Keeping our brain’s structure and neural network healthy may seem like a mystery at times, but often the best advice is simple: ‘use it or lose it!’

The exercise and stimulation your brain gets from an active physical, social and intellectual lifestyle is vital to keeping it healthy. Just like our bodies need movement and exercise to function well, our brains need their own workout to thrive, too.

Lifestyle expert at Food for the Brain, Assistant Professor Tommy Wood, from the University of Washington has advised people at the top of their game, from Formula 1 drivers and Olympians to world champions, on how to maximise their performance, both mentally and physically.  His top tip for keeping our brains sharp?  

“In short, use it or lose it. The brain is an amazing organ, and it’s more resilient and adaptable than we’ve been led to believe. I’m sure you’ve heard that adults have a fixed amount of brain cells. Then, as we get older (or every time we take a sip of wine) we “lose” some of those brain cells as part of an unstoppable decline towards dementia or Alzheimer’s disease.”

“That’s not necessarily true” says Professor Wood. “I like to think about the brain like I think about muscles. In order to grow our muscles, we need to provide a stimulus – like lifting weights in the gym – followed by a period of rest. The opposite also happens – if we stop going to the gym or if we stop using a limb after breaking a bone – our muscles get smaller. Most have experienced this personally, and there’s every indication that your cognitive “muscle” behaves in the same way.”

A classic example of this is a study of London taxi drivers in training who have to learn ‘The Knowledge’. Many spend three years driving the 25,000 streets of London, logging up tens of thousands of miles, on foot or on a scooter. Not all pass the first time. Katherine Woollett at University College London decided to find out if acquiring the knowledge actually changed a person’s brain by measuring the density of grey matter as an indicator of brain volume. About half of her group of training taxi drivers passed first time and the other half failed. She also had a control group of people of the same age, most in their late 30’s with similar other demographics such as IQ. Sure enough, those who passed had increased their brain density of grey matter, and specifically in the central hippocampus area most associated with cognitive resilience. (1)

Keep Cognitively Active

There’s a pattern in our society – we are meant to learn every day as we go through school in childhood and teenage years, then we get a job, which, past a training phase, may not require much more learning, then around 65 we are meant to retire, with no more ‘need’ to work or learn.

Every indicator that you can think of – leaving school early, having a lower educational standard (2), or retiring early (3), has been associated with an increasing risk of cognitive decline.

When Professor May Beydoun, at the US National Institutes of Health (NIH) did a comprehensive study of the biggest risk factors for developing Alzheimer’s, she attributed 24% of risk to educational status and 32% of risk to physical activity(4). So, using our brains, reflected in educational and physical activity, is a huge part of keeping your brain healthy. (It’s worth remembering that  omega-3/seafood and homocysteine-lowering B vitamins account for 22% each while smoking racks up 31% in the risk stakes).

Think about how you use your mind. How much time do you spend stimulated, learning something? How much time do you spend engaged in relatively mindless mental activities? 

Television can be stimulating, or mind-numbing – engaging your attention but not really making you think. Social media activity, like scrolling through TikTok or Instagram, could be mind-numbing, while digital engagement with others could be stimulating. A simple yardstick is to ask ‘am I learning anything? Am I using my mind?’ 

While these activities are keeping your brain busy, what our brains really needs is to be engaged in learning or working something out, ideally without too much stress. Many films are designed to engage you by stimulating a stress response, keeping you on the edge of our seat. On the other hand, doing Wordle or a crossword, or playing a game of backgammon or chess involves concentration and thinking without cranking up your stress response. 

Two high-rating apps designed to engage our minds Brain HQ and Lumosity. Brain HQ (www.brainhq.com) adapts according to your needs – do you want better memory, better attention or faster processing? Three 20-minute sessions weekly are recommended. Lumosity (www.lumosity.com) is also adaptive and achieves much the same improvement in cognition. In just the same way you become physically fitter by increasing the duration or intensity of an exercise, it seems the same is true with your mind.

Reading books, or listening to podcasts can also be a great way to stimulate the old grey matter, mind but it does depend on what you are reading or listening to. The golden question is  ‘am I learning anything from this?’. Even better – join a bookclub for the social stimulation, sharing views, hearing others, and working out where you stand. 

Learn by failing

Land on any social media platform and we are bombarded with stories of people succeeding, urging us to try the latest self-help, diet or exercise programme, meditation or music app (who didn’t try and learn the guitar in lockdown!) but failure, according to Professor Tommy Wood, is when the magic really happens for our brains:

“Failure constitutes protective cognitive demand. The cocktail of hormones released as we try, fail, repeat, and learn, provides the ideal environment for the brain to grow and adapt. This is a real sticking point for improving brain health – as adults we hate the feeling of being bad at something.”

Professor Wood recommends picking an activity that’s truly challenging. “Cognitive demand requires failure, so pick something you’ll be bad at initially. What’s cognitively challenging is personal, but learning a new language is better than sudoku, picking up a guitar is better than listening to music, building model airplanes is probably better than reading the news, and playing chess is definitely better than scrolling through Instagram. As you get better, add challenges to keep stimulating your brain.”

“A fascinating study looked at the brains of musicians.  While both professional and amateur musicians’ brains looked younger compared to non-musicians of the same age, the benefit was greatest in amateur musicians (5) – it’s harder, so they got more benefit. The cocktail of hormones released as we try, fail, repeat, and learn, provides the ideal environment for the brain to grow and adapt.”

