Orthomolecular medicine for dementia prevention: How micronutrients help prevent Alzheimer’s disease

In this article, you will learn how orthomolecular micronutrients can help prevent dementia in a way that is understandable to laypeople and scientifically sound – from vitamin D and B vitamins to omega-3 fatty acids.

What is orthomolecular medicine? (According to Linus Pauling)

Orthomolecular medicine was coined in the 1960s by two-time Nobel Prize winner Linus Pauling. The term literally means “the right molecules” – it refers to supplying the body with optimal concentrations of natural micronutrients (vitamins, minerals, amino acids, fatty acids, etc.) in order to maintain health and prevent disease.

Pauling and colleagues such as the psychiatrist Abram Hoffer discovered early on that biochemical imbalances and nutrient deficiencies contribute to the development of many diseases. The aim of orthomolecular medicine is to correct these imbalances through targeted nutritional supplements and thus create an optimal physiological environment in the body.

Especially in the prevention and treatment of chronic diseases – including neurodegenerative diseases – orthomolecular medicine relies on high-quality vital substances in sometimes high dosages, always individually adapted to the patient’s needs.

Orthomolecular psychiatry deals specifically with the role of nutrients for mental health and brain function. It recognizes that each person has a unique genetic makeup and biochemistry that influences individual nutrient requirements.

For example, a congenital B-vitamin metabolism defect may require a higher intake of certain vitamins. Orthomolecular therapists (often doctors or alternative practitioners with additional knowledge) therefore create personalized nutrient plans based on laboratory values and medical history to compensate for deficiencies and optimize protective factors.

Is orthomolecular medicine scientifically sound? Initially it was ridiculed as an “alternative” method, but numerous studies now support the importance of micronutrients in prevention and therapy.

Particularly in complex diseases such as Alzheimer’s, there is a growing realization that multi-component approaches could be more successful than monotherapies. After previous drugs against Alzheimer’s have been largely disappointing, experts are calling for a holistic approach that positively influences several mechanisms simultaneously.

This is where orthomolecular medicine comes in: It combines scientific evidence with a holistic understanding of therapy to achieve the best possible brain health through nutrition, supplements and lifestyle changes.

Understanding Alzheimer’s: Pathophysiology and targets for micronutrients

Alzheimer’s dementia is a complex neurodegenerative disease in which brain cells (neurons) gradually die over decades and mental abilities are lost. Protein deposits in the brain – beta-amyloid plaques outside the cells and tau fibrils inside the neurons – are typical.

These changes are associated with chronic inflammatory reactions, oxidative stress, disturbances in energy metabolism and loss of synapses. Many factors contribute to the development of this pathology: genetic predisposition (e.g. APOE4 gene), advanced age, but also lifestyle and environmental factors. The latter are also starting points for prevention: by exerting a positive influence on diet, exercise, sleep, stress and nutrient supply, the harmful processes in the brain can be mitigated.

Scientists have discovered that pathological changes in Alzheimer’s begin decades before the first symptoms appear. This long silent phase opens up a crucial window of opportunity for preventive measures. Micronutrients can be used at various points in the development of the disease:

• Antioxidant protection

The brain consumes a lot of oxygen and energy, which produces many free radicals. Oxidative stress damages nerve cells and promotes plaque formation.
Antioxidants such as vitamin C, vitamin E, carotenoids and selenium neutralize free radicals and protect the cells. In Alzheimer’s studies, low levels of these antioxidants were often found in patients. A sufficient supply of these could make brain cells more resistant and reduce the risk of cognitive decline.

• Inflammation inhibition

Chronic neuroinflammation (inflammation in the brain) contributes significantly to the development of Alzheimer’s disease. Some nutrients have an inflammation-modulating effect – e.g. omega-3 fatty acids (DHA, EPA) from fish oil, which serve as a precursor of inflammation-dissolving messenger substances.
Vitamin D and certain plant substances (e.g. curcumin from turmeric or resveratrol from grapes) have also shown anti-inflammatory effects in the nervous system.

• Homocysteine and vascular health

An often overlooked risk factor is amino acid metabolism. High homocysteine levels in the blood correlate with an increased risk of Alzheimer’s and increased brain degeneration.

Homocysteine damages blood vessels and promotes neurodegeneration, even inhibiting the formation of new nerve cells (neurogenesis) in the hippocampus. Elevated homocysteine levels are usually caused by a lack of B vitamins (B₆, B₁₂ and folic acid), which break down homocysteine.

If these vitamins are missing, homocysteine can accumulate. B vitamins are therefore an important point of attack: studies show that lowering homocysteine levels with vitamins B6, B12 and folic acid can slow down brain degeneration in people at risk. Note: A high homocysteine level is a warning signal and should be normalized with appropriate vitamin supplements.

• Energy balance and insulin signaling pathways

The brains of Alzheimer’s patients show signs of insulin resistance and mitochondrial dysfunction – in some cases Alzheimer’s is even referred to as “type 3 diabetes”.

The neurons are less able to utilize glucose and “starve”, so to speak, in the midst of excess. Ketogenic approaches could help here (see below), but also micronutrients: B vitamins, coenzyme Q10, magnesium and L-carnitine support the energy metabolism of the cells. A meta-analysis of 21 studies found that acetyl-L-carnitine (a nutrient for mitochondrial support), for example, led to a slight improvement in cognition, mood and brain energy in patients with mild cognitive impairment and mild Alzheimer’s disease.

NADH (a coenzyme) also showed in initial clinical tests that it can stabilize the course of the disease and slightly improve mental performance. These results indicate that improving brain energy supply through orthomolecular nutrients is a promising path.

• Neurotransmitters and synapses

Certain vitamins and amino acids are building blocks for neurotransmitters (messenger substances in the brain). For example, the formation of acetylcholine (important for memory) requires sufficient choline and vitamin B5.

Vitamin B1 (thiamine) is essential for glucose utilization in the brain; thiamine deficiency (Wernicke-Korsakow syndrome) leads to severe memory impairment. In small Alzheimer’s studies, cognitive functions improved when high doses of thiamine were administered.

Orthomolecular therapy therefore ensures an optimal supply of all neural building blocks in order to support neurotransmitter balance and synapse function.

• Amyloid clearance

One aim is also to promote the disposal of amyloid proteins. The immune system in the brain (microglia) and specific enzymes are involved in this process.

Vitamin D has proven to be important here: It modulates the immune defense and, in laboratory tests, promotes the uptake and degradation of amyloid-β by immune cells . A good vitamin D status could therefore help to prevent or reduce amyloid deposits.

It is also being discussed that curcumin (turmeric) can bind to amyloid and inhibit its clumping (at least in animal experiments). Plant polyphenols in general support cellular cleansing and repair processes.

To summarize: Alzheimer’s is caused by a complex interplay of harmful processes, many of which can be positively influenced by nutrients.

Orthomolecular means taking all the pieces of the puzzle into account: Reduce oxidative stress, dampen inflammation, strengthen mitochondria, optimize vascular health and homocysteine, support neurotransmitters and break down harmful proteins.

No single vitamin will prevent Alzheimer’s – but the orchestrated interaction of many micronutrients plus a healthy lifestyle can create a robust safety net that delays the onset of dementia or, ideally, prevents it altogether.

Most important micronutrients for dementia prevention (with studies)

In this chapter, we present the most important vitamins, minerals and nutrients that research shows play a role in the prevention of Alzheimer’s dementia. We look at their function in the brain, signs of deficiency and current study results on Alzheimer’s prevention.

Infobox: Key nutrients for brain health

• B vitamins (B₆, B₁₂, folic acid): Protect nerve cells, lower homocysteine and prevent brain atrophy. High homocysteine levels due to B vitamin deficiency increase the risk of dementia . Studies: High-dose B vitamins slow brain atrophy in mild cognitive impairment .

• Omega-3 fatty acids (DHA/EPA): Anti-inflammatory “brain food” fats, essential for brain membranes and synapses. Correlate with lower risk of dementia (fish eaters are less likely to develop the disease). Observation: Fish oil supplementation was associated with ~9% fewer cases of dementia (over 11 years) .

• Vitamin D: Hormone-like “sun vitamin”, important for immune function and protective mechanisms in the brain. According to observational studies, a deficiency significantly increases the risk of Alzheimer’s disease . A large study showed a 40% lower dementia rate in older people with vitamin D supplementation.

• Antioxidants (vitamin C, E, selenium): Neutralize free radicals in the energy-hungry brain. Levels often too low in Alzheimer’s disease. Sufficient supply could slow down cognitive deterioration.

• Magnesium: Important for signal transmission between brain cells and memory formation. Animal models suggest that magnesium supplements improve learning ability; epidemiological data link higher magnesium intake with better brain performance in old age.

• Zinc & selenium: Trace elements, essential for the growth and repair of nerve cells. A lack of zinc or selenium disrupts the formation of new neurons and increases the risk of dementia.

• Coenzyme Q10 & L-carnitine: Support the mitochondria (power plants of the cell). Initial studies in dementia show improved energy supply and slight cognitive benefits.

• Lithium (trace element): Essential for the brain in very small quantities. Regions with lithium-poor drinking water record more dementia and suicides. Microdoses of lithium could slow down the progression of Alzheimer’s.

B vitamins (B₆, B₉, B₁₂): Lower homocysteine, protect the brain

What do B vitamins do? Vitamins B₆ (pyridoxine), B₉ (folate) and B₁₂ (cobalamin) are key substances for the nervous system. They are required for myelination (protective layer of nerve fibres), DNA repair and the formation of neurotransmitters.

Their role in homocysteine metabolism is particularly well known: together they convert the cell toxin homocysteine into methionine or cysteine.

Why is this important? Excess homocysteine has a vascular damaging effect (arteriosclerosis) and is neurotoxic – it promotes apoptosis (cell death) and disrupts the development of new brain cells.

