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 laureate Linus Pauling. The term literally means “the right molecules” – referring to providing the body with optimal concentrations of natural micronutrients (vitamins, minerals, amino acids, fatty acids, etc.) to maintain health and prevent diseases.

Pauling and collaborators such as psychiatrist Abram Hoffer discovered early on that biochemical imbalances and nutrient deficiencies contribute to the development of many diseases. The goal of orthomolecular medicine is to correct these imbalances through targeted nutritional supplementation and thereby 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 specifically deals with the role of nutrients in mental health and brain function. It takes into account that each person possesses a unique genetic makeup and biochemistry, which 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 dismissed as an “alternative” method, but numerous studies now support the importance of micronutrients in prevention and therapy.

Especially in complex diseases like Alzheimer’s, there is growing recognition that multi-component approaches may be more successful than monotherapies. After previous Alzheimer’s medications have largely disappointed, 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, leading to a loss of cognitive abilities. Typical features include protein deposits in the brain – beta-amyloid plaques outside the cells and tau fibrils within the neurons.

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 constantly generates 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. Some nutrients have anti-inflammatory effects – e.g., omega-3 fatty acids (DHA, EPA) from fish oil, which serve as precursors to inflammation-resolving mediators.
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 accelerated brain atrophy.

Homocysteine damages blood vessels and promotes neurodegeneration, even inhibiting the formation of new nerve cells (neurogenesis) in the hippocampus. The cause of elevated homocysteine levels is usually a deficiency 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 (chemical messengers 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-Korsakoff syndrome) leads to severe memory impairments. In small Alzheimer’s studies, cognitive functions improved with high-dose thiamine administration.

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

 

• Amyloid clearance

Another goal is to promote the disposal of amyloid proteins. The brain’s immune system (microglia) and specific enzymes are involved in this process.

Vitamin D has proven important here: it modulates the immune response and, in laboratory experiments, promotes the uptake and degradation of amyloid-β by immune cells. A good vitamin D status could thus help 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 needed for myelination (protective sheath of nerve fibers), DNA repair, and neurotransmitter formation.

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: A breakthrough was the VITACOG study in Oxford: elderly people with mild memory problems received high-dose B₆, B₁₂ and folic acid or a placebo. Result: In the B vitamin group, the brain (hippocampal 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 analysis 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 homocysteine levels checked in their blood. If this is elevated (>10–12 µmol/L), B vitamin supplementation should be considered after consulting a doctor, typically: folic acid 400–800 µg, B₆ approx. 20 mg, B₁₂ approx. 500–1000 µg daily.

Combination preparations are often used. Even without elevated homocysteine, moderate supplementation can be useful if, for example, there is a low-normal B₁₂ level (<300 pg/ml) or a diet low in B vitamins (typical for vegetarian/vegan diets, here especially pay attention to B₁₂!).

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 studies with omega-3 capsules have yielded mixed results. Some smaller studies in patients with mild memory impairments 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 seafood once or twice a week or alternatively take a high-quality omega-3 supplement. A common dosage range for prevention is about 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. At very high intake, they can slightly affect blood clotting (caution with blood thinners, consult a 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 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 administration 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 observed for 10 years – those who took vitamin D supplements developed dementia approximately 40% less often than non-supplementers. 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 vitamin D levels (25-OH-D) checked in the blood. Optimal values for various health effects are considered to be in the range of 30–50 ng/ml (75–125 nmol/l).

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.

Since vitamin D is stored in the body, overdoses should be avoided (over 100 ng/ml long-term is not advisable). However, in prevention, safe dosages 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 ensure that their patients have a good vitamin D status.

 

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 body weight, consumes ~20% of total oxygen – constantly producing reactive oxygen species as a byproduct. 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 (fruits, vegetables, nuts) suffer less frequently from cognitive impairments. For example, a high dietary vitamin E intake 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.

In addition, orthomolecular medicine allows for high-dose vitamin C to be taken during periods of increased stress (e.g., 500 mg to 1 g/day, possibly up to 2 g divided – higher amounts may have a laxative effect). Vitamin E should ideally be supplemented as mixed tocopherols/tocotrienols (natural vitamin E consists of 8 forms); a dose of 100–400 IU 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 IU), as it can affect coagulation.

Selenium: In Europe, selenium deficiency is not uncommon, 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 overdose.

