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A neurologist's honest take on Alzheimer's blood tests — Transcript

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0:00during the permenopause transition, that
0:02rapid drop of estrogen for women, man,
0:04that's a critical window of opportunity,
0:06that's when a woman has to do something.
0:08And you know, hormone replacement
0:09therapy, controversial, complicated, but
0:11really important, one of the most
0:12powerful tools a woman can do to reduce
0:14their risk of cognitive decline and
0:16Alzheimer's.
0:20So, what do we actually know [music] in
0:232026
0:24about what causes dementia and
0:27Alzheimer's? I mean, I'm supposed to be
0:30the expert, right? Like, you brought me
0:32here because I'm I'm the That's what I
0:34don't know how I don't know how I got to
0:35be. I don't know. Whatever. I mean, I
0:36don't know what causes Alzheimer's.
0:38Let's just like let's just be honest.
0:39Like, I don't know. Um, that's the best
0:42answer I can give you. Um, I'm going to
0:44give you an answer that I don't know
0:46that you've heard before. I don't know
0:47that it's been said before. I've said
0:49it. I don't even think I've said it
0:50publicly. Um, I don't think Alzheimer's
0:53is a primary brain disease. I think
0:55Alzheimer's is a medical disease, a
0:57medical condition that affects the brain
1:00as what we, you know, doctors say as the
1:02end organ. So as an example, if a person
1:05has high blood pressure, it can cause
1:08vision loss. It can cause kidney
1:09failure. It can cause numbness and
1:11tingling in the toes because the blood
1:12supply you have diabetes and and all
1:15these medical things that cause things.
1:17I believe that whatever Alzheimer's is,
1:20because it's like a waste basket term of
1:22like, you know, a bunch of conditions
1:23that are what I refer to as
1:25heterogeneous, meaning they're all very
1:27different, but some overlap. Um, I don't
1:30even know what Alzheimer's is. Let me
1:31just I don't know what it is. I don't
1:33know what causes it, but I know what we
1:35can do to fight it, and I know what we
1:36can do to reduce risk. And I know the
1:38blood tests that I believe um are
1:41helpful to understand if what we're
1:44telling a person to do to reduce their
1:46risk is working. are we impacting the
1:48biology? And uh no, I don't know what
1:50causes Alzheimer's, but if if you do,
1:51please let me know. I'd love I'd love to
1:53learn.
1:54>> So So with that said, there's a lot of
1:57information or it sounds like your view
1:59it's probably noise around assessing
2:02baseline, there's there's genetic
2:03testing, there's blood testing. Where
2:06does one start if they want to get a
2:09baseline a baseline understanding of
2:11risk?
2:12>> Yeah. So the first thing if anyone out
2:14there is listening and wants to
2:15understand what their risk is and wants
2:16to go down the rabbit hole the very
2:18first thing I would tell you to do is
2:19simple it's
2:22breathe take a deep breath um this is
2:25like stressful like you know um
2:28Alzheimer's is not a I don't like al I
2:31hate Alzheimer's let's just be honest I
2:32have four family members with
2:33Alzheimer's disease it is a tough
2:34disease it robs a person who they are
2:37it's it's a thief it's terrible and I've
2:39seen a lot of people suffer so I think
2:42when someone wants to, you know, learn
2:44about their risk, I think the first
2:45thing is is like take a deep breath like
2:47you can do this. Knowledge is power. Get
2:50educated. Get informed. And and you
2:52know, there's I wouldn't say there's
2:53like any one perfect any thing that a
2:55person can do to like figure out I'm
2:57going to get it. I'm not or I should do
2:58this or that. I think it's about um you
3:00know, multiple pieces of information.
3:04Some that cost nothing you can do online
3:06for free. Some that you know, maybe you
3:08can go to a doctor and get a blood test
3:10potentially. And there's some, you know,
3:12positives and negatives with with blood
3:13testing and I can explain that. A
3:15cognitive screen, regular blood tests
3:18for like cholesterol and metabolism and
3:20inflammation and hormones and all those
3:22things, nutrition markers that can
3:24increase or decrease or, you know, a
3:26person's risk of Alzheimer's or
3:27cognitive decline. But, you know,
3:29wherever a person wants to start, it's
3:31okay to start in different places. And I
3:34don't think there's any one perfect way
3:35to do it. Um but but um I think people
3:38should be motivated to learn about what
3:40their risk factors are and then you know
3:42intervene so you can get off the road to
3:44Alzheimer's. So do you still do you buy
3:47the theory that one should start? Okay.
