Lecanemab: The lifestyle changes you can make to protect your brain and reduce the risk of dementia

Lecanemab is the new antibody drug that has been shown to slow down, but not reverse or halt, the progression of early stages of Alzheimer’s Disease.

It will not be available on the NHS because at £20,000 a year, it would make massive financial dent in the UK’s drug budget. There are estimated cases of 57 million adults worldwide, and 60 to 80 per cent of these caused by Alzheimer’s disease, for which lecanemab is licensed. Many health economists agree that the money would better spent in promoting lifestyle and nutritional strategies which have also been shown to reduce the development of dementia and improve the quality of life for patients and families affected by the condition.

Of course, lifestyle strategies do not make companies billions of dollars a year so don’t have the marketing or PR clout to promote them. That's not to say they are not equally or even more effective, if taken seriously. What’s more, adopting brain-protective lifestyle measures costs very little, reduces the risks of other chronic degenerative diseases and has no side effects, unlike immunotherapy drugs which often have plenty - which doctors and patients also have to deal with.

Numerous well-conducted scientific studies have concluded that exercise and dietary manoeuvres, particularly those which boost plant intake, can improve regular productive sleep, enhance cognition and improve motivation to live healthily, all of which enhance the neuronal chemical composition now and protect the brain from vascular dementia, Alzheimer’s, Parkinson’s and other neurodegenerative conditions later in life.

So what can we do, right now, to protect our brains? Head trauma aside, these are the strategies which have the biggest impact.

• Exercise three hours a week 
• Eat plenty of colourful phytochemical rich plants
• Reduce intake of processed sugar
• Avoid vitamin D deficiency
• Keep your weight down 
• Avoid mineral deficiencies
• Ensure an adequate intake of iodine
• Quit smoking 
• Try to achieve a regular sleep pattern
• Reduced processed meat intake
• Ensure adequate intake of omega fats 
• Moderate your alcohol intake
• Control your or treat raised cholesterol 
• Control your or treat raised blood pressure

It important to note that the best way to avoid dementia is to start healthy approaches before symptoms develop - as early in life as possible. Distinctive types of dementia are influenced by different lifestyle factors although there is considerable overlap. Vascular dementia is mainly caused by untreated high blood pressure, high cholesterol, smoking and a lack of exercise whereas Alzheimer’s is linked to chronic inflammation caused by an ageing, ailing immune system, accelerated by unhealthy dietary habits and a sedentary lifestyle. Both types of dementia are strongly influenced by dietary phytochemicals (the natural chemicals which give plants their colour, smell and taste).

Why and how plant phytochemicals are so important for brain function

These wonderful gifts from nature have been studied extensively for their ability to enhance alertness and memory and in the long term reduce the risk of dementia or slow its progression. Many phytochemicals have more than one mechanism of action and the whole foods, from which they originate, also have other healthy ingredients such as healthy oils, fibre, vitamins, minerals and proteins. Here are the main underlying mechanisms of action:

• Preventing build-up of amyloids or helping to reabsorb existing plaques
• Dampening excess chronic inflammation
• Improving oxidative pathways – reducing damage from free radicals and toxins
• Enhancing nitric oxide (NO) which improves brain oxygenation
• Directly inhibiting brain cell death (apoptosis)
• Supporting gut health which can secondarily affect the brain

Many healthy plant-based foods are rich in phytochemicals. Asian and Mediterranean diets are typically more abundant in phytochemical-rich fruits, mushrooms, vegetables, salads, herbs, spices, teas, nuts, berries, seeds and legumes. Typical western diets, on the other hand, are dreadfully deficient in phytochemicals, meaning we need to eat a lot more of them, preferably some with every meal of the day.  

Here are the phytochemical rich foods which have the strongest evidence of protection:

Pomegranate contains many polyphenols including ellagic acid which has been shown to block accumulation of amyloid plaques in the brain, preventing the age-related decline in cognition, and improving learning and memory performance.

Cranberries, blueberries, beetroot, spinach and celery are rich in nitrates which, following interaction with other phytochemicals, are converted by the body to nitric oxide (NO). This relaxes muscles around arteries, improving blood flow, and results in improved oxygenation and removal of toxic metabolites in tissues such as muscles. This improves recovery after exercise and promotes brain-improving alertness and cognitive function.

Participants in clinical trials given cranberry extract significantly improved their memory, neural functioning and delivery of blood to the brain compared to placebo.

