Ryan Mashiyama

NURS-375
June 3, 2019

Nutrition for the [a]geing brain: Towards evidence for an optimal diet

Increasing life expectancy across the globe has shifted research focus towards the
treatment and prevention of non-communicable diseases (NCD). Preventative measures in
the form of nutritional management have come a long way for many NCDs, but reliable data
and guidelines regarding neurodegenerative conditions such as Alzheimer's disease (AD) is
lacking. There are numerous studies showing benefits for various vitamins, micronutrients,
and dietary patterns but no concrete conclusions can be drawn due to our lack of
understanding of the etiology of AD versus normal age-related cognitive decline and
confounding factors in many of the studies.

We all experience some amount of cognitive decline as we age due to factors like
oxidative stress, neuroinflammation, etc. This normal aging can mimic signs of AD and
studies assessing nutritional benefits for AD may in fact be addressing the normal aging
process if quantifiers such as cognitive function are being used. In addition, certain
conditions such as metabolic syndrome, type 2 diabetes, obesity, etc have been associated
with higher rates of AD. Positive study results may be indirectly associated with AD by
addressing these comorbidities; while this is definitely still promising for reducing AD risk in
these population, extrapolating these studies to the general population cannot be done with
confidence. The following were potentially beneficial based on the literature review performed
by the authors:

1) Mediterranean diet – lots of plant based foods, whole grains, legumes, nuts,
olive/canola oils replacing butter, and limiting red meat intake.
2) Zinc and selenium - antioxidant effects; chromium and zinc – insulin sensitizers
3) Polyphenols – metabolites from plants showing numerous other health benefits (ex:
resveratrol from wine/grapes)
4) Vitamins – tocopherols (antioxidants based on Vit. E, however Vit. E has not shown
benefit on its own), Vit C – antioxidant effects, Vit D – correcting deficits related to
higher cognitive scores, and Vit B deficiencies as assessed with increased
homocysteine levels were associated with higher AD rates, correcting deficiencies or
supplementation have not shown conclusive results
5) Omega-3 Fatty acids (EPA and DHA) – studies show decreases in brain inflammation,
improved executive function, and MRI analysis showed decreases in gray matter
atrophy and improvements in microstructural integrity of white matter
6) Caloric restriction – high density caloric intake associated with higher AD rates.
Restriction studies have shown an association with hippocampal neurogenesis,
 increases in brain plasticity and improved synaptic function. Animal model studies
demonstrated improvements in ventricle enlargement and hippocampal activity.
7) Ketogenic diet – studied due to medium chain triglycerides (often used in ketogenic
diet to aid individuals into reaching ketogenic state faster) showing improvements in
seizure control. Preliminary studies show improvements in cognitive scores vs placebo
when supplementing with MCT and products such as Axona, an MCT medical food are
on the market.

When studying disease states such as AD that often develop slowly over many years,
nutritional studies must often take a longitudinal approach to observe dietary patterns over a
number of years. The tools used for measurement in these studies all suffer from various
forms of bias, inaccuracy, or lack of technological development and/or impractical cost and
implementation (biomarkers). Even in more robust, well designed studies, there is concern
over drawing conclusions about benefits of a particular nutrient as effects or lack thereof may
be due to a combination of nutrients or specific food sources and their own additives and
potential contaminants. However as technology continues to develop and we learn more
about AD, we will continue to get closer to nutritional approaches to decrease its prevalence.

There is no one diet, food type, or specific nutritional approach that we are confidently
able to say helps to prevent the incidence or severity of AD. However based on the available
data, it is likely that making sure you are not nutritionally deficient (vitamins, micronutrients)
and eating a healthy well balanced diet to prevent conditions such as obesity, type 2 diabetes,
cholesterol abnormalities, etc combined with lifestyle interventions will be beneficial in helping
to decrease your risk of developing AD.