For one thing, there was some social mingling between the two groups, and some in the control group may have gotten some clues about what their diet should look like from the study group.

Some critics also said the groups were too small for statistically significant results.  Also, covid interfered with conduct of the study, and control by researchers needed to relax to telephone conversations.  And covid caused a significant number of participants to drop out.

So that was the "definitive" study.  Fortunately, there have been other studies with more positive results for the MIND diet.  We've reported on some of them, including this one.  And here's another, more recent one.  An interesting finding is that the MIND diet is more effective for brain health in women than in men.  Why?  Who knows.

So I'm staying with the MIND diet and intermittent fasting.  It's all working for me.  Why rock the boat?

Can the Cabernet and Bree crowd evade Alzheimer's disease?

My friend Jim alerted me to a study published December 15 in the Journal of Alzheimer's Disease finding ways in which diet affects vulnerability to Alzheimer's disease.  The attention-getters were that wine and cheese consumption were correlated with reduced risk of Alzheimer's disease.  The study was entitled "Genetic Factors of Alzheimer’s Disease Modulate How Diet is Associated with Long-Term Cognitive Trajectories: A UK Biobank Study."  (Here's a more accessible discussion.)  It relied on an extensive database of medical histories of 1,787 subjects in the UK.  It was conducted by researchers from Iowa State University. 

Moderate consumption of alcohol, including but not limited to, the form of red wine, has already been correlated with reduced risk of dementia.  However, the idea cheese can be protective flies in the face of other studies, notably the work of Martha Clare Morris, creator of the MIND diet.  (Dr. Morris died of cancer about a year ago.) 

As we discussed in Beating the Dementia Monster, the MIND diet is a hybrid of the Mediterranean diet and the DASH diet, but it excludes cheese, stick margarine, fried foods, sweets, and red meat.  The new study also suggests avoidance of red meat, except that lamb consumed once a week is protective.  (Someone please alert Mary.)  For me, the hardest reach was to avoid cheese.  

Why does research lead to the exclusion of cheese from the MIND diet, while the new study finds that cheese is the most protective food with respect to resisting Alzheimer's disease?  One possible answer occurs to me, and that is differences in how data was sliced and diced in the different research projects.  

From the information I've seen, the researchers in the new study more finely characterized the different research participants with respect to the nature of their diseases.  I say "diseases" because it's increasingly clear that Alzheimer's disease comes in a variety of flavors, based on its genesis.  Some cases are prompted by the presence of the ApoE4 gene variant, while others are prompted by a variant of the gene for the amyloid precursor protein, and some arise from even more genetic variations.  And some variations of the disease may arise entirely from lifestyle problems.  Alzheimer's disease behaves differently in different diverse populations.  These differences seem to correlate with differing manifestations and behaviors of the disease.  The new study appeared to me to control for these differences differently from other studies.

We're hoping for more enlightenment in April.  That's when the results of the (hopefully) definitive study of the MIND diet -- The MIND Diet Trial -- are to be released.  We've been waiting for a couple of years for this, but I'm worried that covid will affect the release.  We'll see, but I'll write about it as soon as results are available.   

Now a more reliable way of evaluating diet and cognitive decline

Nutritionists and other researchers have been trying for years to correlate the Mediterranean diet with its influence on the rate of cognitive decline.  Does adhering to the diet slow cognitive decline, either from normal aging or from disease?  

We discussed this in Beating the Dementia Monster.  Research to date has actually been a bit confused.  Some research finds the diet is great for the brain, while other studies found no help.

What's going on here?  Well, the big challenge is knowing whether people are accurately reporting what they eat.  The studies are all based on surveys, and the study participants must accurately report how they eat.  My observation is that this information is highly subjective and subject to wishful thinking.  Aren't we all good boys and girls that always eat our Brussels sprouts?

And what about pizza?  Isn't that Mediterranean?  To dieticians like the late Dr. Martha Clare Morris, it's the worst possible food for brain health.  But I'd bet that gets reported as Mediterranean in some surveys.