Cocoa, fruits other berries and leafy green vegetables are rich in flavonoids which have antioxidant-enhancing and anti-inflammatory properties. It is established that their higher intake over time is associated with a lower risk of developing dementia.  A recent small study found that people taking a flavonoid-rich cocoa had improved memory and cognitive function compared to those taking placebo.

Green tea contains epigallocatechin gallate (EGCG) found to help untangle fibres called tau and protect the brain. In Alzheimer’s, excess tau abnormally sticks together in fibrous tangles that spread between brain cells, leading to amyloid formation and cell death.

Curcumin (turmeric) helps reduce inflammation and improves anti-oxidative pathways but also has direct neuroprotective properties. A study  published in the American Journal of Geriatric Psychiatry found that curcumin supplementation improved memory and attention in older adults with cognitive impairment.

Ginger has potent anti-inflammatory and anti-oxidative properties but also helps with the absorption and bioavailability of other phytochemicals which is why it’s called a bioenhancer. Like many of these foods mentioned so far, it is rich in soluble fermentable fibres which act as prebiotics that help to feed healthy gut bacteria and improve gut integrity.

Broccoli and other cruciferous vegetables are rich in Isothiocyanates (ITCs) such as sulforaphane (SFN) which have been shown to decrease levels of pro-inflammatory chemicals, reverse amyloid formation and hence reduce damage to brain cells. SFN also has a peculiar capacity to activate antioxidative defences against toxins which can trigger brain cell death. Unsurprisingly, more than 20 clinical studies have been published linking a higher intake of cruciferous vegetables with a lower risk of dementia.

Here are some tactics which can help boost their daily intake

Juices and smoothies: Many commercial fruit juices are not genuine, often mixed with water, concentrate, and extra sugar. Even real fruit juices have high fructose levels. Juicing whole fruits helps retain pulp and fibre but still results in high sugar content. To reduce this, smoothie enthusiasts add avocado, vegetables like kale, or spices such as ginger to lower sugar while boosting polyphenols.

Soups: Cooking preserves most phytochemicals, making soups a great way to ensure extra intake. A superfood soup mix might include broccoli, onion, pea, turmeric, and pepper. Pair soups with salads containing raw vegetables like onions or radish, which contain myrosinase - necessary for converting polyphenols such as sulforaphane in cruciferous vegetables into active components.

Shots: Health-focused outlets offer phytochemical-rich shots made from ginger, turmeric, and chilli with apple or orange juice. You can create your own at home by grating ginger into apple juice and adding lemon. For a green shot, blend ginger, green apple, spinach, avocado, lemon juice, and cayenne pepper.

Grains and sprouting legumes: Mixing foods like whole grains and pulses provides a variety of nutrients. Soaking grains overnight reduces gluten and phytic acid, making them easier to digest. Sprouting legumes such as chickpeas, lentils, and peas boosts their phytochemical levels, enhancing their nutritional value.

Nuts, pumpkin, chia, and flax seeds: Rich in protein, phytochemicals, and healthy fats, nuts and seeds offer slow-release energy and various health benefits. Omega-3 and -6 fatty acids, particularly DHA, are crucial for brain function. Nuts, especially walnuts, along with fresh seeds like flax and chia, are excellent sources of these nutrients. Soaking chia and crushing flaxseeds improves digestibility and nutrient absorption.

Phytochemical-rich supplements: In the busy world we live in, it’s often difficult to prepare fresh healthy meals on a daily basis. A well-made supplement, for some people, is a convenient way to increase phytochemical intake and spread intake across the day.

Nutritional supplements can also contain foods which are not commonly eaten in a typical UK diet such as turmeric, ginger and cranberries. The problem is, the quality of over-the-counter supplements can vary, contain too much of one particular food or worse still only contain single extracted chemicals from a single food. These miss out on the benefits of the whole plant, or combination of plants, which can work in synergy to enhance their favourable effects. Most of all, the vast majority have not been evaluated for effectiveness in robust medical trials. There are some exceptions, such as the blend developed by the scientific committee of the latest UK national nutritional intervention study. Supplements designed for medical trials have to be scrutinised by ethical approval boards so have a much higher level of level of quality assurance and hence safety.

In conclusion, don’t get angry that the UK cannot afford this new drug, although it would indeed help some people. Instead, direct your energy into effective lifestyle strategies which can do the same thing - if not better.