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How does our ‘do it at home’ pinprick blood test for omega-3 predict your cognitive ability, dementia risk, brain size and intelligence? 

We are a charity dedicated to researching cognitive function and helping people look after their brain and reduce their risk of dementia and other brain-related health challenges, and TODAY we have launched a new ‘do it at home’ pinprick blood test for omega-3.

Multiple studies, including a new study, by psychologists at the Linda Loma University in California and published in the journal Brain Sciences (1), have found that the higher a person’s omega-3 index was in their blood, the more white matter there was in their brain, and the better they performed on cognitive tests that predict less risk for dementia.

With omega-3 such an important brain-health indicator, we have launched an easy, do it yourself, home pin prick test, so your omega-3 levels can be accurately determined. 

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Research also shows that the test can predict brain size and cognitive function. 

The study in California not only found omega-3 was a clear predictor of cognitive function and dementia risk (the higher the omega-3, the lower the risk), it also found that in older people in good health, levels of omega-3 predicted both their brain volume and their cognitive abilities on tests of memory and speed of thinking (the higher the level the bigger their brain volume and the faster their thinking).

“This confirms previous growing evidence that a person’s omega-3 index, which is a composite score of the two main brain-friendly omega-3 fats found in seafood, called EPA and DHA, predicts both the risk for depression (2) and dementia (3), and poorer reading ability, lower IQ, worse memory, difficulty sleeping, aggression and emotional instability in children – hallmarks of ADHD (4) .” says Patrick Holford, our founder and CEO.

The Omega-3 index, which should be above 8%, also predicts risk for heart disease (5) and developmental problems in babies from measures taken in women both before and during pregnancy. “Pregnant women with a higher omega-3 index have a much lower risk of having a baby with developmental problems, according to research at Imperial College London from the Institute of Brain Chemistry at the Chelsea & Westminster Hospital campus.” adds Holford. “It is wise for a woman considering pregnancy to check their omega-3 index and ensure it is above 8%.”

The home test kit, now available HERE also includes our free Cognitive Function Test and a questionnaire to complete about your diet and lifestyle that then identifies the key changes that lower risk of dementia. 

We have tested over 400,000 people and our goal is now to track people’s blood levels of omega-3 with cognitive function to work out exactly what the optimal intake of omega-3 for brain health actually is – so we need your help!

What about Omega-3 from plants?

While there is a type of omega-3 fat (called linolenic acid) in green leafy vegetables, as well as walnuts, chia and flax seeds, its conversion into EPA and DHA is poor. The ability to convert plant-based omega-3 into EPA, which is associated with better mood, and DHA which is the main brain-building omega-3 fat linked to lower risk of age-related memory decline and dementia, varies from person to person. So we hope to find out whether other factors such as age, sex, alcohol consumption and dietary habits, other than seafood intake, make a difference to the ability to make the brain-friendly types of omega-3 measured in this test.

The intake of marine foods has continued to decline over the past hundred years and countries with the lowest intake have the most risk for depression (6), dementia (7) and suicide (8). Even the rate of homicide is linked to a country’s omega-3 intake according to World Health Organisation data (9). 

Less than 5 per cent of children achieve the basic government guidelines for eating fish and omega-3 (10) however we really don’t know if even these guidelines are optimal for mental health. So the more people who are willing to take this inexpensive test and complete a short questionnaire about their dietary habits, plus take a 10-minute online Cognitive Function Test, the more effectively we can discover what an optimal intake of omega-3 for brain health and the prevention of dementia later in life is.

So will you join us and become citizen scientists in this way and help us advance this much-needed area of research – while also helping improve your own brain health?

The test, which costs £49.95, helps to support this research, so to check your omega-3 status click 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

¹ Loong, S.; Barnes, S.; Gatto, N.M.; Chowdhury, S.; Lee, G.J. Omega-3 Fatty Acids, Cognition, and Brain Volume in Older Adults. Brain Sci.2023,13,1278. https://doi.org/ 10.3390/brainsci13091278 

² Yonezawa K, Kusumoto Y, Kanchi N, Kinoshita H, Kanegae S, Yamaguchi N, Ozawa H. Recent trends in mental illness and omega-3 fatty acids. J Neural Transm (Vienna). 2020 Nov;127(11):1491-1499. doi: 10.1007/s00702-020-02212-z. Epub 2020 May 25. PMID: 32451632.

