If the Functional Medicine approach to cognitive decline was simple, then everyone would be doing it!
Finding root causes can take time and determination, as well as a little trial and error.
The benefits are well worth the effort.
Here’s a summary of some of the most common issues we see in patients with cognition and memory problems, and a little bit about how we might tackle them.
Inflammation:
Poor diet, food and environmental sensitivities, autoimmune conditions, high stress levels, chronic infections and toxin exposures are just a few of the triggers for long term inflammation which can damage many organs in the body – including the brain.
Measuring inflammation levels and taking steps to reduce this is a core feature of the Functional Medicine approach.
Treatments to help may include:
- Diet Optimisation – reducing sugar and processed foods, increasing antioxidants and healthy proteins and fats.
- Discovery and elimination of food sensitivities
- Vitamin D acts to regulate neurotransmitters and has anti-inflammatory, antioxidant and neuroprotective properties.
Increased Intestinal Permeability (‘Leaky Gut’):
The gut-brain connection is increasingly recognised as a major player in conditions involving the brain and mental health.
Many of our treatments in Functional Medicine focus on improving gut function and repairing the gut lining, to help reduce inflammatory substances like undigested foods and bacterial toxins from getting through.
Increased permeability at the gut level will increase the entry of unwanted substances to the brain where they can cause an increase the risk of scarring and amyloid plaque formation.
Treatments for healing the gut and blood-brain barrier include:
- Removing foods such as gluten which can damage the gut lining and cause inflammation
- Ensuring micronutrients and amino acids needed for gut repair are well supplied (such as Vitamins A and D, butyrate, glutamine and B vitamins).
- Supporting the microbiome (the friendly bacteria lining in the gut that help with immune tolerance and gut function), with prebiotic high-fibre foods, probiotics and fermented foods
High Blood Sugars:
Diabetes, high blood sugars and high cholesterol are a common side effect of the unhealthy mix of highly processed, addictive, high carb foods which are the staple of our food environment.
Rising levels of diabetes and obesity are driving a rise in both heart disease and dementia. Diet alteration is key for all patients with cognitive decline.
We advise:
- Low-Carb Modified Mediterranean Diet – to reduce inflammation, aid weight loss, and improve all known cardiovascular outcomes.
- Ketogenic Diet – In some patients with cognitive problems, the brain needs extra support to help it to heal and re-grow.
- A Nutritional Therapist-supervised very low carb / Ketogenic diet is a cornerstone of the treatment plan for many of our patients experiencing cognitive decline.
Insufficient Brain Energy
Although our brains only contribute about 2% of our bodyweight, they consume a whopping 20% of the energy we make in a day!
Our energy is produced in the internal ‘cell batteries’ known as the mitochondria. These tiny biological energy factories have very specific nutritional and metabolic requirements to function normally and can be severely affected by some toxins and inflammation.
It’s very common for us to see cognitive decline go hand in hand with physical fatigue. We can support the needs of the brain by identification and remediation of deficiencies in many micronutrients including:
- B Vitamins – B1, B2, B3, B9 and B12 are all needed for normal mitochondrial and brain function.
- Co-Enzyme Q10 – This micronutrient is needed for the production of the energy molecule ATP and low levels may cause significant physical and mental fatigue. Around 75% of dementia patients have been found to have CoQ10 deficiency (often caused by statin medication).
- Iron – Low iron is well known to cause cognitive dysfunction in older adults. As well as helping to transport oxygen around the body in the haemoglobin, iron is also essential for mitochondrial function.
- Carnitine – L-carnitine supplementation can improve cognitive function and decrease cognitive decline in patients with Alzheimer’s disease. Carnitine helps with mitochondrial function and is believed to help cholinergic nerve function (which helps with memory in the brain).
Hormonal and Thyroid Deficiencies
The risk of dementia is higher in women than men and decline in the level of oestrogen after the menopause has been shown to accelerate brain degeneration.
Hypothyroidism (especially low levels of the active T3 hormone), is also strongly linked to a higher risk of cognitive decline. Our Consultant Endocrinologist Dr Clementina La Rosa supports our clinical team in employing a nuanced approach to Hormone replacement therapy.
This may include:
- Replacement of the hormones oestrogen, progesterone, testosterone and DHEA where these are thought to be appropriate and beneficial.
- Nutritional and hormonal support to optimise thyroid function
Cerebrovascular problems
Damage to the blood vessels in the brain is a major cause of dementia and the risk of this occurring increases with high blood pressure, inflammation, high blood sugars and increased blood-clotting potential.
High levels of oxidant stress due to poor diet, toxin exposure and smoking are also major contributors.
Some patients may have inherited risk factors for blood vessel damage due to high Homocysteine levels.
- Monitoring of Homocysteine and optimising methylation with nutritional support (including B12, folate and Vitamin B6)
- Optimisation of blood pressure with prescribed medications, weight loss, a healthy exercise routine and nutritional support
- Optimisation of blood sugars with low carb/ ketogenic diet
- Reduce blood vessel inflammation with Omega 3 / oily fish and diet rich in antioxidants
High Stress Levels
Although we all know that stress is bad for us, not many of us take the time to think about what we could be doing to limit our exposure to stress or learn techniques to mitigate its effects.
Unfortunately, high levels of stress (such as PTSD) have been associated with an increased risk of dementia. Techniques which help to up-regulate the parasympathetic (anti-stress), nervous system include:
- Meditation, relaxation exercises and mindfulness
- Breathing techniques such as Buteyko Breathing
- Transdermal Vagal Nerve Stimulation devices
Sleep Disorders including Sleep Apnoea
There is evidence to show that lack of sleep in your 50’s and 60’s is correlated with increased dementia risks.
Sleep apnoea (stopping breathing during sleep due to airway collapse), with resulting episodes of lower brain oxygenation, has been shown to increase the risks of dementia in both Alzheimer’s disease and Parkinson’s disease.
We use:
- Home sleep studies for the accurate detection of sleep apnoea
- A holistic approach to sleep optimisation using sleep hygiene and melatonin support where required
Increased Toxic Burden
There is an association between exposure to pesticides, heavy metals (aluminium, mercury, lead, arsenic and cadmium), and Biotoxins produced by moulds and bacteria.
We help patients to:
- Assess their level of exposure to various toxins
- Avoid further toxin exposures
- Support effective detoxification from harmful substances
Side effects of medications for other conditions
Many medications are known to be associated with an increased risk of dementia. Some common examples include:
- Proton Pump Inhibitors – commonly used to prevent the symptoms of acid reflux
- Beta Blockers – While useful for regulating heart rate, in some patients these have been found to reduce cognition. However, in some cases they can be protective against the development of dementia, so a nuanced assessment is needed.
- Anticholinergics – This is a large range of medications often used to reduce overactive bladder symptoms which may increase the risk of developing dementia.
Our doctors will review all of your medication and if there are any concerns discuss possible alternatives with your GP or specialist.
If you have any concerns that a medication you are being prescribed may be causing problems with your memory then please see your GP.
To learn more about how Functional Medicine can help with memory and cognitive problems, BOOK an appointment with our patient care team to discuss what we can offer.
