This document discusses strategies for maintaining brain health and preventing disorders as we age. It provides an overview of brain anatomy and the different regions of the brain. While cognitive abilities naturally decline with age, the document suggests simple steps can be taken to support a healthy brain as we age, such as choosing a brain-supporting diet and lifestyle practices to keep the mind sharp.

1. BRAINHEALTH
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3. BRAINHEALTHby PERRY RENSHAW, MD, PhD
magazine presents

4. Copyright © 2009 by Perry Renshaw, MD, PhD, and Active Interest Media, Inc.
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This booklet is part of the Better Nutrition Healthy Living Guide series. For more information,
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The information in this booklet is for educational purposes only and is not recommended
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individuals who choose to self-diagnose and/or self-treat.

5. BRAINHEALTH
CONTENTS
Introduction: Your Amazing Brain...............................4
Chapter One: The Aging Mind.......................................8
Chapter Two: The Citicoline Connection................14
Chapter Three: Food For Thought..............................21
Chapter Four: Keeping Your Mind Sharp................25
Selected References.............................................................31

6. 4 B R A I N H E A L T H
Introduction
Your Amazing Brain
Y
our brain is arguably the most fascinating organ in your body.
Think of it as a super-computer that orchestrates your every
movement, reflex and thought. Your brain controls body tem-
perature, blood pressure, heart rate and breathing. It directs your muscles
and nerves, and processes a never-ending flood of information about the
world around you. It sorts and stores memories, allows you to make deci-
sions, and gives you the ability to communicate through speech. Your
brain also lets you dream, invent and experience emotions. All of these
tasks are coordinated, controlled and regulated by an organ that weighs
just three pounds.
­Your brain consists of approximately 100 billion nerve cells known as
neurons, which function, basically, as on/off switches. If a neuron is turned
on, it shoots an electrical signal through an axon, an appendage of the cell
that is like a cable or wire. When the signal gets to the end of the axon,
it stimulates tiny sacs that release chemicals known as neurotransmitters.
These neurotransmitters then cross a gap called a synapse and attach them-
selves to receptors on the neighboring cell. If the receiving cell is also a neu-
ron, the signal can continue to travel to the next cell. At any given moment,
millions of neurons are sending messages to various parts of your body,
causing a multitude of voluntary and involuntary reactions.
Neurons are made up of three basic parts:
• Cell body: Like cells in the rest of the body, neurons contain a
nucleus that houses DNA, ribosomes that build proteins, and
mitochondria that produce energy. If these crucial processes in the
cell body become impaired, the neuron will die.
• Axon: This long, cable-like projection carries the electrochemical
message from the cell body to the synapse. Depending upon
the type of neuron, axons can be covered with a thin layer of
myelin, a fatty insulation that protects the axon and increases the
transmission speed of electrical signals. Myelinated neurons are
typically found in the peripheral nervous system. Unmyelinated
neurons are found in the brain and spinal cord. The end of the axon
is called an axon terminal.
• Dendrites: These small “branches” project from the cell body and
collect chemical messages (via neurotransmitters) from the axon

7. B R A I N H E A L T H 5
terminals of adjacent neurons. If the chemical messages are strong
enough, they will cause the cell to fire an electrical signal down
the axon to another neuron’s dendrites. These connections allow
neurons to communicate with other cells and interpret information
from internal and external sources.
Even though all neurons contain these three components, all neurons are
not the same. There are several types and each has a different function.
• Sensory neurons carry signals from the outer parts of your body (the
periphery) to the central nervous system (the spinal cord and brain).
• Motor neurons carry signals from the central nervous system to the
periphery (muscles, skin, glands) of your body.
• Receptors sense the environment (light, sound, and touch) and
encode this information into electrochemical messages that are
transmitted by sensory neurons.
• Interneurons connect various neurons within the brain and
spinal cord.

8. 6 B R A I N H E A L T H
Regions of The Brain
Just as neurons have different jobs and abilities, so do the different
regions of the brain. The brain can be divided into three areas: the fore-
brain, the cerebellum and the brain stem. Each area is associated with a
distinct set of functions.
The forebrain is responsible for all higher functions of the brain, like rea-
soning and problem solving. The forebrain includes the cerebrum and the
diencephalon (located in the middle of the brain). The cerebral cortex of
the cerebrum contains four regions, which each perform different tasks.
The frontal lobe sits right behind your forehead, at the front of the
cerebral cortex. It is responsible for performing executive functions, such
as problem solving. It also contains the primary motor cortex, a region
that plans and executes movement, as well as a portion of Broca’s area—
an area of the brain responsible for speech, language processing and
language comprehension.
The parietal lobe sits at the top, or crown, of your head, right behind
the frontal lobe and is the primary sensory area of the brain. This is where
nerve impulses carrying sensations of pain, temperature, touch and pres-
sure travel to. Areas in the parietal lobe are also involved in spatial orien-
tation, speech and language development, and attention.
The temporal lobe is below the frontal and parietal lobes (toward the
ears), and above the hindbrain (the bottom area of the brain at the back of
the head). The temporal lobe is where the majority of sensory processing
occurs—specifically the processing of information from multiple senses,
especially hearing and vision. The temporal lobe also contains a neural
structure called the hippocampus, which plays a key role in the formation
of long-term memories.
The occipital lobe, the fourth and final region of the cerebral cortex, is
located behind the parietal and temporal lobes. It sits at the back of the
skull and above the hindbrain. This region contains the primary visual cor-
tex and is critical for sight.
The diencephalon, which is the second major region of the forebrain,
is located inside the casing of the cerebral cortex and includes two key
structures, the thalamus and the hypothalamus. The thalamus acts like
a switchboard for the brain. Most sensory information passes through
this area before arriving at the appropriate area of the cerebral cortex.
The hypothalamus secretes and regulates the secretion of neurohor-
mones and endocrine hormones. It also appears to control basic sur-
vival responses, such as the “fight or flight” response, hunger, thirst and
sexual responses.

