By Robert H. Lustig, MD, MSL

Most people know that refined sugar is not good for you, but what is it about sugar that’s particularly bad for your brain? Why is it essential, not only for brain health and dementia prevention, to reduce your intake of not only sugar but refined carbohydrates in general? (By refined, I mean those whose fiber has been processed away – not ‘whole’ as in vegetables, whole fruit (not juice), beans, and whole grains.

Let’s start at the extreme. What happens if you lived at the North Pole, and ate virtually no carbohydrates, or at least so little as to force your body and brain to switch to a kind of fuel, ketones, produced from fat? This is often called a “very low carb high fat” (LCHF) or “ketogenic” diet. Would you get sick? This is what Vilhjamur Steffanson did, when his Arctic exploration shipwrecked in 1913, and he was forced to live amongst the Inuit for two years. He noted that there was no diabetes, no cancer — and no Alzheimer’s. In 1928, he and his colleague checked themselves into Bellvue hospital, and ate only meat for one year.[1]They were healthier than the researchers who studied them! 

Your brain likes ketones

Ketones are made in the liver from fat – either breaking down your own fat (for example, if you were fasting, eating very little or exercising a lot), or from ingestion of a type of fat containing ‘medium chain triglycerides’ (MCTs). Coconut oil is approximately 54% MCTs and contains all 4 MCTs (C6, C8, C10, C12), but it turns out that one particular kind of MCT, called C8 because it is 8 carbons long, is the best fat for the liver to convert into ketones.

You may be surprised to know that your brain can run well on glucose (the kind of sugar that is fuel for our cells), but even better on ketones. The reason is that ketones cross into the brain easily, rapidly, and without a biochemical transporter. This is why children with severe epilepsy improve on a ketogenic diet. Watch this short film ‘Fuel your Brain’.

Brain benefits of a low-carb ketogenic diet

In fact, brain cells prefer ketones. In two studies, one on people with Alzheimer’s and the other on those with pre-dementia or mild cognitive impairment, giving 2 tablespoons of C8 oil (called capricin or caprylic acid triglyceride), brain energy derived from ketones went up by 230% and memory and mental acuity improved in those with Minimal Cognitive Impairment (MCI).[2,3]

A ketogenic diet has been shown to reduce schizophrenia symptoms, help reduce shaking in Parkinson’s, and slow down cognitive decline in those with dementia or pre-dementia. In fact, the ketogenic diet has been used to effectively treat childhood epilepsy for over 100 years! There’s a good review on the current status of the ketogenic diet in psychiatry here^.[4]

Ketogenic diets may help in many ways. Firstly, when a person eats too much carbohydrate, sugar, but especially fructose, damages the energy burning factories in cells, called mitochondria, so their ability to produce chemical energy for the neuron is greatly reduced. Switching to burning ketones instead can increase mitochondria number and function. A recent study also shows that a ketogenic diet has a positive effect on the gut microbiome,[5] and this might be one way the diet helps reduce fits in people with epilepsy.[6] Fructose, on the other hand, disrupts the gut microbiome in a negative way.

How sugar damages your brain

But what is it about a ketogenic diet that is good for your brain? Is it the ketones, the lowering of insulin, the type of fat, the elimination of carbohydrate, or specifically the elimination of sugar? We don’t yet know – I ask this question of every Alzheimer’s and metabolic researcher I know, and no one can tell me – just that it works.

There are a few possible mechanisms. First, the more carbs and sugar you eat, the more resistant you become to the hormone insulin. Insulin not only drives glucose into cells (including brain cells), but also sends excess sugar to the liver to turn into fat. When a person becomes insulin resistant, ironically, glucose transport is negatively impacted, reducing brain energy availability. Insulin resistance is a major driver of depression.[7] A ketogenic diet can reverse that. 

Fructose, which comprises half of sucrose (‘white’ or ‘table’ sugar), and half of ‘high-fructose corn syrup’ (added to numerous processed foods), damages our mitochondria, which leads to less brain energy availability. One study showed that fructose reduces liver mitochondrial function, while glucose stimulates it^.[8]  “The most important takeaway of this study is that high fructose in the diet is bad,” said Dr. C. Ronald Kahn from the Joslin Diabetes Center.  “It’s not bad because it’s more calories, but because it has effects on liver metabolism to make it worse at burning fat. As a result, adding fructose to the diet makes the liver store more fat, and this is bad for the liver and bad for whole body metabolism.”

Fructose is the main sugar in most fruits. People then extrapolate, “oh fruit must be bad for you.” Not true. Whole fruit has fibre (both soluble and insoluble); together they slow down glucose and fructose absorption in the GI tract limiting both liver and brain exposure, and they also help feed the gut bacteria (microbiome), so actually you get less fructose entering the bloodstream. Juicing the fruit removes the protective fiber, and juice has been shown to be just as dangerous to metabolism as is soda. So, eat your fruit — don’t drink it!

Carbohydrates and fructose age your brain

There’s another reason why sugar, and especially fructose, is bad for your brain and body. They produce Advanced Glycation Endpoints or AGEs, which damage the brain. These ‘oxidise’ proteins (so does cigarette smoke), rendering them useless , allowing them to aggregate into clumps, and use up valuable antioxidants in your diet such as vitamin C and E.

Fructose acts on your liver to switch your metabolism away from fat burning to fat making and storing, and inhibits an anti-ageing process called ‘autophagy’ which helps clean up and remove damaged mitochondria in order to regenerate new, healthier cells.

