Nutrition News and Views July/August 2015

Vol.19, No. 4

For health professionals

SUSTAIN THE BRAIN By Judith A. DeCava, CNC, LNC The fear of developing dementia often comes with aging, especially as more ‘senior moments’ occur—not recalling a name, where your keys are, what else you were to buy at the store, why you came into a room. But this does not usually signal the onset of dementia. Memory retrieval may slow, but the ability to learn is still there. Some people in their 80s have the brain health and cognitive powers of people 20 or 30 years younger. Some perform as well as people in their 20s on difficult memory tests. Elderly people whose memories are still sharp have a thicker brain cortex than other elderly people. The cortex is the outer layer of the brain and is a prime area responsible for functions such as memory and thinking. This means that severe forgetfulness and loss of cognition are not inevitable and that preventive actions can be taken. 1 Dementia including Alzheimer’s disease (AD) is not a normal consequence of aging, though risk rises with age. Cognitive decline can result from unhealthy lifestyle choices that can be avoided or corrected. Some things can’t be modified such as genetic background, but heredity accounts for relatively few cases of dementia, even AD, and lifestyle can turn genes on or off. Many factors linked to brain deterioration can be controlled. Adults often lose brain volume as they age, especially in areas associated with memory, thinking and decision-making. Yet staying fit mentally, nutritionally, and physically limits such brain shrinkage. The ability to use general knowledge usually continues to improve and can match or even surpass the performance of younger adults. Aging includes protective and enhancing factors like experience-dependent cognitive plasticity—reorganization and change capacities. Leading a healthy life may “mitigate losses and consolidate gains” to maintain the brain for years to come. 2 Dementia is progressive deterioration of the brain resulting in impaired cognition and memory loss. About 60% of cases are AD. Other types include vascular dementia (restricted blood flow to the brain) and frontotemporal dementia (degeneration of frontal and temporal lobes of the brain), or are caused by chronic alcoholism, some medications, Parkinson’s disease, Huntington’s disease, or multiple sclerosis. There is an increasing number of people with dementia, suggesting that environment and lifestyle play big roles. About one-third of AD cases are attributable to modifiable risk factors, meaning there is a chance to prevent it. Some people with memory loss don’t have dementia. For example, people with depression often complain of memory loss and difficulty concentrating. Drug reactions or sudden health conditions can cause thinking problems and delirium. Typical symptoms of real dementia include difficulty remembering recent events; inability to perform complex tasks such as balacing a checkbook; getting lost in familiar places; language problems such as an inability to find the right word when speaking; behavior changes that interfere with performance in daily activities, work, and social relationships; an inability to perform normal activities such as dressing, washing, cooking, eating and using the toilet. Symptoms progress gradually over months or years. Advanced stages bring paranoia, trouble sleeping, depression, screaming, repetitive questioning, aggression, arguments, wandering, and resistance to help. 3 Mild cognitive impairment (MCI) is an early stage of cognitive decline which may or may not advance to dementia. Unlike dementia, there is usually normal cognition (can think, understand, make decisions); normal ability to handle daily living, social and occupational activities with minimal impairment; and limited or no personality changes. There is some memory impairment, but not true dementia. MCI affects 10% to 20% of people aged 65 and older. If it progresses to dementia, it may take up to 12 years, allowing time for slowing or reversing cognitive decline. 4 The most common cause dementia and MCI is damaged blood vessels in the brain; they become stiff, narrow, and sort of distorted, making normal blood flow more difficult. This can lead to small ‘silent’ strokes. “In fact,” says Bruce Reed of UC Davis, “some of the symptoms we think of as normal brain aging may be due to injury to the brain’s blood vessels.” Other possible causes include loss of nerve cells and brain weight, collection of waste products, and slowing of communication between brain cells. A 17-year study of 5,123 people found that those with the most unhealthy behaviors were three times more likely to suffer poor thinking skills and twice as likely to have memory problems as those with the healthiest lifestyles. 5 So what can be done to help prevent loss of cognition?