Studies to date have been qualified and held at arms length by many researchers.  So what to do?

Recently, researchers in France published 12 years worth of research that took a novel approach to verifying what people actually consumed.  Basically, they sampled the blood of the participants and analyzed for the metabolites that should be there if someone is adhering to the diet.  They did this in two geographically distinct study populations.

So what's a metabolite?  A metabolites is a molecule from the chemicals that result when food is metabolized, and they can be found in the blood stream.  Spinach will produce one set of metabolites, while a chocolate eclair will produce another set.  Ingenious.

The research was published in October in the journal Molecular Nutrition and Food Research.  The researchers concluded, "A greater adherence to the [Mediterranean diet], here assessed by a serum [Mediterranean diet metabolic score], is associated with lower odds of [cognitive decline] in older adults."  Here's an article about the study.

How much did the diet help with cognitive decline?  Good question.  And they aren't clear about that.  So I'm guessing not as much as you might hope.

You probably know that I try to follow the MIND diet.  MIND stands for “Mediterranean-DASH Intervention for Neurodegenerative Delay.”  It tries to derive the best from both the Mediterranean and DASH diets.  The DASH diet was designed to help with heart health.  And you know what the neurologists all say: "What's good for the heart is good for the brain!"  I'd just say most simply that the MIND diet is the Mediterranean diet without cheese, butter, and stick margarine.  And maybe an extra helping of blueberries.  The MIND diet seems to produce better results than the Mediterranean and DASH diets for brain health,

Interesting Content in UW Dimensions Magazine

I just received my pdf copy of Dimensions magazine, Spring/Summer 2019 issue, published by the UW Alzheimer's Disease Research Center.  It is chock full of really interesting material.  But if you don't have time to read it, here are my takeaways.

Voice Biomarkers

An article on voice biomarkers was especially significant to me.  Why?  Because I was a participant in some of the research behind the article.

Some time ago I participated in research in which I periodically sent recordings of my voice to be analyzed.  They were looking for clues to the emergence of neurodegenerative disease in changes in someone's voice.  I had been waiting for a long time to hear the outcome of the research, and the article marked where it's now at.

The goal of the research is to be able to take a recording or series of recordings of someone's voice and reliably find indication of AD, ALS, early Parkinson's, and frontotemporal degeneration -- and be able to distinguish them.  They're not there yet, but the researchers are optimistic that, with a lot more voice samples (many more), they'll be able to do this.

I believe this direction of research has basis for optimism.  I have always felt that my own voice did begin to change at about the time my disease was diagnosed.  My perception is that it has varied over the course of time in ways that I can detect, although no one else seems to notice.

Bilingualism and Neurodegenerative Diseases

There was a brief summary article about research into how disease can affect both first languages and acquired second languages.  Researchers would like to know several things, including answering the commonly asked question, does bilingualism confer a protective effect for neurodegenerative diseases, notably AD.  The article noted that, so far, the evidence is conflicting,

The actual research did not study AD, but rather something called primary progressive aphasia, or PPA.  PPA is a neurodegenerative disorder that impairs language abilities over time, such as speaking and word finding.  The main finding so far is that PPA impairs both first and second languages in about the same way.

The article talked about comparing people who's first language is English and their second language is Spanish.  I said, "Hey, that's me!"  I began learning Spanish on my 59th birthday which was in 2008.  My first symptoms of AD (balance problems) probably began in 2012.

My neurologist at Harborview was one of the credited researchers for this study, and she wrote the article for the magazine.

Busting Myths about Alzheimer’s Treatments and Diets

The myth-busting article goes very well with the article I cited in my March 11 post about the FDA going after supplement snake oil salesmen.  Consistent with what I wrote in Beating the Dementia Monster, people will be attracted to supplements when there is a terrible problem, but medical science has so little to offer.  But, as noted in the 2019 Alzheimer's Association Facts and Figures Report, no supplement has been shown scientifically to reverse, stop, or even slow the advance of AD.

