Do supplements really help when it comes to cognitive decline or are they money wasted down the toilet?!
We believe that the science supports the use of correct supplementation in order to reduce risk of dementia and Alzheimer’s – so what is going on and what does the research really say?
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The WHO report saying supplements are ‘not recommended’
A 2018 report by the WHO states: ‘Vitamins B and E, PUFA and multi-complex supplementation should not be recommended to reduce the risk of cognitive decline and/or dementia.’
This 2018 WHO review makes no reference at all to the effect of B vitamins in slowing brain atrophy (1) and in improving cognition (2) in the rather large sub-group, estimated to be up to half of those over 65, with raised homocysteine. After all, why would B vitamins be expected to have an effect in those not deficient?
On closer inspection, three of the four cited studies in the WHO document are actually one meta-analysis (which is a statistical process of analysing and combining results from several similar studies). It cites only one paper which considered B vitamins (the one part-funded by Alzheimer’s Research UK) which showed a clear effect of B vitamins improving cognition in those with raised homocysteine, and one study on omega-3 DHA, which also shows clear benefit as stated in the studies summaries. Thus, it misrepresented the study that ARUK part funded on B vitamins as negative, when they had a clearly positive effect.
The only cited B vitamin study (2) states, “The mean plasma total homocysteine was 30% lower in those treated with B vitamins relative to placebo. B vitamins stabilised executive function (CLOX) relative to placebo. There was significant benefit of B-vitamin treatment among participants with baseline homocysteine above the median in global cognition, episodic memory and semantic memory. Clinical benefit occurred in the B-vitamin group for those in the upper quartile of homocysteine at baseline in global clinical dementia rating score… In this small intervention trial, B vitamins appear to slow cognitive and clinical decline in people with mild cognitive impairment (MCI), in particular in those with elevated homocysteine.”
The only cited study on omega-3 fish oils (3) states, “The fish oil group showed significant improvement in short-term and working memory.” The 12-month change in memory was significantly better in the fish oil group. This study suggested the potential role of fish oil to improve memory function in MCI subjects.
So, even based on its own cited evidence, the benefit of both B vitamins and omega-3 fish oils is supported.
How the WHO statement then recommends the opposite, ‘Vitamins B and E, PUFA and multi-complex supplementation should not be recommended to reduce the risk of cognitive decline and/or dementia.’ beggars belief. But the real problem is not the shoddy research, from 2015, used to produce this report but that it is out of date. The WHO ‘rules’ for this report was to ignore any study that was more than 5 years old, yet the WHO authors republished this same report, with the same conclusions, in 2022, by then redundant according to its own rules!
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What we’ve learned since 2018
Also, much has been learnt, and published, since 2018. There is now evidence that homocysteine lowering B vitamins are most effective in those with sufficient omega-3 status and omega-3 fish oils are most effective in those with low homocysteine. This is clinical confirmation of the known mechanism of co-dependence and illustrates why the WHO document is now out of date. We prefer published, peer-reviewed reviews such as the editorial in the American Journal of Clinical Nutrition in 2021 (4) and a meta-analysis in 2023 (5).
Additionally, since 2018, there have been at least 17 studies (6-22), including both randomised controlled trials and cohort studies which show benefit of either omega-3 fish oil supplementation, or higher intake from seafood with resultant higher omega-3 blood levels, in reducing risk for and incidence of dementia or cognitive decline.
This is another example showing why the WHO document is no longer current and relevant. Yet leading Alzheimer’s charities such as the Alzheimer’s Society and Alzheimer’s Research UK (ARUK – who part funded the highly effective B vitamin trial) still refer to this redundant report.
With regard to multivitamins, the latest meta-analysis states (7), “The meta-analysis of COSMOS substudies showed clear evidence of multivitamin-mineral benefits on global cognition and episodic memory; the magnitude of effect on global cognition was equivalent to reducing cognitive ageing by 2 years”. B vitamins, given to those with raised homocysteine, are much more effective than multivitamins given to all – and more effecctive in those with sufficient omega-3 status.
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Summary
In conclusion, the 2018 WHO report is so sloppy, and out of date – by its own rules. It would be wise for WHO to withdraw this misleading report and certainly for both ARUK and the Alzheimer’s Society and any other Alzheimer’s or dementia organisations to stop referring to it in the context of omega-3, B vitamins or multivitamins, if they are to maintain credibility in being science-based.
Note: Many people are not aware that the WHO is no longer only funded by donations from the countries that it is supposed to serve but is now also privately funded, with the second largest funder being the Bill Gates Foundation, which accounts for 10% of its budget, leading to questions over influences on its agenda.
Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
References
1. Smith AD, Smith SM, de Jager CA, Whitbread P, Johnston C, Agacinski G, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PloS one 2010;5(9):e12244.
2. de Jager CA, Oulhaj A, Jacoby R, Refsum H, Smith AD. Cognitive and clinical outcomes of homocysteine-lowering B-vitamin treatment in mild cognitive impairment: a randomized controlled trial. International journal of geriatric psychiatry 2012;27(6):592-600.
3. Lee et al 2013 – https://pubmed.ncbi.nlm.nih.gov/22932777/
4. Smith AD, Jernerén F, Refsum H. ω-3 fatty acids and their interactions. Am J Clin Nutr 2021;113(4):775-8.
5. Fairbairn P, Dyall SC, Tsofliou F. The effects of multi-nutrient formulas containing a combination of n-3 PUFA and B vitamins on cognition in the older adult: a systematic review and meta-analysis. The British journal of nutrition 2023;129(3):428-41.
6. Liu X, Zhuang P, Li Y, Wu F, Wan X, Zhang Y, et al. Association of fish oil supplementation with risk of incident dementia: A prospective study of 215,083 older adults. Clinical nutrition (Edinburgh, Scotland) 2022;41(3):589-98.
7. Vyas CM, Manson JE, Sesso HD, Cook NR, Rist PM, Weinberg A, et al. Effect of multivitamin-mineral supplementation versus placebo on cognitive function: results from the clinic subcohort of the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial and meta-analysis of 3 cognitive studies within COSMOS. Am J Clin Nutr 2024;119(3):692-701.
8. Jerneren F, Cederholm T, Refsum H, Smith AD, Turner C, Palmblad J, et al. 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. Journal of Alzheimer’s disease : JAD 2019.
9. Rouch L, Virecoulon Giudici K, Cantet C, Guyonnet S, Delrieu J, Legrand P, et al. Associations of erythrocyte omega-3 fatty acids with cognition, brain imaging and biomarkers in the Alzheimer’s disease neuroimaging initiative: cross-sectional and longitudinal retrospective analyses. Am J Clin Nutr 2022;116(6):1492-506.
10. He X, Yu H, Fang J, Qi Z, Pei S, Yan B, et al. The effect of n-3 polyunsaturated fatty acid supplementation on cognitive function outcomes in the elderly depends on the baseline omega-3 index. Food & function 2023;14(21):9506-17.
11. Doughty KN, Blazek J, Leonard D, Barlow CE, DeFina LF, Omree S, et al. Omega-3 index, cardiorespiratory fitness, and cognitive function in mid-age and older adults. Prev Med Rep 2023;35:102364.
12. Loong S, Barnes S, Gatto NM, Chowdhury S, Lee GJ. Omega-3 Fatty Acids, Cognition, and Brain Volume in Older Adults. Brain Sci 2023;13(9).
