Expert Interview: Lisa Mosconi, PH.D.

Illustration of Dr. Lisa Mosconi by Kim Smith

I don’t know anyone who’s spent more time studying, researching and thinking critically about the effects of nutrition on human performance than Dr. Lisa Mosconi.

Lisa is an Assistant Professor of Neuroscience in Neurology and the Associate Director of the Alzheimer’s Prevention Clinic, Weill Cornell Medical College. Her research interests include PET and MRI imaging in the early diagnosis of Alzheimer’s Disease.

Lisa holds a Ph.D. degree in Neuroscience and Nuclear Medicine from the University of Florence, Italy, in association with New York University School of Medicine. She also has a degree in Nutrition Sciences from the Institute for Integrative Nutrition.

When it comes to nutrition, Lisa knows her sh*t. Below is an edited transcript of my conversation with Lisa in June of 2016.


“The Loggia di Lanzi, Florence, Italy” New York Public Library Digital Collection

Tell me about your educational path.

I was born and raised in Florence, Italy and that’s where I went to school.

I received a university degree in experimental psychology from the University of Florence in Italy and started my PhD in neuroscience and nuclear medicine there. One year into my program, I moved to the NYU Medical School — I finished my PhD there. As soon as I graduated, I was offered a position as an assistant professor in the Psychiatry Department at NYU. Two years into this position, I was promoted to a tenured track.

I have been working at NYU for 12 years, and four years ago, I got really interested in nutrition and lifestyle. Because that’s where my research was leading me. Ever since I started school, I’ve been working on the early detection of Alzheimer’s disease. And I’ve been doing that by using brain imaging techniques like the MRI, but mostly nuclear medicine techniques like Positron Emission Tomography (PET).

And what does that mean?

The PET takes pictures of the brain and what the brain looks like. The difference between the PET and the MRI is, by and large, MRI shows you anatomy. So usually when you think about the MRI, it’s the gray pictures of the brain, the brain in different shades of gray, and you can see the anatomy of the brain really well.

PET has more information about the brain structures. It really tells you about brain activity. What the brain is doing. It’s not just the shape of the brain, but it’s really all the things that are going on inside the brain. It could be the way that the neurons are firing together. It could be chemistry in the brain.

For instance, when people are depressed, they have a lower than normal amount of a neurotransmitter or a chemical in the brain that’s called seretonin. We can see that with PET scans. A lot of chemical things that happen in the brain, we can see using this particular technique.

“9 pictures of the brain and its parts” New York Public Library Digital Collection

I started doing brain imaging to really look at people with risk for Alzheimers. And a risk meant they had genetic risks of Alzheimers, like having a parent affected, grandparents affected, or more specifically, having genetic mutations that are responsible for Alzheimers. And after many, many years of doing research, correlating genetics with brain functioning outcomes, I was so disappointed because, in part, the correlation was not as strong as I thought it would be.

In the course of my research, I spent many years just being asked about [Alzheimers] risks based on DNA. And then, at some point, the kind of questions that I was being asked — they really changed. And people would say, “Okay, fine. I know my mom has Alzheimer’s. What should I eat? What should we eat?”

I didn’t know what they should do. But it became really clear to me that many people, maybe intuitively, they associate food with medicine. In ways that we don’t always appreciate. I think everybody — whenever we feel down or sad, something is upsetting to us, we get ice cream. That’s not just because ice cream is a comfort food, but because what we eat has an effect on our mood, which we all know very well. But the reason is that food effects or changes the way the brain is working. Mood is something that we associate more with the heart, right? But in reality is depends on the brain. There’s this kind of neglected component of food that is really the effect that our nutrition diets have on the way our brains work.

This realization led me back to school. I received another degree in integrative nutrition three years ago. And I also did a lot of studying and researching by myself, which led to my founding a new lab at NYU. I’m the founder and director of the Nutrition and Brain Fitness Lab at NYU Medical. The goal of the lab is to understand all of the food choices we make and see what kind of consequences those choices have in the brains of people who don’t have Alzheimer’s, but could be at risk for it.