The article began by discussing what can go wrong when a hypothesis is accepted before it's properly tested.  It recalled how, in 1965, some scientists found that injecting rabbits with a aluminum salts could produce some of the physiological changes associated with AD.  Subsequent research found that human uptake of aluminum could not be correlated with an increased risk of developing AD, but nevertheless there was great anxiety about using aluminum in cooking utensils and other applications.  These included, for example, body deodorants.  Even today, aluminum cookware sometimes carries warnings about a link between aluminum and AD.

In 2013, a researcher at the UW Harborview Brain Wellness Center had some of his research published in the New England Journal of Medicine correlating blood glucose levels with risk of dementia.  This finding was a motivator behind a New York Times best seller, The Grain Brain.  But The Grain Brain seriously distorts the research.  It infers that you can control AD risk by controlling dietary intake of gluten-heavy grains that tend to have a higher glycemic index than fruits and vegetables.  Grains would therefore produce larger changes in blood sugar, and eating more grains will increase your risk for dementia.  The researchers who originated the data reject this conclusion, but The Grain Brain is still a best seller on Amazon.  Medical experts are concerned that the erroneous conclusions will lead people to remove beneficial foods from the diet for invalid reasons.

The neurology researchers went after the coconut oil fad, pointing out that it can actually increase AD risk, not help.  This occurs because coconut oil is is a highly saturated fat, and saturated fat consumption is associated with higher risk of AD.  (The MIND diet pretty much eliminates saturated fats.)  The researchers noted that moving from a diet heavy with saturated fats to one with unsaturated fats can provide a benefit for blood pressure equal to starting on a statin drug.  Bottom line:  throw out your coconut oil and use olive oil.

The article had an interesting discussion of the Keto diet, which has been touted as good for brain health.  And maybe it is, but not necessarily across the board.  If you're interested, you should read the article.  Apparently there are some scenarios in which the Keto diet can help, and others in which it may hurt.  But the article concludes that it's such a difficult diet to maintain, that you should try other options.

The article ends with a plea for common sense.  Eat a balanced diet free of what we know is junk and get plenty of exercise.  The Mediterranean and MIND diets fill that bill for diet.  The Mediterranean diet has us eating what we know is good, and the MIND diet seems to improve on that.  But -- the jury is still out on the MIND diet.  The article noted that there is a major study on the MIND diet, but we won't see results until April 2021.  It then goes on to emphasize the importance of exercise.  It contrasts the contradictory evidence around diet and brain health with the unambiguous connection between an active lifestyle and brain health.

 

Watch This Space

As the primary focus of the search for an Alzheimer's and dementia treatment moves away from a silver bullet pharmaceutical intervention, there is a lot of work going on to understand the power and limitations of lifestyle interventions.  There are two important studies that I'm watching and, when finished, will tell us a lot.

The first is the MIND diet study, which we discussed before.  The existing evidence is that the MIND diet may be measurably better than either the Mediterranean diet or the DASH diet at improving cognition.  There have been several studies suggesting this, but there is a belief that one more big trial is necessary to convince everyone of it's power.  This highly anticipated study employees 600 subjects and is to run three years.  We expect results in April 2021. 

If you read this blog, you know that I follow the MIND diet, and I am quite enthusiastic about its prospects.  It is particularly suited for Alzheimer's disease, because it addresses both oxidation damage in the brain and neuroinflammation.

The other important study is the US POINTER study, sponsored by the Alzheimer's Association.  The study involves 2,000-2,500 subjects who do not currently show signs of cognitive decline but are at higher risk.  It will examine the influence of lifestyle over a two-year period.  Recruitment began in 2018, and they say we can hope for results in late 2022 or early 2023.

