Nutrition Strategies for Improved Cognitive Function in Patients With Alzheimer Disease
This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.
In this podcast episode, Lisa Jones, interviews Amylee Amos, PhD, RDN, IFMCP, about the practical and actionable nutrition strategies that dietitians can recommend to individuals managing Alzheimer disease to help improve cognitive function, enhance overall quality of life, and provide meaningful support in their daily lives. This is episode four of a four-part podcast series on Alzheimer disease.
Additional Resource:
- Amos Institute. Accessed October 5, 2023. https://amosinstitute.com/our-founder/
- The Institute for Functional Medicine. Accessed October 5, 2023. https://www.ifm.org/
- KetoFLEX 12/3. Apollo Health. Accessed October 5, 2023. https://www.apollohealthco.com/ketoflex-12-3/
Listen to episode one of this four-part podcast series here.
Listen to episode two of this four-part podcast series here.
Listen to episode three of this four-part podcast series here.
Speaker 1:
Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietitian and nutritionist Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or consultant 360.
Lisa Jones:
All right, well, welcome to episode four where I have the privilege of talking to Dr. Amylee Amos about practical insights on optimal nutrition strategies. Before we dive into that, I want to talk to Dr. Amylee Amos about the last episode where we talked about debates in dietetics, and we had this wonderful conversation and covered so many things. But Amylee, if you had to sum up that conversation in one or two sentences, what are the key takeaways from that episode?
Amylee Amos:
Oh gosh. I mean, we talked about a lot, but I would say there certainly are some controversies regarding diets in relation to Alzheimer's prevention and management, but the research is actually quite clear on a lot of the issues that are still controversies with quotes around it. And so I think we talked about how if you're going to engage in a conversation about this to make absolutely sure that you are extremely well-versed in all of the research. And that, as a clinician, we talk without the hyperbolic language and with all of the nuance required for that individual topic.
And then the other thing that we talked about was that it's okay to tell your patient that you don't know something if you don't know it. And it's much better to say that than to kind of make something up.
Lisa Jones:
Yes. And then remembering our own biases, which was such great advice.
Amylee Amos:
Yeah, absolutely. I think that is kind of an overlooked area.
Lisa Jones:
Thank you. Thank you for that recap. So let's dive into practical insights.
Amylee Amos:
Okay.
Lisa Jones:
My first question is, what are some practical and actionable nutrition strategies that dietitians can recommend to individuals and families when they're dealing with Alzheimer's disease?
Amylee Amos:
I think for the average person, let's say someone is maybe worried about their cognition, that's not maybe the primary reason that they've come to see you but it's one of the things, let's say, that was mentioned. A Mediterranean diet pattern, which all RDs are familiar with, is going to be a great starting point. And so even if this is an individual who eventually might need to be referred out to somebody who specializes, but you want to get them started, starting them on a Mediterranean diet, so including more plant foods in their diet which is a great way to start, is something that you can recommend.
Depending on who's sitting in front of me, I like to start with the things that an individual should include in their diet rather than getting into all the things that maybe you should be taking out of the diet. I find that that's a much more accessible starting point. It's not as nearly as much of a turnoff for somebody who depending on their stage of change, might not be fully ready to dive in with all of the nutritional interventions that are available. So, what can the individual add to their diet? And what they can be adding in, absolutely, are vegetables, fruits, all of those good healthy plant foods, nuts, seeds, things like that. We also want to make sure that they're getting good, healthy sources of fat in their diet. So, extra virgin olive oil, olives, like I said the nuts, seeds, avocados, those types of foods as well. So all the different foods that we can add in.
Depending on the practitioner and your experience and possibly other kinds of certifications. You might also want to talk about physical activity and if the individual can add into their lifestyle, again, any form of physical activity. That's going to do more than any drug that's out there for Alzheimer's disease, any pharmaceutical available, just the benefits we can get from physical activity. So, I would start with all those things that we can add to the person's life before we start getting into the things that might need to be removed.
Lisa Jones:
So you mentioned physical activity, but is there a specific recommendation that you give or is it specific and individualized based on the patient or client that you're with?
Amylee Amos:
Yeah, it absolutely has to be individualized, because as you can imagine with Alzheimer's I'm dealing with people who have very different levels of physical abilities. So I would say anything is better than nothing. So for the person who hates it, hates exercise, I would just say joyful movement, any sort of joyful movement that they can include would be wonderful regardless of what it is, just something that they're willing to do.
For somebody who's more able and willing to do different types of activities, I would encourage some sort of aerobic activity, depending on their physical abilities, but something where they're getting their heart rate up is essential. And some resistance training, which again can be anything from body weight-bearing to actual using weights. That can mean so many things is my point. In terms of the research, there's some great research on HIIT training, high-intensity interval training, with regard to cognition. There's also some interesting, I think they're correlational studies about leg strength and cognitive function. So encouraging someone to get their lower body really strong, there's some really cool research out there. So depending on the individual, you can get really specific with it. But I would say more than anything, my goal is just to get the individual moving.
Lisa Jones:
Yeah, it definitely sounds like from listening to what you were just saying because that was my next question and you kind of answered it, was the research indicating any specific type, it sounds like it ranges. It could be HIIT, it could be leg strength. So, as long as somebody's doing something that they find joy in and they're moving, that's better than not moving at all.
