How To Age With Better Brain Health
How To Age With Better Brain Health
Q&A with Dr. Annie Fenn, MD
If you asked me to name one person that embodies the spirit of ‘Food is Medicine’, I would say it’s
. We got acquainted via Substack in 2023, and found out that we both coincidentally had cookbooks out the same month! A year later, I am proud to call her a friend and have been endlessly inspired by her recipes, her newsletter and her generosity.
Annie’s personal brush with Alzheimer’s came when her mother was diagnosed with an early stage of the disease. A physician of 20 years, she went on to culinary school (and I quote) ‘traded her stethoscope for a whisk’. She then founded
in 2015 to create awareness that food can be an effective and delicious tool to fight brain disease.Her cookbook, The Brain Health Kitchen is an incredible and important resource, packed with actionable insights and decadent but good-for-you recipes, like this Roasted Strawberries with Almost Instant Cashew Cream. In her newsletter, she shares digestible insights on the latest research in brain health and so much more. She travels to teach cooking classes, courses at universities and host brain-healthy retreats in the best locations (more details below - I hope to be able to join one soon) - I don’t know how she does it all!
Enjoy this Q&A, and if you haven’t already, make sure you subscribe to the Brain Health Kitchen (BHK) newsletter using the special link below to get 30% off the annual membership! Whether you have aging family members to care for, or just want to support yourself in the best way possible, this is an excellent investment to stay informed.
You’re a brain health expert. What’s the most surprising thing you’ve learned?
Alzheimer’s disease is mostly preventable. When my mom was diagnosed with it 10 years ago, I couldn’t help but feel that dementia was my destiny, too. The reality is that nothing is further from the truth! The scientific community now considers Alzheimer’s (and many other types of dementia) to be the consequence of lifestyle (such as a nutrition-poor diet, lack of exercise, smoking) and life circumstances (lack of early childhood education, exposure to air pollution). Less than 3% of people living with Alzheimer’s have it just because of an inherited gene.
9 Things To Know About Alzheimer’s
Why are Alzheimer’s and dementia on the rise? People are living longer. The fastest growing age group in the U.S. is 75 to 85-year olds. The second fastest is centenarians—those who reach 100 years or more. As the population ages, so does the prevalence of Alzheimer’s disease. It appears that while people are living longer (thanks to advances in cancer treatment and less cardiovascular disease), their brains are not aging as well as the rest of them.
But you’ve said that Alzheimer’s is not really an older person’s disease. Please explain. While the symptoms of Alzheimer’s may appear after the 6th decade of life, the disease actually starts in the brain 20 to 30 years before that. The brain is vulnerable to Alzheimer’s pathology (like sticky proteins that don’t get flushed away) starting in one’s 30s and 40s. Alzheimer’s, then, is actually a disease of young adults and midlife adults.
What is the dietary link? Certain dietary patterns have been shown to protect the brain from Alzheimer’s. Most are based on the Mediterranean diet. The MIND diet is a brain-specific spin-off of the Medi diet created just for the purpose of seeing if it can reduce Alzheimer’s risk. And it does—eating this way reduces the risk by as much as 53%. The Green MED diet is another—it has been shown to preserve the size of the brain over time.
How does what you eat protect the brain? Certain foods are neuroprotective—they provide nutrients that block oxidative stress in the brain and actually slow down brain aging. Other foods accelerate brain aging. People that follow a pattern of eating that includes neuroprotective foods and limits or avoids brain-harming foods age with better brain health.
Are there superfoods for the brain? I like to have people think of brain-healthy food groups, not superfoods. There is not one food—like goji berries or Lions’ mane mushrooms—that will protect you from Alzheimer’s. There are, however, food groups with ample science to back them up: berries, leafy greens, vegetables, beans and legumes, nuts and seeds, whole grains, extra-virgin olive oil, poultry, fish and seafood, and certain drinks (coffee and tea).
