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Parkinson’s: The Gut Connection

Parkinson’s: The Gut Connection

Parkinson’s is characterised by symptoms such as body tremors, rigidity and lack of balance, as well as psychological symptoms including depression, anxiety and insomnia. It is a progressive neurological disorder, caused by damage to nerve cells located in a part of the brain called the substantia nigra. Cells located here are responsible for producing a neurotransmitter called dopamine, which acts as a messenger between the brain and the rest of the body to help coordinate movement and balance, as well as many other things.


How Common is Parkinson’s?

Currently in the UK, around 1 in 500 are affected by Parkinson’s, meaning there are an estimated 127,000 people living with the condition. Figures show that Parkinson’s is on the rise – In 2016, an estimated 6.1 million people across the planet had Parkinson’s, more than double compared to figures in the 1990s. Scientists still have yet to understand the exact cause of this disease, however, it is thought that there are genetic and environmental links, such as industrial pollution that can play a key role in the development of this disease. However, in the past few years there has been an explosion of research that points to imbalances in the gut as an influencing factor in the development of Parkinson’s.


How Does the Gut Play a Role in Parkinson’s?

Around 200 years ago an English surgeon named James Parkinson reported that some patients with Parkinson’s also suffered with constipation and that by treating digestive complaints, some of the physical symptoms associated with the neurodegenerative disease were relieved. Since then, constipation has been noted as one of the most common non-motor symptoms related to Parkinson’s, witharound half of patients experiencing constipation which often precedes the diagnosis of this neurodegenerative disease. Much of today’s research therefore lies in investigating the question of where the pathogenesis of Parkinson’s initiates: is it the gut or the brain?


Lewy Body Pathology

One of the hallmarks of Parkinson’s is abnormal aggregates of proteins that develop inside nerve cells, in both the brain and the peripheral nerves, called lewy bodies. In particular, it is the misfolding of the major constituent of lewy bodies, known as alpha-synuclein that causes symptoms related to Parkinson’s. Researchers have found that when this occurs, it catalyses an almost infection-like process, whereby the behaviour of misfolding spreads from cell to cell.

Aggregates of alpha-synuclein have been found in the enteric nerves of Parkinson’s patients, which is an almost autonomous part of the nervous system located in the digestive tract, that orchestrates gastrointestinal behaviour.Research shows that the pathological process may therefore begin in the gut within the enteric nerve cells, which spreads to the central nervous system (spinal cord and brain). In a study where α-synuclein was injected into the intestinal walls of rats, researchers found that α-synuclein was transported via the vagus nerve to the dorsal motor nucleus of the vagus in the brainstem, leading to damage to the dopamine-producing cells in the brain. This theory has been further confirmed by studies showing how vagotomy patients that have had their vagus nerve severed, have less risk of neurodegeneration than those who don’t. However, the question of how changes in the intestines drive neurodegeneration in the brain remains an active area of investigation and there are other theories that are being explored, such as how inflammation in the gut and alterations in the flora (bacteria) of the gut can trigger the pathogenic process of Parkinson’s disease.

 

The Gut Microbiome and Parkinson’s

It has been suggested that changes in the gut microbiota, due to inflammation, may trigger the misfolding of α-synuclein. The intestines are inhabited by tens of trillions of microorganisms, including more than 1000 species of bacteria – both commensal (friendly) and pathogenic (unfriendly) – and studies suggest that the ratio between the two can significantly impact permeability and function of the intestinal barrier, affecting the immune system by activating enteric glial cells and neurons, and causing inflammation.

In a study where mucosal biopsies and fecal samples were collected from a group of patients with Parkinson’s disease and a control group, researchers found that in those that don’t have PD (control group), there were higher levels of commensal bacteria that produce butyrate, a fatty acid compound that is known for its anti-inflammatory properties. This fatty acid, that is produced by bacteria through the break down of fibre, is important for helping to modulate T-regulatory cells, which play an important role in preventing autoimmunity and intestinal permeability. The researchers concluded from this study that dysbiosis (imbalance of bacteria) in the gut, triggers a pro-inflammatory state and leads to the misfolding of α-synuclein.

Another interesting study, using mice that were genetically engineered to be more susceptible in developing Parkinson’s, found that in those that were colonised with gut bacteria from PD patients, rather than from healthy subjects, there was enhanced neuroinflammation and motor symptoms. This further suggests that dysbiosis of the gut leads to the neuropathogenesis of Parkinson’s.
 

Why is it important to support the gut microbiome?

Research shows how the gut microbiota is very sensitive to antibiotics, heavy metals, persistent organic pollutants, pesticides, nanomaterials, and food additives. It is well known that microbial diversity is adopted within the first few hours of after birth and is then shaped over time as food is properly introduced and the immune system develops. Various factors such as exposure to xenobiotics (environmental pollutants), antibiotic therapy, diet and lifestyle, can all play a pivotal role in shaping the gut microbiota to make every individual microbially unique. As bacteria play an important role in protecting and maintaining the cells based in the enteric nervous tissue, as well as the immune system and the integrity of the gut barrier, it is therefore incredibly important to both avoid unnecessary exposure to toxins and eat a diet that supports a healthy flora.


