Omega-3s and Dementia Risk

OmegaMatters: Episode 30

Hosts: Drs. Bill Harris & Kristina Harris Jackson

Guest: Dr. Aleix Sala-Vida

Background and Key Takeaways:

Dr. Aleix Sala-Vila got his PhD in 2004 in biomedicine from the University of Barcelona and did four postdoctoral fellowships, which increased his breadth and depth of understanding in the nutrition field. He has experience from cell culture work all the way up to epidemiology and is particularly interested in how nutrients affect chronic disease. In this episode, Drs. Harris and Sala-Vila talk about omega-3s and how these nutrients affect the chronic disease of dementia. Aleix has got 151 publications, 76 of which have to do with fatty acid. So he’s a bonafide expert in this field. For more information on OmegaMatters, visit:



Dr. Bill Harris: Welcome to another session of Omega Matters. This is Bill Harris and I am having a chat today with my friend and colleague, Dr. Aleix Sala-Vila in Barcelona, Spain. Aleix got his PhD in 2004 in biomedicine from the University of Barcelona [00:00:30] and did four postdoctoral fellowships. So that certainly increased his breadth and depth of understanding and in nutrition and topics we’ll be talking about today. He’s really got experience from cell culture work all the way up to epidemiology, so quite a breadth of knowledge. He’s particularly interested in how nutrients affect chronic disease, and today we’re going to talk about specific nutrients, omega-3 and [00:01:00] the chronic disease of dementia. Aleix has got 151 publications, 76 of which have to do with fatty acid. So he’s a bonafide expert in this field. So welcome, Aleix. Thanks for joining us today.

Dr. Aleix Sala-Vila:  Thank you so much for inviting me. Thanks.

Dr. Bill Harris: Oh, you’re welcome. So Aleix is one of the principal research associates here with us at the Fatty Acid Research Institute, and we work on lots of papers together. [00:01:30] But today we’re going to talk primarily, we’re going to start rather large and talk about the role of diet in cognition and preserving cognitive capacity. And I look back and I see your first paper on this topic. You were second author on a JAMA paper eight years ago now, and you studied in that one defects of the Mediterranean diet on cognition. So can you tell us a little bit about that and then we’ll talk about a paper that was just published this [00:02:00] July on sort of the same topic.

Dr. Aleix Sala-Vila:  Yeah, sure. This paper was a study of the PREDIMED trial. PREDIMED trial was intended to prove that in people free of cardiovascular disease following a diet rich in Mediterranean foods plus supplementation with long known foods to be beneficial, either nuts [00:02:30] or either extra virgin olive oil would help to prevent the incidents of cardiovascular events. So in short, this was a cardiovascular disease trial. However, this trial included different subsets, different nodes across Spain. [inaudible 00:02:48] my former boss was clever enough to think about the heart and brain axis. So he decided, yeah, it would be worth it to ask our participants in Barcelona to undergo [00:03:00] cognitive testing at baseline and after a few years. The participants came every two years. So some of them underwent the testing after two years, some of them after four years, some of them after six years. In average, the median flow up was around four years. The sample was not impressive because it only included participants from our [00:03:30] node in Barcelona. And because this sub study was part of a study not entirely focusing on dementia or cognitive health, it was a study focusing on cardiovascular disease.

Dr. Bill Harris: Right, and when you said Mediterranean diet, then you added to it one arm extra virgin olive oil and you added nuts?

Dr. Aleix Sala-Vila:  No, what we decided was to test three different types of diets for cardiovascular disease. [00:04:00] So one of them was a low fat diet. We asked the participants to cut down the calories and try to follow a low fat diet. At that time, this was intended to be the healthiest diet for people at risk of cardiovascular disease. So we gave them plenty of recipes and we asked them and we were controlling them just to check whether they cut down the amount of calories.

The other one was, the opposite [00:04:30] was, okay, you should eat according to Mediterranean diet. We gave them recipes, we encouraged them to increase the consumption of vegetables, nuts, fatty fish, pulses, reduce the use of sodas and so on. This was for people following Mediterranean diet and they were supplemented with either [00:05:00] extra virgin olive oil that was one arm, and mixed nuts, 30 grams per day. This was a second Mediterranean arm. So in short, there were three arms, one low fat, one Mediterranean diet plus extra virgin olive oil. We gave them one liter per week, which is an absolute amount. So we gave them, so use as much oil as you want. And another one was Mediterranean diet plus mixed nuts, 30 grams per day.