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

 

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

In addition to the prominent vitamins and omega-3s, 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: Law of the Minimum 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 zinc concentrations, 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 medicine focuses on ensuring adequate zinc intake (about 10–15 mg/day, e.g., through meat, nuts, or as zinc orotate/zinc citrate). Caution: Zinc and copper are in balance – if you take high doses of zinc for a long time (>40 mg/day), you should supplement with copper, otherwise there is a risk of copper deficiency.

 

• Selenium

As mentioned above, a trace element with antioxidant effects. In addition to oxidative protection, selenium contributes to thyroid function – indirectly relevant because thyroid hormones affect the brain (an underactive thyroid can mimic dementia symptoms). In Brazil, selenium in combination with vitamin E has been successfully tested to slightly slow down cognitive decline. Ideal selenium status: ~120 µg/l in whole blood. In this country, many do not reach the 70 µg selenium/day recommended by the WHO from food, 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). Balance is important here: iron should only be supplemented if a deficiency has been diagnosed, otherwise not.

 

• Copper

A double-edged sword – necessary for many enzymes, but pro-oxidative in excess. Some research suggests that a high copper level with simultaneously low antioxidant protection could be unfavorable for the brain (keyword: copper/zinc imbalance). In food, copper is found in offal, nuts, and cocoa, for example. Supplementation only in case of proven deficiency.

 

• Lithium

Lithium is primarily known as a psychotropic drug (in high doses) for bipolar disorders. However, in microdoses (under 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). Studies from regions with different lithium content in drinking water show that populations with more lithium in the water have fewer cases of dementia. Even in small clinical trials, a minimally dosed lithium preparation was able to slow the progression of mild cognitive impairment. Orthomolecular medicine sometimes uses lithium as a dietary supplement (e.g., lithium orotate 5 mg) – but this is always accompanied by a doctor, as lithium can affect the thyroid and kidneys.

 

• Vitamin K

Recently, vitamin K (especially K₂) has also come into focus in brain research. This vitamin, known for blood clotting and bones, is also present in the brain. A deficiency of vitamin K₂ has been linked to increased brain aging, likely due to its influence on calcium deposits in blood vessels and inflammation regulation.

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 can be seen, there is no single “miracle nutrient,” but rather a range of micronutrients, all of which 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 basic protection, plus targeted additional doses depending on individual needs (e.g., extra vitamin D, omega-3, B vitamins, etc.). Indeed, a recent study from the USA showed that daily multivitamin intake in seniors could improve cognitive performance and delay cognitive decline by an average of about 2 years.

This caused a stir because earlier studies sometimes found no benefit from supplements. The difference may lie in the fact that new studies often specifically address deficiencies and use combined nutrients. Apparently, older people do benefit from supplementary vital nutrient provision, especially if their normal diet is not optimal.

However, a high-quality selection is important – the well-known saying “vitamins only help those who sell them” applies when you randomly resort to cheap preparations or consider them a substitute for a healthy lifestyle. Used correctly, micronutrients are a powerful tool for dementia prevention.

 

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

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

Carriers of one APOE4 copy have an approximately 3-fold increased risk of developing Alzheimer’s in old age, APOE4 double carriers (approx. 2% of the population) even an 8-12-fold increased risk. APOE4 promotes deposits of beta-amyloid 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 destiny! Many APOE4 carriers remain mentally fit into old age – especially if they maintain a healthy lifestyle.

Conversely, people without APOE4 also develop Alzheimer’s, but statistically less often. So the genes determine the probability, not the certainty.

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

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

 

Orthomolecularly speaking, this means: APOE4 carriers should pay even more attention to their diet and nutrient supply. There is evidence that APOE4 individuals, for example, utilize vitamin D less effectively – which could explain why they often have low levels (one more reason to supplement).

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

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

Should one get tested? APOE gene testing is controversial because there is no targeted gene therapy yet. Many do not want to know to avoid worrying. On the other hand, knowledge can also mean power: those who know their increased risk 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 prevent optimally. In any case, the following applies: Regardless of the genetic status – a healthy lifestyle and micronutrient balance are always worthwhile. Perhaps a little more for risk gene carriers.

 

Diagnostics in prevention: which tests are useful?

Before swallowing masses of pills on suspicion, a thorough diagnosis is required in serious orthomolecular medicine. This allows for tailored treatment and monitoring of success. Important diagnostic building blocks in dementia prevention are:

• Detailed anamnesis: incl. Family history (dementia cases?), pre-existing conditions (e.g., diabetes, high blood pressure, depression – increase dementia risk), dietary habits, medications (some have anticholinergic effects and influence memory).

