Ten years ago, William, a 58-year-old physicist from Albuquerque, came for his first appointment, at the urging of his wife, saying he had signs of early dementia. He had delayed getting evaluated because he was afraid of the diagnosis. It wasn’t until he began making potentially critical mistakes in his work that he realized it was time to get help. He was despondent, fearful he would have to quit the work he loved.

I took a comprehensive history and discovered he ate a healthy diet, exercised regularly, and kept his mind very active. There was no history in his family of early onset dementia. Routine blood work revealed a level of B-12 that was within the normal range, but too low by my standards.

William, being well read, knew that B-12 came mostly from animal food. He said, “How can I be low in B-12 if I eat meat and eggs?”

I explained that as we get older, especially beyond 50, we have decreasing levels of acid in the stomach. He protested that he had too much acid because he had acid reflux. This is a common misconception. Acid reflux is not an indication of too much acid—it indicates that acid is in the wrong place. The esophagus has no protection against even minute amounts of acid that rise up into the esophagus and cause a burning sensation.

After listening to my explanation, William concluded that all he needed to do was take some acid with each meal in order to extract the B-12 from the food. His thinking was logical, but there’s another irreplaceable factor that’s missing as we age called intrinsic factor, a protein produced in the cells that line the stomach. Intrinsic factor binds to the B-12 and allows it to be absorbed into the blood. As we age, those cells make less and less intrinsic factor.

I explained that B-12 is essential for brain function and also helps repair damaged nerves.

William wanted to see fast results and asked if he could get a B-12 shot with a high amount of B-12. I gave him a methylcobalamin shot with 5 mg of B-12. William called me the next day and said he already felt better. I said that was probably just the surge of energy that made him feel better and it would take some weeks for the brain to heal from the damage caused by the low B-12 levels. I recommended sublingual—under the tongue—B-12 in the form of methylcobalamin, 5,000 mcg a day, sometimes listed as 5 mg.

Why under the tongue? There are many little capillaries under the tongue. About 10% of the B-12 diffuses through the capillaries, directly into the blood stream where it can be utilized. The part that is swallowed is not utilized in older people due to the lack of sufficient stomach acid and lack of intrinsic factor, mentioned above.

Along with the methyl B-12, I recommended a special kind of folic acid, called 5-methyltetrahydrafolate 1-2 mg, along with a B-complex supplement. William faithfully took these supplements every day.

I am happy to report that William is thriving since taking his sublingual B-12. He is grateful he still has his job as a physicist, with no more complaints about his brain function.

The latest estimate on the number of people in the US with dementia is 5 million. That number appears to be growing. The good news among these grim statistics is that up to 20% of people with dementia have a potentially reversible cause of the condition, as in the case of the physicist.

In William’s case, it was unusually simple to pinpoint the cause of his reversible dementia. Most cases of dementia are much more complicated to evaluate and difficult to treat.

The best approach is prevention. Below are just a few simple suggestions to begin your brain protection program.

• Get regular exercise which helps oxygenate the brain.

• If you are over 50, consider taking sublingual B-12.

• Take Omega 3 fish oil supplements. The fish oil contains DHA which is essential for brain health. Low levels have been associated with memory loss. If you prefer getting your fish oil from salmon, stick with salmon from Alaska. It’s healthier and less contaminated than elsewhere.

• Many people lack the enzyme needed to metabolize flax oil into the final step of conversion into DHA. That’s why fish oil is preferred when there is concern about the health of the brain.

• Diet plays a critical role in brain health. A high sugar, high refined food diet speeds up ageing of all organs, including the brain.

• The brain is made up mostly of fatty acids. The brain and nervous system need plenty of the good fats, like coconut oil, avocados, olive oil, nuts and seeds. The brain uses the good fats for fuel.

• The bad fats, like fried foods and other oxidized or rancid fats, hydrogenated and partially hydrogenated fats, harm the brain. These damaged fats are taken up into the cell membranes, causing the cell membranes to become stiff, impeding cell-to-cell communication. Egg yolks have substances that are important for brain health, like choline which is essential for making the main neurotransmitter in the brain, acetylcholine. If you are a vegetarian, you could use GMO-free lecithin derived from organically-grown soy.

• Vitamin D can increase nerve growth in the brain. Try to maintain the vitamin D levels in your blood between 50-100 ng/ml. Of course, the best way to get vitamin D is by spending a few minutes in the sun every day with a large area of skin exposed to sunlight—if this is possible. (If you take vitamin D, don’t forget to take vitamin K with it, for reasons discussed in earlier blog posts on osteoporosis and cholesterol.)

• You can keep growing new neurons by learning something new like traveling, learning a new language, learning a musical instrument. Actually, it can be as simple as doing crossword puzzles, or doing something out of the ordinary every day to keep your brain alert, like driving a different route home from work, or even changing your routine slightly.

• Meditation can help retard ageing in the brain because meditation is known to decrease feelings of stress. Decreasing stress, in turn, decreases oxidative damage throughout the body.

All the above measures will help not only the brain, but the entire body. After all, the brain is part of the body.

In Part II, you’ll read about more causes of reversible dementia and more ways to protect the brain from dementia and other neurodegenerative diseases, like Parkinson’s disease, multiple sclerosis, and seizure disorders. Stay tuned.

Here’s to your good health!