In fact, learning an instrument, or a language, are considered heavy lifters when it comes to brain stimulation – it’s challenging and can take a long time to become completely proficient. But every step along the way, even just a few minutes a day, learning new words, processing the grammar, learning chords and finger positions, is a significant mental challenge.  And there are so many language learning apps, like DuoLingo now, playing on the ‘reward’ and game theory to keep us cognitively engaged and coming back for more. 

Speaking two languages is not only associated with less risk of cognitive decline but, according to one study, ‘the neuroprotective effects of lifelong bilingualism act both against neurodegenerative processes and through the modulation of brain networks connectivity.’ (6) Your brain ends up more connected – literally hardwired for brain health.

Keep physically active

The brain also benefits from physical exercise, especially if it involves complex movements and learning – think dance, yoga or t’ai chi or trail running or walking on uneven surfaces. The brain is processing a lot of information, triggering patterns of muscle movement, keeping you in balance. You want a bit of both – movement and balance. Just working out on a fixed machine or walking on a flat, straight, tarmacked path, is not nearly as challenging as hill walking up an uneven path, cycling, surfing, skateboarding or anything where your body is micro-adjusting to keep you in balance.

One study of retired people assigned to walk briskly for 40 minutes three times a week showed increased hippocampal brain volume (7).  Another study showed benefits from doing one or two sessions of resistance or strength training twice a week (8).

Of all the measures relating to how fit or fat we are, muscle mass best predicts brain volume and risk of cognitive decline in later years. 

One big study from the UK Biobank data found that those with a lower fat-to-muscle ratio) in their legs had around 40% less risk for dementia later in life (9). Muscle uses energy and ‘soaks up’ glucose. This helps keep your blood sugar stable and prevent insulin resistance. Often, as we age, it can seem like an uphill battle to keep our weight down, even if we are not eating any more than we used to. This is often simply because we’ve lost muscle mass with age. So hitting those weights can be extra beneficial in later years and many gyms offer classes especially for older clients. Even body weight exercise can build resistance, though, and there are plenty of free videos on the internet – just check with your GP first.

Step it up

A good general guideline is to aim for 30 minutes of brisk walking every day. Some days you may do none and others twice this, so this is a good weekly average to shoot for. Over time you can step it up by walking faster, jogging or including some hills in your circuit. 

A good way to monitor and up our exercise level is to count steps. Smart phones and watches have apps that do this for you. Shoot for increasing daily steps between 10% and 20% a week. If you start at 2,000 and add 200 steps per day each week, that’s a great start. If you’re at 4,000 steps already then getting up to 4,400 daily in this week is also going to stimulate our muscles and brains. While 8,000 steps a day is considered optimal, what’s much more important is to make sustainable improvements as you ‘activate’ your lifestyle.

But, we don’t need to limit ourselves to ‘exercise’. Gardening, mowing the lawn, playing a sport, vigorous cleaning, or clearing out a yard – anything that gives us a faster heart rate, a bit of sweat and engages different sets of muscles, thus including ‘resistance’(10), counts as well, especially if we can do them faster or more energetically.

Aerobic plus resistance exercise anti-ages your brain

As previously mentioned, of all the measures relating to how fit or fat we are, muscle mass best predicts brain volume and risk of cognitive decline in later years. 

Including exercise that helps build and maintain muscle tone correlates most strongly with brain health. A good weekly guideline is to include two resistance training sessions a week. Perhaps you are a member of a gym, go to a pilates or yoga class or have some equipment at home for your own workout.

If you’re not sure where to start, “Burn Fat Fast” (Piatkus, 2013), written by Patrick Holford and exercise guru and former Gladiator (Zodiac) Kate Staples, is a great resource.  Staples devised a series of strength building exercises that anyone can do at home in eight minutes, three times a week, including  beginner version, and intermediate and advanced versions (light to medium weight dumbbells (2kg – 6kg) are needed for these).

The exercises are all explained in the book and  Kate Staples demonstrates each one HERE so you can follow along until you feel comfortable. A five minute warm-up (marching on the spot is great, or stepping side to side) will get your heart rate up and help avoid injury. 

The beginner sequence includes wall sits and reverse lunges, while the advance sequence progresses to jumping squats and mountain climbers. It’s important to build up gradually, keep hydrated, and learn to do the moves safely, so watching the videos is a great way to get started. 

The secret is to find an activity that engages both mind and body, builds muscle, and is not too repetitive. As an example, our very own Patrick Holford says “I’ve taken up paragliding, and qualified at the age of 65. I had to pass an exam on meteorology, aerodynamics and air law, and failed the first time, but now I have to think about these things before and during flight. Then there’s the exercise of carrying an 11 kg pack up a mountain, and the balance and strength and adjustments my brain is having to make to keep the canopy stable even before take off.” This may not be your thing but it shows how one activity can tick so many brain boxes. It is good to learn new sports for this very reason.

Be Social

A lack of meaningful social interaction, and loneliness, is also a major driver of both low mood and cognitive decline later in life (11). 

How often do you go to social gatherings, meet new people and have engaging conversations? This could be meeting friends, going to the movies, a museum, a gallery, a show, church or temple, or a restaurant?

There are times in your lives where you might find yourself more isolated. For example, when relationships break up and you lose connection with ‘their’ friends, or if a partner dies and most of your social interaction was with them. These are extremely challenging times, but facing our fears and getting out there to meet friends can help us on the road to recovery. 

Unset your mind

It’s all too easy to get locked into routines that remove any form of challenging social interaction yet this is not only how we learn, it also nourishes the social aspect of who we are. A good strategy is to make sure you have a significant social event or interaction every week, starting with this week.

