MIND diet associated with reduced incidence of Alzheimer's disease

[Stavia]

This is a new study. IMO the diet is a pretty blunt tool, quite a bit of overlap with our protocol, but whole grains and legumes have been stratified as positive. They say that a lesser effect is e4s but no data on the subgroup was included in the study. I guess its a confirmation that dietary changes do reduce dementia but no hint of mechanism and finer details. Dunno how much new there is for us in it

Alzheimers Dement. 2015 Feb 11. pii: S1552-5260(15)00017-5. doi: 10.1016/j.jalz.2014.11.009. [Epub ahead of print]
MIND diet associated with reduced incidence of Alzheimer's disease.
Morris MC1, Tangney CC2, Wang Y3, Sacks FM4, Bennett DA5, Aggarwal NT5.
Abstract
BACKGROUND:
In a previous study, higher concordance to the MIND diet, a hybrid Mediterranean-Dietary Approaches to Stop Hypertension diet, was associated with slower cognitive decline. In this study we related these three dietary patterns to incident Alzheimer's disease (AD).
METHODS:
We investigated the diet-AD relations in a prospective study of 923 participants, ages 58 to 98 years, followed on average 4.5 years. Diet was assessed by a semiquantitative food frequency questionnaire.
RESULTS:
In adjusted proportional hazards models, the second (hazards ratio or HR = 0.65, 95% confidence interval or CI 0.44, 0.98) and highest tertiles (HR = 0.47, 95% CI 0.26, 0.76) of MIND diet scores had lower rates of AD versus tertile 1, whereas only the third tertiles of the DASH (HR = 0.61, 95% CI 0.38, 0.97) and Mediterranean (HR = 0.46, 95% CI 0.26, 0.79) diets were associated with lower AD rates.
CONCLUSION:
High adherence to all three diets may reduce AD risk. Moderate adherence to the MIND diet may also decrease AD risk.

MIND Diet Associated with Reduced Incidence of Alzheimer’s Disease

[bentkat]

I read about this diet yesterday. My major take away was that wine was on the menu. I have read other studies that claim grains help prevent AD. Is the truth out there?

[Julie G]

FWIW, Dr. Martha Clare Morris was at the conference and did a presentation on this paper. I hope you'll all get to see the video link.

Yes, the whole grain recommendation is confusing. My guess is that participants were probably eating French fries, white flour, and pasta prior to switching to rice and whole wheat. So, yes, THAT was an improvement. Does that mean that those who eat greens now must switch to whole grains...maybe not.

Dr. Isaacson offered his variation on the MIND Diet for those at high risk of AD (E4 carriers.) He recommended less grains, more greens and fish. I'll go through my notes and share more tomorrow.

Overall, I found it to be incredibly good news for us- more proof that diet may be able to reduce Alzheimer's disease risk.

[RichardS]

I really like that work like this is being done, and with a large sample size. I do, however, want to caution that this is not a randomized controlled trial. I know it is a common refrain, and we can learn plenty from non-RCT's, but let's be cautious interpreting these data.

One thing that struck me as I read this study was the following:

The average MIND diet score for the AD sample was
7.4 (15 possible) and ranged from 2.5 to 12.5. Participants
with the lowest scores had lower education, were more likely
to be obese and to have diabetes, and reported fewer hours of
physical activity and more depressive symptoms

Even with some supposed statistical "controlling" for potential confounding variables, the basic message here is that those things associated with higher risk of AD (low education, obesity, diabetes, physical inactivity and greater depression) were associated with poorer MIND diet compliance.

The reason I have harped on the distinction between RCT and non-RCT trials for AD is that in both my clinical and personal experience, I've seen evidence of degradation in healthy personal habits prior to diagnosable dementia. While I certainly believe some form of healthy diet is protective, I have this nagging concern that a lot of the non-randomized trials are tapping into this self-selecting bias where those who are more capable of engaging in these "protective" healthy behaviors are less likely in the first place to progress to dementia.

In the end, I think cleaning up a standard American diet for a sustained period of time is helpful, but I don't believe it is helpful to confidently derive small tweaks on the diet based on studies like this, especially for those who are already following a minimally processed, nutrient dense diet in whatever way works for them.

[marthaNH]

Richard, you make a lot of sense. Fortunately and unfortunately.

[Stavia]

Richard, you make a lot of sense. Fortunately and unfortunately.

I concur. Sigh. Some days I wish I never opened Pandora's box.

[Julie G]

Great cautions, as always- Richard. Thank you.

One thing I forgot to mention yesterday with Dr. Isaacson's adaptations to the MIND diet was that he encouraged his at-risk patients to also restrict carbohydrates for an extended period at night...kind of similar to Dr. Bredesen's protocol. The difference is, Dr. Isaacson singles out carbohydrates, so maybe patients are allowed to eat other macronutrients during this fasting time? He starts his patients with a 12 hour carb fast. Then moves them to 14 hours, then finally 16 hours. Perhaps by restricting carbs to only 8 hours a day, there is more time for autophagy, cellular repair

[RichardS]

Julie, I dont get your autophagy reasoning. Wouldn't autophagy be supported by a protein fast rather than a carb fast?

[Tincup]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106288/
[quote]Our observation that a brief period of food restriction can induce widespread upregulation of autophagy in CNS neurons may have clinical relevance. As noted above, disruption of autophagy can cause neurodegenerative disease, and the converse also may hold true: upregulation of autophagy may have a neuroprotective effect. For example, in vitro models have shown that starvation in neuronal cell lines can remove toxic molecules and damaged mitochondria from neurons.22–24 Other tissue culture studies, of mutant huntingtin and α-synuclein proteins (which are associated with Huntington disease and familial Parkinson disease respectively), have identified autophagy substrates that can be removed by drug-induced enhancement of autophagy. Most importantly, some neuroprotective effects of drug-enhanced autophagy also have been observed in vivo, in a D. melanogaster model of Huntington disease.25 Finally, it has been suggested that intermittent fasting might improve neuronal function by means that are entirely independent of caloric intake, and may instead reflect an intrinsic neuronal response that is triggered by fasting;26,27 we speculate that the reported improvement of neuronal function may be related to the upregulation of autophagy that we show here. The above findings have encouraged the development of drugs that might enhance neuronal autophagy, thereby protecting against disease. Such drugs must: (i) be able to cross the intact blood-brain barrier; (ii) upregulate neuronal autophagy; and (iii) be harmless to the recipient. Food restriction is a simple, reliable, inexpensive and harmless alternative to drug ingestion and, therefore, we propose that short-term food restriction may represent an attractive alternative to the prophylaxis and treatment of diseases in which candidate drugs are currently being sought. However, caution is counseled, because studies in rat brain have suggested that chronic starvation might inhibit autophagy,28 an outcome that could damage, rather than protect, neurons.28,29[/quote]

Maybe there is a Goldilocks effect - a little IF is good, starvation is bad...