We know that nutrition plays a significant role in brain health — it’s been directly tied to Alzheimer’s disease, helping us understand how what we eat affects the aging brain’s ability to think and remember. Since changes in the brain can occur years before the first symptoms of Alzheimer’s appear, preventing or delaying cognitive decline begins with forming healthy habits early.
As part of a series for Alzheimer’s and Brain Awareness Month, five dementia and brain health experts weigh in on nutrition and its impact on brain health and Alzheimer’s disease. They go far beyond the basics of a healthy diet, offering caregivers insight into meal routines, lessons on chewing and swallowing safety, tips for encouraging consistent lifestyle changes, and ways to nurture independence as part of these lifestyle changes.
Read what the experts had to say:
“Although this is a relatively new area of research, new information is constantly coming out,” says Jennifer Hanes, MS, RDN, LD, owner at Go You! Nutrition Counseling. Studies show that the onset and development of Alzheimer’s disease are strongly correlated with lifestyle factors, including diet.
The results of one 2023 study on the effect of nutrition in Alzheimer’s disease show that the Western diet pattern — full of things like repackaged foods, refined grains, fried foods, high-fat dairy products, and high-sugar drinks — is a risk factor for developing Alzheimer’s disease.
Results also show that following a healthy dietary pattern, a high intake of plant-based foods, probiotics, nuts, and omega-3 polyunsaturated fatty acids, and a low intake of saturated fats, animal-based proteins, and refined sugars can decrease the risk of neurocognitive impairment.
Hanes points specifically to the Mediterranean diet and the related MIND diet because they “have the most evidence behind improving cognitive decline and dementia.” Both contain certain nutrients, such as omega-3 fatty acids, antioxidants, and B vitamins, essential for brain health and cognitive function.
The MIND Diet
According to the National Institute on Aging, the MIND diet focuses on plant-based foods linked to dementia prevention. It encourages eating from 10 healthy food groups:
- Leafy green vegetables, at least 6 servings/week
- Other vegetables, at least 1 serving/day
- Berries, at least 2 servings/week
- Whole grains, at least 3 servings/day
- Fish, 1 serving/week
- Poultry, 2 servings/week
- Beans, 3 servings/week
- Nuts, 5 servings/week
- Wine, 1 glass/day*
- Olive oil
The MIND diet limits servings of red meat, sweets, cheese, butter/margarine, and fast/fried food.
*Be careful about how much alcohol you drink. How the body handles alcohol can change with age. Learn more about alcohol and older adults.
Hanes further discusses caregivers’ challenges when encouraging a loved one to follow a meal plan. She shares the “hierarchy of nutrition needs” that she often discusses with her clients:
“The most important part of nutrition is that the individual eats. After they are eating regularly, then we can start to alter what is [being] eaten. There is no benefit to only providing a certain meal plan if the person refuses to eat it, even if it is the most ‘perfect’ meal plan that has ever been produced.”
Hanes encourages caregivers to take a “no arguing” approach when it comes to reminding a loved one to eat and hydrate throughout the day:
“Don’t try to fight, guilt, or force them to eat. Fighting can only lead to increased stress on both the caregiver and the patient’s part, which does not help with cognition. I like to say something like, ‘I’m kinda hungry; I’m going to get a snack. Can I get you anything while I’m up?’
Offer foods they like that [are] compatible with their abilities and that [aren’t] a strain on the family resources, such as time and money. I also like to have pre-portioned foods available, such as snack packs of their favorite fruits and vegetables, cheese and crackers, shredded chicken, etc. This allows them to choose when and how to feed themselves but still gives them some independence over food choices and timing. Meals don’t always have to be a big process, and this can also relieve some time for the caregiver throughout the day.”