3:49Do you have the APOE4 gene? Do you have
3:52one copy? Do you have two copies? Do you
3:54look at PTA? Do you look at amaloid with
3:56the blood testing? Do you look at blood
3:58pressure? Do you look at cholesterol?
3:59Like G give me some baseline like
4:01because we have an audience that likes
4:02testing to some degree like where should
4:04they start in your view where there is
4:07some data. Maybe the data is not
4:09unequivocal
4:10but it's something it's a starting
4:12point.
4:13>> Yeah. So, I mean, I think everyone
4:15should just look at their plate like
4:17what are they eating? Look at their, you
4:19know, trackers. You know, I wear this
4:21thing and this thing and I'm tracking
4:22things all like how much are you
4:24sleeping? How much do you move? Are you
4:26getting exercise? Are you sedentary? Do
4:27you do cardiovascular exercise? What
4:29about strength training? Look at the
4:30factors that you have within your
4:32control in your everyday life. Because
4:35if someone out there is looking for that
4:36magic pill or that magic peptide or that
4:38magic like who knows what's you know in
4:40vogue now like yeah can some of that
4:43stuff help? Sure. Um not unless
4:46everything else isn't optimized. So I
4:48think the first person first the first
4:50thing a person should look at is like
4:52their their their what they do every day
4:54what they're focused on what their
4:56lifestyle behaviors are what you know
4:58their life choices are. That's the first
5:00thing I would say. The second thing is
5:01what are the medical problems that they
5:02have. So if a person has high blood
5:04pressure, diabetes or even insulin
5:07resistance, pre-diabetes, to me
5:08pre-diabetes is diabetes and you know
5:11that can affect memory function and
5:13increased risk way before someone is
5:15diagnosed with you know frank diabetes.
5:18High cholesterol like you know
5:19cholesterol is complicated. Let's let's
5:20let's just put that out there.
5:22Cholesterol is really complicated but um
5:24propoundonder the totality of evidence
5:26suggests that lowering cholesterol to an
5:28acceptable range and making sure the
5:29inflammation markers are are in a in a
5:32well well control you know definitely
5:33you know reduces Alzheimer's risk and
5:35and slows the chance of developing
5:37cognitive decline. So I think you know I
5:39just I take a very you know simple
5:41approach you know what can anyone today
5:44do well they can get their hearing
5:46checked like 8% of dementia cases are
5:49attributable to hearing loss 45% of
5:52cases of dementia may be preventable if
5:54that person does everything right and 8%
5:57of those cases is hearing loss um vision
6:00check um obesity sleep apnea nutrition
6:04changes I mean the list goes on and on
6:06like everyday things that people can do
6:08stress management. I mean, man, burning
6:10a candle at both ends, that's not good.
6:12Um, women, oh, oh boy, two out of every
6:15three brains affected by Alzheimer's are
6:17women's brains. And I used to say, I
6:19don't know why, and then we did bunch of
6:20studies and spent $10 million. And now I
6:23think we kind of know why. And during
6:24the permenopause transition, that rapid
6:27drop of estrogen for women, especially
6:29if a woman has one or more copies of the
6:32APOE4 variant of the APOE gene, and we
6:35can talk about that. Man, that's a
6:37critical window of opportunity. That's
6:39when a woman has to do something. And
6:41you know, hormone replacement therapy,
6:43controversial, complicated, but really
6:45important. One of the most powerful
6:46tools a woman could do to uh you know,
6:49reduce their risk of cognitive decline
6:51and Alzheimer's. So, I think I think the
6:53take-home point is like people are
6:54looking for like these magic pills or
6:56magic things or an infusion or this or a
6:59you know, hyperbaric oxygen. like, okay,
7:01all these things are interesting, but
7:03like how about like just everyday
7:05choices, lifestyle choices, and then you
7:08can get into the COG testing and the
7:09blood testing and the whatever else.