Why sweet foods are so addictive

So far we’ve only explored why sugar is bad for your “physical” brain. Knowing this is a good start. But why does your “emotional” brain keep telling you that you want it? Why do people find it so hard to resist, and so many become sugar addicts? The answer is that fructose activates the “reward system” in the brain. It causes dopamine release, the motivational neurotransmitter associated with ‘reward’. Any chemical that does so can be addictive – cocaine, heroin, alcohol, nicotine, or example. The trouble is the more you have, the more your brain ‘down-regulates’, i.e. becomes less responsive to your own natural feel-good dopamine, so you end up needing more sugar to get the hit and, in the end, you get no hit at all but feel thoroughly awful without it. That’s the Law of Diminishing Returns. That’s addiction.

Blood sugar control reduces dementia risk

Keeping blood glucose levels in the low-normal range is reflected by a low blood glycosylated haemoglobin (HbA1C) level, which means ‘sugar-coated red blood cells’. A low HbA1c is good and is a proxy for improved insulin sensitivity, associated with reduced risk for dementia in several studies.[9,10,11,12,13,14] 

A new study also shows that, in 40 year old adults with so-called normal glucose levels but at the higher end of the normal range, have increased their risk of Alzheimer’s by 15% [37]

Type 2 diabetes, the net result of losing blood sugar control, almost doubles the risk for dementia.[15,16] Diabetes is also associated with more rapid brain shrinkage.[17,18] Even people in the upper normal range of blood glucose have increased brain atrophy, impaired cognition, and increased risk of dementia.[19,20]

For instance, one trial measured HbA1c and glucose levels in several thousand elderly people over the course of almost seven years. In that time, slightly more than a quarter of the participants developed dementia, and the bottom line was that rising glucose levels were associated with increased risk of developing the condition, irrespective of whether the participants also had diabetes. Non-diabetics who experienced a modest increase in blood sugar levels had an 18% increased risk of dementia, as compared to those who already had diabetes at the start of the study or developed it within the trial period, who had a 40% increased risk.[21]

Prevention action – how to cut down your sugar load

In practical terms, preventing dementia today means avoiding sugar as much as possible.  If you’re going to eat carbohydrate, eat ‘whole’ carbohydrate foods such as whole vegetables, fruits (not juice), beans, only wholegrain bread (labelled as ‘100% wholegrain’, or pasta in small quantities. 

Starchy carbohydrates such as pasta, rice and potatoes benefit from being cooked and cooled, then eaten cold or re-heated, as some of the carbohydrate is converted into resistant starch – a type of fibre we can’t digest but which has the added benefit of fermenting and feeding our gut bacteria.

Make sure the carbohydrate comes with its inherent fibre. Oat cakes would be better than bread since the fibre in these foods helps ‘slow release’ the sugars. Eating white bread is associated with a poorer cognitive test performance, whereas high fibre bread is associated with better performance.[34] Eating carbohydrate foods with protein, for example brown rice with fish, or porridge oats with seeds, or fruit with nuts, further reduces the glycemic load (GL) of a meal. The best fruits in this respect are low-sugar high-fiber fruits like berries, cherries, and plums.

These kinds of foods are consistent with a Mediterranean diet which has also been shown to reduce risk.[35] Conversely, grapes, raisins, and bananas are high GL. A study in Finland and Sweden compared those with a healthy versus unhealthy diet, including the above criteria, in mid-life for future risk of developing Alzheimer’s disease and dementia 14 years later. Those who ate the healthiest diet had an 88% decreased risk of developing dementia and a 92% decreased risk of developing Alzheimer’s disease.[36] 

The take-home message is, if you are going to eat complex carbohydrates, eat them with fibre, fat and protein.

However, if you want to go one step further, you can switch to eating a ketogenic low-carb, high fat diet. The problem with the ketogenic diet is staying on it – there’s so much carbohydrate out there it’s hard to avoid it. But there are now breath monitors (e.g. Ketoscan, BioSense from ReadOut Health) that can help you stay in ketosis. A good book to help you explore and put into practice either a low carb ketogenic diet or a low GL diet is ‘The Hybrid Diet’ by Patrick Holford & Jerome Burne. And to understand how processed food is your enemy, take a look at my book ‘Metabolical’.

And if you want to know how sugar is impacting your body and brain then upi can take one of our at-home, pin-prick, HbA1c (sugar) blood test so you can know exactly how sugar is impacting your body and also become apart of our vital research into this area.

Become a Citizen Scientist & Join our Sugar Research today!

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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The mouth is a hub of activity, housing around 50–100 billion bacteria from 200 different bacterial species. The role of these resident bacteria in the mouth, also known as the oral microbiome, is an emerging area of research. Alterations in the oral microbiome may occur as a result of factors including consuming high amounts of sugar, smoking tobacco and experiencing chronic stress. Drinking large amounts of alcohol can also negatively impact the oral microbiome. Disruptions to the oral microbiome can lead to gut dysbiosis, which has been associated with increased permeability of the Blood Brain Barrier (BBB). 

Findings to date suggest that the oral microbiome, via interactions with the gut and brain (a network called the oral-gut-brain axis), may be a key consideration for brain health, and multiple associated conditions. This post will focus on three key areas where there is present research: autism, Down’s syndrome, and Alzheimer’s disease. 

Autism

Individuals with autism have been indicated to have alterations in their oral microbiome, as well as gut dysbiosis and related disruptions to the gut-brain axis. A study investigating the oral microbiome indicated that children with autism have a higher incidence of gastrointestinal disturbance and food allergies. Moreover, children with autism were observed to have a disruption to the ratio of Firmicutes: Bacteroidetes bacteria, in favour of Firmicutes. Balance of the Firmicutes: Bacteroidetes ratio is key for integrity of the gut, and disruptions to this ratio are indicative of gut dysbiosis.  

