Info for AI Roadmap - Simple Smart Science (2025)

Introduction to Brain Health andNeurodegeneration:

Key Topics:

• Introduction to Your Program

• Brain Basics 101: Neuron Anatomy

• Brain Basics 101: Brain Anatomy

• Brain Basics 101: Neurodegeneration

• Brain Basics 101: Common Neurodegenerative Conditions

• The 10 Pillars of Brain Health in Action

• Chapter Review

Terms:

• Neuron

• Soma

• Nucleus

• Chromosome

• Dendrite

• Signal

• Axon

• Axon Terminals

• Myelin Sheath

• White Matter

• Gray Matter

• Synapse

• Neurotransmitters

• Neural Network

• Neurogenesis

• Stem Cell

• Brain Derived Neurotropic Factor (BDNF)

• Neuroplasticity

• Lobe

• Hemisphere

• Frontal Lobe

• Parietal Lobe

• Occipital Lobe

• Temporal Lobe

• Hippocampus

• Brain Stem

• Cerebellum

• Amygdala

• Neurodegeneration

• Neuroinflammation

• Cortisol

• Deficiency

• Dysfunction

• Mitochondria

• Genetics

Introduction to Your Program:

Welcome to the Simple Smart Science Cognitive Academy! You are here today because you understand the importance of keeping your body and your brain healthy, not only for the length of your life, but for the quality of your life. Not only that, but you are passionate about using your coaching skills to help others achieve optimal brain health.

Just like any other part of the body, extra effort needs to be made to ensure that we take care of this 3-pound unit we use 24/7, otherwise known as our brain. These extra efforts are what we refer to as our 10 Pillars of Brain Health; lifestyle factors that can promote or prevent brain degeneration. In this program you will learn the fundamentals of these 10 pillars so you can help clients make a measurable improvement in their brain health. The ramifications of not taking care of brain health can lead to a profound impact on quality of life and suffering for older individuals and their caretakers, as well as a significant financial burden for our health care system.

What we know today is that Alzheimer’s is currently the 6th leading cause of death in the US, stealing the lives of over 5.8 million Americans.1 Of that 5.8 million, 2/3 are woman. This means that if we remain consistent with current statistics, one out of every 10 people over the age of 50 will develop this disease. Researchers are currently claiming that within the next 40 years, Alzheimer’s deaths will nearly triple, and this rate will only continue to rise.2 The statistics on all neurodegeneration diseases are even more staggering.

Currently, the dialogue on neurodegenerative diseases is that they are not curable.3 Pharmaceutically this may be true since no one drug has been developed that can “cure” brain degeneration. However, the conversation needs to shift to what the many causes/contributors of cognitive decline are, rather than looking for a “magic bullet” pharmaceutical treatment. We are starting to see a drastic uptick in instances of cognitive decline every year, even more so since the onset of the Covid-19 pandemic.4

How can we best address the increasing incidence of these devastating diseases? The answer is quite simple. The pharmaceutical industry seems to be solely focused on how to fix the symptoms and is therefore missing the real key to eradicating this quickly evolving epidemic. The key: prevention.5 With so many contributing risk factors, one pharmaceutical drug will likely never be able to address enough of the underlying causes. If we can educate and coach with a focus on the root causes, we can have a more effective impact on halting, reversing, and potentially preventing the disease process.6

Science is showing that the disease process for Alzheimer's can begin up to twenty years before a person shows symptoms.7 Therefore, prevention shouldn’t just begin when we start to notice symptoms, but ideally decades before symptoms appear. Practicing lifestyle medicine is a lifelong effort, but most individuals wait for a medical crisis before searching for treatments or considering lifestyle change. Educating clients as early in the disease process as possible will set them up for the greatest positive impact on their brain health. When a client notices they may not be as sharp as they used to be, or they are having more tip of the tongue moments, we can teach and guide them to use all the preventative tools available to prevent these early signs from progressing. The earlier they begin preventative measures, the more control and power they have over the progression of this disease.

During this program you will be learning a lot about the implementation of our 10 Pillars of Brain Health. As foundation, let’s first begin by learning basic brain anatomy.

Brain Basics 101: Neuron Anatomy

Our brain is responsible for making us who we are as individuals. Our personality, our mood, our actions, and our memories are all stored and utilized in this extremely malleable control center referred to as our brain. Brain cells are differentiated early in embryonic development to have specialized roles.

Neurons are responsible for receiving and transmitting communications. They use electrical and chemical signals to help communicate between the brain and the rest of the nervous system. Neurons are shaped like little, microscopic trees. At the core of each neuron is the cell body, known as the soma. Think of the soma as the base of the trunk of a tree. Within the soma is the nucleus, which contains the chromosomes, the genetic code that gives instructions to the rest of the neuron on how to function. The “roots” of the neuronal tree are called dendrites. Dendrites are the communication receptors of the neuron; they receive outside information, or signals. Once dendrites receive information, the signal is sent up through the “trunk” of the neuron, called the axon, and out through the “branches” of the neuron, known as the axon terminals, where information is then communicated to other neurons, muscles, glands, cells in the body, etc. Each neuron has a protective layer called the myelin sheath. You can think of the myelin sheath as the “bark.” It protects the communication line on the inside from any potential external damage. 8 9

Neuron Anatomy

https://askabiologist.asu.edu/neuron-anatomy

The brain consists of white matter (60%) and gray matter (40%). Our current understanding of white and gray matter is that white matter is responsible for communication within gray matter regions and between the gray matter and the rest of the body. Gray matter enables individuals to control movement, memories, and emotions. In some cases, decreased gray matter is considered to have a causal relationship with the progression of neurodegeneration, but there are many other contributing factors and research continues to expand our understanding each year.10

Neurons are extremely microscopic. There are more neurons in your brain than there are cells in your body, currently estimated to be more than 86 billion!11 When neurons connect to other neurons, there is a little pocket of space between the dendrite of one neuron (the communicating cell) and the axon of the other neuron (the receiving cell). This pocket of space is called a synapse. At the synapse, signals from the neuron sending information release chemical messengers called neurotransmitters. These chemical messengers signal instructions and information from one neuron to another, allowing specific actions to take place.12 There are over 100 known different kinds of neurotransmitters, each with their own specific set of functions and processes.13

Millions of communications are sent between neurons every day, and these communications happen within a specialized system in the brain known as neural networks. Think of neural networks as superhighways, allowing information to move from one part of the brain to the next, delivering information to the receiving neuron in a very procedural fashion. The brain is made up of millions of small chemical messengers that communicate through these neural highways transmitting information throughout the body. It is our responsibility to keep these messengers healthy, and these highways clean.14

It is currently said that the brain declines with age at a rate of around 5% every 10 years after the age of 40.15 At this rate, by the age of 80, our brains could have potentially shrunk up to roughly 20%. Thankfully, studies have shown that it’s possible to regrow our brains by encouraging neuronal regrowth, known as neurogenesis. Neurogenesis occurs when stem cells in the brain, (undifferentiated cells that can be programmed into specialized cells), replicate and grow into new neurons.16

The fertilizer or "miracle grow" for neurogenesis is a protein called Brain Derived Neurotrophic Factor, or BDNF. BDNF plays a critical role in promoting neuronal survival, encouraging growth, strengthening and protecting networks, and improving the signal strength between communicating neurons. BDNF is essential for brain function and regeneration and plays an important role in learning and memory.17 18

Using BDNF to carry out neurogenesis leads to neuroplasticity. Neuroplasticity is defined as the malleable capacity of neurons and neural networks in the brain to regrow and change their connections and behavior in response to new information or cellular damage.19 By implementing lifestyle habits that promote an increase in BDNF, neuroplasticity can occur. Later in this course you’ll learn how each pillar of brain health plays a role in supporting BDNF.

Brain Basics 101: Brain Anatomy

These neural networks are located in "neighborhoods” in the brain, otherwise known as lobes. These lobes are organized sections of neurons that execute specific structured functions within the body and the brain. The brain is divided into two halves referred to as hemispheres. Each hemisphere is divided into four lobes: Frontal, parietal, occipital, and temporal.20 21

• Frontal Lobe: The frontal lobe, located at the forefront of the head, is the largest lobe in the brain. Because of its location, it’s the most susceptible to damage and injury. The frontal lobe controls executive function, movement, learning, language, impulse control, behavior and emotions, and organization.

• Parietal Lobe: The parietal lobe is located at the top of the head, towards the back. It controls processing and interpretation of sensory input and output, spatial and visual awareness, and movement of body parts.

• Occipital Lobe: The occipital lobe is located at the back of the head. It controls visual perception, including colors, shapes/sizes, and motion.

• Temporal Lobe: The temporal lobe is the second largest lobe, located underneath the parietal lobe and in between the ears. The temporal lobe processes auditory information, emotions, understanding, interpretation of language, behavior, memories, and minor visual perceptions.

Within each lobe of the brain are smaller structures that have very specific functions. In addition to the four main lobes, there are 17 known structures in the brain. Some of the more noteworthy parts of the brain that you will need to familiarize yourself with for the purpose of this program are: hippocampus, brain stem, cerebellum, and amygdala.22 23

• Hippocampus: The hippocampus is a small seahorse shaped structure located in the temporal lobe. The hippocampus plays a major role in learning and memory. It is integral in the formation, organization, and storage of new memories, and in converting short term memories into long term memories. It is the region of the brain where clinical symptoms of Alzheimer's disease present themselves first. The hippocampus is extremely malleable, meaning it can shrink AND re-grow through BDNF if proper lifestyle factors are addressed.

• Brain Stem: The brain stem functions as the control center connecting communications between the spinal cord and the brain. The brain stem is responsible for regulating most of the body’s automatic functions like heart rate, breathing, attention, and consciousness. This is the first part of the brain to grow during embryonic development, and is located at the nape, near the base of the skull.

• Cerebellum: Cerebellum is Latin for “little brain.” It makes up 10% of the brain's volume yet houses roughly 50% of the brain's neurons. The cerebellum is involved in maintenance of motor control, posture, balance, and movements.

• Amygdala: The amygdala is an almond-shaped structure in the cerebral cortex. It is the integrative center of experience, motivation, and expression of emotions.

Normal brain anatomy is complex but has built in systems for regeneration when dysfunction or damage occurs. Currently nearly 40% of American adults over the age of 65 experience symptoms of cognitive decline or impairment.24 Therefore, we need to take an active role in implementing lifestyle habits that enhance neurogenesis. The content of this program will educate you on the 10 Pillars of Brain Health, certifying you to coach clients to follow a lifestyle congruent with them, and assist them in optimizing their brain health, prevent symptoms of neurodegeneration, and most notably, reverse cognitive decline that may have already begun.

Brain Basics 101: Neurodegeneration

Neuroplasticity refers both to the brain’s ability to grow (neurogenesis) and its ability to shrink (neurodegeneration). Neurodegeneration results in an overall loss of brain matter, leaving the brain atrophied and weakened.25

Once neurodegeneration accumulates to the point where clinical symptoms occur, it can be classified based on clinical presentation, lab work, and brain scans into a specific diagnosis. Before we get into common neurodegenerative conditions, let’s talk a little about how neurodegeneration comes to be.

Thus far, there are at least five primary contributors to neurodegeneration: inflammation, deficiency, dysfunction, accumulation of toxins, and genetic predisposition.

• Neuroinflammation: Inflammation in the brain, also called neuroinflammation, is caused by chronic exposure to physical, mental, and emotional stress. Chronic physical stress includes things like sleep deprivation, over exercising, a poor diet, any chronic disease, and gut imbalances. Mental and emotional stress can include trauma, financial, relational, and negative thoughts. The chemical component of stress is the stress hormone cortisol. When in excess, cortisol is responsible for the death of neurons. However, inflammation from anywhere in the body can easily cross the blood brain barrier when it is compromised or “leaky.” The blood brain barrier is a one cell layer thick lining that filters what is and is not allowed to enter the brain. Therefore, in order to protect the brain from inflammation, you must address and treat the root cause of inflammation in the body.26 27 28 29 30

• Deficiency: Vitamin, mineral, and hormonal deficiencies usually come from a poor diet, an inflamed gastrointestinal system, lack of sunshine, medications, excess stress, or genetic variations. Common deficiencies that can potentially lead to neurodegeneration include B Vitamins, Omega 3 Fatty Acids, Magnesium, Vitamin D, Folate, Estrogen and other reproductive hormones, growth hormones, BDNF, and MTHFR polymorphisms.31 32 33

• Dysfunction: The health of our mitochondria is intricately linked to neural performance. Mitochondria are known as the “powerhouses of the cell.” They produce the energy necessary for every cell's survival and function through a series of chemical reactions that break down glucose into an energy molecule known as ATP.34 35

• Accumulation of Toxins in the Brain: Our body has a sophisticated natural detoxification system built in. However, we are living at a time where the amount of toxins we are being exposed to overwhelms this system, allowing toxins to build up in our body and brain. Dementia, and Type 3 Alzheimer’s Disease in particular, are characterized by the brain’s response to excessive toxin exposure. Toxin exposure can come in the form of many different things, including heavy metals like mercury, organic compounds like toluene and benzene, and biotoxins like mold, called mycotoxins. Toxins that contribute to cognitive decline are considered “dementogens.”36

• Genetics: There are a few genes that have been linked with an increased risk of neurodegeneration. For example, the ApoE4 gene for Alzheimer’s. However, carrying a gene does not determine disease presence, but rather heightened risk. In other words, carrying a gene does not mean you are destined to develop the disease it is associated with. Epigenetics refers to how behaviors and environmental exposures can change the way genes are expressed. Certain lifestyle factors (addressed in our 10 Pillars of Brain Health) can modify gene expression, making us more, or less, susceptible to neurodegeneration.37 38

Now that you have a better understanding of the root causes of most of the following conditions, let's look at some of the clinical diagnoses associated with symptoms of neurodegeneration.

Brain Basics 101: Common Neurodegenerative Conditions

Alzheimer’s Disease: Alzheimer's is a type of dementia that affects memory, thinking, and behavior. Symptoms typically grow severe enough to interfere with daily tasks of living.39

Parkinson’s Disease: Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually and commonly include tremor, slowed movement, rigid muscles, impaired posture and balance, loss of automatic movements, and changes in speech and writing.40

Multiple Sclerosis (MS): MS is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between the brain and the rest of the body. Symptoms vary depending on how much nerve damage is present but can include numbness or weakness in one or more limbs, electric shock sensations that occur with certain neck movements, tremor, vision problems, slurred speech, fatigue, dizziness, tingling or pain in parts of the body, and problems with sexual, bowel, and bladder function.41

Amyotrophic Lateral Sclerosis (ALS): ALS is a progressive nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control. Symptoms typically include difficulty walking or doing normal daily activities, tripping, falling, weakness in legs, feet, or ankles, hand weakness or clumsiness, slurred speech or troubled swallowing, muscle cramps and twitching in arms, shoulders, and tongue, inappropriate crying, laughing, or yawning, and cognitive and behavioral changes.42

Traumatic Brain Injury (TBI): TBI usually results from a violent blow or jolt to the head or body, or an object that travels through brain tissue, like a bullet. Physical symptoms of a mild TBI can include headache, nausea, fatigue, drowsiness, problems with speech, dizziness, and loss of balance. Mild TBI can also result in sensory problems and sensitivity to light or sound, as well as cognitive, behavioral, or mental symptoms. Physical symptoms of a severe TBI can include loss of consciousness, persistent headache, repeated vomiting, seizures, pupil dilation, clear fluid draining from nose or ears, inability to awaken from sleep, weakness or numbness in fingers and toes, and loss of coordination. Cognitive or mental symptoms of a severe TBI can include profound confusion, agitation, slurred speech, and coma.43

Post CVA (Cerebrovascular Accident) Brain Injury: Stroke is the most common form of Post CVA Brain Injury and occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. A stroke is a medical emergency and prompt treatment is crucial. Symptoms of a stroke include trouble speaking and understanding what others are saying, paralysis or numbness of the face, arm or leg, problems seeing in one or both eyes, headache, and trouble walking.44

Lewy Body Dementia: Lewy Body Dementia is the second most common type of progressive dementia, after Alzheimer's disease. Protein deposits, called Lewy bodies, develop in nerve cells and in brain regions involved in thinking, memory, and movement. Symptoms can include visual hallucinations, movement disorders, poor regulation of the autonomic nervous system, cognitive decline, sleep difficulties, fluctuating attention, depression, and apathy.45

Plugging Up the 36 Holes:

Why Pharmaceutical Drugs Are Not the Answer to Alzheimer’s Disease

Key Topics:

• How Do Neurodegenerative Diseases Develop?
• What is Alzheimer’s Disease?
• Why Hasn’t Alzheimer’s Disease Been Cured?
• Neuroinflammation
• Mitochondrial Dysfunction
• Genetic Predispositions to Alzheimer’s Disease
• What is Epigenetics, and Why is it Important?
• Defining the Different “Types” of Alzheimer’s Disease
• Defining the 10 Pillars of Brain Health

Terms:

• Dementia
• Alzheimer’s Disease
• Dr. Dale Bredesen
• 36 Holes in the Roof
• Subjective Cognitive Impairment
• Mild Cognitive Impairment
• Tau Tangles
• Beta Amyloid Plaque
• Amyloid Precursor Protein
• ReCODE Program
• Neuroinflammation
• Synaptoclastic Activity
• Synaptoblastic Activity
• Apoptosis
• ApoE4 Gene
• Heterozygous
• Homozygous
• Type 1 Alzheimer’s Disease
• Type 2 Alzheimer’s Disease
• Type 1.5 Alzheimer’s Disease
• Type 3 Alzheimer’s Disease
• Type 4 Alzheimer’s Disease
• Type 5 Alzheimer’s Disease
• 10 Pillars of Brain Health

In the last module we talked about the common root causes of cognitive decline and the specific diagnoses associated with neurodegeneration. Dementia is a chronic state of mental dysfunction that can be marked by memory disorders, personality changes, or impaired reasoning. Dementia is the umbrella term for symptoms associated with common neurodegenerative diseases, however, it is not a diagnosis. The most prevalent diagnosis associated with dementia and neurodegeneration today is Alzheimer’s disease.

How Do Neurodegenerative Diseases Develop?

According to Dr. Dale Bredesen, Chief Science Officer at Apollo Health and one of the leading researchers in Alzheimer’s disease, cognitive decline does not happen without reason or because of normal aging; current research has identified up to 36 contributors to cognitive decline. These contributors build up for anywhere from 10 to 25 years before a diagnosis is typically made.

Imagine that having Alzheimer's disease is like having a house with “36 Holes in the Roof.” To treat Alzheimer's disease successfully, you need to address each of the holes in the roof, not just one.If your home had a leaky roof with 36 holes, and you plugged 30 of them, you would still get rain in your home. Therefore, a comprehensive approach to all the underlying causes of cognitive decline is imperative when approaching the diagnosis and treatment of Alzheimer's disease. As Dr. Dale Bredesen puts it, there is no silver bullet approach to treating Alzheimer's. Instead, you must consider a silver buckshot approach. Likewise, treatment should be personalized, starting with treating the largest holes in the roof first

When an individual starts to notice subtle changes in memory, word recall, or the ability to process information but can still function perfectly well in society, they are in the earliest stage of cognitive decline called Subjective Cognitive Impairment, (SCI). Symptoms of SCI are typically noticed by the individual but not necessarily by others, and no measurable clinical change is evident. If subjective cognitive impairment is left untreated, it can progress to Mild Cognitive Impairment, (MCI). MCI begins to affect activities of daily living enough that family members or coworkers notice. MCI is the stage when a diagnosis is likely to be made by a doctor. A diagnosis of MCI is made when one measurable change in cognition is present with no other cause, such as a stroke. When someone is diagnosed with MCI, they can still operate independently, but they often have trouble learning and remembering new information.

What is Alzheimer’s Disease?

Alzheimer's disease is a type of dementia that includes progressive memory loss and cognitive decline. Currently, Alzheimer’s is the most common form of dementia, affecting a yearly average of 6.5 million American people, and over 10% of all Americans over the age of 65. It is typically diagnosed through the identification of “plaques and tangles” in the brain. Tau tangles are made up predominantly of a protein called Tau. In patients with Alzheimer's disease, abnormal chemical changes cause Tau to form sticky threads that eventually create tangles inside of neurons. These tangles block the neuron's transport system and harm communication between neurons. Beta amyloid plaque is made up predominantly of a piece of the amyloid precursor protein (APP).

Amyloid plaques were once thought to be the primary cause of Alzheimer’s disease, as they have been found to be present in most older individuals. Many treatments were focused on removing these plaques only to later find that these may serve as a protective mechanism for a deeper issue.

APP is a protein that protrudes from brain cells and is affected in different ways depending on how healthy the brain’s environment is. For example, in a normal brain that has all the support it needs, APP is cleaved into two pieces that promote growth and maintenance of brain cells. In other words, when a brain has optimal nutrients, hormones, and growth factors, and when it is free of toxins and inflammation, it has time to focus on repairing damaged cells and creating new healthy cells and neural connections. In contrast, when a brain is dealing with chronic insults like inflammation, toxins, or deficiencies, APP is cleaved into four pieces to try and address the imbalances in the brain. But these four pieces signal downsizing of the brain instead of growth as a protective mechanism against these chronic insults. When deficiencies, inflammation, and/or toxins are present in the brain, the brain shrinks and fights inflammatory and toxic invaders with amyloid buildup to shelter the brain from additional damage. Thus, it is not the presence of amyloid that is the problem, but rather the type (which pieces) and origin (why it is being formed) that is.

An Alzheimer’s diagnosis is typically made by a PET scan of the brain, with a spinal tap, and/or by clinical presentation. Tau is part of the synaptoclastic process (breakdown of synapses) and is therefore increased in spinal fluid when Alzheimer’s Disease is present. Amyloid, on the other hand, is decreased in spinal fluid because it is accumulating in the brain.

Measurable criteria for a clinical diagnosis include:

• Memory loss
• Ability/inability to acquire and remember new information
• Visual spatial perception abnormalities
• Reasoning and judgment impairment
• Language disruptions
• Personality changes

In most types of cognitive decline, short term memory is affected first.This is the brain's best protective strategy because other brain functions are too important. After all, it is far more important that you remember who your children are, how to safely cross the street, or how to speak, than it is to remember an episode of a sitcom you watched the previous night on TV. But short term memory loss is not a part of normal aging and therefore should not be ignored. One of the worst things a client can do when they notice a mild loss of cognition is to approach it with a “let's wait and see” mentality. The earlier they start to treat mild cognitive symptoms, the more control they have over halting and reversing its progression.

A clinical assessment of Alzheimer's disease should address identifying and treating the 36 holes. A patient with Alzheimer's disease can be affected by any or all of the following:

• Inflammation: Inflammation can result from an inflammatory diet, high BMI, chronic stress, social isolation, exposure to environmental toxins, impaired sleep, a sedentary lifestyle, exposure to pathogens, gut infections, dysbiosis, food sensitivities, inflammatory bowel disease, autoimmune disease, leaky gut, metabolic syndrome/heart disease, insulin resistance, chronic infections like Lyme disease, and poor dentition.
• Withdrawal of Trophic Support: Decreased trophic support includes nutrient deficiencies, low levels of BDNF, and an imbalance in hormones. Withdrawal of trophic support can result from a poor diet, certain medications, a sedentary lifestyle, alcohol or tobacco abuse, chemotherapy, leaky gut, gut infections, insulin resistance, sleep apnea, genetic variations, and chronic stress. [Trophic factors are protein molecules that support cell survival. When trophic factors are deficient, cells may die]
• Exposure to Toxins: Toxins can include certain medications, chemotherapy, mercury, copper, lead, mycotoxins (mold), environmental organic pollutants, plus polluted air, food, and water. Some individuals are more susceptible to toxin buildup than others because of genetic variations.

Why Hasn’t Alzheimer’s Been Cured?

Once the diagnosis of Alzheimer’s Disease has been made, the allopathic medicine model focuses on pharmaceutical interventions as a means for treatment of symptoms. However, using exclusively a pharmaceutical approach to treating Alzheimer's has failed. The problem is that pharmaceutical companies and drug focused scientific research continue to approach Alzheimer's as a disease with only one cause, for example, targeting the buildup of beta amyloid plaque in the brain. Since the 1980s, over 200 drugs focused on treating the “amyloid hypothesis” have been developed. However, none has been shown to successfully treat or reverse Alzheimer's disease. Likewise, other drugs like Aricept act as cholinesterase inhibitors to preserve acetylcholine, a neurotransmitter reduced in patients with Alzheimer's. Another class of drug, for example Memantine, inhibits the transmission of brain signals from one neuron to the next in the hopes of minimizing the excitotoxic effect associated with neuronal activation. All these drugs at best delay symptoms temporarily but do not stop the disease from worsening, nor do they cure it. Furthermore, they all carry their own list of side effects. Why do these drugs fail? Because addressing beta amyloid plaque, single neurotransmitters, or neuronal activation is like plugging only one hole in the roof. As Dr. Bredesen likes to say, you cannot effectively treat a complex problem with an overly simplistic solution.

Modifiable lifestyle factors play a foundational role in the functional medicine approach to dementia. Modifiable lifestyle factors include sleep and relaxation, exercise and movement, nutrition, stress, social connectedness, and living a life of meaning and purpose. These factors form the foundation of our 10 Pillars of Brain Health. As coaches, you can also elicit a detailed history from clients to identify contributing conditions including chronic inflammation, nutrient and hormone deficiencies, total toxic burden, metabolic imbalances, chronic infections, and microbiome or other gut abnormalities. When appropriate, a coach can help identify conditions where medical intervention is necessary and help clients connect with an appropriate physician.

When proper steps are taken, progression from SCI to MCI can be completely reversed and does not necessarily lead to a diagnosis of dementia or Alzheimer’s. These steps include addressing all contributing lifestyle factors, as well as identifying any underlying conditions that may be contributing to its progression. Our 10 Pillars of Brain Health are proven actionable steps that can be taken to begin plugging up those 36 holes in the roof. One of the best ways to stop the progression of SCI and MCI is to reduce inflammation in the body and brain.

