by John Randolph
WW Norton, 2019
Review by Roy Sugarman, Ph.D. on Dec 31st 2019
The issue of a body-brain dichotomy has its origins in people such as Descartes, who spoke of us thinking and therefore existing, and ended somewhat with the reign of the Damasio's a husband and wife team who in writing of Descartes' "error" showed that we feel, and therefore know we exist. The brain of course, as opposed to mind, is a physical entity continuous with our bodily organs and deeply committed to all of us, including, as we now know, the gut biome with its serotonergic and melatonergic pathways, along with the enteric branch of the ANS and so on. In short, the brain is dependent on the body for its life and nutrition, and the loss of oxygen or nutrients ends badly.
Randolph divides this nutrient-hungry brain's health into four domains, after dispelling the most common myths of brain health and development across the ages. His C.A.P.E. model as per the acronym stands for cognitive strategies, activity engagement, prevention of cognitive decline and education about the brain. The first prompts us to use techniques to improve various aspects of brain output, namely external strategies akin to using a diary, and internal strategies, such as using visuals to recall a person's name on meeting them. The engagement refers to lifestyle activities, physical, social, mental/intellectual. Prevention includes modifiable elements which impact brain health, such as stress, Mediterranean diet, and so on. The final E refers to learning and knowing more, measuring to manage would be an example of this, and most of the book would fit in here. He produces a questionnaire to measure cognitive health with six questions that can then be rated as a measure of how well you are approaching these aspects of the C.A.P.E. elements.
As we have mentioned before in these reviews, the term some are using for neuroscience being hijacked for multiple commercial purposes is 'clapdoodle', but Randolph here has a justification, namely a somewhat odd title for the next chapter, "how does neuroscience relate to brain health?", a question that surely is obvious? In any event, it turns out that the clapdoodle in the popular press has led to many misconceptions about the brain, and again, we have reviewed books that dispel many of these neuromyths, such as gender disparity for instance, and Randolph then sets the record straight with a neuro 101 description of the brain structure and function for neophytes to this arena. He observes genetics and ageing, in particular Minimal Cognitive Impairment, a risk for dementia, and neuroplasticity, without which we wouldn't really think of intervening in the ageing or healing processes within the brain. Of necessity, the London Taxi Driver study, along with Snowden's work in teaching orders of St Joseph's nuns HAS to get the obligatory mention, as they should.
In terms of brain function, he then focuses on the big triad, that of attention, memory and executive function. Whilst ubiquitous in terms of the presence of lapses, these are actually multifactorial in origin, and deciding on the state of origin of these lapses is problematic in terms of the inferences we might draw, compared let's say, to those of a neuropsychologist, such as I. Indeed, our descriptions of our lapses depend on a host of factors, such as how much we exercise, which will lead us to less attention to such issues and hence lower reporting of such issues. He then goes on to describe the elements of the trio in detail, as well as a self-affirmation exercise, kind of a values endorsement, to finish the chapter and the first section.
Section II refers to both cognitive strategies and lifestyle activities in terms of C.A.P.E., that boost our brains. Here, after explaining why South American waiters can recall who ordered what drinks by spatial prompt, which rapidly disintegrates when guests move around, a great leveller down to the level of novice waiters, he goes back to the internal/external strategy compartments he mentioned earlier. After a quick homage to Flow and Csikszentmihalyi, (if you can remember how to spell, pronounce and recall his name, you are doing well), he moves on to memory strategies, including, as I mentioned off my own bat above, recalling novel introductions in social settings. After touching on the executive functions, he produces a personal strategic planning document to assist the processes here. Not much here, just a passing thought or two. He could do with fleshing it out right here.
But we move on to a more compelling, and now ubiquitous recommendation for all ills, namely, exercise. In a sedentary world, perhaps even dating back to recommendations from Jack Lallane in the '40's, and more recently the work of John Ratey, exercise has become the magic pill as it should be. He begins predictably in outlining the perils we now face, and the reasons for it, in a sedentary world. For a wider explanation in how long we have known about these perils, see my 2013 manuscript "Saving your life one day at a time" with references dating back to Italy hundreds of years ago. He describes how exercise directly and indirectly influences brain structure and function, both in terms of brain neurotrophic factors (somewhat less impressively than Ratey did), as well as the dose-response relationship of intensity. The benefits of mid-life fitness, even for those starting late, are emphasised, as well as the provision of the strategic support document to plan it all out. Planning is essential, in motivational terms, compared to say waiting for the muse to strike!
