Brain Health

BRAIN HEALTH

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Help for PREVENTING BRAIN DISORDERS

STRATEGIES to Keep Your MIND SHARP

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BRAIN HEALTHby PERRY RENSHAW, MD, PhD

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Copyright © 2009 by Perry Renshaw, MD, PhD, and Active Interest Media, Inc.

All rights reserved. No part of this booklet may be reproduced, stored in an electronic retrieval system, or transcribed in any form or by any means, electronic or mechanical, including photocopying and recording, without the prior written permission of the publisher, except for the inclusion of quotations in a review.

Published by:Active Interest Media, Inc.300 N. Continental Blvd., Suite 650El Segundo, CA 90245

This booklet is part of the Better Nutrition Healthy Living Guide series. For more information, visit www.betternutrition.com. Better Nutrition magazine is available at fine natural health stores throughout the United States. Design by Aline Design: Bellingham, Wash.

The information in this booklet is for educational purposes only and is not recommended as a means of diagnosing or treating an illness. All health matters should be supervised by a qualified healthcare professional. The publisher and the author(s) are not responsible for individuals who choose to self-diagnose and/or self-treat.

BRAIN HEALTH

CONTENTSIntroduction: Your Amazing Brain ..............................4

Chapter One: The Aging Mind ......................................8

Chapter Two: The Citicoline Connection ...............14

Chapter Three: Food For Thought .............................21

Chapter Four: Keeping Your Mind Sharp ...............25

Selected References ............................................................31

4 B R A I N H E A L T H

Introduction

Your Amazing Brain

Your brain is arguably the most fascinating organ in your body. Think of it as a super-computer that orchestrates your every movement, reflex and thought. Your brain controls body tem-

perature, blood pressure, heart rate and breathing. It directs your muscles and nerves, and processes a never-ending flood of information about the world around you. It sorts and stores memories, allows you to make deci-sions, and gives you the ability to communicate through speech. Your brain also lets you dream, invent and experience emotions. All of these tasks are coordinated, controlled and regulated by an organ that weighs just three pounds.

Your brain consists of approximately 100 billion nerve cells known as neurons, which function, basically, as on/off switches. If a neuron is turned on, it shoots an electrical signal through an axon, an appendage of the cell that is like a cable or wire. When the signal gets to the end of the axon, it stimulates tiny sacs that release chemicals known as neurotransmitters. These neurotransmitters then cross a gap called a synapse and attach them-selves to receptors on the neighboring cell. If the receiving cell is also a neu-ron, the signal can continue to travel to the next cell. At any given moment, millions of neurons are sending messages to various parts of your body, causing a multitude of voluntary and involuntary reactions.

Neurons are made up of three basic parts:

• Cell body: Like cells in the rest of the body, neurons contain a nucleus that houses DNA, ribosomes that build proteins, and mitochondria that produce energy. If these crucial processes in the cell body become impaired, the neuron will die.

• Axon: This long, cable-like projection carries the electrochemical message from the cell body to the synapse. Depending upon the type of neuron, axons can be covered with a thin layer of myelin, a fatty insulation that protects the axon and increases the transmission speed of electrical signals. Myelinated neurons are typically found in the peripheral nervous system. Unmyelinated neurons are found in the brain and spinal cord. The end of the axon is called an axon terminal.

• Dendrites: These small “branches” project from the cell body and collect chemical messages (via neurotransmitters) from the axon

B R A I N H E A L T H 5

terminals of adjacent neurons. If the chemical messages are strong enough, they will cause the cell to fire an electrical signal down the axon to another neuron’s dendrites. These connections allow neurons to communicate with other cells and interpret information from internal and external sources.

Even though all neurons contain these three components, all neurons are not the same. There are several types and each has a different function.

• Sensory neurons carry signals from the outer parts of your body (the periphery) to the central nervous system (the spinal cord and brain).

• Motor neurons carry signals from the central nervous system to the periphery (muscles, skin, glands) of your body.

• Receptors sense the environment (light, sound, and touch) and encode this information into electrochemical messages that are transmitted by sensory neurons.

• Interneurons connect various neurons within the brain and spinal cord.


Regions of The BrainJust as neurons have different jobs and abilities, so do the different

regions of the brain. The brain can be divided into three areas: the fore-brain, the cerebellum and the brain stem. Each area is associated with a distinct set of functions.

The forebrain is responsible for all higher functions of the brain, like rea-soning and problem solving. The forebrain includes the cerebrum and the diencephalon (located in the middle of the brain). The cerebral cortex of the cerebrum contains four regions, which each perform different tasks.

The frontal lobe sits right behind your forehead, at the front of the cerebral cortex. It is responsible for performing executive functions, such as problem solving. It also contains the primary motor cortex, a region that plans and executes movement, as well as a portion of Broca’s area—an area of the brain responsible for speech, language processing and language comprehension.

The parietal lobe sits at the top, or crown, of your head, right behind the frontal lobe and is the primary sensory area of the brain. This is where nerve impulses carrying sensations of pain, temperature, touch and pres-sure travel to. Areas in the parietal lobe are also involved in spatial orien-tation, speech and language development, and attention.

The temporal lobe is below the frontal and parietal lobes (toward the ears), and above the hindbrain (the bottom area of the brain at the back of the head). The temporal lobe is where the majority of sensory processing occurs—specifically the processing of information from multiple senses, especially hearing and vision. The temporal lobe also contains a neural structure called the hippocampus, which plays a key role in the formation of long-term memories.

The occipital lobe, the fourth and final region of the cerebral cortex, is located behind the parietal and temporal lobes. It sits at the back of the skull and above the hindbrain. This region contains the primary visual cor-tex and is critical for sight.