9. B R A I N H E A L T H 7
The cerebellum is the main structure of the hindbrain, situated at the
base of the brain and the top of the spinal cord. The cerebellum controls
our balance and physical stability, and is involved in motor coordination
and the development of “muscle memory.”
The brain stem is the most primitive part of the brain and includes the
midbrain, pons, and the medulla oblongata. The midbrain is involved
in processing visual and auditory information. It also controls eye move-
ment. The pons bridges the cerebellum and brain stem, and helps coordi-
nate breathing, blood pressure, sleep and waking. The medulla oblongata
connects the brain to the spinal cord and controls the most basic bodily
functions, such as breathing and blood circulation.
When we are young, all of these pieces and parts should be function-
ing optimally. Our brains easily soak up new information. Our powers
of deduction, reaction times, and our ability to learn and remember
are at their best. As we age, some of these capabilities seem to wane,
but forgetfulness and cognitive decline are not a certainty. There are
some simple steps you can take now to ensure a better brain for years
to come.
Anatomy and Functions of the Brain

10. 8 B R A I N H E A L T H
Chapter One
The Aging Mind
I
f you have ever forgotten where you left your car keys or drawn a
blank on a familiar name, you may have wondered if these “senior
moments” were the first subtle signs of age-related memory loss. As
we get older, our speed of processing information, and the efficiency of
our short and long term memory naturally decline. It is also a fact that
the brain regions dedicated to these functions actually shrink in size as we
age. This could certainly make you worry about losing your mental edge
with each passing birthday.
However, these changes are not as dire as they may seem. Several years
ago, researchers at Princeton University found new nerve cells being
created in the brains of monkeys. According to their study, neurons are
regenerated deep in the center of the brain. Once reborn, they move to
other parts of the brain associated with higher mental functions, like
the hippocampus, the major neural region associated with long-term
memory storage. This study may have implications for human memory
function. In other words, the aging human brain may be more resilient
than we thought.
Age-Related Memory Loss
Memory loss is a normal part of the aging process. As we age, blood flow
to the brain decreases, causing it to use oxygen and protein less efficiently.
In addition, the number of receptors associated with memory function
declines and aging brain cells may stop sending and receiving chemi-
cal signals. The aging brain also loses some of its ability to protect itself
against inflammation and free radicals. But having an occasional memory
lapse or needing more time to process new information does not always
mean your brain is suffering from old age. Memory loss or a loss of con-
centration can also be caused by such things as dehydration, a poor diet,
fatigue or stress.
Memory and cognition are also affected by changes in the level of sex
hormones. For example, menopausal women may complain of “brain
fade” due to declining levels of estrogen. This hormone protects hip-
pocampal neurons and promotes the formation of new neurons, which
might explain a connection with memory. Two studies, each following
hundreds of women over time to see who developed Alzheimer’s dis-
ease, found that those who received estrogen during or shortly after

11. B R A I N H E A L T H 9
Physical exercise
is as important as
mental exercise to
maintain memory
and mental acuity.

12. Jog Your Memory
We all forget things from time to time, whether it’s due to age-
related memory loss or just from having too much on our minds. To
help you remember more, more easily, the American Academy of
Family Physicians recommends a few techniques:
• Keep lists. Routinely making grocery lists, to-do lists, lists of
projects or goals can prevent everyday tasks and special “to
dos” from falling through the cracks.
• Follow a routine. Doing the same activity at the same time
each day helps cement them in your memory.
• Make associations (connect things in your mind), such as
using landmarks to help you find places.
• Keep a detailed calendar, in
a place where you will see
it every day, so you never
miss another birthday or
appointment.
• Put important items, such as
your keys or glasses, in the
same place every time you
are finished using them.
• Repeat names when you
meet new people. “It’s
nice to meet you, Henry.”
• Do things that keep your
mind and body busy. For
example, gardening or
redecorating a room require
both mental and physical
work.
• Run through the ABCs in your
head to help you remember a
word or name. “Hearing” the
first letter of a word may jog
your memory.
10 B R A I N H E A L T H
Making lists
and keeping
detailed
calendars are
good habits
to form.

13. B R A I N H E A L T H 11
menopause—even for as little as six months—were less likely to later
develop Alzheimer’s disease than the women who had not used estro-
gen replacement therapy. While pharmaceutical estrogen replacement
has been shown to increase many health risks, these studies point to
the important role this hormone plays in cognition and memory. There
are several possible explanations for such effects. For example, estrogen
increases the concentration of an enzyme that is needed to synthesize
acetylcholine, a brain chemical essential for memory function. Estrogen
also enhances communication between neurons in the hippocampus, an
area of the brain that is important for verbal memory.
Estrogen increases the
concentration of an enzyme
that is needed to synthesize
acetylcholine, a brain chemical
essential for memory function.
Although men do not have such a dramatic decline of hormones as
they get older, research shows that men with high levels of testosterone
have better visual and verbal memory skills than men with low levels.
Conversely, low testosterone levels have been observed in patients with
Alzheimer’s disease and mild cognitive impairment.
Certain diseases and medications can affect memory too. For instance,
people with high blood pressure are more prone to memory impairment
than people with normal blood pressure. People with diabetes may experi-
ence memory problems due to high levels of blood sugar. Drugs, includ-
ing sleeping pills, sedatives, painkillers, some antidepressants and even eye
drops for glaucoma, can cause forgetfulness. If you are experiencing mem-
ory problems and suspect that one or more of your medications is respon-
sible, make a list of all the drugs you are taking and talk with your doctor.
Dementia
Usually a small mental lapse is nothing to worry about, but if you find
that memory problems are interfering with your daily life, it is wise to see
a health care practitioner. He or she can tell you if the problem is serious
or is triggered by something temporary, like a medication or stress.

