How we can boost our ageing brains with what we eat

A Waterford professor tells Arlene Harris about his ground-breaking work around dementia and other health issues, which involved using his mother as a 'guinea pig'

Professor John Nolan at the premiere of his film, A Vision For Vision, which details his research

Ageing is a fact of life and, as we get older, the body starts to slow down and the workings of certain parts can become less efficient.

Cognitive health and vision are two areas which are affected as we get older, with age-related macular degeneration and dementia causing problems for many elderly people across the country.

With this in mind, Waterford-based scientist, Professor John Nolan has spent two decades researching the role nutrition might play in supporting both eye and brain health, and he has recently released a new documentary, A Vision For Vision, which explores emerging research around dietary carotenoids, omega-3 fatty acids, visual function, and cognitive health, to ascertain whether or not the choices we make earlier in life help shape how well we age.

Acting as a “guinea pig” for his research, his mother, Helen (now 76) agreed to be one of the first participants of his research programme, and he says that he has been able to see first-hand how nutritional changes were hugely beneficial to her.

“I started my PhD in 2001 and soon afterwards, we secured a fundus camera, which lets us photograph the back of the eye,” he says. 

“Mum kindly agreed to be one of our first participants and when we imaged her eye, we saw changes considered consistent with early age-related macular degeneration, or AMD. Those changes can indicate a higher risk of developing more advanced disease, which can affect central vision.

Professor John Nolan with his parents John Snr, and Helen, who he says was 'patient zero' in his research. Picture: Marc O'Sullivan

“Her vision hadn’t changed according to the standard measurements we were using, but she did describe some difficulties, mentioning problems with low contrast and slight issues with her central vision, which can be consistent with early AMD,” added professor Nolan.

At this time, the father-of-two, who is originally from Tipperary, but lives in Waterford with his wife, Jane and their two daughters, says that although he didn’t know what problems these issues might cause for his mother in the future, he felt that nutritional changes would be beneficial to her.

“I was only beginning my PhD, and I didn’t yet understand the full extent of what AMD could do,” he says. 

We could see the changes in the back of her eye, but my family and I weren’t fully aware of what that might mean for her in the long term and I don’t think we fully understood the significance.

“People can sometimes describe changes in the back of the eye as a normal part of ageing. I would say that ageing is inevitable, but how we age is not. It’s worth asking what we can do to reduce the risk of disease developing or progressing.”

Professor Nolan explained: “So I supported mum in making lifestyle changes, including around nutrition and stopping smoking. Around the same time, we had just got access to a formulation containing the three macular carotenoids: Lutein, zeaxanthin, and meso-zeaxanthin. 

"We were learning how to measure these pigments and how to increase them, so mum became one of the first people to take the supplement. That is why I sometimes refer to her as ‘patient zero’, and thankfully, we didn’t see her vision decline or the disease progress.”

Professor Nolan, who is the director of the Nutrition Research Centre Ireland at South East Technological University, says that although his mother also lives with post-polio syndrome, the issues with her vision did improve and she is now “energetic, alert and very involved” in life. 

Through his role, he has also worked with people with Alzheimer’s, which he says, is “the most challenging disease of all”.

“It affects much more than the person with the diagnosis,” he says. 

For every person with Alzheimer’s, four or five people around them may be significantly affected.

“In the most advanced stages, a person can lose basic abilities, including the ability to function independently, care for themselves, or remember the people they love.

“Families can find the changes in the person they know especially difficult — and it can put enormous pressure on relationships, even when everyone is doing their best to support them.”

Professor Nolan’s work has developed into other areas over time.

“Some of our discoveries in the eye led us to ask whether the same nutrients might also be important in the brain — as the carotenoids we study in the macula are also present in the brain.

In work involving centenarians, we see that the amount of macular pigment in the eye was linked to the amount in the brain, and that suggested that measuring the pigment in the eye could give us a biological marker of brain nutrition, a way to study these brain nutrients in a living person.

Working with professor Riona Mulcahy at University Hospital Waterford, Professor Nolan and his team were the first research group to measure macular pigment in patients with Alzheimer’s disease. And in their initial study, they found that these patients had significantly lower macular pigment and poorer vision than people of a similar age without Alzheimer’s.

“That led us to ask whether supplementation could increase the pigment,” he says. “We found that a carotenoid formulation sourced from Mexico could raise macular pigment levels, although its effect on brain function was not significant.

“The Howard Foundation UK and Dr Alan Howard supported much of this early work.

Professor John Nolan (left) at the Irish premiere of A Vision for Vision at the Light House Cinema, Dublin, with Moya Doherty, broadcaster Clare McKenna, and two-time Emmy Award-winning director and producer Wayne Chesler. Picture: Marc O'Sullivan

“We then added omega-3 fatty acids to the formulation, which improved the availability of the nutrients to the body, and subsequently secured a patent for the use of carotenoids and omega-3 fatty acids in neurodegenerative diseases, including Alzheimer’s.”

Professor Nolan and his team carried out a series of general studies, as well as more specific tests of memory and attention.

“The findings were promising,” he says, “but the major study was ReMIND, which involved people with mild to moderate Alzheimer’s disease. Compared with the placebo group, participants receiving the active formulation increased their carotenoid levels in the blood and target tissue. 

Their primary carers also reported improvements in quality-of-life measures related to memory and mood — and we saw encouraging trends in established measures of Alzheimer’s disease as well.

“The paper concluded that these nutrients could be considered as part of the co-management of Alzheimer’s disease.

“We are not suggesting that they cure the disease or replace medical care — but the potential is as an additional nutritional approach, alongside a person’s existing care and treatment.”

The conclusion Professor Nolan and his team have come to is that “nutrition is one of the most important factors we can modify to support health as we age, including brain and eye health”.

He explains: “Research is helping us to identify which bioactive nutrients may matter and how they work together. We believe carotenoids, in combination with omega-3 fatty acids, are important candidates, and we want to continue testing that carefully. With appropriate funding, our next step is to conduct multi-centre trials to further assess these findings.”

Professor Nolan’s enthusiasm for his work is evident.

“I love my work more today than I did when I started,” he says, “as every research project tends to answer one question and raise several more. 

We now have technologies which let us measure nutrition and its effects with remarkable sensitivity and we can study what is in the blood and how nutrients reach the tissues where they may have an effect.

“But one of the biggest challenges in science is putting research findings into clinical practice. That can take 10 or 15 years from discovery to application and I feel strongly that we need to get better at moving reliable findings into practice, so people can benefit from them sooner.

“Our documentary brings together more than 25 years of this work. It follows how discoveries in the eye led us to investigate the brain, and how those findings developed through research and discussions with experts in the field.”