The Brain is What You Feed It: Effects of Nutrition on the Brain

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The Brain is What You Feed It Effects of
Nutrition on the Brain

• Anne-Marie Kaulfers, MD
• Pediatric Endocrinology
• University of South Alabama

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Disclosures

• www.INRseminars.com
• Institute for Natural Resources
• Food, Mood, and Cognition seminar is where most
  of the references came from, seminar given by
  Gina M. Willett, PhD, RD
• This talk and the topics presented are my own and
  not endorsed or supported by that organization

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Objectives

• Understand how what we eat influences how we
  think and learn, and how it affects our memory
• Examine the relationship of Alzheimers disease
  to diabetes
• Explore how the hormones in our body actually
  promote weight gain and food addiction
• Learn about which foods are good for our brain

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How different breakfast foods affect kids
behavior (2007)

• 5-7 year olds who ate breakfast at school
• Group 1 cornflakes, milk, 2 spoonfuls of sugar,
  waffle, and maple syrup
• Group 2 egg, bread, jam, butter, yogurt
• Group 3 ham, cheese, bread, and butter

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How different breakfast foods affect kids
behavior (2007)

• Then they watched with a video camera to assess
  ability to focus, and behavior
• And also did memory tests 2-3 hours after
  breakfast
• When students ate breakfast 3 they had better
  scores on memory and ability to sustain attention

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Other studies that show relationship of food to
brain function

• 70-90 yr olds
• highest carbs 2 x risk of mild cognitive
  impairment
• Rats fed excessive fructose for 6 weeks
• moved slower and forgot how to get out of a maze
• 2003 815 elderly patients with no dementia
• High fat intake higher chance of Alzheimers
• High omega 3 fatty acid intake less chance
• 2008 1,049 people in CA
• Biggest waist 3 x increased risk of dementia

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Relationship of food and brain

• People at age 60
• Overwt in young age poorer memory at age 60
• Followed 30-60 yr olds for 5 years.
• High BMI lower test scores of mental status
• MRI on 94 elderly adults
• High BMI atrophy of parts of brain, smaller
  brain volume
• CA Dept of Ed 885,000 middle school kids.
• Better fitness level better academic test
  scores
• Adults with Type 2 diabetes.
• High sugar meal poorer memory 2 hours later

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Relationship of Food and Brain

• Summary Overconsumption of energy and high BMI
  suggest poorer academic performance when you are
  a child and more decay of the brain structure as
  an adult. Increased physical activity improves
  brain health and function.
• Conclusion Poor diets can lead to brain
  dysfunction.
• Why?
• Its all insulins fault!

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Insulin and its action on the brain

• In 2005, researchers looked at the brains of
  people with Alzheimers disease.
• They found that their brains had very low levels
  of insulin and insulin receptors, and that all
  the signal pathways that control energy
  metabolism, memory, cognition were all
  functioning poorly.

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Carbohydrates
Blood Sugar
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Carbs
Blood Sugar
Insulin the key that unlocks the door, lets
sugar into the cell
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Cells of the Body
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Type 1 Diabetes

• Autoimmune destruction of the insulin-making
  cells
• Usually starts in childhood
• Completely dependent on insulin injections

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Pancreas
Beta cell
Blood Sugar
Insulin
Body
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Pancreas
Blood Sugar
I
Body
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Pancreas
I
I
I
I
I
Blood Sugar
Blood Sugar
Blood Sugar
Blood Sugar
Blood Sugar
Body
Body
Body
Body
Body
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Pre-Diabetes/Insulin Resistance
Pancreas
ii
ii
ii
ii
ii
Blood Sugar
Blood Sugar
Blood Sugar
Blood Sugar
Blood Sugar
Body
Body
Body
Body
Body
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Type 2 Diabetes
Pancreas
ii
ii
ii
Blood Sugar
Blood Sugar
Blood Sugar
Blood Sugar
Blood Sugar
Body
Body
Body
Body
Body
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Diabetes and Dementia

• Diabetes increases risk of mild cognitive
  impariment, dementia and AD, either due to lack
  of insulin or insulin resistance or both
• Overweight people who are not considered obese
  have a 2-fold increased risk of getting
  Alzheimers disease. Obese has a 3-fold risk.
• There is also mild cognitive impairment in animal
  models of Type 2 diabetes and obesity.

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Alzheimers disease Type 3 diabetes?

• Famous study from 2005
• Rats were ingested with a drug that can cause
  type 2 diabetes (streptozocin).
• When this drug was given by mouth or by IV, they
  got type 2 diabetes.
• When they injected this drug directly into their
  brain, it caused brain insulin deficiency, brain
  insulin resistance, impairment in learning and
  memory, and the identical brain lesions that are
  seen in AD.