Elevated homocysteine levels are found more frequently than average in Alzheimer’s patients. In the renowned Framingham study, people with high homocysteine levels had twice the risk of developing dementia.

Study situation: The VITACOG study in Oxford was a breakthrough: older people with mild memory problems were given high doses of B₆, B₁₂ and folic acid or placebo. Result: In the B-vitamin group, the brain (hippocampus region) shrank 30% slower than in the placebo group – in patients with elevated homocysteine .

Cognitive abilities remained more stable. This suggests that B vitamins are particularly effective when there is actually a deficiency or elevated homocysteine level.

A further evaluation also showed that the effect of the B vitamins was greatest when sufficient omega-3 fatty acids were present in the blood at the same time. Apparently, B vitamins and omega-3 complement each other in their neuroprotective effect (omega-3 stabilizes cell membranes, B vitamins lower homocysteine and provide methyl groups for repair processes).

Practice: As part of dementia prevention, it is recommended that adults (especially those aged 50+) have their blood homocysteine levels determined. If this is elevated (>10-12 µmol/L), B-vitamin supplementation should be taken after consultation with the doctor, typically Folic acid 400-800 µg, B₆ approx. 20 mg, B₁₂ approx. 500-1000 µg daily.

Combination supplements are often used. Even without an increase in homocysteine, moderate supplementation can be useful if, for example, you have a low-normal B₁₂ level (<300 pg/ml) or a diet that is low in B vitamins (typically with a vegetarian/vegan diet, pay particular attention to B₁₂ here!).

As B vitamins are water-soluble, excess amounts are excreted; however, a high-dose intake should be agreed with the therapist.

Important: Vitamin B₁₂ should be checked regularly in old age – an estimated 10-30% of seniors have a deficiency, which can lead to irreversible nerve damage. An untreated B₁₂ deficiency can cause dementia-like symptoms.

Targeted high-dose therapy (orally or by injection) may help here. Orthomolecular medicine therefore always includes laboratory diagnostics (see Diagnostics) in order to detect such deficiencies and take timely countermeasures.

Omega-3 fatty acids: food for the brain

What are omega-3s? Omega-3 fatty acids, especially DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), are polyunsaturated fatty acids that are mainly found in fatty cold-water fish (salmon, herring, mackerel). DHA is a main component of the membranes of brain cells – about 30% of the fatty acids in the brain are DHA! EPA acts primarily as a building block for anti-inflammatory signaling substances.

Why is it important? Omega-3s promote the fluidity and function of synapses, support the formation of new connections (neuroplasticity) and have anti-inflammatory effects. A lack of DHA can lead to learning and memory disorders (known from animal studies and some observations in humans). In addition, people with low omega-3 levels are more likely to have organic brain changes.

Study situation: Numerous observational studies have shown that people who regularly eat fish or have higher omega-3 blood levels are less likely to develop dementia . A meta-analysis suggested that a diet rich in fish could reduce the risk of cognitive impairment by ~20%.

However, clinical trials with omega-3 capsules have produced mixed results. Some small studies in patients with mild memory impairment found a slowing of deterioration with omega-3 administration – especially in those who did not yet have advanced dementia.

However, larger studies (e.g. on patients with existing Alzheimer’s) showed little effect, especially when severe symptoms were already present. More recent data suggest that omega-3 is more effective in prevention than in the treatment of later stages.

A recent large observational study from 2022 (UK Biobank with over 200,000 older participants) investigated the long-term use of fish oil capsules: Interestingly, the incidence of dementia was about 9% lower overall in the group of regular fish oil users compared to non-users (hazard ratio ~0.91) .

There was no significant difference for Alzheimer’s alone, but there was for vascular dementia (HR ~0.83). This means that omega-3s could be particularly protective against vascular dementia – which is logical, as they have an anti-inflammatory effect on blood vessels and prevent thrombosis.

The results of a study that combined omega-3 with exercise are spectacular: High doses (800 mg DHA + 225 mg EPA daily) plus moderate endurance training (5×30 min/week) were able to delay the progression of the disease by around 3.5 years in people with mild Alzheimer’s symptoms!

Without accompanying exercise, the effect was only half as great (approx. 1.5 years delay). This impressively underlines how synergies exist between nutrients and lifestyle factors – and how important it is to use all prevention levers together.

Practice: For brain health, it is recommended to eat sea fish once or twice a week or alternatively to take a high-quality omega-3 supplement. A common dosage range for prevention is around 500-1000 mg DHA + EPA per day.

Higher dosages (e.g. 2000 mg total omega-3) are often used in the case of existing mild cognitive impairment or inflammatory diseases – but please consult your doctor. An omega-3 index test (blood test) can provide information on whether you are sufficiently supplied: an omega-3 index of >8% is considered optimal for the heart and brain, <5% is considered low.

Omega-3 fatty acids are generally well tolerated. If taken in very high doses, they can have a slight effect on blood clotting (be careful with blood thinners, consult your doctor here).

For vegetarians/vegans, algae oil capsules are available as a source of DHA/EPA. Conclusion: Omega-3s are a central component of “natural Alzheimer’s therapy”, as they provide structural building blocks for the brain and slow down inflammatory and vascular-damaging processes.

Vitamin D: the sunshine vitamin for the mind

What is vitamin D? Vitamin D₃ (cholecalciferol) is formed in the skin by sunlight and converted to the active hormone calcitriol in the liver/kidneys. Its role in bones and the immune system is well known. However, vitamin D receptors are found throughout the brain and the vitamin controls a variety of neuronal functions – from growth factors to the regulation of neurotransmitters.

Why is it important? Vitamin D has a neuroprotective effect: it promotes the production of nerve growth factors, supports detoxification (e.g. formation of glutathione) and modulates inflammatory reactions of the microglia.

Interestingly, vitamin D also helps the brain cells to remove the harmful amyloid protein. It also influences the gene expression of hundreds of genes, including those that are relevant to ageing processes.

Study situation: In recent years, there has been increasing evidence that vitamin D deficiency is associated with an increased risk of dementia. A frequently cited study in Neurology (2014) showed that people with severe vitamin D deficiency had more than twice the risk of Alzheimer’s disease and other dementias compared to people with good vitamin D levels. Numerous observational studies confirm this correlation . It is important to remember that older people in particular often have low vitamin D levels (less sun exposure, lower synthesis capacity of the skin).

The crucial point: Does vitamin D supplementation actually help prevent dementia? A large study published in Alzheimer’s & Dementia in 2023 brings encouraging news: Over 12,000 seniors (average age 71) were followed for 10 years – those who took vitamin D supplements were about 40% less likely to develop dementia than those who did not supplement . This correlation remained even after adjusting for influencing factors.

Of course, this is “only” an association; a randomized study would be definitive proof. But as early as 2018, a meta-analysis of randomized trials showed that vitamin D can slightly improve cognitive function in older adults compared to placebo. A review (2020) concluded: Vitamin D supplementation could delay the onset of dementia, especially in people with deficiency.

Practice: Orthomolecular medicine recommends having the vitamin D level (25-OH-D) in the blood checked. Values in the range of 30-50 ng/ml (75-125 nmol/l) are considered optimal for a variety of health effects.

If there is a deficiency (<20 ng/ml), high doses of vitamin D are substituted in order to quickly reach the normal range (monitored by a doctor). For maintenance dosing, an average of approx. 1000-2000 I.U. daily is sufficient, for many even more in winter (3000-4000 I.U.), depending on the initial value and body weight. Important: If possible, vitamin D should be taken together with vitamin K₂ and magnesium, as it influences calcium metabolism. K₂ ensures that calcium is stored in the bones and does not calcify in blood vessels.

As vitamin D is stored by the body, overdoses should be avoided (over 100 ng/ml in the long term is not advisable). In prevention, however, safe doses are usually used.

Tip: Regular moderate exposure to sunlight (~15-30 minutes daily for face and arms, depending on skin type) can already help to maintain the level – useful in summer, but in winter the sun in Germany is usually not enough.

In summary, vitamin D is a simple but powerful lever to support brain health. It is effectively a preventative measure against dementia, which also strengthens the bones and regulates the immune system. Orthomolecular physicians will always pay attention to the vitamin D status of their patients.

Antioxidant vitamins (C, E, beta-carotene) and selenium

What are antioxidants? These are substances that neutralize free radicals and prevent oxidative damage. Particularly relevant in the brain: Vitamin C (water-soluble, highly concentrated in cerebrospinal fluid), vitamin E (fat-soluble, protects cell membranes) and beta-carotene or other carotenoids (antioxidant plant pigments), as well as selenium (component of antioxidant enzymes such as glutathione peroxidase).

Why is it important? The brain, although only ~2% of the body weight, consumes ~20% of the total oxygen – reactive oxygen species are constantly produced as a by-product. This production increases with stress, environmental toxins or inflammation.

If not enough antioxidants are present, oxidative stress occurs, which damages neurons and promotes deposits (plaques, tangles). Oxidative stress is considered to be one of the earliest processes in the Alzheimer’s process. Consequently, Alzheimer’s patients were often found to have lower levels of vitamin C, E and selenium compared to healthy people.

Study situation: Epidemiological studies have shown that people with a high intake of antioxidant-rich foods (fruit, vegetables, nuts) are less likely to suffer from cognitive impairment. For example, a high intake of vitamin E from food correlated with a lower risk of Alzheimer’s in some cohorts.

However, studies with pure antioxidant supplements in the past have sometimes been disappointing. Large vitamin E intervention studies in patients with manifest Alzheimer’s disease showed only mild benefits: In one study, high-dose vitamin E (2000 I.U. daily) delayed functional decline somewhat in Alzheimer’s patients, but with no effect on cognitive performance. Vitamin C alone has been studied less, but does not appear to be very effective in low doses alone.

Why this discrepancy? Experts believe that antioxidants need to be used in a more targeted way: They presumably have an optimal preventive effect before major damage has occurred, and especially in those people who actually have a deficiency or increased oxidative stress.

