Boost Your Brain (8 page)

On the following lines, I want you to write several sentences vividly describing the life you’ve just envisioned. Write it as if you’ve already achieved those goals.

Example: I completed this program last month. Now I can easily remember the name of every person I meet.

______________________________

______________________________

______________________________

______________________________

______________________________

It sounds pretty appealing, doesn’t it? This is the you of the (not too distant) future. You’re ready now to make it a reality.

Your Brain Fitness Assessment

Before you implement any changes, you need to understand just where you stand in terms of all the factors that affect brain health. If you walked into my Brain Center today with concerns about your memory or cognitive function, there are some standard steps I would take:

1. I’d review medical records from your other doctors to learn about any conditions you’ve had in the past.

2. I’d listen to your concerns and obtain detailed information about when symptoms began, how severe they are, and if friends or family have noticed them.

3. I’d ask questions about your health, from head to toe.

4. I’d perform a physical and neurological exam, with special emphasis on checking your memory, attention, and concentration.

5. I’d formulate a potential diagnosis for you and order one or more of the following tests, as needed:

—a brain MRI, to measure the exact size of your hippocampus;

—a sleep study, to check for sleep apnea;

—an actigraphy, a five-day test that measures insomnia at night and activity during the day;

—an ultrasound of the blood vessels in your neck, to check for signs of blockages in the blood flow to the brain;

—a cardiopulmonary exercise test, to measure your “VO
₂
max” (a measurement of stamina and endurance);

—a complete cognitive evaluation, with paper-and-pencil tests to measure the function of each area of the cortex and hippocampus;

—a quantitative EEG brain mapping, to check brain wave frequency and look for signs of anxiety, depression, insomnia, or ADHD; and

—blood tests, to assess levels of vitamins B12 and D, ferritin, cholesterol, and CRP (C-reactive protein), or possibly other tests if your history hints at kidney or liver problems, low testosterone, Lyme disease, or other conditions.

6. I’d review the results of your tests with you and inform you of your brain fitness status.

7. I’d set you up to meet with our brain coach and start you on an individualized three-month brain fitness program.

Since you’re not walking into my office and instead are using this book, I can’t perform these health checks. You will need to see your doctor for a checkup and obtain a set of basic tests. You will also need to discuss your other health issues and lifestyle habits, as you will learn in a moment.

Know Your Numbers

There are certain overall health measurements that also reveal information about your brain’s health and warrant knowing. One is
blood cholesterol,
a vital stat to keep on your radar, especially since high levels of blood cholesterol can cause damage without producing symptoms. As you’ll read in
chapters 11
and
12
, high blood cholesterol and
hypertension,
or high blood pressure, are two warning signs that your brain isn’t getting optimal oxygen flow. They’re also risk factors for heart attack and stroke, the ultimate oxygen starvers.

A healthy blood cholesterol profile, according to the American Heart Association
¹
is:

Total Blood Cholesterol:
less than 200 milligrams per deciliter (200 to 239 is borderline high; 240 is high).

LDL:
less than 100 mg/dL is optimal (130 to 159 is borderline high; 160 or more is high; more than 190 is very high). Patients with diabetes should have an LDL less than 70.

HDL:
more than 60 mg/dL is best (for men, 40 to 49 is average; for women, 50 to 59 is average; less than 40 mg/dL for men and 50 mg/dL for women is low and considered a major risk factor for heart disease).

If your total blood cholesterol is above 200, your LDL is above 160, and your HDL is below 40 for men or 50 for women, you may need an annual cholesterol test.

You should also know your
blood pressure
reading. Ideally, you’ll do this as part of a regular visit to your physician, annually at least, but you can also keep an eye on your blood pressure by using blood pressure machines available in many pharmacies or buying one for home use.

A normal blood pressure is at or below 120 over 80 (120/80). If your blood pressure falls between 120–139 over 80–89, you may be diagnosed as prehypertensive. If it is persistently greater than 140/90, you may be diagnosed as having hypertension.

You should also know your blood levels of:

•   
Thyroid:
One measure of thyroid function for screening purposes is your level of thyroid-stimulating hormone (TSH). Normal TSH levels are between 0.4 and 4.0 mIU/L (milli-international units per liter). If your doctor is concerned that you may have a thyroid problem, he or she might order a full thyroid panel.