Dr. Bill Harris: Yeah, [00:05:30] I guess most people would assume that you wouldn’t need to add olive oil to a Mediterranean diet. I mean that’s just part of it. Is that not the case?

Dr. Aleix Sala-Vila: Yes, yes, you are partly right. Olive oil is integral to Mediterranean diet, but you can have different types of olive oil in terms of quality. Extra virgin olive oil is considered like olive juice. This is [00:06:00] the highest degree of quality.

Dr. Bill Harris: Okay.

Dr. Aleix Sala-Vila: Some people uses different types of olive oil, but without this richness in polyphenols and bioactives. So they just swapped the type of olive oil.

Dr. Bill Harris: So this was instead of the olive oil they would typically use?

Dr. Aleix Sala-Vila: In terms of fat, it was essentially the same. In terms of intake of polyphenols and other bioactives present in olive oil, they did [00:06:30] better because the source that mostly were given was so rich in polyphenols and other bioactives.

Dr. Bill Harris: Yeah. Okay. Got it. Got it. Okay. And then again, your outcome, some kind of mental cognitive test after four years on average, what happened?

Dr. Aleix Sala-Vila: We asked them to undergo a battery testing assessing three different domains. One domain, which encompasses different tests that assess memory, another [00:07:00] domain that encompasses tests for executive function, that’s attention, planning, orientation. And another one which is a global domain, so global cognition. And what we found it was people, control group, they decreased over time the scoring, which is something that was normal. It was kind of expected. And we found [00:07:30] that people following this Mediterranean diet supplemented with either extra virgin olive oil or either mixed nuts did not have the same rate of decrease. Actually some of them remained stable and some of them even increased the score.

Dr. Bill Harris: Interesting. How old were they at baseline?

Dr. Aleix Sala-Vila: Yeah, they were around 66 years. And one thing [00:08:00] that makes this population unique is that they were at high risk of cardiovascular disease. They were free of cardiovascular disease at baseline, but at high risk of having cardiovascular disease. Around half of them were diabetic or they had three or five risk factors being a smoker, being obese, having high levels of LDL, [00:08:30] high levels of triglycerides, lower levels of HDL. So we were not just searching diabetic health with a high accumulation of risk factors, but it was either diabetic or three cardiovascular risk factors.

Dr. Bill Harris: What happened to the body weight in the groups?

Dr. Aleix Sala-Vila: There is a paper which was published a few [00:09:00] years ago, not only in this subset but in the whole subset. And there was no increase in body weight. It was [inaudible 00:09:13].

Dr. Bill Harris: Did the people on the low fat control diet lose weight?

Dr. Aleix Sala-Vila: Kind of, but there was not much difference between the groups in terms, following a high fat diet, because the matter here is not the quantity, it’s the quality of the fat. So following a high fat diet can provide benefits to you without any weight gain.

Dr. Bill Harris: Okay. Great, great. And you found actually some benefits. So let’s leapfrog to July of this year when a study was published in New England Journal on the MIND diet and cognition. How is that different than your study and what did they find?

Dr. Aleix Sala-Vila: Yeah, there are a few differences. Well, the first thing that I should say is that this trial is extremely well done. So my respect to people that try it to test this hypothesis. They were not so lucky because they found no benefits of [00:10:30] the experimental diet. But, well, they did a great job. Some differences, yes. First this trial was specifically decided to test the MIND diet. MIND is Mediterranean and DASH diet, special intervention for neurodegeneration delay. So they were just targeting [00:11:00] neurodegeneration.

Dr. Bill Harris: Neurodegeneration. Okay. Okay.

Dr. Aleix Sala-Vila: So our people was free of cardiovascular disease at baseline, but most of them were at high cardiovascular risk. These people in the MIND trial were free of dementia at baseline, but with a higher risk of dementia and other neurodegenerations because all of them had [00:11:30] family history of this disease.

Dr. Bill Harris: Oh, they had a family history of dementia in the new one?

Dr. Aleix Sala-Vila: Yeah.

Dr. Bill Harris: And that’s very different from your study, right?

Dr. Aleix Sala-Vila: That’s different. In addition, all of them were obese and all of them were following a suboptimal diet.

Dr. Bill Harris: Suboptimal, okay. Yeah, like typical American?