The diencephalon, which is the second major region of the forebrain, is located inside the casing of the cerebral cortex and includes two key structures, the thalamus and the hypothalamus. The thalamus acts like a switchboard for the brain. Most sensory information passes through this area before arriving at the appropriate area of the cerebral cortex. The hypothalamus secretes and regulates the secretion of neurohor-mones and endocrine hormones. It also appears to control basic sur-vival responses, such as the “fight or flight” response, hunger, thirst and sexual responses.


The cerebellum is the main structure of the hindbrain, situated at the base of the brain and the top of the spinal cord. The cerebellum controls our balance and physical stability, and is involved in motor coordination and the development of “muscle memory.”

The brain stem is the most primitive part of the brain and includes the midbrain, pons, and the medulla oblongata. The midbrain is involved in processing visual and auditory information. It also controls eye move-ment. The pons bridges the cerebellum and brain stem, and helps coordi-nate breathing, blood pressure, sleep and waking. The medulla oblongata connects the brain to the spinal cord and controls the most basic bodily functions, such as breathing and blood circulation.

When we are young, all of these pieces and parts should be function-ing optimally. Our brains easily soak up new information. Our powers of deduction, reaction times, and our ability to learn and remember are at their best. As we age, some of these capabilities seem to wane, but forgetfulness and cognitive decline are not a certainty. There are some simple steps you can take now to ensure a better brain for years to come.

Anatomy and Functions of the Brain


Chapter One

The Aging Mind

If you have ever forgotten where you left your car keys or drawn a blank on a familiar name, you may have wondered if these “senior moments” were the first subtle signs of age-related memory loss. As

we get older, our speed of processing information, and the efficiency of our short and long term memory naturally decline. It is also a fact that the brain regions dedicated to these functions actually shrink in size as we age. This could certainly make you worry about losing your mental edge with each passing birthday.

However, these changes are not as dire as they may seem. Several years ago, researchers at Princeton University found new nerve cells being created in the brains of monkeys. According to their study, neurons are regenerated deep in the center of the brain. Once reborn, they move to other parts of the brain associated with higher mental functions, like the hippocampus, the major neural region associated with long-term memory storage. This study may have implications for human memory function. In other words, the aging human brain may be more resilient than we thought.

Age-Related Memory LossMemory loss is a normal part of the aging process. As we age, blood flow

to the brain decreases, causing it to use oxygen and protein less efficiently. In addition, the number of receptors associated with memory function declines and aging brain cells may stop sending and receiving chemi-cal signals. The aging brain also loses some of its ability to protect itself against inflammation and free radicals. But having an occasional memory lapse or needing more time to process new information does not always mean your brain is suffering from old age. Memory loss or a loss of con-centration can also be caused by such things as dehydration, a poor diet, fatigue or stress.

Memory and cognition are also affected by changes in the level of sex hormones. For example, menopausal women may complain of “brain fade” due to declining levels of estrogen. This hormone protects hip-pocampal neurons and promotes the formation of new neurons, which might explain a connection with memory. Two studies, each following hundreds of women over time to see who developed Alzheimer’s dis-ease, found that those who received estrogen during or shortly after


Physical exercise is as important as

mental exercise to maintain memory

and mental acuity.

Jog Your MemoryWe all forget things from time to time, whether it’s due to age-

related memory loss or just from having too much on our minds. To help you remember more, more easily, the American Academy of Family Physicians recommends a few techniques:

• Keep lists. Routinely making grocery lists, to-do lists, lists of projects or goals can prevent everyday tasks and special “to dos” from falling through the cracks.

• Follow a routine. Doing the same activity at the same time each day helps cement them in your memory.

• Make associations (connect things in your mind), such as using landmarks to help you find places.

• Keep a detailed calendar, in a place where you will see it every day, so you never miss another birthday or appointment.

• Put important items, such as your keys or glasses, in the same place every time you are finished using them.

• Repeat names when you meet new people. “It’s nice to meet you, Henry.”

• Do things that keep your mind and body busy. For example, gardening or redecorating a room require both mental and physical work.

• Run through the ABCs in your head to help you remember a word or name. “Hearing” the first letter of a word may jog your memory.


Making lists and keeping

detailed calendars are good habits

to form.


menopause—even for as little as six months—were less likely to later develop Alzheimer’s disease than the women who had not used estro-gen replacement therapy. While pharmaceutical estrogen replacement has been shown to increase many health risks, these studies point to the important role this hormone plays in cognition and memory. There are several possible explanations for such effects. For example, estrogen increases the concentration of an enzyme that is needed to synthesize acetylcholine, a brain chemical essential for memory function. Estrogen also enhances communication between neurons in the hippocampus, an area of the brain that is important for verbal memory.

Estrogen increases the concentration of an enzyme that is needed to synthesize

acetylcholine, a brain chemical essential for memory function. Although men do not have such a dramatic decline of hormones as

they get older, research shows that men with high levels of testosterone have better visual and verbal memory skills than men with low levels. Conversely, low testosterone levels have been observed in patients with Alzheimer’s disease and mild cognitive impairment.

Certain diseases and medications can affect memory too. For instance, people with high blood pressure are more prone to memory impairment than people with normal blood pressure. People with diabetes may experi-ence memory problems due to high levels of blood sugar. Drugs, includ-ing sleeping pills, sedatives, painkillers, some antidepressants and even eye drops for glaucoma, can cause forgetfulness. If you are experiencing mem-ory problems and suspect that one or more of your medications is respon-sible, make a list of all the drugs you are taking and talk with your doctor.

DementiaUsually a small mental lapse is nothing to worry about, but if you find

that memory problems are interfering with your daily life, it is wise to see a health care practitioner. He or she can tell you if the problem is serious or is triggered by something temporary, like a medication or stress.


Seek help if you:

• Forget things much more often than you used to.

