On December 14, 2016, I lost my mother to frontotemporal dementia. Since that time, I’ve been hellbent on finding ways to reduce my dementia risk.
Remembering back, there were definitely signs that there was a problem. A few years before her death, whenever I would go back home to visit, I would give her a hard time about “getting old” and forgetting things. As time went on, however, the forgetfulness morphed into more subtle personality changes. While these issues seem obvious now, they were never quite enough to click with me that there was a problem at the time. As is all too common with dementia, by the time we all realized there definitely was a problem, it was too late.
Watching my mother slide into dementia was an agonizing, horrible experience – and I was watching it mostly from the opposite coast. Since I live in Oregon and my mother was in Maine, helping my mom day-to-day fell entirely on my sister, who was my mother’s main caregiver right up to the very end. She did an amazing job and is an inspiration.
The Growth Of Dementia
While there are over 400 forms of dementia, the most common is Alzheimer’s disease, making up 60-70% of all dementia cases. Not nearly as common as Alzheimer’s, frontotemporal dementia (FTD) affects different parts of the brain and tends to rear its ugly head much earlier, usually between the ages of 40 and 65. It currently affects about 60,000 Americans. When we look at all forms of dementia, however, there are roughly 6 million people living with some form in the US today. That number is expected to grow exponentially as the population ages.
It can be difficult for younger folks to care about dementia, or at least be concerned about it. Most times, when I ask someone in their twenties what they’re doing to reduce their dementia risk, all I get back is a blank stare. It’s unfortunate as that’s exactly when you should be thinking about it. The fact that we tend to think of dementia as something that only happens to “old people” is part of the problem. It’s those decisions you make when you’re younger that can set the stage for this devastating disease to rear its ugly head once you’re older.
To make matters worse, dementia creeps up on you, and unlike other diseases and conditions, by the time you have a real problem, you aren’t capable of weighing in on your own treatment plan. When diagnosed with other lifestyle-type diseases, like cancer, diabetes, or heart disease, you generally have the faculties available to weigh in, but with dementia, you are relying on others (oftentimes fully) to get the care you need. And by then, more often than not, that care is sadly focused on quality of life while you and your loved ones wait for the inevitable end.
Four Fear Factors for Dementia
It’s easy to fear dementia. Short-term memory loss is one of the early signs—you start repeating yourself in conversations, forgetting what you already said. You might start acting a little different, maybe becoming more withdrawn and more easily confused. But it’s only the beginning. Your brain cells start losing their ability to communicate with each other, then they begin dying. You stop being able to pay bills and take care of your own hygiene—eventually, you must be cared for.
Here are four scary reasons to fear this disease that is affecting 10 million people worldwide each year:
1. Genetics count. With the explosive popularity of genetic testing kits now available seemingly everywhere, for many, the #1 fear comes in the form of this key risk factor. Unfortunately for me, genes seem to play a bigger role in frontotemporal dementia than they do in say vascular dementia. Even so, there are several genes that could impact your risk for each form—like APOE for Alzheimer’s or C9ORF72 for FTD. The good news here is that as with most everything gene-related, whether or not your genes play a role in your susceptibility of dementia varies depending on if those genes are “on” or “off.”
2. There is no cure. As the disease progresses, brain cells become impaired, nervous system connections and pathways are interrupted, and eventually brain cells begin to die off. Most current treatments are aimed at managing symptoms for as long as possible. You can’t pop a pill for this.
3. It will eventually kill you. Alzheimer’s is the sixth leading cause of death in the U.S. (fifth if you are already over 65), and those stats are growing. Once you receive a diagnosis, you have about four to eight years to live (on average), and they won’t likely be a walk in the park. When considering all forms, dementia is the 3rd leading cause of death in the US.
4. Diet and lifestyle has a huge effect. Metabolic issues correlated with dementia risk and mental deterioration go hand in hand with a high-carb, nutrient-deficient diet, poor sleep, and a lack of physical exercise and direct human contact. Contributing factors include: obesity, insulin resistance/diabetes, smoking, high blood pressure, and reduced cerebral blood flow, to name just a few. Interestingly, a large number of these conditions are also factors that can result in more severe complications from COVID-19.
But there is a common theme running through these fear factors that provides us with a silver lining. There are lifestyle changes that can reduce your dementia risk and directly contribute to how soon and how badly dementia might affect you.
Strategies for Staving Off Cognitive Decline
It’s important to remember that while there can be some general cognitive decline that typically comes with aging, it doesn’t have to. And dementia is certainly not a normal part of aging.
