Prevention is the Key

How to maintain the brain at every age.

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Most discussion about cognitive health revolves, understandably, around how it affects us in old age: dementia, Alzheimer’s, memory loss and so on. That said, we should start thinking about our brains way before that. First, prevention is better than a cure, and prevention has to start at a young age. Second, cognitive impairment is not solely the realm of seniors. According to Samantha Ford, business development director at AIDP, City of Industry, CA, brain growth peaks in the mid-20s before gradually declining. “The brain processes countless bits of information daily and, as with all muscles, loses efficiency over time,” she says. Antonella Riva, product research manager, Indena, Seattle, WA, says evidence is accumulating that “brain changes typically begin years before people show symptoms, suggesting a window of opportunity to prevent or delay the onset of these conditions.” A 2017 study found there are specific and measurable microstructural changes between early- and mid-adulthood (1).

All of this leaves us with a problem: that the brain is really hard to keep in mind. Signs that something is wrong—headaches, depression, restlessness—can be blamed on something else. We might remember to account for poor life choices (lack of exercise, poor diet) in terms of how they affect our muscles or our heart, but rarely in terms of how they affect the brain. This could be disastrous. A 2018 study looked at 2,068 individuals who underwent cataract surgery and 3,636 individuals who did not, and found that cataract surgery could have a positive impact on trajectories of cognitive decline, although they weren’t certain why (2). Another 2018 study looked at 2,040 adults, and found that the use of hearing aids helped slow cognitive decline (3). Still another 2018 study found that job-related burnout can lead to lower neurotransmitter levels in the cerebral cortex, which the researchers suggested could lead to behavioral and psychiatric disorders (4).

Reduced hearing, reduced sight, and job-related stress are all thought of as normal parts of adulthood, with effects on perhaps a person’s social life or heart, but they all have measurable and significant effects on the brain as well. It is therefore vitally important to keep the brain in mind, and not just as we age. Cognitive health is critical at all stages of life.

Ages and Stages
Pre-Natal/Childhood—“All stages of life” is not an exaggeration: cognitive health is important before the child is born. Brian Appell, marketing manager at OmniActive Health Technologies, Morristown, NJ, says prenatal vitamins and infant formula contain the omega-3 DHA specifically because of its importance in brain development. Tom Druke, director of VitaCholine brand development at Balchem, New Hampton, NY, says that for the first six months of life, babies need 125mg of choline a day; that number increases to 250mg per day between the ages of 4 and 8, and then it continues to increase until adulthood. Shaheen Majeed, president worldwide of Sabinsa Corp., East Windsor, NJ, points to a study published in The Lancet Child and Adolescent Health Journal observing more than 4,500 U.S. children aged 8 to 11 years old that says limiting screen time, getting sufficient sleep, and regular physical activity are associated with improved cognition.

Teen Years—Robin Rogosin, VP of product development at LifeSeasons, Inc., Lewisville, TX, says that “lack of sleep, overeating of junk food, and not drinking enough water can make young people feel scattered and unfocused. Prolonged dysfunction around these three factors can lead to moodiness and irritability, which can undermine success at school and work.”
Teenagers whose circadian rhythms don’t match up with school schedules, who have to eat cafeteria food, and who dehydrate at school and work can find cognitive health adding to the issues brought on by hormonal changes. “Habits established early in life can linger,” warns Rogosin, “and unhealthful habits tend to lead to broader health complications later in life.” Appell mentions functional foods as a great delivery system for people with pill fatigue, but they might work even better with teens, who might not want to start taking pills at all but might see the importance of cognitive health.

Adulthood—“Millennials might want to improve or extend their performance or mental sharpness at work or school,” Appell says. “Or, as they are also having their own children, staying on top of their game and keeping ‘mommy brain’ at bay might be important.” After all, he says, “Millennials are considered the most health-conscious generation ever.”
Trisha Sugarek MacDonald, senior director of research and development and national educator for Bluebonnet Nutrition Corp., Sugar Land, TX, agrees. “Millennials are reporting the highest stress levels compared to all generations. A poll in 2013 by Trending Machine found that millennials are more likely than seniors over 55 to forget what day it is, where they put their keys, to bathe or shower, and to bring a lunch.” All that stress has a big effect: a study published in October 2018 found that higher levels of cortisol, a serum produced in reaction to stress, is associated with worse memory and visual perception, as well as lower total brain gray matter volumes in women (5).