 

• Cognitive status: If initial problems are suspected, simple tests such as the Mini-Mental State Examination (MMSE) or clock drawing test are performed. In prevention programs, such as at VenaZiel Berlin, a computer-based memory performance test (CANTAB or similar) can also be carried out to detect subtle changes early.

 

• Laboratory diagnostics (blood tests): Here, 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 interacts here). However, do not lower it too aggressively in old age, as the brain needs cholesterol – it depends on the balance.
  • 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. Knowing your MTHFR mutation can also be useful (e.g., with a homozygous mutation, active folate is needed instead of a simple folic acid supplement).
  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 was already mentioned under blood tests. In addition, you can determine the omega-6:omega-3 ratio – a high value (>15:1) indicates an inflammatory diet (too much linoleic acid from, e.g., sunflower oil, too little omega-3). The goal is a ratio below 5:1.

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

Heavy metals: Some therapists check for heavy metal exposure (mercury, lead), as these have neurotoxic effects. Especially with relevant medical histories (e.g., amalgam fillings, work in the battery industry, etc.), a test can be useful. In cases of high exposure, chelation therapy could be considered, although evidence for this in relation to dementia is limited.

• 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 allow for personalized intervention. For example, a patient with high homocysteine, low omega-3, and vitamin D deficiency can specifically address these deficits. Or a patient with many signs of inflammation may additionally be prescribed an anti-inflammatory diet and, for example, curcumin.

Diagnostics also prevents overtherapy: you don’t take “everything blindly”, but what is necessary. You can also make follow-up checks to see if values improve (e.g. has homocysteine decreased after 6 months of B vitamins? Omega-3 index increased?).

An often-discussed value is also the amyloid status in CSF or newer blood tests for amyloid/tau (like the PrecivityAD test). These could indicate early on whether pathological deposits are beginning.

However, there is currently no simple therapy for a positive finding, except for our lifestyle and nutrient approach, which we would pursue anyway. In the future, such biomarker tests could help to identify people at risk who should then be treated even more energetically preventively.

 

Checklist: Important laboratory values & target ranges for prevention

Parameters	Target value / optimum range	Meaning
Vitamin B12 (Holo-TC)	> 50 pmol/L (Holo-TC) or B12 > 300 pg/ml	Nerve protection, homocysteine reduction. Deficiency increases the risk of dementia.
Homocysteine	< 10 µmol/L (ideal ~7-8)	High value = B6/B12/folate deficiency; neurotoxic risk factor .
Omega-3 index	> 8% (RBC)	Proportion of DHA/EPA in the blood; higher index associated with lower risk of dementia .
Vitamin D (25-OH)	30-50 ng/ml (75-125 nmol/L)	Below 20 ng/ml increased risk of cognitive decline .
hs-CRP (inflammation)	< 1 mg/L	Marker for silent inflammation; higher with an unhealthy lifestyle.
Selenium (whole blood)	~120 µg/L	Important for antioxidant system; deficiency common in EU.
Zinc (serum)	80-120 µg/dl	Important for immune system & neurogenesis; deficiency inhibits new hippocampal formation .
Vitamin C (plasma)	> 7-8 mg/L (40-50 µmol/L)	Antioxidant; <5 mg/L is considered critical (scurvy limit) . Alzheimer’s patients often low .
HbA1c (long-term blood sugar)	< 5.7% (individual for diabetics)	High value = diabetes; diabetes doubles the risk of dementia – good control is important.
LDL/HDL quotient	< 3.0	Favorable lipid profile supports vascular health (important for the brain).
TSH (thyroid gland)	0.5-2.5 mIU/L	Mild hypothyroidism (TSH >4) can impair memory – treat.
APOE genotype (optional)	–	APOE4 carriers benefit particularly from intensive 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 active ingredients 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: Energy deficiency in the brain. Alzheimer’s is described by some researchers as a state in which the brain “starves” despite a full stomach. Reason: Insulin resistance and mitochondrial disorders lead to neurons not using glucose efficiently. This is referred to as a disturbed brain metabolism.

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

Ketone bodies (such as beta-hydroxybutyrate) can be used by brain cells as fuel – even when glucose utilization is impaired. Studies in patients with mild cognitive impairment 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 the 16:8 rhythm (16 hours fasting, 8 hours eating window per day), can have similar effects: it promotes autophagy (cell cleaning), reduces insulin spikes and inflammation. Animal models show fewer amyloid deposits under intermittent fasting, and first human studies record improvements in attention and sense of well-being.

