It’s tempting to assume that neurodegenerative disease like Alzheimer’s have unavoidable root cause like genetics, traumatic brain injury, or unforeseen environmental toxin exposure.
Dr. Dale Bredesen was one of the first to bring diet, lifestyle, and other more modifiable risk factors into the Alzheimer’s prevention spotlight. In 2014 he published a small study suggesting for the first time that a personalized, multi-faceted approach addressing lifestyle and metabolic factors, including diet, exercise, sleep, and supplementation, could produce measurable improvements in people experiencing cognitive decline. This work set the stage for further research which has continued to show promise for lifestyle medicine in preventing and reversing cognitive decline, especially in the early stages. Larger-scale randomized controlled trials are still ongoing to validate the effectiveness of these methods in diverse populations.
In defining possible root causes of Alzheimer’s, Dr. Bredesen suggests that there are groups of factors that contribute to disease progression. One group of modifiable factors is designated “Atrophic” because it’s related to nerve cells not getting enough nutritive factors to thrive. Examples of such nutritive factors are vitamin D, hormones, and neuronal growth factors.
Thankfully replenishing these factors isn’t restricted to taking supplements, as nutrition and lifestyle strategies can also play a key role in improving access to them. The earlier we recognize signs of atrophy and begin restorative measures, the more potential there is for complete cognitive recovery.
I’m writing about this atrophic issue because it is often one of the most straightforward root causes to fix.
Atrophic causes of cognitive decline are complex, and personalized treatment is essential. However, I’d like to share a few common signs of declining trophic support and some simple strategies to help replenish it.
Common signs we might see in the atrophic state:
LOW VITAMIN D LEVELS
LOW THYROID HORMONE LEVELS
HIGH HOMOCYSTEINE LEVELS
BEING UNDERWEIGHT
Why?
LOW VITAMIN D: Without enough vitamin D, brain cells may struggle to grow and develop properly, which can weaken their ability to communicate. Low vitamin D can also result in lower neurotrophin activity: these are proteins that support neuron survival, growth, and repair. This shortfall leaves the brain more vulnerable to stress and may slow its ability to repair and adapt over time.
LOW THYROID HORMONE: Thyroid hormone is also critical for nerve cell growth, repair, protection, and connectivity. Importantly, low thyroid hormone availability also reduces energy availability for nerve cells, slowing cognitive functions like alertness, focus, and memory.
HIGH HOMOCYSTEINE: Homocysteine is an inflammatory compound that builds up in the blood when we don’t have enough of certain nutrients, like the active forms of folate (B9), and vitamin B12. This buildup can lead to inflammation in blood vessels, which may block essential nerve growth factors from reaching the brain cells that need them.
BEING UNDERWEIGHT: Being underweight is generally a sign of insufficient nutrition, which can lead to an atrophic, or wasting, state. We need adequate fat and protein to make hormones and neurotrophic factors that support brain health. Additionally, muscle mass acts as a reserve of amino acids that the brain relies on to produce neurotransmitters and maintain immune function, which helps keep inflammation under control.
What are some nutritional approaches to reversing these deficits?
VITAMIN D: Modern life often leads to low vitamin D levels. While foods like fatty fish, eggs, and light-exposed mushrooms can boost vitamin D intake, the most effective sources are sunlight and supplements. Sunscreen, however, blocks most of the skin's ability to produce vitamin D, making supplements a more reliable option for many people. It’s best to work with a knowledgeable practitioner to determine the right dose and to monitor levels so that you can reach an optimal level and maintain it long-term.
THYROID HORMONE: Even mild (or "subclinical") hypothyroid function can reduce the brain's trophic support. Often, nutrient deficiencies impair thyroid function or the conversion of inactive to active thyroid hormone. In many cases, focusing on nutrient-rich foods and/or supplements to correct these deficiencies can help. Key nutrients that support thyroid function and hormone production include vitamins A, D, E, B2, B3, B6, and C, along with zinc, selenium, iron, and sometimes iodine in moderation. Again, repletion needs to be based on an individual’s specific needs.
HOMOCYSTEINE: To address high homocysteine, treatment often starts with ensuring enough B vitamins, like folate and B12, which help break down homocysteine. For some, increasing dietary sources may be enough. Others may have genetic differences that prevent these vitamins from being converted to their active forms, therefore requiring specific supplements like methylated folate and B12. Beyond addressing nutrient levels, two natural compounds have shown promise in directly enhancing brain growth factor availability: whole coffee fruit and Lion’s Mane mushrooms. Whole coffee fruit extract can help increase levels of nerve growth factor (NGF), which supports neuron growth and survival. And, Lion's Mane mushroom has been shown to increase brain-derived neurotrophic factor (BDNF), which aids in brain cell repair and promotes new connections between neurons.
Whole Coffee Fruit
BEING UNDERWEIGHT: Along with increasing overall caloric intake, prioritizing healthy fats and quality protein is essential in a balanced nutrition strategy. Higher protein intake helps maintain muscle mass, supplying amino acids that are vital for brain health and immune support. Healthy fats from sources like avocado, nuts, fatty fish, and olive oil help replenish energy stores, balance hormones, and support brain function. Working on gut health is crucial, as a healthy gut enhances nutrient digestion and absorption. So incorporating fiber-rich and prebiotic foods can further improve nutrient uptake and help the body restore balance.
You can see from these examples how an integrative approach that includes diet and supplementation can be valuable for supporting cognitive health when low trophic support is a root cause.
While we’ve covered some key nutrition and supplementation strategies, lifestyle habits are also important for addressing an atrophic brain state. To learn more about lifestyle medicine approaches, download my new Trophic Brain Support Guide here.*
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If you are experiencing chronic or worsening brain fog, consider joining Dr. Dale Bredesen’s community at Apollo Health and seeking help from a functional medicine practitioner trained in lifestyle-based cognitive support.
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