“Cognitive health is among the top five health concerns of consumers aged 18 to 75, and the use of cognitive health supplements is up to 25%, an 8% increase from 2016.”

An Easy Sale
Sugarek MacDonald says forgetfulness is still one of the strong drivers in the industry, but there’s also a push towards supplements that aid concentration and focus. She cites a 2018 Gallup study that says 33% of adults purchase supplements to that end. Moreover, she says, “we are seeing a shift from older populations buying brain health products to younger populations doing the same. Cognitive health is among the top five health concerns of consumers aged 18 to 75, and the use of cognitive health supplements is up to 25%, an 8% increase from 2016.”

Juliana Erickson, senior marketing manager of consumer health and nutrition at Lonza, based in Switzerland, cites a study Lonza commissioned from the Natural Marketing Institute (NMI) that dovetails nicely with Sugarek MacDonald’s research: it says that 76% of U.S. consumers state that they would be very likely to use supplements to manage cognitive health. The average age for that data is 47, which suggests a wide range of ages for which this information is accurate. “Awareness is growing about the benefits of taking care of cognitive health from an earlier age,” Erickson says. “The health impact of aging is more widely publicized, and consumers are beginning to realize that supplements can help play a preventative role in supporting cognitive health.”

And, of course, we live in a digital age. Millennials are particularly likely to have a busy, on-the-go lifestyle, and are therefore likely to look for solutions to help manage their everyday stress and mood levels, Erickson says. “With digital devices becoming more entrenched in our lives, consumers are taking measures to ensure they ‘switch off’ and wind down.” In an age in which stress and anxiety are constant obstacles, people are looking for ways to cope.

Lifestyle Helps
Sleep—“Nothing,” Rogosin says, “can replace good restorative sleep. Often when there is a lack of sleep, mental clarity and mood can be affected.” She suggests merchandising brain, mood, and sleep products together. “Sometimes young people will ask for something to help with focus and concentration, while they may not think to ask for something to help them sleep.”

Exercise—“Get outside for a brisk daily walk, advises Neil E. Levin, senior nutrition education manager at NOW. “Exercising three or more times a week has been linked to a lower risk for dementia.” Majeed points out that exercise lowers the risk of diabetes and cardiovascular disease, which can lead to memory loss. He also says that exercise “helps to produce brain chemicals and reduces stress hormones,” and—in case all that isn’t enough—it boosts growth factors and stimulates new neuronal connections, which are essential for neuroplasticity. If you have space in your stores in which you can hold classes, consider hosting a fitness class, and advertise its brain-boosting effects. For those of you without that space, it might be worth it to reach out to a local yoga studio to see if a business partnership could benefit both of you.

Diet—Majeed compares the brain to the body: “A nutrient-dense diet provides you the energy that is necessary to lead an active life, protects from infection, and helps to maintain overall health and wellness. Likewise, healthy foods also benefit one’s brain health, which may include nourishing brain cells that allow for cognitive functioning and stabilize mood.” Levin says that thanks to changes in food storage and to the extensive processing and assembly of packaged foods, “our food supply has had demonstrably declining levels of essential nutrients over the past several generations.” Add to that specialized diets, limited choices when traveling, and restaurant and cafeteria menus, and “we have a good proportion of the population that is challenged in obtaining enough nutrients from diet alone.” He suggests a Mediterranean diet, which includes vitamins, minerals, omega-3s, and polyphenols. Ford suggests “fatty fish, coffee, blueberries, turmeric, broccoli, pumpkin seeds, and dark chocolate,” all of which are “rich in certain nutrients that can help support brain function.” And Rogosin adds a quick reminder to drink plenty of water, as “avoiding dehydration can help improve concentration and cognition.”

