The MIND Diet: 2nd Edition: A Scientific Approach to Enhancing Brain Function and Helping Prevent Alzheimer's and Dementia Fully Updated with New Recipes, Meal Plans, and More Tips and Tools Based on the Latest Research

PREFACE

Dear Reader,

If you’re new to the MIND diet, it’s helpful to know MIND is an acronym for a dietary pattern created to study how what we eat affects our brain health. It stands for Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay, and research suggests following it is associated with better cognitive performance and a reduced risk of brain diseases.

More than 150 new research papers have been written about the MIND diet since the first research on it was published in 2015. In that time, I’ve grown older and my parents have entered their eighties, mostly in good health, I’m happy to report. But if we’re fortunate to see the years go on, there’s no denying that we must provide more care and maintenance to the brain and body. I’ve seen and felt this firsthand. Nutrition isn’t the only piece of the successful aging puzzle, but it’s a fundamental one. To that end, I’m sharing important updates from the new MIND diet research studies—which are strongest in the areas of memory, cognition, and dementia prevention, but I’ll also cover what we now know about the MIND diet for cardiovascular health, healthy aging, Parkinson’s disease, and mental health.

Since the first edition of this book, I completed culinary school and took the journey from fussy foodie to practical home cook. Fun fact: My husband and I cooked all of our meals for two years during the COVID-19 pandemic. He became an excellent sous-chef and more recently made most of our meals while I was working on updating this book. All that to say, while we save fussy for special occasions, we make most of our meals quick, simple, fresh, and delicious. It’s with this sensibility that I’ve created all new recipes for this edition. But simple doesn’t mean boring, and you can look forward to a dash of global flavors inspired by my childhood in a Korean American home and my world travels.

Like the original edition, this book is about eating right to keep your brain younger for longer. The recommendations continue to be based on the latest science on which foods and nutrients benefit and harm brain function, while staying grounded in two proven diets that have been studied for many decades and practiced, in good health, for centuries. Namely, the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH), which are the M in MIND.

The science is there for you, but if you want to skip straight to the updated tips, tools, recipes, and resources, do what’s right for you. This book is for you, reader, to use in whatever way serves you best right now.

As a nutrition educator by training, I hope this book serves as an approachable guide to the science and foods for optimal brain health, served up in a culturally humble way. Ultimately, my hope is to support and empower you until you’re eating well, living well, and thriving as effortlessly as we breathe.

Be well,

Maggie Moon, MS, RD

INTRODUCTION

The world is aging. In 2020, adults over 60 outnumbered children under 5,¹

and one in every six people in the United States was over 60²

(it will be one in five by 2030). Worldwide, one in six people will be over 60 by 2030, and this represents one of the largest demographic shifts of our lifetime.

With age comes wisdom that should be respected, appreciated, and cherished. However, with age also comes an increased risk of cognitive decline and dementia. Today in the US, one in nine adults over 45 experiences subjective cognitive decline, which could be an early sign of dementia in later years; and one in nine over 65 lives with Alzheimer’s dementia. But dementia is not a normal part of aging.

Research suggests that what we put on our plates can help or hinder how well we think, learn, and remember. Our cognitive health is essential for independent living and thriving in every season of life. The brain is the keeper of our memories, but also the conductor of how well we reason, make sound choices, and even navigate physical spaces. There’s no reason to let cognitive decline or dementia rob us of good years, and a healthy diet is an essential part of the solution.

The best time to start eating for brain health is now, especially since it is well-accepted that changes to the brain and body start 20-plus years before memory loss and other symptoms appear.³

The MIND diet is one approach that may help, and it’s unique because it is a research-backed eating pattern developed specifically for brain health. Following the MIND diet is associated with slowing down brain aging by up to 7.5 years and reducing the risk of Alzheimer’s by up to 53 percent.⁴

It has also shown benefits for healthy aging, premature death, heart health, type 2 diabetes, and mental health. It has components of the well-researched Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets, which are known for being heart-healthy. However, the specific mix of foods in the MIND diet appear to offer superior brain health support.

The MIND diet, which was developed in the US, includes 15 types of food, including five types of foods to limit, but twice as many to enjoy. The best foods for your brain include leafy green vegetables, nuts, beans, berries, poultry, fish, whole grains, and olive oil. The foods to limit (though total elimination is not mandatory) are red meat, butter and stick margarine, whole-fat cheese, pastries and sweets, and fried fast food. The MIND diet has since been adapted by researchers to two non-Western eating patterns with culturally appropriate updates, but they have more in common than not. These alternate takes on the MIND diet from Korea and China are briefly described in this book, noted as K-MIND and cMIND, respectively.

