Good brain health

Dr Ayesha Sherzai Plant-based diet key to good brain health

For a long time, says Ayesha Sherzai, the brain was this elusive organ that nobody had a better understanding of but thanks to neuro imaging and technology we now have a better view of what our brain looks like and how it functions.

“When we look at imaging like angiograms and MRI we have found that the brain is one of the most vascular organs in the body.”

Referring to a graphic representation (image opposite) presented as part of the Holistic Holiday webinars, she said you can tell there are more blood vessels than brain tissue.

“There are millions of tributaries traversing inside and outside of the brain carrying oxygen and vital nutrients to different parts of the brain. This amazing organ is responsible for so many things. It’s our personality, its our feelings, our emotions it’s how we see things. It’s how we process information, it’s our memories. So, imagine when a highway is blocked - that is what stroke is all about.

“Stroke essentially means when there is damage to these arteries, whether it is not getting blood to part of the brain or the blood vessels are damaged and blood is not reaching a particular part of the brain. You can see from different neuro imaging how plaque forms inside the arteries and blocks these pathways.

“There are two main types of stroke. With an Ischemic stroke, plaque forms inside the arteries and that plaque causes the formation of clots and there is an impediment to the flow of blood.

Then there is Haemorrhagic stroke which means that the walls of the arteries get very weak and damaged, and they break so there’s bleeding into the substance of the brain.

“Both types are incredibly dangerous but 80 to 85% are Ischemic stroke, the clot type. For Haemorrhagic stroke the mortality is Dr Ayesha Sherzai MD is a stroke neurologist and with her husband, Dean, is part of teamsherzai.com. Dean is a medical doctor and behavioral neurologist. Both have devoted their careers to exploring the prevention of Alzheimer's and other neurodegenerative diseases. In this article, Ayesha discuses the role of lifestyle in preventing the most debilitating disease: stroke.

very high. There are other types of stroke. When we talk about stroke, people are used to talking about having a paralysed arm or leg or not being able to see or speak – something really profound. Silent strokes occur often

“But there are silent strokes that occur all our lives. These are tiny and occur in different parts of the brain because the smaller arteries, the capillaries, they get either blocked or damaged because of multiple factors.

“People may not notice this. They may carry on with their lives and have minimal symptoms like a mild headache or some mild memory problems or some mild symptoms like numbing or tingling in one part of the arm or leg.

“It’s a very important fact because when you accumulate a lot of silent strokes people tend to have cognitive disorders. It’s called a vascular cognitive impairment. So, essentially, over many years people lose their speed in processing information. They take their time to remember things, they take their time to understand things. Their walking gets slower, their speech gets slower. They kind of feel a little disconnected from everyone else.

“That’s silent stroke and it’s usually not evaluated in an emergency setting or in a doctor’s clinical setting. People may think, well, that’s how you grow old. You kinda get slower but it is actually an accumulation of these silent strokes that result in these kinds of symptoms.” Lifestyle related causes

Referring to The Lancet study on the Global Burden of Disease, she said it was found that of 188 countries reviewed, what contributed to stroke were multiple factors mostly related to lifestyle. Lifestyle factors are generally considered to be matters that an individual has personal control over.

“These factors include: high blood pressure, diets low in fruits, high body mass index (BMI), low physical activity, alcohol use, high cholesterol, diets high in sodium and low in vegetables and whole grains, air pollution, high plasma glucose, second-hand smoke, and diets high in sugar-sweetened beverages.

“A lot of people ask me, when they first come into my clinic, what can I do to reduce my risk for stroke. A lot of people who come in with minor stroke or TIA’S (Trans Ischemic Attack). These are strokes that happen within a few minutes and they go away. So, the clot that clogged an artery didn’t stay there, it just dissolved and it didn’t cause any particular damage, but these individuals have a very high risk of having strokes later on as well.

“The first and foremost thing I say is change your diet. Everything else follows next. About 70 to 80 per cent is your diet and then the rest of it is exercise, smoking cessation etcetera, etcetera. When you look at it, most deaths and disabilities in the United States are preventable and related to nutrition.

Dr Sherzai says stroke risk factors split into two categories: modifiable and non-modifiable. In both cases, whether for Ischemic stroke or Haemorrhagic stroke, non-modifiable risk factors include age, sex, race and ethnicity. For Ischemic stroke, modifiable risk factors include, hypertension, smoking, waistto-hip-ratio, diet, physical inactivity, hyperlipidaemia, diabetes, alcohol, cardiac causes, apolipoprotein B to A1. Stroke risk factors

For Haemorrhagic stroke, modifiable risk factors include, hypertension, smoking, waist-to-hip ratio, alcohol and diet. Genetics can play a part in both types of stroke with Apolipoprotein B to A1 mostly occurring in young people.