• Forget simple words or use the wrong words when trying to explain something.

• Forget how to do something you have done many times before.

• Have trouble learning new things.

• Repeat the same phrase or story in the same conversation.

• Have trouble making choices or handling money.

• Cannot keep track of what happens each day.

• Have trouble doing things that involve a series of steps, like following a recipe.

• Experience sudden mood swings, going from calm to tears to anger in a few minutes.

Chronic or severe forgetfulness does not automatically mean Alzheim-er’s disease. There are several other types of dementia that can interfere


with a person’s ability to function on a daily basis. Some, like Alzheimer’s, are progressive and very serious. Others, however, can be halted or reversed by treating underlying conditions that may contribute to the dementia.

Common types of untreatable dementia include dementia with Lewy bodies (closely allied to Parkinson’s disease) and frontotemporal demen-tia. Lewy bodies are clumps of proteins in neurons that accumulate in the brain, and are similar to the proteins found in the brains of people with Alzheimer’s and Parkinson’s diseases. Frontotemporal dementia affects areas of the brain responsible for judgment and social behavior. As a result, people with this type of dementia can display inappropriate social behavior. Several disorders, such as Huntington’s disease and AIDS, can also result in dementia.

Another type of dementia, known as vascular dementia, occurs when the arteries that feed the brain become blocked or narrowed. This decreases blood flow depriving brain cells of the nutrients and oxygen they need to function normally. Vascular dementia often occurs after a stroke. Prevent-ing further strokes by treating the underlying diseases—high blood pres-sure or unhealthy cholesterol levels—may slow or stop the progression of vascular dementia.

Some types of dementia are associated with reversible diseases like hypothyroidism (decreased thyroid function) and severe hypoglycemic episodes, where there is too little sugar in the bloodstream. Severe infec-tions, like cryptococcal meningitis in people with a compromised immune system (such as AIDS patients), and chronic alcoholism can also cause reversible dementia.

Alzheimer’s DiseaseAlzheimer’s disease is far and away the most common type of demen-

tia, accounting for 50 to 70 percent of all dementia cases. Although early onset can occur, Alzheimer’s—and dementia in general—are much more common after age 60. While no one knows the exact cause of Alzheimer’s, scientists have discovered that plaques—fibrous deposits made of protein fragments—play a key role in the disease. As these plaques build up in the brain they cause abnormal degeneration and eventual death of brain cells, particularly in regions of the brain associated with memory. Eventually, these abnormalities and the loss of neurons extend into other areas of the cortex.

As we age, much can go wrong with the brain. It is impossible to change your genetics or turn back time, but you may be able to maintain your memory and acuity into your seventies, eighties and nineties by being mindful of what you eat and keeping your mind in good shape with regu-lar physical and mental exercise.


Chapter Two

The Citicoline Connection

If you want to prevent age-related cognitive decline and keep serious memory loss at bay, you need to “feed” your brain what it needs to function at its best. Citicoline (CDP-choline; cytidine 5’-diphospho-

choline) is a nucleotide (a building block of DNA) found in every cell in the body. It plays a key role in the creation of cell membranes. Citicoline triggers the production of the neurotransmitter acetylcholine, and modu-lates transmission of other neurotransmitters dopamine and norepineph-rine. It may also help protect and regenerate brain tissue. Recent studies show that increasing citicoline levels through nutritional supplements, may help prevent premature cognitive decline.

One of citicoline’s most important effects in the brain may be its abil-ity to increase production of adenosine triphosphate (ATP) in the frontal lobe. ATP provides energy to the mitrochondria of each cell. Not only is this energy vital for cellular activity, increasing its production may help reduce memory problems and the mental fatigue associated with age.

A study conducted at the Brain Imaging Center at McLean Hospital in Belmont, Massachusetts, used the latest brain scanning technology to monitor brain activity in people taking supplemental citicoline. After supplementing for six weeks, the participants showed increased levels of specific markers for ATP in a frontal lobe region of their brains. Citi-coline’s positive effects on the brain persisted long after supplementation stopped, suggesting that the supplement may have a cumulative ability to repair and maintain neuron function.

Unlocking The Power of The MindHow well does citicoline work? A growing number of clinical trials on

healthy adults with mild forgetfulness show that citicoline improves both immediate and delayed recall of words and objects. Other research shows that citicoline supplements benefit brain function in seniors with cog-nitive impairment. Specifically, citicoline improves short and long-term memory, attention span and perceptual-motor capacity. Supplementing with citicoline can also help seniors remember words and phrases. During a double-blind placebo-controlled trial of 95 volunteers between the ages


of 50 and 85, those taking 2,000 mg of supplemental citicoline daily for two months significantly improved their verbal memory compared to the volunteers taking a placebo.

Citicoline has also been used successfully to treat degenerative brain diseases like Alzheimer’s. In an analysis of 12 clinical trials conducted by the Cochrane Collaboration, researchers found citicoline improved brain function in older people suffering from chronic brain diseases. The researchers concluded that citicoline provided modest and consistent improvements of memory and behavior in patients with Vascular Cog-nitive Impairment and Dementia. While more longer-term studies are needed, these findings are particularly exciting because there are currently very few treatments for dementia.

Future PossibilitiesBecause citicoline readily crosses the blood-brain barrier and reaches

the central nervous system, some researchers are beginning to examine this nutrient as a potential therapy for addiction. Experiments show that citicoline raises both norepinephrine (adrenaline) and dopamine levels, and therefore may reduce cravings experienced by people addicted to cocaine. In a 12-week placebo-controlled study of 44 bipolar patients with a history of cocaine dependency, those taking a citicoline supple-ment every day used cocaine less often than the control group. They also performed better in tests measuring how well they remembered learned facts. To the extent that drugs commonly abused—including heroin and other opiates, alcohol, cocaine, amphetamines and nicotine—activate and regulate dopamine, boosting dopamine levels naturally could help reduce the desire for these drugs.

