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| EDITORIAL |
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| Year : 2013 | Volume
: 1
| Issue : 2 | Page : 99-102 |
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Brain wellbeing and brain-healthy lifestyle in the neurocentric age: Myth or reality?
Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Mangalore, Karnataka, India
| Date of Web Publication | 13-Dec-2013 |
Correspondence Address:
Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Mangalore - 575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.123012
How to cite this article:
Shelley BP. Brain wellbeing and brain-healthy lifestyle in the neurocentric age: Myth or reality?. Arch Med Health Sci 2013;1:99-102 |
"Some people say that the heart is the organ with which we think and that it feels pain and anxiety. But, it is not so. Men ought to know that from the brain and from the brain only arise our pleasures, joys, laughter, and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant….To consciousness the brain is messenger" Hippocrates
"The problem of neurology is to understand man himself" said the neurocartographer Dr. Wilder Penfield. Nevertheless, I wonder whether the human brain can ever achieve understanding of its own intricate process? In this regard, Tom Wolfe once said that the brain being finite, and hard wired, it will probably never have the power to comprehend human existence in any complete way. However, with the advent of the 'cerebroscope' and 'imaging neuroscience,' the 'terra incognita' of the brain cannot be dismissed as nothing more than a "bowl of curds" as once ridiculed by philosopher Henry More. The neuroscientists appear as the heralds of a new era, the 'Neurocentric Age', poised to solve the last riddles of mankind in elucidating cognition and neural functioning, the reconstruction of the working brain terrain through enormous leaps in technology. Furthermore, the reductionists, contrary to the anti-reductionists, view human behaviorism to be reduced to an exclusive perspective of the brain, its neurochemical milieu and connectomics. I would like to reiterate that the Neurocentric age is the era in which the brain is central not only to the body but to our conception of ourselves.
The molecular basis of brain chemistry, neurotransmission, and synaptic connectivity was explicated by Thomas C. Südhof, a neuroscientist, who shared the 2013 Nobel Prize in Medicine. Another feat in computational neuroscience and sensorimotor neural engineering was the demonstration of the first human brain-to-brain interfacing by Professor Rajesh Rao and Andrea Stocco of University of Washington in August 2013 going beyond the frontiers of brain-computer interface. The coming of this 'Neurocentric Age' has even led to the birth of new interdisciplinary fields such as social neuroscience neurophilosophy, neurotheology, and other neurologisms, that include neuroeconomics (behavioral economics), neuro-marketing, neuro-didactics, and neuro-aesthetics as well as neuro-ethics, neuro-theology, neuro-politics, and neuro-law. Neuroessentialism posits that, for all intents and purposes, we are our brains. The progress of man and his civilization is related to the evolution of the human brain, and has now paved the way for a neurocentric world. In an era dominated by neuroessentialism, neurocentric, and genocentric view, where do we stand in terms of brain wellness and brain healthy lifestyle to preserve the social and mental capital of the world? In view of the 'human ageing time bomb,' an 'epidemic of our century,' have we charted a paradigm shift in our public health policies for 'Brain-healthy lifestyle 2020?' Have we envisioned the coming decade to be the 'Decade of Brain Fitness?' Have we considered the impact of lifestyle diseases time bomb, the Achilles heel of modernization, resulting from aculturalization, Coca cola colonization, fast food and Mc Donalization in our Indian society?
Reiterating the statement of James Watson, co-discoverer of the double helix DNA "the brain is the last and greatest biological frontier; the most complex thing we have yet discovered in our universe," it's ironical to note that 'brain health,' 'brain-healthy lifestyles,' and 'brain-friendly nutrition' are not given its due priority in our Indian society by health policy makers. With the dawn of the neurocentric age, there is a lack of public awareness on neurocentric health; let alone preventive neurology strategies. Preventive cardiology is way ahead in this respect as evident by many pioneering efforts and studies such as Framingham Heart Index, PDAY risk score, Saffola life study in India, INTERHEART study, India Heart Watch Study, and models for preventing heart disease in 21st century. The International Heart Protection Summit at New Delhi in 2011 and various other cardiocentric health programs are driven to make India heart-healthy. On the contrary, a study by Joosten and colleagues published in American Heart Association journal, Stroke 2013 [1] underscored that cardiovascular health, brain health and cognition are interwoven. Having a 'World Heart Day,' it is heart-rending to observe a total neglect on brain health awareness.
A wakeup call for urgent changes in our Indian national health policies would be imperative after taking cognisance of the findings of a study by the Kessler Foundation Research Center, US and Sree Chitra Tirunal Institute for Medical Sciences and Technology, India, in 2012. [2] This study unearthed a hidden epidemic of neurological disabilities sweeping through India stemming from disorders such as dementia, stroke, and traumatic brain injuries. In India, 27% of the population is below poverty level, and hence, the family members resort to provide most of the care of disabled persons resorting to sale of family assets, take loans, and loss of wages that leads to iatrogenic poverty, catastrophic health expenditure, and consequent impoverishment of the poor. Therefore, the economic burden of lifestyle disorders in India is likely to be disproportionately experienced by the poor.