Moreover, two specific groups of bacteria, Brucella and Enterococcus faecalis were observed to be elevated in autistic children, whilst Flavobacterium sp. levels were demonstrated to be decreased. Research has suggested that individuals with autism have a higher risk of developing Alzheimer’s disease earlier in life. One potential mechanism for this could be due to alterations to the Firmicutes: Bacterodetes ratio.

Firmicutes and Bacteroidetes both utilise amyloids in the gut as structural material. Recognition of amyloids may become impaired by increased synthesis of inflammatory T cells by the innate immune system, as the result of intestinal permeability. Translocation of amyloids across the BBB has been hypothesised to be associated with enhanced Aβ deposit in the brain, although this requires further research.

Down’s Syndrome

Individuals with Down’s syndrome have been demonstrated to be more susceptible to periodontitis, or gum disease. One potential explanation for these findings could be due to alterations in oral microbiome composition. One study observed that individuals with Down’s syndrome have higher levels of Streptococcus mutans in their saliva. A further study observed increased levels of the pathogenic bacterial strains Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.  Individuals with Down’s syndrome have an increased risk of developing Alzheimer’s disease later in life, with 50% of individuals >60 years of age meeting diagnostic criteria for dementia. One hypothesised mechanism for this is because of altered expression of inflammation and immune system modulating genes in periodontitis.

Alzheimer’s Disease

Individuals with Alzheimer’s disease have been observed to have higher levels of the oral bacteria, Treponema, in the brain. Moreover, disruptions to the oral-gut-brain axis has been associated with increased accumulation of beta amyloid and Tau, two key markers of Alzheimer’s disease.

Supporting the Oral-Gut-Brain Axis 

Supporting the oral-gut-brain axis is an area of research that is undeveloped, however, it seems logical that many of the measures employed for supporting gut and brain health would also be salient. 

Increase Fibre & Polyphenols

Consuming a wide array of colourful vegetables, fruits, herbs and spices is a great way of increasing prebiotic fibres, which help to support gut health via increasing production of SCFAs (short chain fatty acids), and polyphenols, plant compounds that have antioxidant properties and have been demonstrated to support the oral-gut-brain axis. 

Increase Omega-3 Fats

Omega-3 fats exert anti-inflammatory effects in the body, whilst increasing microbiome diversity via balancing the Firmicutes: Bacteroidetes ratio, which is essential for gut health and gut barrier integrity. Additionally, increased levels of omega-3 have been associated with reduced incidence of periodontitis. Ways to increase omega-3 include increasing consumption of oily fish such as salmon, mackerel and sardines, and also flaxseeds, walnuts and algae. 

Increase Fermented, Probiotic Foods

Probiotics have been associated with improved oral health due to decreased presence of pathogenic bacteria in the mouth. Examples of probiotic foods include fermented foods such as kimchi, kombucha, kefir, sauerkraut and sourdough bread.

Stress is a human adaptive response involving complex, yet fascinating physiological and psychological mechanisms. 

Stress has been designed for our daily survival as species, however, when stress becomes the only response we can lean on to live our lives we may find ourselves trapped in a loop with detrimental effects to our overall health and wellbeing.

Exposure to intense, repetitive and prolonged stress (chronic stress) tells our bodies and minds to continue to respond with stress, even when the stressful event is no longer present. Our bodies will not only adapt to cope with higher levels of stress, but will also continue to release hormones (cortisol and adrenaline) that keep this adaptive physical response or continuous loop going. 

This stress mind-body loop can feed an endless list of physical and mental health issues such as Alzheimer’s disease, Type 2 diabetes, insomnia, IBS, depression and anxiety, but it can also impact our nutritional status, i.e. the essential vitamins and minerals that our bodies need to survive and thrive.

Stress can lead to prolonged release of the stress hormone cortisol, impacting the ability of our brains and adrenal glands to regulate it. In turn, excessive cortisol creates inflammation and weakens our immune system.

Nonetheless, stress responses are a key part of our body’s ability to self-regulate and bring itself to a state of homeostasis. Think about stress as a continuum, varying from positive stress-resilient responses to negative ill-health stress responses. As we navigate through this continuum day by day, nutrition and lifestyle can become one of our best allies in helping to minimise the negative effects of this loop, if not stop it completely.

A diet rich in omega-3 fats, vitamin E, magnesium, folic acid and vitamin B6 has been associated with positive benefits with regards to stress resilience. Omega-3 fats can be found in oily fish, flaxseeds and walnuts; vitamin E in olive oil, olives, avocados, nuts and seeds; magnesium in almonds, bananas and dark green leafy vegetables such as kale and broccoli; folic acid in organ meats, spinach and beans; and B6 in chicken, salmon, chickpeas and sunflower seeds. These nutrients can help by regulating our stress response, balancing our hormones, strengthening our immune system and protecting our brain function and mental wellbeing.

Eating processed and refined foods with a higher number of calories and lower nutrient content (e.g. sugar, alcohol, saturated and trans-fats), can make us feel increasingly tired, irritable, anxious and lacking attention and focus. These foods can cause our blood sugar levels to rise quickly then drop suddenly like a rollercoaster ride. A simple change to more nutrient-dense meals and foods, i.e. foods with a high level of essential vitamins and minerals and other nutrients, such as protein, fibre and complex carbohydrates can be very supportive for the body during times of stress.

A lifestyle that includes regular exercise, restorative sleep and rest, emotional support, positive social interactions and relationships, and plenty of laughter, fun and creativity can also help boost our resilience to stress and adversities and support a shift whereby stress is no longer perceived as a permanent threat but as an adaptive bio-psychological response.

With thanks to our volunteer, Catia Soares, for this article. Catia is a Psychologist and Nutritional Therapist with more than 11 years experience in the field.

