The Link Between Nutrition and Dementia

Education Resource Booklet

Domenic Commisso APD

MSc (Nutrition and Dietetics)., B. Health Sc(Naturopathy)., Grad Dip. Clinical Nutrition.,
(PGCert) Nutrition Medicine (RMIT)., Dip. Sport and Recreation
Member DAA, ATMS 19895

Accredited Practicing Dietitian - Medical Nutrition Therapy

Note to readers

The information contained in this educational resource booklet is not intended as a

substitute for consulting with your physician or other health care professional.

The information in this booklet was initially produced for community discussion
groups and presentations on the topic, however groups are made up of individuals
who may have specific diet, nutritional and medical requirements, therefore, the
services of a competent health care professional should be sought if expert
assistance is required.

Domenic Commisso

Accredited Practicing Dietitian & Clinical Nutritionist.

dietarymedicine@optusnet.com.au

January 2012

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Contents

Introduction 3

What is Dementia? 6

Dementia Statistics 7

Risk Factors 9

A closer look at food, nutrition and dementia 11

The Mediterranean Diet 13

Omega 3 fats 14

Olive Oil 17

Antioxidants 18

Flavonoids 22

Fruit and Vegetables in General 24

Folate and B12 26

Vitamin D A brief discussion point 32

Putting it all together 35

Mediterranean diet style meals 37

References 44

Resources 48

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Introduction

Nutrients comes from food and food is very much synonymous with energy to most,
however the notion that food can intricately affect brain function and be linked to
diseases such as dementia and recently to depression is not so synonymous to
many.
Firstly, brain cells (called neurons) and their surrounding helper cells require energy
from food to function. Neurons are cells, and just like all cells they are coated by a
structural lipid (fatty) membrane that allows them to recognise nutrients and
chemicals for their own purposes. Neurons produce chemical compounds that help
us to think, remember things, to learn new tasks and to be organised, they can
speed up our thinking and slow down our thinking.
Neurons are sensitive and very vulnerable to attack by oxidants, just consider what
happens to a sliced apple when exposed to air for a brief period of time, in essence
the apple becomes oxidized. To guard against oxidants and inflammation, neurons
have in built antioxidant and anti-inflammatory defence systems that help guard and
keep them healthy, so they can function and perform for us.
The structure, function, growth potential, chemicals produced, antioxidant and anti-
inflammatory defence systems in neurons very much rely on nutrients amongst other
things, so what you choose to eat and drink may have a profound impact on your
brain and in fact the rest of your body.
Dementia is increasingly being viewed as a neurodegenerative disease (breakdown
in structure, function and eventual death of neuron) accompanied by chronic
inflammation and oxidative stress.
The link between diet and dementia became evident to researchers in the late
1990s. Scientist studying the diets of large numbers of people (population based
studies) found that consistent intake of various foods consumed were associated
with better brain function than other foods and diet patterns when assessed.
Scientist are now becoming more aware of some of the crucial roles that nutrients
from these foods play, not just in brain architecture but also brain function.
There is now a recognised interconnection between chronic diseases and dementia,
in particular diet and lifestyle related chronic diseases such as obesity, diabetes and
vascular diseases which includes high blood pressure and stroke.

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It must be stated that dementia is a disease that is multi-factorial, this means that
there are many factors that can contribute to the development and progression of
dementia, food is one those factors now being taken very seriously by the scientific
community and the focus of this booklet.
Recent studies suggest a role for nutrition and some complementary medicines as
part of an early intervention treatment strategy once diagnosed with dementia,
however this is beyond the scope of the booklet.
This booklet will initially provide some general information about dementia, the
burden of the disease economically, risk factors, the link with diet and nutrition, and
the preventative role for nutrition. This will conclude with some basic recipes to
encourage brain healthy eating.
To health care professionals reading this booklet
The utmost care was taken to ensure that information in this booklet was cited from
credible scientific journals and publications, predominantly from the peer reviewed
literature and is fully referenced to accommodate further reading.
Nutrition is a major modifiable determinant of chronic disease and can affect an
individuals susceptibility to many chronic diseases across all life stages.
Despite significant increases in life expectancy as well as better access to health and
improved living standards, the World Health Organisation predicts that chronic
diseases, mainly cardiovascular disease and diabetes will account for up to 75% of
deaths worldwide within the next 10 years. These particular chronic diseases and
others are major risk factors of dementia and combined with an ageing population,
the significant burden of disability will inexplicably cause a surge in health care cost.
Moving beyond chronic disease interactions, food and specific nutrients have been
implicated to affect many aspects of brain biology, and there are certainly many
patho-physiological phenomena in the brain that have been shown to be modified by
nutrients. These nutrients include the common essential nutrients as well as phyto-
chemical compounds available in many plant derived foods.
In addition to the potential role of aging and chronic disease in dementia, a loss of
plasma membrane integrity, mitochondrial dysfunction and oxidative stress play an
important role in progressive neurodegenerative processes.
Mechanistic and pre clinical evidence within the science of neuro-nutrition is now
starting to make findings from prospective, epidemiological, cross sectional, case
control and clinical trials, physiologically more comprehensible.
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Definitions of Terms