13. Maltais M, Lorrain D, Léveillé P, Viens I, Vachon A, Houeto A, et al. Long-chain Omega-3 fatty acids supplementation and cognitive performance throughout adulthood: A 6-month randomized controlled trial. Prostaglandins, leukotrienes, and essential fatty acids 2022;178:102415.
14. Andriambelo B, Stiffel M, Roke K, Plourde M. New perspectives on randomized controlled trials with omega-3 fatty acid supplements and cognition: A scoping review. Ageing Res Rev 2023;85:101835.
15. Wei BZ, Li L, Dong CW, Tan CC, Xu W. The Relationship of Omega-3 Fatty Acids with Dementia and Cognitive Decline: Evidence from Prospective Cohort Studies of Supplementation, Dietary Intake, and Blood Markers. Am J Clin Nutr 2023;117(6):1096-109.
16. Grande de França NA, Díaz G, Lengelé L, Soriano G, Caspar-Bauguil S, Saint-Aubert L, et al. Associations Between Blood Nutritional Biomarkers and Cerebral Amyloid-β: Insights From the COGFRAIL Cohort Study. The journals of gerontology Series A, Biological sciences and medical sciences 2024;79(1).
17. Sasaki N, Jones LE, Carpenter DO. Fish consumption and omega-3 polyunsaturated fatty acids from diet are positively associated with cognitive function in older adults even in the presence of exposure to lead, cadmium, selenium, and methylmercury: a cross-sectional study using NHANES 2011-2014 data. Am J Clin Nutr 2024;119(2):283-93.
18. van Soest APM, van de Rest O, Witkamp RF, Cederholm T, de Groot L. DHA status influences effects of B-vitamin supplementation on cognitive ageing: a post-hoc analysis of the B-proof trial. European journal of nutrition 2022;61(7):3731-9.
19. Gao J, Fan H, Wang X, Cheng Y, Hao J, Han S, et al. Association between serum omega-3 PUFAs levels and cognitive impairment in never medically treated first-episode patients with geriatric depression: A cross-sectional study. J Affect Disord 2024;346:1-6.
20. He Y, Huang SY, Wang HF, Zhang W, Deng YT, Zhang YR, et al. Circulating polyunsaturated fatty acids, fish oil supplementation, and risk of incident dementia: a prospective cohort study of 440,750 participants. GeroScience 2023.
21. Chedid G, Malik A, Amangurbanova M, Khraishah H, Welty FK. Docosahexaenoic Acid Levels and Omega-3 Index, but Not Eicosapentaenoic Acid Levels, Are Associated With Improved Cognition in Cognitively Healthy Subjects With Coronary Artery Disease. Arteriosclerosis, thrombosis, and vascular biology 2022.
22. Duchaine CS, Fiocco AJ, Carmichael P-H, Cunnane SC, Plourde M, Lampuré A, et al. Serum ω-3 Fatty Acids and Cognitive Domains in Community-Dwelling Older Adults from the NuAge Study: Exploring the Associations with Other Fatty Acids and Sex. The Journal of nutrition 2022;152(9):2117-24.
This is the question we get asked all the time from our community.
Normally if they go to the doctor they may get referred to a memory clinic for a Cognitive Function Test. Some get invited to take part in drug trials and there are basically two kinds of drugs under investigation – anti-amyloid and anti-p-tau. If you’re tempted to participate in any test, we would suggest finding out which type is being tested. So far the anti-amyloid treatments have not delivered any significant clinical benefit and lots of adverse effects including deaths. Anti p-tau drugs have not yet been proven to work. However, p-tau accumulation, making neurofibrillary tangles, is a function of high homocysteine which is lowered with B vitamins (see below). We know this already. So why not test and lower homocysteine with B vitamins?
Some people get prescribed cholinesterase inhibitor drugs, designed to stop the breakdown of acetylcholine. These include rivastigmine, donepezil (Aricept) and galantamine. They are marginally effective, but the effect runs out after 2 years (see why below and other approaches).
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The first steps:
The first step, with help, is to do the Cognitive Function Test here (which they may struggle with), followed by a questionnaire.
Even if they can’t complete the Cognitive Function Test, do encourage them to continue and complete the questionnaire because this will show where the weak areas that need attention are. An example test result is below.
Ideally, they should then sign up as a FRIEND to get access to COGNITION and a focused brain upgrade but if they are too far progressed to receive and respond to emails, then here are some quick wins.
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At home tests to run & what to do with the results
First, have them do the DRIfT home test to measure HBA1c, homocysteine, omega-3 index and vitamin D. If you know their HbA1c and vitamin D already then you can test these individually (see all test options here).
From a raised HbA1c we’d know if sugar balance is a problem, in which case 2 tablespoons (60g) of C8 oil is likely to help, as well as eating low carbs and avoiding sugar as much as possible (and limit alcohol). The C8 oil helps the brain make ketones which is an alternative fuel source for brain cells and fills the ‘energy gap’ created by poor glucose delivery, a function of insulin resistance.
If Homocysteine is above 10mcmol/l. we’d know they need homocysteine lowering B vitamins (including supplementing vitamin B12 500mcg – see here)
If Vitamin D is below 75nmol/l they need to supplement – probably 1,000 to 3,000ius a day or 10,000-20,000ius a week. Click here to read more about what’s needed depending on their level.
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How to support neuronal membranes
Neuronal membranes, which is what breaks down in dementia, are made from phospholipids binding to omega-3, which require B vitamins to drive a process called methylation.
If this process is not working efficiently, homocysteine goes up.
A critical phospholipid is Phosphatidyl Choline (PC), bound to omega-3 DHA (known as PC-DHA, which predicts dementia if low). The cholinesterase inhibitor drugs try to protect this but why not supplement phosphatidyl choline, which is very rich in lecithin capsules or granules? Two high PC lecithin capsules, plus at least 500 mg of omega-3 DHA, plus homocysteine-lowering B vitamin complexes cover all bases. See here for more information on supplements.
A diet low in sugar and carbs, with lots of oily fish, regular exercise and as much social and intellectual stimulation as possible along with good sleep, all make a big difference and we guide you through that in COGNITION for £5 a month or £50 a year. Access COGNITION by joining as a FRIEND here.
Once the Cognitive Function Test is complete, you will get a personalised result showing the areas that are ‘in the green’ and the areas you need to focus on (bear in mind that if dementia is already diagnosed, there will probably be a lot of red and amber colours).
All tests ordered and completed contribute to our charitable work and independent research and are a part of our Citizen Science mission!
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Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
Nutritional therapists have been measuring red cell glutathione and supplementing glutathione or its precursor N-Acetyl-Cysteine (NAC) for decades. But it’s really hard, and expensive, to measure accurately. Until now.
So how does the Glutathione Index work?
All of life is a balance between antioxidants and oxidants. That is why we, an oxygen based lifeform, have a finite life. Inside your cells glutathione (GSH) is working every second to stop harmful oxidants from ageing you. The result is spent or oxidised glutathione (GSSG). Our new test – a world first – measures the ratio between fully loaded glutathione (GSH) and oxidised glutathione (GSSG). The Glutathione index (GSH/GSSG) shows you how much antioxidant potential you have and how many metabolic fires you’ve extinguished. This ratio is the difference between mental health and mental illness.
Why does knowing this single marker help with Alzheimer’s, diabetes, schizophrenia, severe autism, depression & more?
