This article is based on my conversation with Annie Fenn, MD, author of the Brain Health Kitchen Substack and cookbook, this is day 2 of the first-ever Brain Health Substack Summit hosted by The Habit Healers.

Click here to join tomorrow for Brain Health Substack Summit Day 3 with Jud Brewer MD PhD.

If you missed Day 1 of our Brain Health Summit with Julie Fratantoni, PhD you can watch it here. We discussed how to exercise your brain day to day.

Annie Fenn, MD is an OB/GYN turned culinary school graduate who lives in Jackson Hole, Wyoming. She spent twenty years practicing medicine, the last ten focused on menopause, before leaving to pursue a lifelong dream of cooking. She came back to Jackson Hole and started teaching people how to make healthy food that actually tasted good.

Then, around 2015, her mother was diagnosed with mild cognitive impairment. It progressed to Alzheimer’s.

Annie did what any doctor does when disease hits close to home. She went to the research. Not the surface-level stuff. The deep literature. She was looking for anything that could slow her mother’s progression, and what she found changed the direction of her entire career. There was a dietary pattern, backed by real studies, that appeared to protect the brain from developing Alzheimer’s in the first place. And for people with early dementia, there was evidence it could slow things down.

That discovery became Brain Health Kitchen, first as a cooking school, then as a bestselling Brain Health Kitchen cookbook, and now as a Substack and worldwide community where Annie takes people on retreats to longevity hotspots around the globe. When she showed me her original copy of the book during our live conversation for Day 2 of the Brain Health Summit, it was held together by love and tape. She carries it everywhere. Her guests sign it.

What she built from that research is something I think every person reading this needs to know about: a food pyramid designed specifically for the brain.

Ten Rungs on a Different Kind of Pyramid

When Annie wrote her cookbook around 2021, she wanted to create brain-healthy eating guidelines that anyone could follow, regardless of whether they were vegan, Mediterranean, or somewhere in between. She drew from two dietary patterns with the strongest evidence for protecting the brain against dementia: the Mediterranean diet and the MIND diet (which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay). Then she layered in newer research that neither of those original frameworks had included.

The result is a food pyramid with ten brain-healthy food groups, and when Annie walked me through it during our conversation, a few things genuinely surprised me.

Vegetables sit at the base. No surprise there. But what is surprising is the second rung: leafy greens, broken out as their own category. In most dietary guidelines, leafy greens get lumped in with other vegetables. The MIND diet pulled them out separately because the data warranted it. Studies showed that people who ate at least a cup of leafy greens per day had brains that looked 11 years younger on MRI scans.

Eleven years. That is not a marginal benefit. That is a decade of aging you might be able to offset with a daily salad.

Whole grains come next, though Annie is careful to point out that most people have the wrong picture in their head when they hear this term. She is not talking about hamburger buns, flour tortillas, or English muffins. None of those are whole grains. She means red rice, black rice, quinoa, millet, steel-cut oats, and breads where actual wheat is the first ingredient on the label. The distinction matters enormously, especially for people who carry the APOE4 gene variant (a genetic risk factor for Alzheimer’s), who may need to emphasize lower-glycemic options and lean harder on vegetables, legumes, and leafy greens instead.

Berries hold their own rung because they are the only fruit singled out as an official brain-healthy food group. The data links berry consumption specifically to better performance on memory tests.

Beans and legumes are next, and Annie pointed to something that I think is underappreciated: beans are one of the few food groups found on the table in virtually every blue zone on the planet, from Costa Rica to Okinawa to Sardinia. They contain a type of fiber that reaches the lower intestine, where many of the gut bacteria that influence brain health are waiting for nourishment. Most processed food never makes it that far. For people who believe they cannot tolerate beans, I suggested during our conversation that they start with lentils in small amounts, cooked well, and gradually increase from there before moving on to heartier beans. Annie built on that and got even more specific: start with red lentils in particular, the kind that fall apart when cooked. They are lower in fiber than other varieties, need no soaking, and tend to be the gentlest entry point for people rebuilding their tolerance.