And do you have a specific focus within that lab?

I like food, so I think my major interest is really about food as information. Because food is not just the source of nourishment and entertainment, but food is really chemistry. So that’s what I’m beginning to study — to see how the food you put in your body becomes part of your body and also changes the chemistry of your entire system especially the brain.

Fascinating. Can you give me an example of a specific food that impacts the way our brain operates?

We’re used to thinking about nutrients like protein, carbohydrates, amino acids, vitamins — some nutrients are essential for the health of the brain, some nutrients are not. The nutrients that are really essential are those that we eat and the brain uses to do things or even just to replenish the tissues, the very tissues of the brain.

I’ll give you an example of a B-vitamin that is called choline. This vitamin is what the brain uses to manufacture a neurotransmitter (basically what neurons use to communicate with each other). So, this neuron can only speak to the other neurons by sending out a chemical message. This is basically encapsulated in this little tiny neurotransmitter that jumps from one neuron to the next, carrying information.

The neurotransmitters that we use to form memories are called acetocholine. And as the word suggests its made of an acetine group, which is a sugar in the B-vitamin choline. Choline is essential. We cannot produce it ourselves in the body so it has to come from the food we eat. Although, for this particular nutrient, the liver can make little bit, make 10% of all the choline we need, but 90% comes from food.

And what types of foods have choline?

Eggs are a really big source of choline. Fish. Chicken has a little bit. Broccoli has a little bit. But the foods that are really, really rich in the nutrients are eggs and fish.

“Magnified vitamin B crystals” New York Public Library Digital Collection

What is your opinion on getting these nutrients from food versus supplements?

I think there’s a tendency to micromanage nutrients instead of really focusing on the quality of the foods that we eat. I think a lot of people feel like they don’t receive enough nourishment, and that’s why they think, “Well then let me take supplements, because I want to have more energy, or I want to be stronger, I want to think faster,” but I think that if we just focused on the right foods, and high quality foods, then we wouldn’t even need the supplements.

Supplements are expensive and they’re processed. They’re synthesized in a lab. They’re not even close to an actual food in terms of all the range of nutrients that the real foods provide. Sometimes you take a vitamin E supplement and you’re only getting one of the eight possible forms of vitamin E. Whereas if you were to eat flaxseeds you will get all eight of them. And it doesn’t cost anything. A teaspoon of flaxseeds and that’s it, you’re done for the day.

So my research — and other people’s research before mine — has shown very clearly that nutrients from supplements do not have the same impact in your brain as when people derive their nutrients from foods. We published this, other people showed it as well. Clinical trials that use supplements usually don’t work, whereas diets that provide the right foods work. So there’s a lot of confusion about that.

And why is that? Does your research discuss why that might be?

Yes, we have done some research on that. There are other labs that really focus on the molecular biology. We work with people, so there’s only so much data. When when you test that [data], in a serious or vigorous way, what happens is that the nutrients that are synthesized in the lab, they’re isolated components. They just don’t have the potency or they don’t come with all the support that the same nutrient would get a natural food.

I’ll give an example. Olive oil. Extra virgin olive oil. It has a lot of monounsaturated fatty acids that are good for the heart, but it also is a rich source of Vitamin E and is also a rich source of polyunsaturated fats that — like the omega-3s — are good for you.

Olive oil also has a lot of phytonutrients; nutrients that are specifically produced by plants. They are the chemicals that the plant produces to protect themselves from predators. It’s a really strong natural protection against disease, against attackers, and the phytonutrients and Vitamin E work synergistically with each other. Vitamin E is very delicate. It takes nothing to destroy it, to burn it, to pollute it, to put it down. You really need to protect it. The way you protect it — the way the plant protects it is that it creates these phytonutrients. They are called polyphenols that amplify the action of vitamin E, and at the same time protect it.

Fascinating.

So when you eat the olive oil, it’s not just olive oil, it’s like a wide range of things that have this in it.

