Our brain requires optimal levels of nutrition throughout all stages of life, just like the rest of our body. Many factors including age, illness, medication and stress can all affect the level of our cognitive function.
A healthy diet with the appropriate nutrients such as essential fatty acids, vitamins and minerals is, of course, essential to maintaining cognitive health throughout life.
Our article this week is provided by Naturopath and Herbalist Danny O’Rawe who lectures at CNM (College of Naturopathic Medicine). Danny looks at the need for a holistic approach when addressing the common cognitive complaint of ‘brain fog’.
One of the most common things I see in the clinic is issues with memory and cognition. The term ‘brain fog’ is sometimes used to describe various cognitive issues where thinking, retaining information or trying to remember where you put your keys appear to be more difficult than they ought to be. Confusion, poor memory, muddied thinking, agitation and sometimes depression are common symptoms.
So what might we consider could be useful in the treatment of these disorders?
A Holistic Approach
The term cognition is used to describe a number of mental processes including; thinking, reasoning, learning and memorizing, for example. The parts of our brains responsible for these functions are the frontal lobe, the temporal lobe and the hippocampus especially, and yet this is a very reductionist way of looking at things.
From a naturopathic and holistic perspective not only should we be looking at whole brain function on a biochemical level but we should also be looking at the whole body itself.
All the various mechanisms and processes in our brain work in harmony with the rest of the body, striving towards homeostasis, but when one part of our body is impaired we should look to the whole system and not one part in isolation.
A disruption in one system may impact on another further down the line. So while there are certainly many useful herbs and foods we could employ to improve brain function, the naturopath always considers improving the whole system, and furthermore, seeks to look at the issue from the point of view of the individual and all the idiosyncrasies which make us unique.
So first and foremost, a strategy to improve brain health should involve a strategy to optimise overall health.
That said, there are a number of specific nutrients and botanicals which have been found to be especially useful, so let’s take a look at these first. Let’s start by asking what are the key vitamins, minerals and other nutrients that the brain requires for proper function.
Key Vitamins and Minerals for Cognitive Function
Vitamin B6 (Pyroxidine), a water-soluble vitamin first isolated in the 1930s, is vital for the production of hormones and neurotransmitters which carry information all over our body. It is important in the synthesis of serotonin for example, a neurotransmitter involved in feelings of well-being.
So adequate levels of vitamin B6 is necessary for communication between the neurons in the brain, but it is also involved in breaking down amino acids and glycogen into glucose, which is used in very high amounts for brain function.
The brain uses lots of glucose to create ATP (Adenosinetriphosphate) which creates the energy required for cognition, so any deficiency in vitamin B6 could potentially cause issues with memory and the processing of information.
Supplementing vitamin B6 may therefore be indicated, though vitamin B6 should be used alongside a B-complex as the B vitamins work synergistically and act as co-factors to each other.
The RDA for vitamin B6 is a mere 1-2mg, whereas a therapeutic dose for adults would be in the region of 50-100mg. Care should be taken, though, with concomitant use with certain medication such as anti-convulsants.
Interestingly anti-Parkinsonian drugs can bind with vitamin B6, thereby causing a potential deficiency. NSAIDs and oral contraceptives can also interfere with vitamin B6 metabolism (Wilson, et al. 2011). Good food sources of B6 include nuts and seeds, turkey, potato, avocado and brewer’s yeast. Although tuna fish contain very high amounts of B6, there can be issues with heavy metal toxicity accumulation in their flesh.
I mentioned that B-vitamins tend to work together so we might also look especially at vitamin B12 and vitamin B9. Vitamin B12 (Cobalamin) is particularly important in short-term memory and cognition and is known to affect mood when deficient.
Vitamin B12 is involved in the production of myelin-sheath which is the protective insulating barrier around our nerve cells and which are important in electric signalling. Vitamin B9 (Folic Acid) is also important in higher brain function for similar reasons. The best sources of folic acid are pulses and beans especially soya beans and kidney beans. Wheat and rye also contain high amounts, and spinach has important levels. Folic acid supplementation for adults at therapeutic levels would be 500-1000mcg daily.