Nuts and seeds follow, drawing on cardiovascular research that has shown for years that a handful of nuts four to five days a week reduces the risk of heart attack and stroke. Annie included seeds as well, because many people have nut allergies and seeds carry similar brain-protective properties, including monounsaturated fats and flavonoids (the colorful pigment compounds in plants that are emerging as significant players in brain health).

The Surprising Rungs

This is where the pyramid gets interesting.

Fish and seafood occupy the next level, and Annie has actually built a separate pyramid just for this category. At the base are small fish like sardines and anchovies, which are highest in omega-3 fatty acids and lowest in environmental toxins. Cold-water fish like cod and wild-caught salmon sit in the middle. She designed the fish pyramid around three criteria: omega-3 content, environmental sustainability, and toxin accumulation. Low intake of fish and seafood, she told me, is itself a risk factor for Alzheimer’s disease, supported by many studies. For people concerned about microplastics, she noted that omega-3 supplements are now purified and filtered, making them a viable alternative. (Algae omega-3 supplements for those who are plant-based will also work.)

Fermented foods earned their own spot on the pyramid, which is a departure from the Mediterranean and MIND diets, neither of which addressed fermentation directly. Annie drew on research from Stanford showing that adding even a few servings of fermented food per day increases the diversity of the gut microbiome (the vast community of bacteria living in your intestinal tract), which is increasingly understood to be a key driver of brain health. This includes yogurt, kefir, cottage cheese with live cultures, kimchi, sauerkraut, and even authentic long-fermented sourdough bread.

Speaking of sourdough, Annie had something to say about what that word actually means. A loaf of sourdough from the supermarket that sits on the counter for a month without going stale is not what she is talking about. Real sourdough, the kind baked in Sardinian villages using old-fashioned long fermentation, is a different product entirely. Now, an important caveat here: the beneficial bacteria that develop during sourdough fermentation do not survive the oven. Baking temperatures kill them. So sourdough does not deliver live probiotics the way yogurt or sauerkraut does. But the long fermentation process still changes the bread in meaningful ways. It lowers the glycemic response, improves digestibility, and produces organic acids and prebiotic compounds that may support gut health even without live cultures. That is why communities in Sardinia that eat traditionally fermented sourdough bread daily still seem to benefit from it. The fermentation does real work on the grain before it ever reaches the oven.

Meat, poultry, and eggs appear near the top of the pyramid, meaning smaller portions and less frequent servings. This is the most individualized category. Annie explained that previous studies had lumped processed and unprocessed meat together, making meat look uniformly bad for the brain. But recent research from the UK Biobank separated them out and found that unprocessed meat may actually reduce dementia risk, while processed meat remains among the worst foods for the brain. Eggs contain choline, a nutrient important for brain health and nerve function, though people who are cholesterol hyper-responders may need to limit them.

Sweets sit at the very top. Annie refuses to live in a world without brownies, and I respect that. But her sweets are strategic: packed with fiber, made with nutrient-dense ingredients, and built to minimize the glycemic spike that comes from white flour and white sugar. Her rule of thumb is that fiber must accompany sugar to blunt the blood sugar response.

Two additional categories run alongside the pyramid. Extra virgin olive oil is the primary cooking fat, consistent with both the Mediterranean and MIND diets. And the final category is one that tells you a lot about how brain nutrition science has evolved.

What Got Kicked Off the Pyramid

In the original MIND diet, the tenth brain-healthy food group was red wine. That recommendation held up for years, supported by the idea that moderate drinking might offer some protection. Annie kept red wine on the pyramid when she first built it. Then the data changed.

Around 2021, large studies from the UK Biobank and the British Medical Journal dismantled the moderate-drinking hypothesis. We now know there is no amount of alcohol that is safe for the brain. If you drink at all, light drinking, defined as under six drinks per week, is the least harmful option. Annie took red wine off and replaced it with three things we actually have solid evidence for: coffee, tea, and water.

The coffee research in particular has gotten remarkably specific. The largest study on coffee ever conducted, from the UK Biobank at the end of 2024, confirmed that regular coffee drinkers are more protected from dementia and finally sorted out a question that had lingered for years: is it the coffee or the caffeine? The answer is both.

But Annie laid out four conditions that determine whether your coffee is actually helping your brain.