14. 12 B R A I N H E A L T H
Seek help if you:
• Forget things much more often than you used to.
• Forget simple words or use the wrong words when trying to
explain something.
• Forget how to do something you have done many times before.
• Have trouble learning new things.
• Repeat the same phrase or story in the same conversation.
• Have trouble making choices or handling money.
• Cannot keep track of what happens each day.
• Have trouble doing things that involve a series of steps, like
following a recipe.
• Experience sudden mood swings, going from calm to tears to anger
in a few minutes.
Chronic or severe forgetfulness does not automatically mean Alzheim-
er’s disease. There are several other types of dementia that can interfere

15. B R A I N H E A L T H 13
with a person’s ability to function on a daily basis. Some, like ­Alzheimer’s,
are progressive and very serious. Others, however, can be halted or reversed
by treating underlying conditions that may contribute to the dementia.
Common types of untreatable dementia include dementia with Lewy
bodies (closely allied to Parkinson’s disease) and frontotemporal demen-
tia. Lewy bodies are clumps of proteins in neurons that accumulate in
the brain, and are similar to the proteins found in the brains of people
with Alzheimer’s and Parkinson’s diseases. Frontotemporal dementia
affects areas of the brain responsible for judgment and social behavior.
As a result, people with this type of dementia can display inappropriate
social behavior. Several disorders, such as Huntington’s disease and AIDS,
can also result in dementia.
Another type of dementia, known as vascular dementia, occurs when the
arteries that feed the brain become blocked or narrowed. This decreases
blood flow depriving brain cells of the nutrients and oxygen they need to
function normally. Vascular dementia often occurs after a stroke. Prevent-
ing further strokes by treating the underlying diseases—high blood pres-
sure or unhealthy cholesterol levels—may slow or stop the progression of
vascular dementia.
Some types of dementia are associated with reversible diseases like
hypothyroidism (decreased thyroid function) and severe hypoglycemic
episodes, where there is too little sugar in the bloodstream. Severe infec-
tions, like cryptococcal meningitis in people with a compromised immune
system (such as AIDS patients), and chronic alcoholism can also cause
reversible dementia.
Alzheimer’s Disease
Alzheimer’s disease is far and away the most common type of demen-
tia, accounting for 50 to 70 percent of all dementia cases. Although early
onset can occur, Alzheimer’s—and dementia in general—are much more
common after age 60. While no one knows the exact cause of Alzheimer’s,
scientists have discovered that plaques—fibrous deposits made of protein
fragments—play a key role in the disease. As these plaques build up in the
brain they cause abnormal degeneration and eventual death of brain cells,
particularly in regions of the brain associated with memory. Eventually, these
abnormalities and the loss of neurons extend into other areas of the cortex.
As we age, much can go wrong with the brain. It is impossible to change
your genetics or turn back time, but you may be able to maintain your
memory and acuity into your seventies, eighties and nineties by being
mindful of what you eat and keeping your mind in good shape with regu-
lar physical and mental exercise.

16. 14 B R A I N H E A L T H
Chapter Two
The Citicoline
­Connection
I
f you want to prevent age-related cognitive decline and keep serious
memory loss at bay, you need to “feed” your brain what it needs to
function at its best. Citicoline (CDP-choline; cytidine 5’-diphospho-
choline) is a nucleotide (a building block of DNA) found in every cell in
the body. It plays a key role in the creation of cell membranes. Citicoline
triggers the production of the neurotransmitter acetylcholine, and modu-
lates transmission of other neurotransmitters dopamine and norepineph-
rine. It may also help protect and regenerate brain tissue. Recent studies
show that increasing citicoline levels through nutritional supplements,
may help prevent premature cognitive decline.
One of citicoline’s most important effects in the brain may be its abil-
ity to increase production of adenosine triphosphate (ATP) in the frontal
lobe. ATP provides energy to the mitrochondria of each cell. Not only is
this energy vital for cellular activity, increasing its production may help
reduce memory problems and the mental fatigue associated with age.
A study conducted at the Brain Imaging Center at McLean Hospital
in Belmont, Massachusetts, used the latest brain scanning technology
to monitor brain activity in people taking supplemental citicoline. After
supplementing for six weeks, the participants showed increased levels
of specific markers for ATP in a frontal lobe region of their brains. Citi­
coline’s positive effects on the brain persisted long after supplementation
stopped, suggesting that the supplement may have a cumulative ability to
repair and maintain neuron function.
Unlocking The Power of The Mind
How well does citicoline work? A growing number of clinical trials on
healthy adults with mild forgetfulness show that citicoline improves both
immediate and delayed recall of words and objects. Other research shows
that citicoline supplements benefit brain function in seniors with cog-
nitive impairment. Specifically, citicoline improves short and long-term
memory, attention span and perceptual-motor capacity. Supplementing
with citicoline can also help seniors remember words and phrases. During
a double-blind placebo-controlled trial of 95 volunteers between the ages

17. B R A I N H E A L T H 15
of 50 and 85, those taking 2,000 mg of supplemental citicoline daily for
two months significantly improved their verbal memory compared to the
volunteers taking a placebo.
Citicoline has also been used successfully to treat degenerative brain
diseases like Alzheimer’s. In an analysis of 12 clinical trials conducted
by the Cochrane Collaboration, researchers found citicoline improved
brain function in older people suffering from chronic brain diseases. The
researchers concluded that citicoline provided modest and consistent
improvements of memory and behavior in patients with Vascular Cog-
nitive Impairment and Dementia. While more longer-term studies are
needed, these findings are particularly exciting because there are currently
very few treatments for dementia.
Future Possibilities
Because citicoline readily crosses the blood-brain barrier and reaches
the central nervous system, some researchers are beginning to examine
this nutrient as a potential therapy for addiction. Experiments show that
citicoline raises both norepinephrine (adrenaline) and dopamine levels,
and therefore may reduce cravings experienced by people addicted to
cocaine. In a 12-week placebo-controlled study of 44 bipolar patients
with a history of cocaine dependency, those taking a citicoline supple-
ment every day used cocaine less often than the control group. They also
performed better in tests measuring how well they remembered learned
facts. To the extent that drugs commonly abused—including heroin and
other opiates, alcohol, cocaine, amphetamines and nicotine—activate
and regulate dopamine, boosting dopamine levels naturally could help
reduce the desire for these drugs.
Citicoline may also be a viable treatment for those with head injuries. In
a clinical trial of 216 patients who had suffered moderate to severe head
trauma, citicoline accelerated the cognitive recovery from post-traumatic
coma, helping the patients walk better and earlier, and shortening their
hospital stay.
A pure and natural brand of citicoline is Cognizin®, manufactured by
Kyowa Hakko Bio Co. Ltd., a leading global ingredient and pharmaceuti-
cal manufacturer. Cognizin is the only brand that has been scientifically
studied to be safe and effective for use in foods and dietary supplements
to improve brain chemistry and function.

