Cognitive health is intrinsically linked to diet and exercise.
As the population ages and they begin to think about staving off heart disease and metabolic diseases, another area of concern is cognitive health.
Causes of Cognitive Impairment
Cognition is a broad term and includes many processes in the brain that can affect everything from memory to the ability to learn new things to information processing to concentration. When we talk about cognitive impairment, we are not talking about occasional forgetfulness or the inability to recall the name of the actor on television. True cognitive impairment is a verifiable decline in mental capacity, with dementia and Alzheimer’s disease at the extreme end.
“Cognitive function refers to multiple mental abilities, including memory, learning, reasoning, concentration, problem solving and decision making, as well as resistance to stress. Everyday cognitive function can be influenced by modifiable lifestyle factors such as sleep, stress, nutrition, alcohol, exercise and cognitive training,” said Hannah Braye, head of technical advice at ADM Protexin, a manufacturer based in Florida.
“I believe that most people, especially as they age, think about their cognitive health in terms of memory retention, but it is much more than that. Cognitive health is a large category that encompasses focus, concentration, short- and long-term memory, calculation, executive function, mood and even judgment,” said Cheryl Myers, chief of scientific affairs and education at EuroMedica, headquartered in Wisconsin. She added that oxidative stress and inflammation are two of the biggest issues that affect cognitive health concerns, calling them “partners in crime.”
While a bit of cognitive decline due to aging is expected, particularly after the age of 60, “Neurodegeneration is when this decline becomes pathological,” added Braye. “Cognitive decline can start to occur at the cellular level two decades before any symptoms. After 40, we lose 5 percent of brain volume per decade, and that accelerates after 70 but if you start earlier, you have the potential to slow down cognitive decline and reverse brain aging,” said Dr. Kristen Willeumier, a neuroscientist based with extensive experience in studying Parkinson’s disease and a former director of neuroimaging and clinical research for the Amen Clinics.
Impairment can certainly be due to age but other variables come into play as well. These include … “education, lifestyle, poor diet and the presence of other health conditions,” said Zoraida P. Aguilar, PhD, vice president for research services, DBS for BioTech Pharmacal, an Arkansas-based manufacturer.
But cognitive impairment is not always associated with aging. “Early onset neurodegeneration is also a growing problem, and many lifestyle factors such as stress and poor sleep can affect cognitive function at any age. In addition, those with a family history of cognitive decline or neurodegeneration may be particularly concerned to take preventive steps to safeguard their future cognitive health,” said Braye.
Cognition has also greatly been impacted by the pandemic, noted Brian Keenan, ND, medical writer with Ayush Herbs, a manufacturer headquartered in Washington State, particularly as isolation, uncertainty and stress have left many people with a decreased ability to focus. He added that some who are COVID-19 long-haulers are reporting lingering cognitive deficits.
Incidence of Cognitive Impairment
The Centers for Disease Control and Prevention (CDC) reports that one in nine adults are living with subjective cognitive decline, which is considered a public health issue, as by 2030, one in five Americans will be 65 and over.
Other statistics are as alarming. “The CDC reported that an estimated five million Americans age 65 and older may currently have dementia and predicted that the numbers could rise up to 14 million by 2060,” said Jaclyn Bauer, PhD, founder and CEO of Virtue Supplements, a manufacturer headquartered in California.
Though cognitive decline does not affect most people under the age of 60, younger people are also interested in improving cognition, as memory loss is not the only aspect of brain health.
Cognition has been shown to peak in one’s 20s and can start to show some decline even as early as the 30s and 40s. “Early interventions are important for those with risk or family history of cognitive decline,” said Sara LeBrun-Blashka, MS, director of education for Standard Process, a Wisconsin-based manufacturer.
“Younger people are worried about maintaining and optimizing their brain health. Older people are worried about dealing with memory, focus and concentration issues they may already have,” said Dr. Alan Snow, CEO of Cognitive Clarity Inc., a manufacturer based in Washington State.
Pam Stauffer, global marketing programs manager, Cargill, a Minnesota-based manufacturer, concurred. “Younger generations may be looking for a boost as they cram for a final exam. Working-age adults want a longer-term effect, as they strive to improve productivity. For older Americans, the motivation changes once again, as they seek out products to stave off age-related memory issues.”
