High Blood Pressure May Lead to Low Brain Volume

Having hypertension in midlife (ages 40 through 60) is associated with elevated risk of cognitive impairment and Alzheimer’s dementia later in life, even more so than having the so-called Alzheimer’s gene.

“It is clear that cerebral vascular disease”—that is, hardening of the arteries inside our brain—“and cognitive decline travel hand in hand,” something I’ve addressed before. “However, the independent association of AD [Alzheimer’s disease] with multiple AVD [atherosclerotic vascular disease] risk factors suggests that cholesterol is not the sole culprit in dementia.”

As I discuss in my video Higher Blood Pressure May Lead to Brain Shrinkage, one of the most consistent findings is that elevated levels of blood pressure in midlife, ages 40 through 60, is associated with elevated risk of cognitive impairment and Alzheimer’s dementia later in life—in fact, even more so than having the so-called Alzheimer’s gene.

“The normal arterial tree”—all the blood vessels in the brain—“is…designed as both a conduit and cushion.” But when the artery walls become stiffened, the pressure from the pulse every time our heart pumps blood up into our brain can damage small vessels in our brain. This can cause “microbleeds” in our brain, which are frequently found in people with high blood pressure, even if they were never diagnosed with a stroke.

These microbleeds may be “one of the important factors that cause cognitive impairments,” “perhaps not surprising[ly],” because on autopsy, “microbleeds may be associated with [brain] tissue necrosis,” meaning brain tissue death.

And speaking of tissue death, high blood pressure is also associated with so-called lacunar infarcts, from the Latin word lacuna, meaning hole. These holes in our brain appear when little arteries get clogged in the brain and result in the death of a little round region of the brain. Up to a quarter of the elderly have these little mini-strokes, and most don’t even know it, so-called silent infarcts. But “no black holes in the brain are benign.” As you can see at 2:12 in my video, it’s as though your brain has been hole-punched.

“Although silent infarcts, by definition, lack clinically overt stroke-like symptoms, they are associated with subtle deficits in physical and cognitive function that commonly go unnoticed.” What’s more, they can double the risk of dementia. That’s one of the ways high blood pressure is linked to dementia.

There’s so much damage that high blood pressure levels can “lead to brain volume reduction,” literally a shrinkage of our brain, “specifically in the hippocampus,” the memory center of the brain. This helps explain how high blood pressure can be involved in the development of Alzheimer’s disease.

As you can see at 3:02 in my video, we can actually visualize the little arteries in the back of our eyes using an ophthalmoscope, providing “a noninvasive window” to study the health of our intracranial arteries, the little vessels inside our head. Researchers “found a significant association” between visualized arterial disease and brain shrinkage on MRI. However, because that was a cross-sectional study, just a snapshot in time, you can’t prove cause and effect. What’s needed is a prospective study, following people over time. And that’s just what the researchers did. Over a ten-year period, those with visual signs of arterial disease were twice as likely to suffer a significant loss of brain tissue volume over time.


What can we do about high blood pressure? A lot! See, for example:

What else can we do to forestall cognitive decline or dementia? I referenced my video Alzheimer’s and Atherosclerosis of the Brain earlier, and here are other videos that offer information on treatment and prevention:

 

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

A Half Teaspoon of Dried Rosemary May Improve Cognitive Function

In Hamlet, Act 4, Scene 5, Ophelia notes that rosemary is for remembrance, an idea that goes back at least a few thousand years to the ancient Greeks, who claimed that rosemary “comforts the brain…sharpens understanding, restores lost memory, awakens the mind…” After all, “plants can be considered as chemical factories that manufacture all sorts of compounds that could have neuroprotective benefits”. So, let’s cut down on processed foods and eat a lot of phytonutrient-rich whole plant foods, including, perhaps, a variety of herbs. Even the smell of certain herbs may affect how our brain works. Unfortunately, as I discuss in my video Benefits of Rosemary for Brain Function, I’ve found much of the aromatherapy literature scientifically unsatisfying. There are studies offering subjective impressions, for example, but while sniffing an herbal sachet is indeed “easy, inexpensive, and safe,” is it effective? The researchers didn’t even compare test scores.