Cognitive
Pertaining to cognition, the process of knowing and, more precisely, the
process of being aware, knowing, thinking, learning and judging.

Cognitive decline
Cognitive decline is a deterioration in cognitive function.

Recommended Dietary Intake

The nutritional goal for a specific recommendation of a nutrient is to prevent
deficiency states e.g. scurvy, and promote sustenance in a given population.
More formally defined as The average daily dietary intake level that is
sufficient to meet the nutrient requirements of nearly all (97-98%) healthy
individuals in a particular life stage and gender group.

Adequate Intake
When evidence is insufficiently available to establish a recommended dietary
intake, an adequate intake is set.

Optimal Intake
The nutrient intake that may reduce the risk of chronic disease.

Food Fortification
Addition of vitamins and minerals to food.

Chronic Diseases
Chronic diseases are diseases of long duration and generally slow
progression. Chronic diseases include heart disease, stroke, cancer, chronic
respiratory diseases and diabetes.

Population studies
When a sample of the population or even a whole population are selected
and studied over a particular time period. Such a study may determine if a
relationship exists between particular dietary or food intake patterns and
particular diseases.

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 What Is Dementia?

Dementia is a term used to describe a large number of disorders that can

affect thinking and memory. Alzheimers disease and vascular dementia are
among the most common causes of dementia.1

Dementia essentially causes damage to the brain, as brain cells deteriorate,

the brain shrinks or "atrophies". The build up or poor clearance of a particular
protein called Amyloid Beta in the brain, as well as diseased blood vessels
supplying the brain may contribute to the development of dementia.

Diagnosis is usually made by an appropriately qualified general practitioner

(GP), a geriatrician, a psycho geriatrician or by a neurologist.

At present, current medical treatments are only minimally effective for a small
proportion of patients short term, and do not slow the progression of the
disease.5,10

Prevention therefore is now a Public Health Care Priority

Some dementias have reversible components, which include but not

exhausted to; thyroid diseases, brain trauma, HIV related disorders and
vitamin B12 and Folate deficiency.1

Some of the areas of the brain affected by dementia

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 Dementia Statistics
Dementia and Alzheimers disease is now the third leading cause of death overall .
Australian Bureau of Statistics.

Leading causes of death in Australia in 2009

Cause of Death in Australia (2009) Rank

Ischemic heart disease 1

Stroke 2

Dementia and Alzheimers disease 3

Trachea and lung cancer 4

Chronic lower respiratory disease 5

Diabetes 6

Colon and Rectum Cancer 7

Blood and Lymph cancer 8

Diseases of the kidney and urinary system 9

Heart failure 10

Source: Australian Bureau of Statistics, 2011, Available from;

http://abs.gov.au/ausstats/abs@.nsf/Products/B6940E9BF2695EE1CA25788400127B0A?opendocument

Over 250,000 people have dementia in Australia and this number is expected
to double within the 20 years. The estimated cost of dementia in Australia is
over one billion dollars per year and expected to rise.2

There are approximately 30 million people with dementia in the world and the
estimated costs of dementia worldwide in 2010 was 604 billion dollars.4

Dementia is the single greatest cause of disability in older Australians and

every week there are 1500 new cases diagnosed. 4

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 The lack of clinically effective treatments3 as well as a growing ageing
population will likely compound the economic burden of this disease.

A major shift from costly disease management towards prevention and early
intervention should now be mandated

In order to draw our focus on effective prevention measures, we need to

become aware of the RISK factors. Importantly, we need to become aware of
the risk factors that can be modified.

Most of the risk factors listed are common to Alzheimers and vascular related
dementia.6

Lets take a look at them.............................................................................

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 Age, in particularly >65 years of age.6 Australia has an ageing population and age
is the greatest risk factor for dementia

Lower level of education6

Diabetes6

Insulin Resistance7 (this occurs when higher than normal levels of insulin are
required to keep blood glucose in safer ranges) some call this Pre Diabetes

Vascular risk factors6

o Heart Disease

o Stroke

o High Blood Pressure

o Obesity

o High Cholesterol

o Elevated level of Homocysteine

History of Depression6

History of Asthma6

Head Injury6

Genetic Factor (Apo E 4 Genotype)6

Mild Cognitive Impairment6

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A little bit about Mild Cognitive Impairment.........