As we age, and friends move away, or pass on, it’s important to find ways to expose ourselves to new ideas and new ways of thinking and feeling differently and swapping ideas. Travelling and exploring other cultures can be an incredibly enriching way to broaden our mindset and there are lots of companies that cater for the solo traveller these days.

But there’s no need to go far from home to get the benefits of brain gain. There are many opportunities to ‘use it or lose it’, for example, volunteering at a local garden or school or supporting the local arts club. The brain boost from being out of your comfort zone will reap dividends, whether it’s joining a group of new people, engaging in a new activity you’ve never tried, like drawing, writing or yoga – or even just catching up with old friends you haven’t seen for ages, or striking up a conversation with someone you meet on the daily dog walk.

Local bookshops, art centres, churches or schools can be great sources of information, so check them out. 

Be inquisitive

As Tommy Wood says “The key is to push right at the boundaries of what you’re capable of – with occasional failure showing that you’re at the right level of difficulty. Keep at it, and you’ll be more likely to be healthy and sharp for decades to come.”

And if you want more personalised information on how you can improve and support your brain through nutrition and lifestyle changes then make sure you complete our Cognitive Function Test. A FREE, online and validated test to assess your current cognitive function and dementia risk and then get a clear plan of action on how you can improve your brain health and score over the next 6 months.

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Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.

By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices.

Please support our research by becoming a Friend of Food for the Brain.

References:

¹ Woollett K, Maguire EA. Acquiring “the Knowledge” of London’s layout drives structural brain changes. Current biology: CB. 2011;21(24):2109-14. Epub 2011/12/08. doi: 0.1016/j.cub.2011.11.018. PubMed PMID: 22169537.

² Yu JT, Xu W, Tan CC, Andrieu S, Suckling J, Evangelou E, Pan A, Zhang C, Jia J, Feng L, Kua EH, Wang YJ, Wang HF, Tan MS, Li JQ, Hou XH, Wan Y, Tan L, Mok V, Tan L, Dong Q, Touchon J, Gauthier S, Aisen PS, Vellas B. Evidence-based prevention of Alzheimer’s disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials. J Neurol Neurosurg Psychiatry. 2020;91(11):1201-9. Epub 2020/07/22. doi: 10.1136/jnnp-2019-321913. PubMed PMID: 32690803; PMCID: PMC7569385.

³ Hale JM, Bijlsma MJ, Lorenti A. Does postponing retirement affect cognitive function? A counterfactual experiment to disentangle life course risk factors. SSM – Population Health. 2021;15:100855. doi: https://doi.org/10.1016/j.ssmph.2021.100855; see also Dufouil C, Pereira E, Chêne G, Glymour MM, Alpérovitch A, Saubusse E, Risse- Fleury M, Heuls B, Salord JC, Brieu MA, Forette F. Older age at retirement is associated with decreased risk of dementia. Eur J Epidemiol. 2014;29(5):353-61. Epub 2014/05/06. doi: 10.1007/s10654-014-9906-3. PubMed PMID: 24791704.

⁴ Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health. 2014 Jun 24;14:643. doi: 10.1186/1471-2458-14-643. PMID: 24962204; PMCID: PMC4099157.

⁵ Erickson KI, Voss MW, Prakash RS, Basak C, Szabo A, Chaddock L, Kim JS, Heo S, Alves H, White SM, Wojcicki TR, Mailey E, Vieira VJ, Martin SA, Pence BD, Woods JA, McAuley E, Kramer AF. Exercise training increases size of hippocampus and improves memory. Proceedings of the National Academy of Sciences. 2011;108(7):3017. doi: 10.1073/pnas.1015950108.

⁶ Sala A, Malpetti M, Farsad M, Lubian F, Magnani G, Frasca Polara G, Epiney JB, Abutalebi J, Assal F, Garibotto V, Perani D. Lifelong bilingualism and mechanisms of neuroprotection in Alzheimer dementia. Hum Brain Mapp. 2022;43(2):581-92. Epub 2021/11/04. doi: 10.1002/hbm.25605. PubMed PMID: 34729858; PMCID: PMC8720191.

⁷ Ludyga S, Gerber M, Pühse U, Looser VN, Kamijo K. Systematic review and meta- analysis investigating moderators of long-term effects of exercise on cognition in healthy individuals. Nature Human Behaviour. 2020;4(6):603-12. doi: 10.1038/s41562-020-0851-8.

⁸ Herold F, Törpel A, Schega L, Müller NG. Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements – a systematic review. Eur Rev Aging Phys Act. 2019;16:10. Epub 2019/07/25. doi: 10.1186/s11556-019-0217-2. PubMed PMID: 31333805; PMCID: PMC6617693.

⁹ Wang W, Luo Y, Zhuang Z, Song Z, Huang N, Li Y, Dong X, Xiao W, Zhao Y, Huang T. Total and regional fat-to-muscle mass ratio and risks of incident all-cause dementia, Alzheimer’s disease, and vascular dementia. J Cachexia Sarcopenia Muscle. 2022 Oct;13(5):2447-2455. doi: 10.1002/jcsm.13054. Epub 2022 Jul 20. PMID: 35856185; PMCID: PMC9530585.