Mounting evidence links exposure to xenobiotics to an increased risk of developing diseases such as Parkinson’s. There have been many animal studies that prove this, and now some human studies have begun to actually look into specific compounds, mainly pesticides, that play a role in the pathogenesis of Parkinson’s. Studies have shown that Organochloride pesticides are most commonly associated to Parkinson’s in comparison to others, and despite the fact that many of these were banned years ago, it is well known that these chemical compounds are very resistant to break down in soil and so can remain in the food chain for a long time. A study investigating the link between two pesticides known as rotenone and paraquat, showed how people who reported use of either one of these pesticides were 2.5 times more likely to develop Parkinson’s than those who hadn’t. This is one of many that demonstrate the risks of environmental pollutants and the development of neurodegeneration and although the mechanism is not yet understood, there are clear correlations that must not be overlooked.

What can we do to support the gut microbiome and symptoms related to Parkinson’s?

There are key dietary steps we can take to help support a healthy gut microbiome, which can help to address symptoms related to Parkinson’s.
 

  • Eat a wide variety of vegetables and fruit

Vegetables and fruit contain a lot of fibre, which is a source of fuel for the healthy bacteria in our gut. This helps to keep the ratio between the commensal and pathogenic bacteria in check, making sure that unfriendly bacteria, viruses, fungi and parasites don’t take over and cause inflammation. In addition, vegetables and fruit also contain a high amount of compounds such as antioxidants and bioflavonoids, which help to regulate the immune and protect the cells in your gut from foreign invaders. Aim to get half of your plate made up of colourful vegetables and aim to have fruit as a healthy snack in between meals.

 
  • Include Fermented Foods in your Diet

Traditional foods such as live yoghurt, sauerkraut and pickled vegetables are rich in probiotics, which are friendly bacteria. This is due to the process of fermentation, which requires an anaerobic (oxygen-free) environment whereby bacteria and yeast feed on the carbohydrate portion of the vegetable. This not only increases the shelf life of the food, but it also enhances the amount of friendly bacteria, meaning that when eaten it offers a healthy dose of beneficial bacteria in the gut.

 
  • Avoid Processed Foods  

Studies show that the composition of gut microbiota can change significantly depending on the food we eat. For example, processed foods have been shown to alter the bacteria that live in the digestive tract – specifically having a negative impact on the ‘friendly’ bacteria, meaning that there is more room for the bad guys to take shelter where they’re not wanted. Packaged foods such as ready made meals, canned meals, frozen meals, confectionary etc, contain chemicals such as flavour enhancers, additives, sweeteners, colours and modified fats to make the foods highly palatable. How these chemicals affect our digestive tract isn’t yet fully understood by scientists. However, some studies demonstrate how certain compounds that are readily found in processed foods can encourage intestinal inflammation and liver dysfunction due to the negative impact they have on gut bacteria.

In order to prevent inflammation and encourage optimal diversity in gut bacteria, avoid processed foods and stick to wholefoods, i.e fresh vegetables and fruit, pulses, wholegrains and fresh meat, poultry and fish.

 

Key Supplements and Nutrients to Target Parkinson’s Symptoms

Whilst it’s important to focus primarily on the diet to make sure you’re getting the right combination of nutrients in their natural form, supplements can offer a therapeutic dose of key nutrients that have been shown to be helpful in supporting neurological health.

 
  • Omega 3 Fatty Acid

Omega 3 is a fatty acid found readily in oily fish such as sardines, herring, salmon and mackerel. It can also be found in flaxseeds, pumpkin seeds, chia seeds and walnuts in smaller amounts and in a different form, which once ingested must go through a conversion process in the body in order to fully benefit from the oils. Omega 3 is known for its anti-inflammatory properties and has been shown in studies to help reduce neuroinflammation and help boost mood in those with depression amongst Parkinson’s patients. To get healthy amounts, aim to eat oily fish at least twice a week and seeds every day. In addition, in order to boost levels, supplementing is a convenient way of getting a therapeutic dose of omega 3. Find a supplement that contains 1g of EPA and 500mg of DHA (or near to these amounts).

 
  • Vitamin D

Otherwise known as the sunshine vitamin, vitamin D is essential for neurological health. We make vitamin D through our skin’s exposure to sunlight, however, the problem is most of us don’t get enough unless we’re lucky enough to live in a warm, sunny country. Relying on food sources of vitamin D won’t provide the right amount to sustain our health, so it’s important to supplement the majority of the year to optimise levels.

Vitamin D has been shown to enhance brain-derived neurotrophic factor (BDNF), which helps to boost brain neuron growth. Higher levels of BDNF are associated with improved cognitive function along with a decreased risk of developing neurodegenerative diseases like Alzheimer’s and Parkinson’s.

Before supplementing with vitamin D, it is important to have your levels tested so that you have a benchmark to compare with. Vitamin D levels must then be monitored every few months during supplementation in order to avoid toxicity. Optimal levels are between 100 – 150nmol/L. During months where there is little sun, aim to supplement between 2000iu – 3000iu a day.
 

  • Probiotics

As discussed above, keeping a healthy balance of good and bad bacteria in the gut is crucial for helping to prevent some of the symptoms associated with Parkinson’s. Supplementing with probiotics can therefore be a convenient way to make sure you’re getting a healthy dose of the good guys on a daily basis. When choosing a probiotic, it’s important to have a minimum of 4 different strains and 20 billion live organisms in each capsule.
 