³ Wei BZ, Li L, Dong CW, Tan CC; Alzheimer’s Disease Neuroimaging Initiative; 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 Jun;117(6):1096-1109. doi: 10.1016/j.ajcnut.2023.04.001. Epub 2023 Apr 5. PMID: 37028557; PMCID: PMC10447496.

⁴ Montgomery P, Burton JR, Sewell RP, Spreckelsen TF, Richardson AJ. Low blood long chain omega-3 fatty acids in UK children are associated with poor cognitive performance and behavior: a cross-sectional analysis from the DOLAB study. PLoS One. 2013 Jun 24;8(6):e66697. doi: 10.1371/journal.pone.0066697. Erratum in: PLoS One. 2013;8(9).doi:10.1371/annotation/26c6b13f-b83a-4a3f-978a-c09d8ccf1ae2. PMID: 23826114; PMCID: PMC3691187; see also Raine A, Ang RP, Choy O, Hibbeln JR, Ho RM, Lim CG, Lim-Ashworth NSJ, Ling S, Liu JCJ, Ooi YP, Tan YR, Fung DSS. Omega-3 (ω-3) and social skills interventions for reactive aggression and childhood externalizing behavior problems: a randomized, stratified, double-blind, placebo-controlled, factorial trial. Psychol Med. 2019 Jan;49(2):335-344. Doi 10.1007/s11920-018-0894-y. PMID: 29623453. ; see also Liu, J., Cui, Y., Li, L. et al. The mediating role of sleep in the fish consumption – cognitive functioning relationship: a cohort study. Sci Rep 7, 17961 (2017). https://doi.org/10.1038/s41598-017-17520-w

⁵ 1 Elagizi A, Lavie CJ, O’Keefe E, Marshall K, O’Keefe JH, Milani RV. An Update on Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Health. Nutrients. 2021 Jan 12;13(1):204. doi: 10.3390/nu13010204. PMID: 33445534; PMCID: PMC7827286.

⁷ Yonezawa K, Kusumoto Y, Kanchi N, Kinoshita H, Kanegae S, Yamaguchi N, Ozawa H. Recent trends in mental illness and omega-3 fatty acids. J Neural Transm (Vienna). 2020 Nov;127(11):1491-1499. doi: 10.1007/s00702-020-02212-z. Epub 2020 May 25. PMID: 32451632.

⁸ 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. Epub 2009 Jan 9. PMID: 19136836.

⁹ Hibbeln JR. From homicide to happiness–a commentary on omega-3 fatty acids in human society. Cleave Award Lecture. Nutr Health. 2007;19(1-2):9-19. doi: 10.1177/026010600701900204. PMID: 18309762.

¹⁰ Kranz, S.; Jones, N.R.V.; Monsivais, P. Intake Levels of Fish in the UK Paediatric Population. Nutrients 2017, 9, 392. https://doi.org/10.3390/nu9040392

What is HbA1c?

HbA1c stands for Hemoglobin A1c, which is a specific type of protein that glucose becomes attached to. Glucose is a simple sugar that is absorbed into the bloodstream when your body breaks down carbohydrate foods. When glucose is absorbed, some of it becomes attached to the hemoglobin A1c protein and, over time, the more glucose that is circulating in the blood stream, the more glucose becomes attached to the hemoglobin A1c protein. HbA1c is expressed as a percentage because it is the percent of hemoglobin A1c protein that has glucose attached, so if your HbA1c is 5.5% (36.6 mmol/mol), that means that 5.5% of the hemoglobin A1c proteins have glucose attached to them.

Where does blood sugar (glucose) come from?

The main source of sugar in your blood comes directly from the foods you eat. Some examples of these types of foods include rice, potatoes, pasta and bread, as well as sugary foods such as cookies, cakes, and pastries. When glucose enters the bloodstream after you eat carbohydrates, it goes through the pancreas. The pancreas secretes insulin when you consume carbohydrates and sends excess glucose to the liver as glycogen. The pancreases also produces glucagon, which actually raises blood sugar when necessary. You need both glycogen and glucagon to keep blood sugar levels balanced.