Citicoline may also be a viable treatment for those with head injuries. In a clinical trial of 216 patients who had suffered moderate to severe head trauma, citicoline accelerated the cognitive recovery from post-traumatic coma, helping the patients walk better and earlier, and shortening their hospital stay.

A pure and natural brand of citicoline is Cognizin®, manufactured by Kyowa Hakko Bio Co. Ltd., a leading global ingredient and pharmaceuti-cal manufacturer. Cognizin is the only brand that has been scientifically studied to be safe and effective for use in foods and dietary supplements to improve brain chemistry and function.


Smart Brain Supplements Cognition and memory can be enhanced by a variety of herbs and nutri-

ents that increase blood flow, support antioxidant levels in the brain and protect it from inflammation. Following are some of the most promising and effective.

Acetyl-L-Carnitine: Similar to the amino acid L-carnitine, acetyl-L-carnitine can protect the brain from neurotoxicity and oxygen depriva-tion. It also preserves the energy-producing mitochondria in brain cells. It appears to be effective in treating mild cognitive impairment, as well as

continued on page 18

Beyond CognitionCiticoline’s cognition support benefits are enough to recommend

it to everyone as they age, however, because it supports proper func-tioning of neurons, this remarkable nutrient may also improve other conditions caused by neurological dysfunction. The most promising potential use of citicoline may be in the treatment of stroke.

A groundbreaking trial recently showed that patients given citico-line within 24 hours of an ischemic stroke (ischemic means due to restriction of blood supply) recovered consciousness faster and had a higher probability of overcoming motor deficit than those who were not given the nutrient. In a meta-analysis of four different clini-cal trials involving more than 1,600 stroke patients, approximately 25 percent of the patients given 2,000 mg, 1000 mg, or 500 mg of citicoline within 24 hours of their stroke, recovered completely within three months. Subjects who took the highest dose of citico-line had a recovery rate of nearly 28 percent compared to just 20 percent among the control group taking a placebo.

Studies suggest that citicoline can also benefit vision. Glaucoma, for instance, is most commonly the result of a buildup of pressure from the fluid in the eye (intraocular pressure). This pressure can damage the optic nerve, which transmits images to the brain. In an open trial, 36 patients with glaucoma were given one gram of citicoline daily for ten days. The researchers concluded that citi-coline had a positive effect on optic nerve damage by increaing the flow of nutrients to nerves affected by the disease. In another study of seniors with mild to severe glaucoma, high doses of citico-line improved vision and retinal function in those who had the most


common form of the disease. Supplemental citicoline has few side effects and a strong record of safety, allowing patients to take high doses on a long-term basis.

Citicoline’s capacity to increase dopamine levels is the key to its use in improving vision. Dopamine is the main neurotransmitter in the retina and it is a chemical messenger for light adaptation in the eye—helping sharpen the contrast between light and dark. Cell sur-vival and eye growth also depend on dopamine.

A lack of dopamine in the retina can also cause amblyopia, or “lazy eye.” People suffering from amblyopia experience dimness or blurring of their eyesight in one eye, which is otherwise healthy, due to a fault in the transmission of signals to the brain. Eventually, amblyopia can cause blindness, but citicoline may offer hope. Italian researchers have performed several trials in patients with amblyo-pia, confirming that citicoline significantly improves both the symp-toms of the “lazy eye” and neurological function. As a result, people with amblyopia regain much of their visual acuity.

Citicoline has been shown to improve vision as well as neurological function.


early stages of Alzheimer’s. One clinical trial of 334 Alzheimer’s patients at Stanford University School of Medicine discovered that acetyl- L-carnitine slowed the progression of the disease, especially among younger participants.

People without cognitive problems or memory loss can also benefit from acetyl-L-carnitine. During one recent study of 96 people over the age of 70, Italian researchers found that those taking acetyl-L-carnitine had less mental and physical fatigue. The supplement group also experienced a boost in cognition.

Alpha-Lipoic Acid (ALA): ALA is an antioxidant that has been researched as a treatment for Alzheimer’s and Parkinson’s diseases. Both fat- and water-soluble, ALA travels throughout the body and may protect cells by enhancing other detoxifying agents such as glutathione, which serves as an antioxidant in brain tissues. ALA also contributes to meta-bolic functions that affect the brain, including glucose metabolism. It is so effective that studies show it can halt the oxidative damage that occurs as our brains age. ALA also has the ability to recycle vitamins C & E, increas-ing their effectiveness.

Additionally, there is preliminary evidence that combining alpha-lipoic-acid with acetyl-L-carnitine provides enhanced antioxidant, anti-inflammatory and metabolic regulation in the brain, which, in turn, improves cognition.

B Vitamins: There is some evidence that this family of vitamins—particularly folic acid and vitamin B6—helps guard against age-related memory loss and dementia. Folic acid, with the aid of B6 and B12, may support memory by moderating homocysteine—an amino acid found naturally in the body that, in high amounts, is considered a significant risk factor for heart disease, Alzheimer’s disease and dementia.

In a study of more than 1,200 people, French researchers found that those with homocysteine levels higher than 15 µmol/L had a risk of cognitive decline three times greater than people with lower levels, below 10 µmol/L. Another study of 818 volunteers between ages 50 and 75 found that those who took high levels of folic acid—800 mcg—over the course of three years had less age-related memory loss than people taking a placebo.

Evidence from clinical trials suggests that both folic acid and citico-line ameliorate the cognitive decline associated with aging. Folic acid, by itself, lowers circulating concentrations of homocysteine, while citicoline improves memory by helping maintain neuronal membranes. It also influ-ences acetylcholine production and regulates the transmission of dopamine and norepinephrine. However, the cognitive effects of taking folic acid and citicoline together have never been studied. Given their complementary

mechanisms, a combination of folic acid and citicoline is likely to have a synergistic effect on memory and executive brain functions.

