It’s estimated that by the year 2060, 14 million American adults will have some form of dementia, and Alzheimer’s disease (the most common type of dementia) is currently the seventh leading cause of death in the U.S. While you may think losing your memory is just a normal part of aging, thankfully it’s not; there’s actually a lot that can be done to prevent cognitive decline as you age.
While no single nutrient alone will prevent dementia, nutrition can be used to target underlying risk factors, potentially reducing your risk of developing dementia as you age. In this article, we’ll tackle how nutrition impacts cognition and which nutrients you may want to prioritize to make sure your brain stays healthy. Additionally, we will discuss some functional medicine lab tests you can use to assess your dementia risk.
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What is Dementia?
Dementia is a general term used to describe the inability to remember, think, or make decisions. A person with dementia may be unable to perform activities of daily living like showering or cooking a meal, and in the later stages, they often require 24-hour care.
There are several different types of dementia, including Alzheimer’s disease (AD), vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia. Additionally, patients can experience dementia symptoms that are caused by medication side effects, increased pressure in the brain, vitamin deficiency, and altered thyroid hormone. Dementia symptoms related to these causes are referred to as reversible – meaning once the underlying cause is corrected, dementia symptoms resolve.
Everyone with dementia will experience it differently, but generally, there are issues with memory, attention, communication, reasoning, judgment, problem-solving, and visual perception. Some common signs and symptoms of dementia include:
- Forgetting things easily
- Losing or misplacing items
- Getting lost or being confused even in familiar places
- Difficulty finding words
- Problems with familiar tasks
Aging and certain genetics can increase dementia risk, but there are many lifestyle factors that can make a dementia diagnosis more likely, such as:
- Hypertension (high blood pressure)
- Diabetes or pre-diabetes
- Obesity
- Smoking
- Alcohol use
- Physical inactivity
- Depression
- Social isolation
It’s estimated that 67% of people think dementia is a normal part of aging, and 25% think nothing can be done to prevent it. However, since the majority of dementia risk factors involve nutrition and lifestyle, simply making changes in these areas can be a very effective way to reduce the risk of all types of dementia.
What is The Importance of Nutrition in Maintaining Brain Health?
The development of dementia is multifaceted, so personalization is key when it comes to dementia prevention. Each patient needs to have their own risk factors evaluated and addressed one by one to ultimately restore great brain health. With this in mind, many underlying dementia risk factors are rooted in uncontrolled inflammation, which is largely driven by nutrition and lifestyle. So, diet-related changes should be considered a first-line intervention.
The Standard American Diet, which is high in ultra-processed foods, sugar, and inflammatory oils, is notoriously deficient in brain-health supportive nutrients and may also be one root cause of inflammation in the body. Unchecked inflammation is characterized by the continuous release of pro-inflammatory mediators that eventually build up and damage tissues and organs like the brain. Additionally, as this process continues, insulin resistance, which is thought to be a significant contributor to AD, can result. One powerful way to prevent, reduce, and or resolve inflammation and insulin resistance is to follow an anti-inflammatory, nutrient-dense diet. This type of dietary pattern may provide benefits by improving the gut microbiome profile, optimizing immune system function, and lowering oxidative stress in the body. All of which can take the burden off of the brain.
How Can Specific Nutrients Lower Dementia Risk?
For the brain to function, it requires a lot of energy (in the form of ATP), and the creation of that energy requires nutrients. Without adequate nutrients from the diet (or from targeted supplementation), the brain has less energy, so it’s also less able to protect itself from inflammation, insulin resistance, oxidative stress, free radicals, and toxins. On the other hand, optimizing important nutrients like omega-3 fatty acids, antioxidants, B vitamins, vitamin D, and choline may help to optimize energy production and combat the underlying causes of poor brain function.
What Are The Top Nutrients For Reducing Dementia Risk?
