Updated May 20, 2016
Dementia, or memory loss, is a concern to all of us. We all want to maintain the health of our brains, yet often encounter some degree of confusion and/or denial when we think about how to do that.
A patient I'll call Bea has been an elegant and regular visitor to my practice for the last 15 years. Well into her 80's she is still fastidious about her appearance, but struggles to keep up with all the other details of her life. She is aware she is not as sharp as she used to be, but doesn't recognize the problem with outright memory lapses.
“I have NEVER taken that supplement I would know it!” and ten minutes later, “Oh yes, now I remember, I ran out of it and wasn't sure if I should replace it.” As we work together on her increasing dementia, she had the clarity to say, "I wish I had started following your advice earlier."
Loss of memory and reasoning ability are the aspects of mental decline most feared, but the ravages of dementia also cause changes in personality and behavior and loss of ability to perform simple activities, such as walking or swallowing. One in eight older Americans has Alzheimer's, a number likely to increase rapidly as baby boomers age. In 2012, it is estimated that 5.4 million Americans have Alzheimer's, the greatest majority of them over the age of 65. Onset younger than 65 is considered unusual. Alzheimer's is also called Type 3 Diabetes, for the similarities in problems of glucose metabolism.
The criteria for a diagnosis of dementia include a decline in both memory and at least one of the following abilities:
- Facility with language comprehension or expression, spoken or written;
- Recognition and identification of familiar objects;
- Execution of motor activities; and
- Abstract thinking, judgment, planning and implementation of complex tasks.
- The decline in memory and one of the above listed abilities must be severe enough to interfere with daily life.
Important medical considerations involve a thorough screening for any metabolic abnormality that might masquerade as or aggravate dementia. Medical testing should include evaluation of thyroid status and iodine level, levels of vitamin B12, folate, and D, general blood counts and metabolic profiles, as well as brain imaging studies (CT scans and/or MRI's). For folks with adequate B12 levels but any symptoms suggestive of B12 deficiency, consider asking your doctor for an MTHFR (methyl tetrahydrofolate reductase) test, which identifies a not uncommon genetic variant in which B12 and folate must be taken in their methylated forms to be effective.
Individuals usually note symptoms first, but with a degree of intelligence, they are able to conceal the problem from others. Once dementia is diagnosed, it is usually the case that a fair degree of cognitive loss has already occurred. At that time, a neurologist should be consulted to confirm the type of dementia, by tests including brain visualization (usually an MRI) as well as studies of the blood and perhaps the spinal fluid. A patient may have one or more of the following categories of dementia:
- Alzheimer's accounts for 60-80% of all dementias. The cause is not known, although characteristic “tangles” and plaques found after death confirm that there is a characteristic disease process, although normally functioning brains have also been found to demonstrate tangles and plaques at autopsy. The crucial factor in Alzheimers involves a reduced ability to process the sugar previously used as fuel for the brain. Changes at first are mild - MCI: mild cognitive impairment - during which time intervention is most likely to be helpful. Disease progression can include changes in mood, personality, impaired judgment and eventually confusion, and disorientation. A reduced brain size on a volume-assessing MRI is strongly suggestive of Alzheimer's as the cause of a clinically identified dementia.
- Vascular dementia - the result of silent or recognized strokes, but visible on brain imagine - often presents with impaired judgment or ability to make plans.
- Dementia with Lewy bodies (DLB) resembles Alzheimer's but often presents with unusual symptoms as well, such as sleep disturbances, visual hallucinations or parkinsonian like movement features.
- Mixed dementia involves both Alzheimer's and one other clearly identified form of dementia.
- Parkinson's disease often progresses to include a severe dementia such as that seen in DLB or Alzheimer's. Problems with movement are the common first symptom. The incidence is about 10% that of Alzheimer's.
- Other more rare dementias include Frontal-temporal lobar degeneration, Creutzfeldt-Jakob disease, and normal pressure hydrocephalus.