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The Science
NAC has plenty of evidence to support its use as a promoter of glutathione and mental health, thus reducing the brain’s oxidative stress. The latest 2022 review states: “N-acetyl-L-cysteine (NAC) is a compound of increasing interest in the treatment of psychiatric disorders. Primarily through its antioxidant, anti-inflammatory, and glutamate modulation activity, NAC has been investigated in the treatment of neurodevelopmental disorders, schizophrenia spectrum disorders, bipolar-related disorders, depressive disorders, anxiety disorders, obsessive compulsive-related disorders, substance-use disorders, neurocognitive disorders, and chronic pain. Currently NAC has the most evidence of having a beneficial effect as an adjuvant agent in the negative symptoms of schizophrenia, severe autism, depression, and obsessive compulsive and related disorders.” (1)
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Glutathione and Schizophrenia
Quoting Lorraine Wilder (whose MSc in schizophrenia we funded) “Glutathione (GSH) is an important antioxidant and free radical scavenger that has been found to be decreased in the brains of people with schizophrenia [2, 3]. Although oral GSH supplementation has poor bioavailability [4], N-Acetyl Cysteine (NAC) has been shown to successfully raise plasma glutathione levels in those with schizophrenia [5]”.
In a case study of a 24 year old woman with chronic and worsening paranoid-type schizophrenia that was generally unresponsive to anti-psychotic treatment, the addition of NAC supplementation improved the patient’s symptomatology in seven days. In addition to the schizophrenia-specific symptoms, improvements were observed in spontaneity, social skills and family relations by both the patient and family members. A randomised placebo-controlled trial (RCT) including 42 participants with schizophrenia, who were experiencing an acute phase of symptomatology, were randomly assigned to receive up to 2 g/d of NAC plus up to 6 mg/d of risperidone for 8 weeks as an adjunct intervention.
Significant negative symptoms were found in the active treatment group compared to controls but not in positive or general psychopathology [6]. Furthermore, a larger RCT of 140 participants observed significant improvements on global symptomatology and general and negative symptoms of schizophrenia in the NAC supplementation (2 g/d; in addition to anti-psychotic medication) group in comparison to the placebo group over a 24-week period, but not positive symptoms [7]. Notably, after a 4-week washout period these beneficial effects diminished, with the exception of clinical severity scores.
According to Dr Chris Palmer, assistant professor at Harvard Medical School, “Glutathione (GSH), the brain’s primary antioxidant, plays a crucial role in maintaining redox balance. Magnetic resonance studies have provided mixed results regarding GSH levels in schizophrenia patients, with some studies indicating decreased levels in chronic schizophrenia, while others found no significant differences. However, these inconsistencies may be due to variations in disease chronicity, age, and symptom severity among study participants. The findings from these studies suggest several potential therapeutic targets for schizophrenia. Addressing mitochondrial dysfunction, redox imbalance, and impaired energy metabolism could lead to more effective treatments. For instance, N-acetylcysteine (NAC), a precursor to GSH, has shown promise in increasing brain GSH levels and improving symptoms in first episode psychosis patients.”
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The Glutathione Index (GSH/GSSG) is the best indicator of brain oxidative stress.
The GSH/GSSG ratio reflects the activity of the enzyme glutathione reductase which is responsible for the transformation of GSSG (used, oxidised) to GSH (the reduced or fully loaded form that acts as a radical scavenger).
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Reductions in glutathione reductase (GR) enzyme levels in patients with dementia are well established. GR levels alone are therefore a fairly good biomarker of dementia. But the mere presence of the enzyme does not guarantee its high activity. GR needs to consume NADP molecules to function properly. The advantage of our test is, therefore, that it shows changes in GR activity not only due to higher/lower GR gene activity but also due to the absence of the reaction cofactor NADP.
As shown by Irene Martinez de Toda et al 2019 (8) data, patients with dementia have a reduction in both the enzymes (GR and GP) that recycle glutathione. Thus, in general, it can be said that the glutathione metabolism (recycling) loop in those with dementia ‘spins’ much slower than in healthy patients. As a result, dementia patients have a lower potential to dynamically fight free radicals and will have a worse Glutathione Index.
In patients, the enzyme GR, which is responsible for recycling spent/oxidised glutathione back to fully loaded, slows down, which leads to the accumulation of oxidised glutathione (GSSG) and the depletion and inability to produce GSH.
Thus, the concentration of GSH decreases while that of GSSG increases. Hence the Glutathione Index gets worse / is lower.
This is why we have created the Glutathione Index test alongside analytic chemist, Dr Konrad Kowalski. “This ratio, the Glutathione Index, is a biomarker for many diseases, including both type 1 and 2 diabetes, liver cirrhosis, multiple sclerosis and Alzheimer’s disease.” says Dr Kowalski, “It’s too early to know the perfect number but it is looking like a Glutathione Index of 500 means your brain can roll with the punches, while below 200 a person definitely needs to be both changing their diet and supplementing antioxidants. Having a way to measure brain ageing with a home test kit from a pin prick of blood, means we can realistically see what the impact of specific diet changes and antioxidant supplements might be.”
So will you join us and become a part of our Anti-Age Your Brain Campaign? We need Citizen Scientists to order and complete the test so you can start to protect your brain from ageing and so we can research what the ‘perfect number’ is.
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
References
1. Bradlow RCJ, Berk M, Kalivas PW, Back SE, Kanaan RA. The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders. CNS Drugs. 2022 May;36(5):451-482. doi: 10.1007/s40263-022-00907-3. Epub 2022 Mar 22. Erratum in: CNS Drugs. 2022 Apr 28;: PMID: 35316513; PMCID: PMC9095537.
2 Yao JK, Leonard S, Reddy R: Altered glutathione redox state in schizophrenia. Dis Markers 2006, 22(1):83–93.
3 Gawryluk JW, Wang J-F, Andreazza AC, Shao L, Young LT: Decreased levels of glutathione, the major brain antioxidant, in post-mortem prefrontal cortex from patients with psychiatric disorders. Int J Neuropsychopharmacol 2011, 14(01):123–130.
4 Witschi A, Reddy S, Stofer B, Lauterburg B: The systemic availability of oral glutathione. Eur J Clin Pharmacol 1992, 43(6):667–669.
5. Lavoie S, Murray MM, Deppen P, Knyazeva MG, Berk M, Boulat O, Bovet P, Bush AI, Conus P, Copolov D, Fornari E, Meuli R, Solida A, Vianin P, Cuénod M, Buclin T, Do KQ:Glutathione precursor, N-acetyl-cysteine, improves mismatch negativity in schizophrenia patients. Neuropsychopharmacology 2008, 33(9):2187–2199.
6. Farokhnia M, Azarkolah A, Adinehfar F, Khodaie-Ardakani M-R, Hosseini S-M-R, Yekehtaz H, Tabrizi M, Rezaei F, Salehi B, Sadeghi S-M-H, Moghadam M, Gharibi F, Mirshafiee O:, Akhondzadeh S: N-acetylcysteine as an adjunct to risperidone for treatment of negative symptoms in patients with chronic schizophrenia: a randomized, double-blind, placebo-controlled study. Clin Neuropharmacol 2013, 36(6):185–192.
7. Berk M, Copolov D, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Judd F, Katz F, Katz P, Ording-Jespersen S, Little J, Conus P, Cuenod M, Do KQ, Busha AI: N-acetyl cysteine as a glutathione precursor for schizophrenia—a double-blind, randomized, placebo-controlled trial. Biol Psychiatry 2008, 64(5):361–368.