Quite a few strategies have been shown to slow progression of dementia or decrease the severity of symptoms. These actions focus on building nervous system health, decreasing plaquing, increasing circulation, reducing brain cell atrophy, and reducing risk factors such as inflammation. In combination, these choices have been shown to reinforce each other and give you more bang for your anti-dementia buck. Just remember, there are two catches:
- They must be started early. If you are aiming at prevention, start long before 65. (I’m looking right at you millennials.) If you’ve already been diagnosed and your goal is symptom minimization, start as soon after your diagnosis as possible.
- They must be implemented consistently. You can’t just do these things for a week and be in the clear. It takes months and even years to bring the brain and body into tip-top shape, at which point the benefits must be maintained. You’ve got to think of this as more of an overall lifestyle change than a short-term strategy. Think of it as retirement planning for your mind—you’re exercising discipline now so that things work well in the future.
Many of these interventions already fit into, or can be easily implemented, an existing healthy lifestyle and diet. Regardless of your age, you should be investing in these strategies to reap the biggest benefits and lower your dementia risk.
Diet and Nutrition Choices
Eat a Mediterranean diet.
One of the most promising diet strategies tested widely is the Mediterranean diet, significantly outperforming low-fat diets when it comes to cognitive health. Unfortunately, the exact definition of “the Mediterranean diet” can vary widely, and finding specific guidelines can be challenging. There are, however, some general guidelines that you can follow when putting together your Mediterranean diet:
- The name of the game is nutrient-density – consume a ton of different vegetables and plant foods for polyphenols, flavonoids, and antioxidants.
- Aim for 37% fat, 15% protein, and 43% carbs.
- Fats should come primarily from monounsaturated fats, with a MUFA:SFA ratio of 2.
- Strive for at least 30 g/day of fiber.
Try a healthy keto diet.
Originally designed for epilepsy patients, this very low-carb diet can reduce symptoms of other neurodegenerative disorders as well, including dementia. Studies suggest that the combination of ketone production and lower carbs may help reduce build up of amyloid plaque, improve glucose metabolism in the brain, and boost neuronal and mitochondrial function.
When considering a keto diet for cognition, it’s important to keep two key points in mind. First, it’s vital to reduce carbohydrate intake in addition to increasing fat or adding MCT oil to your diet. Second, you have to keep your diet clean and steer clear of so-called “dirty keto.” If you’re embracing this diet in an effort to improve your cognitive function and keep your brain performing optimally for life, leave the highly processed and packaged foods on the store shelves. Stick with real, whole foods in their unadulterated state.
If you’re unfamiliar with keto, the fine folks over at Perfect Keto have an incredibly helpful macro calculator that will help you find the appropriate ratio of carbs, fats, and protein.
Consume healthy oils.
Numerous studies have demonstrated that boosting your omega-3 intake may help improve cognitive function. And like most of these strategies, the earlier you increase your omega-3 intake, the better. Most studies seem to lean toward the idea that omega-3 fatty acids have a stronger effect in helping to prevent dementia, with a weaker effect if you’ve already been diagnosed. Maintaining ideal levels of omega-3 fatty acids throughout your lifetime can help keep your brain operating optimally, reduce inflammation and oxidation, and may even help reduce the formation of amyloid plaques.
In those with dementia, the brain’s ability to utilize glucose is often impaired. Thankfully, there appears to be another energy pathway that continues to function properly – ketones. While you can obviously increase ketone production via a keto diet, MCT oil also possesses ketogenic properties. Studies have demonstrated cognitive improvements in those with Alzheimer’s when supplementing with MCT oil. And, unlike omega-3 fatty acids, these improvements were more acute and measurable after short-term supplementation.
Only eat nutrient-rich whole foods.
Forget about fast food and junk that comes in boxes and bags. Nutrient-dense whole foods contain key vitamins, minerals, and other compounds shown to have a positive impact on dementia. Dark colored foods like berries, purple cabbage, black plums, and cocoa are rich in polyphenols and anthocyanin. Onions, garlic, and shallots contain allium sulphur compounds.
These pigments and organic compounds can help protect against cognitive decline by improving vascular function, reducing amyloid plaque formation, lowering inflammation, and protecting against oxidative stress.
Take key supplements.
In addition to diet, supplemental nutritional approaches can improve brain functioning. As one study put it, “B vitamins are involved as cofactors in all of the core pathways or pathologies and, together with vitamins C and E, are consistently associated with a protective role against dementia.”