You can expect this second edition of The MIND Diet to provide an update on the past nine years of research findings, along with updated tip sheets, worksheets, a new frequently asked questions section, and all-new recipes.

To set the stage, part one of this book explains the basics of the brain and mental fitness, as well as the science behind the MIND diet, in an approachable and understandable way. It summarizes the research backing the recommendations to seek or avoid certain foods and nutrients for brain health.

Next, part two of the book will guide you through how to create your own MIND diet plan, including what to eat, how much, and how often. You’ll find helpful worksheets for meal planning, keeping track of your progress, and overall lifestyle recommendations for brain health.

Part three of the book features profiles on the brain-healthy foods that form the foundation of the MIND diet, from seasonality and culinary uses to fascinating historical background. I provide guidance and strategies for choosing the healthiest options when confronted with foods from the brain-harming food groups. I also provide tip sheets that deliver practical information at a glance to help you get started and take the guesswork out of navigating the MIND diet, as well as a fully updated frequently asked questions section that addresses the top questions I’ve received over the years.

Part four brings the MIND diet to life through 60-plus all-new recipes that offer delicious and nutritious options for smoothies, small plates, snacks, salads, soups, mains, sides, desserts, and even sips and elixirs.

This book is about hope, prevention, and taking positive action today to slow cognitive decline and minimize the risk of Alzheimer’s disease down the road.

1

 World Health Organization, Ageing and Health, October 1, 2022, https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

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2

 US Census Bureau, 2020 Census: 1 in 6 People in the United States Were 65 and Older, May 25, 2023, https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html

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3

 Livingston et al., Dementia Prevention, Intervention, and Care, Lancet 396, no. 10248 (2020): 413–446, doi: 10.1016/S0140-6736(20)30367-6.

4

 Morris et al., MIND Diet Associated with Reduced Incidence of Alzheimer’s Disease, Alzheimer’s & Dementia Journal, 11, no. 9 (2015): 1007–1014, doi: 10.1016/j.jalz.2014.11.009; Morris et al., MIND Diet Slows Cognitive Decline with Aging, Alzheimer’s & Dementia Journal 11, no. 9 (2015): 1015–1022. doi: 10.1016/j.jalz.2015.04.011.

PART ONE

The Science of the MIND Diet

The science of the MIND diet is an active area of study that’s more than 150 studies strong at the time of this writing. To better understand the science, it’s helpful to understand basic brain anatomy and key concepts such as cognition, cognitive decline, dementia, Alzheimer’s disease, and how mental fitness is tested.

Part one of this book reviews seminal studies demonstrating the diet’s potential to cut Alzheimer’s risk in half and slow cognitive decline. The focus then shifts to the broad health benefits of the MIND diet, including its positive impact on cognitive health, heart health, diabetes, metabolic syndrome, mental health, Parkinson’s disease, healthy aging, and reducing premature death.

Research on how the MIND diet has been adapted to cultures outside the US, with specific insights into results from Korea, China and France, reveals how eating for brain health can include culturally relevant foods. The final section of part one explains the science behind specific foods and nutrients that impact brain health and provides a wide range of examples of brain-healthy foods.

CHAPTER 1

THE BRAIN

Super-Basic Brain Overview

What follows is a very basic orientation to the brain and general cognitive functions that will be relevant in this book. It is by no means comprehensive or even very detailed. Simple information about various sections of the brain will be explained in approachable language. For example, rather than discuss the anterior and posterior brain, words like front and back will be used.

After establishing a basic framework for how the brain works, this chapter will explore how the brain changes with cognitive decline, dementia, and Alzheimer’s disease.

Brain Basics

The brain has three main parts. The largest part of the brain is called the cerebrum, and it handles higher functions like reasoning, learning, emotions, speech, fine motor control, correctly interpreting touch, vision, and hearing, and of course, memory. The other two parts are smaller and sit under the cerebrum. They’re called the cerebellum and brainstem, and they regulate basic functions like breathing, digestion, body temperature, and balance. When this book discusses brain health, it is referring to the cerebrum.

The brain has two sides—left and right—called hemispheres. Each hemisphere has four sections, one in front, one in back, and two in the middle stacked on top of each other. These sections are called lobes, and there are eight total.

