The MIND diet

It’s never too early or too late. 

                                                                                                   –Dr. Martha Clare Morris

The MIND diet was constructed from a very broad base of scientific evidence. MIND is an acronym that stands for:

M-Mediterraean-DASH

I- Intervention for

N-Neurodegenerative

D- Delay

Information for this article has been taken from the book “Diet for the Mind” written by Dr. Morris (in which case, I cite page numbers)  and from other scientific sources that are linked in the article.

What is the scientific basis for the MIND diet?

The MIND diet was developed by Dr. Martha Clare Morris, her team at Rush University, and Dr. Frank Sacks of Harvard. Dr.  Morris has a PhD in nutritional epidemiology from Harvard School of Public Health (now Harvard THChan School of Public Health). She is currently at Rush University in Chicago, where she established a program called “Nutritional Medicine” to help medical professionals understand the relationship between nutrition, health, and disease. At Rush, Dr. Morris has been lead researcher on two very large studies: CHAP & MAP, described below.

The MIND diet is a hybrid of the Mediterranean and DASH* diets and is based on both a broad and deep delve into scientifc research such as:

• The CHAP and MAP studies at Rush University
• Studies of the Mediterranean diet, including the RCT (Randomized, controlled study) PREMIED
• Studies of the DASH diet, including the ENCORE study, a RCT
• Other scientific studies of specific nutrients

*DASH is an acronym that stands for Dietary Approaches to Stop Hypertension

CHAP: Chicago Health & Aging Project

• Began in 1993 (ongoing for over 25 years)
• 10,000 + residents 65 years and older
• Participants are evaluated every 3 years for health and lifestyle behaviors
• A random sample of participants also receive neurological evaluations for Alzheimer’s and dementia

MAP: Memory & Aging Project

• Began in 1997 ( ongoing for over 20 years)
• 1800 participants
• Annual evaluation of diet for every participant
• Annual comprehensive neurological evaluation of 19 different cognitive tests measuring cognitive abilities and neurological conditions for every participant
• Participants agree to donate their brain for study after death

The CHAP and MAP studies are observational studies which show correlation between eating patterns and cognitive health or decline, but cannot show causality.

Two of the randomized, controlled studies of the Mediterranean and DASH patterns of eating that informed the MIND diet are:

Mediterranean pattern of eating: The PREDIMED randomized, controlled study

• 2005-2010
• Previous studies had demonstrated  the efficacy of the Mediterranean diet on altering cardiovascular factors for the better.
• Purpose: Study the effects of diet on cardiovascular risk factors in people at high risk of cardiovascular problems
• Participants were randomized to :  Meditteranean + extra olive oil, Mediterranean+ extra nuts, or a lowfat diet.
• The trial was stopped after less than 5 years because benefits for the Mediterranean+ olive oil & Mediterranean + nuts groups had respectively 30% and 28% fewer cardiovascular events than the lowfat group. (This reduction is similar to the impact of statin drugs)
• The results of the PREDIMED study also included assessement of effects on cognitive performance. Changes reached a level of significant improvement for the Mediterranean diet + olive oil and improved in the Mediterranean diet+ nuts arms of the trial. Mediterranean Diet Improves Cognition

The DASH diet (Dietary Approaches to Stop Hypertension) : ENCORE randomized controlled study 

• Previous randomized controlled studies had demonstrated the DASH diet was effective for reducing or preventing high blood pressure, preventing diabetes, weight loss, and reduced markers of  inflammaton and oxidative stress. p 109
• Purpose: to study the impact of the DASH diet on cardiovascular factors in people with high blood pressure and obesity.
• Randomized to 1) DASH, 2) DASH+ weight management (including exercise), 3) just weight management, or 4) “usual diet” control group (Note: these participants had prehypertension to moderate hypertension and no evidence of cognitive difficulties.)
• Outcomes related to cognitive functioning: After 8 weeks, those on DASH alone had higher cognitive speed scores; those on DASH +weight management had superior performance on tests of memory and problem-solving as well as processing speed. These effects were “modest.” Implications of ENCORE study findings on cognition

Other research on specific nutrients

The purpose of the MIND diet is to pinpoint which specific nutrients in what quantities are responsible for a protective effect on the brain.  This research includes both nutrient specific research on humans but also information from animal studies whose findings are confirmed by research with humans, such as the patterns of food intake in the CHAP and MAP studies.

