According to the World Health Organization, 80% of all heart disease, stroke, and type 2 diabetes as well as 40% of all cancer diagnoses are preventable with proper risk-factor management via lifestyle interventions. Furthermore, the fundamental cause of mental health conditions such as depression and anxiety may be rooted in lifestyle patterns.
According to research, participants who complete a multimodal lifestyle intervention can enhance their overall mental health by 20% and reduce their depressive symptoms, anxiety, and stress by 30%.
Implementation of Lifestyle Medicine principles can encourage sustainable daily habits, optimize physical and mental health, and improve overall quality of life for all individuals.
A recent study in the Journal of the American Medical Association has also revealed a lower risk of dementia in participants with a favourable lifestyle, emphasizing the beneficial impact of healthy lifestyle habits on cognitive function.
In this feature, we look at how lifestyle medicine can help in improving neurocognitive decline by applying the six pillars of Lifestyle Management which include plant-based nutrition, physical activity, stress management, avoidance of risky substances, restorative sleep, and social connections.
What is Lifestyle Medicine?
According to Standford, Lifestyle medicine strives to optimize physical and mental health through seven lifestyle pillars: nutrition, sleep, fitness, stress management, social relationships, passion and purpose, and cognitive enhancement. Rather than just treating symptoms, lifestyle medicine uses evidence-based principles to develop preventive measures and address the underlying cause of disease. The ultimate goal is to increase longevity and improve the quality of life for people of all ages and backgrounds.
The Impact of the Six Pillars of Lifestyle Medicine on Brain Health
A research study published in the journal PubMed Central demonstrates with evidence improvement in neurocognitive decline by applying the six pillars of Lifestyle Management which include plant-based nutrition, physical activity, stress management, avoidance of risky substances, restorative sleep, and social connections.
The research study focussed on how the pillars of Lifestyle Medicine (LM) impact Brain Health and specifically dementia. According to the authors of the study Ecler Jaqua, Edna Biddy, Clare Moore, and Genise Browne Lifestyle changes have a significant impact on brain health.
According to the study, plant-based eating improves cognition by lowering the risk of Alzheimer’s disease (AD) in those who follow the Mediterranean-Dietary Approach to Systolic Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND). Physical activity may also protect against neurocognitive decline by increasing the levels of fibronectin type III domain-containing protein 5 (FNDC5) and Irisin in the hippocampus, which enhances energy expenditure and endurance.
Furthermore, higher levels of perceived stress in adulthood, as well as the use of dangerous substances such as alcohol, cigarettes, and opioids, are strongly linked to the development of moderate cognitive impairment and all-cause dementia. Furthermore, there is a link between poor sleep and social isolation, and a rapid deterioration in cognitive function. Changes in lifestyle have a significant impact on brain health. As a result, the primary treatment tool should always be prevention.
Lifestyle medicine and its six pillars Lifestyle medicine (LM) is a medical specialty that focuses on changing one’s lifestyle to treat chronic conditions. It is an evidence-based practise that assists individuals and families in implementing and maintaining healthy behaviours that improve their quality of life. Many studies show that using the six pillars of LM can help to avoid and eventually improve neurocognitive deterioration:
- Plant-based nutrition
- Physical activity
- Stress management
- Avoidance of risky substances
- Restorative sleep
- Social connections
Furthermore, the LM pillars address modifiable risk factors for substantial neurocognitive impairment, such as hypertension, depression, smoking, insulin resistance, type 2 diabetes, hypercholesterolemia, and obesity.
- Whole food, plant-based nutrition
Numerous studies have suggested and firmly supported a whole foods diet’s good impact on cognition. The Mediterranean diet, the Dietary Approach to Systolic Hypertension (DASH), and the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) are the most frequent diets related to cognitive protection.
The Mediterranean diet was inspired by places such as Greece, where the nutritional pattern is impacted by the country’s proximity to the Mediterranean Sea. It emphasizes a high intake of fruits, vegetables, legumes, nuts, grains, and olive oil, a moderate intake of alcohol and dairy, and a reduction in intake of red meat, processed meat, saturated fats, and sweets. This mix of food groups is thought to supply vital micronutrients and fibres while lowering the risk of neurodegenerative diseases such as AD.
Daytime eating boosts mental health
A Brigham and Women’s Hospital study on meal scheduling discovered that eating at night raised participants’ melancholy and anxiety-related mood levels.
The researchers devised a trial that replicated night work and then compared the impact of daytime and midnight eating with solely daytime eating. The researchers discovered that among participants in the daytime and nighttime eating groups, depression-like mood levels increased by 26% and anxiety-like mood levels increased by 16%. This rise was not observed in the daytime-only eating group, implying that meal timing may alter mood vulnerability.
“Our findings provide evidence for the timing of food intake as a novel strategy to potentially minimize mood vulnerability in individuals experiencing circadian misalignment, such as people engaged in shift work, experiencing jet lag, or suffering from circadian rhythm disorders,” said co-corresponding author Frank A. J. L. Scheer, PhD, Director of the Medical Chronobiology Program in the Brigham’s Division of Sleep and Circadian Disorders. “Future studies in shift workers and clinical populations are required to firmly establish if changes in meal timing can prevent their increased mood vulnerability. Until then, our study brings a new ‘player’ to the table: the timing of food intake matters for our mood.”
