Recommended Key Performance Indicators
Measuring and monitoring by you:
1. Overall activity measured in metabolic equivalents (MET). Some examples of a MET per hour: sitting, 1; slow walk, 2; Yoga, 3.2; brisk walk, 3.5; cycling, 7.5; swimming, 9; weight training, 10; running, 10; kayaking, 10; sprinting, 23. Aim for 9–15 MET hours per week.
2. You can record the number of steps per day (for example, 10 000 is good) with smartphones or electronic fitness devices.
3. Keep a log of timed distance and speed data from activities you do, such as walking, running, swimming, cycling, or kayaking with the aid of electronic monitoring devices (e.g., Garmin, Fitbit).
Measuring and monitoring by medical professionals:
1. Garmin devices measure VO2 max.
2. VO2 max may also be computed using the formula VO2 max = 15 × HR max/HR rest (Uth–Sorensen–Overgaard–Pedersen test).
3. VO2 max can be computed using VO2 max = d12 – 505/45 where d12 is distance in meters covered in 12 minutes (Cooper test).
4. vVO2 max estimation is used for competitive athletes. The vVO2 max is computed by measuring the distance run in meters at maximum heart rate for a time of 6 min, and is recorded in meters per second.
5. Measure heart rate variability (HRV), which allows estimation of stress monitoring by specific Garmin devices (Vivoactive 3).
6. Record fitness age as a comparison to your biological age (Garmin devices) or from the website www.ntnu.edu/cerg/vo2 max.
Brain Foods 167
Cerebral white matter lesions or leukoaraiosis and white matter hyperintensity vol- ume (WMHV) reduction, which is associated with cognitive decline, was also lessened by following the M diet [48]. An amelioration in mild cognitive impairment and conversion to Alzheimer’s disease has also been reported [49]. Although the M diet is the most exten- sively studied to date, other diets with similar core compositions and relatively void of processed ingredients have also been shown to be effective. Examples include the Nordic, Okinawan, modified Atkins, Paleo, and Rosedale diets [50–54].
However, there is increasing awareness of what is thought to be our “original diet” or a high- fat, low- carbohydrate diet also known as the Banting diet, described in 1864 by William Banting of London, England [55]. This consists of seven foodstuffs: fish, meat, eggs, nuts, dairy produce, leafy vegetables, and low- carbohydrate fruits, predominantly berries. Carbohydrates were not an essential part of the Neolithic human diet, and now adays insulin resistance manifests in people who consistently consume >50 g per day of carbohydrates. Insulin resistance results in weight gain, elevated blood pressure, fat depos- ition in the abdominal organs – especially the liver – elevated uric acid, elevated glucose levels, impaired arterial dilatation, endothelial dysfunction, whole- body inflamma- tion, mitochondrial dysfunction, and impaired physical exercise capability. High car- bohydrate intake and insulin resistance in turn manifest with six principle widespread conditions today: obesity; myocardial infarction; stroke; type 2 diabetes mellitus; type 3 diabetes (Alzheimer’s disease); non- alcoholic fatty liver disease (NAFLD); and cancer.
Rather than a random collection of diseases, these are different expressions of the same disease or insulin resistance, and should be labeled as such to allow effective prevention and treatment. A key requirement in those with insulin resistance is to limit carbohy- drates to no more than 25–50 g per day [56]. Noakes has compiled evidence that pursuing the correct diet is more effective than pharmacotherapy for our major global diseases of diabetes mellitus type 2, hypertension, and obesity [57].
What has worked, therefore, are those diets that all include composite food items in combinations that very likely contribute to success. However, what has not worked is the studying of food items or substances in isolation, nor vitamin supplementation studies that have seen some spectacular failures [58]. Nutritional factors are potent determinants of our brain health. For whatever reason, serotonin production has been outsourced to our gut, the bacterial microbiome being responsible for about 90 percent of its produc- tion. Microbiome health is key to our physical and mental well- being and is surprisingly capricious. For example, only two weeks of a suboptimal fast- food diet can alter the bacterial gut populations (microbiome) in a deleterious manner, with increased gastro- intestinal inflammation that depletes serotonin. The by- products of inflammation convert serotonin into tryptophan, which in turn generates neurotoxic metabolites that are linked to depression, Alzheimer’s disease, and schizophrenia [59]. The extensive and rapid com- munication between the gut and the brain is composed of neural networks, the vagus nerve, and neurotransmitters such as serotonin. The gut has an extensive nervous sys- tem, also called the enteric nervous system, and the resident bacteria and viruses, the gut microbiome, number ~200 trillion cells, elaborating neurochemicals and conferring immune functions integral to our health. Hence, diet is vitally important, as what you eat influences genes and alters them by epigenetic mechanisms even for future generations.