What happens when blood sugar (glucose) levels are too high?

Glucose is the primary sugar found in your blood. It is also your body’s main source of energy. However, when there is too much in your blood over a period of time it can damage blood vessels, tissues and organs and potentially lead to serious health issues like diabetes, heart disease and cognitive disorders, as well as vision and nerve problems.

Some signs of high blood sugar include frequent urination, increased hunger and thirst, fatigue, blurred vision, tingling or numbness in the hands or feet, and unexplained weight loss. If you are experiencing any of these, you should immediately consult a health care provider.

What happens when blood sugar (glucose) levels are too low?

Low blood sugar, also called hypoglycemia, is an issue faced most often by diabetics who have taken too much insulin, causing their blood sugar level to drop. This typically requires quick treatment with sugary drinks like orange juice or honey or candy. In severe cases, someone will require a shot of glucagon to bring the level back up. Some of the signs of low blood sugar are an irregular or fast heartbeat, fatigue, sweating, irritability, and tingling or numbness on the lips, tongue and cheeks. In severe cases, hypoglycemia can also cause confusion, loss of consciousness, seizures and blurred vision. If you are experiencing any of these symptoms, you should immediately consult a health care provider.

Do I need to fast for a HbA1c test?

You do not need to fast for the HbA1c test. Unlike other glucose tests, your HbA1c number reflects glucose levels over time, not a quick, one-time snapshot of a current glucose level.

Why HbA1c vs. a fasting glucose test?

A fasting glucose test will give you a great snapshot of your current glucose level. However, fasting glucose can also be affected acutely by a lot of different factors that don’t necessarily reflect your overall glucose metabolism. On the other hand, HbA1c offers you a window into your glucose levels over a longer period (~3 months).

Is the HbA1c Test NGSP-Certified?

The HbA1c method (reagents/kit) that we purchase from the manufacturer is NGSP-certified. This means our test’s reference values are compatible with NGSP reference values.

NGSP stands for National Glycohemoglobin Standardization Program (NGSP), which was implemented to enable laboratories to report DCCT/UKPDS-traceable GHb/HbA1c results.

How often should you take an HbA1c test?

HbA1c should be tested every 2-3 months if you are making diet and lifestyle changes.

Can HbA1c be too low?

While it is possible for your HbA1c to be too low, it is very rare. HbA1c under 4.0% (20.2 mmol/mol) is considered extremely low and is associated with a significant increase in all-cause mortality. Although it is not well understood why a low HbA1c is associated with an increase in all-cause mortality, it is likely because individuals with other conditions such as iron-deficiency anemia, liver diseases/disorders, or inflammatory conditions have lower circulating glucose or lower hemoglobin levels that can affect their HbA1c. If your HbA1c is extremely low, you need to speak with a health care provider to discuss your results.

Who should get their HbA1c tested?

Anyone can benefit from better understanding their health, specifically their glucose metabolism.

I thought only diabetics needed to check their HbA1c. Is that true?

While it is important for diabetics to monitor and manage their HbA1c, anyone can benefit from checking their levels. Being proactive can help you identify areas of your health/lifestyle that may need adjusting. Or if you’ve recently made a change, checking to see if that change is having the desired metabolic effect. Elevated blood glucose is very common and can escalate quickly, so monitoring your HbA1c regularly can help you get a head of any problems down the road.

I’m active, at a healthy weight, and exercise regularly. Do I need to check my HbA1c?

Absolutely. There are so many factors that can affect blood glucose, including stress, sleep, and genetics. Checking your HbA1c can help you determine if your lifestyle is, in fact, supporting a healthy blood sugar level. And if not, you can re-check in 2-3 months when you adjust in your diet or activity.

I don’t eat a lot of desserts or sugary foods. Why should I bother checking my blood sugar?

The term “blood sugar” can be confusing as it implies that only sugary, dessert-type foods will increase blood glucose. Any carbohydrate, even healthy ones such as whole grains, beans, vegetables, and fruits can be broken down into glucose as well. Your body also can produce its own glucose in the liver when it is stressed or deprived of glucose in your diet, so checking your HbA1c can give you an idea of how well your body is regulating glucose and if you might need to make any changes.

I’m on a low carb diet. Do I still need to test my HbA1c?