March is caffeine awareness month. Coffee is one of the commonest forms in which caffeine is consumed daily. In the UK alone, it is estimated that nearly 100 million cups of coffee are consumed per day. Despite coffee’s popularity, there remains much conflicting scientific evidence regarding the benefits and potential downsides of drinking coffee, and the impact of caffeine on brain health.

Caffeine is a psychoactive substance, which may increase alertness and arousal, and therefore enhance cognitive performance. Long term coffee consumption across the lifespan has been associated with a decreased risk of developing Alzheimer’s disease and Parkinson’s disease. These findings may be explained by some of the phytochemicals present in coffee, which may exert protective effects. 

Coffee has been indicated to modulate dopamine-mediated responses related to cognition and movement, which may have some preventative and ameliorative effects in Parkinson’s disease.  In Alzheimer’s, coffee has been suggested to decrease the accumulation of beta-amyloid, a key marker of Alzheimer’s, when >2 cups per day were consumed. However, positive results with respect to coffee and Alzheimer’s risk reduction specifically have not been observed consistently across studies, and therefore further research is merited. Additionally, caffeine consumption may disrupt sleep, depending on the time of day that it is consumed. This could theoretically increase risk of Alzheimer’s disease development long term as sleep is essential for the functioning of the glymphatic system, which is involved in beta amyloid clearance. 

Daily consumption of caffeine over 600 mg could have a detrimental impact on the heart-brain axis, via increasing serum homocysteine and cholesterol levels. Furthermore, higher intakes of caffeine have also been suggested to increase anxiety, restlessness and cause gastrointestinal disturbances. 

Caffeine increases levels of dopamine, a neurotransmitter, involved in experiencing pleasure, and also involved in the biology of addiction. Addiction to coffee, and therefore caffeine, is prevalent, and can manifest with a variety of withdrawal symptoms, including headaches, tiredness and irritability. Coffee should therefore be enjoyed in moderation, at no more than 200 mg in one sitting (around 2½ cups of coffee) or 400 mg overall daily (which equates to 5 cups of coffee). 

Current NHS guidelines suggest that no more than 200mg of caffeine should be consumed daily during pregnancy. Notably, the British Medical Journal has recently challenged this view based on findings from observational studies, which suggest that caffeine should be avoided completely whilst trying to conceive and during pregnancy, as it may increase incidences of miscarriage, stillbirth and adverse pregnancy outcomes. 

In conclusion, individuals should moderate their consumption of coffee, and caffeine. If sensitive to the effects of caffeine, trying to become pregnant, or pregnant, individuals should consider caffeine free alternatives to coffee. A further caveat specifically for pregnancy is that some caffeine free herbal teas should only be consumed in small amounts, and some must be avoided completely, in pregnancy, and the advice of a midwife or physician should be sought if needed. 

Our latest blog explores specific nutrients and dietary patterns that are most supportive of female brain health across the lifespan.

Premenstruation

The age at which periods begin varies from female to female. Therefore it is highly beneficial to establish a varied diet from an early age, with a wide range of colourful vegetables and fruits, nuts, seeds, pulses and essential fats from nutritious sources such as oily fish and unprocessed olive and coconut oils. This will help to set the foundations for key nutrients, which will support female hormone health, as well as brain and overall health, across the lifespan.  

Menstruation

Periods normally begin between the ages of 10-16, although they can begin at a younger age, due to genetic and environmental factors. Periods onset may also be delayed to a later age in individuals who have a family history of late-onset periods, are doing large amounts of exercise, experience stress, are underweight, or have an eating disorder or health condition affecting the ovaries. 

Some key nutrients for menstruating women include:

Iron

The average blood loss experienced across a period is estimated to be between 3-5 tbsps of blood, and iron loss may occur at varying degrees depending on heaviness of the period blood flow. It is therefore imperative to ensure iron levels are maintained across a woman’s lifespan. Females with iron deficiency may manifest with symptoms such as pale skin, low energy, failure to thrive, reduced appetite and behavioural and emotional issues. 

Females with iron deficiency may also have higher risk of developing depression and anxiety, because deficiency of iron causes altered levels of serotonin and dopamine. Serotonin and dopamine are two neurotransmitters involved in mood regulation. Furthermore, iron deficiency results in alteration to balances of the neurotransmitters glutamate and GABA, which have an excitatory and calming effect on the nervous system, respectively. Iron status should be monitored and supported through nutrition and, if required, supplementation throughout a woman’s menstrual life. 

Fats 

Consuming fats is essential for female hormone health. Oestrogen and progesterone, hormones involved in the female reproductive system, are synthesised from cholesterol. There has been a focus in the last few decades on cholesterol levels that are too high. However, it is equally important, but perhaps less discussed, to ensure that cholesterol levels do not become too low, as this can impact on female hormone balance. Female adolescents following low fat diets, or diagnosed with an eating disorder, are particularly at risk of experiencing hormonal imbalance, for this reason.  

Women should ensure they are consuming monounsaturated fats, such as avocado and olive oil, and polyunsaturated fats, such as omega-3. Research has demonstrated that omega-3 is involved in modulating mood, memory and cognition. The role of omega-3 in supporting the gut-brain axis is also an important consideration. Omega-3 fats are essential for increasing and maintaining levels of beneficial bacteria in the gut microbiome. Some strains of beneficial gut bacteria are involved in the synthesis of neurotransmitters such as serotonin, dopamine and GABA, which are all involved in modulating mood. This provides one possible explanatory mechanism for why omega-3 may be supportive of mental well being during a woman’s cycle, as low serotonin and dopamine levels have been suggested to be associated with some symptoms of PMS and PMDD. Furthermore, in a recent study women with PMS who were administered omega-3 fatty acids were observed to experience fewer symptoms long term.