Because of the brain’s large energy consumption, energy transfer from nutrients to neurons is integral to optimal brain function. The close link between brain- derived neurotrophic factor (BDNF), mediated synaptic plasticity, and energy metabolism is an
example. BDNF is prolific in cognitive (hippocampus) and metabolic regulatory (hypo- thalamus) areas [60,61]. IGF- 1 is also involved in hippocampal regions, influencing nerve growth, neurotransmitter synthesis processing, and synaptic plasticity [62]. Food- derived signals or energy metabolism are translated into synaptic plasticity via the mTOR (mammalian target of rapamycin) and Akt activation pathways. Omega- 3 fatty acids also influence synaptic plasticity and cognition [63,64].
The concept of intermittent metabolic switching (IMS), or various methods of fast- ing, has been gaining popularity in improving brain health. Although most of the data to date stem from rodent models, some impressive results have been reported. The physi- ological basis is best understood in evolutionary terms. Those individuals whose bodies and brains performed well while undergoing a variety of fasting states were clearly in an advantageous position with respect to obtaining nutrients, ongoing reproduction, and overall survival. The change or switch in metabolism in supplying cellular fuel source is attended by molecular and cellular modifications with respect to cerebral neural net- works in the brain, with an overall enhancement of function as well as improved ability to ward off disease, injury, and stress. Differing IMS protocols of intermittent fasting in ani- mals have been employed, including alternate day fasting (ADF), by fasting for 24 hours at a time, and daily time restricted feeding (TRF) by fasting for 16 hours at a time. These induce depletion of liver energy glycogen stores and consequently adipose cells release fatty acids, which in turn are converted into ketone bodies (beta hydroxybutyrate and acetoacetate), also termed the glucose to ketone switch. An overall enhancement of phys- ical performance, cognition, and motor function has been reported by such IMS proto- cols. Physiologically, an upregulation of neurotrophic factors and antioxidants occurs, as well as various DNA repair systems, including protein deacetylase and autophagy, being engaged. Both neuroprotection and mitochondrial biogenesis ensue. Human trials are now underway, but there is already a large body of evidence of benefit, including the ketogenic diet, that is both neuroprotective and successful in reducing drug- resistant epilepsy syndromes [65].
Six taste senses guide our intake of foods, with the first four being beneficial indica- tors and the latter two heralding potential “poisons”:
1. salt: critical electrolyte for all animals;
2. sweet: complex sugars, high- density energy food;
3. umami: protein, savory detection, high- density energy food;
4. fat detection receptor: high- density energy food;
5. sour: acid, H+ detection, food decomposition;
6. bitter: toxin detection.
These assist in supplying what the body needs. There are no strict rules with respect to proportions or calorie counting, but only general guidelines. Both quality of food and portion sizes are important in optimal nutrition. In addition, the closer one can follow what has been termed an ancestral type of diet as the overall general guiding principle, the better. A synopsis of these guidelines follows.
What the Body Needs
• Fish should be preferably wild in origin and shellfish should be evaluated for potential heavy metals such as mercury and arsenic.
Brain Foods 169
• Fruit and vegetable consumption should be fibrous; oranges instead of orange juice.
• Some saturated fats are healthy and the obsession with low- fat diets has paradoxically increased cardiovascular disease.
• Large type A LDL particles are healthy and are reduced by a low- fat diet, whereas the small, dense type B LDL particles, driven by high sugar intake, are predominantly responsible for atherogenic dyslipidemia (clogging of blood vessels in the heart, brain, kidneys).
• Meat, whether red or white, should be from free- range animals.
• Dairy products should be full- fat and not reduced or fat- free; healthy saturated fats contain vitamins A and D.
• Maintain an anti- nutrient awareness with respect to grains, which should probably not be consumed in excess and when consumed should be whole grains.