In order for nutritional therapy to be effective, it is important to work with a therapist that can tailor advice. Everyone is unique and will therefore have different needs and medical histories that must be taken into account, despite having the same diagnosis. If you’d like to find an appropriate nutritional therapist to work with, BANT (British Association of Nutrition and Lifestyle Medicine) have a search engine where you can filter practitioners that offer consultations in your local area. In addition, our clinic the Brain Bio Centre specialises in neurological conditions such as Parkinson’s and has an expert team of therapists that can support you.
DHA, Veganism And Brain Health

DHA, Veganism And Brain Health

Over the past few years there has been a boom in interest around veganism, with people choosing to switch to plant based foods and products for a variety of reasons – namely environmental, ethical and health related. This surge of interest is reflected by supportive vegan food trends, social media influencers and the launch of impactful documentaries such as ‘What the Health?’ and ‘Cowspiracy’ that have all played a large role in encouraging people to consider removing animal based foods from their diet.

Whilst increasing vegetables and fruit intake is crucial for improving health due to their richness in micronutrients, fibre and antioxidants, when it comes to brain health there are some key nutrients that cannot be found easily in a vegan diet that must be taken into consideration, if we want to keep the brain healthy on a long term basis. For example, nutrients such as B12, Zinc and omega 3 fats, are examples of where the vegan approach can be at a shortfall when compared to diets that contain animal-based foods. For the purpose of today’s article, the focus will be on DHA (one of two components of omega 3 fatty acids), why it is so important for the brain and if you choose a vegan, vegetarian or a more plant-based diet, what you need to consider in trying to get adequate amounts.

What is DHA?

DHA (Docosahexaenoic acid) is one of two components of Omega 3 fatty acids (the other being EPA – Eicosapentaenoic acid), a family of fats that our body is not capable of producing, and as such, are necessary to be consumed through our diet to support health. DHA is particularly important for building and protecting brain cell membranes, which are the very intelligent outer structures of cells that play a central role in signalling – i.e how our cells communicate with each other via neurotransmitters, helping us learn, develop and keeping us emotionally stable. It is also well known that the membranes are in fact the ‘brain’ of our cells, rather than the nucleus. This is because when the membrane is healthy, it is able to selectively manage the intake of nutrients and the removal of waste, effectively acting like a traffic steward – allowing in all the good stuff that keeps our cells healthy and filtering out toxins that are no longer needed.

Another of DHA’s key factors is its ability to switch on BDNF, the brain’s growth hormone, which supports neuroplasticity. This is a mechanism that allows the brain to build new, healthy neural pathways, preventing brain injury and supporting learning and cognition. Studies show that those with higher levels of DHA in red blood cells have larger volumed brains, less incidence of stroke and better memory and cognitive function.  

DHA and Pregnancy

Where DHA is perhaps most important in all life stages is throughout pregnancy. Fetal brain development depends on levels of DHA provided by the mother. The accumulation of DHA in fetal brain is mainly in the last trimester of pregnancy and continues up until the end of the second year, helping to lay down the groundwork for a healthy brain for the rest of their lives. It is therefore commonly known that DHA needs increase at this critical lifestage in order to support fetal growth, particularly of the brain and eyes. Animal studieshave highlighted that deprivation of omega 3 fatty acids during pregnancy is associated with both behavioural and visual deficits that cannot be reversed with postnatal supplementation.

In order to optimise pregnancy outcomes and fetal health, consensus guidelines have recommended that pregnant women consume at least 200 mg of DHA per day. This can normally be obtained from eating roughly two portions of fish or seafood per week, however, those on a vegan diet would have to supplement with alternative algae supplements that contain concentrated amounts of EPA and DHA.

Vegan Sources of DHA

DHA can be acquired from both vegan and non-vegan diets. However, the form in which it is found in changes according to whether it is coming from an animal or plant source and is therefore processed by the body differently. For example, DHA is readily found in oily fish such as salmon, mackerel, anchovies, sardines and herring. Once ingested, the body does not need to do anything to it for it be used adequately. However, this is not the case with a plant-based diet – the body must first convert another fatty acid called ALA (alpha-linolenic acid), via enzymes, in order to create DHA. ALA is found in flaxseeds, walnuts, chia seeds, pumpkin seeds, green leafy vegetables and algae. Some Studiesshow that conversion rates are, however, very low – with only about 5% of ALA being converted to EPA, while less than 0.5% is converted to DHA, meaning that those choosing vegetarian or vegan diets may benefit from including these foods in their meals every day in order to have adequate amounts.

However, recent investigations have suggested in the absence of fish in the diet, the body may be able to adapt, increasing the efficiency of the conversion from ALA to EPA and DHA. According to findings published in the American Journal of Clinical Nutrition, in a cohort of 14,22 women and men between 39 and 78 years of age, the average DHA level in fish eaters was 271 micromoles per litre, compared with 241.3, 223.5 and 286.4 micromoles per liter for non-fish-eating meat eaters, vegetarians and vegans. This demonstrated that there is not much difference in DHA levels between those excluding fish in their diet to those including fish in their diets.

