Top 5 nutrients for optimal cognitive health


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I was saddened by the recent news of Monty Python star Terry Jones’ diagnosis with primary progressive aphasia, a severe form of dementia that directly affects the speech.  Along with so many of my favourite personalities, including Robin Williams, Peter Falk (‘Columbo’) and the wonderfully creative Terry Pratchett, he is just another in a long line of brilliantly talented people to fall victim to dementia over the last few years.   The rise in dementia, including Alzheimer’s disease, has dominated the headlines for a number of years, the most recent of which reveals dementia as the leading cause of death in England and Wales (Office for National Statistics [1]), knocking CVD off the top spot.

Whilst this increase is partly accounted for by people living longer, the processes related to cognitive decline/dementia begin to damage the brain many years, or decades, before symptoms become apparent.  The resulting progressive decline in function, as more of the brain is damaged, makes early intervention key to slowing/preventing cognitive decline. Increasingly, I find myself advising clients, family and friends concerned by memory issues on how to eat well for optimal mental and cognitive health. It is reassuring to know that, despite these daunting statistics, there are many nutritional factors that can have a significant positive impact on long-term brain health when they form a lifelong part of a healthy diet and lifestyle. When it comes to the most useful brain-protective nutrients, the science behind them speaks wonders and helps provide valuable insight into disease mechanisms and progression to help us combat brain decline early. Below I outline my top 5 nutrients for cognitive health, together with what you should be taking /recommending to help stave off the disease.

Omega-3s

Inuit’s are known to have a high intake of fatty fish and low incidence of cardiovascular disease. Pure EPA supplements derived from purified fish oil are a convenient alternative.

Low body levels of omega-3 increases the risk for cognitive impairment in older age; it’s a good idea to eat oily fish regularly or take a high strength supplement like Pharmepa.

The marine-derived long-chain fatty acids EPA & DHA are well known to be associated with a reduced risk of Alzheimer’s disease;  indeed, a recent study has shed some interesting light on just how they may offer their protective effects.  The study, published in the highly regarded FASAB journal, has shown a direct link between brain levels of omega-3 and the efficiency of the brain’s clearance system in removing the abnormal protein aggregates that are associated with most neurodegenerative diseases. The study showed that omega-3 directly improves the function of the lymphatic system, thereby promoting the clearance of brain-derived amyloid-β peptides. [2]

Researchers used a transgenic mouse model known to express and accumulate high brain levels of omega-3, to investigate the effect of EPA and DHA on the clearance function of the glymphatic system.  This specialised form of the lymphatic system promotes the efficient elimination of soluble proteins and other undesirable metabolites from the central nervous system.  Compared to the wild-type mice (with normal levels of omega-3), the transgenic mice were shown to have a higher clearance rate of waste products, including amyloidβ peptides which are the main component of the amyloid plaques – the hallmark of Alzheimer’s disease.  When the wild-type mice were supplemented with fish oil, they too were shown to have improved the clearance function of the glymphatic system compared to un-supplemented control mice.   Whilst these results may provide benefits for a number of neurological diseases, including Alzheimer’s disease, the importance of the functioning of the glymphatic system also applies to a number of other health conditions including chronic fatigue syndrome and even migraine.

These results also appear to support the hypothesis that low omega-3 status increases the risk for cognitive impairment in older age.  Indeed, a recent population-based study found a robust and significant association between cognitive status and omega-3 levels, with those individuals with an omega-3 index ≤5.7% found to be 1.8 times more likely to exhibit signs of cognitive decline than those with a higher omega-3 index. [3]

Recommendations

Consuming 2-3 portions of oily fish per week can help increase the omega-3 index whilst also supplying an array of other important nutrients including amino acids, micronutrients and antioxidants.  For those not partial to fish consumption and because it is hard to know that fish sources are delivering adequate doses of long-chain omega-3, (depending on where they are sourced, what they are fed and how they are cooked) it may also be worth supplementing with  a high-concentration, purified fish oil.  A daily dose of Pharmepa MAINTAIN delivers 1g rTG omega-3 EPA and DHA, in small easy to swallow (lemon oil-infused to avoid fishy reflux) capsules. Alternatively, Pure Essentials and Mindcare deliver 660mg EPA plus DHA in a convenient 1-a-day lemon oil-infused capsule for those requiring slightly lower doses.

