Hypertension, poor sleep quality, malaria are bad for brain health —Dr Iwuozo

Dr Emmanuel Iwuozo, a consultant neurologist at the Benue State University Teaching Hospital in Makurdi, Benue State, and secretary general of the Nigerian Society of Neurological Sciences, in this interview with Sade Oguntola, explains the importance of brain health and factors inimical to it in Nigerians.

What is brain health all about?

Brain health refers to the overall functioning, resilience, and well-being of your brain across your lifespan. It’s a holistic concept that goes beyond just avoiding disease—it’s about how well your brain supports your daily life, thinking, emotions, and behaviours. Brain health is an important aspect of humanity that is gaining prominence in neuroscience. It matters because it helps to stay independent, engaged, and mentally sharp. Maintaining good brain health reduces the risk of neurodegenerative diseases like Alzheimer’s, Parkinson’s, and stroke, and it improves quality of life—emotionally, socially, and physically.

So, the American Heart Association/American Stroke Association (AHA/ASA) defined it as the optimal capacity to function adaptively across various domains, which encompasses the abilities to pay attention, perceive and recognise sensory input, learn and remember, communicate, solve problems, make decisions, have mobility, and regulate emotional status.

What are those things that Nigerians need to know about brain health throughout all ages?

Nigerians need to understand the vital role of brain health in society. A healthy brain provides cognitive benefits, such as improved memory, higher levels of creativity, better problem-solving, and clearer thinking. It also offers emotional benefits, including improved self-awareness and better emotional regulation, which can help an individual live his/her best life in every possible way. Ultimately, optimal brain health creates positive social and economic impacts that contribute to greater well-being and help advance society.

Why must brain health be prioritised at every stage of life?

Brain health is crucial at every stage of life because the brain influences and controls an individual’s daily activities. When lost, it can lead to incapacitation. Numerous factors influence brain health in Nigeria, affecting individuals from the prenatal period to adulthood. Some factors may be specific to certain age groups, while others impact all age groups. For example, lack of access to prenatal care, poor maternal health, and inadequate nutrition negatively impact brain development in infants; the increasing use of illicit drugs leading to drug addiction and excessive alcohol use in young adults also negatively affects brain health, and the increasing prevalence of cardiovascular risks (systemic hypertension, diabetes mellitus, etc.) among adults also predisposes them to stroke.

Genetic predisposition can also play a role in the development of certain brain disorders. Infections such as meningitis and malaria can have a direct impact on brain health and function, particularly in children. Also, malnutrition and nutrient deficiencies can impair brain development and function, particularly in children.

Insufficient or poor-quality sleep can negatively impact cognitive function and mental health. Likewise, there is limited access to healthcare, inadequate infrastructure, a shortage of trained professionals, a lack of specialised facilities, and restricted access, especially in rural areas.

Poverty, unemployment, and lack of education lead to restricted access to resources essential for brain health. Economic hardship, limited job opportunities, and financial insecurity can create significant stress, adversely affecting mental well-being.

Many cultural beliefs and practices can influence perceptions of mental health and impact health-seeking behaviour. Violence, conflicts, and displacement can lead to traumatic brain injury and mental health problems, especially post-traumatic stress disorder. The emigration of skilled healthcare professionals poses a significant challenge that further strains the healthcare system, with no solution in sight to halt this trend. Air and water pollution can hurt brain health because certain environmental toxins may also impair brain function and development.

How can individuals ensure brain health at every stage of life?

Each individual can promote brain health by engaging in regular exercise, getting adequate sleep (6 to 8 hours) at night, and eating a healthy diet rich in fruits and vegetables. It is also important to manage chronic medical conditions such as hypertension, diabetes, and obesity. Nurturing healthy social relationships and staying engaged with others can make a difference as well. Learning to manage stress, committing to lifelong learning, participating in mental tasking exercises during leisure time, and maintaining a proactive approach to health are vital for overall brain health.

Do things like hypertension and poor sleep quality, and quantity affect the decline in brain health?