In addition, the combination of several antioxidants could be more useful than a single substance (synergy effects). For example, vitamin C protects vitamin E in the membranes from oxidation; selenium requires sufficient vitamin E to be optimally effective.

Practice: A colorful, plant-rich diet is the best basis for supplying antioxidants: Berries, citrus fruits, green vegetables (vitamin C), nuts and seeds (vitamin E), carrots, pumpkin, leafy vegetables (beta-carotene) – all these foods provide a whole network of protective substances.

Orthomolecularly, high doses of vitamin C can also be taken in phases of increased stress (e.g. 500 mg to 1 g/day, possibly divided up to 2 g – higher quantities can have a laxative effect). Vitamin E should preferably be supplemented as mixed tocopherols/tocotrienols (natural vitamin E consists of 8 forms); a dose of 100-400 I.U. per day is considered safe. If you have an existing cardiovascular disease or are taking blood thinners, be careful with high doses of vitamin E (>400 I.U.), as it can affect coagulation.

Selenium: Selenium deficiency is not uncommon in Europe, as soils are low in selenium. Selenium is linked to cognitive performance: a very low selenium status could increase the risk of dementia. Brazil nuts are extremely rich in selenium (just 2 nuts cover the daily requirement).

Alternatively, sodium selenite can be supplemented in small doses (50-100 µg/day). Important: Selenium has a narrow therapeutic range – do not take more than 300 µg/day to avoid overdosing.

All in all, it can be said that Antioxidants are like “rust inhibitors” for our brain. They alone will not prevent Alzheimer’s, but they are an essential part of the overall preventive strategy – especially if they are taken in good time and in sufficient quantities.

Other essential nutrients: magnesium, zinc, selenium, iron & co.

In addition to the prominent vitamins and omega-3, we must not forget the classic minerals and trace elements. A holistic orthomolecular approach considers all micronutrients as a team: if one link in the chain is missing, the whole system cannot function optimally (keyword: minimum law according to Justus von Liebig).

An article by Alzheimer’s researcher Dr. Michael Nehls sums it up succinctly: “All vitamins, trace elements and countless other micronutrients are crucial for adult hippocampal neurogenesis and should therefore play an important role in the holistic prevention and treatment of Alzheimer’s disease.”

Here are some important players:

• Magnesium

Involved in over 300 enzymatic reactions, including energy production (ATP) and the stabilization of electrical membrane potentials of nerve cells. A magnesium deficiency can lead to irritability, poor concentration and sleep disorders – all risk factors for cognitive decline. Experimental studies suggest that magnesium promotes synapse growth and can improve memory performance. In practice, magnesium (e.g. as citrate or bisglycinate, 200-400 mg in the evening) is often part of an orthomolecular nutrient plan as it also improves sleep quality and muscle function.

• Zinc

An essential cofactor of over 100 enzymes, important for cell division and immune function. The brain contains high concentrations of zinc, especially in the hippocampus (memory center). Zinc deficiency in old age is common and has been linked to depression and cognitive deficits. Animal studies show that zinc deficiency inhibits neurogenesis. Orthomolecular care is taken to ensure sufficient zinc intake (approx. 10-15 mg/day, e.g. via meat, nuts or as zinc orotate/zinc citrate). Caution: Zinc and copper are in balance – anyone taking high doses of zinc for a long time (>40 mg/day) should also supplement copper, otherwise there is a risk of copper deficiency.

• Selenium

As mentioned above, a trace element with an antioxidant effect. In addition to oxidative protection, selenium contributes to thyroid function – indirectly relevant as thyroid hormones affect the brain (hypothyroidism can mimic dementia symptoms). In Brazil, selenium has been successfully tested in combination with vitamin E to slightly slow cognitive decline. Ideal selenium status: ~120 µg/l in whole blood. In this country, many people do not achieve the 70 µg selenium/day from food recommended by the WHO, which is why a moderate supplement (e.g. 50 µg daily) is often useful.

• Iron

Iron deficiency is particularly common in women and leads to anemia – the brain is then less well supplied with oxygen, which leads to fatigue and reduced cognitive performance. However, there is also evidence that too much free iron in the brain promotes oxidative stress (iron deposits are found in Alzheimer’s plaques). A balance is important here: iron should only be supplemented if a deficiency is diagnosed, otherwise not.

• Copper

A double-edged sword – necessary for many enzymes, but pro-oxidant in excess. Some research suggests that a high copper level combined with low antioxidant protection could be unfavorable for the brain (keyword: copper/zinc imbalance). Copper is found in foods such as offal, nuts and cocoa. Supplementation only in cases of proven deficiency.

• Lithium

Lithium is primarily known as a psychotropic drug (in high doses) for bipolar disorders. However, in microdoses (less than 5 mg/day), lithium appears to have neuroprotective properties – it promotes the growth of nerve cells, stabilizes moods and reduces the phosphorylation of tau proteins (which clump together in Alzheimer’s disease). Studies from regions with different levels of lithium in drinking water show that Populations with more lithium in their water have fewer cases of dementia . In small clinical studies, a minimal-dose lithium preparation was even able to slow down the progression of mild cognitive impairment. Lithium is sometimes used orthomolecularly as a dietary supplement (e.g. lithium orotate 5 mg) – but always under medical supervision, as lithium can affect the thyroid and kidneys.

• Vitamin K

Recently, vitamin K (especially K₂) has also become the focus of brain research. This vitamin, known for blood clotting and bones, is also present in the brain. A lack of vitamin K₂ has been linked to increased brain ageing, probably due to influences on calcium deposits in blood vessels and the regulation of inflammation.

More research is being done on this; until then, you can aim for a good supply through green vegetables (K₁) and fermented foods such as matured cheese or natto (K₂).

As you can see, there is no single “miracle nutrient”, but a range of micronutrients that all make small contributions. Orthomolecular medicine therefore often relies on broad-based nutrient combinations – for example in the form of a high-quality multivitamin preparation as a basic safeguard, plus targeted additional doses depending on individual needs (e.g. extra vitamin D, omega-3, B vitamins, etc.). In fact, a recent study from the USA showed that taking a daily multivitamin could improve mental performance in seniors and delay cognitive decline by an average of around 2 years.

This caused a stir because previous studies had found no benefit from supplements in some cases. The difference may lie in the fact that new studies often specifically compensate for deficiencies and use combined nutrients. Apparently, older people do benefit from a supplementary supply of vital substances, especially if their normal diet is not optimal.

However, it is important to make a high-quality selection – the well-known saying “vitamins only help those who sell them” applies if you indiscriminately reach for cheap supplements or regard them as a substitute for a healthy lifestyle. When used correctly, micronutrients are a powerful tool for preventing dementia.

Genetic predisposition: APOE4 and co. – what does that mean?

Genetics is a significant risk factor for Alzheimer’s disease. Apolipoprotein E (APOE) is at the center of attention here. This gene exists in three variants: APOE2, APOE3 and APOE4. Each person inherits two copies (one from each parent). APOE4 is the variant associated with an increased risk of Alzheimer’s disease.

Carriers of an APOE4 copy have an approximately 3-fold increased risk of developing Alzheimer’s disease into old age, APOE4 double carriers (approx. 2% of the population) even have an 8-12-fold increased risk. APOE4 promotes beta-amyloid deposits in the brain and is often associated with higher cholesterol formation.

Does a risk gene mean that you “automatically” get Alzheimer’s? No. Important: Genetic predisposition is not fate! Many carriers of APOE4 remain mentally fit into old age – especially if they maintain a healthy lifestyle.

Conversely, people without APOE4 also develop Alzheimer’s disease, just statistically less frequently. The genes therefore determine the probability, not the certainty.

Orthomolecular approaches for APOE4: If you know that you carry an APOE4 gene (genetic test via a doctor or commercial DNA tests), you can take targeted preventive measures. Some studies indicate that APOE4 carriers benefit particularly strongly from lifestyle interventions.

In a large prospective study, individuals with high genetic risk but who adhered to 7 healthy lifestyle factors had ~40% lower dementia risk than gene risk carriers with unhealthy lifestyles. In other words, genes load the gun, but lifestyle pulls the trigger.

In orthomolecular terms, this means that APOE4 carriers should pay even closer attention to their diet and nutrient supply. There are indications that APOE4 people, for example, are less able to utilize vitamin D – which could explain why they often have low levels (one more reason to supplement).

Also, E4 carriers sometimes respond less well to omega-3 supplementation in studies, but this may be because they require higher doses or longer doses. Some experts recommend a more plant-based, Mediterranean diet with a moderate fat content for APOE4 carriers – as E4 also increases the cardiovascular risk, saturated fatty acids should be limited (animal fats) and fish, olive oil and nuts should be preferred.

Another genetic factor: homocysteine metabolism genes such as MTHFR. Variants in this gene can lead to folic acid not being activated well – in this case you can supplement with the active form (5-MTHF). So you see: personalization is important.

Should you get tested? APOE gene testing is controversial because there is still no targeted gene therapy. Many people don’t even want to know so as not to worry. On the other hand, knowledge can also mean power: If you know your increased risk, you can take countermeasures earlier. It should be an individual decision, ideally with genetic counseling.

Orthomolecular doctors sometimes have APOE tested if someone has a strong family history or wants to take optimal preventative measures. In any case, regardless of genetic status, a healthy lifestyle and micronutrient balance are always worthwhile. Perhaps even a little more for risk gene carriers.

Diagnostics in prevention: which tests are useful?

Before swallowing tons of pills on suspicion, serious orthomolecular medicine requires thorough diagnostics. This makes it possible to tailor treatment and monitor its success. Important diagnostic components in dementia prevention are

• Detailed anamnesis: incl. family history (cases of dementia?), own pre-existing conditions (e.g. diabetes, high blood pressure, depression – increase dementia risk), dietary habits, medication (some have an anticholinergic effect and influence memory).

