Those who have experienced the loss of a loved one to dementia will know that it’s like losing someone twice. With Alzheimer’s now the leading cause of death in the UK, this cruel disease is feared more than cancer, heart disease or stroke as we age.
While it can be frightening to be told that you have the markers for Alzheimer’s, Dr Sabine Donnai, a longevity and brain expert, says that it doesn’t mean there’s nothing you can do. “There’s a perception that whether you develop Alzheimer’s or not is a lottery, but that’s not the case. It’s a lifestyle disease in the main,” she says.
There are genetic factors, just like with cancer and vascular disease, but of the 13 risk factors for dementia and Alzheimer’s, she points out that only one is genetic. “The 12 others are in our hands,” says Donnai, a former medical director of Nuffield Health.
A little over 100 years ago Alzheimer’s didn’t exist. Today one in 11 people over the age of 65 has dementia in the UK. “The environment we’re living in has changed significantly and that’s what is driving the rates up,” Donnai says.
Poor sleep and diet, stress levels and environmental toxins are all part of the picture of modern life that has caused rampant inflammation in our cells. This in turn damages the blood-brain barrier (BBB), the purpose of which is to shield the brain from toxins in the blood. A symptom of a weak BBB is brain fog or difficulty concentrating.
The founder of Viavi, a clinic that focuses on preventative medicine and health screening, Dr Donnai works with clients to try to stem cognitive decline. Its six-week Better Brain programme focuses on eliminating the risk factors harming brain function as well as positive changes that support good brain health.
Vascular dementia starts 15 years before you get your first symptoms, and your lifestyle hugely influences whether it expresses itself or not.
Six weeks is long enough to see radical changes, Donnai says: “There is so much you can do without having to take medication. The most important thing is not to wait until you’ve got symptoms.”
While it’s always best to start early, Donnai’s biggest challenge is to help people with early-onset dementia to make changes and not lose motivation.
Diet is one of the most effective ways of doing so. “If we look at people with early-onset cognitive decline, what makes the biggest difference to reversing that is diet and then starting to exercise. It’s that simple.”
Week one
Kick-start the ketones
The quickest way to jolt the brain out of brain fog is to kick-start the production of ketones in the body. Scientists have suggested that a keto diet boosts brain function and might serve as a possible treatment for Alzheimer’s disease.
Ketones are acids that your body makes when it breaks down fat. They cross the blood-brain barrier and can be used by brain cells as fuel. “Your brain thrives on a high-ketone diet,” says Dr Donnai. “It’s like jump-starting your car. Your brain says: ‘Oh my gosh, this is how I can function!’”
The simplest way to start ketosis is by intermittent fasting.
Donnai recommends an intermittent fast three times per week: “Try not eating for a 16-hour period and avoid eating later than three hours before bedtime. Skipping breakfast or an evening meal can have a massive difference to your brain.”
She adds: “Our genes haven’t changed in more than 30,000 years; we’re not used to having food all day.”
You might think that intermittent fasting is about deprivation, but that is precisely what Donnai doesn’t recommend. “On the contrary, it is about being abundant in providing your brain with the right nutrients.”
Once you’ve started to clear the brain fog, you can start to bring in the nutrients to support brain function. The modern diet has displaced fat in favour of sugar, and it’s toxic for our brains. “Fears about high cholesterol saw low-fat products fill supermarket shelves. But what’s happened is that we’ve added sugar where the fat used to be,” Donnai says.
Fat, though, is good for our brain. “Unless you’re overweight, the vast majority of our fat is in our brain. It’s a very fatty tissue. The medium-chain fatty acids omega-3s are hugely beneficial for your brain. But our modern diet goes towards omega-6s and 9s.”
Omega-3 can be found in olive oil, oily fish, flaxseed, pasture-fed red meat, good-quality cheese and eggs: “There’s a misconception about eggs. People worry about cholesterol, but they’re a source of good oils and protein.”
Donnai also takes wild salmon fish oil, although she says it pays to be careful of mercury levels. She also favours cooking with avocado or coconut oil and ghee, because they are heat-resistant. “A common mistake is cooking with olive oil, which changes it to an unhealthy fat.” Instead, pour it cold on pasta or salads.
Sugar, meanwhile, causes inflammation and damage to the BBB. “It allows toxins to settle in our brain. The amyloid plaque that we see building up in Alzheimer’s patients is the brain trying to protect itself from all these insults. It’s similar to the build-up of cholesterol we see in the vascular wall.”