Mental Gymnastics—“Use it or lose it,” says Sugarek MacDonald. “Exercising your brain daily by engaging in mentally stimulating activities will help support healthy cognition.” She suggests taking 15 minutes a day to learn something new, or cross training at work—doing things, in other words, that keep people on their toes, and force them to create connections they otherwise would not. Appell agrees, saying “Harvard Health points to research showing that creative outlets like painting and other art forms, learning an instrument, doing expressive or autobiographical writing, and learning a language also can improve cognitive function.” He holds up Lumosity.com, which claims that upwards of 85 million people have played its brain games, as proof that people are looking for “anything and everything” to maintain a cognitive edge, regardless of age. And just as the body requires rest in order to recover from exercise, so does the mind. A 2013 pilot study was conducted on 39 dementia caregivers, who were randomized to a meditation group or a group that listened to relaxation music. It found that meditating for 12 minutes a day for 8 weeks significantly lowered levels of depressive symptoms, while improving cognitive function (6).

They’re backed up by Jessica Langbaum, the associate director of the Alzheimer’s Prevention Initiative at the Banner Alzheimer’s Institute in Phoenix, AZ. In order to keep her brain strong, Langbaum says, she goes to work. “While you’re still in the workforce you are getting that daily challenge of multitasking, of remembering things, of processing information. Puzzles and games—sudoku, crosswords, and the like—only focus on one very narrow task,” the equivalent of exercising one single muscle in your body. The best thing, Langbaum says, is social interaction. “People who have a lot of social interactions, particularly in mid-life, have a lower risk of Alzheimer’s dementia in later life. There’s something about being around people that’s helpful for our brains” (7).

Choosing a Supplement
“No matter who the audience,” says Ford, “the customer wants a product that is proven effective and with few side effects.” Given the wide range of end points, ingredients, and products out there, helping a customer settle on a particular product is a role for the retailer, although Sugarek MacDonald says many customers don’t have the knowledge of “a biologist, chemist, nutritionist, and clinical researcher all rolled into one.” She provided a helpful list of steps to help all involved choose a supplement.

The first step is to pick a delivery system, based on the customer’s preference—and don’t skip that, as a delivery system the customer likes makes the customer more willing to take the product. Then, pick an end point: memory, focus, attention, mood, stress relief and so on. Figure out whether this can be best achieved by a vitamin, mineral, botanical, or specialty ingredient.

After that, we move into a section you, as a retailer, can help with: are the ingredients clinically studied? Do they exist in the product in the dosages that clinical studies have determined to be therapeutic? Is the label transparent? Is it a trustworthy brand from a reputable company? Is it a high value for the cost?

Delivery System—Delivery system for a cognitive health supplement is particularly important, on a molecular level. In order to make it to the brain, it has to cross the blood-brain barrier (BBB). The BBB is, in Majeed’s words, “a continuous endothelial membrane that limits the entry of toxins, pathogens, and blood cells to the brain,” which helps keep the brain safe from diseases that could otherwise harm it, but also prevents helpful supplements from getting in. In order to cross the BBB, Majeed says, ingredients must be fat-soluble and have a low molecular weight.

Furthermore, Erickson says, different release profiles can make a difference. “Lipid Multiparticulate technology allows formulations to be released steadily. Such a sustained release, with an ingredient like caffeine, can enhance alertness and mood.” Riva mentioned Indena’s Phytosome approach: whereas liposomes keep the ingredient in the inner cavity of the lipid, Phytosomes hold the active ingredient in the outer phospholipid layer, increasing bioavailability.

End Point—When choosing an end point, Rogosin feels that group brainstorming can help. “A quick chat with a customer can help determine if there’s mood involvement, whether anxiety or depression. Neuro-T is helpful for supporting healthy focus and concentration—for example, when someone is easily distracted. Rest-ZZZ is a great addition when sleeplessness leads to daytime fatigue, which can undermine healthy cognition.” This conversation might be necessary even if a customer comes in with a specific request—as mentioned earlier, problems with focus might actually be due to sleep issues.

Mechanism—When deciding between types of ingredients, it might help to start with diet: is the customer eating a nutrient-deficient diet? If so, it might be easiest to start there. The brain needs niacin, vitamin B12, folic acid, magnesium, choline, and DHA to perform basic activities, and a person’s cognitive health issues might be due to a lack of these building blocks. If the customer is getting what they need, through diet or supplements, move on to botanicals and special ingredients, and don’t forget to double check that the customer isn’t allergic to anything.