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 was certainly included here, as it is now popular.

Practice: Not everyone needs to immediately adopt a strict ketogenic lifestyle. However, a moderate reduction of fast carbohydrates (sugar, white flour) and regular breaks between meals (instead of constantly snacking) improve the body’s metabolic flexibility. Fasting for just 12 hours overnight (e.g., not eating from 8 PM to 8 AM) is a start. If tolerated, one can fast for 16 hours 1–2 days per week or occasionally incorporate a longer fasting day.

It is important to still consume enough calories and nutrients during eating phases – thus avoiding malnutrition. A ketogenic diet (e.g., max 20-50g carbohydrates/day, high fat content with healthy fats) is more of a therapeutic measure and should ideally be started under guidance.

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 seems to benefit the brain. It complements orthomolecular care: 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 neuroprotective substances in fruits, vegetables, herbs, and spices. Some of these have been specifically investigated for their effects against Alzheimer’s:

• Curcumin (turmeric): The yellow ginger spice can cross the blood-brain barrier and has strong anti-inflammatory and antioxidant effects. Animal studies show that curcumin can break down amyloid plaques and improve cognitive performance.
  In human small 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 are often recommended (with piperine from pepper or as a special formula so that it is better absorbed).

 

• Resveratrol: A polyphenol from red grapes (also in red wine, but only in low doses there). Resveratrol activates so-called sirtuins (longevity enzymes) and is a descendant 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 mimics the effect of calorie restriction a little. As a dietary supplement, it (trans-resveratrol) is used in doses of 100–500 mg, sometimes even higher, although bioavailability is limited. It is considered relatively safe but can slightly affect estrogen levels.

 

• Ginkgo biloba: The extract from Ginkgo tree leaves is approved in Germany as a medicine 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 for prevention, but due to the promotion of blood circulation, Ginkgo is also used preventively. Important: Only use highly concentrated extracts; teas etc. are too weakly dosed.

 

• 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 experiments and has an antioxidant effect. Epidemiologically, heavy drinkers of green tea have a lower risk of cognitive decline.
  However, one would have to drink a lot of tea; extracts are available, but caution is advised in very high doses due to potential liver toxicity. 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 for age-related forgetfulness.

The evidence for plant compounds varies from robust (Ginkgo) to preliminary (much else). However, they have the advantage of usually acting multi-modally (multiple points of attack simultaneously) 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.

Practically, one can also consider the MIND diet: This was specifically developed for dementia prevention and combines the Mediterranean diet with the 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

How could a specific orthomolecular prevention plan against dementia look? In practice, this is created individually – depending on laboratory values, risk factors and the person’s living circumstances. In the following, we outline an example of a possible plan for a fictitious patient, Mr. M., 60 years old, who is cognitively healthy, but wants to reduce his risk due to a family history (mother had Alzheimer’s) and slightly elevated homocysteine. Mr. M. had 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 simply positive (i.e. moderate genetic risk). Blood pressure and weight are borderline, otherwise everything is normal. He complains of occasional word-finding difficulties and concentration problems under stress, but no manifest lapses.

Therapy plan for Mr. M.:

• • Nutrition: Switch to a Mediterranean diet with a low-carb tendency. Specifically: lots of vegetables, salad and at least 3x per week legumes; a handful of nuts every day; 2x per week sea fish (salmon, mackerel) and otherwise rather poultry or plant-based proteins instead of red meat; use of olive oil as the main fat; reduction of sugar and white flour (sweets to max. 1x per week, drinks without sugar); moderate consumption of fruit (berries preferred because of 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 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 min brisk walking or cycling; 2x/week light strength training at home (Theraband, own weight) à 30 min. In addition, daily active everyday movement (stairs, gardening etc.). Exercise works synergistically with omega-3 – both are intended to normalize blood pressure and improve insulin sensitivity.
  • Stress management & sleep: Mr. M. reports a lot of professional stress. He is encouraged to try relaxation techniques (e.g. 10 min breathing exercises in the evening, progressive muscle relaxation or meditation with an app). Sleep goal is 7-8 hours. If he has trouble falling asleep, he may take a low dose of magnesium in the evening. “Digital detox” is also recommended: no more work laptop late in the evening, 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 IU vitamin D daily (drops) plus 100 µg vitamin K₂ to quickly bring Mr. M.’s levels from 22 ng/ml towards 40 ng/ml. Vitamin D 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: Since homocysteine is elevated, Mr. M. gets a B-complex preparation with 50 mg B6, 800 µg folate (of which 400 µg 5-MTHF), 1000 µg B12 (methylcobalamin) – 1 tablet daily, for initially 6 months. This should lower 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, we want to compensate for that until new habits take hold. Vitamin C also as an immune-boosting measure (he tends to get 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: lab check (vitamin D, homocysteine, inflammation markers, possibly omega-3 index). 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 level).
  In addition, cognitive short test again to objectify subjective improvements. Mr. M. keeps a “brain journal” in which he notes weekly how he assesses his memory performance and mood – this helps to recognize changes.

