My last two articles focused on medical treatments for Alzheimer’s disease. Cholinesterase inhibitors donepezil (Aricept), Rivastigmine (Exelon), galantamine (Razadyne), produce statistically significant but small effects. Namenda (memantine) appears to only work in moderate to severe dementia. Attempts to find effective drugs that modify the disease process have so far failed. As long as there are no powerful treatments for Alzheimer’s disease, we need to consider strategies for delaying the onset. Physical exercise and diet are the best strategies for delaying onset.

The so called Mediterranean diet may be an effective way to slow down the progression of Alzheimer’s disease based on epidemiological evidence. Although there are many variants, the main components of a Mediterranean diet are high consumption of fruits, vegetables, nuts, legumes, cereals, and fish. Olive oil is the central source of monounsaturated fat (canola oil is the main source of monounsaturated fat in the US diet). Additionally, meats, eggs, and dairy products are limited and alcohol is consumed in “moderate” amounts. Generally, studies indicate that consuming a Mediterranean diet is correlated with slowing the progression of dementias.

There are two research strategies used to determine if what we eat influences the risk of developing dementia. The first strategy explores the effects of individual components of the Mediterranean diet: e.g., fish oil, vitamins, antioxidants, antiinflammatory medications, alcohol consumption (there are no data indicating that consuming alcohol reduces the risk in those who don’t drink). Despite the intense search for the magic food or supplement in prospective studies, there are no good data associating single foods or supplements with better outcome for Alzheimer’s disease.

The second research strategy is to assess the effects of whole-diet on the occurrence of Alzheimer’s disease. The idea is that the whole is greater than the sum of the parts. Furthermore, we don’t eat isolated nutrients but rather we eat whole foods as meals. Several longitudinal studies have demonstrated that eating a Mediterranean type diet reduces the risk of developing Alzheimer’s disease.

The key to eating for brain health may be to eat (80% of the time) a diet consisting of foods that are associated with a Mediterranean style of eating. There are no long term guarantees but supplements (despite good marketing) and single foods do not appear to make the grade. It’s the pattern of eating that is important. Increase your consumption of plant foods (e.g., fruits and vegetables) and fish. It may be better to use olive rather than canola oil. Limit your intake of whole milk products, eggs, and red meat. Drink alcohol in moderation, if you drink.