Fish Oil. This is an excellent source of the omega-3 fatty acid docosa-hexaenoic acid (DHA), an essential fatty acid in the brain, necessary for neural integrity and function. In double-blind, randomized, controlled trials, accelerated cognitive decline and mild cognitive impairment were found to be related to lower tissue levels of DHA and another omega-3 fatty acid EPA, also found in fish oils. Supplementation with fish oil, how-ever, improved cognitive function.

In one study conducted at Tufts University, low dietary intakes and plasma concentrations of DHA were associated with low risk of dementia and Alzheimer’s disease. Among the large group of elderly Americans who took part in the nine-year Framingham Heart Study, those with the high-est blood levels of DHA were about half as likely to develop dementia and had a 39 percent lower risk of developing Alzheimer’s disease than those with the lowest DHA levels.

Ginkgo Biloba: Perhaps the most well known memory-enhancing herb, ginkgo biloba boosts blood flow in the brain, destroys free radicals and pro-tects brain cells from premature death. There is also some evidence that this Ayurvedic herb modulates dopamine levels in some neural regions. One study of 262 adults found that those taking 180 mg of ginkgo for six weeks scored better on memory tests than those taking a placebo. Smaller trials show that ginkgo can also improve attention span and mental flexibility.

Huperzine A: Used to treat dementia and memory loss, huperzine A (HupA) inhibits acetylcholinest-erase, an enzyme that degrades the neurotransmitter acetylcholine in the brain. HupA also lowers oxi-dative stress and reduces the death of brain cells caused by exposure to toxins.

In one double-blind trial, 50 patients with Alzheimer’s disease were treated with 200 mcg of HupA for eight weeks. The patients were evaluated with an array of psychologi-cal and physiological tests to determine their mental and physical health before and after treatment. About 58 percent of the patients treated with HupA showed


Ginkgo leaf


improvements in their memory, as well as in cognitive and behavioral functions. These results were significantly better than those seen in the placebo group. Other research shows that HupA can improve learning performance. Best of all, this natural memory-enhancer passes through the blood-brain barrier, so it works quickly and stays active for hours without adverse side effects.

Phosphatidylserine (PS): PS is an essential fatty acid that makes up part of every cell membrane in the body. In the brain, it helps cells effec-tively communicate with each other.

A number of double-blind trials have validated the ability of supple-mental plant-derived PS to improve memory, learning, concentration, word recall and mood in both middle-aged and elderly subjects suffering from age-related cognitive dysfunction. In one study, 425 elderly volun-teers were given either 300 mg of PS or a placebo for six months. Research-ers measured cognitive function at the end of the trial and found that the subjects in the treatment group had significantly higher memory and learning scores than those taking the placebo.

Turmeric: This curry spice is an excellent source of curcumin, a potent anti-inflammatory that reduces oxidative damage in the brain. Recent studies suggest that curcumin may also inhibit the formation and accumu-lation of amyloid plaque. Turmeric bolsters brain-derived neurotrophic factor (BDNF), a signaling molecule involved in mood. In the Singapore National Mental Health Survey of the Elderly, which involved more than 1,000 people, researchers found that those who ate the most curcumin-rich curry had a significantly lower risk of cognitive impairment than those who rarely consumed it.

Vinpocetine: This extract from the seeds of the periwinkle plant rap-idly passes through the blood-brain barrier where it increases circulation. There is also some evidence that vinpocetine can protect brain cells from the damage induced by excitotoxins such as glutamate.

One double-blind study divided 42 patients with chronic cerebral dys-function into two groups. One group received 10 mg of vinpocetine three times a day for 30 days, followed by 5 mg three times daily for 60 days. The other group received a placebo. By the end of the trial, the patients on vinpocetine scored consistently better in all evaluations of the effective-ness of treatment.

Because vinpocetine increases cerebral blood flow, it may also help stroke victims. A meta-analysis of international clinical trials showed a sig-nificant improvement in cognitive achievement in chronic stroke patients after oral therapy with vinpocetine.


Chapter Three

Food For Thought

Research suggests that eating a Mediterranean-type diet can protect against mental decline. In fact, new evidence from Columbia Uni-versity Medical Center shows that people with mild age-related

forgetfulness who closely follow this type of eating plan are 45 percent less likely to suffer from long-term cognitive impairment than people who do not. Such a diet can also lower the risk of developing Alzheimer’s disease significantly.

Anti upWhat makes the Mediterranean diet such a smart way to eat? It is packed

with fruits and vegetables, fish, olive oil and whole grains. Fruits and veg-etables provide antioxidants that can protect against harmful free radicals and guard against inflammation in the brain.

In one clinical trial, researchers at the Rush Institute for Healthy Aging in Chicago, Illinois, surveyed 3,718 patients, age 65 and older. Each of the volunteers filled out food questionnaires and completed at least two of three cognitive tests at the start of the study, then again at three and six years afterward. The Rush team found that those who ate the most veg-etables had a slower rate of cognitive decline as they got older.

Foods rich in vitamins C and E appear to be especially effective at pre-serving brain function as we age. Important to the central nervous system, these two nutrients protect cells from oxidative damage and inflamma-tion. High amounts of vitamin C can be found in citrus fruits, strawber-ries, papaya, bell peppers, tomatoes and broccoli. Nuts, seeds, whole grains and green leafy vegetables are good sources of vitamin E.