If appetite is low, some medications may help. However, the best way to improve food intake is some physical activity:
“Luckily, exercise has so many positive effects on the brain. Anything they are willing to do that is active is fine, but you may get a bigger boost if you take them outside, somewhere pretty, such as a park, for some ‘green’ exercise. If this isn’t possible, consider some Youtube videos of chair exercises, gentle yoga, or even just throwing on music and having a dance party. Joining in on the fun will also help the caregiver’s stress levels and give some social aspect to the activity.”
Anna Annecca, OTD, clinical operations leader at Assured Allies and her multidisciplinary team of certified healthy aging experts. Anna and her team discuss the impact poor nutrition has on people with Alzheimer’s disease:
“Poor nutrition increases behavioral symptoms and may cause significant weight loss for people with Alzheimer’s disease. Additionally, poor nutrition can cause inflammation in brain cells and impair the function of the brain and your other body systems. Brain inflammation can impair mood, digestion, and immune system function. Depending on the stage of Alzheimer’s disease, an individual may be forgetful about consuming food, so focusing on caloric intake is a priority for brain function.”
Annecca says a balanced diet consists of half your daily food intake in fruits and vegetables and incorporating lean proteins, whole grains, and low-fat dairy products. She points out these benefits:
- Whole fruits and vegetables contain fiber and essential vitamins and minerals.
- Whole grains contain fiber and help with proper digestion. Whole grains also contain essential vitamins and minerals.
- Lean proteins contain unsaturated fats, protein, vitamin D, and fiber. Examples include nuts, fish such as salmon, beans, peas, lentils, eggs, and soy products.
- Low-fat dairy contains essential nutrients such as vitamin D, B12, A, calcium, and protein. It promotes bone health and limits the formation of osteoporosis in adults.
She offers several helpful tips caregivers can use to help someone with Alzheimer’s eat and stay hydrated:
- Have water/drinks readily available (i.e., straw cups/tumblers around the home).
- Make food and drinks as visually appealing as possible.
- If your loved one does not enjoy plain water, adding a squeeze of fresh lemon or lime could make it more appealing, plus it has vitamin C.
- Set meals/snacks/drinks reminders on a smartphone or smart home device. Alexa can set reminders that can be labeled.
- If possible, make meals/snacks social; eating with friends and family can make meals more enjoyable and encourage eating/drinking.
- The Red Plate method: Studies have shown that Alzheimer patients increase food intake by 24% and liquid by 84% when using dinnerware with vivid colors, such as red dishes.
Annecca also points out that different people have different preferences regarding their meal experiences. She suggests learning what makes your loved one most comfortable and relaxed for meals and snacks by considering these questions:
- Does music add a nice ambiance, or does it feel chaotic?
- Do they want to converse or keep things quiet?
- Do they prefer to eat alone or with others?
- Do they enjoy sitting outdoors for meals?
She offers ways caregivers can encourage independence during meal times:
“Offer a limited number of choices for the meal when possible (e.g., pasta, chicken, or meatloaf). Involve your loved one in meal prep at the level that they are able; this could mean chopping vegetables, mixing ingredients, setting the table, wiping down the counter, or loading the dishwasher.”
As a doctor of occupational therapy, Annecca provides information about swallowing difficulties and how to mitigate the hazards:
“Swallowing difficulties, medically known as Dysphagia, is a common side effect of cognitive decline such as Alzheimer’s disease. These difficulties can increase the risk of choking or aspiration, which also increases someone’s risk of pneumonia. Therefore, these difficulties can impact a loved one’s ability to successfully get all their nutritional/caloric requirements in a day and put them at risk for hospitalization.
Luckily, there are Dysphagia experts (typically Speech and Language Pathologists, Occupational Therapists, or MDs) that can help connect you with strategies or modifications to help keep your loved one safe. Early detection and assessment of Dysphagia are key to success.”