Mild Cognitive Impairment (MCI) is a form of Pre Dementia.3 Some degree of

memory loss is associated with aging however people with MCI start to
experience more memory problems that what would be considered normal for
their age, however they still demonstrate normal thinking and reasoning
skills.8

Some typical complaints include; a greater tendency to displace things and

trouble remembering the flow of a conversation.

MCI has been termed a transitional stage between normal brain function and
Alzheimers disease9, and is suggested that people with MCI have a 3-5 times
increased risk of developing dementia.8

People with MCI have a 3-5 times increased risk of developing Dementia

Many experts state that if early medical treatment along with preventative
strategies (diet, nutrition and lifestyle) are applied during the MCI stage, then
one increases their likelihood of delaying and/or even protect against the
progression to dementia.9,10,3

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 A Closer Look at Risk Factors
Look carefully at the risk factors. Chronic diseases such as obesity, diabetes
and heart disease may increase the risk of dementia. It is widely accepted
that an unhealthy diet over an entire life span is a major cause of many
chronic diseases of western civilisation.11

Chronic disease is projected to represent up to 75% of total deaths worldwide

by the year 2020.11Many chronic diseases are largely preventable through
sensible diet and lifestyle choices.

A Closer Look at Food, Nutrition and Dementia

Question: Is there evidence from scientific based research to suggest a link

between diet and dementia?

Answer: Yes

Question: So what is the link between diet and dementia?

Answer: Simply speaking, proper food choices may protect you from
many of the risk factors noted (e.g. High blood pressure, diabetes) BUT
certain foods provide higher amounts of nutrients beneficial for the brain as
well as higher amounts of nutrients that are Anti-inflammatory and Anti-
Oxidative which may protect brain cells from deteriorating.

Dementia is now being increasingly described as a Chronic Inflammatory

Disease with lots of Oxidative Stress

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 Oxidative stress can be seen on an apple when exposed to oxidants in air.

This is what happens to an Apple when it is oxidized.

All cells in the body including nerve cells, just like an apple, are vulnerable to
oxidation; hence we have antioxidant defence systems which require nutrients
from food which support these systems.

There is one particular diet that has been shown to potentially protect many
people from developing Dementia. This particular diet has been termed The
Anti inflammatory Diet.

The nutrients provided by this diet can be found in many foods, however
much of the research has focused on foods from this diet.

Which diet is this?

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 The Mediterranean Diet

The Mediterranean diet is characterized by a higher intake of vegetables,

fruits, legumes, cereals, olive oil, nuts and fish and a lower intake of meat and
dairy products.

First of all, consuming a Mediterranean style of diet is associated with lower

risk of heart disease, high cholesterol, high blood pressure and overall
mortality (measure of number of deaths in a given population).12

Mediterranean diet style of eating has been shown to;

Decrease risk of dementia
Help keep the brain healthy
Stop progression of Mild Cognitive Impairment to
dementia 9,13

Adhering to a Mediterranean style diet was reported to decrease the risk of

Alzheimers disease by 40% independent of many risk factors including
genetics.21

Lets take a closer look at Foods and Nutrients provided by the

Mediterranean diet that are deemed to be brain protective

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 OMEGA 3 FATS

The specific Omega 3 fatty acids reported to decrease risk of dementia in

general are those found in cold water fish.

Studies report that fatty fish consumption up to 2-3 times weekly may reduce
risk of Alzheimers dementia by up to 40%.14,16

Low intake as well as low blood and brain levels of Docosohexanoic acid
(DHA), one of the omega 3 fats found in cold water fish is associated with
accelerated cognitive decline and development of dementia.15

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 Nerve cell (Neuron)

Essential dietary fats play a key role in nerve cell structure and function

Omega 3 Fats are one of the Essential fats needed by the body and brain.
Essential means that the body cannot produce them and we must obtain them
from our diet on a daily basis.

Cells including brain cells (neurons) survive and thrive within a bath of fatty
acids, in fact the omega 3 DHA from cold water fish makes up approximately
40% of the fatty acids surrounding nerve cells in the brain.15

How much omega 3 fats do you need daily?