The benefits of socializing too are now well accepted, with socializing a mitigating factor in dementia for instance. We know for instance, and have reviewed, evidence that such creatures as Hyenas and Elephants have produced larger brains in response to socializing in bigger groups, and vice versa, with bigger groups helping grow brain. The same applies to us, as humans. Dogs for instance, left alone for long periods, demonstrate anxiety in response to feeling vulnerable, and in a recent market research, we found in Australia that people who were retired were now feeling vulnerable to home invasion, something that so rarely happens, it cannot explain the fear, as Randolph does. The chapter does need some editing, as it becomes repetitious though. He moves on to how troubling social experiences affect the brain, in some detail, again, referring mostly back to stress and its troubling relationship with cortical health.
As Lumosity and other lookalikes have tried to cash in on, sometimes with troubling exaggeration of the benefits, the idea that brain workouts and hobbies and related activities such as crosswords and Sudoku have cortical benefits is contentious. He enters this field by looking at the commonly researched ones such as the above, and immediately focuses on the idea that being a beginner, namely embracing the idea that novelty and increasing complexity are winners for us, should inspire us to try something new, again and again. Passive and active cognitive reserve strategies demand attention across the lifespan, and the idea of increasing mind- or brain-span is attractive. In this vein, mental activity, according to some studies at least, was even more important than those previously discussed in this book. He looks at the specific mental activities that matter, without necessarily going into the effect sizes or other more technical ways of evaluating if these studies are really impacting what they say they are proving: we need to rely on his vetting to assume they are all informative in the right way, not just statistical but actually meaningful. Brain training, as I noted above is contentious, and he explains this by the expectation effect, almost a placebo, so if you think it will help…….?
Part III now looks at other ways to potentially affect brain enhancement. Nutrition is the obvious choice, again close to my heart, and most people's hearts. He acknowledges that the science of nutrition largely centres on self-report, and hence the obvious emerges: Mediterranean style of eating vs. sugary and processed foods will always emerge as a factor. Not only that, but predictably, vegetables and fruit consumption within all diets from DASH to low Human Interference included, will predict more positive cardiac and brain outcomes, with specific nutrients such as lutein, folate, phylloquinone (vit K1) influencing brain health positively. As I have suggested in my own writing on the subject, berries stand out. Slow and steady consumption of all fruits and veggies seems to be the key, with consistency there, rather than say fanatically veganism, effective at reducing brain risk. Combing the Med style of eating with berries and leafy greens will seem to be the way to go (see MIND diet). And then there is fish…but not fried, baked or boiled. This would include all of the Omega-3 rich fish, such as salmon, mackerel, sardines, tuna and so on, including barramundi here in Australia. My only issue is now with farmed fish, but certainly wild caught salmon and sardines and mackerel are still available in tinned form, if nothing else. Alpha-linolenic acid, found in plants and nuts such as walnuts, flax seeds and soybeans is another winner. He summarises with his bottom line, based on the above, his perfect diet day in other words.
Sleep, in terms of the P above, is of course vital, and in he goes, for chapter 9. Apart from flushing beta-amyloid plaque, sleep has multiple benefits, as long as it isn't too much sleep, which has its own risks. Sleep hygiene interventions are vital, literally, including the benefits of napping. Purpose and gratitude are part of wellbeing, and that will include sleep, but the relationship is not clear. More than 6, less than 9, and with less than 30min naps would appear to be the bottom line. Routine of necessity is a powerful hygiene factor, doing the same things at the same times, reserving the bed for sleep and sex.
Modifying stress is a given. Goleman, Yerkes-Dodson, the usual players all come in here, as does mindfulness in the remedies section, as does yoga, positive psychology and values etc. Medical problems and smoking are also going to be big ones, and he entertains these in chapter 11. Metabolic issues like diabetes-obesity, high blood pressure, smoking, all will impact on brain output.
Part IV now looks at how we translate inspiring speech and science into action. As I have done before, in my third chapter in 2013, now we know what to do, but motivation and habit are not easily directed or adopted. We hate compliance with instruction, and self-efficacy is a 'thing', if we are to adopt change easily. Setting goals, following a plan rather than waiting for a NYE inspiration, are essential. He follows this up with an executive summary of the bottom lines he has produced across the four parts of the book, which is most helpful.
All in all, a great book for the layperson setting out to address brain issues. As I have said, the rot starts early, so for the young reader, and of course the ageing one, this is essential reading in terms of lifestyle. I would certainly endorse and recommend this book to all and sundry, of all ages, and to fledgling psychologists who need to motivate and inspire resolve to change in their clients to make a difference, early on in life, to their brain health.
© 2019 Roy Sugarman
Roy Sugarman PhD, Director Applied Neuroscience: Team EXOS Performance Innovation Team, AZ, USA.