However, even when there was a control group, such as one study where researchers had people perform a battery of tests in a room that smelled like rosemary, lavender, or nothing, and even when the researchers did compare test results, the lavender appeared to slow down the subjects and impair their performance, whereas the rosemary group seemed to do better. Perhaps that was just because of the mood effects, though, as I show at 1:36 in my video. Maybe the rosemary group did better simply because the aroma pepped them up in some way—and not necessarily in a good way, as perhaps the rosemary was somehow overstimulating in some circumstances?

Now, there have been studies that measured people’s brain waves and were able to correlate the EEG findings with the changes in mood and performance, as well as associate them with objective changes in stress hormone levels, as you can see at 2:05 in my video, but is that all simply because pleasant smells improve people’s moods? For instance, if you created a synthetic rosemary fragrance with a bunch of chemicals that had nothing to do with the rosemary plant, would it have the same effect? We didn’t know…until now.

Aromatic herbs do have volatile compounds that theoretically could enter the blood stream by way of the lining of the nose or lungs and then potentially cross into the brain and have direct effects. A 2012 study was the first to put it to the test. Researchers had people do math in a cubicle infused with rosemary aroma. The subjects got that same boost in performance, but for the first time, the researchers showed that their improvement correlated with the amount of a rosemary compound that made it into their bloodstream just from being in the same room. So, not only did this show that it gets absorbed, but that such natural aromatic plant compounds may have a direct effect on changes in brain function.

If that’s what just smelling it can do, what about eating rosemary? We have studies on alertness, cognition, and reduced stress hormone levels inhaling rosemary. “However, there were no clinical studies on cognitive performance following ingestion of rosemary”…until now. Older adults, average age of 75, were given two cups of tomato juice, with either nothing, a half teaspoon of powdered rosemary, which is what one might use in a typical recipe, a full teaspoon, two teaspoons, more than a tablespoon of rosemary powder, or placebo pills to go even further to eliminate any placebo effects.

“Speed of memory is a potentially useful predictor of cognitive function during aging,” and, as you can see at 4:08 in my video, researchers found that the lowest dose had a beneficial effect, accelerating the subjects’ processing speed, but the highest dose impaired their processing speed, perhaps because the half-teaspoon dose improved alertness, while the four-teaspoon dose decreased alertness. So, “rosemary powder at the dose nearest normal culinary consumption demonstrated positive effects on speed of memory…” The implicit take-home message is more isn’t necessarily better. Don’t take high-dose herbal supplements, extracts, or tinctures—just cooking with spices is sufficient. A conclusion, no doubt, pleasing to the spice company that sponsored the study. No side effects were reported, but that doesn’t mean you can eat the whole rosemary bush. In one study, an unlucky guy swallowed a rosemary twig that punctured through the stomach into his liver, causing an abscess from which two cups of pus and a two-inch twig were removed. So, explore herbs and spices in your cooking. Branch out—just leave the branches out.

That twig is like a plant-based equivalent of Migrating Fish Bones!


Interested in more on aromatherapy? See:

For more on spicing up your life, check out:

And, learn more about improving cognition and preventing age-related cognitive decline in:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

 

Vegans Should Consider Taking DHA Supplements

We are all fatheads.

Indeed, about half the dry weight of our brain is fat. Lower levels of the long-chain omega-3 fat DHA in some areas of Alzheimer’s brains got people thinking that perhaps DHA is protective. Since the level of DHA in the brain tends to correlate with the level of DHA in the blood, cross-sectional studies of dementia and pre-dementia patients have been done. The result? The dementia and pre-dementia subjects do tend to have lower levels of both long-chain omega-3s, EPA and DHA, circulating in their bloodstream. This doesn’t necessarily mean that lower omega-3 levels cause cognitive impairment, however. It was just a snapshot in time, so we don’t know which came first. As I discuss in my video Should Vegans Take DHA to Preserve Brain Function?, maybe the dementia led to a dietary deficiency, rather than a dietary deficiency leading to dementia.