Which food groups are on the brain-harming list? Ultra-processed foods are the brain’s worst nightmare. Americans now get 55% of their calories from highly processed, nutrient-poor foods. That needs to change if we want to get a handle on reducing Alzheimer’s rates. Other foods on my list don’t need to be vilified, just limited or avoided because they provide too much added sugar or don’t provide the brain with the right balance of fats: sugar- and artificially-sweetened drinks, dairy products (especially processed dairy), fast and fried food, red meat (especially processed meat). Alcoholic beverages are on this list, too. We have new data to say that moderate drinking is not as good for health as once thought and in fact leads to brain shrinkage over time.
Are there metabolic factors? Yes, absolutely. Poor metabolic health is one of the pathways to developing Alzheimer’s. Borderline diabetes and adult-onset diabetes have both been shown to increase risk twofold or more. Insulin resistance, metabolic syndrome, and obesity all increase Alzheimer’s risk. Maintaining a healthy weight and stable blood sugar over decades is a key pillar of preventing the disease.
What about environmental factors? Do we need to worry about air pollution and microplastics? Until recently, there wasn’t much support for an environmental link with Alzheimer’s. Now we know that exposure to air pollution is damaging to the brain over time; it increases the risk of Alzheimer’s. We are just starting to see data about microplastics—how they travel in the body and incite inflammation. There is some evidence that microplastics contribute to atherosclerotic heart disease. We don’t have the same data for the brain but it is just a matter of time.
Why are women getting more Alzheimer’s than men? Women are twice as likely to be diagnosed than men. The reason why is a hot area of research. For some women, menopause changes the brain to make it more vulnerable to Alzheimer’s. Another factor may be a cumulative lack of sleep during certain life stages—pregnancy, post-partum, perimenopause, post-menopause. And women are more susceptible to the effects of alcohol on the brain.
Bite Size Takes
Protein: Frailty and Alzheimer’s go hand in hand. That’s where protein intake comes in. People who are more muscled and fit are less likely to develop any type of dementia. Protein requirements depend on your size, age, and how active you are. With age, protein intake usually needs to go up to compensate for a body that is not as good at maintaining muscle.
Gut-health: A healthy gut microbiome helps the brain age well. Feed the trillions of microbiota (bacteria, viruses, fungi) that reside in the gastrointestinal tract the right foods and they will flourish. One way they give back to the brain is by making brain-specific substances—neurotransmitters (like GABA) and short chain fatty acids (that are anti-inflammatory in the brain).
Polyphenols: These are bioactive substances in plant foods that do many good things for the brain, like blocking oxidative stress, repairing brain cells, and helping brain cells stay in a loop of communication. Some foods are especially polyphenol-rich, like green tea, coffee, walnuts, and dark leafy greens.
Omega 3’s: There are 3 types of omega-3 fatty acids: DHA and EPA (found in fish and seafood), and ALA (found in plants). All are beneficial but DHA and EPA are especially crucial for brain health because your body can’t make them. You get these from fatty fish (like anchovies, salmon, sardines), fish oil supplements, or algae supplements.
Intermittent Fasting: There’s no solid brain health data to say that eating within a window of time can prevent Alzheimer’s. Eating this way can, however, help some people maintain a healthy weight. And there are brain health benefits to not eating 3 to 4 hours before going to sleep. The downside: it can be tough to achieve protein and other nutrient requirements when the eating window is restricted. Plus, if someone has had disordered eating in the past, intermittent fasting may not be a good fit.
Exercise: Getting enough heart-pumping exercise is just as important as following a brain-healthy dietary pattern for preventing Alzheimer’s. And twice-weekly resistance training is the minimum needed to maintain muscle with age.
Menopause: Menopause changes the brain in ways that make it more susceptible to Alzheimer’s. A woman’s natural supply estrogen protects the brain throughout life; taking estrogen as a birth control pill or as hormone replacement therapy has also been shown to protect a woman’s brain from Alzheimer’s and other dementias.
