Strong Heart, Sharp Mind

Table of Contents with chapter outlines for STRONG HEART, SHARP MIND: The 6-Step Brain-Body Balance Program that Reverses Heart Disease and Helps Prevent Alzheimer's by Joseph C. Piscatella and Marwan Noel Sabbagh, M.D., with a Foreword by Michael F. Roizen, M.D.

Introduction

Part I: The New Science of Heart and Brain Health

Chapter 1: The Heart-Brain Connection for Optimal Health

For years, plenty of learned skeptics were convinced that no matter how virtuously you ate or how many hours you dedicated to the treadmill, the brain and heart would inevitably march towards deterioration.

The landmark 2012 Heart and Brain Conference in Paris (mentioned in our Introduction) suggested that the tide was turning. The following year, the G8 Dementia Summit in London provided even more evidence of a paradigm shift in the making: More than 100 scientists from 36 countries agreed that, based on the research, at least 20 percent of dementia cases could be avoided by switching to a lean and healthy lifestyle in middle age, and an even higher percentage if people embraced good health habits when they were young.

Heart health would also benefit tremendously from those same practices, they noted. Many cardiovascular risk factors are the same as those for Alzheimer's, they pointed out, including stroke, low HDL, high LDL, high blood pressure, smoking, overeating of unhealthy fats, excess body weight, lack of exercise, and Type 2 diabetes.

Just a few short years later, as this chapter will explain, the dissenting view has become accepted wisdom among forward-thinkers in the cardiological and neurological communities. Lifestyle interventions, long known to be important for heart health, are now seen as equally critical as drugs and genetics for brain health.

Moreover, the combination of the two preventive approaches have important ramifications. Addressing these risk factors-by adopting a battery of healthy lifestyle practices-can help prevent both America's number one killer (heart disease) and its fastest-growing, most feared affliction (Alzheimer's disease). "These strategies work," says our co-author Marwan Sabbagh, M.D. "Data is now showing that lifestyle interventions in many cases are handily beating drug target interventions."

Chapter 2: Lessons of Lifestyle in the Fight Against CVD and AD

A common bond exists between your heartbeats and brainwaves that ties their fate together. We know, for example, that people who suffer from congestive heart failure are at much higher risk for loss of brain function. It is also quite common for someone who is diagnosed with the condition known as atherosclerosis-clogging and hardening of the arteries-to progress to dementia. Even a disruption within the body's tiniest blood vessels can cause significant disturbance to the blood-brain barrier and impair the ability of both organs to operate at full capacity. (This is particularly important for females, as many women experience arterial contraction in small blood vessels, thereby restricting blood flow; as opposed to men who typically have plaque in larger coronary arteries.)

What's behind the connection? Blood flow is part of it. But there's a lot more to the emerging heart-brain connection: We now know that the well-known risk factors for cardiovascular disease (CVD) are very similar to those of Alzheimer's disease (AD). Both hypertension and Type 2 diabetes, for example, long known as culprits for CVD, are also risk factors for AD. Recent research suggests that Apo E 4, the genetic signature associated with higher rates of Alzheimer's, is also implicated in heart disease. In addition, elevated cholesterol-again, a well-known risk factor for heart disease-is linked to higher levels of amyloid, the substance that forms the brain tangles that are a hallmark of Alzheimer's.

The relationship gets broader and deeper: Stroke, high blood pressure, overconsumption of unhealthy facts, excess body weight, smoking, lack of exercise-all well-known cardiovascular risk factors-are now linked to Alzheimer's as well.

Meaning, that we have the power to prevent these diseases, and to improve our overall health in the process.

That's the uplifting promise and purpose of this book.

Chapter 3: Vital Signs for Vital Organs

Helping readers achieve optimal heart-brain health, while keeping CVD and AD at bay, the goal of this book. How do you measure your progress along the way? The best way is to establish critical markers.

In this chapter, we provide a "vital signs" scorecard-the most important values for heart-brain health. Some of these will be familiar, such as HDL and LDL. But, as there is clear evidence now about the link between hypercholesterolemia and cognitive disorders, we move into more sophisticated lipid values-particle size and apoproteins.

Similarly, we drill down into other values, and look at measurements related to cognitive health and how these can be gauged.

The goal here is not to get readers to run off and schedule a battery of additional tests beyond the ones they should be having as part of routine medical screenings. But as the association among things like metabolic syndrome, inflammation, stroke, Type 2 diabetes and both heart disease and Alzheimer's disease becomes clear, it's important to be aware of these benchmarks. Moreover, many of these share common risk factors-such as obesity, hypertension, metabolic syndrome, etc.-that one can gauge and track, with something as accessible as a BMI chart, for example.

