Whether you or a loved one is struggling with or are concerned about memory loss, it’s worth knowing that there is a lot you can do with food and lifestyle to help.

Just like you would with any major health concern, the best thing to do is to talk to your doctor as a starting point if you’re worried. They will be able to evaluate your situation and may signpost you to resources and groups that might help support you.  It’s possible – though unlikely – that the doctor will know about the food and lifestyle strategies that would help. They’re just not given the training, but I can help. I want you to know that what you eat (both historically and also what you eat from now on) plays a critical role in brain health. If you or someone you know and love has been told they have some kind of cognitive impairment, I wrote this for you.

Diet has been found to have a significant impact on the prevention and progression of Alzheimer's disease (Stefaniak et al., 2022). A number of studies have reported that what you eat, and your lifestyle strongly influence the risk of cognitive decline, dementia, and Alzheimer's disease (Sousa & Guimarães, 2015).

Mediterranean Diet
One well-studied diet for Alzheimer's disease prevention is the Mediterranean diet (Sousa & Guimarães, 2015). It’s diet that is do-able for many and you may have heard of this already. It favours real food over processed foods, which is a benefit for each and every one of us regardless of our current health status. The diet promotes good quality, lean protein like meat, fish, eggs and vegetarian sources like beans and lentils, healthy fats like olive oil, nuts and seeds, plenty of fruit and vegetables, plus wholegrains like brown rice and wholemeal bread.

The Mediterranean diet has long been associated with increased longevity and a lower risk of chronic diseases, including Alzheimer's disease (Sousa & Guimarães, 2015), as well as cardiovascular disease and certain cancers.

Further work demonstrates cognitive and Alzheimer's disease biomarkers, including the APOE genotype, may be influenced by the diet (Farmer et al., 2019).

Ketogenic Diet

Another dietary approach that has gained popularity as a nutritional intervention is the ketogenic diet (Rusek et al., 2019). Since Alzheimer’s is sometimes referred to as Type 3 Diabetes for its links to blood glucose regulation, it’s small wonder that a diet high in fat and very low-carbohydrates (like bread, pasta, potatoes, rice and sugar or refined foods of any kind) has been shown to have great potential as a therapeutic strategy for the disease (Rusek et al., 2019). As the ketogenic diet is likely to be a stretch from whatever you’re currently eating, it's worth working with a nutrition coach to support you to find the best diet for your condition and to motivate you to follow it for long enough that it becomes second nature – and, of course, for you to experience the therapeutic benefit.
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Delirium Superimposed on Dementia DSD

DSD is when someone with dementia develops a delirium on top of their dementia. Delirium is an acute, transient disorder of attention and cognition.

The trigger for the delirium might be an infection, an acute illness, surgery, hospitalisation, constipation, drug side effects, sudden withdrawal of some medications.

Physical changes that contribute to delirium are low blood oxygen, high blood carbon dioxide, high or low sodium, high calcium, low glucose, neurotransmitter changes in the brain.

It’s a common condition, affecting as much as 50% of older adults with dementia on hospital wards.

Because of diminished cognitive reserve, people with dementia are more prone to having a delirium. They can also take longer than adults without dementia to recover. It may take days, weeks or even up to six months to recover. People with dementia may not recover back to their previous level of cognition and functioning after the delirium.

Treating delirium:
Identify and treat the cause. It may be more than one cause.
Are there metabolic abnormalities?
Are medications or medication withdrawal implicated?
Are there any psychological predisposing factors?
Adequate hydration and a good balanced diet are critical to recovery.
Address any constipation.
Nutritional deficiencies such as vitamin D, B6, B12.
Provide reassurance, reorientation, involve family.
Prioritise sleep.

The Gut Microbiome in Alzheimer’s disease

Our gut provides a home for tens of thousands of bacteria. They play a crucial role in maintaining homeostasis (or physical equilibrium) which is important because any alterations to homeostasis could lead to the onset and progression of diseases.
We know that in Alzheimer’s disease there tends to be an imbalance in gut bacteria. There are less beneficial bacteria and there are lower numbers overall.