Choose The Right FatsYour choice of dietary fat can also impact brain function. One investiga-

tion of more than 800 seniors in Chicago discovered that those eating a diet loaded with trans fat (found in processed foods containing partially-hydro-genated oils) and saturated fat (found in meat and dairy products) were likely to have a higher risk of developing Alzheimer’s. Healthy fats, like the omega-3 fatty acids found in fish, can guard against dementia and Alzheim-er’s disease. Since the omega-3 fatty acid DHA is the major building block of cell membranes in the brain, it is critical for healthy neurons. Salmon, tuna, trout, halibut, sardines and mackerel are among the best sources of DHA.


Boost Your BsRecent studies show that foods high in the B vitamins are vitally impor-

tant to brain health. Vitamins B6 and B12 may play a role in the develop-ment of new brain cells. Good sources of these two B vitamins include poultry, fish, eggs, soybeans, oats, whole grains, bananas and nuts.

Folic acid—called folate when found in food—plays a critical role in lowering dangerously high homocysteine levels that can contribute to brain atrophy and vascular disease. Orange juice is a great source of folate. You can also find this nutrient in avocados, strawberries, beans, peas and green leafy vegetables like spinach and kale. Many ready-to-eat cereals are also fortified with folic acid.

Carb ComplexityIn a recent study from Tufts University, 19 overweight women followed

either a “low carbohydrate” diet or a “low-calorie” whole foods diet for three weeks. After the first week, those who completely eliminated car-bohydrates from their diet performed worse on memory tests than the people in the low-calorie group. The reason? Complex carbohydrates—like those found in fruits, vegetables, legumes and whole grains—provide glucose to the brain, which helps memory performance. Another study published in The American Journal of Clinical Nutrition showed that people on a high-carbohydrate diet process information faster than those on a low-carbohydrate diet.

Brain FoodWhile eating a healthy diet can give your brain overall protection against

age-related cognitive decline, the following foods have been found to enhance cognition. Include them in your diet often.

Avocados: This fatty fruit contains monounsaturated fat which con-tributes to healthy blood flow. And healthy blood flow means a healthy brain. However, avocados are high in calories, so limit them to no more than one-half an avocado daily.

Blueberries: The anthocyanins in blueberries—potent antioxidants that give these berries their blue color—reduce both oxidative damage to your neurons and inflammation within the brain. Eating blueberries often may improve mental acuity and may even help reverse age-related declines in cognition and short-term memory loss.

Coffee: Regular coffee consumption reduces the risk of mental decline, including dementia and Alzheimer’s disease. In one trial of 676 healthy men over the age of 80, those who drank an average of three cups of coffee


each day during their adult lives experienced fewer cognitive problems than those who drank less.

Dark Chocolate: Yes, chocolate can now be considered a health food—as long as it contains at least 60 percent cacao. One study at the University of Nottingham found that eating a small amount (150 mg) of flavonol-rich chocolate every day increased blood flow to the brain’s gray matter—which could be good news for preventing or treating vascular impairments like dementia and strokes.

Green Tea: In a recent study of more than 1,000 seniors participating in the Comprehensive Geriatric Assessment in the US, researchers discovered that those who drank the most green tea experienced less cognitive decline as they got older. Earlier animal studies show that green tea’s catechins improve learning ability and working memory. It may also decrease the amount of plaque build-up impli-cated in the development of Alzheimer’s disease.

Nuts and Seeds: Nuts and seeds are high in vita-min E, an impor-tant nutrient that helps support mem-ory as we age and is a component of cell mem-branes. Walnuts also have high concen-tration of omega-3 fats and vitamin B6. Eating one ounce of nuts or seeds every day may give your brain an added measure of protection. Along with walnuts, try hazelnuts, Brazil nuts, filberts, almonds, cashews, peanuts, sunflower seeds, sesame seeds,

Nuts and seeds have essential fats.


Brain BustersJust as certain foods can literally

make you smarter, eating the wrong foods can negatively impact your cog-nition and memory. Excess calories can reduce the flexibility of synapses and increase the vulnerability of brain cells to free radical damage. Foods high in calories are also often high on the glycemic index (GI), which measures the effect carbohydrates have on blood sugar levels. A growing number of clinical trials suggest that eating a low GI diet can improve cognitive performance.

flax seed and unhydrogenated nut butters such as peanut and almond butter and tahini (ground sesame seed paste).

Spinach: This leafy green food helps protect the brain from oxidative stress while reducing the risk of age-related cognitive decline. Rich in folate, researchers found that feeding aging rats spinach-rich diets improved their learning capacity and motor skills. Including spinach in your diet may also lessen brain damage from strokes and neurological disorders.

Whole Grains: A diet rich in whole grains such as whole wheat, barley, oats, millet, quinoa and rye can increase your intake of vitamin E and the B vitamins—B6, B12 and folate—that are critical for brain health. One study found that women who increased dietary intake of folate, vitamin B6 and vitamin B12 showed an improvement in recalling infor-mation compared to women who were not taking a B vitamin supple-ment. Research conducted at Tufts University in Boston also found that a diet rich in whole grains reduced the risk of ischemic stroke.

Wild Salmon: Wild salmon is one of the best sources of omega-3 fatty acids. It can help protect your brain’s neurons and improve synaptic con-nections. Including wild salmon in your meal plan can also keep your arteries healthy and reduce your risk of dementia, Alzheimer’s disease and stroke. Certain types of fresh fish may be susceptible to high mercury lev-els, so many people choose a pharmaceutical wild salmon oil or fish oil supplement to ensure adequate omega-3 intake.


Chapter Four

Keeping Your Mind Sharp

As the old saying goes, you really do need to “use it or lose it” when it comes to your brain. Fortunately, that can be as easy as taking a walk or getting a good night’s sleep.

Exercise Your OptionsA growing body of evidence suggests that regular exercise—especially

aerobic exercise—can have a positive impact on certain mental functions like memory and recall, concentration, decision-making and complex problem solving. A recent investigation showed that women who main-tain a fit lifestyle as they age are more likely to have better clarity and acu-ity than their sedentary counterparts.

