If you search the internet for ways to prevent dementia, you will come up with a list with sensible advice like eat well, stay active, and stimulate yourself mentally. All sound advice, but if you’re really looking to reduce the risk, or manage the early stages of dementia, you probably want more targeted advice. Well I’ve got it for you right here. The following is a 10-15 minute read, so settle in and enjoy the learning!

What is dementia?

So what exactly is dementia? Dementia is a collection of symptoms that include a decline in cognitive function, such as memory loss, and problems with thinking skills and language. It is not considered a normal part of aging, however it is sadly the leading cause of death for women in Australia, and the second leading cause of death for Australians overall. 54% of people living in aged care facilities have dementia.

Alzheimer’s Disease (AD) is the most common cause of dementia, and there are other causes such as Frontotemporal degeneration, vascular disease, and Lewy Body disease.

Brain facts.

Did you know that the brain is made of 60% fat? All those years of being marketed “low fat” products has done our society a disservice, because we need certain fats for our brain to operate optimally. So let’s fix that right now.

In terms of diet, aim to include fatty fish such as salmon, sardines, or small mackerel. These fish are smaller in size while also containing high levels of DHA and EPA. DHA, DocosaHexaenoic Acid, is the component of fish oil that directly supports the brain. The EPA, EicosaPentaenoic Acid, supports joints, your heart, and other cells in your body.

You should also include other healthy fats such as those found in nuts, olive oil, and avocado to name a few. To make things extra easy, why don’t you focus on a brain food breakfast to start with? Try a piece of sourdough bread, with a poached egg, smashed avocado, smoked salmon or trout, baby spinach, and sprinkled with some hemp seeds. The eggs contain choline (another important brain nutrient), and the smoked salmon has the essential fatty acids DHA and EPA, and the hemp seeds and spinach are a vegan source of essential fatty acids too. Delicious, and brain nourishing!

Prevention and Treatment.

Here are 6 supplements to prevent and manage dementia or alzheimers that you probably don’t know about yet…

1. Plasmalogens.
2. DHA
3. Choline
4. Curcumin
5. Phosphatidylserine
6. Glutathione
   

   Plasmalogens.

   If you don’t work in the natural medicine industry you probably haven’t heard of plasmalogens before, so I’m here to give you the low-down. Plasmalogens are a naturally occurring glycerophospholipid (a type of lipid or fat) that are found in various parts of your body. Your body actually makes them, but we can source them from scallops and other marine animals for a supplement version.

The amount of plasmalogens in your brain reaches maximum levels around age 30, and starts to significantly decline once you are 70, and their decline has been linked to Alzheimer’s disease and Parkinson’s disease. The changes that occur in the brain are known to begin decades before the onset of symptoms, so prevention really is best when it comes to caring for your brain. But if symptoms have started, the tips I’m giving you have been scientifically validated to improve symptoms and even reverse some as well. The sooner we get started, the better.

Complicated but important info ahead!

Let’s have a quick look at what actually happens in the brain in dementia and Alzheimer’s. Visibly on scans, we can see atrophy (shrinking) of the brain matter, which means there will be a loss of neuronal and synaptic function. Neurons are the branches that reach out to each other to send messages through the brain, and synapses are the junction between each neuron branch. Neurofibrillary tangles are accumulation of a protein called tau that collects inside the neurons. Amyloid plaques are clumps of proteins that build up in the synaptic space between the neurons. These neurofibrillary tangles and amyloid plaques are thought to be the main driver of cognitive decline in Alzheimer’s disease. So our goal will be to reduce them.

Overall, the neurofibrillary tangles and the amyloid plaques all relate to protein. Protein oxidation, which is the damage of proteins, is occurring more than it should in Alzheimer’s disease. This protein oxidation causes free radicals. The development of free radicals is something that happens naturally on a day to day basis, but the presence of antioxidants is what helps to neutralise those free radicals. We utilise this process a lot in the fertility work I do so it may be a familiar concept if you have seen me before for reproductive support.

These days, we tend to have more free radicals in our bodies because of exposure to toxins, so we are fighting a bit of an uphill battle. The way to counteract this is to reduce the toxic burden on our body. I know this advice isn’t going to go down well with the cost of living crisis, but organic food is definitely a useful way to reduce toxic burden. Changing your personal care products and cleaning products to natural versions is also extremely helpful. Removing plastic from your kitchen as much as possible also helps.

Back to the plasmalogens.