Polyphenols

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Curcumin is well documented to possess anti-oxidant and anti-inflammatory properties.

Whilst found naturally in a wide range of plant foods, these antioxidant phytochemicals (especially curcumin, resveratrol and Epigallocatechin gallate [EGCG]) appear to be most potent in their isolated forms and show extreme therapeutic potential as agents for managing a range of health conditions, including neurodegenerative diseases.  Their actions are numerous and diverse, and include an ability to chelate metal ions to prevent free radical formation, direct alleviation of oxidative stress by acting as scavengers of free radicals, superoxide and hydroxyl radicals, and through their ability to raise levels of important antioxidant enzymes such as glutathione peroxidase.  Polyphenols also have a direct role in managing inflammation, directly affecting transcription factors such as Nuclear Factor-kappa B (NF-κB).  Some polyphenols may have the potential to inhibit glutamate excitotoxicity thereby having favourable effects on neuronal survival, dendrite & axon development and synaptic plasticity, whereas others appear to directly prevent the formation of amyloid β aggregates, the hallmark of Alzheimer’s disease. [4]

Recommendations

Polyphenol-rich foods include fruits, vegetables, nuts, seeds and spices and should feature prominently in any healthy diet. Given their importance, I would also actively recommend co-supplementing with one or more of following: resveratrol, EGCG and curcumin. .  Curcumin is well documented to possess anti-oxidant and anti-inflammatory actions, with exciting evidence to support free curcumin’s ability to cross the blood brain barrier and clear amyloid-β peptides in healthy middle-aged people. [5] As such we are excited to announce the newest addition to our therapeutic range of products -stable, highly bioavailable Longvida Curcumin, which will be on the shelves by Christmas!

Probiotics

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Fermented foods like sauerkraut and live yogurt contain good bacteria and should be included in your daily diet; alternatively, supplement with a good-quality probiotic.

The management of dysbiosis through the use of probiotics is usually thought of as a useful intervention for gastrointestinal issues; however, given that a number of neurotransmitters, including g-aminobutyric acid (GABA), glutamate and serotonin, are influenced by gut flora it’s no surprise that recent studies suggest a significant correlation between the changes in the normal gut microbiota and cognitive behaviour.  Dysbiosis can lead to low-grade inflammation with proinflammatory products able to activate glial cells and exacerbate neuro-inflammatory processes linked to cognitive decline. [6] Whilst human studies are clearly lacking, the neuroprotective effects of specific probiotic strains such as clostridium butyricum have been shown in a  mouse model of vascular dementia. [7]

Recommendations

There are a number of ways to enhance gut function and reduce inflammation, firstly (and simply) by increasing intake of  the type of food needed to support healthy bacteria.  By this I mean increased intake of short-chain non-digestible carbohydrates (inulin-type fructans, fructo-oligosaccharides (FOS) and galacto-oligosaccharides (GOS)), known commonly as prebiotics (occurring naturally in cereals, fruits and vegetables),  the target bacterial groups for which are typically Bifidobacterium and Lactobacillus. Fermented foods like sauerkraut, kimchi, live yogurt and kefir can also help feed good bacteria.  With regard to probiotic supplements, Bifidobacteria, Lactobacilli, and Saccharomyces are three families that have been found to be beneficial for gut function.  Specific strains that are linked to cognitive health include Lactobacillus rhamnosus, Lactobacillus helveticus and Clostridium butyricum.

Vitamin D

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Elderly people with low levels of vitamin D, commonly referred to as the ‘sunshine vitamin’, are approximately twice the risk of developing dementia or Alzheimer’s disease.