¹⁰0 Gallardo-Gómez D, Del Pozo-Cruz J, Noetel M, Álvarez-Barbosa F, Alfonso-Rosa RM, Del Pozo Cruz B. Optimal dose and type of exercise to improve cognitive function in older adults: A systematic review and bayesian model-based network meta-analysis of RCTs. Ageing Res Rev. 2022 Apr;76:101591. doi: 10.1016/j.arr.2022.101591. Epub 2022 Feb 17. PMID: 35182742.

¹¹1 Penninkilampi R, Casey AN, Singh MF, Brodaty H. The Association between Social Engagement, Loneliness, and Risk of Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis. 2018;66(4):1619-33. Epub 2018/11/20. doi: 10.3233/jad- PubMed PMID: 30452410.

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Last week a discovery, published in the journal Science, showed that a high level of an abnormal ‘phosphorylated-tau’ protein triggers brain cells to self-destruct. It also gives a vital clue as to how to stop your brain cells dying with specific vitamins.

When cells become largely dysfunctional, they self-destruct. This process in neurons (brain cells) is called ‘necroptosis’. The recent discovery, made by researchers at the UK’s Dementia Research Institute at University College London (1), showed that an abnormal accumulation of a protein called tau that then becomes phosphorylated, making it tangled and dysfunctional, triggers a specific molecule called MEG3 that triggers brain cell death.

“For the first time we get a clue to how and why neurons die in Alzheimer’s disease. There’s been a lot of speculation for 30-40 years, but nobody has been able to pinpoint the mechanisms. It really provides strong evidence it’s this specific suicide pathway.” researcher Prof Bart De Strooper, from the UK’s Dementia Research Institute. told the BBC.

Even before this, too much phosphorylated-tau (abbreviated to p-tau) interferes with the cell’s energy factories (called mitochondria), potentially leading to brain fatigue. The more p-tau accumulates, the greater a person’s risk for cognitive problems and Alzheimer’s dementia. Also, those with memory decline have been shown to have relatively more p-tau to tau protein.

The critical prevention question is, then, what stops too much of the tau protein from turning into the potentially harmful p-tau and what helps restore p-tau to normal tau protein. 

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The answer is remarkably simple – a lack of B vitamins and raised blood levels of homocysteine which is an established risk factor for memory decline, measurable in the blood. When levels of B vitamins (B6, B12 and folate) are low, blood levels of homocysteine go up. This activates one enzyme (Cdk5 kinase) that adds the bad ‘p’ to tau and blocks another enzyme (protein phosphatase A2) which removes the dangerous ‘p’ restoring normal tau protein (2)(3).  High homocysteine also damages the tiny blood vessels in the brain, leading to ‘mini strokes’ or transient ischemic attacks (TIAs), which further raise levels of p-tau (4). Homocysteine both raises levels of the dangerous p-tau and can also bind to tau (5), further generating the neurofibrillary tangles that then trigger brain cell death.

So, the simplest way to stop the formation of p-tau, and neurofibrillary tangles, and keep your brain healthy, is to keep your plasma homocysteine level below 10 mcmol/L. Half of those above 65 have a level of homocysteine higher than this. The easiest way to lower your homocysteine below 10 mcmol/L is to supplement B6, B12 and folate. 

But it’s also good to eat greens and beans that are high in folate. While B12 is only in animal foods – meat, seafood, eggs and milk. While an optimal supplemental intake for a middle-aged person might be 20mg of B6, 10 mcg of B12, and 400 mcg of folate, many older people start to dramatically lose their ability to absorb B12, the absorption of which requires stomach secretions. Antacid ‘PPI’ medication such as omeprazole accelerates this decline, promoting B12 deficiency. And, over four years of use, increases dementia risk by a third (6). Then, as studies show, you might need a lot more B12, such as 500 mcg, to get a little more into your bloodstream, and possibly more supplemental folate, in the region of 500 to 800 mcg.

This is the cheapest, safest and most logical solution to lower p-tau and prevent brain cells from committing suicide. The problem is that these nutrients, invented by nature, cannot be patented. Therefore it is not in the interest of the pharmaceutical industry to research them.

Consequently, drugs are being developed and tested that block the kinase enzyme and activate the phosphatase enzyme (7), which is exactly what the homocysteine-lowering B vitamins do. But, so far, there are no human clinical trials reporting significant benefit. 

On the other hand, trials giving these kinds of doses of B6, B12 and folic acid have shown up to a two-thirds slower rate of brain shrinkage (8) and virtually no further memory loss in those with pre-dementia (9).

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Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.

By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices.

Please support our research by becoming a Friend of Food for the Brain.

———

References

¹ https://www.science.org/doi/10.1126/science.abp9556 Balasu S et al. Science
14 Sep 2023 Vol 381, Issue 6663 pp. 1176-1182 DOI: 10.1126/science.abp9556

² Smith AD, Refsum H. Homocysteine, B Vitamins, and Cognitive Impairment. Annu Rev Nutr. 2016 Jul 17;36:211-39. doi: 10.1146/annurev-nutr-071715-050947. PMID: 27431367.

³ LiJ-G,ChuJ,BarreroC,MeraliS,Pratico`D.2014.Homocysteine exacerbatesβ-amyloid, tau pathology, and cognitive deficit in a mouse model of Alzheimer’s disease with plaques and tangles. Ann. Neurol. 75:851–63 

⁴ Shirafuji N et al Homocysteine Increases Tau Phosphorylation, Truncation and Oligomerization. Int J Mol Sci. 2018 Mar 17;19(3):891. doi: 10.3390/ijms19030891. PMID: 29562600; PMCID: PMC5877752.