Aim for healthy circulation. Blood carries nutrients and oxygen to every part of the body, including the brain. Although the brain makes up only 2% of total body weight, it gets 16% of the heart’s blood production and uses nearly 25% of the oxygen consumed by the body. Anything that stresses or indicates constriction, damage or loss of integrity to blood vessels can affect the brain. The blood-brain barrier (BBB) which permits only certain substances to travel from the blood to the brain, can be weakened in a number of ways—high blood pressure, increased particle concentration in the blood, radiation or microwave exposure, trauma, diminished blood flow, and damage that produces inflammation. When blood vessel or BBB function is affected, insufficient oxygen and nutrients get to the brain. With blood flow restriction and resultant depleted brain fuel, the brain functions less efficiently and is prone to insult and injury. If the blood supply gets cut off to a small area of brain, the tissue can die from lack of oxygen. That’s a small or silent (less apparent) stroke. A person who suffers a major stroke almost always has had small strokes too. Silent strokes can lead to cognitive impairment yet are largely preventable. Vascular disease (blood vessel damage), hypertension, smoking, diabetes and other factors can weaken or injure small blood vessels in the brain and damage the brain’s communications network. Brain atrophy attributed to aging is related far more to vascular disease than to atrophy of the brain itself. Lifestyle measures that maintain or improve vascular health—a healthful diet, exercise, real food supplements as needed, and the like—are vital for brain protection. The higher the risk of cardiovascular disease or stroke, the greater the likelihood of cognitive decline. Hypertension increases risk even if medication is taken. Very low blood pressure in the elderly increases risk due to lower nutrient and oxygen supplies getting to the brain. 6 Work for a balanced metabolic system. Disruptions in blood sugar and insulin balance affect the brain. Type 2 diabetes is a strong risk factor for dementia. It adversely affects memory and processing speed, and depletes directive functioning. Blood sugar soars because insulin no longer works properly due to insulin resistance of cells. Over time, there is a reduction in the number of insulin receptors in the BBB, allowing less insulin the brain. For one thing, insulin helps clear toxic beta-amyloid (related to AD) out of the brain. Small blood vessels are damaged and parts of the brain may shrink. Blood sugar is high, but less gets to the brain. Glucose is the main fuel for the brain; a reduction affects brain function. Blood sugar elevations not high enough to be diabetes, such as metabolic syndrome and prediabetes, also have a higher risk for cognitive decline and dementia—the higher the blood sugar, the higher the risk. A poor diet, being overweight, and being inactive often lead to blood sugar problems and then cognitive problems. To change this situation and improve brain chemistry, excess weight needs to be lost, diet improved, nutrient levels and exercise increased. It’s not just how much, but what one eats that matters. A diet high in refined carbohydrates and altered fats; low in fruit, vegetables, whole grains and legumes, and the like, can cause high-blood, low-brain glucose and insulin. 7 Attain and maintain a healthy weight. Overweight and obesity are linked to declining memory and brain function. Overweight can lead to type-2 diabetes and high blood pressure, among other things. People who are obese and have high blood pressure, blood sugar, and triglycerides have a 22.5% faster decline in many thinking skills than people of normal weight and no metabolic abnormality. Obese adults have less brain volume and more brain atrophy than those of normal weight. The more an individual weighs, the worse his/her memory is likely to be and the higher the risk for dementia. Weight loss and exercise improve cognition. Achieveing and maintaining a healthy weight is a vital means for preserving heart, metabolic and brain health into old age. Yet being severely underweight can also increase risk for dementia. Being underweight increases risk of dementia by 36%; being overweight increases risk by 42% and being obese ups risk by 80%. 8 Support a healthy microbiome. Intestinal microbiota influence the brain’s health and function as well as BBB permeability. The intestinal tract is a “second brain” due to the presence of the enteric nervous system that engages in digestive functions. Many neurotransmitters used in the brain also reside in the gut such as dopamine (vasodilation, reduction of insulin) and 95% of the body’s serotonin (mood, eating, sleep). Some brain-essential nutrients are produced in the gut. Natural foods, nonpasteurized fermented foods, and quality probiotic supplements are all supportive. People with AD or other forms of dementia may benefit from taking probiotics, consuming a healthful diet, and avoiding toxins and some medications. 9 Avoid toxins. Many environmental toxins can have brain-damaging effects. Plasticizers can result in inhibition of energy production in mitochondria and fat processing in brain cell membranes—affecting focus, motivation, inquisitiveness, interest, and contendedness. Pollution from traffic exhaust; living in areas of high air pollution; smoking; exposure to chemicals such as chlorinated solvents, petroleum solvents and benzene (in many drycleaning solutions, paints, carpet glue, furniture polishes, dyes, detergents, engine cleaners, plastics, rubber, 2