Each lobe is affiliated with a certain set of functions. Lobes are not independent, though. It’s important to recognize that just like no individual is an island, no lobe can act alone. Brain-imaging studies have shown how multiple parts of the brain are active at the same time during any given task.

The front lobe, aptly called the frontal lobe (they aren’t all named with as much common sense), is the most advanced area of the brain. It receives information gathered through the senses (sight, touch, taste, hearing, smell) and spatial awareness (e.g., balance and movement), and is in charge of planning, short-term memory (working memory), understanding abstract ideas, inhibiting behaviors that may be emotionally or socially inappropriate, voluntary movement, and expressive language. These complex planning behaviors are associated with activity in the front part of the frontal lobe, called the prefrontal cortex, which lies just behind the forehead.

The lower middle lobe, called the temporal lobe, plays a major role in hearing, understanding language, memory, and learning and retaining information. There are upper, middle, and lower regions that are technically called superior, medial, and inferior. The medial temporal lobe (MTL) includes the hippocampus, which is involved with forming long-term memories and spatial navigation abilities. When it’s damaged, the result is memory loss and disorientation.

The upper middle lobe is called the parietal lobe and is the key player in making sense of what the body touches. It’s also involved in spatial thinking, such as rotating objects in your mind, being able to store ideas of movement, and controlling your intention to move. This part of the brain comes in handy in dance classes. Also, like the frontal lobe, it’s involved in short-term memory.

The last and fourth section is at the back of the brain. This back lobe is called the occipital lobe. This area of the brain is farthest from the eyes, and yet, is the primary center for making sense of what you see. It is extremely important in vision.

Just below the back lobe is an area called the cerebellum, which is important to know because it has more neurons than any other part of the brain. It has many connections to the frontal lobe and most other areas of the brain. It’s involved in learning and coordinating movement.

The Hungry Brain

The brain is one of the body’s hungriest organs, especially for its size. The brain makes up only 2 percent of body weight but consumes up to 20 percent of daily calories and oxygen. The brain’s preferred energy source is glucose, which it gets when the food we eat is broken down and some of the glucose is transported in blood, across the blood-brain barrier, and into brain cells. It has a high metabolism and uses up nutrients quickly.

Not only is the brain hungry for energy (calories), it’s also hungry for antioxidants. The brain has a high need for antioxidants because it’s such a metabolically active organ, which creates an abundance of oxidative molecules called free radicals (unstable molecules that damage cells). As you can imagine, this makes the brain particularly susceptible to oxidative stress, a result of having more free radicals than antioxidants to neutralize them. Oxidative stress causes damage to the brain tissue. In fact, a theory in the field of brain disorders is that the brain needs to be saved from oxidation and inflammation via protective plant compounds with antioxidant and anti-inflammatory properties (e.g., vitamins E, C, and A, flavonoids and other polyphenols, manganese, copper, selenium, zinc, enzymes, and more).

There are two kinds of antioxidants the body uses: enzymes made by the body (endogenous antioxidants) and nutrients from food (dietary antioxidants). The antioxidant enzymes the body creates can prevent toxic substances from being created in the first place, and antioxidant nutrients from food can neutralize the damaging consequences of oxidation, such as free radicals. The brain doesn’t have as many endogenous antioxidant enzymes at its disposal as other parts of the body, which means dietary antioxidants have a big role to play. This is one reason good nutrition and healthy eating is so important to maintaining a healthy brain.

The Fat Brain

Similar to the rest of the body, most of the brain is water (about 75 percent). However, take away the water and you’re left with brain matter, 60 percent of which is fat (also known as lipids). Fats are an essential structural component of neurons. It’s no surprise, then, that the brain needs healthy fats to function properly, from facilitating better blood flow to improving memory and mood. Neurons communicate through a signaling system that gets updated when a new supply of fatty acids is available.

The body produces all the saturated fat it needs, but some fats need to come from the diet. Namely, essential polyunsaturated omega-3 and omega-6 fats. The American diet typically supplies enough omega-6 fats, but not enough omega-3s, which come from fish, nuts, and seeds.

The most metabolically active fat in the brain is a polyunsaturated type of fat called omega-3 docosahexaenoic acid (DHA), which is found in fatty fish like salmon. The body can also convert omega-3 alpha-linolenic acid (ALA), which comes from plant foods like flaxseed, perilla seeds, and walnuts, into DHA. That means the body doesn’t technically require outside sources of DHA, but it’s helpful since it only converts about half a percent of ALA to DHA.