18. 16 B R A I N H E A L T H
Smart Brain Supplements
Cognition and memory can be enhanced by a variety of herbs and nutri-
ents that increase blood flow, support antioxidant levels in the brain and
protect it from inflammation. Following are some of the most promising
and effective.
Acetyl-L-Carnitine: Similar to the amino acid L-carnitine, acetyl-L-
carnitine can protect the brain from neurotoxicity and oxygen depriva-
tion. It also preserves the energy-producing mitochondria in brain cells.
It appears to be effective in treating mild cognitive impairment, as well as
continued on page 18
Beyond Cognition
Citicoline’s cognition support benefits are enough to recommend
it to everyone as they age, however, because it supports proper func-
tioning of neurons, this remarkable nutrient may also improve other
conditions caused by neurological dysfunction. The most promising
potential use of citicoline may be in the treatment of stroke.
A groundbreaking trial recently showed that patients given citico-
line within 24 hours of an ischemic stroke (ischemic means due to
restriction of blood supply) recovered consciousness faster and had
a higher probability of overcoming motor deficit than those who
were not given the nutrient. In a meta-analysis of four different clini-
cal trials involving more than 1,600 stroke patients, approximately
25 percent of the patients given 2,000 mg, 1000 mg, or 500 mg
of citicoline within 24 hours of their stroke, recovered completely
within three months. Subjects who took the highest dose of citico-
line had a recovery rate of nearly 28 percent compared to just 20
percent among the control group taking a placebo.
Studies suggest that citicoline can also benefit vision. Glaucoma,
for instance, is most commonly the result of a buildup of pressure
from the fluid in the eye (intraocular pressure). This pressure can
damage the optic nerve, which transmits images to the brain. In
an open trial, 36 patients with glaucoma were given one gram of
citicoline daily for ten days. The researchers concluded that citi-
coline had a positive effect on optic nerve damage by increaing
the flow of nutrients to nerves affected by the disease. In another
study of seniors with mild to severe glaucoma, high doses of citico-
line improved vision and retinal function in those who had the most

19. B R A I N H E A L T H 17
common form of the disease. Supplemental citicoline has few side
effects and a strong record of safety, allowing patients to take high
doses on a long-term basis.
Citicoline’s capacity to increase dopamine levels is the key to its
use in improving vision. Dopamine is the main neurotransmitter in
the retina and it is a chemical messenger for light adaptation in the
eye—helping sharpen the contrast between light and dark. Cell sur-
vival and eye growth also depend on dopamine.
A lack of dopamine in the retina can also cause amblyopia, or
“lazy eye.” People suffering from amblyopia experience dimness or
blurring of their eyesight in one eye, which is otherwise healthy,
due to a fault in the transmission of signals to the brain. Eventually,
amblyopia can cause blindness, but citicoline may offer hope. Italian
researchers have performed several trials in patients with amblyo-
pia, confirming that citicoline significantly improves both the symp-
toms of the “lazy eye” and neurological function. As a result, people
with amblyopia regain much of their visual acuity.
Citicoline has been
shown to improve
vision as well as
neurological function.

20. 18 B R A I N H E A L T H
early stages of Alzheimer’s. One clinical trial of 334 Alzheimer’s patients
at Stanford University School of Medicine discovered that acetyl-
L-carnitine slowed the progression of the disease, especially among
younger participants.
People without cognitive problems or memory loss can also benefit
from acetyl-L-carnitine. During one recent study of 96 people over the age
of 70, Italian researchers found that those taking acetyl-L-carnitine had
less mental and physical fatigue. The supplement group also experienced
a boost in cognition.
Alpha-Lipoic Acid (ALA): ALA is an antioxidant that has been
researched as a treatment for Alzheimer’s and Parkinson’s diseases. Both
fat- and water-soluble, ALA travels throughout the body and may protect
cells by enhancing other detoxifying agents such as glutathione, which
serves as an antioxidant in brain tissues. ALA also contributes to meta-
bolic functions that affect the brain, including glucose metabolism. It is so
effective that studies show it can halt the oxidative damage that occurs as
our brains age. ALA also has the ability to recycle vitamins C E, increas-
ing their effectiveness.
Additionally, there is preliminary evidence that combining alpha-
lipoic-acid with acetyl-L-carnitine provides enhanced antioxidant, anti-
inflammatory and metabolic regulation in the brain, which, in turn,
improves cognition.
B Vitamins: There is some evidence that this family of vitamins—
particularly folic acid and vitamin B6—helps guard against age-related
memory loss and dementia. Folic acid, with the aid of B6 and B12, may
support memory by moderating homocysteine—an amino acid found
naturally in the body that, in high amounts, is considered a significant
risk factor for heart disease, Alzheimer’s disease and dementia.
In a study of more than 1,200 people, French researchers found that those
with homocysteine levels higher than 15 µmol/L had a risk of cognitive
decline three times greater than people with lower levels, below 10 µmol/L.
Another study of 818 volunteers between ages 50 and 75 found that those
who took high levels of folic acid—800 mcg—over the course of three
years had less age-related memory loss than people taking a placebo.
Evidence from clinical trials suggests that both folic acid and citico-
line ameliorate the cognitive decline associated with aging. Folic acid, by
itself, lowers circulating concentrations of homocysteine, while citicoline
improves memory by helping maintain neuronal membranes. It also influ-
encesacetylcholineproductionandregulatesthetransmissionofdopamine
and norepinephrine. However, the cognitive effects of taking folic acid and
citicoline together have never been studied. Given their complementary