more); heavy metals (such as mercury, lead, cadmium); aluminum (some food preservatives, antiperspirants, municipal water supplies); and organophosphate pesticides—all are toxic to the brain, reducing thinking and memory abilities. 10 Many medications have anticholinergic effects (interfere with acetylcholine actions) which can cause or worsen cognitive impairment, memory problems, confusion, and delirium. Included are some drugs for insomnia, colds, allergies, depression, bladder-control, and motion sickess. Problems are most commonly linked to benzydiazepines, triclyclic antidepressants, opiates, and anticonvulsants. Older people taking the drugs are 46% more likely to have mental function decline. Drugs that reduce stomach acid—protonpump inhibitors (Prilosec, Nexium) and histamine-2-receptor antagonists (Zantac, Tagamet)—can cause poor cognition; they reduce absorption of nutrients such as vitamins B12 and C needed for brain-cell function. Statins are linked to memory loss; cholesterol is essential to brain cell membranes; AD-amyloid risk may increase. 11 Reduce stress. Chronic or excessive worry, depression, anxiety and other stressors disrupt neural circuitry, result in elevated adrenal stress hormones, and cause brain tissue loss and hippocampal atrophy. Brain cells lose synapses (communication bridges between brain cells) and receptors are reduced so cells are less capable of responding to neurochemical cues, making it more difficult to create and retrieve memories. In older people, depression can profoundly impact mental function, leading to cognitive impairment. The capacity to deal with challenging conditions and stress has much to do with nutritional status and delivery to the brain. 12 Get enough sleep. Sleep deprivation leads to accumulation of the beta-amyloid toxin linked to AD. Adequate sleep allows the space between brain cells to expand, making it easier for toxic waste products to get flushed out. With less sleep, less gets cleared. Middle-aged or older people who get six to nine hours of sleep a night have better cognitive scores than those sleeping either fewer or more hours. Sleeping less than six hours or more than nine hours impairs memory and lessens attention. Chronic sleep deprivation is linked to abnormal behavior of brain cells; impairment of memory, concentration and decision-making; increased depression, anxiety and stroke risk. High levels of fragmented sleep or low sleep quality increase risk of cognitive decline by 40% to 50%. Sleep apnea may damage tissue in some parts of the brain that store memory. 13 Stay mentally active. People who continue to use and challenge their mental capacities have a lower risk for dementia. Involvement in mentally stimulating activities like reading, learning new skills, attending classes, playing games and the like, all support cognitive reserve and limit brain shrinkage. Cognitive decline is reduced by 32% in those who frequently engage in brain-stimulating activities. Those who infrequently do so have a 48% faster rate of decline. High brain reserve almost halves the risk of developing dementia. 14 Engage in regular physical activity. A number of studies confirm that regular exercise is beneficial for brain health. If an individual is sedentary, blood does not get to the far reaches of the brain’s small blood vessels and thus to areas that support executive functions which are vulnerable to deterioration from inadequate oxygen and nutrients. Exercise can cause the small vessels to grow and expand their reach, expand brain volume and protect endothelial cells that line blood vessels. The amount of toxic beta amyloid is lower in individuals with high exercise and activity levels, perhaps due to the ability of exercise to raise neurotransmitter levels, brainderived neurotrophic factor, and insulin-like growth factor. Brain mass and volume may be increased. Exercise affects insulin, blood flow, mood, physiologic and psychological stress, and more. It helps memory, thought, executive function, judgment, attention, perception, remembered skills, and ability to live a purposeful life. 15 Avoid nutritional deficiencies. Deficiencies of a number of nutrients, even if marginal, affect brain function and cognitive performance. The modern Western diet is highly nutrient-deficient, so many people lack what they need for good brain function. Nutrients are building blocks for neurotransmitters that make up the main network of communication in the brain. If the brain isn’t properly nourished, the health of neurotransmitters is compromised. Processed sugars, refined carbohydrates (such as stripped and bleached flours), fast foods, excess alcohol, unnatural altered fats and the like, are all as bad for the brain as they are for the rest of the body. Excessive refined sugar lowers levels of factors needed for memory and learning, plus dulls the brain’s ability to determine satiation, contributing to overeating and over-weight. High fructose corn syrup slows brain function, adversely affecting learning, concentration, and memory. Trans fats increase risk of dementias and MCI. Lack of good nutrition and toxic additives and preservatives in highly processed, refined nonfood can directly reduce mental faculties. A highly refined-carbohydrate diet impairs glucose metabolism that is strongly linked to decreased general cognitive performance, memory impairment, and degneration of a brain area that is key for learning and memory. A glucose deficiency is created in the brain which affects the ability to focus and think; eventually arteries are constricted and stressed, making the brain more vulnerable to damage. People who eat the most refined sugars have a 1.5 times higher risk of cognitive impairment compared to the 3