7:10And, you know, our goal is to get this
7:14information out there. And we have free
7:15tools online and we can show you
7:17educational things. And we did this NIH
7:19funded research study to show that like
7:21people can take control of their brain
7:22health and use these free tools online.
7:24But moral of the story is there's things
7:26to do before you jump on the blood
7:28testing and the cognitive testing. Let's
7:30assume someone listening is doing a lot
7:32of the right things. Where should they
7:34start? So like they're eating healthy,
7:36they're exercising, they don't have high
7:37blood pressure, they're not
7:38pre-diabetic, their cholesterol is in
7:40check. They're kind of doing all the
7:41right things. And I'm cur like where
7:43should they start with even, you know,
7:45you mentioned your trackers. I think
7:46you're wearing a garment and I couldn't
7:48tell what you were wearing. Like where
7:49where should we like let's go from
7:51wearable to jeans to labs. What do you
7:53think is actually worth someone's time?
7:55>> Cool. Yeah. So let's let's talk about
7:57wearables first. And with wearables, I'm
7:59going to also lump in um biometrics or
8:02body composition devices because I think
8:04those are both important. So, you know,
8:06no radiation, no whatever. Like there
8:09are body fat scales. They're they're
8:11they're imperfect, but they're but
8:12they're okay and they can use comparable
8:14over time. Um understanding your track
8:16and I've been wearing a Whoop uh device
8:17and I have nothing to disclose. No
8:19commercial relationships with Garmin or
8:21Whoop. I I would love to get a free
8:22Garmin or Whoop if anyone's listen. No,
8:24I'm kidding. Um I we I've been wearing
8:26this since 2017. We did a a research
8:28study. I think one we did one of the
8:29first not the first like brain health
8:31related research studies using Whoop uh
8:33you know almost a decade ago now which
8:34is crazy. What is a person's sleep
8:37patterns? Like we actually showed in a
8:38study we published I think in the
8:40journal of the prevention of Alzheimer's
8:41disease or or or maybe not maybe medical
8:44device therapeut I don't know there's
8:45all these journals we showed that by
8:47looking at whoop statistics you know
8:50putting a combination together of sleep
8:52metrics and physical activity metrics
8:54using this K means clustering I don't
8:56know statistic method that's way over my
8:58head we showed that you can predict a
9:00person's cognitive decline just based on
9:02looking at Whoop statistics like how
9:05crazy is that not doing cognitive tests
9:07but Just looking at Whoop statistics.
9:08>> So essentially if you mentioned sleep is
9:10it quality of sleep if someone looks at
9:12their sleep score.
9:13>> Yeah. Exactly. And you know again no
9:16device is perfect. I like Whoop. I you
9:18know people use Aura. Aura works well
9:20and the sleep metrics are good. I like
9:21Garmin. I've gotten to know it and I do
9:23half marathons every year. So like
9:25whatever device it's is imperfect. But
9:27um you know deep sleep is the time of
9:31sleep when people's trash gets taken
9:34out. There's a system everyone knows
9:36about the bloodstream. the blood the
9:37blood bloodstream and then there's a
9:38lymphatic system which is like when you
9:40have infections the bad cells get taken
9:42out. The trash gets taken out at night
9:44in the glimpmphatic system. So exercise
9:47during the day loosens up amaloid.
9:49Amaloid is the sticky protein. The
9:51plaque that builds up in the brain of a
9:52person with Alzheimer's or a person with
9:54one or more copies of this APOE4 variant
9:56which we can talk about 25% of the
9:58population has one or more of these
10:00genes. Doesn't cause Alzheimer's but it
10:02increases risk. So when you have
10:03amaloid, you want to loosen it up by
10:06exercise. It's kind of true and it is
10:08true, but just collocally speaking. And
10:10then you need to take the trash out at
10:11night. So if you're burning the candle
10:12at both ends, you're not exercising on a
10:14regular basis and you're not sleeping
10:16sufficiently, getting at least hour and
10:1815, 20 minutes a night of deep sleep.
