Steps to Prevent Alzheimer’s

The good news about Alzheimer’s is that while there is no real evidence that you can bring back brain cells (neurons) there is lots you can do right now to make sure you don’t get the accelerated brain shrinkage that leads gradually from memory decline to Alzheimer’s. Given that brain shrinkage starts, for many, in their 40’s these prevention steps should be actioned now, not just later in life.

1. Check your memory

The first and most important step, is to check your memory with the free on-line Cognitive Function Test at, act accordingly and do this every year from the age of 50 since this will give you an accurate measure of your memory, and a yardstick against which to measure the benefits of these prevention steps.

2. Eat fish

Eat fish three to four times a week, with at least two servings of oily fish (salmon, mackerel, herrings, kippers, sardines or tuna). Eating more nuts and seeds, preferably, raw.

Eating one serving of oily fish a week is associated with halving the risk of Alzheimer’s1. Supplements of one kind of fish omega 3 fish oil, called DHA, has been shown to enhance memory in adults 2 who don’t eat fish, and to prevent memory loss in those in the early stages of memory decline3. But it’s not just oily fish. The more fish you eat the better your memory test performance. Fish is also an excellent source of vitamins B12 4, D and choline, all essential for the brain. Chia and flax seeds have the most omega 3. As well as eating these foods I’d recommend you aim to supplement about 250mg of DHA a day. If your supplement contains DPA this converts readily to DHA so add to the DHA level and aim for a total of 250mg.

The studies above used around 1,000mg a day, which is what I’d recommend if you don’t score well on the Cognitive Function Test. This would mean adding a 1,000mg fish oil capsule to your daily supplements, as well as eating oily fish at least three times a week.

3. Up your fruit and veg

Eat at least six servings of brightly coloured vegetables and berries a day. Half a plate of vegetables counts as two servings. A glass of good quality red wine counts as one. The more fruit and vegetables you eat the lower is your risk of cognitive decline 5 with vegetables being particularly protective.6 The best kinds of vegetables are carrots, cauliflower, broccoli, Brussels sprouts, cabbage, spinach, mushrooms and the best fruits are berries, especially blueberries and strawberries7.

Flavonoids and polyphenols, found not only in fruit and vegetables, but also in tea, red wine and dark chocolate, are associated with preserving memory.8 The most protective effect is found eating six servings (500g) a day of fruit and vegetables.6 Supplementing both vitamin C (1g) and vitamin E combined is associated with halving the risk of Alzheimer’s disease.9

4. Minimise sugar – Eat a Low GL Diet

Follow a low GL diet, with slow-releasing ‘whole’ carbohydrates. Minimise sugar, sugary drinks and juices.

Keeping you blood sugar levels down, which also means you make less insulin, preserves your memory10. That means avoiding sugar as much as possible and eating slow-releasing ‘whole’ carbohydrate foods such as wholegrain bread or pasta and oat cakes. Eating white bread is associated with a poorer cognitive test performance, whereas high fibre bread is associated with better performance. Eating carbohydrate foods with protein, for example brown rice with fish, or porridge oats with seeds further reduces the glycemic load (GL) of a meal. Best fruits in this respect are berries, cherries and plums while too many grapes, raisins or banana are high GL. These kind of foods are consistent with a Mediterranean diet which has also been shown to reduce risk.11 Eat your fruit, don’t drink it. Fruit juice has a lot of sugar in it.

5. Supplement B vitamins – Check your homocysteine

Supplement vitamin B6 (20mg), B12 (10mcg) and folic acid (200mcg) as a sensible precaution. But do check your homocysteine level to find out how much you need. Homocysteine testing can be carried out by your doctor or you can do it privately through many laboratories, or with a hometest kit purchased from YorkTest. If above 10mcmol/l supplement high dose B6 (20mg), folic acid (800mcg) and B12 (500mcg) preferably in a supplement that also provides zinc and TMG.

Having a higher intake and blood level of vitamin B12 and folic acid is associated with a quarter of the risk of developing Alzheimer’s.12 Vitamin B6, B12 and folic acid, especially in combination, lower blood levels of homocysteine, which is a key predictor of risk.13

Lowering your homocysteine, if above 10mcmol/l by supplementing high dose B6 (20mg), folic acid (800mcg) and B12 (500mcg) has been shown to greatly reduce the rate of brain shrinkage14 and memory loss15 in those at risk of Alzheimer’s. Homocysteine is also lowered by the combination of zinc and TMG, which are included in homocysteine-lowering formulas.

B12 absorption can greatly worsen with age, and is inhibited by the diabetes drug metformin16, and antacid ‘proton-pump inhibitor (PPI) medication17. If you are taking these be sure your GP checks your homocysteine level.

6. Limit coffee – Green tea is better

While there is inconsistent evidence linking coffee with more or less risk, drinking lots of coffee both raises homocysteine levels18 and promotes the excretion of protective B vitamins19. For example, two cups of coffee raises homocysteine by 11% in 4 hours.20 Green tea, on the other hand, is associated with a lower risk of cognitive impairment.21 Ordinary tea drinking was also associated with better cognition.22 My advice is to limit coffee to one a day and drink tea, ideally green, instead. The occasional or daily glass of red wine is also likely to lower your risk.