The National Health and Medical Research Council Guidelines31suggest an

optimal intake of 610 milligrams daily for men and 430 milligrams daily for
women of the long chain Omega 3 fats (cold water fish derived) in an effort to
reduce chronic disease. This is equal to approximately;

100grams (gms) of Atlantic Salmon 2-3 times weekly, OR

100gms of Mackerel 3 times weekly OR
100gms of Tuna once daily with 1-2 Capsules Fish Oil

Tip: Do not fry fish, but bake or stew fish at lower temperatures

Important Note: Fish Oil capsules may be warranted, BUT first seek advice
from your Health care professional.

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Rich plant based sources of Omega 3 fatty acids include;

Flaxseeds and flaxseed Oil

Walnuts
Chia seeds
Canola Oil

Walnuts Canola Oil

Chia seeds Flaxseed Oil

These foods can be part of a healthy diet, however, much of the evidence
suggest that fish derived omega 3 fats are most protective against dementia
and for optimal brain as well as optimal heart health.

Are you consuming enough Omega 3 foods daily?

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 Olive Oil

OLIVE OIL is a major component of the Mediterranean diet and highly

suggested to be protective against Alzheimers related dementia.17,13

Higher intake of olive oil has been shown to preserve cognitive function in
healthy elderly people and higher intakes of Monounsaturated fat containing
food such as olive oil is believed to help protect against nerve cell
degeneration.17

Olive oil is not a significant source of omega 3 fats however extra virgin olive
oil contains healthy unsaturated fats as well as a healthy mix of Antioxidants
that may be brain protective.17

Antioxidants protect against oxidative stress (remember the apple) and may
also protect the very sensitive omega 3 fats from destruction, allowing omega
3s to work more effectively in the body.

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 Antioxidants
Antioxidants are provided by food, so what we choose to eat will determine
the level of antioxidants circulating in our bodies. Certainly some foods
provide more antioxidant than others. We will focus on the specific foods and
food derived antioxidants shown to be more protective against the
development of cognitive decline and dementia.

Lower levels of antioxidant nutrients in circulation has been observed in

patients with mild cognitive impairment and Alzheimers disease.18

Studies suggest that dietary intake of antioxidants may help preserve healthy
brain function into old age and prevent dementia later in life.19, 20

Specific antioxidants found to be most protective include;

Vitamin E
Vitamin C
Flavonoids

The evidence supporting these antioxidants is much stronger in favour for

dietary sources rather than from supplements.

Lets have a closer look at each of them & which Foods contain lots
of these!

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 Vitamin E Rich Foods
Olive oil
Peacans, Almonds, Walnuts and Pistachio nuts.
Avocado
Green leafy vegetables such as Broccoli and Spinach
Pumpkin seeds and Sunflower seeds

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 How much Vitamin E do you need?

The optimal intake suggested by the National Health and Medical Research
Council is 14 milligrams per day for women and 19 milligrams per day for
men.

This amount is also similar to the amount demonstrated to protect healthy

elderly people from cognitive decline when compared to elderly people
consuming lower amounts of vitamin E.20

This can be accomplished by using;

1-2 Tablespoons of olive oil daily for cooking and salads + cupful of nuts
and seeds mix daily (containing Walnuts OR Almonds mixed with sunflower
and/or pumpkin seeds and fruit as a healthy snack).

Tip: Cook with olive oil at lower temperatures, as olive oil is still vulnerable to damage at very
high temperatures when cooked for longer periods of time.

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 Vitamin C Rich Foods
Spinach, Brussels Sprouts, Cauliflower & Capsicum
Parsley, Kale
Cabbage, Tomato
Oranges, Lemons and Strawberries

How much Vitamin C do you need?

Aim for the recommended optimal intake of 220 milligrams per day for men
and 190 milligrams per day for women as suggested by the National Health
and Medical Research Council, and an intake similarly in accord with studies
demonstrating protection against cognitive decline.19, 20

Food Serve size Vitamin C Content

milligrams (mg)
Black current Juice 125ml glass 215
Orange 1Small 50
Strawberries cup 40
Cooked Broccoli 1 cup 40
Raw parsley 3 tablespoon 30
Red Capsicum 1 Medium 170
Source
United States Department of Agriculture (USDA) National Nutrient Database SR24
Food Standards Australia New Zealand NUTTAB 2010 Online Searchable Database

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 What about Flavonoids?

