November/December 2020 Issue
Brain Healthy Holiday Foods
By Jessica Ivey, RDN, LDN
Today’s Dietitian
Vol. 22, No. 9, P. 24
Festive, tasty dishes that may support cognitive health offer a reason to celebrate.
The holidays are fast approaching. And while many people across the country won’t be able to travel and attend gatherings with loved ones like they used to due to COVID-19, many still will want to celebrate the holidays and enjoy festive meals with their immediate family and other members of their household.
For those concerned with cognitive health and reducing risk of Alzheimer’s disease (AD) and other dementias, diverse options abound for healthful holiday appetizers, sides, main dishes, and desserts. RDs can help clients incorporate a variety of potentially neuroprotective ingredients while pleasing everyone’s palate during this joyful time of year.
Alzheimer’s Defined
AD and other dementias affect millions of Americans. There are more than 5 million Americans living with AD and over 16 million Americans providing unpaid care for them. One out of 3 seniors will die with AD or another dementia.1 It isn’t surprising that many clients are seeking guidance from dietitians regarding nutrition interventions for the holidays and beyond to help prevent or delay the onset of this widespread disease.
Dementia is a broad term for symptoms associated with a decline in memory, reasoning, and other cognitive skills beyond what’s considered a normal part of aging. There are numerous types of dementias and causes, but the No. 1 cause of dementia is AD. AD is a complex neurodegenerative disease that leads to dementia symptoms that get progressively worse. Typically, the first symptom is difficulty recalling new information, followed by disorientation, confusion, and eventually trouble speaking, swallowing, and walking.2
The greatest risk factor for AD and dementia is age, and most individuals with the disease are older than 65. Other risk factors include family history, genetics, previous head injury, and preceding chronic health conditions, including heart disease, diabetes, stroke, high blood pressure, and high cholesterol.3
The pathology of AD is multifactorial, but the key characteristics are amyloid plaques and neurofibrillary tangles and inflammation in the brain, leading to nerve cell death and eventual cognitive impairment.4 To date, lifestyle interventions, including nutrition, exercise, and cognitive training seem to be more promising than pharmaceuticals in terms of prevention and treatment, suggesting that dietitians have an important role to play in the battle against this debilitating disease.
Neuroprotective Diets
Current research shows dietary patterns are more important factors than individual nutrients or specific foods in preventing or slowing the progression of AD. Whole foods containing nutrients with brain health benefits, such as nuts, winter greens, and fish, consumed together as part of an overall diet convey a synergistic effect.5 Dietary patterns rich in unsaturated fats, polyphenols, and vitamins have been shown to be protective against AD; specifically, the Mediterranean diet, the DASH (Dietary Approaches to Stop Hypertension) diet, and the MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) diet all have been found to reduce the rate of AD.6
The culturally based Mediterranean diet consists of foods traditionally eaten in countries surrounding the Mediterranean Sea, and includes vegetables, fruits, whole grains, fish, olive oil, and moderate consumption of red wine. Many health benefits have been attributed to the Mediterranean diet, such as a reduced rate of overall mortality, CVD, some cancers, Parkinson’s disease, and AD, and protection against cognitive decline.6,7
The DASH diet also has shown promise in improving neurocognitive function.8 The diet focuses on fruits, vegetables, whole grains, low-fat dairy, and lean protein, and is low in salt.
The MIND diet is patterned after the Mediterranean and DASH diets but with a special focus on foods that have been shown to benefit cognitive health, such as green leafy vegetables, which have been associated with the greatest protection against cognitive decline. While all three diets are rich in vegetables and fruits, the MIND diet doesn’t emphasize overall fruit consumption but does include at least two servings per week of berries, which have been specifically identified as protective against cognitive loss.9
Unlike the Mediterranean and DASH diets, the MIND diet doesn’t specify high dairy consumption (two to three servings per day in the DASH diet) or high potato consumption (about two servings per day in the Mediterranean diet), and is lower in fish, recommending at least one serving per week vs six or more servings per week in the Mediterranean diet. A recent study found that strong adherence to the MIND, Mediterranean, or DASH diet may reduce AD risk, while even a moderate adherence to the MIND diet also may lower risk.10
While a growing body of research shows that individual components of a dietary pattern may have interactive, synergistic, and even cumulative effects on AD risk, some foods are common in each of these three diets.