We wrote earlier about the very important Finnish FINGER study, which produced a trove of data relating lifestyle to cognition.  (We noted that it evaluated a diet similar to the Mediterranean diet, but not like the MIND diet.)  So the United States is one of several countries trying to replicate these results, but also putting on our own spin.   For example, Finland has a pretty homogeneous population, where the US and some other countries are more ethnically diverse.  We know that Alzheimer's disease affects different ethnicities differently, so it may be that the effectiveness of lifestyle interventions may vary by ethnicity.  The US study will try to evaluate for this.    

Why the MIND diet excludes cheese, butter, and margarine -- now we may know

In the longitudinal studies the late Dr. Martha Clare Morris conducted that led to the development of the MIND diet, Dr. Morris found an association between consumption of red meat, butter, stick margarine, and cheese with the development of Alzheimer's disease.  So these are excluded from the MIND diet, even if they might be more tolerated in the Mediterranean diet.  When I speak to a group about diet, and I say that avoiding saturated fats helps insulate you from Alzheimer's disease, I hear groans.  Especially when I mention the cheese.

Longitudinal studies look at associations of behaviors and possible consequences over time, without necessarily explaining the reason for the associations.  So correlation isn't causation, and maybe there's some weird reason for the association that, if understood, would allow us to go back to cheese.  Unfortunately...

Saturated fats, cholesterol, and high-fat diets got a lot of bad press in the 1980s and 90s as being strongly correlated with heart disease.  But it turned out that the evidence for these associations was weak, and the government and health authorities backed off on strong recommendations that food high in saturated fats and cholesterol be avoided.  For example, it seemed like eggs were just poison, because they have so much cholesterol in the yolks.  But later research failed to find the strong link between egg consumption and the actual heart disease postulated by the cholesterol-heart disease hypothesis.  So they told us to go back to eating eggs.

So while the evidence of an association between a diet high in saturated fats and heart disease began to weaken, the association with Alzheimer's disease actually strengthened.  But what was the basis for the association?  I've been wondering this for a while.  And maybe we now know.

I came across this article on the science news web site, PsyPost.  It cites research from the journal, Nutrients, which claims to have found evidence that could explain the association between saturated dietary fats (cheese, butter, etc.) and Alzheimer's disease.  But it's kind of complicated, so you may just want to know that they think they're better able to explain the relationship between consumption of saturated fats and the development of obesity, type 2 diabetes, and Alzheimer's disease.  (Note that this particular study does not connect heart disease with a diet with saturated fats.)

Going a little deeper, the study examined the role of microRNAs (miRNA) in the "expression of genes."  Which means how proteins are generated when genes in DNA are read by messenger RNA (mRNA).  The miRNA (which have only been recently discovered) are supposed to regulate the production of proteins by exercising control over the mRNA that's making the proteins.  There are many different types of miRNA influencing the production of many different proteins.  Many of the miRNA live in parts of the brain like the hippocampus -- ground-zero for Alzheimer's disease.  Some can influence the development of insulin resistance in the brain.  As we explained in Beating the Dementia Monster, as insulin resistance advances we call it type 2 diabetes and it is strongly associated with Alzheimer's disease.

With that background, the researchers studied the diets of mice (again...) along with changes in their memories and other abilities.  The researchers also examined the mouse brains in autopsy.  They controlled the mouse diets so that the mice consumed known amounts of saturated fats.  The researchers found that a diet high in saturated fat seemed to disrupt the miRNA in its task of allowing proper generation of proteins and the work of insulin in signaling cells to consume glucose.  An important part of both type 2 diabetes and Alzheimer's disease is the failure of cells to properly take up and metabolize glucose.  And so they call Alzheimer's disease type 3 diabetes.  (We discussed all of this in Beating the Dementia Monster.)

It appears to me that this is a very different pathway to type 2 diabetes than the one we discussed in Beating the Dementia Monster.  The better known pathway is excessive consumption of carbohydrates generates a steady output of insulin that overwhelms the cells.  The insulin is supposed to signal the cells to take up glucose, but it hits a point where the overwhelmed cells stop taking up glucose.  Then glucose levels in the blood get excessively high and begin damaging organs.

