Dietary Pattern Diagnosis to Delay Brain Aging

Zhenzhen Zhang

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.

辨證飲食延緩大腦衰老

章珍珍

MIND 飲食法對大腦的健康有益正被受矚目。 MIND 飲食法是在以地中海飲食和DASH飲食的基礎上加以改進的，旨在延緩大腦神經退化的飲食療法的縮寫（Mediterranean-DASH Intervention for Neurodegenerative Delay）。 多年流行的地中海飲食，被認為是能降低心臟病死亡率，保護大腦的血管，並減少中風和記憶力減退。 並得到研究所證實。 DASH 飲食則是一種降低高血壓的飲食方式。 以阿茲海默症為代表的大腦功能衰退，與心臟和腦血管疾病密切相關，而心血管疾病又與飲食密不可分。 近十多年來，大量科學家的研究證實了消化系統對大腦的影響，是直接的，多方位的，故有腸道是人體的第二大腦之說。 簡而言之，不健康的飲食結構，導致了多發的心腦血管疾病和代謝疾病（如糖尿病等），心腦血管疾病和糖尿病又是導致大腦萎縮，癡呆症和阿茲海默症的重要因素 之一。 今天我嘗試把方興未艾的MIND 飲食療法，與古老中醫辨證藥膳概念和方法結合。 推出在臨床上可以指導病人的飲食療法，期許對預防老年癡呆，或延緩老年癡呆的進展有所幫助。

地中海飲食，具體說來就是，每天攝取6-12份水果與蔬菜；4-6份的豆類、穀物類；1-3份低脂乳製品；1-2份肉類(家禽、魚類、 貝類) 和一杯紅酒。 特徵是以植物性食物為主，如全穀類、蔬菜、豆類、水果、堅果等。 橄欖油是脂肪的主要來源。 飲食中包含適量的魚、海鮮、乳製品和禽肉。

DASH 飲食，每天6 至8 份的全穀物； 4 至5 份的蔬菜；4 至5 份水果；2 至3 份脫脂或低脂乳製品；6盎司（168克）的瘦肉、禽肉和魚肉 ；2 至3 份脂肪與油脂（1 茶匙植物油、 2 湯匙沙拉醬）。 每週 4 至 5 份的堅果、種籽或乾豆和豌豆（一份是指 1/3 杯堅果、2 湯匙花生醬、2 湯匙種籽或 1/2 杯豌豆）。 每週 5 份或更少的甜食和添加糖（如一份指1 湯匙糖、果凍或果醬）。 特徵是低鹽、低糖、低飽和脂肪，多蔬菜和全穀物的飲食，用於降低血壓和壞膽固醇。

一份食物的標準份量：全穀物，1/2杯煮熟的穀物（生全穀物16g）；蔬菜，約為1/2杯煮熟的蔬菜（生的75 克）；水果，一份為 150g；堅果，一份約1/3杯30g，或一把。 莓果，1杯（190g）；豆類，約57g（生的）；生魚4盎司（113g）；煮熟的瘦紅肉，一份是65g（生的約100g）；〖JP2〗瘦肉家禽80g（ 生的100g）一份；熟魚100g（生的115g）一份。 其實我們只是參考這些份量，了解西方的飲食結構，不必拘泥。

MIND 飲食療法，將地中海飲食和DASH 飲食中的大量多樣性的蔬菜、水果、橄欖油和適量紅酒結合莓類水果和堅果，減少紅肉和加工食品等引發身體炎症的食物，增加莓類水果和綠葉 深色蔬菜可以抗發炎，以此強調了對大腦有益的食物。重要的是，有923人參與的臨床研究證實，罹患阿茲海默症的機率足足降低了約53%。科學家認為MIND 飲食富含某些維生素、類胡蘿蔔素和類黃酮的食物，這些食物被認為可以透過減少氧化壓力和發炎來保護大腦。儘管 MIND 飲食的目標是促進大腦健康，但它也有益於心臟健康、糖尿病和某些癌症，因為它包含地中海飲食和 DASH 飲食的成分，這些成分已被證明可以降低這些疾病的風險。 參與MIND 飲食研究的，而且得分較高的人群，俱有更好的認知功能、更大的大腦總體積、更高的記憶力分數、更低的癡呆風險以及較慢的認知衰退，即使包括患有 阿爾茨海默氏症和中風病史的參與者（1）。评分和大脑成像的研究結果都表明，MIND 飲食對於患有各種癡呆症的患者來說可是一種有用的長期预防和治療的選擇(2).(3)。

MIND 飲食模式及其建議的健康食物：

每天： 全穀類3份以上；非綠葉蔬菜1份以上；

每週：綠葉蔬菜6份以上；堅果5份以上；豆類4份以上；莓果2份以上 家禽2餐以上；魚一餐以上。 每天使用橄欖油料理。

不建議的不健康食品，是飽和脂肪和反式脂肪含量高的食品:

每週少於5份糕點和甜食；每週少於4份紅肉（牛肉、豬肉、羊肉 及其加工品）；每週少於一份起司和油炸食品。 每天少於一湯匙的奶油或人造奶油。

中醫的藥膳療法是因人、因時而異，因為食材有寒熱溫涼、人體的體質有寒熱虛實，地域有春夏秋冬，我們的飲食也要符合「天人合一」之理，以食物和 季節的寒熱屬性，矯正人體寒熱虛實的偏差。

簡單而言，就是寒者熱之，熱者寒之，實者虛之，虛者補之的辨證飲食。 如手腳冰冷的人，多吃溫熱食物，少吃生冷，減少寒涼食物。 潮熱盜汗，手腳燥熱之人，多吃寒涼之品，意在清熱。 以此類推。

