Notes from How to Build a Healthy Brain By Kimberley Wilson

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CHAPTER 2: A Quick Note on Research

Takeaways 

• Science is a methodology that attempts to get closer and closer to an objective, robust ‘truth’while always leaving space for the things that are not yet known. 
• There is a hierarchy of evidence. Broadly speaking, the higher up the hierarchy one goes the more difficult and expensive the research is to conduct, but the more confident we can be of the conclusions. 
• When you read a news headline or a blog post about a health claim look for what level of evidence is being reported. If possible, ask the person to provide a link to the source they are referring to. It is not enough that the person ‘seems trustworthy’or has a large online following. When it comes to implementing advice that could have an effect on your health you deserve to have the best quality, most reliable information you can get. 
• The research I refer to in this book is based on human trials, because I want the information to be as relevant to you as possible. Where I mention animal trials this will be clearly identified and used in relation to explaining a mechanism of action where it is not possible or ethical to conduct the research with human participants.

CHAPTER 3: Getting to Know the Brain

1. Acetylcholine 

The key compound for neuroplasticity. When an event or action is important or meaningful, acetylcholine is produced at the synapses that were activated during the event, reinforcing them and keeping them more activated. This makes acetylcholine crucial to the learning process. 

2. Dopamine 

The reward and motivation hormone. Promotes the continuation of a behaviour or activity by producing feelings of pleasure. Eating, cuddling, pictures of kittens, all upregulate dopamine secretion. 

3. Endocannabinoids 

These are chemicals synthesised within the body that can dock into cannabinoid receptors in the brain and act as signalling molecules. Their function and activity are still under investigation, but they are thought to play a role in appetite regulation, pain management, immune function, inflammation and neuronal health. 

4. Endorphins E

ndorphins are endogenous opioids that are released in response to injury, physical exertion and extreme stress (acute inflammation) to reduce pain. 

5. Gamma-Aminobutyric acid (GABA) 

This inhibitory neurotransmitter calms or slows down brain activity. Alcohol, barbiturates, benzodiazepines and theanine (a compound found in tea) all act on this system. 

6. Glutamate 

An excitatory neurotransmitter, glutamate makes it more likely that a receptor neurone will produce an action potential, and enhances synaptic plasticity, making this amino acid important for learning and memory. 

7. Noradrenaline/ norepinephrine

Prepares the brain and the body for actions. Promotes wakefulness, vigilance and attention. Crucial part of the ‘fight or flight’response. 

8. Serotonin 

The good mood hormone. Serotonin is linked to good mood and feelings of well-being. It is synthesised from the essential amino acid tryptophan, which we get from food. Takeaways •Neurones (nerves) are the courier brain

Takeaways 

• Neurones (nerves) are the courier brain cells. They carry the messages and information between the body and the brain that are responsible for all your actions, thoughts, beliefs and ideas.
• The synapse is the location of the transmission of messages between the messenger (pre-synaptic) neurone and the receptor (post-synaptic) neurone.
• Messages are passed in the form of chemicals called neurotransmitters.
• Several types of non-neuronal cells called glia carry out important supportive functions for neurones, including providing nutrients, enhancing signalling, recycling neurotransmitters and launching an immune response.
• The blood–brain barrier is a specialised membrane that protects the brain by being highly selective about what molecules are allowed to cross over into the brain from the bloodstream.
• The areas of the brain that deal with logic and emotions are deeply interconnected. You cannot make decisions without utilising emotion networks and protecting your brain health must include attending to your emotions. 
• Even house plants come with care instructions but we rarely think about what our brains need to be healthy. Hopefully, having a better understanding of the brain and its needs will help you to look after it. The brain is complex and requires a range of interventions to protect it. A single quick fix just won’t cut it.

CHAPTER 4: The Major Players

The two major players when it comes to the maintenance of brain health are the processes of inflammation and neurogenesis.

Cytokines 

When the innate immune system calls for backup the signal is sent via molecules called ‘cytokines’.

Takeaways 

• Inflammation is immune activation. In the short-term, inflammation protects us from harmful bugs, but chronic inflammation is associated with serious physical and psychological illness. 
• Cytokines are signalling proteins released by immune cells in response to an immunological challenge.
• Immunological inflammation within the body may be a crucial biological mechanism underlying depression and other unhealthy mental states.
• Cytokines can inhibit the release of key neurotransmitters such as serotonin, dopamine and noradrenaline. 
• Cytokines increase the reuptake of serotonin in the brain, meaning that less serotonin is available at the synapse (e.g. this is the opposite of what antidepressant medication is designed to do). 
• Cytokines interfere with tryptophan metabolism, meaning that less of this essential amino acid is available for serotonin synthesis. 
• Understanding what is contributing to elevated inflammation may help to improve treatment and outcomes for patients. 
• Neurogenesis is the process of creating new neurones and connections in the brain. 
• Cognitive reserve, the principle of building up extra brain volume, is like a pension plan for the brain. Current research suggests that BDNF is a key factor in this process. Throughout this book there is information on the lifestyle factors that have been shown to increase levels of this important compound.