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Alzheimers Disease (AD)

• The most common cause of dementia
• It is a severe, age-related decline in memory and
  cognitive functioning
• 1 in 8 people over age 65 have AD
• Nearly half of people over age 85 have AD
• The difference between age-related cognitive
  decline and AD is that AD had actual physical
  damage to brain cells, which also causes
  behavioral changes

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AD Physical brain changes
Too many Tau proteins
Too many Amyloid-beta (AB) plaques
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Alzheimers Disease Physical brain changes
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AD and insulin the connection

• Tau is controlled by insulin signals
• Brain insulin resistance leads to disruption of
  the insulin signals that control nerve cell
  survival. It messes up the systems that control
  neuron plasticity (storing and creating
  memories) and cognition.
• Turning off insulin signaling in the brain causes
  oxidative stress which damages proteins and
  DNA, promotes inflammation, causes brain cell
  death, and increases both tau and AB plaques.

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AD and insulin how it starts

• The Blood-Brain Barrier (BBB)
• This BBB keeps bad stuff from our body from
  getting into our brains. It protects us from
  toxins.
• So anything we eat or make in our body, if we
  need it to go to the brain, it has to cross the
  BBB first.

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The Blood Brain Barrier
Im the Blood Brain Barrier. You wanna get into
the brain, you gotta go through me
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The Blood Brain Barrier Normal State
1st up Sugar. Yep go right in, we need
you Next Insulin. Sure, come on in, we need
you too.
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Blood Brain Barrier In a patient with
pre-diabetes/insulin resistance or Type 2 Diabetes
Insulin! Again! I am sick of seeing you. You
come around too much. Go away, I am tired of
letting you in
Obesity and high-fat diets decrease the ability
of insulin to get across the blood brain barrier
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AD Insulin cant get through the Blood brain
barrier

• Without enough insulin in the brain, bad things
  start happening.
• Lower brain insulin signaling increases tau and
  AB plaques in mice
• Too much insulin in the body also interferes with
  the bodys ability to get rid of the AB plaques
  once they are made
• People with AD have reduced levels of insulin in
  their brain and lower levels of insulin signaling
  too

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Insulin Effects in the Brain

• Parts of the brain that use insulin
• Cerebral cortex
• Hippocampus
• Hypothalamus
• Amygdala

Without enough insulin in the brain, all of these
systems suffer
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Consequences of Insulin Problems in the Brain

• Glut-4 dysfunction
• Oxidative stress
• The insulin resistance in the brain can damage
  the blood vessels, leading to strokes
• White matter of the brain starts to disappear

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Consequences of Diet in the Brain

• Brain-derived neurotrophic factor (BDNF) plays an
  important role in the survival, maintenance, and
  growth of brain cells, especially in the
  hippocampus and hypothalamus.
• Interference with BDNF reduces synaptic
  plasticity, which is important for learning and
  memory.
• Diets high in saturated fats and simple sugars
  have been shown to reduce BDNF levels and to
  interfere with synaptic plasticity and making new
  nerve cells

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Alzheimers Disease is a Metabolic Disorder

• MRI of patients with AD show decrease in sugar
  metabolism in the hippocampus (learning and
  memory)
• The neurodegeneration seen in AD can be produced
  by experiments that cause brain insulin
  resistance and deficiency
• Brain insulin deficiency and resistance could
  account for the structural , molecular, and
  biochemical lesions that correlate with the
  cognitive decline and dementia in AD

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Alzheimers Disease Is metabolism really to
blame?

• Conclusions
• Type 2 diabetes can enhance progression but is
  not sufficient to cause AD by itself.
• Obesity, insulin resistance, and Type 2 diabetes
  and all of these processes that result from it
  contribute to AD and mild cognitive impairment,
  but they are not proven to cause it yet.
• Insulin resistance is just a co-factor,
  contributing to the problem.

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Why are we going to keep eating foods high in
sugar and fats even though we know how harmful it
is?

• It is all insulins fault
• Leptin
• Ghrelin
• Cortisol
• Dopamine

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Bad fat vs Good Fat

• Saturated Fat

• Mono/Polyunsaturated Fat

• Butter
• Ghee
• Lard
• Coconut oil
• Cottonseed Oil
• Palm kernel Oil
• Dairy Creams/cheese
• Fatty Meats

• Vegetable Oil
• Olive, Canola, Soybean
• Avocado
• Oily fish
• Nuts
• Seeds

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Foods high in Simple Sugars
?
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Appetite Hormones Ghrelin
When there is no food in your belly, and your
body needs the energy, you make Ghrelin, which
tells you that you are hungry
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Appetite Hormones Leptin
When you have eaten enough food, you make Leptin.
Leptin tells you that you are full, and that you
should stop eating.
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Appetite Hormones Cortisol
When you are stressed out, anxious, or depressed,
you make Cortisol, which tells you to go eat high
sugar and high fat food. Cortisol also tells
you to make Ghrelin, so you get super hungry for
all the wrong foods. Cortisol also turns off
Leptin, so you never feel full. Cortisol also
tells you to store everything you eat as fat.
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Appetite Hormones Dopamine
When we eat high fat, high sugar foods, we make
lots of Dopamine, which gives us the reward from
food. It turns on the pleasure center of the
brain the same part of the brain that responds
to morphine, nicotine, and alcohol.
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Appetite Hormones