Older individuals with vitamin D levels of below 25 nmol/L are at approximately twice the risk of developing dementia or Alzheimer’s disease. [8] In the brain, vitamin D’s functions include regulating the production of neurotrophic factor (a key protein required to support the growth, survival and differentiation of neurones), neurotransmitter release, calcium homeostasis, reducing oxidative stress and modulating immune system and inflammatory processes.[9]  Given vitamin’s D plethora of benefits, it’s not surprising the UK Reference Nutrient Intake (RNI) for vitamin D has recently  increased from 5 µg/day to 10 µg/day, (400IU).  Yet, given that 10 µg is considered adequate only to maintain serum 25(OH)D concentration of 25 nmol/L when UVB sunshine exposure is minimal, the amount needed to avoid deficiency (25nmol/L and 50nmol/L) or achieve optimal status (50 -100nmol/L), for many it may be 25 µg (1000iu) and perhaps substantially more.

Recommendations

Foods that are naturally high in vitamin D include oily fish, mushrooms, liver, cheese and egg yolks. Alternatively and in addition to the 1g rTG omega-3, Pharmepa MAINTAIN also delivers 30mg (1200IU) vitamin D3. Pure Essentials Omega-3 fish oil and all of the MindCare products deliver 25 µg (1000iu), whilst our new multivitamin provides 10µg as the recommended minimum.

Micronutrients

It is estimated that only  a third of the UK population currently meet the requirements for fruit and vegetable consumption.  As a major source of vitamins and minerals, low intake can put individuals at a significantly increased risk of deficiency of key micronutrients, a number of which are associated with increased risk of cognitive decline.  These include selenium [10], folate, cobalamin (vitamin B12) and vitamin B6.  Low levels of the nutrients required to support the methylation cycle are, unsurprisingly, implicated in accelerated ageing: healthy methylation (and homocysteine recycling) is involved in the synthesis of substances required for healthy cellular and cognitive function (including choline, carnitine and coenzyme Q10), as well as for the production of myelin proteins and neurotransmitters, including melatonin, serotonin, dopamine, and GABA.

When homocysteine is inadequately recycled (which can arise in part through nutrient deficiency) the resulting hyperhomocysteinaemia causes huge disruption in a number of key metabolic pathways.[11]  As yet, however, it is not entirely clear if elevated homocysteine is a direct risk factor for development of dementia and Alzheimer’s disease, or simply a marker of the disease.[12] Regardless of cause or effect, managing healthy homocysteine levels should be a priority for all aspects of health.

Recommendations

Our Pure Essentials Advanced Multivitamin and Minerals supplement is an excellent choice for those needing a bit of extra support to help ensure adequate intake, as it provides a blend of 22 carefully selected vitamins and minerals, scientifically proven to support brain function, energy & metabolism, eye health, heart health, normal inflammatory response & immune system function. The MindCare range of products also contain a specific blend of the key micronutrients to support brain and central nervous system function, at doses designed for higher intensity support.

Our high potency Super B-complex contains a synergistic blend of 8 highly bioavailable B-vitamins with vitamin C to provide comprehensive energy, mood and brain support.  The folate and vitamins B6 and B12 in Super B-Complex are in their most active forms and at optimal dosages to help maintain healthy homocysteine levels.

Summary

Diet quality and diversity is key to managing both physical and mental health.   The above nutrient recommendations exert their effects on cognitive health through multiple biological mechanisms and as a result provide a multitude of body-wide health benefits. In addition to supporting and protecting cognitive function, reduced risk of coronary heart disease, hypertension, diabetes, dyslipidaemia and metabolic syndrome have been observed, all of which have also been associated with an increased risk of mild cognitive impairment, dementia or Alzheimer’s disease.

