Do Omega-3s Slow Cognitive Decline?

Written by Dr. Steve Chaney on . Posted in current health articles, Healthy Lifestyle, Vitamins and Health

Why Omega-3s Should Be Part Of Your Holistic Brain Health Program

Author: Dr. Stephen Chaney

 

Omega3-Cognitive-DeclineWho wouldn’t want to avoid dementia and Alzheimer’s in our later years? There is a ton of advice on the internet about “magic” solutions to keep our brains sharp well into our 90s. Unfortunately, most of that advice is contradicted by other claims on the internet that those solutions don’t work. What should a person do if they want to keep their brain healthy?

Two weeks ago I talked about a study showing that a holistic approach, which to me includes healthy diet, weight control, exercise, supplementation, socialization and memory training, significantly reduces cognitive decline in the elderly (Is There Hope For Alzheimer’s?).

Last week I sorted out the conflicting advice about B vitamins and cognitive decline (Do B Vitamins Slow Cognitive Decline?). More importantly, I told you who would benefit from B vitamin supplementation and who would not.

In part three of this series I’m going to help you sort out the conflicting information on omega-3s and cognitive decline. Then I will sum up what a holistic brain health program might look like for you.

Why Might Omega-3s Slow Cognitive Decline?

There are lots of reasons to believe that omega-3 fatty acids are important for brain health and might, therefore, slow cognitive decline. For example:

Omega-3 fatty acids improve blood flow to the brain.

The omega-3 fatty acid DHA is an important part of the myelin sheath, the protective coating for every neuron in our body.

DHA is also converted to a neuroprotective agent that protects the brain from oxidative stress.

The Confusing Evidence About Omega-3s And Cognitive Decline

The data about omega-3s and cognitive function to date have been confusing. Most observational studies have reported better cognitive functioning and lower incidence of Alzheimer’s disease in populations that consume large amounts of fatty fish rich in omega-3s. There is also some evidence that omega-3 supplementation improves cognitive function for patients with mild cognitive impairment or very mild Alzheimer’s disease. However, most short-term, randomized, placebo-controlled studies have found no effect of omega-3 supplementation on cognitive functioning for patients who already have mild to moderate Alzheimer’s disease.

It had been assumed for years that by the time one already had Alzheimer’s it was too late for omega-3s to exert a protective effect. However, some recent studies have suggested a possible genetic explanation for the conflicting information on omega-3s and cognitive decline.

There is a genetic variant of the ApoE gene called ApoE4 that dramatically increases the risk of Alzheimer’s disease. Around 20-25% of the general population and 40-50% of Alzheimer’s patients have this genotype. Several recent studies have suggested that omega-3s may protect against cognitive decline only in people who do not carry the ApoE4 genotype. The current study (Daiello et al, Alzheimer’s & Dementia, doi: 10.1016/j.jalz.2014.02.005) was designed to test this hypothesis.

Do Omega-3s Slow Cognitive Decline?

This was a very well designed study. The investigators enrolled 819 older adults (average age 75, range 55-90) in the study and followed them for 3 to 4 years. 229 of the participants had normal cognition at enrollment, 337 had mild cognitive impairment and 193 had Alzheimer’s disease. All participants were tested for ApoE genotype.

The study participants were tested at baseline and every 6 months with two tests of cognitive function – the Alzheimer’s Disease Assessment Scale (ADAS) and the fish-oil-benefitsMini-Mental State Examination (MMSE). MRI tests were also done at baseline and every 6 months to assess brain volume.

The participants were asked about fish oil supplement use at each of those times. Only those who reported taking fish oil supplements at every examination were considered fish oil supplement users (117), and only those who never consumed fish oil supplements were considered non-users (682).

The results were pretty interesting:

  • Fish oil supplements significantly decreased cognitive decline and brain shrinkage in the ApoE4 negative population, but not in the ApoE4 positive population.
  • The beneficial effects of fish oil supplementation were only seen in the population with normal cognition at the time the study started. Those benefits were not significant in the populations with mild cognitive impairment or Alzheimer’s disease.
  • Unfortunately, the study was not large enough to perform a statistic analysis of the ApoE positive and negative subpopulations of the groups with mild cognitive impairment or Alzheimer’s disease, so it was not possible to tell whether omega-3s might have been beneficial in people with mild cognitive impairment or Alzheimer’s disease who are ApoE4 negative.

The authors concluded that their results “highlight the need for future research on the effects of long-term fish oil supplement use on cognitive aging and dementia prevention in middle-aged and older adults”.

They also highlighted a major reason why so many previous studies have failed to find a link between omega-3s and cognitive decline when they said “Studies on cognitive aging that don’t screen subjects for ApoE4 are doomed to failure”.