• Cognitive status: If incipient problems are suspected, simple tests such as the Mini Mental Status Test (MMST) or clock test are carried out. In prevention programs such as VenaZiel Berlin, a computer test of memory performance (CANTAB or similar) can also be carried out to detect subtle changes at an early stage.

• Laboratory diagnostics (blood tests): A comprehensive nutrient profile is created. Important parameters:
  • Vitamin B12 (and preferably holo-transcobalamin as a bioavailability marker), folic acid, vitamin B6 – to assess the homocysteine metabolism.
  • Homocysteine: As described, an independent risk marker. Aim for values <10 µmol/L .
  • Vitamin D (25-OH): Status of the sunshine vitamin. Target: 30-50 ng/ml. At <20 ng/ml there is a need for action.
  • Omega-3 index: Percentage of EPA+DHA in the red blood cells. Value >8% is considered optimal protection (at <5% high deficiency). Alternatively: Total cholesterol to triglycerides ratio gives indirect indications, or directly fatty acid profile in serum.
  • Inflammation marker: hsCRP (inflammation value, should be as low as possible <1 mg/L), as chronic inflammation damages the brain.
  • Blood sugar, HbA1c: Elevated values indicate insulin resistance/diabetes, a major dementia risk factor. Take early countermeasures here (diet, metformin if necessary).
  • Thyroid values: TSH, fT3, fT4 – hypothyroidism can reduce cognitive performance.
  • Minerals/trace elements: Serum or whole blood levels of magnesium, zinc, selenium, copper. Selenium and zinc are particularly relevant; deficiencies should be corrected.
  • Blood lipids: Cholesterol profile, as high cholesterol levels in middle age can increase the risk of Alzheimer’s (and APOE4 has an effect here). However, don’t lower too aggressively in old age as the brain needs cholesterol – it’s the balance that matters.
  • Liver and kidney values: For general health and to rule out liver stress caused by many supplements, for example.

• Genetic testing: As mentioned, optional APOE gene status. MTHFR mutation can also be useful to know (in the case of a homozygous mutation, for example, active folate is needed instead of a simple folic acid preparation).
  Such genetic tests are self-pay services, but are often available in a specialized practice (such as an orthomolecular practice in Berlin).

• Special tests: Omega-3 index has already been included in blood tests. You can also determine the omega-6:omega-3 ratio – a high value (>15:1) indicates a pro-inflammatory diet (too much linoleic acid from sunflower oil, for example, and too little omega-3). The goal is a ratio of less than 5:1.

Oxidative stress marker: There are tests such as the determination of F2-isoprostanes or the GSH/GSSG quotient, but these are mostly used in research. More practical is indirect: e.g. measuring the activity of superoxide dismutase (an antioxidant enzyme) or simply CRP + clinical indicators.

Heavy metals: Some therapists test for exposure to heavy metals (mercury, lead), as these have a neurotoxic effect. A test can be particularly useful if there is a corresponding medical history (e.g. amalgam fillings, work in the battery industry, etc.). In the case of high exposure, a detoxification therapy could be considered, although the evidence for this is limited in relation to dementia.

• Imaging (rarely necessary in a preventive context): In special cases, an MRI of the brain can be done to detect vascular changes or incipient atrophy. PET scans for amyloid or tau are more research tools or for diagnosing existing dementia than for prevention.

The diagnostic data obtained allows for personalized intervention. For example, a patient with high homocysteine, low omega-3 and vitamin D deficiency can target these deficiencies. Or a patient with many signs of inflammation can also be prescribed an anti-inflammatory diet and curcumin, for example.

Diagnostics also prevent overtreatment: you don’t “blindly take everything”, but only what is necessary. You can also carry out follow-up checks to see whether values are improving (e.g. has homocysteine fallen after 6 months of B vitamins? Has the omega-3 index risen?)

Another frequently discussed value is the amyloid status in the cerebrospinal fluid or newer blood tests for amyloid/tau (such as the PrecivityAD test). These could indicate at an early stage whether pathological deposits are beginning.

However, there is currently no simple treatment for positive findings, apart from our lifestyle and nutritional approach, which we would pursue anyway. In future, however, such biomarker tests could help to identify people at risk, who should then receive even more vigorous preventive treatment.

Checklist: Important laboratory values & target ranges for prevention

(This table serves as a rough guide. Individual target values may vary depending on the laboratory and patient. The overall view of all values by an experienced specialist is decisive).

Combining holistic approaches: Ketogenic diet, intermittent fasting & plant substances

In addition to vitamins and minerals, the classic domains of orthomolecular medicine, there are other evidence-based, “alternative” approaches that work synergistically. These include special diets and herbal substances that can protect the brain. Successful dementia prevention draws the best from all these areas.

Ketogenic diet & intermittent fasting – fuel metabolism for the brain

Problem: Lack of energy in the brain. Alzheimer’s is described by some researchers as a condition in which the brain “starves” despite having a full stomach. The reason: insulin resistance and mitochondrial disorders mean that neurons do not use glucose efficiently. This is referred to as impaired brain metabolism.

Solution: Ketone bodies as an alternative source of energy. With a ketogenic diet (very low in carbohydrates, high in fat) or intermittent fasting (intermittent fasting, e.g. 16 hours a day), the body switches its metabolism and produces more ketones from fat.

Ketone bodies (such as beta-hydroxybutyrate) can be used as fuel by brain cells – even when glucose utilization is impaired. Studies on mildly cognitively impaired patients show that a ketogenic diet can lead to short-term improvements in memory.

Positive effects were also seen with known ketogenic interventions (e.g. MCT oil – medium-chain triglycerides that are converted into ketones): In one study, MCT oil slightly improved cognitive function in Alzheimer’s patients, but only in non-APOE4 subjects.

Intermittent fasting, for example in a 16:8 rhythm (16 hours fasting, 8 hours eating window per day), can have similar effects: It promotes autophagy (cell cleansing), reduces insulin spikes and inflammation. Animal models show less amyloid deposition during intermittent fasting, and initial human studies show improvements in alertness and mood.

A study published in the BMJ (2022) underlines general lifestyle factors: People with a healthy, active lifestyle (including a balanced diet and exercise) lived on average several years longer without dementia than those with an unhealthy lifestyle. Intermittent fasting certainly played a role here, as it is now popular.

Practice: Not everyone needs to follow a strict ketogenic diet. But a moderate reduction in fast carbohydrates (sugar, white flour) and regular breaks between meals (instead of constantly snacking) improve the body’s metabolic flexibility. Fasting for as little as 12 hours overnight (e.g. nothing to eat from 8 pm to 8 am) is a good start. If you can tolerate it, you can fast for 16 hours 1-2 days a week or occasionally take a longer fasting day.

It is important to still consume sufficient calories and nutrients during the eating phase – i.e. no malnutrition. A ketogenic diet (e.g. max. 20-50g carbohydrate/day, high fat content with healthy fats) is more of a therapeutic measure and should ideally be started under supervision.

Some patients take an “MCT cure” by adding MCT oil (e.g. isolated from coconut oil) to their coffee or smoothie every day to increase ketone production – but be careful, too much MCT can cause diarrhea.

Conclusion: A metabolism-friendly lifestyle with phases of low insulin levels appears to benefit the brain. It complements the orthomolecular supply: While nutrients provide the material, the right metabolic mode improves processing in the brain.

Plant substances (polyphenols, herbs) – the natural pharmacy for the brain

Nature offers a wealth of neuro-protective substances in fruits, vegetables, herbs and spices. Some of these have been specifically studied for their effect against Alzheimer’s:

• Curcumin (turmeric): The yellow ginger spice can cross the blood-brain barrier and has a strong anti-inflammatory and antioxidant effect. Animal studies show that curcumin can break down amyloid plaques and improve cognitive performance.
  In small human studies, highly bioavailable curcumin led to improvements in memory in older adults after 18 months. Curcumin has been part of Ayurvedic medicine for centuries – for prevention, 500-1000 mg of curcumin extract is often recommended (with piperine from pepper or as a special formula for better absorption).

• Resveratrol: A polyphenol from red grapes (also found in red wine, but only in low doses). Resveratrol activates so-called sirtuins (longevity enzymes) and descendants of autophagy.
  In a clinical trial (2015) with mild Alzheimer’s patients, high-dose resveratrol (1 g/day) showed more stable biomarkers (less drop in Aβ42 in the CSF, indicating slower disease).
  It also slightly improved everyday activities. Resveratrol somewhat mimics the effect of calorie restriction. It is used as a dietary supplement (trans-resveratrol) in doses of 100-500 mg, sometimes higher, although its bioavailability is limited. It is considered relatively safe, but may slightly affect oestrogen levels.

• Ginkgo biloba: The extract from the leaves of the ginkgo tree is approved in Germany as a drug for the treatment of dementia. Ginkgo improves microcirculation and has antioxidant effects.
  Study situation: Mixed, but a large meta-analysis showed that standardized ginkgo extract (EGb 761, 240 mg/day) has a significant positive effect on cognition and coping with everyday life in patients with mild to moderate dementia – comparable to classic medication, but with better tolerability.
  There is less data on prevention, but ginkgo is also used preventively due to its ability to promote blood circulation. Important: Only use highly concentrated extracts; teas etc. are too low in dosage.

• Bacopa monnieri: Also called Brahmi, an herb from Indian Ayurveda, traditionally used to enhance memory. Some modern studies on older adults without dementia actually showed improved memory performance after 12 weeks of Bacopa intake.
  Possible mechanisms: promotion of new synapse formation and antioxidation. Dose usually ~300 mg extract.

• Green tea (EGCG): The catechin EGCG from green tea reduces beta-amyloid formation in cell tests and has an antioxidant effect. Epidemiologically, frequent drinkers of green tea have a lower risk of cognitive decline.
  However, you would have to drink a lot of tea; extracts are available, but be careful in very high doses due to possible liver toxicity. However, a few cups of green tea a day are harmless and beneficial.