First, caffeinated coffee provides the protection. Decaf is not harmful, but it does not appear to reduce dementia risk. Second, it should be unsweetened, and that includes artificial sweeteners. The UK Biobank study actually looked at what people put in their coffee and found that additives can undermine the benefits. Third, skip the creamers. Even high-quality dairy cream may bind up the polyphenols (the plant compounds responsible for many of coffee’s health benefits) and reduce their effectiveness. In European studies, where people tend to drink coffee black, the results were always strongly positive. American coffee culture, with its syrups and creamers, is a different story. Fourth, use a paper filter. Unfiltered coffee from a French press or espresso machine allows compounds called diterpenes through, which can raise LDL cholesterol.

As for tea, green tea performed especially well in the research, thanks to its high concentration of catechins and EGCG, both types of polyphenols with brain-protective properties. And hydration itself turned out to be more important than I expected. Annie’s point was direct: you need to be well hydrated for your brain to thrive. My simplest recommendation is to drink water first thing in the morning. Rehydrate the brain after a night of sleep.

The Supplement Question

Supplements came up frequently during our conversation, and Annie’s perspective as a physician who is also deeply skeptical of the supplement industry made her advice especially practical.

She recommends a brain-focused multivitamin. The one she takes is called Relevate, made by a company called NeuroReserve, where she sits on the scientific advisory board. It combines omega-3 fatty acids in a specific DHA-to-EPA ratio, vitamin D, B vitamins, choline, lutein, and flavonoids into three capsules. She noted that it simplified her routine because she no longer needed to take multiple separate supplements.

For people who prefer a more widely available option, she pointed to the Centrum Silver multivitamin, which was used in one of the largest supplement studies ever conducted. That study, called COSMOS, found that people who took a daily multivitamin had a reduced risk of dementia. The likely explanation is a catch-all effect: when you give a multivitamin to a large population of older adults, you end up correcting iron, folate, B12, and other micronutrient deficiencies that many people do not even know they have. Those deficiencies, left uncorrected, can contribute to cognitive decline.

Creatine was the other supplement we discussed at length. Annie said she is highly skeptical of supplements in general, so anything that makes her list has to impress her. Creatine did. The data on creatine and muscle maintenance during resistance training has been solid for years, but in the last five years, brain health research has caught up. A pilot study looked at creatine in people with Alzheimer’s and found a slight improvement in cognitive symptoms with no adverse reactions. There is also emerging data on creatine during perimenopause. Annie herself started using it as a jet lag protocol during her frequent international travel, doubling her dose for three days upon arrival in a new time zone, based on military sleep-deprivation research.

Dr. Darren Candow, the top creatine researcher in Canada, spaces his creatine away from coffee and sips it in his water bottle throughout the day. Annie does the same. I put mine in my oatmeal every morning, which also works.

For any supplement purchase, Annie stressed the importance of third-party testing for heavy metals and verification. I recommend a site called ConsumerLab.com, which costs about $90 a year and independently tests supplement quality.

Building Your Own Pyramid

One of the things I appreciated most about Annie’s approach is that she does not insist everyone eat the same way. The Brain Health Kitchen food pyramid is a foundation built on the best available science. But she encourages every person to build their own version of it, based on what they enjoy eating, whether they like to cook, what their personal health vulnerabilities are, and what their goals look like.

If you are APOE4 positive, you might dial back whole grains and emphasize leafy greens and legumes. If cholesterol is a concern, you might skip the eggs and choose soy milk, which Annie’s research identified as the top milk for brain health due to its ability to lower LDL cholesterol. If you cannot eat beans, you can increase cruciferous vegetables, nuts, seeds, and other high-fiber foods. If dairy is part of your life, go organic, especially after researchers like Dr. Ray Dorsey have established strong links between pesticide exposure in conventional dairy products and Parkinson’s disease risk. The pesticides concentrate in animal fat, which means full-fat conventional dairy carries more risk.

The point is not perfection. The point is getting the big picture right and making it your own.

Your Brain-Healthy Eating Action Guide

Based on my conversation with Annie, here are the most actionable takeaways:

Eat a cup of leafy greens every day. This is the single food habit with some of the most dramatic brain-imaging data behind it. Spinach, kale, arugula, romaine, Swiss chard. Put them in a salad, blend them into a smoothie, wilt them into a soup. The method does not matter as much as the consistency.