Conventional treatment of dementia is never curative, but only can help with symptoms. Medications prescribed fall in one of two categories, either medications that inhibit the recycling of neurotransmitter (brain information messengers) molecules, or medications affecting mood changes seen in some people with dementia. Conventional medicine will certainly step up with some better options for treatment: one just reported relates to the thought that Alzheimer's is a type of diabetes, shows improved mental function with intra-nasal applications of insulin to patients with Alzheimer's!
On the other hand, the only trial of comprehensive lifestyle management of dementia showed a 90% strongly favorable response, with not only improved memory and executive function, but also return of the diminished brain volume on MRI.
What causes the brain changes of Alzheimer's disease is the million dollar question and there is obviously no simple answer. High insulin levels (sugar! carbohydrates!), inflammation and nutritional deficiencies are some of the culprits we can remedy with our choices of food and supplements. With those thoughts in mind, sound nutritional and lifestyle choices can minimize toxins and optimize brain health and longevity.
Important risk factors might be identified through genetic testing at 23andMe.com. The gene known as ApoE comes in three forms, and the most common type is epsilon 3 or ApoE3. If you received a 3 from both your mother and father, you are ApoE 3. On the other hand if you received a 3 from one parent and a 2 or 4 from the other you would be an ApoE 2/3 or ApoE 3/4. The final possibilities are to receive 2 of the atypical genes to constitute a genotype of ApoE 2/2, 2/4, or 4/4. Here's the Alheimer's link: one copy of ApoE4 increases risk to about 25-33%, and two copies raises the risk to greater than 50-75%. On the other hand, ApoE 2 confers a modest degree of protection. Knowing you have one or more copies of ApoE 4 should inspire the adoption of a healthy lifestyle regardless of whether symptoms have appeared or not!
For the greatest health improvement with the fewest steps, do the following:
- Avoid sugar. This first step is essential. All concentrated sweeteners and refined carbohydrates must be eliminated, and all carbohydrates must be minimized until your blood sugar stabilizes and you achieve a healthy weight. For fruit lovers, choose berries. For a sweetener, stevia and xylitol are probably safe. Reducing sugar encourages your brain to switch to more useful ketones for fuel.
- Take organic, virgin coconut oil daily, either directly or in its more concentrated form, MCT oil. Coconut oil is an excellent source of ketones which are an excellent brain food for all, and the preferred food for folks with Alzheimer's, and Dr. Bronner's oil is the most reliable high quality oil.
- The best foods for dementia include: organic pasture-raised liver, cold water fish (salmon, halibut, mackerel, herring, and others) and egg yolks, but you might as well eat the whole egg! Eat two of these foods daily and if you are unwilling or unable to eat good liver, take Dr. Ron's Ultra-Pure Liver capsules, 2-6 daily with meals.
A full program involves many areas in which action steps can be taken, gradually or all at once. You will be your own most valuable health manager. Some of the suggestions below include flexibility: balance gentleness and honesty with yourself!
Start by following the basic nutrition and healthy lifestyle guidelines, with the following modifications:
Foods to Enjoy
- Eat at least 2-3 eggs daily for choline and cholesterol.
- Liver provides many valuable nutrients. Choose organic grass fed liver and eat lightly cooked or made into pate. If you are unwilling or unable to eat good liver twice weekly, take Dr. Ron's Ultra-Pure Liver capsules, 2-6 daily with meals.
- Cold water fish, such as salmon, halibut, mackerel, and herring. Eat at least twice a week.
- Take organic, virgin coconut oil daily. Coconut oil is an excellent source of ketones which are an excellent brain food for all, and the preferred food for folks with Alzheimer's, and Dr. Bronner's oil is the most pliable high quality oil. The benefit of coconut oil is the provision of “ketones” as an alternate brain fuel. Other ways to provide ketones would be to follow a very low carb, high-fat diet. More later on that one!
- Berries are the best fruits to eat. You can enjoy daily servings of berries, but limit other fruits as they might add excess sugars.
- Zinc in foods is a prudent choice. Foods richest in zinc include oysters, beef, pork, chicken, crab, lobster, and dairy.
- Cook with anti-inflammatory spices: ginger and turmeric.