Putting It All Together: Holistic Approaches For Preserving Brain Health

When I began this series three weeks ago with Is There Hope For Alzheimer’s? , I talked about the importance of holistic approaches. I referred back to a cancer expert who said that he could prove that a holistic lifestyle approach significantly reduced the risk of colon cancer, but he couldn’t prove that any individual lifestyle change had any effect on colon cancer risk.

holistic-health-programThe situation is very similar when we talk about preserving cognitive function. Over the past three weeks I have identified many things that can reduce the risk of cognitive decline – healthy diets, exercise, socialization, mental exercise, maintaining a healthy weight, B vitamins and omega-3 fatty acids. If we follow a holistic lifestyle that combines all of these things, we are likely to dramatically increase our probability of maintaining a healthy brain well into our golden years.

However, holistic lifestyle changes are difficult. I know some of you will want to take a simpler approach. You are going to ask:

1)  Are there some individual lifestyle changes that are certain to slow cognitive decline on their own?

The answer is probably not. Maintaining a healthy weight comes close. However, some evidence suggests that it is not obesity itself that increases the risk of dementia. It is the insulin resistance and elevated blood sugar associated with obesity – and not everyone with obesity has insulin resistance and elevated blood sugar levels. So for some people obesity may not increase their risk of dementia. For those people weight loss might not reduce their risk of dementia.

2)  Are there some lifestyle changes I don’t need to make if my diet is OK?

The study I described in last week’s Health Tips From the Professor  found that B vitamin supplementation only reduced the risk of cognitive decline for people who were B vitamin deficient.

So one might assume that you could get a simple test for B vitamin deficiency and determine whether B vitamin supplementation would be beneficial or not. But which test should you get? Who is at risk? Is it the 5-10% of the population with elevated homocysteine levels, the 10% of the population with a deficiency of methylenetetrahydrofolate reductase (MTHFR), the 25% of the population with low blood levels of B6 or the 40% of the population over 60 with B12 deficiency? We simply don’t know.

3)  Is it even worth bothering making lifestyle changes if I’m genetically predisposed to developing Alzheimer’s?

This week’s study found that omega-3s reduced the risk of cognitive decline only in people who did not have the ApoE4 genotype. Does that mean that you should rush out and test yourself for ApoE4?

Here the answer is a clear no. In the first place, we have no idea how the ApoE4 genotype affects the other lifestyle changes that slow cognitive decline.

In addition, there is another, very important reason why most experts, including the professor, decline being tested for ApoE4. The ApoE4 genotype dramatically increases your risk of developing Alzheimer’s disease, and there is no proven treatment for reducing that risk if you are ApoE4 positive. Who wants to know that they are at increased risk of developing Alzheimer’s if there is nothing they can do about it?

 

The Bottom Line

1)     This study suggests that supplementation with omega-3s (fish oil) significantly reduces cognitive decline and brain shrinkage in older adults (average age 75).

2)     The effect of fish oil supplementation on cognitive decline and brain shrinkage was only seen in people who lacked the ApoE4 genotype. Fish oil supplementation was ineffective in people who were ApoE4 positive.

3)     The study showed that fish oil supplementation was effective at reducing cognitive decline and brain shrinkage in older adults with normal brain function who were ApoE4 negative, but the study was not large enough to determine whether it was also effective in older adults with cognitive decline or Alzheimer’s disease who were ApoE4 negative. Further research is needed to clarify this important point.

4)     This was a relatively well designed study, but it was a small study. Larger, long-term studies are needed to confirm these results. More importantly, based on the results of this study, future studies will need to screen participants for ApoE4 status to assure that there is a large group of ApoE4 negative participants. This would provide enough statistical power to clearly determine whether fish oil supplementation can also benefit people who already have symptoms of cognitive decline or Alzheimer’s and are ApoE4 negative.

5)     Even though ApoE4 status influences the effectiveness of fish oil supplementation on slowing cognitive decline, you probably don’t want to rush out and get yourself tested for ApoE4. We don’t know whether ApoE4 status influences other lifestyle changes that slow cognitive decline. More importantly, the ApoE4 genotype dramatically increases the risk of developing Alzheimer’s disease, and there is currently no proven treatment for reducing that risk if you are ApoE4. Who wants to know that they are at increased risk of developing Alzheimer’s if there is nothing you they do about it?

6)     Finally, don’t rely solely on supplementation with B vitamins or omega-3s to reduce your risk of cognitive decline. Your chances of reducing cognitive decline are best with a holistic approach that includes healthy diet, exercise, socialization, mental exercises, maintaining a healthy weight, B vitamins and omega-3 fatty acids.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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