“Betsy is a 79-year-old woman who first developed memory loss after anesthesia for a hysterectomy at age 66. She was diagnosed with Alzheimer’s disease at age 74 and placed on Aricept, which was then discontinued because it did not help and caused her to be aggressive. Her dementia symptoms continued to progress, including sundown syndrome at age 75, in which she would become confused and very agitated starting at about 4pm and pack her suitcases to move back with her mother (who had been deceased for several decades). This went on for three years until [she was evaluated by a doctor trained in looking for the underlying causes of Alzheimer’s (i.e., the 36 holes). Despite very low scores on cognitive assessments, she began to exhibit a dramatic turnaround when taking specific nutritional supplements to address very high homocysteine levels and a previously undiagnosed autoimmune condition. After having been unable to read for three years, she regained the ability to read words on TV, headlines in the newspapers, and road signs. To her husband’s great relief, after she had been following this new strategy for only one month, her sundown syndrome resolved.” Dr. Dale Bredesen

Neuroinflammation

Inflammation is your body’s first line of defense against infection and injury and is an essential component of the body’s healing system. However, when inflammation becomes chronic the immune system remains engaged and on high alert. This prolonged chronic inflammation can lead to illness, disease, and neurodegeneration. Unlike a sprained ankle where inflammation is obvious, yet temporary, chronic inflammation can build slowly with incongruent symptoms that are harder to classify. Chronic inflammation is an underlying contributor to all chronic diseases, silently causing damage to any part of the body including arteries, joints, skin, the gut lining, and brain.

Inflammation in the brain, also called neuroinflammation, can be so destructive that it results in neurodegeneration and cell death. Our brains naturally balance normal synaptoclastic activity (pulling apart of synapses) with synaptoblastic activity (building new synapses). But when synaptoclastic activity is happening at a greater rate than synaptoblastic activity, cell death can occur. Accelerated cell death hinders communication between other neurons, leaving them to fire more slowly. Symptomatically, this can be experienced as subtle changes in mood, memory, and brain fog, as well as slower mental speed, recall, and reflexes. This can lead to difficulty reading, working, or concentrating for any length of time. There are many lifestyle related factors that influence the level of inflammation in our bodies and our brains. Some of these factors include stress, sleep, toxin exposure, and diet.

Mitochondrial Dysfunction

As we learned in the last module, the mitochondria are cell organelles that generate most of the energy required to power the cell’s biochemical reactions.36 They are integral in determining whether a cell lives or dies. When the mitochondria are not working optimally, they send out signals for the cell to kill itself (apoptosis). Therefore, when we enhance or protect our mitochondrial function, we decrease the likelihood of cell death. Fundamentally, Alzheimer's, Parkinson's, MS, autism, and depression are all acquired mitochondrial

Environmental and lifestyle events can challenge mitochondria, induce energy production failure, and pave the way for neuronal damage. The type of disease that manifests is determined by which part of the brain is affected. The key then is to protect mitochondria from environmental and/or lifestyle insults and provide the raw materials necessary for optimal mitochondrial health.

The number one insult to mitochondrial health is chronic inflammation. Inflammation causes the mitochondria to become dysfunctional. Chronic inflammation has been identified as a contributing cause of mood disorders, neurodegeneration, ADHD, autism, heart disease, diabetes, cancer, plus joint and skin diseases.

Genetic Predispositions to Alzheimer’s Disease:

We all inherit genes and gene predispositions for disease. However, a gene is not a diagnosis. The primary gene associated with an increased risk of developing Alzheimer’s disease is called apolipoprotein E4, or ApoE4 for short.41 In general, we carry two copies of most genes, one inherited from our mother and one from our father. So, it is possible to inherit zero copies, one copy, or two copies of the ApoE4 gene depending on what our parents pass down to us.

Research going back seven million years shows that all our ancestors were ApoE4/4 carriers (two copies of the gene). The ApoE4 gene carries with it an enhanced immune response to invaders. For our ancestors, this provided a great evolutionary advantage. The ApoE4 gene helped them to resist parasites and other infections and allowed them to come down from the trees and walk barefoot while puncturing their feet. It limited life-threatening infections from wounds, as well as from eating raw meat that likely contained parasites. This enhanced inflammatory response was great for survival when living in the wild but now increases our lifetime risk of inflammation related conditions such as Alzheimer’s and heart disease in our modern society.

About 220,000 years ago the ApoE4 gene mutated into a new form called ApoE3. This mutation likely happened after the advent of fire and the ability to cook meat. Carriers of the ApoE3 gene create less inflammation and have a more efficient metabolism. About 70 to 75% of our current population carry the ApoE3 gene and are not at increased risk for Alzheimer’s Disease.

Once again, about 80,000 years ago, the ApoE3 gene mutated into the ApoE2 form. This gene is still relatively rare and present in less than 5% of the population. But it is thought to be protective against Alzheimer's disease.

In very rare cases, an individual can have a very early onset of Alzheimer’s symptoms. (Early 30s and 40s) In these cases, it is wise to test for mutations in the APP, presenilin 1 and presenilin 2 genes, uncommon genes associated with rare very early onset of AD.

The average lifetime risk for Alzheimer's disease for an individual who does not carry any copies of the ApoE4 gene is approximately 9%. For an individual who is heterozygous (one copy) for the ApoE4 gene, their lifetime risk increases to 30%. An individual who is homozygous (2 copies) for the ApoE4 gene, their lifetime risk increases to 50 to 90%. Clients can become extremely overwhelmed, depressed, and fatalistic when they find out they carry the ApoE4 gene, especially if they have been a caretaker for a parent or family member and have experienced the devastation firsthand. It is therefore the coach's responsibility to provide hope through education around the concept of epigenetics and lifestyle medicine.

What Is Epigenetics, and Why is it Important?

Your genes are not your destiny! The concept of epigenetics refers to how your behaviors and environmental exposures can change the way certain genes are expressed. What this means is that carrying a gene variation does not mean you are destined to develop that disease. Genes, in effect, have on and off switches.46 Imagine that you are born with a bucket. Over the course of your lifetime your bucket is gathering up all the environmental exposures and behaviors that happen to you. While your bucket is filling, you have no symptoms of the genes you carry. However, if your environmental exposures and lifestyle factors accumulate to the point where your bucket begins to overflow, then a gene or genes will be turned into the ’ON‘ position, and you will start to manifest symptoms associated with that gene.

Epigenetics gives us control over how our genes are expressed. Carrying an ApoE4 gene, therefore, does not mean you are destined to develop Alzheimer’s, but rather provides motivation to use lifestyle medicine and epigenetics to your greatest advantage.

Defining the Different “Types” of Alzheimer’s Disease

When we look at all the contributing factors to Alzheimer's disease (the 36 holes), we see that we can categorize the presentation of Alzheimer's disease into different types. The hallmarks of Alzheimer's Disease include inflammation, nutrient and hormone deficiencies, excessive toxin buildup, diabetes and cardiac inflammation, and traumatic brain injury. Alzheimer's disease is a protective response. The brain is defending itself against inflammation, trying to function without adequate support molecules and nutrients, and fighting off damage from toxic substances.

Currently, Alzheimer’s Disease has been broken down into six specific “types” based on the primary underlying cause47: (From Dr. Dale Bredesen)

• Type 1: Inflammatory or “hot”

The underlying cause of Type 1 is inflammation. Chronic inflammation can be caused by chronic infections like Lyme disease, an inflammatory diet, obesity, leaky gut and food sensitivities, chronic stress, disrupted sleep, a sedentary lifestyle, or parasites and other gut infections. ApoE4 carriers are particularly vulnerable to Type 1 Alzheimer’s because of their exaggerated inflammatory response. However, they also usually respond very well to lifestyle changes that decrease inflammation.

• Type 2: Atrophic or “cold”

The underlying cause of Type 2 is a deficiency in nutrients, hormones, or growth factors. Deficiencies can be caused by a nutrient poor diet, lack of sunshine, a sedentary lifestyle, leaky gut or other gut infections, chronic stress, or diabetes. Type 2 Alzheimer’s can also occur in ApoE4 carriers, but symptoms usually present later in life. Type 2 is closely associated with suboptimal hormone levels, low vitamin D, and insulin resistance.

• Type 1.5: (combination of types 1 and 2): Glycotoxic or “sweet”

The underlying cause of Type 1.5 is an increase in inflammation AND a decrease in nutrients, hormones, and brain support, that is characteristic of insulin resistance. A diagnosis of diabetes or prediabetes is closely linked to an increased risk of Alzheimer’s. Alzheimer’s Disease that results from insulin resistance is now being called Type 3 Diabetes, or diabetes of the brain. Patients with Type 1.5 respond very well to lifestyle medicine including addressing diet, stress, sleep, and exercise.

• Type 3: Toxic or “vile”

Type 3 presents differently from other types and is often associated with depression. Rather than short term memory loss, the first symptoms can affect executive functioning like loss of planning and organization, calculations, speaking, or visual perception. The onset of symptoms usually occurs much earlier, typically 40s to mid 50s. Type 3 is more common in women especially at the time of menopause because bone loss releases toxins that have been held in bones. The onset of symptoms is commonly initiated by an intense stress event. Type 3 is more common in ApoE3 carriers because they do not have an exaggerated inflammatory response protecting them from toxic buildup. Excessive toxin exposure can come from unclean air, water, food, beauty products, household items, mold exposure, mercury from contaminated fish or amalgam fillings, other heavy metals, electromagnetic fields, and infections.

• Type 4: Vascular or “pale”

Type 4 is directly linked to the chronic inflammation associated with heart disease. Heart disease can be caused by an inflammatory diet, obesity, abnormal metabolic markers like cholesterol and triglycerides, smoking, and a sedentary lifestyle. Like Type 1 Alzheimer’s, Type 4 patients do very well after making lifestyle changes.

• Type 5: Traumatic or “dazed”

Type 5 occurs as a result of head trauma such as a car accident, a fall, a sports injury, or repeated jostling motion.

For many years, the diagnosis of dementia was filled with devastation and hopelessness. However, there is currently a tremendous amount of research that has identified a myriad of contributing factors that allow cognitive decline to progress. As coaches, you are in the unique position of being able to provide hope to clients through the use of epigenetics and lasting lifestyle change. Let’s now begin learning the 10 Pillars of Brain Health.

Defining the 10 Pillars of Brain Health

Julia Lundstrom, CEO and Neuroscience and Brain Health Educator for Simple Smart Science, has diligently followed the work of Dr. Dale Bredesen, Dr. Daniel Amen, and Dr. Majid Fortuhi in hopes of bringing simple and tangible lifestyle changes that have been proven to work toward plugging up many of the 36 holes. Her findings have been boiled down to 10 Pillars of Brain Health:

• Nutrition
• Exercise
• Sleep
• Stress Reduction
• Meditation
• Breathwork
• Supplementation
• Social Connection and Purpose
• Learning and Challenging Your Brain
• Use It or Lose It

The next 10 modules of this program will walk you through the science behind each of these pillars, and what tools you can use in your coaching practice to make sure that your clients are practicing optimal brain healthy lifestyles.

Works Cited:

Bredesen, D., 2021. End of Alzheimer's Program: The First Protocol to Enhance Cognition and Reverse Decline at Any Age. Cengage Gale.

Bredesen, D., 2022. Coaches. [online] Apollo Health. Available at: <https://www.apollohealthco.com/practitioners/for-coaches/> [Accessed 22 February 2022].

Bredesen, D., n.d. The End of Alzheimer's.

Scheinbaum, S., 2022. Functional Medicine Training & Health Coach Certification. [online] Functional Medicine Coaching Academy. Available at: <https://functionalmedicinecoaching.org/> [Accessed 22 February 2022].

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2. “What Is Dementia? Symptoms, Types, and Diagnosis.” National Institute on Aging, U.S. Department of Health and Human Services, https://www.nia.nih.gov/health/what-is-dementia#:~:text=Alzheimer's%20disease%2C%20the%20most%20common,amyloid%20plaques%20and%20tau%20tangles.

3. Bredesen, D. E. (2017). The End of Alzheimer's: The first program to prevent and reverse cognitive decline. Avery.

4. “36 'Holes in the Roof' the Dawn of the Era of Treatable and Preventable Alzheimer's Disease.” Clinical Education, https://www.clinicaleducation.org/resources/reviews/36-holes-in-the-roof-the-dawn-of-the-era-of-treatable-and-preventable-alzheimers-disease/.

5. Gustafson, Craig. “Dale E. Bredesen, MD: Reversing Cognitive Decline.” Integrative Medicine (Encinitas, Calif.), InnoVision Professional Media, Oct. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712873/.

6. “Articles.” Cedars, https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/subjective-cognitive-impairment-sci.html.

7. Yoon B;Shim YS;Hong YJ;Kim YD;Lee KO;Na SJ;Yang DW; “Which Symptoms Can Distinguish between Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI)?” Archives of Gerontology and Geriatrics, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/21696835/.

8. 2022 Alzheimer’s Disease Facts and Figures. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf.

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10. “What Happens to the Brain in Alzheimer's Disease?” National Institute on Aging, U.S. Department of Health and Human Services, https://www.nia.nih.gov/health/what-happens-brain-alzheimers-disease.

11. O'Brien, Richard J, and Philip C Wong. “Amyloid Precursor Protein Processing and Alzheimer's Disease.” Annual Review of Neuroscience, U.S. National Library of Medicine, 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174086/.

12. “In Surprising Twist, Some Alzheimer's Plaques May Be Protective, Not Destructive.” ScienceDaily, ScienceDaily, 15 Apr. 2021, https://www.sciencedaily.com/releases/2021/04/210415114143.htm.

13. Chow, Vivian W, et al. “An Overview of APP Processing Enzymes and Products.” Neuromolecular Medicine, U.S. National Library of Medicine, Mar. 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889200/.

14. “Alzheimer's Brain vs. Normal Brain: Differences in Function.” Medical News Today, MediLexicon International, https://www.medicalnewstoday.com/articles/alzheimers-brain-vs-normal-brain#summary.

15. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

16. “Having a Lumbar Puncture.” Alzheimer's Society, 30 Nov. 2021, https://www.alzheimers.org.uk/research/take-part-research/lumbar-puncture.

17. “Having a PET Scan.” Alzheimer's Society, 12 Apr. 2017, https://www.alzheimers.org.uk/research/take-part-research/pet-scan#:~:text=Positron%20Emission%20Tomography%20(PET)%20scans,key%20hallmarks%20of%20Alzheimer's%20disease.

18. A;, Förstl H;Kurz. “Clinical Features of Alzheimer's Disease.” European Archives of Psychiatry and Clinical Neuroscience, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/10653284/.

19. Yaari, Roy, et al. “Updates to Diagnostic Guidelines for Alzheimer's Disease.” The Primary Care Companion for CNS Disorders, Physicians Postgraduate Press, Inc., 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267500/.

20. “Are Memory Problems an Indication of Alzheimer's Disease?” Are Memory Problems an Indication of Alzheimer's Disease? | BrightFocus Foundation, https://www.brightfocus.org/alzheimers/question/are-memory-problems-indication-alzheimers-disease.

21. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

22. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

23. Akiyama H;Barger S;Barnum S;Bradt B;Bauer J;Cole GM;Cooper NR;Eikelenboom P;Emmerling M;Fiebich BL;Finch CE;Frautschy S;Griffin WS;Hampel H;Hull M;Landreth G;Lue L;Mrak R;Mackenzie IR;McGeer PL;O'Banion MK;Pachter J;Pasinetti G;Plata-Salaman C;Rogers J;Ry. “Inflammation and Alzheimer's Disease.” Neurobiology of Aging, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/10858586/.

24. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

25. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

26. Bredesen, Dale E. “Neurodegeneration in Alzheimer's Disease: Caspases and Synaptic Element Interdependence - Molecular Neurodegeneration.” BioMed Central, BioMed Central, 26 June 2009, https://molecularneurodegeneration.biomedcentral.com/articles/10.1186/1750-1326-4-27.

27. Trophic factors: Overview & benefits: RST SANEXAS. RST. (2023, March 28). https://www.rstsanexas.com/blog/what-are-trophic-factors/#:~:text=Trophic%20factors%20are%20specific%20types,lacking%2C%20the%20cells%20may%20die.

28. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

29. A;, Vasefi M;Ghaboolian-Zare E;Abedelwahab H;Osu. “Environmental Toxins and Alzheimer's Disease Progression.” Neurochemistry International, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/33010393/#:~:text=Chronic%20exposure%20to%20toxins%20has,and%20pathophysiology%20associated%20with%2n.d..

30. Bredesen, Dale E. The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery, an Imprint of Penguin Random House, 2020.

31. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

32. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

33. Pahwa, Roma. “Chronic Inflammation.” StatPearls [Internet]., U.S. National Library of Medicine, 28 Sept. 2021, https://www.ncbi.nlm.nih.gov/books/NBK493173/#:~:text=Chronic%20Inflammation-,Chronic%20inflammation%20is%20also%20referred%20to%20as%20slow%2C%20long%2Dterm,repair%20and%20overcome%20the%20damage.

34. Walker, Keenan A. “Inflammation and Neurodegeneration: Chronicity Matters.” Aging, Impact Journals, 16 Dec. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339781/.

35. Bredesen, Dale E, and Varghese John. “Next Generation Therapeutics for Alzheimer's Disease.” EMBO Molecular Medicine, WILEY-VCH Verlag, June 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779441/.

36. Mitochondria. Genome.gov. (n.d.). https://www.genome.gov/genetics-glossary/Mitochondria#:~:text=Mitochondria%20are%20membrane-bound%20cell,power%20the%20cell%27s%20biochemical%20reactions.

37. Eckert, Anne, et al. “Mitochondrial Dysfunction, Apoptotic Cell Death, and Alzheimer's Disease.” Biochemical Pharmacology, Elsevier, 2 Sept. 2003, https://www.sciencedirect.com/science/article/abs/pii/S0006295203005343.

38. van Horssen J;van Schaik P;Witte M; “Inflammation and Mitochondrial Dysfunction: A Vicious Circle in Neurodegenerative Disorders?” Neuroscience Letters, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/28668382/.

39. “Understanding Acute and Chronic Inflammation.” Harvard Health, 1 Apr. 2020, https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation#:~:text=Research%20has%20shown%20that%20chronic,to%20know%20its%20exact%20impact.

40. “Alzheimer's Disease Genetics Fact Sheet.” National Institute on Aging, U.S. Department of Health and Human Services, https://www.nia.nih.gov/health/alzheimers-disease-genetics-fact-sheet#:~:text=APOE%20%CE%B54%20increases%20risk%20for,3%20percent%20carry%20two%20copies.

41. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

42. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

43. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

44. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

45. Alberts, Bruce. “How Genetic Switches Work.” Molecular Biology of the Cell. 4th Edition., U.S. National Library of Medicine, 1 Jan. 1970, https://www.ncbi.nlm.nih.gov/books/NBK26872/.

46. Bredesen, D. E. (2017). The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery.

10 Pillars of Brain Health:Nutrition

Key Topics:

• The Psychological Development of Eating and Food Choices
• Functional Nutrition
• Bridging the Gap to a Brain Healing Diet
• The Ketoflex 12/3 Brain Food Pyramid
• Eating For Your Mitochondrial Health
• Resources for Dietary Transitions with Clients

Terms:

• Associative Learning
• Functional Nutrition
• Standard American Diet (SAD)
• 6-Step Process to a Brain Healing Diet
• Phytonutrients
• Mesolimbic System
• Dopamine
• A1 Protein
• rBGH
• A2 Protein
• Lactose
• Lactase
• Gluten
• Zonulin
• Leaky Gut
• Cilia
• Glyphosate
• Omega-3 Fatty Acids
• EPA
• DHA
• ALA
• ARA
• GLA
• DGLA
• Omega-6 Fatty Acids
• Ketosis
• Ketones
• Polyunsaturated Fat
• Monounsaturated Fat
• Saturated Fat
• Hydrogenated Fat
• Trans Fat
• Autophagy
• Endocytosis

Video 1: The Psychological Development of Eating and Food Choices

Over the course of our lifetime, food takes on more meaning than just calories. As we grow and develop our personalities, food can become part of our identity and self-expression. Therefore, it is important for you to establish rapport with your client so that they can understand the many social and emotional experiences they connect with food. For some people, asking them to change their eating habits is a threat to their identity.

Our society habitually attaches many labels to our eating habits. For example, an infant or a small child that is a good eater is considered “good.” Whereas a fussy, picky eater can sometimes be labeled as “bad.” And yet, these early labels can change when a good eater becomes overweight. We then create judgement and associate obesity with gluttony. It is easy to see how these associations are reinforced throughout childhood. Even as mature adults, we can start to think of ourselves as “good” when we have a healthy eating day or “bad” when we have an unhealthy eating day. There are many things that subconsciously influence how and what we eat including genetics, personality, gender, age, experience, emotions, family, ethnicity, external cues, advertising, and our peers.1

And some food preferences are even genetic. We are programmed to prefer sweets because a preference for sweets ensured greater survival for our ancestors. Likewise, we are programmed to have an aversion to bitter tastes, because bitter taste could be associated with poisonous foods. We are also programmed to rate foods as better tasting when we are hungry to make sure that we eat even undesirable foods when calories are needed for survival.2

Personality influences our food choices as well. For example, are you a sensation seeker and prefer spicy foods? Do you prefer to play it safe and gravitate towards bland or milder foods? Do you prefer to stick with familiar foods? Or are you adventurous and like to try new foods? Some people define themselves based on their relationship with food. For example, do you define yourself by an obsession with food, as a human garbage disposal, or a foodie? A client's personality can also dictate their likelihood of wanting to change. An “upholder” typically goes ahead and follows through. A “questioner” typically wants to dig into the research before attempting change. An “obliger” is quick to say yes but they don't really feel like it and have a hard time following through. A “rebel” says no immediately to any suggestions for change.

Gender can also affect our relationship with food. Traditional societal stereotypes categorize female activities as day-to-day cooking, meal planning, and grocery shopping. Likewise traditional male stereotypes include grilling and carving the turkey. Men or women can eat out of hedonism, because it tastes good. Or they can eat out of nutritionism, because it's good for you. Sometimes when a client is in a relationship with somebody that has a very different food personality than their own, they are even more resistant to change.

Food is part of each developmental stage in life. In infancy, food can be associated with trust or mistrust because we rely on others to feed us. As toddlers, we experiment with making food choices and refusing foods. Adolescents can use food to express personal choices independent of family upbringing. College is a common time to rebel with food. In our late 20s and 30s, we tend to reinforce intimacy through a shared food experience. In our 30s and 40s, many individuals transition to a healthier diet as they begin to raise a family. Healthy food choices often become a priority as we get into our later years, but several problems are associated with aging, including a loss of interest in cooking, decline in taste sensitivity, chewing problems, loss of interest in eating, and forgetting to eat.

Our peers can have a significant influence on how and what we eat. Childhood friends can influence our food preferences and aversions. It is not uncommon for a preteen to order or eat something just so they don't disappoint their friend. Studies have shown you are much more likely to be overweight if your friends are also overweight.3

Culture also plays a role in our food choices. Certain cultures accept or reject certain types of food, for example: meat, kidneys, tongue, frog's legs, snails. We also tend to share cultural traditions with certain foods. Holidays and food go together, different types of music are associated with different types of food, events are paired with specific foods, and different parts of the world are known for particular foods.

Humans tend to experience associative learning when it comes to food. For example, pairing food together, e.g., sugar with coffee. Pairing food with an activity, e.g., movie with popcorn, or a hot dog at a ball game. We also tend to pair food with certain emotions.4 Do you eat because you are happy, sad, bored, depressed, angry, anxious, excited, or lonely? Comfort foods can be a connection to a memory of celebration or comfort, or the person who used to prepare it for you.

What happens to a client that defines themselves as a foodie and then is asked to make significant changes? What happens when eating for health clashes with a cultural tradition or religious identity? Clearly, how and what we eat is a complicated issue. That is why it is important to discern not just what your clients eat but why they eat. Listen to and observe signs that your client's personality, developmental stage, gender, connection to family, culture, religion, or social status will either promote healthy eating changes or hinder progress. Understanding where your client is coming from around food will help you craft a successful model for change. Enlisting others (spouse, friends, etc.) in the change process increases the likelihood of change happening.

Video 2: Functional Nutrition

Modern, chronic diseases due to inflammation are a result of an environmental epigenetic effect on gene expression.5 Up to 90% of disease contributors are environmental, including things like dietary influences, lifestyle habits, genetic predispositions, and environmental load. Only a small percentage of diseases are purely genetic.6 A functional medicine approach to chronic disease models a “Food First” intervention.

Functional nutrition is a clinical solution for addressing the underlying causes of disease. It puts an emphasis on the importance of high-quality foods and phytonutrient diversity to address clinical imbalances and move people to the highest expression of health.7 Most chronic diseases are caused by lifestyle issues.8 And for most chronic diseases, food outperforms a pharmaceutical approach. Food can cause disease or heal disease.9 Yet traditional allopathic medical students only receive an average of less than 20 hours of nutrition training in medical school.10

The functional nutrition approach involves11:

• The gathering of information through measurements, biomarkers, physical exams, and nutrition and lifestyle journals.
• Organizing clinical information, looking for points of connection and pattern recognition, and determining the need for further tests and evaluation.
• Initiating a nutrition care plan and patient education.

In order to provide clients with a deeper understanding of the why’s behind changing eating habits for the better, it is essential to understand the functional nutrition fundamentals which include:

• Understanding that food is energy. Food can create or cure disease, sustain nourishment, be converted to energy, and provide necessary micronutrients.
• Food is information. Our genes are influenced by our food choices. Quality and quantity matters. We inform our genes with every meal. Epigenetics determines gene expression.
• Food is a connection. Food brings communities together. Food choices are based on personal beliefs, religious preferences, and cultural influences. Food connection includes acknowledging the full journey food took to get to your plate.

Currently in the US, 85% of the population has a suboptimal diet and is considered malnourished.12 In a nutshell, we are overweight and undernourished. Processed foods + rushed eating (no rest and digest) + poor soil + crop handling + long travel time to market = a significant loss of nutrients. In addition, it is estimated that over 42% of the adult population is obese.13 Of that 42%, roughly 9% are considered morbidly obese. What’s more, a significant portion of the population is “skinny fat,” which means they're undernourished and have poor muscle mass even though they are not overweight.14

What you eat literally becomes a biological messenger for every system in your body. Every piece of food that enters your body is responsible for supplying your cells with energy to carry out the daily functions needed to optimize cellular health. And not only your cells, but every organ or tissue your cells differentiate into including your brain! Every day your brain uses roughly 20% of your daily intake of calories for energy.15 Unfortunately, this source of “energy” is not always the best quality. Upgrading the quality of your food ultimately upgrades the quality of your cellular health and has an impact on the performance, health, and longevity of your body. Therefore, the first step for improved health is to address diet.

