By Patrick Holford, Founder of the Food for the Brain Foundation.
Professor David Smith, former Deputy Head of the Faculty of Medical Science at the University of Oxford, who is one of a team of world-leading prevention experts at the Food for the Brain Foundation, says that Alzheimer’s is largely a preventable disease, and we know quite a lot about what people need to do to help prevent it.
The Food for the Brain charity focuses on helping people make simple, positive changes that will give your brain and memory an upgrade and dementia-proof your diet and lifestyle in the future.
A free on-line Cognitive Function Test, available at foodforthebrain.org not only shows how your brain is working, but there’s also a simple questionnaire about your diet and lifestyle that identifies the key changes that will make the most difference to dementia-proofing your future.
So here are the six most common, and most effective changes you can make:
- Eat less sugar and refined carbs
The first simple step is to eat less sugar, sugary junk food, sweetened drinks and white, refined bread, rice and pasta. A 2022 US study reported that having a blood sugar level in the high end of the normal range, at age 35, increased a person’s risk of developing Alzheimer’s later in life by 15 per cent.[1] So cutting back on sugar is the first of six simple changes that can cut your risk.
Have more beans, fish, chicken, and less rice, pasta and potatoes. Eat eggs for breakfast or yoghurt, nuts, seeds and berries. Have oats instead of sugary cereals and oat cakes instead of bread. Our sugar expert Professor Robert Lustig, from the University of California, showed that sweet-toothed teenagers already have shrinking brains and worsening memory.[2] It starts that young!
- Eat fish and omega-3 fish oils (and/or vegan alternative)
The next simple step to cut your risk is to eat fish and supplement omega-3 fish oils. Fat literally makes up half your brain cell membranes – the bit that does the ‘talking’. DHA (Docosahexaenoic acid) is an important omega-3 fatty acid and it is found in seafood and certain types of algae.
A study of almost half a million people from the UK’s Bio Bank found that those taking fish oil supplements had a seven per cent lower risk of dementia[3]. The same was true for those with higher blood levels. Eating three servings of fish a week cuts Alzheimer’s risk by a third.[4][5] The best fish are those that swim in cold water and eat other fish – salmon and mackerel. Sardines, anchovies, herring and kippers are also excellent. The best of all is caviar.
Algal or seaweed-derived DHA is just as good as that found in fish, so this is essential for any vegan wishing to protect their brain. You need at least 200mg a day, but ideally double this amount. A very small amount of ALA (alpha-linolenic acid) in walnuts, chia and flax seeds, as well as colder climate leafy vegetables, does convert through to DHA so these foods are also important to eat on a daily basis.
- Supplement B vitamins
The first study that showed a reversal in the rate of brain shrinkage in people with pre-dementia gave a supplement of vitamin B6, B12 and folic acid. The study showed that the B vitamins halved the rate of brain shrinkage, cut the shrinkage in the Alzheimer’s areas of the brain by nine times.[6] The best drug to date has cut brain shrinkage by 2 per cent with virtually no clinical benefit.
B vitamins are needed to help attach omega-3 into your brain. The next big breakthrough came when Professor David Smith’s group at Oxford University showed that the omega-3 fats don’t work nearly so well without B vitamins – and the B vitamins don’t work in people with low intake of omega-3. You need both.
“In those with sufficient omega-3 status B vitamins resulted in up to 73 per cent less brain shrinkage and slowed memory decline,”[7] says Professor Smith. One in three ended the trial with no clinical signs of dementia at all. Two other trials, in the Netherlands[8] and Sweden[9], have confirmed that omega-3 and B vitamins are a dynamic duo, slowing down cognitive decline when both are sufficient.