While it’s unlikely that any single nutrient on its own will reduce dementia risk, there are several nutrients of concern when it comes to keeping your brain healthy. These nutrients provide structure to brain cells, improve cell-to-cell communication, remove harmful wastes, and lower inflammation, all of which work together to secure brain health as you age. Here are some of the nutrients that have a special role to play in brain health and cognitive function.
Omega-3 Fatty Acids: The Brain's Best Friend
Omega-3s are polyunsaturated fats that help to provide energy and structure for cell membranes, as well as form signaling molecules that are used by multiple body systems. Low intakes of omega-3 fatty acids like docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are associated with a higher risk of dementia, and an imbalanced omega-6 to omega-3 fatty acid ratio has been associated with AD and cognitive decline. EPA and DHA both seem to protect the brain by lowering inflammation. But DHA specifically may impart significant brain health benefits by reducing arachidonic acid, increasing brain-derived neurotrophic factor (BDNF), and reducing oxidative stress.
The adequate intake (AI) for omega-3 fats for adults is 1.6 grams per day for men and 1.1 grams per day for women. Good food sources of omega-3s include salmon, herring, mackerel, and sardines. If you don’t eat fish or if you have an allergy, you can obtain some omega-3s from plant-based foods like chia seeds, walnuts, flaxseeds, and flaxseed oil. But the omega-3s contained in plant foods need to be converted into EPA and DHA, which is a very inefficient process, so supplementation is often the best option.
Antioxidants: Safeguarding Your Brain Health
Oxidative stress may be one underlying factor in dementia. The brain requires a lot of energy, but energy creation itself is a major generator of reactive oxygen species (ROS) and free radicals that can damage the brain. In addition, the brain’s antioxidant capacity is limited, so ensuring adequate antioxidants in the diet from vitamins and minerals may be one way to protect the brain.
Minerals like selenium and zinc act as antioxidant enzyme cofactors. Low selenium concentrations have been found in the brains of patients with Huntington’s disease (a neurodegenerative disorder), and zinc supplementation has been shown to increase the total antioxidant capacity and BDNF in women with premenstrual syndrome.
Vitamins A, C, and E act as ROS scavengers. Vitamin C (ascorbate) may improve neurodegeneration, vitamin E plus omega-3 fatty acids improve antioxidant capacity in Parkinson’s disease patients, and vitamin A supplementation may reduce inflammation and improve cognitive function in AD patients.
Vitamin B Complex: Nourishing The Nervous System
Vitamin B complex refers to eight water-soluble vitamins, namely thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, folate (B9), and vitamin B12. While they each have unique benefits, the B vitamins as a group act as coenzymes for a variety of bodily processes and, as such, play an important role in brain function. B vitamins assist in creating energy for the brain, DNA and RNA synthesis and repair, methylation, and the creation of neurotransmitters and other signaling molecules.
Research indicates that people in developed nations frequently suffer from inadequacy and even deficiency of at least one of the B vitamins, which may increase the risk of cognitive decline. Studies involving multivitamins that contain high amounts of B vitamins have found improvements in cognition and memory. Adequate B vitamin intake can be obtained from consuming a wide variety of plant and animal foods.
Vitamin D: The Sunshine Nutrient For Brain Health
Vitamin D is a steroid hormone that’s involved in numerous bodily processes. Among them are brain and immune system functions. And low levels are associated with a variety of ailments, including cognitive decline. Vitamin D provides protection to the brain, supports cell-to-cell communication in the brain, and increases synaptic plasticity. It may also stimulate the immune system to remove amyloid plaques that are thought to be part of the AD process.
The current recommended dietary allowance (RDA) of vitamin D is 600 international units (IU) per day for those aged 15 to 70 years and 800 IU for those 71 years old and up. However, controversy exists, and many health professionals feel these levels are too low to maintain adequate vitamin D levels in the body.