21. mechanisms, a combination of folic acid and citicoline is likely to have a
synergistic effect on memory and executive brain functions.
Fish Oil. This is an excellent source of the omega-3 fatty acid docosa-
hexaenoic acid (DHA), an essential fatty acid in the brain, necessary for
neural integrity and function. In double-blind, randomized, controlled
trials, accelerated cognitive decline and mild cognitive impairment were
found to be related to lower tissue levels of DHA and another omega-3
fatty acid EPA, also found in fish oils. Supplementation with fish oil, how-
ever, improved cognitive function.
In one study conducted at Tufts University, low dietary intakes and
plasma concentrations of DHA were associated with low risk of dementia
and Alzheimer’s disease. Among the large group of elderly Americans who
took part in the nine-year Framingham Heart Study, those with the high-
est blood levels of DHA were about half as likely to develop dementia and
had a 39 percent lower risk of developing Alzheimer’s disease than those
with the lowest DHA levels.
Ginkgo Biloba: Perhaps the most well known memory-enhancing herb,
ginkgo biloba boosts blood flow in the brain, destroys free radicals and pro-
tects brain cells from premature death. There is also some evidence that this
Ayurvedic herb modulates dopamine levels in some neural regions. One
study of 262 adults found that those taking 180 mg of ginkgo for six weeks
scored better on memory tests than those taking a placebo. Smaller trials
show that ginkgo can also improve attention span and mental flexibility.
Huperzine A: Used to treat dementia and memory
loss, huperzine A (HupA) inhibits acetylcholinest-
erase, an enzyme that degrades the
neurotransmitter acetylcholine in
the brain. HupA also lowers oxi-
dative stress and reduces the
death of brain cells caused by
exposure to toxins.
In one double-blind trial,
50 patients with Alzheimer’s
disease were treated with 200
mcg of HupA for eight weeks.
The patients were evaluated
with an array of psychologi-
cal and physiological tests to determine
their mental and physical health before
and after treatment. About 58 percent of
the patients treated with HupA showed
B R A I N H E A L T H 19
Ginkgo leaf

22. 20 B R A I N H E A L T H
improvements in their memory, as well as in cognitive and behavioral
functions. These results were significantly better than those seen in the
placebo group. Other research shows that HupA can improve learning
performance. Best of all, this natural memory-enhancer passes through
the blood-brain barrier, so it works quickly and stays active for hours
without adverse side effects.
Phosphatidylserine (PS): PS is an essential fatty acid that makes up
part of every cell membrane in the body. In the brain, it helps cells effec-
tively communicate with each other.
A number of double-blind trials have validated the ability of supple-
mental plant-derived PS to improve memory, learning, concentration,
word recall and mood in both middle-aged and elderly subjects suffering
from age-related cognitive dysfunction. In one study, 425 elderly volun-
teers were given either 300 mg of PS or a placebo for six months. Research-
ers measured cognitive function at the end of the trial and found that
the subjects in the treatment group had significantly higher memory and
learning scores than those taking the placebo.
Turmeric: This curry spice is an excellent source of curcumin, a potent
anti-inflammatory that reduces oxidative damage in the brain. Recent
studies suggest that curcumin may also inhibit the formation and accumu-
lation of amyloid plaque. Turmeric bolsters brain-derived neurotrophic
factor (BDNF), a signaling molecule involved in mood. In the Singapore
National Mental Health Survey of the Elderly, which involved more than
1,000 people, researchers found that those who ate the most curcumin-
rich curry had a significantly lower risk of cognitive impairment than
those who rarely consumed it.
Vinpocetine: This extract from the seeds of the periwinkle plant rap-
idly passes through the blood-brain barrier where it increases circulation.
There is also some evidence that vinpocetine can protect brain cells from
the damage induced by excitotoxins such as glutamate.
One double-blind study divided 42 patients with chronic cerebral dys-
function into two groups. One group received 10 mg of vinpocetine three
times a day for 30 days, followed by 5 mg three times daily for 60 days.
The other group received a placebo. By the end of the trial, the patients on
vinpocetine scored consistently better in all evaluations of the effective-
ness of treatment.
Because vinpocetine increases cerebral blood flow, it may also help
stroke victims. A meta-analysis of international clinical trials showed a sig-
nificant improvement in cognitive achievement in chronic stroke patients
after oral therapy with vinpocetine.

23. B R A I N H E A L T H 21
Chapter Three
Food For Thought
R
esearch suggests that eating a Mediterranean-type diet can protect
against mental decline. In fact, new evidence from Columbia Uni-
versity Medical Center shows that people with mild age-related
forgetfulness who closely follow this type of eating plan are 45 percent
less likely to suffer from long-term cognitive impairment than people
who do not. Such a diet can also lower the risk of developing Alzheimer’s
disease significantly.
Anti up
What makes the Mediterranean diet such a smart way to eat? It is packed
with fruits and vegetables, fish, olive oil and whole grains. Fruits and veg-
etables provide antioxidants that can protect against harmful free radicals
and guard against inflammation in the brain.
In one clinical trial, researchers at the Rush Institute for Healthy Aging
in Chicago, Illinois, surveyed 3,718 patients, age 65 and older. Each of
the volunteers filled out food questionnaires and completed at least two
of three cognitive tests at the start of the study, then again at three and six
years afterward. The Rush team found that those who ate the most veg-
etables had a slower rate of cognitive decline as they got older.
Foods rich in vitamins C and E appear to be especially effective at pre-
serving brain function as we age. Important to the central nervous system,
these two nutrients protect cells from oxidative damage and inflamma-
tion. High amounts of vitamin C can be found in citrus fruits, strawber-
ries, papaya, bell peppers, tomatoes and broccoli. Nuts, seeds, whole
grains and green leafy vegetables are good sources of vitamin E.
Choose The Right Fats
Your choice of dietary fat can also impact brain function. One investiga-
tion of more than 800 seniors in Chicago discovered that those eating a diet
loaded with trans fat (found in processed foods containing partially-hydro-
genated oils) and saturated fat (found in meat and dairy products) were
likely to have a higher risk of developing Alzheimer’s. Healthy fats, like the
omega-3 fatty acids found in fish, can guard against dementia and Alzheim-
er’s disease. Since the omega-3 fatty acid DHA is the major building block of
cell membranes in the brain, it is critical for healthy neurons. Salmon, tuna,
trout, halibut, sardines and mackerel are among the best sources of DHA.