What we need is to measure long-chain omega-3 levels at the beginning and then follow people over time, and, indeed, there may be a slower rate of cognitive decline in those who start out with higher levels. We can actually see the difference on MRI. Thousands of older men and women had their levels checked and were scanned and then re-scanned. The brains of those with higher levels looked noticeably healthier five years later.

The size of our brain actually shrinks as we get older, starting around age 20. Between ages 16 and 80, our brain loses about 1 percent of its volume every two to three years, such that by the time we’re in our 70s, our brain has lost 26 percent of its size and ends up smaller than that of 2- to 3-year-old children.

As we age, our ability to make long-chain omega-3s like DHA from short-chain omega-3s in plant foods, such as flaxseeds, chia seeds, walnuts, and greens, may decline. Researchers compared DHA levels to brain volumes in the famed Framingham Study and found that lower DHA levels were associated with smaller brain volumes, but this was just from a snapshot in time, so more information was needed. A subsequent study was published that found that higher EPA and DHA levels correlated with larger brain volume eight years later. While normal aging results in overall brain shrinkage, having lower levels of long-chain omega-3s may signal increased risk. The only thing we’d now need to prove cause and effect is a randomized controlled trial showing we can actually slow brain loss by giving people extra long-chain omega-3s, but the trials to date showed no cognitive benefits from supplementation…until now.

A “double-blind randomized interventional study provide[d] first-time evidence that [extra long-chain omega-3s] exert positive effects on brain functions in healthy older adults,” a significant improvement in executive function after six and a half months of supplementation, and significantly less brain shrinkage compared to placebo. This kind of gray matter shrinkage in the placebo might be considered just normal brain aging, but it was significantly slowed in the supplementation group. The researchers also described changes in the white matter of the brain, increased fractional anisotropy, and decreases in mean and radial diffusivity—terms I’ve never heard before but evidently imply greater structural integrity.

So, we know that having sufficient long-chain omega-3s EPA and DHA may be important for preserving brain function and structure, but what’s “sufficient” and how do we get there? The Framingham Study found what appears to be a threshold value around an omega-3 index of 4.4, which is a measure of our EPA and DHA levels. Having more or much more than 4.4 didn’t seem to matter, but having less was associated with accelerated brain loss equivalent to about an extra two years of brain aging, which comes out to about a teaspoon less of brain matter, so it’s probably good to have an omega-3 index over 4.4.

The problem is that people who don’t eat fish may be under 4.4. Nearly two-thirds of vegans may fall below 4.0, suggesting a substantial number of vegans have an omega-3 status associated with accelerated brain aging. The average American just exceeds the threshold at about 4.5, though if we age- and gender-match with the vegans, ironically, the omnivores do just as bad. There aren’t a lot of long-chain omega-3s in Big Macs either, but having a nutrient status no worse than those eating the Standard American Diet is not saying much.

What we need is a study that gives those with such low levels some pollutant-free EPA and DHA, and then sees how much it takes to push people past the threshold…and here we go: Phase 2 of the study gave algae-derived EPA and DHA to those eating vegan diets with levels under 4.0. About 250mg a day took them from an average of 3.1 over the threshold to 4.8 within four months. This is why I recommend everyone consider eating a plant-based diet along with contaminant-free EPA and DHA to get the best of both worlds—omega-3 levels associated with brain preservation while minimizing exposure to toxic pollutants.


A list of my recommendations can be found here: Optimum Nutrition Recommendations.

Why not just eat fish or take fish oil? I explain why in these videos:

How else can we protect our brains? See, for example:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: