What it is:
As we age, a certain degree of cognitive decline is expected to occur; however, we can adapt our lifestyles to minimize this loss.
One area of declining cognitive health is dementia. Different types of brain diseases may include dementia as a symptom, as it is a loss of cognitive ability and memory. The most common cause of Dementia is Alzheimer's disease. Alzheimer's disease is a type of dementia that is noticeable when forgetting impedes simple tasks. For example, it's not necessarily about forgetting where you left your phone but how to use it. It's the loss of memory where actions that were once intuitive become challenging to process and execute.
According to the NHS, Alzheimer's is believed to be caused by an abnormal build-up of proteins, some of these are called amyloid plaques. Little is known as to why this breakdown and, therefore, build-up of proteins occur. However, it is known that certain lifestyle factors can exacerbate or delay the symptoms. Although genetic predisposition and environment impact cognitive decline, there are controllables. Any neuroprotective practices that preserve and prevent nerve/brain damage are beneficial, so the more you participate in brain-healthy lifestyle habits, the better off you'll be overall.
Purported claims:
Performing certain risk reduction habits may assist in the prevention of cognitive health decline. These include:
Reducing Inflammation and Inflammatory Behaviors
Preventing Amyloid Protein Plaque Burden
Maintaining Balanced Blood Sugar Levels
Minimizing Alcohol Intake
Increasing or maintaining the correct boundaries of nutrition and lifestyle factors may support a healthy brain. These include:
Healthy Fats
Phytonutrient-rich fruits and vegetables
Increase BDNF
Microbiome health
Protein and muscle levels
B-Vitamins
What the science says:
Inflammation
Living a less inflammatory life is one of the most promising preventative measures against many diseases, including dementia.
One significant action is to keep overall inflammation balanced, especially avoiding any chronic inflammation in the body or brain. Inflammation is natural, but a constant inflammatory response is not healthy. An area discovered to be an inflammatory response in dementia is the build-up of Amyloid plaques in the brain. Amyloid plaques are a much-discussed deposit found in high quantities in some types of neurodegenerative disorders. It is unknown exactly what role the plaque deposits play, but that they form in response to a negative effect. Therefore, determining why this inflammatory response is occurring for each person can help maintain neural functioning for longer.
Reducing inflammation can occur in many forms, but some of the major areas are:
Limiting processed foods and replacing them with as many whole-food items as possible.
Limiting alcohol.
Limiting added sugar.
Reducing stress
Anti-inflammatory foods include:
Turmeric root (consume with black pepper), ginger root
Probiotic foods - Yogurt, Miso, Kombucha, Sauerkraut, Pickled Vegetables
Prebiotic foods - Chicory, Jerusalem artichoke, Bananas, Garlic
Red and Purple Polyphenols - Blueberries, Raspberries, Blackberries
Dark leafy greens - Kale and Spinach
Colorful fruits and vegetables - phytonutrient rich
Healthy Fats - Nuts, Seeds, Fatty fish, and Olive oil
Blood Sugar Levels
Maintaining steady blood sugar levels is vital for many disease prevention measures. Keeping your body within its optimal limits and preventing spikes or dips can limit inflammation, metabolic dysfunction, and ultimately decrease the risk of many diseases, including dementia. An analysis of the UK Biobank of 500,000 people found that high blood sugar levels led to a 42% higher risk of cognitive decline (Garfield, 2021). Therefore keep a steady blood sugar level by consuming high-fiber foods balanced with fat and protein to avoid spikes in blood glucose levels. Speak with your Nutrition Advisor for more information regarding Continuous Glucose Monitoring (CGM) to better understand your daily blood glucose fluctuations.
Brain derived neurotrophic factor (BDNF)
Brain derived neurotrophic factor naturally declines as we age. However, in those with dementia, BDNF levels tend to be quite a bit lower. Maintaining or increasing these levels could be beneficial. Research is still in the early stages, but BDNF sustaining foods coincide with anti-inflammatory foods. These include green tea, blueberries, olive oil, turmeric, dark chocolate, fatty fish, eggs, and coffee. Other factors, such as sleep, daily movement, and exercise, are also critical. Being less sedentary helps support BDNF levels.
Microbiome Matters:
There is growing evidence that the composition, species, combination, density, and distribution of gut bacteria may influence the protection and inflammatory response in the body. (Mohajeri et al, 2018). Adequate levels of both probiotic and prebiotic foods have a vast influence on your brain and overall health. The gut-brain access is the communication that occurs between your brain and your gut, known as the “second brain.” This is because bi-directional communication links cognitive function with intestinal functions. So feeding your microbiome will have a direct effect on the brain. Specifically, focusing on dietary fiber such as soluble, insoluble, fermented, and an array of plant foods will all shape your gut response and increase good gut bacteria.
MIND Eating Pattern
The MIND diet is specifically formed from the Mediterranean and DASH eating patterns to help maintain membrane integrity. It emphasizes a greater intake of dark leafy greens, colorful fruits and vegetables, berries, olive oil, nuts, and seeds. The idea is that these foods contain high amounts of antioxidants, phytonutrients, and healthy fats. See the bottom of this article for a list of beneficial food groups.
Fat:
We know the brain is composed of ~80% fat. Therefore, we can trust that lifestyle practices that preserve the brain's fat and nerve cell composition will have highly positive results. Aim for a balanced diet high in good fats (Olive oil, avocados, nuts, seeds, olives, eggs, and fish).
The healthy fats to focus on include:
Omega-3 Alpha-linolenic acid (ALA) - A plant-based source found in flax, chia, sunflower, soybean, and walnuts.
Omega-3 Eicosapentaenoic acid (EPA) - Fatty fish (salmon, mackerel, anchovies, sardines, herring)
Omega-3 Docosahexaenoic acid (DHA) - Fatty fish (salmon, mackerel, anchovies, sardines, herring) and Seafood (mussels, oysters)
Omega-3 Fatty Acids are essential to brain health. It’s not just the type of fat you’re consuming but also the ratio that you’re consuming them in, as the omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) balance matters. An optimal ratio is omega-6 to omega-3 ratio of 4:1. Omega-6 foods are nuts, seeds, eggs, and sunflower oil.
Healthy fats keep our cells and passageways clear and flexible. We need the movement of cell walls to be supple and smooth for areas such as our circulatory system so that we can pump blood in strong strokes and keep our body and brain flush with oxygen-rich blood. Unhealthy saturated fats (e.g. butter, fatty meats) can cause our circulatory system to stiffen and blockages to form. Occasionally consuming foods that contain saturated fats is okay as long as it is a minor part of an overall healthy diet.
Middle age is a particularly important time to eat foods high in Omega-3, as multiple studies have shown its role in cognitive resilience.
Protein:
Maintaining or even gaining muscle mass as we age is crucial for everyone. Loss of muscle mass (sarcopenia) is a significant factor in many diseases. Research shows that older adults are far better off if they can maintain a high muscle mass and level of strength.
Our neurons are highly dependent upon a group of nutrients, that an inadequate intake of can lead to neural issues. We can gain quite a few of these through high-protein foods, including:
Amino acids:
Tryptophan (Milk, Tuna, Turkey, Oats, Nuts, and Seeds)
Tyrosine (Milk, Turkey, Pumpkin seeds, Nuts, Soybeans)
Glutamine (Milk, Beef, Fish, Nuts, and Seeds)
B vitamins - Salmon, Liver, Beef, Tofu, Eggs, Oyster, Mussels
We can find all of these in a whole food-rich diet but making sure to get the recommended daily intake rather than occasionally consuming these items will help maintain the function of your neurons and neurotransmitters.
Maintaining good Mineral levels is also essential. When it comes to cognitive focus, especially on:
Zinc
Copper
Iron
Iodine
Selenium
Magnesium
Toxins: Alcohol, Marijuana, and Environmental Toxins
Research has shown that mind-altering substances such as alcohol and marijuana impair cognitive abilities and, in some cases, exacerbate cognitive decline. Limiting or eradicating these substances from your lifestyle is only positive regarding brain health. However, the MIND diet does allow for a daily 5oz glass of red wine if you judge this to be an integral part of your lifestyle. If you’re able to reduce alcohol consumption by alternating other beverages every other night, such as kombucha or apple cider vinegar in sparkling water, this can only be beneficial to both your brain and liver. Taking a break from alcohol every so often would also be highly beneficial to brain function. Try taking a month or two off and see if your cognitive health improves.