- Flavonols and anti-oxidants in general are good for you. Choose green tea, black tea, dark chocolate (70% cocoa or higher)
- Dark leafy greens. Blend into soups or omelets - with eggs, butter or cream, or simply cooked with lots of butter to enhance the absorption of vital nutrients.
Foods to Avoid
- Sugars of all sorts. Excessively sweet foods make your blood as sticky as a syrup, which wreaks havoc with areas of the body (like the brain) defective on efficient circulation in small blood vessels.
- Gluten. Conventional medical testing for gluten sensitivity is notoriously incomplete. Eliminate gluten from your diet (wheat, barley, rye and most oats) for 3 months to see if you discern a difference. If you are perfectly happy without gluten, stay off of it - it's a potential hazard for many illnesses.
- Inflammatory grains. If you eat grains, make sure they are well-prepared: soak and sprout the before eating, or buy breads made from sprouted grain flour.
- Industrial trans fats (baked goods, fast foods, margarine) AND vegetable oils. The fats safe for cooking are those solid at room temperature, such as coconut, tallow and lard. Olive oil is wonderful for salad dressings. All other oils are potentially contaminated by GMO's, faulty processing yielding rancidity and indigestible components. Butter and fats from grass-fed animals contain healthful natural trans fats.
- Soy? Regular readers of this site know that I am no fan of unfermented soy. There has been one study linking tofu (unfermented soy) twice weekly to mental decline, so if you're really concerned about your brain, you might want to sit out tofu and soy milk while this controversy continues to play out.
- Barleans Fish Oil. Take 1 tablespoon, or 1500 mg, daily. My favorite is the key lime flavor.
- Well formulated multi-vitamin supplement. A good choice is Thorne Research Basic Nutrients III. Take 4-6 capsules daily. *If you have been “eating” plenty of B vitamins, but your levels test low, consider supplementing with mealtime Thorne Research Betaine HCl and Dipan-9 to enhance absorption of the B vitamins from both food and supplements.
Supplements Can Help
- Phosphatidyl Serine may be protective against all causes dementia. Take 100 mg three times daily, as contained in NOW Foods Phosphatidylserine with Gingko Biloba or Integrative Therapeutics Phosphatidylserine.
- A diversity of probiotics supports brain and total body health. For brain health, perhaps the most important is L. Rhamnosus, which is found in useful and significant amounts in Garden of Life Primal Defense. Take 1 three times daily between meals.
- Vitamin B3, otherwise known as niacinamide, is undergoing clinical trials in England. Some people have had relief of dementia symptoms taking 1000 mg three times a day (start at half that dose for a couple weeks to develop tolerance). Thorne Research Niacinamide comes in 500 mg capsules.
- Allergy Research Group NAC, 500 mg taken once daily has been a helpful nutritional supplement for people with dementia or other memory problems.
- A study of Alzheimer's patients showed that 2000 IU daily of vitamin E as alpha tocopherol slowed progression of disability (and less need for caretakers), better than memantine (Nemanda) and better than memantine combined with the same dose of vitamin E. Allergy Research Group vitamin E in a 400 IU capsule could be taken 2 or 3 on alternate days.
- Optimize your vitamin D levels, between 40-65 ng/mL. In the United States, daily supplementation of 2000 i.u. (Los Angeles) to 6000 i.u. (Seattle) is usually required, but you only know if you ask your doctor for a test. Test at the beginning of fall and the end of winter to plan low-sun (winter) and high-sun (summer) degrees of supplementation.
Supplements to avoid:
- Iron. For many reasons, including brain health, the only people taking iron in supplement form should be those with a documented iron deficiency and recommendation from a physician to supplement.
- Excess calcium. Calcium is another mineral that can be harmful in excess. Consult with your physician: more is not necessarily better. In general, the amounts included in a multi-vitamin are acceptable, but calcium as a supplement on its own should be avoided.
- Omega 3's at a discount. Omega-3 oils can easily turn rancid, in which case they offer more harm than good. Obtain your omega-3 fatty acids from cold water fish or from a highly reliable and specialized fish oil product, such as Barlean's or Nordic Naturals.