Both hypertension (high blood pressure) and poor sleep quality or quantity have been strongly linked to declines in brain health over time, although these medical conditions are treatable. Hypertension and poor sleep interact; just as poor sleep can worsen blood pressure regulation, so also hypertension can interfere with sleep quality, for example, by increasing the risk for sleep apnoea. A common symptom of sleep apnoea in many individuals is snoring.

Chronic high blood pressure can damage the brain by reducing blood flow to the brain, leading to small vessel disease and increasing the risk of stroke and silent infarcts. Even small, “silent” strokes accumulate and impair brain function.

Poor sleep affects the brain in several important ways. It impairs memory and cognitive function; increases Alzheimer’s risk, affects emotional regulation and executive function and disrupts the lymphatic system. The brain “clean-up” system works best during deep sleep, removing toxins.

What is the most important thing for brain health?

There isn’t a single most important factor for brain health; instead, it requires an intentional, unified, multifaceted approach that encompasses physical health, adequate diet, a supportive environment, safety and security, opportunities for learning and social connections, and access to quality healthcare services.

What should I eat to keep my brain healthy?

The saying “you are what you eat” highlights the importance of our diet in determining our ability to reach our full potential. Since brain health is crucial for realising this potential, we should emphasise a varied diet that includes different fruits, green leafy vegetables, nuts, seeds, and healthy fats and oils. Brain health isn’t about one superfood—it’s about consistency and variety. Combine a good diet with exercise, sleep, stress management, and learning for the best results.

Of course, foods to avoid or limit include highly processed foods (chips, sugary cereals, packaged snacks), refined sugars, and trans fats (partially hydrogenated oils). Also, excess alcohol is harmful to brain health. It can, over time, shrink brain volume.

Are there policies to support brain health in Nigeria, and if so, to what extent are they being implemented?

Currently, there are no policies to support brain health in Nigeria. However, on January 5, 2023, the Nigerian president signed the Mental Health Bill 2021 into law, replacing the outdated Lunacy Act, which had been in place for 65 years. These frameworks cover mental disorders, substance use, community services, and human rights protections and strive to integrate mental health into primary healthcare, especially in general hospitals and community health centres. They implicitly support brain health through access to mental healthcare services. It is important to clarify that mental health is not the same as brain health; the latter is all-encompassing.

Are there challenges militating against the provision of services to support brain health for Nigerians?

There are several challenges to address, including inadequate resources, insufficient infrastructure, and a shortage of trained professionals, many of whom are leaving the country for better opportunities. Socioeconomic factors such as poverty and unemployment also contribute. Furthermore, cultural beliefs and a lack of awareness about brain health, along with the absence of supportive policies, are factors militating against the provision of services to support brain health in Nigeria.

Increasingly, many Nigerians are being isolated: more people are becoming lonely for different reasons. How can this impact their brain health both in the short and long run?

Loneliness is not just a feeling—it’s a physiological and neurological stressor that can reshape how the brain functions and even how it is structured. It is a biological signal, much like hunger. It tells the brain it needs social nourishment. Ignoring it over time has real consequences, but like any biological need, it can be met and reversed with the right input.

Social isolation negatively impacts brain health. When we consider our ageing population, we notice a troubling trend: the elderly are increasingly neglected. This is largely due to the decline of communal living, as many younger individuals move far away for work, leaving their parents behind. In some cases, elderly women are relocated to be with their children, leaving elderly men alone to care for themselves without any significant social support. In the short term, this situation leads to poor social relationships, social isolation, and psychosocial stress. Over the long term, it can result in depression and memory loss. Long-term loneliness significantly increases the risk of dementia, Alzheimer’s disease, and cognitive impairment, independent of age or genetics.

Can brain health be restored after it was disrupted, maybe by trauma, chronic stress, anxiety, and so on?

Yes, brain health can often be restored or significantly improved after being disrupted by trauma, chronic stress, anxiety, or other psychological conditions. The brain is highly adaptable—a quality known as neuroplasticity, which means it can reorganise itself, form new neural connections, and even compensate for damage or loss of function. However, recovery depends on the cause, degree of injury or damage to the brain, the person’s age, overall health, support system, and availability of a facility to make a definite diagnosis and ultimately proffer the appropriate treatment.

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