We don’t know if having an imbalance (dysbiosis) of the gut bacteria is one of the causes of Alzheimer’s disease or if it a consequence. We do know that by making improvements to the balance of bacteria in Alzheimer’s disease, there is the potential to;
- make the brain more adaptable to change
- that it could lead to changes in brain pathology
- and that symptoms could be improved
#more#
Neuroinflammation
Some of the less beneficial bacteria that are abundant in the gut of someone with Alzheimer’s can be pro-inflammatory. This could be through the production of lipopolysaccharides (which induce inflammation) by some bacteria.2

Beneficial bacteria make beneficial things for us including producing short-chain fatty acids that help to nourish the lining of the gut. Without this nourishment, and in the presence of pro-inflammatory bacteria and lipopolysaccharides, it’s possible for the gut lining to become compromised and allow particles through. This leaky gut could be one of the causes of the brain becoming inflamed in Alzheimer’s.

A Wholefoods Approach to a Healthy Microbiome
Our diet can positively and negatively influence the microbiome. Fatty foods tend to increase the abundance of inflammatory bacteria. Eating a sugary diet has been shown to lead to pathogenic and pro-inflammatory bacteria and a reduced diversity. A diet high in protein can lead to undigested protein ending up in the large part of the gut. The bacteria that ferment the protein are encouraged to grow which leads to an abundance of protein fermenting and pro-inflammatory bacteria.

Tips for a healthy microbiome

- Limit fatty foods containing trans fats and saturated fats. These include processed foods, cakes and biscuits.
- Eat foods rich in omega-3 fatty acids such as walnuts, hemp, chia, and flaxseeds and oily fish such as salmon, mackerel, and sardines.
- Eat fermented foods such as kimchi, yogurt, sauerkraut and kefir. These have been proven to improve cognition. (1)
- Eat foods rich in monounsaturated fatty acids such as olive oil, nuts, and seeds.
- Include coconut oil in your diet which contains medium-chain triglycerides which are anti-microbial to gut microbes.
- Eat plenty of vegetables and fruits as it helps to promote bacteria that ferment the fibre and leads to microbial richness. (1)  Foods high in fibre - such as vegetables and wholegrains promote a healthy ratio of beneficial bacteria. (1)
- Eat foods that contain curcumin. The richest source of curcumin is turmeric. Curcumin favours beneficial bacteria.
- Eat a wide variety of coloured fruits and vegetables because they contain polyphenols that promote beneficial bacteria.
- If your struggling to eat a wide variety of fruits, vegetables, pulses, and grains, consider a supplement containing a blend of bifidobacteria and lactobacilli. Studies conducted so far have been poorly designed and more quality studies need to be conducted. Overall, the studies support the use of supplements for improving cognition. (2)

Diagram reference: Toribio-Mateas, M., 2018. Harnessing the Power of Microbiome Assessment Tools as Part of Neuroprotective Nutrition and Lifestyle Medicine Interventions. Microorganisms, 6(2), p.35.

(1) Frausto, D., Forsyth, C., Keshavarzian, A. and Voigt, R., 2021. Dietary Regulation of Gut-Brain Axis in Alzheimer’s Disease: Importance of Microbiota Metabolites. Frontiers in Neuroscience, 15.

(2) Ticinesi, A., Mancabelli, L., Carnevali, L., Nouvenne, A., Meschi, T., Del Rio, D., Ventura, M., Sgoifo, A. and Angelino, D., 2022. Interaction Between Diet and Microbiota in the Pathophysiology of Alzheimer’s Disease: Focus on Polyphenols and Dietary Fibers. Journal of Alzheimer's Disease, pp.1-22.

Folate is essential for making new cells, healthy red blood cells, and healthy nerves.
🥕A folate deficiency is rarely alone without other deficiencies so a full vitamin and mineral screening blood test is a good idea.
🌶A folate deficiency could indicate that there is a problem with absorbing the vitamin from the gut. Undiagnosed coeliac disease could be a cause. Inflammatory bowel diseases such as Crohn's disease can also affect absorption.
🥦Taking certain medications can affect folate absorption. These include antiepileptic drugs and sulfasalazine. Furosemide also decreases intestinal folate absorption.
🥬Alcohol can affect folate absorption. As little as two glasses of wine a day can impact hepatic uptake and lead to folate being excreted in the urine.
🌽MTHFR methylenetetrahydrafolate–1 in 10 white British will have the MTHFR genetic polymorphism. This means the reductase enzyme needed for the conversion of folate to its active form is less active.  Not eating a variety of foods could also contribute to a low folate.

If a folate blood test, full vitamin, and mineral test, coeliac test, or a test to see if you have the MTHFR gene are of interest to you, contact me via my website. I offer a full phlebotomy, specimen packaging, and test interpretation package.