Coming in 2021: results of a randomized controlled study of the MIND diet

An exciting development is that Dr. Morris and her team are actually currently conducting a randomized controlled study (RCT)  comparing the effect of the MIND diet to a diet with a modest reduction in calories. This study will be able to establish causation, not simply correlation between the MIND pattern of eating and risk of dementia.

Additionally, in studies around the world attempting to replicate the positive findings of the FINGER study in Finland (See Foundations I), the MIND diet will be used in at least two countries as the indicator of a “healthy diet.”

 

What are the components of the MIND diet?

Foods to include:

1. *Leafy greens –eat at least 6 days per week
2. **At least one other vegetable (not including white potatoes)—eat 7 days per week
3. Whole grains–eat at least 3 servings daily
4. Olive oil is primary oil used –2 Tablespoons per day
5. Beans–eat at least 4 times a week
6. Nuts—eat at least 5 times a week
7. Berries–eat at least 2 times a week
8. Fish (not fried & not shellfish) —eat at least once a week
9. Poultry (not fried) –eat at least twice a week
10. Wine– 1 glass per day but no more

Foods to limit:

1. Butter & cream: less than 1 serving per day
2. Regular cheese: less than 1 serving per week
3. Red meat: No more than 3 times per week
4. Sweets & pastries: no more than 4 times per week
5. Fast food (and fried food) : less than once per week

*What counts as a “leafy green” varies depending on the source. Dr. Morris places some vegetables sometimes defined as leafy greens (such as broccoli and cabbage) in other publications in the “Other vegetable” category in her book Diet for the Mind. (p 59) Leafy greens would include collard, turnip, mustard, & beet greens; arugala, spinach, romaine lettuce, kale, watercress, etc.

** Cruciferous vegetables (broccoli, cabbage, collards, kale, cauliflower, etc.) have been shown in some studies to delay the onset of cognitive decline (p 57)

How does my pattern of eating compare with the MIND pattern of eating?

Go back over the two lists above, and give yourself 1 point for each item that is true of your eating pattern. How many points did you get? _____ (15 max)

Good news! There is partial credit! If you did not score a full point in any of the items above, you can give yourself another 1/2 point for the following:

1. Leafy greens –3-5 servings per week
2. Any other vegetable—5-6 times per week
3. Whole grains– 1-2 servings per day
4. Olive oil as primary oil–no partial points
5. Beans–1-3 times a week
6. Nuts—once per month to 4 times per week
7. Berries–once per week
8. Fish (not fried & not shellfish) — 1-3 times per month
9. Poultry (not fried) –once per week
10. Wine– once per month to 6 times per week (you get no credit for more than 7 times per week)
11. Butter & cream: no more than 1-2 servings per day
12. Regular cheese: no more than 1-6 servings per week
13. Red meat: no more than 4-6 times per week
14. Sweets & pastries: no more than 5-6 times per week
15. Fast food (and fried food) :  no more than 1-3 times per week

 

Add total points including both full points and half points: ______  (Greatest possible score is 15 points)

Point system taken from chart in “Nutrition for a Healthy Brain : UC Davis Alzheimer’s Disease Center Lecture” by Martha Clare Morris.

Do you need to score 15 points to see a reduction in your risk of developing Alzheimer’s or other dementias? No! Partial credit again!

Those whose MIND diet scores were in the top third (8.5-12.5 points) had a 53% reduction in the rate of dementia compared to those who scored in the bottom third. Those in the middle third (7-8 points) had a 35% reduction compared to those with scores of 6.5 or less. The number of people with the APOE-4 gene was the same in each third of the study, so even people with that gene benefitted!  Research study: MIND diet associated with reduced incidence of Alzheimer’s Disease 2015 

Questions:

What about eggs? 