Ingredients—When picking supplements, Majeed says it’s best to stick with those with branded ingredients. “Those are more likely to have research and robust quality programs backing them up,” he says, which saves you time spent researching effectiveness and therapeutic dosage. They’re also more likely to invest in improvement: “AIDP invests in ongoing research to help solidify the science and identify new mechanisms of action for all our ingredients, including Magtein, which is currently being investigated in 7 ongoing clinical trials, including areas of sleep, mood, and attention,” says Ford.

Appell emphasizes that, regardless, you should “rely on ingredients that have clinical support, like omega-3s.” There’s a broad range of ingredients to choose from. Curcumin, as in Sabinsa’s Curcumin C3 Complex or NOW’s CurcuBrain, has a multitude of studies backing it up. AIDP’s Magtein is a specific and patented form of magnesium, which has past research on its side and research in the works that promises further proof. Lonza has L-Optizinc, a highly absorbable form of zinc, which has been shown to promote memory and mood functions. Indena’s Ginkgoselect and Virtiva make use of the terpenoids and bioflavonoids in Ginkgo biloba leaves, which, Riva says, have been shown to improve speed and quality of memory and to improve calmness. ExcelVite’s EVNol is a tocotrienol complex that boasts no fewer than 16 studies, one of which was performed on 121 participants and found that it protected brain white matter from lesions (8).

Label—“Supplements that are clean label or vegetarian,” says Erickson, “are increasingly holding wide appeal for more discerning consumers.” The data “highlights that 54% of cognitive health supplement users are more likely to buy a product if it uses sustainable or environmentally friendly ingredients, and that 23% of cognitive health supplement users are willing to pay 15-20% more for a product that incorporates ingredients from sustainable sources.” She says you should look beyond the active ingredients: “there is an opportunity to incorporate clean label capsules and different release profiles to cater to changing needs. Lonza offers a wide range of vegetarian capsules, enabling vegetarian and organic labeling, as well as halal and kosher options.”

Final Takeaway
Levin has a ray of hope from the UCSF Memory and Aging Center: “Many scientists believe that major declines in mental abilities are not inevitable as people age. Growing evidence of the adaptive capabilities of the older brain provide hope that people may be able to do things to sustain good brain function.” WF

References:

  1. Lixia Tian and Lin Ma, “Microstructural Changes of the Human Brain from Early to Mid-Adulthood.” Frontiers in Human Neuroscience, 11, 393 (2017).
  2. Asri Maharani et al, “Cataract surgery and age-related cognitive decline: A 13-year follow-up of the English Longitudinal Study of Ageing,” PLOS One, 2018.
  3. Asri Maharani et al, “Longitudinal Relationship Between Hearing Aid Use and Cognitive Function in Older Americans,” Journal of the American Geriatric Society, 66(6), 1130-1136 (2018).
  4. Yongcheng Yao et al, “Job-related burnout is associated with brain neurotransmitter levels in Chinese medical workers: a cross-sectional study,” Journal of International Medical Research, 46(8), 3226-3235 (2018).
  5. Justin Echouffo-Tcheugui et al, “Circulating cortisol and cognitive and structural brain measures,” Neurology, 2018.
  6. Tameka Kee, “This is Your Brain on VR… The Neuroscientist’s Perspective,” Thrive Global, 10/15/18. Accessed 11/02/18.
  7. H. Lavretsky et al, “A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: Effects on mental health, cognition, and telomerase activity,” International Journal of Geriatric Psychiatry, 28(1), 57-65 (2013).
  8. Jon Hamilton, “A Brain Scientist Who Studies Alzheimer’s Explains How She Stays Mentally Fit,” NPR, 10/08/18.
  9. Y. Gopalan et al, “Clinical investigation of the protective effects of palm vitamin E tocotrienols on brain white matter,” Stroke, 45(5), 1422-1428 (2014).
  10. “Noomato,” www.naturalea.ch/noomato/. Accessed 11/02/18.

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