CHAPTER 5: How Stress Affects Brain and Mental Health

Stress Equation:

Stress / ( Hormesis (good stress) + Recovery) = Health

Too much stress and/ or too little hormesis and recovery will lead to poorer outcomes. Conversely, frequent hormetic stress and recovery build resilience to negative and chronic stress.

Takeaways 

• Stress is an experience associated with tension, nervousness or strain. It may have physical, environmental or psychological triggers, but all have measurable biological effects on the body. 
• Stress falls into three categories: acute, chronic and hormesis. 
• We evolved a stress response to allow us to adapt and respond to short-term environmental stressors. Unfortunately, our modern lives provide many sources of long-term or chronic stress. 
• Chronic stress activates inflammation in the body and the brain. 
• Regular exposure to hormesis, with sufficient recovery, is associated with better health and greater resilience.

CHAPTER 6: The Importance of Sleep

Takeaways 

• Adequate, good-quality sleep is essential for brain care and mental health. Addressing sleep issues and trying to restore natural sleep should be a priority for patients and mental health professionals. 
• Watch out for sleep inertia! Leave at least 20 minutes between waking and doing a task that requires high levels of focus or accuracy. 
• Aim to get at least 30 minutes of natural light in the morning or at lunchtime –this will help to anchor your circadian rhythm and promote healthy sleep. 
• It may be worth trying to identify your BRAC. Use the tracker on page 313 to identify your ideal bedtime. 
• If you are having trouble maintaining a healthy sleep pattern try working with a therapist trained in CBT-I or an evidence-based app like Sleepio.

CHAPTER 7: Improving Your Brain Health through Nutrition

The healthier your diet the less likely you were to develop depression over 10 years.

The diet in the SMILES Trial (see page 95) looked like this: 

• Whole grains (5–8 servings per day; 1 serving = 2 heaped tablespoons) •Vegetables (6 servings per day) 
• Fruit (3 servings per day, especially berries) 
• Legumes/ beans (3–4 servings per week) 
• Low-fat and unsweetened dairy foods (2–3 servings per day) 
• Raw and unsalted nuts (1 serving per day) 
• Fish (at least 2 servings per week) 
• Lean red meats (3–4 servings per week) 
• Chicken (2–3 servings per week) 
• Eggs (up to 6 per week) 
• Olive oil (3 tablespoons per day) 
• Wine (up to 2 standard glasses per day, ideally red) 
• ‘Extras’: sweets, refined cereals, fried food, fast food, processed meats and sugary drinks (3 servings per week)

Takeaways 

• The brain is a highly metabolically active organ that needs a lot of energy, nutrients and hydration to function optimally. 
• Immune function has direct and indirect effects on the brain. Nutrition and the microbiome influence the immune system. 
• Overall eating patterns with lower pro-inflammatory potential are associated with better brain health in both the short- and long-term. Diets that are rich in fibre, diverse plant foods, nuts, beans and legumes, herbs and spices, olive oil and fatty fish are associated with lower systemic inflammation, and reduced risk and severity of depression and dementia. 
• The brain can derive all the glucose it needs from the digestion of wholegrains and vegetables. Free sugars and sugar-sweetened beverages, fried foods and heavily processed foods should be eaten infrequently, ideally no more than three to five portions per week, if possible. 
• Food is more than just the nutrients on our plate; it plays a central role in our social, cultural, religious and family lives. While I want you to eat well for your long-term brain health, you should also retain the freedom to enjoy food in these other important ways. Balance is the key. An obsession with ‘healthy eating’(orthorexia) is just as detrimental to mental well-being as being malnourished.

CHAPTER 8 To Fast or Not to Fast

Takeaways 

• Human fasting research holds promise in relation to potential brain benefits, but it is still in its infancy and there is much that we still need to know about the long-term effects, both positive and negative, especially for women. 
• Eating all of your daily meals within a 10–12-hour window seems to be a safe intervention for women wanting to access the potential benefits of elevated ghrelin and SIRT signalling. 
• Listen to your body: if any fasting protocol makes your feel unwell or impairs performance, stop.