Eggs are neutral in the MIND diet: you neither receive nor get docked points for eating them. In Diet for the Mind, Dr. Morris notes that with the exception of the small number of people who are hypersensitive to dietary cholesterol, or those with heart disease or diabetes, “eating an egg a day… poses no health risk.” p. 94

What about dairy products other than cheese, butter, and cream?

“There is no direct research on their effects on the brain or on dementia.” The issue is the saturated fat content. So if you choose to eat milk or yogurt, Dr. Morris suggests low-fat. p. 93

Why are only berries listed? Should I avoid other fruits?

Fruits are very beneficial in the diet and are associated with lower risks of other diseases such as cancer, cardiovascular disease, and osteoporosis. However, there is no evidence of a protective effect on the brain from fruits other than berries. So other fruits will neither harm nor help your brain, but they will help your general health. p. 74

Note: While frozen fruits and vegetables are typically just as nutritious as fresh, this is not true with respect to berries which lose a portion of some nutrients in the freezing process (p.73) , so you may need to eat more to get the equivalent of two 1/2 cup servings of fresh berries per week.

But I’ve heard that grains are bad for your brain.  

There is a popular book that promotes this theory.

Dr. Morris comments: “It is true that Alzheimer’s disease involves inflammation and that impaired insulin sensitivy and glucose metabolism increase the risk of the disease, but this is where the link to scientific evidence ends with Dr. Perlmutter’s hypothesis. Numerous studies, including dietary intervention trials rich in whole grains, have demonstrated decreased inflammation and oxidative stress, decreased occurrence of cardiovascular conditions and diseases, and improved cognition.” p 63 -64  Emphasis mine.  The book cites specific very large studies supporting her statement.

What if I have a gluten sensitivity? Get your 3 servings of whole grains from grains that don’t contain gluten.

Is there anything else I should pay attention to besides specific foods?

Yes, the way you cook your foods affects something called Advanced Glycation End products (AGEs) which are known to increase inflammation in the body. Though the body can make its own AGEs, they are also formed in some foods when cooking methods involving high heat are used. Inflammation is a contributer to many chronic diseases, including diabetes and kidney problems.

Dr. Morris notes that  studies have found that increased levels of AGEs are associated with faster cognitive decline.”They influence normal cell function in a way that makes cells more susceptible to damage and premature aging.”  p 100

Which foods and cooking methods introduce greater amounts of AGEs into the body? 

Information and data below is taken from AGEs in Foods & a Practical Guide to their Reduction in Diet

Generally, meat (especially red meat) and fats have intrinsically higher level of AGEs than grains, fruits, or vegetables, but how you cook your meat can make a big difference. Cooking methods involving high, dry heat (grilling, roasting, broiling, frying) increase AGEs significantly compared to cooking methods involving moist heat such as poaching or steaming.

Example#1: Chicken breast and kU/serving of AGEs

• Breaded, oven fried with skin 8965
• Roasted (45 min with skin) 5,975
• Grilled: 4364
• Poached with skin: 991
• Poached skinless : 968

Example #2 Egg

• Fried: 1237
• Omelette low heat olive oil 12 min:101
• Omelette low heat butter 13 min: 152
• Poached below simmer: 27
• Scrambled high butter: 101
• Scrambled med-low butter: 50

Marinades: You can reduce the AGEs formed when cooking meats with dry heat by 50% when using an acid-based marinade (such as lemon juice or vinegar) for an hour before cooking.

Now that you know your starting line, are you ready to use I-SSEE self-coaching to reduce your chances of developing Alzheimer’s or other dementias?

Remember the words of Dr. Martha Clare Morris:

“It’s never too early or too late, and you are never too old to benefit from a healthy diet and lifestyle that preserve your mind and overall health.” p.5

[1]  Morris, M. C. (2017). Diet for the Mind. NY, NY: Little, Brown, & Company.

<insert photo> I highly recommend this book, but be careful. There are many books with nearly the same title on Amazon, but this is the one written by the actual researcher.  I have merely summarized key points here, but she provides clear explanations of the research and the scientific rationale behind each element of the MIND diet. Additionally, there are 80 specific recipes included, created by the daughter of Dr. Morris.

 

Go to Self-Coaching for the MIND diet: Step 1 Identify (link not ready yet)