⁵ Bossenmeyer-Pourié C et al. N-homocysteinylation of tau and MAP1 is increased in autopsy specimens of Alzheimer’s disease and vascular dementia. J Pathol. 2019 Jul;248(3):291-303. doi: 10.1002/path.5254. Epub 2019 Mar 19. PMID: 307349

⁶ Northuis C, Bell E, Lutsey P, George KM, Gottesman RF, Mosley TH, Whitsel EA, Lakshminarayan K. Cumulative Use of Proton Pump Inhibitors and Risk of Dementia: The Atherosclerosis Risk in Communities Study. Neurology. 2023 Aug 9:10.1212/WNL.0000000000207747. doi: 10.1212/WNL.0000000000207747. Epub ahead of print. PMID: 37558503.

⁷ Xia, Y., Prokop, S. & Giasson, B.I. “Don’t Phos Over Tau”: recent developments in clinical biomarkers and therapies targeting tau phosphorylation in Alzheimer’s disease and other tauopathies. Mol Neurodegeneration 16, 37 (2021). https://doi.org/10.1186/s13024-021-00460-5

⁸ Smith AD, Refsum H. Homocysteine, B Vitamins, and Cognitive Impairment. Annu Rev Nutr. 2016 Jul 17;36:211-39. doi: 10.1146/annurev-nutr-071715-050947. PMID: 27431367; see also Jernerén F., et al. Am J Clin Nutr. 2015 Jul;102(1):215-21.

⁹ Oulhaj A., et al. J Alzheimers Dis. 2016;50(2):547-57.

We now know that today’s diet, lacking in brain-friendly fats and other nutrients, yet high in sugar and ultra-processed food, is likely to be shrinking our brains, dumbing us down and triggering a big increase in mental health problems. But it isn’t just nutrition that is creating the perfect storm for our mental demise.

The digital culture we exist in is pushing us towards a whole new paradigm of background stress. This is partly because the marketeers have learnt how to get us addicted to their products – applying a level of stress and variable reward to trick the brain’s reward system – leaving you with a ‘gotta have it’ feeling.

This mechanism of ‘variable reward’

This was first discovered in the 1930’s by the psychologist B.F. Skinner. He found that mice responded most frequently to reward-associated stimuli when the reward was given after a varying number of responses – so the animal didn’t know when it would get the prize. It seems we are no different; if we perceive a reward to be delivered at random, and if checking for that reward comes at little or no cost, we end up checking habitually.

So is this where smartphone addiction comes from?

This manipulation of the stress/reward response is one of the oldest mechanisms of the brain. It is both core for our survival, but also makes us more impulsive, manipulatable and, effectively, stupid.

Most of all, it makes us good consumers. Reward, based on dopamine, equals pleasure. We are living in space-age times with stone age minds and multinational companies have learnt how to get us hooked – literally neurochemically addicted to consuming their products.

We are being sold pleasure in the guise of happiness: the happy hour, the happy meal, happiness in a can. But joy and happiness are regulated by the neurotransmitter serotonin, not the latest special offer. And in fact, this pleasure-seeking may be counterproductive.

“The more pleasure you seek, the more unhappy you get” says Professor Robert Lustig, author of ‘Hacking the American Mind’. This is because too much dopamine (the ‘reward’ neurotransmitter) suppresses serotonin (the ‘happy’ neurotransmitter) and we end up feeling unhappy and depressed. This brain hijack may be why depression, suicide and psychiatric drug prescriptions have rocketed to the point where, in the UK and US (and probably elsewhere), there are almost twice as many prescriptions for psychiatric drugs per year than there are people.  

“We are the most in debt, the most obese, the most medicated and the most drugged up adult population in human history” says Lustig. We have literally learnt how to fool our brains and in doing so have fooled ourselves, by creating addictive behaviours and addictive foods. 

An example of this is what happens in your brain if you eat sugar and/or fat. 

Sugar…just like cocaine and heroin?

Sugar, just like cocaine and heroin, stimulates dopamine and endorphins. It triggers the reward system but with overuse, leads to reward deficiency (1). Dr Candace Pert, Research Professor in the Department of Physiology and Biophysics at Georgetown University Medical Center in Washington DC, and author of the seminal book ‘The Molecules of Emotion’, was the first to point this out in no uncertain terms: “I consider sugar to be a drug, a highly purified plant product that can become addictive. Relying on an artificial form of glucose – sugar – to give us a quick pick-me-up is analogous to, if not as dangerous as, shooting heroin. (2)” At the time, this was heresy but, today, most people are well aware of this. But it’s not just sugar that’s feeding our addiction.

Neuropharmacologist Professor Paul Kenny, a Dubliner now working in his Manhattan lab at Mount Sinai Hospital, discovered this when he started feeding rats different diets. When he fed one group of rats either lots of sugary foods and another group lots of fatty foods, neither group would gain much weight. They’d control their intake and it would take over a month to see a small weight gain. 

However, when he fed them a combination of 50% sugar and 50% fat, such as in a cheesecake, he noted the mice would “dive head first into a slice and gorge so vigorously that it covered its fur in blobs. It’s not pleasant.” After a binge on cheesecake they continued to graze, constantly eating food, he says, as if the off-switch telling them they were full had malfunctioned. “It completely changed them.” They stopped exercising and gained significant weight after only seven days. They also became addicted (3). When he took away the junk food and replaced it with healthy food they went on a hunger strike, refusing to eat it. 

