Presumably people would aquire a healthy diet and habits in order to live free of disease or disability for a longer time. That is the case in the countries that surround the Mediterranean Sea and in Japan, according to very reliable statistics and epidemiology over the past 20 years. In these regions people are living well into their 80s in good health. Although many would say that these concepts were well known for hundreds of years already, the habits and the people more likely to achieve this status became quite obvious to western medicine in the past 20 years .

The bottom line on healthy diet and habits is to keep lean and thin, close to a body mass index of 22-25, with an abdominal circumference below 95cm for somebody who is 175cm tall; to have active habits physically and mentally; to eat as close as possible to once daily; that means frequent intermittent fasting of 15h or more; meals should be colourful with vegetables, fruit, grain, and protein out of the sea or of small animals and birds. Dairy products, milk, meat of cattle or other large animals, are verbotten. Or luxurious, to be had once in a long while as if they were belluga caviar. Substance abuse, including alcohol or nicotine, is to be avoided at any cost.

It is very helpful to keep an eye on your health status. In case you want to monitor your health closely, you can plot and check whether your healthy diet and habits are working. First keep your blood pressure below 130/80 mmHg all the time. That means any time, all the time, even in case of maximum stress. The most sensitive medical exam to detect vascular disease these days is an MRI of the brain, requested and interpreted by someone with neurological know-how. Microangiopathy, disease of small vessels, is the precursor of the complications of diabetes, hypertension and dyslipidemia. It appears ealier on MRI than in cardiac, renal or ophtalmic exams. In the blood you should keep your fasting glucose below 100 mg/dl; glycosylated hemoglobin well below 5.7 md/dl; low density lipoprotein – LDL – cholesterol  below 70 mg/dl, or, at least below 110 mg/dl.  The value of 70 has been shown in studies in France to be superior to reduce re-stroke and major cardiovascular events as compared to 90-110.

Amarenco et al. N Eng J Med 2019 epub 2019 Nov 18

During young and adult life personality traits with calmness, consciousness, reflection, perception of one’s self and of others, decreases the risk of later dementia, in studies carried out in Minnesota over 50 years. Maturity and calmness in youth and early adult life have a protective effect . Psychoteraphy with the objective of developing these traits may decrease the neurotoxicity of rumination, a personality trait that appears linked to the risk of dementia.

JAMA Psychiatry 2019, epub 2019 October 16.

Finally, you need to trust your luck and choices, besides healthy diet and habits. Life course predictors of cognition at 70 years of age were evaluated in a national study between 2015 and 2018 in London, UK, on all people born on the same week in March 1946. Female sex, greater childhood cognitive ability, higher educational achievement, higher socioeconomic position, amyloid negativity on PET scans and lesser small vessel disease on MRI were related with better cognition measured by Preclinical Alzheimer Cognitive Composite.

Kirsty Lu et al. Neurology 2019, 93:e2144-e2156

Dr Paulo Bittencourt

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