When I share with colleagues that I prescribe Valtrex (valacyclovir) and low-dose lithium orotate to patients anxious about the risk of Alzheimer’s, the atmosphere in the room grows tense. Someone inevitably asks, “Where’s the randomized controlled trial?” That’s precisely the issue. We continue to wait for definitive proof while the affliction erodes people’s cognitive function.

I’m an internist and lipidologist who has dedicated years to observing the medical community pursue misguided adversaries, such as cholesterol, salt, and saturated fat, while neglecting the influence of infection, inflammation, and immune dysfunction. Alzheimer’s represents the newest challenge in this zone of oversight.

The infectious hypothesis regarding Alzheimer’s is no longer fringe. Research from Tufts University, Harvard, and Oxford has discovered herpes simplex virus type 1 (HSV-1) present in the brains of older adults exhibiting Alzheimer’s characteristics. Epidemiological insights from Taiwan’s National Health Insurance Research Database indicated that individuals with HSV infection faced a 2.5-fold elevated chance of developing dementia, and those who received antiviral medications like acyclovir or valacyclovir experienced an 88 percent decrease in that risk. Let that resonate: an 88 percent decrease.

We’ve encountered this narrative previously. In the 1980s, ulcers were attributed to “stress” until Barry Marshall ingested a sample of H. pylori to demonstrate an infectious source. In cardiology, we’ve been reluctant to acknowledge that Chlamydia pneumoniae has been found in atherosclerotic plaques for decades. Yet here we find ourselves again, maintaining the illusion that Alzheimer’s must strictly be metabolic, genetic, or a mere chance.

Valtrex isn’t a cure-all, but it is affordable, safe, and mechanistically sound. Present clinical trials are investigating high-dose valacyclovir in patients with early-stage Alzheimer’s, but the safety information we already possess from years of HSV treatment is robust. Typically, I initiate treatment for patients with HSV-1 or HSV-2 seropositivity at 500 mg-1 g daily. I pair that with lithium orotate 5 mg, not for mood stabilization, but because microdose lithium has been linked to decreased dementia occurrences in various population studies and may help stabilize tau phosphorylation.

This isn’t reckless; it’s a form of proactive empiricism. We manage hypertension to avert strokes long before randomized controlled trials established benefits for each drug class. We prescribe metformin to those with prediabetes without certainty regarding who will truly progress to diabetes. Yet in terms of the brain, where the ramifications are irreversible, we hesitate.

So yes, I’m weary of waiting. If a patient presents with a significant family history or initial cognitive concerns and wishes to take action, I will propose a low-cost antiviral and lithium combination with comprehensive informed consent. The risks are minimal; the potential rewards, immense. One day, the randomized controlled trials will align with us. By then, some of my patients might still recall my name.

Larry Kaskel is an internist and “lipidologist in recovery” who has practiced medicine for over thirty-five years. He runs a concierge practice in the Chicago area and is part of the teaching faculty at the Northwestern University Feinberg School of Medicine. Additionally, he is associated with Northwestern Lake Forest Hospital.

Prior to the advent of podcasts in popular culture, Dr. Kaskel hosted Lipid Luminations on ReachMD, where he developed a collection of more than four hundred programs featuring prominent figures in cardiology, lipidology, and preventive medicine.

He is the author of Dr. Kaskel’s Living in Wellness, Volume One: Let Food Be Thy Medicine, works that fuse evidence-based medical practice with accessible methods for enhancing healthspan. His current endeavors concentrate on reinterpreting the cholesterol hypothesis and examining the infectious roots of atherosclerosis. More information can be found at larrykaskel.com.