That’s miraculous.

Yeah, exactly. Another example that I love is berries. Berries are the most precious part of the plant because they’re the only way the plant can reproduce itself, for they contain seeds. All of the energy, all the intention that the plant puts into surviving goes into the berry.

The berry is loaded with nutrients that are really protected. The berries need to be able to give birth to another organism. So they’re incredibly nutritious, they have all possible antioxidants, they have anti-inflammatory components. But they also have all sorts of pigments, the special chemicals in the plant that are very unique to the plant. And they need the most protection from the outside. For instance, cherries contain this pigment that’s called anthocyanin, and it gives the cherry it’s bright red color. And, it’s one of the best antioxidants on the planet.

“Cherries” New York Public Library Digital Collection

Lycopene is the nutrient — or the phytochemical — that gives tomatoes their red color. The brighter the better. And, that’s in the skin. And that’s what protects, literally, the fruit from the outside.

That’s incredible.

It’s strong. It’s like magic.

Would you mind talking about the Alzheimer’s specific research and the impact of food on the brain?

Yes. Alzheimer’s disease is a neurological disease that usually effects people as they age and leads to cognitive impairments in memory, attention, language reasoning, and daily living activities, meaning at the end of hospitalization, a loss of normal function.

The thing about Alzheimer’s is that it’s usually understood as either being an inevitable consequence of your genes or as an inevitable consequence of aging, and what research has been showing us in the past five, ten years, is that neither of those are true. Alzheimer’s is genetically determined in 1% of the entire population — actually less than 1% of the entire population. So for 99% of the population at large, Alzheimer’s disease is not determined by inherited genes.

The other thing is that Alzheimer’s is not a disease of old age. My research, and other people’s research as well, has shown that Alzheimer’s is a process. It may start as early as at birth for some people, it may start during adolescence, so the brain changes that eventually make people develop symptoms of Alzheimer’s can start very, very early on life.

We have some people who are 22 and show some changes. Other studies that have shown that a lot more people who are just really, really young in their 30s and 40s. And so it’s really — something happens so the brain can tolerate a lot of damage before it just exhausts it’s capacity to keep itself in check. And at that point, boom, you start showing symptoms.

That usually happens to people 60–65, and then the disease progresses a little faster, but if you wanted to see the upside, it means you have 60–65 years to really make sure that you’re as healthy as you can possibly be, and that we can really take care of our brains so that by the time we’re 65 our brains are strong. And so whoever is at the risk of getting Alzheimer’s could potentially delay the onset by many years, just by giving the brain all the resources and support that it needs. There’s no trick. The brain is chemistry, so you need to have the right chemistry in your brain to make sure it doesn’t get sick.

So if less then 1% of people have the genetic mutations, why do so many people end up getting Alzheimers?

For people who don’t have the [Alzheimers] risk genes, which is a lot of people, it’s more about lifestyle and environment. A lot of people are at risk because they just don’t lead a healthy life. All the choices they make just damage their brain, especially the nutritional choices.

Here’s an example: If you exercise, your brain situation is going to be much better, as compared to people who do not exercise. The nutrients can go to your brain better, and oxygen, as well, so your brain can breathe and you can also eat. On top of that, exercise stimulates the release of a lot of chemicals in the brain that are very good.

For instance, endorphins. They are like a feel good hormone and makes you feel, “Ahh.” When you go to the gym — use the endorphins inside your brain — it produces more serotonin in your brain which also makes people happier. But also it makes your brain produce hormones like growth factors, especially ones called BDNF, brain-derived neurotrophic factor that literally stimulate growth of new brain cells in your brain. So the more young cells you have a new brain, the younger your brain is going to be overall over time.

“Exercise 6. For generally loosening the body.” New York Public Library Digital Collection

I see.

So if you don’t exercise ever, you’re going to have the opposite effect. Your brain won’t have any of the advantages that a physical activity user, and the same’s true for diet.