Originally developed to help stroke patients heal, citicoline may limit Alzheimer’s nervous system damage. Nootropics are a recent entrant into the brain-health game as well. Look for high-quality supplements and take them consistently. Some of these supplements can take 6 weeks or so to actually start having a noticeable effect.
It’s important to keep in mind, however, whether talking about basic vitamins or nootropics, supplementation should be used as just that—to supplement an already nutrient-dense diet of whole foods to fill in any gaps. Don’t use supplements as a replacement for a good diet.
Treat yourself to very dark chocolate.
Cocoa flavonoids can be beneficial by helping to increase blood flow and oxygen to the brain. They have also shown promise in enhancing cognitive function as well as offering up protection against future decline.
When picking your chocolate, make sure you avoid added sugar and dairy. Alter Eco has a 90% dark chocolate called Super Blackout that I really like. Only 3g of sugar per serving (with 4g of fiber).
Reduce your sugar and carb intake.
The relationship between out of control blood sugar and Alzheimer’s is so strong, it’s often referred to as type-3 diabetes. Thanks to diets high in sugar and a lack of exercise, a growing number of people are experiencing weight gain and insulin resistance—setting them up for type-2 diabetes and increasing their risk of developing dementia. And in those already diagnosed with Alzheimer’s, high carb intake, especially those that are processed and/or low in fiber, has been shown to worsen cognitive performance.
Above all, the amount of sugar (especially added sugar) in your diet should be as low as possible. The more sugar you eat, the higher your risk. When choosing carbs to include in your diet, it can be beneficial to focus on whole, unrefined foods—ideally low/no-starch vegetables, fruits, and nuts.
Watch your iron.
The brain’s iron content increases with age and iron deposits have been found in the hallmark β-amyloid plaque associated with Alzheimer’s. Removing free iron from the body has been used to help improve cognitive function in Alzheimer’s patients. Additionally, some of the neuroinflammation, oxidative stress, and neuronal cell death of Alzheimer’s is now thought to be exacerbated by free iron and iron-loving bacteria.
As a person who naturally builds up too much iron, that’s scary to me. Thankfully, on the positive side, there are natural iron chelators and dietary choices that can help keep any iron buildup under control.
Physical and Mental Exercise
Regular exercise improves brain health, mental performance, and focus in anyone. For dementia, it reduces disease risks and boosts both cognition and daily functioning in sufferers. Aim for at least 30 minutes a day of movement. This can be anything from walking to lifting weights to biking to skiing, you name it. Just pick activities that you enjoy and keep you moving and stick with them.
Likewise, regular cognitive engagement has been shown to stave off decline. Consider puzzles, online classes, picking up a new language, a book discussion group, or listening to new podcasts or music. Maintaining and nutruring a strong, tight social circle is also key. Regular social interaction has been shown to reduce stress, improve self-esteem, and improve vascular risk factors – all of which can help lower the risk and slow the progression of those with dementia.
Good Sleep Hygiene
A disrupted circadian rhythm leads to inflammation and other dementia risk factors, and, once you are diagnosed, poor sleep is both a symptom and a condition that can worsen the disease. Interventions like melatonin can help. Yoga in the evenings and turning off screens a couple hours before bed can also help. However you get there, good sleep creates health.
A Strong and Diverse Microbiome
The gut-brain connection is increasingly being noted in a slew of health conditions, from cirrhosis to depression. A poor microbiome is known to contribute to dementia risk factors including inflammation and what researchers call “cognitive frailty.” Many of the physical symptoms of this “frailty” are associated with changes in the microbiome, specifically a lower biodiversity and an absence of beneficial bugs. Take care of your microbiota by eating plenty of prebiotic rich foods, as well as fermented foods. Finding a good, high-quality probiotic supplement is also a good idea.
Tooth and Gum Health
Recently, studies have begun to show that poor oral health is correlated with dementia, including factors such as tooth loss and gum disease or periodontitis. The exact cause is unclear, whether bacteria themselves, or the irritants they produce, cross into the brain. Either way, keeping your teeth and gums healthy and taking care of any problems immediately can benefit your state of health outside of your mouth. Also consider adding oil-pulling to your dental routine if you don’t have mercury fillings.
Let Go and Live
With risk factors up and down my family, I’ve chosen to combine a healthy lifestyle (including good sleep, regular exercise, nurturing my social circle, and a nutrient-dense diet) with key supplements to help mitigate my dementia risk. Once you do that, all that’s left is letting go, trusting that what you are doing is helping, watching as further research develops, and living your life to the utmost right now.
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