Aug 25, 2023·edited Aug 26, 2023Liked by Annie Fenn, MD
Hi Annie,
I especially loved your posts on protein. So helpful!
And I am interested to know about:
- Mushrooms and brain health.
- Fluid intake and hydration (fluid and electrolytes) and brain health, and how to optimize this over course of a day in cold and hot weather
I would also love for you to do an article that gives 5 or 6 FOUNDATIONAL recipes for brain health (for example, a recipe for a high protein bread, a generic smoothie, sautéed greens, berry compote, mushroom soup or paté-- just thinking off the top of my head about the food groups we might want to include and a foundational recipe that's easy to make and easily varied according to needs).
For example, I like to make a high protein bread with oat flour, chickpea flour, and canned chickpeas. Ever since I discovered the recipe for this amazing bread, it has become a cornerstone of our diet. I would be happy to share the recipe. Maybe you could even improve on it.
So many great questions! Here is mine: what are your specific brain-healthy recommendations regarding added sugar. The MIND diet seems artfully vague: no more than 5 servings of pastries or sweets each week. But what is a serving? The AHA guidelines are more specific: 9 teaspoons (~150 calories) for men, and 6 teaspoons (~100 calories) for women. But that added sugar could come from many sources, e.g., catsup, salad dressing, bread, tomato soup, etc. Would love your guidelines on this. (Note that in my recent Stanford presentation, I got the most questions about sugar!)
Annie, so many of your newsletters have been very helpful, it would be difficult for me to select a favorite! I look forward to your in-depth report on HRT and dementia, also osteoporosis. After your recent podcast recommendation, I read "Estrogen Matters" by Avrum Bluming and Carol Tavris. What an enlightening, informative, and also frustrating read! Since I stopped taking Premarin in 2003, after the scary WHI report, I have developed osteoporosis and osteonecrosis of the jaw bones (possibly from the bisphosphonates that were prescribed). After reading the book and your newsletters, I requested to start HRT and had to present my arguments for doing so. My PCP finally reluctantly agreed to prescribe estradiol for three months. We will revisit the issue again, so I would love to have even more research results or information to show her.
I have one question on this topic: In the book, there is a statement that "Premarin contains at least ten forms of estrogen, including estradiol, but it also has equilin, the form believed to be most beneficial in preserving brain function". So is taking only estradiol not going to be beneficial for brain health? Have you found any research on this?
My biggest challenge is major dental surgery in the near future, which will mean a completely soft food diet for a few months. I am trying to not feel guilty when I can't meet the MIND diet guidelines!
Hi Michele. It makes me so sad to hear this. I had a full menopausal health practice when the WHI came out and I know many who ended up going off HRT because of it. Equilin did stand out as a brain-friendly estrogen but it's not entirely biologically plausible that this one type of estrogen is the only one with brain benefits. More soon! Good luck with your upcoming surgery. And remember, the brain health diet is about what you eat over years and decades, not months. Be sure to check out the green smoothie in my book, but mostly focus on getting enough calories and stay as active as possible so you won't lose muscle.
Eating brain healthy at restaurants where carbs are almost always processed & proteins are farmed. Is eating farmed salmon healthy or am I better off with a vegan entree with processed carbs/fake cheese, etc? How to navigate menus. I typically order a salad with grilled salmon or a seafood dish that is broiled but it is most often Atlantic seafood. Alaskan is almost impossible to find. Farmed shrimp & Tillapia abound as do Mussels.
I use Silk unsweetened soy milk most days, it has a little fiber and good amount of protein compared to Almond milk. Does that count as beans and legumes in my scoring of Mind diet foods?
Hi Kathy. I think it's great that you drink soy milk. If you make soy milk from scratch, you get about 1 ounce of soy beans in each cup. It's hard to tell how much is in commercial products, but it is probably less. A half cup of beans or legumes is about 3 ounces. So, yes, you are getting a small dose of legumes, but not enough to count as a MIND diet serving. But 3 cups soy milk probably gets you there!
Great question, Annie, and thank you for posing it.
(BTW, you may not recall but 2-3 years ago I challenged you privately on content from a newsletter and you were incredible; you took the time to respond kindly and to provide that ApoE4 Precision Nutrition study which Dr Isaacson had co-authored. I spent a week deciphering it, taking notes and setting up my own plan. Thank you!)