CHAPTER 9 How Physical Activity Protects the Brain

Aerobic or resistance 

Aerobic activity includes activities that speed up your heart and breathing rate, while resistance activity is movements that help to strengthen muscle and maintain bone health. 

Aerobic 

• aerobics, water aerobics and step class 
• cycling 
• dancing and Zumba 
• elliptical machine 
• hiking 
• ice or roller skating 
• jogging/ running 
• Nordic walking and ‘power walking’
• rowing 
• skipping 
• step machine 
• swimming 
• tennis

Resistance 

• body weight exercises, such as push-ups, pull-ups, planks, squats, duck walks and exercises incorporating rubber resistance bands 
• calisthenics 
• free weight exercises incorporating dumbbells, barbells, kettlebells, medicine balls and weighted bags 
• weight machines such as the leg press or squat rack Combination 
• boxing training 
• circuit training 
• climbing and bouldering 
• CrossFit 
• HIIT and circuit training class 
• Vinyasa and rocket yoga

How much exercise is enough? 

• at least 150 minutes of   moderate aerobic activity,   such as   cycling or   brisk walking every week   and   
• strength exercises   on   two or more days a   week that   work   all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)   

Or: 

• 75 minutes   of   vigorous aerobic activity such as running or a game of singles tennis every week   and 
• Strength exercises on   two or more days a   week that   work   all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)   

             Or: 

• a mix of moderate and vigorous aerobic activity every week –for example, 2 x 30-minute runs plus 30 minutes of brisk walking equates to 150 minutes of moderate aerobic activity  –and •strength   exercises on   two or more days a week that   work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)

Takeaways 

• Next to sleep, regular physical activity is the best investment you can make to your long-term brain health. 
• For the most part, PA is a powerful tonic for the brain, improving perfusion, function, plasticity and cognitive reserve, and reducing the risk of highly prevalent disorders such as depression, anxiety and Alzheimer’s disease. 
• We tend to think of movement as a bit of a chore. Try to think of all physical activity as an opportunity to improve the health of your brain. 
• PA increases neurogenesis and can, in effect, reverse brain ageing. 
• Exercise can help to mitigate the negative effects of chronic stress on the body by reducing the circulation of neurotoxic compounds in the bloodstream. 
• People who participate in regular physical activity have better brain function and are more likely to retain their cognitive abilities as they age. 
• All forms of activity count: aerobic, resistance training, HIIT and walking all infer brain, mood and mental health benefits. The emphasis is to simply move. 
• There may be additional brain benefits to doing exercise that involves an element of learning or balance such as dancing or yoga. 
• Contact sports (and any activity that incurs a likelihood of concussion) are associated with increased brain-health risks, even when helmets are worn. 
• It is right that you (especially parents of children and adolescents) know that every blow to the head or concussion increases the risk of later developing cognitive impairment or CTE.

CHAPTER 10 Using the Breath

Takeaways 

• The way we breathe may influence brain activation, and controlled breathing practices have the potential to influence several biological systems, including cortisol, heart rate and even cognitive performance. 
• The vagus nerve has a potent anti-inflammatory and regulatory effect on the body. 
• Controlled breathing is the most accessible way of influencing the vagus nerve and activating the PSNS. 
• Two minutes of slow nasal breathing has been shown to reduce symptoms of stress and depression. Try the 4-4-8 breath when you begin to get a rising feeling of stress or panic. 
• Mindful movement practices, such as yoga, that combine controlled breathing with gentle movement are effective stress management interventions and valuable adjuncts to standard treatment. 
• Singing offers multiple mechanisms for improving brain health including lower levels of stress hormones and reduced depression. 
• Air pollution poses a risk to health including cognitive function. If you cycle in built-up areas be sure to use a protective mask. If you smoke, contact your local smoking cessation service to try to reduce or stop altogether.

CHAPTER 11 Understanding Emotions

How to Have Difficult Conversations

Here’s why you shouldn’t avoid an important conversation: 

• The longer you put it off, the harder it will be. 
• The longer you avoid it the more days of your life you live compromising your integrity by not being honest about your thoughts, feelings or who you are. 
• Even if the other person can’t understand or won’t change, there is often tremendous value in demonstrating to yourself that you are worth sticking up for. 
• You are massively underestimating the pressure that avoiding this conversation is putting you under. Every time you think about that person, the relationship or the event it chips away at your well-being and your emotional freedom to think about other things. If you can get the conversation out of the way, you free yourself of that burden. 
• It builds emotional competence. Having one big conversation makes it easier to have another one. People who can speak honestly about their feelings benefit from having richer, more fulfilling relationships. 
• It almost never goes as badly as you think it will. I say this as someone who has supported dozens of clients through what they thought would be the worst event of their lives. All survived and all said they felt much better for it. 