“While senior citizens certainly do utilize cognition supporting products, I think younger people as well are readily using them to stay sharp and focused at school and work. I think the younger generation has so many distractions in their day-to-day life as part of a more tech-reliant demographic that we see attention, focus, and fatigue issues,” added Dr. Keenan.
Natural vs. Conventional Approaches
For those who are in cognitive decline, drug therapies can be appropriate, depending on the circumstance. However, like other pharmaceuticals, they can have deleterious side effects, prompting some people to seek out alternative therapies.
Besides medicine, there are many natural solutions to keep the mind sharp, and much of it starts with diet. “Cognitive health is associated with good general nutrition, which includes managing healthy blood glucose levels, consuming enough omega-3s, which most American’s don’t consume enough of, and incorporating key nutrients and herbs into the diet,” said Le-Brun-Blashka, adding that this includes vitamin D and magnesium, turmeric and Gingko biloba.
Indeed, Dr. Willeumier said that dietary and lifestyle habits practiced today will help prevent cognitive decline later. “One third of Alzheimer’s cases are attributable to modifiable risk factors. Diabetes, midlife hypertension, midlife obesity; all of those can lead to Alzheimer’s,” she said, adding that smoking, untreated depression, and both cognitive and physical activity are factors as well.
Braye also pointed to the link between the gut microbiome and cognitive behavior. “Research is indicating the popular Mediterranean diet may help improve our brain power,” she said. This diet includes whole foods, fruits, vegetables and food rich in omega-3s, such as fish. Dr. Aguilar added that black and green tea have been found to reduce the risk of cognitive impairment.
Depending on the cause of the impairment, though, it is difficult, but not always impossible, to reverse. For example, said Dr. Bauer, “Some cognitive impairment can be due to a mood disorder, sleep difficulties or medication. If those are the causes, once the underlying issue is treated, then people can see a difference.”
Indeed, Dr. Snow said that there are six key lifestyle changes that are important for optimizing brain health, called “SHIELD,” discovered by his colleague and partner, Dr. Rudy Tanzi of Harvard University: Sleep; Handle Stress; Interact with Others; Exercise; Learn New Things; and Diet.
Mentally stimulating activities, even while younger, such as puzzles and crosswords, can go a long way toward preserving cognitive health. After all, said Dr. Keenan, of memory and cognitive decline, “It is important to remember it’s not something that happens right at 60; it is a slow and gradual process. The key is stimulating your mind: just like exercise, we need to be sharpening the mind throughout our lives, not waiting until there’s a symptom of cognitive decline.”
“Physical exercise is a strong gene modulator that induces structural and functional changes in the brain, deriving enormous benefit on both cognitive functioning and wellbeing. Physical exercise is also a protective factor for neurodegeneration,” added Braye.
Physical health is inextricably intertwined with cognitive health, and often, a regimen of diet and exercise paired with supplements is the best approach. “Yoga, herbalism and other mind/body practices continue to be very popular as puzzle pieces for restoring and maintaining cognitive function,” said Dr. Keenan.
State of the Market
As the nation continues to age, the need for cognitive products will still be in demand.
Citing a study conducted by Grandview Research, Dr. Aguilar said that in 2020, the global brain health supplements market was estimated at $7.21 billion and will only increase in years to come. “The driving forces in this increased market are the growing awareness among the young adults for improving and maintaining brain health, rising self-directed users, growth in promotional activities from supplements companies, and the willingness of the consumers to improve their brain functions,” she said.
Dr. Keenan believes that there will continue to be a huge demand for cognitive support supplements, especially in the areas of energy, focus and mood support. “The marketing of overall cognitive health products has largely focused on aging populations seeking to improve memory and focus and improve libido. That has been shifting for a few years now and the industry is at a tipping point in being more inclusive in who they are reaching out to. The trend now is really focusing on mood support and how it impacts cognitive function,” said Dr. Keenan.
Dr. Snow said that going forward, the market will likely be dominated by products that have plenty of science and research studies behind them.