Vitamin D can be synthesized in the body when the sun touches bare skin. Unfortunately, many areas of the world lack adequate sunlight for much of the year, and outside of fatty fish like salmon, trout, tuna, and mackerel, there aren’t many good food sources of vitamin D.
Choline: Cell Structure and Signaling For Brain Health
Perhaps one of the most important but less well-known nutrients for brain health is choline. It’s made in small amounts by the body, but humans don’t make enough to meet the brain’s demand, so the vast majority must come from the diet.
Choline is vital for early brain development and acts as a methyl donor to help synthesize phospholipids like phosphatidylcholine, which is needed for the structural integrity of brain cell membranes and also for communication between brain cells. Choline is also required for the production of the neurotransmitter acetylcholine, which is crucial for memory and mood.
Low choline intake (less than 215 milligrams per day) has been associated with dementia. The AI for choline for people 19 years old and up is 550 mg/day for men and 425 mg/day for women. Pregnant and lactating women need 450mg and 550mg, respectively. Foods with the greatest amounts of choline include meat, poultry, dairy, eggs, and fish.
Functional Medicine Labs to Help Test The Nutrient Status For Patients With Dementia Risk
Since nutrient insufficiency and deficiency are potential contributors to poor brain health, testing the levels of certain nutrients can provide clues about a patient’s dementia risk. Here are two testing options providers may wish to consider.
Micronutrient Testing
Poor nutrient status can increase the risk of high blood pressure, obesity, high blood sugar, inflammation, and insulin resistance, which are all risk factors for dementia. The SpectraCell Micronutrient Test analyzes 31 vitamins, minerals, and other nutrients (including choline) to determine nutritional deficiencies, but it also analyzes nutrient performance and functional micronutrient deficiencies. In addition to determining how the cells respond to oxidative stress and how they metabolize carbohydrates, the test will also determine how cells function when launching an immune response. Practitioners can use this test to determine which nutrients a patient may need to prioritize in their meal plan or if nutritional supplementation is necessary.
Omega-3 Index
An imbalanced omega-6 to omega-3 ratio is indicative of inflammation, and low EPA and DHA levels have been associated with cognitive decline. The Omega-3 Index Complete from Ayumetrix can give practitioners insight into the percentage of EPA and DHA in the blood. An optimal percentage may indicate a lower risk of cognitive decline. If the omega-3 index is suboptimal, practitioners can better personalize the meal plan and supplement recommendations.
Functional Medicine Labs to Help Dementia Risk Patients Individualize Treatments
Since inflammation is a common occurrence in those with dementia, it’s a good idea to test for inflammation and its root causes. Common blood tests for inflammation aren’t always diagnostic. But along with traditional blood tests (like C-reactive protein), integrative providers can use many tests to determine the root cause of inflammation, such as poor gut function, food sensitivities, and glucose dysregulation. Here are some functional medicine labs that may be able to identify the underlying causes of inflammation.
Comprehensive Stool Test
The GI-MAP stool test evaluates stool samples for various markers of gastrointestinal health, including microbial imbalance, digestive enzyme levels, and inflammation. Poor gut function and microbiome imbalances may contribute to poor brain health. Identifying imbalances and digestive issues can lead to uncovering the root causes of inflammation and guiding targeted treatments to improve gut health.
Food Sensitivity Testing
The Array-10 Multiple Food Immune Reactivity Screen by Cyrex Laboratories measures the body's immune response to various foods. This test analyzes blood samples for IgG and IgA antibodies against common food proteins. Food sensitivities may be one driver of inflammation, which is a root cause of cognitive decline. Identifying food sensitivities in an individual will help the practitioner tailor the meal plan.
Genetic Testing
There are many genes involved in the development of dementia; however, the APOE4 gene may be the most important for the development of AD (the most common type of dementia). Patients with two copies of the APOE4 genetic variant are 15 times more likely to develop AD. The 3x4 Genetics + Blueprint Report test offers a means to examine the root causes of brain health issues and helps patients better understand how their genetics can impact their brain health. Providers can use this information to help patients make optimal decisions to prevent, reverse, or resolve brain health issues.