“Shift workers — as well as individuals experiencing circadian disruption, including jet lag — may benefit from our meal timing intervention,” said co-corresponding author Sarah L. Chellappa, MD, PhD, who completed work on this project while at the Brigham. Chellappa is now in the Department of Nuclear Medicine, University of Cologne, Germany. “Our findings open the door for a novel sleep/circadian behavioural strategy that might also benefit individuals experiencing mental health disorders. Our study adds to a growing body of evidence finding that strategies that optimize sleep and circadian rhythms may help promote mental health.”
“Meal timing is emerging as an important aspect of nutrition that may influence physical health,” said Chellappa.
Some flavours in some foods resemble a prescription mood stabilizer
According to scientists in Philadelphia, a research study presented at an exposition reveals the possibility of mood-enhancing effects associated with some flavours, stemming at least in part from natural ingredients bearing a striking chemical similarity to valproic acid, a widely used prescription mood-stabilizing drug. This impact is like those previously documented for chocolate, tea, and a few other well-known comfort foods.
“Molecules in chocolate, a variety of berries, and foods containing omega-3 fatty acids have shown positive effects on mood. In turn, our studies show that some commonly used flavour components are structurally like valproic acid,” said Karina Martinez-Mayorga, Ph.D., leader of a research team that has been studying the effects of flavours on mood.
Sold under brand names that include Depakene, Depakote, and Stavzor, valproic acid is used to smooth out the mood swings of people with manic-depressive disorder and related conditions.
“The large body of evidence that chemicals in chocolate, blueberries, raspberries, strawberries, teas, and certain foods could well be mood-enhancers encourages the search for other mood modulators in food,” noted Martinez-Mayorga.
“It is important to remember that just eating foods that may improve mood is not a substitute for prescribed antidepressive drugs,” Martinez-Mayorga cautioned. And for people not requiring medication, she notes that eating specific foods and living a healthful lifestyle can generally boost mood.
Your mood depends on the food you eat
According to new research from Binghamton University, State University of New York, diet and dietary practices effect mental health differently in young adults than older adults.
Lina Begdache, assistant professor of health and wellness studies at Binghamton University, and Nasim Sabounchi, assistant professor of Systems Science and Industrial Engineering, discovered that food that increases the availability of neurotransmitter precursors and concentrations in the brain (meat) appears to be dependent on mood in young adults (18-29). However, mood in mature adults (over 30 years) may be more dependent on foods that improve antioxidant availability (fruits) and abstinence from foods that incorrectly activate the sympathetic nervous system (coffee, high glycemic index, and missing breakfast).
“One of the major findings of this paper is that diet and dietary practices differentially affect mental health in young adults versus mature adults,” said Begdache. “Another noteworthy finding is that young adult mood appears to be sensitive to the build-up of brain chemicals. Regular consumption of meat leads to the build-up of two brain chemicals (serotonin and dopamine) known to promote mood. Regular exercise leads to a build-up of these and other neurotransmitters as well. In other words, young adults who ate meat (red or white) less than three times a week and exercised less than three times week showed a significant mental distress.”
“Conversely, the mature adult mood seems to be more sensitive to regular consumption of sources of antioxidants and abstinence of food that inappropriately activates the innate fight-or-flight response (commonly known as the stress response),” added Begdache. “With aging, there is an increase in free radical formation (oxidants), so our need for antioxidants increases. Free radicals cause disturbances in the brain, which increases the risk of mental distress. Also, our ability to regulate stress decreases, so if we consume food that activates the stress response (such as coffee and too many carbohydrates), we are more likely to experience mental distress.”
2. Physical activity
Physical activity offers numerous benefits for physical, social, and emotional health and is advised for health promotion, particularly in older persons. According to research, regular physical activity helps reduce the growth of serious neurocognitive illnesses such as Alzheimer’s. Furthermore, physical exercise promotes brain chemicals and neural connections, both of which may protect the brain and diminish with age. Mobility also aids in the prevention and improvement of some risk factors for substantial neurocognitive impairment, such as type 2 diabetes, cardiovascular disease, hyperlipidemia, and metabolic syndrome.
A few studies have suggested that physical activity may help to prevent neurocognitive deterioration by boosting the levels of fibronectin type III domain-containing protein 5 (FNDC5) and Irisin in the hippocampus. Irisin is an exercise-induced hormone that transforms white adipose tissues into brown adipose tissues, resulting in enhanced energy expenditure. Furthermore, irisin improves total glucose tolerance by increasing exercise endurance and decreasing insulin resistance. As expected, FNDC5/irisin levels in the hippocampus and cerebrospinal fluid are lower in people with Alzheimer’s disease.
When the FNDC5/Irisin pathway is triggered by exercise, a cascade of events occurs that alters neuronal activity. Increased FNDC5/Irisin levels may increase brain-derived neurotrophic factor (BDNF) production in the hippocampus, increasing synaptic integrity, neuronal cell survival, learning development, and memory. Irisin also enhances neurogenesis and inhibits amyloid-beta (A) accumulation.
