There is a strange silence around dementia.
Not because it is rare, but because it is everywhere — and growing.
We are told it is genetic.
Or inevitable.
Or simply the price of living longer.
Yet beneath the surface, a quieter body of evidence suggests something far less comforting to the system built around treatment instead of prevention.
What if most dementia is not a mystery at all?
What if it is largely metabolic, nutritional, and cumulative — the result of small choices repeated over decades?
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This is where the conversation becomes uncomfortable.
Because three patterns keep appearing, again and again, across neurological research, aging studies, and metabolic health data. They are not exotic. They are not expensive. And they do not require futuristic medicine.
They require attention.
The first pattern is energy.
The brain is the most energy-demanding organ in the body. Yet for decades, we have fueled it almost exclusively with glucose — even as insulin resistance quietly rises with age. A low-carbohydrate ketogenic diet changes that equation. By shifting the brain’s primary fuel toward ketones, metabolic stress appears to ease. Inflammation drops. Mitochondrial efficiency improves. Cognitive stability follows in many cases.
This is not a trend.
It is basic biochemistry.
The second pattern is deficiency.
B vitamins, particularly B12, B6, and folate, are deeply involved in nerve function, methylation, and homocysteine regulation. Elevated homocysteine has been linked repeatedly to brain atrophy and cognitive decline. Yet mild deficiencies are common, especially in older adults — often unnoticed for years.
A slow erosion, not a sudden collapse.
The third pattern is fat — but not just any fat.
Omega-3 fatty acids from fish oils are structural components of the brain itself. DHA, in particular, is woven into neuronal membranes. When intake is low, resilience declines. When intake is restored, markers of inflammation and degeneration often shift in a favorable direction.
None of this is radical on its own.
What is striking is how rarely these three factors are discussed together — energy, nutrients, and structure — as a unified defense system for the brain.
Instead, we wait.
We screen late.
We prescribe once damage is visible.
And we call it care.
If dementia were truly unavoidable, prevention would not keep resurfacing in the data. If it were purely genetic, dietary and nutritional interventions would not show consistent protective signals. And if it were simply age, populations with different metabolic and dietary patterns would not age so differently.
The uncomfortable possibility is this:
A large portion of dementia risk may be optional.
Not guaranteed to disappear.
But dramatically reduced.
The real question is not whether these three factors matter.
It is why they remain peripheral to mainstream guidance — despite decades of accumulating evidence.
Sometimes what is missing from the conversation tells you more than what is included.