Additional Lab Tests to Consider
C-reactive protein (CRP) is a protein made in the liver that tends to rise when inflammation is present. Since inflammation may be a significant dementia contributor, it’s a good idea for practitioners to run this test and monitor how it changes over time. A typical normal value is less than 3mg/L.
Nutritional Recommendations For Patients With a Risk for Dementia
Dementia was once considered inevitable, but we now know nutrition and lifestyle can be harnessed to not only prevent it but also improve it. When it comes to nutrition, there is a spectrum of brain health-promoting meal plans. The Mediterranean diet is a well-researched, anti-inflammatory meal pattern that’s been associated with better cognitive outcomes. While we can’t say for sure this type of diet prevents dementia, it’s nutrient-dense and fights inflammation and insulin resistance, which are underlying risk factors.
Likewise, the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet, which emphasizes green leafy vegetables and berries, has also been associated with improved cognitive performance and lower dementia risk.
And finally, the KetoFLEX 12/3 is a heavily plant-based, nutrient-dense, whole foods diet that emphasizes organic, seasonal non-starchy vegetables, adequate protein, generous amounts of healthy fat, and targeted fasting. This diet, when combined with personalized treatments for individual risk factors, has been found to improve cognition in patients with mild cognitive impairment.
It’s important to understand that the majority of nutrition trials are observational in nature, so it’s difficult to say definitively that one diet works better than another for all people who are at risk for cognitive decline. The goal is to keep inflammation low, improve insulin sensitivity, maintain a healthy weight, avoid toxin exposure, and obtain optimal amounts of nutrients. These goals can be accomplished with any meal pattern that focuses on clean, whole foods, plenty of plants, protein, and healthy fat, while significantly reducing processed foods and sugar.
Supplements & Herbs That Can Reduce Your Risk of Dementia
Obtaining nutrients from food is important, but there are some instances when therapeutic benefit requires more than you would be able to consume in the diet. When it comes to brain health, vitamin D and curcumin are two options that fit into this category.
Vitamin D
There are very few food sources of vitamin D, and the RDA may not be adequate to maintain optimal vitamin D levels in the body. Sun exposure is another option but may not be practical for much of the year for many. Testing vitamin D levels can help provide some insight into how much supplemental vitamin D should be taken.
Curcumin: The Golden Spice For Cognitive Wellness
Curcumin is an extensively studied polyphenolic compound found in the spice turmeric. Epidemiological studies have found the incidence of AD to be much lower in areas of the world where curcumin is a staple in the diet, like India. And other studies have found people who consume curcumin perform better on cognitive tests as they age.
As it relates to dementia, curcumin may decrease beta-amyloid plaques, provide anti-inflammatory and antioxidant benefits, chelate metals, and have a favorable impact on the myelinating cells of the central nervous system. Curcumin bioavailability from foods is low, and therapeutic benefits may require large doses, as would be found in a supplement. Curcumin in the dose of 1500 milligrams per day may provide cognitive benefits for older adults.
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Summary
Despite a common misconception, dementia is not a normal part of aging. The increase in the prevalence of this devastating disease seems to be related, in part, to nutrition and lifestyle-related factors that lead to inflammation resulting in high blood pressure, obesity, and insulin resistance.
While the development of dementia is unique to an individual, inflammation seems to be a common underlying factor. Food is a significant contributor to inflammation, so making positive diet-related changes should be a first-line option for creating and preserving brain health. Rather than focusing on one specific nutrient, the dietary pattern, on the whole, should be centered around nutrient-dense plant foods and healthy fats, with the exclusion of added sugar and processed foods. In addition, optimizing intakes of vitamin D, omega-3 fatty acids, B vitamins, antioxidants, and choline can help to improve brain cell structure, cell-to-cell communication, remove harmful brain waste, and lower brain inflammation.
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