• Anthocyanins: Colorants from berries (blueberries, currants) have been shown to improve memory performance in studies with older adults, presumably by improving signal transmission in areas of the brain.
  “Berries every day” is a simple recommendation for brain health – it tastes good and is beneficial.

• Adaptogenic herbs: Rhodiola, ashwagandha, ginseng – they all have indirect effects, e.g. lowering stress hormones, protecting nerve cells, promoting concentration.
  For example, ashwagandha can reduce the deposition of plaques in animal models. In India, it is traditionally used to treat forgetfulness in old age.

The evidence for plant substances varies from robust (ginkgo) to preliminary (many others). However, they have the advantage of usually having a multi-modal effect (several points of attack at the same time) and being relatively safe.

In orthomolecular therapy, plant extracts are often given as a supplement to the micronutrients – depending on the individual profile: e.g. curcumin and resveratrol for a patient with a strong inflammatory environment; ginkgo for someone with circulatory problems and concentration disorders; or bacopa for stress sufferers with incipient forgetfulness.

Ketogenic plus plant substances? – Yes, it can be combined: For example, a Mediterranean ketogenic diet (“Green Keto” with lots of olive oil, vegetables, low-glycemic berries, turmeric spices) combines everything.

Another practical option is the MIND diet, which was specially developed to prevent dementia and combines a Mediterranean diet with a blood pressure-lowering DASH diet. Key points: Lots of green leafy vegetables, berries, nuts, olive oil, fish, some wine; little red meat, butter, cheese, sweets.

In observational studies, the MIND diet performed even better than the Mediterranean diet – it was associated with up to 53% lower Alzheimer’s risk with high adherence, and even moderate adherence resulted in ~35% risk reduction.

These nutritional and botanical approaches are highly synergistic with orthomolecular medicine: a nutrient-rich diet reduces supplement requirements and provides natural adjuncts, while targeted supplements fill gaps or provide therapeutic doses that would be difficult to achieve through diet.

Together, this results in a holistic prevention package that is much more effective than isolated measures.

Orthomolecular therapy in practice: example of a prevention plan

What could an orthomolecular prevention plan against dementia look like in practice? In practice, this is created individually – depending on the person’s laboratory values, risk factors and life circumstances. The following is an example of a possible plan for a fictitious patient, Mr. M., aged 60, who is cognitively healthy but would like to reduce his risk due to a family history (mother had Alzheimer’s) and slightly elevated homocysteine. Mr. M. underwent a comprehensive check-up, which revealed the following relevant findings: homocysteine 12 µmol/L (slightly elevated), vitamin D 22 ng/ml (insufficient), omega-3 index 4% (low), APOE4 single positive (i.e. medium genetic risk). Blood pressure and weight are borderline, otherwise all O.B. He complains of occasional word-finding difficulties and concentration problems under stress, but no manifest dropouts.

Therapy plan for Mr. M.:

• • Nutrition: Switch to a Mediterranean diet with a low-carb tendency. Specifically: lots of vegetables, salad and pulses at least 3 times a week; a handful of nuts daily; sea fish (salmon, mackerel) twice a week and otherwise poultry or vegetable proteins rather than red meat; use of olive oil as the main fat; reduction of sugar and white flour (sweets to max. 1 per week, drinks without sugar); moderate consumption of fruit (berries preferred due to lower fructose); max. 1 glass of red wine allowed with meals. In addition, introduction of 16:8 intermittent fasting on 5 days/week (dinner until 7 pm, first meal the next day at 11 am, only water/herbal tea in between). Mr. M. receives recipes and nutritional training for the MIND diet.
  • Movement: Target: 150 minutes of endurance training + 2x strength training per week. Specifically agreed: 3x/week 50 minutes of brisk walking or cycling; 2x/week light strength training at home (Theraband, own weight) of 30 minutes each. In addition, daily active everyday exercise (stairs, gardening etc.). Exercise works synergistically with omega-3 – both should normalize blood pressure and improve insulin sensitivity.
  • Stress management & sleep: Mr. M. reports a lot of stress at work. He is encouraged to try out relaxation techniques (e.g. 10 minutes of breathing exercises in the evening, progressive muscle relaxation or meditation with an app). The sleep target is 7-8 hours. If he has problems falling asleep, he can take low doses of magnesium in the evening. A “digital detox” is also recommended: no more work laptops late at night, but relaxing reading instead.

• Basic supplementation:

• • Multivitamin-mineral preparation: A high-quality preparation, 1× daily with breakfast, to ensure a basic supply of all vitamins (incl. B group, C, E, K) and minerals (magnesium, zinc, selenium, chromium etc.).
    Contains e.g. 50 µg selenium, 10 mg zinc, 100 mg magnesium, B vitamins in activated form (methylfolate, methyl-B12), vitamin E from mixed tocopherols 50 I.U., vitamin C 200 mg etc. 
  • Vitamin D₃ + K₂: 4000 I.U. vitamin D daily (drops) plus 100 µg vitamin K₂ to bring Mr. M.’s level rapidly from 22 ng/ml towards 40 ng/ml. VitD level check planned after 3 months.  
  • Omega-3 fish oil: High purity fish oil concentrate, 2 capsules of 1000 mg each, together they provide ~1200 mg EPA + DHA per day. Take with a meal (better absorption). Target: Omega-3 index in 6 months >8%.> 
  • Vitamin B complex in high doses: As homocysteine is elevated, Mr. M. is given a B-complex preparation with 50 mg B6, 800 µg folate (of which 400 µg 5-MTHF), 1000 µg B12 (methylcobalamin) – 1 tablet daily, initially for 6 months. This should reduce homocysteine.  
  • Magnesium citrate: 150 mg in the evening, to improve sleep and muscular relaxation (also good for the brain). 
  • Vitamin C: In addition to the 200 mg contained in the Multi, Mr. M. takes a vitamin C powder drink with 500 mg in the morning (e.g. as acerola powder in a smoothie). Reason: his fruit/vegetable consumption was very low and we want to compensate for this until new habits take hold. Vitamin C also as an immune-boosting measure (he is prone to infections).  
  • Phosphatidylserine: A specific nutrient (from lecithin), building block for cell membranes in the brain. Proven to help with concentration problems. 100 mg in the morning, 100 mg at midday as a capsule.

• Targeted additional “boosters”:

• • Curcumin extract: 500 mg of specially formulated curcumin (with piperine) twice daily. Background: Mr. M. has slightly elevated systemic inflammation levels (hsCRP was 2.5 mg/L). Curcumin is said to reduce inflammation and have a preventive effect in the brain. In addition, Mr. M. has mild osteoarthritis – curcumin also has an anti-inflammatory effect here. 
  • Ginkgo biloba extract (EGb 761): 120 mg in the morning, 120 mg in the evening (total 240 mg/day). The ginkgo is intended to support his slight forgetfulness and blood circulation. After 3 months he will report whether he feels more mentally alert. 
  • Alpha lipoic acid: 200 mg midday. A powerful antioxidant that is both fat and water soluble and crosses the blood-brain barrier. It regenerates other antioxidants (Vit C, E) and improves insulin sensitivity. Particularly useful for preventing prediabetes with its borderline fasting blood sugar (just under 100 mg/dl). 
  • Melatonin (optional if required): 2 mg sublingually at night if sleep is not restful despite magnesium. Melatonin is a sleep hormone and potent brain antioxidant, which could also reduce plaque formation. But first see if sleep can be improved in this way.

• Check-ups & coaching: After 3 months: Laboratory check (vitamin D, homocysteine, inflammation markers, omega-3 index if necessary). Previous supplements and doses are evaluated and adjusted if necessary (e.g. reduce vitamin D dose if target is reached; adjust B-vitamin dose according to homocysteine value).
  In addition, short cognitive test again to objectify subjective improvements. Mr. M. keeps a “brain journal” in which he notes how he assesses his memory performance and mood on a weekly basis – this helps to identify changes.

This plan is of course individual and only serves as an example. For another person, e.g. APOE4 status, diabetes or other concomitant diseases may require further measures.

For example, a diabetic might be given chromium, cinnamon extract or berberine to control blood sugar, or an APOE4 carrier would be recommended more polyphenols from green tea and berries, because these have a favorable effect on specific gene interactions.

It is important that such plans are holistic: Not only pills, but also lifestyle is taken care of. Many orthomolecular practices – for example integrative medical centers in large cities (such as the practice VenaZiel in Berlin) – therefore offer programs that include nutritional advice, exercise classes and stress management in addition to nutrient therapy.

In this way, the patient is taken by the hand and motivated to implement the numerous changes in everyday life.

Lifestyle measures: Foundation of brain health (diet, exercise, sleep, stress)

No nutrient in the world can fully compensate for poor lifestyle habits. Orthomolecular prevention always means optimizing the lifestyle basis – because micronutrients work best in a healthy environment. The most important pillars are:

Healthy nutrition – “brain food” on your plate every day

A balanced, micronutrient-rich diet is the basis. The aforementioned MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) combines the best of the Mediterranean diet with special brain food recommendations. Here are the key points as a reminder:

• Plenty of vegetables, especially green leafy vegetables: Lettuce/spinach/kale etc. are recommended daily. These provide folate, carotenoids and vitamin K. In one study, people who ate green vegetables daily had the cognitive fitness of people 11 years younger compared to those who almost never ate them. 
• Berries: At least 2× per week a portion of berries (blueberries, strawberries etc.). Berries are full of anthocyanins, which have been shown to be associated with better memory performance. 
• Nuts: ~5 portions per week. Nuts (walnuts, almonds, hazelnuts) provide vitamin E, healthy fats and polyphenols. 
• Pulses: Beans, lentils, chickpeas 3-4× per week – as a source of fiber and vitamin B, also good for blood sugar. 
• Whole grain products: instead of white flour. Fiber and B vitamins support the gut and brain (gut health also influences inflammation in the brain).  
• Fish: a fish meal at least once (preferably twice) a week (source of omega-3, selenium, vitamin D).  
• Poultry: Approx. 2× per week lean poultry instead of red meat. 
• Olive oil: as the main cooking oil/fat. It contains monounsaturated fatty acids and polyphenols, which have a vasoprotective and anti-inflammatory effect.  
• Spices and herbs: These are little micronutrient packages! E.g. rosemary, sage, turmeric, ginger – all have shown neuroprotective properties in studies. So feel free to add plenty of spices (unlike salt, which should be used in moderation). 
• Red wine in moderation: The MIND diet allows 1 glass of red wine per day, because of resveratrol and vascular protection. But be careful: More alcohol is harmful, and if you don’t drink alcohol, you don’t have to start. For many people, non-alcoholic grape juice or wine extract may also be an alternative.

