Brain Health: The Heart of the Matter

By David X. Cifu, M.D., Senior TBI Specialist, U.S. Department of Veterans Affairs, Associate Dean of Innovation and System Integration and Eminent Scholar, Herman J. Flax, MD Professor and Chair, Department of Physical Medicine and Rehabilitation, Senior Consultant, Sheltering Arms Institute, Virginia Commonwealth University School of Medicine

The impact and durability of the ever growing array of cutting edge technologies, smart pills, and innovative rehabilitation approaches used to enhance recovery after acute neurologic trauma or insult can be significantly amplified by addressing several scientifically proven, easily affected modifiable factors. Both individuals and every day clinicians can take steps to improve one or more of these elements that will not only improve overall functioning, wellness and longevity but also specifically diminish the short- and long-term impact of brain insult. In fact, these factors account for up to 40% of the risk for dementia, so, why shouldn’t all therapeutic programs manage these factors? Simply put, they may not seem as exciting or not be as profitable as the standard “magic bullet” approach, so they often are overlooked. The good news is that these lifestyle modifications can be integrated into comprehensive “curative” programs or done independently but either way they will make all interventions more effective. Importantly, these wellness approaches will improve heart, kidney, liver, gut, mental, brain and every other organ’s health, so there’s a lot of bang for the buck in them. Also, you don’t have to do all of them at once to begin getting benefit, so just start with 1 or 2, and begin the overall wellness journey!

1.  Be Active: Physical activity, 30-60 minutes/day, preferably outdoors in nature and with a group builds brain health. While the type of activities isn’t important, walking, swimming, and bicycling are good choices, with goals of 5,000 steps a day, elevating heart rate to 65% of maximal (~110 BPM) and finding activities that you will do every day. More blood and oxygen flow to the brain helps with healing, symptom management and dementia prevention.
2.  Eat Right: The more vegetables, nuts, legumes and non-soluble fiber (30+ grams/day) you eat per day, the healthier you will be. No fancy diets are needed; just limit animal protein and fats, keep your calories <2,000/day, drink plenty of water, and, if in doubt, EAT MO’ VEGGIES! While the Mediterranean Diet is a good starting point, lean towards the Vegan end of the scale. As you’re working on eating healthier also try to avoid alcohol, tobacco products (including vaping) and drugs (including marijuana), since they all compete with healthy nutrients for key receptors in your brain!
3.  Stay Trim: Maintaining your weight on the lower side has innumerable benefits, from reducing arthritic pain to lowering blood pressure to enhancing sleep to preventing diabetes! So, be mindful of your weight (Body Mass Index between 18-24), monitor your waist size (waist to hip ratio <0.85), and identify the many ways of keeping your weight in the healthy range (#’s 1 and 2 above are a good start). While it’s tempting to believe the ever changing clothing size labels created by manufacturers who are looking to flatter you into buying new styles and fashions, the scale and tape measure are your real friends, so believe what they say. Lower weight enhances longevity, eases pain, enhances sleep and helps the brain prosper.
4.  Take It Easy: Daily attention to your level of stress and frustration is important. Identifying factors that affect stress is the first step to improving it. While many can self-monitor, there are also countless wearables and APPS available to help you. Once you’re mindful of your stress levels, a range of approaches can be used to manage elevations, from breathing exercises, to calming music, to meditation, to counseling. Addressing items #1-3 above will also help you to de-stress, so picking one or more of these may be your best first step.
5.  See Your PCP: Primary care clinicians are the foundations of health promotion and prevention, and every person should have one and see them at least annually. Even if you are fully aware of your health and wellness needs, getting the expert opinions of trained professionals is important. Oftentimes, your PCP will be your best cheerleader and will offer you the encouragement and information needed to take even more steps to enhance your physical and mental health. Population health science is as solid as it gets and its Big Data helps guide your PCP to monitor and counsel you in ways that will keep you healthy and enhance your brain’s recovery, reduce symptoms and prevent degeneration. So go regularly and create a wellness alliance!
6.  Be Social: Social engagement and community integration are key elements to support your brain’s recovery and resilience. They are also keys to supporting your mental health, getting you involved with activities outside the house, and offering you the loving attention of others – all vitally important to brain health. Of course, it’s important to make sure to “hang out” with people with healthy habits and your best wishes in mind. If you can also add an element of productivity (work, volunteer, hobbies) to these activities, you will be providing your brain with another important tool to enhance recovery, reduce symptoms and prevent degeneration.
7.  Get To Sleep: The healthy heart and brain both need restorative sleep every night, ideally 7-8 hours. There is no “sleep bank” where you can borrow from on busy days or deposit into on the weekends, so make every night count. During periods of rapid eye movement (REM) sleep, your brain processes the day’s events and exposures, and also rids itself of the day’s waste, so it’s vital for brain health. Approaches to restorative sleep include optimizing sleep hygiene like preparing yourself and your environment, using relaxation strategies, getting into sleep shape (i.e., #’s 1-6 above), and using sleep cognitive behavior therapy (CBT) APPS.

So, for your brain’s sake, whether if you’re searching for that “miracle cure” or you just want to guarantee the success of your other treatments, it’s time to take “heart healthy” to the next level.