The Standard American Diet (SAD) promotes inflammation, an imbalanced quality of fats, a high glycemic impact, and inconsistent eating behaviors.16 A functional approach to meal planning focuses on healthy foods, phytonutrient density, and balanced dietary choices. In this approach, food is energy, information, connection, and medicine. An overall health-promoting food plan focuses on whole foods, clean and organic choices, adequate quality protein, balanced quality fats, is high in fiber, low in simple sugars, and promotes phytonutrient diversity.

This healthier approach to meal planning is appropriate for everyone of all ages, but certain modifications for dietary preferences and needs should be made for each individual client. Modifications can include common dietary preferences (vegetarian, vegan, pescatarian), or common exclusions for allergies or sensitivities (gluten, grains, dairy, eggs, nuts, and shellfish). Other lifestyle factors and health goals to consider when creating a food plan include weight loss, weight gain, athletic performance, or targeted health outcomes (controlling blood pressure, blood sugars, insulin resistance, lipids, etc.).

When teaching clients about their nutrition, common obstacles to sticking with a new dietary plan include:

• Cost – Help clients prioritize which foods need to be bought at a higher quality, and which ones can be bought conventionally. (Refer to Dirty Dozen and Clean 15 from the Environmental Working Group - EWG.org)
• Time – assist clients with meal planning tips and resources.
• Reading food labels – educate clients on what to look for and what to avoid.
• Portion and serving sizes – educate on proper serving and portion sizes for activity levels, age, etc.
• Understanding inflammatory versus anti-inflammatory fats – educate on how not all fats are created equally.
• Cutting out sweetened drinks – start slowly by offering healthier alternatives.
• Increasing water intake – coach them on body weight divided by two = ideal daily water goal.

Video 3: Bridging the Gap to a Brain Healing Diet

When it comes to brain health specifically, we at Simple Smart Science have identified a 6-step process to bridge the gap between the SAD diet (brain damaging diet) and the Keto-Flex 12/3 (brain healing diet). This process is not always linear for each client, so be sure to consider any specific dietary modifications or concerns that need to be made to optimize their success.

6-Step Process to a Brain Healing Diet:

1. Increase Veggies and Fruits

2. Remove Added Sugars

3. Remove Gluten and Dairy

4. Limit/Remove Alcohol

5. Follow the Mediterranean Diet

6. Follow the KetoFlex 12/3 Diet

Before Starting: Stop eating a SAD diet!

The standard American diet is an example of what NOT to do when it comes to eating for brain health:17

1. High in saturated and trans fatty acids which shifts fat composition towards inflammation.

2. Low in fiber and high in refined grains which alters the glycemic load and shifts metabolic function towards diseases of inflammation.

3. High in sodium and low in fruits and vegetables which supports sodium dominance and leads to low potassium and other micronutrients.

4. High in refined sugars which alters glycemic load and shifts metabolic function towards diseases of inflammation.

5. Is “supersized” with a focus on high quantity rather than quality which supports imbalances in macronutrient composition and micronutrient density, not to mention tendency to overeat.

Every cell in your body has a cell cycle which can include dying (apoptosis) and regenerating (genesis). Old, damaged cells can be cleaned out, recycled, or renewed. New cells are made from the fuel you provide it with, which is generally from the foods you consume.

Help your client conceptualize that food is fuel by imagining that their body is like a nice sports car – a Mercedes, a BMW, or a Jaguar – and they are filling it up daily with poor quality gasoline. Is that car going to run? Sure. It’ll turn on and do what it needs to do, but its parts will slowly deteriorate at a faster pace than designed for. The term “you are what you eat” is literally analogous to putting low quality gasoline into a high-performance car.

Poor quality food, like the SAD, can eventually translate to fatigue, obesity, heart disease, diabetes, and Alzheimer’s or dementia. The top foods and ingredients found in the SAD that promote inflammation include:18

• Gluten
• Sugar
• Refined carbohydrates
• Conventionally raised meats and dairy
• Farm raised fish and seafood
• Processed conventional meats
• Trans fats (partially hydrogenated oils)
• Food additives and preservatives
• Highly processed vegetable and seed oils
• Artificial sweeteners

In order to prevent further damage and begin working towards reversing inflammatory damage within the body, we need to incorporate more anti-inflammatory foods. The top anti-inflammatory foods that you will work towards incorporating into your client's diet include:19 20

• Lemons and limes
• Berries
• Avocados
• Olives
• Coconuts
• Nuts and seeds
• Green tea
• Non-starchy vegetables
• Turmeric
• Wild caught small species of fish
• Herbs and spices

Video 4: 6-Steps to a Brain Healthy Diet - Step 1: Increase Veggies and Fruits

The standard American diet is mainly made up of animal protein and carbs. Encourage clients to recognize the inflammatory nature of a typical American meal and help them to craft a brain healthy plate instead. The best way to do this is by changing the portions to align more with an anti-inflammatory, nutrient dense meal. Start by encouraging your clients to fill their plate with a variety of vegetables. Quality (organic), quantity (mostly veggies), and variety (eat the rainbow) all matter when crafting a healthy plate.

Food isn’t like medicine – it IS medicine.21 This ancient wisdom has been largely forgotten but is still available if we teach our clients how to utilize it and why it’s so integral to preventing and reversing chronic disease. Meals should be crafted with a variety of organic vegetables taking up 50 – 75% of the plate. The remainder is reserved for high quality, anti-inflammatory fats, organic grass-fed, free-range animal protein (or organic vegetarian protein), and low sugar fruits.22 The more color represented in a meal, the higher the phytonutrient content.

Phytonutrients are components of plants that are powerful defenders of health. They stimulate enzymes that clear toxins, boost the immune system, improve cardiac health, promote healthy estrogen metabolism, and stimulate the death of cancer cells.23 They are found in fruits, vegetables, whole grains, legumes, herbs, spices, nuts, seeds, and teas. Phytonutrients are more than antioxidants because they have physiological location specificity. For example, beta carotene (orange) interacts with the corpus luteum and ovulation.24 Lutein (yellow) interacts with the macula and vision.25 Anthocyanins (purple) interact with the brain and cognition.26 Phytonutrients communicate messages to cell networks. They affect pathways of inflammation, energy utilization, and stress response.27 Encouraging a client to “eat the rainbow” ensures phytonutrient diversity and maximum health benefits.

Plants that aren't protected by herbicides, insecticides, and pesticides must work harder to protect themselves from environmental stressors such as starvation, dehydration, infection, and cellular damage from predators. Organic “stressed” plants therefore create stronger antioxidants and phytonutrients to protect themselves. When we eat plants that are grown organically, we reap the benefits of the increased nutrients they have created to protect themselves. Thus, eating organically is not just a way of avoiding ingesting herbicides and pesticides ourselves, but also ensures we are ingesting plants with the greatest phytonutrient strength possible.28

Here are 5 simple steps for encouraging clients to eat a rainbow of phytonutrients:

1. Aim for 9 to 13 servings of plant-based food every day.

2. Know your phytonutrient sources: Plants, vegetables, grains, legumes, spices, tea.

3. Eat a rainbow of colors.

4. Create variety with your choices.

5. Be creative with food substitutions and stick to whole foods.

Video 5: 6-Steps to a Brain Healthy Diet - Step 2: Remove Added Sugars

Sugar and/or simple carbs are converted into glucose and quickly absorbed into the blood stream. Excessive dietary sugar and simple carbs stimulate the pancreas to release insulin to protect the body from excessive blood glucose levels. Ancestrally, the only source of sugar available to humans occurred towards the end of the summer when fruit ripened. This ripe fruit provided excess glucose to be stored in the liver and fat cells to protect us from the coming winter months when food might be scarce. Insulin was therefore called upon infrequently to shuttle excess glucose into storage, leaving insulin free to perform other necessary metabolic functions for the remainder of the year.29

In our modern industrialized society, we not only have access to fruit year-round, but we also have access to thousands of “food like” items that are sugar laden and highly processed. When we eat sugar and simple carbs in excess, we overwork our pancreas and insulin response, eventually leading to insulin resistance, a condition in which our insulin no longer responds to high blood glucose levels. You will learn more about this in a later session, but essentially insulin resistance sets up a vicious cycle of increased carb/sugar cravings, increased blood glucose levels and increased inflammation. This can lead to dangerously high blood glucose, and ultimately Type 2 diabetes.30 To treat diabetes, allopathic doctors prescribe exogenous insulin to help balance glucose, but damage to the body continues to occur resulting in chronic inflammation, nutrient deficiencies, and ultimately a significantly increased risk of developing dementia or Alzheimer’s disease.31 Clearly, the more effective treatment would be returning to a low sugar, low simple carb diet consistent with how our ancestors ate.

Sugar has a direct impact on the brain. It affects the hippocampus, inhibits the production of new neurons, and increases the amount of inflammation in the body and brain.32 When we eat sugar or simple carbs, our mesolimbic system, which is the reward center of the brain, gets activated, and dopamine is released. Dopamine is the “feel good” hormone. When dopamine is released, it creates a neural connection in the brain, connecting sweets and processed snacks with feelings of pleasure. This explains why when we are stressed, sad, or tired, we often turn to sweet or processed foods for a pick me up. Each time we eat sugar or simple carbs, we reinforce this neural connection eventually leading to a sugar addiction. Sugar can literally rewire your brain.33 Remarkably, studies have proven sugar to be more addictive than cocaine. But unlike cocaine, sugar is a readily available, inexpensive, legal drug!34

It’s important to note the many names of sugar that tend to be hidden in our manufactured foods – 56 to be exact:35

Teaching clients how to recognize alternative names to sugar, as well as how to read nutrition labels, is the first step in helping them eliminate added sugars from their diet. However, be cognizant of the fact that sugar is a true addiction and can be very difficult for clients to give up. Start by adding more nutritive meal choices. Focus on the many foods they can eat rather than what they cannot. If they create meals with lots of vegetables, clean protein, and healthy fats, they will fill their plate and their belly, “crowding out” any room for processed foods. Offer healthier options of their favorite foods (dark chocolate, fresh berries) so they can begin to swap-out highly processed inflammatory sugars for healthier, whole food options.

Every nutrition label is required by law to differentiate between total sugar and added sugar. Teach clients to identify the two on a nutrition label. The difference between added sugar and total sugar equals the naturally occurring sugars. Naturally occurring sugar is typically not a primary contributor to inflammation and dementia, but too much added sugar and processed carbs are.36 Encourage clients to make the switch to adding in their own natural sweetener to unsweetened products, rather than buying the sweetened version. Organic 100% maple syrup and local raw honey are natural sweeteners with some health benefits but can easily be overconsumed and promote an insulin response. A better choice is organic stevia or monk fruit extract which do not elicit an insulin response.

Video 6: 6-Steps to a Brain Healthy Diet - Step 3: Remove Gluten and Dairy

Dairy

Like most things, there is a spectrum from best to worst when making dietary choices like dairy. The most inflammatory dairy choices come from factory farmed cows.37 These cows produce large inflammatory A1 protein,38 are kept in barns sheltered from the sun and vitamin D, are fed an unnatural inflammatory diet, and are given overdoses of hormones to keep them lactating year-round.

Sadly, a common practice in conventional dairy farming is the use of pituitary, steroid, hypothalamic and thyroid hormones, as well as rBGH, or Recombinant Bovine Growth Hormone.39 These are all used to increase milk production year-round, rather than naturally limiting it to the period after a calf is born.40 These conditions make cows sick, leading to ongoing treatments with antibiotics.41 When we consume dairy from factory farmed cows, we are ingesting dairy with a compromised nutrient profile like low vitamin D, herbicides and pesticides that have been sprayed on their inflammatory and GMO grain-based diet, hormones, and antibiotics. As a result, consuming dairy from factory farmed cows can lead to chronic inflammation, fatigue, acne, hormone dysregulation, increase risk for hormone related cancers, antibiotic resistance, gut dysbiosis, leaky gut, and food sensitivities.42 (Incidentally, consuming meat from factory raised animals is equally contaminated, nutrient poor, and inflammatory.) A better, less inflammatory choice would be to buy dairy products (and meat) from organically raised, 100% grass fed cows. This switch does not eliminate the inflammatory nature of A1 dairy, but does eliminate lifestyle imposed nutrient deficiencies, GMOs, herbicides, pesticides, hormones, and antibiotics.

The next best choice is to choose dairy products from organic A2 protein cows.43 When cows were first domesticated, they all contained a less inflammatory protein called A2. Over time, scientists believe that the A2 protein mutated into a more inflammatory form, A1. Cows with the A1 protein naturally produced more milk and were favored by farmers because more milk meant feeding more family members and making more profit. So, farmers began to selectively cross breed A1 cows leading eventually to a near extinction of A2 cows. Recently, the demand for less inflammatory milk has increased tremendously, and A2 cows are making a comeback. You can find milk from A2 cows now in grocery stores like Whole Foods. The next best choice is to choose dairy products from smaller lactating animals like sheep or goat. Smaller animals naturally contain less inflammatory, smaller protein molecules (A2). They are also unlikely to be mass produced in large factory farm conditions and, because of this, are higher in nutrients and lower in pesticides, hormones, and antibiotics.

When considering cheese, the longer a cheese ferments, the less inflammatory it is because the bacteria present in the cheese consume some of the inflammatory proteins and sugars.44 For example, hard Parmesan cheese is a better choice than soft brie cheese. Always look for organic varieties, preferably from sheep or goat. This same principle applies to fermented dairy products like yogurt and kefir.

Aside from the inflammatory nature of dairy, a large portion of the population is lactose intolerant meaning they are unable to digest the naturally occurring sugar molecule lactose.45 Originally, all homo sapiens were unable to digest lactose, and the only milk consumed by humans was breast milk. However, as the human population migrated to other regions worldwide, dairy became a primary source of food and nutrition for some cultures. These cultures evolved over time to have an enzyme, lactase, able to break down lactose. However, cultures that did not rely on dairy as a primary source of food and nutrition did not evolve to have this enzyme.46 For example, Scandinavian countries where goat and sheep farming were common, rarely have lactose intolerance. Whereas Asian countries whose diets were primarily based on fish, vegetables, and rice, remain lactose intolerant. Being tested for lactose intolerance may allow some flexibility by using exogenous lactase enzymes.

A recent metanalysis of 52 previous studies on dairy consumption in humans found that dairy may not be inflammatory for all individuals, and even potentially anti-inflammatory for some.47 This caveat is based on two things; the quality of the dairy and the health of the client. As previously discussed, the least inflammatory (and possibly anti-inflammatory) dairy comes from organic grass-fed A2 sheep or goat. Organic, 100% grass fed, unsweetened yogurt and other fermented dairy products from healthy animals may also be well tolerated. But even these better dairy choices may not be a good choice for all clients. Clients with gut issues, cancer, lactose intolerance, a true dairy allergy, or dairy sensitivity should avoid dairy regardless of quality.

Gluten

Gluten is a protein found in wheat, barley, rye, triticale, farina, spelt, kamut, wheat berries, farro, and couscous. In addition, most oats, although naturally gluten free, are contaminated by gluten during harvesting, processing, and shipping.48 Gluten is especially inflammatory especially to the gastrointestinal lining. In addition, it increases production of zonulin, a protein that regulates intestinal permeability.49 A diet high in gluten, like SAD, leads to chronic inflammation in the gut and eventually intestinal permeability, commonly called leaky gut. For genetically susceptible individuals, chronic gut inflammation and leaky gut can lead to food sensitivities.50 Symptoms of gluten sensitivity can present in any body system, not just the gut, and can include51:

• Fatigue
• Brain fog
• Anxiety
• Depression
• Mood disorders
• Acne
• Bloating and GI discomfort
• Abnormal bowel movements
• Insomnia
• Joint pain
• Skin disorders

If left untreated, leaky gut and food sensitivities eventually lead to autoimmunity.52 Just as chronic inflammation in the gut can lead to intestinal permeability, this inflammation can travel to the brain, causing permeability of the blood brain barrier (leaky brain), and result in inflammation in the brain. As a result, inflammation in the gut is closely related to inflammation in the brain and cognitive decline.53

A smaller portion of individuals contain a genetic immune reaction to eating gluten that leads to the erosion of cilia, small hair like structures lining the intestinal walls. As cilia deteriorate, nutrient absorption is compromised and can lead to malnutrition.54 Like non-celiac gluten sensitivity, celiac disease symptoms can present anywhere in the body. Therefore, any clients with chronic symptoms that do not resolve with basic lifestyle changes, should be tested for non-celiac gluten sensitivity and celiac disease so proper intervention can be employed.

In addition to gluten’s inherent inflammatory nature, nearly all gluten containing crops in the US are sprayed with glyphosate.55 Glyphosate is the active ingredient in Round Up, and is an herbicide sprayed on wheat and grain plants to speed up the drying process and lessen the time between planting and harvesting. Many individuals react to eating grains simply because they are sensitive to glyphosate. The best way to avoid ingesting glyphosate is to eat organic. A good choice for clients if they are struggling to transition from a gluten heavy diet to a gluten free diet is to first transition to an organic local sourdough. The bacterial enzymes in sourdough bread partially break down gluten, making it less inflammatory.56

Video 7: 6-Steps to a Brain Healthy Diet - Step 4: Limit/Remove Alcohol

Alcohol, just like sugar, has no nutritional value and is inflammatory in nature. When consumed in excess, alcohol impairs brain function and can kill healthy brain cells.57 The CDC recommends, in the 2020-2025 Dietary Guidelines for Americans, limiting intake of alcohol to 2 drinks or less per day for men and 1 drink or less per day for women on days when alcohol is consumed.58 Here are some important factors to consider when choosing to drink alcohol:59

• Alcohol is inflammatory in nature – it can cause inflammation in your gut, organs, and joints.
• Alcohol can inhibit your gut’s ability to absorb crucial nutrients and proteins, and create dysbiosis by killing off favorable bacteria.
• Alcohol can cause spikes in insulin levels.
• During consumption, alcohol acts as a depressant and slows down the connections between neurons.

Due to its small molecular size, alcohol is absorbed directly into the bloodstream through the stomach lining and the small intestines.60 How effectively you metabolize alcohol is dependent on overall health, age, gender, ethnicity, and genetics. So how much is ‘excessive?’ Although there is significant variation amongst individuals, the CDC states that excessive drinking for the average adult is defined as61:

• more than 8 drinks/week for women
• more than 15 drinks/week for men

Research shows that even moderate alcohol use can cause shrinkage in the hippocampus. The amount of shrinkage was found to be directly related to the quantity of alcohol consumed.62

When considering alcohol’s effects on the brain, we are less focused on the short-term effects associated with a night of drinking, but rather the long-term chronic misuse of alcohol as a cause of neurological damage. Alcohol “depresses” the connections between neurons, specifically in the hippocampus. When these connections slow down, it causes an interruption in the function of the memory sector of our brain. Chronic alcohol misuse can eventually lead to damage of neural connections in the hippocampus, decreased cognition, and depression.63

Inflammation

Alcohol is inflammatory in nature and can lead to many major organs in the body becoming inflamed, including the brain. Inflammation is responsible for damaging and/or killing brain cells, which directly effects memory and cognition. Alcohol can also disrupt the gut microbiome, leading to dysbiosis, inflammation in the gut lining, and eventually intestinal permeability.64 A healthy gut is essential to create, restore, and repair neurotransmitters, as well as for proper nutrient absorption. Regularly drinking large quantities of alcohol decreases digestive enzymes produced by the pancreas, affecting digestion and use of nutrients.65

Vitamin B Deficiency

Alcohol misuse depletes the body of essential B vitamins, most notably B1 (Thiamine). Thiamine, alongside the other essential B-vitamins, is needed for the conversion of energy in our nerve and brain cells. Wernicke-Korsakoff Syndrome, also known as “Alcohol Dementia”, is a neurodegenerative syndrome caused by severe B1 vitamin deficiency secondary to chronic alcohol overuse. It is possible to recover from Wernicke-Korsakoff Syndrome with a medically supervised treatment plan. However, if left untreated it can significantly limit life expectancy.66

Insulin Resistance

Because of its high sugar content, most alcohol causes spikes in blood glucose levels, a release of insulin, and the resulting dip in blood glucose, creating swings in energy, metabolism, and cognition. In chronic alcohol misuse, blood sugar spikes and dips can lead to insulin resistance, a major contributor to cognitive decline.67

General health recommendations include:

• Limit alcohol to no more than 1-2 drinks per day (depending on metabolism and body weight)
• Avoid drinking close to bedtime (to give your body time to metabolize the alcohol before you fall asleep)
• Drink one glass of water per alcoholic drink
• Drink alcohol with food to slow absorption
• Avoid sweetened mixers
• Avoid alcohol altogether if you have insulin resistance, diabetes, liver disease, or suffer from depression

Low sugar organic red wine in moderation can be a good choice for clients because some studies have identified the neuroprotective benefits of resveratrol, an antioxidant present in red grapes, that may promote anti-aging and cellular protection.68

Video 8: 6-Steps to a Brain Healthy Diet - Step 5: Follow the Mediterranean Diet

The Mediterranean diet has been researched for decades in relation to longevity and its protective effects on chronic disease. The Mediterranean diet is based on the traditional eating practices of people living in countries that surround the Mediterranean Sea – Spain, Greece, and Italy - and is high in vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, herbs, spices, fish, seafood, and extra virgin olive oil (proportions vary based on region). In general, the Mediterranean diet does not include fried foods, sugar-sweetened beverages, added sugars, processed meat, refined grains, refined oils, and other highly processed foods. The likelihood of cellular damage in the brain is drastically lowered when a Mediterranean diet is strictly followed due to its high proportion of antioxidants, fiber, omega 3 rich protein, and healthy fats.69 The brain is made of over 60% fat, half of which is Omega-3 fatty acids, consistent with the Mediterranean diet.70

Omega-3 Fatty Acids vs Omega-6 Fatty Acids

Omega 6 and Omega 3 fatty acids are considered essential, meaning the body does not produce them independently, and they must be acquired through diet. Let’s start by breaking down the different types of fatty acids.

Eicosapentaenoic Acid, or EPA, is an omega-3 fatty acid, found in cold water fish. EPA is anti-inflammatory, prevents blood clots, reduces triglyceride levels, and may reduce pain and swelling.71

Foods containing EPA include salmon, tuna, mackerel, sardines, shellfish, and herring.72

Docosahexaenoic Acid, or DHA, is also found in cold water fatty fish. DHA is anti-inflammatory, lowers the risk of cardiovascular death, decreases symptoms related to joint pain, improves cognitive decline and focus, may reduce the risk of glaucoma and is linked to lower blood pressure.73 Like EPA, DHA is found in salmon, tuna, mackerel, sardines, shellfish, and herring.74

Alpha lipoic acid, or ALA, is an antioxidant that protects against damage to the body's cells. It is vital for cellular functions such as energy production. It can be made naturally in the body or acquired through food.75 Foods high in ALA include flaxseeds, chia seeds, hemp seeds, canola oil, soybean oil, edamame, navy beans, avocado, whole wheat bread, and oatmeal.76

Arachidonic acid, or ARA, is an Omega 6 fatty acid. It is a chemical messenger released by your muscles during intense exercise. Although it's inflammatory in nature, this inflammation is vital in wound healing and muscle repair.77 Foods high in ARA include poultry, animal organs and meat, fish, seafood, and eggs.78

Gamma Linoleic Acid, or GLA, is an Omega 6 fatty acid. It can help stimulate skin and hair growth, maintain bone health, regulate metabolism, promote proper brain function, and maintain the reproductive system. Although it is an Omega 6 fatty acid, GLA may reduce inflammation.79 GLA is found in spirulina and plant seed oils, including evening primrose oil, black current oil, borage oil, and fungal oils.80

Dihomo Gamma Linoleic Acid, or DGLA, is an Omega 6 fatty acid. It is made in the body by elongating GLA. DGLA is found in trace amounts in animal products.81

Our ancestors ate a diet with a 1:1 Omega 6 to Omega 3 ratio. Although all fatty acids have beneficial biological functions, the problem arises because our modern diets are far too high in inflammatory Omega 6 fatty acids. It is estimated that our current diet is closer to a 40 to 1 Omega 6 to Omega 3 ratio, leading to chronic inflammation.82

Inflammation contributes to every disease state – pain, allergies, depression, cancer, heart disease, autoimmunity, cognitive decline, etc. Omega-3 fatty acids are anti-inflammatory by nature. Therefore, when we have enough Omega 3s in our diet we offset inflammation. Animal sources of Omega-3 fatty acids include wild fatty fish. Farm raised fish is full of toxins, low in Omega-3's, and high in inflammatory Omega-6's.83 Therefore, when we are looking to get our healthy fats from fish, it is best to choose wild-caught and sustainably sourced options. Plant sources of Omega-3 fatty acids include algae, which is mostly DHA, with some EPA. Other plant sources, such as hemp seeds, flax seeds, and chia seeds, need to be converted from ALA to EPA and DHA. This conversion process is helped by a low glycemic index diet. It could be helpful to recommend that vegan clients get tested to make sure they can convert ALA to EPA and DHA properly.84

Omega-6 fatty acids are readily converted to arachidonic acid, which is inflammatory.85 The SAD is concentrated with Omega-6 fatty acids and is lacking in Omega-3 sources, leading to a state of chronic inflammation. There are some good Omega-6‘s, for example, GLA (Borage oil, evening primrose oil). GLA converts to DGLA which makes anti-inflammatory compounds. But DGLA also converts to arachidonic acid so it's very important to balance with Omega-3s. When you get a good balance of DHA, EPA, and ALA, you inhibit conversion of DGLA to arachidonic acid. Arachidonic acid drives inflammation, but it is necessary for a normal healthy immune response. Therefore, balance is the key.

Omega-3 fatty acids blunt inflammation and resolve existing inflammation. EPA and DHA both have potent anti-inflammatory properties. Fish oil is the best Omega-3 supplement to decrease inflammation. However, Omega-3s are polyunsaturated, and the double bonds within their structure are more vulnerable to breakage due to oxidative stress and free radical damage.86 Therefore, the best way to protect Omega-3's is to combine them with a high antioxidant and phytonutrient diet.

Video 9: 6-Steps to a Brain Healthy Diet - Step 6: Follow the KetoFlex 12/3 Diet87

The KetoFlex 12/3 Diet was designed by Dr. Dale Bredesen. He is internationally recognized as an expert in the mechanisms of neurodegenerative diseases such as Alzheimer’s disease, and the author of the New York Times bestselling book The End of Alzheimer's. The term KetoFlex 12/3 combines the principles of the ketogenic diet, a flexitarian diet, and intermittent fasting for optimal brain function.

