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Mini-Med #1 2020- Maintaining Cognitive Reserve, Part 2

Mini-Med #1 2020- Maintaining Cognitive Reserve, Part 2

Mini-Med #1 2020-Maintaining Cognitive Reserve, Part Two

Maintaining Cognitive Reserve-Part 2

Enhanced Blue Zones

Stephanie Taylor MD PhD


Reference: The Blue Zones: 9 lessons for living longer by Dale Buttener.

There have been several stories in the local newspapers about the Blue Zone initiative for Monterey County. This is an excellent first step to better health for all of us. The inspiration and data cited here is taken from The Blue Zones: 9 lessons for living longer published in 2008 through the support of National Geographic. The author visited several communities world-wide noteworthy for very long lived and vital individuals. We will review some of the findings from that book and add updates appropriate for the 21st-century and our local community.


The inhabitants of the blue zone were ordinary people having ordinary lives.

The author estimated that if they followed the United States lifestyle, they would have lost 10 years of good health.

Somehow, they managed to avoid the chronic diseases that afflict Western nations, specifically heart disease, cancer, stroke and diabetes.

These individuals were adults in 1950. How is life different or better at that time?

A common theme expressed in many different languages was the central importance of a sense of life purpose. This was expressed by the elders as “a reason for waking up in the morning”.

There were no institutionalized homes for elders. The family care for the older individuals out of filial duty, affection and community expectations. One individual pointed out that he would lose face with his community if he sent his grandmother away.

Although they are not vegetarians, they have a vegetable-based diet of homegrown and local foods.

They maintain daily activity. They don’t have specific workouts because they are naturally physically active with daily chores.

They have a degree of serenity and handle stress without difficulty.

They have lifelong friends that are maintained through ritualized companionship. This is often done through cultural, social, religious or special interest groups.

They set aside a fixed time weekly for rest, social interaction, reflection and good food.

The Power Nine

The author distilled his research into the Power 9 which consistently appeared to enhance longevity in all cultures studied. Here is his list:

1 – Move naturally. Engage in regular low intensity exercise. Many of the blue zoners were shepherd, gardeners or went on regular nature walks. As falls are a common risk for older individuals, balance training was recommended in addition to the strength from general exercise. This could be yoga, tai chi or simply alternating standing on one foot while you’re brushing your teeth. It’s helpful to develop a walking group through the Sierra Club, Volksmarching or local interest groups.

2 – Stop eating when you feel 80% full. This results in an automatic calorie restriction. Decrease portion size, cup size and plate size. Research shows that with a smaller portion, smaller plate or smaller cup individuals consume 30% less calories without being aware of it. Eat more low caloric density foods. For example, a hamburger, French fries and a Coke has 1500 calories whereas the average meal of the long-lived is 400 cal. They also eat early, and the largest meal is either the first or second meal of the day.

3 – Eat more plants. Avoid processed meat and packaged foods. Emphasize beans, whole grains and garden vegetables. Individuals who eat nuts regularly have a dramatic decrease in heart disease, probably from the essential fatty acids. Recommendation is 1.5 oz of nuts and 4-6 vegetables per day or two vegetables per meal.

4 – Grapes. The long-lived consumed one serving of beer, wine or spirits daily consistently and in moderation and almost always with friends in a social situation.

5 – Sense of purpose. Why to wake up in the morning? Figure out what is personally meaningful for you and find a partner in your activity. This is the section where learning a complex new skill is recommended. Learn to play a musical instrument or learn a new foreign language. This engages more senses than the puzzles and generates a social connection as well.

6 – Downshift. Take a moment to enjoy the day. Meditation also serves this purpose. Eliminate or limit electronic noise. This decreases stress and inflammation which in turn accelerates aging.

7 – Belong – participate in the like-minded community. This could be a faith community or a shared goals community.

8 – Loved ones come first. Maintain closeness in the family. Many of the long-lived have an ancestor shrine or spend time in the company of ancestors and they pass this on to the younger generations. Quote: “We are not islands in time but are connected”

9 – Surround yourself with people who share Blue Zone values. Maintain social connectedness. Find friends who support but also challenge you and check in daily. Don’t be a grump.

References for Mini-Med 2020-1

Stephanie Taylor MD PhD

Real Organic Project

Why the Real Organic Project exists:

The Real Organic Project is a farmer-led movement created to distinguish soil-grown and pasture-raised products under USDA organic. In response to the lack of enforcement of some vital USDA Organic standards to protect soil health and animal welfare, organic farmers rallied together to fight to protect the integrity of the organic label.

Organic farming has always been based on “feed the soil, not the plant.” Real organic farming relies on the microbial activity of the soil to slowly release nutrients to the plant. In recent years, many organic farmers have grown distraught over USDA decisions that have negated this fundamental truth, even though growing in soil is original to the USDA Organic standards. Further, rules have been overlooked regarding the proper care of grazing animals resulting in cruel and unhealthy circumstances.

Where things stand today:

The lobbying efforts of Big Ag ultimately won, allowing the input-dependent confined animal operations and hydroponic industries to bend the rules for their own benefit. Family farmers meeting the letter and spirit of organic law are suffering while consumers are once again in need of transparency in the marketplace.


The organic marketplace was a $52.5 Billion in 2019. In contrast, the US profit from illegal drug trade is $100 Billion. As the EU tightened standards, the US became a dumping ground for fake organic grain. Approximately 70% of imported organic soy and 30% of imported organic corn is falsely certified as organic. Turkey and the UAE are primary shippers. Low cost fake grains cause the legitimate farmers to lose market to lower cost frauds, and consumers unwillingly consume non-organic grain products, eggs, meat and dairy. There are more imports from Turkey than it has in certified organic acreage.