Dr. Aleix Sala-Vila: Well, so to speak. So they also asked to all participants, [00:12:00] all of them, both arms to cut down the amount of the calories, the daily calories. The target was to reduce by 250 calories per day. So there was no low fat versus high fat, but good quality fat. No. They decided, “Okay, we should eat less fat.” In addition, participants were randomized [00:12:30] to follow one diet of control, just reduce, less fat, another one reduce fat but also they were given nuts, they were given berries, they were given foods intended to be good for the brain.

Dr. Bill Harris: Did they give them omega-3 supplements?

Dr. Aleix Sala-Vila: No, no supplements of omega-3, no specific supplements. And the third difference, it was the length of the trial and the outcomes. [00:13:00] In our case, we just had just cognitive testing. Here in the MIND trial, participants underwent cognitive testing and in a small subset also underwent magnetic resonance imaging. So the researchers were able to see some subtle changes inside the brain, maybe happening much before any changes in cogition. For instance, you know that as [00:13:30] we get older, some changes in our brain habits. So our arteries in the brain, there is some stiffness. In addition, some areas of our brain undergo some atrophy. But this is not normal. In some cases there is some atrophy in special areas, some accumulation of [00:14:00] some compounds, which do not happen in a random matter. Some areas, for instance, hippocampus undergo rapid atrophy in participants or in people who develop Alzheimer a few years later. So this can be seen by neuroimaging and these changes can be seen much before than the onset of clinical symptomology.

Dr. Bill Harris: So just to reemphasize that, the hippocampus is [00:14:30] a memory center, a small piece of your brain that’s really-

Dr. Aleix Sala-Vila: Yes, it’s [inaudible 00:14:37].

Dr. Bill Harris: You can see shrinkage of that area even before you see any cognitive change on the outside.

Dr. Aleix Sala-Vila: Yes, yes. Or the total volume, the brain or something which is called white matter hyperintensities, which is related to vessel damage in the brains.

Dr. Bill Harris: Oh, blood vessels.

Dr. Aleix Sala-Vila: [inaudible 00:15:00] [00:15:00] of little damages in the brains. These are three typical features, structural features of the brain that in some cases are considered as predictors future cases of Alzheimer’s disease. So rapid shrinkage of hippocampus, loss of volume, and this a accumulation of hyperintensities in the white matter. It’s something that can be seen through [00:15:30] magnetic resonance imaging protocol, which it’s something that it’s physical to do. And this was also done in this MIND trial in a small subset.

Dr. Bill Harris: And what’d they find?

Dr. Aleix Sala-Vila: Okay, well they found that actually both groups did well. Both groups lose some weight, but they found no significant [00:16:00] differences in terms of cognitive performance between the groups before and after three years of intervention. So this can be, at least to me, either two things. If we consider that this population was correctly selected, at least to me, they were at risk, a genetic risk because of the family history. They were not healthy, they had obesity. They don’t have a very good diet, so they had [00:16:30] room for to do better things. So the selection of the participants was, at least to me, it was great.

But the lack of effect can be a couple of things. The first one MIND is not effective at all. I don’t think so. I think that MIND can be effective because it has some elements from Mediterranean diet, which has been proven to be beneficial. [00:17:00] And has also elements of the DASH diet also proven to be beneficial. I think that MIND diet is effective. The other one is maybe that the intervention was too small to see these changes. Maybe the changes were too subtle to be seen in this short period of intervention, in these three years of intervention.

Dr. Bill Harris: Did they actually, both groups got better or they just declined at a slower rate than [00:17:30] expected? They didn’t have a group that they didn’t intervene on at all. So a third group kind of control group. And so they had a low calorie weight loss group versus a weight loss Mediterranean group. So the effect of weight loss, can we say anything about weight loss and the effects on cognition?

Dr. Aleix Sala-Vila: No, because both of the groups, so weight loss was pretty [00:18:00] similar in both groups.

Dr. Bill Harris: Yeah. Okay, okay. So we can come up with reasons why it might not have worked, but in point of fact, and these were, again, people in their 60s also?

Dr. Aleix Sala-Vila: Yeah, I think so. I think so.

Dr. Bill Harris: Yeah, yeah. So at least these short term interventions late in life are… And just to talk about how difficult it is to actually study nutrition and [00:18:30] the brain.