A diet rich in magnesium, zinc and vitamins B and D will help optimise brain function. Find them in dark-coloured fruit and veg such as blueberries, blackberries, aubergine and beetroot, as well as leafy green veg such as kale, broccoli and cabbage. “I used to hide cabbage in homemade ice cream for my kids,” says Donnai.
Favour veg over fruit and prioritise orchard fruits over tropical ones. “You might think they are healthy, but fruits such as pineapple, mangoes and bananas are full of sugar,” she says.
Week two
Be gutsy and knock out the sugar
When Dr Donnai began her career, the importance of the gut to brain health was entirely ignored. “Now we know how it influences our immune system and the brain. We treat people with OCD and anxiety purely by changing the microbes in the gut, feeding people particular probiotics. That suddenly changes their mood. It’s remarkable.”
It is the reason that a brain-healthy diet is one that also feeds the gut microbiome. If you allow bad bacteria to thrive in the intestinal flora, it can produce amyloid, which enters blood circulation and crosses the BBB to the brain.
Brain carbohydrates include wholegrains, legumes, sweet potatoes and beetroot. Variety is also the aim. “So many people eat a samey diet week after week,” says Donnai. She advises we aim for 100 different foods a week, including herbs and spices.
Focusing on a high-protein and low-refined carbohydrate diet will also help you to control blood sugar fluctuations and reduce body fat if necessary. ”People don’t think obesity will affect their brain, but we’re finding that Alzheimer’s is a third more prevalent in people who are overweight.”
Donnai recommends ensuring that protein makes up 30 per cent of every meal: “And avoid eating sugars – especially in isolation of a meal.” Although “a piece of 70 per cent dark chocolate is good for the brain”.
Week three
Get the body pumping
The most obvious answer to why movement aids brain health is that we need oxygen to reach the brain. “The more blood supply to the brain, the more nutrients we get to the brain and the more debris we can carry away from it,” says Donnai.
It’s why she prioritises exercise rather than stress management with her patients. Stress is damaging for cognitive function because it diverts energy away from the brain.
Chronic stress shifts our hormones from the anabolic system, which is about growth and healing, towards the catabolic nervous system associated with wear and tear: “Therefore we age faster,” Donnai says. “There’s no repairing and restoring taking place and our brain is the organ that will suffer most.”
So uncompensated stress is a problem, but gentle exercise helps reduce our stress hormones. “It has to be gentle exercise because you don’t want to spike the cortisol even more,” explains Donnai. “You don’t need to end up an athlete; you just need to make sure you move.”
Tai chi, yoga and a brisk walk will make a massive difference to your brain. Donnai recommends 20 minutes of strength training twice per week (think squats, lunges, wall sits, crab walks, pull-ups and push-ups) as well as a 30-minute walk daily, including 60-second bursts of really fast walking every four minutes.
Week four
Dump the toxins
It’s time to turn your attention to your environment. With your brain feeling more energetic, it will be easier to clear out the things you don’t want there. What harmful toxins are you harbouring in your home and your fridge that could be damaging your brain?
Food-wise, if it doesn’t look like nature has produced it, avoid it: “Check labels for additives, colourants and artificial sugars,” says Donnai.
Sadly, not all fresh fruit and veg is toxin-free. “The worst offenders are apples, cucumbers and strawberries, which are heavily sprayed with pesticides and, due to their water content, absorb the chemicals.” Donnai only consumes these if they are organic. However: “It’s not as important to have an organic avocado or banana, due to their skin not being edible.
”We live in a material world, and a lot of it is toxic,” Donnai says. Avoid aluminium cookware, as well as heating food or drinks in plastic. Your detergent and toothpaste, your fire-retardant sofa – even walking on a freshly cleaned floor could have consequences for your long-term brain health.
“In our check-ups, four times out of 10 we find cleaning products as a DNA adduct, which is a chemical that attaches itself to your DNA and changes how it expresses itself, like an epigenetic influence but in a negative way,” Donnai says.
Drinking 1.5L of water per day, she says, will help detoxify through the kidneys, liver and gut, as well as by sweating: “The only ways to get rid of toxins.”
Week five
Happiness and hormones
By now, you might already have noticed your mood improving. Dementia and depression are closely linked. Some research suggests that having depression earlier in your life is a risk factor for developing dementia later on.
