Mediterranean diet

Diet may help preserve cognitive function

Analysis of data from the Age-Related Eye Disease Study (AREDS) and AREDS2, involving a total of around 8,000 older adults, has found that those with the greatest adherence to the Mediterranean diet had the lowest risk of cognitive impairment. High fish and vegetable consumption appeared to have the greatest protective effect. At 10 years, AREDS2 participants with the highest fish consumption had the slowest rate of cognitive decline.

Those with the Alzheimer's gene ApoE4 on average had lower cognitive function scores and greater decline than those without the gene, but close adherence to a Mediterranean diet had similar benefits for people with and without the ApoE4 gene.

Reference: 

Keenan TD, Agron E, Mares J, Clemons TE, van Asten F, Swaroop A, and Chew E, for the AREDS and AREDS2 research groups. Adherence to a Mediterranean diet and cognitive function in the Age-Related Eye Disease Studies 1 & 2. April 14, 2020. Alzheimer's and Dementia.

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Mediterranean-style diets linked to better brain function

A study involving 5,907 older adults (average age 68) found that those who ate Mediterranean and MIND-style diets scored significantly better on cognitive tests than those who ate less healthy diets, with adherence to a brain-healthy diet correlating with cognitive benefit in a dose-response way. Those who followed these healthy diets also had lower risk of cognitive impairment in later life.

This is in keeping with a 2016 review of research looking at the effects of the Mediterranean diet on cognition. This review found that positive cognitive effects of a higher adherence to such a diet were similar in all evaluated papers, from across the world. Attention, memory, and language improved, with memory in particular showing benefits.

The research indicates a number of factors are behind these benefits, including

  • reducing inflammatory responses
  • increasing micronutrients
  • improving vitamin and mineral imbalances
  • changing lipid profiles by using olive oils as the main source of dietary fats
  • maintaining weight and potentially reducing obesity
  • improving polyphenols in the blood, improving cellular energy metabolism
  • maybe changing the gut micro-biota, although there’s not much research on this yet.

Although most research has involved older adults, two studies looked at younger adults, and they both found improvements in cognition as well.

Reference: 

McEvoy, C. T., Guyer, H., Langa, K. M., & Yaffe, K. (2017). Neuroprotective Diets Are Associated with Better Cognitive Function: The Health and Retirement Study. Journal of the American Geriatrics Society, 65(8), 1857–1862. https://doi.org/10.1111/jgs.14922

Hardman, R. J., Kennedy, G., Macpherson, H., Scholey, A. B., & Pipingas, A. (2016). Adherence to a Mediterranean-Style Diet and Effects on Cognition in Adults: A Qualitative Evaluation and Systematic Review of Longitudinal and Prospective Trials. Frontiers in Nutrition, 3. https://doi.org/10.3389/fnut.2016.00022

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Nutrients linked to better brain connectivity, cognition in older adults

  • A study found that higher levels of several key nutrients were associated with more efficient brain connectivity and better cognitive performance in older adults.

A study involving 116 healthy older adults (65-75) has found that higher levels of several key nutrients in the blood were associated with more efficient brain connectivity and better cognitive performance. In fact, the findings suggest that the level of nutrients governs the strength of the association between functional brain network efficiency and cognitive performance.

The study looked at 32 key nutrients in the Mediterranean diet. The effective nutrients, which appeared to work synergistically, included omega-3 and omega-6 fatty acids, carotenoids, lycopene, riboflavin, folate, vitamin B12 and vitamin D.

A pattern of omega-3s, omega-6s and carotene was linked to better functional brain network efficiency.

Omega-3 fatty acids are abundant in fish, walnuts and Brussels sprouts; omega-6 fatty acids are found in flaxseed, pumpkin seeds, pine nuts and pistachios; lycopene is the vivid red pigment in tomatoes, watermelon and a few other fruits and vegetables; alpha- and beta-carotenoids give sweet potatoes and carrots their characteristic orange color.

https://www.eurekalert.org/pub_releases/2018-12/uoia-sln121918.php

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The right diet may slow cognitive decline in stroke survivors

  • An observational study involving over 100 stroke survivors suggests the MIND diet may help substantially slow cognitive decline in those impaired by stroke.