Dr. Aleix Sala-Vila: I think it’s something really difficult. First, if you go to a progress to dementia and Alzheimer’s, diet, at least not at this point, has a prominent role. I like to figure that as something similar to cardiovascular disease, maybe 40 or 50 years ago. Nowadays, if you go to a doctor, the first thing is just quit smoking. The next [00:19:00] one is improve your diet, do some sport and so on. So there is no doubt between the connection between diet and heart disease, heart failure, stroke, whatever. So cardiovascular disease, there is no doubt that is connected. I think that in 40 years all people will be completely aware on the connection between diet and brain health, but we are still not at this point. [00:19:30] So there are not much trials. At this point, research on dementia mostly goes, let’s go for biomarkers, let’s go to understand what’s actually going on. Let’s understand the disease. So then you will have some space to go to prevent.

But we should understand why some people have Alzheimer, why some people don’t, the importance of the genetics. Why some people with a really [00:20:00] bad genetic burden surprisingly is so resilient to developing the brain. And the opposite why some people develop this dementia before their 60s. Why some people reach 90s completely fine. So at this point, most of the work is focusing on biomarkers, new techniques, new tests to better capture the evolution [00:20:30] of the disease. But I’m hoping that maybe in 10, 20 years we’ll be completely aware of how this is happening and then we will be able to say diet is so important. Smoking is so important. Sleeping is so important. Exercise is so important. I think that most people are thinking, “Yeah, okay, lifestyle, it’s so important.” [00:21:00] But I think that not everyone is so aware on how powerful are our choices in midlife to determine what is going to happen 30 years later. I think that the sooner the better.

Dr. Bill Harris: Right, right. And we’ll get to that at the end of our little talk about it. We’d like to get your advice to people across the whole wide… But let’s [00:21:30] focus in on what we love here at Omega Matters, which is omega-3. And you’ve got at least a couple of papers on that. And one just published last month in November of 2023. The first paper we went over in episode number 16 of Omega Matters. We interviewed you on that one. So you can briefly summarize that one, then talk about your new paper and how they compare.

Dr. Aleix Sala-Vila: So that paper was published year and a half ago [00:22:00] or so. We used data from the Framingham Health Study and we determined what we had data on, red blood cell fatty acids and different types of omega-3. And at that paper we focused on DHA, we decided to study DHA because, first, it’s a fatty acid, which is supplied by fatty fish. And second, because it’s the main fatty acid that we can find in our brain, this fatty acid [00:22:30] is rapidly accumulated in our brain even before birth. So if we accumulate this fatty acid, if this fatty acid is present in breast milk, it means that it might have something important, might have an important role in our brain.

So we decided to focus on in this specific fatty acid. And well, we had very nice data [00:23:00] in the Framingham. I think it was nearly 3,000 participants free in dementia at the time that they gave blood samples to determine the fatty acids. And these participants were followed for a long, long time. And during this time, this follow-up, some of them developed Alzheimer’s disease, some of them developed other [00:23:30] dementias. So to speak, dementia, well, Alzheimer’s disease, it’s around 70% of dementias. Alzheimer’s disease is one type of dementia, which is the most abundant. So we decided to examine the associations between red blood cell, DHA, and the risk of having incident Alzheimer’s disease and the risk of having incident dementia over time.

Dr. Bill Harris: And [00:24:00] how old were they baseline and how long did you follow them?

Dr. Aleix Sala-Vila: I’m speaking… They were over 65 at baseline.

Dr. Bill Harris: I think… Yeah, right.

Dr. Aleix Sala-Vila: And the follow up, I need to check that, but I think it was around five years meaning follow up.

Dr. Bill Harris: Okay, yeah.

Dr. Aleix Sala-Vila: Roughly five years.

Dr. Bill Harris: I think if, I recall, the average [00:24:30] age was around mid 70s and we only looked at people over age 65.

Dr. Aleix Sala-Vila: We decided to only use data from participants 65 or over because most of the studies, the similar observational studies done until that moment were examining the same population. So people which are people considered old, 65 or over. [00:25:00] So we found that after controlling for different factors that can also influence the risk of having dementia or having Alzheimer’s in short, age, gender, years of clarity, presence of APOE4 carriership, this is a genetic risk factor. So we found that compared to the first quartile, so being at the bottom 20%, being at the [00:25:30] top, nearly halved the risk of having Alzheimer’s disease and the risk of having dementia.

Dr. Bill Harris: Right.

