Fortunately, longevity researcher and Blue Zones founder Dan Buettner tells me the most recent data shows that more than 50 percent of dementia is preventable through early lifestyle interventions and changes. And he's seen that play out in Blue Zones communities, aka populations around the world with lifespans far above average.
He notes that people living in Ikaria, Greece (one of the five Blue Zones in the world) are one-fifth as likely to develop dementia as Americans, according to surveys his team conducted in collaboration with the University of Athens. Anecdotally, Buettner says dementia in other Blue Zones is extremely rare, too. John Day, MD, a cardiologist and author of The Longevity Plan, found this to be the case while studying the long-living population of Bapan, China. (Among 267 residents of the county wherein Bapan is located, just one case of dementia was found.)
Both experts believe that if we care about our cognitive health, there is much about these groups we may want to emulate as best as possible. "We know these people have the outcome we want—they've lived a long time, and they stayed sharp until the end," Buettner says. "So then you start asking yourself, 'Well, what's going on in these cultures that might explain it?'"
According to Buettner, these outcomes can't be explained away by genetics. Most of the Blue Zones, he says, are melting pots, with various new demographics mingling in at various points over time. Plus, just 12 miles away from Ikaria is Samos, which has a genetically-identical population mix but does not enjoy the same low rates of dementia, he says.
The logical conclusion, he says, is that these differences are instead attributable to lifestyle factors. "We're doing this sort of insanely expensive quest to cure Alzheimer's disease [in America] when it's clear there's a lifestyle combination that would yield outcome far better than any drug," he says.
While it's not possible to prescribe an entire way of life, with a little effort you can adopt practices Buettner and Dr. Day see as the key to good cognitive health lying in these regions. Below, 5 such brain-healthy habits to start practicing, stat.
1. Eat a (mostly) plant-based diet
For the last century at least, Blue Zones populations have consumed mostly plant-based diets, says Buettner. "The five pillars of these diets are whole grains, nuts, tubers, greens, and beans," he adds. The same is true in Bapan, where Dr. Day says diets are typically high in plants and low in processed foods and added sugar.
While the relationship between the plant-based diets in these regions and the cognitive health of their long-living populations isn't proven causative (meaning, you can't definitively say that the diets led to the outstanding brain health enjoyed within these demographics), science has shown that both plant-centric Mediterranean diets and vegetarian diets are associated with a reduced risk of dementia.
Still, Buettner says simply resolving to add more plant-based meals into your routine likely isn't going to get you to Blue Zones-levels of brain health because self-imposed "diets" rarely work; it has to be a normal part of your lifestyle. "What we do know works is finding a few friends who are plant-based and will introduce you to new restaurants with delicious plant-based food or serve you wonderful plant-based meals," he says. In other words, it's time to befriend those loud and proud vegans from Instagram.
2. Drink herbal tea
With respect specifically to Ikaria, Buettner points to another dietary habit that might benefit the population's cognitive health. "Throughout the ages in Ikaria, and even to this day, instead of drinking a lot of coffee or even imported tea, the beverage of choice has been herbal teas—which they just grow naturally like weeds," he says. "[In Ikaria], you're likely to walk out into the field behind your house and grab a handful of herbs and just boil them in some water."
Common among these herbs are rosemary, oregano, sage, and dandelion leaf, which Buettner says are anti-inflammatory. "Every major age-related disease in the world has its roots in chronic inflammation," he says. "So here you have a population that's pretty much every day of their life drinking these teas, and it may explain low low rates of Alzheimer's disease." In his opinion, it certainly can't hurt to add herbal teas to your diet—just don't pick them from your yard unless you know what they are, and make sure to be aware of any contraindications.
3. Walk as much as possible (bonus points for hills)
In the Blue Zones, walking is an inescapable part of life—there are occasions to walk all day, every day. This is fortunate, because Buettner tells me that walking and dementia are inversely correlated, meaning that the more you walk, the less likely you are to experience cognitive decline. This is partially explained by the fact that when you're walking, your brain is controlling about 200 muscles. "On top of that, you're thinking or talking or observing—it's a very cognitively intense activity," he says.
Uphill treks offer an additional boost to health, too. "In Sardinia, one of the biggest predictors of long lives are the steepness of grade," says Buettner. "In other words, people live in the steepest villages are living the longest, and they also may have the sharpest minds for longer."
Dr. Day also found that the people he studied in Bapan had much higher levels of physical activity than most Americans do—some were still working in field after the age of 100. He says that if he had to pick just one behavior to emulate from long-living populations, it would be maintaining a high level of cardiovascular fitness, aka "a religious commitment to daily exercise."
This is because several studies show that those at the highest levels of physical fitness for their age group are very unlikely to develop cognitive decline. "Physical exercise stimulates brain-derived neurotrophic factor (BDNF), which is like Miracle-Gro to the brain," Dr. Day says. (BDNF is a protein that supports neuron growth and maintenance.) "Also, behavioral studies show that the commitment to daily physical exercise is the 'key domino' to a series of behavioral habits—for example, those committed to daily exercise are much more likely to eat healthier, sleep better at night, etc," he says.
4. Interact with others often
Lonely people have much higher rates of dementia than those who are socially-fulfilled, says Buettner, and in the Blue Zones, people don't really have the option of being lonely. "Every time there's a party or a village festival or church or public effort to build a bridge or help a family out, you see, especially in Ikaria or Sardinia, someone would come pounding on your door and say, 'Where are you man? Get out here!' So people are social by default," he says. Dr. Day had similar findings in Bapan. "These people were very socially connected (no social isolation/loneliness), with most living in three, four, or five generational homes," he says.
While it can be difficult to approximate this level of social interaction within the more isolating culture of America, Buettner recommends considering a move from the suburbs to a city if you care about your cognitive health. There, he posits that you'll be more likely to bump into other people. "You're way less likely to be lonely if you live in a walkable community than if you live on a cul-de-sac," he says. Of course, this depends on the city and the neighborhood within that city—I live in Los Angeles and can get everywhere in my car without interacting with a single stranger—so if you're considering a move, keep pedestrian-friendly infrastructure in mind. While this advice may not be super relevant in COVID times, when we need to stay distanced from people who aren't within our households, it's certainly something to keep in mind for the future.
5. Develop a strong sense of purpose
While here in America we tend to put our old folks out to pasture, so to speak, Dr. Day says that the elderly in Bapan and elsewhere in China are highly revered. They're considered essential to the functioning of those aforementioned multigenerational homes, which he says gives them a strong sense of purpose and reason for living. The connection between this purpose and cognitive health isn't just speculative, either. Research has shown that higher levels of purpose mitigate the effects of Alzheimer's Disease.
It's not so easy to find that purpose when you're not needed in the fields or to babysit your great-grandkids as an octogenarian, but a technique called "life crafting," may help. It's an evidence-based, seven-step process which helps you plot a path to purpose via introspection, goal identification and achievement plans, and public commitment to your desired outcomes. You can try these six more spiritual steps, too.
It might also help to frame purpose not as something you find but rather as something you develop—meaning that instead of seeking it out, you may need to look at what you already have and find the purpose within it. It can also change over time, so if you find meaning in your work and then retire, you might then find meaning in volunteering, or gardening to create bounty for your neighbors, or painting landscapes that will outlive you. The key is just to find it somewhere.
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