Omega-3 fats, in the forms of EPA and DHA, are found in oily fish such as salmon and mackerel, as well as in algae. They are also found in walnuts and flaxseeds, in the form of ALA. However, it should be noted that the body has to convert ALA into DHA and EPA, forms the brain can utilise more readily. This conversion process is not particularly efficient, but recent research has suggested that this conversion pathway can be enhanced by curcumin, which is found in turmeric. Although these findings hold promise for the potential role of curcumin, and possibly other polyphenols, in supporting ALA conversion, further research is required to explore these findings in humans.

Zinc

An emerging area of research is the role of zinc in supporting women’s hormone health. A recent randomised double blinded control trial indicated that women with PMS who were administered zinc sulphate were observed to experience significant improvement to PMS symptom severity and improvement to quality of life. These findings were further supported in a 2020 study on female university students. An additional study demonstrated that zinc supplementation had a significant impact on reducing physical and psychological symptoms of PMS, as well as increasing levels of BDNF (brain derived neurotrophic factor), a key molecule in the brain involved in learning and memory, and reducing oxidative stress, a major trigger for inflammatory processes.

Menopause

Menopause is a normal part of a woman’s natural ageing process. It normally occurs between the ages of 45-55. However, premature menopause affects 1 in 100 women, and may occur due to genetic and environmental factors, including early menarche and heavy alcohol consumption throughout life.

Role of Oestrogen and Homocysteine in Women’s Increased Risk of Cognitive Decline Postmenopausally

The nutrition research and strategies discussed above are of merit to continue throughout menopause due to their role in supporting female hormone health, as well as the gut-brain-axis. A key consideration for menopause and brain health is that women’s risk of developing Alzheimer’s disease increases. One hypothesis is that changes in levels of oestrogen and subsequent impact on the brain’s bioenergetic system may decrease metabolic activity and increase deposit of a key marker of Alzheimer’s disease, beta-amyloid.  Recent research has also indicated that levels of homocysteine, a marker involved in neurological diseases such as Alzheimer’s disease, rise in response to a fall in oestrogen levels during the menopause.

B Vitamins, Omega-3 and Zinc 

Research has indicated that increasing levels of folate and B12, as well as omega-3, may help to reduce levels of homocysteine. This can be done through increasing consumption of green leafy vegetables (folate), chicken and fish (B12) and oily fish (omega-3), as well as through supplementation of these nutrients (particularly B12 and omega-3 if vegetarian or vegan). Furthermore, recent research has highlighted the key role of zinc in significantly reducing concentrations of homocysteine. This may be due to its synergistic relationship with folate and B12. 

Mediterranean Diet

Following the Mediterranean diet, which involves consuming extra-virgin olive oil, vegetables, fruits, legumes, pulses, nuts and oily fish, may be particularly supportive during menopause. The European Menopause and Andropause Society has also recently proposed the Mediterranean diet as an appropriate dietary pattern post-menopause, as it may help to reduce cognitive decline, cardiovascular and metabolic diseases, which are both risk factors for Alzheimer’s disease. An additional food of note, which can be incorporated into a Mediterranean diet, is flaxseed, which has been specifically shown to support women during and post menopause. This is possibly due to flaxseed’s omega-3 content (ALA), as well as lignan content, which may help to modulate oestrogen levels. 

Manganese

An area of emerging research is manganese levels and menopause. A recent study  indicated that alterations in blood levels of manganese occur before and during menopause. Manganese is a micronutrient required for insulin secretion and blood glucose balance, as well as modulating the body’s endogenous antioxidant systems and thereby reducing oxidative stress, as well as the homeostasis of neurotransmitters such as dopamine, glutamate, and GABA. Further research is required to explore the full mechanisms through which manganese is involved in the menopause, and how altered levels may impact on female brain health.

Notably, many women opt during this stage of life to take hormone replacement therapies (HRT). A recent study published in the British Medical Journal has demonstrated that some types of HRT may increase risk of developing Alzheimer’s disease when used long term. Individuals should consult their doctor before beginning HRT, particularly raising any concerns if they have a family history of Alzheimer’s disease, or exhibiting symptoms of cognitive decline. 

Disclaimer: Always consult your doctor or a qualified healthcare practitioner if you are experiencing any symptoms that concern you, such as unexpected period cessation, heavy blood loss, mood swings or memory loss. Also always consult a qualified healthcare practitioner before beginning any new supplement regimen.

You may not be surprised to know that what is good for the heart is good for the brain, and vice versa. This is because, like many other body systems, there is a bidirectional relationship between the cardiovascular and nervous systems, referred to as the “heart-brain axis” or HBA.

This is still a fairly new and emerging area, but so far research has suggested that the HBA  involves a complex network of neurological, biochemical, biophysical and energetic crossover between the nervous and cardiovascular systems.

The heart possesses its own intrinsic cardiac nervous system, populated by 40,000 neurons, sometimes referred to as the “heart brain”. This heart brain has the capacity to send signals to regions of the brain, such as the medulla, hypothalamus, thalamus, and amygdala and the cerebral cortex.

Furthermore, the vagus nerve acts as a go between, carrying information from the heart to the brain, and vagal stimulation by the heart has been indicated to be involved in neurological processes such as pain perception (nociception). 

This intrinsic link between the heart and brain is further evidenced by how cardiac dysfunction has been identified as a predictor for cerebrovascular events. Cardiovascular disease has also  been demonstrated to increase the risk of Alzheimer’s disease, due to shared vascular pathologies.  

3 Key Nutrients for Supporting the Heart-Brain Axis

Prebiotics and Probiotics

The health of the gut is essential for both the health of the brain and the heart. Imbalances in the composition of gut bacteria have been associated with increased risk of cardiovascular disease and Alzheimer’s disease.