This plan is, of course, individual and serves only as an example. For another person, for example, APOE4 status, diabetes, or other comorbidities might 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 just pills, but also lifestyle is managed. Many orthomolecular practices – for example, integrative medical centers in large cities (like the VenaZiel practice in Berlin) – therefore offer programs that include nutritional counseling, 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 completely compensate for bad lifestyle habits. Orthomolecular prevention always also 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 already mentioned 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 intestines and brain (intestinal health also affects inflammation in the brain).  
• Fish: at least 1× (preferably 2×) per week a fish meal (source of omega-3, selenium, vitamin D). 
• Poultry: Approx. 2× per week lean poultry instead of red meat. 
• Olive oil: use as main cooking oil/fat. It contains monounsaturated fatty acids and polyphenols, which have a vascular-protective 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 serving per week, sweets/pastry <5× per week, fried/fast food <1× per week. These restrictions aim to reduce saturated trans fats and sugar – critical for blood vessels and weight.

Studies have shown: The more one adheres to these recommendations, the lower the risk of Alzheimer’s. Even moderate adherence can bring benefits. Important: sufficient calorie intake, but not too much – overweight is a risk factor, so if in doubt, a moderately negative energy balance is preferable to achieve normal weight.

 

Physical exercise – the neuro-booster

Exercise keeps not only muscles fit, but also the brain. Physical activity increases blood flow to 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”).

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

Exercise also has indirect effects: it improves sleep, reduces stress, lowers blood pressure, regulates blood sugar – all of which, in turn, protect against Alzheimer’s. Endurance training combined with strength training seems 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 get at least 7000–10000 steps per day. Stairs instead of elevator, gardening, dancing – everything counts. Ideally, look for activities that are fun, then you are more likely to stick with it.

For older or inexperienced people, balance and coordination exercises are also helpful (reduces the risk of falls and trains the brain at the same time). Qigong, Tai Chi or simply standing on one leg while brushing your teeth – there are many possibilities.

 

Sleep – the brain’s garbage disposal

Amazing things happen in 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 products such as beta-amyloid out of the brain tissue. Those who sleep poorly or too little risk that these wastes accumulate. 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, bedroom dark+cool, no screen light late in the evening (or blue light filter), no heavy meals directly before sleeping, limited alcohol (it disturbs the sleep architecture despite drowsiness), 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 low doses. It is important to take sleep problems seriously and discuss them with your doctor if necessary – untreated sleep apnea or chronic insomnia can impair brain health.

 

Stress management – protecting the brain from burnout

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

Reducing stress is easier said than done, but there are techniques: regular relaxation exercises (meditation, yoga, autogenic training), pursuing hobbies, perceiving social contacts, stays in nature – all this activates the parasympathetic nervous system, lowers cortisol and gives the brain recovery. Even 5–10 minutes of daily meditation can demonstrably strengthen the gray matter in the prefrontal cortex (the area for memory and attention).

Also interaction with micronutrients: Certain nutrients (magnesium, B vitamins, omega-3) help the body to cope better with stress because they are involved in the stress axis regulation. Conversely, stress reduction improves the effect of the nutrients because the need 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 neural 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 an increased risk of dementia by ~50%. The exchange with others keeps mentally flexible and stabilizes the mood (depression is in turn 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 be self-evident, but for completeness: smoking doubles the risk of dementia. Smokers experience vascular damage earlier and have less antioxidant protection.

The oxidative stress from smoking is poison for the brain. So: please live smoke-free. If it is difficult – professional withdrawal programs, hypnosis or medication can help. It is worth stopping at any age.