- Stay physically active, with some particular considerations. For some specific tips, visit our bloggers Carol Porter and Anna Rose.
- Regular exercise of a gentle nature - walking, swimming, yoga - has been associated with better retention of cognitive skills.
- Lift something heavy! Weight training, resistance training, or high intensity interval training have been shown to provide additional benefit.
- Maintain balance and coordination. Whether yoga, tai chi, or dancing appeals to you more, all of these activities help preserve balance and coordination, and likely also the fluidity of brain channels of communication!
- Stay mentally active as well.
- Learn something new, whether it's gardening or a foreign language.
- Games and puzzles, crossword puzzles, playing boggle, or card games keep mental faculties warmed up.
- Did you memorize poems or aphorisms when you were young? Memorization requires a different brain activity than learning, and it can be useful to flex memory muscles in different ways.
- Find a new path! Traveling familiar routes tends to stifle the brain's participation, so choose alternate routes whether walking or driving between familiar places.
- Get healthy sleep. Plan for 7-8 hours of restful sleep each evening, and a nap if you can manage it. If sleep is a challenge for you, see my suggestions for Insomnia
- Meditation may have two benefits. A wandering mind is one of the frequent complaints of early dementia, and the physical changes associated with that complaint may benefit from the practice of meditation. Additionally, how you manage your stress may be crucial. What is your strategy? Do you go for a run? A walk? Take a nap? All decent ideas and better than grabbing a cigarette or a beer. For calming the body and mind, have you considered meditation? For two reasons I invite you to incorporate meditation into your life. I have written a description of the simplest form of the technicque in Meditation Made Simple!
- Stay Social. Join a group with whom you share interests in mental or physical pursuits: a book club, a dance class, or a soup kitchen's staff.
- Chat with your doctor if you need updated evaluation of your thyroid status and iodine levels (a quick urine test is reliable), levels of vitamins B12, folate or D, cholesterol, or blood sugar.
- If you wonder if depression could be affecting your memory, please read through my discussion about depression here.
In addition to all the dietary and lifestyle suggestions listed above, some unusual findings suggest additional steps that may help keep dementia, or specifically Alzheimer's, at bay:
- Minimal to moderate alcohol. One or two drinks a day may keep Alzheimer's away, and wine is probably best. Avoid indulging more than that.
- Three cups of coffee has been cited, as has chocolate, so I'll just re-state my preference for flavonols in general, and a little caffeine can't hurt: dark (70% or more) chocolate, green and black tea, coffee and wine.
- Hormones? Okay, this requires a full-length article, but I have been convinced (from controversial literature) that post-menopausal women benefit from bio-identical hormone replacement therapy, well-monitored, and that one of the benefits is preservation of cognitive function. Look for an upcoming article on hormones. Male hormones can be helpful as well - there is less information on testosterone and brain function. Same goes for DHEA, another hormone that declines in later age and may be helpful.
Homeopathic treatment for memory problems or dementia must be individualized in cooperation with a skilled practitioner of homeopathy. Slowing mental decline is possible in individual cases with the correct remedy.
For an excellent discussion of brain health in general, I encourage you to read Nora Gedgaudas' book, Primal Body, Primal Mind . Thoroughly researched yet easily readable, her book convinced me of the neuro-toxicity of gluten sufficiently to get the last traces of gluten out of the kitchen! Newly released in 2013, Dr. David Perlmutter's Grain Brain arrives at the same conclusion from his years as a practicing and research neurologist.
I have applied her insights as well as the recommendations listed in this article to my own life and particularly with those patients worried about the health specifically of their brain. My patient Bea, whom I mentioned at the top of the page, is doing her best to comply with my recommendations for coconut oil daily, and her family and I believe there has been some help. A friend of mine consulted with me about her father: he's been the longest trial. 18 months on coconut oil, slightly improved and no further deterioration.
This is an emerging field of study: nutritional treatment for emerging dementia. I will be curious to hear of your experiences when you implement some or all of these suggestions.