November/December 2013

Evidence-Based Memory Preservation Nutrition

By Nancy B. Emerson Lombardo, PhD
Today’s Geratric Medicine
Vol. 6 No. 6 P. 26

The evidence-based Memory Preservation Nutrition (MPN) program is an integrated whole-foods nutrition program that improves cognitive and emotional health while increasing overall health. It is continually updated and enhanced as new brain-relevant research becomes available.

Researchers studying Alzheimer’s disease (AD) believe brain changes and damage begin years before AD symptoms appear. Following the MPN program can help protect brain health and help even those already experiencing cognitive problems.

How MPN Works
MPN involves following six key strategies that target specific biological outcomes. Each strategy involves consuming a variety of foods customized to each patient according to his or her individual tastes, preferences, ethnic/cultural proclivities, and available foodstuffs and allowing for flexibility in the presence of comorbidities or food allergies/intolerances.

The overall goal of MPN is to promote brain health and, specifically, to reduce the risk of AD and other neurodegenerative diseases, delay the onset of symptoms in those with presymptomatic AD, and slow progression in those already diagnosed with mild cognitive impairment (MCI) or AD. An additional objective is to promote overall health, particularly in the areas identified as being closely related to brain health: sugar metabolism, healthy insulin function, and healthy cardiovascular function.

Strategies Emphasize Whole Foods
Patients who adhere to the MPN program adopt the following practices:

• They increase their intake and the variety of antioxidants they consume, including those found in spices, nuts and seeds, whole grains, green leafy vegetables, and berries. This also helps reduce inflammation.

• They increase their consumption of omega-3s and other healthy fats (eg, monounsaturated), such as those found in fish and seafood; walnuts; seeds such as flax, chia, and hemp; canola and extra-virgin olive oils; leafy greens and purslane; and flax, fish, and marine oils. They also eat fewer foods containing omega-6s, including avoiding corn oil.

• They work to reduce insulin resistance by limiting their sugar intake and eating complex carbohydrates and whole grains (along with other foods listed here).

• They work to reduce their LDL cholesterol level and their intake of animal-based saturated fats. They also avoid trans fats.

• They consume adequate amounts of vitamins B, D, and E, which are critical for brain health. Those of particular importance include vitamin D3; the family of eight vitamin Es, including tocotrienols; vitamin B12; and niacin.

Recommended Foods
Patients following the MPN program should consume more plant foods and fewer animal foods. They should obtain their nutrients from whole foods or juices, reducing their consumption of processed foods as much as possible and preferably avoiding them. They should stay hydrated, preferably by drinking plenty of water. Probiotics and prebiotics are important for maintaining good gut microbiome health, and patients can eat fermented foods such as Greek yogurt, pickles, and sauerkraut to do this.

Vegetables are critical for good brain health, especially leafy greens, which contain omega-3s, vitamin E, and key B vitamins (including folate). Some leafy greens, such as romaine lettuce, also contain S-adenosylmethionine, which has been identified as directly benefiting cognitive health.1 Legumes have been linked to good brain health as well.2-5

Berries offer potent antioxidant properties and anti-inflammatory action, and they facilitate brain-cell signaling, which has been established as being especially beneficial for good brain health.6,7

The MPN program advocates replacing dietary salt and sugar with herbs and spices. All spices, herbs, teas (especially green tea), and dark chocolate are potent antioxidants and anti-inflammatories, and they help protect the brain and heart. Some studies have established spices, including cinnamon, turmeric, and hot peppers, as potent means of reducing LDL cholesterol and improving blood sugar levels and insulin resistance.8-10 The emphasis on herbs and spices as a nutrient-dense, delicious way to maximize MPN’s key strategies helps distinguish it from other programs.

In addition, some herbs have been established as agents that improve acetylcholine availability in the brains of Alzheimer’s patients, including sage, lemon balm, and saffron.11-13 In fact, saffron has been found to be as effective as donepezil (Aricept) in a head-to-head trial and superior in that it has no side effects and costs less.13 Additionally, mice studies suggest that cinnamon, turmeric, and grapeseed extract can prevent oligomerization,14-16 and cinnamon appears to remove excess beta-amyloid from the brain.14

Fish, seafood, and other sources of omega-3 fats also are important for good brain health; fatty fish such as salmon, sardines, and tuna are especially beneficial along with plant-based sources such as leafy greens, walnuts, and seeds such as chia, flax, and hemp. The recommendation is to eat fish or seafood at least three times per week and omega-3–rich plant foods daily. Marine oil supplementation also is recommended.