High amounts of alcohol directly damage the brain (alcoholic dementia) and indirectly (vitamin deficiencies due to alcoholism). Moderate consumption (see red wine 1 glass) may be harmless or even slightly protective according to some studies, but caution: newer research suggests that even 1–2 glasses daily can reduce brain volume.

When in doubt, less is more. For many, alcohol abstinence or less frequent consumption is the better choice.

As you can see, lifestyle and orthomolecular therapy go hand in hand. A study by the German Neurological Society impressively showed that five simple measures – healthy diet, sufficient exercise, mental training, non-smoking, and moderate alcohol consumption – together drastically reduce the likelihood of developing Alzheimer’s.

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

For patients, this means: They have large parts of their brain health in their own hands! Orthomolecular medicine supports you by compensating for possible hidden deficiencies and guiding you which nutrients and measures are useful for you personally. It is 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 prove that you can significantly reduce the risk and possibly delay the outbreak by years. Vitamins and other micronutrients play an important role, especially when deficiencies exist. For example, a good vitamin D level demonstrably reduces the risk of dementia, and B vitamins can slow down brain aging.

However, the interaction is important: Vitamins work best in combination with a healthy lifestyle (diet, exercise, mental activity). One can say, orthomolecular measures can prevent or delay Alzheimer’s in many cases, especially if started early. There is no 100% protection – it only 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 the brain cells and reduce inflammation. Omega-3 deficiency leads to structural deficits in the brain, enough omega-3 is associated with better cognition.

Also very important: antioxidants (vitamins C, E, selenium) – they scavenge free radicals that arise during aging processes. Magnesium (for neuronal signal transmission) and zinc/selenium (for neurogenesis and antioxidant enzymes) should also not be forgotten.

Ultimately, the brain works optimally only when all essential micronutrients are present in sufficient quantity. One should therefore pay attention to a broad spectrum, for example through a good diet or a combination preparation, and specifically dose the mentioned “critical” vitamins higher, if necessary.

 

Question 3: Is a healthy diet not 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), individual absorption disorders, unbalanced eating habits, or increased demand (stress, illness, age). Especially in old age, for example, vitamin B12 absorption via the stomach decreases. Vitamin D formation in the skin also significantly decreases after age 65.

Nutritional supplements can close such gaps. Studies such as COSMOS-Mind (2022) showed that a daily multivitamin could improve cognitive performance in older adults – suggesting that a normal diet is indeed not always “enough.”

Nevertheless: pills are no substitute for a healthy diet! The optimal approach is a combination: eating nutrient-rich foods and targeted supplementation for what is missing. Think of supplements as an insurance policy: you hope you don’t urgently need them, but you’re covered if your diet is sometimes incomplete.

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 operates between conventional medicine and complementary medicine. Many of its recommendations are based on hard science – e.g., studies on vitamins published in top journals.

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

However, high-dose B vitamins, for example, are certainly prescribed by general practitioners for proven deficiencies or elevated homocysteine. Vitamin D supplementation for 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 evidence-based, i.e., relies on studies and measures success, instead of treating blindly. For example, he will consult 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, start a brain-healthy lifestyle as early as possible – because changes in the brain can begin decades before symptoms appear. Practically, prevention is usually considered from age 50+, as the risk increases then and measurable risk factors (high blood pressure, cholesterol, etc.) become common. But it’s also worthwhile to establish good habits in your 40s, or even 30s: train your brain, eat a balanced diet, manage stress.

This creates a high “cognitive reserve.” Those who build more synapses and brain volume when young can afford more decline in old age before it becomes clinically noticeable. For specific orthomolecular measures (e.g., regular supplements): For younger people without complaints, a good diet and a general multivitamin are often sufficient, provided there is no particular deficiency. However, by age 60 at the latest, one should have their nutrient status checked (B12, D, omega-3, etc.) and fill any gaps.

If there is existing mild forgetfulness or a family history of dementia, become very active from age 50 – like Mr. M. in our example. Important: prevention can still help mitigate the course even in the early stages of dementia. Even those who already have initial symptoms (MCI – mild cognitive impairment) can often delay or halt 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 to be true – Alzheimer’s cannot currently be cured in the sense of being completely eliminated. However, there are individual case reports (Dale Bredesen et al.) where patients in the early stages returned to normal ranges through very extensive lifestyle and nutrient interventions.

But these are exceptions and require an extremely consistent approach (special diet, dozens of supplements, daily exercise, etc.). More realistically, orthomolecular therapy can slow the progression and alleviate symptoms.