Being a part of the consultative group for India Dementia Report 2010, and movement for a National Dementia Report for India, my ruminations are centered on the issue of dementia. Quoting Louis Pasteur "When meditating over a disease, I never think of finding a remedy for it, but instead a means of preventing it" (1884), I am a proponent of healthy brain ageing and believe that preventive neurology strategies will be the Holy Grail to fight dementia, a lifestyle disorder, and that would ensure a creative and successful ageing. How many of the public and healthcare professionals have an awareness of attitudes of brain health and a connection between health behaviors and brain wellbeing?
After the original 1984 clinical criteria for Alzheimer's disease (AD), a major milestone in re-conceptualization of AD in 2011 proposed the continuum of AD to reflect the earliest stages of the AD pathophysiological process. This takes into consideration the fact that the dementia pathophysiology starts 20-30 years earlier, and justifies the concept of early, midlife, late-life multi-component intensive vascular and multi-domain life style risk intervention strategies aimed at promoting brain health through brain-healthy lifestyle strategies. Another shift in understanding of dementia rests on the evidence that both AD and vascular dementia share many risk common vascular risk factors, and it should be realized that AD and VaD rarely occur in isolation. A study published in Lancet Neurology 2011 [3] did show that over half of AD worldwide may be preventable if smoking, physical inactivity, depression, mid-life hypertension, diabetes, and mid-life obesity are tackled. Evidence from large observational studies do certainly suggest regular exercise, brain-healthy diet, creative engagement, positive and active socially integrated lifestyle, intellectually challenging leisure activity, cognitive exercises and mentally stimulating activities, spiritual engagement, and meditation/mindfulness practices to be promising healthy brain avenues. Such strategies does revitalize the brain through cognitive reserve capacity, nurture brain resilience, reduce allostatic load/stress, and build "compensatory neural scaffolds" to protect against development or expression of dementia. These strategies could help the brain to stave off the ravages of cognitive decline and alter brain's cognitive and emotional trajectory to one of a positive, creative, and successful brain ageing.
Lifestyle contribution to longevity and healthy brain ageing is evident from three studies. The Okinawa Centenarian Study (OCS) documented that the traditional Okinawans had healthier lifestyles. Their lifestyle practices included healthy diet comprising of low caloric intake, high vegetables/fruits consumption, higher intake of good fats (omega-3, mono-unsaturated fat), high fiber diet, high flavonoid intake, regular exercise, avoidance of smoking, blood pressure control, and a stress-minimizing psycho-spiritual engagement. The Nun study, a longitudinal study of aging, also did emphasize the model of healthy aging, cognitive reserve hypothesis and the contributions of early life positive emotions, life course events, social factors, nutrition, intellectual stimulation, education, and lifelong learning. The Kimberley study on the Australian Aboriginal people strikingly revealed six times higher prevalence of dementia when compared to the general Australian population. Poorer health outcomes, higher cardiovascular disease, higher hypertension, diabetes mellitus, smoking, obesity, physical inactivity, and poor quality diet (limited fruit/vegetable intake) were incriminated for this discrepancy. Nutrigenomics and nutrigenetics have also established an association between telomere length, telomerase activity, sirtuin activators, Mediterranean diet, and healthy ageing. The so-called "MediterrAsian" diet that is especially rich in 'sirtfoods' and caloric restriction exerts their effects through sirtuin activation. Thus such dietary modifications may be promising new strategies in brain wellbeing to ensure protection against and recovery from the various aging-related neurological diseases, and steer human longevity towards successful and healthy brain ageing.
The field of exercise neuroscience has strengthened the evidence for the link between physical activity and exercise throughout the lifespan to brain wellbeing and cognitive health through mediators such as BDNF, IGF-1, and other neurotrophic factors. There is a health consciousness that running is good for the heart as shown by the recent multicity Max Bupa Walk for Health 2013 in India that popularizes the initiative to promote awareness for cardiac fitness through exercise. However, the effect of exercise on cognition and brain health is hardly stressed upon. Results from the Cardiovascular Health Study has shown that greater amounts of walking earlier in life are associated with greater gray matter volumes in later adulthood involving the brain regions susceptible to age-related deterioration. [4]
Yoga, Ayurveda and its Medhya rasayanas, Meditation and Pranayama (YAMP) are 'push-ups for the brain' and paths to brain wellness. The neuroscience of meditation does indeed show structural changes in cortical thickness, grey matter density, gray and white matter neuroplasticity, changes in functional connectivity and anatomical connectivity, and changes in EEG patterns. Moreover, the neural mechanisms of Mindfulness-Based Stress Reduction (MBSR) did also reveal an increase in gray matter concentrations in areas that were involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking. [3] Despite our rich Indian heritage of YAMP, isn't it disappointing to note our ignorance of such brain salutogenic factors that could accomplish brain health in terms of cognitive, emotional, and spiritual health?