Fish and Seafood
Lean white fish is low in fat, while oily fish, such as salmon and albacore tuna, are rich in omega-3 fatty acids. One large prospective study found that weekly consumption of fish and dietary omega-3 fatty acid intake were associated with a decreased risk of developing AD, and a recent systematic review found that higher fish intake could be correlated with a reduced risk of dementia of Alzheimer type.11,12
According to the 2015–2020 Dietary Guidelines for Americans, seafood intake is below the recommended amounts for all age-sex groups.13 To address barriers, dietitians can provide education regarding how to prepare fish and seafood before, during, and after the holidays (see “Meeting Weekly Seafood Recommendations” in the October issue of Today’s Dietitian), as well as budget-friendly tips, such as purchasing frozen and low-sodium canned options.
Green Leafy Vegetables
A large prospective cohort study found that high vegetable consumption was associated with a slower rate of cognitive decline in older adults and that green leafy vegetables had the greatest benefit.14 As with seafood, intake of dark green leafy vegetables is below the recommended amounts for all age-sex groups.13 Dietitians can host virtual cooking classes or demonstrations focusing on how to prepare and cook different types of greens or how to make green salads to promote the consumption of this category of vegetables.
Berries
Greater intake of flavonoids from berries has been associated with a slower rate of cognitive decline in women.15 Clients can purchase berries fresh or frozen for the holidays and easily incorporate them into the diet as part of a snack or breakfast, in a salad or side dish, or in place of a dessert.
Olive Oil
Olive oil is rich in omega-3 fatty acids and polyphenols. Research shows olive oil polyphenols can interfere with the formation of amyloid plaques and neurofibrillary tangles in the brain, and a Mediterranean diet intervention enhanced with olive oil can promote better cognitive performance.6,7 Olive oil is versatile and can be used for sautéing, roasting, grilling, preparing salad dressings, and baking during the holidays.
— Jessica Ivey, RDN, LDN, is a dietitian and chef with a passion for teaching people to eat healthfully for a happy and delicious life. Ivey offers approachable healthful living tips, from fast recipes to meal prep guides, and ways to enjoy exercise on her website, JessicaIveyRDN.com.
[Recipes]
Smoky Pumpkin Hummus
Serves 8
Ingredients
1 (15-oz) can chickpeas (garbanzo beans), with liquid
2 garlic cloves
2 T lemon juice
2 T tahini (sesame seed paste)
1/4 tsp ground black pepper
1 T extra virgin olive oil
3/4 cup pumpkin, canned or cooked, puréed
1 tsp cumin seeds
1/2 tsp smoked paprika
Optional garnish: additional extra virgin olive oil, additional smoked paprika, 1 T pumpkin seeds
Directions
1. Drain the chickpeas, reserving the liquid. Put the chickpeas into a blender or food processor.
2. Add the garlic, lemon juice, tahini, black pepper, olive oil, pumpkin, cumin seeds, and smoked paprika.
3. Blend, gradually adding enough of the reserved chickpea liquid to make a smooth, thick, creamy dip.
4. Pour the dip into a serving dish and garnish with a drizzle of olive oil and sprinkle of smoked paprika and pumpkin seeds, if desired.
5. Serve with whole grain pita bread, sliced into wedges, and fresh vegetables.
If not serving immediately, store in an airtight container in the refrigerator for up to three days.
