I was inspired to write Healing the Broken Brain with my brother David, a stroke survivor, because this information is needed now more than ever. The information included in the book is a more specialized take on brain health and prevention that I discussed in my NY Times bestselling book, The Brain Fog Fix. A recent study from 2016 dispelled the notion that stroke is something you only need to actively prevent when you’re 60 or 70. This study found that strokes doubled in younger American adults in their 30’s and 40’s; strokes don’t just happen to older people. You should be making lifestyle and diet choices in your 20’s and 30’s to actively prevent a stroke. The fact that so many MORE younger people are having strokes also means that they’re related to our everyday lifestyle choices. The stroke belt in the US – the southeastern US – has doubled the stroke rates in the rest of the country, and that’s largely because of high blood pressure, diabetes, and smoking. Read below for my tips for preventing a stroke!
In The Brain Fog Fix, I recommend a “modified” Mediterranean diet. For overall brain health, this modified Mediterranean diet can help prevent stroke in both the short and long term. It’s “modified” because it is very low in processed carbohydrates, including flour and sugar; it is high in beans, vegetables, whole fruits, omega-3 superfoods like wild salmon, and healthy fats like olive oil; and it’s low in the saturated fats you find in American pepperoni pizza and cheese. Most Americans think of pasta and pizza when they think of Italy, but the pepperoni pizza and spaghetti and meatballs Americans eat have no place in this type of diet.
A study published in The New England Journal of Medicine found that 30 percent of strokes, heart attacks, and deaths from heart disease can be prevented by following a Mediterranean diet. Another that was just published found it can even treat depression. The dietary changes in the study included eating extra-virgin olive oil and/or nuts daily, fish three or more times a week, beans three or more times a week, white meat instead of red meat, at least three daily servings of fruits, and two daily servings of vegetables. A Mediterranean diet can even help your brain get bigger!
A 2016 study found that people who followed a Mediterranean diet had larger brains: the frontal, parietal, and occipital lobes were actually thicker. Of the foods in the Mediterranean diet, fish and beans were found to be especially associated with thicker brain structures. In this same study, the subjects who consumed large amounts of carbohydrates and sugar had smaller brains, as those same lobes were thinner. Look for clean fish. I have an omega-3 superfood list in The Brain Fog Fix. It’s important to know which fish you need to buy wild caught. Salmon is on that list. But others like farm-raised varieties of arctic char and rainbow trout are high in omega-3’s AND low in toxins like mercury. Another tip: when you eat fish, pair it with unsweetened green or black tea (hot or iced) or black coffee. This can prevent your body from absorbing about half of the mercury if you don’t know if the fish you’re eating is high in toxins.
Spiking your blood sugar with too many processed carbohydrates and too much soda, bread, pasta, flour, sugar, and high-fructose corn syrup can interfere with the brain’s ability to rewire. In terms of stroke prevention, this also leads to weight gain and high blood pressure – which spikes your risk of stroke. Factory-farmed animal products have high levels of omega-6s that lead to inflammation in the body and brain. You need some carbohydrates, but most people around the world eat far too many processed carbohydrates.
High blood pressure is a major risk factor, so eat a healthy diet and reduce salt intake, exercising or being physically active, and, for a lot of people with high blood pressure, talk to your doctor to see if you need to consider medication. We are recognizing more and more how important it is to keep the blood pressure optimally controlled—not just so-so, not high normal, but optimally controlled.
As you reduce sodium, you can add fresh herbs and spices that are fantastic for the brain. Turmeric and black pepper are my favorites. Throw in a fresh sprig of rosemary. Add it to cherry tomatoes, and use extra virgin olive oil instead of store-bought sauces that have too much sodium. If you’re eating Asian food, instead of “salt bombing” your food with soy sauce, you can “hot bomb” it with wasabi or fresh peppers. If you are eating soy sauce, look for the reduced sodium versions. Don’t “dunk” your sushi in soy sauce; just a few drops will do. Fresh ginger is another great substitute for high sodium teriyaki sauces. Salt is also found in many store bought breads. Use a spiralizer to turn zucchini into a pasta or bread substitute. At Subway, get your bread shelled out. Pass on the high sodium sauces and ask for olive oil, black pepper, and vinegar. Balsamic vinegar is one of my favorites. The strong taste actually mimics high sodium dressings without adding sodium to your diet.
Vegetables and whole fruits are a vital part of a modified Mediterranean diet as well. Eating at least five servings daily has been shown to reduce stroke risk significantly. In The Brain Fog Fix, I recommend a whopping seven servings of vegetables and whole fruits a day, as this is how many servings the healthiest and happiest people around the world reported eating. Cruciferous vegetables like broccoli, kale, cauliflower, and Brussel’s sprouts may be especially helpful in reducing stroke risk, but you should also talk to your doctor if you are taking the blood thinner Coumadin, since vitamin K in these vegetables can interfere with this medication. Talk to you doctor to see if there are any dietary restrictions with any of the medications you are taking.