Alcohol. It’s a myth that drinking red wine or any other alcoholic beverage is good for the brain. Alcohol is directly neurotoxic and associated with accelerated brain shrinkage with age starting at 4 drinks per week.
Sleep. While you sleep, the brain cleans up. As it cycles through different sleep stages, the brain’s glymphatic system gets triggered—a pressure gradient that filters out damaging proteins and inflammatory particles. It’s a myth that some people can go without sleep. Everyone needs 6 to 8 hours of sleep that cycles through deep and REM stages.
Stress. When stress levels are chronically high, the brain shrinks. Stress mitigation is a crucial aspect of Alzheimer’s prevention. That will look different for everyone, but meditation and deep breathing have been proven effective. Everyone needs a plan in place to quell the effects of stress.
Up, close and personal
I live in Jackson, Wyoming with my college boyfriend (ok, we’ve been married for 34 years) and four-legged kids: Orzo (a pudelpointer) and Livvie (short for Olive Oyl, a German wire-haired pointer). My two boys are out on their own living their best brain-healthy lives: Jack (26) lives in Denver and Nick (23) lives in Austin. In my free time, I like to cook for friends, hike, bike, and ski, and forage for huckleberries and mushrooms in the mountains.
I spend much of my time researching medical data and scientific studies on Alzheimer’s prevention and writing my twice-weekly newsletter. I also work on new recipes and collaborate on projects with the 5 non-profit boards I serve. I travel to give talks throughout the U.S. and host brain health retreats in the spring and fall in Italy and Mexico, and in Costa Rica in the winter. And I am really excited about teaching brain health nutrition to young adults—I am working on several undergraduate and medical school courses for 2025.
Rapid fire round - “My favorite brain-healthy”
Beverage is.. matcha
Breakfast is.. avocado toast
Purse Snack is.. dark chocolate
Cooking Oil is.. Extra-virgin olive oil
Spice is.. Dried oregano from Sicily
Mocktail is.. Hibiscus Lime Sangria
Dessert is.. Fudgy Quinoa Brownies
Airport Snack is Matcha Crispy Rice Bars
Takeout Dish is.. Spring rolls with spicy peanut sauce
Supplement is.. (Relevate from NeuroReserve)
Brain Health Retreats
The best part of my job is when I get to take people on weeklong educational vacations to help them cultivate a personal plan for brain health! These are always in amazing locations with incredible food, like Italy, Mexico, and Costa Rica. I have a few retreats coming up, and plans for a Sardinia retreat in 2025.
Ortigia, Sicily October 13 to 19, 2024: In this culinary adventure we’ll cook with local chefs, tour almond, avocado, and olive farms, and learn all about olive oil.
Palermo, Sicily October 27 to November 4, 2024: The vibrant city of Palermo is our home base for exploring less-traveled western Sicily. We’ll visit farms and cook local dishes, while soaking up the beauty of ancient Greek temples, medieval villages, coastal salt flats, and maybe even get to see olive oil pressed!
Tecate, Mexico, Rancho La Puerta BHK Group November 2024: Once a year I host a BHK group at this wellness destination with an amazing spa and 5-acre organic garden and culinary center (plus exclusive perks and discounts), just an hour from San Diego.
Costa Rica, January 9 to 14, 2025. A cozy cabaña nestled in the jungle near the beach is the home base for this 6-day brain health retreat. We’ll enjoy energizing yoga, plant-based cuisine, waterfall walks and a comprehensive brain health education in this jungle oasis.
Host a summer party with brain-healthy foods
An irresistible mocktail: Hibiscus Lime Sangria
A brain-healthy Charcuterie Board
A special salad: Your New Favorite Kale Salad from my book has a blueberry shallot dressing everyone loves.
A crowd-pleasing burger, like the Falafel Burgers from my book
A make-ahead dessert, like my Fudgy Quinoa Brownies or the Almond Butter Tahini Blondies or
Almond Butter Gelato with 3 swirl-in variations
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