Peter Attia's latest podcast: Deep dive into APOE, Alzheimer's and brain health

[broiler_x]

I'm about a third of the way into this podcast, and so far it is excellent.

https://peterattiamd.com/husseinyassine/

Just came out today (Feb.1 2021).

[TheresaB]

I'm about a third of the way into this podcast, and so far it is excellent.

https://peterattiamd.com/husseinyassine/

Just came out today (Feb.1 2021).

Thanks for the heads up on this broiler. Lots of information in this and I wasn't able to direct my full attention, so I'm going to need to listen again when I can really listen, but you're right, excellent.

[broiler_x]

I finished it this morning (it's a little over 2 hours). If you're just interested in the practical advice, it all comes in the last 20 minutes or so. The guest is a very conservative scientist, which I love. For example, he states that consumption of DHA-rich fatty fish does appear to reduce likelihood of having AD, especially when consumed decades prior to symptoms. However, he doesn't recommend supplementation with Omega-3 fatty acids (like fish oil and krill oil). He states that the data is inconclusive. This is different then stating that those supplements don't work, but instead he won't recommend those until there are more conclusive studies.

For those that don't want to listen, but are curious of the recommendations specifically for E4 carriers (again stated very conservatively), he says: 1) start young, as young as you can, 2) eat omega-3 rich fatty fish at least once a week, 3) exercise, and 4) control blood pressure if you are hypertensive. To this guy, these are the best "proven" AD prevention techniques for E4 carriers.

[tracey]

Thank you for the quick summary. I listened to the entire podcast and probably 99% of it went over my head (which caused a deep dive down a rabbit hole and ended here). I have learned so much from this board in the 30 minutes I've been here!

Many thanks.

[SoCalGuy]

Yeah, broiler's summary is very good. I was quite impressed with this doctor, another stellar podcast from Peter Attia.

[samspade]

I listened as well the day after it came out. Yes very conservative approach.

A few things else he said or implied:

• talked about the inability to process glucose which raises oxidative stress
• fasting brain is very efficient at extracting and using ketones
• APOE 4 alleles indicate additional risks for trauma to the brain
• APOE 4 can be a contributor to inflammation but one can work to reduce sources of inflammation
• APOE 4 thrives on fat (~53 mins in)
• diabetics with E4 are at greater risk than without E4 or with E4 and without diabetics
• diet pattern should match E4 (~1:07:55)
• many E4 people are thriving
• Implied but did not state directly that fasting or time-restricted feeding will help aging cells regenerate
• Omega 3 FA consumption needs to be marine-based
• half life of DHA and EPA in the blood is 3 to 6 weeks and much longer in the brain
• Once AD has set in and the blood-brain barrier is compromised then ketone supplementation or via diet may not be of benefit

There was a conversation about the benefits of education for E4 carriers. As mentioned above exercise is beneficial and reduces apparently AB buildup.

At the end, I did not take good notes but there was an implication that if you work to reduce your risk of AD then you will reduce your risk of CVD.

My final takeaway was there were implications of actions we can take that will benefit us but he did not summarize some of them that were implied when he was stating fatty fish 1/wk min (he said there may be a threshold of O3 FA), exercise, and reduce BP. so fasting & ketogenic diet.

I hope this is helpful.

[Tincup]

[*]diabetics with E4 are at greater risk than without E4 or with E4 and without diabetics

A throwback to a study Julie G posted 1 Dec 2014.

This is on CVD not cognition. Bottom line, "Among patients with MetS, we observed an independent association between CVD prevalence and E4 allele frequency (OR 2.42 (1.17- 5.0, p < 0,05)). On the opposite direction, in those without MetS, there was lesser CVD burden in E4 allele carriers (OR 0,14 (0,02-0,75)). These associations remained significant even after confounding factor corrections."

So the difference in odds ratios is 2.42/.14 = 17.3! in other words, 4's with MetS (metabolic syndrome) have a 17x greater risk of CVD (cardiovascular disease) than those without!

[circular]

Once AD has set in and the blood-brain barrier is compromised then ketone supplementation or via diet may not be of benefit

Thanks for sharing you summary samspade - and others. I listened also, but I came away with the feeling that the blood-brain barrier can be compromised before AD has set in, since it's part of why AD eventually sets in. This left me concerned that ketones may have less effect over the years if there are other factors going on that are harming one's blood brain barrier, that while ketones may help ameliorate mid-life symptoms they may not necessarily help to prevent AD at all. Of course we know we have to address all kinds of factors, but I would have thought ketones would help ameliorate the effects of whatever "hits" keep on coming. If the hits are to the blood brain barrier (my guess is that many are), they may not.

Meanwhile, a long time ago I did the Cyrex kit that tells you whether you have a leaky blood brain barrier and I didn't. But later I heard Dr. Gundry's opinion/knowledge/belief? that that test will only show problems once they are advanced and critical. Is there any evidence based way to assess the integrity one's blood brain barrier at an earlier stage? It would seem like a tall order … maybe through imaging of some kind?