8. Martínez de Toda I, Vida C, Sanz San Miguel L, De la Fuente M. Function, Oxidative, and Inflammatory Stress Parameters in Immune Cells as Predictive Markers of Lifespan throughout Aging. Oxid Med Cell Longev. 2019 Jun 2;2019:4574276. doi: 10.1155/2019/4574276. PMID: 31281577; PMCID: PMC6589234.
In a world often filled with daunting health challenges, Alzheimer’s Prevention Day stood out as a beacon of hope and action.
This year was the first launch of this global initiative and we were privileged to witness an incredible turnout: over 10,000 individuals visited our site, driven by a shared determination to tackle Alzheimer’s disease head-on. The day was not just about awareness but about tangible actions that each person can take to safeguard their cognitive health.
One of the highlights was our interactive 3-minute Alzheimer’s Prevention Check, which 8,000 participants eagerly completed. This simple yet impactful test empowers individuals to assess their cognitive health and take proactive steps towards prevention.
Moreover, the 30-second challenge captured hearts and imaginations alike. We asked people to share on video what they do to help prevent Alzheimer’s each day?
And the answers are astounding!
From paragliding adventures to quirky activities like standing on one’s head or foraging in local forests, participants demonstrated that preventing Alzheimer’s can be both effective and fun.
Ali’s daring paragliding escapade, Zoe’s upside-down yoga prowess, and Nodge’s foraging adventures exemplify the creativity and commitment shown by our community. These actions not only inspire but also remind us that preventing Alzheimer’s is within everyone’s reach, with room for creativity and enjoyment along the way.
Central to the success of Alzheimer’s Prevention Day were the dedicated individuals behind the scenes. We extend heartfelt thanks to Cath and the team for their meticulous editing of inspiring films, and to Alex for crafting a user-friendly website that hosted invaluable resources and engaging content.
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A BIG thank you!
Behind every groundbreaking initiative are the scientists and professors whose expertise and dedication drive progress. Their research forms the backbone of our mission, guiding us towards effective prevention strategies and empowering individuals to make informed choices about their cognitive health.
As we reflect on the triumphs of Alzheimer’s Prevention Day, we invite you to join us in building a repository of inspiring actions. Visit our website to explore videos showcasing innovative ways people are preventing Alzheimer’s, and most importantly, create your own 30-second film. Share your daily practices that promote brain health, from physical activities to dietary choices, and inspire others to do the same.
Together, let’s continue to raise awareness, take meaningful action, and pave the way towards a future where Alzheimer’s is preventable. Visit Alzheimer’s Prevention Day website to learn more and get involved today.
Your actions today can make a difference tomorrow.
Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
Too much sugar shrinks the brain, but it’s so attractive. Why?
We are led by the science here at Food for the Brain, so we know that one of the best things you can do for your brain is to reduce your sugar and support your insulin control. That is why it is one of our key lifestyle domains in the COGNITION programme.
However, you probably already know too much sugar isn’t great for health but how can we make eating a lower carb and sugar life easier?
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First, let’s recap the science…
Dr. Robert Lustig, a renowned expert on brain health and a member of our scientific advisory board, highlights the significant role of insulin control and dietary choices in preventing cognitive decline.
Research from Columbia University in 2004 revealed that individuals with high insulin levels, (a primary indicator of metabolic dysfunction), were twice as likely to develop dementia compared to those with healthy insulin levels (1). Furthermore, those with the highest insulin levels exhibited the worst memory retrieval abilities (1). Similarly, an Italian study linked elevated insulin levels to declining mental function (2).
Several studies have established a connection between high sugar consumption and poor cognitive outcomes. For instance, a study among Puerto Ricans found that high sugar intake doubled the risk of cognitive impairment (3), while another U.S. study correlated elevated blood sugar levels with memory loss (4). The detrimental impact of high dietary glycaemic load (GL) on cognitive function has been observed in studies from Ireland and the United States, indicating that high GL diets are strongly associated with Alzheimer’s-related pathological changes (5,6).
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What is Glycaemic load?
Glycaemic load considers both the quality (GI – glycaemic index) and the quantity (carbohydrate content) of the carbohydrates in a food serving. It provides a more accurate picture of how a food will affect blood sugar levels. The formula for calculating glycaemic load is:
GL = GI x carbohydrate / 100
A high GL diet measured by the total glucose load on the bloodstream, is linked to increased amyloid plaque formation and cognitive decline, particularly in individuals with the ApoE4 gene, which regulates fat metabolism (7). Even individuals with high-normal blood glucose levels experience greater brain shrinkage and cognitive impairment compared to those with lower levels, as shown in long-term studies (8).
Plus, the damage of a high-GL diet can start early in life. Dr. Lustig points out that overweight children on high-GL diets show signs of cognitive decline, and adolescents with metabolic dysfunction from such diets exhibit hippocampal shrinkage and other brain structure changes (9,10).
So it is clear that eating excess sugar or the wrong types of carbohydrates with a high GL is a problem, so what do you eat?
(Wondering if you’re eating too much sugar? Then test, don’t guess with our home HbA1c test – find out more here.)
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What to eat?
There are two options: following a low GL diet or going a step further and adhering to a ketogenic approach (or switching between the two as Patrick highlights in the Hybrid Diet book). For more info on the ketogenic diet click here to find out more
A low GL diet is focused on consuming foods that have a minimal impact on blood sugar. Basically a diet rich in:
Vegetables: Most non-starchy vegetables like spinach, broccoli, and bell peppers.
Fruits: Berries, cherries, grapefruit, and apples.
Legumes: Lentils, chickpeas, and black beans.
Whole Grains: Barley, quinoa, and whole oats.
Fish and meat or tofu/tempeh: unprocessed
Dairy: Plain yoghurt and milk (unsweetened).
Nuts and Seeds: Almonds, walnuts, chia seeds, and flaxseeds.
Whilst eating this way can support your brain health it can also help you sustain energy levels, help with weight loss and improve heart health.
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So how can we make it easier?
At Food for the Brain we have a few ways to help you feed your brain on the right foods:
Complete the Cognitive Function Test and join COGNITION so we can walk you through how to reduce sugar and upgrade your brain over the next few months.
Upgrade Your Brain Cook App – full of low GL recipes and coming soon. Help us by pre ordering today to get brain-loving recipes at your fingertips.
Here is a recipe sample:
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Almond and coconut porridge
Breakfast Serves 2, generously
TOTAL GLs: 4
Ingredients:
2 tbsp milled flaxseed 2 tbsp coconut flour 2 tbsp whole flaxseed 2 tbsp chia seeds 2 tbsp coconut flakes, toasted in a dry pan 2 tbsp raspberries 2 tbsp blueberries 2 strawberries 8 walnuts, broken up 1 tbsp soft brown sugar alternative (or sweetener of choice) 300ml unsweetened almond milk 1 tbsp chicory root syrup (or sweetener of choice)
Instructions:
Stir everything (except the desiccated coconut, nuts and berries) together in a saucepan and let sit for 10 mins.
Gently heat through until thickened – add a little more milk if needed to get the consistency you like.
Top with the berries, nuts and toasted coconut – add some natural yoghurt if you like.
Drizzle with the chicory syrup
Cooks Notes
It’s worth seeking out the chicory syrup – very low sugar and also high fibre.