As different fats are digested and absorbed, cholesterol is transported around the body in various forms, such as LDL cholesterol (sometimes called bad cholesterol) and HDL cholesterol (sometimes called good cholesterol). Cholesterol is an essential part of healthy cell membranes, and plays a role in hormone and vitamin D production. The role of cholesterol in Alzheimer’s disease isn’t fully clear, but studies have found that higher levels of LDL cholesterol is linked to more Alzheimer’s disease–associated plaque in the brain (amyloid plaques).

What Is Cognition?

To understand what cognitive decline is, it’s important to first identify just what cognition is. Cognition includes how we think, learn, and remember. Cognition affects how a person understands the world and acts within it, and it includes all the mental skills needed to carry out simple and complex tasks alike, from locking the front door to analyzing a scientific report. To elaborate, cognition is a word that describes the process of receiving sensory inputs (e.g., what we see, read, touch, taste, feel, smell, or hear), and transforming those inputs into their most important components (reduction), filling in gaps (elaboration), remembering (storing and recovering memories), and using the inputs to interact with the world around us, understand language, solve problems, and more.

According to the National Institute on Aging, a division of the National Institutes of Health in the U.S. Department of Health & Human Services:

Cognition is the ability to think, learn, and remember. It is the basis for how we reason, judge, concentrate, plan, and organize. Good cognitive health, like physical health, is very important as we get older, so that we can stay independent and keep active. Some declines in cognition and memory with age are normal, but sometimes they can signal problems.

Types of cognitive functions include perception, attention, memory, motor skills, language, visuospatial processing, and executive functioning, as further explained below.

Perception is how our senses recognize and process information. It’s what happens when we receive sensory inputs.

Attention is the ability to continue to concentrate on something while filtering out competing thoughts or sensory stimulation in the environment. It includes reduction skills.

Memory can be short term or long term. Short-term memory can be as short as 20 seconds and might be used when reading a step in a recipe before doing it, for example, while long-term memory is just that and stores memories for years and years.

Motor skills, not often thought of as a cognitive ability, definitely use brain power, and the loss of these skills can be part of the challenges of cognitive decline. These are the skills used to move our muscles, from walking and cooking to dancing or playing sports, including the ability to manipulate objects such as swinging a pickleball paddle or using a pen.

Language skills are what allow the brain to understand (translate sounds into words) and use language (generate verbal responses).

Visuospatial skills include the ability to see objects and understand the spatial relationship between them. For example, being able to tell how far apart two pencils are when placed near each other, and whether they are lying at the same or different angles. These skills are also used when mentally rotating a shape (helpful when organizing a full refrigerator or packing a suitcase).

Executive functioning can also be thought of as reasoning skills and includes the ability to plan and do things. These abilities include using flexible thinking modes, empathetically imagining what someone else likes or dislikes, anticipating an outcome based on past experience, identifying a problem and finding solutions, making choices, using short-term memory to receive information just long enough to use it (working memory), being self-aware of emotions enough to manage them, breaking down complex ideas or actions into small steps and putting them in the right order of what needs to get done first (this is what a home cook does when they think through how to make a recipe), and focusing in a manner that can eliminate inner and outer distractions.

What Is Cognitive Decline?

Cognitive decline is a decrease in cognitive abilities over time. Some age-related cognitive decline is considered normal, including slower thinking and having a harder time with prolonged attention, multitasking, short-term memory, and word finding. On the other hand, vocabulary, verbal reasoning, and synthesizing information from diverse sources of information is often maintained or improved.

The normal aging brain may show signs of cognitive wear and tear due to a loss of gray matter volume and changes to white matter. Gray matter fills 40 percent of the brain, and white matter fills the remaining 60 percent. Gray matter is where all the processing goes on; white matter allows different gray areas to communicate with one another and with other parts of the body. If gray matter is like a factory, then white matter is the trucking fleet that transports goods from one factory to another, or from factory to store. It seems that when it comes to age-related cognitive decline, the issue is not black and white, it’s gray and white.

