The Peter Attia Drive - Qualy #24 - What are the ＂ABCs＂ of Alzheimer's prevention？

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00:00:59.240 subscribe so without further delay i hope you enjoy today's quali we try to keep it simple so the abcs of

00:01:07.660 alzheimer's prevention management it sounds kitschy but i really think abcs actually fit so a is

00:01:12.840 anthropometric we look at body fat we look at lean mass we look at is it visceral fat where is the fat

00:01:17.960 you know i learned a lot of this stuff we really take a deep dive it's not just about weight and bmi

00:01:22.060 like that's just like the worst no it's about body fat where's the fat metabolically active yada yada

00:01:26.620 then the b is for biomarkers blood-based biomarkers specifically cholesterol markers especially the

00:01:33.600 deeper dive i just want to take my hat off to you richard you do more detailed lipid profiling than

00:01:39.680 most cardiologists do i remember the first time i sat down with you i was fully expecting you to just

00:01:44.800 whip out like the ldl hdl triglycerides or this and you went deep i mean you had apob you had

00:01:51.880 ldlp you had particle subtype you really got into it and i was like why is the neurologist knowing all

00:01:58.900 of this stuff when every cardiologist seems to like still be in the dark ages on this that drives

00:02:04.620 me crazy you know it's interesting we have four cardiologists now in the practice actually one who

00:02:08.120 listens to the podcast like give him a shout out she probably shouldn't say his name let's not say

00:02:12.460 his name what's up really great guy actually he's been a great he's a patient but he's been a mentor and

00:02:16.720 that teacher to me too and you know we have cardiologists in the practice and one is what

00:02:20.500 was like totally anti like what are you ordering and he's still anti all that stuff but he really

00:02:25.100 wants to know his numbers and he really wants me to interpret it but but for his patients you know

00:02:28.720 i don't use this stuff what are some of the other biomarkers you focus on so the four main categories

00:02:32.960 are cholesterol but deep dive cholesterol um inflammation however there's just four inflammation

00:02:37.500 labs and they're just not great but it's just in our panel so what are you looking at besides crp

00:02:41.800 and fibrinogen what do you look at il1 or il6 tnf yeah i wish did baby steps it's myeloperoxidase

00:02:49.320 and lp pla2 which i don't exactly know what to do with but yeah fibrinogen interesting and high

00:02:55.760 sensitivity crp now that i see all the results and our outcomes hscrp is probably the most informative

00:03:01.740 but you know something like myeloperoxidase is a risk factor for vascular cognitive impairment later

00:03:07.180 that's a new study so i don't exactly know what to do with the inflammatory markers but we're

00:03:11.020 checking them and what stands in the way of adding some interleukins to that some of the money

00:03:14.820 benjamin's i would love to get better nutritional biomarkers which we'll talk about we do it in the

00:03:21.660 serum we'd absolutely need to do it in the red blood cell but we need to send it to a different

00:03:24.980 place in a different fedex account and this is the thing can i just i'm just going to get back

00:03:28.480 on my soapbox god damn it i'm allowed to do this i guess this is the one perk of having your show

00:03:32.800 if you're listening to this and you're in some way touched by alzheimer's disease either because

00:03:37.760 you have a family member who's got it or you're concerned about anything like that and

00:03:40.480 you're considering like funding research in alzheimer's disease i can't emphasize enough

00:03:44.780 the importance of funding the type of research that richard does whether that means funding

00:03:48.100 richard directly or somebody else because alzheimer's prevention is so underfunded it is an embarrassment

00:03:55.220 to this disease state and so and i've had patients who have said to me you know a loved one just passed

00:04:01.860 away and i'd like to throw a hundred thousand dollars at something for alzheimer's research and i think

00:04:06.440 to myself luckily those patients like to give that money to you because you can do more with a hundred

00:04:10.460 thousand dollars in your clinic immediately a hundred thousand dollars doesn't buy you five

00:04:14.000 animals to do a study on a drug that has a 99.6 percent chance of not working let me repeat that

00:04:21.340 the success rate of pharmacology for alzheimer's disease is 0.4 percent in other words 99.6 of drugs

00:04:32.100 brought forth to treat alzheimer's disease are abject failures now if you are interested in the

00:04:38.160 philanthropic side of alzheimer's disease and you want to put more money in that pot you must ask

00:04:42.700 yourself the question which is what is the definition of crazy is it throwing more money into the same

00:04:48.820 pile that's taking the same approach to a disease that's not working or is it possibly looking to this

00:04:54.240 novel idea of alzheimer's prevention okay rant over off the soapbox let's go back and it's funny like

00:05:00.120 if i would have had 75 000 more three years ago i would have had the right biomarkers so i could

00:05:09.920 definitively say about which omega-3 which this which that i could have for 75 000 you know we've gone

00:05:18.020 through eight million dollars in five years okay it's not too bad actually i mean for a major research

00:05:22.880 program five million of it philanthropy three million nih and other grants 75 000 extra i could have

00:05:28.960 definitive evidence about which omega-3s to take is it ala dha epa i think it's dha and epa but i wasn't

00:05:35.700 doing the right biomarkers because i couldn't afford the right test so for the littlest tiny investments

00:05:40.120 you know we have a data set with 3 000 pieces of data on every patient we have such a deep phenotypic

00:05:46.880 characterization i have thousands of pages of data i don't know how i'm going to write this up i need

00:05:51.760 to hire two full-time people for fifty thousand dollars per person we can churn out papers you know