Flavonoids are biologically active chemical compounds found in plants that

are linked to reducing the risk of major chronic diseases.22

Fruit and vegetables are major dietary sources of flavonoids, in fact higher
intake of flavonoids from foods is associated with better cognitive function in
older people23 and reduced risk of dementia.24

Lets take a look at some Flavonoid Rich Foods

Berries Apples Celery Broccoli Red Onions Dark Chocolate Green Tea Red Wine
Parsley - Chives Oregano Dill Rosemary - Thyme

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 Particular flavonoids called anthocyanins found in berries are holding great
promise as a preventative as well therapeutic agent in neurodegenerative
(nerve cell) related diseases.13

A recent but relatively small human study found that blueberry juice given
daily for 12 weeks improved memory in older adults25 echoing many of the
findings observed in animal studies. 26

Low to moderate alcohol intake e.g. up to 1-2 glasses (100ml glass) of red
wine daily has been proposed as a protective factor against mild cognitive
impairment and dementia.9,27 High intakes of alcohol is likely to increase
dementia risk.28

Cocoa based foods like dark bitter chocolate has been found to reduce the
risk of coronary artery disease, stroke and diabetes.29 Cocoa has been shown
to promote blood flow to the brain and shows promise as an agent to maintain
healthy brain function.30

It is recommended by the author of this paper that no more than 15 grams of

dark chocolate be consumed at one time (equivalent to 2-3 small squares).
Most forms of chocolate contain higher amounts of free sugar and saturated
fat which can be harmful to health at high intakes.

Important Note

Please seek advice from your health care professional before making any dietary
changes in particularly in regards to alcohol and/or dark chocolate.
These may not be suitable with various health conditions and medications.

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 Fruit and Vegetables in General
Higher intakes of fruit and vegetables daily has been shown to be protective
against decline in brain function in various studies in the middle aged and the
elderly.18,19,20

Studies report that frequent fruit and vegetable consumers experience a 30%
reduction in risk of developing dementia.16 Frequent consumption was defined
as daily consumption of fruit and vegetables.

The amounts reported to be protective is similar to the amounts of fruits and

vegetables recommended in the Dietary Guidelines for all Australians,
available from [www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n31.pdf] and in
the current Cancer Council Australias Position Statement on Fruit,
Vegetables and Cancer prevention, available from
[www.cancercouncil.com.au/html/healthprofessionals/nutrition_physical/downloads/positionst
atement_fruit_n_veg.pdf]

Vegetables in general, especially the colourful ones are recommended. Daily

incorporation of green leafy vegetables such as spinach and cruciferous
vegetables (broccoli, kale, cauliflower, brussels sprouts, cabbage, bok choy)
which are mainly green and leafy have demonstrated to be associated with
better cognitive function and slower rate of decline in brain function. 18,19

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 Aim to consume at least

Minimum of Two and a Half (21/2) cups of a variety of coloured vegetables,

both cooked and salad vegetables daily:
Choose from a variety and include those discussed in this paper.

Minimum of Two pieces of fruit daily: Try to include flavonoid and vitamin C
rich fruits discussed in this paper including citrus and kiwi fruit, red grapes,
apples and berries

Vegetables generally contain antioxidant chemicals called carotenoids as well

as flavonoids so try to create a colourful vegetable plate.

Green leafy vegetables generally contain more vitamin E than other

vegetables and generally contain a higher amount of the B vitamin called
Folate.

Folate along with Vitamin B12 are important brain nutrients and some
evidence suggest that they may be protective against cognitive decline and
subsequent dementia.

Lets take a look at them..........................................................................

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 FOLATE & B12
Low folate and B12 concentrations in blood have been related to dementia
and general poor cognitive function.32, 33

Folate and B12 affect and participate in many crucial functions in the brain. 36

Folate and B12 lower the concentrations of homocysteine, recalling that

homocysteine is a widely accepted risk factor of dementia.

Elevated levels of homocysteine is also a risk factor for mild cognitive

impairment, cognitive decline and brain atrophy (shrinking of the brain). 34

Brain atrophy (shrinking) attributable to significant loss of neurons

Although brain atrophy is common in the elderly, much higher rates of brain
atrophy is observed in those with cognitive decline, mild cognitive impairment
and dementia.34

A recent study revealed up to 53% reduction in brain atrophy in people with

mild cognitive impairment supplemented with folate, B12 as well as vitamin B6
over a period of 2 years when compared to the group who did not receive the
supplements.34

At present, it is highly recommended that elderly people ensure optimal

dietary intake of folate and B12 as a plausible preventative strategy against
cognitive decline.

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 Folate Rich Foods
Green leafy vegetables
String beans, Lentils, Chickpeas, Navy beans
Wholegrain bread & Australian derived bread in general due to fortification.

Folate intake in the Australian population was reported to be below the current
recommended intake and significantly below the proposed optimal
requirement.3

How much Folate do you need?