Amylee Amos:
Right. And that they're going to stick with it. I mean, that's also huge. So if you like it, you're probably going to keep doing it. If you're hating whatever it is, you might do it for a couple of weeks, a month, and then probably you're going to fall off of it eventually.
The other thing, there's also some great research that shows any kind of physical activity that includes the mind and body. So if we think of things like ballroom dancing, which is like it's highly physical but it takes a lot of brainpower both to follow your partner and pick up on those sorts of cues. Also, if there's a certain dance routine that you're trying to follow, you have to be remembering it. There's a component of that with certain types of martial arts as well. So there's been some really cool studies on mind-body movement and how that's also helpful with regard to cognitive function.
Lisa Jones:
And that also adds an additional layer for people who are looking for other options. Because when you say like, oh, ballroom dancing, sometimes some forms of dancing you don't even consider it exercise, people love to do it.
Amylee Amos:
Right. But it absolutely is. I mean, you're working up a sweat. It's hard to do. It's wonderful. And then there are other benefits to that as well. You're listening to music, which is good for the brain. You're hopefully having a good time, which is good just everything, for your stress level. So yes, I think that's sort of also what I mean with joyful movement, whatever that might be to you, is great.
Lisa Jones:
Yes. And even walking down the street is better than not doing anything and sitting on the couch.
Amylee Amos:
Absolutely. Yep. Absolutely.
Lisa Jones:
Thank you for that. I guess my second part to the original question was talking more about cognitive function, enhancing the overall quality of life, which exercise does, eating right does, and then making sure that we're providing meaningful support in their daily lives. So if you have clients how else can you provide meaningful support besides all these recommendations?
Amylee Amos:
Right. And depending on an individual's cognitive function, that's going to mean different things. So certainly in my practice when I work with people who have Alzheimer's disease, it's absolutely critical that the family is involved. Certainly, the people who live with the individual, but also sometimes those who don't, like adult children. That's going to be essential with regard to compliance, as you can imagine. So it's important to help your patient to make that call together. Who needs to attend these sessions in order to make the interventions realistic and something that can be translated into real life? Or if someone can't attend the intervention, who needs to be copied on the follow-up email where you summarize the different goals for that session? That's going to be a really important piece as well.
And then for somebody who maybe has just kind of subjective cognitive impairment, you still might want to do that. Even though they're able to take all of the interventions cognitively, they're able to process them and implement them on their own. I mean, if let's say the individual, you're giving them a new kind of nutrition plan if they're able to do that with their spouse, as opposed to now, okay, we have to create two separate meals for us before we sit down to eat. It's going to be a lot easier if the spouse or partner or anyone that they live with is on board with that. So, it's really important to get, I say family involvement but really anyone in their inner circle to get those people involved as well, to be actively supporting the individual. That's just going to make it far more likely that they're going to be successful.
Lisa Jones:
And long-term too. I like that inner circle terminology that you're using, getting them involved.
Amylee Amos:
Yeah.
Lisa Jones:
Well, great. Is there anything else that you can think of that you want to share, practical insights maybe, an example of one of your previous patients without saying their name, that kind of thing, like something like a best practice?
Amylee Amos:
Well, I would say one of my favorite stories to tell, the point of this story is that sometimes you have to really stick with this. So for someone who if you're specializing in this and you're really working to help improve cognition in somebody who has Alzheimer's disease, often that's going to be part of a multidisciplinary team. And the example here, this gentleman that I had been working with for months, I think we were at month nine of really working the diet, working all of those modifiable lifestyle factors. He was working with neurologists and physical therapists, all kinds of other practitioners as well, working so hard on this and seeing zero improvement for the longest time, seeing the symptoms. The decline had slowed and the decline had stopped, but no improvements, which was just devastating for this individual's wife.
And one day I got a phone call from his wife, and she was just sobbing on the phone. And when she finally is able to get words out, she says he shaved. For the first time in years, her husband who had lost the ability to shave, she walked past the bathroom and there he was in the mirror shaving his face. Which sounds like such a small thing. He still had Alzheimer's. He didn't recover from Alzheimer's. But all of that work had led to a very small increase in one of his activities of daily living, which was powerful for the spouse, powerful for me, and the rest of this individual's care team. It shows that sometimes you have to stick with this for a long time and keep tweaking as needed until you can start to see some improvements.
Lisa Jones:
Oh, thank you for sharing. That's a fantastic story. It's so powerful. He shaved.
Amylee Amos:
Yeah. I mean, it's like one of those things that you don't think about, but those are big things. Someone's activities of daily living are huge. And if you can help someone, even in a small way like that, that's really big with regard to their quality of life.
Lisa Jones:
Yeah. I'm sure his inner circle, they were elated to hear news about that.
Amylee Amos:
They were. Oh my gosh, it was huge for them, which is really wonderful. So the small improvements are actually still really profound in this population.
Lisa Jones:
That's a powerful message. And I thank you, Dr. Amylee Amos, for being on our podcast here and sharing all your wisdom with us.
Amylee Amos:
Oh my gosh.
Lisa Jones:
Thank you so much.
Amylee Amos:
Thank you for having me. This was so fun.
Lisa Jones:
Thank you.
Speaker 1:
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