It is a common misconception that people on a low-carb diet will always have low blood sugar. Although you won’t be taking in much glucose, your body can and will produce it on its own in your liver through a process called gluconeogenesis. In fact, depriving your body of exogenous carbohydrates (via food) can result in an increase in cortisol production, which then triggers the process of gluconeogenesis in your liver. Your liver will produce glucose to feed your organs, specifically your brain, because you are not taking in enough carbohydrates via your diet. So, while decreasing carbohydrates can be an effective way to manage high blood sugar, going too low in carbohydrates can lead to the opposite effect. Therefore, measuring your HbA1c while making any dietary changes is still very important.

By Patrick Holford

What does any animal, perhaps your dog, do after exercising or going for a walk?

Sleep. 

Sleep is how the brain recovers. There is now overwhelming evidence that sleep is a ‘brain essential’ and just like Goldilocks, it seems we need just the right amount. Getting too much, or too little, increases our risk for cognitive decline.

If you want to put a number on it, it appears the optimal amount of sleep for brain health is seven hours in total. And, for the light sleepers among us, there is some debate about whether it needs to all be in one go – one study found that a nap after physical exercise was in fact good for the brain, reducing the risk of cognitive impairment. 

However, for those of us with problems sleeping, or who get consistently less than the recommended seven hours, we may be literally doubling our risk of age-related cognitive decline. A UK study of Whitehall civil servants, started in the 1980’s, examining their health from the age of 35 and onwards found that ‘persistent short sleep duration at age 50, 60, and 70 compared to persistent normal sleep duration was also associated with a 30% increased dementia risk’. But it’s not just future risk of dementia that lack of sleep cranks up: it’s our ability to function the next day and to feel good. Lack of sleep decreases empathy and increases negative emotions.

Why do we sleep and why is it essential to the brain? 

Sleep can be thought of as the brain’s housekeeper. During sleep, blood and cerebrospinal fluid circulation improves, and waste products of brain metabolism get removed. These waste products include both oxidants and amyloid protein, associated with Alzheimer’s and brain inflammation, which starts to accumulate after just one night of sleep deprivation. That’s a big reason your brain needs this downtime.

One of the key powerhouses that helps clean up our brains while we sleep is melatonin. So why doesn’t melatonin do this all the time? As nightfall approaches, our brains convert serotonin into melatonin. Deep in the centre of our brain – the centre of our soul according to the philosopher Descartes, or the ‘third eye’ chakra in Yoga – melatonin is made in the pineal gland. Sensitive to light, most likely through receptors at the back of our eyes, the pineal is the only endocrine gland in contact with the outside world. Darkness stimulates the production of melatonin, whereas exposure to light (cue that late night phone scrolling!) suppresses production. 

Melatonin, then, keeps us ‘in sync’ with the day/night cycle. (Indeed, some frequent flyers find that taking melatonin supplements can help them adjust more quickly to a new time zone and avoid the tired-all-day feeling of jet lag and give them a better night’s sleep.)

Increasing levels of melatonin help us fall asleep and keep us asleep, so what is melatonin actually doing? 

Although there are many by-products of the day’s brain activity, one big slice of the toxins that accumulate in the brain are various oxidants. Apart from all the antioxidants and polyphenols we can eat to keep our brains young, melatonin is perhaps the most important antioxidant helping to disarm these oxidants and restore the mitochondrial energy factories to full function. 

Melatonin is made from a type of tryptophan, 5-HTP, a potent antidepressant. Melatonin is also a powerful anti-inflammatory and supplementation has been used to speed up recovery from cancer, covid and cardiovascular disease.

Melatonin, then, is crucial for brain health and sleep routine, and a loss of this natural circadian rhythm, and lower brain levels of melatonin are found in those with cognitive decline. 

Why dreaming is important

But there’s something else going on while we sleep, and particularly as we dream, that supports brain health. 

All being well, after about 30 minutes, we enter a period of deep sleep when our heart rate reduces, our blood pressure drops and our breathing becomes slower. This is the most restorative stage of sleep when tissue repair and regeneration occurs. After around 90 minutes, we then shift to a period of REM (rapid-eye-movement) sleep, which is when most dreaming occurs. As far as the brain is concerned, the most critical phases of sleep are these bursts of REM sleep. Lasting about 30 minutes, we move back and forth between deep sleep, lighter sleep and REM,on average between three to five times a night, with the REM stage ideally accounting for around 25% of our overall sleep time.

