Zhenzhen Zhang

DOI
10.5281/zenodo.20025187

Resource type
Journal article
Publisher
New England Journal of Traditional Chinese Medicine
Published in
New England Journal of Traditional Chinese Medicine, V(4), ISSN: 1536-8017, 2023.

The MIND diet’s benefits for brain health are currently in the spotlight. The MIND diet is an improvement on the basis of the Mediterranean and DASH diets; “MIND” is an abbreviation for “Mediterranean-DASH Intervention for Neurodegenerative Delay”. The Mediterranean diet, which has been popular for years, is believed to lower the rate of death from heart disease, protect the blood vessels in the brain, and decrease the risk of stroke and memory loss, and these benefits have been confirmed by research institutions. The DASH diet is intended to lower high blood pressure. Conditions of declining mental function, such as Alzheimer’s disease, have a close relationship to diseases of the heart and cerebral blood vessels, and cardiovascular diseases are also closely linked to diet. In the past decade, a substantial body of scientific research has proven that the digestive system has a direct and multidimensional impact on the brain, hence the saying that the intestinal tract is the human body’s second brain. Simply put, an unhealthy diet leads to increased incidence of cardiovascular, cerebrovascular, and metabolic diseases (such as diabetes). Furthermore, cardiovascular diseases, cerebrovascular diseases, and diabetes are among the main factors leading to brain atrophy, dementia, and Alzheimer’s disease. Today, I will endeavor to combine the up-and-coming MIND diet with therapeutic dietary concepts and approaches based on ancient Chinese medicine pattern diagnosis. I will introduce a method of diet therapy that can be used to guide patients in clinical practice, which I expect will be helpful in preventing senile dementia or delaying its progression.

In specific terms, the Mediterranean diet consists of a daily intake of 6-12 servings of fruit and vegetables, 4-6 servings of beans and grains, 1-3 servings of low-fat dairy products, 1-2 servings of meat (poultry, fish, and shellfish), and a glass of red wine. Its defining characteristic is that it mainly features plant-based foods, such as whole grains, vegetables, beans, fruit, and nuts. Olive oil is the primary source of fat. The diet includes appropriate amounts of fish, seafood, dairy products, and poultry.

The DASH diet consists of a daily intake of 6 to 8 servings of whole grains; 4 to 5 servings of vegetables; 4 to 5 servings of fruit; 2 to 3 servings of fat-free or low-fat dairy products; 6 ounces (168 grams) of lean meat, poultry, or fish; 2 to 3 servings of fat or oil (1 teaspoon of vegetable oil, 2 tablespoons of salad dressing). It also includes 4 to 5 servings of nuts, seeds, and dry beans and peas per week (1 serving refers to 1/3 cup of nuts, 2 tablespoons of peanut butter, 2 tablespoons of seeds, or ? cup of peas). The diet limits sweets and added sugar to 5 or fewer servings per week (1 serving refers to 1 tablespoon of sugar, jelly, or jam). Its defining characteristics are low salt, low sugar, low saturated fat, and large amounts of vegetables and whole grains. It is used to lower blood pressure and bad cholesterol levels.

The standard serving sizes are as follows: whole grains, 1/2 cup cooked grains (16 grams uncooked grains); vegetables, approximately 1/2 cup cooked vegetables (75 grams raw); fruit, 150 grams; nuts, 1/3 cup or 30 grams, or a handful; berries, 1 cup (190 grams); beans, about 57 grams (uncooked); raw fish, 4 ounces (113 grams); cooked lean red meat, 65 grams (about 100 grams raw); lean poultry, 80 grams (100 grams raw); cooked fish, 100 grams (115 grams raw). In actuality, we only use these serving sizes for reference to understand the structure of western diets; there is no need to stick to them.

The MIND diet combines the large amount and variety of vegetables, fruit, olive oil, and red wine from the Mediterranean and DASH diets with berries, nuts, and restriction of foods that trigger inflammation, such as red meat and processed foods. By increasing consumption of berries and dark green leafy vegetables, which can fight inflammation, this diet emphasizes foods that benefit the brain. Most importantly, a study with 923 participants showed that this diet reduced the rate of Alzheimer’s disease by approximately 53%. Scientists believe that the MIND diet contains foods that are rich in certain vitamins, carotenoids, and flavonoids; these foods are thought to protect the brain by reducing oxidative stress and inflammation. Although the purpose of the MIND diet is to promote brain health, it also has benefits for cardiovascular health, diabetes, and certain forms of cancer because it contains components from the Mediterranean and DASH diets that have already been shown to reduce the risk of these diseases. The higher-scoring group that participated in the MIND diet research had better cognitive function, larger total brain volume, higher memory scores, lower risk of dementia and a relatively slower rate of cognitive decline, even when participants with a history of Alzheimer’s disease and stroke were included (1). Research results, including assessments and brain imaging, show that the MIND diet is a useful long-term prevention and treatment option for patients with various types of dementia (2)(3).