In mild stages, partial improvement is certainly possible – for example, a patient with deficiencies may think more clearly after correction than before. But with advanced dementia, it is unlikely to fully regain lost abilities. Orthomolecular measures can then at most increase well-being or slightly slow down decline. Therefore, the focus is on prevention and early intervention.

If you start early, it is theoretically possible to delay the onset of the disease so far that you die “with a clear head” in old age without ever developing manifest dementia – i.e., prevent Alzheimer’s by preventing it from breaking out 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 usual dosages. Water-soluble vitamins (B, C) are excreted in excess – overdosing problems are rare here (at most diarrhea with extremely high vitamin C).

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

Therefore, dietary supplementation should be carried out with medical supervision, at least at high dosages. The doses mentioned in our article are usually in the safe range, and are often only temporary “cures”. If lab values are within the normal range, the dose can be reduced.

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

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

Furthermore: many products on the open market are unregulated regarding quality. There have been cases where products did not contain the stated ingredients 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 have regular check-ups, the risk is low. Most people tolerate the micronutrients mentioned well and experience more positive effects (more energy, better mood) than side effects. If in doubt, it is better to consult a specialist (doctor/alternative practitioner with experience in orthomolecular medicine), especially if you want to combine several remedies.

 

Question 8: What is the deal with homocysteine? Should I have my homocysteine level measured?

Yes, homocysteine (HCY) is an important risk marker and easily measurable via a blood test. High homocysteine levels damage blood vessels and neurons and are considered an independent risk factor for dementia.

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

If your homocysteine, for example, is >10 µmol/L, it would be advisable to supplement B vitamins – studies then show a reduction in HCY and often a parallel slowing of brain atrophy. Many neurologists now routinely measure homocysteine in memory patients. In prevention, it is definitely useful, especially if there is a family history or if your diet is not optimal.

The test doesn’t cost the earth (~€20-30) and provides valuable information. Goal: Ideally, 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 specialized practices or centers.

For example, the VenaZiel practice in Berlin offers orthomolecular prevention programs in which detailed check-ups, laboratory analyses and individual vital substance plans are created. Also, specialized memory clinics at hospitals are increasingly open to nutritional and nutrient topics – it is worth mentioning this at the appointment.

Otherwise, you can contact the German Society for Preventive Medicine or Orthomolecular Medicine e.V., which often maintain lists of therapists. It is important to find someone who has both medical know-how (laboratory diagnostics, conventional medicine) and orthomolecular expertise. A good approach: Ask your family doctor if they are willing 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 a portion of prevention courses (e.g., nutritional counseling, 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 drugs (such as high-dose folic acid 5mg for proven anemia) are covered, but over-the-counter drugs are unfortunately not. Vitamin D, for example, usually has to be bought yourself (unless a severe deficiency is diagnosed).

If you have private health insurance, you often have more options – many private health insurance companies reimburse sensible preventive examinations or alternative healing methods depending on the tariff. It is best to inquire beforehand.

Bottom line: Yes, you have to invest something in your own health, but consider the “return” – even if you spend a few hundred euros a year on prevention, it can add many years of 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 expenses, similar to a gym membership. Of course, you shouldn’t spend money senselessly – invest in a targeted manner where there is a need. A start could be a one-time preventive check-up (laboratory costs depending on the scope perhaps €200–300). With the results, you can then proceed in a targeted manner.

 

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 problem of energy weakness in the aging 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. In humans, there are positive reports: e.g., patients with MCI who underwent 12 weeks of 5:2 intermittent fasting performed better on cognitive tasks than a control group.

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

However, strict ketosis is not sustainable for everyone in the long term and can have side effects initially (“keto flu”). A middle ground (low-carb, healthy-fat + occasional fasting) is probably practical and sufficient for the majority. So yes: metabolic adaptations like fasting/keto can be part of the prevention plan, but they must fit your lifestyle.

If you want to try it, do it under guidance and listen to your body. And remember to supply enough micronutrients anyway (with strict keto possibly extra electrolytes and vitamins, as you initially lose a lot of water and minerals).

 

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

The aluminum theory was popular for a long time because aluminum was found in plaques. Today, it is generally assumed that aluminum is not the main cause, but rather an accompanying phenomenon. There is currently no clear evidence that normal everyday aluminum (in deodorant, cookware) causes dementia.