He even tried to stop them by giving them an electric shock to their feet. “We then warned the rats as they were eating—by flashing a light—that they would receive a nasty foot shock. Rats eating the bland chow would quickly stop and scramble away, but time and again the obese rats continued to devour the rich food, ignoring the warning they had been trained to fear. Their hedonic desire overruled their basic sense of self-preservation.” 

Overeating, he found, juices up the reward systems in the brain — so much so, that in some people, it can overpower the brain’s ability to tell them to stop eating when they have had enough. As with alcoholics and drug addicts, the more they have, the more they want, creating a vicious cycle of dopamine resistance, eventually leading to the brain’s receptors for dopamine to shut down. 

It seems dopamine, the brain’s main neurotransmitter of reward and desire, is the key. 

Obese people and drug addicts have been shown to have less dopamine D2 receptors (D2R)s (4). People who are born with reduced levels of D2R are therefore at greater genetic risk of developing obesity and drug addiction – so you can be genetically predisposed to addiction. Researchers at Brookhaven National Laboratory and the Oregon Research Institute have shown that the reward system in obese people responds weakly to food, even to junk food(5). How does an individual overcome this absence of pleasure? By eating more pleasure foods to gain a temporary boost, thereby perpetuating the cycle. The researchers found that obese people may overeat just to experience the same degree of pleasure that lean individuals enjoy from less food.

Nicole Avena of the University of Florida, and others, have found that particular fats or sugars, sugars together with fats, and possibly salt, are the most addictive (6). A study by Professor David Ludwig of Boston Children’s Hospital suggests that highly processed, quickly digested fast carbs could trigger cravings (7). But research overall indicates that no one ingredient stokes food addiction better than the combo of fats and sugars, high in calories. Nature just doesn’t make these kinds of foods. Only the food industry does.

Similarly, cola drinks combine the stimulant caffeine, with sugar and salt, to make you drink more. And we crave sugary food and drink even more when fructose is used instead of glucose. Why? Because our cells run on glucose and quickly feedback when we’ve had enough. Fructose (or high fructose corn syrup, derived from corn) takes longer to send us that signal, leading us to consume more. No wonder then that glucose has been replaced by fructose and is a key ingredient in today’s ultra-processed foods.

Are you addicted to your smartphone?

Of all the changes that have taken place in the 21st century, the ‘digital revolution’ has changed our world beyond recognition, seemingly speeding up time. Yes, our diet and environment have changed a lot, but what’s really changed, especially in cities that now house half of humanity and an estimated two-thirds of the world’s population by 2035, is the pace of life. People all over the world are sleeping less, having less downtime, feeling more anxious and stressed and burning out at a far higher rate. This is reflected in the increasing rate of work absenteeism, depression and suicide, especially in cities.

The speeding up of communication – emails, smartphones and digital media – means that we are supposed to react to demands, and are bombarded with them, at an ever-increasing speed. 

We have literally become addicted to our phones(8). The average person picks up their phone 352 times a day – more than every three minutes, and swipes it thousands of times a day. A UK survey reports 62% cannot make it through dinner without checking their phone. Almost half of us report anxiety if we don’t have our phone, or a signal, suffering ‘nomophobia’. We are going to sleep with our phones and checking them first thing on waking up. One survey found that one in ten university students in the US admitted to having checked their smartphones during sex! 

Why? Basically, to sell stuff. “I feel tremendous guilt,” admitted Chamath Palihapitiya, former Vice President of User Growth at Facebook, to an audience of Stanford students. “The short-term, dopamine-driven feedback loops that we have created are destroying how society works.” Whether it’s Facebook, Instagram, Twitter, Snapchat, LinkedIn or any other platform, the core design is to get your attention, then show you ads tailored to your attributes and behaviours which the technology learns about you. Facebook, for example, has learnt how to do this with prompts, swipe downs, red icons that you press and don’t know what you receive. Is it a ‘like’? Do I have more ‘friends’? Or has another person ‘linked’ to me on LinkedIn etc. 

Facebook even knows when you’re feeling ‘insecure’, ‘worthless’ and ‘need a confidence boost’ or are ‘bored’, and can make sure you receive a notification of a ‘like’ at just the right time to keep you hooked. If you find yourself checking your phone at the slightest feeling of boredom, purely out of habit, know that programmers work very hard behind the screens to keep you doing exactly that. A study of 143 undergraduates at the University of Pennsylvania, limiting use to 30 minutes a day versus a control group found significant reductions in loneliness and depression (9). The researchers concluded, “Our findings strongly suggest that limiting social media use to approximately 30 minutes per day may lead to significant improvement in well-being.”

Whether it’s a text, a notification or a ‘like’, just like sugar, this digital consumption triggers a reward signal in our brains. The marketing algorithms schedule the precise times to deliver our digital diet and serve up the extra addictive quality of a variable reward.

Your brain’s reward system

It’s to do with a tiny organ in the central hippocampal area of the brain called the nucleus accumbens. This is the headquarters of our dopamine-based ‘reward’ system.

The more dopamine you release the more receptors shut down, so you seek more pleasurable behaviours and foods. Insidiously and unknowingly your brain has been hijacked and the symptoms you feel are the direct consequences of an intended addiction. Gambling, gaming, overeating, sex, drugs, food, social media and other digital addictions are all part of it. We end up needing this constant stimulation and, to fuel that, need instant energy foods and drinks – sugar and coffee. 

Alcohol – the opiate of the masses

Whether you’ve become addicted to sugar, food, caffeinated drinks, social media, gambling, gaming or non-stop stimulation, or simply get caught in the stress trap, perhaps due to work and life demands and debts, this often results in an inability to switch off with a background feeling on anxiety and stress without alcohol, and difficulty sleeping. 