lowest consumers. People aged 70 and older eating a diet high in refined carbohydrates have a fourfold increased risk of developing MCI. Whole natural foods, including unrefined carbohydrates, help keep blood sugar steady and support memory and attention. Natural fats and proteins from real foods lower the risk of cognitive impairment. But altered, refined, fabricated, overheated oils and fats are detrimental. Trans fats in many processed and fast foods are linked to greater mental decline with age, including poor word recall. Harmful fats can adversely affect blood vessels around the brain and result in long-term memory loss. 16 Vitamin complexes including A, Bs C, D, E and K plus minerals including magnesium, calcium, potassium, iron, zinc and others, are all required for good brain function. High intake of vitamin C, vitamin E and carotenes may delay cognitive decline in the elderly. The concentration of vitamin C and beta-carotene in the serum of people with dementia is significantly lower than in those without dementia. Low levels of carotenoids (such as lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha- and beta-carotene) play a role in cognitive impairment. Folate and vitamin B12 are particularly important for avoiding dementia and MCI. Older people are more likely to develop anemia (low level of red blood cells) due to iron or vitamin B12 deficiency, blood loss, various chronic diseases, and other causes. Since older people tend to have more difficulty absorbing B12, deficits are not uncommon. The link between iron status and cognition has been shown. Anemia increases the risk of dementia because red blood cells carry oxygen and so less oxygen gets to the brain. Other B vitamins such as thiamine (B1) riboflavin (B2), niacinamide (B3), and pyridoxine (B6) are also crucial to the brain for production of neurotransmitters. Magnesium, iodine, iron, copper, zinc and protein are involved in top-level brain function. Magnesium is essential for synaptic plasticity (growth and formation of new neuronal connections and networks) for brain cell communication. Adequate magnesium intake increases learning abilities and short- and long-term memory. Calcium and magnesium, both supportive to brain function, need to be balanced. Taking either mineral separately in large amounts can create detrimental imbalances. 17 Inadequate levels of vitamin D are linked to cognitive impairment and dementias including AD. Getting vitamin D through sunlight exposure, the diet, and food source supplements such as quality cod liver oil is different than supplementing with isolated, manufactured vitamin D (which has a risk of toxicity at high doses and does not work biochemically as well). A lower risk of cognitive decline and AD was found in people who consumed more vitamin E from food such as nuts, seeds, green leafy vegetables and whole grains. In another study in which tests measuring verbal memory, working memory, and other cognitive skills were given to participants, those who ate the most vegetables—particularly green, leafy vegetables—had the least cognitive decline compared to those who ate the least. Study participants with an average age of 81 who ate one to two servings of green leafy vegetables each day had cognitive abilities of people 11 years younger than participants who consumed none. Vitamin E helps protect against cognitive impairment and dementia; a 2014 study found that older adults with high levels of vitamin E were less likely to suffer from memory disorders than those with lower levels. If mitochondria (where cellular energy is produced) are too damaged, they cannot produce enough lipoic acid. Lipoic acid recycles vitamin C, coenzyme Q10 and glutathione back to their useful forms and aids the brain’s chemistry. Phosphatidyl choline, needed for cell-membrane function and toxin removal, is important to ensure that mitochondria can produce energy for brain cells; depleted energy reserve in brain tissue is often found in people with dementia. Higher intake of choline is related to better cognitive performance; good food sources include egg yolk, liver, meat and fish. Serum coenzyme Q10 levels are inversely associated with risk of dementia. 18 A deficit of boron results in decreased brain electrical activity. When boron levels are increased, attention span, memory, hand-eye coordination, and manual dexterity improve. Even a mild iodine deficiency can affect cognitive function later in life, but megadoses can cause thyroid dysfunction and other side effects. Improving chromium levels may enhance cognitive inhibitory control and cerebral function in older adults by supporting blood sugar metabolism. Cognition is closely linked to selenium levels in older people. It is required for the synthesis of several selenoproteins in the brain which protect the brain from damage. Lithium serves a role in protecting brain receptors, regenerating damaged brain cells and protecting against aluminum toxity; but large isolated doses can lead to hypothyroidism. Copper supports brain function, yet high isolated supplementation may contribute to mental decline, possibly due to a relative deficit of zinc. 19 Omega-3 fatty acids (DHA and EPA) are abundant in the brain’s gray matter and are important to normal brain function. Omega-3s improve learning ability, play a significant role in regeneration and development of brain cells, and may increase neurotransmitter activity. Low levels are associated with smaller brain volume and 4