To avoid: Butter/margarine >1 tsp per day, cheese >1 portion per week, sweets/pastries <5× per week, fried/fast food <1× per week. These restrictions are aimed at reducing saturated trans fats and sugar – critical for blood vessels and weight.

Studies have shown: The more you follow these recommendations, the lower the risk of Alzheimer’s disease. Even those who follow them moderately can benefit. Important: Get enough calories, but not too many – being overweight is a risk factor, so if in doubt, it is better to have a moderately negative energy balance to achieve a normal weight.

Physical exercise – the neuro-booster

Sport not only keeps muscles fit, but also the brain. Physical activity increases blood circulation in the head, promotes the formation of new nerve cells (neurogenesis) and releases growth factors (BDNF – Brain Derived Neurotrophic Factor, often referred to as “fertilizer for the brain”).

Just 150 minutes of moderate exercise per week can significantly reduce the incidence of dementia, according to the WHO. A long-term study showed that fit 50-year-olds had a significantly lower risk of dementia over the next 20 years than couch potatoes of the same age.

Exercise also has an indirect effect: it improves sleep, reduces stress, lowers blood pressure and regulates blood sugar levels – all of which in turn protect against Alzheimer’s disease. Endurance training combined with strength training appears to be particularly effective.

Endurance (walking, jogging, cycling, swimming…) improves cardiovascular fitness, strength training maintains muscle mass and mobilizes hormones such as irisin, which act on the hippocampus.

Everyday tip: Use a pedometer and try to take at least 7000-10000 steps per day. Stairs instead of the elevator, gardening, dancing – everything counts. Ideally, you should look for activities that are fun, then you are more likely to stick to them.

Balance and coordination exercises are also helpful for older or untrained people (reduces the risk of falling and also trains the brain). Qigong, Tai Chi or simply standing on one leg while brushing your teeth – there are many options.

Sleep – the brain’s garbage disposal

Amazing things happen during sleep: the brain “cleans” itself. The glymphatic clearance – a kind of channel system between the brain cells – is particularly active at night and flushes metabolic waste such as beta-amyloid out of the brain tissue. Anyone who sleeps poorly or too little runs the risk of this waste accumulating. In fact, people with chronic sleep deprivation have higher amyloid levels and an increased risk of dementia.

Good sleep (7-8 hours, deep non-REM phases) is therefore crucial. Tips for sleep hygiene: regular bedtimes, dark + cool bedroom, no screen light late at night (or blue light filter), no heavy meals directly before sleep, limited alcohol (it disrupts the sleep architecture despite sleepiness), possibly bedtime rituals such as reading or a warm bath.

Natural sleep aids can also be used: Herbal teas (valerian, hops, lemon balm), magnesium, lavender oil or, in persistent cases, melatonin in small doses. It is important to take sleep problems seriously and discuss them with your doctor if necessary – untreated sleep apnoea or chronic insomnia can affect brain health.

Stress management – protecting the brain from burnout

Chronic stress increases the hormone cortisol, which damages the brain in excess. The volume of the hippocampus shrinks with prolonged stress; memory and mood suffer. Stress also promotes inflammation and unhealthy behavior (poor diet, alcohol, etc.). Mental balance is therefore an important factor in preventing dementia.

Reducing stress is easier said than done, but there are techniques: regular relaxation exercises (meditation, yoga, autogenic training), cultivating hobbies, socializing, spending time in nature – all of these activate the parasympathetic nervous system, lower cortisol and give the brain a rest. Just 5-10 minutes of daily meditation has been shown to strengthen the gray matter in the prefrontal cortex (the area responsible for memory and attention).

Interaction with micronutrients here too: Certain nutrients (magnesium, B vitamins, omega-3) help the body to cope better with stress because they are involved in stress axis regulation. Conversely, stress reduction improves the effect of the nutrients because the need for them is not constantly increased.

Social and mental activity – “Use it or lose it”

An often overlooked lifestyle factor is mental and social stimulation. The brain wants to be used – lifelong learning, hobbies, puzzles, playing music or social interaction keep the neuronal networks active and promote cognitive reserve.

People with higher mental activity in old age show symptoms of dementia later and less frequently, even if pathological changes are present in the brain (theory of cognitive reserve).

Therefore: Stay curious and connected. Learn new things (a language, an instrument, a new computer system), play board games, join clubs, play with grandchildren – anything that challenges the brain. Social activity is particularly important: loneliness in old age is a major risk factor for dementia.

Studies show: Older people who live in isolation have a ~50% increased risk of dementia. Interacting with others keeps you mentally flexible and stabilizes your mood (depression, in turn, is a risk factor for dementia).

Tip: Combine exercise with mental activity – e.g. go hiking in a group, take dance classes (dancing trains your body and brain as you memorize step sequences), or attend adult education courses that also offer a social setting.

No smoking, alcohol only in moderation

This should go without saying, but it should be mentioned for the sake of completeness: smoking doubles the risk of dementia. Smokers have earlier vascular damage and less antioxidant protection.

The oxidative stress caused by smoking is poison for the brain. So: please live smoke-free. If you find it difficult – professional smoking cessation programs, hypnosis or medication can help. It’s worth quitting at any age.

Alcohol in high quantities damages the brain directly (alcohol-induced dementia) and indirectly (vitamin deficiencies due to alcoholism). Moderate consumption (see 1 glass of red wine) may be harmless or even slightly protective according to some studies, but beware: recent studies suggest that even 1-2 glasses a day reduce brain volume.

When in doubt, less is more. For many people, abstaining from alcohol or consuming less is the better choice.

As you can see, lifestyle and orthomolecular therapy go hand in hand. A study by the German Neurological Society has impressively shown that five simple measures – a healthy diet, sufficient exercise, mental training, not smoking and moderate alcohol consumption – together drastically reduce the likelihood of developing Alzheimer’s disease.

Women with all these lifestyle factors lived on average 4.6 years longer without dementia than those with an unhealthy lifestyle. Men even lived up to 5.7 years longer without dementia . And even those who only start to change their lifestyle in middle age can still turn the tide. Every single factor counts – but the more you do, the greater the protection .

For patients, this means that you have a large part of your brain health in your own hands! Orthomolecular medicine supports you in this by compensating for possible hidden deficiencies and guiding you as to which nutrients and measures make sense for you personally. It’s never too late (and rarely too early) to start.

FAQ – Frequently asked patient questions about orthomolecular dementia prevention

Question 1: Can vitamins really prevent Alzheimer’s?

There is no complete guarantee – Alzheimer’s is a multifactorial disease. But studies show that the risk can be significantly reduced and the onset delayed by years in some cases. Vitamins and other micronutrients play an important role in this, especially if there are deficiencies. For example, a good vitamin D level has been shown to reduce the risk of dementia, and B vitamins can slow down brain ageing.

However, the interaction is important: vitamins work best in combination with a healthy lifestyle (diet, exercise, mental activity). It can be said that orthomolecular measures can prevent or delay Alzheimer’s in many cases, especially if they are started early. However, there is no 100% protection – it merely reduces the probability and often gives extra healthy years.

Question 2: Which vitamins are most important against dementia?

The “top 3” are often mentioned: B vitamins, vitamin D and omega-3 fatty acids.

– B6, B12, folic acid because of homocysteine (high homocysteine damages the brain, B vitamins lower it).

– Vitamin D because of its comprehensive brain protection effects (anti-inflammation, immune modulation, amyloid degradation) and because deficiency is so common.

– Omega-3 (DHA/EPA), as they are building blocks of brain cells and reduce inflammation. Omega-3 deficiency leads to structural deficits in the brain, sufficient omega-3 is associated with better cognition.

Also very important: antioxidants (vitamin C, E, selenium) – they intercept free radicals that arise during the ageing process. Magnesium (for neuronal signal transmission) and zinc/selenium (for neurogenesis and antioxidant enzymes) should not be forgotten either.

Ultimately, the brain can only function optimally if all essential micronutrients are present in sufficient quantities. You should therefore ensure a broad spectrum, for example through a good diet or a combination preparation, and specifically increase the doses of the “critical” vitamins mentioned if necessary.

Question 3: Isn’t a healthy diet enough? Why swallow pills?

A very good question – in principle, a wholesome, nutrient-rich diet is the be-all and end-all. However, many people do not manage to keep all the necessary micronutrients in the optimum range through their diet alone.

Reasons: modern foods sometimes contain fewer nutrients (depleted soils, long storage periods), individual absorption disorders, unbalanced eating habits or increased requirements (stress, illness, old age). The absorption of vitamin B12 via the stomach, for example, decreases in old age. Vitamin D is also formed significantly less in the skin after 65.

Supplements can close such gaps. Studies such as COSMOS-Mind (2022) showed that a daily multivitamin was able to improve mental performance in older adults – which suggests that the normal diet is not always “enough” after all.

However, pills are no substitute for a healthy diet! The ideal combination is to eat a nutritious diet and take targeted supplements to make up for any deficiencies. Think of supplements as an insurance policy: you hope you won’t need them urgently, but you are covered in case your diet is lacking.