Dr. Aleix Sala-Vila: And importantly, the associations were much stronger in people at higher genetic risk. In other words, APOE4 carriers. This is something that you cannot change. People having this special genetic characteristic have a higher [00:26:00] risk to develop Alzheimer’s disease and to develop much sooner than other people.

Dr. Bill Harris: And so you think, does omega-3, should people with APOE4, carriers who have that genetic marker, should they be more attentive to omega-3 intake earlier in life?

Dr. Aleix Sala-Vila: Yeah, I think so. I think so. Because this is something that is related to lipid metabolism. And [00:26:30] well, I think that it has been described, and I refer to the excellent work from Dr. Yassine from University of Southern California, he has been doing great things in this specific topic. So people with APOE4 carriership have derangements in lipid metabolism, including some disturbances in the metabolism of DHA, meaning [00:27:00] that they have lower status and they might have higher requirements.

Dr. Bill Harris: Yeah, yeah, that’s interesting.

Dr. Aleix Sala-Vila: In other words, they might have the highest benefits of interventions based on these type of nutrients especially DHA.

Dr. Bill Harris: Sure. Let’s jump to your paper then, the one you published last month. How is that different from the Framingham paper?

Dr. Aleix Sala-Vila: It’s different [00:27:30] not on the idea because it’s once again an observational study, but it’s different in terms of methods. The first one is the population, first one. So in the first nutrients papers, they were from the Framingham Health Study, American people. This is from the UK Biobank, it’s English people, well English, Wales Scotland. So [00:28:00] people from Great Britain, United Kingdom. So that’s the first difference. The second one is that here we focused on DHA, but we also focused on other types of fatty acids, of other types of omega-3 fatty acids. In this particular study, we used data used metabolomics that had not been generated through gas chromatography, which is the gold standard to assess the fatty [00:28:30] acid profile in your blood or in different tissues. They used something which is based to nuclear magnetic resonance.

This is good because you can get a very wide profile of different metabolites. Not only focusing on omega-3 fatty acids, other fatty acids, other lipids, other analytes as well. But the granularity of these fatty acids [00:29:00] is not so good because for DHA, it’s fine, but it’s DHA and total omega-3 fatty acids. So that’s the only data regarding omega-3 that we have access to. So we decided okay, we have total omega-3, we had DHA, but instead of analyzing different species of omega-3 fatty acids different than DHA as an isolated [00:29:30] metabolites, we couldn’t do that. So we had just to create a new one, which is non DHA omega-3 fatty acids. This means that we were not able to study other important species like EPA or a ALA, which is the vegetable omega-3 fatty acid. So we weren’t able to do so. We had total, we had DHA and we created the third category, which is non DHA omega-3 [00:30:00] fatty acids. And another novelty is that, well, this was using data of more than quarter a million participants. This is a huge amount. I think it’s a lot-

Dr. Bill Harris: How many?

Dr. Aleix Sala-Vila: Sorry?

Dr. Bill Harris: How many again?

Dr. Aleix Sala-Vila: More than a quarter million participants.

Dr. Bill Harris: Okay. 250,000 people. That’s much bigger than 2,000.

Dr. Aleix Sala-Vila: This is the largest [00:30:30] observational trial ever done on the topic. This is nice because it allowed us to go for subgroups that are usually not explored, not because there is no interest, but because there is no statistical power to get reliable associations. So most of the trials or most of the studies in this case usually work with people age [00:31:00] 50, 60, 65 or over or so. But here we had data on people who were at their 40s at baseline. So we decided, “Okay, let’s go with three different groups.” Besides exploring the associations between DHA, non DHA omega-3 and total omega-3 with Alzheimer’s and with total dementia, we also decided, “Okay, let’s separate between, [00:31:30] let’s just stratify men and woman and also, okay, let’s just stratify in different decades at baseline from 40 to 50, one group, from 50 to 60, another group, and 60 or over the third group.” The later one, is what it has been usually done in other traditional similar studies.

And what we found, in general terms, we found nice associations [00:32:00] regardless of the group, regardless of the species, regardless of the disease. In general terms, the first idea that we should get is the higher omega-3 in your blood, the lower risk. However, when searching for those cases with the strongest associations, we found that men over 60 for [00:32:30] non DHA species and for dementias that were not Alzheimer’s, these were the stronger associations.

Dr. Bill Harris: Interesting.