This is not a victimless crime, but it is an enforcement free crime. Penalty for organic smuggling is $18,000 and no significant risk of jail time.

What to do: Use the Cornucopia scorecard to track changes in the ratings of organic food producers. https://www.cornucopia.org/

Buy locally from farmers that you know: https://www.montereybayfarmers.org/

Social determinants of Health

The Food is Medicine Coalition http://www.fimcoalition.org/

20% due to medical intervention, 40% SES, 10% environment, 30% health behaviors.

Therefore: Patients receiving Medically Tailored Meals are 23% more likely to be discharged home than to an institution; deliver a 28% savings in monthly healthcare costs for patients with life threatening illness and 50% fewer hospital admissions.

Food Insecurity

What is the relationship of food insecurity to health- after all calories are calories, aren’t they? Well, no. just because something is not counted does not mean it doesn’t count.

The Ceres Projecthttps://www.ceresproject.org/

Ceres operates three kitchens and two organic gardens in the Bay Area. There are 13 affiliate programs in the US and one in Denmark.

Teen Empowerment:

All the meals Ceres provides are prepared by youth ages 14 and up who volunteer in our ¾ acre food production garden and three commercial kitchen sites in Marin and Sonoma Counties. Ceres’ expert mentors give teens the opportunity to learn to cook and eat for health, gain the skills to be successful at school and work, develop leadership, become change-makers in their community, and discover the joy of giving back. The average youth works at Ceres for a year and many for much longer. Two youth serve as voting members on our board of directors and all our youth are authentically engaged in planning and decision-making throughout our organization.

Community Education:

We educate the whole community about the vital importance of a diet based on healthy organic and locally produced foods, and provide the knowledge, skills and inspiration for people to make and maintain real change in how they eat. We publish and distribute Nourishing Connections Cookbook, offer healthy eating classes for the community, partner with local community clinics to teach nutrition through our Nutrition for Wellness Program, offer catering featuring nutrient-rich, organic and locally grown whole foods, and actively work to educate our volunteers, donors and especially health professionals about the difference that whole organic foods can make for themselves and their patients.

Kaiser is leading in value-based food purchasing and is closely followed by Dignity. The latter increased their organics 20% in 2019.

Healthy food in Healthcare: https://noharm-uscanada.org/healthyfoodinhealthcare

Healthy Food Playbook: The “Delivering community benefit: Healthy food playbook” is a suite of resources to support hospital community benefit professionals and community partners in developing community health interventions that promote healthy food access and healthier food environments. https://foodcommunitybenefit.noharm.org/

Changing the Adult Brain

Research show that the adult brain can generate new neurons. This allows the brain to adapt to new learning (neuroplasticity). The ability to renew the brain is affected by many environmental factors. Research supports a supportive role for an enriched environment, calorie restriction, nutritional phytochemicals, specifically curcumin, resveratrol, essential fatty acids, blueberry polyphenols, and grain with high soluble fiber. Inflammation impairs neurogenesis. Inflammation can be from trauma, toxins or bacterial and viral infection. High fat and sugar diets promote dementia probably through production of chemical that cause cell damage. Lack of essential vitamins and other co-factors in the diet are also linked to cognitive decline.

Enriched Environment-Play

Language-Most of the published studies enrolled persons who are bilingual or multilingual from a young age. On average, being multilingual adds years of vital life with the maximum improvement of 10 years. Learning a new language as an adult is less studied, but the current evidence demonstrates the activation of multiple neuronal systems in language learning. This would suggest significant activation of neural plasticity, as language learning requires auditory acuity, verbal capacity, analysis, learning and the verbal engagement of another person.

Exercise– Multiple studies show improved cognitive function in individuals with moderate fitness utilizing multiple measures.

Music– Music has a strong effect on neuroplasticity. There are several research papers and reviews of music training on cognitive function, but the field is just beginning to get appropriate attention. The NIH/Kennedy Center Workshop on Music and the Brain published its results in March 2018. The ability of music training to enhance other functions is called a “pour over” effect. Benefits are seen in language development, attention, visuo-spatial perception and executive function. In one study, individuals over age 75 were followed for 5 years. Those who frequently played a musical instrument had a lower rate of dementia. In this study, music’s protective effect was stronger than swimming, reading, writing or puzzles.

In another study, musically naïve adults (60-85) were given 6 months of “intensive” piano lessons. They had a 30-minute lesson each week and practiced a minimum of 3 hours a week. They had “marked” improvement in working memory, perceptual speed and motor skills compared to a matched untutored group.

For those who do not wish to play an instrument, choir singing, and dancing also show a beneficial effect.

You may correctly conclude that there are other factors at “Play” here, specifically the social connection formed by playing a musical instrument, singing dancing or engaging in a sport.

You may enjoy the following lyrics from the hit song by Des’ree:

You Gotta Be” is a R&B and soul song by British singer Des’ree

Released 1994

Listen as your day unfolds

Challenge what the future holds

Try and keep your head up to the sky

Lovers, they may cause you tears

Go ahead release your fears

Stand up and be counted

Don’t be ashamed to cry

You gotta be bad, you gotta be bold, you gotta be wiser

You gotta be hard, you gotta be tough, you gotta be stronger

You gotta be cool, you gotta be calm, you gotta stay together

All I know, all I know

Love will save the day