Research has shown how chronic low-grade exposure to certain toxins can be linked to some diseases and be detrimental to health issues such as cognitive decline. While we can't control everything in our environment, we can take steps to reduce our exposure and accumulation of toxins in our bodies. For more ways to reduce exposure, check out the post on a True Detox to understand how burdensome accumulated toxins can be on everyday function.
Caffeine - Coffee & Tea
Caffeine has been shown to improve alertness, mood, reaction times, and short-term memory recall. When consumed in the form of coffee and tea that have other bioactive and beneficial compounds, caffeine may additionally support healthy neurology, preventing cognitive decline such as in Alzheimer’s, dementia, and Parkinson’s disease.
Coffee is full of antioxidants, and studies regarding longevity are highly positive towards its healthful properties. Opt for low and medium roasts in order to obtain a higher level of antioxidants whilst avoiding Advanced glycation end products (AGE’s).
Black, green and white tea, in particular, contains L-theanine, which can promote dopamine and GABA activity and increases alpha brain waves - leading to a more relaxed alertness and improved brain function.
Adaptogens
Aside from the foundational and well-known requirements stated above, there is ongoing research into alternative items, such as the Adaptogens of Ashwagandha and Lions Mane, that have potential for future use in neurological disorders such as dementia. However, getting your diet foundation set with the above items is absolutely critical before exploring alternative items.
Exercise and Physical Activity
Preservation of muscle mass is essential for many reasons, one of which is how skeletal muscle mediates the physiological and metabolic response of the brain. Although the mechanisms are not fully understood, the evidence is mounting that our brain-muscle connection is so intertwined that the muscle-borne signals have a massive effect on learning, memory, and mood. There is a direct association with physical activity, cognitive health, and memory preservation.
One highly promising study (Broadhouse, 2020) showed older adults who performed 45 minutes of strength training (using dumbbells, weights, or machines) twice a week for six months saw a decline in the rate of brain shrinkage compared to those in the control group.
Three sets of eight repetitions of each of the five–six exercises per session. The exercises aimed for most major muscle groups (chest press, leg press, seated row, standing hip abduction, knee extension).
Stretching and Seated Calisthenics (eg. Chair Squats and Lying Hip Bridges) were also included.
Farmer’s-Carry Assessment - Try four sets of 100 paces three times a week. Work upwards in weight gradually.
In order to understand your strength levels, farmer-carry’s are a good assessment as they also involve grip strength.
For a male: You should be able to farmer-carry your body weight for two minutes.
For women: It’s ~75% of body weight for two minutes.
Studies have shown the direct link between substantial muscle mass and cognitive function. Therefore flooding the brain with nutrient-rich blood is vital to maintaining its integrity. It would be best if you incorporated all aspects of movement, including:
Aerobic
Balance
Agility
Flexibility
We mentioned brain derived neurotrophic factor (BDNF) above and the cognitive benefits of balanced protein levels. Exercise is one of the best ways to increase your BDNF protein levels to maintain neural plasticity, memory, and learning abilities.
Rejuvenation & Sleep
Sleep is a vital part of cleansing, healing, and refocusing the brain. The duration and timing of your sleep has a direct effect on your brain’s ability to cleanse itself of toxins.
Get 7-8 hours of sleep per night.
Keep your bedroom dark, cool, and quiet.
Address any disturbances such as Sleep Apnea where breathing becomes impaired and restricts our vital supply of oxygen to the brain.
Support healthy melatonin production.
Be mindful of night-time alcohol habits.
Without sleep, our system cannot utilize the unique clearance process to eliminate neurotoxic waste products, including the beta-amyloid plaques mentioned above. When we are awake, the glymphatic system downregulates clearance pathways. Without these pathways, the elimination of toxic substances and the circulation of neuroprotective substances can not occur. Sleep is vital for our brains.
Our take:
Each individual is different when it comes to an overarching issue like cognitive decline. However, the above research-backed nutrition and lifestyle approaches are the best-known current interventions.
Our brains are not an island unto themselves, so nutrition is not a cure-all but one feature of a complexly intertwined set of lifestyle habits. No matter your cognitive health state, implementing as many healthy lifestyle changes as possible will benefit you now and in the long run.
Will this benefit you?
Yes! A healthy lifestyle filled with nutrient-rich foods, regular exercise, and consistent sleep is beneficial for everybody, even if your focus is not currently on cognitive health.
The below protocol is based on the MIND diet, Kara Fitzgerald study, and Dietetic-backed research.
