The brain is a complex organ that neuroscientists are still attempting to understand. As people live longer, dysfunction of the brain is becoming a predominant issue for the healthcare system. Cognitive decline, particularly in elderly people, often derives from the interaction between age-related changes and age-related diseases, and covers a wide spectrum of clinical manifestations, from intact cognition through mild cognitive impairment and dementia. Epidemiological evidence supports the hypothesis that modifiable lifestyle-related factors are associated with cognitive decline, opening new avenues for prevention.

Diet & Nutrients
There is convincing evidence that nutrients are essential for human health and physiological functioning. The human body cannot synthesize certain nutrients internally (not at all or not in sufficient amount) and they need to be substantiated from food. The brain is a complex organ with a high metabolism and high turnover of nutrients, and this makes it a high-maintenance device in terms of optimal nutrient intake.

Due to the multifactorial nature, the role of nutrition in cognitive neuroscience is complex. The concern is not simply with the impact of a single chemical on the brain but with multiple nutrients, metabolites and interacting factors. In addition, a myriad of nutrient-specific transport systems and physiological mechanisms adds more complexities in the nutrient-brain interaction.

The general assumption is that specific dietary patterns, like the Mediterranean diet, may be more beneficial than a high consumption of single nutrients or specific food items. A strong link between vascular risk factors and cognition decline has been demonstrated, and the association of diet with several vascular and metabolic diseases is well known. Other plausible mechanisms underlying the relationship between diet and cognitive decline, such as inflammation and oxidative stress, have been established. In addition to the traditional etiological pathways, new hypotheses, such as the role of the intestinal microbiome in cognitive function, have been suggested and warrant further investigation.

Cognition: Tool for Brain Health Measurement
Cognition refers to the mental processes involved in acquiring knowledge and the integration of these processes into responses such as learning, attention, memory, intelligence (intelligence quotient; IQ) and consciousness. Many aspects of nutrition, from entire diets to individual nutrients, have been implicated in cognition, mental health, dysfunction and disease.

A large number of dietary intervention studies in humans and animals, in particular those using foods and beverages comprising flavonoids, have demonstrated beneficial effects on human vascular function and on improving memory and learning. Flavonoids are now thought to be capable of improving cognitive performance via an ability to interact with neuronal and glial signaling pathways crucial to inducing synaptic plasticity.


Market vs. Science
The friction between science and marketing goes on every day, particularly in the dietary supplement/nutraceutical industry, but safety is critical when dealing with the fragile brain. The brain controls all physiological functions including memory, hunger, thirst, movement and sleep. Because the entire system is delicately interconnected with many different neurotransmitters, all of which are continuously working, extensive care must be taken when it comes to products aimed at the brain. Both formulators and marketers are interested in memory, mood and stress categories. While from a functionality point of view each has ingredients that can overlap, there remain specific ingredients that target each area. Some current market formulations have been developed based on the “kitchen sink” model, which includes many different ingredients with the same mechanism of action—or companies may throw in extra ingredients just to make the formulation unique.

Clinically Proven Solution
Numerous nutraceutical combinations have entered the international market through exploration of ethno-pharmacological claims made by different traditional practices without robust quality, safety and efficacy proof. More evidence is needed before these products can be broadly integrated into national health systems for brain-related disease prevention for which they have promise.

KeenMind (www.keenmind.info) is the result of more than 40 years of research. It demonstrates benefits for enhancing memory retention and recall, improving mental clarity and focus, as well as assisting learning, concentration and attention. KeenMind contains a special extract called CDRI 08, which is made from an Indian Ayurvedic herb, Bacopa monnieri. It is a natural nootropic (well tolerated cognitive enhancer) designed to improve and protect brain function.

Numerous randomized, double-blind, placebo-controlled studies on KeenMind have provided an excellent platform to assess the utility of treatment in humans for maintenance and improvement of cognitive functions, and normal cognitive aging (see Table 3). KeenMind is very useful to facilitate learning and concentration, particularly in children and students. This can be used for mature and elderly individuals to aid memory and reduce decline in mental performance. KeenMind supplementation can be an ideal choice for those with intellectually demanding jobs or those who are under pressure.


Out of Box: Epigenetics
Recent research suggests that epigenetics plays a key role in the early nutritional programming of long-term cognition and mental health. Two major components of epigenetic regulation are DNA methylation and histone acetylation. The former represses gene activity, while the latter increases gene activity via chromatin remodeling. The epigenetic marking of genes is quite persistent, and the effects of early nutrition on cognition and mental health may be passed between generations via epigenetic mechanisms that modify DNA function but not sequence.

The environment exerts a powerful effect on epigenetic regulation and alterations can occur during the lifetime of identical twins, resulting in differences in gene expression between closely related individuals. These differences may be critical for brain function; epigenetic mechanisms have been implicated in cognitive function, memory and mental health. These recent studies suggest that nutrition probably has marked influences on the epigenetic programming of brain health and cognition.