Dr. Aleix Sala-Vila: This has an importance. We think that this might be important because when you are planning to these types of interventional trials, you will know that we might have different [00:33:00] responses in different groups. Men don’t respond similar to women, younger people don’t respond similar to older people. So just trying to design a new trial, it’s something daunting because you are going to invest millions of dollars and you need to do some important choices. You are trying to prevent Alzheimer’s, fine. Prevent means [00:33:30] you need to try to treat this population much before Alzheimer’s is present. Fine.

What does this before means? Five years, 10 years, 15 years? Each year of intervention, consider the amount of the money that it’s cost for each year of intervention. Second is the same using DHA, EPA plus DHA? What about [00:34:00] the omega-3 from vegetable origin. Third, fish oil. Well, in our regular diet, these nutrients never come alone. Okay, fine. Should just be EPA plus DHA? Should be EPA plus DHA, in addition to other lifestyle changes? Which is called multimodal interventions. Five, if I’m [00:34:30] already consuming couple of servings of fatty fish per week, is there any point to participate in this trial based on supplementation with EPA plus DHA? More questions.

So you have plenty of questions. How to reach the perfect population at the perfect time with the perfect dose, with the perfect nutrient and all these decisions will have a huge impact in the final outcome. [00:35:00] More considering that, well, you will probably have money for two, three, four years of follow up. Maybe you are not going to have money for 15 years of follow up and you are at risk to see similar results for the MIND trial we were discussing. Very well thought, very well executed, [00:35:30] but maybe it was too short. Maybe the population should have been with higher genetic risk burden, I don’t know. Maybe. Or maybe with less scholarity maybe. Or maybe, besides obesity, also smokers out also at higher risk of cardiovascular disease. Maybe. We don’t know. When we did the first trial with the PREDIMED, [00:36:00] so we were lucky, but we weren’t aware that we were going to have such successful results.

Dr. Bill Harris: Right. Yeah. So-

Dr. Aleix Sala-Vila: I think that these observational trials can be helpful to better define the populations who can obtain the high benefits based on these omega-3 based interventions.

Dr. Bill Harris: Yeah, yeah. That’s great. And it’s nice that they’re in two different groups of people [00:36:30] separated by an ocean that we really get basically the same story, that higher omega-3 is associated with lower risk for developing.

Dr. Aleix Sala-Vila: Yeah, I think that this is the main idea, higher omega-3, lower risk. This was seen different populations, different ages, different backgrounds, different genetic backgrounds, racial backgrounds, dietary backgrounds, lifestyle. So I think that the take home message is higher omega-3, [00:37:00] lower risk of dementia. This is good.

Dr. Bill Harris: Yeah, yeah.

Dr. Aleix Sala-Vila: In one case we saw that being at the top compared to being at the bottom, nearly half the risk. Not in that case. So in the UK Biobank, the reduction, yeah, it was statistically significant, but it was around 30% risk reduction, not so big. But well, this can be because the populations were so different. [00:37:30] So I think it’s important trying to use data around the world, different genetics, different backgrounds to test how important is having high omega-3. And if we can see that higher omega-3, lower risk, regardless of the place of the world you are working, I think that this is a really strong message.

Dr. Bill Harris: Yeah. And I understand you’re [00:38:00] trying to get NIH grant funding to do just that kind of study.

Dr. Aleix Sala-Vila: Yeah, starting on that. There are plenty of excellent cohorts worldwide. Lots of thousands of dollars or millions already invested with data on omega-3, blood with data on incident dementia. So we’re trying to persuade big guys to get money just to pull [00:38:30] data on as many cohorts as possible, just trying to investigate, just trying to confirm that higher omega-3, lower risk of dementia, lower risk of Alzheimer’s. Being completely aware that this is not an intervention trial. There are no intervention trials at the moment on omega-3 and incident Alzheimer’s because you would need a lot of time and this means a lot [00:39:00] of money. So at this point, we’re just trying to help better define the best populations, the best doses, and how non-modifiable risk factors, how these factors can affect the response to the omega-3.

Dr. Bill Harris: Right, right. So let’s begin to wrap up, if a friend asks you at a party, ” [00:39:30] I know you study diet and cognition and dementia. What’s your advice? What are your top five things that you can do in your life to reduce your risk?”

Dr. Aleix Sala-Vila: Yeah. First, improve your diet. So you eat at least three times a day. So you have a lot of power in your hands. So improve your diet. If you had the best car in the world, you would put the best gas in the world. And if you lose your car, [00:40:00] okay, it’s bad luck, but you can buy another one. You cannot buy another body. So you have the best car in the world.