Add a fermented food daily. Yogurt (unsweetened, unflavored, with live cultures), kefir, sauerkraut, kimchi, or cottage cheese with CFU counts on the label. These deliver live beneficial bacteria that support gut microbiome diversity, which in turn supports the brain.

Rethink your coffee. If you drink it, make it caffeinated, black, unsweetened, and paper-filtered. If you use a French press, pour the coffee through a paper filter before drinking it. If you prefer pods, Green Mountain appears to be one brand that includes a small paper filter.

Eat fish or seafood regularly, or supplement with omega-3s. Low intake of omega-3 fatty acids from seafood is a documented risk factor for Alzheimer’s. Prioritize small fish like sardines and anchovies, or cold-water fish like wild-caught salmon and cod. If fish is not part of your diet, a purified algae omega-3 supplement is a reasonable alternative.

Swap processed grains for real whole grains. Red rice, black rice, quinoa, millet, steel-cut oats. If the first ingredient on the bread label is not “whole wheat” or a recognizable whole grain, it is not a whole grain product.

Eliminate processed meat. The distinction between processed and unprocessed meat is now well-established in the brain health literature. Hot dogs, deli meat, bacon, and sausages carry clear risk. Unprocessed meat in moderate amounts sits in a different category entirely.

Consider a multivitamin. Either a brain-specific formulation like Relevate or a well-studied general multivitamin like Centrum Silver. Think of it as insurance against the micronutrient deficiencies that accumulate with age.

If you drink alcohol, know the current science. There is no amount that is safe for the brain. If you choose to drink, keep it under six per week and understand that you are accepting a tradeoff.

Want to go deeper? Check out Dr. Annie Fenn’s Substack, Brain Health Kitchen, and her bestselling cookbook, The Brain Health Kitchen: Preventing Alzheimer’s Through Food.

Read Dr. Annie Fenn’s article here.

Order The Brain Health Kitchen cookbook here.

Brain-Healthy Recipe from Chef Martin Oswald

As part of the Brain Health Substack Summit, Chef Martin Oswald created a special brain-healthy recipe inspired by Dr. Annie Fenn’s food pyramid. This recipe brings together several of the brain-healthy food groups into a single dish.

See Chef Martin Oswald’s recipe here.

Want to train your brain with games backed by science? Check out my free weekly Substack, Train the Brain Games, where I share cognitive challenges focused on processing speed and other skills the research actually supports.

This article is part of the Brain Health Substack Summit, the first-ever summit of its kind on the Substack platform. All week long, I am sitting down with leading experts in neuroscience and cognitive health for live conversations and in-depth articles. The summit is hosted by The Habit Healers. Subscribe to both The Habit Healers and Brain Health Kitchen so you do not miss a single conversation.

References

* Morris MC, Tangney CC, Wang Y, Sacks FM, Bennett DA, Aggarwal NT. MIND diet associated with reduced incidence of Alzheimer's disease. Alzheimers Dement. 2015;11(9):1007-1014. doi:10.1016/j.jalz.2014.11.009

* Morris MC, Wang Y, Barnes LL, Bennett DA, Dawson-Hughes B, Booth SL. Nutrients and bioactives in green leafy vegetables and cognitive decline: Prospective study. Neurology. 2018;90(3):e214-e222. doi:10.1212/WNL.0000000000004815

* Zhang Y, Chen J, Qiu J, Li Y, Wang J, Jiao J. Intakes of fish and polyunsaturated fatty acids and mild-to-severe cognitive impairment risks: a dose-response meta-analysis of 21 cohort studies. Am J Clin Nutr. 2016;103(2):330-340. doi:10.3945/ajcn.115.124081

* Kim JH, Kwon YJ, Lee Y, et al. Associations of Individual Beverage Types and Substitution with Dementia Risk: A UK Biobank Cohort Study. J Nutr Health Aging. 2026;30(1):100740. doi:10.1016/j.jnha.2025.100740

* Baker LD, Manson JE, Rapp SR, et al. Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial. Alzheimers Dement. 2023;19(4):1308-1319. doi:10.1002/alz.12767

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