From the diet perspective, what can we do to keep our brains healthy?

Okay, there are so many things you can do.

I think the most important thing is to understand what the brain actually needs, in terms of food. What I have come to realize is that there’s a huge difference between the foods the brain needs and the foods the rest of the body. The brain is a picky eater.

There are many nutrients that can’t even get inside the brain. A good example is fat. What happens when we eat fat, especially saturated fat like triglycerides — the meat, the cheese — is that the fat in the foods is broken down, and triglycerides are broken down into saturated fats, glycerol and whatever smaller components they’re made of.

And then this fat is taken up, some is used because the body needs a little padding here and there and everything else is stored for energy. So it goes in your adipose tissue, in your storage, fat — white fat. And you just stick it there for the future.

But the brain doesn’t take any of that [fat]. None. It can’t get inside the brain, the brain doesn’t need it, the brain doesn’t want it, because the brain doesn’t have the capacity to burn that fat to produce energy.

The only thing that the brain can burn for energy is glucose. That’s it pretty much. The best way for the brain to work is to burn the sugar glucose to produce energy. In case of total starvation there’s a backup mechanism that supplies a different form of fuel to the brain, but that’s really in case of starvation, so the brain needs glucose to function. It doesn’t need fat, it can’t burn fat. So fat just can’t get inside the brain.

The only kind of fat that can get inside the brain is called polyunsaturated fat and that’s the omega-3s and omega-6 and omega-9s. These are the fats that the brain really craves. So as soon as you eat them the brain take it’s share, and then the body gets the rest. It’s a preferential mechanism, which sends them up to the brain. The brain doesn’t burn these fats but merely uses them to incorporate the fats into whatever fat is already present in the brain. So literally patching up the brain with new pieces every time you eat fish or nuts, seeds, some vegetables.

That’s brilliant.

For Omega-3s whatever you eat today, stays in your brain for over two years. Sometimes it’s used a little faster but it could stay in there for up to two years.

That’s incredible. Tell me a little bit about your upcoming book & your private practice.

My book is called Neuronutrition, Nutrition for the Brain and hopefully it will be ready by the end of 2017. The practice is really about taking the research out of the lab and making it available to the public. And basically, all the concepts that I’m including in the book are very easily applied to a private practice. Our practice combines medical assessments that are done by my colleague who’s a board-certified psychiatrist, which is great when we’re talking about diet. I think a lot of people can’t stick to a diet because of lack of psychological support and psychological tools to really be motivated and consistent all the time.

The other side of the practice is more about lifestyle. Really teaching people and coaching — for educating people to eat right for their brains. And not only foods to nourish their brains in a very holistic way. So it’s not just about the foods you eat, but it’s also about how rich your life is.

Physical exercise is important. Intellectual stimulation is important. Social networks are very important. Just being active, activity is important for the brain as well. The brain doesn’t want to be depressed. Something that just doesn’t belong there. It’s not the optimal state for the brain. Love is very important for the brain as well. It’s one of the most powerful emotions. Sleep is incredibly important. There’s evidence that a reduced quality of sleep would be a risk factor for dementia as we age, because it’s really important.

So there’s not just food going inside the brain, there’s also toxins. Sometimes they can get inside the brain as well. The waste also. The brain works all the time so it produces things that it has to get rid of.

The best way for the brain to get rid of all this waste is during sleep. Because finally you shut down, and so the brain has a chance to literally clean everything up, toss it into the fluids that surround the brain, and then the fluids just flush everything else to the rest of the body and then the kidneys get rid of them.

“Gadus Morhua, The Cod Fish” New York Public Library Digital Collection

What would be the one thing routine or recommendation you would make for people who want to improve their health with respect to their brain?

I would say my number one recommendation is to drink water.

A lot of people are dehydrated, and a lot of people in the United States don’t drink water. They drink soda, they drink coffee, they drink juice, they drink caffeinated beverages, they drink water with bubbles in it — just drink water. Plain water. Not cold because it’s hard on the stomach. Just good water. Not purified, because purified water means that all the nutrients or the electrolytes have been gotten rid of and so it’s just nothing. It’s just a fluid it doesn’t really help you.