Takeaways 

• Emotional health is mental health. You cannot be psychologically resilient without an effective way to understand and manage your emotions. 
• Emotions are highly evolved physiological sensations, many of which are hardwired into our brains. 
• Emotional expression is a crucial part of interpersonal communication, relationships with others and personal well-being. 
• Habitually suppressing your feelings is a form of chronic stress. Emotional suppression is not only ineffective, but is associated with greater risk of psychological and physical illness. 
• The function of the PFC is suppressed under conditions of physiological or psychological stress. This means that we are less able to select an appropriate response to a strong emotion when we are stressed, and are more likely to act out in ways that we may later regret. Following the principles of basic self-care can help reduce the likelihood of this happening. 
• Daily management of your emotional health should include both emotional and physical practices. 
• So many of life’s most important problems can only be solved by conjuring the courage to have a difficult conversation. Make a decision about whether it is worth the risk and safe to do so and, if the answer is ‘yes’, consider giving it a go. 
• Expressive writing is an evidence-based intervention for emotional management. Making regular time to appraise the emotions and events of the day will increase general emotional awareness and your ability to respond appropriately to any challenges that emerge.

CHAPTER 12 Building Psychological Resilience

Takeaways 

• Resilience is our psychological capacity to bounce back from challenging or traumatic situations. It is associated with lower stress-reactivity and reduced risk of depression. 
• There is a genetic component to resilience, but the most important contribution is made by psychosocial factors that can be learned, developed and practised. 
• Making time to invest in friendships and close relationships is probably the most important single thing you can do to improve your resilience. Be sure not to neglect the important people in your life. Make it a rule to schedule a regular catch-up, with penalties for cancelling, such as buying your friends an expensive dinner or agreeing to wash their car. If you know you are bad at keeping in touch, set yourself reminders. Put it in your diary to encourage yourself to make maintaining friendships at least as important as work. 
• You become what you see or what you believe yourself to be, so surround yourself with people who live value-driven lives. They don’t need to have exactly the same values as you, but they should be people whom you think are good role models. 
• Physical health contributes to psychological resilience (but you knew that already) so do what you can to eat well, exercise regularly, maintain good sleep and manage stress. 
• Consider joining a local team or meet-up group. This can help to foster a sense of community and help you to meet new people. Whether it’s hockey, walking or a book club, local interest groups are a great place to meet people and deepen connections. 
• Avoid unnecessary risks but do not shy away from challenge. Keep challenging your brain with novelty and learning opportunities. Keep challenging your courage by practising vulnerability and honesty. 
• Take some time to work out what you stand for. What do you want your life to mean? The meaning for your life does not have to be earth-shattering; personal and private definitions of meaning and success can be powerful. What positive difference could you make to your family, friends or your town? 
• Try to cultivate an attitude of realistic optimism. This will help to prevent you from being blown over by small fluctuations in fortunes, saving your energy for when you need it most.

CHAPTER 13 Other Lifestyle Factors That Impact Brain Health

Takeaways 

• Heat stress upregulates BDNF production, thereby supporting neurogenesis. 
• Heat reduces markers of inflammation in a dose-response manner. 
• Regular sauna use is associated with reduced depression incidence and reduced risk of dementia and Alzheimer’s disease, in a dose-response manner. 
• In trials, 20 minutes of 80 ° C heat is an effective dose. If you are new to sauna use, build up your heat tolerance slowly, starting with just a few minutes per session. Try to go once or twice a week. 
• If you do not have access to a sauna, the temperature-raising effect of 30 minutes in a hot bath and/ or exercise may also confer at least some of these benefits. 
• Sauna use is not without risk. If you are part of a vulnerable group, please seek medical advice as to whether it is safe for you to use saunas. 
• Attention is one of the driving forces behind neuroplasticity. If you want to increase your chances of successful learning try to limit any distractions and give the task or activity your full attention. 
• Meaning motivates attention. We are better learners of information that feels more personally relevant to us. When undertaking learning a new skill try to remind yourself of why it is important to you. 
• Repetition strengthens neural networks. The more you repeat something the more it will be hardwired into your brain. Meditation and mindfulness practices strengthen our attention ‘muscles’and can reshape the brain in healthy ways. Try the 4-4-8 breath practice on page 169 if you are new to these sorts of attention practices. 
• Stay curious –novel experiences and learning something new help to stimulate new connections in the brain, building cognitive reserve, but it’s not just formal education that can provide these benefits. There are thousands of hours of free classes and courses available online, or try learning a new skill in your local area. A list of online learning resources is provided on page 317. 
• Gum disease may be a significant factor in the progress of Alzheimer’s disease, which means looking after your teeth offers an accessible way of reducing your risk.