如今MIND 飲食療法獲得研究證實，降低了53%的阿茲海默症的發生率。 我們按其食物種類和份額，把人體體質、食物和季節的屬性考慮進去，能為每一個人規劃出其獨特的辨證飲食食譜。 能更好的保護腦部、心血管，預防及延緩老化的進程。

表一:依據中醫辨證理論，人體的寒熱虛實體質和與之對應的食物屬性

1. 體質於春夏季節為內寒外熱，故飲食應以性平溫食物為主；於秋冬季節，是內外均寒，故飲食應以溫熱食物為主。

2. 熱體質於春夏季為內外均熱，故以寒涼食物為主。 堅果以性溫為多，實熱之人不易多吃，多吃會生熱生痰。 另外酒類都是熱性的，實熱體質的人，春夏不宜飲酒； 實熱體質於秋冬季節是內熱外寒以涼平食物為主。冬季可以少量紅酒。

3. 質的人，痰和熱糾纏在一起，熱不宜清，痰不宜化，常年都應以偏於寒涼的食物為主，糾正其熱。 痰熱之人，最好不吃堅果或飲酒，否則容易生痰產熱。

4. 性體質之人的飲食以平溫健脾為主，而且不宜吃堅果；紅酒少量為宜。

5. /血不足之人的飲食，當以性涼性平食物為主，杜絕燥熱之品，尤其是夏秋之時。

6. 虛/陽虛之人的飲食，當以性平溫熱的食物為主。 冬季更要用溫熱食物。

MIND 飲食療法推薦的每日食材的中醫特性：

穀物，多是涼平和性溫的，不會太寒或太熱。 所以幾乎適合所有體質的人，仍以全穀物為佳。

豆類，多是涼性（如綠豆）和性平（赤小豆、黑豆、黃豆、扁豆、蠶豆），也適合多數人。

蔬菜， MIND 建議多吃綠葉蔬菜。 很少有大寒或大熱性的，紅辣椒、蔥薑等調味品除外。 以涼、平和溫性居多。 寒症的人加熱後基本上可吃所有蔬菜，少吃涼菜即可。 熱症的人選擇比較多，而且可多吃涼拌菜。

莓類和水果，水果少有大熱之品，寒症之人可以溫性和性平水果為主。 熱症之人可選擇比較多，忌口較少。但 MIND 飲食療法建議多吃莓果，如草莓、藍莓、蔓越莓等。 其他可以選擇糖少，不是特別甜的水果。 如蘋果、李、桃、杏等。 葡萄和西瓜有些過甜，適當少吃。

堅果，多是好脂肪，多性平、溫，四季可適量食用，但多吃生痰濕。

肉類， MIND建議適量的白肉每週不應少於2份，紅肉不能多於每週4份。 我們要依寒熱體質選擇對應的肉類。

海鮮，是蛋白的最佳來源，但多寒性，或性平。 虛寒體質的人，可用熱性調味料中和海鮮的寒性。

葡萄酒，是地中海飲食的特徵。 每天一杯，有益無害。 多了則相反。

橄欖油，是公認的地中海飲食的健康食用油。 可用於每日料理。

MIND不建議或要杜絕的飲食有：

任何奶油或人造奶油，非吃不可的話 不要超過每日一茶勺

任何快餐或煎炸的食物，非吃不可的話， 每週不能超過一次

甜點，非吃不可的話，不要超過每週5次。

表二:依MIND 飲食療法的建議，配合中醫的體質辨證和季節，可參考以下食物。舉例：

小結

老年癡呆是一個緩慢漸進的過程，大腦的影像研究表明，在症狀出現之前10年甚或20年，大腦已經開始衰退、萎縮。而且，經過治療和生活方式的改善，萎縮了的大腦還能逆轉。本文試圖將西方的延緩大腦神經衰老的膳食模式——MIND 飲食，與中醫古老膳食的辨證理念結合起來。建立一種因人、因時而異的，延緩大腦神經衰退的辨證飲食模式。不論是地中海飲食、MIND 飲食，還是中醫辨證藥膳模式，都是一個綱領，指導人們如何選擇對個體最佳的飲食。 以上所列食物，僅供參考。不必拘泥。性平食物，一般人都適合；沒有寒熱偏差的人，選擇食物時，可以寒熱溫涼配合食用，不要過寒過熱。如果大眾能辯證地選擇食物種類，应用MIND合理搭配。相信會大大減少老年癡呆症和阿茲海默症的發生率。如有同行將此方法進行大樣本的臨床研究，獲得有說服力的結果，並將其普及到世界各地，將是全世界老年人的福音。

參考文獻

1.Morris MC、Tangney CC、Wang Y、Sacks FM、Barnes LL、Bennett DA、Ag-garwal NT。 MIND 飲食可以減緩隨著年齡增長而導致的認知能力下降。 阿茲海默症和癡呆症。 2015 年 9 月 1 日；11(9):1015-22。

2. Healy, Elizabeth： MIND 飲食對失智症患者認知的影響，https://content.iospress.com/articles/journal-of-alzheimers-disease/jad230651

3. Alime Thomas 等：MIND 飲食與法國人群大腦結構和癡呆症的關聯，https://link.springer.com/article/10.14283/jpad.2022.67

作者簡介

章珍珍，中醫師，新英格蘭中醫雜誌主編，擁有40多年中醫臨床經驗，畢業於河北醫學院中醫系和中國中醫研究院。 曾在中國、日本和美國行醫和教學。 章醫生曾在美國麻州的新英格蘭針灸學院任教 20多年，同時，在麻州Salem醫院的婦女健康中心兼職工作近20年。