•   
Vitamin B12:
The standard “normal” amount for B12 is above 200 pg/mL (picograms per milliliter), but knowing the importance of B12 for brain function, I always help my patients maintain levels above 500 pg/mL. For example, you might be told you have normal levels of B12 (if your level is above 300 pg/mL) but I’d recommend taking B12 supplements until your level reaches 500 pg/mL.

•   
Vitamin D:
Low vitamin D is a common problem and is associated with many neurological conditions as well as fatigue, memory loss, and dementia. The standard “normal” amount for vitamin D is above 40 nmo/L (nanomoles per liter), but given vitamin D’s importance in brain health I (along with most clinicians) favor levels above 60 nmo/L.

•   
Hemoglobin A1c:
Glycosylated hemoglobin A1c, or HgA1c, is a measurement used to detect diabetes. People who have HgA1c greater than 6.5 percent have diabetes. A level of 5.5 percent to 6.5 percent signifies pre-diabetes, and a level below 5.5 percent is normal.

•   
Fasting Blood Glucose:
A normal fasting blood glucose level is less than 100 mg/dL. A level of 100 to 125 mg/dL indicates pre-diabetes and 126 mg/dL or greater indicates diabetes.

•   
C-Reactive Protein:
CRP is a measure of cardiovascular risk factor and it should be less than 1 mg/dL. Between 1 and 3 mg/dL is considered intermediate risk, and greater than 3 mg/dL is considered high risk. Sometimes elevated CRP is seen in conditions other than cardiovascular disease, such as rheumatoid arthritis.

•   
Ferritin:
Ferritin level is a measure of iron storage. A normal ferritin level for men is between 12 and 300 ng/mL (nanograms per milliliter); for women, it is between 12 and 150 ng/mL. A level below 12 ng/mL is associated with iron deficiency and anemia, and a high ferritin level is associated with alcoholic liver disease.

•   
Testosterone:
In men, the normal range for testosterone is between 300 and 1,000 ng/dL (nanograms per deciliter). Low testosterone is associated with reduced libido, erectile dysfunction, fatigue, lack of energy, and difficulty concentrating. And it’s not as uncommon as you might think. I see many patients who have low testosterone and don’t realize it.

In addition to your blood levels, you should be aware of your weight status. A good measure of healthy weight is the waist-to-height ratio (WHtR), which is your waist circumference in inches divided by your height in inches. A healthy WHtR is under 0.5.

Now it’s time to see where you stand. In the following table, list your health measurements. If they’re not in the normal ranges, talk to your doctor about treatment. If you don’t yet know your measurements, be sure to get them and fill in this chart when you do. You can also come back to this page at the end of your twelve-week program and fill in your measurements at that time (in the three-month column).

My Health Measurements

Get a Baseline

Your next step toward a bigger brain is to use the following calculator to determine your baseline “Fotuhi Brain Fitness Score.” This is a rough estimate of your current brain health status based on modifiable factors in your life, intended merely as a big-picture view of your brain function at this time. You’ll complete this chart again at the end of your twelve-week brain fitness program. By then your score will have risen significantly.

Brain Fitness Calculator

Use your final Fotuhi Brain Fitness Score to determine your current brain health status.

Green: 50 to 60
Good news! You’re starting your journey with a relatively fit brain. There’s always room for improvement, though, so your twelve-week plan will focus on fine-tuning your lifestyle choices to grow your brain.

Yellow: 35 to 49
You’re starting your journey in relatively good brain health but with some problem areas. You’ll likely need to identify key weaknesses and devote a strong effort to strengthening them, while maintaining brain-healthy habits in other areas.

Red: 20 to 34
Your brain is in need of some TLC. Your goal over the next twelve weeks will be to improve your scores across the board. This may involve some major lifestyle changes. As you read the chapters that follow, think about which lifestyle changes you can realistically make and which will have the biggest impact for the effort. Committing to regular exercise, as you’ll read, may provide greater benefits than memorizing your grocery list. For patients who have many changes to make, or who have physical limitations, I advise tackling one or two meaningful changes at a time and adding in other changes as the weeks progress. Please work closely with your doctor or other health care professional.

Warning Card

This assessment is only a reflection of your current lifestyle and health conditions. Just as years of big spending might drain your retirement funds long before you reach old age, years of poor health can shrink your brain.

If you’ve had brain-shrinking health conditions or lifestyle factors in the past, you might already have decreased your brain reserve. Don’t panic. Growing your brain over the next twelve weeks—and into the future—will help you more fully fund your reserve.