My biggest challenge is to understand how to triangulate the idea that a "keto flex" way of eating may be valuable for cognition in ApoE4s, but keeping saturated fats low is also important for 4s who show signs of being hyper-absorbers of dietary cholesterol and sat fats when looking at LDL. Additionally, building muscle is critical for better metabolic function which means one must incorporate consistent resistance training, and that requires a respectable level of carbs to do successfully. (I have been lifting for over 2 decades and going low carb is not fun for me.)
Hello CFL! Thanks for you comment! Glad that paper was useful for you. I did not go into the ketogenic diet data in my recent ApoE4 newsletter for a few reasons. Like you say, it is very difficult to conceptualize how this would work in a brain healthy diet. The ketone bodies may be beneficial but the food choices leave out important brain health food groups. While Isaacson and his group lay out several theoretical reasons how keto would help ApoE4s, the only papers cited are a case study of one person, and another small paper looking how keto vs fasting impacts brain network stability. I don't think the science is strong enough to recommend a keto diet for ApoE4s yet. But I do think intermittent fasting may end up being part of the recomendations as it provides some ketone bodies for part of the day but doesn't interfere with food groups. If you all are interested, we could dive into the brain health benefits of fasting in an upcoming newsletter.
My daughter is just entering menopause, and for awhile now has been mentioning "brain fog." Earlier she has thought it was something related to Covid, but now she's thinking it's related to menopause. I realize it could be a mixture of things, etc. My question is, naturally, what foods might be best to leave out of her diet to help with hot flashes, etc. and brain fog. She is a vegetarian, and I also wonder is that has anything to do with it.
Hello Dottie. I am really interested in how to support perimenopausal brain fog with brain healthy food. To be honest, there is not a lot of data to guide us, but there is some. Stay tuned!
Annie: struggling to get enough protein. Have added 1/2 scoop of Optimum NutritionGold Standard 100%Whey to my Kefir. That adds 12 gms of protein plus 10 from Kefir. (22)With steel cut oats(6) and 1/2 cup soy milk(3.5) total 31.5 breakfast. Is adding protein powder a good idea. Would you recommend another brand?
Hi Marsha! I like how you are trying to get most of your protein through whole foods. I reserve the powder for busy days when I may be falling behind. But I don't have a lot of personal experience with different brands because most I've tried hurt my stomach:( Anyone else here want to call out some brands they like?
After trying several other protein powders, we have been using Orgain Organic Protein powder in our smoothies for a couple of years. We like the Vanilla Bean flavor ... it adds some "richness" to the smoothie.
I don't have a lot of experience with protein powder, but I've been playing around with the plain Orgain unsweetened (it's a combo of pea, chia, and rice protein). On busy days, swapping out my standard coffee and blending a scoop with cold coffee, ice, milk, almond butter, vanilla, and a splash of maple syrup. It's a protein-rich iced coffee.
I love this recommendation Katie. It's kind of like the protein boosted version of my Coffee Date Smoothie as an ice coffee. Will definitely give that brand a try.
Hi! Your challenges, Annie, are my challenges. Work/life balance is a huge one for me, reducing stress, and getting enough exercise every day vs pushing it all to the weekend (better than nothing). I loved your last challenge about learning to tolerate others who are making bad choices - MAJOR CHALLENGE that comes with family, adult children in their 20s, and co-workers. We are offered lunch at work but I am usually at the salad bar line and I bring my own dressing - ignore the weird stares from others... ;). The "break snacks" offered which are cakes and bagels and the like...you want to socialize but...One tip I have found is to determine if you are a "moderator" or an "abstainer" (this is from Gretchen Rubin) regarding food. I am an abstainer - it's much easier for me to cut something out completely than to moderate it. My daughter is the opposite. Once you figure it out, it does make life easier. I abstain from gluten for example. It makes socializing at work events much easier. I just don't even have the inclination to eat a bagel or donut. Same for alcohol. For others though, they like to have a moderated bit and then they don't feel less or slighted etc. I also like Jim Kwik's refrain: "everything you put in your mouth is either good for your brain or not good for your brain". You decide.