reduced visual memory, executive function and abstract thinking. But study results are not consistent, probably due to supplement quality (most are highly processed which alters fatty acids and supporting nutrients). Yet fish (salmon, anchovies, herring, sardines, trout, mackerel, etc.) and other food sources (such as plant omega3, ALA, as in flaxseed and walnuts) consistently show improvement. Medium chain triglycerides, the primary fat in coconut oil, improves cognitive function in older adults with memory disorders. Phospholipids such as phosphatidylserine (PS, a fat abundant in the brain), aid memory, learning, concentration, and vocabulary skills. PS may improve the ability to cope with stress, enhance the brain’s blood glucose levels, reduce depression, and stimulate production of acetylcholine for brain cell communication; soy lecithin is a good source. When digesting fats that contain oleic acid—a monounsaturated fatty acid (MUFA) in olive oil, fish, nuts and some legumes—the small intestine produces a molecule called oleoylethanolamide (OEA). OEA binds to a receptor in the gut, which sends signals to the brain; one signal ends up where emotionally charged memories are cemented into long-term memories. Arachidonic acid, a polyunsaturated fatty acid (PUFA), is the most highly concentrated omega-6 in the brain. Unrefined, unaltered PUFA and MUFA sources reduce the likelihood of MCI and dementia among the elderly. Low total cholestserol levels are associated with lower cognition and information processing speed; this may predict diminished cognitive functioning. 20 A number of clinical studies using synthetic vitamins or other nonfood chemical nutrients have not found cognitive improvements. Synthetic B-vitamin supplementation reduces high homocysteine levels but does not always improve cognitive function. Low serum or plasma levels of B12, folate and B6 appear to be more important indicators for cognitive decline than serum homocysteine levels. Multivitamin/mineral supplements of separate, nonfood, mostly synthetic ‘nutrients’ are often found to make no difference. Such supplements can have adverse effects. Nutrients from real food consistently show brain-boosting powers. 21 Use herbs. Evidence shows that Ginkgo biloba can improve mental performance and complex memory function by increasing proper blood flow to the brain, even reducing long-term cognitive decline in the elderly. Ginkgo extracts have improved cognition in people with vascular dementia and AD. Bacopa has been shown to enhance attention, cognition and cognitive processing, improve working and free recall memory, and enhance cholinergic function. It is unrealistic to expect bacopa or any herb to cure AD, yet herbs may help with mental function. Green tea rich in theanine may lower the risk of cognitive impairment, improve memory and attention, boost brain activity and help protect the brain from amyloid plaques. Other herbs that can have positive effects on cognition include gotu kola, rosemary, Lion’s Mane mushroom, sage, lemon balm, and Asian ginseng. 22 Establish healthy eating habits. Nutrition looms large in the strategy to prevent or delay dementia. Research often focuses on the role of individual nutrients, but now studies are demonstrating that it is the combined effects and interactions of many nutrients in whole foods and dietary patterns that really work. This approach incorporates the complexity, interworkings and synergy among nutrients in healthful, real-food diets that reduce cognitive decline and risk of dementia. 23 Some studies indicate that moderate alcohol (specifically wine) consumption may reduce risk of dementia, yet others do not. The definition of “moderate” intake varies plus overall health, lifestyle, age, and other factors affect the results. Basically it depends on the individual; some do better with a bit of wine while others do not. 24 Foods shown to improve brain health and cognitive function include: Vegetables, such as asparagus, peppers, tomatoes, cabbage family (kale, broccoli, etc.); beets, celery, spinach, carrots (all rich in nitrates to increase blood flow to the brain). Green leafy vegetables are particularly helpful. Fruit, including avocado, berries of all kinds, mango, melons, citus and papaya. Nuts and seeds such as almonds, walnuts, pecans; sunflower, pumpkin and flax seeds. Legumes including peas and dried beans. Whole grains of all types. Seafood, particularly fatty ocean (not farmed) fish such as salmon, mackerel and sardines (all low in toxins and mercury), and quality cod liver oil. Eggs, preferably from freerange, pasture fed poultry. Other foods include meats, poultry and milk products from organic pasture-fed animals; and fermented foods such as kefir, unpasteurized yogurt, kimchi and sauerkraut. Brain cells are made up mainly of fat. Fatty acids needed by the brain come from fish, seeds, nuts, olives, quality meats and dairy plus other real foods rich in natural, unaltered fats. The amount of fat intake is not the issue—it’s the quality that is crucial. Dietary patterns rich in such foods, such as a Mediterranean-style pattern, are consistenly associated with higher levels of cognitive function in elderly people over long periods of time. Consuming a diverse diet with a variety of healthful foods is the way to attenuate cognitive decline, enhance memory and improve attention. A quality diet and real whole-food supplements are greater than the sum of their parts. They 5

are food for thought. 25 Numerous nutrients benefit brain function and cognition, and real foods with their hundreds, if not thousands, of nutrients and other food components are the best way to feed the brain. This indicates that, if supplements are needed, real food concentrates would be the most logical and helpful. ________________________________________________________________________________________ 1

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