It is necessary, however, to point out that this study also presented with some significant limitations in that only a statistical estimation of ALA to EPA and DHA conversion was used. This meant that both the actual conversion rate and the end product of ALA was not measured, meaning that accurate knowledge of how effectively ALA actually converts was not gathered.

It is also important to add that the conversion rate of ALA to EPA and DHA can be inhibited by a variety of factors. For example, high levels of alpha-linoleic acid (omega 6 fatty acid), as well as nutrient deficiencies that play an important role in the functioning of the enzyme that triggers conversion and other factors like genetics and health status can all impact the rate of conversion.

How to Optimise Conversion of ALA to EPA and DHA:

  • Avoid Cooking with Plant Oils:

Omega 6 is a fatty acid that is widely found in plant oils such as sunflower oil, rapeseed oil, corn oil and soybean oil – these are commonly used in a vegan diet and must therefore be avoided to help optimise conversion rate. Instead, opt for coconut oil for sauteing foods – it has a very small amount of omega 6 and is able to withstand high temperatures without becoming damaged, unlike other plant and seed oils.

  • Ensure Optimal Intake of Cofactor Nutrients:

The very clever enzyme that is responsible for converting ALA to EPA and DHA is called Omega 3 Desaturase. In order for its proper functioning, it needs the cofactor nutrients niacin (vitamin B3), vitamin B6, vitamin C, zinc and magnesium. Niacin, B6 and vitamin C are widely found in the diet, however, zinc and magnesium can often be a little more tricky to get enough of. Great vegan sources of zinc are pumpkin seeds, hemp seeds and tofu. Magnesium is found in green leafy vegetables, dark chocolate and avocado. Be sure to have regular intake of these foods to make sure you’re loading up on all the necessary vitamins and minerals that help your body make enough DHA.

A final word on DHA…

Levels of DHA may depend on a variety of factors, so if this is something that concerns you, you may want to consider having a blood test to check your levels of essential fats and also see how well your body is converting ALA to EPA and DHA. There are some private test companies such as Medichecks and Invivo Health, which offer tests to measure both omega 3 and omega 6, as well as other fatty acids to gain a full picture of what you may be lacking.

If you’re vegan or vegetarian and would like to supplement with omega 3, companies such as Nordic Naturals and Cytoplan offer algae based supplements that have good quantities of EPA and DHA. It is also worth working with a nutritional therapist or nutritionist if you have concerns about nutrient intake, and specifically, symptoms related to deficiency of omega 3 fats such as slow cognition, poor memory and lack of focus. BANT (British Association for Nutrition and Lifestyle Medicine) has a database of practitioners that are fully certified if you wish to find a suitable therapist.

Lastly, as a final reminder, if paying for supplements and therapy isn’t within your budget, be sure to have abundant amounts of ALA sources in your diet to make sure you’re making enough EPA and DHA. Good sources of ALA are:

  • Walnuts, hemp seeds, chia seeds, flaxseeds and pumpkin seeds

  • Green leafy vegetables
  • Algae
The Interplay of Genetics, Environment and Health: Can we avoid inherited predisposition to disease?

The Interplay of Genetics, Environment and Health: Can we avoid inherited predisposition to disease?

Is there such a thing as having bad genes?

We now know that we are not at the mercy of having ‘bad genes’. Research is showing that there is actually no such thing as ‘bad genes’  – they do not determine whether someone will develop a disease, or be healthy, for that matter. It is, however, the interplay between our genetic individuality and our environment that can increase or lessen the risk of poor health. 

This fascinating field of study is known as Epigenetics – it investigates how external environmental factors such as our diet, lifestyle, and exposure to pollution and stress, have the ability to ‘switch our genes on or off’. Through evolution, we have all developed variations in our genes, known as polymorphisms, and research is beginning to enable us to identify some of the more common polymorphisms which exist in our populations that may predispose us to ill health or certain diseases. More importantly, research has also helped us to understand that these predispositions are not our fate and that polymorphisms are modifiable by changing the environment around us. For example, a woman may inherit a genetic variation that would predispose her to developingAlzheimer’s, however, this doesn’t necessarily mean that she will develop this disease. It is the environment – i.e her diet and lifestyle – that will affect how that particular gene is ‘expressed’, either potentially being activated by high exposure to toxins and a diet high in refined sugars, for example, or deactivated by a diet low in sugar and high in antioxidants, as well as other protective nutrients. 

The Impact of our Diet on our Genes

A more specific field of study called nutrigenomics, within the wider study of epigenetics, seeks to understand how genetic polymorphisms can help us to identify how diet and nutrition can be modified to meet more personalised nutritional needs of an individual. This knowledge opens up exciting avenues in delivering more preventive and personalised health approaches, especially when used alongside other functional testing. This integrative approach enables an understanding of an individual’s biochemical individuality, providing a clearer picture of their unique needs. In the past 10 years DNA test kits have become increasingly popular for many who seek to unlock key genetic information about their ancestry, predispositions for particular diseases such as Multiple Sclerosis, Cancer and Alzheimer’s, as well as fitness potential and nutrient requirements.Testing is carried out with a simple saliva sample, through which scientists identify a person’s polymorphisms found in the sequence of DNA. Each of these genes represent a specific pathway, which has various phases, each requiring ‘co-factors’, or in simpler terms, nutrients, to either help these genes express themselves or inhibit their function. Through diet and use of nutritional supplements, it is therefore feasible to modify gene expression, or switch our genes on or off. Other environmental influences such as pollution and physical or psychological stress can increase or decrease our need for certain nutrients, also playing a role in this expression.