I'd like to see some articles on snacks that I can bring to work easily. So far I've done your muffins, and coconut or almond milk yogurt with berries/nuts, as well as your overnight oats.
I'm also a bit confused by smoothies being healthy - even in your book - since I've read that "juice" is high-glycemic and you're really pulverizing away the fiber etc. So an article on that. (Maybe I missed one already?)
An additional article on hormone therapy would be interesting. I know you have done one and I loved the podcast your referred us all too. Hence I was shocked when I listened to the author of a recent book called "Hags: The Demonisation of Middle-Aged Women" whose POV was that HRT stems from the patriarchy insisting women continue to be baby-producing if possible vs HRT being neuro-protective. I found her opinion on this sadly mis-informed but I recognize the subject is sensitive. I had never heard this POV. I was shocked - it's the exact opposite of what the podcast you referred us to talked about.
I love your recipe book and the newsletter. The one thing I really like about it is that you are so upbeat. I can get really down after a visit with my Mom who hasn't recognized me in 10 years and cannot talk or feed herself anymore...I am an APOE4 carrier (3/4) and I liked your recent article on this. I've been focused on my DESStiny (diet, exercise,stress, and sleep) + hormones, for 5 years now and it's helpful to read your articles to stay the course when my motivation sags.
Hi Liz! Thanks for sharing so many pearls of wisdom here from the POV of an ApoE 3/ 4 who's been diving into this topic for awhile. I would love to address the brain healthy lunchbox at work/school in an upcoming article. I like how you think about abstaining from the brain-harming foods--moderation can be tricky for most.
More coming on HRT. Also, I probably won't write a whole piece about smoothies but take a look at the sidebar next to the Easy Green Smoothie in the book where I discuss the downside of predigesting all that fiber. Thanks for being here!
Hi dear Annie, My challenges are (1) a husband who likes big meals with lots of foods we shouldn’t eat, and (2) we go out to eat to eat frequently and I’m faced with temptation and non-brain healthy foods.
Love you, your amazing body of research and teaching, and the advice you offer.
Hi Toni, yes perhaps we should do something about partner-friendly meals, or how to stick to brain health when your partner does not. I have some personal experience! Love you too.
As someone with an “impressive family history” of dementia (according to one cognitive specialist MD), I’d be interested to see a newsletter focused on the interplay of risk reductions. We hear that good diet can reduce risk of developing dementia by x%. Exercise can reduce risk by y%. Other factors by a, b, or c%. But how do all those fit together? Does anyone know? Thanks, Annie!
I'm not sure this is completely in line with your question above, and please ignore if off topic, but I am personally very confused by "family history" vs. having a clear genetic risk (such as APOE4). I DO NOT have APOE4. I am 65 and so far perfectly fine and healthy. I work hard at it. However, my mother had dementia (died at 68) and my older brother has mid-stage Alzheimer's (he is 71). I do not know what their APOE status was/is. But both had/have many, many known health and lifestyle risk factors that I do not have. So where does "family history" then become a big factor here? So confusing! At least for me.
Hello M.L. I think you've hit upon the difference here. Family history is general and can be very nonspecific. Genetic risk is more individualized. Each person has their own mosaic of risk factors. The key thing is to recognize which ones you have the power to change. It sounds like you are doing an excellent job!
With Back to School, my biggest challenge will be figuring out pack-able lunches and daytime snacks. Lots of the salads in BHK adapt to mason jars...would love to learn which soups can be made ahead or are great as leftovers for lunches during the week...sandwiches or just some new ways to think about staying BHK during the day at work and on the go whether it's commuting or driving kids to school and activities.
Hi Annie,
I especially loved your posts on protein. So helpful!
And I am interested to know about:
- Mushrooms and brain health.
- Fluid intake and hydration (fluid and electrolytes) and brain health, and how to optimize this over course of a day in cold and hot weather
I would also love for you to do an article that gives 5 or 6 FOUNDATIONAL recipes for brain health (for example, a recipe for a high protein bread, a generic smoothie, sautéed greens, berry compote, mushroom soup or paté-- just thinking off the top of my head about the food groups we might want to include and a foundational recipe that's easy to make and easily varied according to needs).