Nutrition Highlights
Antioxidants: High in antioxidants, particularly vitamins A, C, and E, which help protect cells from damage and support immune function.
Protein: A moderate source of protein, supporting muscle maintenance and repair.
Fibre: Contains a high amount of fibre, aiding in digestion and promoting satiety.
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Other resources
Here are a few other resources to make low sugar easier,
FATT bars– easy low GL and low carb snacks for on-the-go. Use the code FFTB10 to save 10% and FATT will donate to the charity with every purchase.
Dillon bread– low carb bread and their brand new high fibre, low GL, Chicory Fibre Syrup perfect for adding to porridge and also suitable for diabetics. Use code FFB10 to save 10% and Dillon will donate 10% with every purchase.
Keto Mojo– if you want to take it a step further and follow a ketogenic diet then grab one of their ketone readers to make life easier and to check you are in ketosis. Use code FFB10 to save 10%.
These companies are some of our supporting organisations – find out more here.
Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
References
Abbatecola AM, Paolisso G, Lamponi M, Bandinelli S, Lauretani F, Launer L, Ferrucci L. Insulin resistance and executive dysfunction in older persons. J Am Geriatr Soc. 2004 Oct;52(10):1713-8. doi: 10.1111/j.1532-5415.2004.52466.x. PMID: 15450050.
Abbatecola AM, Paolisso G, Lamponi M, Bandinelli S, Lauretani F, Launer L, Ferrucci L. Insulin resistance and executive dysfunction in older persons. J Am Geriatr Soc. 2004 Oct;52(10):1713-8. doi: 10.1111/j.1532-5415.2004.52466.x. PMID: 15450050.
Ye X, Gao X, Scott T, Tucker KL. Habitual sugar intake and cognitive function among middle-aged and older Puerto Ricans without diabetes. Br J Nutr. 2011 Nov;106(9):1423-32; doi: 10.1017/S0007114511001760. Epub 2011 Jun 1. PMID: 21736803; PMCID: PMC4876724.
Power SE, O’Connor EM, Ross RP, Stanton C, O’Toole PW, Fitzgerald GF, Jeffery IB. Dietary glycaemic load associated with cognitive performance in elderly subjects. Eur J Nutr. 2015 Jun;54(4):557-68. doi: 10.1007/s00394-014-0737-5. Epub 2014 Jul 18. PMID: 25034880.
Seetharaman S, Andel R, McEvoy C, Dahl Aslan AK, Finkel D, Pedersen NL. Blood glucose, diet-based glycemic load and cognitive aging among dementia-free older adults. J Gerontol A Biol Sci Med Sci. 2015 Apr;70(4):471-9. doi: 10.1093/gerona/glu135. Epub 2014 Aug 22. PMID: 25149688; PMCID: PMC4447796.
Taylor MK, Sullivan DK, Swerdlow RH, Vidoni ED, Morris JK, Mahnken JD, Burns JM. A high-glycemic diet is associated with cerebral amyloid burden in cognitively normal older adults. Am J Clin Nutr. 2017 Dec;106(6):1463-1470. doi: 10.3945/ajcn.117.162263. Epub 2017 Oct 25. PMID: 29070566; PMCID: PMC5698843.
Taylor MK, Sullivan DK, Swerdlow RH, Vidoni ED, Morris JK, Mahnken JD, Burns JM. A high-glycemic diet is associated with cerebral amyloid burden in cognitively normal older adults. Am J Clin Nutr. 2017 Dec;106(6):1463-1470. doi: 10.3945/ajcn.117.162263. Epub 2017 Oct 25. PMID: 29070566; PMCID: PMC5698843.
M.E. Mortby et al., ‘High “normal” blood glucose is associated with decreased brain volume and cognitive performance in the 60s: the PATH through Life Study’, PLoS One (2013), vol 8 .
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) . doi: 10.1542/peds.2012-0324. Epub 2012 Sep 3. PMID: 22945407; PMCID: PMC3457620.
Lakhan, S.E., Kirchgessner, A. The emerging role of dietary fructose in obesity and cognitive decline. Nutr J 12, 114 (2013).
Loef M, Walach H. Fruit, vegetables and prevention of cognitive decline or dementia: a systematic review of cohort studies. J Nutr Health Aging. 2012 Jul;16(7):626-30. doi: 10.1007/s12603-012-0097-x. PMID: 22836704.
You may have heard of a search for new tests to find those most likely to get Alzheimer’s disease? But is this misdirected?
Perhaps so, according to the Alzheimer’s Prevention Expert Group (APEG) – a collaboration of top UK, American and Chinese academics (which we are a part of – find out more here) who consider this to be “..a misguided waste of money”.
Controversially, their stance challenges the major thrust of charities such as Alzheimer’s Research (ARUK), which strongly supports search for a reliable test for the disease.
APEG explains that there is already a widely used way to spot failing memory and thinking skills – hallmarks for dementia and Alzheimer’s. These include a neuropsychological test battery (NTB) and a validated Cognitive Function Test (CFT) similar to the one we provide free. Both are routinely used in memory clinics to diagnose mild cognitive impairment and support the diagnosis of dementia.
Over the last decade the charity Food for the Brain has used the Cognitive Function Test to find people at risk and advise them how to reduce their risk with simple dietary and lifestyle changes.
Nearly half a million people to date have been tested, with someone taking the test every 2 minutes!
When does Cognitive Decline begin?
Cognitive function declines steadily from the age of 18. This means that it is possible to spot individuals whose cognitive function is dropping off faster than the average, giving time to encourage preventative actions with personalised advice on their diet and lifestyle changes.
Alzheimer’s, which makes up two-thirds of dementia cases, involves the shrinking of certain areas of the brain as neurons die off. It can be detected with a specialised brain scan several years before a diagnosis. These ‘PET’ scans can be used to diagnose Alzheimer’s and/or vascular dementia. The trouble is that such scans are expensive and not likely performed early enough to discover those ‘at risk’.
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What about p-tau?
As well as shrinkage, another marker for Alzheimer’s is a toxic protein called p-tau. This creates clumps of tangled nerves in the brain. These can be found in the fluid that bathes the brain but again there is a problem. Detecting it can be done with a lumbar puncture, but this is a risky and expensive process and certainly not suitable to test tens of thousands of people.
At first sight, if a blood test could identify those heading towards Alzheimer’s earlier this could be a cheaper and less invasive alternative to such scans. However, the search is likely driven by a quite different ulterior motive – to create and sell drugs – much like cholesterol and statins. What’s more it’s unlikely to be an improvement!
A recent New York Times article pointed out that such a test would result in people being diagnosed with ‘pre’ Alzheimer’s, even if they have no obvious symptoms. That’s because having the marker would be considered enough to justify a diagnosis of the disease or, at least, the prescription of a drug.
This is what happens with amyloid protein. Amyloid forms plaque in the brains of those with Alzheimer’s. The latest drugs, such as lecanemab and aducanumab, remove this. But not all those with Alzheimer’s have plaque, and people can develop dementia without plaque. What’s more none of these drugs have a clinically significant effect, and they come with the risk of severe adverse effects, including death from brain bleeding and swelling, especially in those with a history of stroke.
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A very cheap and safe alternative…
Perhaps the most convincing reason why the new blood marker hunt is “misguided” is that there is something very cheap and very safe that can prevent the accumulation of p-tau tangles in the brain – B vitamins.