Beneficial bacteria can be increased in the gut through consuming probiotic foods, such as fermented rye sourdough, kimchi, kefir, sauerkraut and kombucha. Prebiotics are a type of dietary fibre, which help to feed and maintain beneficial bacteria in the gut. Vegetables such as broccoli, onions and leeks are great ways to increase prebiotic fibre in the diet, as are Jerusalem artichokes, chicory and garlic.   

Polyphenols

Polyphenols are naturally occurring compounds in plants, which have been shown to have antioxidant and anti-inflammatory properties. Polyphenols can be enjoyed by increasing consumption of a wide array of colourful fruits and vegetables. Government guidelines suggest 5 portions per day. However, recent research has indicated that individuals with the lowest risk of cardiovascular disease development consumed 10 x 80g portions per day.

Try to include plenty of colourful fruit and vegetables such as blueberries, aubergine, raspberries, red grapes, peppers, red onions, spinach and carrots to ensure you are consuming a wide range of polyphenols. Raw cacao, dark chocolate (85% and above) and green tea, and spices such as turmeric and ginger are also excellent ways of increasing polyphenols.

Omega 3 Fatty Acids

Omega 3 fatty acids are important for both heart and brain health due to their anti-inflammatory properties. The Bacteroidetes:Firmicutes ratio, which is a marker for gut health and integrity, is an important consideration too. Bacteria from the Bacteroidetes family are able to synthesise vitamins that are vital for brain and heart health, including: B1, B2, B3, folate, B5, B6, B12 and Biotin, many of which are important for reducing homocysteine – a risk factor for both cardiovascular and neurodegenerative diseases.

When the Firmicutes:Bacteroidetes ratio is higher in favour of bacteria from the Firmicutes family, there is lower synthesis of these vitamins. Further, imbalances in the Bacteroidetes:Firmicutes ratio may also increase deposition of Aβ plaques, which is involved in Alzheimer’s development. Additionally, individuals with imbalances in the Firmicutes:Bacteroidetes ratio have also been demonstrated to have increased risk of heart failure.

However, this ratio can be addressed through increasing omega 3 fatty acid consumption. This can be done through increasing consumption of oily fish, and taking either a fish oil or vegan omega 3 (EPA/DHA) supplement.

Like many people, I enjoy a glass of wine or two a few times a week (perhaps more at times of celebration and holidays). Alcohol makes me feel happy, relaxed and sociable, and a little bit of red wine is good for you, isn’t it? “Dry January” hadn’t appealed before, but this year the scientist in me was intrigued to find out if short-term abstinence can really make a difference to brain health.

What I found was genuinely surprising! For healthy people with a moderate or heavy alcohol consumption, a month’s abstinence from alcohol can lead to significant improvements in blood sugar control, blood pressure, weight loss and a reduction in cancer related factors; all of which can affect brain health and mental wellbeing. In addition, moderate drinkers who avoid alcohol for a month will reduce the risk of liver cell damage because oxidative cellular stress is reduced. I couldn’t find any studies that prove this has a knock-on effect on brain health (for obvious reasons), but what is good for the liver is most usually beneficial for the brain too.

I also discovered that good dietary sources of folate and riboflavin (vitamin B₂) may be protective of cognitive function following a period of regular alcohol intake. It does this by helping to reduce homocysteine levels, which is an important biomarker for brain health.

This next bit of information will be disappointing for many people (myself included). The perceived connection between a little bit of red wine and good health is being eroded by science. Yes, red grapes and red wine contain a polyphenol called resveratrol that has been found to be beneficial for rat brains, but research doesn’t support the view that drinking wine is as beneficial for human cognition as eating the grapes. 

With all this in mind, how to approach lifestyle change, even if short-term? For me, I prefer to slowly reduce consumption in order to give my liver and brain a chance to wind down naturally. For others, it’s easier to get started knowing that others are doing it too. Whichever route you choose, research does show that as soon as we reduce our alcohol consumption and initiate some longer-term changes like eating well and taking more exercise, the sooner we can feel more energised and develop healthier drinking patterns!

I’ve changed my mind about Dry January. It’s not about depriving ourselves of enjoyment, it’s about getting ourselves and our brain back in harmony so we can make 2022 an awesome year. This January I will be raising a glass of elderflower cordial and saying “Cheers” to that!

With thanks to Tracey Hipkiss, Food for the Brain Volunteer, for this article.

Turkey, salmon and Brazil nuts are familiar Christmas fayre that also happen to be excellent sources of proteins, B vitamins and the essential element selenium. All these nutrients have been linked to maintaining brain health, but the selenium content of our food is attracting new scientific interest because it is an essential factor in our diet that helps to remove hydrogen peroxide from in and around cells. Hydrogen peroxide is produced during normal cell function, but it has the potential to damage brain cells if it builds up.

Only a very small amount of selenium is required for good health and sufficiency is easily achieved from a healthy balanced diet that has been derived from well managed soils. However, a recent study revealed that approximately 50% of women and 25% of men living in the UK may not be reaching the lower recommended dietary intake for selenium.

Surprisingly, just one Brazil nut a day (about 5g) will give your selenium intake a good boost!

A Brazil nut provides roughly 12.7 micrograms (mcg) of selenium (according to the UK Food Standards Agency dataset). Therefore, two a day should make good progress towards reaching the UK government recommended intake (75mcg per day for adult males and 60mcg per day for adult females). Brazil nuts vary enormously in selenium content; do check the nutritional information on the packet. For comparison, a 100g serving of salmon provides approximately 21mcg selenium and a 100g serving of turkey provides approximately 14mcg selenium.

What is the relevance of selenium rich foods to brain health? 