Nutrient Analysis per serving (hummus alone, not including optional ingredients)
Calories: 100; Total fat: 5 g; Sat fat: 0.5 g; Cholesterol: 0 mg; Sodium: 150 mg; Total carbohydrate: 11 g; Dietary fiber: 3 g; Sugars: 1 g; Protein: 4 g
— Source: Recipe and photo courtesy of Sharon Palmer, MSFS, RDN
Pomegranate Glazed Salmon With Roasted Veggies
Serves 4
Ingredients
1 1/4 lb salmon filet
1 delicata squash
1/2 lb Brussels sprouts
1 1/2 T olive oil
1/2 tsp salt, divided
1/4 tsp black pepper
1/4 cup pomegranate molasses
4 cups fresh spinach and arugula
1/4 cup pomegranate arils
1/4 cup chopped walnuts
Directions
1. Wash and dry the delicata squash and Brussels sprouts. Cut both ends off the squash, then slice in half lengthwise down the center. Use a spoon to scrape the seeds out. Slice into half moons, about 1/4- to 1/2-in thick. Cut the Brussels sprouts in half. Add the squash and Brussels sprouts to a large mixing bowl with the olive oil. Toss to combine and season with 1/4 tsp each salt and pepper.
2. Line a large baking sheet with parchment paper. Place the salmon filet in the center and sprinkle with remaining 1/4 tsp salt. Arrange the squash and Brussels sprouts in a single layer around the salmon. Spoon the pomegranate molasses over the salmon, then bake 15 minutes or until cooked to your preferred doneness.
3. Remove from oven and allow to cool slightly. Arrange the fresh greens on a serving platter. Place the salmon and roasted veggies on top of the greens. Garnish with the pomegranate arils and chopped walnuts. Serve immediately.
Notes
If you prefer a more heavily dressed salad, mix two parts olive oil to one part pomegranate molasses. Drizzle over the salad just before serving.
Nutrient Analysis per serving
Calories: 460; Total fat: 20 g; Sat fat: 3 g; Cholesterol: 90 mg; Sodium: 400 mg; Total carbohydrate: 36 g; Dietary fiber: 3 g; Sugars: 16 g; Protein: 38 g
— Source: Recipe and photo courtesy of Cara Harbstreet, MS, RD, LD
Warm Kale Salad With Sweet Potato, Cranberries, and Pecans
Serves 4
Ingredients
1/3 cup chopped pecans
1 large sweet potato, cut into bite-size pieces
2 T plus 4 tsp olive oil, divided
1/4 tsp salt
2 T balsamic vinegar
2 T cranberry juice
1 T honey
1 medium shallot, thinly sliced
1 large bunch kale, torn into bite-size pieces
1/3 cup dried cranberries
Directions
1. Preheat oven to 350˚ F.
2. Place pecans on a cookie sheet and toast about 5 minutes until fragrant.
3. Remove from the oven and let cool.
4. Turn oven temperature up to 400˚ F.
5. Place sweet potatoes on a cookie sheet and drizzle with 2 tsp olive oil and the salt. Roast for 30 minutes. Pull out halfway through cooking time to shuffle sweet potatoes. Return and cook until roasted.
6. While sweet potatoes are roasting, prepare the vinaigrette. In a small bowl, combine 2 T olive oil, the vinegar, cranberry juice, and honey. Set aside.
7. Preheat a large skillet to medium heat and drizzle 2 tsp olive oil in the pan.
8. Add thinly sliced shallot and sauté until translucent. Add kale to the pan with the shallot and sauté until dark and bright green.