Dealing with Dementia:
If the process of cognitive decline is already noticeable, you can still implement all of these healthy lifestyle factors to slow or halt the symptoms of decline. It is not guaranteed, but there is strong evidence that increasing phytonutrient-dense, anti-inflammatory, and neuroprotective foods may help.
Adequate Folate and B12 levels.
For those who consume alcohol regularly, Vitamin B and certain minerals should be focused upon.
Vitamin B3 ( Niacin) is crucial for those who consume alcohol and have dementia symptoms.
Vitamin B1 (Thiamine), Vitamin B6 (pyridoxine), Vitamin B12 (Cyanocobalamin).
Minerals - Magnesium, Phosphorus, and Zinc
Optimal RDA of Iodine- 150mcg/day for optimal thyroid function.
Vitamin E
Helps maintain cell membranes which are vital to nerve communication and connection. Aim for foods rich in Vitamin E, such as Sunflower seeds, Almonds, Wheat Germ oil, Sunflower oil, Salmon, and Avocado.
Supplements do not necessarily have the same effect on Dementia due to their iteration of alpha-tocopherol not showing promise in brain health. A mixed natural tocopherol may, however, have promising benefits.
Healthy Fats:
As we stated above, the brain is formed of ~80% fat which means consuming healthy fats is vital.
Omega-3: EFA and DHA levels
eg. Olive oil and Flax oil
Bioactive and anti-inflammatory compounds such as Curcumin (Turmeric) mixed with Piperine (Black pepper). (Rigacci and Stefani, 2015) (Reddy et al, 2018)
“Combining curcumin and vitamin D was also associated with increased amyloid clearance by macrophages (Masoumi et al, 2009).
Curcumin may be generally neuroprotective, also showing benefits in Parkinson’s disease (PD) (Pan et al, 2012).”
Support your detoxification pathways:
Alginate from seaweed may bind to any heavy metal in the gut.
Minerals: May help with the detoxification process.
Selenium - You can find your daily recommendation in just one brazil nut.
Zinc - Legumes, oysters, nuts, and seeds.
Sulfur-containing foods - Broccoli, kale, daikon radish, garlic, and onions.
References and additional reading:
Anderson JG, Lopez RP, Rose KM, et al: Nonpharmacological strategies for patients with early-stage dementia or mild cognitive impairment: a 10-year update, Res Gerontol Nurs 10(1):5–11, 2017.
Dyall SC: Long-chain omega-3 fatty acids and the brain: a review of the independent and shared effects of EPA, DPA and DHA, Front Aging Neurosci 7:52, 2015.
Kim Y, Clifton P: Curcumin, cardiometabolic health and dementia, Int J Environ Res Public Health 15:E2093, 2018.
Morris JK, Vidoni ED, Honea RA, et al: Impaired glycemia inceases disease progression in mild cognitive impairment, Neurobiol Aging 35:585–589, 2014.
Morris MC, Evans DA, Bienias JL, et al: Dietary intake of antioxidant nutri- ents and the risk of incident Alzheimer disease in a biracial community study, JAMA 287(24):3230–3237, 2002.
Morris MC, Selhub J, Jacques PF: Vitamin B-12 and folate status in relation to decline in scores on the mini-mental state examination in the framingham heart study, J Am Geriatr Soc 60(8):1457–1464, 2012.
Morris MC, Tangney CC, Wang Y, et al: MIND diet slows cognitive decline with aging, Alzheimers Dement 11(9):1015–1022, 2015a.
Morris MC, Tangney CC, Wang Y, et al: MIND diet associated with reduced incidence of Alzheimer’s disease, Alzheimers Dement 11(9):1007–1014, 2015b.
Morris MC. Nutritional determinants of cognitive aging and dementia, Proc Nutr Soc 71(1):1–13, 2012.
Pivi GAK, de Andrade Vieira NM, et al: Nutritional management for Alzheimer’s disease in all stages: mild, moderate, and severe, BMC Nutrire 42:1, 2017.
Volkert D, Chourdakis M, Faxen-Irving G, et al: ESPEN guidelines on nutrition in dementia, Clin Nutr 34:1052–1073, 2015.
Westfall S, Lomis N, Kahouli I, et al: Microbiome, probiotics and neurodegenerative diseases: deciphering the gut brain axis, Cell Mol Life Sci 74(20):3769–3787, 2017.
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