Orthomolecular experts always try to optimize the diet first before relying on many supplements – but they also know where supplements realistically make sense (e.g. vitamin D in our latitudes almost always).

Question 4: Is orthomolecular medicine scientifically recognized? Or esoteric?

Orthomolecular medicine straddles the line between conventional and complementary medicine. Many of its recommendations are based on hard science – e.g. studies on vitamins that have been published in top journals.

In neurology guidelines, lifestyle and diet now appear as preventive measures (the German Society of Neurology, for example, emphasizes diet, exercise and non-smoking for the prevention of Alzheimer’s). As far as the high-dose therapy of some vitamins is concerned, conventional medicine is sometimes more cautious because large RCTs are not always available.

However, high-dose B vitamins, for example, are prescribed by GPs in cases of proven deficiency or homocysteine elevation. Vitamin D supplementation in cases of deficiency is standard. Conclusion: The basic principles of orthomolecular prevention (correcting deficiencies, healthy diet, lifestyle) are scientifically recognized.

Some extreme applications (mega megadoses without indication) are viewed critically by evidence-based medicine. However, a reputable orthomolecular physician works in an evidence-based manner, i.e. he relies on studies and measures successes instead of treating into the blue. He will, for example, use laboratory values, name references and not sell “secret recipes” without proof.

All in all, it can be said that orthomolecular medicine is scientific and professional when it is used in addition to conventional medicine and is based on the latest research – as described in this article.

Question 5: At what age should you start dementia prevention?

Ideally as early as possible with a brain-healthy lifestyle – because changes in the brain can begin decades before symptoms appear. In practice, prevention is usually considered from the age of 50+, as this is when the risk increases and measurable risk factors (high blood pressure, cholesterol, etc.) become common. But it is also worth establishing good habits in your 40s and even 30s: Exercise your brain, eat a balanced diet, get stress under control.

This creates a high “cognitive reserve”. If you build up more synapses and brain volume when you are young, you can lose more in old age before it becomes clinically noticeable. The following applies to specific orthomolecular measures (e.g. regular supplements): for younger people without symptoms, a good diet and a general multivitamin is often sufficient, provided there is no particular deficiency. However, you should have your nutrient status checked (B12, D, omega-3, etc.) and any gaps filled by the age of 60 at the latest.

If you already have mild forgetfulness or if dementia runs in the family, you should become very active from the age of 50 – like Mr. M. in our example. Important: Prevention can also help to slow down the progression of dementia in the early stages. Even those who already have the first symptoms (MCI – mild cognitive impairment) can often delay or stop the conversion to Alzheimer’s with intensive measures.

After a diagnosis of dementia, it is of course more difficult, but even then a healthy lifestyle does no harm – it improves quality of life and can reduce comorbidities.

Question 6: Can orthomolecular therapy cure or reverse Alzheimer’s disease?

That would be too good – it is currently not possible to cure Alzheimer’s in the sense of completely eliminating it. However, there are individual case reports (Dale Bredesen et al.) where very extensive lifestyle and nutritional interventions have brought patients in the early stages back into the normal range.

However, these are exceptions and require an extremely consistent approach (special diet, dozens of supplements, daily training, etc.). Realistically, orthomolecular therapy can slow down the progression and alleviate symptoms.

In mild stages, a partial improvement is also possible – for example, a patient with deficiencies can think more clearly after correction than before. But in advanced dementia, it is unlikely that lost abilities will be completely restored. Orthomolecular measures can then at best increase well-being or slow down the decline somewhat. This is why the focus is on prevention and early intervention.

If you start early, it is theoretically possible to delay the onset of the disease to such an extent that you die “in old age with a clear head” without ever having developed manifest dementia – in other words, to prevent Alzheimer’s by preventing its onset during your lifetime. That is the goal of prevention.

Question 7: Are there any risks associated with taking so many vitamins and supplements?

In general, vitamins and minerals are well tolerated in normal doses. Water-soluble vitamins (B, C) are excreted in excess – overdosing problems rarely occur here (at most diarrhea with extremely high doses of vitamin C).

Fat-soluble vitamins (A, D, E, K) and minerals can accumulate in the body – therefore the dosage must be monitored. For example, too much vitamin D (over 10,000 I.U. daily for months) can lead to calcium overload. Too much vitamin A can damage the liver and bones. Excessive iron, zinc and selenium can cause symptoms of poisoning.

Therefore, dietary supplements should be taken under medical supervision, at least in high doses. The doses mentioned in our article are usually within the safe range and are often only temporary “cures”. If laboratory values are within the normal range, the dose can be reduced.

Another risk is that supplements can interact with medication: e.g. high doses of vitamin E or omega-3 can increase blood thinning – relevant for Marcumar patients. Ginkgo can also increase the risk of bleeding, especially in combination with blood thinners.

Some herbs affect the liver enzymes (St. John’s wort, for example, reduces other drug levels). Therefore, always inform your doctor what you are taking so that he or she can check for interactions.

In addition, many preparations on the free market are unregulated in terms of quality. There have been cases where products did not have the stated content or were contaminated with harmful substances.

You should therefore choose high-quality, certified products – if in doubt, ask at the pharmacy or use brands recommended by your doctor.

However, if you stick to the recommended dosages and monitor them regularly, the risk is low. Most people tolerate the micronutrients mentioned well and experience positive effects (more energy, better mood) rather than side effects. If you are unsure, it is better to consult a specialist (doctor/health practitioner with experience in orthomolecular medicine), especially if you want to combine several products.

Question 8: What is homocysteine all about? Should I have my homocysteine level measured?

Yes, homocysteine (HCY) is an important risk marker and can be easily measured by blood test. A high homocysteine level damages blood vessels and neurons and is considered an independent risk factor for dementia.

In particular, it increases the risk of Alzheimer’s disease by inhibiting neurogenesis and promoting amyloid deposits. The main cause of high HCY is a lack of B vitamins (B6, B12, folic acid), which break down HCY. So by measuring HCY you can indirectly see if you have enough of these vitamins.

If your homocysteine is e.g. >10 µmol/L, it would be advisable to supplement B vitamins – studies then show a reduction in HCY and often a parallel slowdown in brain degradation. Many neurologists now routinely measure homocysteine in memory patients. In any case, it makes sense for prevention, especially if there is a family history of stress or if you are not eating an optimal diet.

The test doesn’t cost the earth (~€20-30) and provides valuable information. The aim is to bring homocysteine into the single-digit range (approx. 7-9). So yes: Have HCY determined – if the value is elevated, you can achieve a lot with simple means (B-complex).

Question 9: How can I find a doctor or therapist who is familiar with this?

You can search for keywords such as “orthomolecular medicine doctor [your city]” or “holistic Alzheimer’s prevention”. Many larger cities have specialty practices or centers.

For example, the practice VenaZiel in Berlin offers orthomolecular prevention programs, which include detailed check-ups, laboratory analyses and individual vital substance plans. Specialized memory outpatient clinics at hospitals are also increasingly open to nutrition and nutrient topics – it is worth bringing this up at your appointment.

Otherwise, you can contact the German Society for Preventive Medicine or Orthomolecular Medicine e.V., which often have lists of therapists. It is important to find someone who has both the medical know-how (laboratory diagnostics, conventional medicine) and the orthomolecular expertise. A good approach: ask your GP whether he or she is prepared to test relevant blood values, for example, and discuss a supplementation strategy with you.

Many GPs are now aware of vitamin D & Co. – even if they don’t advertise it openly, they may support you if you express the desire yourself.

Question 10: Does the health insurance company pay for such prevention programs or nutrient tests?

Unfortunately, we are not quite there yet. Most preventive check-ups specifically for micronutrients are individual services (IGeL). Statutory health insurance companies generally do not pay for vitamin D tests, homocysteine etc. as long as there is no illness (they do pay for manifest vitamin D deficiency or anemia, but not for “preventive care”).

However, there are exceptions: Some health insurance companies reimburse health check-ups as part of bonus programs, or they cover part of preventive courses (e.g. nutritional advice, sports courses). Laboratory profiles are also sometimes offered as a “health check-up plus” for a private co-payment.

The following applies to supplements: Prescription supplements (such as high-dose folic acid 5mg for proven anemia) are covered, but over-the-counter supplements are unfortunately not. Vitamin D, for example, you usually have to buy yourself (unless a severe deficiency is diagnosed).

If you have private insurance, you often have more options – many private health insurers reimburse useful preventive examinations or alternative treatment methods, depending on the tariff. It’s best to find out beforehand.

Bottom line: yes, you have to invest something in your own health, but think about the “return on investment” – even if you spend a few hundred euros a year on prevention, this can add up to several years of life in good mental health. And the costs of dementia (financial and emotional) are many times higher.

Some patients consider supplements as part of their monthly health expenditure, similar to a gym membership. Of course, you shouldn’t spend money pointlessly – invest in a targeted manner where there is a need. A start could be a one-off preventive check-up (laboratory costs may be €200-300 depending on the scope). The results can then be used to take targeted action.

Question 11: Does a ketogenic diet or intermittent fasting really help the brain?

There is growing evidence for this. A ketogenic diet can counteract the energy depletion problem in the ageing brain by providing alternative energy (ketones). In mild cognitive impairment, ketogenic diets showed improvements in memory tests within a few months.

Intermittent fasting promotes similar mechanisms (ketosis phases, autophagy) and has delayed Alzheimer’s in animal models. There are positive reports in humans: for example, patients with MCI who did 12 weeks of 5:2 intermittent fasting performed better in cognitive tasks than a control group.

And as mentioned, combination of omega-3 + exercise was particularly effective; fasting mimics some effects of exercise at the cellular level. Many experts are convinced that periodic periods of starvation allow the brain to “clean house” by breaking down damaged proteins and stimulating repair.

However, strict ketosis is not sustainable for everyone and can have side effects at the beginning (“keto flu”). A middle ground (low-carb, healthy-fat + occasional fasting) is probably workable and sufficient for the majority. So yes: metabolic adjustments such as fasting/keto can be part of the prevention plan, but must fit in with your lifestyle.