But, she says, there is a profound amount of evidence showing that diet makes a difference. Adherence to a whole food, plantbased diet reduces the risk of stroke. The DASH, Mediterranean, and prudent eating patterns reduced the risk of stroke but the standard western diet was associated with increased stroke risk.

“The harmful foods are added salt, added sugar, meat and high saturated fatty foods like cheese. If you eat plants, you reduce your inflammation, you reduce your oxidative stress at the cellular level and it also regulates your glucose metabolism and your lipid metabolism which can lead to damage to the inner linings of your arteries.

“Our arteries need to be nice and elastic and allow blood to flow. It’s so important for the brain, the energy hungry brain, to keep on getting oxygen and nutrients on a regular basis. Imagine these arteries getting hardened and damaged. It’s obviously going to cause stroke.

“The Mediterranean diet comes back over and over again and there’s been a lot of studies that have looked at Mediterranean dietary patterns, it’s impact on stroke and how it can prevent stroke.

“I did a lot of study at Cornell as a resident and a fellow, on the Mediterranean dietary patterns. What I found was yes, it is important to look at dietary patterns but what is it in these diets that stands out? Is it the fat, is it the nuts? What is it? Plants are the key

“What I found is that when you look at the elements of these diets, whether its DASH or Mediterranean - it’s essentially plants.

She says the ideal diet for stroke prevention: 1. Emphasizes whole food, plant-based eating 2. Eliminates meat, poultry and dairy and 3. Specifies consumption of berries, green leafy vegetables and beans.

“The other great news is that it’s not about perfection. Every increase in plant intake reduces the risk of stroke.”

She recommends working towards eliminating sugar, meats, pastries and sweets, cheese and dairy and extracted tropical oils.

“I know there has been a lot of confusion about coconut oil but coconut oil is more than 90 per cent saturated fat. It damages the arteries the same way that meat and cheese and dairy do.”

Exercise is also important.

“There is a lifelong inverse relationship between physical exercise and stroke. Compared with physically inactive individuals, those who are highly active (2 hours of daily vigorous activity) are estimated to have a 25 to 30 per cent lower risk of stroke. There is no medication that equals that.

“If people exercise regularly and eat a healthy diet they will avoid silent stroke. The exercise needs to be moderate to strenuous, it can’t be just walking from your living room to your kitchen. You need to make exercise as important as the air you breathe or as you sleep or any other meaningful activity that you do.

In summary, Dr Sherzai concludes, 1. Diet is profoundly important for stroke prevention. 2. A whole food (unprocessed), plant-based diet is associated with the lowest risk of stroke. 3. Progress over perfection is what counts. You don’t have to be perfect. 4. Living a physically active lifestyle compounds the salutary effect of diet on brain vessels.

Socca Bread (Chickpea Flatbread)

This is so easy to make and is a workable pizza base. Other ideas are pancakes, pita bread or wedges for dipping. Serves: 2

INGREDIENTS

1 cup 1 cup 1/4 tsp 1/4 tsp 1 tsp 1 tsp chickpea flour water onion powder garlic powder thyme (dried) rosemary (dried)

Pizza topping idea:

pizza tomato paste cherry tomatoes olives baby spinach leaves red onion

METHOD

1. Add the chickpea flour, powders and herbs to a mixing bowl. 2. Add water gradually and whisk well. 3. Let the batter sit for 10 minutes while heat the non stick frying pan. 4. Once frying pan is hot, pour in half the batter, use a spatula to spread mix to your desired thickness. 5. Just like a pancake flip when the edge looks cooked and a few bubbles appear on the service. Test by carefully lifting one the edges, the batter should lift easily. 6. Flip and cook other side for another three to four minutes. 7. Remove from heat to a bread board and add your desired toppings before heating for around 8 minutes in a pizza cooker or kitchen oven.

A Mexican quick pickled red onion recipe. Perfect for burgers, sandwiches, salads or pizza. Serves: 2 cups

INGREDIENTS

2 tsp 1 1 tsp 1 cup 2 Tbsp 2 Tbsp 2 2 1 dried marjoram or oregano bay leaf black peppercorns water white vinegar apple cider vinegar garlic cloves, peeled and sliced in half red onions lime (optional)

Tip

To get the closest, most authentic flavour of Mexican pickle, use marjoram. Mexican oregano, traditionally used, is not the same as the regular oregano. Mexican oregano has a more citrus taste where regular oregano is more sweet.

METHOD

1. Add all ingredients except the onion to a pot and bring to boil. 2. When boiling vigorously, turn off the element and add the onion. 3. Allow to completely cool before straining, remove the bay leaf 4. Add the onion mix into a jar and finish with the juice of one lime (optional). 5. Pour the strained liquid into the jar until full. 6. Seal and place in the fridge.

The pickle will be ready to use after one hour of sitting in the brine, and will last in the fridge for around a month