The market is strong currently, in part because of the pandemic. Pandemic brain fog has been reported by many people who have had COVID-19 or even just the lack of focus caused by an extraordinarily stressful year; those factors have increased interest in products that support cognition and focus.
“The challenge is letting patients know that cognitive health and the supplements that support it are incredibly important at any age,” said Myers.
Products for the Practitioner Market
Dr. Willeumier said that after 40, our neurotransmitters decline, which is why she would recommend everyone take a high quality multivitamin/multimineral, particularly one that includes an omega-3 fatty acid to help support brain volume. She added that vitamin D is important as well, along with the antioxidant NAC (n-acetyl cysteine). Other important nutraceuticals include curcumin.
The Pennsylvania-based company, Vinco, manufactures Brain/Memory, a nutritional supplement with ingredients designed to support cognitive health, such as “… acetyl-l-carnitine, phosphatide complex and Bacopa monniera extract rounded out with a little Vinpocetine and Huperzia serrata extract.” Its founder, Vincent Nudi, said that the ingredients are all targeted to support cerebral metabolism.
Vinco’s sister company, Madre Terra Science, makes a hemp-infused brain support product called Brain-NF CBD. The key ingredient, said Nudi, is a patented whole fruit coffee extract, infused with the hemp-based CBD to feed the CB1 receptors of the brain.
Cargill manufactures a fat-soluble phosphatidylcholine-rich lecithin. Patricia Williams, PhD, principal, scientist, scientific and regulatory affairs, said that Pc-enriched lecithin can be a highly bioavailable source of the essential nutrient, choline. “Choline consumption supports normal development and function of the brain and nervous system. It is an integral building block of all biological membranes, including in nervous tissue. Dietary choline has been positively correlated with cognitive performance on verbal and visual memory tasks,” she said, adding that the company’s PC-enriched lecithin can be incorporated into supplements as well as functional foods and beverages.
Ayush Herbs manufactures six products using ayurvedic herbs grown in India, all in capsule format, that address cognitive support. For example, the company makes ashwagandha, an adaptogen that helps the body adapt to stress and promotes healthy sleep; Macuna Plus, an herb with large amounts of dopamine precursors’ and Bacopa Plus to support mental alacrity, metabolism and energy to help with focus.
Backed by two decades of research and containing an ingredient not found in other memory support supplements, Cognitive Clarity has developed three dietary supplements in a capsule format: Percepta, Percepta Sport and Percepta Professional, the latter of which is exclusive to practitioners. Percepta products contain patented ingredients of PTI-00703 cat’s claw, “..a woody vine that grows in the Amazon rain forest that was previously used by the Peruvian tribes for over 2,000 years,” said Dr. Snow. The products also contain oolong tea extract. “Percepta products have been shown to markedly reduce and inhibit brain plaques, tangles and inflammation, which is the trilogy of memory loss and the real reason we lose memory as we age.”
Standard Process manufactures several supplements pertaining to cognitive health, including Ginkgo Synergy, Olprima DHA, Olprima EPA/DHA, Turmeric Forte, E-Z Mg, and Neuroplex.
Bio-Kult Mind is a probiotic multi-action formulation, in capsule format, targeting cognitive function and contains the live bacteria strain Bacillus subtilis PXN 21, bioavailable flavonoids from French grape and wild blueberry extracts, and zinc. It targets both the gut and cognitive function.
EuroMedica has two supplements that address cognitive issues: CuraPro Curcumin, containing BCM-95 and HRG80 Red Ginseng Energy. Curcumin is regarded as a powerful anti-inflammatory and free radical fighter. EuroMedica’s formula adds turmeric essential oil, containing ar-turmerone, that improves absorbability by 700 percent. “Research shows that red ginseng helps preserve mental and physical energy, and supports healthy hypothalamic-pituitary-adrenal (HPA) axis activity and serotonin, cortisol and GABA levels. That translates into making it easier for people to get through their days, especially if they experience post-lunchtime slumps in the afternoon,” said Myers.
Virtue Supplement contains Suntheanine, a trademark version of L-theanine, which affects brain waves and memory retention. “Virtue Supplement’s first line is for anxiety and stress and very beneficial for mental health. When people are feeling very stressed or anxious, one of the symptoms is memory and cognition difficulties,” said Dr. Bauer.