You may find, in time, that your need for alcohol increases – from a glass a night to two, three, half a bottle or even more. Alcohol, a well-established neurotoxin (10), surely is the opiate of the masses. Consumption keeps going up. It’s the currency of a good time, normalised as a response to stress, glorified in movies and at the core of our modern culture, with a 1.5 trillion dollar industry, expected to rise to 2 trillion by 2027 (11), promoting its use. While smoking has become frowned upon, anything other than heavy drinking is considered socially acceptable. Yet according to WHO alcohol is in the top five causes of death and disability, and has become the most common cause of death in men under 50 (and soon will be for women), accounting for one-fifth of all deaths under 50 and almost 30,000 deaths a year overall, roughly a third that of smoking and ten times more than opioids (inc heroin) and is ranked more harmful than any other drug, including opioids (12). This addictive drug is so socially acceptable that governments avoid attempts to curtail its use for fear of voter reprisals.

A commonly unknown fact is that death or disability from alcohol doesn’t only occur in heavy drinkers. The risk goes up exponentially with the quantity you drink. The good news is that small reductions have big positive effects on your health. To make this real, a 12.5% vol. bottle of wine contains 75g alcohol: drinkers who have 2/3rds of a bottle of wine (two large glasses) or the equivalent 50g of alcohol, have a lifetime risk of death of 16%. But one medium glass (175ml) of wine (17.5g of alcohol) brings that risk below 1%. In terms of mitigating serious health risks, including death, the advice of the UK government’s former advisor, Professor David Nutt, is for women to consume no more than 15g of alcohol per day  and for men no more than 20g alcohol per day, and to have at least two alcohol-free days per week. Sadly, Professor Nutt was sacked for saying that alcohol was a ‘time bomb’ and more dangerous than Ecstasy, but the statistics point to this being true.

The trouble is, when you get stuck in the cycle of seeking rewards, needing stimulants and relaxants, you become more tired, more anxious and may even have started to feel more depressed. 

When things get bad and you visit your doctor they may prescribe antidepressants, tranquillisers (short-term use only) or sleeping pills. Others learn to use illicit uppers and downers.

Are you addicted to stimulants?

The other major acceptable and glorified drug is caffeine, mainly in the form of coffee, although many people don’t realise that strong tea has as much caffeine as a regular cup of coffee. Like sugar, alcohol and our digital diet, it stimulates dopamine release and the feeling of pleasure or reward. Imagine a day with no coffee, tea, sugar, chocolate or that well-earned glass of something! If you shout, ‘No way!’ there is a very real possibility that you have some level of addiction to these stimulants. This can range from a mild addiction that you can live with quite happily to a major problem that is controlling your life. 

However, whatever the level of addiction, the net consequence is always less energy, not more. One of my clients, Bobbie, serves as a case in point. She was already eating a healthy diet and took a sensible daily programme of vitamin and mineral supplements. She had only two problems: a lack of energy in the morning and occasional headaches. She also had one vice: three cups of coffee a day. After some persuasion, she agreed to stop the coffee for a month. To her surprise, her energy levels rose and the headaches stopped. 

Like Bobbie, it’s useful to audit your stimulant consumption from time to time. Using a Stimulant Inventory below can be helpful, but in making an accurate assessment of your current relationship to stimulants, you need to be honest with yourself about how you use them. There’s a space for alcohol which, while not a stimulant, still triggers those dopamine receptors.

It’s useful to write down the time of day you consume the above and to spend time thinking about what your relationship to these substances is. 

Do you, for example, ever buy sweets and hide the wrappers so other people don’t know you’ve eaten them? 
Do you swoon at the dessert menu in restaurants? 
How much do you think about and look forward to that morning cup of coffee or a mid-morning second cup? 
How important is that drink after work?
Does everyone really know how much you smoke? 
Have you cranked up your caffeine intake to ‘double espresso’ equivalent drinks using more coffee at home than you used to? 
Do you need more to get a ‘kick’ if you even get one, or does coffee now just relieve the fuzzy tiredness you feel without it?

This kind of relationship to stimulants, often cloaked in an attitude that they are just some of the innocent pleasures of life, is indicative of an underlying chemical imbalance that depletes your energy and peace of mind and, at its worst, feeds into mental health issues.

Coffee and Caffeine Withdrawal and Sleep

If you wake up feeling good and can function without a coffee, and have no major mental health issues, sleeping well for example, but enjoy one coffee a day which will give you a dopamine kick, that’s not a problem. The best measure of your relationship with coffee or caffeine, and whether your brain has ‘downregulated’ dopamine and adrenaline receptors is what happens when you quit. If the answer is nothing then there’s no issue. If, on the other hand, you get a variety of withdrawal symptoms (13), including headaches, tiredness and irritability that means your neurotransmitter receptors have downregulated and it will take a few days for them to upregulate and bring you back to normal. For many just one cup of coffee a day can result in withdrawal effects if stopped (14). It’s also worth knowing that coffee, or caffeine, consumed 6 hours before sleep, which is about as long as caffeine stays in the system, is associated with disturbed sleep (15) – either difficulty falling asleep or waking in the night so, at least, it is wise to consume no caffeine after noon, especially if you have issues with sleeping.

Tea or coffee?