The three critical B vitamins are vitamin B6, B12 and folic acid or folate which is found in green foods (think foliage). We recommend that older people supplement at least 10mcg of vitamin B12 a day, but the study gave 500mcg. Why? Because many older people absorb B12 less well. It needs stomach acid so those on antacid drugs often end up lacking B12.[10]
The US National Institutes of Health researchers attribute 32 per cent of risk to inactive lifestyle, 22 per cent to smoking, 22 per cent to lack of seafood or omega-3 and another 22 per cent to a raised blood homocysteine level, which is a measure of B vitamin status.[11]
- Increase antioxidant rich in fruit and veg
Your brain spends a lot of energy thinking. This makes ‘exhaust fumes’, called oxidants, which age the brain. That’s why smoking is a big risk factor. Fruits, vegetables, herbs, spices and cacao are rich in brain-friendly antioxidants and polyphenols which improve circulation in your brain and help keep it young. So, while eating five servings of fruit and veg is good advice, having a handful of berries a day (blueberries being the best), and at least four servings of vegetables is better. Cacao in chocolate is also brain-friendly[12], but the sugar isn’t. Having a cocoa drink, made with cacao powder (without sugar) is the best of both worlds. Spices such as turmeric, cumin and chilli, cayenne or paprika are also great sources of polyphenols.
- Have an active lifestyle
In the online test at foodforthebrain.org, we assess your ‘active mind’, ‘active body’ as well as ‘sleep and calm’. Your brain needs exercise. “For many people, the worst thing they can do for their brain is to retire,” says exercise expert Tommy Wood, Assistant Professor at the University of Washington. He has shown that your muscle mass predicts brain volume.
“Exercise, especially resistance exercise, is important because it makes the brain do things that keep it healthy, such as growth and repair,” he says. “When they aren’t stimulated, the health of brain tissues deteriorates, with a knock-on effect on memory and thinking.”
A study on trainee London taxi drivers learning ‘The Knowledge’—which involves memorising 26,000 streets—found that those who passed, compared to those that failed had literally built more brain tissue and connections.[13]
And it’s not just physical exercise that does this, we also benefit from the mental exercise involved in activities like solving puzzles or learning a new language. “For many people the worst thing they can do for their brain is to retire,” says Wood. “They lose much of the stimulation that kept it healthy.” It’s especially good to learn things you’re bad at. Those taking up learning musical instruments did better than professional musicians.
- Sleep well and stay calm
Just as you need a period of rest after exercise for muscles to recover, your brain needs sleep after a period of cognitive activity. The quantity and quality of sleep makes a big difference. Sleeping only five hours, or nine or more hours, doubles dementia risk.[14] The optimal sleep duration is 7 hours and the optimal time for going to sleep is10pm. ‘Owls’, who go to sleep late, have higher risk. Also, the least disrupted sleep, the better. Stress also takes its toll.
Foodforthebrain.org, has tested 380,000 people with the free online Cognitive Function Test. An NHS and University College of London study reported that nine in ten found the test useful.[15] With the new COGNITION app, which is a personalized, interactive brain upgrade programme that helps you make simple changes to dementia-proof your diet and lifestyle, you not only find out what simple changes will make the biggest difference to your risk but also get support along the way, guiding you step by step. The aim is to help you to dementia-proof your diet and lifestyle.
Foodforthebrain.org offers a free online Cognitive Function test and a Dementia Risk Index questionnaire that works out what changes you need to make to protect yourself and your brain.
ABOUT THE AUTHOR
Patrick Holford is a Nutrition and Mental Health expert & Founder of the Institute for Optimum Nutrition, VitaminC4Covid, and the charitable Food for the Brain Foundation, where he directs their Alzheimer’s prevention project. Patrick reads hundreds of studies a year assimilating the latest health breakthroughs and turning them into practical advice to make it easy for everyone to live a healthy life. He is author of 46 health books translated into over 30 languages. www.patrickholford.com
[1] Zhang X, Tong T, Chang A, Ang TFA, Tao Q, Auerbach S, Devine S, Qiu WQ, Mez J, Massaro J, Lunetta KL, Au R, Farrer LA. Midlife lipid and glucose levels are associated with Alzheimer’s disease. Alzheimers Dement. 2022 . doi: 10.1002/alz.12641. Epub ahead of print. PMID: 35319157.
[2] Yau PL, Castro MG, Tagani A, Tsui WH, Convit A. Obesity and metabolic syndrome and functional and structural brain impairments in adolescence. Pediatrics. 2012 Oct;130(4):e856-64. doi: 10.1542/peds.2012-0324. Epub 2012 Sep 3. PMID: 22945407; PMCID: PMC3457620.