During the night, and especially during the deep and REM sleep phases, our brains also produce higher levels of growth hormone. This hormone helps with the repair and regeneration of our body’s tissues while melatonin helps clear out the waste products of metabolism. 

However, when we are stressed, high levels of the stress hormone cortisol suppress REM sleep and growth hormone production, diverting energy away from repair, and effectively speeding up the brain’s ageing process. In fact, people who are deprived of REM sleep won’t feel fully rested on waking and in turn are more likely to get depressed. When they do get a chance to sleep, they will often have longer periods of REM sleep, of which suggests that our brains need this time while we’re asleep to process what’s been happening in our lives. One theory is that negative emotions such as anger, fear, sadness, or frustration, often suppressed in our hectic lifestyles or the modern workplace, can be experienced and released during dreaming. To test this theory, when we have a strong negative emotion in a dream, it’s useful to track back to our experiences the day before when we felt a similar emotion.

Stress ages your brain

A good night’s sleep might help us process a bad day at the office, major stress, or prolonged anxiety, stress or overwhelm, age the brain and increase our risk of cognitive decline and dementia in the future. This has been shown by tracking people who have had two or more major stressful events such as death of a spouse, child or grandchild, divorce, financial or health problems, but also perceived psychological stress in adulthood and levels of neuroticism. 

Stress is also linked to our perception of control in our lives. One study assessed people’s work based on two criteria: how demanding the job was and how much control the person had. Those who did worse both for depression and cognitive decline had both high demands and low control over the circumstances. For example, a classic example of high stress might be caring for a parent with dementia and dealing with various NHS and social service bureaucracies. Another would be a stressful job where you don’t have the power, or the budget, to make necessary changes. Having too many unfinished things is also a classic source of overwhelm. 

But what is stress actually doing to our brain?

 The best way to understand this is to talk about the two main stress hormones, Adrenaline and Cortisol, both essential for keeping us safe and alive. Adrenalin is short-acting, kicking in, in under a second and lasting for up to an hour (but usually less). It’s what we needed to get away from the sabre-toothed tiger, or feel ready to take on a sporting challenge or that big presentation. Cortisol, on the other hand, is long acting and its level cycles throughout the day. In the morning, cortisol levels rise to kick start our day and in the evening, as we approach sleep, our cortisol levels should be reducing. But if our cortisol level is high at night we’ll have difficulty getting to sleep and if it’s low in the morning, we’ll be reaching for the caffeine before we’ve opened our eyes. 

At an evolutionary level, our ‘stress’ reaction is vital to our survival..  

However, when we get stuck in reacting stressfully, sleeping poorly or waking up with stressful thoughts, and operating with a background level of anxiety, we end up with continuous elevated cortisol as a result. This is bad news as excess cortisol is linked by many studies with worsening overall cognitive functioning, memory, slower thinking and poorer social skills, and ultimately, a greater risk of dementia and Alzheimer’s in our later years.   

What’s actually going on in the brain is that cortisol triggers these stress responses in the limbic brain which includes the hippocampus. This part of the brain then feeds back to put the brakes on further cortisol release. But, with prolonged stress, or anything else that triggers hippocampal shrinkage, the brakes on cortisol don’t get fully applied so you get into a negative loop of continued cortisol leading to increased hippocampal brain shrinkage. 

The negative loop of sugar, alcohol and stress

But this isn’t the only negative feedback chemical keeping us stressed out and stuck.  The psychologist and philosopher Oscar Ichazo uses the term ‘doors of compensation’ to describe those things we reach for when we’re stressed, and not all of them are good. 

Drinking alcohol, smoking or taking drugs, and sugar are common choices to make us feel better in the short term but the long-term effect is anything but. . 

 Alcohol, for example, causes an immediate increase in the calming neurotransmitter GABA, which also switches off adrenalin – at least for an hour or so. But there are two main problems with this. Firstly, the effect wears off and drinking too much in the evening actually shuts down GABA receptors the next day, cue the negative cycle of feeling more anxious and more stressed. The second is that alcohol is a neurotoxin and, ultimately, contributes to a brain downgrade, increasing the risk of dementia. It also negatively impacts the quality of our sleep, as the brain ‘shuts down’ rather than getting on with the vital repair and regeneration it needs during those vital hours of shut eye. 

