Reversing Dementia in MS Patients: Could Seafood Be the Key?

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Last year, the National Institute of Environmental Health Sciences reported that over 7 million Americans[1] are affected by neurodegenerative disorders, the most common of which are Alzheimer’s disease (AD), Parkinson’s disease (PD), and multiple sclerosis (MS).[2]  Important risk factors for neurodegenerative disorders are age and genes, but environment also may be involved.[3]^, [4]  Whiles there is currently no cure, clinical treatments for AD, PD, and MS symptoms may include medications, lifestyle modifications, and some other types of therapies.[5]^, [6] ^,[7]  

One research focus is nutrition, as it is a risk factor that can be controlled by individuals. A number of studies of the general population suggest that what you eat may help protect you from cognitive decline.[8]^{, [9], [10], [11]} Special interest has been on three diets associated with longer, healthier lives and cognitive benefits:  Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) diet, and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet.[12]  The Mediterranean diet is characterized by eating lots of fruits, vegetables, olive oil, and fish; the DASH diet, developed to prevent and treat hypertension, includes eating lots of plant-based foods and limiting saturated fatty acids; and the MIND diet, developed to try and prevent dementia, is a combination of the Mediterranean and DASH diets and emphasizes consumption of whole grains, berries, vegetables, fish, poultry, and olive oil. 

In a comprehensive review of the literature up to 2019, researchers examined 56 articles (including cross-sectional studies, a case-control study, longitudinal studies, and articles on intervention studies) that provide evidence of associations between the three diets with cognitive decline and dementia. The results of the review suggest that higher adherence to the Mediterranean, DASH, or MIND diets is associated with less cognitive decline.[13] Interestingly, researchers identified fish as the single most important dietary factor in lowering the risk of cognitive impairment (the risk that in 10 years, your cognition will be worse than your peers) and cognitive decline (the risk that in 10 years, your cognition will be worse than it is now), with vegetables in second place. [14] 

MS is a chronic autoimmune disease that affects the central nervous system wherein the immune system mistakenly attacks the myelin sheath (the protective coating on nerve fibers in the brain, spinal cord, and optic nerve) which can disrupt nerve activity throughout the body. This can result in a variety of physical and mental issues, including fatigue, weakness, difficulty walking or seeing, problems with swallowing, bladder control issues, constipation and other bowel changes, and emotional and cognitive changes.  No two people with MS have exactly the same symptoms, nor is symptom progression predictable.

In 2022, an article in the European Journal of Neurology described a study in which participants from the Health Outcomes and Lifestyle In a Sample of people with MS (HOLISM) were assessed over 2.5 years.  From self-reported dietary data and other questionnaires, the researchers concluded that better quality of diet, as well as not consuming meat, were associated with reduced disability progression in people with MS.[15]

A recent study led by Mount Sinai suggests that people with new-onset MS may benefit from the MIND diet, which emphasizes consumption of whole grains, berries, vegetables, fish, poultry, and olive oil. [16]  The Reserve Against Disability in Early MS (RADIEMS) study drew on information, including MRIs and food frequency questionnaires, in following participants with early MS.[17]  A study of 180 people who had been diagnosed with MS five years prior to their participation in the study reports that those who adhered to the MIND diet had greater tissue volume in certain parts of the brain and smaller lesion size.[18] 

As in the general population, people with MS struggle with the results of a sedentary lifestyle, obesity, and the potential for cognitive decline and dementia.  As in the general population, a diet rich in seafood has shown promising results in restoring and maintaining a healthy weight and in slowing cognitive decline.  Adopting a nutritional approach for ameliorating symptoms has already proven beneficial for some patients, and personalized nutrition strategies have been suggested as preventive tools.[20]

Sea Food with a Greek View

Other healthy choices for a healthy brain

Diet is not the only lifestyle choice that can affect the health of your brain as you age, the list below includes other factors that contribute to your risk of dementia. [21]^, [22]

• Regular exercise, even as little as two hours per week, may be one of the better ways to help prevent or slow cognitive decline.
• Control blood pressure in midlife, keeping it below 120 if possible.
• Use your brain – activities such as reading, learning a new skill or language, playing or listening to music, and doing crossword puzzles all stimulate and challenge your brain.
• Reduce stress – studies show that a 12-minute yoga/meditation technique called Kirtan Kriya has had significant benefits,[23] including reducing inflammation and increasing blood flow to the brain.
• Quit smoking
• Avoid junk food
• Avoid sleeping pills
• Drink alcohol in moderation