Dr. Bill Harris: And what do you mean by the best diet?

Dr. Aleix Sala-Vila: Best diet, there is something which is, it’s good, it’s just seven words, eat food, not much, and mostly plants.

Dr. Bill Harris: Eat food, not much, and mostly plants. Yeah.

Dr. Aleix Sala-Vila: Yeah. So try to avoid this ultra processed food. Eat nuts, eat fish, [00:40:30] eat grains, vegetables, try to cut down your sodas. If you like wine, drink wine, but not too much. It’s important, try to get pleasure in what you eat. Try to find pleasure in cooking. It’s difficult because at this time it’s difficult. Try to find pleasure in food. It’s not just a source of energy and that’s it. Try [00:41:00] to eat with someone, try to talk with. But well, I think that it’s top level. My advice would be eat better.

Dr. Bill Harris: Yeah.

Dr. Aleix Sala-Vila: Second one, try to incorporate omega-3 in your diet. Maybe, maybe it won’t help to delay your dementia. Maybe. [00:41:30] But for sure you will have plenty of other benefits. Your cardiovascular health will improve for sure. But maybe it’ll help, it will cut down the risk of having dementia. Or maybe if you are prone to have dementia, maybe this omega-3 will give some, I don’t know, two years of extra life without dementia, which is important as well.

Dr. Bill Harris: Yeah. And the risk to doing that is zero.

Dr. Aleix Sala-Vila: Is zero. Zero. No increased [00:42:00] risk. You are not going to be obese, you are not going to gain weight, you are not going to have higher risk of bleeding. So try to include your omega-3 in your diet. And the third one is that from the PREDIMED trial, we learned that it’s never too late to start taking care of yourself. Something good [00:42:30] can happen even if you start after the 60s, after the 70s, someone can say, “Oh, it’s too late.” No, no, no, no, it’s never too late. It’s never too soon. If you can start taking care of you, I don’t know, your 20s, good for you. How you are being in your 20s, it will determine your 40s. And in your 40s it will determine your 60s. But [00:43:00] it’s never too early or too late to start taking care of yourself.

Dr. Bill Harris: So besides diet, what do you got?

Dr. Aleix Sala-Vila: Besides diet, well, I think it’s important try to improve every day in terms of your lifestyle/ try to sleep better. Obviously quit smoking. Try to manage your emotions. I think it’s something that we should pay a lot of attention to that. [00:43:30] Do some exercise. Socialize, have engagements in terms of don’t be an isolated person. Try to have relationships with your neighbors, talk. Try to stimulate yourself. Try to read. Try to learn a new language. Play an instrument or so. Try to do what’s in your hands just to avoid or at least delay the onset [00:44:00] of dementia.

Dr. Bill Harris: Yeah. Great advice. A lot of things we can do that are in our control, may be tough. But we just [inaudible 00:44:09].

Dr. Aleix Sala-Vila: Yeah, there are some things that we cannot control. We become older and older and older. Okay. It’s a matter of fact, we cannot control that. Genetics, we cannot control that. So if you have an APOE4 genotype, okay, that’s bad luck. But well, you still have plenty of tools [00:44:30] in your hand just to avoid or at least to delay the onset of dementia or cognitive decline.

Dr. Bill Harris: That’s okay. But we know that you can’t do anything about your genetic risk. All you can do is other things, all the lifestyle things you mentioned to help mitigate whatever risk you’ve got.

Dr. Aleix Sala-Vila: And it’s promising because we see more and more that the higher the risk, the better the results related to intervention. For instance, if you want to lose weight, your chances will be much higher if you have some extra pounds than if you are slim. So if you are in a worse condition, so your chances to benefit from these changes in your life are much higher than people who is doing great.

Dr. Bill Harris: Well, let’s wrap up. Thank you for your time. Thank you for the insights you share about omega-3 and diet and dementia. And we look forward to this project you mentioned trying to get more of a worldwide look at the relationship between omega-3 levels and cognition. But at the end of the day, what people can do is they can increase their omega-3 levels by eating oily fish, taking fish oil supplements, omega-3 supplements. And that’s at least one thing you can do. And Aleix, thank you for your time and best of luck.

Dr. Aleix Sala-Vila: Thanks. It was a pleasure. Thanks, Bill.

Dr. Bill Harris: Bye-Bye

Dr. Aleix Sala-Vila: Bye.

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