10:22Add on to that another hour and 15 or 20
10:24minutes minimum of REM sleep. Best way
10:27to get those two up are increasing your
10:29total sleep. If you're sleeping six
10:30hours a night, that's not that's not
10:32good. seven uh 7 hours and 11 minutes.
10:347-Eleven. That was the magic number in
10:35our Whoop study where we had this like
10:37split where people that were getting
10:38more than that did better cognitively
10:40and people that did less than that um
10:42you know did did worse. Um but you know
10:45that's just a gen generality. Um the
10:47take-home point here is like if if you
10:49stay in balance you get rested sleep.
10:51Now again none of these devices are
10:53perfect but it's an estimate okay but
10:55but that's what I would track. What do
10:57you want to track at home? What is your
10:58deep sleep? What is your REM sleep? and
11:00what you can do about it. Um, breathing
11:02exercises, like I I could not believe
11:05breathing exercises like actually
11:08lowered my HRV, my heart rate
11:10variability, got me into more deep
11:12sleep. Like these phones that we use
11:14like like electronics, like the last
11:16thing we need to do before bed is like
11:18have two phones with bright lights like
11:20in our face like it shuts off melatonin.
11:23That's not the right thing to do. So
11:24sleep hygiene is a great way to get in
11:27balance. having the same bedtime every
11:29night, waking up the same time in the in
11:31the daytime, not doing like, you know,
11:32not caffeine after like 1:00 in the
11:34afternoon. Caffeine has a halflife of 6
11:36hours. So 5 to 6 hours. So like you
11:39drink a coffee in the afternoon, like
11:40you're still caffeinated before going to
11:42bed. Not drinking alcohol before bed,
11:44like alcohol bad, especially, you know,
11:46in certain people with the 8.4 variant.
11:48Like drinking alcohol before bed, you
11:50may fall asleep quicker, but it's not
11:51going to be quality sleep. So I think
11:53you know using devices to track your
11:56relative baseline and changes over time
11:58and to track how your body individually
12:01responds to whatever you're doing to try
12:03to make your sleep better and then doing
12:05physical activity physical exercise on a
12:08regular basis and then using the
12:10biometric devices whether it's an at
12:12home scale again nothing to disclose I
12:14have an inbody at home I've used inbody
12:16scales in my in my research there's hum
12:18and there's weddings and whatever else
12:19they're not perfect but they're okay um
12:22a dexa scan like people like need to get
12:24dex like I can't believe how few people
12:26have had they're like 150 bucks like
12:28usually not covered by insurance which
12:30is crazy you can look at bone density
12:32which is a proxy for brain health even
12:34and grip strength you look at muscle
12:36mass and appendicular lean mass index
12:39which is ALMI something we look at
12:41really closely and we look at body fat
12:43not just your percent body fat but where
12:44is it is it around the midsection
12:46visceral fat so tracking all of these
12:49things either from home or using these
12:51like you know tests
12:52I mean, it's it's brain health 101. It's
12:54not brain health 2011 301. It's it's
12:56it's literally the building blocks of of
12:59of of maintaining and building a healthy
13:01brain.
13:01>> So, it feels like if you're
13:02metabolically fit and your sleep is
13:05relatively good, you're off to a
13:07fantastic start.
