Alzheimer’s disease is a devastating illness without effective treatment. Yet it may, in fact, be largely preventable. The first shocking fact to absorb is that the pathogenesis is largely extracranial, though assuredly not entirely so. That clearly defies the conventional pharmacologic wisdom, which has obsessed with amyloid-beta as the offending agent and has approached it by crafting and evaluating antibodies against it. The FDA has even bought into that theory and approved drugs based on a reduction in amyloid deposits and the slightest slowing of cognitive decline.

But if one examines amyloid-beta, one finds it possesses anti-microbial properties in itself. Is that perhaps not a clue that we are dealing with a dysfunctional immune system with a possible role of common infections ranging from food mouth flora to herpes viruses? Many neuroscientists believe that is so but find their research approach difficult to get funded because the dominant theory still holds sway over the funding agencies, although there are some signs that may be changing finally.

I entered the fray as I researched and wrote the book Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine and Public Health  as well as several scholarly articles. My understanding evolved through a complex nexus of gut-brain, liver-brain, gut-immune, endocrine-immune, and nutrient-immune interactions to develop a comprehensive view. I also saw that environmental toxicants have a substantial role in pathogenesis, including heavy metals, volatile organic compounds, herbicides, and PM 2.5. A healthy microbiome, a well-functioning liver, an endocrine system free of insulin resistance and lessening the decline in DHEA, and provision of adequate vitamins and essential trace elements are all necessary for an intact blood-brain barrier (BBB) and a well-functioning set of neuron support cells, the microglia and astrocytes.

Having been in academic medicine for four decades in a variety of roles and having pretty much challenged conventional wisdom for all that time, I was still taken aback by the difficulty of getting these insights their proper attention. This ship that is the clinical research juggernaut does not take turning around easily, especially when doing so may hurt its rather enormous profit margin.

So how does one prevent Alzheimer’s?

1. Start by eating a Mediterranean diet or a Japanese diet, i.e., a diet that is anti-inflammatory (which seems to have worked for Tom Brady in defying aging). What’s more, it also reduces the lethality of  COVID too. Adequate micronutrients like selenium and zinc, as well as vitamins, are essential but too much of them can be toxic too.

2. Exercise throughout your lifetime or at least since middle age, and be sure to sweat when exercising, as that is a major means of toxin excretion.

3. Avoid biotoxins like BMAA secreted by blue-green algae, really cyanobacteria. To do so, you will need to recognize what it looks like to avoid it on lakes and streams. Also, avoid toxicants like mercury or arsenic that harm the gut-immune-brain nexus. The latter can be found in water in many states, while the former is unfortunately common in fish, a food usually associated with brain health. Sorry, even an excess of essential metals like copper and iron can damage the BBB. Probably toss that no-stick frying pan, too (PFAS, an endocrine disruptor which may also be harmful).

4. Avoid tobacco products and moderate alcohol consumption to minimize these sources of toxins.

Probably not all AD would be eliminated but most likely more than half, although following these steps may be easier said than done.

None of these steps requires a new patented drug to avoid AD, which may be the problem in getting this approach accepted by the medical world, which has a Pavlovian response to RCTs virtually controlled by Pharma. When I explained this view to a medical journalist, she asked how this would be monetized. Oops, as a retiree, I was not focused on that. I had given talks on this subject for medical grand rounds, neurology grand rounds, and gerontology grand rounds both nationally and internationally to some acclaim. However, one chairman did not like it when I indicated from a brain health perspective, two days a week of alcohol abstinence is preferable.

My friends comforted me that change of this nature takes time and organizational support, so that recognition will be slow at best. I am not looking for any glory in this, just some real change that would reduce the suffering engendered by AD and related disorders. Besides a huge number of scientists throughout the world have contributed to these insights. I also would like general recognition of environmental toxins by allopathic medicine because it is a common cause of many disorders besides neurodegenerative disorders, including many cancers and heart, lung, and renal diseases.

Finally, I need to qualify my earlier statement that there is no effective treatment for AD. There may well be one for early AD and mild cognitive impairment, often a pre-stage of AD. Dale Bredesen, MD, a long-time dementia researcher, had developed a multifaceted individualized intervention based on a battery of clinical tests that cover the gamut of items, many of which I have discussed above. He has taught physicians his protocol for doing so now through the Institute for Functional Medicine and compiled some impressive pilot results published in  July 2022. Based on my study of the available neuroscientific evidence, I can only offer an opinion that this approach may well be effective. Still, I fully understand the call for more detailed studies with suitable controls and robust, detailed reports before it can be considered an effective treatment.

So while the ship of AD clinical research may be turning slowly, we need to understand the mercantile nature of research and treatment on both sides of this divide. One longs for medical science to be free of such financial considerations, but that does not appear to be possible. Nevertheless, we must understand that the profit motive is not always beneficial to advancing the science of discovery. To put it another way, the scientific reality is not concerned with our society’s financial organization and its needs. So we have this disease with no known cure and clear obstacles to attaining it. But a path to prevention is clearer and perhaps the more reasonable ask.

Arnold R. Eiser is an internal medicine physician and author of Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health.