For example, I like to make a high protein bread with oat flour, chickpea flour, and canned chickpeas. Ever since I discovered the recipe for this amazing bread, it has become a cornerstone of our diet. I would be happy to share the recipe. Maybe you could even improve on it.
Thanks for asking!
Leni
Such wonderful ideas Leni. Mushrooms have been on my list for a while. Yes, please send the recipe--I'd love to give it a try.
I'm also interested in learning about Lion's Mane mushroom and high protein bread.
So many great questions! Here is mine: what are your specific brain-healthy recommendations regarding added sugar. The MIND diet seems artfully vague: no more than 5 servings of pastries or sweets each week. But what is a serving? The AHA guidelines are more specific: 9 teaspoons (~150 calories) for men, and 6 teaspoons (~100 calories) for women. But that added sugar could come from many sources, e.g., catsup, salad dressing, bread, tomato soup, etc. Would love your guidelines on this. (Note that in my recent Stanford presentation, I got the most questions about sugar!)
Hi Sally! Such an excellent question. The MIND diet was vague on many things, especially sugar. A great future topic to dive into.
Annie, so many of your newsletters have been very helpful, it would be difficult for me to select a favorite! I look forward to your in-depth report on HRT and dementia, also osteoporosis. After your recent podcast recommendation, I read "Estrogen Matters" by Avrum Bluming and Carol Tavris. What an enlightening, informative, and also frustrating read! Since I stopped taking Premarin in 2003, after the scary WHI report, I have developed osteoporosis and osteonecrosis of the jaw bones (possibly from the bisphosphonates that were prescribed). After reading the book and your newsletters, I requested to start HRT and had to present my arguments for doing so. My PCP finally reluctantly agreed to prescribe estradiol for three months. We will revisit the issue again, so I would love to have even more research results or information to show her.
I have one question on this topic: In the book, there is a statement that "Premarin contains at least ten forms of estrogen, including estradiol, but it also has equilin, the form believed to be most beneficial in preserving brain function". So is taking only estradiol not going to be beneficial for brain health? Have you found any research on this?
My biggest challenge is major dental surgery in the near future, which will mean a completely soft food diet for a few months. I am trying to not feel guilty when I can't meet the MIND diet guidelines!
Hi Michele. It makes me so sad to hear this. I had a full menopausal health practice when the WHI came out and I know many who ended up going off HRT because of it. Equilin did stand out as a brain-friendly estrogen but it's not entirely biologically plausible that this one type of estrogen is the only one with brain benefits. More soon! Good luck with your upcoming surgery. And remember, the brain health diet is about what you eat over years and decades, not months. Be sure to check out the green smoothie in my book, but mostly focus on getting enough calories and stay as active as possible so you won't lose muscle.
Thanks for your encouraging words! And yes, I will continue to stay active, do my exercise, and use the smoothie recipe from your book. It’s so good!
Eating brain healthy at restaurants where carbs are almost always processed & proteins are farmed. Is eating farmed salmon healthy or am I better off with a vegan entree with processed carbs/fake cheese, etc? How to navigate menus. I typically order a salad with grilled salmon or a seafood dish that is broiled but it is most often Atlantic seafood. Alaskan is almost impossible to find. Farmed shrimp & Tillapia abound as do Mussels.
Fantastic topic!!!
I use Silk unsweetened soy milk most days, it has a little fiber and good amount of protein compared to Almond milk. Does that count as beans and legumes in my scoring of Mind diet foods?
Hi Kathy. I think it's great that you drink soy milk. If you make soy milk from scratch, you get about 1 ounce of soy beans in each cup. It's hard to tell how much is in commercial products, but it is probably less. A half cup of beans or legumes is about 3 ounces. So, yes, you are getting a small dose of legumes, but not enough to count as a MIND diet serving. But 3 cups soy milk probably gets you there!
Great question, Annie, and thank you for posing it.
(BTW, you may not recall but 2-3 years ago I challenged you privately on content from a newsletter and you were incredible; you took the time to respond kindly and to provide that ApoE4 Precision Nutrition study which Dr Isaacson had co-authored. I spent a week deciphering it, taking notes and setting up my own plan. Thank you!)
