Richard Isaacson, MD: Help! I’m at Risk for Alzheimer’s Disease – The Genius Life with Max Lugavere

Check out The Genius Life Episode Page & Show Notes

Key Takeaways

  • Alzheimer’s disease starts in the brain 20 to 30 years before the first symptoms of memory loss
  • On ApoE:
    • ApoE is a gene
    • There are four different isoforms (aka alleles) of ApoE
      • They’re referred to as 1, 2, 3, and 4 (but most of the time you’ll find 2, 3 and 4)
    • Everybody has two copies of the ApoE gene (one from mom and one from dad)
      • Most people have two copies of ApoE3
    • People with an ApoE4 allele have an increased risk of Alzheimer’s disease (you can use 23andMe to see your ApoE phenotype)
      • People with one allele have a 2-3 fold higher risk of Alzheimer’s disease, while those two alleles have a 10-15 fold higher risk 
  • Alzheimer’s disease risk reduction techniques:
    • Physical activity is SUPER important 
      • “Exercise is by far the best thing a person can do to protect against Alzheimer’s disease… Physical exercise is by far the most powerful antidote to ApoE that I know of.” – Richard Isaacson
    • Eat fatty fish (wild salmon, sardines, mackerel, lake trout, and herring) for optimal omega-3 fatty acid consumption
    • Get adequate sleep
    • Monitor your body fat: “As the belly size gets larger, the memory center in the brain gets smaller”Richard Isaacson
  • If someone with mild cognitive impairment (AKA Stage II Alzheimer’s disease) follows a tailored set of recommendations and risk reduction techniques, it’s possible to delay conversion to dementia (AKA Stage III Alzheimer’s disease)

Products and Supplements Mentioned

  • People with an ApoE4 allele need adequate amounts of omega-3 fatty acids
    • If you’re not frequently eating fatty fish, Richard recommends supplementing with DHA and EPA
  • Richard wears an Oura Ring which tracks his REM sleep, deep sleep, total time in bed, total sleep time, heart rate variability, and resting heart rate
    • Purchase a ring from our link for a $50 discount applied at checkout
  • To improve your sleep, wear blue light blocking glasses a few hours before bed (use the code “PodcastNotes10” for 10% off at checkout) 
  • Richard has found running a white noise machine at night improves his sleep quality (15% off with PODCASTNOTES15)

Intro

Let’s Set the Stage

  • On the horrible effects of Alzheimer’s disease: “When you see someone just become a shell of what they were, it’s absolutely devastating” – Richard Isaacson 
  • “We now know that Alzheimer’s disease starts in the brain 20 to 30 years before the first symptom of memory loss begins”Richard Isaacson 
    • 46 million Americans have Alzheimer’s disease in their brain but have yet to show any symptoms

How do you screen for people at risk for developing Alzheimer’s disease?

  • Start early and simply
    • Talk to a person: Have they noticed changes in their mood or sleep? Do they have slight memory glitches?
  • Using sophisticated computer/digital-based cognitive/memory tests, Richard tries to detect the presence of Alzheimer’ s-related changes in the brain before symptoms show
  • The ABCs of Alzheimer’s Prevention Management
    • A: Anthroprometrics – Body composition, body fat, and muscle mass
    • B: Biomarkers – Specifically cholesterol markers
      • The basics: LDL, HDL, and triglycerides
    • C: Cognitive tests
    • Richard adds: Using the above inputs, you’re able to predict whether someone is on the potential road to Alzheimer’s disease
  • Other methods: 
    • A brain MRI showing shrinkage in the memory center of the brain may be predictive of Alzheimer’s disease
    • A PET scan, which examines amyloid levels in the brain (amyloid is the protein that builds up in a person’s brain with Alzheimer’s disease)

You Can Prevent Alzheimer’s Disease

Individualized Clinical Care

  • Check out Richard’s new study which was just published: Individualized Clinical Management of Patients at Risk for Alzheimer’s Dementia by Richard S. Isaacson et al., Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association
    • One of the major findings: “There is no one size fits all approach to Alzheimer’s disease”Richard Isaacson
      • Richard adds: “Once you’ve seen one person with Alzheimer’s, you’ve seen one person with Alzheimer’s”
      • EVERY single patient Richard meets with gets a different set of recommendations for treating/preventing Alzheimer’s disease

Resources

ApoE4

  • ApoeE is a gene
  • There are 4 different isoforms (aka alleles) of ApoE
    • They’re referred to as 1, 2, 3, and 4 (but most of the time you’ll find 2, 3 and 4)
  • Everybody has two copies of the ApoE gene (one from mom and one from dad)
    • Most people have two copies of ApoE3
  • People with an ApoE4 allele have an increased risk of Alzheimer’s disease (you can use 23andMe to see your ApoE phenotype)
    • People with one allele have a 2-3 fold higher risk of Alzheimer’s disease
      • ~25% of the population has at least one ApoE4 allele
    • People with two alleles have a 10-15 fold higher risk of Alzheimer’s disease
      • ~1% of the population fits this fill
  • Another fact: ApoE2 seems to be protective against Alzheimer’s disease
  • That said:
    • Men with the ApoE4 gene don’t seem to be as affected in terms of Alzheimer’s disease risk, compared to women
    • Same thing with African Americans (compared to Caucasians) 