00:05:57.460 two papers every few months so the take-home point is in an imprecise world in an imperfect world where

00:06:02.380 i don't have unlimited funds we have to be cautious so we've done the best we can but oh man i wish if

00:06:07.980 we could have tnf alpha interleukins and cd50s and i i wish we could yeah and i think the way to think

00:06:13.960 about this if again if you're listening to this and you're trying to understand how should funding be

00:06:19.020 allocated you have to think about this as how would you hedge right so i'm not suggesting for a

00:06:23.380 moment that no effort should be made at doing research around alzheimer's treatment i mean the

00:06:28.340 disease is devastating and you don't have to meet but one person who suffers from this disease to think

00:06:33.240 we should be throwing heaven and earth at figuring out how to treat these patients the question is how

00:06:38.840 would you balance that portfolio because right now that portfolio is about 99 to 1 99.9 dollars are

00:06:44.980 going into treatment 0.1 going into prevention i'm asking simply what if it were 90 10 what if it

00:06:51.360 were 90 that go into treatment and 10 into prevention in reality i think if it were 10 90 we'd move the

00:06:59.360 needle even more if we were willing to acknowledge that hey a lot of people can't be helped right now

00:07:04.220 which is an awful message to consider so anyway i do think that prevention suffers from a number of

00:07:10.620 things it's way squishier there's always going to be a bias against the idea that you can get people

00:07:15.740 to change behaviors lifestyle behaviors in other words it's one thing to get a patient to take their

00:07:20.480 pill it's quite another thing to get a patient to change the way they sleep the way they meditate if

00:07:25.460 they do at all the way they exercise the way they eat these things are harder to do that's the

00:07:31.440 downside the upside is if you can do those things i think the evidence is pointing to you can have a much

00:07:37.520 bigger impact oh yeah and if when you do this precision medicine approach where you look at

00:07:41.740 their cholesterol inflammation metabolism we'll talk about in a second nutrition biomarkers genetics

00:07:46.280 and you take all these factors and you look at their body fat and you look at their cognitive function

00:07:51.420 which we'll talk about the a b's and c's you can then give them a personalized precision medicine plan

00:07:56.520 and they end up getting that right plan and then the outcome is better and then they're going to have

00:08:03.720 positive reinforcement to where they're going to keep doing it i have people that say i haven't been

00:08:07.340 able to lose weight my whole life are you doing the wrong thing you're on elliptical for 20 minutes

00:08:12.780 three times a week that's not going to get you to lose weight that may get you to maintain yourself

00:08:16.980 a little bit but not really you need to do high intensity interval training you need to lose body

00:08:20.880 fat here's your fat here's your this here's your that when you attack it with knowledge about

00:08:25.220 the non one size fits all approach and the n of one do everything and everything based on your

00:08:31.380 individual biology and genetics that's when a person can have the most success when they have

00:08:35.940 success it's positive reinforcement yeah and i think seeing those biomarkers improve i saw three

00:08:41.220 patients today in clinic and in all cases we're reviewing labs and it's really i love it yeah they

00:08:47.100 really like to be able to especially the ones that dial into this stuff that think oh wow look at

00:08:51.700 how this change led to that but not this and what do i need to do more here and i mean i guess in the

00:08:57.300 end one of the challenges is you and i both have a luxury that not not a lot of doctors too which is

00:09:01.900 we have small practices that allow us that luxury of time and so hopefully some of these other tools

00:09:08.100 you're developing will allow physicians to be able to scale themselves a little bit by saying look

00:09:13.840 i you know dr smith might not have as much time as dr isaacson to sit down and spend an hour with

00:09:19.320 each patient going over this stuff but i can at least point a patient to a tool that can help streamline

00:09:26.100 this process yeah when i'm sleeping without any pr without any everything just because the way the

00:09:30.420 internet works when i go to sleep and wake up my ex-girlfriend with the phone the phone thing who

00:09:35.900 i was trying to show off and impress she said well you work so much and every time you give a lecture

00:09:40.240 okay fine but make money while you're sleeping well it's the same thing i want to help people and

00:09:45.260 educate people i'm sleeping you're right i see seven patients in a day sometimes five because it takes a

00:09:50.100 lot of time but when i'm sleeping over a thousand patients are on that free education website with two

00:09:55.300 hours of interactive educational content about alzheimer's prevention that's how we impact

00:10:00.120 lives so i'm hoping that we can increase that from a thousand to eighty six hundred patients

00:10:04.600 while you're sleeping i would the astute listener will get the reference to that so does my pocket

00:10:10.380 book absolutely so and it's everything's free and we don't charge for any of this stuff but that was

00:10:14.040 an inside joke i hope you enjoyed today's quali now sit tight for that legal disclaimer this podcast

00:10:20.800 is for general informational purposes only and does not constitute the practice of medicine

00:10:25.040 nursing or other professional health care services including the giving of medical advice

00:10:30.100 and note no doctor patient relationship is formed the use of this information and the materials linked

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00:10:41.280 for professional medical advice diagnoses or treatment users should not disregard or delay in obtaining

00:10:47.100 medical advice for any medical condition they have and should seek the assistance of their

00:10:51.340 healthcare professionals for any such conditions lastly and perhaps most importantly i take conflicts of

00:10:57.420 interest very seriously for all of my disclosures the companies i invest in and or advise please visit

00:11:03.420 peter atia md.com forward slash about

The Peter Attia Drive - September 13, 2019

Qualy #24 - What are the ＂ABCs＂ of Alzheimer's prevention？

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