By following the Mediterranean, DASH, or MIND diet, not only are you eating well but also avoiding what is unhealthy.  A study published by scientists at the University of Exeter and presented at the Alzheimer’s Association International Conference 2019 in Los Angeles, the risk of dementia was 32% lower in people with a high genetic risk if they had followed a healthy lifestyle, compared to those with an unhealthy lifestyle.  Those who reported eating a diet higher in sugar and salt, who got little exercise, and who smoked cigarettes were more likely to develop dementia.  Drinking at least one artificially sweetened drink per day was associated with a higher risk of dementia.[24]

It’s easy and healthy to include seafood in your diet

It doesn’t get easier than ordering up your favorite seafood, perfectly portioned, from Sizzlefish.  The FDA says fish and shellfish are part of a healthy eating pattern and provide protein; healthy omega-3 fatty acids; more vitamin B12 and vitamin D than any other type of food; iron which is important for infants, young children, and women who are pregnant or who could become pregnant; and other minerals like selenium, zinc, and iodine.  The FDA recommends that adults should eat two to three four-ounce servings of seafood per week.[25] [26] 

Follow a Mediterranean, DASH, or MIND-style diet that includes fish several times per week to reduce the risk of cognitive impairment and decline.  Among the fish and seafood that are good for you are catfish, cod, crab, flounder, haddock, lobster, salmon, sardines, scallops, shrimp, sole, squid, trout, and light tuna.

The FDA website displays this chart to help you select which fish to eat and how often:

References

[1]  National Institute of Environmental Health Sciences. Neurodegenerative diseases. Reviewed June 9, 2022. https://www.niehs.nih.gov/research/supported/health/neurodegenerative/index.cfm

[2]  https://www.ifm.org/news-insights/neuro-slowing-neurodegeneration-with-nutrition/

[3]  https://www.ifm.org/news-insights/neuro-slowing-neurodegeneration-with-nutrition/

[4]  Caveat:  Some causes of dementia-like symptoms are reversible (e.g., normal pressure hydrocephalitus, thyroid problems, vitamin B12 deficiencies, sleep deprivation, side effects or interactions of medications, and depression).  Home Care Assistance Edmonton, August 21, 2019 https://www.homecareassistanceedmonton.ca/what-conditions-are-reversible-causes-of-dementia/

[5]  Alzheimer’s Association. Alternative treatments. https://www.alz.org/alzheimers-dementia/treatments/alternative-treatments

[6]  Parkinson’s Foundation. Over the counter and complementary therapies. https://www.parkinson.org/Understanding-Parkinsons/Treatment/Over-the-Counter-and-Complementary-Therapies

[7]  National Multiple Sclerosis Society. Complementary and alternative medicines. https://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines

[8]  Ballarini, T., van Lent, D.M., Brunner, J., Schröder, A., Wolfsgruber, S., Altenstein, S., Brosseron, F., Buerger, K., Dechent, P., Dobisch, L., Duzel, E., Ertl-Wagner, B., Fliessbach, K., Freiesleben, S.D., Frommann, I., Glanz, W., Hauser, D., Haynes, J.D., Heneka, M.T., Janowitz, D., Kilimann, I., Laske, C., Maier, F., Metzger, C.D., Munk, M., Perneczky, R., Peters, O., Priller, J., Ramirez, A., Rauchmann, B., Roy, N., Scheffler, K., Schneider, A., Spottke, A., Spruth, E.J., Teipel, S.J., Vukovich, R., Wiltfang, J., Jessen, F., & Wagner, M. (2021) Mediterranean Diet, Alzheimer Disease biomarkers and brain atrophy in old age, Neurology, May 2021, https://doi.org/10.1212/WNL.0000000000012067

[9]  Petersson, S.D., and Philippou, E. (2016). Mediterranean diet, cognitive function, and dementia:  a systematic review of the evidence.  Advances in Nutrition, 7(5):889-904. https://doi.org/10.3945/an.116.012138