Another favourite ‘door of compensation’, especially among those who don’t drink, is sugar.

 This is partly because of the ‘feel good’ effect of glucose, stimulating the brain’s reward system but, which in excess, leads us to continue to crave sugar more and more.  But what makes the combo of sugar and stress particularly insidious is that glucose cranks up the adrenal system, magnifying the response to stress and corresponding cortisol levels. Just in case you’re wondering, other foods high in protein or fat don’t do this. It is specifically sugar or glucose.

We routinely ‘cope’ with stress by drinking alcohol or eating sugar or both then, the likelihood is that, the next day we’ll feel more dopey and anxious or stressed on waking due to the lack of GABA receptors and lower blood sugar levels. Invariably, we are more inclined to reach for that morning cuppa Joe – a caffeinated drink and something sweet to eat. This then sets you up for more cortisol release, which makes us more stressed so, by the evening, we need more alcohol. This combo increasingly shrinks our hippocampus, the part of the brain which gives the feedback signal to switch off cortisol. Result? We live in a constant state of stress. This is a cycle we need to get out of.

The good news is, it’s possible to reverse the cycle, and start feeling good.

Here are some some simple steps to support your brain and feel better:

Focus on your sleep. Are you getting at least 7 hours a night? 
What regularly stresses you out? How could it be reduced?
Are you mindful of your alcohol and sugar intake? 
Can you find some positive ‘doors of compensation’, like gentle yoga, or a good book?
Complete the Cognitive Function Test to assess your brain health and then join COGNITION to get personalised recommendations so that you can reclaim your brain over the next 6 months.

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And if you want to get more support and more tools on how to deal with stress and support, then make sure you join us in our next webinar.

Solving Anxiety: How to Identify Your Individual Triggers and Find Resolution is on Thursday 19th October 

Click here to find out more

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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.

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References:

¹ Qian YX, Ma QH, Sun HP, Xu Y, Pan CW. Combined effect of three common lifestyle factors on cognitive impairment among older Chinese adults: a community-based, cross-sectional survey. Psychogeriatrics. 2020 Nov;20(6):844-849. doi: 10.1111/psyg.12604. Epub 2020 Aug 31. PMID: 32869429.

² Bubu OM, Brannick M, Mortimer J, Umasabor-Bubu O, Sebastião YV, Wen Y, Schwartz S, Borenstein AR, Wu Y, Morgan D, Anderson WM. Sleep, Cognitive impairment, and Alzheimer’s disease: A Systematic Review and Meta-Analysis. Sleep. 2017 Jan 1;40(1). doi: 10.1093/sleep/zsw032. PMID: 28364458.

³ Sabia S, Fayosse A, Dumurgier J, van Hees VT, Paquet C, Sommerlad A, Kivimäki M, Dugravot A, Singh-Manoux A. Association of sleep duration in middle and old age with incidence of dementia. Nat Commun. 2021 Apr 20;12(1):2289. doi: 10.1038/s41467-021-22354-2. PMID: 33879784; PMCID: PMC8058039.

⁴ Krause AJ, Simon EB, Mander BA, Greer SM, Saletin JM, Goldstein-Piekarski AN, Walker MP. The sleep-deprived human brain. Nat Rev Neurosci. 2017 Jul;18(7):404-418. doi: 10.1038/nrn.2017.55. Epub 2017 May 18. PMID: 28515433; PMCID: PMC6143346.

⁵ Herxheimer A, Petrie KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database Syst Rev. 2002;(2):CD001520. doi: 10.1002/14651858.CD001520. PMID: 12076414.

⁶ Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O’Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M. Sleep drives metabolite clearance from the adult brain. Science. 2013 Oct 18;342(6156):373-7. doi: 10.1126/science.1241224. PMID: 24136970; PMCID: PMC3880190.