This was all fascinating to me, but I'm not sure how many of you are still here.  The bottom line?  Staying away from red meat, butter, stick margarine, and cheese remains part of a diet for those of us avoiding or fighting Alzheimer's disease.

Is consuming olive oil associated with reducing dementia-related death risk? Answer: Yes

We said in Beating the Dementia Monster that olive oil is an important component of the MIND diet -- and, for that matter, the Mediterranean and DASH diets.  Since the MIND diet avoids stick margarine and butter, we use olive oil in their place.  I put olive oil on whole grain bread and enjoy it just as much as butter.  (Your mileage may vary...)  But how good is the evidence that olive oil is really better for you than those other fats?  Well, there's some news.

It turns out that one of the most widely read articles of 2024 in the JAMA Network publication (formerly Journal of the American Medical Association) addressed this.  The article reported on a study of 92,383 adults observed over 28 years that found those who consumed at least 7 grams per day (g/d) of olive oil had a 28% lower risk of dementia-related death compared with never or rarely consuming olive oil.  That's pretty substantial!  This was irrespective of diet quality or genetic predisposition.  Authors of the study concluded, "In US adults, higher olive oil intake was associated with a lower risk of dementia-related mortality, irrespective of diet quality. Beyond heart health, the findings extend the current dietary recommendations of choosing olive oil and other vegetable oils for cognitive-related health."

Some who commented on the research noted that it was a longitudinal study, which is considered a little less reliable than a randomized controlled study.  A longitudinal study looks at a population and draws conclusions about correlations.  But "correlation is not causation," as they like to say.  Randomized controlled studies do a better job of accounting for "confounding variables."  In a randomized controlled study, you actually change something and measure the result.  We look forward to the results of the US POINTER study which is now in progress.  It will hopefully confirm the findings of the FINGER study we discussed in Beating the Dementia Monster.  Both studies address lifestyle factors with respect to the development of Alzheimer's disease, including diet.

I'm thinking that blueberries and olive oil may be the two key ingredients in the MIND diet.  Of course, diet is a key tool in the Dementia Toolkit.

Consume stinky stuff to improve cognition

In the second edition of Beating the Dementia Monster, we were cool to the role of dietary supplements in improving cognition in Alzheimer's disease.  However, we noted that some interesting research was in progress on something called spermidine.  Spermidine is a chemical found in the ribosomes of living tissue that contributes to a variety of metabolic functions.  

Ribosomes are an example of a type of structure in the cell called organelles in which proteins are constructed.  Organelles are to the cell what organs are to the body.  Messenger RNA brings design information from DNA to the ribosome, where a polypeptide chains of amino acids is assembled to be shaped into a functional protein.  

Spermidine contributes to maintaining the correct electric charge on membranes, and helps control the pH and volume of fluids between cells.  It does this by synchronizing an array of biological processes.  (Or that's what the Wikipedia says.) 

Spermidine is considered to be an agent of longevity in mammals, because it can, among other things, reduce inflammation and discourage oxidation.  And, of course, inflammation and oxidation play major roles in Alzheimer's disease.

So where do you find spermidine?  Well, it was first isolated in semen, but it can also be found in rotting flesh ... as well as other stuff that's gone bad, such as fermented beans.  But a properly constructed Mediterranean diet will have plenty of spermidine.  Aged cheddar cheese, broccoli, and wheat germ are recognized sources of spermidine.

The question is, can taking spermidine as a supplement improve cognition, perhaps by battling the Alzheimer's disease process?  Maybe, but we don't know yet.

Over the past several years research with fruit flies and mice have suggested that it can, although not strongly.  But what about in people?