You need to have good water and drink a lot of that. Too many people don’t do that. Dehydration is one of the first reasons that your brain suffers. There is evidence that people who are even just mildly dehydrated, have slow reaction times, poor attention, poor focus. They have more difficulty just doing simple tasks as compared to people who just drink a glass of water. So I drink a lot of water. I think it’s really good for your entire body, but it’s also good for your brain and your mental capacities especially as older people are more naturally dehydrated than younger people. so it’s very important to maintain a balance.

Tip number two — you’ve got to eat fish. You have to eat fish.

Any particular type of fish or any fish will do?

Any fish is better than no fish.

That being said — farm-raised fish comes with a lot of risks because of pollutants, because of drugs that can get into fish, because of the unhealthy environment that the fish has been raised in. Also they can’t swim so the meat that you eat is very fatty — it’s not as healthy as that of wild caught. I usually eat wild caught fish.

Tell me how often do you eat it?

At least a three or four times a week. A portion. And a portion is small. It’s like two ounces. And it doesn’t have to be live Alaskan Salmon — I mean, it’s nice if it is, but it doesn’t have to.

It could be blue fish. It’s cheap. It can be halibut. It’s good for you. Could be mackerel, it’s really healthy for you. You can even just do sardines or anchovies. You can buy them in a can. It’s not even $2. Eat three, you’re done for the day.

It has to be done in a consistent way though. Most people don’t eat any fish, or they don’t eat healthy fish. So I think really good goal would be fish once a day if you’ve never had any fish before. Twice a day, if you’re used to having it.

There’s a lot of research shown that people who eat a portion of fish twice a week, have a 40 to 70% lowered risk of Alzheimer’s as they get older, as compared to people who eat no fish.

Wow.

Yes, 40–70%, that’s a lot. Two ounces is two small pieces of sashimi. It’s nothing, it can be a snack. So that’s my number two tip.

My number three tip is veggies — vegetables and fruit. Fresh, possibly organic, as much as you can, but organic and fresh. Fresh fruits and vegetables, and also nuts, seeds, and legumes, like plants. Plant based fruits. It should be the biggest part of a diet.

I love it.

Number four tip: Glucose rich foods. And I think it’s very important because when I say, “Glucose is a sugar.” Everybody’s like, “Gross.”

But glucose is a very peculiar sugar, and is found in various things. If you eat spring onions or scallions, they contain almost 80% glucose.

“Drying Apricots, California” New York Public Library Digital Collection

Really? What else is high in glucose?

Dried apricots, grapes, turnips, beets, rutabaga, chickpeas, bananas, honey, maple syrup —

Glucose is the sugar that’s important for the brain?

Yes. It’s the only energy source for the brain unless there is no glucose whatsoever in the system, but the preferred the source. To give you a sense of what that means in practical terms, to have the same amount of glucose, you can have either a teaspoon of honey or 30 chocolate chip cookies.

Incredible.

Yes. So when you eat the cookies, there are other sugars that can be converted to glucose, but that’s hard on the liver. It’s hard work that your body needs to do, and the cookies come with a lot of saturated fats. Sometimes there’s transaturated fat, which is horrible for you. There’s a lot of white sugar that crashes your insulin as soon as you eat them. They’re just not healthy.

And so most people eat a lot of sugary foods that just don’t provide immediate fuel to the brain, but they give you a high and then they give you a crash, and that’s how people have developed sugar cravings.

So my tip number five would be, it’s not just what you eat, it’s also about what you shouldn’t eat. And that means, processed foods — forget about it. Fried foods — leave fried foods, and I personally would say goodbye to fast food. All these foods that are chemically produced somehow, they’re just not natural foods. They’re just really hard on the body and they’re useless for the brain. So again, fresh, clean, and the right ones.

That’s wonderful advice.

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