24. 22 B R A I N H E A L T H
Boost Your Bs
Recent studies show that foods high in the B vitamins are vitally impor-
tant to brain health. Vitamins B6 and B12 may play a role in the develop-
ment of new brain cells. Good sources of these two B vitamins include
poultry, fish, eggs, soybeans, oats, whole grains, bananas and nuts.
Folic acid—called folate when found in food—plays a critical role in
lowering dangerously high homocysteine levels that can contribute to
brain atrophy and vascular disease. Orange juice is a great source of folate.
You can also find this nutrient in avocados, strawberries, beans, peas and
green leafy vegetables like spinach and kale. Many ready-to-eat cereals are
also fortified with folic acid.
Carb Complexity
In a recent study from Tufts University, 19 overweight women followed
either a “low carbohydrate” diet or a “low-calorie” whole foods diet for
three weeks. After the first week, those who completely eliminated car-
bohydrates from their diet performed worse on memory tests than the
people in the low-calorie group. The reason? Complex carbohydrates—
like those found in fruits, vegetables, legumes and whole grains—provide
glucose to the brain, which helps memory performance. Another study
published in The American Journal of Clinical Nutrition showed that people
on a high-carbohydrate diet process information faster than those on a
low-carbohydrate diet.
Brain Food
While eating a healthy diet can give your brain overall protection against
age-related cognitive decline, the following foods have been found to
enhance cognition. Include them in your diet often.
Avocados: This fatty fruit contains monounsaturated fat which con-
tributes to healthy blood flow. And healthy blood flow means a healthy
brain. However, avocados are high in calories, so limit them to no more
than one-half an avocado daily.
Blueberries: The anthocyanins in blueberries—potent antioxidants
that give these berries their blue color—reduce both oxidative damage
to your neurons and inflammation within the brain. Eating blueberries
often may improve mental acuity and may even help reverse age-related
declines in cognition and short-term memory loss.
Coffee: Regular coffee consumption reduces the risk of mental decline,
including dementia and Alzheimer’s disease. In one trial of 676 healthy
men over the age of 80, those who drank an average of three cups of coffee

25. B R A I N H E A L T H 23
each day during their adult lives experienced fewer cognitive problems
than those who drank less.
Dark Chocolate: Yes, chocolate can now be considered a health food—
as long as it contains at least 60 percent cacao. One study at the University
of Nottingham found that eating a small amount (150 mg) of flavonol-
rich chocolate every day increased blood flow to the brain’s gray matter—
which could be good news for preventing or treating vascular impairments
like dementia and strokes.
Green Tea: In a recent study of more than 1,000 seniors participating in
the Comprehensive Geriatric Assessment in the US, researchers discovered
that those who drank the most green tea experienced less cognitive decline
as they got older. Earlier animal studies show that green tea’s catechins
improve learning ability and working memory. It may also decrease the
amount of plaque build-up impli-
cated in the development of
Alzheimer’s disease.
Nuts and Seeds:
Nuts and seeds
are high in vita-
min E, an impor-
tant nutrient that
helps support mem-
ory as we age and is a
component of cell mem-
branes. Walnuts also have high concen-
tration of omega-3 fats and vitamin B6.
Eating one ounce of nuts or seeds
every day may give your brain an
added measure of protection.
Along with walnuts, try
hazelnuts, Brazil nuts,
filberts, almonds,
cashews, peanuts,
sunflower seeds,
sesame seeds,
Nuts and seeds have
essential fats.

26. 24 B R A I N H E A L T H
Brain Busters
Just as certain foods can literally
make you smarter, eating the wrong
foods can negatively impact your cog-
nition and memory. Excess calories
can reduce the flexibility of synapses
and increase the vulnerability of brain
cells to free radical damage. Foods
high in calories are also often high on
the glycemic index (GI), which measures
the effect carbohydrates have on blood
sugar levels. A growing number of clinical
trials suggest that eating a low GI diet can
improve cognitive performance.
flax seed and unhydrogenated nut butters such as peanut and almond
butter and tahini (ground sesame seed paste).
Spinach: This leafy green food helps protect the brain from oxidative
stress while reducing the risk of age-related cognitive decline. Rich in folate,
researchers found that feeding aging rats spinach-rich diets improved their
learning capacity and motor skills. Including spinach in your diet may also
lessen brain damage from strokes and neurological disorders.
Whole Grains: A diet rich in whole grains such as whole wheat, barley,
oats, millet, quinoa and rye can increase your intake of vitamin E and
the B vitamins—B6, B12 and folate—that are critical for brain health.
One study found that women who increased dietary intake of folate,
vitamin B6 and vitamin B12 showed an improvement in recalling infor-
mation compared to women who were not taking a B vitamin supple-
ment. Research conducted at Tufts University in Boston also found that
a diet rich in whole grains reduced the risk of ischemic stroke.
Wild Salmon: Wild salmon is one of the best sources of omega-3 fatty
acids. It can help protect your brain’s neurons and improve synaptic con-
nections. Including wild salmon in your meal plan can also keep your
arteries healthy and reduce your risk of dementia, Alzheimer’s disease and
stroke. Certain types of fresh fish may be susceptible to high mercury lev-
els, so many people choose a pharmaceutical wild salmon oil or fish oil
supplement to ensure adequate omega-3 intake.