Part II: Six Steps to Brain-Body Balance

Chapter 4: In this brief chapter introducing the prescriptive section of the book, we provide an overview of our evidenced-based plan, which involves some surprising new twists on familiar behaviors. For example, we recommend:

• Exercise, but with a new combination of activities-including some suggested workouts-designed to maximize the heart-brain connection.
• The Mediterranean Diet, but with a fresh look at the recently-revised dietary pyramid, and a few specific new suggestions for heart-and-brain-healthy nutrients, informed by the most recent research.
• Stress management, but with the recommendation of a new technique that has been shown to calm the body and brain in only 12 minutes, and help improve cognitive function, to boot.

We do the same with the other components of our plans, showing readers our six-step program-plus new iterations and twists-that they can follow to incorporate into their lifestyle.

Also, in this chapter, we'll review the structure of our prescriptive chapters: Each will include motivational, first-person perspective from Joe Piscatella and a closer look at the science with Dr. Sabbagh-as well as actionable tips and advice.

Chapter 5: Functional Fitness for Heart-Brain Health

Yes, exercise is as close as we come to having a miracle drug. At this point, no one can dispute this. But what type? How much? How fast? How hard? There are so many conflicting recommendations about the best way to get active, from so many different expert groups, it's hard to know what provides the most sweat equity.

And of particular importance to this book: Are there exercise regimens that can actually promote both heart and brain health together?

The answer to that last question is a resounding "yes!"

We've created a step-by-step guide to help readers determine the perfect mix of frequency, intensity, time and type of exercise that is both realistic for them and that will actually help extend their health-span -- essentially their quality of life. The basis of our program is cardiovascular exercise, such as brisk walking, cycling and running. But we also include a new genre of physical activity-one that is still unfamiliar, even to many fitness professionals-that's designed to promote brain health and a healthy neural system.

We put these together in a unique combination, incorporating some cutting-edge approaches, and designed to optimize what we call "brain-body balance."

Chapter 6: The Mediterranean Diet's New Borders

The Mediterranean diet was recently voted to be the overall best diet for the 10th year in a row by a panel of 25 medical and nutrition professionals reviewing more than 40 popular diets for US News & World Report.

A plan that prioritizes eating more fruits and veggies with an accent on lean protein and healthy fat, it rated tops in both the heart-health and brain-health-categories as well as the weight loss and diabetes management categories. Further, it received praise for being easy to follow and budget friendly.

While the common principles of the diet are more or less the same, there is not just one standard Mediterranean diet. The French, Greeks, Italians and Spanish are all part of the Mediterranean region but take their own unique approach to eating. To complicate matters, some of the popular "internet" diets claim to be the Mediterranean diet but really aren't.

In this chapter, we explore the varying shoreline of the Mediterranean diet, as well as some of the diet's new principles, which are less about what foods are eaten and more about how the eating is done: In Mediterranean cultures, for example, food is shared; eating is not rushed. Moreover, the base of the new pyramid is now physical activity, underscoring one of the important points of this book-that optimal health is not "just" about modifications in diet or joining a gym; it's a way of life.

Also, in Chapter 6, we'll include some specific tips not found in many nutrition books: For example, new research suggests that elevation of the amino acid homocysteine increases risk for both CAD and AD. And it's reduced by taking folic acid. We'll talk about how to get more of that in your diet, as well as the important role of flavonoids-phytonutrients whose important role in both heart and brain health has been confirmed by research published as recently as May, 2020.

Chapter 7: Restful Sleep for Body and Brain

Lack of sleep used to be a badge of honor, a way to show off how important and busy you were. We now understand such a boast comes at huge cost to the neuro-cardio system.

At least 100 million Americans struggle with sleep issues. Lack of shuteye causes glitches in glucose metabolism and blood pressure and robs neurons of their ability to operate properly. A common sleeping problem known as obstructive sleep apnea ups the risk of heart failure by 140%, the risk of stroke by 60%, and the risk of coronary heart disease by 30%, according to the National Institute of Health. Sleep-disordered breathing also leads to a build-up of brain beta-amyloid, a key marker for Alzheimer's and other forms of dementia.

Our program includes sleep hygiene because of its powerful protective effect on brain-body health. We turn to the new specialty of sleep medicine for expert advice from physicians in this discipline, and sleep coaches for creating an environment conducive to sleep-and for mending broken sleep habits without pills or gadgets.

Chapter 8: A Sound Approach to Stress Management

We Americans are stressed, and it's wrecking our health. As studies show, when you feel like you're in an emotional pressure cooker on a daily basis (as half of Americans do) plaque accumulates in the arteries, making blood platelets sticky and prone to forming clots. Arteries begin to constrict, starving the heart of nourishing blood. Meanwhile, as the blood is trying to deal with compromised blood flow, it's also pumping out high levels of cortisol that wear down nervous systems. Chronic stress causes brain shrinkage, particularly in the prefrontal cortex, the area of the brain responsible for memory and learning.