7. Keep physically, mentally and socially active

Keeping fit,23 learning new things, stimulating your mind, and staying in touch with friends and family all helps to reduce your risk. There may also be a benefit in exercises that require more mind-body coordination, such as t’ai chi24 or yoga, and exercising outdoors – we make vitamin D in the presence of sunlight. These activities also help to reduce stress, which is another prevention step in the right direction as is keeping your blood pressure down.25

For more information read my book The Alzheimer’s Prevention Plan.


  1. M Morris et al., ‘Consumption of Fish and n-3 Fatty Acids and Risk of Incident Alzheimer Disease.’ Archives of Neurology 2003;volume 60: pages 940-946
  2. W Stonehouse et al., ‘DHA supplementation improved both memory and reaction time in healthy young adults: a randomized controlled trial.’ Am J Clin Nutr. 2013 May;97(5):1134-43
  3. K Yurko-Mauro, et al., ‘Beneficial effects of docosahexaenoic acid on cognition in age-related cognitive decline.’ Alzheimers Dement. 2010 Nov;6(6):456-64
  4. A Vogiatzoglou et al., ‘Dietary sources of vitamin B-12 and their association with plasma vitamin B-12 concentrations in the general population: the Hordaland Homocysteine Study.’ Am J Clin Nutr. 2009 Apr;89(4):1078-87 []; also Nurk E et al., ‘Cognitive performance among the elderly and dietary fish intake: the Hordaland Health Study.’ Am J Clin Nutr. 2007 Nov;86(5):1470-8
  5. E Nurk et al., ‘Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study.’ British Journal of Nutrition (2010), 104, 1190–1201
  6. EE Devore et al., ‘Dietary intakes of berries and flavonoids in relation to cognitive decline.’ Annals of neurology 2012; 72: 135-43
  7. E Nurk, H Refsum, CA Drevon, et al., ‘Intake of flavonoid rich wine, tea, and chocolate by elderly men and women is associated with better cognitive test performance.’ J Nutr 2009; 139: 120–127
  8. PP Zandi et al., ‘Reduced risk of Alzheimer disease in users of antioxidant vitamin supplements: the Cache County Study.’ Arch Neurol 2004; 61: 82-8
  9. JA Luchsinger et al., Neurology 2004; AM Abbatecola et al., J Am Geriatr Soc, 2004; Xu WL et al.,Neurology, 63:1181–6 (2004); LB Hassing et al., J Int Neuropsychol Soc, 2004; K Yaffe et al., Neurology, 2004; Z Arvanitakis et al., Arch Neurol, 2004; K Yaffe et al.,J Nutr Health Aging, 2006; R Roberts et al., Alzheimer Dis Assoc Disord, 2010
  10. EH Martinez-Lapiscina et al, ‘Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial.’ Journal of neurology, neurosurgery, and psychiatry 2013 12. R Clarke et al., ‘Folate, Vitamin B12, and Serum Total Homocysteine Levels in Confirmed Alzheimer Disease.’ Archives of Neurology, 1998
  11. DS Wald, A Kasturiratne, M Simmonds, ‘Serum homocysteine and dementia: Meta-analysis of eight cohort studies including 8669 participants.’ Alzheimers Dement 2011; 7: 412-7
  12. AD Smith et al, ‘Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial,’ PLoS ONE, September 2010 | Volume 5 | Issue 9 | e12244
  13. C De Jager et al., ‘Cognitive and clinical outcomes of homocysteine lowering B vitamin treatment in mild cognitive impairment: a randomized controlled trial.’ Int J Geriatr Psychiatry (2011) Jul 21. doi: 10.1002/gps.2758
  14. LS Hermann et al. ‘Vitamin B12 Status of Patients Treated With Metformin: A Cross-Sectional Cohort Study.’ Br J Diabetes Vasc Dis. 2004; 4 (6): 401-406
  15. T Ito, RT Jensen, ‘Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium.’ Curr Gastroenterol Rep. 2010 Dec;12(6):448-57
  16. MJ Grubben et al., ‘Unfiltered coffee increases plasma homocysteine concentrations in healthy volunteers: a randomized trial.’ American Journal of Clin. Nutrition, Vol. 71, No. 2, 480-484, Feb 2000
  17. A Ulvik et al., ‘Coffee consumption and circulating B-vitamins in healthy middle-aged men and women.’ Clin Chem. 2008 Sep;54(9):1489-96 []
  18. P Verhoef et al., ‘Contribution of caffeine to the homocysteine-raising effect of coffee: a randomized controlled trial in humans.’ American Journal of Clin. Nutrition, vol. 76, No. 6 (2002), pp. 1244-1248
  19. S Kuriyama et al., ‘Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project 1.’ Am J Clin Nutr 2006; 83: 355-61
  20. See reference 9 above. Nurk et al.
  21. NT Lautenschlager et al., ‘Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial.’ Jama 2008; 300: 1027-37
  22. LC Lam et al., ‘A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline.’ J Am Med Dir Assoc. 2012 Jul;13(6):568.e15-20
  23. R Peila R, White LR, Masaki K, Petrovitch H, Launer LJ. ‘Reducing the risk of dementia. Efficacy of long-term treatment of hypertension.’ Stroke 2006; 37: 1165-70 see also Launer LJ, Hughes T, Yu B, Masaki K, Petrovitch H, Ross GW, et al., ‘Lowering midlife levels of systolic blood pressure as a public health strategy to reduce late-life dementia: perspective from the Honolulu Heart Program/Honolulu Asia Aging Study.’ Hypertension 2010; 55: 1352-9