 

DNA, Diet and Mental Health

In November we hosted a fascinating talk on ‘DNA, Diet and Mental Health’ by Emma Beswick, founder of Lifecode Gx, a company that specialises in genetic testing. The presentation outlined genes that are currently understood to play a key role in our mental health and how variations of these genes can influence changes in how neurotransmitters are produced, how well they perform after being produced, and then finally, how they are broken down. Each of these phases is governed by our genetic makeup and can greatly influence our mental health.

For example, it is common knowledge that serotonin plays a crucial role in our mental health, and in particular feelings of happiness and tranquility, as well as appetite and sleep. This neurotransmitter is also targeted by SSRI’s, a common antidepressant medication, that aims to keep serotonin in circulation by preventing it from being broken down so that there is more available in the brain. In order for serotonin to be made, it needs to go through various steps (see image below).

The primary step is to convert the amino acid, tryptophan, to 5-HTP, a precursor molecule to serotonin. The efficiency of this particular step can vary from person to person depending on their genes. A key example of this is with the gene FKB5P, which governs our resilience to chronic stress. Certain variations of this gene can decrease someone’s tolerance to everyday stressors, which redirects tryptophan towards a another pathway instead of 5-HTP, creating a neurotoxin called quinolinic acid. This means that the tryptophan is there but it isn’t being converted properly to the precursor of serotonin, which can consequently lead to mood imbalances. Antioxidants are vital for mitigating the negative impact of neurotoxins, meaning a person with this particular gene variant would benefit highly from increasing their intake of colorful fruits and vegetables (known for being high in antioxidant compounds), such as berries, green leafy veg, carrots and sweet potatoes, as well as nuts and seeds, seafood and spices such as turmeric and ginger.

Another interesting genetic component of serotonin metabolism, is how someone’s sensitivity to this neurotransmitter can affect their mental health. For example, tryptophan may be converting efficiently to 5-HTP and 5-HTP may be converting to serotonin, but once the serotonin is there it then has to be used properly. For example, if we use the simple analogy of a lock and a key – imagine that the key is the serotonin that’s trying to open a door, but the lock is rusty and the key is therefore not able to open the door – meaning that serotonin is not performing its function. A variant of the 5-HT1A gene can lower someone’s sensitivity to serotonin, meaning the serotonin may be produced efficiently but it’s not being used properly. This can consequently lead to feelings of low mood, anxiety and increased impulsivity. Someone with this genetic variant may benefit from nutrients such as ginkgo biloba, which help to increase serotonin receptors, as well as a popular herb called st John’s Wort, that can help increase sensitivity to serotonin.
 

Learn more about how our genes can impact our mental health and what to do about it…

These are just two examples of how our genes can vary and influence our mental health, however, there are many more genetic variations that can impact how we synthesise, transport and react to neurotransmitters. These genetic variations may help to explain why some medications such as SSRI’s may work for one person but might not work for another, which is why DNA testing could be very valuable. However, this is still an emerging area of health and therefore it is advisable to have the test done under the guidance of a nutritional therapist or a functional medicine practitioner, so that the information is interpreted properly and clear steps can be taken to help optimise an individual’s physical and mental health.

If you would like to know more about this fascinating topic, we’re delighted to offer an online recording of Emma Beswick’s presentation (below), where she shares some key information on many other genetic variations that impact mental health, as well as examples of how nutrients can support. As a charity we charge a small fee for our webinars to help cover our costs, however, we are keen to make our videos and events accessible for everyone. If you cannot afford the fee, please email us at info@foodforthebrain.org.

The Brain on Ketones; Following a Ketogenic Diet to Improve Brain Health

The Brain on Ketones; Following a Ketogenic Diet to Improve Brain Health

From Low GL to Ketogenic 

At Food for the Brain, one of the key messages we enforce is the importance of eating a diet that’s low in glycemic load, which in other words means avoiding refined sugars and flours, and swapping them for wholegrains, fibre-rich legumes and starchy vegetables. These sources of carbohydrates release their sugars gradually instead of all at once, which not only helps to sustain energy levels throughout the day, but also positively impacts the brain, which is sensitive to fluctuating blood sugar levels. Research in the last 10 years has exploded on the role that insulin resistance and insulin deficiency (caused by diets high in refined sugars) plays in cognitive decline and the development of Alzheimer’s disease, so much so that scientists have begun to label Alzheimer’s as a type 3 diabetes or diabetes of the brain. Switching to a low GL diet is relatively easy, but what about those diets that go as far to say that eliminating carbohydrates almost completely from the diet, such as in the ketogenic approach, is more efficient in improving brain health?

What is the Ketogenic Diet? 