An Austrian study, called the Bruneck Prospective Study, evaluated the lifestyles and eating habits of 829 subjects in five-year increments from 1995 through 2010, with followup in 2015.  The study explicitly inferred the amount of spermidine in people's diets and compared that to mortality.  While not a direct objective of the study, the researchers tested cognition of participants at each milestone.

The first finding was that people with spermidine in their diets statistically lived longer, although its not clear that all confounding factors were controlled.  The study also produced a rich database with which the influence of spermidine on cognition could be assessed.  Those who evaluated the data concluded that those with higher spermidine content in their diets were less likely to become cognitively impaired in succeeding years.  

Another study correlated spermidine dietary intake with changes in hippocampus volume and thickness of the cortex.  The study relied on the Mediterranean diet as a source of spermidine.  Since the MIND diet is derived from the Mediterranean diet, it's likely that results would be similar with the MIND diet.  Perhaps the results of the MIND Diet Trial in June will support this correlation.

But what about spermidine supplements?  There are certainly a lot of them on the market.  At this point, there is interest in the prospect that spermidine supplementation will have the same effect as consuming a diet high in spermidine, but there are no completed studies with sufficient credibility to support the idea.  However, there is one study that had promising results with a small cohort of test subjects, and it formed the basis for a larger study.  That study, called the SmartAge study, and a phase 2B is now in progress.  

What will if find?  We'll need to wait and see.  The difficulty is that results with animal models found a positive but disappointingly mild influence of spermidine on cognition.  Will humans fare better? 

No cheese -- Why not??

When I speak to a group about lifestyle changes to prevent or slow the advance of Alzheimer's disease, I hear the loudest groan when I talk about diet ... notably when I say that the MIND diet rules out cheese.  That's because everyone loves cheese.

Cheese and other saturated fats were implicated in heart disease for many years, but they were somewhat rehabilitated during the 1990s.  This rehabilitation is controversial, and the fact that most saturated fats have animal origins prompts those wishing to protect animals to influence the debate.  It's been my observation that, over the past two years or so, the consensus of online authoritative sources has shifted from a relatively benign view of saturated fat to a more critical one.  And so some authorities discourage the consumption of saturated fats (for example here and here), while others cite less critical research to permit moderate consumption (for example here and here).  We discussed this in Beating the Dementia Monster, citing the writing of Dr. Mark Hyman, and his book Food; What the heck should I eat.

Regardless of how one might come down on the debate with respect to heart disease, research by the late Dr. Martha Clare Morris sustained the strike against saturated fat with respect to Alzheimer's disease.  (See her book Diet for the Mind.)  Neurologists like to say "what's good for the heart is good for the brain," and there is a strong correlation between heart disease and Alzheimer's disease.  So shouldn't the influence of saturated fat on heart disease (whether strong or weak) have a consistent influence on Alzheimer's disease?  

Well, apparently not.  Dr. Morris's research seems to dissociate the two effects.  (Again, this is all controversial with respect to heart disease, and everyone cites their favorite research.)  

When I was preparing the second edition of Beating the Dementia Monster, I puzzled over this apparent anomaly.  Of course, my underlying assumption was that a negative effect on saturated fat should come to the brain via a negative effect on the cardiovascular system.  But maybe that's not true.  And I've found something to suggest an explanation.

Several times on this blog we have discussed the gut-brain axis.  There is a poorly understood relationship between what goes on in the gut and what goes on in the brain.  Most of it hinges on the activity of many different bacteria (and archaea) in the gut.  So when the life of the "microbiome" in your gut is disrupted by antibiotics or the wrong kind of nutrients, it can adversely influence the brain.  And on this blog, we are very interested in influences on the brain that promote or discouraged the advance of Alzheimer's disease.

I got to thinking about this today when I was at the gym watching this video about diet and the gut microbiome.  This particular channel is big on promoting a vegan or vegetarian lifestyle (and so may be a bit biased), but I found what they were saying compelling.  (Acknowledging that they may be biased is not to discount their authority, only to acknowledge that every source is biased in some way, and we are wise to always consider that in assessing what someone is telling us.)  