[3] Yu JT et al, Circulating polyunsaturated fatty acids, fish oil supplementation, and risk of incident dementia: a prospective cohort study of 440,750 participants, BMC medicine (pending publication)
[4] Kosti RI, Kasdagli MI, Kyrozis A, Orsini N, Lagiou P, Taiganidou F, Naska A. Fish intake, n-3 fatty acid body status, and risk of cognitive decline: a systematic review and a dose-response meta-analysis of observational and experimental studies. Nutr Rev. 2022 May 9;80(6):1445-1458. doi: 10.1093/nutrit/nuab078. PMID: 34605891.
[6] Smith AD, Smith SM, de Jager CA, Whitbread P, Johnston C, Agacinski G, Oulhaj A, Bradley KM, Jacoby R, Refsum H. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PLoS One. 2010 Sep 8;5(9):e12244. doi: 10.1371/journal.pone.0012244. PMID: 20838622; PMCID: PMC2935890.
[7] JeJernerén F, Elshorbagy AK, Oulhaj A, Smith SM, Refsum H, Smith AD (2015). Brain atrophy in cognitively impaired elderly: the importance of long-chain ω-3 fatty acids and B vitamin status in a randomized controlled trial. Am J Clin Nutr. 2015 Jul;102(1):215-21
[8] van Soest, A.P.M., van de Rest, O., Witkamp, R.F. et al. DHA status influences effects of B-vitamin supplementation on cognitive ageing: a post-hoc analysis of the B-proof trial. Eur J Nutr (2022). https://doi.org/10.1007/s00394-022-02924-w
[9] Jernerén F, Cederholm T, Refsum H, Smith AD, Turner C, Palmblad J, Eriksdotter M, Hjorth E, Faxen-Irving G, Wahlund LO, Schultzberg M, Basun H, Freund-Levi Y. Homocysteine Status Modifies the Treatment Effect of Omega-3 Fatty Acids on Cognition in a Randomized Clinical Trial in Mild to Moderate Alzheimer’s Disease: The OmegAD Study. J Alzheimers Dis. 2019;69(1):189-197. doi: 10.3233/JAD-181148. PMID: 30958356.
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[11]Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health. 2014 Jun 24;14:643. doi: 10.1186/1471-2458-14-643. PMID: 24962204; PMCID: PMC4099157.
[12] Smith AD, Smith SM, de Jager CA, Whitbread P, Johnston C, Agacinski G, Oulhaj A, Bradley KM, Jacoby R, Refsum H. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PLoS One. 2010 Sep 8;5(9):e12244. doi: 10.1371/journal.pone.0012244. PMID: 20838622; PMCID: PMC2935890.
[13] Woollett K, Maguire EA. Acquiring “the Knowledge” of London’s layout drives structural brain changes. Curr Biol. 2011 Dec 20;21(24):2109-14. doi: 10.1016/j.cub.2011.11.018. Epub 2011 Dec 8. PMID: 22169537; PMCID: PMC3268356.
[14] Bubu OM, Brannick M, Mortimer J, Umasabor-Bubu O, Sebastião YV, Wen Y, Schwartz S, Borenstein AR, Wu Y, Morgan D, Anderson WM. Sleep, Cognitive impairment, and Alzheimer’s disease: A Systematic Review and Meta-Analysis. Sleep. 2017 Jan 1;40(1). doi: 10.1093/sleep/zsw032. PMID: 28364458; see also Sabia S, Fayosse A, Dumurgier J, van Hees VT, Paquet C, Sommerlad A, Kivimäki M, Dugravot A, Singh-Manoux A. Association of sleep duration in middle and old age with incidence of dementia. Nat Commun. 2021 Apr 20;12(1):2289. doi: 10.1038/s41467-021-22354-2. PMID: 33879784; PMCID: PMC8058039.
[15] M. Bird, C. Cooper, F. Patel, C. Copeman, J.L. Stansfeld, G. Charlesworth, E. Aguirre, The psychological determinants of making lifestyle and dietary behaviours after using an online cognitive health tool and its associated recommendations for protective cognitive health behaviours,The European Journal of Psychiatry,Volume 35, Issue 3,2021,Pages 145-https://doi.org/10.1016/j.ejpsy.2021.02.001.