PUBLIC HEALTH
HEALTHY EATING AND LIFESTYLE TO REDUCE THE RISK OF DEMENTIA In the UK, 850,000 people are estimated to be living with dementia. As ageing is the greatest risk factor for dementia, this number is expected to grow rapidly over the next few decades due to an increasing life expectancy. It is estimated that one million people in the UK will have dementia by 2025 and this will increase to two million by 2050.1 With this in mind are there any changes we can make to reduce the risk of dementia? WHAT IS DEMENTIA?
Dementia is an umbrella term that describes a set of cognitive symptoms, which may include a loss of shortterm memory and difficulties with problem solving, visuospatial skills, orientation, or language. Dementia is caused by diseases of the brain such as Alzheimer’s disease, vascular dementia and frontotemporal dementia. Symptoms will vary from person to person and will depend on the part of the brain which has been damaged. Alzheimer’s disease and other dementias are the leading cause of death in the UK and dementia is the most feared condition for people over the age of 50 (ahead of cancer).2 The other top four leading causes of death in 2017 (ischaemic heart diseases, cerebrovascular diseases, chronic lower respiratory diseases and lung cancer), have all seen falling mortality rates over the last 15 years.3 A key reason for this is increased public health information and awareness of the risk factors for these diseases and that lifestyle changes can have a positive impact. There is still no cure for dementia and, with one person developing dementia every three minutes in the
UK,4 it is important to focus on reducing our risk factors, in particular opting for a healthy diet and making lifestyle changes. RISK FACTORS FOR DEMENTIA
In addition to ageing and genetic risks (factors that we can’t change), the most significant risk factors for dementia are poor vascular health, smoking, drinking too much alcohol, diabetes and obesity. Several of these factors are modifiable and swapping to a healthy balanced diet may help reduce the risk of dementia, as well as other conditions such as Type 2 diabetes, obesity, stroke and cardiovascular disease (all risk factors for dementia). As the damage to the brain in dementia occurs 15 to 20 years before the onset of clinical symptoms, it is important to modify lifestyle as early as possible in order to potentially reduce the risk of developing dementia. HEALTHY EATING CHANGES
So what changes can we make? It is often said: “What’s good for the heart is good for the brain” and a Mediterranean diet has been associated in some studies with a reduced risk of cardiovascular disease, in addition to Type 2 diabetes, some forms of cancer and overall mortality.5 A Mediterranean diet incorporates the traditional healthy eating habits of people from countries bordering the Mediterranean Sea. It’s a diet
Gill Hooper Freelance Registered Nutritionist Gill works in training and education around nutrition and hydration to provide quality dementia and frailty care. She is currently working with Bournemouth University looking at the impact of improving nutritional care for people with dementia.
REFERENCES Please visit the Subscriber zone at NHDmag.com
Gill's useful infographic on healthy eating to reduce the risk of dementia can be found at www.NHDmag. com/dementia
www.NHDmag.com June/July 2019 - Issue 145
15
WHEN YOUR PATIENTS NEED MORE BUT WANT LESS
Wiltshire Farm Foods is part of the apetito family, providers of award winning meals to hospitals. apetito.co.uk
Kcal*
500
Protein*
20g
Maximum Portion Size
300g
*Range contains 501-532 calories and 20-28g protein.
Mini Meals Extra is a range of nutritious smaller meals created to support those with reduced appetites who may be at risk of malnutrition.
For more information contact us to arrange a FREE tasting session 0800 or visit www.wiltshirefarmfoods.com
OVER 300 DELICIOUS DISHES FREE DELIVERY TO YOUR PATIENT’S FREEZER SPECIALIST DIET RANGES
066 3169
PUBLIC HEALTH that includes plenty of fruit and vegetables, pulses, fish, nuts and wholegrains. Olive oil is used for cooking and it is low in saturated fat, red meat and processed foods. Moderate alcohol consumption with meals is part of the Mediterranean diet, but strictly within national guidelines.6 Similar to the Mediterranean Diet, the research based DASH diet – Dietary Approaches to Stop Hypertension – was originally developed to lower blood pressure (hypertension). Developed in the 1990s, the core foods recommended in the DASH diet plan include fruit and vegetables, low fat dairy, nuts, beans, seeds and grains. More recent research has resulted in the diet being improved to include more protein foods and heart healthy fats, such as olive oil.7 Past research has shown that the Mediterranean and DASH diets have brain boosting benefits, as well as protective qualities against heart disease. A new diet, claiming to lower the risk of developing Alzheimer’s and slow mental decline, was published in 2015 in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association.8 The MediterraneanDASH Inter-vention for Neurodegenerative Delay (or MIND diet for short) combines elements linked to dementia prevention from these two diets, with some beneficial additions, such as an emphasis on berries, especially blueberries high in antioxidants, and green leafy vegetables, such as spinach. It also recommends wholegrains, nuts, legumes, fish, poultry and olive oil. WHAT ARE THE BENEFITS OF A MEDITERRANEAN OR MIND DIET?