What caught my attention was a statement that cheese has a bad effect on the gut microbiome.  If so, that would explain it.  Cheese (and other saturated fats) may be getting something of a pass with respect to cardiovascular disease, but it's still a recognized and important factor in the development and advance of Alzheimer's disease. 

So cheese is bad for brain health, but not because it affects the cardiovascular system.  It affects the gut microbiome.

So what do the recommend that you eat?  After discussing the affect of different nutrients on the gut, the presenter reviewed the best foods to eat for gut health.  Well, guess what ... everything she named as being positive for gut health is right out of the MIND diet.  

Of course, we discuss the MIND diet in Beating the Dementia Monster, and I've been trying to follow it now for several years.  I'm sure it's making a contribution to my success in dealing with Alzheimer's disease.

How Bad Are Ultraprocessed Foods?

How bad are ultraprocessed foods?  Well, it depends on who you ask.

But first, what are we even talking about?  Back in August 2022, we discussed a relationship between a lifestyle of consuming ultraprocessed foods and Alzheimer's disease.  One thing we did in that article was explain what ultraprocessed foods are and give examples.  We also cited specific research associating things we eat that may qualify more as industrial products than food with the development of dementia.  For our purposes, in the Dementia Toolkit, we focused on the correlation of refined sugar and refined flour with inflammation and oxidation in the brain.  That's bad for Alzheimer's disease.  But the thought is that, beyond that, more bad stuff is going on with carbonated soft drinks, sweetened breakfast cereals, candy, packaged snacks, powdered instant soup, reconstituted meat products, etc.  These may (or may not) be causing the worldwide obesity epidemic, and obesity is associated with the development of Alzheimer's disease.

I came across a fascinating article in The New Yorker magazine that first looked at some interesting research conducted at the National Institute of Health but then interviewed some of the critics of the research.  The outcome was a sort of survey of diverse thinking on this subject.  And it is diverse.  

The concept of ultraprocessed foods was proposed by the Brazilian researcher we discussed in the 2022 article, but research aimed at confirming the hypothesis that anything meeting the definition of ultraprocessed food will put you in memory care has been mixed.  The research was published in the journal Cell Metabolism.  They weren't concerned with Alzheimer's disease, but rather obesity.  Does consuming ultraprocessed foods really cause obesity, or is that a myth?  And if so, why?  (Anything causing obesity will lead to Alzheimer's.)  

The answer is yes, it does.  But calorie for calorie, the influence on body mass is the same between ultraprocessed foods and real food.  It seems that, more than anything, people just like the soda and salami a lot more than real food, and so they eat a lot more of it.

The article did discuss the spectrum of foods that can be classified as ultraprocessed, noting that they're not all bad for you.  It kind of depends.  Yogurt without cane sugar can be considered ultraprocessed, but the article says that doesn't mean that it's bad for you.  (Exceptions: people with lactose intolerance and those concerned that dairy in general has a downside.)  Organic whole grain bread can also be considered ultraprocessed, but it's part of the MIND diet.  So some critics don't think there's been adequate discernment between the types of ultraprocessed foods that are or are not a problem.

How the research was conducted was quite interesting.  They took 10 men and 10 women and locked them away for a couple of weeks.  They were watched closely enough to make sure that no one ate anything that wasn't provided to them in the study protocol.  They were given as much food as they wanted to eat during 60 minute meal times, rotating between unprocessed and ultraprocessed foods at the end of each week.  Steps were taken to obscure what class of food people were being given.  Test participants were weighed at the end of each rotation of foods.

Participants gained an average of nearly 0.9 pounds after a week on ultraprocessed foods, but lost an average of about 0.7 pounds after a week on real food.  The authors concluded, "Our data suggest that eliminating ultra-processed foods from the diet decreases energy intake and results in weight loss, whereas a diet with a large proportion of ultra-processed food increases energy intake and leads to weight gain."