13:08>> You are. And then, you know, and again,
13:10your question was a lot of people who
13:12are listening are going to be doing
13:13everything right. I think I agree with
13:16that to a degree because it's everything
13:18right for them and there's a precision
13:21medicine thing like APOE4s, you know,
13:23are different eggs like so there's
13:25there's there's some nuance here. I'm
13:26talking in generalities, but I think
13:28once you're doing everything right and
13:29you set the baseline, that's when you
13:31bring in a baseline cognitive check, a
13:34baseline uh blood biomarker check. The
13:37problem is the blood tests that are out
13:38there. There's a lot a lot a lot a lot
13:40of nuance and it drives me kind of crazy
13:43that people oh pal 217 it's going to
13:45change the world like everyone get this
13:47test like no no no no no no like in what
13:51on what planet do people out there
13:53medically when they get a test for
13:55cardiovascular disease get a total
13:57cholesterol test? No. You get a panel,
13:59you look at the total cholesterol, the
14:01HDL, the LDL, the Apo, triglycerides,
14:03LP, little A. There is no one magic test
14:07for brain health. Um, you know, our lab,
14:09like what we've created actually, one
14:11test, a lab called a lab developed test
14:13that we've brought to clinical use for
14:15people with the April4 variant, which is
14:17pretty cool. And I think we're the only
14:18lab that's doing this now clinically,
14:20which is cool. But when we test for
14:22brain biomarkers, we look at um the
14:25whole panel. So we look at multiple TOAO
14:27proteins, not just, you know, PTA 181
14:30comes up first, then PTA 217. The
14:33problem is these commercially available
14:34tests. I don't want to like throw shade
14:36on any one thing or the other, but
14:37they're really variable depending on
14:39which machine is is it mailed on dry
14:41ice. Was the person sick that day? Like
14:44like we do a nasal swab on every person
14:46with every brain biioarker. Why? Because
14:49the last thing we need is a false
14:50positive. if someone was sick and has
14:52like elevated inflammation in their
14:54brain and the towel goes up like there's
14:56a lot of nuance in these tests and what
14:59I guess I want to say is um there is no
15:00one perfect test. So, if someone does
15:02want to be empowered and get access to
15:04some of these and I can, you know, give
15:05you information and we have lots of
15:06education online for free about this
15:08stuff. Um, there's um there's a panel
15:10that we that we recommend and um these
15:12will, you know, right now they're, you
15:14know, expensive. They're not covered by
15:15insurance, but like it's a really good
15:17investment in a person, you know, for a
15:19person's brain health. So, you can you
15:21can pay for the test, but yeah, that the
15:22panel of tests is key. And then also the
15:25regular uh blood tests that we get all
15:27the time, the cholesterol test,
15:28nutrition markers, like people with one
15:30or more copies of the 8.4 variant need
15:32to have adequate levels of omega-3 fatty
15:34acids in the blood. And some people eat
15:36lots of fatty fish and they still don't.
15:38So they may need to take a high quality
15:39supplement. There's a lot of like if
15:41this, then this, if this, then this.
15:42It's precision medicine, and uh this is
15:45how we try to prevent Alzheimer's
15:47disease.
15:47>> Well, let me get your read on what many
15:50use is like the the quest panel here.
15:53Uh, so I would love your honest take and
15:55and I'll share what what I did. I think
15:57a lot of people do do similar. So I did
15:59the PAL 181, the PA 217, I did amaloid
16:03and the AB4240.
16:05I did the NFL, I did HSC CRP, I did MOO,
16:12and then I also did SARS Kovv2 spike
16:16protein cuz and that was like kind of a
16:18snapshot in addition to, you know, the
16:21Apo and all the metabolic health stuff.
16:22But like would that be what's your view
16:24on this snapshot
16:26of what a lot of people do to assess
16:29where they're at?
16:30>> Uh part like you're not going to like my
16:32answer. Um, but
16:34>> I love it when when people say that.
16:37>> Yeah. My answer is uh my my uncle Ruby,
16:40my great uncle Ruby was an old family
16:42practice doctor in Long Island. You and
16:44I are both from Long Island, which is a
16:45cool thing. He he was uh on the on the
16:47east further east in Suffach County, but
16:49and my brother's a neurologist. My
16:51brother's son is neurologist, brother's
16:52brother. Like we're we're a family of
16:53doctors. My cousin Steven's a
16:55cardiologist. Step into my office. like
16:57like the only way that I can deduce
16:59anything reasonable from the
17:01gobbledegook that you just told me and
17:03again there's no shade on any like one
17:04lab or one thing whatever is is like
17:07trust but verify when it comes to
17:08preventive neurology and and and blood
17:11testing for Alzheimer's it's a trust but
17:13verify um you know I don't exactly know
17:16when the blood was drawn in which
17:18machine was it mailed on dry ice was it
17:20on the you know their own bespoke you
17:23know assay that their company developed
17:26which like, you know, that's not the one
17:28that we use. And there's I've seen
17:30variability in that. Again, I'm not
17:31trying to throw shade on any one thing
17:33or whatever. Did they do the 217 to 42
17:35ratio and was that the FDA cleared test?