Antioxidant vitamins The antioxidant vitamins, A, C, E and betacarotene can help fight cell damage caused by oxidative stress as we get older, which is linked to Alzheimer’s disease and vascular dementia. The brain is particularly susceptible to oxidative stress for a number of reasons: brain cells are more prone to oxidation and the brain uses more oxygen than other organs. Consumption of a range of fruit, vegetables, wholegrains, nuts and oils will ensure plenty of these antioxidant nutrients in our diet.
Polyphenols Polyphenols are naturally occurring chemicals produced by plants and are widely found in fruit, vegetables, legumes and cereals. Foods that are a good source of polyphenols are often identified by their bright colours. They have antioxidant properties that, as already stated, are beneficial due to the brain being prone to oxidative stress. Some also have anti-inflammatory properties. Berries are a great source of polyphenols, called anthocyanins, especially blueberries, blackberries and raspberries and other richly coloured red, blue and purple fruit. A moderate intake of red wine (within national guidelines6) may be linked with a lower risk of dementia, due to the polyphenol, resveratrol, which is also found in grape juice. Green tea is a good source of EGCG, a flavonoid which can bind to beta-amyloid proteins and help prevent formation of plaques in the brain.9 Flavonols found in cocoa and dark chocolate (at least 70% cocoa solids) may also be beneficial to brain health, but it is important to remember that this doesn’t include milk chocolate! The spice turmeric has gained popularity over recent years. Its yellow pigment, curcumin, has been shown to have antioxidant, anti-inflammatory and antiamyloid properties. B vitamins B vitamins have many health benefits, including a lower risk of heart disease and diabetes. Vitamin B6, folate and vitamin B12 may protect against Alzheimer’s disease and other cognitive decline by reducing homocysteine levels (an amino acid linked with Alzheimer’s disease.) The best sources of folate are found in green leafy vegetables and liver, vitamin B6 in oily fish, meat and fortified cereals and B12 found only in animal products, such as meat, fish and dairy products. Omega-3 fats It may be an old wives tale, but we’ve always been told that fish is ‘brain food’. Is there any truth in this adage? Oily fish, such as salmon, mackerel and sardines, contain the long-chain fatty acids, EPA and DHA which are important for the brain throughout our lives, from early cognitive development www.NHDmag.com June/July 2019 - Issue 145
17
PUBLIC HEALTH Table 1: Foods to choose and foods to limit as part of the MIND Diet Foods to choose
Foods to limit
Wholegrains – at least three servings a day
Limit red meat to less than four times a week
Leafy green vegetables – every day plus at least one other choice of vegetable a day
Butter – less than one tablespoon a day
Berries – at least twice a week
Cheese – less than one serving a week
Nuts – at least five servings a week
Pastries and sweets – limit to less than five times a week
Legumes – every other day
Fried or fast foods – less than one serving a week
Fish – at least once a week Poultry – at least twice a week Olive oil – primary oil in home cooking Wine – no more than 1 x 150ml glass a day6
in foetuses to learning and memory in adults. Brain cells with high levels of omega-3 in their membranes appear to be better at communicating with other cells.10 There is little evidence to suggest that an omega-3 supplement alone has a role in a reduced risk of dementia, rather, the benefits are from eating the fish and consuming other nutrients alongside the omega-3 fats. LIFESTYLE CHANGES
A report in The Lancet in 2017, Dementia prevention, intervention and care, highlighted ‘nine potentially modifiable health and lifestyle factors from different phases of life that, if eliminated, might prevent dementia.’11 These risk factors include physical inactivity, high blood pressure, Type 2 diabetes, obesity, smoking and social isolation. It was estimated that a third of dementia cases could be prevented by making lifestyle changes. It is also important to keep your brain healthy and active; a phrase we often hear is “use it, or lose it”. Challenging yourself mentally can help build up the brain’s ability to cope with the disease.12 This might include studying for a new qualification, doing puzzles, Sudoku or crosswords, playing board games, or even completing the NHD CPD eArticles (all found online at www.NHDmag. com). Talking and communicating with other people and staying socially active may also help to reduce your risk of dementia. It is important to remember that whilst dementia risk increases with age, it is not an inevitable part of ageing. 18
www.NHDmag.com June/July 2019 - Issue 145
SUMMARY
A key message from a report published by Alzheimer’s Disease International, states that, ‘there is quite consistent evidence from epidemiological cohort studies that adherence to a Mediterranean diet…may lower the risk of cognitive decline and dementia’.5 Further research is needed to fully understand the preventive role of the Mediterranean diet and the active ingredients to improve cognitive function and reduce the risk of dementia, but a healthy, varied diet with plenty of fresh fruit and vegetables, wholegrains, legumes, fish, nuts, seeds and oils, and low in saturated fats, free sugars and processed foods, is generally beneficial. We know it can help prevent vascular diseases, including stroke and heart attacks, which in turn are risk factors for Alzheimer’s disease and vascular dementia. It has already been said: “What’s good for the heart is good for the brain.” As we have seen, damage to the brain in dementia occurs 15 to 20 years before the onset of clinical symptoms and there is good evidence that healthy eating and a healthy lifestyle can help reduce the risk of developing dementia as we age. This is a message that we should all be talking about and actively making changes. Young people may not be thinking about the possibility of dementia in later life, but most likely, many of them will know a loved one living with dementia and the effects of the disease. If there is a chance we could do something about it by making simple lifestyle changes, isn’t it a chance worth taking?