⁷ Shokri-Kojori E, Wang GJ, Wiers CE, Demiral SB, Guo M, Kim SW, Lindgren E, Ramirez V, Zehra A, Freeman C, Miller G, Manza P, Srivastava T, De Santi S, Tomasi D, Benveniste H, Volkow ND. β-Amyloid accumulation in the human brain after one night of sleep deprivation. Proc Natl Acad Sci U S A. 2018 Apr 24;115(17):4483-4488. doi: 10.1073/pnas.1721694115. Epub 2018 Apr 9. PMID: 29632177; PMCID: PMC5924922.

⁸ Keithahn C, Lerchl A. 5-hydroxytryptophan is a more potent in vitro hydroxyl radical scavenger than melatonin or vitamin C. J Pineal Res. 2005 Jan;38(1):62-6. doi: 10.1111/j.1600-079X.2004.00177.x. PMID: 15617538.

⁹ Chitimus DM, Popescu MR, Voiculescu SE, Panaitescu AM, Pavel B, Zagrean L, Zagrean AM. Melatonin’s Impact on Antioxidative and Anti-Inflammatory Reprogramming in Homeostasis and Disease. Biomolecules. 2020 Aug 20;10(9):1211. doi: 10.3390/biom10091211. PMID: 32825327; PMCID: PMC7563541; regarding covid see also Tan DX, Reiter RJ. Mechanisms and clinical evidence to support melatonin’s use in severe COVID-19 patients to lower mortality. Life Sci. 2022 Apr 1;294:120368. doi: 10.1016/j.lfs.2022.120368. Epub 2022 Jan 30. PMID: 35108568; PMCID: PMC8800937.; see also Begum R, Mamun-Or-Rashid ANM, Lucy TT, Pramanik MK, Sil BK, Mukerjee N, Tagde P, Yagi M, Yonei Y. Potential Therapeutic Approach of Melatonin against Omicron and Some Other Variants of SARS-CoV-2. Molecules. 2022 Oct 16;27(20):6934. doi: 10.3390/molecules27206934. PMID: 36296527; PMCID: PMC9609612.; regarding cancer see Reiter RJ, Rosales-Corral SA, Tan DX, Acuna-Castroviejo D, Qin L, Yang SF, Xu K. Melatonin, a Full Service Anti-Cancer Agent: Inhibition of Initiation, Progression and Metastasis. Int J Mol Sci. 2017 Apr 17;18(4):843. doi: 10.3390/ijms18040843. PMID: 28420185; PMCID: PMC5412427.

¹0 Franks KH, Bransby L, Saling MM, Pase MP. Association of Stress with Risk of Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. J Alzheimers Dis. 2021;82(4):1573-1590. doi: 10.3233/JAD-210094. PMID: 34366334.

¹1 Wang HX, Wahlberg M, Karp A, Winblad B, Fratiglioni L. Psychosocial stress at work is associated with increased dementia risk in late life. Alzheimers Dement. 2012;8(2):114-20. doi: 10.1016/j.jalz.2011.03.001. PMID: 22404853; see also Gonzalez-Mulé, E., & Cockburn, B. S. (2021). This job is (literally) killing me: A moderated-mediated model linking work characteristics to mortality. Journal of Applied Psychology, 106(1), 140–151. https://doi.org/10.1037/apl0000501; see also Gonzalez-Mulé E, Kim MM, Ryu JW. A meta-analytic test of multiplicative and additive models of job demands, resources, and stress. J Appl Psychol. 2021 Sep;106(9):1391-1411. doi: 10.1037/apl0000840. Epub 2020 Sep 21. PMID: 32955269.

¹2 Ouanes S, Popp J. High Cortisol and the Risk of Dementia and Alzheimer’s Disease: A Review of the Literature. Front Aging Neurosci. 2019 Mar 1;11:43. doi: 10.3389/fnagi.2019.00043. PMID: 30881301; PMCID: PMC6405479.

¹3 Gonzalez-Bono E, Rohleder N, Hellhammer DH, Salvador A, Kirschbaum C. Glucose but not protein or fat load amplifies the cortisol response to psychosocial stress. Horm Behav. 2002 May;41(3):328-33. doi: 10.1006/hbeh.2002.1766. PMID: 11971667.

Developing dementia is the second biggest health fear, after cancer. But what can you do about it? 