9. Add sweet potatoes, cranberries, pecans, and vinaigrette to the pan. Toss until combined.
10. Serve immediately.
Nutrient Analysis per serving
Calories: 280; Total fat: 18 g; Sat fat: 2 g; Cholesterol: 0 mg; Sodium: 190 mg; Total carbohydrate: 29 g; Dietary fiber: 4 g; Sugars: 17 g; Protein: 3 g
— Source: Recipe and photo courtesy of Betsy Ramirez, MEd, RDN
Mini Mixed Berry Bread Pudding
Serves 8
Ingredients
4 cups cubed whole grain bread
2 cups fresh or frozen mixed berries
4 large eggs
3 T granulated sugar
1/2 cup milk of choice
1/2 T pure vanilla extract
1/2 T ground cinnamon
1/2 cup chopped walnuts or pecans
2 T maple syrup
Directions
1. Preheat oven to 375˚ F. Coat eight soufflé cups or ramekins with cooking spray. Set aside.
2. In a large bowl, mix together bread cubes and berries.
3. In a separate medium mixing bowl, whisk together eggs, sugar, milk, vanilla extract, and cinnamon until well combined.
4. Distribute bread and berry mixture into each soufflé cup or ramekin. Pour egg mixture into each. Top with walnuts or pecans. Bake 20 to 25 minutes or until bread pudding is set.
5. Drizzle evenly with maple syrup and serve immediately.
Nutrient Analysis per serving
Calories: 240; Total fat: 8 g; Sat fat: 1 g; Cholesterol: 95 mg; Sodium: 180 mg; Total carbohydrate: 36 g; Dietary fiber: 3 g; Sugars: 18 g; Protein: 9 g
— Source: Excerpt from The Brain Health Cookbook: Mind Diet Recipes to Prevent Disease and Enhance Cognitive Power, by Julie Andrews, MS, RDN, CD, published by 2020 Press. Copyright © Rockridge by Callisto Media. All rights reserved.
Photography Credit: Alicia Cho; Food Styling: Ashley Nevarez; Prop Styling: Alicia Cho And Ashley Nevarez
References
1. Facts and figures. Alzheimer’s Association website. https://www.alz.org/alzheimers-dementia/facts-figures. Accessed August 5, 2020.
2. Dementia vs. Alzheimer’s disease: what is the difference? Alzheimer’s Association website. https://www.alz.org/alzheimers-dementia/difference-between-dementia-and-alzheimer-s. Accessed August 5, 2020.
3. Causes and risk factors for Alzheimer’s disease. Alzheimer’s Association website. https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors. Accessed August 5, 2020.
4. Pathology. Cure Alzheimer’s Fund website. https://curealz.org/the-disease/pathology/. Accessed August 5, 2020.
5. Cremonini AL, Caffa I, Cea M, Nencioni A, Odetti P, Monacelli F. Nutrients in the prevention of Alzheimer’s disease. Oxid Med Cell Longev. 2019;2019:9874159.
6. Ravi S, Narasingappa R, Vincent B. Neuro-nutrients as anti-Alzheimer's disease agents: a critical review. Crit Rev Food Sci Nutr. 2019;59(18):2999-3018.
7. Martínez-Lapiscina E, Clavero P, Toledo E, et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry. 2013;84(12):1318-1325.
8. Smith PJ, Blumenthal JA, Babyak MA, et al. Effects of the Dietary Approaches to Stop Hypertension Diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure. Hypertension. 2010;55(6):1331-1338.
9. Morris MC, Tangney CC, Wang Y, et al. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11(9):1015-1022.
10. Morris MC, Tangney CC, Wang Y, et al. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement. 2015;11(9):1007-1014.
11. Morris MC, Evans DA, Bienias JL, et al. Consumption of fish and n-3 fatty acids and risk of incident Alzheimer disease. Arch Neurol. 2003;60(7):940-946.
12. Zeng LF, Cao Y, Liang WX, et al. An exploration of the role of a fish-oriented diet in cognitive decline: a systematic review of the literature. Oncotarget. 2017;8(24):39877-39895.
13. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans: Eighth Edition. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-2/. Published January 7, 2016. Accessed August 5, 2020.
14. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology. 2006;67(8):1370-1376.
15. Devore EE, Kang JH, Breteler MMB, Grodstein F. Dietary intake of berries and flavonoids in relation to cognitive decline. Ann Neurol. 2012;72(1):135-143.