Readers don't have to live life in the stress lane, despite the blinding pace of American life. This chapter reveals some simple changes and choices they can make to stress-proof themselves.

One of the most intriguing for brain-body health is a new form of meditation known as Kirtan Kriya, which involves using fingertips in conjunction with relaxing sounds to stimulate the brain. A 2017 study found that beginner classes in Kirtan Kriya, or simply listening to music for 12 minutes a day for three months, had significant benefits for adults with preclinical memory loss, including those at risk for AD.

In this chapter, we will also look at other surprising and diverse stress-relief techniques that can be satisfying in their own way, including the practice of prayer, the art of threading a needle, getting a massage… even doing dishes.

Chapter 9: Cognitive Stimulation to Jump-Start Your Brain

At Cleveland Clinic's Lou Ruvo Center for Brain Health, where co-author Dr. Sabbagh is director, "cog-stim"-cognitive stimulation-is one of the pillars of brain health.

In this chapter, we'll talk about how to stimulate and challenge your brain. We will introduce the topic of "brain reserve"-essentially your brain's resilience and ability to improvise, and a critical component of maintaining a sharp mind as you age. Research shows how a broad array of brain-boosting activities-everything from pottery to painting, reading the classics to mastering a foreign language-can help keep your brain reserve agile and deep.

How do you choose the best approach for you? And what is the cog-stim prescription? How often, how long, how systematically must one pursue these new activities in order to reap the brain-boosting rewards? We'll address those important questions, but we'll also look at the other part of the equation, specific to this book, by showing readers how to combine their heart-pumping cardio exercise with brain-boosting cog-stim activities. Done together, at the right time, they can provide an enormous one-two punch that can not only replenish your brain reserve, but actually enhance your ability to learn and think creatively (useful not just for the future, but for higher-functioning in daily life right now!).

Chapter 10: Close Encounters in a Socially-Distanced World

The famous Roseto experiment proved the power of close, homogenous communities and their relationship to public health. The story of the rural Pennsylvania town that defied national trends in heart disease in the 1950s and 1960s-only to reverse direction as its Italian immigrant-population became more Americanized-is a lesson for us today. "What Roseto taught us," wrote one cardiologist, "is that we humans are social animals who fare best when we're not alone or isolated. The price of modern society in our diet, our stress levels, our exposure to toxins and also our loneliness has been high."

That famous study also reminds us that social connections-whether through family, friends, church or community organizations or interest groups--are every bit as powerful as adequate sleep, a good diet, and a regular exercise program for long-term health. Conversely, a relative lack of social ties is associated with depression and later-life cognitive decline, as well as with increased mortality.

Another more recent study, which examined data from more than 309,000 people, found that lack of strong relationships increased the risk of premature death from all causes by percent, which is about the same effect as smoking up to 15 cigarettes a day.

In this chapter, we cover the science behind the importance of having close relationships at any and every age. And we've got suggestions for increasing the quality and quantity of social interactions as well, even in the age of social distancing.

Chapter 11: Other Factors That Can Improve Brain-Body Health

Visiting the dentist and flossing your teeth can brighten your smile. Can such practices also brighten the picture for your heart-brain health?

Supplements promise much in the way of heart and brain health. What do they actually deliver?

Hand washing was the prosaic cornerstone of the public-health battle against the Coronavirus: Can it help ensure our heart and brain health, too?

And let's not forget things like coffee, dark chocolate and two glasses of wine per day. All have heralded as keys to a healthy heart and brain. Is this true? (Please tell us it is! Maybe even just a little?)

In this final chapter, we offer a checklist of other health habits that can promote optimal heart-brain health, as well as some that have been shown to have little value; and still others (as alas, may be the case with alcohol, sweets and caffeine) in which further research is still needed.

Part 3: Brain-Body Balance in Action

Chapter 12: Making Healthy Changes, Step by Step

Our program is constructed on sound building blocks of brain and heart health, with new scaffolding that links the two in specific ways. It is comprehensive. It is multi-faceted. And while it is well within the grasp of your average person, it is challenging. Where do you start? Right here:

In this motivational and practical chapter to conclude the book, we show readers how to take the steps that can lead them to optimal brain-heart health, as well as protect them from heart disease and Alzheimer's.

Co-author Joe Piscatella has helped thousands in their journey to better heart health, in part by teaching them how to adopt the right kind of mindset needed for lifestyle change. About how to set goals, about taking responsibility, about developing a positive mindset, and resilience when one hits the inevitable bumps in the behavioral road. Here, he guides readers, step by step, through a process specific to this program. "No Ordinary Joe" will teach them how to get in the right mindset; how to integrate these principles into their daily lives-and lead them to the extraordinary benefits to be accrued by a heart and brain in healthy harmony.

Chapter 13: Additional Resources to Help You Maximize Your Heart and Brain Health

In this chapter we recommend additional resources to help readers. We include websites, books, online classes and more.

Source List/Citations