[10]   van den Brink, A.C., Brouwer-Brolsma, E.M., Berendsen, A.A.M., and van de Rest, O. (2019). The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer's Disease—A Review.  Advances in Nutrition, 10(6):1040–1065, https://doi.org/10.1093/advances/nmz054

[11]  Keenan, T.D., Agrón, E., Mares, J.A., Clemons, T.E., van Asten, F., Swaroop, A., and Chew, E.Y. (2020). Adherence to a Mediterranean diet and cognitive function in the Age-Related Eye Disease Studies 1 & 2. Alzheimer’s & Dementia, 16(6):831-842. https://doi.org/10.1002/alz.12077

[12]  https://www.nia.nih.gov/health/what-do-we-know-about-diet-and-prevention-alzheimers-disease

[13]  van den Brink, A.C., Brouwer-Brolsma, E.M., Berendsen, A.A.M., and van de Rest, O. (2019). The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer's Disease—A Review.  Advances in Nutrition, 10(6):1040–1065, https://doi.org/10.1093/advances/nmz054

[14]  Budson, A.E. (2020). What to eat to reduce your risk of Alzheimer’s disease. Harvard Health Blog, May 20, 2020. https://www.health.harvard.edu/blog/what-to-eat-to-reduce-your-risk-of-alzheimers-disease-2020050819774

[15]   Simpson-Yap, S., Nag, N., Probst, Y., Jelinek, G., and Neate, S. (2022) Higher-quality diet and non-consumption of meat are associated with less self-determined disability progression in people with multiple sclerosis: A longitudinal cohort study. Eur J Neurol. 2022 Jan;29(1):225-236. https://doi.org/10.1111/ene.15066

[16]  Isenberg, S. (2023). Healthy eating habits for Multiple Sclerosis,” Everydayhealth, June 15, 2023. Reviewed by J.P. Chua, MD, https://www.everydayhealth.com/multiple-sclerosis/diet/healthy-eating-habits-multiple-sclerosis/

[17]  “A Big Step” Toward Establishing Link Between Dietary Factors and Brain Structure in Multiple Sclerosis (MS), Mout Sinai Reports,  https://reports.mountsinai.org/article/neuro2022-06-multiple-sclerosis-katz-sand

[18]   Katz Sand, I.B., Fitzgerald, K.C., Gu, Y., Brandstadter, R., Riley, C.S., Buyukturkoglu, K., Leavitt, V.M., Krieger, S., Miller, A., Lublin, F., Klineova, S., Fabian, M., and Sumowski, J.F. (2021). Dietary factors and MRI metrics in early Multiple Sclerosis. Mult Scler Relat Disord. 2021 Aug;53:103031. https://doi.org/10.1016/j.msard.2021.103031.

[19]   van den Brink, A.C., Brouwer-Brolsma, E.M., Berendsen, A.A.M., and van de Rest, O. (2019). The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer's Disease—A Review.  Advances in Nutrition, 10(6):1040–1065, https://doi.org/10.1093/advances/nmz054

[20]   https://www.ifm.org/news-insights/neuro-slowing-neurodegeneration-with-nutrition/

[21]  https://www.washingtonpost.com/health/lifestyle-strategies-to-keep-brains-healthy-which-also-might-push-back-the-onset-of-dementia/2020/02/14/370599bc-3c81-11ea-baca-eb7ace0a3455_story.html

[22]  Khalsa, D. S., & Perry, G. (2017). The Four Pillars of Alzheimer's Prevention. Cerebrum : the Dana forum on brain science, 2017, cer-03-17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501038/

[23]  Khalsa, D.S. (2015).  Stress, Meditation and Alzheimer’s Disease Prevention: Where the Evidence Stands. Journal of Alzheimer’s Disease. 48:1–12. https://www.ncbi.nlm.nih.gov

[24]   Fottrell, Q. (2020). 5 ways to reduce your risk of developing dementia, according to new research. Marketwatch, Jan. 4, 2020.  https://www.marketwatch.com/story/a-major-new-study-suggests-its-possible-to-avoid-dementia-here-are-5-ways-to-reduce-your-risks-2019-07-15

[25]  https://www.fda.gov/food/consumers/advice-about-eating-fish

[26]  https://www.fda.gov/food/consumers/advice-about-eating-fish