The B vitamins are fantastic for brain health. This is true for mood, energy, and stroke prevention. This is especially true for vitamin B9, which more commonly known as folate. It plays such as a large role in mood regulation that it’s now available as a prescription to treat depression. Folate also helps to support healthy adrenal function. Instead of taking a pill, you can get your folate fix by eating a wide variety of vegetables and beans. You may be familiar with folic acid, the synthetic form of folate found in fortified products like cereals and other grains. But most Americans eat far too many carbohydrates, which, as you know, can drain brain with blood sugar spikes. The naturally occurring folate found in vegetables is more effective and better for you than folic acid added to cereals and other carbs.
Thus, the best solution is to get more folate from the two sources almost everyone can stand to eat more of: green vegetables and beans. Here is a summary of the simple changes to your diet I recommend making:
- The best protein foods for brain health are seafood and beans. Eat them regularly. When eating seafood, favor the varieties in the list above. These are high in DHA omega-3s and low in toxins like mercury.
- Eat less meat in general. When you do eat meat, favor grilled chicken over red meat. When you eat animal products, favor organic, grass-fed, or pastured varieties over conventional varieties. This is true for dairy products and eggs as well. These types of animal products have more anti-inflammatory omega-3s and fewer pro-inflammatory omega-6s compared to conventional varieties of meat, dairy, and eggs.
- Olive oil is the best oil to use for overall brain health. Use extra-virgin olive oil for dressings and salads. Extra-virgin is not stable at high temperatures, however, so use light or plain olive oil for cooking. Reduce or eliminate industrial vegetable oils (such as corn oil and soybean oil) that are found in most processed foods.
- Eat more nuts. Favor any kind of nut over peanuts, since peanuts are not a true tree nut like walnuts, almonds, cashews, and pistachios. Look for plain nuts rather than nuts cooked in oil, as the oils tend to be high in pro-inflammatory omega-6s.
- Reduce or eliminate flour, sugar, and artificial sweeteners. If you need a sweetener, choose stevia. Favor healthy grains like quinoa, barley, sprouted grains, and brown rice. Get carbohydrates from whole fruits and beans. Reduce your carbohydrate intake by substituting cauliflower or broccoli for pasta. Make cauliflower rice or buy frozen varieties. Use a vegetable peeler to make zucchini noodles, or use spaghetti squash in lieu of noodles. When you eat a sandwich, order it wrapped in lettuce instead of bread, eat just one of the pieces of bread, or, if you’re eating somewhere that serves sandwiches on big rolls, ask for your bread to be shelled out. If you’re eating pizza, favor thin crust over thicker crust to reduce the carbohydrate content.
- Aim for five to seven whole fruits and vegetables a day.
Most foods in the typical American diet! Processed carbs, sugar, factory farmed animal products which are higher in pro-inflammatory omega-6’s and lower in anti-inflammatory omega-3’s.
Also, stress! Hostility, stress, and depression increase your risk. Mental illness is treatable, so seek treatment. Bonus: the foods you’ll be eating that prevent stroke also help you improve mood. If you find stress is hijacking your life, make sure to find ways to relieve it. Practice a loving-kindness meditation to remedy hostility you may be carrying. In your mind’s eye, picture someone easy to love like your pet or significant other. Picture love and kindness radiating out from your heart. Then, picture the person you’ve had a disagreement with. Send them the same amount of loving-kindness. Finally, see yourself, and send yourself that same energy.
For quick stress relief, be sure to have a few tools. I like diaphragmatic breathing, because it’s so simple to use. Place one hand on your chest and another on your belly. When you’re stressed, the fight or flight response will try to take breathing up into your chest. Move it back down into the belly. Breathe, and try to keep the hand on your chest still and only move the hand on your belly. Then, make the exhales twice as long as the inhales. Inhale to the count of 3; exhale to the count of 6.
Sitting disease is the new smoking. Avoid it all costs. American commutes have gotten longer. That means more time in trains or cars. Less moving, more stroke. If you don’t have time to exercise for an hour today, find small ways to move. Take a conference call while pacing in your office. Find the parking spot that’s the furthest away from the entrance at the grocery store.
The good news is that simple, feel-good activities can profoundly reduce your risk of stroke. Exercise is the most important. But other activities that are fun where you connect can help as well. When you feel like stress by playing a board game with your kids or have a great dinner, you’re also boosting your mood and energy. This makes it easier to reach the nutrition or exercise goals that may seem out of reach. Also, use a really simple strategies I recommend to stroke survivors to prevent stroke: set a SMART goal. If you’re not exercising enough or not eating enough fish, beans, or veggies, don’t be hard on yourself. Set a Specific, Measurable, Achievable, Relevant, and Time-Sensitive goal. Instead of: “I’ve got to stop eating so much junk food and get back to the gym…” Say: “This week, I’m going to make sure to exercise for 45 minutes 3 times this week and eat 3 servings of fish.” Track your progress, and these everyday lifestyle choices will start to come easily.