It is clear that no single, stand-alone nutrient will provide the answer for reducing the risk of cognitive decline; it is for this reason that the above recommendations are offered to provide synergistic benefits for brain health, particularly when consumed as part of a Mediterranean-style diet, the importance of which  is by now well known. [13]

References

  1. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredinenglandandwalesseriesdr/2015
  2. Ren H, Luo C, Feng Y, Yao X, Shi Z, Liang F, Kang JX, Wan JB, Pei Z, Su H.Omega-3 polyunsaturated fatty acids promote amyloid-β clearance from the brain through mediating the function of the glymphatic system. FASEB J. 2016 Oct 7. https://www.ncbi.nlm.nih.gov/pubmed/27789520
  3. Lukaschek K, von Schacky C, Kruse J, Ladwig KH. Cognitive Impairment Is Associated with a Low Omega-3 Index in the Elderly: Results from the KORA-Age Study. Dement Geriatr Cogn Disord. 2016;42(3-4):236-245. https://www.ncbi.nlm.nih.gov/pubmed/27701160
  4. Molino S, Dossena M, Buonocore D, Ferrari F, Venturini L, Ricevuti G, Verri M. Polyphenols indementia: From molecular basis to clinical trials. Life Sci. 2016 Sep 15;161:69-77.
  5. DiSilvestroRA, Joseph E, Zhao S, Bomser J. Diverse effects of a low dose supplement of lipidated curcumin in healthy middle aged people. Nutr J. 2012 Sep 26;11:79.
  6. Caracciolo B, Xu W, Collins S, Fratiglioni L. Cognitive decline, dietary factors and gut-brain interactions. Mech Ageing Dev. 2014 Mar-Apr;136-137:59-69.
  7. Liu J, Sun J, Wang F, Yu X, Ling Z, Li H, Zhang H, Jin J, Chen W, Pang M, Yu J, He Y, Xu J. Neuroprotective Effects of Clostridium butyricum against vascular dementia in Mice via Metabolic Butyrate. Biomed Res Int. 2015;2015:412946. doi: 10.1155/2015/412946.
  8. Littlejohns TJ, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PH, Fried L, Kestenbaum BR, Kuller LH, Langa KM, Lopez OL, Kos K, Soni M, Llewellyn DJ. Vitamin Dand the risk of dementia and Alzheimer disease. Neurology. 2014 Sep 2;83(10):920-8.
  9. Millet P, Landel V, Virard I, Morello M, Féron F. Role of vitamin Din the physiopathology of neurodegenerative disease. Biol Aujourdhui. 2014;208(1):77-88.
  10. Rita Cardoso B, Silva Bandeira V, Jacob-Filho W, Franciscato Cozzolino SM. Seleniumstatus in elderly: relation to cognitive decline.J Trace Elem Med Biol. 2014 Oct;28(4):422-6.
  11. McCully KS. Homocysteine, Infections, Polyamines, Oxidative Metabolism, and the Pathogenesis ofDementia and Atherosclerosis. J Alzheimers Dis. 2016 Oct 18;54(4):1283-1290.
  12. Zhuo JM, Wang H, Praticò D. Ishyperhomocysteinemia an Alzheimer’s disease (AD) risk factor, an AD marker, or neither? Trends Pharmacol Sci. 2011 Sep;32(9):562-71.
  13. Keys et al., The diet and 15-year death rate in the seven countries study. Am J Epidemiol. 1986 Dec;124(6):903-15.
  14. Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC, Llewellyn DJ. Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology. 2013 Jul;24(4):479-89.

 

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Dr Nina Bailey

About Dr Nina Bailey

Nina is a leading expert in marine fatty acids and their role in health and disease. Nina holds a master’s degree in Clinical Nutrition and received her doctorate from Cambridge University. Nina’s main area of interest is the role of essential fatty acids in inflammatory disorders. She is a published scientist and regularly features in national health publications and has featured as a nutrition expert on several leading and regional radio stations including SKY.FM, various BBC stations and London’s Biggest Conversation. Nina regularly holds training workshops and webinars both with the public and health practitioners.