A pilot study involving 106 participants of the Rush Memory and Aging Project who had experienced a stroke followed participants for an average of 5.9 years, testing their cognitive function and monitoring their eating habits using food journals. It was found that those whose diets scored highest on the MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) diet score had substantially slower rates of cognitive decline than those who scored lowest. The estimated effect of the diet remained strong even after taking into account participants' level of education and participation in cognitive and physical activities. Those who instead scored high on the Mediterranean or DASH diets did not show the same slower decline.

Both the Mediterranean and DASH diets have been shown to be protective against coronary artery disease and stroke, but this finding suggests the MIND diet is better for overall brain health.

The MIND diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. It has 15 components: 10 “brain-healthy food groups” and five unhealthy groups (red meat, butter, cheese, pastries and sweets, and fried or fast food).

To adhere to the MIND diet, you need to

  • eat at least three daily servings of whole grains
  • eat a green leafy vegetable and one other vegetable every day
  • drink a regular glass of wine
  • snack most days on nuts
  • have beans every other day or so
  • eat poultry and berries at least twice a week
  • eat fish at least once a week
  • limit butter to less than 1 1/2 teaspoons a day
  • eat less than 5 servings a week of sweets and pastries
  • eat less than one serving per week of whole fat cheese, and fried or fast food.

The researchers stress that this is a preliminary study, observational only. They are currently seeking participants for a wider, intervention study.

https://www.eurekalert.org/pub_releases/2018-01/rumc-mdm012418.php

Reference: 

Laurel J. Cherian & Martha Clare Morris: Presentation at the American Stroke Association's International Stroke Conference 2018 in Los Angeles, January 25.

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Mediterranean diet reduces brain shrinkage in old age

  • The Mediterranean diet is the diet most associated with cognitive and health benefits in older adults.
  • A new study has found larger brain volumes among those following this sort of diet, equivalent to that of brains five years younger.
  • Much of this was associated with two components of the diet in particular: eating fish regularly, and eating less meat.

Another study adds to the growing evidence that a Mediterranean diet is good for the aging brain.

The New York study used data from 674 non-demented older adults (average age 80). It found that those who closely followed such a diet showed significantly less brain shrinkage. Specifically, total brain volume was an average 13.11 milliliters greater, with grey matter volume 5 millilitres greater, and white matter 6.4 millilitres greater.

Eating at least five of the recommended Mediterranean diet components was associated with benefits equivalent to five years of age. By far the most important of these components was regular fish and reduced meat intake — at least 3 to 5 ounces of fish weekly; no more than 3.5 ounces of meat daily.

This is consistent with a considerable amount of research indicating the benefits of fish in fighting age-related cognitive decline.

http://www.theguardian.com/lifeandstyle/2015/oct/21/mediterranean-diet-may-slow-the-ageing-process-by-five-years

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A diet to delay age-related cognitive decline

More evidence for the benefits of the Mediterranean diet for fighting age-related cognitive decline comes from a large 5-year study. The study involved 960 older adults, whose cognitive change was assessed over 4.7 years. Those who followed the MIND diet more rigorously showed an equivalent of being 7.5 years younger cognitively than those who followed the diet least.

The Mediterranean-DASH Diet Intervention for Neurodegenerative Delay is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. It requires at least:

  • three servings of whole grains every day
  • a green leafy vegetable and one other vegetable every day
  • a glass of wine
  • snack most days on nuts
  • beans every other day or so
  • poultry at least twice a week
  • fish at least once a week
  • berries at least twice a week (blueberries are particularly recommended)
  • very limited intake of designated unhealthy foods, especially:
    • butter
    • sweets and pastries
    • whole fat cheese
    • fried or fast food

http://www.eurekalert.org/pub_releases/2015-08/rumc-eaa080415.php

http://www.theguardian.com/society/2015/aug/05/diet-high-in-leafy-green-vegetables-may-slow-cognitive-decline-in-elderly-study

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Risk factors that affect progression from MCI to dementia

A large meta-analysis has concluded that having diabetes increases the chance that a person with mild cognitive impairment will progress to dementia by 65%.