The National Health and Medical Research Council recommends 400

micrograms of folate per day for the adult population, however it is reported
that an optimal folate intake up to approximately 700 micrograms may be
required to optimise homocysteine levels and reduce chronic disease. 31

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 Aim to consume a minimum of 400 micrograms folate daily.

Food Serve Size Content of folate in

micrograms (ug)
Wholegrain Bread 2 slices Approximately 140

Spinach 1/2 cup cooked Approximately 100

Chickpeas 1/2 cup cooked Approximately 70

Baked Beans 1/2 cup cooked Approximately 50

Red Kidney Beans 1/2 cup cooked Approximately 50

Green Peas 1/2 cup cooked Approximately 60

Cos lettuce 1 cup raw Approximately 60

Eggs 1 cooked Approximately 60

Asparagus 1/2 cup cooked Approximately 40

Source
United States Department of Agriculture (USDA) National Nutrient Database SR24
Food Standards Australia New Zealand NUTTAB 2010 Online Searchable Database

Please note: Folate requirements are higher during during pregancy and 3 months post
conception. Talk to your health care professional for further advice .

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 B12 Rich Foods
Red meat - Fish/Seafood - Chicken
Dairy related products (Milk, Yoghurt & Cheese)
Eggs
Foods fortified with B12 e.g. some soy beverages

How Much vitamin B12 do I need?

Ensure to consume the National Health and Medical Research Councils
recommended daily amount of 2.4 micrograms per day for the Adult
population.

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 Aim to consume the recommended daily amount of 2.4 micrograms per day

Food Serve size Vitamin B12 Content in

micrograms (ug)
Beef steak, trimmed, Grilled 100gm 3.0
Veal steak, trimmed, Grilled 100gm 3.0
Salmon Grilled 100gm 2.0
Lamb tenderloin, lean, 100gm 1.6
Grilled
Soy Milk (Fortified with B12) 250ml 1.8
Tuna canned 100gm 1.6
Milk 250 ml 1.5
Chicken, lean, Baked 100gm 0.7
Egg 1 medium 0.5
Cheese, Cheddar 25gm 0.5
Yogurt 125gm 0.5
Source
United States Department of Agriculture (USDA) National Nutrient Database SR24
Food Standards Australia New Zealand NUTTAB 2010 Online Searchable
Database

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 Are you at Risk of Folate and B12 Deficiency?

In developed nations, folate deficiency has reported to be very common.35 In

Australia, intakes among adults are lower than the recommended intake.

Alcohol abuse increases the risk of folate deficiency.

Gastrointestinal disorders such as Crohns disease and Celiac disease or any

disorder causing mal-absorption can affect folate status.

Metformin is a medication used to treat diabetes that can interfere with folate
metabolism.36

Inadequate production of gastric acid can inhibit the release of vitamin B12
and subsequent absorption from foods. Reduced gastric acid production can
affect up to 30% of the elderly 35 and it is widely reported that the prevalence
of vitamin B12 deficiency is high among the elderly.37,38

Some medications that suppress acid production (Anti acids), more

specifically known as Proton Pump Inhibitors (PPIs) used to treat
gastroesophageal reflux disease and peptic ulcer disease, can interfere with
vitamin B12 absorption from food.35,38

Metformin might reduce absorption of vitamin B12.36

Recommendation
If you feel you are at risk of folate or B12 deficiency, ask your health care
professional to arrange to check your status of these vitamins.

If you are already supplementing with folate, please advise your health care
professional.

31 | P a g e
 Vitamin D An Important Discussion Point
Adequate vitamin D is important to maintain healthy bones and protect
against falls and hip fractures.

Vitamin D works within many systems of the body including the immune
system and the nervous system which includes the brain, in other words,
vitamin D has many functions that are not related to skeletal (bone) health.

Many researches acknowledge the link between vitamin D deficiency and

chronic diseases which includes multiple sclerosis, cancer, diabetes and
cardiovascular disease.39, 40

It is being increasingly recognised that low vitamin D levels is associated

with cognitive decline 40 and preliminary evidence suggest that vitamin D
may protect the central nervous system and brain function through complex
mechanisms.41

Vitamin D deficiency is becoming a worldwide problem and Australians are

not immune from this. Marginal vitamin D deficiency has been observed in
many Australians, from young adults to the elderly with deficiency rates of up
to 76% in the elderly population.42

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 Generally, Australian men and women are consuming only about 50% of the
Adequate Intake set by the National Health and Medical Research Council
Guidelines.42

There are very few foods (list provided below) that contain vitamin D,
although, there is mandatory fortification of vitamin D in margarine and oil
spreads (Australia only). Meeting the recommended intake of Vitamin D
through diet is probably unlikely, particularly in the older population group.42

The major source of vitamin D is sunlight and without a moderate but sensible
exposure to sunlight, vitamin D from food becomes imperative and
supplementation may be required.