She lists symptoms to look out for that would tell you it’s time to schedule an appointment for further evaluation:
- Frequent coughing after or during meals
- “Wet” sounding voice after eating or drinking
- A sensation of food being stuck in the throat
- Increased, persistent drool
- Decrease in appetite or desire to eat
- Increased incidents of pneumonia
Sheri Berger, registered dietitian and certified diabetes care & education specialist based in San Jose, CA, owner of Sheri The Plant Strong Dietitian, LLC. She offers these tips for incorporating whole foods for a healthy, balanced diet:
“Choosing a variety of fruits, vegetables, whole grains, legumes, nuts, and seeds is best for a healthy and balanced diet. Animal protein sources such as chicken, beef, and pork can be included, but more so as the garnish and not the main attraction. Anytime you swap out animal protein for plant protein such as lentils, garbanzo beans, edamame, kidney beans, or tofu, you are reducing saturated and increasing fiber, which helps to reduce inflammation in the body.”
Berger offers more tips to help encourage hydration:
“I like to encourage my patients and their caregivers to always have water readily available. For example, if spending the day at home, fill up a large pitcher of water and have it in eyesight, make it a goal to finish it by the end of the day. And when leaving home, always bring a water bottle along.”
Dr. Dung Trinh, chief medical officer at the Healthy Brain Clinic, says encouraging and reminding individuals with Alzheimer’s disease to eat and drink regularly can be challenging for caregivers. He offers a few strategies to help:
- Set regular meal and snack times to create structure and make it easier for individuals to remember when to eat.
- Prepare simple, visually appealing meals and offer familiar foods that the person enjoys.
- Set alarms or use visual cues, such as notes or pictures, to remind them to eat and drink.
- Assist without being too forceful. Gentle reminders and guidance can be helpful in encouraging individuals to eat and drink.
Creating a calm and comfortable environment during meal and snack times can help individuals with Alzheimer’s disease feel at ease and more willing to eat, he adds. Here are some tips for caregivers:
- Choose a quiet and well-lit area for meals to minimize distractions that could divert their attention from eating.
- Offer one food at a time to avoid confusion and make it easier for them to focus on eating.
- Avoid rushing the mealtime process and offer ample time for eating; individuals with Alzheimer’s may require more time to chew and swallow.
Trinh says that encouraging independence during meal times is important for promoting a sense of autonomy and dignity, offering these suggestions for caregivers:
- Involve them in meal prep: Allow the person to participate in simple meal preparation tasks, such as stirring, setting the table, or washing vegetables. This can help maintain their sense of purpose and involvement.
- Hand-over-hand feeding: If the person is having difficulty eating independently, gently guide their hand to bring the utensil to their mouth or provide support as needed. This can help them maintain their motor skills and independence to the best of their ability.
With dysphagia being a safety concern for individuals with Alzheimer’s disease, the chief medical officer offers some safety tips to mitigate these hazards:
- Serve soft foods: Offer foods that are easy to chew and swallow, such as mashed potatoes, cooked vegetables, or pureed soups.
- Pay attention to signs of choking: Be aware of signs like coughing, gagging, or difficulty swallowing. If you notice any signs of choking, seek medical assistance immediately.
- Monitor appetite changes: Keep track of any changes in appetite or difficulties in eating. Consult a healthcare professional for further evaluation and guidance if there are concerns.
Stuart Bensusan, director at Surewise, a leading supplier of care workers’ insurance in the UK, offers this advice for creating calm and comfortable meal times:
“I would suggest simplifying choices and offering only a few food options at each meal to make decisions manageable. Ensure the environment is peaceful, reducing any background noise or visual distractions. Lastly, introducing one dish at a time can lessen any feelings of being overwhelmed and promote a more focused, enjoyable dining experience.”
He adds that many caregivers working with Alzheimer’s patients believe in the power of maintaining personal autonomy where possible, giving this advice for fostering independence during meal times:
“Encouraging your clients to participate in easy meal prep tasks can spark interest and a sense of achievement. A hand-over-hand feeding approach can also be effective; gently guide their hand to their mouth, supporting their continued involvement in the eating process. These strategies can foster feelings of independence and dignity, integral in caregiving for Alzheimer’s patients.”