There are ways to improve mental health through diet. Saffron has been shown to improve mood, while fresh tomatoes contain serotonin, which plays a role in modulating the neuro-transmitter Gaba. Dr Donnai also recommends taking an ashwagandha (an evergreen shrub that grows in Asia and Africa) supplement if you feel anxious, or doing breathing exercises.
“Ageing isn’t inevitable as you get older,” Donnai says. If you are living a healthy life, there should be little difference in your kidney, liver and immune system function whether you are 20 or 50.”
But what does change as we age are our hormones. “The whole endocrine system works on feedback mechanisms with your pituitary gland and hypothalamus. It is almost impossible for one to change without the other changing. They work as a team,” Donnai says.
So supporting good hormone health supports our brain, too. Two-thirds of women over the age of 40 that Donnai sees in her clinic have an underactive thyroid. “And the thyroid is hugely important for cognitive flexibility.”
The good news is that hormones are influenced by how we eat. “Again, this is where omega-3 fatty acids come in. They are superfoods for your hormonal system.” Iodine is also key. “You can find it in seaweed, nuts and eggs.”
While we still don’t fully understand why women are more likely to develop Alzheimer’s disease than men, a leading theory is to do with oestrogen. When women go through menopause, their bodies stop producing as much of this hormone. Ensuring you have enough vitamin B and D is crucial to boosting oestrogen levels naturally.
As well as hormones, optimising our immune system is also possible via diet. New studies are revealing that the immune system might be a major driver of Alzheimer’s. Any infection or inflammation takes away energy from the brain to restore.
An example is gum disease, known to cause an increase in markers of systemic inflammation, with several studies suggesting this may contribute to the development of dementia.
“Floss your teeth,” Donnai says. “The biggest inflammation people tend to have is in their gums and in their gut. You’ve got a 13 per cent risk of Alzheimer’s if you don’t floss your teeth.”
Meanwhile, we can suppress gut inflammation with probiotic foods such as sauerkraut, kefir, kombucha and kimchi, and prebiotics such as nuts, beans, pulses, spices and herbs.
Week six
Life with your new brain
Notice how you’re feeling. Do you have more focus, energy and positivity?
“You might feel 10 years younger,” says Donnai. With your new brain-healthy food habits established, you can start to think about other areas of your life that will augment your brain health.
A major problem in the modern world is that people have forgotten how to relax, Donnai says: “Most people are not so much overstimulated as under-relaxed.”
Today she frequently sees brain fog in 15-year-olds: “Something that would never have been seen 10 years ago. Their brain is physically tired because it has forgotten how to switch off.”
Recommendations to counteract our digitally stimulating culture include meditation, mindfulness, tai chi and yoga. Swap the TV for a board game or jigsaw puzzle at night.
When it comes to sleep, switching off electronic devices at least an hour before bedtime is crucial. “Have a bath with Epsom salts and some lavender oil drops before bed. Sleep in a cool, dark room and aim for seven to eight hours’ sleep,” Donnai says.
While constantly stimulating our brains with technology, we’re also under-using them. Donnai says it is a misconception that our brains become slower with age. Throughout our life our brain continues to grow by making more neural pathways, so we should get brighter and brighter as we age: “Like your ears, the brain keeps growing.”
However, while aged 16 we push our brains to learn, by 60 we stop pushing ourselves to be cognitively flexible. “As you get older, your brain gets lazy because it operates on memory, not learning. If we put in the same effort at 60 as we did at 16, we would learn faster because we have more neural connections now.”
The type of activity matters. Brain exercises such as sudoku don’t rely too much on memory but on building new connections, says Donnai.
She recommends training your brain with coordinated activities. Learn to dance the tango, play table tennis (“the world’s best brain sport!” says Donnai), juggle, play a new instrument or learn a new language.
“Spend 10 minutes a day learning a new poem by heart or just 15 minutes a day learning something new.” Alter your daily routines if you can: “Brush your teeth with the ‘wrong’ hand,” Donnai says.
Doing this won’t just make new neural connections, but will improve your mood. “I see people every day and I think: ‘Your brain’s unhappy because it’s bored’, and when it’s bored it becomes depressed, or gets OCD, or becomes anxious, because actually it’s not stimulated enough.”
Brain smoothie
On non-fasting days, this is a great way to start the day.
½ cup frozen organic cherries or other berries
2 organic egg yolks
250ml coconut water or filtered water
3tbsp collagen hydrolysate as a protein base
1tbsp nut butter
1tbsp coconut oil
1-2tbsp ghee
1-2tbsp raw cocoa powder