Overview
The cornerstone to healthy eating involves eating moderate- to high- fat foods as opposed to the frequently promoted low- fat foods, minimizing grain consumption, drastically reducing sugar intake that causes heart attacks, strokes, diabetes, obesity, fatty liver, and dementia. Food quality, quantity, and timing of intake are all important. High- quality foods are outlined below; portion size in general involves one plate and one serving. Meal timing involves eating the majority in the first half of the waking day. Practice intermit- tent fasting for 12–16 h once per week and monthly 24 h fasts.
The key wholefoods include (1) seafood; (2) eggs; (3) red/white meat (free range);
(4) fruit (berries); (5) regular- fat dairy; (6) tubers (potatoes, sweet potatoes, carrots); (7) cruciferous vegetables (broccoli, cabbage); (8) legumes (peas, beans, lentils); (9) probiot- ics (fermented dairy, yogurt, pickles, olives, sauerkraut); (10) prebiotics (garlic, onions, leeks); (11) nuts, seeds, and spices (curcumin, cinnamon, oregano, chili peppers, thyme, basil). In general, this may be achieved by following the original diet of Banting, or others such as the Mediterranean, Nordic, Pegan, or Okinawan diets.
Avoiding What the Body Does Not Need
• refined sugars: cane sugar, corn syrup, sodas, diet sodas;
• processed fats and oils: trans- fats, vegetable oils;
• processed dairy products: low- fat or fat- free dairy;
• processed meats;
• avoidance of meats contaminated with antibiotic use;
• cigarettes and substance abuse;
• avoidance of insecticides and toxins;
• avoidance of unnecessary vitamins and supplements;
• water purification – be aware of potential heavy metals (arsenic, mercury).
The Relation of Nutrition to Sleep and Exercise
• In the diurnal cycle, ghrelin increases with lack of sleep, which initiates hunger and feeding. Hence the best diet adherence can be derailed if sleep is impaired.
• Physical activity and nutrition are synergistic and both stimulate brain growth factors such as BDNF.
Microbiome Awareness and Monitoring
• Avoid unnecessary antibiotic use.
• Consider use of probiotics in yogurts, for example.
• There is a “Godzilla” within us of 200 trillion cells – respect it.
A Proposed Evolution- Based Diet: The Legacy Diet and the Macronutrient Index
• Beneficial foods category – small portion sizes! For example, portion sizes for fruit typically refer to one average- sized apple, one banana, or about a dozen blueberries.
• Appropriate portion sizes for other foods can be reviewed at the website (www.nhlbi .nih.gov/health/educational/wecan/eat-right/distortion.htm).
• From the lists below:
– score one point for each category only in the right frequency intake;
– minus one point for any component in the deleterious nutrition category taken at any time, daily or weekly;
– maximum macronutrient index score: 20.
Intake 5–7 times per week
1. Fruits deciduous – apples, pears, plums, grapes, berries 2. Fruits tropical – mango, papaya, pineapple
3. Fruits citrus – oranges, grapefruit, mandarin
4. Vegetables – broccoli, cabbage, cauliflower, tomatoes, peas 5. Nuts, seeds
6. Eggs – preferably from free- range hens 7. Yogurt with probiotics, milk, cheese
8. Grains (whole, not refined) – oats, barley, rye, wheat, bran, muesli 9. Coffee (ground beans), black or green tea, dark chocolate
10. Alcohol ≤30 g/d for men (2 units), ≤20 g/d for women (1.5 units) Intake 3–4 times per week
1. Fish – pelagic (preferably wild)
2. Shellfish – oysters, clams, mussels, scallops 3. Crustaceans – shrimp, lobster
4. Meat (white) – chicken, turkey, preferably free-range 5. Tubers – potatoes, sweet potatoes, yams, carrots, cassava 6. Leafy vegetables – lettuce, spinach
7. Complex starches – maize, rice 8. Legumes – beans, lentils, peas, peanuts 9. Spices – curcumin, oleander, cinnamon Intake 1–2 times per week
1. Meat (red) preferably free- range or bison
Intake 0 times per week: deleterious nutrition category – subtract points 1. Added refined sugar, sucrose, high- fructose corn syrup (HFCS) 2. Sodas, soft drinks – diet or regular