To simplify this, we have broken this diet down into 3 sub-parts: Keto, Flex, and 12/3.

Keto

Ketosis refers to the process in which your liver produces certain chemicals called ketone bodies (acetoacetate, beta-hydroxybutyrate, and acetone) by breaking down fat. Your body’s first source of energy comes from glucose, the breakdown product of carbohydrates. However, in the absence of carbs, the body utilizes dietary and stored fat to produce ketones as an alternative source of energy. Mild ketosis is optimal for cognitive function because beta-hydroxybutyrate increases production of BDNF.88

The brain healing benefits of the ketogenic diet have been utilized for decades in the treatment of intractable seizures in children and adolescents.89 It has since been used in the treatment of Alzheimer’s disease, Parkinson’s disease, brain tumors, autism spectrum disorders, and migraines.90 Its brain healing properties (listed below) occur because the ketogenic diet:

• Mimics a fasting state, triggering a switch from the metabolism of glucose to the metabolism of ketones for energy
• Enhances growth of new neuronal networks
• Reduces amyloid in the brain (a source of inflammation)
• Increases glutathione (the body's master antioxidant)
• Increases mitochondrial biogenesis
• Enhances ATP production (cellular energy)
• Reduces Reactive Oxygen Species or ROS (free radicals)
• Increases apoptosis (targeted cell death)
• Increases insulin sensitivity
• Increases leptin sensitivity (satiety hormone)
• Downregulates inflammatory pathways

The approximate macronutrient range needed to achieve ketosis is 30% clean protein, 60% anti-inflammatory fats, and 10% carbohydrates from vegetables.91 However, this range can vary from person to person. Ketone monitors are useful in determining the exact macros needed to achieve ketosis.

Culturally, our society has demonized fats for so long that it can be challenging to convince clients of their health-promoting properties. Education is key in assisting clients to embrace transitioning from a carb heavy diet to a brain healing keto diet. Color coding types of fat into “green, yellow, and red” may help clients to understand the difference between healthy and unhealthy fats.

Polyunsaturated and Monounsaturated Fats

Fats in the green zone are essential to a brain healthy diet. Monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) have either one (mono) or many (poly) carbon bonds that are free of a hydrogen molecule. When a carbon molecule is not “saturated” in every position with a hydrogen molecule, it allows the carbon structure flexibility and thus it remains liquid at room temperature. However, this flexibility also makes it more susceptible to damage by heat. Therefore, it is best to consume MUFAs and PUFAs at room temperature (think salad dressing) or lightly heated (think low heat sauté). These two classes of fats are made up predominantly of omega 3 fatty acids. Polyunsaturated and monounsaturated fats include avocados, avocado oil, olives, olive oil, fatty fish, nuts, seeds, and cold pressed flax seed oil.

Saturated Fat

Fats in the yellow zone should be consumed by organic sources and in moderation. Saturated fats have every available carbon bond “saturated” with a hydrogen molecule. Because there are no open bonds, saturated fats have a more rigid structure making them solid at room temperature. This rigid structure protects them from damage and is therefore a good choice for higher heat cooking. Saturated fats found in meat, dairy, and eggs are categorized based on structure as long chain triglycerides. Saturated fats found in coconut oil, palm oil and some cheeses are categorized as medium chain triglycerides (MCTs). MCT oil is the most efficient fat for ketone production and is therefore highly utilized in ketogenic diets. However, MCT oil can have a laxative effect on some clients so it’s important to increase amounts slowly (1 tsp per day up to 3 Tbs per day). It is also very important to note that clients that carry the ApoE4 gene for Alzheimer’s disease have impaired fat metabolism and should limit saturated fats to prevent build up and inflammation.92 High quality saturated fat can be beneficial in small quantities but is not deemed an “essential” fat and should be utilized within the context of a client's overall metabolic health. A study following the fat intake of 6,000 women showed that the amount of fat consumption didn’t raise concerns, but the rather the kind of fat did. Those who consumed more saturated fats had reduced cognitive function due to restricted blood flow and inflammation.93

A special note on high heat cooking: AGEs (advanced glycation end products) are formed when a sugar molecule attaches to a protein or lipid. They are naturally occurring in some uncooked animal proteins and other foods. However, high heat cooking dramatically increases AGEs. Food that is browned, caramelized, or charred during cooking is a sign of an increase in AGEs. (Think crust on bread, the top of creme brulee, the char on BBQ). AGEs have been linked to premature aging and the development and worsening of many chronic degenerative diseases, including Alzheimer's disease.94 Therefore, it is recommended to use moist heat such as braising, stewing, sautéing, and poaching, instead of dry heat such as grilling, roasting, broiling, and frying. Adding acidic ingredients such as vinegar, citrus, or wine, as well as herbs such as rosemary help mitigate the formation of AGEs up to 50%.95

Hydrogenated and Trans Fat

Fats in the red zone should be avoided completely if possible. When two hydrogen molecules sit side by side in a molecule, they are in the “cis” position. When they sit diagonally opposite each other, they are in the “trans” position. Trans fats, or hydrogenated oil, are formed through an industrial process that unnaturally adds hydrogen to liquid vegetable oils. These fats are called hydrogenated or trans fats because of the positioning and addition of hydrogen to a previously unsaturated molecule. When an unsaturated fat is chemically hydrogenated, it changes from liquid to solid at room temperature, increasing the shelf life of packaged foods. Hydrogenated and trans-fats are found in manufactured vegetable oils, margarine, fried foods, fast food, and pre-packaged foods. Trans fats flooded the packaged food market in the 70s and 80s because of the increased profitability of extending shelf life but were originally invented in 1911 with the creation of Crisco Oil. We now know that trans fats increase “bad” cholesterol and decrease “good” cholesterol, leading to increased risk for heart disease.96 However, trans fats can also disturb hormone production, increase inflammation in the body, and adversely affect memory.97 One study followed 1,628 people over the age of 60 with normal brain function for a 10-year span. Those who consumed trans fats had an increased risk of dementia because trans fats altered the effectiveness and connection between neurons.98

Flex

The “Flex” in the KetoFlex diet is short for a flexitarian diet. Consider it a “Flexible Mediterranean/ Vegetarian Diet” meets “Flexible Ketogenic Diet.” A flexitarian diet is largely plant based with an emphasis on non-starchy vegetables. Some fish, poultry, and meat are included, but are considered more of a condiment rather than the main focus of the meal. Quality of animal protein should be emphasized with clients since inorganic and farm raised animals have significantly decreased nutrient profiles and high levels of environmental contaminants. Organic, wild, free range, and grass fed are always preferred. Since the cost of higher quality protein is a concern for many clients, remind them that they will be decreasing animal protein to smaller portions as they increase portions of vegetables and healthy fats. For example, if your client is used to eating a 6 oz steak for dinner, encourage them to split it into 3, 2 oz portions. This will not only benefit their health, but their wallet as well.

12/3

12/3 refers to the timing between meals: Finishing your last meal of the day 3 hours before bed, and not eating your first meal of the next day until 12 hours after you finished your last meal of the previous day.

For example, if you have a client with a 10 pm bedtime, they should finish eating their dinner by 7pm, and not eat breakfast until after 7 am the next morning. Stopping eating 3 hours prior to bedtime prevents an insulin spike which can interfere with melatonin production and eventually contribute to insulin resistance, a significant risk factor for Alzheimer's disease.99 Extending an overnight fast beyond 12 hours can increase its benefits proportionately, but special attention should be paid to a client's metabolic health and genetic status when considering longer periods of fasting.100

For clients who have tested positive for the ApoE4 gene, associated with an increased risk of Alzheimer’s, it can be beneficial to encourage them to strive for a 14-16 hour fasting window to maximize the amount of neural clean-up secondary to autophagy. Autophagy refers to a process in which damaged cells are preferentially killed, creating space and energy for new cells to regenerate.101

Video 10: The Ketoflex 12/3 Brain Food Pyramid102

The KetoFlex 12/3 diet can be further broken down into 5 pyramid levels, denoting a hierarchy of importance:

Pyramid level 1: Clean house with a 12/3 overnight fast.

It is best to break an overnight fast with room temperature water and a squeeze of lemon, or a detoxing herbal tea such as milk thistle or dandelion. This will help to kickstart metabolism, as well as help detoxify the liver.

Pyramid level 2: Non-Starchy Vegetables and Healthy Fats.

Eat a wide variety and unlimited quantity of organic non-starchy vegetables. Always include a generous serving of healthy fats with your meal to make fat soluble vitamins and minerals more bioavailable and easier to absorb into the bloodstream. Non-starchy vegetables are anti-inflammatory and have a low glycemic index, meaning they will not cause an increase in blood glucose levels, the alternate fuel to ketones.

Pyramid level 3: Upgrade your gut with Prebiotics, Resistant Starches, and Probiotics.

The gut and brain are bidirectionally connected via the gut brain axis. The gut microbiome, the trillions of species that live in our gut, is intricately involved in the healthy functioning of our nutritional, immune, hormonal, and neurological systems. The current explosion in chronic disease goes hand in hand with dysfunction of the gut microbiome, making gut health a priority when addressing cognitive decline. Probiotics refer to beneficial bacteria, available in fermented foods and supplement form. Prebiotics provide nourishment for probiotics, available in certain foods and in supplement form. And resistant starches, such as legumes, parsnips, cassava, and pistachio are resistant to digestion and have been shown to improve insulin sensitivity, lower blood sugar levels, and decrease appetite.103

Pyramid Level 4: Animal Protein and Fruit.

Animal protein is optional and should be considered a condiment to a plant heavy diet. A good rule of thumb is 1g of protein, per 1kg body weight per day.104 For example, a person weighing 170 lbs. (77 kg) should consume no more than 77g of protein a day. Divided into 3 meals, this translates to approximately 25g of protein in each meal. The quality of animal protein should be emphasized with clients due to the increased toxicity and decreased nutrient density of farm raised animals. Educate and encourage clients to choose organic, free range, and wild options. Likewise, encourage clients to choose organic, local, and seasonal fruits with a low glycemic index such as berries, grapefruits, cherries, and green bananas.

Pyramid Level 5: Indulgences.

No eating plan would be sustainable without a few indulgences. Studies suggest that sweetness, even from non-caloric sweeteners, prompts your body to produce insulin and other hormones involved in glucose regulation.105 However, because of the addictive nature of sugar, clients can struggle with letting go of their favorite treats and may need to gradually transition away from their dessert habit. Approved sweeteners include organic stevia, monk fruit, local honey, and high cacao chocolates (85%+), but all should be consumed in very small amounts. Because dairy is inflammatory, and inflammation is one of the driving forces behind cognitive decline, Dr. Bredesen recommends against the use of dairy. (See the breakdown of different types of dairy in the previous section). And lastly, we have dry red wine. Red wine, when consumed in moderation, can have neuroprotective qualities as it is rich in antioxidants, but when consumed in excess it can have a pronounced effect on neuro-inflammation. For clients who choose wine as their occasional indulgence, connect them to companies that produce organic low sugar red wine, such as Dry Farms Wine.

As coaches, you know that every client comes to you from a different place in their illness/healing journey. Although KetoFlex is the gold standard for optimal cognition, strive to meet your clients where they are and help them to make small changes on their way to lasting dietary changes.

Video 11: Eating For Your Mitochondrial Health

The human body is comprised of 37.2 trillion cells.106 Through a process called endocytosis, our cells take in fluids, proteins, molecules and other nutrients that are necessary for their functioning. Nutrients are converted into cellular energy by the mitochondria. Mitochondria have a life cycle, just like all other cells in our body. However, as we age, regeneration of new mitochondria slows.107

Telomeres are antennae like structures on the end of chromosomes. They function to protect our DNA from damage but degrade and “shorten” as we age. In fact, the length of our telomeres is directly proportionate to our life span. Telomere length has also been shown to be correlated with mitochondrial health, with a shorter telomere associated with mitochondrial dysfunction.108 It is essential that the mitochondria communicate with other parts of the cell, but as it ages, communication slows because of damage and overuse. David Sinclair, a Harvard Medical School biologist, puts it very simply:

“The aging process, we discovered, is like a married couple. When they are young, they communicate well. But over time, living in close quarters for many years, communication breaks down.” 109

The healthier your mitochondria, the better you feel. One of the best ways that we can support our mitochondria is through diet.110 A diet high in sugar, processed foods, and refined flour spikes our insulin levels and leads to inflammation and mitochondrial damage. Let’s look at 10 specific foods that improve mitochondrial functioning. Once again, encourage clients to purchase high quality, organic, local produce to maximize mitochondrial support. You are not only what you eat, but what your food ate. (i.e. quality of soil)

• Blueberries are very densely packed with antioxidants which promote healthy mitochondria. In addition to improving mitochondrial production, blueberries have been shown to improve neural pathways in the brain, as well as help balance normal blood sugar levels.
• Broccoli is very high in sulphoraphanes which is continuously used by the mitochondria to maintain normal functioning. The abundance of antioxidants in broccoli also helps reverse nervous system degeneration.
• Olive Oil is high in brain healthy Omega 3 fatty acids and helps build strong cellular membranes, providing protection for our mitochondria.
• Avocados are also a great source of healthy fat, providing strong cellular membranes to protect our mitochondria. In addition, they are high in magnesium with 1 avocado providing 10% of the RDA. Magnesium prevents nerve cells from being overstimulated and damaged.
• Spinach is high in magnesium and antioxidants. Its mild flavor makes it more palatable to clients who don’t enjoy the bitter taste of some greens. Smoothies, soups, sauces, and stir frys are just a few ways to incorporate spinach into a brain healthy meal.
• Pomegranate Seeds are densely packed with antioxidants. They are also very high in Vitamin C, fiber, and potassium.
• Collard Greens are an antioxidant-rich leafy green that supplies a small dose of B-vitamins, an important nutrient especially for older clients. B vitamins are essential for neurological functioning and provide fuel for mitochondria. Like broccoli, collard greens are high in sulphoraphanes.
• Cabbage is a close cousin to collard greens, supplying a generous dose of sulphur and antioxidants. Fermented cabbage provides probiotics which can improve the gut microbiome, and ultimately have a positive impact on inflammation, brain health, immunity, and cellular health.
• Nuts are high in Omega-3 fatty acids which are protective for our neurological health as well as our mitochondrial health. Like avocados, nuts are high in magnesium, e.g., a one ounce serving of almonds contains 20% of the RDA for magnesium.111
• MCT Oil is a medium-chain-triglyceride that is found in coconut oil and palm kernel oil. MCT oil is quickly absorbed directly into the liver where it metabolizes into ketones for immediate fuel for the body and brain. Ketones are the preferred fuel for the brain and may improve insulin resistance, making MCT oil a valuable addition to a brain healthy meal plan. Because it is flavorless, clients can add it to coffee, tea, smoothies, baked goods etc. [MCT oil does have a laxative effect on some, so it is important for clients to slowly build quantity from 1 tsp up to 3 tbsp per day.] Additional caution should be taken with clients who carry the ApoE4 gene because of their impaired fat metabolism.

There are 5 key elements present in foods that promote cellular and mitochondrial health, which are included in the foods above112:

• B Vitamins
• Magnesium
• Sulphur
• Antioxidants
• Fats

Video 12: Resources for Dietary Transitions with Clients

Eating a brain healthy diet after decades of unhealthy eating patterns and emotional associations with food can make dietary changes a daunting task for clients. Most, if not all, need assistance with menu planning, recipes, and meal prep ideas.

Encourage clients to buy organic when affordable and available, avoid shopping while hungry, minimize processed foods in the center aisles of the grocery store, read and understand labels, and set time aside each week for meal planning and prep.

For clients that can afford it, prepared meal kit services can provide a less overwhelming transition towards eating a healthy diet. Prepared meal services can eliminate the need to grocery shop and meal plan, minimize food waste, increase meal variety and creativity, provide perfect portions, and provide opportunities for sale promotions. Some meal planning services that provide brain healthy meals include Epicured, Nutrition for Longevity, Green Chef, and Sun Basket.

For clients who enjoy cooking but are overwhelmed by meal planning and finding new recipes, we recommend LivingPlate.com. LivingPlate provides meal planning, grocery lists, and recipes for a variety of dietary plans including a Mediterranean plan, a Plant Based plan, a low-FODMAP plan, and an anti-inflammatory plan. (Prices range from $9 - $20/month).

Each of your clients will start at a different place in their progression towards a brain-healing diet. Likewise, they have unique medical histories and personal histories. An in-depth intake is essential for identifying the best place to start so clients are not overwhelmed by too many changes at once.

“Georgia is 58 years old and suffered from arthritis, high cholesterol, prediabetes, low thyroid function, obesity, and poor memory. She was eating the Standard American Diet. [She was encouraged to read a few books on functional nutrition] including Eat to Live by Dr. Joel Fuhrman, Eat Fat Get Thin by Dr. Mark Hyman, and The Plant Paradox by Dr. Steven Gundry. She began to change her diet. She lost 100 lbs., her cholesterol came down to normal, her arthritis disappeared, and her pre-diabetes abated. She became more energetic and started to ride her bicycle. She started to read voraciously about nutrition and health, and her memory improved...”113 Dr. Dale Bredesen

10 Pillars of Brain Health:Exercise

Key Topics:

• Physical Activity vs. Exercise

• The Dangers of a Sedentary Lifestyle

• How Movement Impacts Our Brains

• Exercise and Cognitive Decline

• Physical Benefits of Regular Exercise

• The Different Forms of Exercise

• Creating a Sustainable Exercise Plan

• Identifying Your Exercise Why

Terms:

• Exercise

• Physical Activity

• Sedentary Lifestyle

• Primordial Brain

• Fight or Flight Response

• Atrophy

• Blood Brain Barrier

• Mitochondrial Biogenesis

• Nitric Oxide

• Low Intensity Exercise

• Moderate Intensity Exercise

• High Intensity Exercise

• Beta-endorphin

• Aerobic Exercise

• Strength Training

• Flexibility

• Balance

Physical Activity vs. Exercise

Physical activity and exercise are often used interchangeably. While both effectively get results, from a coaching perspective they are very different.

Exercise can be defined as planned, structured, and repetitive bodily movement done to improve and/or maintain one or more components of physical fitness. Exercise directly improves our physical health by promoting circulation, lowering levels of inflammation, reducing the likelihood or presence of insulin resistance, and stimulating neurogenesis. Indirectly, exercise can improve mental health by reducing anxiety, stress, and depression.

Physical activity, on the other hand, can be defined as any form of muscular movement that requires the use of energy. This can be intentional, or non-intentional.

Exercise tends to have a more negative connotation than physical activity because of how society has glamorized what exercise should look like: powerlifting, high-intensity aerobic classes, hiking 4,000 ft+ mountain elevations, etc. While all of these are excellent goals for those who are already properly conditioned, beginners can feel overwhelmed and motivation levels are likely to drop when goals aren’t easily met.

Exercise can be anything from going for a walk, to doing mat Pilates, to swimming in the lake. The mere difference is exercise is a planned activity, physical activity is a part of an active lifestyle. For those just beginning to be active, physical activity generally leads to a healthy exercise routine. Once a more active lifestyle is adopted, planned exercises are more likely to be consistently followed.

Common types of exercise include cardiorespiratory endurance, muscular strength, muscular endurance, and flexibility. Common skills created during adherence to a well-planned physical activity routine include agility, coordination, balance, power, reaction time, and speed. We will provide you with beginner, intermediate, and advanced examples for each type of activity to offer as suggestions to your clients.

The Dangers of a Sedentary Lifestyle

A sedentary lifestyle is defined as involving very little or no physical activity and minimal energy expenditure. Lack of movement, or being sedentary, is associated with poor health outcomes, including musculoskeletal problems, and an overall increased risk of disease and death.1 The opposite of sedentary is not necessarily “exercise,” it is simply just actively moving around more.

Numbers can be immensely powerful when it comes to expressing the importance of having an active lifestyle to your clients. Here are some shocking facts that can help aid you in your coaching:

• “Every single hour of television watched after age 25 was associated with a 22-minute reduction in average life expectancy. Researchers say their calculations show that an adult who spends an average of six hours per day watching TV can expect to live 4.8 years fewer than someone who does not watch TV.”2

• A 2009 study of 17,000 Canadians found that those who sat the most were 50% more likely to die by their next follow up visit with their physician.3

• The World Health Organization and American Heart Association list physical inactivity as the 4th leading cause of death and the 4th leading risk factor for non-communicable diseases, behind high blood pressure, smoking, and elevated glucose.4

Being sedentary has been found to be a risk factor for type 2 diabetes, insulin resistance, and all-cause mortality.5 Subsequently, diabetes and insulin resistance are major risk factors for cognitive decline. Evolutionarily, our bodies are programmed to move often throughout the day. Our ancestors spent their days walking, foraging for food, hunting, building shelter, and playing. Our modern industrialized lives tend to promote inactivity with transportation, desk jobs, inactive leisure activities such as TV, and little free time to enjoy movement and exercise. Although the last 100 years have seen a dramatic change in lifestyle habits, our DNA has not evolved as quickly and still relies on activity for optimal health.6 Likewise, our ancestors spent all or most of their time outdoors. Spending time outdoors has been shown to reduce stress, increase creativity, boost problem solving skills, sharpen focus, and decrease negative thoughts.7 8

How Movement Impacts Our Brains

Movement = Improved Physiology

Improved Physiology = Improved Neurophysiology

We are currently living in a world where our brains are being utilized harder and longer than our ancestors did. Our primordial brain, collectively called the “old brain,” is wired for survival, which we often refer to as our fight or flight response. However, our complex, modern lives are overwhelmed by real and imagined stressors our brain interprets as a threat, including lack of sleep, a poor diet, stress at home or at work, and illness. Unfortunately, the hippocampus, where memories are processed, is particularly vulnerable to the effects of common lifestyle stressors.9

Think of lifestyle damage like craters on the moon—years and years of environmental stress “meteors,” inflammation “meteors,” sleep deprivation “meteors,” etc., all slowly chipping away at the moon's surface. In this analogy, the moon is your brain. After a while, the structural integrity of the moon begins to break down, or atrophy. In Alzheimer’s patients, this damage and shrinkage first manifests as short-term memory loss.10 Luckily, we can mitigate some of the negative damage caused by lifestyle stressors through exercise.

Exercise plays a large role in the protection and regeneration of our brains.11 The first way that exercise protects the brain is through the generation of ketones. Again, ketones are the byproduct of fat metabolism, which occurs in the absence of carbohydrates. Our bodies use either glucose (from carbs) or ketones (from fat) for energy. Ketones are the preferred source of fuel and energy for our brains.12 When we exercise, we have the potential to burn fat as a source of energy. And when we burn fat, our bodies release ketones naturally. Exercise also upregulates mitochondria which creates metabolic flexibility; the ability for the body to easily switch between using glucose or ketones for energy depending on what’s available.13 The increased blood flow resulting from exercise enhances the passage of ketones through the blood brain barrier.

The blood brain barrier is a single cell layer thick protective lining that allows brain-healthy nutrients like water, oxygen, glucose, ketones, and hormones to cross over. Under normal conditions, the cells of the blood brain barrier are tightly linked creating an intact protective membrane around the brain, and preventing neurotoxins like cortisol, mercury, and carbon dioxide from entering. However, things like high blood pressure, inflammation, an inflammatory diet, trauma, lack of oxygen, lack of blood flow, and toxins can compromise the integrity of this membrane, allowing it to become inflamed and damaged.14

We can keep this barrier healthy by reducing inflammation, maintaining healthy blood pressure and cardiovascular health, and reducing stress levels. Each of these risk factors can be improved with regular moderate exercise.

Exercise and Cognitive Decline

ANY form of exercise helps improve cognition by increasing brain volume.15 Exercise specifically improves cognition for patients with Alzheimer's disease by slowing down cognitive decline.16 No single consistent exercise strategy exists for different stages of cognitive decline. Rather, different types of exercise impact different parts of the brain:

• Cognitive exercises, e.g., playing chess or learning something new, create neurogenesis.17

• Aerobic exercise increases executive function in the prefrontal lobe.18

• Resistance training increases spatial and memory performance.19

• Cross training stimulates all parts of the brain.

Exercise increases mitochondrial biogenesis,20 or the creation of new mitochondria, in a wide range of tissues: adipose, liver, brain, and kidney. It also helps to clear dead mitochondria out of the brain. Exercise has been shown to boost levels of nitric oxide, which helps to increase blood flow and the production of BDNF.21 BDNF, as we now know, helps to promote neuroplasticity - the regrowth, repair, and survival of neurons.

When it comes to formulating an exercise plan conducive to increasing cognitive functioning, a common question that coaches are faced with is: Does the intensity of exercise matter? Before we go into the most effective intensity for exercise, let’s define the various levels of intensity:

• Low Intensity = 40 to 55% maximum heart rate. No sweat or heavy breathing.

• Moderate Intensity = 55 to 69% maximum heart rate. Sweat after 10 minutes, can converse but cannot sing.

• High Intensity Exercise = 70% maximum heart rate. Sweat after three to five minutes, can only talk in short phrases.

High intensity exercise has the largest neurophysiological effect over other types of exercise.22 The following benefits can happen in as little as four minutes of intense exercise:

• Intense exercise promotes the release of the opioid peptide beta-endorphin.23 Beta-endorphin helps with pain relief, appetite regulation, anxiety relief, and other visceral functions.24 The duration of exercise is not critical. However, low and moderate exercise does not stimulate the beta-endorphin response.

• Increases in BDNF levels help build new neuronal branching. The increase in BDNF is elevated with exercise proportionate to its intensity.25

• Intense exercise promotes superior improvements in cardio metabolic risk factors compared to continuous moderate exercise.26

Physical Benefits of Regular Exercise

Exercise benefits not only the brain, but also contributes to both physical and mental health. Exercise promotes a healthy BMI, reduces insulin resistance and blood pressure, and reduces heart disease and stroke incidence.27 It also improves sleep, balances mood, and reduces stress and anxiety.28

In addition to the benefits listed above for the physical and mental/emotional body, exercise impacts every other biochemical system of the body:29 Within the functional medicine model, the body’s functions are viewed as seven separate systems.30 Exercise benefits each of these systems.

Defense and repair: This system refers to your immune system and its interactions with tissue repair. Exercise improves this system by improving the immune system, decreasing inflammation, and increasing natural killer cell activity.