Although any sort of exercise is important for overall health, several studies have found that aerobic exercise is more useful for neurocognition in patients with mild cognitive impairment (MCI) than strength training and multimodal exercises. The intensity of exercise was also investigated, and it was found to have a positive link with extraneous physical activity and increased blood flow to the brain, which improved executive function, increased brain size, and reduced the risk of neurocognitive decline.
Physical activity has been found to be the most feasible way to improve and lower the risk of dementia of all lifestyle improvements.
3. Stress management
Another factor to consider when assessing a patient at risk for dementia is their stress history. Higher felt stress in adulthood was strongly related to developing mild cognitive impairment and all-cause dementia in a comprehensive systemic review and meta-analysis of over a thousand research. In these investigations, self-reported stress levels appeared to be a credible metric, indicating that the patient was aware of the stress in their lives. Interventions for this stress, such as behavioural health, would aid in the processing of the stress experience. Patients experiencing more than two important stressful life events had a greater incidence of all-cause dementia in the same research.
Surprisingly, a single substantial stressful life experience did not correlate with dementia. It is possible to conclude that resilience to stress declines with each subsequent traumatic occurrence. In general, assisting our patients through stressful situations will benefit them not only now, but also in the future by minimizing the degree of dementia.
For at-risk individuals, proper history-taking and follow-up on stress-related risk factors is recommended. Nonpharmacologic therapies may also prevent or delay additional brain injury.
4. Avoidance of risky substances
Alcohol, cigarettes, and prescription medicines such as benzodiazepines can all have a negative impact on cognition in the elderly. Chronic alcohol consumption has a wide range of consequences, from changes in nutrition to anatomical alterations in the brain. Although much remains unknown about its impact on the progression or worsening of cognitive impairment in the elderly, several investigations have reached similar conclusions.
Alcohol use was identified as a modifiable factor in avoiding dementia in one study released by the Lancet Commission. A five-year longitudinal study and a systematic analysis discovered a link between alcohol use disorder and an elevated risk of dementia (particularly early onset). Light to moderate alcohol consumption, on the other hand, has been associated with a lower incidence of dementia. Alcohol’s protective component has recently been put into question due to potential socioeconomic class and IQ complicating factors. Furthermore, quantifying the definitions of light and moderate alcohol intake has proved difficult and contentious.
These studies, taken together, shed light on the influence of these medications on a population already predisposed to cognitive impairment and decline.
5. Restorative sleep
Sleeping allows for the repair and cleaning required to repair and avoid neural damage, as well as aiding learning and synaptic homeostasis. We spend roughly one-third of our lives sleeping; however, not all sleep is considered desirable. To begin, we must comprehend the anatomy of sleep, which is separated into four stages: N1, N2, N3 (slow sleep), and Rapid Eye Movement (REM), during which dreams are formed. Sleep patterns will change as we progress through life.
Sleep stages alter as we become older. In older persons, for example, total sleep time decreases from 14 to 7-9 hours. Most changes in sleep patterns occur before the age of 60. Total sleep time has been linked to dementia risk, with individuals needing between 7 and 9 hours of sleep every night. It has been hypothesized physio pathologically that one of the reasons for the decreasing need for sleep is that as we age, we lose neurons, particularly those connected with rest.
As a result, sleep is linked to cognitive impairment. It has also been discovered that as we age, we produce less melatonin, which aids in sleep circadian cycle management. Retirement, altered routines, stressors, caffeine consumption, and exercising before bedtime are examples of extrinsic variables. Sleep problems such as insomnia, movement disorders, and obstructive sleep apnea (OSA) are linked to increased cognitive impairment, type 2 diabetes, cardiovascular disease, obesity, and depression. Several studies have found a link between sleep and the rapid advancement of cognitive impairment caused by accumulation in Alzheimer’s disease and oxidative stress in vascular dementia.
Improving sleep quality is an effective way to prevent neurocognitive problems. Nonpharmacological treatment, such as cognitive behavioural therapy for insomnia (CBT-I) and sleep hygiene education, should be regarded as first-line therapy because it outperforms pharmacological treatment.
6. Social connections
When evaluating people with cognitive impairment, it is critical to examine social ties. Humans are distinguished from other animals by their ability to process larger volumes of information and memorize long-term and short-term knowledge. Humans were uniquely suited to create deeper relationships with other humans due to the development of the brain, which includes social connections. The social brain is thought to have evolved as a defense mechanism. Those who live in more complicated social groups may be able to execute more complex computations to aid in cooperation and competition.
“Healthy living is a way of life that helps you enjoy more aspects of your life,” according to the WHO. A healthy lifestyle will not only keep you physically fit, but it will also provide you with a wonderful social and mental life. According to the Ministry of Ayush, Government of India, for any lifestyle to be adopted the bottom line is – it should generate ‘zest for life’. And any activity, be it physical or mental, should make one look forward to a thrilling and vibrant tomorrow.