The MIND diet model and the healthy foods it recommends are as follows:

Every day: 3 or more servings of whole grains, 1 or more servings of non-leafy vegetables.

Every week: 6 or more servings of green, leafy vegetables; 5 or more servings of nuts; 4 or more servings of beans; 2 or more servings of berries; 2 or more meals with poultry; 1 or more meals with fish. Use olive oil daily in food preparation.

Unhealthy foods that are not recommended are those that contain high levels of saturated fats and trans fats:

Fewer than 5 servings per week of pastries and sweets per week, fewer than 4 servings per week of red meat (beef, pork, mutton, and products made from them), less than 1 serving per week of cheese and fried food, less than 1 tablespoon of butter or margarine per day.

In Chinese medicine, dietary therapy is based on individual characteristics and seasons. Foods may be cold, hot, warm, or cool; a person’s physical constitution may be cold or hot, replete or vacuous; and a given region may be in spring, summer, fall, or winter. Our diets must also adhere to the theory of “harmony between humans and nature” by using the hot and cold properties of foods and seasons to correct deviations of cold, heat, vacuity, or repletion in the human body. To put it simply, this is a pattern diagnosis-based diet in which we heat up that which is cold, cool down that which is hot, make vacuous that which is replete, and supplement that which is vacuous. For instance, a person who has cold hands and feet should eat more warm and hot foods, and eat less raw and cold food; they should reduce their consumption of foods that are cold or cool. A person with tidal heat, night sweats, and hands and feet that are dry and hot should eat more cold and cool foods, with the intent of clearing heat, and so on.

At present, research has proven that the MIND diet reduces the incidence rate of Alzheimer’s by 53%. Following its food categories and servings, we can take the properties of physical constitutions, foods, and seasons into account, enabling us to produce an individual pattern diagnosis-based diet for each person. This allows us to better protect the brain, heart, and blood vessels, and prevent and delay the progression of aging.

Table 1: Cold, hot, replete, and vacuous constitutions, and their corresponding food properties according to pattern diagnosis theory in Chinese medicine

1. A cold constitution in spring and summer is a state of internal cold and external heat, so the diet should primarily consist of neutral or warm-natured foods. In autumn and winter, the interior and exterior are both cold, so the diet should focus on warm and hot foods.

2. A repletion heat constitution in spring and summer is a state of internal and external heat, so the diet should primarily feature cold and cool foods. Most nuts are warm-natured, so people with repletion heat should eat less of them; excessive consumption will generate heat and phlegm. In addition, all types of alcohol are hot-natured, so people with repletion heat constitutions should not drink alcohol in spring and summer. A repletion heat constitution in fall and winter is a state of internal heat and external cold, so the diet should consist mainly of cool and neutral foods. In winter, small amounts of red wine may be consumed.

3. For people with a phlegm-heat constitution, the phlegm and heat are tangled up together, making it difficult to clear the heat and transform the phlegm. Over the long term, they should mainly eat cold and cool foods to correct the heat. People with phlegm-heat should avoid eating nuts or drinking alcohol; otherwise, they will easily generate more phlegm and heat.

4. People with a damp constitution should eat a diet consisting mainly of neutral and warm foods that fortify the spleen, and they should not eat nuts. They may drink red wine in small amounts.

5. People with insufficiency of yin/blood should eat a diet consisting mainly of cool and neutral-natured foods, and avoid all foods that are dry and hot, especially in the summer and fall.

6. People with qi/yang vacuity should eat a diet that primarily features neutral, warm, and hot-natured foods. In the winter, they should eat more warm and hot foods.

Properties of daily foods recommended by the MIND diet according to Chinese medicine:

Grains: Mostly cool and neutral or warm-natured; not too cold or too hot. Therefore, they are suitable for almost all constitutions. Whole grains are best.

Beans: Mostly cool-natured (e.g. mung beans) and neutral-natured (rice beans, black beans, soybeans, hyacinth beans, broad beans); also suitable for most people.