How much Vitamin D do you need?

The National Health and Medical Research Council recommends;

5 micrograms per day for adults between 19-51 years of age
10 micrograms per day for adults between 51-70 years of age
15 micrograms per day for adults over 70 years of age

33 | P a g e
 How can I get enough Vitamin D?

Firstly, vitamin D forms in the skin when exposed to sunlight, so sensible sun
exposure is an important way to ensure adequate vitamin D levels.

Please see the cancer councils How Much Sun Is Enough position statement
on vitamin D, accessible via;
http://www.cancer.org.au/File/Cancersmartlifestyle/Howmuchsunisenough.pdf or by
phone contact: 13 11 20.

Some foods that contain vitamin D

Food Serve Size Vitamin D content in

micrograms (ug)
Mackerel 100 grams 10
Sardines, canned in oil 2 Sardines 1.1
Pink Salmon 100 grams 1.1
Eggs 2 Large eggs 0.8
Margarine (vitamin D 2 teaspoons 1.0
added)
Milk (Vitamin D added) 250ml (1cup) 1.3
Source
Nestle Australia
United States Department of Agriculture (USDA) National Nutrient Database SR24
Food Standards Australia New Zealand (FSANZ) NUTTAB 2010 Online Searchable Database

Recommendation
See your Doctor if you are concerned about your vitamin D levels. Vitamin D
status can be assessed by a simple blood test.

Supplementation may be necessary for some people.

34 | P a g e
 Putting it all Together
Every living cell in your body requires nutrients for its structural
integrity, health and optimal function. Therefore, what you choose to
eat and drink from morning to evening can have a powerful effect on
your health, physically and mentally.

Food provides nutrients to the body including the brain. Different foods
provide different nutrients; therefore a variety of foods should be
consumed daily.

Many foods were discussed in this booklet, in particularly specific foods

and nutrients that may be more protective against dementia than
others. However a combination of foods should be included in your
diet, these include;

Fish, particularly cold water (oily) fish species

Lean red meat
Fruits and Vegetables
Legumes
Nuts and Seeds
Wholegrain bread, cereals and pasta
Low fat diary (Milk, cheese and yoghurt)
Extra virgin olive oil as the preferred cooking oil at low temperatures
and as a salad oil. Canola Oil can also be used for these purposes
Flaxseed Oil for salads or add to vegetable dishes

Lacto Ovo vegetarians are able to choose foods that contain many of the
nutrients discussed however care needs to be taken to ensure sufficient
intake of the essential omega 3 fats daily from plant based sources.

Vegans need to ensure to consume vitamin B12 fortified food or a vitamin B12
supplement as well as including plant based essential omega 3 fats daily.

All vegetarians need to ensure optimal intake of the plant based omega 3
essential fats by choosing 1-2 plant based omega 3 foods daily in their diet.

By virtue of the above recommendations, one automatically minimizes the

consumption of various foods that contain little nutritional value and which
may actually contribute to chronic disease as well as dementia.

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 Foods that will automatically be minimized include;

Processed foods such as snack foods, convenient foods and deli meats which
contain high amounts of Salt and subsequently sodium.

Soft drinks, cordials and many sweetened food and drink items, many which
contain excess amounts of Free Sugars.

Baked goods such as pastries, cakes, biscuits, deep fried food and take away
foods which may contain excess amounts of Trans Fats.

What about Vegetable Oils?

It is recommended that vegetable oil consumption be minimal whilst increasing the
use of olive and canola based oils. Higher intakes of monounsaturated fats
predominantly from olive oil and omega 3 fats particularly from fish may reduce the
risk of dementia.27There has been observations that suggest an increase risk of
dementia with regular vegetable oil consumption, especially when not accompanied
by daily consumption of omega 3 fats.13,14,16

Should I stop consuming vegetable oils?

Not necessarily, but ensure to include the omega 3 fats into your diet daily. This will
maintain relative balance between the omega 3 fats found in fish and the plant based
sources and what is called the omega 6 fats which are found in vegetable oils in high
amounts. Many researchers advise balance between the two fats and caution the
excess use of vegetable oils.16

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 Mediterranean Diet Style Breakfast
Vegetable Egg Omelette

1 cup of fresh chopped vegetables (spinach, kale, capsicum, mushrooms)

sauted in 2 teaspoons canola oil, 2 egg whites + 1 yolk (try to use omega 3
enriched eggs).
Pinch of iodized salt
1 Slice Whole grain bread + Olive oil based spread

*Fresh or frozen vegetables are both suitable

This meal provides high quality protein and B12 from egg, vegetables rich in
antioxidants including vitamin C, E, flavonoids and carotenoids. Whole grain bread
provides B vitamins, minerals and fibre, helping to maintain colon health.