I try to stick with the MIND diet, avoiding ultraprocessed foods.  I do eat plain yogurt that I sweeten with allulose and monk fruit sweeteners (mixing in walnuts and blueberries), which might qualify as ultraprocessed.  And I eat a couple of slices of whole grain bread, as called for by the MIND diet.  But, even when I combine this diet with regular fasting, I still struggle to keep my weight where I want it.

Early exposure to a "western diet" impairs memory function. Uh oh.

Yes, it's been more than two weeks since I last posted. I've had plenty to keep me busy; I'm not just running out of gas.  I hear from some of you who worry about me.  But I'm OK.

I came across some recent research with implications for the diets of children and later memory loss.  But there's no real news.  Saturated fats, refined sugar, refined flour, and otherwise processed foods are still bad.  Very bad.  What's new in this research is that the negative effects begin with children when they are on what they referred to as a "western diet."  You know, pizza, red meat, fast food, and other processed foods.  (According to the late Dr. Martha Clare Morris, in her book Diet for the Mind, pizza seems to be the very worst thing for your brain that you can take in...)

The research was published in the journal Brain, Behavior, and Immunity.  The article was "Western diet consumption impairs memory function via dysregulated hippocampus acetylcholine signaling."  The researchers claimed to find causes and effects in several areas we've discussed before, both in Beating the Dementia Monster and in this blog.  For example, the western diet is hard on the gut microbiome that has such an important regulatory function for the brain.  Also, the western diet disrupts processes in the hippocampus that are so vital to memory.

Now, to be fair to McDonald's, the research was conducted with rats, not people.  And we've discussed before how brain research results from rodent models applied to people has sometimes been discredited.  In this case, the researchers wanted to know what would happen if rats ate a western diet during their juvenile stage of development, 26 to 56 days after their birth.  The rats were fed cafeteria-style, giving them the opportunity to choose whatever (junk) food they wanted.

I'm thinking this age may correspond, in people years, to when I began to earn enough money to begin eating fast food on my own.  Fast food became my regular diet at a fairly young age.  So maybe diet in my juvenile years has something to do with why I'm where I'm at today.  But I'm confident that generally following the MIND diet over the past seven or eight years has contributed to my present well-being.

How it all went

As advertised, I had my lumbar puncture/spinal tap on Monday, and the kidney stone treatment on Wednesday.  All went fine.  The spinal tap was significant, because it probed what was going wrong in my brain to cause my balance problems.  The kidney stone seems to be a consequence of the way I have implemented the MIND diet -- too much spinach and almonds.  So I should rely more on kale and broccoli instead of spinach, as well as peanuts and walnuts instead of almonds.  These have less oxalate, but have similar benefits for brain health.

We arrived at the hospital in time for my appointment at 5:55 a.m.  Really early.  I was in general anesthesia when they inserted the stent in my right ureter and then hit the stone with shock waves.  When I woke up, I was back in the recovery room for a couple of hours, and then we went home.  That was a little after 11:00 a.m.  

So far I've had very little pain but a certain amount of blood in my urine.  With the stent still in, they don't want me to go back to the gym for a while.  They want to give the fragments a couple of weeks to pass, and then they'll do a CT scan to see if any are left too big to pass through the stent.  If there are, we go back for another shock wave treatment.  I may still need general anesthesia to remove the stent, but I'm not sure.

So this wasn't too terrible, at least no so far.  I always feel kind of crummy the day after general anesthesia, and today is no exception.  But I'll be fine.

I'll be seeing the urologist in early January.  He should have results of chemical analysis of the stone to determine how I should modify my diet.  But the situation looks clear to me.  I read that about 80% of kidney stones are oxalate, and that correlates with me increasing my intake of foods high in oxalate for the MIND diet.  But there are plenty of ways to implement the MIND diet without overdoing it on oxalate.