According to researchers at the University of Illinois, Urbana, exercise may slow the loss of brain tissue that naturally occurs starting in our 30s. The UI team examined MRI scans from 59 older adults, half of whom were assigned to an aerobic training group and half of whom were assigned to a toning and stretching control group. The neural tissue of those who par-ticipated in aerobic fitness was significantly denser than the participants in the control group. Apparently exercise doesn’t just help protect brain cells from deterioration, it may also enhance them. A recent meta-analysis by the University of Illinois’ Beckman Institute found that aerobic exercise boosts both the speed and sharpness of thought and the volume of brain tissue. As little as 50 minutes of brisk walking three times a week was found to have this brain-expanding effect.

Exercise may also improve your ability to think clearly. In a meta-analy-sis of 18 studies, the UI investigators discovered that inactive older adults who began an aerobic exercise routine performed significantly better than control group members on cognitive tests that measure skills such as plan-ning and paying attention. One explanation for this improvement may be that exercise boosts the brain protein BDNF, a protein that supports the function and survival of neurons, and may thus help prevent neurodegen-eration associated with age.

A preliminary animal study featured in the Journal of Applied Physiol-ogy gave further evidence that exercise restores healthy BDNF levels. The


researchers discovered that physical activity significantly slowed down the loss of new nerve cells in middle-aged mice. In fact, the production of neural stem cells improved approximately 200 percent compared to mid-dle-aged mice that did not exercise. The research team concluded that exercise reverses the age-related decline in the production of neural stem cells in the hippocampus. This occurs because exercise restores BDNF, which promotes production and maturation of new stem cells.

Exercises that improve cognition include walking, jogging, cycling, danc-ing, elliptical cross-training and swimming. Adding music to your work-out may further enhance the mental benefits of aerobic exercise. Accord-ing to a study of 33 patients in a cardiac rehabilitation program at Ohio State University, those who listened to music during a 30 minute workout scored better on verbal fluency tests than those who exercised in silence. This suggests that the combination of music and exercise may stimulate and increase cognitive arousal while helping to organize cognitive output.

If walking is your exercise of choice, try a brisk walk in a park. University of Michigan researchers found that volunteers whose course took them through a tree-filled setting performed 20 percent better on memory and attention tests than those who walked downtown.

Sleep Yourself SmartPeople who do not sleep well at night tend to be more forgetful than

people who sleep soundly. According to one theory, sleep is important for memory because the brain replays information learned during the day, and in so doing, strengthens the neuronal connections that store this information. A study in the Proceedings of the National Academy of Sciences examined the pattern of brain activity in sleeping rats and found neuronal discharges between the hippocampus and the somatosensory cortex. This “cross-talk” between the hippocampus and cortex may be what cements our memories.

Getting a good night’s sleep also helps ensure adequate ATP (Adenosine-5’-triphosphate) levels. When we are awake and active, we break down ATP to produce energy. Over time, adenosine (a component of ATP) builds up in the forebrain and may be a trigger for sleepiness. During sleep, many of the body’s cells are less active and use less ATP, so adenosine levels fall again, setting the stage for wakefulness.

Decompress StressChronic stress has been linked to memory loss in several studies. Sci-

entists have discovered that neurons are damaged by cortisol, a hormone released during highly stressful situations. Animal studies suggest that



long-term stress can also change the actual structure of the brain. One of these studies found that, after laboratory rats were tightly restrained for six hours a day for 21 days without food or water, the animals’ hippocampi shrank by three percent.

People, especially as they age, are highly susceptible to stress. In one study, a group of healthy adults received daily low-dose treatments of the stress hor-mone cortisol over the course of four consecutive days—about the amount that would be released under everyday stress. Another group received high doses over the same period of time. Cognitive testing was done periodically during the study and again six days after the treatment. The people who had received the higher cortisol dose had a significant (and fortunately revers-ible) decrease in verbal declarative memory. In another cross-sectional study of older Americans, those with high levels of cortisol in their saliva—signal-ing above-normal stress levels—also had poor cognitive performance.

Cortisol released during times of stress travels into the brain and binds to the receptors inside many neurons. Through a cascade of reactions, this causes neurons to admit more calcium through channels in their mem-brane. In the short-term, cortisol presumably helps the brain cope with a life-threatening situation. However, if neurons become over-loaded with calcium they fire too frequently and die.

A healthy lifestyle can help prevent and reduce adverse effects of chronic stress. In fact, there are specific stress-relieving activities and habits you can cultivate to further ease the stresses of modern life:

• Physical exercise not only strengthens the body, it can reduce the frequency and severity of stress, depression and anxiety. As previously discussed, dozens of scientific studies have demonstrated the relationship between exercise, cognition and mood. Exercise promotes the release of endorphins, enhances relaxation and improves the quality of sleep. These conditions help the body recover more quickly and completely from the stress response.

• Relaxation through meditation, biofeedback and a variety of other techniques promotes lower blood pressure, slows respiration, reduces metabolism and eases muscle tension. These counteract the effects of stress.

• Social contacts, friends and family relationships can help create emotional trust, support and relaxation. Even caring for a pet can provide significant emotional comfort that helps reduce stress.

• Attitudes of confidence, a positive approach to problem solving and attention to emotional balance can help get one out of the stress response cycle.


Head GamesAlthough a healthy diet, regular exer-

cise, plenty of sleep and brain-boosting supplements can help keep you mentally sharp, it is also important to give your brain a regular workout. The brain is like a muscle: the more you use it, the stron-ger it gets. Activities like reading, doing crossword puzzles or playing mentally-challenging games can give your brain the exercise it needs.