Risk Reduction Techniques

  • If someone has 1 or 2 copies of the ApoE4 gene:
    • Cholesterol management is essential (high cholesterol accelerates the development of dementia/Alzheimer’s disease)
    • Physical activity is SUPER important (Richard recommends 4-5 days/week of exercise)
      • “Exercise is by far, on a regular basis, the best thing a person can do to protect against Alzheimer’s disease… Physical exercise is by far the most powerful antidote to ApoE that I know of.” Richard Isaacson
    • You absolutely can not be smoking 
      • Smoking has more of a detrimental effect on people with the ApoE4 gene
  • Also, people with an ApoE4 allele need adequate amounts of omega-3 fatty acids
    • Thus, ApoE4-positive individuals should be eating fatty fish (wild salmon, sardines, mackerel, lake trout, and herring)
      • If you’re not frequently eating fatty fish, Richard recommends supplementing with DHA and EPA
  • People with 2 copies of ApoE4 seem to preferentially benefit from vitamin D supplementation

A New Alzheimer’s Disease Study

  • A new study recently examined 174 people (ages 25-86)
  • Patients were divided into 2 groups:
    • The first group (139 people) was identified as the “prevention group,” which included those with normal cognitive function, those with mild/minimal cognitive complaints, and people characterized as having pre-symptomatic (AKA pre-clinical, or Stage I) Alzheimer’s disease (meaning Alzheimer’s has started in their brain, but no symptoms are showing)
    • The second group (35 people) was identified as the “early treatment group,” which contained people with mild cognitive impairment (MCI) due to Alzheimer’s disease (this is the Alzheimer’s disease stage after pre-clinical Alzheimer’s, AKA Stage II)
      • Specifically, these people have mild memory issues, but their daily life isn’t affected
      • (For more background, Stage III Alzheimer’s disease is better identified as “dementia”)
  • Then, each patient was given an individually tailored intervention protocol consisting of, on average, 21 recommendations in the areas of:
    • Online education
    • Pharmacologic recommendations (vitamins and supplements)
    • Non-pharmacologic diet recommendations
  • Patients were rated on compliance:
    • If someone followed >60% of the recommendations, they were placed in the high-compliance group 
    • If someone followed <60% of the recommendations, they were placed in the low-compliance group 
  • Findings (after 18 months):
    • Those in the prevention group, in both compliance sets, experienced improved cognitive function
    • Those in the early treatment group, in the high-compliance set, improved their cognitive function 
      • (Those in the low-compliance group showed no difference from a control group)
    • In a secondary analysis, both of the groups mentioned above showed a reduced risk of cardiovascular disease
  • One note:
    • Although not proven, Richard suspects that people with 2 copies of the ApoE4 gene take longer to respond to intervention methods (and also don’t respond as robustly)
  • Conclusion:
    • “We delay conversion to dementia in a person with mild cognitive impairment by up to a few years, whether it’s 6 months, a year, 2 years, or 3 years. I don’t know the exact answer, and it probably varies per person.” Richard Isaacson

The Tactical | How to Boost Your Brain Health

  • Know your numbers (specifically your blood pressure, cholesterol levels, and body fat percentage)
    • “As the belly size gets larger, the memory center in the brain gets smaller”Richard Isaacson
    • A high blood pressure increases the risk of cognitive impairment
      • “Normal” blood pressure numbers may be dictated by doctors as 140/80, but OPTIMAL is ~120/70
    • Also, know your sleep numbers
      • Richard wears an Oura Ring which tracks his REM sleep, deep sleep, total time in bed, total sleep time, heart rate variability, and resting heart rate
        • Purchase a ring from our link for a $50 discount applied at checkout
  • Exercise!!!
    • Exercise stimulates brain-derived neurotrophic factor (BDNF) which is like miracle grow for the brain
  • Less is more when it comes to unhealthy carbs
  • Eat more green leafy greens, fruits, and berries
  • Time-restrict your eating (a daily 12-16 hour fast is optimal)
  • Get adequate sleep. Here are some tips
    • Stop using electronics close to bedtime
    • Wear blue light blocking glasses (use the code “PodcastNotes10” for 10% off at checkout) 1-2 hours before bed to limit blue light exposure
    • Richard has found that running a white noise machine at night improves his sleep quality (15% Off with PODCASTNOTES15)
    • Keep your room cold
  • Reduce stress with meditation
    • Stress is terrible for the body – it promotes brain aging and makes it extremely difficult to lose weight

What does living a genius life mean to Richard?

  • Giving back and having a sense of purpose
    • “Giving back to society and having a sense of purpose is one of the most important non-pharmacological ways a person can protect their brain health over time” – Richard Isaacson