A Health Writer's Quest to Preserve His Brain Through Diet

Bret S. Stetka, MD


March 30, 2018

Max's Inspiration

The evidence suggesting that the risk for cognitive decline and Alzheimer dementia can be modified through diet and lifestyle interventions is mounting. And for years now, health and science journalist Max Lugavere has been out to educate both healthcare professionals and the public about how to optimize brain health through nutrition. Max's newly released book, Genius Foods, explores his own personal quest to improve brain health, and where the data stand on dementia prevention strategies.

Medscape: What inspired you to go into health journalism? And how did Genius Foods come about?

Max Lugavere

Lugavere: I began as a generalist and decided to focus on health when my mother developed dementia at age 58. I was met with very limited treatment options despite having been fortunate enough to visit many of the country's top neurology departments.

I decided to investigate whether diet and lifestyle factors, such as sleep and exercise, may play a role in the etiology of Alzheimer disease, the most common form of dementia. The research that I reviewed filled me with optimism but also drove home the notion that, as with many of the chronic diseases burdening society today, prevention is probably key. Although we still don't yet fully understand what causes Alzheimer disease (let alone other dementias), by tending to the known risk factors and improving cardiometabolic fitness and psychosocial risk factors, the best available evidence seems to indicate that for a significant portion of the population, it is a disease we may be able to delay at the very least.

Medscape: You're the creator of the first documentary specifically exploring brain nutrition. Can you tell us about this, and when it will be out?

Lugavere: I wanted to drive home fact that most of the time, dementia begins in the brain decades before the first symptom. So as a millennial, an age group that is now approaching the age of 40, I felt that this was an issue that my peers needed to be talking about.

I decided to use the tools of mass media, and as a filmmaker, I thought making a movie would be the best medium. In it, I interview Miia Kivipelto, the lead researcher of the FINGER trial,[1] which is the first large-population long-term trial to show us that cognitive decline needn't be destiny. Her study, which is ongoing, includes 1200 at-risk older adults. After 2 years, her team showed that those enrolled into a dietary intervention focusing on whole, unprocessed foods; extra-virgin olive oil; fatty fish; and fruits and vegetables were able to not only maintain their cognitive function but improve it by 25%, compared with control.

I also interview Suzanne de la Monte, a neuropathologist who coined the term "type 3 diabetes" to describe Alzheimer disease. When I began production, the theory that Alzheimer disease may be metabolic in origin was a fairly novel concept, but it has since become referenced widely throughout the medical literature.

Medscape: What are a few brain nutrition facts that surprised you in researching your book?

Lugavere: I learned that grain and seed oils are among the most damaging foodstuffs in our modern food environment. These oils, which are largely constituted of polyunsaturated fats, now make up around 10% of our caloric intake, up from virtually zero at the turn of the century.[2] The fats in these oils are easily oxidized, and the deodorization process (used to ensure that the oils are tasteless and odorless so that they may be used in a myriad of processed foods) actually generates trans fats,[3] the consumption of which is related to increased risk for early mortality,[4] reduced brain volume,[5] and worse memory function in young and healthy persons.[6]

I also discovered that the modern diet, which contains upward of 300 g of carbohydrates daily—mostly from ultra-processed foods that now make up 60% of our caloric intake[7]—keeps levels of insulin chronically elevated. Although the mechanism is unclear and probably complex, the Journal of Alzheimer's Disease recently published that 40% of Alzheimer cases may be owed to chronically elevated insulin alone.[8]

Medscape: How has your work changed how you live your life, in terms of diet and brain health?

Lugavere: My diet has refocused on whole, unprocessed foods, and I place priority on lower-carbohydrate foods with high nutrient density. Few foods are as nutrient-dense as dark leafy greens, the consumption of which is associated with reduced brain aging by up to 11 years,[9] according to a recent Rush University study.

I also integrate fatty fish, eggs, and grass-fed beef. Although the research on beef as it pertains to brain health is scant, I find Charlotte Neumann's research at UCLA[10] compelling, where children who were supplemented with beef showed the greatest improvement in terms of reading and math, along with signs of mental health, compared with children who did not receive beef or dairy supplementation. The brain-supportive nutrients in beef are nontrivial and include bioavailable forms of DHA fat (when grass-fed), choline, creatine, zinc, and vitamin B12. Many people underconsume these nutrients—the daily adequate intake of choline for example, is probably unmet in 90% of the population.[11]

Medscape: Who are the physicians and researchers who have inspired you along the way?

Lugavere: One of my mentors is Richard Isaacson, MD, who is the director of the Alzheimer's Prevention Clinic at Weill Cornell Medical Center and NewYork-Presbyterian. I discovered his work early on in my investigation, and we've since become collaborators. I had a great experience writing my book Genius Foods with Paul Grewal, MD, a New York City-based physician who became a weight-loss expert after his experience of losing 100 lb himself. The work of Miia Kivipelto, Robert Krikorian, Lisa Mosconi, Suzanne de la Monte, and many others continue to inspire me.

Medscape: Finally, what's next for your career?

Lugavere: I hope Genius Foods finds a wide audience of healthcare practitioners and laypeople alike (I wrote it to appeal to both). I believe health literacy is of critical importance, and my goal is to continue to use the tools of media to help younger people sift through misinformation and be empowered to make healthier choices. I also want to continue to teach healthcare practitioners about nutrition, which I've had the privilege to do at various academic institutions.


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