Working your brain is so effective that a study of 2,832 seniors (average age 73.6 years old), reported in the Journal of the American Medical Association that regular memory-training exercises reduced func-tional decline and improved cognitive ability up to five years. In other words, mental age was “reduced” the equivalent of five years. This supported an earlier study that showed frequent participation in brain-stimulating activities was able to reduce cognitive decline in elderly people.

Scientists believe that intellectual enrichment and learning stimulate the brain to increase synaptic density and interconnections, whatever your age or cognitive status. Studies show that stimulating the mind with various activities can even improve memory in Alzheimer’s patients.

There are a number of ways to stimulate your mind. Here are a few men-tal exercises to get you started:

Search The Internet: Spend about 20 minutes, a few days a week, search-ing topics on the Internet that you’ve always wanted to learn more about. According to scientists at the University of California, Los Angeles, Internet searching uses neural circuitry that is not activated during reading. MRI results showed almost three times more brain activity in regular Internet searchers than in first-timers, suggesting that repeated time spent online can be a great way to build cognitive strength.

Focus on Your Breath: Close your eyes, and breathe slowly and deeply. Inhale through your nose and exhale through your mouth. Give your full attention to your breath as you breathe in and again as you breathe out. Doing this for just five minutes each day can improve your mental focus.

Use Your Other Hand: Whenever basic tasks become second nature, our brains fail to get any exercise. One way to give your brain a workout is

Crossword puzzles: the classic brain game.


to use your other hand for common tasks. If you are right-handed, try eat-ing with your left hand. Brush your teeth with your other hand, too. This might sound easy enough, but you will find yourself actually focusing on accomplishing these simple tasks.

Expand Your Vocabulary: Learning new words does not just make you sound smart in social settings, it keeps your mind fit as well. Try learning one new word every day.

Test Your Recall: Make a list—it can be grocery items, things to do or anything else that comes to mind—and memorize it. An hour or so later, see how many items you can recall. Make items on the list as challenging as possible for the greatest mental stimulation.

Draw A Map From Memory: After returning home from visiting a new place, try to draw a map of the area; repeat this exercise each time you visit a new location.

Create Word Pictures: Visualize the spelling of a word in your head, then try and think of any other words that begin (or end) with the same two letters.

Try An Anagram: Increase your mental flexibility with these word puz-zles. Anagrams rearrange the letters of one word to create another word or phrase. For instance, another word for “teach” is “cheat.” Practice ana-grams by writing down your own first name and see how many hidden words you can find.

The One-Minute Conversation: Choose a subject and talk about it for 60 seconds. It can be anything from the weather to your favorite novel. Doing this often will enhance your ability to communicate clearly and concisely.

Be A Human Calculator: Flex your mental calculating skills by thinking of a number and then doubling it. Keep doubling it to see how high you can go. For example: 2, 4, 8, 16, 32, 64 and so on.

Final ThoughtsGiven the proper care, your brain can stay healthy and adapt throughout

all the years of your life. Of course, your genes, general health and level of education can affect both your cognitive power and your memory, but the little things you do every day can add up to lifelong intellectual vigor.

The same habits you practice to promote overall health—eating a healthy diet, exercising regularly and getting enough sleep—can have a profound impact on your mental health too. Stimulating your mind daily, and adding brain-specific nutrients like citicoline to your diet, can fortify your brain cells and encourage the growth of new neuronal connections, protecting your memory and learning capacity for years to come.


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Bazan NG. Omega-3 fatty acids, pro-inflammatory signaling and neuroprotection. Current Opinion in Clinical Nutrition and Metabolic Care. 10(2):136-141, 2007.

Brown ES. A randomized, placebo-controlled trial of citicoline add-on therapy in outpatients with bipolar disorder and cocaine dependence. Journal of Clinical Psychopharmacology. 27(5):498-502, 2007.

Cansev M. Oral administration of circulating precursors for membrane phosphatides can promote the synthesis of new brain synpases. Alzheimer’s and Dementia. 4(1 Suppl 1):S153-168, 2007.

D’Anci KE. Low-carbohydrate weight-loss diets. Effects on cognition and mood. Appetite. 52:96-103, 2009.

Durga J. Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomized, double blind, controlled trial. Lancet. 369(9557):208-216, 2007.

Feldman D. Synaptic mechanisms for plasticity in neocortex. Annual Review of Neuroscience. 2009.

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For a complete list of references for this booklet, please visit www.kyowa-usa.com.

CHECK OUT ANOTHER BETTER NUTRITION HEALTHY LIVING GUIDE TODAY!

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IMPROVE MEMORY, FOCUS AND CONCENTRATION

betternutrition.com

T he brain is one of the most fascinating and complex organs

of the human body. However, it is also susceptible to dam-

age from environmental pollution, oxidative stress, poor

diet, lack of exercise, and other factors. Over time the brain can lose

its ability to remember, focus, and function properly. In this informa-

tive booklet, award-winning brain researcher Perry Renshaw, MD,

explains how you can increase the your brain’s mental acuity while

also helping to prevent and even reverse age- related damage to the

brain. Dr. Renshaw also shares his innovative research on a natural

substance known as citicoline. This booklet will describe how you

can protect and boost your brain power.

Perry Renshaw, MD, PhD, is Director of Magnetic Resonance

Imaging at The Brain Institute of the University of Utah, and

Professor of Psychiatry at the University of Utah School of

Medicine. For the past 15 years, Dr. Renshaw has been on the

faculty of the Department of Psychiatry at Harvard Medical

School and for 10 years was the Director of the Brain Imaging

Center at McLean Hospital. He is the author of more than 240

peer-reviewed articles and has received numerous honors

for his research.

ABOUT THE AUTHOR OF THIS BOOKLET

BRAIN HEALTHmagazine presents

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Brain Health

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