Vegetables: MIND recommends eating more green, leafy vegetables. There are few very cold or very hot-natured vegetables, 〖JP2〗with the exception of spices like red peppers, scallions, and ginger. Most are cool, neutral, or warm-natured. People with cold patterns can eat almost all vegetables after they have been heated, and small amounts of cold vegetables are acceptable. People with heat patterns have more options and can eat more cold vegetables.

Berries and fruits: There are few very hot fruits; people with cold patterns can mainly eat warm and neutral-natured fruit. People with heat patterns have more options to choose from and there are fewer contraindications. But the MIND diet recommends eating more berries, such as strawberries, blueberries, and cranberries. Aside from these, one can choose fruits that are low in sugar and not particularly sweet, such as apples, pears, peaches, and apricots. Grapes and watermelon are too sweet, so they should.

Nuts: Mostly consisting of good fats, they are primarily neutral or warm-natured. They can be eaten in moderation year-round, but excessive consumption will generate phlegm and damp.

Meats: MIND recommends eating appropriate amounts of white meat, with no fewer than 2 servings a week, while no more than 4 servings of red meat should be eaten in a week. We should choose the types of meat that correspond to cold or hot constitutions.

Seafood: This is the best source of protein, but it is mostly cold or neutral in nature. People with vacuity cold constitutions can use hot-natured spices to neutralize the cold nature of seafood.

Wine: This is a feature of the Mediterranean diet. One glass a day is beneficial and harmless, but more than that will have the opposite effect.

Olive oil: This is the universally recognized healthy oil in the Mediterranean diet. It can be used for daily food preparation.

Foods that MIND does not recommend or advises to avoid are:

Any butter or margarine; if it is absolutely necessary to have some, do not consume more than 1 teaspoon per day.

Any fast food or fried food; if it is absolutely necessary to have some, do not consume more than once per week.

Sweets; if it is absolutely necessary to have some, do not eat them more than 5 times a week.

Table 2: The following are examples of foods that may be considered based on the MIND dietary recommendations in combination with constitutional pattern diagnosis and seasons in Chinese medicine:

Conclusion

Senile dementia progresses slowly; brain imaging studies have shown that 10 or even 20 years before symptoms appear, the brain has already begun to decline and atrophy. Moreover, through treatment and lifestyle improvements, brain atrophy can be reversed. This paper attempts to combine the western MIND diet, a dietary model developed to delay cerebral and neurological aging, with ancient Chinese medicinal dietary therapy using pattern diagnosis concepts, thereby establishing a pattern diagnosis-based dietary model based on individual characteristics and seasons that can delay cerebral and neurological aging. The Mediterranean diet, the MIND diet, and the pattern diagnosis-based dietary model in Chinese medicine all provide guiding principles that instruct people on how to choose the best diet for themselves. The foods listed above are provided for reference only and there is no need to stick to them. Foods with a neutral nature are suitable for the average person; when choosing food, people without a tendency to heat or cold can combine cold, hot, warm, and cool foods, but they should not eat foods that are too cold or too hot. If the general public was able to choose types of food based on a reasonable combination of pattern diagnosis and MIND, I believe this would drastically reduce the incidence rates of senile dementia and Alzheimers disease. If others in our field were to use this approach in a clinical study with a large sample size, obtain convincing results, and popularize it worldwide, this would be incredible news for elderly people all over the world.

References

1. Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA, Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimer’s & dementia. 2015 Sep 1;11(9):1015-22.

2. Healy, Elizabeth: Impact of the MIND Diet on Cognition in Individuals with Dementia, https://content.iospress.com/articles/journal-of-alzheimers-disease/jad230651

3. Alime Thomas etc. : Association of a MIND Diet with Brain Structure and Dementia in a French Population, https://link.springer.com/article/10.14283/jpad.2022.67

Author information:

Zhang Zhenzhen is a traditional Chinese medicine practitioner and editor-in-chief of the New England Journal of Traditional Chinese Medicine. She has more than 40 years of clinical experience in traditional Chinese medicine. She graduated from the Department of Traditional Chinese Medicine of Hebei Medical College and the China Academy of Traditional Chinese Medicine. He has practiced medicine and taught in China, Japan, and the United States. Dr. Zhang has taught at the New England Acupuncture College in Massachusetts for over 20 years. At the same time, he has worked part-time at the Women’s Health Center of Salem Hospital in Massachusetts for nearly 20 years.