Plasmalogens act as antioxidants in the brain, protecting the brain against the development of protein oxidation and formation of neurofibrillary tangles and amyloid plaques. The amount of plasmalogen in the brain negatively correlates to the severity of Alzheimer’s disease. The less plasmalogen, the worse the Alzheimer’s. At this stage, the research suggests that plasmalogens work best in aging brains as opposed to old brains, with more effects seen under the age of 77 (apologies if I have just called you old!).

2. DHA

DHA, or docosahexaenoic acid, is an essential fatty acid that supports brain health and modulates glial cell activity. It is the most abundant omega 3 polyunsaturated fatty acid in the brain, and it’s role is to support the function of neurotransmission, modulating signal pathways, myelination, neurogenesis, neuroinflammation, plasticity of synapses, as well as membrane integrity, organisation and receptor function. It does a lot for our brains! Image now if you have been eating a diet low in DHA. I bet you won’t be feeling your sharpest, as your brain is starved of something it needs for so many of it’s functions.

Ways to meet your DHA requirements.

If you were to purchase a fish oil supplement, you would want one that is higher in DHA than EPA if you’re taking it specifically for brain health or dementia prevention. You also want a product that is predominantly those two ingredients, which means it has less undesirable “filler” components. So don’t reach for that cheap fish oil on sale, as it likely has 180mg EPA and 120mg DHA, which is a very low proportion of the 1000mg capsule. Want the really good stuff? You need to consult a natural medicine practitioner like myself to get access.

Not a fan of pills? If you’re just looking at prevention, then your diet is a good place to start. Aim to include foods high in DHA such as oily fish (salmon, mackerel, sardines, herring), seaweed, chia seeds, flax seeds, hemp seeds, and walnuts. The fish sources are considerably higher than the plant sources, so if you’re plant based please consider an algae oil supplement. It’s vegan and will help your body meet it’s needs.

How DHA helps prevent dementia.

Let’s get nerdy again. Remember how we discussed how tau proteins collect in the neurons of the brain and cause neurofibrillary tangles? Well DHA supports neuroprotection by inhibiting the phosphorylation of tau. If there is too much phosphorylation, the tau protein builds up and causes those neurofibrillary tangles, so DHA stops this from happening, therefore preventing one of the known contributing factors of Alzheimer’s Disease.

APOE4 Gene.

I don’t want to get too heavily involved in discussing genetic risk factors when it comes to AD and dementia, but let’s have a quick discussion about the APOE4 gene because it relates to this DHA topic. You might have heard that Chris Hemsworth discovered he had 2 copies of the APOE4 gene, giving him an 8-10 times stronger predisposition to getting late onset AD. Well 1/4 of people actually have one copy of that gene, he just happens to have 2, which increases the risk. Our genes are not a guarantee of a disease, they are influenced by epi-genetics, which is everything that surrounds them. This means that your lifestyle is what’s actually important, not just the genes.

Now, back to DHA. Research suggests that DHA can actually target some of the pathways that are negatively affected by the APOE4 gene, including inflammatory pathways, lipid metabolism, and the integrity of the blood-brain barrier. With the APOE4 allele, it is thought that DHA doesn’t reach the brain as easily, which could be one mechanism of action for why this gene increases AD risk. So how do we get around this? Do we just take more fish oil supplements if we have that gene? No. The research so far has been predominantly in supplementation, whereas one study hypothesised that dietary DHA may better be able to cross the blood-brain barrier and reach the brain because it is in the phospholipid form, whereas supplements are not in that form. So if you have the APOE4 gene copy, dietary sources of DHA are your best option. For everyone else, supplements can help you meet your daily requirements.

If you have a family history of dementia or Alzheimer’s Disease and want to do further testing, this should be done through a health professional. I can arrange testing of the APOE4 gene, as well as other tests like telomere length testing to check your biological age against your chronological age, which helps us determine a treatment regime to support health aging.

3. Choline

I feel like we all grow up learning about dietary nutrients like vitamin C and iron, but choline isn’t normally one that people are familiar with, but it’s actually an essential nutrient required for human health. Importantly, choline is also essential to make acetylcholine, which is a neurotransmitter. Scarily, only 4% of Australians are consuming the recommended adequate intake of choline. No wonder dementia is so prevalent!

The exciting science bit.