The conventional view is that genes play a big part and that factors under our control, including diet, lifestyle and health status, account for up to 40% of risk and therefore up to 40% of dementia cases could be prevented or delayed. Genes actually account for less than 1% of Alzheimer’s cases. But a new study from the UK BioBank, following 344,000 people over 15 years, estimates that “up to 73% of cases could be prevented” by targeting risk factors largely under our control. 

The authors of the study, published in the Nature Human Behaviour journal (1), investigated 210 modifiable risk factors. They found that increased hand grip strength (a good reflection of physical strength), increasing leisure or social activities or time spent in sports clubs or gyms, spending less time watching TV or on a computer, having better dental health, drinking more water, not dozing off in the day and sleeping between 7 to 9 hours a night, not smoking or being exposed to smoke and having better lung function were all associated with less risk of Alzheimer’s. Being unemployed, having a low income, having diabetes, high blood pressure or having had a stroke or brain injury all increased risk. Inheriting the so-called ‘Alzheimer’s gene’, ApoE4, didn’t make any significant difference to overall risk.

However, even this figure of 73% may be an underestimate as this study excluded blood test measures. “We have under-estimated the power of prevention,” says Professor David Smith from the University of Oxford, one of the study authors. “Even this figure of up to 73% of cases preventable could be higher if a person’s omega-3 and B vitamin status, measured by a blood test for homocysteine that any GP can do, were taken into account.”

While the BioBank study didn’t include blood test measures of either homocysteine or omega-3, scientists at the US National Institutes of Health have attributed 22% of the risk of Alzheimer’s to raised blood homocysteine and 22% to a lack of omega-3 (2). “These have been shown to predict risk but were beyond the scope of this study.” confirmed the study author, Professor Jin-Tai Yu from Shanghai’s Fudan University. “Homocysteine-lowering treatment with B vitamins, especially B12, is one of the most promising interventions for dementia prevention.” 

The Impact of B Vitamins & Omega-3

Professor Smith’s group at Oxford University tested the effects of giving B vitamins (B6, B12, folate) versus placebo to those with pre-dementia and found that the 10p a day supplements halved the rate of brain shrinkage in one year and virtually stopped further memory loss (3). “The greatest effect we found in our trial was in those in the top third of DHA blood levels (an omega-3 found in fish or fish oil supplements). Those with high DHA reduced their rate of brain shrinkage by 73%, down to the level normally seen in older people with loss of cognitive function. They also had virtually no further memory loss and almost a third ended the trial with no clinical dementia rating at all.”

The benefit of omega-3 was also confirmed in a major study this year of over 100,000 people, finding that increased omega-3 cut the risk of dementia or cognitive decline by around 20%. An increase in intake of omega-3 DHA of 200 mg decreased risk by almost a fifth (4). 

And here at Food for the Brain, we take prevention seriously.

Alzheimer’s is preventable, but not curable

We developed the free online Cognitive Function Test,  which includes a Dementia Risk Index questionnaire assessing your diet, omega-3 and B vitamin status, and lifestyle and an optional home-test kit for pinprick blood tests that will be available soon.

“Over 400,000 people have taken our validated Cognitive Function Test, which not only shows a person their cognitive status right now but also their future risk based on our Dementia Risk Index questionnaire, the factors driving future risk and what they can easily do right now to lower it. If all modifiable risk factors are taken into account, including B vitamins and omega-3, it is highly likely a person could reduce risk by over 80%.” says our CEO, Patrick Holford.

“The government has pledged £160 million a year for dementia prevention research but we are not seeing any of this going into easy prevention wins. Most seem to be fueling drug research for an apparent ‘cure’.

Alzheimer’s is preventable, but not curable. You cannot reverse holes in the brain. With over 200,000 people diagnosed every year with dementia, if prevention were taken seriously we could halve the number of people developing this terrible, but preventable disease.”

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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.

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References

¹ Zhang, Y., et al. Nature Human Behaviour. 2023 7, 1185–1195

² Beydoun MA., et al. BMC Public Health. 2014 Jun 24;14:643.

 Jernerén F., et al. Am J Clin Nutr. 2015 Jul;102(1):215-21.

³ Oulhaj A., et al. J Alzheimers Dis. 2016;50(2):547-57.

⁴ Wei B., et al. Am J Clin Nutr 2023 Jun;117(6):1096-1109.