As a part of normal aging, the amount of gray matter starts to go down after age 20, especially in the prefrontal cortex, but also in the hippocampus. Scientists believe this decrease might be due to dying neurons. A protein called beta-amyloid, which has been found in all people with Alzheimer’s dementia, can kill neurons. Beta-amyloid is also found in 20 to 30 percent of normal adults, which may, but doesn’t necessarily, predict that they’ll develop Alzheimer’s disease. Another explanation is that neurons grow smaller and the number of connections between them also decreases. These decreases are very well documented in older adults. With aging, neurons become simpler, shorter, and less connected to other neurons.

White matter shrinks more than gray matter as we get older. Similar areas of the brain have shown 16 to 20 percent losses of white matter but only 6 percent of gray matter loss. The consequences of these normal changes to the brain over time are small and shouldn’t get in the way of daily activities.

In contrast to age-related cognitive decline, a condition called mild cognitive impairment (MCI) is more serious and is a risk factor for Alzheimer’s disease. However, having mild cognitive impairment doesn’t always lead to Alzheimer’s disease and presents an opportunity to make important lifestyle changes. MCI is a condition that affects memory and thinking (e.g., planning, organizing, judgment) enough that it’s noticeable, but not to the point that it interferes with daily life. Some causes of cognitive impairment, such as medication side effects, vitamin B12 deficiency, and depression, are treatable.

A newer designation of subjective cognitive decline (SCD) represents an even earlier opportunity for intervention. It is defined by the Centers for Disease Control as self-reported confusion or memory problems that have been happening more often or getting worse in the past 12 months.

What Is Dementia?

Dementia literally means without mind (de = without; mentia = mind). Dementia is a set of symptoms but not a disease of its own. It’s a term used to describe symptoms that can be caused by brain disorders such as Alzheimer’s disease or a stroke. Symptoms of dementia include problems with memory, thinking, language, or social skills, and uncharacteristic behavior changes. Getting older doesn’t cause dementia, though dementia is more common in older adults. The occasional forgetfulness, having trouble recalling a word, or any of these symptoms could be a normal part of aging without being related to dementia. The difference is when the symptoms start to get in the way of everyday life, or activities of daily living (ADL); for example, when symptoms become disruptive to working, getting dressed, or making meals. Cognitive impairment is also associated with difficulty managing instrumental activities of daily living (IADL). These activities are associated with multiple mental processes, which is why they are sensitive to cognitive decline. They can provide another signal to pay more attention to brain health.

Examples of ADL:

Bathing—washing yourself, including getting in and out of the tub or shower.

Dressing—putting on and taking off clothes, shoes, braces, artificial limbs.

Going to the toilet—getting to and from, on and off, and using the toilet.

Getting around the house—sometimes called transferring. This refers to getting in and out of bed, chairs, or a wheelchair.

Continence—being able to control bowel and bladder functions.

Eating—eating and drinking enough to meet nutritional needs.

Examples of IADL:

Managing finances

Managing medications

Using a phone

Preparing hot meals

Shopping for groceries

Using a map

Driving a car

By mid-century, approximately a quarter of the US population will be 65 years and older, and more than one in three of this older population is projected to develop dementia. The rate of dementia rises drastically with advancing years. According to the 2024 Alzheimer’s disease facts and figures report from the Alzheimer’s Association, 27 percent of Alzheimer’s cases are in adults ages 65 to 74, while 73 percent are in adults over 75. Alzheimer’s currently affects 5 percent of 65- to 74-year-olds, 13 percent of 75- to 84-year-olds, and 33 percent of those 85 years old and up.⁵

Further, people of color are projected to be disproportionately affected.

There are over 50 different conditions associated with dementia, but the most common cause of dementia is Alzheimer’s disease, which accounts for 60 to 80 percent of all cases of dementia. Lewy body disease (abnormal protein clumps in brain cells), hardening arteries (arteriosclerosis) in the brain, and stroke are also common causes of dementia. Other diseases that can cause the symptoms of dementia are Parkinson’s disease, Huntington’s disease, HIV infection, head injury, severe depression, and Creutzfeldt-Jakob disease.

There are also nondisease causes of dementia symptoms. The National Institutes of Health indicates that dementia-like symptoms could be the result of medications, metabolic problems, nutritional deficiencies, infections, poisoning, brain tumors, lack of oxygen to the brain, and heart and lung problems.

Most dementias are irreversible. However, there are exceptions to this rule. Some forms of dementia can be stopped or even reversed if caught soon enough. These include dementia-like symptoms caused by vitamin deficiencies, brain tumors, chronic alcoholism, and some medications. For the remaining forms of dementia, current treatment options may help with symptoms but do offer a cure. This is why