Our fasting rituals and traditions do dwell upon the science of dietary and caloric restriction (CR) and alternate-day fasting (ADF). The nascent literature from both animal and human trials does show beneficial effects of fasting by promoting brain health, healthy brain ageing and life span through resistance of neurons to neurodegeneration, and chronic disease prevention such as type 2 diabetes mellitus, cardiovascular disease (CVD), and cancer. Observational studies on the Okinawa centenarians revealed that the adult energy intake was 20% less than the Japanese national average. It is interesting to know that the anti-ageing effects of caloric restriction is mediated at various levels i.e. through effective modulation of metabolic, mitochondrial bioenergetics, and functional risk factors, retardation of oxidative stress, improving insulin sensitivity, regulation of neuroendocrine status, suppression of apoptosis, and regulation of gene expression and preventing macromolecular damage. Future research studies in CR research are sorely needed, which could translate into new strategies for effective brain-healthy lifestyle interventions.
Notwithstanding cardiocentric health programs, it is reassuring that many intervention studies are underway in Europe such as Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), Prevention of Dementia by Intensive Vascular Care (preDIVA), Multidomain Alzheimer Preventive Trial (MAPT), The Impact of Nutritional Lipids on Neuronal and Cognitive Performance in Aging, Alzheimer's Disease, and Vascular Dementia (LipiDiDiet). Other lifestyle research studies currently underway include Study of Mental Activity and Resistance Training (SMART Trial), Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing (AIBL), The Personality and Total Health (PATH) Through Life, The Body, Brain, Life (BBL) project, and The Fitness for the Ageing Brain Study II (FABS II). I wonder if similar thrust areas in research on brain wellbeing and brain-healthy lifestyles are planned in India.
Why are we as 'thinkers' not thinking of protecting our 'thinking brain' to adopt brain-healthy lifestyles and neurocentric health? The future of our civilization similar to the extinction of our feathered dinosaurs by meteorites dwells on preservation of brain health. Concrete effective actions are needed to foster brain health, public health engineering to raise awareness of brain fitness, attitudes on brain health, development of predictor models for dementia in analogy to the Framingham heart scores, and put in place 'preventive neurology' akin to preventive cardiology.
I would advocate a broad social and cultural change to pervade the entire Indian population to foster a 'Brain-healthy lifestyle 2020' and 'Decade of Brain Fitness 2020' because life matters, brain health matters, humankind matters, and our civilization matters. Children, school professionals, teenagers, adults, and the elderly should create a brain health labyrinth adopting a concept of 'cradle to grave life course approach' in India. With India's mobile users to be estimated as more than 500 million, m-health should be channelized to create brain health awareness and to disseminate effective cognitive health messages for wider targets in our society. Public health message such as "Take as good care of the brain as you do your body" does emphasize upon lifelong opportunity of taking care of one's brain. The proactive brain-healthy lifestyle needs to be started at the earliest of ages, beginning in the womb, and to be prioritized across the entire lifespan. Healthy brain conferences and brain wellness research programs are needed to build evidence-based strategies for a 'Healthy brain-healthy India' by 2020.
In my mind, I am optimistic that there may be simple solutions to complex problems. Neurotherapeutic research in brain health, dementia, and research in the field of anti-aging and telomerases may provide answers. However, pluralistic approaches of anthroposophical medicine, salutogenic health outcomes, and promotion of brain health in our Indian society should also be sacrosanct. The 'yin-yang' of our Indian strategy for brain-health and dementia-free healthy ageing would be to adopt a harmonizing approach of the western and the eastern salutogenic health perspectives. Such brain-health strategies at the heart of health policy-making would certainly go a long way towards preservation of our cognitive and emotional capital, and brain wellbeing of not only India, but of all nations. I believe that a neurocentric health perspective would steer the humankind towards medical and social benefits. Thus, it may not be long before brain wellness, brain-healthy lifestyles, healthy brain ageing, and Brain Health and Wellness Centers becomes a reality!
"Something, and indeed, the ultimate thing must be left over for the mind to do."
Arthur Schopenhauer, 1859
| References | |  |
| 1. | Joosten H, van Eersel ME, Gansevoort RT, Bilo HJ, Slaets JP, Izaks GJ. Cardiovascular risk profile and cognitive function in young, middle-aged, and elderly subjects. Stroke 2013;44:1543-9. 
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| 2. | Das A, Boticello AL, Wylie GR, Radhakrishnan K. Neurologic disability: A hidden epidemic for India. Neurology 2012;79:2146-7.
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| 3. | Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res 2011;191:36-43.
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| 4. | Erickson KI, Raji CA, Lopez OL, Becker JT, Rosano C, Newman AB, et al. Physical activity predicts gray matter volume in late adulthood: The Cardiovascular Health Study. Neurology 2010;75:1415-22.
[PUBMED] |
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