MPN focuses on reducing cholesterol, trans fats, and animal-based saturated fats while increasing healthy fats, especially omega-3 and monounsaturated fats. People diagnosed with MCI or AD may benefit from consuming a higher proportion of calories from healthy fats found in items such as extra-virgin olive oil, sesame oil, avocados, nuts, and seeds.

Foods to Avoid and Reduce
Patients should avoid trans fats and processed meats with nitrates and should limit red meats such as beef, pork, and lamb to no more than once per week. Multiple studies of trans fats agree that higher consumption is associated with a higher risk of cognitive impairment.17

Excess sugar consumption has been linked to brain problems such as hippocampus shrinkage,18,19 increased beta-amyloid levels,20 impaired insulin function and glucose use in the brain,21 and impaired memory and cognitive processes.20,22 Therefore, patients should limit their intake of foods that are quickly converted to sugar after consumption, such as starches and refined grains, including white rice, white skinless potatoes, and products made with white flour.

Mechanisms of Action
Nutrition is pleiotrophic, working simultaneously through multiple mechanisms. In terms of brain health, similar and complementary nutrients promote both cognitive and emotional health. With regard to AD, MPN is designed to block or delay multiple mechanisms identified as possibly related to AD etiology with minimal or no side effects. For example, omega-3 fatty acids can reduce beta-amyloid burden, improve cognition, and protect against dendritic pathology.

Because scientists do not agree on the sequence of causal events or even whether there may be multiple pathways that result in the classic pathology of AD, nutrition can be an excellent recourse to recommend to patients already dealing with cognitive impairment or diagnosed with MCI or AD as well as patients considered to be at risk based on family or medical history.

The mechanisms by which specific foods may help or harm the brain appear to vary, and with many whole foods, there can be multiple actions at work simultaneously. Moreover, foods work together synergistically.

A few ways foods can enhance brain health include the following:

• increasing the availability of the memory neurotransmitter acetylcholine in the brain by directly increasing production or slowing its metabolic breakdown, similar to the action of the cholinesterase inhibitors currently on the market;

• increasing levels of other neurotransmitters;

• influencing antioxidant and/or anti-inflammatory action on multiple mechanisms that regulate beta-amyloid peptides, including reducing the amount of beta-amyloid;

• slowing or preventing oligomerization or fibrilization of the beta-amyloid molecule or removing beta-amyloid from the brain;

• inhibiting extracellular signal-regulated kinase and nuclear factor-kappa B pathways by affecting secretase activity;

• protecting omega-3 fatty acids in brain cell membranes;

• regulating blood sugar and insulin and/or cholesterol;

• creating estrogenic effects that can be neuroprotective, promoting the creation of new brain cells or connective parts (eg, dendritic branching) or slowing their destruction; and

• improving neuronal signaling and synapse activity, restoring mitochondrial function (related to energy) of brain cells, and retarding tau pathology (the other problem protein in Alzheimer’s).

Additional pathways that are positively influenced by nutrients (evidence based) include microtubule stability, microgliosis, metal ion homeostasis, cAMP-response element-binding protein, calcium channel regulation, phosphorylation state of extracellular signal-related kinase, and improved vascular function.

Motivating Patients to Adopt MPN
Nutritional and dietary changes are challenging for many, and it may be difficult for an individual with moderate AD to adopt MPN on his or her own. Caregivers or companions taught to follow MPN can offer assistance or partnership to adhere to the program. People with MCI and mild AD may be able to undertake changes on their own with the help of MPN guides and menus, recipes, and shopping lists along with occasional coaching. Individuals’ motivation varies, but the idea of being able to maximize brain power or preventing or slowing MCI and/or AD by eating specific foods, particularly with the broad choice available, may be enough to prompt people to adopt a lifestyle change and embrace MPN.

MPN appears safe and should improve overall health. However, it’s important to remember that good food choices are most beneficial when combined with adequate sleep, frequent physical exercise, mental stimulation, and social activity.

— Nancy B. Emerson Lombardo, PhD, is a founder of the national Alzheimer’s Association and Alzheimer’s Disease International. She is an adjunct research assistant professor of neurology at Boston University School of Medicine and Boston University Alzheimer’s Disease Center and the recipient of a grant to study a combination of nutritional supplements based on the MPN. She also is president of the Brain Health and Wellness Center.

References
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2. Fu Z, Zhang W, Zhen W, et al. Genistein induces pancreatic beta-cell proliferation through activation of multiple signaling pathways and prevents insulin-deficient diabetes in mice. Endocrinology. 2010;151(7):3026-3037.

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