The ketogenic diet was first introduced by physicians in the 1920s for the treatment of childhood epilepsy, after scientists discovered that during periods of fasting the body begins to use fat as a source of energy instead of glucose, which resulted in less seizures in patients. Two specific compounds were found to be produced in the body during fasts – acetone and beta‐hydroxybutyric acid – now known as ketones, which are a byproduct of fat breakdown in the liver and are used by the body as energy when there is no more glucose available. During this research study, scientists discovered that following a diet with moderate protein, minimal carbohydrate and high fat (roughly 60%-80% fat,15%-35% protein, 5% or less carbohydrates of total daily caloric intake) could also lead to the production of ‘ketosis’, where the body begins to use ketones as energy instead of glucose. Improvements in behaviour and cognition were also reported, which set the tone for future trialling of the ketogenic diet to improve brain health for a variety of conditions.

Why is ketosis good for the brain? 

Research on the ketogenic diet in the past few years has increased, in particular its therapeutic application in symptoms related to neurological disorders and mental health, as well as in treating conditions such as type 2 diabetes. Whilst the exact mechanism of how ketones improve brain health is still unclear, ketones used as fuel for the body have shown to increase neuronal growth factors (meaning neurons are able to regenerate and proliferate), reduce brain inflammation and oxidative stress, strengthen signals between synapses and enhance mitochondrial respiration (a process of energy production that takes place in our cells). 

Human studies are, however, minimal in researching the value of the ketogenic diet in improving brain health, with most scientific studies still being focussed on animals. In addition, many studies use supplements such as MCT (medium-chain triglycerides) capsules to induce the production of ketones in the body, which may be due to the fact that following a ketogenic diet and monitoring large groups of people is difficult. MCTs are fatty acids that do not require bile to be digested, instead they go directly into the liver and are able to feed into the mitochondria of the cells without needing L-carnitine to shuttle them across the mitochondrial membrane, unlike other fatty acids. This translates as an immediate energy source, functioning much like simple carbohydrates do but without the impact on blood sugar levels.

There has been some positive results using supplements such as MCT. For example, in a 90-day randomized, double-blind, placebo-controlled, parallel study of 152 people with mild to moderate Alzheimer’s Disease, a daily MCT supplement was given. Participants were asked to take a cognitive test at 45 and 90 days using the ADAS-Cog scale and patients taking the MCT supplements showed significant improvement in the cognitive test, unless they carried a gene called ApoE4, which is associated with a higher risk for developing Alzheimer’s disease.

Can the ketogenic diet help with mental health symptoms? 

The majority of studies are animal-based, which despite demonstrating positive results, there is still a long way to go with regards to understanding the direct mechanism of how the ketogenic approach alters brain chemistry and its value in long term improvements to mental health. One interesting study in children with medication resistant epilepsy, showed how following the diet had a significant impact on the neurotransmitters, dopamine and serotonin, both of which are implicated in depression and anxiety. The children followed the diet for a period of 3 months, neurotransmitters were measured before and after in their CSF (cerebrospinal fluid). Metabolites of both serotonin and dopamine had significantly reduced after following the ketogenic diet, demonstrating that these neurotransmitters were being utilised more efficiently in the brain.

There have also been some case studies that encourage further research into this field. In one particular study, a significant improvement in symptoms were reported. 2 women with bipolar disorder type II followed the ketogenic diet for an extended period of 2 and 3 years respectively. Only one measured their macronutrient composition, which was roughly 70% fat, 22% protein, and 8% carbohydrates, and ketones were measured in the urine. Both women reported subjective improvement in mood stabilisation as well as an overall improvement of their condition, which surpassed the effects of medication.

Is it safe to follow the ketogenic diet unsupervised? 

Research to date suggests that the ketogenic diet is safe for most people, however, it has a large impact on the body and for this reason we would always advise people to seek expert guidance before trying it, especially if they are are on medication of any form. According to Dr Georgia Ede, a Harvard-trained psychiatrist and nutrition consultant, in the first couple of months of the ketogenic diet your body goes through profound shifts in chemistry, which may affect the metabolism of medication, as well as significant mood changes. Here is a list of medications related to common mental health conditions and how they can be affected by following the ketogenic diet.

Whilst the emphasis is on achieving the correct amount of macronutrients (ratio between carbohydrates, protein and fat) to encourage ketosis, the nutrient value of food should also be taken into account in order to prevent deficiencies. For example, many may be drawn away from having a significant amount of vegetables on the keto diet,  due to the fact that some can be high in carbohydrate content. However, it is critical to ensure enough fresh vegetables whilst undertaking this approach to prevent falling short on micronutrients that play an important role in our cellular health and preventing oxidative stress. In addition, eating the right protein and fat sources is also very important, as processed meat and hydrogenated or refined oils can leave us more vulnerable to long-term health problems such as cardiovascular disease.

Low GL or Keto?…

Whilst research on the ketogenic diet and brain health has showed and continues to show some positive results, it’s still very much in the early stages and a lot needs to be understood about the underlying mechanism of how ketones improve biomarkers associated to poor mental health and the long term impacts of this dietary approach. Eating a diet that’s low in glycemic load may be an easier, more accessible way of switching to a way of eating that has little impact on blood sugar levels and encourages a healthy insulin response, which has shown to have a positive impact on cognitive health. If you’d like some more support on how to switch to a low GL diet, please click below for our mini guide.

