Nutrients for brain health

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By Kellie Blake, RDN, LD, IFNCP

As an integrative dietitian, I see patients with a variety of conditions. While each patient is unique, most of the people I see have some type of brain health complaint. Many of my private practice patients don’t experience symptoms severe enough to qualify for a formal psychiatric diagnosis, but their symptoms are nonetheless significantly affecting quality of life.

Among the most common complaints I receive are brain fog, headaches, memory and mood changes, depression, automatic negative thoughts, anxiety, attention issues, and insomnia. The conventional medicine model treats these symptoms with medications, which may be necessary at times. However, the use of nutrition-related strategies has been proven helpful in reversing many of these symptoms for my patients.

Naturally, the health of the brain is intimately tied to the health of the rest of the body and comprehensive lifestyle change is required for the reversal of brain health symptoms. I focus on not only nutrition, but also help my patients create healthy sleep and exercise routines, learn to manage stress in a healthy way, and avoid environmental toxins to help enhance brain function.

While the therapeutic meal plan must be personalized, I generally start with a plant-based diet adequate in healthy fat and clean protein. I encourage patients to avoid processed foods and additives, inflammatory oils, sugar, caffeine if not tolerated, sensitive foods such as gluten and dairy, excess calories, conventionally raised animal products, processed meats, farmed fish, and alcohol. In addition to these general recommendations, I focus on several key brain-supporting nutrients.

Water

As reported in the Annals of Nutrition and Metabolism, mild dehydration can significantly impact mood, especially for adult females, but it also alters cognitive performance in school-age children and the elderly. I find hydration is often overlooked, but is a simple target, especially when it comes to energy levels and headaches. While there is no standardized recommendation for daily water intake and hydration needs should be personalized based on activity level and lifestyle, I typically recommend 25 to 30 milliliters per kilogram for adults and 30 to 35 milliliters per kilogram for elderly patients over age 65. I also educate my patients to choose filtered water and to avoid bottled water in plastic.

Omega-3 Fatty Acids

Omega-3 fatty acids have been widely researched and are known to be beneficial in a number of capacities. When it comes to brain function, they are important component of neuronal membranes and play a major role in brain development. One type of omega-3 fatty acid, docosahexaenoic acid (DHA), is especially important for brain health related to its function in neural cell signaling. As reported in CNS & Neurological Disorder-Drug Targets, insufficient levels of omega-3 fatty acids affect the brain dopamine system and can predispose certain individuals to a variety of neuropsychiatric disorders.

The maintenance of healthy tissue levels of omega-3’s over the lifetime is important for prevention and treatment of depression and supplemental omega-3’s have been shown to improve depressive symptoms. One manner in which omega-3’s improve depression may be via gut microbiome regulation. When the gut microbiome is out of balance, an inflammatory response occurs, triggering neuroinflammation. Omega-3 fatty acids help to prevent or quiet this neuroinflammatory response by increasing butyrate-producing bacteria in the gut, which are responsible for maintaining balance in the gut microbiome. I use omega-3 fatty acids, but also pre- and probiotics to support a healthy gut microbiome to take advantage of the gut-brain connection.

I encourage my patients to consume food sources of omega-3 fatty acids such as fatty fish like tuna, salmon, mackerel, and sardines, always being mindful of fish quality to avoid toxins, as well as nuts, seeds, and fortified foods. The plant-based omega-3 fatty acids are more difficult to convert into the more usable EPA and DHA, so I often recommend omega-3 supplements from reputable sources and am mindful of any medication interactions. Depending on the needs of the patient, I recommend 1,000 milligrams up to 4,000 milligrams of omega-3 fatty acids per day.

Vitamin D

Vitamin D is a vital hormone responsible for proper immune function, inflammation regulation, cell growth modulation, bone health, and neuromuscular function. Vitamin D is also important for supporting cell differentiation and inhibiting apoptosis during neurodevelopment. Vitamin D deficiency is associated with a number of illnesses, including neurological disease. In fact, those with psychiatric disorders are more likely to be deficient in vitamin D than the general population. As reported in Psychiatria Danubina, 52 percent of acute care psychiatric patients are deficient in vitamin D and when accounting for those with insufficient levels, that percentage is likely more dramatic. In addition, higher vitamin D levels are associated with improved cognition via enhanced executive function and mental flexibility.

While normal levels of vitamin D are reported to be above 30ng/mL, I recommend patients reach and maintain an optimal level of 50 to 80ng/mL. I encourage daily sunshine on bare skin for 15 to 20 minutes, but this is not possible for many patients and depending on the season, may not be feasible. In those instances, I encourage vitamin D-rich foods such as mushrooms, egg yolks, and fatty fish, but it is nearly impossible to meet vitamin D requirements with food alone. I often recommend vitamin D3 supplements, typically with vitamin K2, based on the need of the patient, which can range from 1,000 international units (IUs) up to 10,000 IUs per day.

