By Richard Podell, M.D., MPH
For more decades than I can count an army of dietary fads all claim they can improve our health. But, almost all these claims are based on anecdotes. They lack scientific studies to prove that they really work. Fortunately, that’s changing. Controlled studies of diet and health are starting to be done.
The best research so far has focused on the “Mediterranean Diet” as a preventive treatment for heart disease and stroke. (1)
Two points are especially encouraging. The Mediterranean Diet was practical. Most people stayed on it for more than 5 years. As importantly, just five years was long enough to reduce the incidence cardiovascular events by 30%. It did not take a life-time.
The Mediterranean Diet might also delay or prevent the onset of Alzheimer’s dementia.
About six years after beginning the Mediterranean Diet versus Low Fat Diet study, the Spanish researchers selected 522 persons from within the main study and put them through neuro-cognitive testing. (2) Since these persons had been assigned to different diets at random, if formal cognitive tests had been done at the start of the study, in theory the initial scores for the two groups should have been roughly equal. But, after six years in the study the Mediterranean Diet group scored significantly higher on the cognitive tests compared to those in the Low Fat arm of the study.
The differences favoring the Mediterranean Diet group remained after adjusting for risk factors that are believed to affect cognition–including age, sex, education, ApoE genotype, family history of dementia, smoking, physical activity, body mass index, high blood pressure, high cholesterol, and diabetes.
Therefore, the higher cognitive test scores after six years suggests that the Mediterranean Diet, not only prevents heart attacks and stroke, but also helps maintain cognitive skills.
In 2015 Valls-Pedret and a Mediterranean Diet study group provided further support for the cognitive benefit of the Mediterranean Diet. Before assigning 447 healthy 60 + year old Spanish volunteers to a Mediterranean Diet versus a Low Fat Diet, they obtained baseline cognitive test scores. After 4.1 years cognitive test and memory scores were higher for the Mediterranean Diet group (3)
So, what has this to do with the brain fog of fibromyalgia or chronic fatigue syndrome? We can’t answer this question yet. But, I hope readers will be encouraged by the fact that a relatively simple dietary change probably can block a different form of “untreatable” cognitive decay—even if that cause might have nothing in common with FM or CFS.
Martha Morris, Ph.D. and her research team at Chicago’s Rush University Medical Center may be the world’s leading experts studying cognitive decline due to aging and or Alzheimer’s.
Dr. Morris modified the Mediterranean diet to take into account other research on dementia. She named this the MIND DIET. (4) (See table 1 below.)
Dr. Morris and her colleagues enrolled 923 Chicago men and women, age 58 to 98. None had Alzheimer’s at the start of the study. At baseline dieticians analyzed each person’s current eating pattern to compare it with the key principles of the MIND DIET. These principles are shown below on table 1.
Over the next 4.5 years 144 of 923 (16%) of those in Dr. Morris’ study were diagnosed with Alzheimer’s. Participants whose Mind DIET scores were initially in the top third were only 47% as likely to develop Alzheimer’s compared to those in the bottom third. This difference was highly significant statistically (P=.0006). Those in the middle third did better than those in the lowest third, but not as well as those in the upper third.
The Mediterranean Diet pattern also predicted a low Alzheimer’s rate, almost but not quite as well as did the MIND DIET adherence score.
A strength of Dr. Morris’ study was that the statistical analysis controlled for life style behaviors, illnesses and genetic risks for Alzheimer’s. The study’s main limitation is that the researchers did not actively assign subjects to each diet. They simply scored how closely each subject’s self-chosen diet compared to the MIND DIET ideal. So, we can’t be sure whether high adherence to the MIND diet caused the lower rate of Alzheimer’s or whether other factors might have been at work.
In a separate paper Dr. Morris group calculated that better adherence to a MIND DIET style of eating was associated with slower decline in global cognitive score over-all ( P < .0001). The difference in cognitive skills between the top third on the MIND DIET scores and those in the bottom third was the equivalent of the top third being “7.5 years younger in age” compared to the bottom third—although chronologically in fact their average age was the same. (5)
The MIND diet contains 15 separate elements. These are listed in the table below:
|Table 1—MIND DIET SCORING (15=perfect adherence to MIND DIET principles. 0=no adherence at all. Average Score for top third of patients=9.6 (range:8.5-12.5); middle third=7.5 (range: 7-8) bottom third=5.6 (range 2.5-6.5)|
|MIND DIET COMPONENTS||One Point scored for each component|
|Eat Whole Grain foods 3 times a day||1 point|
|Eat Green leafy vegetables 6 times each week||1 point|
|Eat an additional vegetable once a day||1 point|
|Eat berries twice a week||1 point|
|Eat red meat products less than 4 times a week||1 point|
|Eat Fish at least once a week||1 point|
|Eat poultry twice a week||1 point|
|Eat beans 3 times a week||1 point|
|Eat nuts 5 times a week||1 point|
|Eat fried foods less than once a week||1 point|
|Eat butter or margarine less than once a day||1 point|
|Eat cheese less than once a week||1 point|
|Eat Pastries, or sweets less than 5 times a week||1 point|
|Drink alcohol or wine one serving per day||1 point|
|The Bottom Line: This study adds to the growing evidence that relatively simple changes in diet such as eating lots of green leafy vegetables and reducing saturated fat have a fairly prompt, fairly powerful effect on reducing the risk of cognitive decline due to Alzheimer’s Disease.|
So, which diet should we follow if our “brain fog” symptoms are due to Fibromyalgia or Chronic Fatigue Syndrome? At this time, we have no easy answer. Ideally, someone would fund a study where several hundred people with CFS or Fibromyalgia would take a cognitive test, then go on either the MIND DIET or their usual way of eating.
But, things being as they are, that kind of funding isn’t likely to appear. Next best: if people who voluntarily adopt the MIND DIET or the Mediterranean Diet on their own would email ProHealth.com to report on their progress. Favorable self-reports might create enough wind to shake someone’s money tree.
For those interested in trying the MIND DIET it might be best to aim for a score of 12 on the MIND DIET index. (See table 1.) For those interested in the Mediterranean Diet, consider a book by Nick Nigro and Bay Ewald, Living the Mediterranean Diet: Proven Principles and Modern Recipes for Staying Healthy.
(2) Martinez-Lapiseina, et al. Mediterranean diet improves cognition: the PREMIDED_NAVARRA randomized trial. J Neurol Neurosurg Psychiatry 2013:84: 1318-25. Link to abstract here.
(3) Valls-Pedret, C et al. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial, JAMA Intern Med 2015;175(7): 1094-1-3 Link to abstract here.
(4) Morris, M et al. MIND diet associated with reduced incidence of Alzheimer’s disease, Alzheimer’s & Dementia, (2015) 1-
Link to abstract here.
(5) Morris, M, et. al MIND diet slows cognitive decline with aging. Alzheimer’s &Dementia, 2015 Jun 15. pii: S1552-5260(15)00194-6. doi: 10.1016/j.jalz.2015.04.011. [Epub ahead of print]. Link to abstract here.