Energy: This system refers to mitochondria, cellular energy production, and its effect on disease. Exercise improves this system by increasing energy, decreasing fatigue, increasing mitochondrial biogenesis, increasing ATP production, and enhancing the browning of white adipose tissue. [White adipose tissue stores extra calories (or energy) to use when you don’t get enough through diet. Most body fat is “white”. Brown adipose tissue breaks down glucose to create heat and helps maintain body temperature. Brown adipose tissue has a high concentration of mitochondria for energy production.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661118/#:~:text=While%20white%20adipose%20tissue%20is,for%20energy%20expenditure%20and%20thermogenesis.

Biotransformation and elimination: This system refers to the body's ability to convert the waste products of metabolism into something that can be safely eliminated. Exercise improves this system by increasing skeletal muscle glucose disposal and improving bowel function and efficiency.

Transport: This system refers to the transport of nutrients, hormones, and enzymes within the body. Exercise improves this system by increasing heart rate variability, increasing maximum oxygen consumption, improving aerobic threshold, decreasing resting heart rate, decreasing blood pressure, decreasing LDL cholesterol, increasing HDL cholesterol, decreasing triglycerides and total cholesterol, increasing angiogenesis, and improving endothelial function.

Communication: This system refers to the whole-body hormone system. Exercise improves this system by increasing insulin sensitivity, reducing HbA1c, increasing AMPK, increasing nitric oxide, decreasing estradiol, increasing vagal tone, and decreasing adrenergic activity.

Structural integrity: This system refers to the totality of cellular integrity, including arteries, veins, and tissues. Exercise benefits this system by producing positive changes in body composition, increasing muscle mass, decreasing body fat, promoting a healthy BMI, and decreasing platelet adhesiveness, fibrinogen, and blood viscosity (leading to a decrease in stroke and heart disease).

Assimilation: This system refers to how your body breaks down food and water into energy and nutrients. Exercise improves this system by having a positive influence on gut bacterial biodiversity.

The Different Forms of Exercise

The 3 main types of exercise include: aerobics, strength, and flexibility. All forms of exercise contribute to good health. Aerobic activity increases the health and performance of our heart and lungs. Strength training allows us to maintain and build muscle mass and strengthen bones. Exercises that promote flexibility, balance, and coordination help with activities of daily living. Let’s dig deeper into the different types of exercise.

Aerobic Activity

Aerobic translates to “with oxygen.” Aerobic exercise is defined as a measure of your body's ability to take oxygen from the atmosphere and use it to produce energy for your muscle cells. Many factors influence aerobic fitness including lung efficiency, cardiac function, gender, age, and genetic makeup. In 2018 a study was published looking at 23 different proposed interventions for cognitive decline. Exercise was identified for its ability to delay cognitive decline in individuals diagnosed with or at risk for AD. Within this meta-analysis, aerobic exercise was identified as having the greatest positive impact.31

Brain imaging has shown that vigorous exercise reduces levels of tau tangles associated with AD. Aerobic exercise also increases blood flow to the memory and processing centers of the brain, leading to measurable improvements in executive functions including attention, planning, and organization.32 Cardiovascular fitness is directly correlated to better overall brain volume, cortical thickness, and greater white matter integrity in older individuals.33

Decreased blood flow to the brain is one of the first clinical measurements indicating the AD process. Aerobic exercise is therefore helpful in that it provides a steady level of cerebral blood flow.34 Research shows that aerobic exercise optimally promotes the production of BDNF and neurogenesis. In contrast, decreased BDNF contributes to cognitive decline.35

Like the lymphatic system in the body, the brain has a similar “waste” management system in the brain called the glymphatic system. The glymphatic system functions to clear excess beta amyloid and other extracellular proteins from the brain.36 Studies on mice show a twofold increase in glymphatic flow after five weeks of aerobic exercise.37

One particularly beneficial type of aerobic exercise involves jumping on a mini-trampoline, or rebounder. Rebounding stimulates the lymphatic system, helping the body rid itself of excess toxins. This type of exercise is especially important for clients dealing with toxin exposures and/or a diagnosis of Type 3 (toxic) AD.38

High intensity interval training, or HIIT for short, involves short bursts of intense activity alternating with periods of recovery. HIIT has been shown to have many health benefits including decreased body fat composition, decreased heart rate and blood pressure39, and improved insulin sensitivity.40 More importantly, for our purposes, HIIT has been shown to improve cognition in older individuals, with benefits identified in speed processing, memory, and executive function.41

It’s important to identify your clients' medical risk factors and general fitness level because what may qualify as aerobic activity for one client may be too little or too much for another client. Activities like walking, running, hiking, swimming, group fitness classes, HIIT training, even chair exercises, can be considered aerobic depending on the fitness level of your client.

Experience level examples of Aerobic Activity:

Beginner

• Walking (Optional: Hand weights)

• Swimming

• Chair exercises

• Recumbent Bike

Intermediate

• Stationary Bike

• Hiking

• Tennis

Advanced

• Running

• HIIT Training

• CrossFit

Strength Training

Strength training is defined as a method of improving muscular strength by gradually increasing the ability to resist force through the use of free weights, machines, resistance bands, or body weight. Strength training promotes muscle retention, as well as growth of new muscle tissue. Even something as minimal as walking with hand and ankle weights, Pilates, or isolation exercises like squats and planks can activate muscles.

A review of twenty-four studies examining the effects of interventions on AD risk showed significant improvements in AD screening parameters associated with strength training, with executive functioning showing the greatest improvement.42 Strength training is particularly important for older clients because loss of muscle mass, a process called sarcopenia, occurs naturally as we age, and potentially puts clients at a higher risk of falls and injuries. Strength training prevents sarcopenia43 which can be a process that is correlated with cognitive decline.44 Strength training also inhibits bone loss, aging in general, and brain atrophy, leading to a reduction in cognitive decline.45 Adults who include strength training in their routine perform tasks of daily living with greater ease, exhibit an enhanced gait, have fewer white matter lesions, and show cognitive improvement.46

Leg strength in particular has been correlated with better cognition and greater brain volume.47 Encourage clients to integrate squats and lunges, with or without weights, or machines geared towards increasing leg strength.

General guidelines for strength training include:

• Strength train two times per week on non-consecutive days

• Train each major muscle group

• Do two to four sets of each exercise

• For improved strength prior to middle age, do 8-12 reps in each set

• For improved strength in middle age or older, do 10-15 reps in each set.

• To improve muscular endurance, do 15-20 reps in each set

Risks of strength training include muscle strains and soreness, an injury from free weights, and falls. Be sure to focus on safety with clients and encourage them to start low and go slow, warm up, cool down, and stretch. Exercising with a partner is always important for accountability, safety, and fun.

Experience level examples of Strength Training:

Beginner

• Towel Exercises

• Pilates

• Bodyweight Exercises

Intermediate

• Dumbbell Exercises

• Strength Training Classes

• Strength Machines

Advanced

• Powerlifting

• Bodybuilding

Flexibility and Balance

Flexibility is defined as the degree to which a joint can move through a normal, pain-free range of motion. Balance is defined as the ability to maintain the body's position over its base of support within stability limits, both statically and dynamically.

Flexibility is critical for pain free movement, full range of motion, preventing injuries and still joints, and performing activities of daily living. Balance is critical for walking and moving safely throughout the day and preventing falls while performing activities of daily living.

General guidelines for flexibility include:

• Stretch two to three times per week to improve range of motion

• Hold each stretch for 10-30 seconds

• Repeat each stretch two to four times

• Stretching is most effective when muscles are warm

General guidelines for balance include:

• Practice balance exercises two to three times per week

• Sessions should last 20-30 minutes

• Balance work is best before strength and stretching, or after aerobic activity

• Examples of balance work include Tai chi, Qigong, and yoga.

There are many safety considerations when encouraging clients to include flexibility, balance, and stretch work in their routine. Encourage clients to talk to their doctors about their exercise plans, especially after surgery. Additional tips for clients include always warming up, breathing normally throughout, understanding that it’s ok to feel discomfort but not pain, never bouncing in a stretching position to avoid injury, and avoiding locking the joints.

Experience level examples of Flexibility and Balance:

Beginner

• Chair Stretches

• Mat Stretches

• Cross-body Exercises

Intermediate

• Yoga Classes

• Bosu Ball

Advanced

• Advanced Yoga Classes

• Myofascial Releasing

In addition to enhancing balance and flexibility, yoga is particularly beneficial for combatting cognitive decline because many of the positions involve inversion postures, like downward dog and legs up the wall. Inversion postures use gravity and positioning to activate the glymphatic system and promote neural clean up.48

Creating a Sustainable Exercise Plan

For many clients, the word exercise carries a negative connotation. If you have a client resistant to exercise, find ways to encourage them to move more within their already existing routine.

• Cleaning – do more deep cleaning. Have them get into the nooks and crannies of their house.

• Parking – stop taking laps to find the closest spot to their destination. Have them park far away to get extra steps in.

• Stairs – stop taking the elevator if possible or reduce the number of floors that are used for it. For example, if your client is going to the 4th floor, encourage them to walk the first-floor stairs, take the elevator from the second floor to the third, and walk the stairs to the fourth. It doesn’t have to be an all-or-nothing approach.

• Taking a phone call – walk around the house when on the phone. This is a great way for clients to mindlessly get in a few extra steps.

• Watching TV – during the commercial breaks, get up and walk around, do squats, push-ups, or stretch, and don’t stop until the show comes back on. Or, during the show, have your client get a yoga mat out and do some floor exercises or stretches.

• Brushing Teeth – Have your client balance on one foot while brushing their teeth.

• Making tea – boiling water takes time. Encourage your client to stretch while waiting for tea to boil.

• Cooking – Talk to your client about dancing to their favorite music while cooking dinner.

• Combine exercising your body with exercising your brain. While moving, listen to a podcast, audio book, or learn a new language.

• Wear a weighted vest while moving around the house.

• Add music, a friend, or a dog to make moving more fun!

The general recommendations for exercise are at least 150-minutes a week, or 30-minutes a day, 5 days a week. Help clients to identify types of movement that they consider fun. Have them think back to their childhood – did they love swimming, dancing, and riding a bike? Help them to remember that movement can be fun rather than a chore and help them create an actionable plan to incorporate movement into their daily routine.

Since exercise levels are individual, elevate clients to their capacity rather than following a strict definition. High intensity means something different for each client. Don't encourage them to overtrain. If they are too tired to train the next day, they overdid it. Once you overtrain, you lose the health benefits because of an increase in oxidative stress associated with overtraining. Start with four minutes and increase to 20 or 30 minutes.

There is no known supplement that can replicate the benefits of exercise!

Identifying Your Exercise “Why”

Just as with diet, you will encounter clients all over the exercise spectrum; some that don’t exercise at all, some that engage in a variety of exercise types, and even some that overtrain.

Education will help them make the connection between exercise and brain health. As a coach, it is important for you to help your clients identify their “WHY.” Do they want to lose weight, be able to run around with their grandchildren, or feel less aches and pains? Helping them clearly identify how exercise will personally enhance their life will help them to establish and stick to their exercise goals.

There are many reasons for people wanting to start an exercise routine. External motivations can include a family history of dementia, a medical setback, watching a close friend suffer from disease, clothes that are too tight, an upcoming reunion, wanting to change body composition, or wanting to increase fitness levels. Internal motivators can include feeling energized after exercise, feeling calmer throughout the day, having clear thoughts and ideas, and feeling invigorated.

To help guide your client on finding their “why,” walk them through this set of questions:

1. How do you currently feel about exercising?

2. What has prevented you from exercising in the past?

3. If you choose not to start making a change, what might be the consequences?

4. What would increasing your physical activity do for your life?

5. What could you accomplish, participate in, or facilitate with more ease with the help of exercise?

6. What is one thing you could do today to increase your fitness level by 1%?

7. What are 5-10 reasons you want to be more physically active?

Helping a client transition from a sedentary lifestyle to one with more physical activity can be challenging. Helping them to identify what motivates them is one way to get through the barriers of excuses so it is less of a challenge for them. It is also crucial to coach clients through identifying obstacles, creating concrete strategies, and identifying strengths that can help them overcome resistance to change.

“Teri, age 65, was an accomplished distant runner and writer, but when she turned 60, she began to note problems with focus and memory. Given her family history of Alzheimer's disease, she underwent genetic testing, and learned she was ApoE4 positive... Her regular physician said there was nothing he could do to reduce her risks. [After enrolling in a comprehensive lifestyle program to reverse cognitive decline], she noted improvement within three months... She has now been on the protocol for four years, remains mentally sharp and active, and recently had a pet scan that was normal.” Excerpt from The End of Alzheimer’s by Dale Bredesen, MD.

10 Pillars of Brain Health:Sleep

Key Topics:

• The Importance of Sleep

• The Dangers of Sleep Deprivation

• REM vs. non-REM Sleep

• How Sleep Impacts Memory and Brain Health

• The Dangers of Insomnia

• Sleep Disturbances, Inflammation, and Stress

• Medical Considerations

• The Coaches Approach to Sleep Disturbances

• List of “DOs”

• List of “DON’Ts”

• Lifestyle and Sleep

• Naps: Good or Bad?

• Sleep Aids

• Alternative Approaches to Sleep Aids

Terms:

• Hypothalamus

• GABA

• Insomnia

• Cytokines

• Cortisol

• Sleep Apnea

• Restless leg syndrome

• Sleep Hygiene

• Benzodiazepines

• Z-drugs

• Parasomnia

• Orexin Receptor Antagonists

• Orexin

• Melatonin Receptor Agonists

• Antidepressants

• Antipsychotics

• Over the Counter (OTC) Sleep Aids

• Anticholinergics

• CBTi

The Importance of Sleep

Quality of sleep is very important in the formation and prevention of chronic diseases including neurodegenerative disease. Lack of sleep is a hormone disruptor and physiological stressor and can also affect weight, which can contribute to inflammation and disease risk.1 Our DNA has a built-in code, our “clock genes,” that helps guide it based on time of day and the corresponding physiological processes.2 Therefore, it is important for clients to establish a routine that includes when they wake, eat, and sleep.

Clock genes govern our circadian rhythm which regulates sleep-wake cycles by driving hormones and other physiological changes, allowing us to transition between sleep and wakefulness. The circadian rhythm repeats roughly every 24 hours and is based on light, darkness, and the release of the hormone melatonin. Darkness signals the release of melatonin which promotes sleep, and light inhibits the production of melatonin.3

In addition to melatonin, our hypothalamus (part of the brain that regulates body temperature, thirst, hunger, other homeostatic systems, sleep, and emotional activity)4 produces a neurotransmitter called GABA or gamma-aminobutyric acid. GABA is known as the body’s most important inhibitory neurotransmitter, lowering the activity of neural cells in the brain and central nervous system. By inhibiting neural activity, GABA facilitates sleep, reduces mental and physical stress, lowers anxiety, and creates calmness of mood.5

The Dangers of Sleep Deprivation

Sleep deprivation is defined as less than 7-9 hours of sleep per night.6 Keeping a food/mood/energy/sleep journal can help a coach assess a client's sleep patterns and potential inhibitory habits. It's important to note that the actual time during which your client is asleep is equally as important as the number of hours they sleep. Sleeping during the day and working at night is in direct opposition to our circadian rhythm and clock genes. Studies of shift workers have consistently shown a decrease in lifespan, an increase in depression, and an increase in relationship problems, regardless of how many hours of sleep they are getting.7

Research is showing that even moderate sleep deprivation can produce impairments in cognitive and motor performance analogous to alcohol intoxication. One study looking at the effects of sleep deprivation showed that an individual who has been awake for 17 hours has cognitive functions equivalent to that of one who has a blood alcohol concentration of 0.05%.8 Likewise, studies looking at combat soldiers showed that sleep deprivation impaired alertness, cognitive performance, and mood.9

REM vs. non-REM sleep: (Rapid Eye Movement)

There are 4 different stages of sleep. Stages 1-3 are known as non-REM sleep and stage 4 is known as REM sleep.10

During stage 1 sleep, we are in a light transition stage, drifting in and out of sleep, and can be easily disturbed. During stage 2, sleep is deeper, includes slower brain waves, is more restorative, and appears to be involved with motor learning.

Stage 3 involves very deep sleep, otherwise known as Deep Wave Sleep, and is characterized by very slow brain waves known as delta waves. Stage 3 is especially important for visual learning, memory retention, recall, and for consolidating memories from short term memories into long term memories. Stages 2 and 3 play an instrumental role in replenishing our ability to learn, making it optimal to approach new tasks or information when well rested.

Stage 4, REM sleep, is when we dream. During stage 4 our voluntary muscles become limp or “paralyzed,” breathing becomes more rapid, and eyes move rapidly in different directions. The 4th stage is believed to be integral in strengthening skills such as critical thinking, creative problem-solving, memory consolidation, and emotional processing and regulation.11

As a generalization, non-REM sleep is associated with boosting the performance of newly acquired skills by restoring flexibility and neuroplasticity,12 while REM sleep stabilizes these improvements and prevents new learning from replacing them.13

By properly moving through the sleep stages, the synapses and the neuronal connections created during the day are strengthened, so new knowledge can be solidified and protected from being “overwritten” by new learning.14

When it comes to cognitive decline, REM sleep is an active brain sleep that connects memories with emotions.15 Heart rate increases, as well as blood flow to organs. The body is paralyzed so we don't act out our dreams.16 (Parkinson's patients lose paralysis and have REM behavior disorder).17 Both REM and non-REM sleep are critical for normal neurocognitive functioning:18

• Visual perception is improved by late night REM sleep and early slow wave sleep19

• Motor skills are improved by late night non-REM sleep20

• Memorization is improved by early night non-REM sleep21

• Emotional declarative memory is improved by late night REM sleep22

• Consolidation of perceptual and emotional memories is improved by non-REM sleep23

How Sleep Impacts Memory and Brain Health

While sleeping, our brain builds and repairs the damage of the previous day and cleans up the leftover harmful debris.24 Both are essential to optimal brain function particularly when it comes to making, retaining, and recalling memory. When we get sufficient sleep, our short-term memories can be consolidated, stored, and converted into long term memories.25

Sleep, therefore, is restorative for our brain.

• Sleep consolidates memories and restores synaptic homeostasis by globally downsizing excitatory synapses26

• The glymphatic system pumps cerebral spinal fluid through brain tissues, flushing garbage from the brain into the bloodstream and liver for elimination27

• Brain cells shrink about 60% during sleep for more efficient waste removal28

In other words, during sleep, our brain is going through a deep clean where the toxic waste products from the days cellular activity are removed. Waves of cerebrospinal fluid wash through the brain and remove toxic waste and proteins like Beta amyloid plaque.29 Excess amyloid plaque in the brain is closely linked to the development of Alzheimer's. In addition, when we sleep, certain growth hormones and proteins like BDNF stimulate growth, aid in cell reproduction, regeneration, and repair in our brains.30 Research supports 7-9 hours of sleep as ideal, with less having a potentially negative impact on memory.31 Getting less than 6-7 hours sleep is associated with an increase in inflammation, increased Beta amyloid plaque in the brain, increased risk for stroke and heart disease, and immune system dysregulation. Unfortunately, over 35% of Americans get less than the recommended 7-9 hours.32 This stat includes only the reported data - the real percentage is likely a lot higher.

The Dangers of Insomnia

Insomnia can include difficulty falling asleep, staying asleep, or poor-quality sleep33 and is the most common sleep complaint in the industrialized world.34 Thirty to forty percent of individuals in industrialized nations report episodes of insomnia.35 Fifteen to twenty percent of individuals report having at least one episode of “adjustment” insomnia per year, which occurs in association with a stressful life event.36 Psychophysiological insomnia is quite common. For example, difficulty falling or staying asleep leads to frustration and fear of sleepiness, which leads to a physiological activation of the stress response. In other words, the more you worry about sleep, the harder it is to fall and stay asleep. This creates a vicious cycle.37

Insomnia commonly predates Alzheimer's disease.38 Sleep disturbances that have been linked to dementia include: 39 40

• Insomnia (trouble falling and/or staying asleep)

• Sleep disordered breathing (nocturnal resistance to airflow leading to sleep related conditions)

• Hypersomnia (excessive sleepiness during the day)

• Parasomnia (abnormal nocturnal movements, talk, or emotions that disrupt sleep)

• Sleep related movement disorders (e.g., restless leg syndrome and other movement disorders, sleep related leg cramps, and sleep related bruxism)

• Circadian rhythm sleep disorders (misalignment between sleep-wake cycles and environment)

Sleep Disturbances, Inflammation, and Stress

Sleep disturbances are well known to occur in the caregivers of individuals with dementia.41Sleep has an epigenetic effect,42 that is, it turns gene expression on and off. Sleep restores the function of the vagus nerve43 and decreases inflammatory cytokines. In other words, the less sleep you get, the more inflammation you produce.44

Chronic exposure to innate immune cytokines (inflammation) reduces sleep continuity and depth and induces a sleep pattern consistent with insomnia and hyperarousal. As a result, people with inflammatory disorders have an increased rate of sleep disorders.45 Every time we eat, we create a small inflammatory response.46 However, a good number of people have dysbiosis, intestinal permeability or other inflammatory bowel issues that create an enhanced inflammatory response when eating.47 It is therefore important for everyone, inflammatory condition or not, to avoid eating at least two to three hours prior to bedtime.48

Sleep loss may be one of the ways that inflammatory processes are activated and contribute to the association of sleep complaints, short sleep duration, and cardiovascular morbidity.49 Therefore, lack of sleep and inflammation go hand in hand and are intricately involved in Type 1, inflammatory, Alzheimer's disease.50 51

Inadequate or low levels of vitamin D are associated with the development of wake impairment commonly associated with sleep disorders.52 Low vitamin D levels may also increase the risk for obstructive sleep apnea, autoimmune disease, chronic rhinitis, tonsillar hypertrophy, cardiac disease, and diabetes.53 Therefore, lack of sleep and low vitamin D levels go hand in hand and are intricately involved in Type 2, atrophic, Alzheimer's disease.54 55

Several toxins have been associated with sleep disturbances, including mycotoxins, arsenic, heavy metals, phthalates, pesticides, and polyaromatic hydrocarbons.56 Sleep is intricately involved in detoxing our body and brain.57 Therefore, toxin buildup and lack of sleep go hand in hand and are intricately involved in Type 3, vile, Alzheimer's disease.58 59

The following cascade is an example of how lack of sleep can increase significant health issues and risk factors for cognitive decline:

Obstructive sleep apnea -> short sleep duration -> circadian misalignment -> sympathetic activation -> HPA axis alteration -> oxidative stress -> activation of inflammatory pathways -> insulin resistance -> pancreatic beta cell dysfunction -> glucose intolerance -> type 2 diabetes.60

Therefore, lack of sleep and insulin resistance go hand in hand and are intricately involved in Type 1.5, glycotoxic, Alzheimer’s disease.61

While there are many reasons for clients to have trouble sleeping, the number one reason for a disrupted sleep cycle is stress.62 Cortisol (stress) is released in direct opposition to melatonin (sleep) with cortisol normally being highest in the morning and lowest at night, while melatonin is lowest in the morning and highest at night.63 Our bodies are hardwired to release cortisol and keep us awake when we’re stressed for optimal survival in the event of a life-threatening emergency.64 However, chronic stress, as is common in our modern society, allows cortisol to remain elevated throughout the day which hinders the natural release of melatonin in the evening.65

Medical Considerations

In addition to stress, there are medical conditions that can greatly affect our ability to fall asleep and stay asleep, such as hormonal imbalances, menopause, thyroid conditions, diabetes, restless leg syndrome, and sleep apnea.66

The most common of these is obstructive sleep apnea which occurs when airways are temporarily blocked during sleep. Sleep apnea is a medical condition that causes nocturnal hypoxia and is a risk factor for a cardiovascular event leading to sudden death, depression, headaches, memory loss, and strokes.67 Chronic overnight oxygen depletion also damages the brain and increases the incidence of dementia.68

Difficulty breathing 5 to 15 times an hour is considered mild sleep apnea. Difficulty breathing greater than 30 times per hour is considered severe sleep apnea.69 Sleep apnea decreases oxygen flow to the brain and disrupts brain activity.70 In one of the earliest studies on sleep apnea prevalence, 70% of men and 56% of women between the age of 65 and 99, had obstructive sleep apnea.71 Severity of sleep disordered breathing and nocturnal hypoxia independently predict both hemoglobin A1c levels and type 2 diabetes.72

The performance impact of obstructive sleep apnea includes:

• Slower working memory73

• Decreased brain activation74

• Slower reaction time75

• Impairment in regions involved with conflict monitoring, attention, motor function, and decision making76

• Personality and mood changes, including depression and anxiety77

The gold standard for treatment of sleep apnea is a CPAP (continuous positive airway pressure) machine.78 Elderly patients with apnea who present with cognitive decline can benefit from CPAP.79 Episodes of depression are also reduced when treating apnea with CPAP.80 Since apnea is physiologically related to impaired glucose homeostasis, several studies are underway looking at the efficacy of using CPAP as a therapeutic approach for diabetes patients with apnea. One study suggests that the use of CPAP greater than four hours per day is associated with a reduction in hemoglobin A1c.81

Restless leg syndrome is another common medical condition that can chronically disrupt sleep, as are night terrors and narcolepsy.82 Taking sleeping pills or other sleep supplements when an underlying medical condition exists does not usually restore high quality sleep.83 Therefore, it is essential to get to the root cause of any medical condition disrupting sleep rather than taking sleep aids.

The Coach Approach to Sleep Disturbances

To get a better handle on your client’s sleep status, it's a good idea to encourage them to keep a sleep journal and track sleep habits for a couple of weeks. Have clients record the time they go to bed, the number of times they wake up, and what time they get up for the day. Also record what difficulties they had sleeping, like nightmares or bathroom visits, and any significant events that could have affected sleep.

One modern day contributor to sleep difficulties is the use of technology, specifically the light emitted from electronic devices.84 Ancestrally, our sleep cycle was tied to sunlight and darkness.85 Our modern industrialized lives have introduced an onslaught of blue light and artificial lighting that disrupts our production of melatonin and our circadian rhythm.86 Blue light depletes lutein in the eyes and can lead to macular degeneration.87 Minimizing exposure to blue light is essential. Blue light is most prevalent in electronic devices such as TVs, computers, and smartphones. Short wavelength [blue] light has a greater effect on shifting the circadian clock and on melatonin suppression than natural light does.88 A recent study from Harvard University had participants read from a paper book 4 hours before bed, and another group read from an eBook 4 hours prior to going to bed. This study showed that the blue light emitted from eBooks made it harder for participants to fall asleep, because it made participants less sleepy in the evening. It was also found to reduce melatonin secretion in participants, which shifted the timing of the participants’ circadian clock much later, which resulted in a reduced next-morning alertness than when reading a printed book.89

A single night of light exposure acutely impacts insulin resistance.90 Chronic overnight exposure (e.g., sleeping with the TV on) may have long term effects on metabolic function.91 And EMFs (electromagnetic fields) can cause neuro psychiatric symptoms including insomnia.92 Clients who find themselves on their phone all day and into the evening can change the backlight to “sleep mode” or shift the brightness to a warmer hue. This will help with eye strain, as well as reducing exposure to blue light. Encourage your clients to start dimming the lights a couple of hours before bed and get sunlight exposure upon waking in the morning, to work with the body's natural cycle of melatonin production. Avoiding electronics at least two hours prior to bedtime is essential for normal sleep patterns. Blue light blocking glasses can also assist individuals when electronics are necessary.93

Many people have sleep associations. For example, they “learn” that they can’t sleep in their bed, but they fall asleep easily on the couch.94 Practicing good sleep hygiene is important for resetting sleep associations. A good night's sleep starts first thing in the morning; what a client does during the day is as important as what they do at night.95 Encourage them to stay hydrated, eat healthy meals, exercise or move often, and meditate or use other stress management techniques during the day. Keep in mind that exercise increases core body temperature.96 Ancestrally, the ambient nighttime temperature was much cooler than daytime temperatures. A cool environment and body temperature is essential for proper physiological signaling of the sleep cycle.97 Therefore, exercising close to bedtime is disruptive to sleep. However, everyone is different so personal experimentation is recommended.98

Unfortunately, our modern way of living with artificial lights, electronics, and chronic stress works in direct opposition to our ancient sleep signals.99 Creating a sleep atmosphere more in line with our ancestors helps to reinforce our natural circadian rhythm. There are many things clients can do to enhance their sleep at night. Although none are magic sleeping pills, they will all slowly reset sleep patterns over time. These approaches are collectively called sleep

hygiene.100 101 102

Here’s a list of practical Do's and Don'ts for setting clients up for a good night's sleep.

List of “DO”s

• Create a consistent pre bed routine

• Use the bedroom for sleep and intimacy only

• Go to bed at the same time each night

• Try meditation or deep breathing before bed

• Put your bedside clock out of sight so you can't check the time if you wake up in the middle of the night

• Avoid substances like caffeine and alcohol in the evening

• Try decaf herbal teas that promote relaxation before bed

• Put your phone on airplane mode and remove all electronics from your bedroom

• Get black-out blinds or keep your room very dark

• Keep room temperature a cool 61-68 degrees - making sure feet remain at body temperature, not cold or hot

• Keep a notebook next to your bed to write down ruminating thoughts

• Avoid mentally stimulating activities before bed

• Begin to darken the house in the evening

• Exercise in the morning rather than before bed (exercise increases core body temperature, and a decreased body temperature promotes sound sleep)

• Turn Wi-Fi off overnight if possible

• Avoid eating 2 - 3 hours before bed.

• Avoid exposure to artificial light and electronics/phone/TV 2 - 3 hours before bed.

List of “DON’T”s

• Use your bed for anything but sleep or intimacy, like reading or working in bed

• Stay in bed if you are unable to fall asleep. If after 20-30 mins you haven't been able to get to sleep, move to another room and read or find another activity until you feel sleepy again

• Fight it- If you feel yourself getting drowsy at night, take this as your cue to go to bed

• Consume coffee or dark chocolate after mid afternoon

• Drink a lot of liquid too close to bedtime

• Eat sugary sweetened foods, especially before bed

• Drink alcohol, as much as it can feel helpful to fall asleep, it can lead to restless sleep and early morning waking **

**One drink of red wine per day can have health benefits103, but alcohol should not be used as a sedative to fall asleep. Alcohol use has been associated with:

1. Decrease in sleep latency.104

2. Decreased REM first half of the night.105

3. Increase in REM later in the night.106

4. Shallow disrupted sleep later in the night, particularly with higher doses of alcohol.107

5. Alcoholics in particular experience an increase in sleep latency, awakening, and wake time. In addition, alcoholics experience decreased REM and slow wave sleep.108

Lifestyle and Sleep

The best approach to good health is to combine positive lifestyle factors that have epigenetic effects: e.g., food, sleep, stress, love, and community. A functional medicine approach to sleep disorders is a food as medicine first approach. Quality of food is more important than quantity because poor quality increases inflammation and toxicity.109

Dietary considerations:

• A diet high in bioflavonoid intake is positively associated with optimal sleep duration and quality.110

• Nutrient intake of vitamins, minerals, and fatty acids is instrumental in blood sugar regulation, insulin resistance, and inflammation.111 112

• Higher protein diets improve sleep in overweight and obese adults.113 Protein quality is determined by the level of amino acids such as tryptophan and methionine. Protein intake of 20% of calories produces the best Global Sleep Score regardless of quality from either animal or vegetable sources.114

• Oleic acid: Alzheimer's disease is generally associated with lower omega-3 intake from fish.115 A study of oleic acid supplementation and cholesterol intake restriction in mice reduced Alzheimer's disease type neuropathology.116 Oleic acid functions as a precursor for the sleep-inducing compound oleamide.

• Ketones: ketogenic diets have been shown to improve sleep quality in kids with therapy resistant epilepsy.117 A study of the ketogenic diet, measuring quality of life in cancer patients, also showed improved emotional functioning and a decrease in insomnia.118

Exercise considerations:

• Exercise early in the day decreases the impact of stress119, regulates blood sugar120, decreases insulin resistance121, lowers blood pressure122, and increases hippocampal volume123, all of which contribute to better sleep outcomes

• Exercising for at least 150 minutes per week is associated with better sleep and a feeling of increased alertness when awake.124 Exercise also increases BDNF125 and is associated with a good quality of sleep.

Naps: Good or Bad?

It wouldn’t be right to address the issue of sleep without talking about naps and how they fit into healthy sleep habits. In the case of short-term acute insomnia, it’s better to avoid napping because it’s likely to disrupt the natural circadian rhythm further.126 For clients with chronic insomnia, it's important to plan when and for how long to nap. Napping in these cases can sometimes help improve performance, concentration, judgement and focus.127 Studies show that the best nap length for most people is approximately 10-20 minutes.128 This provides some restorative sleep without causing drowsiness after waking. Once a nap lasts longer than 30 minutes, a deeper sleep cycle begins, leading to feeling groggy and disorientated upon waking.129 The benefits also appear to be greater with deliberate naps vs just falling asleep when tired. Therefore, have your clients plan naps earlier in the day and set an alarm to prevent oversleeping. When planning a long nap to make up for prolonged sleep deficits, have them nap for at least 90 minutes to 2 hours so they can complete a full sleep cycle and wake up feeling more rested.

Although guidelines exist, there is no magic number of hours of sleep that's perfect for everyone, as needs are individual. However, elderly clients don't get into as deep a sleep pattern as younger individuals.130 Many things can contribute to sleep fragmentation including existing medical conditions.131 The reintroduction of naps in the elderly is a normal occurrence, with 30 to 60 minutes being ideal.132

Unfortunately, one of the most common approaches to sleep problems is over the counter or prescription sleep aids. Prescription sleeping pills, especially anti-anxiety medications and commonly used OTC sleep aids like Benadryl or Tylenol PM, have been linked to the onset of dementia, or to worsening of existing dementia symptoms.133

Sleep Aids

Prescription sleep aids achieve results by altering chemicals in the brain that are involved in regulating sleep and wakefulness.134 The active ingredients and the way they function separates these drugs into different classifications. Let’s review the ones you are most likely to encounter with clients.

Hypnotics and Sedatives

The most commonly prescribed hypnotics are a class of drugs known as benzodiazepines. (benzos) They are extremely effective at inducing sleep and can be formulated to release slowly throughout the night in order to help someone stay asleep. Examples are alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril).135

These drugs work by increasing the brain’s production of gamma-aminobutyric acid (GABA), a chemical/ neurotransmitter that induces drowsiness and suppresses the activity of nerves in the brain and spinal cord.136 Because of their calming/sedating effect, these drugs are prescribed for sleeplessness and for anxiety.

Benzos are highly addictive and if used long term, can lead to physical dependence and dangerous withdrawals if stopped abruptly. They also come with many potential side effects including feelings of depression, disorientation, confusion, irritability, and memory impairment. Benzodiazepines can cause acute cognitive impairment, even for younger people, and an Increased risk of dementia with long-term use.137

Because of the addictive nature of benzos, a newer class of hypnotics, often called Z-drugs has become more commonly prescribed. These drugs also increase GABA production but in a modified way that is believed to have less side effects. Examples of these drugs are Zaleplon (Sonata), Zolpidem (Ambien), Zopiclone (Imovane), and Eszopiclone (Lunesta). Z drugs have similar side effects to benzos, but also include the side effect of behaviors called parasomnias, also known as “Complex sleep behaviors.” Parasomnia behaviors include activities like sleepwalking, sleep driving, making phone calls while asleep, sleep eating, etc.138 Typically, a person has no memory of the parasomnia activities carried out while sleeping. Both benzos and z-drugs are associated with a buildup of tolerance, requiring higher doses to achieve the same effect over time.139

While on hypnotics, the brain does not move properly through stages of sleep.140 The deeper brain waves produced during REM sleep are restricted, affecting the crucial process of memory consolidation, learning, and creativity.

Orexin Receptor Antagonists

The next class of prescription sleep aids are the “Orexin Receptor Antagonists”. These relatively new drugs include Belsomra (suvorexant) and Dayvigo (lemborexant). They work by blocking the effect of orexin, a neurotransmitter that increases wakefulness. By decreasing levels of orexin, these drugs promote sleepiness without the side effects associated with other sleep drugs. However, some common adverse effects include somnolence (drowsiness), headache, and dizziness. Long term effects are relatively unknown as they are a newer type of drug, but it is believed that they are not addictive, and therefore potentially a safer choice than benzos.141

Melatonin Receptor Agonists

Another prescription sleep aid is the “Melatonin Receptor Agonists.” These include Rozerem (ramelteon) and Tasimelteon (Hetlioz). These drugs mimic the effect of melatonin in order to help induce sleep and regulate the circadian rhythm. (These are prescription drugs and not the same thing as an over-the-counter melatonin supplement).142

They are not considered addictive but can induce a rebound affect (the return of insomnia) when discontinued.143 Common side effects include sedation, headache, elevated liver enzymes, and nightmares. They can worsen depression and are also not recommended for use in patients with severe COPD or sleep apnea.144

Antidepressants

Antidepressants are commonly prescribed to help with sleep problems. This class of drugs, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), has been found to cause drowsiness, leading to its off-label use for sleeping problems.145 Examples include Trazodone (Desyrel), Amitriptyline (Elavil), and Doxepin (Sinequan).

Antidepressants work by acting on neurotransmitters that affect mood, including norepinephrine and serotonin. However, they also act on the neurotransmitters histamine, acetylcholine, and dopamine, resulting in drowsiness.146 Most antidepressants affect the normal cyclical progression through sleep stages. Most notable is the reduction in REM sleep and increase in REM sleep onset latency, i.e., a delayed onset of REM sleep. Antidepressants that increase serotonin function by blocking reuptake or by inhibiting metabolism (SSRI’s) have the greatest effect on REM sleep.147

Trazadone, a popular antidepressant prescribed for sleep, decreases nighttime awakenings, stage 1 sleep, and perceived sleep difficulty. BUT it also suppresses REM sleep, significantly impairs recall, causes short-term memory impairment, and is associated with fewer words entering long-term storage. Trazodone also impairs next-day memory performance, equilibrium, and muscle endurance. Potential side effects include cardiac arrhythmias, and weight gain.148

Antipsychotics

Antipsychotics are a class of drugs used to treat mental health disorders as they work to reduce delusions and hallucinations. They are sometimes prescribed off-label as a treatment for sleep problems because their influence on serotonin can produce a sedative effect.149

Over the Counter (OTC) Sleep Aids

Over the counter (OTC) drugs can be purchased without a prescription and are frequently sold in pharmacies, drug stores, and supermarkets. The most common OTC drugs used for sleep are antihistamines.150 Diphenhydramine is the active ingredient found in Benadryl and Tylenol PM. These medications are classified as Anticholinergics because they block the neurotransmitter acetylcholine, which decreases brain function making it difficult to stay alert. This neurotransmitter plays a crucial role in attention and short-term memory; therefore, regular use significantly increases the risk of developing dementia and Alzheimer’s Disease.151 Another OTC sleep aid, Unisom (Doxylamine succinate), has the same anticholinergic properties and associated dangers.

Conclusion

Sleeping pills present a risk to cognition and memory, including temporary side effects, like brain fog, confusion, drowsiness, depression or irritability, as well as long-term effects including an increased risk of developing dementia. There is no question that sleep architecture (the basic structural organization of normal sleep) is affected by these drugs. This results in disturbed sleep quality and impaired progression through the stages of sleep leading to impaired memory and cognitive processing.

In addition, older clients are less able to clear drugs from their body, allowing sleeping pills to stay in their system longer. This may result in an increased chance of falls, broken hips, and car accidents.152 Some doctors recommend avoiding all sleep aids after age 65.153 If you have a client with a history of long-term use of sleep aids, it is advisable to gradually taper medication under the care of a doctor. There are also trained practitioners that can help assist the process with the use of nutritional support, supplements and alternative methods.

Alternative Approaches to Sleep Aids

Of course, the first and most effective place to start with clients is to ensure that they are practicing good “sleep hygiene.” Often it is lifestyle practices and habits that interfere with the ability to fall asleep and stay asleep, and by identifying and changing some small but crucial elements, sleep can be greatly improved. If your client is still having trouble sleeping, there are some natural sleep aids and techniques that can be very helpful.

Cognitive Behavioral Therapy

For many people who have chronic insomnia, a therapy known as CBTi or Cognitive Behavioral Therapy for Insomnia can be very effective. CBTi focuses on exploring the connection between the way we think, the things we do, and how we sleep. During treatment, a trained CBTi therapist helps to identify thoughts, feelings, and behaviors that are contributing to the symptoms of insomnia, and in so doing, helps to overcome the underlying causes of sleep problems.154

Herbs:

Herbs can be used in many forms such as teas, tinctures, capsules and oils, and can help promote relaxation in preparation for sleep.

• Chamomile is perhaps one of the most widely known herbs utilized for sleep. Its effectiveness is due to apigenin, a chemical compound that induces sleepiness when it binds to the GABA receptors in the brain. It has a similar action to anti-anxiety medications inducing relaxation and sedation. Concentrated apigenin is also available in supplement form.155

• Lavender has antidepressant, sedative, and calming properties. It reduces stress and anxiety levels, stabilizes mood, and relaxes nerves.156

• Valerian root acts on the neurotransmitter GABA and inhibits its breakdown. This promotes calmness and helps induce sleep quicker, similar to the action of anti-anxiety medication.157

• Passionflower contains nerve-relaxing flavonoids, which help reduce stress and promote sleep.158

• Ashwagandha contains the compounds Triethylene glycol and Withanolides, which improve sleep onset latency (time it takes to fall asleep) and overall quality of sleep, by inducing calmness and reducing stress and anxiety.159

• Holy Basil has adaptogenic effects that promote better sleep by easing anxiety and reducing stress.160

• St. John’s Wort boosts serotonin synthesis, which facilitates the production of melatonin in the body. St John’s Wort also helps the brain use the 161neurotransmitters serotonin, dopamine, GABA, and norepinephrine more effectively. This improves overall wellbeing and happiness and may reduce symptoms of anxiety.162

• Hops flowers contain methylbutenol, a sleep-inducing chemical.163

• Lemon Balm supports the production of the neurotransmitter GABA which helps modulate the body’s response to stress, induces calmness, and reduces symptoms of nervousness and anxiety.164

• California Poppy acts as an analgesic, muscle relaxant, and sedative. It contains protopine and allocryptopine that enhance the response of GABA.165

Amino Acids
Amino acids are an integral component of almost all biological functions. They are organic compounds that aid in the body’s metabolism and are otherwise known as the building blocks of protein. The most common amino acids used to aid sleep are GABA, Glycine, L-Theanine, and Tryptophan.166

• GABA: GABA is both an amino acid and a neurotransmitter. It acts as an inhibitory neurotransmitter for the central nervous system and promotes calmness and reduces anxiety. The effectiveness of supplemental GABA may be due to the presence of GABA receptors in the gastrointestinal system and their connection to the brain through the Vagus Nerve.167 It is theorized that supplemental GABA can affect the body without crossing the BBB through its interactions with this gastrointestinal network of nerves and receptors known as the Enteric Nervous System (ENS).168 Some evidence also suggests that taking GABA with the amino acid L Arginine may facilitate supplemental GABA in crossing the BBB.169

• Tryptophan: Supplementing with L-tryptophan helps improve sleep because it increases melatonin and serotonin, which work in harmony to regulate a person’s sleep-wake cycle.170

• L-Theanine encourages relaxation and supports sleep by increasing levels of GABA, serotonin, and dopamine, which work to regulate mood, emotion, and sleep. L-theanine also reduces the activity of the excitatory neurotransmitter Glutamate.171

• Glycine can help clients to fall asleep more quickly and improves sleep quality by increasing blood flow to the body’s extremities resulting in reduced core body temperature.172 Studies also show that taking glycine before going to bed increases serotonin levels, therefore improving melatonin production and assisting the sleep-wake cycle. Glycine can also speed up the transition to deep slow wave sleep, increase time in REM stage of sleep, and act on the hippocampus reportedly benefiting daytime cognitive function.173

Melatonin

Melatonin has a broad range of physiological effects. It is not FDA approved or regulated and has potential vasoactive, CNS, and reproductive side effects. However, it may be useful in shifting circadian phase and is likely effective with circadian rhythm sleep disorders in the blind, delayed sleep phase syndrome, sleep wake disturbances, sleep disturbances in neuro developmental disabilities, increased REM sleep, and secondary insomnia.174 Short term supplementation can help establish a healthy circadian rhythm, particularly for those who are shift workers or have jet leg.175 Melatonin also preserves the integrity of mitochondria and helps maintain cell function and survival.176 Because if it's positive effect on mitochondrial function, melatonin is being considered as a major potential therapeutic tool for treating neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease.177 In addition to its benefits for sleep, this hormone has strong antioxidant and anti-inflammatory effects.178

Minerals

• Magnesium improves ISI (insomnia severity index) score, which includes sleep efficiency, sleep timing, sleep onset latency, and early morning awakening. Magnesium also benefits insomnia related objective measures such as concentration of serum renin, melatonin, and serum cortisol.179 Magnesium can help clients fall asleep quicker, sleep longer and more deeply by aiding muscle relaxation and nerve function.180 Magnesium helps to activate and maintain levels of GABA, resulting in a calming effect, "turning off" wakefulness and reducing anxiety.181

• Zinc: Sufficient zinc concentration is associated with good sleep quality.182 Supplemental zinc one hour before bed improves quality of sleep and quality of life in long term care facility residents with primary insomnia.183 Zinc doesn't seem to trigger sleep, but adequate levels of zinc in the blood shorten the time it takes to fall asleep (sleep latency), increasing overall amount and quality of sleep.184

Vitamins

Vitamins are not typically used as sleep aids, but it should be noted that Vitamin D, C, B6 and B12 deficiencies have been linked to poor sleep.185 Addressing vitamin deficiencies in your clients would potentially lead to better sleep.

Mind Boost Night, made by Simple Smart Science, is an all-natural night-time formula that helps get the mind and body into a calm relaxed state to aid falling asleep and staying asleep. Two powerful adaptogens, Ashwagandha and Rhodiola Rosea help the body to “adapt” to stress, reducing the effect of mental fatigue, stress, and anxiety.186 187 The herbs lemon balm and chamomile help promote a calm state, rest, and relaxation.188 This formulation naturally stimulates the body's production of GABA to induce calmness and assist with falling asleep.189

Essential Oils

Aromatherapy, or the use of essential oils, is correlated with an increase in free radical scavenging activity and a decrease in cortisol in saliva.190 Essential oils can positively affect cognition and mood in healthy adults. Some essential oils are well known for their benefits on sleep, cognition, and mood.  Aromatherapy involves inhaling or applying essential oil scents or vapor for therapeutic effects. Some commonly used essential oils for sleep are:

• Cedarwood increases total sleep time and reduces early morning awakenings by activating the parasympathetic nervous system.191

• Clary Sage has antidepressant and anti-anxiety effects, helps reduce cortisol levels, and regulates circadian rhythm. Clary sage oil inhalation appears to reduce stress by lowering blood pressure and respiratory rate.192

• Lavender calms the nervous system, primarily due to the chemical compounds linalool and linalyl acetate. Many studies support lavender’s positive effect on sleep.193

• Bergamot lowers blood pressure, improves mood, and has a calming effect which can improve sleep.194

Cannabis

The actions of cannabinoids (chemical compounds found in cannabis/marijuana) are sometimes used to help with sleep. They can be formulated for use via tinctures, oils, edibles, or vapes.

• CBD is not associated with any perceptible psychoactive effects.195 Low doses of CBD tend to provide stimulation, while higher doses deliver sedation by relieving pain and reducing stress and anxiety.196 There are some studies that show that CBD can reduce cortisol levels and interact with receptors that affect the body’s sleep/wake cycle.197 However, more research is necessary.

• THC induces sleep by increasing levels of the inhibitory neurotransmitter adenosine, thus suppressing the brain’s arousal system and promoting sleep.198 THC is believed to disrupt the sleep stages (sleep architecture), increasing slow-wave sleep and reducing REM sleep.199 Chronic THC exposure accelerates the loss of hippocampal neurons and causes neural changes affecting many cognitive processes.***200

***Therefore, THC is not a recommended alternative treatment due to its potential to create long term alterations to brain chemistry and structure.

Hot Bath or Shower

Around bedtime, the average person experiences a 0.5 to 1°F drop in body temperature signaling the pineal gland to produce melatonin. It may seem counterintuitive, but by stimulating the body’s thermoregulatory system with a hot bath or shower, blood circulates away from the core towards the extremities. In this way, a hot shower or bath can assist in the processes of lowering core body temperature, helping you to fall asleep quicker. An hour or so before bedtime will allow enough time for the body to cool before getting into bed.201

Doctor Mark Hyman’s “ultra-bath”: Combine two cups of Epsom salts, One Cup of baking soda, 10 drops of lavender, and water as hot as you can tolerate. Encourage clients to take an ultra-bath 20 minutes before bed every night. Core body temperature will drop when getting out of the bath which will aid in better sleep outcomes.202

Relaxation Techniques

Relaxation techniques can be useful in activating the body’s relaxation response and preparing for sleep.203 These exercises lower heart rate and blood pressure and help to create a feeling of calmness and an increased sense of well-being.204 Many mind-body techniques counteract the stress response (SNS) and enhance the relaxation response (PNS), helping calm the mind and relax the body.205 There are many techniques that can be used to help prepare for sleep that will be covered in detail in upcoming modules.

Consistent good sleep is instrumental in establishing optimal health and cognition.206 Therefore, it is common for clients who present with cognitive decline to have a history of insomnia, medical conditions that impact sleep, and chronic use of sleeping pills.207 Sleep hygiene is always important when coaching clients with sleep disorders. But a thorough history is essential for getting to the root cause of insomnia and providing proper guidance to clients.

10 Pillars of Brain Health:Stress Reduction

Key Topics:

• A Modern World of Stress

• The Biochemistry of Stress

• The Sympathetic and Parasympathetic Nervous Systems

• Your Brain on Stress

• Stress: From a Coaching Perspective

• Stress and Thinking Patterns

• Helping Clients Interpret Stressors

• Mind-Body Techniques

• Tools to Enhance Your Practices

• Meeting Your Clients Where They Are

Terms:

• Psychosocial Stressor

• Physiological Stressor

• Environmental Stressor

• Adrenal Gland

• Adrenal Medulla

• Epinephrine

• Norepinephrine

• Adrenal Cortex

• Glucocorticoids

• HPA Axis

• Sympathetic Nervous System (SNS)

• Three Stages of Cortisol Response

• Parasympathetic Nervous System (PNS)

• Antecedents, Triggers, and Mediators (ATM’s)

• Cognitive Behavioral Therapy (CBT)

• Cognitive Distortions

• “Tend and Befriend” Response

• Social Nervous System

• Binaural Beats

A Modern World of Stress

Stress is a recurring topic in coaching conversations. Some clients may need dietary guidance, some may need motivation to exercise, others may need education on sleep hygiene, but nearly 100% of clients are dealing with some form of chronic stress. Let’s dig deep into the science of stress, the impact it has on the brain, and the coaching toolbox you can employ to help your clients manage their stressors.

From an ancestral perspective, our DNA is programmed to send signals that change our physiology and biochemistry during times of stress to ensure our greatest chance of survival. What is important to remember though is that ancestral stress came in the form of seeking protection from a predatory animal, an invading tribe, or the threat of starvation. Our “fight or flight” response provided an instantaneous biological advantage for our ancestors during a threat, with a quick return to biological homeostasis when the threat was escaped. Fast forward to our modern industrialized lives, and our stress response is unlikely to be triggered by an encounter with a bear in the woods. Rather, we are bombarded with real or imagined physical, emotional, and psychological stressors daily.1

In our modern day lives, stress comes in many forms. Psychosocial stressors include death, divorce, job loss, emotional abuse, workplace tension, displacement, isolation, family interactions, and holding multiple jobs. Physiological stressors include accidents, injury, physical abuse, chronic illness, starvation, sleep deprivation, and homelessness. Environmental stressors include work related chemical exposure, living conditions such as unclean air or water, long term use of medications, exposure to mold, and the Standard American Diet. Although our industrialized lives are vastly different from those of our ancestors, our DNA has not evolved at such a rapid pace, and the response to stress remains unchanged. As a result, our body undergoes the same physiological and biochemical changes when we are late for an important meeting as it would if we were being attacked by a bear.

Let’s explore the biochemistry of stress further to understand why our amazing lifesaving stress response can instead undermine our health in our modern, chronically stressed world.2

The Biochemistry of Stress

The adrenal gland is a triangular shaped, walnut sized gland that sits atop the kidneys and is protected by the rib cage. The interior portion of the adrenal gland is called the adrenal medulla and is where epinephrine and norepinephrine are produced. Epinephrine and norepinephrine are the hormones behind your “fight or flight” response and are released when you experience stress. The remainder of the gland is called the adrenal cortex and is where glucocorticoids, like the stress hormone cortisol, are produced. Glucocorticoids are hormones that control how your cells use sugar and fat, and play a role in decreasing inflammation. Synthetic versions of glucocorticoids are used as medication to fight inflammation.3 The adrenal gland is part of the HPA (hypothalamic-pituitary-adrenal) axis, a group of glands that control the body's reaction to stress, and regulate other bodily processes including digestion, the immune system, mood and emotions, sexuality, and energy storage and usage.4

Stress primarily activates the HPA axis and the sympathetic nervous system (SNS). The stress response is coded into our DNA as a physiological response to danger. This response to danger allows us to:

• Freeze - increased sensory acuity

• Flight - increase blood supply to muscles for escape

• Fight - if there is no way to escape

• Fright - tonic incapacitation

• Faint - sympathetic overload

In fact, all hormones work together and are connected by an intricate web that allows for balance and homeostasis.5 However, when stress is chronic, excess cortisol will lead to an imbalance of other hormones within this connected system, and ultimately to chronic inflammation, hormonal deficiencies, and illness. For example, when cortisol remains elevated, the body may attempt to balance excess cortisol by decreasing the manufacturing and activity of progesterone, estrogen, DHEA, and testosterone, leading to infertility, low libido, and increased risk of hormone driven cancers.6

From an evolutionary standpoint, stress was typically episodic and acute. An example of chronic stress for our ancestors would have been lack of food and the resulting starvation. Historically, when a woman's body had chronically elevated cortisol, as would be the case in starvation, it was a signal that the environment was not safe for reproduction and therefore infertility resulted. In our modern society, infertility is on the rise, with chronic stress being a primary contributor, even though it is unlikely that our current environment is unsafe for reproduction.7 Again, our pre-programmed stress response does not know that difference between the ancestral threat of starvation and a modern stress of the Standard American Diet, even though both may lead to an increased rate of infertility.

There are three stages in the cortisol response8:

• During stage 1 (arousal), both cortisol and DHEA increase with episodic stress, but recovery occurs and returns hormone levels back to baseline. This type of stress is typically asymptomatic and is indicative of the normal “fight or flight” response.

• During stage 2 (adaptation), cortisol remains chronically elevated, but DHEA declines to baseline. Symptoms include feeling stressed, having anxiety attacks, mood swings, or depression. When untreated, this stage can result in long term alterations in glucose tolerance, blood pressure, thyroid hormones, sex hormones, and metabolism.

• During stage 3 (exhaustion), adrenal insufficiency occurs with chronically low cortisol and DHEA levels. Symptoms include depression and chronic fatigue, as well as the promotion and continued advance of degenerative diseases. This stage occurs after long term chronic stress and is often referred to as adrenal fatigue.

The normal role of cortisol encompasses more than just protecting us from stress. In addition to protecting us from stress, the functions of cortisol include9:

• Stimulating the liver to convert amino acids to glucose

• Increasing glycogen in the liver

• Mobilizing fatty acids into blood circulation

• Increasing coagulation

• Suppressing parts of the inflammatory response

• Preventing the loss of sodium in urine

While all of the functions above are normal and frequent processes in the body, as you have learned by now, our modern day lives create more cortisol than is needed for these basic life sustaining functions. As a result, prolonged elevations in cortisol result in a disruption of many biological processes including10:

• Stimulation of fat deposits

• Increased blood pressure

• Increased protein breakdown

• Demineralization of bone

• Suppression of the immune system

• Memory loss

• Depression

• High blood sugar

The Sympathetic and Parasympathetic Nervous Systems

Even in our modern world, where escaping life threatening danger is uncommon, we still elicit the same physiological response as if we were being attacked by a bear. The stress response, however, is not always bad. It helps us respond quickly to threats, it fuels short-term awareness and excitement, it directs and engages our attention to process problems, it improves responsiveness and focuses attention.11 However, when you compare the physiological changes between the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS) you can see how chronic stress can undermine health.

The stress response and the SNS’s role is to provide us with a physiological advantage to save us in the moment of an emergency. As such, our SNS recognizes that survival is significantly more important during an emergency than the day-to-day maintenance of cellular systems. The result is an upregulation of processes our biology associates with survival and a downregulation of processes associated with general maintenance and repair.

When the sympathetic nervous system is engaged, the body's physiological response includes12:

• Interrupted sleep cycles and disruption to the natural circadian rhythm

• A reactive rather than logical response, that is, a subconscious survival reaction takes priority over an analytical and reasoned response

• Enhanced sight and smell to identify predators

• Increased blood clotting in anticipation of potential trauma or bleeding

• Breathing becomes shallow and rapid to deliver oxygen to the body and regulate carbon dioxide levels

• Sweating occurs in order to cool the body

• Heart rate is elevated to better pump blood to muscles and other essential systems needed for escape

• Glucose is released to provide additional energy

• Nonessential processes are suspended including digestion, fertility, bone building, and cellular repair

• Muscles shorten and tense in preparation for movement

• Blood vessels contract and dilate to direct blood to muscles and away from the organs

• Increased desire to urinate or empty bowels occurs to make us lighter so we can run faster

This incredible response is instrumental for survival during an acute stress event. However, our modern lifestyle promotes a state of chronic stress resulting in major challenges to the body's homeostasis and balance.

In comparison, when the parasympathetic nervous system is engaged, the body's physiological response includes13:

• Restful sleep and balanced circadian rhythms

• Logical thought and memory

• Enhanced immune system

• Normal cell regulation and regeneration

• Improved blood circulation

• Slow deep breaths leading to proper balance between oxygen and carbon dioxide

• Decreased heart rate and blood pressure

• Normal energy production and storage leading to lower blood sugar levels, balanced appetite, and less fat storage around the abdomen

• Focus on digestion and absorption of essential nutrients

• Bowels are regulated for efficient disposal of waste

• Fertility is prioritized

• Muscles relax, recover, and regenerate

• Hair, bones, and other body structures are regenerated

Chronic Stress Among the Systems

It is clear to see from the lists above that chronically activating the SNS can lead to physical effects in every system of our body and readily contribute to our modern epidemic of chronic disease. Let’s take a look at the effects of chronic stress system by system.

• Chronic stress affects blood pressure and circulation: resulting in hypertension, increased risk of stroke, damaged blood vessels, reduced kidney function, and heart damage.14

• Chronic stress affects digestion: resulting in disruption of digestive acids, reduced absorption of nutrients, disrupted bowel movements, inflammation of the gastrointestinal system, and muscular spasms.15

• Chronic stress affects the immune system: resulting in increased inflammation, a compromised immune system and greater susceptibility to disease, and increased risk for autoimmune disease.16

• Chronic stress affects cholesterol and triglycerides: resulting in unhealthy cholesterol and triglyceride levels which increase the risk of heart disease.17

• Chronic stress affects sleep: resulting in insomnia which leads to impaired reflexes and thought processes, fatigue, gastrointestinal symptoms, tension headaches, depression, irritability and anxiety.18

• Chronic stress affects bone strength: resulting in weaker bone structure, increased osteoporosis risk, and weaker teeth.19

• Chronic stress affects muscle health and recovery: resulting in weakening and breakdown of muscles, and poor muscle recovery after exercise.20

• Chronic stress affects muscle tension: resulting in tension in shoulders and neck, tension headaches, compromised posture, back pain, tendonitis, and teeth grinding.21

• Chronic stress affects weight gain: resulting in increased storage of fat, secondary increase in appetite, persistent high blood sugar levels and increase risk for type 2 diabetes.22

• Chronic stress affects mood and depression: resulting in decreased transport of serotonin, activation of genes linked to depression, and disruption in biochemical messaging systems.23

• Chronic stress affects brain function: resulting in increased anxiety, memory loss, and decrease in communication circuits in the brain.24

• Chronic stress affects skin health: resulting in increased oil production, aggravation of conditions like psoriasis, rosacea, hives, eczema, and acne, reduced healing properties, and loss of collagen.25

• Chronic stress effects aging: resulting in shortened telomeres that may cause cells to die prematurely, and a decrease in cellular memory and resilience.26

• Chronic stress affects hair: resulting in loss of hair and premature graying.27

• Chronic stress affects heart disease: resulting in damage to blood vessels, enlargement of the heart's left ventricle, heart attacks, and arrythmias.28

• Chronic stress affects oral health: resulting in tooth wear and breakage, dry mouth syndrome, pain and limited movement of the jaw, headaches, earaches, and periodontal disease.29

With nearly every biological system being impacted by chronic stress, we can now understand its causal effect on chronic disease. When our body prioritizes survival, it is meant to temporarily downregulate cellular maintenance. However chronic downregulation allows cells and systems to break down leading to our modern epidemic of chronic disease. Medical conditions shown to be associated with chronic elevations of cortisol include30:

• Cancer

• Heart Disease

• Infertility

• Depression

• Chronic fatigue

• Panic disorders/anxiety

• OCD

• Memory impairment/Cognitive decline

• Malnutrition

• Type 2 diabetes

• Hypothyroidism

• Central obesity

• Osteoporosis

• Immune suppression/Autoimmunity

• GI dysfunction

• Sleep deprivation***

*** Chronic sleep deprivation translates to chronic elevations in cortisol and vice versa, because sleep is the primary biological deposit available for our adrenal bank account. In this way chronic stress and chronic sleep deprivation are intricately linked and equally contribute to chronic disease. As reviewed in our sleep module, chronic sleep deprivation leads to:

• increased evening cortisol levels, and decreased evening melatonin levels

• increased insulin and blood glucose

• decreased parasympathetic tone and increased sympathetic tone

• increased appetite and energy expenditure

• increased levels of proinflammatory cytokines

• increased blood pressure

Your Brain on Stress

For our purposes, we are particularly focused on the effects of stress on the brain and cognition. The adverse effects of stress on the brain include: reduced neurogenesis, increased risk factors for cognitive decline, and a decrease in brain protective mechanisms.31 We’ve talked previously about the brain being like the moon, and cortisol acting as meteors that cause damage to, and deficits in the brain. Your brain is made up of neurons that are susceptible to cell death when in the presence of chronically high cortisol levels. A study done at Rosalind Franklin University of Medicine and Science studied the impact that stress has on neurons and concluded that just 1 stressful event can be responsible for the death of hundreds to thousands of neurons in the hippocampus, which again, is the memory center of the brain.32

Although the hippocampus is extremely sensitive to stress33, it is also malleable and able to regenerate under the right conditions through the process of neurogenesis and neuroplasticity. As you recall, neuroplasticity is the concept that our brains have the ability to rebuild, rewire, and restructure themselves. Chronically stressed clients with symptoms of cognitive decline can increase the number of neurons in the brain through engaging in activities that increase BDNF, or brain derived neurotrophic factor. But ongoing stress management techniques are the foundation for allowing the brain to regenerate. Techniques that are especially beneficial to the brain include meditation, neural agility, and mindfulness. Meditation reduces biomarkers of stress and beneficially changes genetic expression (epigenetics). Neural agility refers to a recorded program that drives brain frequencies, enhances neurogenesis, and is associated with deep relaxation. Mindfulness refers to a practice of simply being in the moment, increasing self-awareness, engaging in contemplative observation, and practicing intuitive eating.34

Stress: From a Coaching Perspective

In a world where stress seems ever present, how can we provide proper coaching support to clients with chronic stress and the resulting downstream physical consequences? In the coaching relationship it is important to listen to the client's entire life story in order to identify the antecedents, triggers, and mediators (ATMs) of chronic illness. Antecedents are factors, genetic or acquired, that predispose an individual to an illness or pattern, for example family history. Triggers are incidents that provoke symptoms such as a divorce, a death, an accident, or a traumatic event in childhood. Mediators are ongoing factors, biochemical or psychological, that perpetuate dysfunctional biological responses such as chronic financial stress, living in an abusive relationship, recurring antibiotic use, or ongoing insulin resistance.35

Establishing a good rapport with your client is important so that they feel comfortable sharing their entire story. When you understand a client's antecedents, triggers, and mediators, you will be better equipped to identify possible root causes of illness as well as any resistance to lifestyle change. When talking to a client, past stressors are just as important as current stressors, as they may have set the stage for illness. For example, childhood trauma is strongly correlated with chronic illness later in life.36 It is not uncommon to encounter clients with physical and emotional illnesses that resulted from a significant history of trauma. Coaches can provide immense support and guidance but be cautious to remain within your scope of practice and refer clients to other professionals when more medical and psychological support is needed.

Stress and Thinking Patterns

It is not uncommon for clients to be impacted by stressful situations like being late for work, giving a presentation, flying during turbulence, etc. But it’s not the situation that is causing the stress response, but the personal response to it.37 That’s why one person can give a presentation without hesitation and another person feels sick to their stomach. They both face the same situation, but their response is different. How we react to stress is a learned and reinforced response strengthened by life experiences. Helping a client separate an event or thought from their emotional response can be instrumental in beginning to retrain their reaction to stress.

Taking this one step further, we now know that merely thinking about a stressful situation can elicit the same physiological response as if it were currently happening.38 How many times do you replay an old argument in your head when it’s long over? How often do you ruminate over past resentments, and how often do you stress about an upcoming situation with “what if” thinking, e.g., what if this or that goes wrong? Most of our stressful thoughts have nothing to do with what is happening at the moment. Instead, we tend to spend an enormous amount of mental energy regretting the past and worrying about the future. Helping clients to recognize that stress is driven by a personal reaction to situations, that internal negative dialogue is enough to create a stress response, and the importance of keeping their thoughts in the present moment, is the first step to processing stress in a healthier way.

One very effective approach to stress management is cognitive-behavioral therapy, which aims to change thought patterns, conscious and unconscious beliefs, attitudes, and, ultimately behavior, in order to help us face difficulties and achieve our goals. Cognitive therapy for stress rests on the premise that it’s not only the events in our lives that cause us stress, but also the way we think about them.39

This is an extensive topic, but let’s take a brief look at cognitive distortions, that is, thoughts that are not quite accurate and tend to reinforce negative thought patterns or emotions. Look for these patterns in your client’s story to determine if they might be contributing to their stress levels:

• Filtering – is ignoring all the positive and good things in life to focus solely on the negative.

• Polarized thinking (black-and-white thinking) – often entails false conclusions that if it’s not good, then its bad.

• Overgeneralization (and/or jumping to conclusions) involves taking a single incident or point in time and using it as the sole piece of evidence for a broader conclusion.

• “Shoulds” – when we let ourselves be overly focused on the rules we set for ourselves and others. This can lead to stress in the form of guilt when we break those rules or being angry/hurt when others do.

If you recognize that your client’s stress is driven significantly by past ruminations, future “what ifs,” or cognitive distortions, introduce techniques to increase positivity.

• Journaling – encourage your client to use their journal to counteract negative thoughts. Sometimes writing down or even verbalizing a positive opposite thought to a negative one can be helpful.

• Successive approximation – this is a fancy term for breaking up large tasks into small steps. It’s a way to reduce overwhelm when your client is faced with a stressful goal or task.

• Visualization – encourage your client to visualize the best parts of their day and practice an attitude of gratitude. The simple act of visualizing and/or writing down these good things can create new associations in the brain that make it easier to see the positive, even when they may be experiencing negative emotions.

• Reframing negative thoughts – this may require significant practice for some clients if they have been creating and listening to their own negative dialogue for years. Help them to practice countering negative thoughts about something with a positive thought.

*** Stress can undeniably be brought on by objective factors like life-changing events, illnesses, and losses so be careful not to diminish the devastating effects that such life-changing events can have on your client by implying it’s their fault because they are a negative thinker.

Helping Clients Interpret Stressors

Thus far we have been talking about our classic view of stress, i.e., that it is a fundamentally toxic state of mind and body. According to Dr Kelly McGonigal we can transform our view of stress to create a healthier response.40 Stress is what arises when something you care about is at stake. Humans can have many different stress responses depending on how they feel, their resources, and their connection to community. It's important for clients to recognize that anxiety is not a sign that they are doomed, but rather a response to something they care about. In this light, stress can be redefined as a positive motivator. For example, top athletes in their field are anxious before a game, but they view anxiety as a source of energy that they can harness rather than a sign that they do not have what it takes to succeed. Instead of interpreting stress as something to avoid, help clients to imagine stress as their body and brain getting them ready to move toward something they care about.

When clients see stress solely as the trigger of poor health and early death, they can become overwhelmed with feelings of hopelessness and feel like they are doomed if they can't control or decrease their life's stressors. Many clients are dealing with significant life stressors that cannot be changed. For example, loss of a loved one, being primary caretake to an elderly parent, sick spouse, ill child, or significant financial concerns. Therefore, it may be more useful as a coach to help them redefine stress, recognize their reaction, and teach methods to minimize the physiological response to stress, rather than promote the notion that the ideal healthy life is stress free. What may be helpful for clients is for you to help them change their view of stress and connect with meaning and community so they can transform the stress experience into something that is not threatening and may even be good for them. Sometimes stressful situations are a catalyst for change that can be positive. For example, fear over a diagnosis of cognitive decline, or other medical condition, could motivate a client to change their diet and other lifestyle factors.

Stress is classically thought of as a “fight or flight” response. However, another type of stress response is the “tend and befriend” response. The “tend and befriend” response is stress that is caused by recognizing someone else's stress or suffering. You can feel deep compassion for them and connected to their distress, however this empathy can drive you to be more courageous and caring, resulting in a meaningful experience. When empathic stress drives you to reach out and help others, it creates an anti-inflammatory state.41 However, some clients’ empathic stress for friends, family members, strangers, the planet etc., can create a significant ongoing stress response. Coaching guidance may be needed to give them permission to be empathetic without allowing it to affect their own health. A “tend and befriend” type of stress is a common personality characteristic of coaches. Creating a healthy balance of compassion and stress management is equally important for coaches, as for clients.

We’ve spent a good chunk of this module explaining what stress is, how it affects different parts of the body, including the brain, and how we can interpret stressors in our own lives. Let’s take some time now to look at ways to not only reduce stress in the moment, but also ways to keep our stress levels consistently lowered. Before we get into the specifics, let’s talk about a theorized third nervous system, and how the balancing of this is done through most of the techniques that we will talk about in just a moment.

In addition to the sympathetic and parasympathetic nervous system, it is theorized that there is a third nervous system called the social nervous system.42 The social nervous system is governed by communication, love, empathy, comfort, teamwork, group action, group psychology, eye contact, voice, sympathy, facial expressions, interpersonal awareness, and neurotransmitters like oxytocin and vasopressin. The benefits of the social nervous system can be utilized and enhanced with mind-body techniques. Mind-body techniques, which are the basis of mind-body medicine, have shown great promise for mobilizing the body's inherent power to reduce the physiological impact of stress and heal itself.43

Mind-Body Techniques

There are hundreds of different kinds of mind-body techniques out there. It is important to encourage clients to try a few different modalities to see which ones resonate with them the most. Some mind body therapies/techniques include:

• Biofeedback: This technique is one of the best ways to see your work in action. Sensors are hooked up to you before and after a modality is used, allowing you to see in real time how your body responds to certain therapies.44

• Breathwork: Intentional deep belly breathing helps us to get out of a state of “fight or flight” and into a state of “rest and digest.” When we breathe deeply enough to expand the diaphragm, it stimulates the vagus nerve, which sends a signal to the brain to relax, and enter a state of rest and digest. It also helps to lower our heart rates and decrease blood pressure.45

• Guided Imagery: Studies show that 30 minutes of guided imagery, which is a visualization technique that focuses on calm, peaceful, and relaxing sounds and places, had similar relaxation benefits to a 15-minute massage.46

• Reiki: A Japanese form of healing that channels energy from practitioner to client by touch and/or hovering of hands to activate the body’s nature healing ability and promote wellbeing.47

• Massage: Done by a licensed practitioner, massage therapists work with manipulating the muscles and soft tissues of the body to not only support physical recovery of the body, but also mental and emotional relief as well.48

• Meditation: Current research supports the idea that meditation can help regrow and restructure the brain.49 Meditation does not mean absence of thought, but rather, ‘the practice of increasing present moment awareness.’ Awareness can be assisted by attention to a mantra, a feeling, a visualization, the breath, the body, a song, a painting, the sky, walking in nature, yoga postures, etc.50 (We will explore meditation in more depth in the next couple of modules)

• Mindfulness: Mindfulness is the practice of disengaging from thoughts of the past and future and coming into the present.51 Breath is commonly used as a focal point or anchor in mindfulness practices. Staying present, especially in stressful situations, can retrain our nervous system to move from stress (sympathetic dominance) to calm (parasympathetic dominance) as its default. Some memory lapses may be the result of doing things mindlessly, that is, not paying attention because our thoughts are in the past or future while our actions are mindlessly in the present. Training the mind to ‘focus’ on the here and now is one practice that our clients can utilize to enhance their memory.52

• Qigong: A meditation and healing practice that uses movements to balance and optimize energy within the body. It encapsulates breath, movement, and visualization for a completely harmonious practice.53

• Tai Chi: Tai Chi is considered “moving meditation” because it brings balance between body and mind. In Chinese, tai chi means “Supreme Ultimate.” The moves in Tai Chi have been found to calm emotions, bring focus and awareness to the mind, straighten posture, improve balance, and enhance the immune system.54

• Yoga: Yoga is a physical practice that encourages the slowing down of thoughts, strengthening of body, and promotion of a steadier mind. Think of yoga as a ‘moving meditation’ - aligning mind, body, and breath. Yoga combines mindfulness with fitness, and practices can range from active to inactive.55

• Tapping: Tapping draws on the ancient Chinese practice of acupuncture, which teaches that the body’s energy travels along specific pathways or meridian lines. By stimulating certain points on these pathways, tapping improves energy flow.

Tools to Enhance Your Practices

While all of the above mind-body techniques are extremely beneficial in their own special ways for brain health, there are ways that we can further support our practices, through tools that enhance our senses. We will talk about 2 specific methods below that can improve your results with mind-body techniques.

Essential Oils

Essential oils are compounds extracted from plants. The oils capture the plant's scent and flavor, or “essence.” Unique aromatic compounds give each essential oil its characteristic essence. Essential oils are obtained through distillation (via steam and/or water) or mechanical methods, such as cold pressing.56

Essential oils can be powerful tools in helping release and heal unresolved emotions.57 The sense of smell is linked directly to the amygdala in the limbic lobe of the brain, which stores and releases emotional trauma. With the limbic system physically located near the olfactory bulb, smell can be used to mobilize long forgotten memories and emotions.58

The limbic system includes your amygdala (associated with emotions), hypothalamus (regulates autonomic nervous system and hormones), and cingulate gyrus (regulates blood pressure, heart rate, and attention).59 It also impacts long-term memory through the hippocampus which stores our memories. When smell triggers emotions or memories, it is the hippocampus that is at play.60

Essential oils can stimulate or sedate the brain to promote or inhibit the production and release of various neurotransmitters, which then impact the nervous system. This makes essential oils powerful tools for dealing with emotional challenges like anxiety, depression, fear, worry, grief, trauma, anger, and self-abuse.61

As you know, emotions and thought patterns can trigger a stress response in the body equivalent to that of a physical stressor, since our stress response cannot differentiate between physical or thought driven stress. Essential oils can be a powerful tool for moving through and releasing these thought patterns.

Top 9 Essential Oils for Brain Health:62

1. Rosemary

2. Peppermint

3. Lavender

4. Frankincense

5. Lemon

6. Vetiver

7. Mandarin

8. Sage

9. Sweet Basil

Sound Therapy

Therapeutic sound, or sound therapy, can be done in many different forms, and is often used to help balance the mental and emotional mind, as well as the physical body.63 In fact, a study showed music was more effective than medication in calming their nerves when prepping for surgery.64

While there are many forms of sound and music that can alter our mood, performance, and overall state of wellness, there is one form in particular that we are interested in as far as brain health goes.

Binaural Beats65 are best delivered with the use of headphones. Essentially, specifically curated songs send different frequencies of sound (or hertz) to each ear. Let’s say for example, one ear receives 210 hertz (hz), and the other ear receives 205 hz. The “net” hertz here would be 5 hz, bringing the brain waves into a Theta state – which promotes rest, relaxation, creativity, and meditation.

There are many different forms of binaural beats out there, all with goals of getting you into different brain wave states. The brain wave states, what frequencies they are entered at, and the effects that each stage promotes are as follows:

Gamma: 30+ hz: Memory recall, peak awareness, high-level cognition.

Beta: 13-30 hz: Focused attention, cognitive thinking, problem solving.

Alpha: 8-13 hz: Relaxed focus, stress reduction, positive thinking, fast learning.

Theta: 4-8 hz: REM sleep, deep relaxation, meditation, creativity.

Delta: 0.1-4 hz: Deep sleep, pain relief, anti-aging, healing.

Meeting Your Clients Where They Are

Mind-body techniques are extremely versatile, and generally well received. They can help us rewire for stronger relationships: trustworthy versus unstable, empathy versus indifference, belonging versus isolation, and enjoyment versus addiction. However, not every client is open to or aware of these intricate modalities. Because of this, when introducing mind-body techniques in coaching be sure to:

1. Ask permission – not every client is going to be open to mind-body techniques. It is important to educate first so they can better understand the science behind each modality.

2. Maintain client autonomy – regardless of your experience with certain modalities, be sure to honor and respect your client's decision, and remain unbiased in their choices. Remember you are there to guide and support, not to decide.

3. Emphasize that they are in control – especially for clients with a background in trauma, it is important to gently remind them that they are able to discontinue any of these modalities at any given time – with or without explanation.

4. Provide time for support, practice, and discussion – mind-body techniques can be highly effective in uncovering past traumas and tendencies. While this is an extremely important part of the healing process, it can be overwhelming. Make sure to provide encouragement and acknowledgement for the hard work they are putting in. Help clients discover their thoughts, beliefs, perceptions, emotions, and moods that strengthen their ability to take action and achieve what is important to them.

If mind-body techniques are not the most appropriate place for you to start on your coaching journey together, there are many other ways to promote stress reduction in the body. Work with your client to find their specific needs and help them to fine tune a stress reduction protocol that works best for them.

10 Pillars of Brain Health:Meditation

Key Topics:

• Brain Wave States

• What is Mindfulness?

• Mindfulness and The Brain

• What is Meditation?

• Meditation and The Brain

• Meditation Practices

• Client Resources

Terms:

• Beta Brain Waves

• Alpha Brain Waves

• Theta Brain Waves

• Delta Brain Waves

• Gamma Brain Waves

• Mindfulness

• White Matter

• Grey Matter

• Meditation

• Left Hemisphere

• Right Hemisphere

• Corpus Callosum

Mindfulness and meditation are centered around being present in the moment. The main difference between the two is that mindfulness can be practiced while engaging with your environment, whereas meditation practices are intended for a more internal focus, are more formal, and are usually practiced in a stationary position where you will not be disturbed. Even though they are different, mindfulness practices can help develop a mediation practice, and a meditation practice can help to become more mindful.

Brain Wave States

Before diving deeper into the definitions and practices of mindfulness and meditation, let’s briefly cover the different brain waves states – that is: Beta, Alpha, Theta, Delta, and Gamma.

Beta: Alert, externally focused. Associated with analytical problem solving, judgement, decision making, and processing the world around us. Our modern, active society has most of us living primarily in a beta or high beta state due to increased stress and anxiety.

Alpha: More internally focused, creative, relaxed, calm, present. A bridge between the conscious and subconscious. Alpha is typically associated with good moods and a sense of calmness.

Theta: In between sleep and awake state, creative, intuition, daydreaming, and is a repository for memories, emotions, and sensations. Theta waves are strong during internal focus, meditation, prayer, and spiritual awareness.

Delta: Restorative sleep state. As science and research supports, being in the delta state is extremely beneficial to brain health.

Gamma: The only frequency group found in every part of the brain. Gamma consolidates and simultaneously processes information from different parts of the brain.

It is important to note that all states can be beneficial to our overall brain health. In the same breath, it is about balance. If spending too much time in the beta state, for example, the body and brain will experience chronic elevated levels of stress and associated inflammation. Both mindfulness and meditation are instrumental in moving from a beta state into calmer brain states.1

What is Mindfulness?

Mindfulness is the act of maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment. Mindfulness also embraces acceptance of our thoughts and feelings without judging them – that is, with a belief and understanding that there’s no “right” or “wrong” way to think or feel. When we practice mindfulness, our thoughts tune into what we’re sensing in the present moment rather than ruminating over the past or worrying about the future.2

Mindfulness originated from ancient eastern and Buddhist philosophy and dates back approximately 2500 years. The concept of mindfulness was introduced to the western world by Jon Kabat-Zinn – a world-renowned author, educator, and leader in the world of mindfulness.3

Jon Kabat-Zinn emphasizes that although mindfulness can be cultivated through formal meditation, “It’s not really about sitting in the full lotus, like pretending you’re a statue in a British museum … It’s about living your life as if it really mattered, moment by moment by moment by moment.”4

Here are a few key components of mindfulness that you can practice with clients.

• Pay close attention to your breathing, especially when you’re feeling emotional or stressed.

• Really notice the sights, sounds, and smells happening in the moment, that ordinarily slip by without reaching your conscious awareness.

• Recognize that thoughts and emotions are temporary and do not define you. Use this insight to free yourself from negative thought patterns.

• Tune into your body’s physical sensations, from the water hitting your skin in the shower, the pressure points while sitting, any pain or discomfort, temperature, etc.

• Find small moments of mindfulness throughout the day to reset your focus and sense of purpose.5

Studies have shown that practicing mindfulness, even for just a few weeks, can bring a variety of physical, psychological, and social benefits. Let’s take a brief look at the vast benefits of practicing mindfulness.

• Mindfulness is good for our physical health: As little as eight weeks of practicing mindfulness boosts the immune system’s ability to fight off illness, as measured by increased antibody Titres.6 Practicing mindfulness has also been shown to improve sleep quality and duration.7

• Mindfulness is good for our psychological health: Several studies have found that mindfulness contributes to emotional well-being by increasing positive emotions while reducing negative emotions and stress.8 One study suggests mindfulness may be as good as antidepressants in fighting depression and preventing relapse.9

• Mindfulness helps with focus: Studies conclude that mindfulness helps us tune out distractions, improve attention, and support better decision-making processes.10 11

• Mindfulness fosters compassion and altruism: Research suggests mindfulness training makes us more likely to lend a helping hand, be compassionate, and regulate emotions.12 Evidence suggests it might boost self-compassion as well.13

• Mindfulness enhances relationships: Research suggests mindfulness training makes couples more satisfied with their relationship, makes each partner feel more optimistic and relaxed, and makes them feel more accepting of and closer to one another.14

• Mindfulness affects the way we see ourselves: Mindful people have a stronger sense of self and seem to act more in line with their values. They may also have a healthier body image, more secure self-esteem, and more resilience to negative feedback.15

• Mindfulness makes us more resilient: Some evidence suggests that mindfulness training could help veterans facing post-traumatic stress disorder, police officers, women who suffered child abuse, and caregivers.16

• Mindfulness is good for business: Mindfulness training could help make leaders more confident, improve creativity, reduce multitasking, and improve client satisfaction.17

• Mindfulness is good for parents and parents-to-be: Studies suggest it may reduce pregnancy-related anxiety, stress, and depression in expectant parents, and may even reduce the risk of premature births and developmental issues. Parents who practice mindful parenting report less stress, more positive parenting practices, and better relationships with their kids. Their kids, in turn, are less susceptible to depression and anxiety, and have better social skills.18

• Mindfulness may be beneficial to teens: Practicing mindfulness can help teens reduce stress and depression and increase their self-compassion and happiness. Once teens arrive at college, it could also reduce their binge drinking.19 20

• Mindfulness helps schools: Scientific evidence supports that teaching mindfulness in the classroom reduces behavior problems, aggression, and depression among students, and improves their happiness levels, self-regulation, and ability to pay attention. Teachers trained in mindfulness also show lower blood pressure, less negative emotion and symptoms of depression, less distress and urgency, greater compassion and empathy, and more effective teaching.21

• Mindfulness helps health care professionals cope with stress, connect with their patients, and improve their general quality of life. It also helps mental health professionals by reducing negative emotions and anxiety, and increasing their positive emotions and feelings of self-compassion.22

• Mindfulness fights obesity: Practicing “mindful eating” encourages healthier eating habits, helps people lose weight, and helps them savor the food they do eat.23

Mindfulness and The Brain

Let’s now take a deeper dive into how mindfulness specifically affects the brain. Studies have documented that daily mindfulness can increase the density of the brain’s grey matter over time.24 Our nervous system is comprised of the central nervous system, including the brain and spinal cord, and the peripheral nervous system, including the nerves outside of the brain that control various activities of the body. The brain’s white matter controls unconscious systems such as body temperature, blood pressure, and heart rate. The brain’s grey matter is involved in processes like emotions, memory, speech, and muscle control. 40% of the brain is made up of grey matter which can be found in the prefrontal lobe, the hippocampus, and the amygdala.25

The prefrontal lobe is primarily responsible for executive functioning such as planning, problem solving, and regulating emotions.26 In just 8 weeks of mindfulness practice, the prefrontal cortex becomes thicker resulting in an enhanced ability to control emotions, an increased tolerance for pain, an increase in compassion for ourselves and others, and increased performance on all executive functioning tasks.

The hippocampus plays an important role in learning, memory, self-awareness, compassion, and introspection. The hippocampus is one of the first regions of the brain affected by Alzheimer’s Disease. By increasing grey matter in the hippocampus, mindfulness is a great preventive tool against memory loss and dementia.

The amygdala is the core of the central nervous system responsible for processing fearful and threatening stimuli. In other words, it is the home of the “fight or flight” response and gives rise to fearful or anxious emotions. When grey matter increases in the brain as a result of mindfulness, the amygdala shrinks and the connection between the amygdala and the pre-frontal cortex is weakened. This translates to less reactivity, lower anxiety, and an increase in attention and concentration.27

Living in a high-tech information age makes it increasingly harder to be present and at peace at any given moment. Modern life has created a culture of multi-tasking, constant distraction, and divided attention. As a society, we have become very attached to external devices such as cell phones and the internet for connection to other people and the world around us. These devices ensure we are constantly bombarded with messages, notifications, and news feeds, making us less present to the present moment, and who or what is right in front of us. Pay attention to your client’s dialogue and try and notice their level of disconnect with the present moment. This can be evident if they are constantly ruminating over the past, worrying about the future, or checking other devices during your coaching sessions.

What is Meditation?

Unlike mindfulness which is an act of paying attention throughout everyday activities, meditation is typically a more intentional seated practice where a specific amount of time is spent bringing awareness to the breath and then bringing the mind to a single point of focus. Meditation is intended to increase calmness, concentration, awareness, and emotional balance.28

Since mindfulness is the foundation of meditation, meditation also leads to increases in grey matter in the brain and all the associated benefits listed above under mindfulness. Meditation enhances connectivity between brain regions, relieves anxiety and depression, improves attention and concentration, and enhances overall psychological well-being. The practice of meditation appears to have an amazing variety of neurological benefits including:

• Meditation Helps Preserve the Aging Brain

A study done by UCLA showed that long-term meditators had better preserved brains and more grey matter volume throughout the brain than non-meditators as they aged. These effects were widespread and encompassed regions throughout the brain, rather than local regions.29

• Meditation Reduces Uncontrolled Mind Wandering

One study carried out at Yale University, found that mindfulness meditation decreases activity in the default mode network (DMN), the brain network responsible for mind-wandering – a.k.a., “monkey mind.” The DMN is “on” or active when we’re not thinking about anything in particular, but our minds are just wandering from thought to thought. Mind-wandering is typically associated with being less happy, ruminating, and worrying about the past and future. Meditation results in a quieting effect on the DMN.30

• The Effects of Meditation Rival Antidepressants

A comprehensive review study at Johns Hopkins looked at the relationship between mindfulness meditation and its ability to reduce symptoms of depression, anxiety, and pain. Researcher Madhav Goyal and his team found that the effect increase of meditation measured 0.3. If this sounds low, keep in mind that the effect increase for antidepressants is also 0.3, which makes the effect of meditation equivalent to antidepressant medication. Meditation isn’t a magic bullet for depression, as no treatment is, but it’s one of the tools that may help manage symptoms.31

• Meditation May Lead to Volume Changes in Key Areas of the Brain

Sara Lazar and her team at Harvard found that mindfulness meditation can change the structure of the brain: Eight weeks of Mindfulness-Based Stress Reduction (MBSR) specifically, was found to increase cortical thickness in the hippocampus, which governs learning and memory, and in certain areas of the brain governing emotion regulation and self-referential processing. There were also decreases in brain cell volume in the amygdala, which is responsible for fear, anxiety, and stress. These changes matched the participants’ self-reports of their stress levels, indicating that meditation not only changed the brain, but it also changed the degree of perceived stress in the study participants. A follow-up study by Lazar’s team found that after meditation training, changes in brain areas linked to mood and arousal were also linked to improvements in participants psychological well-being. These findings support those showing increased grey matter with mindfulness alone.32

• Just a Few Days of Training Improves Concentration and Attention

Not surprisingly, one of the central benefits of meditation is that it improves attention and concentration: One recent study found that just a couple of weeks of meditation training helped people’s focus and memory during the verbal reasoning section of the GRE. The increase in score was equivalent to 16 percentile points. Since the strong focus of attention (on an object, idea, or activity) is a central theme of meditation, it’s not surprising that meditation helps people’s cognitive skills at the workplace too.33

• Meditation Reduces Anxiety — and Social Anxiety

Mindfulness-Based Stress Reduction (MBSR), developed by Jon Kabat-Zinn at the University of Massachusetts’ Center for Mindfulness aims to reduce a person’s stress level, physically and mentally. Studies have shown its benefits in reducing anxiety, even years after the initial 8-week course.34 Research has also shown that mindfulness meditation, in contrast to attending to the breath alone, can reduce anxiety – and that these changes seem to be mediated through the brain regions associated with self-referential (“me-centered”) thoughts.35 Mindfulness meditation has also been shown to help people with social anxiety disorders.36

• Meditation Can Help with Addiction

A growing number of studies have shown that, given its effects on the self-control regions of the brain, meditation can be very effective in helping people recover from various types of addiction. One study, for example, pitted meditation training against the American Lung Association's freedom from smoking (FFS) program and found that people who learned mindfulness meditation were several times more likely to quit smoking by the end of the training than those in the conventional treatment. Meditation seems to help people “decouple” the state of craving from the act of smoking. Other research has found that mindfulness training, mindfulness-based cognitive therapy (MBCT), and mindfulness-based relapse prevention (MBRP) can be helpful in treating other forms of addiction.37 38

• Short Meditation Breaks Can Help Kids in School

For developing brains, meditation has as much as, or perhaps even more promise than it has for adults. There’s been increasing interest from educators and researchers in bringing meditation and yoga to school kids, who are dealing with the usual stressors inside school, and oftentimes additional stress and trauma outside school. Some schools have started implementing meditation into their daily schedules, and with good effect: One district in San Francisco started a twice daily meditation program in some of its high-risk schools – and saw suspensions decrease, and GPAs and attendance increase. Studies have confirmed the cognitive and emotional benefits of meditation for schoolchildren.39 40 41

Meditation and The Brain

More specifically, meditation has been shown to increase BDNF, the protein that promotes growth, maturation, and maintenance of brain cells.42 In 2017, a study done at University of Southern California (USC) tested 38 people before and after a three-month meditation retreat. After three months of consistent practice, the mindful meditators had increased their BDNF levels by 280% (from 2513 to 7039 pg/ml)!43

Meditation also benefits the brain by balancing activity between its two hemispheres. The left hemisphere is best characterized as logical, practical, and mathematical, while the right hemisphere is associated with non-linear, intuitive, abstract, creative, and big-picture thinking. Most of us have a dominant hemisphere, but some of the greatest thinkers, inventors, artists, and scientists utilize both hemispheres in a more balanced way.

UCLA School of Medicine researchers found that during meditation the corpus callosum, a large nerve fiber bundle connecting the left and right hemispheres, becomes very active, stimulating it to strengthen and grow. This results in increased focus and concentration, clearer thinking, and sharper long and short-term memory.44

Meditation also benefits the brain and overall health by reducing systemic inflammation, decreasing cortisol levels, and promoting longevity. Longevity is proportionately linked to the size of our telomeres, protective caps on the ends of our chromosomes. As we age, telomeres begin to shorten, eventually leading to cell death. Essentially, the shorter the telomeres, the shorter our life expectancy. Studies comparing the telomeres of meditators versus non meditators found that those who meditated had longer telomeres than those who did not, while correcting for other lifestyle factors. Meditating, therefore, slowed down the aging process.45

Meditation Practices

Meditation does not mean absence of thought – it means the practice of increasing present moment awareness of a chosen thing. That could be a mantra, a feeling, a visualization, the breath, the body, a song, a painting, the sky, walking in nature, yoga postures, literally anything you bring consistent focus to. Have clients start with something that is easy for them to focus on, that is beneficial for their body and mind, and encourage them to commit to trying it regularly. Some simple places to start include movement meditations, chanting, drumming, silent meditation, or guided meditation.

There are several types of meditation, but here is a small list of the most common:

• Mindfulness meditation

• Spiritual meditation

• Focused meditation

• Movement meditation

• Mantra meditation

• Transcendental meditation

• Progressive relaxation

• Loving-kindness meditation

Encourage your clients to experiment with many different types of mindfulness and meditative practices. Below are some specific mindfulness meditations that you can teach your clients. Use your rapport with your client to discern what type of meditation might benefit them most.

• Mindfulness Based Stress Reduction

Mindfulness Based Stress Reduction (MBSR), developed by Dr. Jon Kabat-Zinn, was initially developed for stress reduction. It has since been found to be instrumental in the treatment of a variety of health conditions, including anxiety, depression, skin diseases, pain, immune disorders, hypertension and diabetes. MBSR promotes mindfulness as an awareness that arises from paying attention on purpose, in the present moment, and nonjudgmentally.46 47

To develop these skills in everyday life, you can have your clients try these exercises used in Kabat-Zinn’s Mindfulness Based Stress Reduction program:

• Mindful breathing is a common component of many forms of meditation that involves bringing attention to the physical sensations of the breath as it flows in and out.48

• A “Body Scan” is a meditative practice where you bring attention to different parts of your body, moving from head to toe.49

• The “Raisin Exercise” involves slowly using all your senses to observe a raisin in great detail, from the way it feels in your hand, to its smell, to the way it tastes on your tongue.50

• A “Walking Meditation” is where you focus on the movement of your body as you take step after step, your feet touching and leaving the ground—an everyday activity we usually take for granted.51

• “Loving Kindness Meditation” involves extending feelings of compassion toward people, starting with yourself then branching out to someone close to you, then to an acquaintance, then to someone giving you a hard time, then finally to all beings everywhere.52

• Lovingkindness Meditation by Jon Kabat Zinn.

This type of meditation is almost prayer like, guiding yourself through a mantra of wishes for yourself, someone you love, someone you feel neutral towards, someone you are in a difficult relationship with, and the greater community or world.

May I be safe and protected, and free from inner and outer harm.

May I be happy and contented.

May I be healthy and whole to whatever degree possible.

May I experience ease of well-being.

May he/she/they be safe and protected, and free from inner and outer harm.

May he/she/they be happy and contented.

May he/she/they be healthy and whole to whatever degree possible.

May he/she/they experience ease of well-being.

May all beings, near and far, be safe and protected, and free from inner and outer harm...

This type of meditation has been shown to increase happiness as it transitions from thoughts of self, then to others, and then to the greater world.

• Meditation for Connection to Self

With your eyes closed, place your hands over your heart.

Take a few deep breaths and relax any tension you are holding in your body.

As you exhale, feel that stress dispersing and leaving your body.

Feel the gentle touch and warmth of your hands resting on your chest.

Feel a warm, comforting, kind light building in your hands and spreading to your heart.

Give this healing to yourself.

Allow this gentle, healing energy to flow from you and to you, spreading to your whole body and bringing calm and healing where it is needed.

• Stature Meditation:

This type of meditation can help clients use positioning and discomfort to identify which of their strengths they draw on to overcome obstacles.

Relax and loosen up. Shake out your arms.

Breathe deeply.

Raise your arms slowly and position them in front of your chest like you’re hugging a large beach ball.

Pay attention to your breathing, your arms, your torso, your hips.

Hold the position (strive for 5 minutes).

(As the position gets difficult, help your client to identify and draw on one of their strengths to help them deal with the discomfort).

Slowly bring your arms down.

Ask your client: what obstacles are you facing and how can you use your strengths to handle them?

• Best Possible Self Meditation:

Write about your best possible self for 10 minutes.

Imagine a time when you were really happy.

Where were you? What were you doing? Who were you with?

Imagine this time as a movie and spend time watching this movie in your mind.

Pay attention to the details.

Help your client to identify what was so good about this memory. What were their strengths at that time? Help them to live in that moment and feel happy and loved. Can they use those strengths to create a new memory at this moment?

• Fists of Anger Meditation:

This meditation has been shown to be useful in managing irritability, agitation, and rage.

Sit cross legged with eyes closed.

Touch each thumb to the base of the pinky finger. Close the rest of the fingers over the thumbs to create a fist. Alternate raising each arm in a backstroke position like you are swimming.

Through an 0-shaped mouth, begin strong, rhythmic inhale/exhale in sync with arm movements.

Intentionally think about anything or anyone that makes you angry or negative.

Continue for 3 minutes.

• Meditation for Cognitive Function:

This meditation has been shown to be useful in managing brain fog and fatigue.

Sit cross legged with eyes gazing forward.

Bend the elbows and place hands at shoulder height with palms facing away from the body (like you are saying STOP).

Begin moving your forearms in quick, outward circles, allowing thumbs to touch lightly when they meet at the center of the chest.

Complete one breath per cycle.

Continue for 3 minutes.

• Five Senses Presence + Grounding Meditation

Relax, get present, find your breath, and go through the following steps to help ground yourself in this present moment:

5: Acknowledge FIVE things you see around you. ...

4: Acknowledge FOUR things you can touch around you. ...

3: Acknowledge THREE things you hear. ...

2: Acknowledge TWO things you can smell. ...

1: Acknowledge ONE thing you can taste.

• Tapping:

Tapping draws on the ancient Chinese practice of acupuncture, which teaches that the body’s energy travels along specific pathways or meridian lines. By stimulating certain points on these pathways, tapping improves energy flow. Tapping is also called EFT (emotional freedom technique). Each session follows a set sequence:

• Begin by rating your stress/pain/feeling on a scale of 0 to 10

• Express a statement that identifies the main issue plus a statement of self–acceptance

• Use your fingers to begin the tapping sequence

• As you tap, use a reminder phrase to maintain focus on the issue at hand

• At the end of the tapping sequence, rate your stress/pain/feelings again on a scale of 0 to 10

• Continue the tapping sequence until your distress rating is very low

Tapping has been shown to improve psychological disorders such as anxiety and depression, decrease heart rate and blood pressure, lower levels of the stress hormone cortisol, improve PTSD symptoms, and decrease pain.53 54

Client Resources

Here are some additional resources to share with clients.

• Eckart Tolle – https://eckharttolle.com/ - Book: The Power of Now

• Deepak Chopra - https://www.deepakchopra.com/

• Dr. Andrew Weil - https://www.drweil.com/ - Breathing Techniques

• Dr. Joe Dispenza – https://drjoedispenza.com/ - Book: Breaking the Habit of Being Yourself

• Dave Asprey - https://daveasprey.com/benefits-of-meditation-how-to-meditate/

• Apps: There are many apps available that can guide a client through 5–30-minute meditations (Headspace, Insight Timer, iRest, Calm). Courses are also available, as well as many types of meditation retreats for more interested clients. A meditation practice of 20 minutes a day appears to be the magic number studies show that neurological pathways begin to change.55 The best time for a client to meditate is any time they are most likely to do it consistently!

10 Pillars of Brain Health:Breathwork

Key Topics:

• The Power of Breathwork

• How Breath Impacts the Boday and Brain

• Coaches Guide to Different Breathing Techniques

• Breathwork FAQ’s

• Final Thoughts

The Power of Breathwork

Breathwork is a powerful tool that can be used to improve mood and decrease stress levels. Proper oxygenation to the brain sends a signal to the body that we are safe – we are not under attack, and we can relax. Breath is literally our connection to life and living. We can live three weeks without food, three days without water, and only three minutes without oxygen.1 While we don’t need to think about breathing, to do so in intentional ways can result in positive and powerful impacts on our health and wellness.

Breathing is inherently grounded in human physiology and neurochemistry. In addition, it is the foundation of relaxation. If we draw from ancient wisdom, Chinese medicine refers to Chi or Qi as the essential energy or vital life force. Inhalation draws in Chi in addition to fresh oxygen. During exhalation, toxins and waste products are expelled. Yoga masters refer to Prana, which in Sanskrit means living or ultimate energy. We breathe to maintain this powerful force that unites body and mind.2

How Breath Impacts the Body and Brain

Controlling the breath is a prerequisite for controlling the mind. The resting state is achieved when we have activated our parasympathetic nervous system. When you inhale deeply and expand your abdomen, the diaphragm drops down and triggers an activation of the Vagus nerve. This vagal response acts as a break on the stress response by buffering the fight or flight response and balancing cortisol.3 Breathing is controlled by both the autonomic and voluntary nervous system and is both conscious and unconscious. For example, breathing happens automatically when we sleep, but can be consciously controlled when we are awake. How we breathe is both a response to our emotional state: rapid, shallow breathing is a response to stress (SNS), and a determinant of our emotional state: slow, deep breaths can induce relaxation (PNS).

Sympathetic nervous system activation induces rapid shallow breathing in order to increase oxygen supply to the heart, brain, and muscles. However, this can cause a decrease in CO2 and induce anxiety and panic.4 The parasympathetic state is associated with deep belly diaphragmatic breathing. Deep breathing has a slow, calming effect through stimulation of the vagus nerve that runs through the diaphragm. Because blood flow is greatest at the base of the lungs, deep breathing increases oxygenation without decreasing CO2, and therefore does not promote panic.5 Diaphragmatic breathing lowers blood pressure, improves oxygenation in patients with chronic heart failure, improves asthmatic symptoms, improves blood sugar levels in patients with diabetes, and has an epigenetic effect on gene expression.6

Proper breathing is essential for moving from sympathetic dominance (fight or flight) to parasympathetic dominance (rest and repair). Four dysfunctional breathing patterns include:7

1. Chest breathing.

You can identify a chest breather when you see their shoulders and upper chest rising with each breath. Chest breathing is closely associated with the stress response and is common in individuals with poor posture. The physiological consequences of chest breathing range from upper body tension, to feeling breathless, and having a faster heart rate.

2. Inhaling more than exhaling.

Inhaling more than exhaling can lead to hyperventilation and is associated with panic attacks.

3. Breathing too rapidly.

Breathing too rapidly activates the stress response and is associated with anxiety.

4. Holding your breath or a shallow breathing.

Holding your breath or shallow breathing is associated with fear or as a response to pain.

How many breaths an individual takes per minute can be indicative of parasympathetic or sympathetic state.

• 4 breaths per minute = a meditative state or prayer.8

• 5 to 8 breaths per minute = relaxed and quiet.9

• 9 to 14 breaths per minute = routine tasks or conversation.10

• Greater than 15 breaths per minute = running or panicking.11

Breathing through the nose vs. the mouth is beneficial for several reasons:12

• Filters out foreign particles. Nasal hair filters out dust, allergens, and pollen, which helps prevent them from entering your lungs.

• Humidifies inhaled air. Your nose warms and moisturizes the air you breathe in. This brings the air you inhale to body temperature, making it easier for your lungs to use.

• Produces nitric oxide. During nasal breathing, your nose releases nitric oxide (NO). NO is a vasodilator, which means it helps to widen blood vessels. This can help improve oxygen circulation in your body.

When practiced consistently, breathwork can change neural patterns, lower stress, increase energy, and improve overall functioning of the body.13

Coaches Guide to Different Breathing Techniques

Here are some basics for instructing clients in better breathing techniques:

• The easiest place to begin is in a lying down position, or in a comfortable upright sitting position.

• Place one hand on your belly, and one on your chest.

• If possible, watch your breathing in a mirror.

• Only practice for a few minutes at a time, when beginning, and never to the point of discomfort or pain.

• Practice counting breaths: begin by inhaling to the count of 5 and exhaling to the count of 5. Try inhaling to the count of 4 and exhaling to the count of 6. Try inhaling to the count of 4 and exhaling to the count of 7 or 8. There is no correct number or pattern. However, 6 breaths per minute results in optimal heart rate variability, i.e., the beat-to-beat changes in the heart's rhythm. Help your clients discern what feels most comfortable for them.