If you want to try it, do it under supervision and listen to your body. And remember to still get enough micronutrients (with strict keto possibly extra electrolytes and vitamins, as you lose a lot of water and minerals at the beginning).

Question 12: I have heard that aluminum (e.g. from pots or deodorants) causes Alzheimer’s disease. Is that true?

Aluminum was a popular theory for a long time because aluminum was found in the plaques. Today, it is assumed that aluminum is not the main cause, but a side effect. So far, there is no clear evidence that normal everyday aluminum (in deodorant, cookware) causes dementia.

Extreme exposure (to kidney disease or occupational exposure) can damage the nervous system, yes. But the average person probably doesn’t need to be terrified of aluminum.

Nonetheless: As a precaution, you can avoid aluminum deodorants and avoid aluminum tableware, especially do not pack anything sour in aluminum foil, etc., as this can dissolve aluminum. It doesn’t hurt to be careful – but it would be wrong to see aluminum as the sole culprit.

The disease is much more complex. To be on the safe side, orthomolecular medicine tends to rely on a sufficient supply of silicon (e.g. in the form of silica gel or silica-rich mineral water), as silicon can bind aluminum and eliminate it from the body. But these are subtleties.

To summarize: The aluminum hypothesis is controversial; the known factors (genes, diet, blood vessels, diabetes, etc.) are more important.

Question 13: Do Ginkgo & Co. really help? You hear so many different things.

Ginkgo biloba has been well studied. In cases of existing moderate dementia, it improves symptoms (memory, everyday competence) similarly well to classic medication, but without the side effects – this has been relatively well documented in meta-analyses.

As a purely preventive measure, the data is sparse; however, there are some studies where people with mild complaints remained more stable over the years with ginkgo than without it. Ginkgo promotes blood circulation and has an antioxidant effect, which cannot do any harm. It is important to take the correct dosage (240 mg/day) and to take it for a sufficiently long time (the effect builds up over weeks).

Other remedies: Curcumin has great lab effects, but bioavailability in humans is the hurdle – newer formulations should solve this, initial studies are positive (better alertness in older adults). Resveratrol has improved some biomarkers in Alzheimer’s studies and is promising overall as an anti-ageing molecule (cardiovascular protection etc), but we still need more data for concrete recommendations.

Bacopa shows benefits in small trials for memory, especially in cases of stress. Vinpocetine (from the periwinkle) is often used in Eastern Europe for cerebral circulation. Huperzine A (an alkaloid from a moss) has a similar effect to Aricept (inhibits the breakdown of acetylcholine) and showed cognitive improvements in Chinese studies – however, it is not approved as a medicine in Germany and can only be obtained as a supplement from the USA, which we do not generally recommend without medical supervision.

In short, many plant substances can have a supportive effect, but they are often not as well studied as vitamins. In practice, they are combined to cover different mechanisms (e.g. ginkgo + omega-3 + curcumin).

Patient reports vary – for some it helps noticeably (better memory, more alert feelings), others notice little. Individual biochemistry plays a role here. The orthomolecular approach is often based on the principle “it’s worth a try”: If a remedy is plausible and safe, you can try it for 3-6 months and see if it does anything subjectively or objectively (test values).

If not, you can leave it out. Important: choose good quality (e.g. the standardized EGb761 for ginkgo, a formulated version for curcumin). And don’t start everything at once, otherwise you won’t know what’s working. With professional guidance, you can make a sensible plan.

Question 14: What are the chances of success if I implement all this?

This is difficult to quantify because it depends on the individual situation. But let’s assume you are 60, healthy but with some risk factors (perhaps APOE4 or mild hypertension, etc.). If you consistently adjust your lifestyle and optimize micronutrients, you could halve your risk of dementia or better – epidemiological models suggest this.

Even if it is “only” a matter of a delay: even 5 years of healthy time gained is an extremely high quality of life. Perhaps you would have fallen ill at 75 if no measures had been taken, but not until 80 or 85, or not at all because you die of something else before then. This is of course hypothetical, but it shows the dimension.

Basically, the aim is to get older without the typical cognitive impairments. In studies with combined interventions (e.g. the FINGER study in Finland), significant cognitive improvements were already evident in the intervention group vs. the control group after 2 years – that is success in a short time.

Measuring success in the long term is difficult because you never know what would have happened if you had done nothing. But you can check intermediate steps: normal laboratory values achieved? Risk factors eliminated? Memory tests stable? If so, you are on the right track.

And even if dementia does occur at some point, you start from a higher level and may have a milder course because your body is fitter overall.

One aspect: patients who take preventive action often report general health improvements – more energy, better mood, fewer infections, more stable blood pressure, more ideal weight. These are all indirect benefits that also reduce the risk of dementia.

But we must not be unrealistic either: For example, if someone has a high genetic burden and has lived a very unhealthy life up to the age of 70, it may be possible to reduce the risk, but the disease may still occur at some point – perhaps a little later or in a milder form. Then you should look at it this way: Every month/year gained in clarity is valuable.

To summarize: The prospects of significantly reducing your personal risk are good. Some researchers believe that up to 40% of all dementias could be avoided through optimal prevention.

That’s almost half! So why not seize this opportunity? It requires discipline and commitment, yes – but science increasingly supports the effectiveness of this approach. We are not helplessly at the mercy of the disease.

In the words of a neurologist: “Ultimately, dementia prevention is the sum of many small everyday decisions in favor of your own brain health.” Make these decisions in your favor – your future self will thank you.

Scientific references and study situation

Orthomolecular dementia prevention is based on a large number of studies from nutritional medicine, neurology and gerontology. Here is a selection of important scientific sources that were mentioned or used in this article:

• Neurology 2014 (Littlejohns et al.) – Prospective study: Link between vitamin D levels and dementia risk. Result: severe vitamin D deficiency doubles the risk of dementia and Alzheimer’s disease.
• Alzheimer’s & Dementia 2023 – Study by University of Calgary & Exeter: Vitamin D Supplementation and Dementia Incidence. Result: ~40% lower dementia rate over 10 years in vitamin D users >70 y. .
• BMJ 2022 (Dhana et al.) – Cohort study on lifestyle and Alzheimer’s disease. Found 5 lifestyle factors that significantly extend dementia-free lifespan (including diet, exercise, cognitive activity, non-smoking, moderate alcohol consumption).
• PNAS 2013 (Smith et al.) – Randomized VITACOG study: B vitamins vs placebo in mild cognitive impairment. Result: Homocysteine reduction by B6/B12/folate slowed brain atrophy by ~30%, especially at high omega-3 levels.
• JAMA Neurology 2017 (Soininen et al., LipiDiDiet) – Multinutrient trial (Souvenaid) in prodromal Alzheimer’s disease: 2 years no significant slowing of cognitive decline, but 36-month follow-up showed benefit on secondary endpoints. Shows: Nutrient intervention may be effective in the longer term .
• Neurology 2002 (Framingham Study) – Homocysteine as a risk factor for dementia. Elevated homocysteine doubles the risk of dementia over 8 years of follow-up.
• Frontiers in Neuroscience 2022 – UK Biobank analysis: regular fish oil intake and dementia risk. Result: significantly less all-cause dementia (HR 0.91) and vascular dementia (HR 0.83) in fish oil users, no effect on Alzheimer’s alone (HR ~1.0).
• Journal of Alzheimer’s Disease 2018 – Meta-analysis: Ginkgo biloba in dementia. Result: significant improvement in cognitive symptoms with 240 mg EGb761/day compared to placebo (mainly mild-moderate dementia).
• The Lancet 2020 (Livingston et al.) – Lancet Commission on Dementia Prevention: identifies modifiable risk factors (education, hypertension, obesity, diabetes, smoking, depression, social isolation, physical inactivity, hearing loss) – about 40% of dementias could be prevented or delayed by addressing these factors. Orthomolecular approaches have an effect on many of these factors (e.g. blood pressure via nutrition, depression via nutrient therapy).
• ISOM Review 2017 (Brown, Orthomolecular Medicine and Alzheimer’s) – Review paper: Advocates multi-modal nutrient and lifestyle therapy for Alzheimer’s, with reference to initial case reports in which an individualized protocol (Bredesen’s MEND/ReCODE) achieved cognitive improvements and even reversion of early Alzheimer’s . Underlines the importance of personalized orthomolecular medicine.
• Nature 2005 (Lahiri et al.) – Animal study: Curcumin reduces amyloid plaques in mice by ~50%, improves memory performance. Laid foundation for curcumin hope in humans. Clinical trials (Small et al. 2018) confirmed at least mood-enhancing and moderate cognitive effects with long-term intake of bioavailable curcumin.
• Alzheimer’s Research & Therapy 2014 – Review: Omega-3 and B-vitamins synergy in brain aging (Jernerén et al.). Shows interdependence of the two nutrient classes for the reduction of brain atrophy.

(Further sources: Beyreuther K. Interview 2017 on micronutrients ; Cardoso et al. Clin Interv Aging 2013 – Review on micronutrient deficiencies in Alzheimer’s disease; Cochrane 2018 Review – Supplements and dementia prevention ; as well as various guidelines and reference books).

The overall evidence shows a consistent picture: diet and micronutrients significantly influence the risk of dementia. There is epidemiological evidence (observational studies) as well as mechanistic explanations and increasingly intervention studies that demonstrate positive effects.

Although many questions remain unanswered (e.g. optimal combinations, exact dose-response relationships), we should not wait: the current state of knowledge absolutely justifies taking preventive action – according to the motto of Alzheimer’s prevention experts: “Prevention is better than cure.” Or as Prof. Konrad Beyreuther puts it: Dementia prevention is not witchcraft – you just have to eliminate the known risk factors and apply the right protective factors. Orthomolecular medicine offers a sound roadmap for this.