The best food sources of vitamin B12 include beef-liver and lamb-liver and it is worth noting that even people who eat meat may not be getting sufficient quantities as liver is not commonly eaten. Clams and seafood are also a good source. There are no significant vegetable sources of B-12.
Foods which contain the element cobalt will encourage the activity of the bacteria which create B12 as Cobalamin, however such sources are not reliable so strict vegetarians and vegans should be wary. Spirulina for example, once thought to contain significant amounts, actually contains vitamin B-12 analogues which are not bioavailable, so the use of fortified foods or supplementation is strongly advised at a therapeutic level of 500-2000mcg per day for one month, followed by 500mcg thereafter.
Therapeutic doses should be based on individual constitutions and following a thorough case history. Persons who have low stomach acid may have suboptimal B-12 levels. This is because HCL and pepsin are required to detach B-12 from food. Intrinsic factor, a glycoprotein secreted by parietal cells in the gastric mucosa, is important for the binding of B-12 and may also be impaired in low stomach acid.
Hypochlorhydria, the clinical name given to low stomach acid, can result from taking medications such as proton pump inhibitors, and can in turn give rise to proliferation of Helicobacter pylori.
Interestingly, these 3 B vitamins are also important in preventing the build-up of a toxic amino acid called Homocysteine. There are at least 80 studies which show the connection between low vitamin B-status and cardiovascular degeneration, but as a marker for cognitive decline research has shown high homocysteine is significant (Moustaffa, et al. 2012; Morris, et al. 2012; Strand, et al. 2013).
Another important vitamin in cognition is the fat soluble vitamin A. Optimal vitamin A levels are now known to influence short-term memory and enhance learning capability (Jiang, et al. 2012; Khor & Misra, 2012). Vitamin A is also an important anti-oxidant and prevents cellular ageing. Good food sources of vitamin A include liver meats and cod liver oil, but for vegetarians in the precursor form of beta-carotene, carrots, spinach and parsley and colourful fruits and vegetables such as pumpkin and cantaloupe melon are encouraged. Supplementation is a matter of controversy because vitamin A is a fat-soluble vitamin and therefore can accumulate in the system. Around 3000mcg (10000iu) is thought to be the upper tolerable level in adults. Care must be taken in pregnancy with supplemental Vitamin A in the form of retinol.
Vitamin D has become all the rage recently for many reasons but for the purposes of this article we know that it is involved in brain development and cognitive capacity (Jorde, et al. 2015). The vitamin is made by the interaction of sunlight on skin. However, in northern latitudes supplementation is advised over the winter months using a suitable supplement. Vitamin D requires several co-factors including magnesium, zinc, boron, vitamin A and vitamin K, so a good supplement would contain appropriate levels. I prefer the D3 form of Vitamin D.
Diet and Lifestyle Choices
We can already see the importance of certain foods in the diet and how they can contribute the vitamins we need. Certain minerals such as zinc, iron, calcium, iodine, selenium, and magnesium are also vital to function, so this is why we need to look at the whole diet and subsequently the lifestyle choices people make and how these impact on their overall nutritional status and health.
High caffeine intake can interfere with B-vitamins; smoking destroys vitamin C and some B-vitamins, while certain medications can act as antagonists, for example. It would be a poor recommendation to suggest a handful of supplements without addressing the entire diet and lifestyle choices.
Before moving on from individual nutrients it is vital to mention the essential fatty acids omega 3 and omega 6. These fats are very important in the body as a whole, but especially in cognitive function. Deficiency among children during development can lead to impaired cognitive function (Gibson & Blass, 1999), so regular use of cold-pressed seed oils like flax, chia and hemp or krill oil which has been sourced from clean waters and certified free of heavy metals and persistent organic pollutants (POPs) are suggested.
Fish oils are often touted as the best supplemental form, however, production of fish oils must not involve heat as this will denature the oil while the issue of heavy metal toxicity has already been flagged.
Contrary to what some nutritionists say, fish oils are not essential as the Hindus of India have testified for millennia. In some degenerative conditions such as diabetes and insulin resistance, though, fish oils would be indicated as conversion from vegetable parent sources alpha linolenic acid (omega 3) and linoleic acid (omega 6) to utilisable forms EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) can be impaired. In this instance I’d suggest either krill oil or a supplement made from the marine microalgae Schyzochytrium which has preformed EPA and DHA, a rarity in the vegetable kingdom!