27. B R A I N H E A L T H 25
Chapter Four
Keeping Your
Mind Sharp
A
s the old saying goes, you really do need to “use it or lose it” when
it comes to your brain. Fortunately, that can be as easy as taking a
walk or getting a good night’s sleep.
Exercise Your Options
A growing body of evidence suggests that regular exercise—especially
aerobic exercise—can have a positive impact on certain mental functions
like memory and recall, concentration, decision-making and complex
problem solving. A recent investigation showed that women who main-
tain a fit lifestyle as they age are more likely to have better clarity and acu-
ity than their sedentary counterparts.
According to researchers at the University of Illinois, Urbana, exercise
may slow the loss of brain tissue that naturally occurs starting in our 30s.
The UI team examined MRI scans from 59 older adults, half of whom were
assigned to an aerobic training group and half of whom were assigned to
a toning and stretching control group. The neural tissue of those who par-
ticipated in aerobic fitness was significantly denser than the participants
in the control group. Apparently exercise doesn’t just help protect brain
cells from deterioration, it may also enhance them. A recent meta-analysis
by the University of Illinois’ Beckman Institute found that aerobic exercise
boosts both the speed and sharpness of thought and the volume of brain
tissue. As little as 50 minutes of brisk walking three times a week was
found to have this brain-expanding effect.
Exercise may also improve your ability to think clearly. In a meta-analy-
sis of 18 studies, the UI investigators discovered that inactive older adults
who began an aerobic exercise routine performed significantly better than
control group members on cognitive tests that measure skills such as plan-
ning and paying attention. One explanation for this improvement may be
that exercise boosts the brain protein BDNF, a protein that supports the
function and survival of neurons, and may thus help prevent neurodegen-
eration associated with age.
A preliminary animal study featured in the Journal of Applied Physiol-
ogy gave further evidence that exercise restores healthy BDNF levels. The

28. 26 B R A I N H E A L T H
researchers discovered that physical activity significantly slowed down
the loss of new nerve cells in middle-aged mice. In fact, the production of
neural stem cells improved approximately 200 percent compared to mid-
dle-aged mice that did not exercise. The research team concluded that
exercise reverses the age-related decline in the production of neural stem
cells in the hippocampus. This occurs because exercise restores BDNF,
which promotes production and maturation of new stem cells.
Exercises that improve cognition include walking, jogging, cycling, danc-
ing, elliptical cross-training and swimming. Adding music to your work-
out may further enhance the mental benefits of aerobic exercise. Accord-
ing to a study of 33 patients in a cardiac rehabilitation program at Ohio
State University, those who listened to music during a 30 minute workout
scored better on verbal fluency tests than those who exercised in silence.
This suggests that the combination of music and exercise may stimulate
and increase cognitive arousal while helping to organize cognitive output.
If walking is your exercise of choice, try a brisk walk in a park. University
of Michigan researchers found that volunteers whose course took them
through a tree-filled setting performed 20 percent better on memory and
attention tests than those who walked downtown.
Sleep Yourself Smart
People who do not sleep well at night tend to be more forgetful than
people who sleep soundly. According to one theory, sleep is important
for memory because the brain replays information learned during the
day, and in so doing, strengthens the neuronal connections that store this
information. A study in the Proceedings of the National Academy of Sciences
examined the pattern of brain activity in sleeping rats and found neuronal
discharges between the hippocampus and the somatosensory cortex. This
“cross-talk” between the hippocampus and cortex may be what cements
our memories.
Getting a good night’s sleep also helps ensure adequate ATP (Adenosine-
5’-triphosphate) levels. When we are awake and active, we break down ATP
to produce energy. Over time, adenosine (a component of ATP) builds up
in the forebrain and may be a trigger for sleepiness. During sleep, many
of the body’s cells are less active and use less ATP, so adenosine levels fall
again, setting the stage for wakefulness.
Decompress Stress
Chronic stress has been linked to memory loss in several studies. Sci-
entists have discovered that neurons are damaged by cortisol, a hormone
released during highly stressful situations. Animal studies suggest that

29. B R A I N H E A L T H 27

30. 28 B R A I N H E A L T H
long-term stress can also change the actual structure of the brain. One of
these studies found that, after laboratory rats were tightly restrained for six
hours a day for 21 days without food or water, the animals’ hippocampi
shrank by three percent.
People, especially as they age, are highly susceptible to stress. In one study,
a group of healthy adults received daily low-dose treatments of the stress hor-
mone cortisol over the course of four consecutive days—about the amount
that would be released under everyday stress. Another group received high
doses over the same period of time. Cognitive testing was done periodically
during the study and again six days after the treatment. The people who had
received the higher cortisol dose had a significant (and fortunately revers-
ible) decrease in verbal declarative memory. In another cross-sectional study
of older Americans, those with high levels of cortisol in their saliva—signal-
ing above-normal stress levels—also had poor cognitive performance.
Cortisol released during times of stress travels into the brain and binds
to the receptors inside many neurons. Through a cascade of reactions, this
causes neurons to admit more calcium through channels in their mem-
brane. In the short-term, cortisol presumably helps the brain cope with a
life-threatening situation. However, if neurons become over-loaded with
calcium they fire too frequently and die.
A healthy lifestyle can help prevent and reduce adverse effects of chronic
stress. In fact, there are specific stress-relieving activities and habits you
can cultivate to further ease the stresses of modern life:
• Physical exercise not only strengthens the body, it can reduce
the frequency and severity of stress, depression and anxiety. As
previously discussed, dozens of scientific studies have demonstrated
the relationship between exercise, cognition and mood. Exercise
promotes the release of endorphins, enhances relaxation and
improves the quality of sleep. These conditions help the body
recover more quickly and completely from the stress response.
• Relaxation through meditation, biofeedback and a variety of other
techniques promotes lower blood pressure, slows respiration,
reduces metabolism and eases muscle tension. These counteract the
effects of stress.
• Social contacts, friends and family relationships can help create
emotional trust, support and relaxation. Even caring for a pet can
provide significant emotional comfort that helps reduce stress.
• Attitudes of confidence, a positive approach to problem solving
and attention to emotional balance can help get one out of the
stress response cycle.