Extreme exposure (in kidney patients or occupationally exposed individuals) can damage the nervous system, yes. But the average person probably doesn’t need to be panicky about 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 safe, orthomolecular medicine tends to rely on sufficient silicon intake (e.g., in the form of silicic acid gel or mineral water rich in silicic acid), because silicon can bind aluminum and excrete 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 do anything? You hear such different things.

Ginkgo biloba is well-researched. In existing moderate dementia, it improves symptoms (memory, daily competence) as well as classical medications, but without their side effects – this is relatively well documented in meta-analyses.

As a pure preventive measure, the data is sparse; however, there are some studies where individuals with mild complaints remained more stable over the years with Ginkgo than without. Ginkgo promotes blood circulation and has antioxidant effects, which certainly cannot hurt. The correct dosage (240 mg/day) and sufficiently long intake are important (effect builds up over weeks).

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

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

In short: many plant compounds can have a supportive effect, but they are often not as thoroughly studied as vitamins. In practice, they are combined to cover various mechanisms (e.g., Ginkgo + Omega-3 + Curcumin).

Patient reports vary – some feel a noticeable improvement (better recall, feeling more alert), others notice little. Individual biochemistry plays a role here. Orthomolecular approaches often follow the principle of “it’s worth a try”: If a remedy is plausible and safe, you can try it for 3–6 months and see if it yields subjective or objective (test results) benefits.

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 works. With professional support, you can make a sensible plan there.

 

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 high blood pressure, etc.). If you consistently adapt your lifestyle and optimize micronutrients, you could halve or even better your risk of dementia – epidemiological models suggest this.

Even if it’s “only” about a delay: Just 5 years of gained healthy time represent an extreme amount of quality of life. Perhaps without measures, you would have fallen ill at 75, but now only at 80 or 85, or not at all because you die of something else beforehand. This is, of course, hypothetical, but it shows the dimension.

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

 

Long-term success measurement is difficult because you never know what would have happened if you had done nothing. But you can check intermediate steps: normal lab 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 are preventively active often report general health improvements – more energy, better mood, fewer infections, more stable blood pressure, more ideal weight. These are all indirect successes that also reduce the risk of dementia.

But you must not be unrealistic either: If someone is, for example, heavily genetically burdened and has lived very unhealthily until 70, you will be able to reduce the risk, but the disease may still occur at some point – perhaps a little later or milder. Then you should see it this way: Every month/year gained in clarity is valuable.

 

To summarize: The prospects are good for significantly reducing one’s personal risk. 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 a sum of many small everyday decisions in favor of one’s 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 variety 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: Association of vitamin D levels and dementia risk. Result: severe vitamin D deficiency doubles the risk of dementia and Alzheimer’s.
• 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 J..
• BMJ 2022 (Dhana et al.) – Cohort study on lifestyle and Alzheimer’s. Found 5 lifestyle factors that significantly extend dementia-free life (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 with high omega-3 levels.
• JAMA Neurology 2017 (Soininen et al., LipiDiDiet) – Multinutrient trial (Souvenaid) in prodromal Alzheimer’s: 2 years no significant slowing of cognitive decline, but in 36-month follow-up benefit was shown on secondary endpoints. Shows: Nutrient intervention may take 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 of cognitive symptoms with 240 mg EGb761/day compared to placebo (especially 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 affect many of these factors (e.g. blood pressure via diet, depression via nutrient therapy).
• ISOM Review 2017 (Brown, Orthomolecular Medicine and Alzheimer’s) – Overview: Advocates for multi-modal nutrient and lifestyle therapy for Alzheimer’s, referencing initial case reports where an individualized protocol (Bredesen’s MEND/ReCODE) achieved cognitive improvements and even reversion of early Alzheimer’s. Emphasizes the importance of personalized orthomolecular medicine.
• Nature 2005 (Lahiri et al.) – Animal study: Curcumin reduces amyloid plaques in mice by ~50%, improving memory performance. Laid the foundation for curcumin’s promise in humans. Clinical trials (Small et al. 2018) confirmed at least mood-lifting 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.). Demonstrates the interdependence of the two nutrient classes for reducing 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 both epidemiological evidence (observational studies) and mechanistic explanations, and increasingly intervention studies demonstrating positive effects.

Although many questions remain open (e.g., optimal combinations, precise 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 rocket science – you just have to eliminate the known risk factors and use the right protective factors. Orthomolecular medicine offers a well-founded roadmap for this.