Low GL Diet

Where to go for support…

We believe that following a ketogenic approach should be under the guidance of a nutrition professional, to ensure you’re still getting the right nutrients and that the diet is tailored to your individual needs. If you’d like to reach out to a qualified nutritional therapist to guide you through this process, BANT (British Association for Nutrition and Lifestyle Medicine), have a search engine for practitioners that are local to you. Our not-for-profit clinic, the Brain Bio Centre also have a team of therapists that specialise in brain health and can discuss the best approach for you individually. If you’d like to get in touch to find out more about their services, please call 0208 332 9600 or visit their website here Brain Bio Centre.

Nutrition Tips to Support Children with ADHD

Nutrition Tips to Support Children with ADHD

Nutrition; the Building Blocks of Health

Proper nutrition is important for all children to help them grow and develop, both physically and mentally. It stands to reason that the brain benefits from the best possible nutrition as much as the body, and the evidence-base in this area is growing. Many vitamins and minerals support brain health including magnesium, zinc, B vitamins, calcium and iron, some of which are often found to be low in tests.

Key Nutrients for Brain Health

Magnesium, in particular, supports improved focus and concentration, and supports calm and sleep. Vitamin D is a key brain nutrient and deficiency is very common in the UK. Most children would benefit from vitamin D supplementation especially those with learning, behavioural or developmental differences. Colourful plant-based foods contain a range of special nutrients known as phytonutrients which also support brain health. Omega-3 essential fats have a very important role in optimising brain function. Blood tests reveal that most children with learning, behavioural or developmental differences have low or sub-optimal levels of these important fats. These fats are found in oily fish and fish oil supplements. Specific amino acids from protein-rich foods are involved in neurotransmitter production which can have a range of effects including balanced mood, better concentration, reduced anxiety and improved sleep.

Sugar; the Brain’s Enemy

Sugar is, quite simply, bad for the brain. Most children, including those on quite ordinary diets, take in excessive sugar and refined carbohydrates which adversely affect their health including behaviour, concentration and sleep. Many sources of sugar are ‘hidden’ in foods which are marketed as ‘healthy’ or ‘low fat’, making this a minefield for parents. In fact, fat is an essential nutrient for the growing child’s brain.

The Gut Brain

Food sensitivities may contribute to symptoms too. It is best to work with a nutritional therapist to identify which foods or food additives are affecting your child before making major changes or cutting out whole food groups. The bacteria in your child’s gut (‘gut flora’) can have a significant impact on brain function too. Assessing the mix of gut flora and improving the balance can affect learning, behaviour, mood, development and supports physical health and immunity. Gut flora balance is heavily influenced by diet (the bacteria live off the food that your child eats), so whilst probiotic (good bacteria) supplementation can be very helpful, it is dietary change which is required over the long term.

The Importance of Working with a Nutritional Therapist

Nutritional therapy works well alongside other therapies including medication and other therapies, and these therapies may be even more effective in a well-nourished individual. Even children who already eat a relatively healthy diet are likely to benefit from nutritional therapy. The benefits that most parents report including better focus and concentration and improved sleep, along with reduced sugar cravings, fewer coughs and colds, and a healthier digestive system (fewer tummy aches, constipation, bloating etc).

Nutritional support for depression before, during and after pregnancy

Nutritional support for depression before, during and after pregnancy

According to Dr Vivette Glover, Director of the Foetal and Neonatal Stress and Research Centre, at any one time during pregnancy, one in every ten women will be depressed and around one in every thirty will be depressed both during pregnancy and the postnatal period (1). It is not yet understood exactly what causes the symptoms associated to depression during and after pregnancy. However, factors such as the large changes that the body undergoes due to the demands of the growing foetus, as well as breastfeeding and potential sleep deprivation, can all play a significant role in how the body deals with stress. It is during this period of time that our bodies require more nourishment from food than ever and it can also be at exactly this time when we perhaps struggle to prioritise nutrition due to lack of energy, loss of appetite or sickness.

Pre and Post-Natal Depression are both complex conditions that can have multifactorial underlying drivers, including genetic and environmental influences. These are currently poorly investigated and the gold standard of treatment is often medication to help stabilise mood. Whilst SSRIs and other types of antidepressants have proven to be helpful for many, they do not address potential causes or drivers of poor mental health and can often mask symptoms. Antidepressants are also not regularly recommended during pregnancy, which is why being more mindful of nutrition and lifestyle habits can be a safer option for you and your baby. There are some natural, evidence-based steps you can take to help support optimal mental wellbeing:

Eat Foods to Support Energy Depletion:

Common issues such as poor sleep during pregnancy and sleep deprivation following the birth can often heighten cravings for stimulants and sugary foods, which may seem like a good option for quick sources of energy, however, these foods can often cause further issues with energy and lead to fatigue and low mood. Eating foods that are high in refined sugar and refined grains such as commercial white bread, pastries, cakes and biscuits, give us an unsustainable source of energy. The brain is a very metabolically active organ; despite it only being 7% of the body’s weight, it can take up to 20% of the body’s metabolic needs (2), meaning that it is very energy hungry. This is why it is important to nourish the brain with foods that are nutrient rich, providing the body the building blocks to produce neurotransmitters, as well as a sustainable source of energy. The best options are fresh, unprocessed foods such as wholegrains (brown bread, brown rice, quinoa, rye and oats), pulses, vegetables, good quality sources of protein (meat, poultry and fish) and healthy fats such as those found in olive oil, coconut oil, avocados and oily fish.