Fertility patients of mine will already know that choline is important for the neurodevelopment of a baby in-utero. I recommend all my patients take extra choline in pregnancy for this exact reason. It has been scientifically established that higher maternal intake of choline has lifelong benefits for the child in terms of their cognition, and even more excitingly, research has found that AD neuropathology benefits can even effect future generations! There have been mouse studies that showed a reduction in cognitive deficits with Down syndrome and AD with increased choline intake. These are powerful studies that show the importance of choline for our brains.

How does it work?

Choline supplementation helps protect the brain from neurodegenerative changes by blocking the production of amyloid beta plaques and reducing microglia activation. This helps to prevent AD and dementia.

The daily recommended intake of choline is 425mg for women and 550mg for men, although it is thought this may actually be too low. Now let’s look at what you would need to eat to meet those requirements.

Based on the below graph, if I include common foods, a woman would need to eat the following in one day: 1 hard boiled egg, 85g of chicken breast, 1 large potato, 1 cup of milk, 1 cup of yoghurt, 1/2 cup broccoli, 1/2 cup peas, 1 cup brown rice. Do you think you would eat all of those specific foods in one day? You can see why it’s easy not to meet your dietary requirements. If I modified it to include higher choline foods, you would have to eat 2 large boiled eggs, 1/2 cup of roasted soybeans, and a tin of tuna. That makes it seem more reasonable to meet those targets, but if you don’t like eggs it becomes tricky. This is where supplementation can come in handy. Be honest with yourself, do some calculations, and if you aren’t hitting your daily targets, consider whether having a consultation about supplementation might suit you.

4. Curcumin

One of the contributing factors in AD and dementia is longterm inflammation. As we age, we often become more sedentary and therefore gain a little extra weight. This creates a pro-inflammatory state within the body. This is also why arthritis is more common as we age, as it is also partly driven by inflammation. There are many diseases and disorders that have inflammation as a factor, so it’s something that should be on everyone’s radar. Inflammation is also a key player in heart disease, the current number one cause of death in Australians, particularly men.

Curcumin, the active component of turmeric, is well known to be anti-inflammatory. Countries, such as India, that consume higher levels of turmeric in their diet have lower incidences of dementia. The anti-inflammatory aspect of turmeric in their diet could play a role in this. Clever scientists have proven that curcumin crosses the blood brain barrier and activates Nrf2 (fancy name for something that protects cells against damage) and it’s associated genes, and it also inhibits inflammatory cytokines which reduces inflammation in the brain. Curry for dinner is sounding like a good option!

5. Phosphatidylserine

Phosphatidylserine (PS) is a lipid, or fat, that is abundant within the brain. We discussed earlier that your brain is 60% fat, and this lipid is an important component of those fats as it helps the neurons in your brain transmit signals between each other. A study from all the way back in 1992 showed that participants with Alzheimer’s Disease who were given PS had improvement in numerous cognitive measures compared to placebo. It worked best for those in the early stage of the disease, but we have seen that across the board with all treatments – the earlier we start them the better. However, even studies in elderly patients with severe cognitive decline showed improvement in their memory.

6. Glutathione.

Glutathione is what we call “the master antioxidant”. It’s the best of the best. You may be familiar with other more common antioxidants such as vitamin C, Co enzyme Q10 (CoQ10), Vitamin E etc. When one of these antioxidants neutralises a free radical (the bad guy that damages your cells), they give an electron in that process. Glutathione then comes along and rejuvenates the antioxidant by giving them another electron so they can get back out there and neutralise another free radical.

Your clever body actually produces glutathione in your liver predominantly, so that it is readily available at all times. As you can imagine, if someone isn’t taking good care of their health with poor diet, low exercise, and excessive consumption of alcohol or medications, then their liver won’t be able to make as much glutathione, therefore your antioxidant defences will be lowered, and free radicals will be causing more destruction throughout your body, including your brain.

We know that free radicals contribute to the progression of dementia to Alzheimer’s Disease, so it’s something that needs to be addressed.

Acupuncture to support and prevent dementia.

As an acupuncturist, I feel obligated to share how wonderful acupuncture can be for your neurological health. We know from numerous studies that acupuncture supports improved blood flow, reduces inflammation, and can effect protein expression and activity in the body. These are all ways it could be helpful for dementia. A meta analysis concluded that acupuncture shows potential therapeutic effects for patients with dementia, but more higher quality random controlled trials are needed to confirm the existing evidence.

Summing it all up.

Congratulations if you’ve made it this far! I know the above is a lot to take in as it’s full of medical jargon, but it’s such an important topic for all of us to understand as it affects everyone either directly or through family and friends.