Studies suggest that there is an intriguing connection between Alzheimer’s disease and selenium insufficiency. A small preliminary trial has revealed surprising results; consuming one Brazil nut daily for 6 months was sufficient to have a positive effect on some cognitive function in older adults with mild cognitive impairment. More research is underway.

A word of warning though: be aware that eating too many Brazil nuts and taking a supplement will move you towards the limit of safe intake for selenium. The currently accepted safe level for selenium is below 450mcg a day for a 60kg adult. Ask your healthcare provider to check your selenium status before taking a supplement.

It wouldn’t be Christmas without sprouts!

Brussels sprouts and the other cruciferous vegetables such as broccoli and cauliflower are a fantastic source of many nutrients including vitamin K, folate and carotenoids. The signature ‘bitter’ flavour of cruciferous vegetables is provided by sulphur-containing compounds that are essential for the body to maintain lots of important functions.

Interestingly, sulphur and selenium work alongside each other in every cell throughout the body to remove hydrogen peroxide, a molecule that acts as a trigger for inflammation and may be a contributing factor to neurodegeneration.

Does regular consumption of cruciferous vegetables reduce inflammation and slow-down neurodegeneration in humans? We don’t have the answer yet, but there has been a call for studies to investigate this potentially important link between diet and disease.

Christmas herbs and spices

Spices may seem expensive, but they store well and are useful for adding interesting flavours to food, helping us to use less salt. They provide a host of other health benefits too.

Ginger, allspice, cloves, cinnamon and thyme are synonymous with the warming flavours of Christmas drinks, savoury foods, desserts, sauces and chutneys. Traditional herbal medicine has long valued these spices and herbs as effective aids to digestion, and more recent studies indicate that they have antioxidant, anti-fungal and antibacterial effects too.

It is easy to overlook the significance of herbs and spices in enabling effective digestion because we only use them in very small amounts, but they are a first line of defence that is very useful to reduce some of the challenges faced by our own cells. They may also enhance breakdown and control absorption of the nutrients present in our food.

Effective digestion is necessary to feed our body and brain to keep us healthy and functioning well throughout the year.

Studies suggest that the health benefits from these herbs and spices are not limited to the digestive tract; the complex array of chemicals they contain may work in harmony or in a synergistic way within and around human cells. For example, cinnamon may help to improve blood sugar control and improve lipid profiles for people with type II diabetes and, along with allspice, cloves and thyme, may also be efficient at reducing the formation of glycated proteins. Glycated proteins are a complication of type II diabetes and implicated in ageing and neurodegenerative conditions such as Huntington’s disease and Parkinson’s disease.

Key points

Brazil nuts, turkey and salmon are excellent sources of protein and selenium (Brazil nuts are a rich source of selenium so limit intake to a few a day)

Dietary selenium is essential, and helps to protect against brain cell damage

Human studies suggest that Alzheimer’s disease patients may have a lower selenium status

Ask your doctor to check your selenium status before taking a supplement

Cruciferous vegetables such as Brussels sprouts and broccoli provide important sulphur-compounds that work with selenium to reduce the damage caused by normal inflammatory responses in the body and brain

Try new recipes that help you to incorporate seasonal cruciferous vegetables, herbs and spices in your regular diet throughout the year

Including herbs and spices into our regular diet may indirectly support long-term brain health, but there is currently a lack of evidence for this from human studies

Small amounts of ginger, allspice, cloves, cinnamon and thyme help us to keep healthy by aiding digestion, supplying antioxidants and helping our immune cells to resist bugs

Studies suggest that cinnamon may be helpful to balance blood sugar levels

Alternative uses for Christmas herbs and spices

Infuse a cinnamon stick when you make apple sauce. Serve the spiced apple with yoghurt for a quick dessert or use in a crumble

Add a sprinkle of ground cinnamon when preparing overnight oats for breakfast the next day

Use spices to pump up the flavour of homemade curry sauces, marinades and stir-fries; ginger, allspice, cloves and cinnamon all work well in sweet and savoury recipes.

Make a simple garlic and thyme infused olive oil to use in your cooking: Save an empty jam or pickle jar, wash and dry it thoroughly. Add 1-2 tablespoons dried thyme and the skinned cloves from half a large garlic bulb to the jar, then pour in 250ml extra virgin olive oil. Put on the lid, give it a good shake every day for a week. Leave to infuse at room temperature for a week and then discard the garlic cloves and store the oil in the fridge door. Infused oils go wonderfully with quick cook turkey steaks, fish, drizzled over poached eggs or oven roasted vegetables and a great start when frying onions for a savoury dish

A thyme tea made with a pinch of dried thyme in 250ml of boiling water and left to infuse for 10 minutes then strained before drinking is reviving, helpful for digestion and may also be beneficial if you have a cough or chest infection. Add a squeeze of lemon and a dash of honey for extra flavour

Treat your brain this Christmas… enjoy a dark chocolate coated Brazil nut everyday through the festive season!

With thanks to Tracey Hipkiss, Food for the Brain Volunteer, for this article.

SAD (or seasonal affective disorder) is a sub-form of major depression or bipolar, according to the Diagnostic and Statistical Manual of Mental Disorders, which most commonly occurs during the darker and colder autumn and winter months. Key identified risk factors include: a family history of the disorder, and living at northern latitudes. Specifically women, people with darker skin tones and individuals between the ages of 18 to 30 years of age are most at risk of developing the disorder. In order to have a diagnosis of SAD, the condition must be observed to improve outside of the colder seasons. Depending on the latitude, SAD has a prevalence of 1.9 – 9%. Individuals with lower levels of the metabolism regulating hormone adiponectin have also been observed to be at higher risk of developing SAD.