There was no consistent evidence that hypertension or cholesterol levels increased the risk of someone with MCI progressing to dementia. Smoking was similarly not associated with increased risk, although the reason for this probably lies in mortality: smokers tend to die before developing dementia.

There was some evidence that having symptoms of psychiatric conditions, including depression, increased the risk of progressing to dementia.

There was some evidence that following a Mediterranean diet decreased the risk of an individual with amnestic MCI progressing to Alzheimer's, and that higher folate levels decrease the risk of progressing from MCI to dementia. The evidence regarding homocysteine levels was inconsistent.

The evidence indicates that level of education does not affect the risk of someone with MCI progressing to dementia.

Do note that all this is solely about progression from MCI to dementia, not about overall risk of developing dementia. Risk factors are complex. For example, cholesterol levels in mid-life are associated with the later development of dementia, but cholesterol levels later in life are not. This is consistent with cholesterol levels not predicting progression from MCI to dementia. Level of education is a known risk factor for dementia, but it acts by masking the damage in the brain, not preventing it. It is not surprising, therefore, that it doesn't affect progression from MCI to dementia, because higher education helps delay the start, it doesn't slow the rate of decline.

Do note also that a meta-analysis is only as good as the studies it's reviewing! Some factors couldn't be investigated because they haven't been sufficiently studied in this particular population (those with MCI).

The long-running Cache County study has previously found that 46% of those with MCI progressed to dementia within three years; this compared with 3% of those (age-matched) with no cognitive impairment at the beginning of the study.

More recently, data from the long-running, population-based Rotterdam study revealed that those diagnosed with MCI were four times more likely to develop dementia, over seven years. compared with those without MCI. Of those with MCI (10% of the 4,198 study participants), 40% had amnestic MCI — the form of MCI that is more closely associated with Alzheimer's disease.

The 2014 study also found that older age, positive APOE-ɛ4 status, low total cholesterol levels, and stroke, were all risk factors for MCI. Having the APOE-ɛ4 genotype and smoking were related only to amnestic MCI. Waist circumference, hypertension, and diabetes were not significantly associated with MCI. This may be related to medical treatment — research has suggested that hypertension and diabetes may be significant risk factors only when untreated or managed poorly.

http://www.theguardian.com/science/occams-corner/2015/feb/24/speeding-up-the-battle-against-slowing-minds

http://www.eurekalert.org/pub_releases/2015-02/ucl-dad022015.php

http://www.eurekalert.org/pub_releases/2014-08/ip-drq080614.php

Reference: 

[3913] Cooper, C., Sommerlad A., Lyketsos C. G., & Livingston G.
(2015).  Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis.
American Journal of Psychiatry. 172(4), 323 - 334.

[3914] Tschanz, J. T., Welsh-Bohmer K. A., Lyketsos C. G., Corcoran C., Green R. C., Hayden K., et al.
(2006).  Conversion to dementia from mild cognitive disorder The Cache County Study.
Neurology. 67(2), 229 - 234.

de Bruijn, R.F.A.G. et al. Determinants, MRI Correlates, and Prognosis of Mild Cognitive Impairment: The Rotterdam Study. Journal of Alzheimer’s Disease, Volume 42/Supplement 3 (August 2014): 2013 International Congress on Vascular Dementia (Guest Editor: Amos D. Korczyn), DOI: 10.3233/JAD-132558.

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Mediterranean diet may lower risk of diabetes

A review of 19 studies involving over 162,000 people has found that adherence to the Mediterranean diet was associated with a 21% reduced risk of diabetes, with a greater effect (27%) for those at high risk for cardiovascular disease. The association was found in both European and non-European groups.

The research was presented at the American College of Cardiology's 63rd Annual Scientific Session.

http://www.eurekalert.org/pub_releases/2014-03/acoc-mdm032614.php

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