31. B R A I N H E A L T H 29
Head Games
Although a healthy diet, regular exer-
cise, plenty of sleep and brain-boosting
supplements can help keep you mentally
sharp, it is also important to give your
brain a regular workout. The brain is like
a muscle: the more you use it, the stron-
ger it gets. Activities like reading, doing
crossword puzzles or playing mentally-
challenging games can give your brain the
exercise it needs.
Working your brain is so effective that
a study of 2,832 seniors (average age 73.6
years old), reported in the Journal of the
American Medical Association that regular
memory-training exercises reduced func-
tional decline and improved cognitive
ability up to five years. In other words,
mental age was “reduced” the equivalent of five years. This supported
an earlier study that showed frequent participation in brain-stimulating
activities was able to reduce cognitive decline in elderly people.
Scientists believe that intellectual enrichment and learning stimulate
the brain to increase synaptic density and interconnections, whatever
your age or cognitive status. Studies show that stimulating the mind with
various activities can even improve memory in Alzheimer’s patients.
There are a number of ways to stimulate your mind. Here are a few men-
tal exercises to get you started:
Search The Internet: Spend about 20 minutes, a few days a week, search-
ing topics on the Internet that you’ve always wanted to learn more about.
According to scientists at the University of California, Los Angeles, Internet
searching uses neural circuitry that is not activated during reading. MRI
results showed almost three times more brain activity in regular Internet
searchers than in first-timers, suggesting that repeated time spent online
can be a great way to build cognitive strength.
Focus on Your Breath: Close your eyes, and breathe slowly and deeply.
Inhale through your nose and exhale through your mouth. Give your full
attention to your breath as you breathe in and again as you breathe out.
Doing this for just five minutes each day can improve your mental focus.
Use Your Other Hand: Whenever basic tasks become second nature,
our brains fail to get any exercise. One way to give your brain a workout is
Crossword puzzles: the classic
brain game.

32. 30 B R A I N H E A L T H
to use your other hand for common tasks. If you are right-handed, try eat-
ing with your left hand. Brush your teeth with your other hand, too. This
might sound easy enough, but you will find yourself actually focusing on
accomplishing these simple tasks.
Expand Your Vocabulary: Learning new words does not just make you
sound smart in social settings, it keeps your mind fit as well. Try learning
one new word every day.
Test Your Recall: Make a list—it can be grocery items, things to do or
anything else that comes to mind—and memorize it. An hour or so later,
see how many items you can recall. Make items on the list as challenging
as possible for the greatest mental stimulation.
Draw A Map From Memory: After returning home from visiting a new
place, try to draw a map of the area; repeat this exercise each time you visit
a new location.
Create Word Pictures: Visualize the spelling of a word in your head,
then try and think of any other words that begin (or end) with the same
two letters.
Try An Anagram: Increase your mental flexibility with these word puz-
zles. Anagrams rearrange the letters of one word to create another word
or phrase. For instance, another word for “teach” is “cheat.” Practice ana-
grams by writing down your own first name and see how many hidden
words you can find.
The One-Minute Conversation: Choose a subject and talk about it for 60
seconds. It can be anything from the weather to your favorite novel. Doing
this often will enhance your ability to communicate clearly and concisely.
Be A Human Calculator: Flex your mental calculating skills by thinking
of a number and then doubling it. Keep doubling it to see how high you
can go. For example: 2, 4, 8, 16, 32, 64 and so on.
Final Thoughts
Given the proper care, your brain can stay healthy and adapt throughout
all the years of your life. Of course, your genes, general health and level of
education can affect both your cognitive power and your memory, but the
little things you do every day can add up to lifelong intellectual vigor.
The same habits you practice to promote overall health—eating a
healthy diet, exercising regularly and getting enough sleep—can have a
profound impact on your mental health too. Stimulating your mind daily,
and adding brain-specific nutrients like citicoline to your diet, can fortify
your brain cells and encourage the growth of new neuronal connections,
protecting your memory and learning capacity for years to come.

33. B R A I N H E A L T H 31
Selected References
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34. 32 B R A I N H E A L T H
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For a complete list of references for this booklet, please visit www.kyowa-usa.com.

35. CHECK OUT ANOTHER BETTER NUTRITION
HEALTHY LIVING GUIDE TODAY!
This booklet is a part of the Better Nutrition Healthy
Living Guide series. For more information about
other topics in this series, visit your local independent
health food store or visit us online.
betternutrition.com

36. IMPROVE MEMORY, FOCUS AND
CONCENTRATION
betternutrition.com
T
he brain is one of the most fascinating and complex organs
of the human body. However, it is also susceptible to dam-
age from environmental pollution, oxidative stress, poor
diet, lack of exercise, and other factors. Over time the brain can lose
its ability to remember, focus, and function properly. In this informa-
tive booklet, award-winning brain researcher Perry Renshaw, MD,
explains how you can increase the your brain’s mental acuity while
also helping to prevent and even reverse age-­related damage to the
brain. Dr. Renshaw also shares his innovative ­research on a natural
substance known as citicoline. This booklet will describe how you
can protect and boost your brain power.
Perry Renshaw, MD, PhD, is Director of Magnetic Resonance
Imaging at The Brain Institute of the University of Utah, and
Professor of Psychiatry at the University of Utah School of
Medicine. For the past 15 years, Dr. Renshaw has been on the
faculty of the Department of Psychiatry at Harvard Medical
School and for 10 years was the Director of the Brain Imaging
Center at McLean Hospital. He is the author of more than 240
peer-reviewed articles and has received numerous honors
for his research.
ABOUT THE AUTHOR OF THIS BOOKLET
BRAINHEALTH
magazine presents