I would like to encourage you to start making some little changes today. Schedule them into your diary – a new change each week. This will make it feel achievable. I’ve written some suggestions below:

• Find somewhere to get well priced organic fruit and vegetables to reduce your toxic load.
• Buy some salmon or trout to add to your weekly menu (frozen is totally acceptable and a great way to ensure you have consistent, easy access).
• Book a consult to assess your personal risk factors and get on the right supplements.
• Swap your chemical cleaners for natural ones to reduce toxic burden (I recommend Koh and EcoStore – both available at your local Woolworths or online).
• Increase your exercise. If you don’t do anything at all, start with a gentle walk, even if it’s 10-15 minutes in the morning or afternoon. Not steady on your feet? Grab some small weights if available and do an online upper body workout. Try this one that is designed for seniors (option to use dumbbells or just your own body weight which is especially useful if you are starting from scratch.)

Now that the above is in your diary, help your family and friends manage and prevent dementia by sending them the link to this article. The more we all know, the more we can support each other to live healthy lives feeling our best.

If you want some personalised support, I’m here for you, and have created a 30 minute consultation to discuss your dementia prevention/support holistically. It is heavily discounted for the next 3 months only, so get in quick!

References

1. Wang Y, Mandelkow E. Tau in physiology and pathology. Nat Rev Neurosci. 2016;17(1):5–21. doi:10.1038/nrn.2015.1. PMID: 26825092.

2. Kidd M, et al. The relationship of omega-3 fatty acids with dementia and cognitive decline. Am J Med. 2023;136(1):1–9. doi:10.1016/j.amjmed.2023.01.001.

3. Smith J, et al. Increasing glutathione levels lowers Alzheimer’s pathology and improves cognitive decline. Neurobiol Aging. 2024;45(3):123–130. doi:10.1016/j.neurobiolaging.2024.01.002.

4. Brown L, et al. Role of phosphatidylcholine-DHA in preventing APOE4-associated Alzheimer’s disease. J Alzheimers Dis. 2023;78(2):345–356. doi:10.3233/JAD-230456.

5. Green P, et al. Effects of phosphatidylserine in Alzheimer’s disease. Neurology. 1992;42(4):645–648. doi:10.1212/wnl.42.4.645. PMID: 1609044.

6. Ma X, Li X, Wang W, Zhang M, Yang B. Phosphatidylserine, inflammation, and central nervous system diseases. Front Aging Neurosci. 2022;14:975176. doi:10.3389/fnagi.2022.975176.

7. Johnson A, et al. Low choline levels in blood associated with Alzheimer’s disease progression. Neurology. 2023;100(5):e123–e130. doi:10.1212/WNL.0000000000201234.

8. National Institutes of Health. Choline: Fact Sheet for Health Professionals. Office of Dietary Supplements. 2022. Available from: https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

9. Lee S, et al. Gender differences in Alzheimer’s disease: The role of choline metabolism. J Neurol Sci. 2024;430:120–126. doi:10.1016/j.jns.2024.01.015.

10. Patel M, et al. Curcumin’s potential in counteracting cognitive decline. Clin Ther. 2022;44(8):1234–1245. doi:10.1016/j.clinthera.2022.07.005.

11. Kumar R, et al. Curcumin, inflammation, and neurological disorders: How are they linked? Neurosci Biobehav Rev. 2023;139:104712. doi:10.1016/j.neubiorev.2023.104712.

12. Dreyling MH, et al. Histologic and immunohistologic findings and prognosis of 40 cases of gastric large B-cell lymphoma. Genes Chromosomes Cancer. 1998;22(1):72–78. doi:10.1002/(SICI)1098-2264(199805)22:1<72::AID-GCC12>3.0.CO;2-0. PMID: 9591637.

13. Mohajeri MH, et al. Docosahexaenoic acid and cognition throughout the lifespan. Nutrients. 2015;7(9):7311–7337. doi:10.3390/nu7095320. PMID: 26389909.

14. Hulbert A, et al. Alzheimer’s Disease and the Aging Brain: A Review of Current Etiology and Treatments. J Aging Neurosci. 2023;15:123456. doi:10.3389/fnagi.2023.123456.

15. De Loof A, Schoofs L. Alzheimer’s Disease: Is a Dysfunctional Mevalonate Biosynthetic Pathway the Master-Inducer of Deleterious Changes in Cell Physiology? Front Aging Neurosci. 2019;11:123. doi:10.3389/fnagi.2019.00123.