B Vitamins

The eight B vitamins are vital for brain function in that they act as coenzymes and play a role in the majority of cellular functions such as the methylation cycle, monoamine oxidase production, DNA synthesis and phospholipid repair. Deficiency in the B vitamins can influence a number of conditions including dementia and depression. As reported in Nutrients, a large percentage of people in developed countries are either deficient or marginally deficient in one or more of the B vitamins, predisposing them to a variety of diseases. In addition, many of the medications commonly taken by Americans, including metformin and oral contraceptives, impair B vitamin absorption. I often recommend my patients consume a variety of B-vitamin-rich foods daily. Particularly beneficial sources include leafy greens, fish, eggs, meat, poultry, legumes, nuts, fortified foods, and nutritional yeast. I also often recommend a B-complex supplement at least short-term for my patients experiencing brain health symptoms.

Magnesium

Magnesium is another brain nutrient I utilize frequently as 68 percent of Americans do not consume the recommended amount of magnesium. Magnesium is involved in hundreds of biochemical reactions in the body, so limited or deficient amounts can create an environment for disease. For mental health specifically, magnesium is a co-factor required for many of the pathways, enzymes, hormones, and neurotransmitters associated with regulating mood. Supplemental magnesium has been shown to increase brain-derived neurotropic factor (BDNF) and decrease depressive symptoms, as reported in Nutrients. I encourage patients to consume magnesium-rich foods such as dark chocolate, avocados, nuts, seeds, legumes, bananas, and leafy greens daily. I also add magnesium glycinate 200 to 400 milligrams per day based on patient need.

Zinc

While overt zinc deficiency is rare, NHANES III data report 35 to 45 percent of Americans over age 60 have inadequate intake of zinc. Zinc is found in higher concentrations in the brain than other tissues and is important for brain function and maturation, specifically related to its role in synapse function and neuromodulation. Lower zinc levels are seen in many psychiatric and neurological diseases. With regard to depression, low levels of zinc can create depression and anxiety and zinc supplementation has been shown to reduce symptoms of depression in study participants. I encourage my patients to consume zinc-rich foods such as grass-fed red meat, sustainable shellfish, legumes, hemp seeds, pumpkin seeds, ground flax seeds, cashews, almonds, and dark chocolate. I also utilize supplemental zinc, often 25 milligrams per day, when indicated.

Intermittent Fasting

Intermittent fasting has gained much attention recently and the research is strong for its use in boosting brain function. As reported in Nature Reviews Neuroscience, intermittent fasting suppresses microglia-mediated neuroinflammation and improves cognitive and sensory-motor function. While intermittent fasting may not be appropriate for every patient, I do encourage at least a 12-hour overnight fast and often recommend a longer fast twice per week for many of my patients. Giving the body a rest from digestion has more benefits than just brain health, it can also aid in weight management, metabolic dysfunction, and physical performance.

As important as these brain-boosting nutrients and intermittent fasting are, they will not be as effective if brain-harming food- and lifestyle-choices continue. In addition, no one stand-alone nutrient or nutritional supplement will be effective for enhancing brain function long-term. I focus on improving the lifestyle and overall diet quality and then add in specific nutrients as needed based on the patient.

References:

Grabrucker, A. M., Rowan, M., & Garner, C. C. (2011). Brain-Delivery of Zinc-Ions as Potential Treatment for Neurological Diseases: Mini Review. Drug delivery letters. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220161/

Healy-Stoffel, M., & Levant, B. (2018). N-3 (Omega-3) Fatty Acids: Effects on Brain Dopamine Systems and Potential Role in the Etiology and Treatment of Neuropsychiatric Disorders. CNS & neurological disorders drug targets. Retrieved from: https://doi.org/10.2174/1871527317666180412153612

Kennedy, D. (2016). B Vitamins and the Brain: Mechanisms, Dose, and Efficacy – A Review. Nutrients. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772032/

La Rosa, F., Clerici, M., Ratto, D., Occhinegro, A., Licito, A., Romeo, M., Di Lorio, C., & Rossi, P. (2018) The Gut-Brain Axis in Alzheimer’s Disease and Omega-3. A Critical Overview of Clinical Trials. Nutrients. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164598/

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Mikkelsen, K., Stojanovska, L., Apostolopoulos, V. (2016). The Effects of Vitamin B in Depression. Current Medicinal Chemistry. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/27655070

National Institutes of Health Office of Dietary Supplements. Omega-3 Fatty Acids https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/ accessed 04/06/2020.

National Institutes of Health Office of Dietary Supplements. Zinc. Accessed 04/09/20. Retrieved from: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

Pross, N. (2017). Effects of Dehydration on Brain Functioning: A Lifespan Perspective. Annals of Nutrition and Metabolism. Retrieved from: https://www.karger.com/Article/FullText/463060

Tarleton, E., Kennedy, A., Rose, G., Crocker, A., & Littenberg, B. (2019). The association between serum magnesium levels and depression in an adult primary care population. Nutrients. Retrieved from: https://www.mdpi.com/2072-6643/11/7/1475/htm

Woodward, G., Wan, JCM., Viswanath, K., & Zaman, R. (2019). Serum Vitamin D and Magnesium levels in a psychiatric cohort. Psychiatria Danubina. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/31488730

Zugic Soares, J., Pettersen, R., Saltyte Benth, J., Knapskog, AB., Selbaek, G. & Bogdanovic, N. (2019). Higher Vitamin D Levels Are Associated with Better Attentional Functions: Data from the NorCog Register. The Journal of Nutrition, Health, and Aging. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/31560030