The caffeine in both coffee and tea increases the release of adrenalin, cortisol and dopamine in your body and brain, while inhibiting the absorption of adenosine, a brain-calming chemical. The release of adrenaline into your system gives you a temporary boost, but frequently makes you fatigued and depressed later. If you take more caffeine to counteract these effects, you end up spending the day in an agitated state, and might find yourself jumpy and edgy by night.

Tea contains caffeine, but also theanine, which has a more calming amino acid shown to enhance cognitive abilities (16). It also protects GABA receptors, which is the brain’s adrenalin off switch. Overall then, tea is better for you. Green tea may also have some benefits over black tea (the same plant, but processed differently such that green tea contains more antioxidants and polyphenols, which are good guys as far as our bodies are concerned).

Benefits or excuses?

Many things could be written on the apparent benefits of tea, coffee, even some forms of alcohol. We read about the beneficial effects of resveratrol in red wine, polyphenols in coffee and cacao and other antioxidants in tea. However, the nature of ANY dependence creates a psychological set of ‘excuses’ that we use to justify our addictive behaviour. 

This could be anything from ‘that’s a lovely sauce’ (sugar), ‘a little bit of what you fancy won’t harm you’ ‘I’m so stressed I have to have a drink’, ‘I’ve got to focus so I need a coffee’ and so on. Of course, all these substances work, otherwise we wouldn’t be attracted to them and, in that sense, mindful consumption in certain circumstances makes sense. For example, if someone experiences a shock, a sugary drink can help. And when a deadline looms and you need to burn the candle at both ends, caffeine can certainly help.

The issue here is to understand how the combination of sugar, caffeinated stimulants, alcohol, tech and social media addiction, shopping, gambling, gaming and so on can hijack your brain’s natural reward system and result in the opposite – you feeling more tired, anxious, unfulfilled and depressed. If that’s happened to you, rest assured there are some simple suggestions that will help you reclaim your brain’s full potential for feeling good, energised, clear, focussed and purposeful.

Simple ways to win back your brain

Limit your time spent on social media – 30 minutes a day max is a good target but you may need to build down to this. Turn your phone off (or to ‘airplane’ mode) at least an hour before bed and keep it that way for at least an hour in the morning. If you have to have it on, don’t check social media for a couple of hours. 

Limit your intake of caffeine to under 100 grams a day – that’s one strong cup of coffee or two weaker cups of tea. If you have a second cup, use the same tea bag, or have a filter coffee ‘run through’. Avoid all caffeine after noon.

Avoid buying food that contains added sugar, dates or raisins – if in doubt, read the label and remember sugar is often disguised as high fructose corn syrup. When looking at food labels remember 5g is a teaspoon of sugar and foods with more than 22.5g per 100g of sugar are considered high sugar and those with 5g or less per 100g are considered low sugar. Ideally, only have sugar in whole fresh fruits. Fruit juice is also high in sugar so best avoided or limited. 

Limit your daily intake of alcohol to 20 grams, or a maximum of two small glasses (125ml is one small glass) of wine. Have at least two days a week alcohol-free.

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References

¹ P. Holford, How to Quit Without Feeling S**t, Piatkus, 2008.

² P. Holford, How to Quit Without Feeling S**t, Piatkus, 2008.

³ P.M. Johnson and P.J. Kenny ‘Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats’, Nature Neuroscience (2010), vol. 13(5), pp. 635-641. 

⁴ .P. Kenny ‘Reward Mechanisms in Obesity: New Insights and Future Directions’ Neuron. 2011 Feb 24; vol 69(4): pp.664–679. 

 ⁵  See ref 4 above

⁶ N.M. Avena and M.S. Gold, ‘Food Addiction – Sugars, Fats and Hedonic Eating’, Addiction (2011), vol. 106(7), pp. 1214-1215.

⁷ B. Lennerz et al., ‘Effects of dietary glycemic index on brain regions related to reward and craving in men’ The American Journal of Clinical Nutrition, Volume 98, Issue 3, 1 September 2013, Pages 641–647

⁸ https://explodingtopics.com/blog/smartphone-addiction-stats

⁹ https://guilfordjournals.com/doi/10.1521/jscp.2018.37.10.751

¹⁰ Nutt, D.;Hayes,A.; Fonville, L.; Zafar, R.; Palmer, E.O.; Paterson, L.; Lingford-Hughes, A. Alcohol and the Brain. Nutrients 2021, 13,3938. https://doi.org/10.3390/ nu13113938

¹¹ https://www.statista.com/forecasts/696641/market-value-alcoholic-beverages-worldwide

¹²  David J Nutt and Jürgen Rehm J Psychopharmacol 2014 28: 3 DOI: 10.1177/0269881113512038 

The online version of this article can be found at: http://jop.sagepub.com/content/28/1/3

¹³ https://www.ncbi.nlm.nih.gov/books/NBK430790/

¹⁴ Juliano LM, Griffiths RR. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology (Berl). 2004 Oct;176(1):1-29. doi: 10.1007/s00213-004-2000-x. Epub 2004 Sep 21. PMID: 15448977.

¹⁵ Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013 Nov 15;9(11):1195-200. doi: 10.5664/jcsm.3170. PMID: 24235903; PMCID: PMC3805807.

¹⁶ Anas Sohail A, Ortiz F, Varghese T, Fabara SP, Batth AS, Sandesara DP, Sabir A, Khurana M, Datta S, Patel UK. The Cognitive-Enhancing Outcomes of Caffeine and L-theanine: A Systematic Review. Cureus. 2021 Dec 30;13(12):e20828. doi: 10.7759/cureus.20828. PMID: 35111479; PMCID: PMC8794723.