Conclusion
Although there is probable evidence about the relevance of diet in brain health, many pieces of this complex puzzle are still missing. Research in this field is complicated by several challenging issues, such as:

1. Lack of reliable dietary intake tool assessments
2. Long-term exposure studies
3. Non-linear relationship between single nutrient components and cognitive decline
4. No visible explanation on synergistic or counteracting effects at different levels
5. Variability among individuals in dietary consumption and distribution level
6. Methodological difficulties in measuring biomarkers of dietary components and/or their biological effects.

It was believed that early nutrition is especially critical for long-term cognitive function and mental health. However, recent findings on plasticity and neurogenesis suggest that proper nutrition throughout the life cycle could be essential to optimize brain function, prevent dysfunction and treat brain diseases. Not only just the very young and the very old, but people at different ages are considered as vulnerable groups in relation to suboptimal nutritional status.

The roles of genomics and epigenomics in modulating the effects of nutrition on the brain and mental health should be included in new health policy development. In the long term, personalized nutrition, based on individual genetic variability and environmental susceptibility, should help to optimize brain function and prevent or alleviate mental disorders. New genomic technologies and sophisticated imaging techniques with classical nutrition studies should result in long-term benefits for optimal brain health, longevity and quality of life. 

DSM Explores the Role of Nutrition in the Aging Brain Further characterizing the consequences of insufficient vitamin and nutrient supply on the aging brain, DSM published a new paper appearing in Nutrition. The manuscript highlighted the contributing factors to the malnourishment of the elderly, which is linked to the progression of pathological events causing Alzheimer’s type dementia. It argued that, to delay the onset of Alzheimer’s disease, neuronal health must be maintained for as long as possible and concluded that the optimal supply of micronutrients plays a vital metabolic role in supporting the normal functioning of the brain. The paper highlighted that a variety of vitamins and polyunsaturated fatty acids (PUFAs) have been identified as having essential roles in the metabolism of vital components of a healthy brain and contribute to a myriad of processes, including the synthesis of cell membranes, neurotransmitters, amino acids, amines and steroids that support signal transduction and neuronal health. Energy production in the brain is heavily dependent on several vitamins and minerals, such as vitamins C and A, which are essential co-factors in the metabolic processes responsible for the release of energy from carbohydrates.  “The brain has exceptionally high metabolic activity and uses a large proportion of the body’s total nutrient and energy intake, making the brain susceptible to any shortage of nutrients,” explained Dr. M. Hasan Mohajeri, R&D Human Nutrition and Health, DSM Nutritional Products. “As we age, the brain has altering requirements of essential nutrients including vitamins. Clinical research has shown that the ability to recall events in time and place declines with age, starting at 20 years of age. High nutrient food or targeted nutritional supplements are essential to maintain a healthy brain throughout our developmental and adult years.” “With the increase in prevalence of Alzheimer’s disease in our aging population, it is imperative that—in the absence of a cure—we endeavor to delay the onset of neurological degeneration,” added Professor Manfred Eggersdorfer, senior vice-president, Nutrition Science & Advocacy at DSM and Professor for Healthy Ageing at the University of Groningen. “It is forecast that degenerative neurological conditions will cost global economies trillions in patient healthcare costs over the next 35 years. We encourage healthcare professionals, governments and other key stakeholders to take note of the strong science in support of an alternative, nutritional approach to protecting against the onset of Alzheimer’s disease pathology.”

References

1. Stough C et al.  2001. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl.), 156 (4): 481-484.
2. Stough C et al. 2008. Examining the Nootropic Effects of a special extract of Bacopa monniera on Human Cognitive Functioning: 90 day Double-Blind Placebo-Controlled Randomized Trial. Phytother. Res., 22: 1629-1634.
3. Downey LA et al. 2012. An acute, double-blind, placebo-controlled crossover study of 320 mg and 640 mg doses of a special extract of Bacopa monnieri (CDRI 08) on sustained cognitive performance. Phytother Res. 19.
4. Benson S et al. 2013. An Acute, Double-Blind, Placebo-Controlled Cross-over Study of 320 mg and 640 mg Doses of Bacopa monnieri (CDRI08) on Multitasking Stress Reactivity and Mood. Phytother. Res. DOI: 10.1002/ptr.5029

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Dilip Ghosh, PhD, FACN, is director of nutriConnect, based in Sydney, Australia. He is also professionally involved with Soho Flordis International, the University of Western Sydney, Australia, and is an Honorary Ambassador with the Global Harmonization Initiative (GHI). Dr. Ghosh received his PhD in biomedical science from University of Calcutta, India. He has been involved in drug-development (both synthetic and natural) and functional food research and development both in academic and industry domains. Dr. Ghosh has published more than 60 papers in peer-reviewed journals, and he has authored two recent books, “Biotechnology in Functional Foods and Nutraceuticals,” and “Innovation in Healthy and Functional Foods,” under CRC Press. His next book, “Clinical Perspective of Functional Foods and Nutraceuticals” is in press. He can be reached at [email protected]; www.nutriconnect.com.au.