CHAPTER 14 How Social Media and Technology Affect the Brain

Takeaways 

• There is as yet no consensus on whether smartphone technology is good for us or not. It is likely that the way that we interact with and use technology is the deciding factor on its impact on mental health. 
• Remembering that social comparison happens every time we are confronted with information about other people’s lives may help to buffer us from its effects. 
• People tend to make more upwards comparisons on social media than they do in real life, which may be linked to the ‘showreel’nature of most people’s social media content. 
• The risk of upwards comparisons does seem to increase with the amount of time spent on social media. Though the direction of causality is unclear (does sadness drive greater use or does greater use drive sadness?), it would seem wise to try to exert some control over the amount of time spent on social networking sites. Consider setting a curfew or downloading an app that limits your access to these sites. 
• Try not to get into the habit of simply scrolling through social media as this kind of passive use is associated with poorer mental health outcomes. •Following a diverse range of positive role models may have beneficial effects on mental health, especially for young people. 
• If you are trying to focus on some deep work (such as revision or analysing data) it may help to put your smartphone out of sight and out of easy reach. Leave it in another room or in a lockable drawer. 
• Phones may interfere with real-world social opportunities. Agree with friends to keep phones out of sight when you catch up. Leave them in a bag or pocket, not out on the restaurant table. 
• Try to have a least one ‘phone-free’journey per week. Decide not to use your phone on the way home from work, for example. You could read a book or simply observe what is happening around you instead. 
• If you’re revising or preparing for an important presentation consider writing out your notes by hand to help improve retention. Additionally, a handwritten journal can help you work through complex ideas and difficult emotions. 
• Falling for fake news is bad for our psychological well-being. Critical thinking can help protect us from falling foul of misinformation. 
• Critical thinking means interrogating the argument being put forward and, importantly, challenging your own assumptions. Use the questions on page 249 as a framework for improving your critical thinking. 
• When engaging in a debate, take care to engage with the central point and avoid lower levels of argument.

CHAPTER 15 Money Matters

Takeaways 

• Money worries are a significant contributor to the burden of chronic stress and the relationship between money and psychological difficulties is bidirectional: money worries can promote or worsen mental health concerns, and mental illness can make it difficult to manage money responsibly.
• Marketers employ numerous sophisticated strategies to capitalise on our cognitive biases and heuristics. Being aware of them may help you to avoid spending more money than you intended. 
• Use a list when you go shopping and stick to it. 
• Try to avoid purchasing non-essential items on credit. The stress of paying off the debt will likely outlive the pleasure of the purchase. 
• Gambling is a common activity that most people enjoy without coming to any harm. However, for some people, problem gambling and the debt that can come with it bring significant psychological risks. If you think you might have a gambling problem, please speak to someone and seek professional support. Resources are provided on page 318.

CHAPTER 16 Better Problem-Solving

First it is important to be clear about what type of problem you are attempting to solve. Here is a list of common problems: 

1. One-off problems
2. People or situations that are habitually bad for you You have a friend who is a ‘bad influence’. 
3. People or situations that you find painful so you avoid them 
4. Recurring problems 
5. Long-term problems 
6. Repeated failures to stop harmful or ineffective behaviours

Here are the four ways to tackle any problem: 1. Solve the problem (in a way that respects yourself and anyone else involved*).

2. Change your perception or attitude to the problem. 

3. Learn to tolerate the problem: radical acceptance. 

4. Stay miserable.

Takeaways 

• Problems can often feel ambiguous and overwhelming. Understanding what kind of problem( s) you are facing is the first step in getting to grips with it and reminding yourself that you do have some control over the situation or how you manage it. 
• Just this step can reduce the amount of stress the problem causes and this is valuable because stress is a major risk to brain health and mental well-being. 
• The Four Options are a useful framework for clarifying how to approach a problem. Use them to work through potential strategies before choosing the most appropriate one for you at the time.

CHAPTER 18 Making Change Stick

Making change stick requires a few elements to be in place:

• A compelling, intrinsic reason:
• A clear plan with attainable goals:
• Ease of implementation:
• Self-compassion:
• Commitment devices:

Say hello to your Future Self

Imagine you are sitting at a table in a sunny kitchen. A few moments later you, 10 years from now, walk in and sit opposite you. How do you look? How do you move? What emotions can you read in your face? How do you feel? What do you want to say to the present -day version of you? What advice do you want to give yourself?