17:37Oh, wait. But then the FDA clear test
17:39was pulled off the market because of
17:40inconsistencies. Oh, okay. Wait a
17:43minute. So, like, was it the 181? Like,
17:45which 181 was it on the on the this
17:48machine or the that machine? And again,
17:49dry ice. Did it melt? What day was it
17:52shipped? What day was it received? We do
17:55a totally we just have a different
17:57approach to to brain biioarker testing.
18:00You know, every time someone gets a
18:01blood draw, we store it in a negative
18:0480°ree freezer in perpetuity because we
18:06know that our blood tests now are like
18:08inning one to three, like the first, you
18:11know, first part of a nine inning
18:12baseball game. I don't know if you're a
18:14Yankees or Mets fan, but you know, Long
18:15Island, a lot of us are Mets fans, but
18:17I'm I'm a Yankee fan, but I respect the
18:19Mets.
18:20>> I'm with you. Yankees.
18:21>> Okay, cool. Right on. My friend Brett's
18:23a Mets fan, so I got to be respectful.
18:24And my accountants, and it's it's like
18:26tax season, so I got to be respectful to
18:28my accountant Josh. He's a Mets fan,
18:29too. But moving right along, like like
18:31we are still in the infancy early days
18:33of brain biomarker testing. So, um I
18:36don't believe that even running these
18:38tests on one instrument is sufficient.
18:40Like, you know, there's multiple
18:41instruments and then we like
18:43cross-check. Different technologies have
18:45interference from different things. you
18:47mentioned like COVID and and like like
18:50on one on one platform when someone has
18:52an infection they have funny results on
18:55other platforms we don't. So it depends
18:56on the the type of test that is
18:58assessing the tow and amaloid and
19:00whatnot. So I I hate to throw I'm not
19:03throwing shade on anything but the best
19:04thing I can say is step into my office.
19:06We'll do the panel and I'll tell you
19:08tell you really what's going on.
19:09>> I will step into your office because
19:11it's an hour away. But I I think I think
19:13where I'm going here is for me this has
19:15been such an eyeopening experience cuz I
19:19started to do these tests cuz I came I I
19:20I did the test and I'd high pal and so
19:23we did the other tests to to essentially
19:26see if there was anything else potenti
19:28if there was a downstream effect and the
19:30good news is there all these other
19:31markers were great. we found out we had
19:34I have also high SARS cove uh spike
19:37protein. But the more I learn and the
19:40more I've read your work, I want to
19:42double click on the point is I think the
19:44more we learn, the more we're starting
19:45to realize we don't know what really
19:48causes Alzheimer's and cognitive
19:49decline. And I think the beauty and the
19:51curse with all this testing your point
19:53of like how is it stored and transported
19:56that's a lot like there's a lot of that
19:59we need to know in terms of whether
20:01they're you know are you going to uh are
20:04you driving to a lab is is or is someone
20:07coming to your home how is this being
20:09transported there's so much that's
20:10critical here and it's beautiful that
20:12people are doing all this testing but I
20:15think the point you're trying to get is
20:16it could be wildly inaccurate and
20:18there's just so much that's critical
20:20here.
20:20>> Yes, that that and that. Exactly. You
20:22you you said in in one sentence what I
20:24said in five minutes, so good job.
20:26You're hired. Um you know what what I
20:28would say is um you know we are
20:31maniacally focused on trying to like cut
20:34through the noise on this stuff and we
20:36are trying really hard to you know
20:39answer the call for more accurate
20:41testing and there's accuracy and there's
20:43transparency. got to be transparent in
20:46what these tests, you know, do and may
20:48may or may not show. Um, you know, in a
20:50few months, um, you know, we we we ran
20:52this NIH funded study, um, it's free
20:54free software. It's it's a website,
20:56retainyoubrain.com, where anyone today
20:58can go to this site and learn about
21:00their Alzheimer's risk factors, take
21:01cognitive assessments, and then the
21:03software, you know, this is before AI
21:04was cool. We called it machine learning.
21:06But 7 years ago, we started programming
21:08this thing to like teach people how to
21:10reduce their risk of Alzheimer's through
21:11software. It was like a virtual
21:12Alzheimer's prevention clinic. And we
21:14did this, we did this NIH funded study.