My biggest challenge is to understand how to triangulate the idea that a "keto flex" way of eating may be valuable for cognition in ApoE4s, but keeping saturated fats low is also important for 4s who show signs of being hyper-absorbers of dietary cholesterol and sat fats when looking at LDL. Additionally, building muscle is critical for better metabolic function which means one must incorporate consistent resistance training, and that requires a respectable level of carbs to do successfully. (I have been lifting for over 2 decades and going low carb is not fun for me.)
Thank you once again. You are a gem.
Hello CFL! Thanks for you comment! Glad that paper was useful for you. I did not go into the ketogenic diet data in my recent ApoE4 newsletter for a few reasons. Like you say, it is very difficult to conceptualize how this would work in a brain healthy diet. The ketone bodies may be beneficial but the food choices leave out important brain health food groups. While Isaacson and his group lay out several theoretical reasons how keto would help ApoE4s, the only papers cited are a case study of one person, and another small paper looking how keto vs fasting impacts brain network stability. I don't think the science is strong enough to recommend a keto diet for ApoE4s yet. But I do think intermittent fasting may end up being part of the recomendations as it provides some ketone bodies for part of the day but doesn't interfere with food groups. If you all are interested, we could dive into the brain health benefits of fasting in an upcoming newsletter.
My daughter is just entering menopause, and for awhile now has been mentioning "brain fog." Earlier she has thought it was something related to Covid, but now she's thinking it's related to menopause. I realize it could be a mixture of things, etc. My question is, naturally, what foods might be best to leave out of her diet to help with hot flashes, etc. and brain fog. She is a vegetarian, and I also wonder is that has anything to do with it.
Hello Dottie. I am really interested in how to support perimenopausal brain fog with brain healthy food. To be honest, there is not a lot of data to guide us, but there is some. Stay tuned!
Annie: struggling to get enough protein. Have added 1/2 scoop of Optimum NutritionGold Standard 100%Whey to my Kefir. That adds 12 gms of protein plus 10 from Kefir. (22)With steel cut oats(6) and 1/2 cup soy milk(3.5) total 31.5 breakfast. Is adding protein powder a good idea. Would you recommend another brand?
Thank you
Marsha
Hi Marsha! I like how you are trying to get most of your protein through whole foods. I reserve the powder for busy days when I may be falling behind. But I don't have a lot of personal experience with different brands because most I've tried hurt my stomach:( Anyone else here want to call out some brands they like?
After trying several other protein powders, we have been using Orgain Organic Protein powder in our smoothies for a couple of years. We like the Vanilla Bean flavor ... it adds some "richness" to the smoothie.
Great to hear!
I don't have a lot of experience with protein powder, but I've been playing around with the plain Orgain unsweetened (it's a combo of pea, chia, and rice protein). On busy days, swapping out my standard coffee and blending a scoop with cold coffee, ice, milk, almond butter, vanilla, and a splash of maple syrup. It's a protein-rich iced coffee.
I love this recommendation Katie. It's kind of like the protein boosted version of my Coffee Date Smoothie as an ice coffee. Will definitely give that brand a try.
Should I try for 90gms a day of protein?
I am 77 yrs old.
This would depend on your weight and activity level. If you are an active person, shoot for ⅔ of your body weight in grams.
I'd like for you to weigh in on the relationship between brain health and your gut microbial makeup.
Hi Janie. Yes, there's so much we could go into here. In case you missed it, I did an introductory post here: https://brainhealthkitchen.substack.com/p/pay-attention-to-your-gut-to-boost
Hi! Your challenges, Annie, are my challenges. Work/life balance is a huge one for me, reducing stress, and getting enough exercise every day vs pushing it all to the weekend (better than nothing). I loved your last challenge about learning to tolerate others who are making bad choices - MAJOR CHALLENGE that comes with family, adult children in their 20s, and co-workers. We are offered lunch at work but I am usually at the salad bar line and I bring my own dressing - ignore the weird stares from others... ;). The "break snacks" offered which are cakes and bagels and the like...you want to socialize but...One tip I have found is to determine if you are a "moderator" or an "abstainer" (this is from Gretchen Rubin) regarding food. I am an abstainer - it's much easier for me to cut something out completely than to moderate it. My daughter is the opposite. Once you figure it out, it does make life easier. I abstain from gluten for example. It makes socializing at work events much easier. I just don't even have the inclination to eat a bagel or donut. Same for alcohol. For others though, they like to have a moderated bit and then they don't feel less or slighted etc. I also like Jim Kwik's refrain: "everything you put in your mouth is either good for your brain or not good for your brain". You decide.