After 20 years of scientific research on supplemental carotenoid and five clinical trials, Memory Health, headquartered in Michigan, makes the only patented formula for the treatment of dementia and Alzheimer’s. Ingredients include lutein, zeaxanthin, meso-zeaxanthin, fish oil and vitamin E. “This is a nutritional supplement. We need nutritional support not just for our cardiovascular system but for our eyes and our brains. Even though carotenoids and omegas are available in food sources, we can’t get enough,” said Edward Shehab, founder. He added that while the target market for the supplement is 40-70, it helps feed the brain at all the life stages, and that people who experience brain fog (including “mommy brain” and “chemo brain”) use the product, not just those with dementia. As they come in gelatin capsules, they are immediately bioavailable.
Because of the intrinsic link between nutrition and cognition, Bio Tech Pharmacal manufactures several products designed to support cognitive health. Some of these products include vitamin D, omega fish oils, vitamin B2, Lith-Oro, taurine and tryptophan. For example, Dr. Aguilar pointed to studies that show low levels of vitamin D are associated with cognitive impairment and that taurine is a GABA that helps prevent age-related memory loss and learning abilities.
The Practitioner’s Role
Practitioners should keep in mind the significant role that physical health plays in cognitive health and because of this, it is essential to treat a patient’s whole being.
“The primary thing that practitioners can do is listen. Really pay attention to what a patient is talking about when they discuss symptoms and then tailor a regimen that is appropriate,” said Myers. For example, a practitioner might prescribe brain exercises along with a supplement.
Dr. Keenan agreed, adding, “Remembering there is a mind/body connection and that sometimes when cognitive functions are suboptimal, that starting with the body, the diet, the sleep, can really transform people’s lives.”
Braye also agreed, suggesting that practitioners address underlying risk factors through diet and lifestyle modification to help reduce a patient’s neurodegenerative risk. “When clients improve their metabolic health, they may see unexpected cognitive benefits, e.g. greater energy, less brain-fog, better concentration,” she said.
To assess cognition, Dr. Willeumier performs standardized neurocognitive assessments and if any abnormalities are suspected, neuroimaging can be done. “We can do functional imaging to see changes in blood flow, and can have lab tests done to check for markers of inflammation like C-reactive protein, blood glucose levels and hemoglobin AIC; diabetes is a precursor to cognitive impairment,” she said.
Shehab said that practitioners need to be more integrative in their approaches and that achieving good results can be accomplished out of the pharmaceutical world. “The more we use proven supplementation, the better off we’ll be,” he said.
Dr. Bauer suggested it is important for practitioners to examine patients’ vitamin deficiencies as well as discuss natural alternatives to prescription medications. “I believe the best things practitioners can do is screen for cognitive health, look at patient’s blood panels to be aware of any dietary deficiencies, and have a conversation with patients before they show any symptoms of cognitive decline. Getting patients into the routine of establishing healthy habits is the best prevention,” said Dr. Bauer.
Dr. Willeumier agreed with screening for cognitive health. “It would be a really wise move for people to get a baseline cognitive assessment done, and potentially do that on an annual basis. Practitioners often say we think about things from the neck down—they don’t always think about what they can do to support patients’ brain health,” she said.
Healthy Take Aways
• Cognitive function refers to multiple mental abilities, including memory, learning, reasoning, concentration, problem solving and decision making, as well as resistance to stress.
• The Centers for Disease Control and Prevention (CDC) reports that one in nine adults are living with subjective cognitive decline.
• Cognition has been shown to peak in one’s 20s and can start to show some decline even as early as the 30s and 40s.
For More Information:
• ADM Protexin, www.protexin.com
• Ayush Herbs, www.ayush.com
• Bio-Tech Pharmacal, www.biotechpharmacal.com
• Cargill, www.cargill.com
• Cognitive Clarity, https://perceptabrain.com
• EuroMedica, www.euromedicausa.com
• Madre Terra Science, https://madreterrascience.com
• Memory Health, www.memoryhealth.com
• Standard Process, www.standardprocess.com
• Virtue Supplements, https://virtuesupplements.com