Suppose you are not taking in enough B6, folate or B12, which becomes harder to absorb as you get older, blood levels of a toxic amino acid called homocysteine rise. This increases the level of p-tau and inhibits the brain from clearing it. According to pharmacology professor David Smith, a member of APEG and our Scientific Advisory Board: “Homocysteine is not a diagnostic marker for dementia but it is a modifiable risk factor. Raised levels of homocysteine account for some 20% of dementia cases and homocysteine testing is relatively inexpensive and available.”
Smith, who was second in charge at Oxford University’s School of Medical Sciences, ran the VITACOG trial which found that high doses of B vitamins given to people with Mild Cognitive Impairment (MCI) and high homocysteine, not only slowed the rate of brain cell death by up to 73% but also arrested cognitive decline.
He, and his APEG colleagues, favour using a Cognitive Function Test, to identify those at risk. Then, testing risk factors and biomarkers such as homocysteine to be included in the research, with funds being made available for testing blood biomarkers because this is one thing you can actually do something about.
Other useful tests for risk factors include omega-3 and vitamin D levels, since low levels of these nutrients also increase risk; also HbA1c, the standard measure used to diagnose diabetes, since lower levels help protect the brain and high levels indicate those who need to reduce their intake of sugar and processed foods. These tests are corroborative rather than diagnostic but importantly identify prevention actions that people can take.
2. Then do further blood tests such as homocysteine, omega-3, vitamin D and HBA1c for glucose control that help guide diet and lifestyle prevention, which is available right now. Order your DRIfT test here
So keep things simple and start today!
Complete our validated Cognitive Function Test, then order your blood tests and be a part of our Citizen Science research and movement.
Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
References
The VITACOG trials, evidence for homocysteine as causal and lowering it with B vitamins as disease modifying and a consensus statement regarding this evidence, in the Journal of Alzheimer’s Disease, is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836397/
Widespread omega-3 deficiency is cranking up aggression.
Children flying off the handle, fighting at school, increasing rates of ADHD, depression and violent offences, perhaps even more global conflicts – a new study suggests that something very simple could be cranking up aggression.
Less omega-3 from seafood.
A study of 4,000 participants over 28 years, has found a clear reduction in aggression when children and adults are given either omega-3 supplements or eat more fish. According to advisor to the US National Institutes of Health, Dr Joseph Hibbeln, a country’s incidence of homicide, depression and suicide ‘tracks’ their seafood consumption. In Australia, a prisoner’s omega-3 index, measured in a pin prick blood test predicts anger, aggression and AHDH. A study in UK prisons found that giving omega-3 supplements to prison inmates, compared to placebos, reduced violent offences by more than a third.
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Omega-3 support in community, clinics and our criminal justice system
“Based on this evidence our considered opinion is that there is now sufficient evidence to begin to implement omega-3 supplementation to reduce aggression in children and adults, whether the setting is community, the clinic or criminal justice system” say the study authors Adrian Raine and Lia Brodrick from the University of Pennsylvania.
“There is now clear evidence that not only are low blood omega-3 levels associated with increased aggressive behaviour but supplementation with fish oil can reduce aggressive tendencies in adults and children.” says Professor William Harris from the Fatty Acid Research Institute in the US, one of our scientific advisors.
This is why we now offer an easy, pin prick home test for omega-3 to go alongside our free online Cognitive Function Test and diet and lifestyle questionnaire that assesses omega-3 status and other factors that are important to your brain function and development.
We need to treat it the same as vitamin D
“Less than 5% of children in the UK achieve the basic recommended levels of omega-3” says Dr Simon Dyall, clinical neuroscientist at the University of Roehampton who also advises the charity “Even these recommendations are too low, according to the evidence regarding brain function. Many children eat no fish at all and don’t supplement omega-3. The evidence is more than sufficient to recommend that we take action now to protect our children’s brains.”
In the same way that GPs test vitamin D we need to test both children and adults presenting with ADHD, depression, anxiety and aggression for their omega-3 index.
In Japan, where a lot of seafood is eaten, the level is 10% and rates of violence, depression, suicide and Alzheimer’s are a fraction of those in the UK. People in the UK and US average 4% on the pinprick omega-3 index. You need over 8% for a healthy brain. Many offenders test as low as 2%.
You can’t build a healthy brain without omega-3. Our children are suffering. There is more than enough evidence of this.
Yet there is no government recommendation in the UK of how much omega-3 we need. The advice to eat fish twice a week is neither enough, nor heeded.
That is why we are helping people help themselves by testing their omega-3 index and advising them accordingly. But we need this done on a national scale, especially in poorer communities.
If doctors can test and prescribe vitamin D, why can’t they test and prescribe omega-3?
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
References
A. Raine, L. Brodrick ‘Omega-3 supplementation reduces aggressive behavior: A meta-analytic review of randomized controlled trials’Aggression and Violent Behavior, 2024, 101956 doi.org/10.1016/j.avb.2024.101956.
Hibbeln JR. Depression, suicide and deficiencies of omega-3 essential fatty acids in modern diets. World Rev Nutr Diet. 2009;99:17-30. doi: 10.1159/000192992.
Meyer BJ, Byrne MK, Collier C, Parletta N, Crawford D, Winberg PC, et al. (2015) Baseline Omega-3 Index Correlates with Aggressive and Attention Deficit Disorder Behaviours in Adult Prisoners. PLoS ONE 10(3): e0120220. doi:10.1371/ journal.pone.0120220
Gesch CB, Hammond SM, Hampson SE, Eves A, Crowder MJ. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial. Br J Psychiatry. 2002 Jul;181:22-8. doi: 10.1192/bjp.181.1.22.
Today marks the halfway point for 28 Upgrade Your Brain events in Ireland and the UK and it has been a delight to meet mothers, daughters, fathers and sons sharing their hopes, struggles and stories of transformation, joining the mission to save as many brains as possible from unnecessary mental illness.
Here are a few recent sharings. Please encourage all your friends and family to attend the remaining seminars (book your tickets here) and – if not near you – come to the webinar on June 5th – book your virtual ticket here.
We’ve received many requests for more seminars in the North (and in Wales) so I’m cooking up a tour in late October of Wrexham, Leeds, Edinburgh and Glasgow. Maybe Manchester if anyone on the ground invites me. Then we’re off to China and Japan!
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The Music…
Some have asked to hear the songs, my HeartStuff playlist on Spotify that I’ve been playing before and after the seminars, and on the road, as we drive through the early hours, over mountains and rolling hills, by the water, crossing bridges in the early morning mist and driving rain. (What a magnificent green world this is!)
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The Poems…
Also, some have asked for poems such as Ignosis, Demented, The Beach and The Cat Who got Corona from her Owner. Read the poem here.
Looking forward to meeting you down the road in June. Then we’re off to America and Canada in July. Get your tickets here.
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A big thank you!
A big thanks to Viridian who are spreading the word to all health food stores, Ros at patrickholford.com, you and all the local health food stores (too many to mention) for helping spread the word.
For helping to spread the word to your people and practitioners.
As Dr David Perlmutter says “You are the architect of your brain’s destiny.”
Make it a good one! No need for this dementia devastation.
Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
Attention-Deficit Hyperactivity Disorder (ADHD) is not just an issue to address with our children. Many adults are finding themselves diagnosed with this brain disorder and conventional medicinal support is limited.