As a herbalist I will often use several botanicals to help improve memory and get rid of brain fog alongside recommending good diet, plenty of fresh water and adequate exercise. A great herb for example is rosemary (Rosmarinus officinalis).
Rosemary has been in use for centuries: Dioscorides mentions it thousands of years ago in his monumental work De Materia Medica long before it made its way across Europe with the Romans. Markham’s famous herbal from 1615 suggests rosemary ‘comfortath the brain’ . Culpeper tells us in 1652 that it ‘helps a weak memory and quickens the senses’ .
In more recent times research has confirmed what was already known to the ancients (Moss, et al. 2003; Pengelly, et al. 2012), that rosemary improves brain function. Use of rosemary essential oil can be a useful adjunct in dementia and Alzheimer’s Disease.
Another oft-touted herb is Gingko. The Gingko biloba tree, which incredibly survived the bombing of Hiroshima, is known to affect the blood-brain barrier and improve general circulation to the brain.
However there are mixed opinions in research as to whether it improves cognition. Research has been mixed, which questions the legitimacy of the RCT (randomised controlled trials) research model in relation to herbal medicines.
A systematic review of RCTs by Birks and Evans (2009), for example, found Ginkgo to be safe but the researchers found that most trials were unreliable.
Ginkgo leaf has only been used in herbal medicine since the 1960s for impaired peripheral and cerebral circulation. Traditionally the Ginkgo nut was used as a food and medicine but the Ginkgo leaf used by herbalists does not have the historical longevity of Rosemary, for example, so research becomes an important source of information. Oskouei, et al (2013) found Gingko useful for memory loss while Herrschaftt, et al. (2012) found it could slow the progression of Alzheimer’s Disease while Bäurle, et al (2009) found it enhanced cognition in people with mild cognitive impairment.
Other useful memory-enhancing herbs include peppermint (Mentha piperita) essential oil and the adaptogens Ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosis), which improve function at the cellular level. Gotu kola (Centella asiatica) Brahma (Bacopa monnieria) which enhances nerve conductivity and Holy Basil (Ocimum tulsi) are also very useful herbs from the Ayurvedic tradition. A herbalist will tend to make an individualised formula and may use these or other herbs according to the individual presentation.
We must also consider the role of exercise. Exercise is not just about toning muscle and looking good. It also improves neurotransmitter function and how the body communicates along various negative feedback systems. It induces endorphins which are mood enhancing and help to moderate stress response, while also preventing cognitive decline.
Finally we must also consider the enteric nervous system, also known as the gut brain. We now know that the bacteria which live inside us can influence our mood. Most serotonin for example is made in the gut and not the brain. The gut brain, sheaths of neurons embedded in the gut wall, can control gut behaviour independently but can also influence the brain and shape our emotions. It is therefore worth looking at gut flora and how their balance affects our mental health. The use of fermented foods helps to maintain bacterial equilibrium while prebiotics and probiotics can be particularly important.
So what all of this tells us is that a good diet which incorporates plenty of fresh, colourful and vibrant foods; adequate exercise; plenty of fresh air and exposure to sunlight are all central to good brain function. A high strength multi may be a useful adjunct, while Co-Enzyme Q-10, 5-HTP and L-carnitine may play a role.
All of these things alongside the herbs mentioned (there are many others) can help to improve our cognitive ability but the practitioner should always aim to individualize the protocol to suit the person in front of them. There is no one-size-fits-all in the holistic approach.
Danny O’Rawe MIRH, Dip Herb, Dip Nat, MABC, Dip Aro. is a Herbalist and Naturopath who practices in Belfast and London www.belfastherbalist.co.uk. He lectures for CNM (College of Naturopathic Medicine) at their Dublin and Belfast colleges. For information on CNM Diploma Courses, Postgraduate Courses and Short Courses in a range of natural therapies, and locations at which they are available, visit www.naturopathy-uk.com
With many thanks to Danny for this article. If you have any questions regarding the health topics raised then please do get in touch via phone (01684 310099) or e-mail (firstname.lastname@example.org)
Amanda Williams, Managing Director of Cytoplan