I'd like to see some articles on snacks that I can bring to work easily. So far I've done your muffins, and coconut or almond milk yogurt with berries/nuts, as well as your overnight oats.
I'm also a bit confused by smoothies being healthy - even in your book - since I've read that "juice" is high-glycemic and you're really pulverizing away the fiber etc. So an article on that. (Maybe I missed one already?)
An additional article on hormone therapy would be interesting. I know you have done one and I loved the podcast your referred us all too. Hence I was shocked when I listened to the author of a recent book called "Hags: The Demonisation of Middle-Aged Women" whose POV was that HRT stems from the patriarchy insisting women continue to be baby-producing if possible vs HRT being neuro-protective. I found her opinion on this sadly mis-informed but I recognize the subject is sensitive. I had never heard this POV. I was shocked - it's the exact opposite of what the podcast you referred us to talked about.
I love your recipe book and the newsletter. The one thing I really like about it is that you are so upbeat. I can get really down after a visit with my Mom who hasn't recognized me in 10 years and cannot talk or feed herself anymore...I am an APOE4 carrier (3/4) and I liked your recent article on this. I've been focused on my DESStiny (diet, exercise,stress, and sleep) + hormones, for 5 years now and it's helpful to read your articles to stay the course when my motivation sags.
Thanks for all you do!
Hi Liz! Thanks for sharing so many pearls of wisdom here from the POV of an ApoE 3/ 4 who's been diving into this topic for awhile. I would love to address the brain healthy lunchbox at work/school in an upcoming article. I like how you think about abstaining from the brain-harming foods--moderation can be tricky for most.
More coming on HRT. Also, I probably won't write a whole piece about smoothies but take a look at the sidebar next to the Easy Green Smoothie in the book where I discuss the downside of predigesting all that fiber. Thanks for being here!
Hi dear Annie, My challenges are (1) a husband who likes big meals with lots of foods we shouldn’t eat, and (2) we go out to eat to eat frequently and I’m faced with temptation and non-brain healthy foods.
Love you, your amazing body of research and teaching, and the advice you offer.
Toni Smith
Hi Toni, yes perhaps we should do something about partner-friendly meals, or how to stick to brain health when your partner does not. I have some personal experience! Love you too.
As someone with an “impressive family history” of dementia (according to one cognitive specialist MD), I’d be interested to see a newsletter focused on the interplay of risk reductions. We hear that good diet can reduce risk of developing dementia by x%. Exercise can reduce risk by y%. Other factors by a, b, or c%. But how do all those fit together? Does anyone know? Thanks, Annie!
Hi Susan, such a great question. I'll think about this more.
Hi Annie, I'd love to hear your thoughts on the supplement phosphatidylserine. Thanks!
Great topic Katie!
I'm not sure this is completely in line with your question above, and please ignore if off topic, but I am personally very confused by "family history" vs. having a clear genetic risk (such as APOE4). I DO NOT have APOE4. I am 65 and so far perfectly fine and healthy. I work hard at it. However, my mother had dementia (died at 68) and my older brother has mid-stage Alzheimer's (he is 71). I do not know what their APOE status was/is. But both had/have many, many known health and lifestyle risk factors that I do not have. So where does "family history" then become a big factor here? So confusing! At least for me.
Hello M.L. I think you've hit upon the difference here. Family history is general and can be very nonspecific. Genetic risk is more individualized. Each person has their own mosaic of risk factors. The key thing is to recognize which ones you have the power to change. It sounds like you are doing an excellent job!
With Back to School, my biggest challenge will be figuring out pack-able lunches and daytime snacks. Lots of the salads in BHK adapt to mason jars...would love to learn which soups can be made ahead or are great as leftovers for lunches during the week...sandwiches or just some new ways to think about staying BHK during the day at work and on the go whether it's commuting or driving kids to school and activities.
Hi KC! I love this topic. I am doing a back to school themed collaboration with a non-profit soon.
Sleep
Definitely need to write about sleep soon!