Why are we struggling to focus and concentrate OR focus on one specific task at a cost to our health, relationships and other essential life activities (known as hyperfocus)?
We can see how this, if not managed, can be problematic for children and the impact it can have on their learning and confidence but what if you are an adult who has recently realised that your brain works and struggles differently to those around you? (If you are interested in supporting your child’s brain and development we have our Smart Kids programme coming soon)
The incidence of neurodevelopmental disorders like Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) has surged in recent years and both are classified as neurodivergent conditions (along with other conditions like learning disabilities, attention-deficit and anxiety disorders, obsessive-compulsive disorder and Tourette’s syndrome).
In the UK and the USA, the rise in diagnoses has been significant, prompting questions about underlying causes and potential solutions. While there may be a familial aspect, we know ‘it is not in the genes’. So, why are we facing this attention deficit disaster?
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The Attention Deficit Disaster in Adults
ADHD is not confined to childhood; many adults continue to experience its symptoms, which can significantly impact their personal and professional lives. Also, many parents discover this about themselves as they go through the process of getting their child diagnosed.
Common symptoms of adult ADHD include:
Inattention: difficulty sustaining attention during tasks, making careless mistakes, not listening when spoken to directly, and being easily distracted (1,2).
Hyperfocus: paradoxically, some adults with ADHD can become intensely focused on tasks they find stimulating or rewarding, often to the exclusion of other activities (3).
Disorganisation: chronic issues with organising tasks and activities, often leading to missed deadlines and forgotten appointments (4).
Time Management Problems: struggling to manage time effectively, leading to procrastination and difficulty completing tasks (5).
Impulsivity: making hasty decisions without considering the long-term consequences, interrupting others, and difficulty waiting for their turn (6).
Emotional Dysregulation: experiencing intense emotions, such as frustration or anger, and difficulty managing stress (7,8).
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It looks different for men and women…
ADHD can present differently in men and women, which often leads to underdiagnosis or misdiagnosis in women. Here are some key differences:
Inattention vs. Hyperactivity: women are more likely to exhibit inattentive symptoms, such as disorganisation, forgetfulness, and difficulty focusing. In contrast, men often display more hyperactive and impulsive behaviours, like restlessness and acting without thinking (9,10).
Emotional Symptoms: women with ADHD may experience higher levels of emotional dysregulation, including mood swings, anxiety, and depression. Men are more likely to exhibit externalising behaviours, such as aggression and conduct problems (11,12).
Coping Mechanisms: women tend to develop coping strategies that mask their symptoms, such as becoming perfectionists or overworking to compensate for their inattentiveness. This can delay diagnosis and treatment (13).
Social Consequences: women with ADHD often face significant social consequences, including challenges in maintaining relationships and social isolation. Men, however, may struggle more with academic and behavioural issues in school settings (14,15).
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Start at the very beginning of brain development…
The adult brain begins at conception, making maternal nutrition crucial.
As well as avoiding alcohol and smoking during pregnancy we know from a study of 11,875 pregnant women there is a clear relationship between the amount of seafood consumed by a pregnant woman and their child’s development. The less seafood consumed, the worse the child’s social behaviour, fine motor skills, communication and social development, and verbal IQ. (16)
In addition, a lack of vitamin A during pregnancy, another nutrient rich in seafood, can affect brain development and lead to long-term or even permanent impairment in the learning process, memory formation, and cognitive function. (17)
Plus, there is folic acid. A mother’s folate intake predicts the child’s performance in cognitive tests at the age of nine to ten (18) and the higher a baby’s B-vitamin status, the higher their cognitive function at the age of 25. (19) Supplementing mothers-to-be with folic acid (400mcg/day) during the second and third trimesters of pregnancy is associated with better cognition in their children at the age of three and better word reasoning and IQ (verbal and performance) at seven.(20)
Nothing can be built properly in the brain without healthy methylation and methylation requires folate (which is reflected by a low homocysteine level). Raised homocysteine is a well-known predictor of miscarriage and pregnancy problems, which is why I recommend no woman attempts pregnancy until her homocysteine level is below 7 mcmol/l.
While we have learned that a homocysteine level above 11 means increased brain shrinkage, even a homocysteine level of above 9 during pregnancy predicts more problems, specifically withdrawn behaviour, anxiety, depression, social problems and aggressive behaviour in the child at the age of six. (21)
So looking back to your childhood development might help you to understand your adult brain. How well nourished was it? Did you get adequate folate, vitamin A and consume seafoods as a child?
Our hope is some of the deficit in brain function can be recovered by providing all brain-dependent nutrients at an optimal level and see what happens.
What would happen if you started to eat more fish and seafood? Here is some of the science:
Lower DHA concentrations are associated with poorer reading ability, poorer memory, oppositional behaviour and emotional instability. (22)
Several studies have shown increased aggression in those with low omega-3 DHA and EPA, and giving more omega-3 reduces aggression.(23)
Improved IQ and sleep quality: a study of 541 Chinese schoolchildren found that fish consumption predicted sleep quality and that those who ate the most fish had the highest IQ – 4.8 points higher than those who ate none. Improved sleep quality, linked to fish intake, was correlated with IQ. (24)
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Other Essential Nutrients for Brain Health
The brain needs nourishing, especially in childhood as it is growing and developing rapidly, but also as adults.
Here are some of the essential nutrients you may want to focus on to optimise your brain:
Vitamin A: can affect brain development and lead to long-term or even permanent impairment in the learning process, memory formation, and cognitive function. (17)
Vitamin D: low vitamin D levels in childhood are related to behaviour problems in adolescence (25) and are significantly linked to a higher risk of dementia and cognitive decline. (26, 27, 28)
Chromium, copper, zinc, and magnesium: children with ADHD tend to have lower levels of zinc, chromium, and magnesium, with some having low levels of copper (29). One study found a higher copper to zinc ratio in neurodivergent children compared to neurotypical children, predicting the degree of ADHD (30). Zinc supplementation has been shown to improve memory and attention spans in ADHD (31). Additionally, magnesium deficiency is common in ADHD, and supplementation has been linked to reduced hyperactivity (32). Deficiencies in these minerals can contribute to symptoms of ADHD and other neurodevelopmental disorders.
So are we Neurodivergent or Neurodeficient?
In the chart below I’ve listed the most common characteristics in those with autistic spectrum disorder by the US Center for Disease Control and Prevention
I’ve added a column for the nutrients, when deficient, that have been shown to induce these symptoms.
Omega-3 DHA, Hcy/B vitamins, dysglycemia (sugar), vitamin C
Lack of fear or more fear than expected
Omega-3 DHA, Hcy/B vitamins, dysglycemia (sugar), vitamin C
Hcy stands for homocysteine which is the best indicator of lack of methylating B vitamins
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Ending your sweet tooth…
It’s not just about specific nutrients, the amount of sugar you consume has a big impact on your brain health.
Too many carbs and ultra-processed foods are bad for anyone at any age, as is too much sugar. They are linked to children’s mental health issues relating to symptoms of ADHD (33) and autism and adult anxiety and depression, (34) and strongly linked to increased risk of age-related cognitive decline, dementia and Alzheimer’s.
Going back to childhood, even the glycemic load of a mother’s diet predicts a massive four-fold risk of anxiety in toddlers, with five times more impulsivity in boys, and four times as many sleeping problems, while girls have 15 times the likelihood of anxiety in those in the top third for glycemic load. (35)
So while you probably already know it, reducing sugar is imperative to your brain health.