Nutrition and SAD

Vitamin D has been hypothesised to play a key role in SAD development due to reduced sunlight in northern latitudes during colder months. Additionally, it has been observed that there is a correlation between blood levels of Vitamin D and symptoms of depression, due to reduced levels of the neurotransmitters serotonin and dopamine. Vitamin D has also been hypothesised as being involved in circadian rhythm, which is affected by seasonal changes. However, supplementation of Vitamin D in SAD has yielded mixed results, and further studies are needed in this area.

Practical Interventions for Supporting Individuals with SAD

Due to the prevalence of Vitamin D in depressive conditions, the lack of sunlight during the winter months and the hypothesised role of Vitamin D deficiency in the development of SAD, increasing Vitamin D exposure is potentially of merit. This may be done through the following:

• Consuming foods which are natural sources of Vitamin D, such as oily fish including salmon and mackerel, egg yolks and organic milk and cheese
• Increasing exposure to sunlight in the winter months by being outside, particularly engaging in physical activities and spending time in nature 
• Supplementation of Vitamin D3. The RDA in the UK for Vitamin D is 10 micrograms (µg) or 400 IU. However, some individuals may benefit from supplementing higher levels of this vitamin, particularly if they have a higher BMI, a diagnosed mental health condition or darker skin pigmentation. Baseline levels of Vitamin D as established via blood test, calcium intake, genetics, oestrogen use, dietary fat content and composition, as well as co-existing diseases and medication use may also impact on Vitamin D requirements*.

*Note: before beginning any new supplement regimen, always consult your physician and a qualified nutrition practitioner.

Four years ago I was diagnosed with multiple sclerosis. Diet, vitamin supplementation, exercise, stress reduction and cognitive activity (also known as a brain-healthy lifestyle) have all been shown to significantly improve outcomes in MS – great news, right?! So why is it so hard to keep doing what is right?  As a clinical psychologist I’ve spent years working with people who are finding it difficult to make changes in their lives, despite knowing that ultimately there will be benefits. Below are some of things I have learned along the way and that have helped me navigate a new path towards a brain healthy lifestyle.

Have compassion for where you are at

Our health behaviours depend upon many factors, including what attitudes and ideas about health were laid down in our early life experience. I grew up in a low socioeconomic status inner-city household in the 1990s – I never owned a bike, never saw or heard of anyone “going for a run” and diet was only discussed as a thing you “went on” if you wanted to be thinner (usually before Christmas, so you could eat and drink with abandon during the festive season). Crucially, my family was time-poor, working long hours to make ends meet; active relaxation and ‘self-care’ was not on the agenda.

Unsurprisingly then, I have spent the majority of my adult life replicating what my early-life taught me – working hard, eating for convenience (rather than health) and neglecting balance. It’s easy to be judgemental and regretful about not having made smarter health choices in the past and label ourselves as lazy, reckless or not capable. However, research shows us that self-criticism reduces motivation and leaves us feeling worse, whereas showing ourselves compassion and understanding is much more likely to free us to make changes.  Whatever health and lifestyle choices you made so far, you were doing your best with the information and resources you had at the time.  If your inner voice is harsh and critical, remind them that you have done your best and will continue to do so – that’s all any of us can.

Expect changes to be challenging

Long term behaviour change is difficult to achieve and involves a series of small steps and crucially, ‘failures’. What sets apart people who successfully implement long term change is not an innate ability to stick perfectly to a plan, but the ability to pick oneself up and get back on track when the plan has not…gone to plan! Failing to stick to a healthy lifestyle plan does not mean you are “not capable”, “can’t do it” or “just not into a healthy lifestyle”- it simply means you are a human, not a robot. Try to see all setbacks as an opportunity to learn by asking yourself why it didn’t go to plan and what you can do differently to achieve your goal. 

Set good goals

Good goal setting is the bedrock of many psychological interventions and research shows that it works. My top tips for good goals are

1) Set positive goals about what you want more of (I want to learn one new health recipe) rather than what you want less of (I want to stop eating junk food)

2) Set achievable short term goals that will bring quick benefits, such as sticking to a good sleep routine and regular bedtime for a week – this will set you on the right path and increase your confidence that those longer term and less visible benefits are also achievable

3) Link your goals to your values – list all the reasons why your goals are important to you – including those beyond your own health. When I stopped eating dairy for health reasons I found it really helpful to learn about the ethical and environmental benefits of doing so – whilst these were not my primary motivations, they have become increasingly important to me and serve as further important reasons to stick to my plan. 

Find your support team

It is hard to make change and it can be hard for those around us – my family still object to vegan, oil free meals 4 years down the road. Finding positive reinforcement for the healthy lifestyle you want to adopt can help you stay committed in the face of doubt and objection (whether that be from people around you or inside your own head!). Instagram is a wonderful way to connect with inspiring people who just really LOVE living a healthy lifestyle, sharing tips/recipes/exercises/mindfulness practices/motivation, as are Facebook groups and internet forums. You may also find local groups, like beginners running clubs and yoga classes.

Set yourself up for success

Compassion, goals and encouragement aside – good old practical planning and problem solving will go a long way in facilitating behavioural change. Strategies that I have found useful include –

●  Planning ahead for the week what I will eat and when I will exercise

●  Batch cooking and freezing meals

●  Cooking simple meals on busy days

●  Using a slow cooker and an air fryer for ease and speed

●  Planning exercise for the time of the day when I have most energy

●  Setting reminders in my phone to take supplements

●  Setting a bedtime reminder in my phone for 30 minutes before I want to be in bed

●  Leaving my phone out of the bedroom and my book next to my bed (I read a chapter a night for cognitive stimulation and relaxation)

I hope these tips can help you incorporate changes you want to make!

With thanks to Dr Nicky Hartigan for this article. Dr Nicky is a Clinical Psychologist and Director at HelloSelf, and has recently joined Food for the Brain’s Board of Trustees.