• These are all supposed to work together and play
  nice, but when you have insulin resistance, these
  hormones get all of their signals crossed
• 2007 Gave obese and normal weight people a meal,
  then they asked about their appetite after
  lunch. The normal weight people were not hungry
  after they ate. The obese group still reported
  that they felt hungry.
• Obese people may not respond correctly to hormone
  signals after eating, correlating with insulin
  levels

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Appetite Hormones

• Normal State

• Insulin Resistance/Type 2

• If your stomach is empty
• Ghrelin Leptin
• After you eat
• Ghrelin Leptin

• If your stomach is empty
• Ghrelin Leptin
• After you eat
• Ghrelin Leptin

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Appetite Food Addiction

• Eat healthy carbs

• Eat high sugar foods that taste REALLY sweet

• Make some insulin
• Insulin makes sure that the pleasure center of
  the brain never gets told anything, so you dont
  crave food. You just eat till you are full and
  then stop eating.

• The excessive sugar goes right to the pleasure
  center of the brain and causes tons of Dopamine
  to be released.
• This causes an exaggerated emotional response,
  reduced ability to stay away from that food,
  leading to compulsive eating.

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Diet Drinks and Low fat foods

• Diet Drinks, made with artificial sweetners,
  taste REALLY sweet, maybe too sweet. This causes
  excessive releases of Dopamine also, causing us
  to crave real sugar. Eating the real sugar
  causes the weight gain.
• Low fat foods add in extra sugar or artificial
  sweeteners, making it taste REALLY sweet, leading
  to the same process.
• Fructose also tastes REALLY sweet, so foods with
  high-fructose corn syrup will lead you down this
  same road to being addicted to high sugar foods.

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Dopamine and Obesity

• Over time, our body can become resistant to these
  excessive dopamine surges (the same way you get
  resistant to insulin).
• Our body panics without Dopamine, causing us to
  go try to find it again, so we eat even higher
  and higher amounts of high sugar/high fat foods
  to try to turn on Dopamine again.
• Drugs that cause weight gain are the ones that
  turn off Dopamine in our brains.

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What foods should we eat to protect our brain?

• Hopeful but unproven yet
• Curry? improves cognitive decay in rat models
• B vitamins? some positive effects on memory
• Vitamin D? important for preserving cognition
• Vitamin E? shown to delay progression of AD,
  but high doses can be harmful
• Vitamin A and C? antioxidant vitamins, but no
  proven benefit and can be toxic
• Ginseng? - not studied well enough to know
• Ginkgo biloba? lots of bad medication
  interactions

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Foods that protect the brain

• Proven to be beneficial
• Antioxidant rich foods
• Alcohol/Wine
• Fiber Improves alertness and decreases perceived
  stress
• Omega-3 fatty acids (DHA)
• Major building structures of the membranes in the
  brain
• Fish, salmon, flax seeds, krill, chia, kiwi,
  butternuts, walnuts, baby formula
• Flavanoids
• Cocoa, green tea, Ginkgo tree, citrus fruits, red
  wine, dark chocolate

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Antioxidants

• No formal recommendation on the amount per day
• No proven benefit in supplements, and high doses
  can be toxic
• Experts think these foods have a wide range of
  functions besides reducing oxidative stress
• Foods that naturally contain antioxidants
• Fruits, veggies, nuts, seeds, grains, olive oil
• Fresh spices oregano, cinnamon, turmeric,
  parsley, basil, ginger black pepper

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Alcohol/Wine

• Light and moderate drinking protective effect
  against cognitive impairment and dementia
• Heavy drinking no protective effect
• Wine is better than beer or hard liquor, since
  wine has natural antioxidants.

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Omega 3 fatty acids (FA)

• 2012 Rats with cognitive decline and a
  high-fructose diet. They started giving them
  omega-3 FA and the brain problems/memory
  improved.
• Dietary deficiency can prevent the renewal of the
  brain structures and accelerate brain aging
• Most common dietary supplement is DHA

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Flavonoids

• Reduce oxidative stress, improve insulin
  sensitivity, protects heart and blood vessels
• 2012 90 elderly patients with mild cognitive
  impairment.
• Gave them a drink once a day with different
  amounts of flavanols, then did cognitive brain
  tests before and after
• Test scores were higher in the high flavanol
  groups after 8 weeks and the high flavanol group
  also had improved insulin resistance and blood
  pressure.

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Chocolate Buyer Beware

• Most chocolates bought in a grocery store and so
  processed and full of sugar that the harm is more
  than the benefit
• White chocolate no cocoa (Flavonoids)
• Milk chocolate 20 cocoa
• Dark chocolate 1 ounce of 70-85 cocoa is
  beneficial

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The End

• Questions?