We argue that the provision of substantial dietary modifications to individuals who wish to maximize their brain health is ethically permitted, despite evidence for such an intervention being not yet fully conclusive. However, we argue that for a burdensome therapy with weak evidence and potential harms, balanced communication, informed consent and follow-up are necessary components of the ethical provision of such lifestyle changes. Moreover, health should be discussed as a value with individuals alongside non-health priorities to achieve balance and avoid brain healthism.
United States. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research: Appendix. Department of Health, Education, and Welfare, National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, https://play.google.com/store/books/details?id=-d6JqXCFQuIC (1978).
2.
MastroleoIHolzerF. New non-validated practice: an enhanced definition of innovative practice for medicine. Law Innov Technol2020; 12: 318–346.
3.
DalyTMastroleoIGorskiD, et al.The ethics of innovation for Alzheimer’s disease: the risk of overstating evidence for metabolic enhancement protocols. Theor Med Bioeth2020; 41: 223–237.
4.
BarbareskoJKochMSchulzeMB, et al.Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review. Nutr Rev2013; 71: 511–527.
5.
RameyMMShieldsGSYonelinasAP. Markers of a plant-based diet relate to memory and executive function in older adults. Nutr Neurosci2022; 25: 276–285.
6.
DavinelliSMaesMCorbiG, et al.Dietary phytochemicals and neuro-inflammaging: from mechanistic insights to translational challenges. Immun Ageing2016; 13: 16.
7.
LiJAbdel-AalE-SM. Dietary lutein and cognitive function in adults: a meta-analysis of randomized controlled trials. Molecules2021; 26: 5794.
8.
LindberghCAMewbornCMHammondBR, et al.Relationship of lutein and zeaxanthin levels to neurocognitive functioning: an fMRI study of older adults. J Int Neuropsychol Soc2017; 23: 11–22.
9.
KrikorianRShidlerMDNashTA, et al.Blueberry supplementation improves memory in older adults. J Agric Food Chem2010; 58: 3996–4000.
10.
RutledgeGAFisherDRMillerMG, et al.The effects of blueberry and strawberry serum metabolites on age-related oxidative and inflammatory signaling in vitro. Food Funct2019; 10: 7707–7713.
11.
NilssonASaloIPlazaM, et al.Effects of a mixed berry beverage on cognitive functions and cardiometabolic risk markers; A randomized cross-over study in healthy older adults. PLoS One2017; 12: e0188173.
12.
BoespflugELEliassenJCDudleyJA, et al.Enhanced neural activation with blueberry supplementation in mild cognitive impairment. Nutr Neurosci2018; 21: 297–305.
13.
RutledgeGASandhuAKMillerMG, et al.Blueberry phenolics are associated with cognitive enhancement in supplemented healthy older adults. Food Funct2021; 12: 107–118.
14.
CheathamCLCanipe 3rdLGMillsapG, et al.Six-month intervention with wild blueberries improved speed of processing in mild cognitive decline: a double-blind, placebo-controlled, randomized clinical trial. Nutr Neurosci2023; 26: 1019–1033.
15.
MillerMGHamiltonDAJosephJA, et al.Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr2018; 57: 1169–1180.
16.
LamportDJLawtonCLMeratN, et al.Concord grape juice, cognitive function, and driving performance: a 12-wk, placebo-controlled, randomized crossover trial in mothers of preteen children. Am J Clin Nutr2016; 103: 775–783.
17.
WangJSongYGaoM, et al.Neuroprotective effect of several phytochemicals and its potential application in the prevention of neurodegenerative diseases. Geriatrics2016; 1: 29.
18.
KaplanAZelichaHYaskolka MeirA, et al.The effect of a high-polyphenol Mediterranean diet (Green-MED) combined with physical activity on age-related brain atrophy: the dietary intervention randomized controlled trial polyphenols unprocessed study (DIRECT PLUS). Am J Clin Nutr2022; 115: 1270–1281.
19.
GovindpaniKMcNamaraLGSmithNR, et al.Vascular dysfunction in Alzheimer’s disease: a prelude to the pathological process or a consequence of it?J Clin Med Res2019; 8: 651.
20.
TianZJiXLiuJ. Neuroinflammation in vascular cognitive impairment and dementia: current evidence, advances, and prospects. Int J Mol Sci2022; 23: 6224.
21.
NelsonPTBrayneCFlanaganME, et al.Frequency of LATE neuropathologic change across the spectrum of Alzheimer’s disease neuropathology: combined data from 13 community-based or population-based autopsy cohorts. Acta Neuropathol2022; 144: 27–44.
22.
ZhouYWangJCaoL, et al.Fruit and vegetable consumption and cognitive disorders in older adults: a meta-analysis of observational studies. Front Nutr2022; 9: 871061.
23.
AnastasiouCAYannakouliaMKosmidisMH, et al.Mediterranean Diet and cognitive health: initial results from the hellenic longitudinal investigation of ageing and diet. PLoS One2017; 12: e0182048.
24.
CharisisSNtanasiEYannakouliaM, et al.Mediterranean Diet and risk for dementia and cognitive decline in a Mediterranean population. J Am Geriatr Soc2021; 69: 1548–1559.
25.
MaoXChenCXunP, et al.Intake of vegetables and fruits through young adulthood is associated with better cognitive function in midlife in the US general population. J Nutr2019; 149: 1424–1433.
26.
WangRSWangB-LHuangY-N, et al.The combined effect of physical activity and fruit and vegetable intake on decreasing cognitive decline in older Taiwanese adults. Sci Rep2022; 12: 9825.
27.
MorrisMCWangYBarnesLL, et al.Nutrients and bioactives in green leafy vegetables and cognitive decline: prospective study. Neurology2018; 90: e214–e222.
28.
HenneyAEGillespieCSAlamU, et al.High intake of ultra-processed food is associated with dementia in adults: a systematic review and meta-analysis of observational studies. J Neurol2024; 271: 198–210.
29.
ScarmeasNAnastasiouCAYannakouliaM. Nutrition and prevention of cognitive impairment. Lancet Neurol2018; 17: 1006–1015.
30.
AllmarkP. Health promotion in public health: philosophical analysis. In: SchrammeTEdwardsS (eds) Handbook of the philosophy of medicine. Dordrecht: Springer Netherlands, 2015, pp.1089–1108.
31.
DalyT. DOSE: a lifestyle philosophy for dementia prevention informed by drug development and epidemiology. Dement Neuropsychol2024; 18: e20230112.
32.
DalyTMastroleoIHenryV, et al.An argument for simple tests of treatment of Alzheimer’s disease. J Alzheimers Dis2022; 86: 49–52.
33.
OrnishDMadisonCKivipeltoM, et al.Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alzheimers Res Ther2024; 16: 122.
34.
HellmuthJRabinoviciGDMillerBL. The rise of pseudomedicine for dementia and brain health. JAMA2019; 321: 543–544.
35.
LivingstonGHuntleyJLiuKY, et al.Dementia prevention, intervention, and care: 2024 report of the lancet standing commission. Lancet2024; 404: 572–628.
36.
SietteJDoddsLDeckersK, et al.A pilot study of BRAIN BOOTCAMP, a low-intensity intervention on diet, exercise, cognitive activity, and social interaction to improve older adults’ dementia risk scores. J Prev Alzheimers Dis2024; 11: 1500–1512.
37.
ThunborgCWangRRosenbergA, et al.Integrating a multimodal lifestyle intervention with medical food in prodromal Alzheimer’s disease: the MIND-ADmini randomized controlled trial. Alzheimers Res Ther2024; 16: 118.