Just like throughout pregnancy, nutritional needs after birth, especially if breastfeeding, are incredibly important. The healthier the diet, the easier it will be to sustain the energy needed to take care of a newborn. Research shows that a breastfeeding mother needs an extra 300-500 calories a day, from food that is rich in the right macro and micronutrients to nourish both mother and baby (3). For example, nutrients such as B vitamins have shown to be important in supporting the mother in ensuring she has enough energy to meet the demands of lactation (4). These nutrients can be found in green leafy vegetables, wholegrains and good sources of animal protein.

Protect yourself from Oxidative Stress:

Oxidative stress refers to a biochemical process that occurs as a result of an accumulative everyday exposure to toxic burdens such as chemicals in cosmetics, furniture, paints, cars, and pollution. Our body has its own way of armouring itself from the damage that exposure to toxins can create through its production of endogenous antioxidants, which is nature’s way of neutralising oxidative stress. Although we have our own production of these wonder molecules, when we are continuously overloaded with toxins in our environment and have problems detoxifying, the liver can become overwhelmed. Research shows that over time oxidative stress can lead to an increase in inflammatory molecules such as cytokines, which have been shown to correlate with depression (5).This is why it is important to have a high intake of nutrients that support the liver in metabolising and removing toxins from the body, as well as regulating the inflammatory response. There are a few things we can change in our diet to support this area, for example eating foods such as the cruciferous family of vegetables which includes kale, cauliflower, broccoli and cabbage. These are particularly effective at supporting the liver in ushering out toxins as they all share an antioxidant compound called indole-3 Carbinol, which plays an important role in liver health (6). In addition, bitter greens such as collard greens, rocket, chicory and swiss chard are also great for supporting the liver’s own antioxidant defence system.

Increase intake of Omega-3 Fatty Acids:

During pregnancy and after pregnancy there is often a concern for the potential depletion of the maternal nutrient reservoir due to the needs of the growing foetus. A nutrient that is particularly important for mental wellbeing and is also essential for the growth of the foetus’s brain, is DHA. This is an omega 3 fatty acid that is found in oily fish and is the primary structural component of brain tissue, as well as playing a crucial role in the maintenance of brain cells and neurotransmitter metabolism (our body can also convert plant sources of omegas 3’s into DHA, such as those found in flaxseeds or chia seeds into DHA, but the conversion can often very poor). Deficiency in this nutrient during pregnancy is common, namely because of lack of seafood intake (the most bioavailable source of DHA) due to poor eating habits and concerns of mercury levels in fish during pregnancy, as well as higher requirements during foetal growth, which can lead to depletion. Due to the role that DHA plays in neurotransmitter metabolism, deficiency in this nutrient has been correlated to symptoms of depression during pregnancy (7). In order, to support your intake of omega 3, aim to have 3 portions of oily fish a week from sources that are low in mercury. These are mainly small fish that have a short life-span such as sardines, mackerel and herring. If you are vegetarian or vegan, although omega 3 is less readily available, it is still possible to get this nutrient from your diet through flax seeds, chia seeds, walnuts and seaweed. If you feel you may not be getting enough through your diet, you may want to consider using a good quality fish oil supplement (or algae based supplement if vegan) as an option. With fish oils, aim to choose a supplement that has been filtered for heavy metals and other pollutants to make sure you’re getting the full benefits of the omega 3 oils.

Exercise and Personalised Nutritional Therapy:

In addition to diet, there are many other things you can also do related to lifestyle, such as stress management through mindfulness (8) or gentle movement such as pre or post natal yoga (9), which have both shown to be incredibly helpful in encouraging mental wellbeing. If you feel you need extra support, personalised nutritional therapy can be very helpful as there can often be other drivers such as nutrient deficiencies and digestive complaints that can play a significant role in mental health and will need to be addressed in a way that is tailored to the individual.

At the Brain Bio Centre, our nutritional therapy clinic, our therapists specialise in mental health and biochemical testing that can provide in-depth information about your own specific needs, so we can create a personalised plan to support your health. For more information, please visit our website: www.brainbiocentre.com. Alternatively, BANT (British Association for Applied Nutrition and Nutritional Therapy), have a large network of therapists you can use to find a therapist suitable for you.
For wider help and information, you might want to contact the PANDAS Foundation, a charity who offer pre and post natal advice and support. They also have a helpline, 0843 28 98 401, open 9am-8pm, 7 days a week.

References:

(1) http://www.pandasfoundation.org.uk/preantenatal-depression/
(2) https://www.scientificamerican.com/article/why-does-the-brain-need-s/
(3) American Academy of Pediatrics. Policy Statement. Breastfeeding and the use of human milk. Pediatrics, March 2012 Sneed SM, Zane C, Thomas MR.
(4) The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women. Am J Clin Nutr. 1981 Jul;34(7):1338-46.
(5) http://onlinelibrary.wiley.com/doi/10.1111/imm.12443/pdf
(6) https://www.ncbi.nlm.nih.gov/pubmed/29331880
(7) https://www.ncbi.nlm.nih.gov/pubmed/19289957/
(8) https://www.mindful.org/mindfulness-protects-post-partum-depression
(9) http://journals.sagepub.com/doi/full/10.1177/2156587217715927

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