← The Peter Attia Drive

#138 - Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer's disease prevention—patient and doctor perspectives

Nov 23, 2020 2h 11m 19 insights
<div>Peter is joined by writer, director, actress, and founder of <a href="https://wearehfc.org/" title="https://wearehfc.org/">HFC</a>, Lauren Miller Rogen, and previous podcast guest and director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, Dr. Richard Isaacson. In this episode, Lauren tells the heartbreaking story of watching members of her family succumb to Alzheimer's disease (AD) which motivated her to proactively address her own risk with Richard's guidance. Richard discusses the various genetic and lifestyle factors that influence the risk of AD and uses Lauren's unique situation to explain how he diagnoses patients and personalizes care. They go through Lauren's protocol of preventative measures that have already produced marked results, and end with the uplifting message that one's genetic predisposition does not seal one's fate.<br /> <br /></div> <div> <div> <p>We discuss:</p> <ul type="disc"> <li>Lauren's deep family history of Alzheimer's disease (3:10);</li> <li>The influence of genetics, epigenetics, and lifestyle on Alzheimer's disease risk (13:45);</li> <li>Lauren's mother's disease progression and the enormous stress it causes for family members (24:30);</li> <li>The various manifestations of Alzheimer's disease depending on the location of pathology (29:30);</li> <li>The three stages of Alzheimer's disease (34:45);</li> <li>Richard's deep exploration into Lauren's family history revealing clues about a diagnosis and a roadmap to successful disease mitigation (39:15);</li> <li>How exercise reduces Alzheimer's disease risk, and the different risk between males and females (58:00);</li> <li>Why knowing your APOE status is important, and whether certain people should be wearier of head trauma (1:08:00);</li> <li>How Richard uses genetic testing to personalize care (1:14:45);</li> <li>The "ABCs" of Alzheimer's prevention, lifestyle interventions, and Lauren's personal protocol for reducing her risk (1:21:45);</li> <li>Unique treatment for people with the ApoE4 variant (1:36:30);</li> <li>Richard's mixed opinion on CBD and THC as a tool for disease prevention (1:40:00);</li> <li>Cognitive testing procedures, and how Lauren's tests furthered her commitment to her disease prevention protocol (1:41:45);</li> <li>The relevance of sense of smell and hearing in Alzheimer's disease risk and prevention (1:50:00);</li> <li>The emotional benefit of knowing you have control over your mental and physical health (1:57:30);</li> <li>HFC—a charitable organization founded by Lauren and Seth (2:00:15); and</li> <li>More.</li> </ul> </div> </div> <p>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/laurenmillerrogen-richardisaacson/">https://peterattiamd.com/laurenmillerrogen-richardisaacson/</a> <br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.</p>
Actionable Insights

1. Embrace Early Prevention Mindset

Recognize that Alzheimer’s disease begins decades before symptoms appear, making early intervention critical. Don’t wait until later in life; take control of your brain health as early as possible, as science provides tools to modify risk.

2. Prioritize High-Intensity Exercise

Engage in regular physical activity, specifically high-intensity interval training (HIIT), cardiovascular exercise, and strength training. This is especially crucial for individuals with the APOE4 variant, as it can significantly improve cognitive function and counteract the effects of a sedentary lifestyle.

3. Optimize Omega-3 Intake

Consume fatty fish and consider supplementing with omega-3 fatty acids, particularly DHA and EPA, aiming for higher doses (e.g., 2000mg combined DHA/EPA) if you carry the APOE4 variant. This is vital for brain protection, as E4 carriers may require more to achieve optimal red blood cell levels (aim for 12-14+ index).

4. Address Hormonal Shifts in Women

Women, especially those with APOE4, should be aware of bioenergetic shifts during perimenopause, which can accelerate Alzheimer’s pathology. Consult an OBGYN to discuss potential interventions with specific types of hormone replacement therapy (e.g., natural estrogen, progesterone) to mitigate the negative impact of estrogen withdrawal.

5. Prioritize Quality Sleep

Improve sleep habits, as poor sleep can negatively impact brain health and accelerate neurodegenerative processes. Consider strategies like magnesium L-threonate, which may aid sleep and cognitive function.

6. Reduce Sugar and Refined Carbs

Limit consumption of sugar and high glycemic index foods, as excessive intake can contribute to metabolic dysfunction that impacts brain health. This is particularly important for individuals with a genetic predisposition to Alzheimer’s.

7. Manage Homocysteine Levels

Address elevated homocysteine levels, an independent risk factor for brain shrinkage and impaired memory, by supplementing with B-complex vitamins (B12, B6, folic acid). This intervention can help slow brain atrophy and improve memory function.

8. Optimize Vitamin D Levels

Ensure your vitamin D levels are optimal, aiming for a range of 40-50 ng/mL, or potentially 50-70 ng/mL for APOE4-4 carriers. Take vitamin D supplements with a fat-containing meal for better absorption and get 10-15 minutes of sun exposure between 11 AM and 1 PM.

9. Stay Cognitively Engaged

Continuously challenge your brain by learning new things and staying intellectually active. Cognitive engagement is critical for brain health, as the principle ‘if you don’t use it, you lose it’ applies to cognitive function.

10. Monitor Body Composition

For women, pay close attention to body fat percentage and visceral fat (enlarged waist circumference), as abdominal obesity increases dementia risk. For men, focus on maintaining muscle mass.

11. Screen and Correct Hearing Loss

Get early recognition and address any hearing impairment, as hearing loss is identified as a highly impactful modifiable risk factor for dementia. Correcting hearing loss may help maintain social engagement and cognitive function.

12. Reconsider Alcohol Intake (E4)

While light to moderate alcohol consumption (4-7 drinks/week) might be beneficial for non-APOE4 carriers, individuals with the APOE4 variant may benefit more from decreasing alcohol intake or abstaining altogether.

13. Avoid Tobacco Use

Refrain from tobacco use, as it exacerbates Alzheimer’s risk, especially for individuals with the APOE4 variant.

14. Be Cautious with Head Trauma

Individuals with the APOE4 gene may be more susceptible to the negative effects of head trauma. Reconsider participation in contact sports, particularly for children with this genetic predisposition.

15. Consider Curcumin Supplementation

For those at higher risk, especially with inflammatory markers like TNF alpha, consider a nanoparticle version of curcumin (e.g., Theracurmin) due to its potential anti-inflammatory effects and ability to cross the blood-brain barrier, as suggested by some studies.

16. Utilize Regular Health Tracking

Engage in regular follow-up with healthcare professionals, including body composition measurements (anthropometrics), blood-based biomarkers (cholesterol, inflammation, metabolism, nutrition), and cognitive function assessments. This iterative process allows for personalized care refinement.

17. Use Odor Identification Test

Be aware that a decreased ability to identify odors can be an early harbinger of neurodegenerative diseases like Alzheimer’s. While not perfect, it can be a useful objective indicator for monitoring brain health.

18. Approach THC/CBD Individually

If considering CBD or THC for sleep or stress reduction, treat it as an individualized ’n of 1’ study. Monitor objective metrics (e.g., sleep trackers, cognitive function) to assess its specific impact on your health, and consider edibles over inhaled forms.

19. Support Alzheimer’s Caregivers

Recognize the immense strain on primary caregivers for Alzheimer’s patients. Support organizations like Hilarity for Charity (HFC) that provide respite care, personalized support groups, and caregiver training to alleviate this burden.