What are the best bets in the supplement field for delaying the onset of dementia, a.k.a. vascular disease or Alzheimers?

Supplements which boost vascular production of the protective hormone nitric oxide, which quell oxidative stress, and which suppress the activity of brain inflammatory cells should be useful for slowing age-related cognitive decline and preventing Alzheimers or stroke-induced dementia.  These can include: phytochemical polyphenols such as quercetin, cocoa flavanols, and (possibly) resveratrol; potassium nitrate (or natural sources thereof, such as green leafy vegetables and beet juice); antioxidants such as spirulina, lipoic acid, melatonin, astaxanthin; and agents which have anti-inflammatory effects on the brain, such as vitamin D, soy isoflavones, caffeine, and fish oil.  These measures should be complementary to lifestyle strategies which prevent/control metabolic syndrome and hypertension, and which exert protective hormetic stresses on the brain: calorie restriction or caloric hormesis, as achieved practically with carb-concentrated dieting; exercise training; and regular mental exercise. 

Prevention of age-related cognitive decline/dementia/AD can likely be achieved by integrating measures of this type:

Nitric Oxide Production (NO) – This supports blood flow to the brain while suppressing neural production of amyloid beta, and minimizing risk for stroke.  Dietary nitrate (and possibly nitrovasodilator drugs), quercetin (or cocoa flavanols), exercise training, should all boost brain availability of NO.

Antioxidant measures – These have the joint effects of supporting NO bioactivity (by avoiding superoxide quenching, and maintaining the activity of NO synthase), suppressing activation of brain microglia, and acting directly on neurons to prevent apoptosis.  Spirulina (owing to its high content of phycocyanobilin) may of paramount utility in this regard, but phase 2 inducers, melatonin, N-acetylcysteine and possibly astaxanthin may also be worthwhile.  Also, avoiding metabolic syndrome or hypertension will lessen the stimulus to oxidative stress in the vasculature, and possibly the brain.  Salt restricted diets may also be useful in this regard.

Anti-inflammatory measures – These prevent undue activation of brain inflammatory cells (microglia).  VitD, soy isoflavones, caffeine, spirulina, and likely fish oil (or high omega-3/omega-6 ratio) can be recommended for this purpose.

Hormetic measures – These boost neural expression of protective proteins and of neurotropic factors.  Calorie restriction or caloric hormesis (intermittent fasting, CC diets), exercise, and regular mental exercise are likely beneficial.

Obviously, many of these measures should be beneficial for vascular health and cancer prevention, and thus fit in well with a global health strategy.

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