Approximately cost of meal: $ 2.50

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Or something as simple as............................................
Yoghurt with fruit rich in vitamin C and flavonoids.

cup (125ml) reduced fat yoghurt

-1 cup of fruit rich in vitamin C and flavonoids
1 slice of wholegrain bread, spread with 2 tablespoons fresh avocado.

This meal provides a rich source of calcium from yoghurt, some high quality protein,
antioxidants and an abundance of flavonoids discussed in the booklet. Avocado
providing healthy unsaturated fats and some vitamin E.

Approximately cost of meal: $ 3.80

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 Mediterranean Diet Style Lunch
Tuna Pasta Salad

1 small can of tuna (drained)

cup cooked pasta
1 cup of cucumber and capsicum diced
cup of cos lettuce and cup parsley
1 tablespoon extra virgin Olive oil
Pinch of iodized salt

Mix together and serve warm or cold.

This meal provides a rich source of B12 and omega 3 fats from tuna, antioxidants
including vitamin C from capsicum, parsley and Cos lettuce. Cos lettuce also
providing a generous amount of folate. Olive oil again providing the healthy fats and
some flavonoids, whilst pasta providing a form of energy that is released slowly in
the body.

Important to note that tuna and fish are also excellent sources of the antioxidant
selenium. They also contain vitamin D and just as importantly, the mineral iodine.

Approximately cost of meal: $ 4.70

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Or something as simple as............................................

Boiled egg salad sandwich on wholegrain bread

2 slices of wholegrain bread or 1 whole wheat roll

1 large boiled egg
1 small tomato sliced
red onion
Handful of cos lettuce
1 slice of low fat cheese
Spread with canola based spread

This meal provides high quality protein and B12 from egg, antioxidants in particularly
flavonoids from red onion, carotenoids and vitamin C from lettuce and tomato. Low
fat cheese will provide much needed calcium.

Approximately cost of meal: $ 3.00

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 Mediterranean Diet Style Dinner
Baked Salmon with Vegetables

100gram of Salmon baked with 1 clove of garlic, sliced red onion, basil and
parsley

Serve with steamed vegetables;

cup of broccoli or other leafy green vegetable

1 squash
cup chopped carrots
tablespoon Olive Oil
1-2 slices of wholegrain bread dipped in extra virgin olive oil.

This meal provides high quality protein, B12 and omega 3 fats from salmon,
antioxidant rich nutrients from squash, broccoli and carrots with broccoli and/or leafy
greens also providing folate along with wholegrain bread. This is complemented with
flavonoids and heart healthy fats from olive oil

Approximately cost of meal: $ 6.50

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 Or something simple as..........................................
Lentil Soup

cup of lentils and bring to boil

Add
cup of celery diced
1 carrot sliced
teaspoon dried thyme
1 bay leaf
1 tablespoon extra virgin olive oil
Pinch of iodized salt
Simmer
1 slice of wholegrain bread with a canola based spread

This meal provides an alternative source of good quality protein and iron from lentils.
It is antioxidant and flavonoid rich by virtue of celery, carrots and some of the spices
chosen. Olive oil providing healthy fats, flavonoids as well as a source of vitamin E.

Approximately cost of meal: $ 2.80

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Health Snack Ideas

cup of nuts with cup of flavonoid and/or vitamin C rich fruit

Slice of reduced fat cheese (2 thumb size) with 2 small fresh figs
1 slice wholegrain bread with 1-2 tablespoons of avocado as spread
1 cup of a banana and strawberry smoothie with reduced fat milk
80-100gm slice of ricotta cheese with cup fresh celery and carrot sticks
1 piece of favourite fruit
15-20 gms of dark chocolate with a small piece of fruit

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Resources for further information about food, nutrition and health related information

Dietitians Association of Australia

http://daa.asn.au/ (02) 6163 5200

Nutrition Society of Australia

http://www.nsa.asn.au/ (08) 8363 1307

National Institute of Complementary Medicine

http://www.nicm.edu.au (02) 4620 3284

Australian Traditional Medicine Society

http://www.atms.com.au/ (02) 9080 6800

Alzheimers Australia

http://www.fightdementia.org.au/ 1800 100 500

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