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Gut health & food intolerances
Dr Alessio Fasano, who is both Professor of Paediatrics at Harvard Medical School and Professor of Nutrition at Harvard’s Chan School of Public Health, thinks something is going wrong in the gut, with many ASD children reporting gut problems, including diarrhoea, constipation, belching and excessive flatulence and dysbiosis indicated by an abnormal pattern of gut bacteria. (36)
Professor Fasano’s research finds that neurodivergent guts show high levels of zonulin, which can lead to leaky gut. (37) The gluten in wheat makes the zonulin levels go up.
Opioid-like wheat and milk proteins have been found in the urine samples of those with ASD, making these foods especially ‘addictive’. This was the discovery of researchers at the Autism Research Unit at the University of Sunderland, headed by Paul Shattock, now known as ESPA Research. They developed successful strategies for helping children with autism known as the Sunderland Protocol. (38)
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The four drivers of ADHD
Optimum nutrition has a big role to play in helping ameliorate negative symptoms of neurodivergence.
Multi-nutrient trials have shown improvements in irritability, hyperactivity and self-harm in children with ADHD.(39) Raised homocysteine and low B12 or folate are associated with greater risk of developing ASD and worse symptoms, (40) creating methylation abnormalities that could explain many of the symptoms. (41) Supplementing homocysteine- lowering B vitamins makes symptoms better. (42)
So to summarise conditions like ADHD may be the result of either:
A high-GL diet, with too much sugar
A lack of essential omega-3 fats
A lack of critical nutrients such as B vitamins, zinc and magnesium
Unidentified food intolerances (read more about how food intolerance can impact the brain here)
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What you can do
For adults managing ADHD, a holistic approach that incorporates dietary changes and supplementation can be highly effective. Here are some strategies:
Feed your brain! The food you eat provides the ‘raw material’ for your brain and body. Focus on a diet rich in whole foods, including 3-5 portions of oily fish a week, nuts, seeds, leafy greens, and vegetables, to ensure adequate intake of essential nutrients.
Add in key nutrients. Consider supplementing with B-vitamins, zinc, magnesium, copper, chromium, and other essential nutrients to address deficiencies and support optimal brain function. Find out more about recommended supplements and dose requirements here
Test don’t guess. Test your vitamin D, omega-3, and sugar levels, along with your homocysteine to get accurate data on what you need to focus on or supplement with.Find out more about the accurate, at-home tests here
Mindful Eating. Pay attention to food intolerances and adopt a low-glycemic load (low sugar) diet to stabilise blood sugar levels and improve cognitive function.
Complete the Cognitive Function test below to get personalised information on your area of risk and what you can do to mitigate them and upgrade your brain over the next 6 months..
Reclaim your brain so that your neurodivergence can serve and support you, and no longer create additional struggle in your life.
Thank you for reading!
Food for the Brain is a non-for-profit educational and research charity that offers a free Cognitive Function Test and assesses your Dementia Risk Index to be able to advise you on how to dementia-proof your diet and lifestyle.
By completing the Cognitive Function Test you are joining our grassroots research initiative to find out what really works for preventing cognitive decline. We share our ongoing research results with you to help you make brain-friendly choices. Please support our research by becoming a Friend of Food for the Brain.
References
1 Barkley RA. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press; 2010.
2 Kooij JJS, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry. 2010;10(1):67.
3 Asherson P, et al. Attention deficit hyperactivity disorder in adults: A review of the literature. Nat Rev Neurol. 2012;8(2):93-104.
4 Brown TE. Attention Deficit Disorder: The Unfocused Mind in Children and Adults. New Haven: Yale University Press; 2005.
5 Faraone SV, Biederman J, Mick E. The age-dependent decline of ADHD: A meta-analysis of follow-up studies. Psychol Med. 2006;36(2):159-165.
6 Willcutt EG, et al. Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. J Abnorm Psychol. 2012;121(4):991.
7 Shaw P, et al. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry. 2014;171(3):276-293.
8 Surman CB, et al. Emotional dysregulation in adult ADHD and response to atomoxetine. J Atten Disord. 2011;15(5):354-368.
9 Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596.
10. Williamson D, Johnston C. Gender differences in adults with attention-deficit/hyperactivity disorder: A narrative review. Clin Psychol Rev. 2015;40:15-27.
11.Loo SK, et al. Cognition in girls with attention-deficit/hyperactivity disorder: Executive functions, emotion regulation, and comorbidity. J Am Acad Child Adolesc Psychiatry. 2008;47(3):262-274.
12 Babinski DE, et al. A meta-analysis of neuropsychological functioning in posttraumatic stress disorder. Arch Clin Neuropsychol. 2015;30(8):724-743.
13 Skogli EW, et al. Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence. J Affect Disord. 2013;145(2):241-249.
14 Grevet EH, et al. Gender differences in prevalence of symptoms of attention deficit and hyperactivity disorder in adults. Rev Bras Psiquiatr. 2005;27(1):21-24.
15 Solanto MV, et al. The prevalence of sluggish cognitive tempo in psychiatric outpatients with ADHD, anxiety, and mood disorders. J Atten Disord. 2017;21(8):666-674.
16 Hibbeln JR, Davis JM,] Steer C, Emmett P, Rogers I, Williams C, Golding J. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet. 2007 Feb 17;369(9561):578-85. doi: 10.1016/S0140-6736(07)60277-3. PMID: 17307104.
17 Z.Liu Behav Neurol. 2021 Dec 7;2021:5417497
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The brain of H. sapiens evolved from a chimpanzee cranial capacity of 340cc to the peak of 1,500 to 1,700cc about 28,000 – 32,000 years ago. That encephalization was powered by the epigenetic force of wild foods, in which marine foods would have been essential to provide omega 3 DHA, and trace elements including iodine, essential for brain growth, function and maintenance. (Encephalization is an evolutionary increase in the complexity or relative size of the brain, involving a shift of function from non-cortical parts of the brain to the cortex.) The brain evolved in the sea some 500 million years ago using such nutrients and science shows they are still required today.
In recent times, the brain has been shrinking, likely due to the increasing reliance on intensively produced land foods and the decline in fish and seafoods.
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Since 1950 there has been a 40% per capita decrease in fish landings in the UK and a decline in the fishing communities and ports. At the same time, there has been a decline in average IQs and an escalation of mental ill-health. Just recently the Children’s Society declared that there had been a 3-fold increase in hospital referrals for mental ill-health in children in the last 3 years. In March 2023, the Federation of European Neuroscientists declared that brain health was now a global emergency.
The continued shrinking of the brain and escalation of mental ill health can only end in disaster.
The solution lies in the restoration of destroyed sea beds with marine pastures, planting of kelp forests, farming of shellfish and the planting of artificial reefs to provide surfaces for marine flora to flourish and as with the seagrass, enhance the natural productivity.
At the same time this solution of marine enhancement fixes CO2. This has been done in Japan, starting in 1991. It is also being started in many other places including Scotland, Korea, Oman, Saudi, Australia, and in the US. It now needs to be escalated with energy which could create a new industrial revolution and a sea change in nutrition and brain health. It is all in our book, The Shrinking Brain by Crawford and Marsh, just published.
Want to dive even deeper? Then you can get instant access to the Upgrade Your Brain Conference, with world-class speakers like Dr David Perlmutter, Dr Robert Lustig and many more!
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Thank you for reading!
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