21:16What did we do? We had a sub study where
21:1850 people all around the country.
21:20There's a thousand people in the NIH
21:21funded study and we hope to publish this
21:23soon. Free software. 50 people in that
21:25study. We sent mobile phabotamists had
21:28an army of mobile phabotamists
21:30throughout the country. And we did
21:31everything like per it was expensive. It
21:33was hard dry ice and really process and
21:36we had to train each person, you know,
21:38do all the samples. Like what we realize
21:39very quickly in that is that out in the
21:41wild, you know, when people do blood
21:44tests, things happen. Like things happen
21:46and and we we have temperature trackers
21:49and we have, you know, uh those little
21:51eye tags like Apple tag, whatever the
21:53heck they are, like oh where where is
21:54this? Is it sitting in a lab? So like we
21:56had a supply chain that was that was
21:58really tight. And what we found was that
22:00when there was excursions, we had, you
22:01know, garbage in, garbage out. So, you
22:03know, our goal is for people out there
22:05that want to like learn about what their
22:07risk is and have something accessible.
22:10You know, in a couple of months, we're
22:11going to have, you know, more more tools
22:14available for at home testing. We've
22:15been developing these at home
22:16fingerprint card testing, which is
22:18really cool that people will get to do
22:19again within a research setting. Some of
22:21the stuff we do is, you know, trying to
22:23do research and prove that this stuff
22:25is, you know, you know, ready for prime
22:26time. Some of these assays are. We have
22:28eight clinical grade tests that that
22:30that that people can access to in four
22:32ratios. But long story short, this is
22:34going to get better. It's going to get
22:36better soon, but we have to be really
22:38careful and, you know, promise not to
22:40overpromise. If there's an offering out
22:42there related to blood testing, um, you
22:44know, more power to you. Go get it. Just
22:46know that there's limitations. Um, and
22:48you know, the devil is in the details.
22:49We run things in duplicates. Why?
22:52Because we need to make sure they're
22:53accurate. Like if you're going to be
22:55tracking something pre versus post, we
22:57run some of these tests twice every time
22:59just to make sure that there's no
23:00variance. Like that's where we are in in
23:04today in bloodbased biomarker testing.
23:06We're we're not at one test run one time
23:09yet.
23:10>> Well, also you I think it's worth
23:12spending a minute on what you said about
23:14mobile phbotomy makes a lot of sense is
23:16there's so much variable between someone
23:18getting in a car and taking your blood
23:19and bringing it to the lab. Do they stop
23:21for a ham sandwich? Do they go straight
23:23to the lab? Is the window open? Is the
23:26AC on? We're in South Florida. What else
23:28is going on?
23:29>> Yes. Yes. And yes. Like I we have a
23:31doctor uh in a preventive cardiologist
23:33in Miami. Like like when he sends us
23:35samples like we do we do a courier
23:37service using dry ice. That's hard.
23:40That's complicated. You know, we we have
23:42doctors that send us samples all over
23:43the country. Like I wish this was throw
23:46an ice pack in and like no we only let
23:48people mail us samples Monday through
23:50Wednesday because if if they mail it
23:52Wednesday they mail mail it Thursday and
23:53it gets stuck over the weekend the
23:55samples are done. Like we put enough dry
23:56ice in the box. Yes, it's an extra $20
23:59for for dry ice. Yes, the box needs to
24:00be bigger. That's an extra $30 for
24:02shipping. Like the right way to do
24:05bloodbased biomarker testing right now
24:06is is is just barely ready for prime
24:09time. And there's a there's an added
24:10cost to it. So if people want to do this
24:12the right way, it's it's just it's it's
24:14harder, but it'll get better. I swear
24:16it'll get better soon.
24:17>> So in terms with all the there's so much
24:20information coming at us with regards to
24:22Alzheimer's, dementia, we've got
24:24markers, we've got genetics, there's
24:26we're learning so much. It it's but to
24:28your point there a lot of it's noise. In
24:32your view,
24:34what what do you see when you pick up a
24:37a newspaper or you see something on
24:40social media and you just nod your head
24:42and said, "This is just noise. It's not
24:43helping anybody."
24:44>> So, I'm not on social media. I'm not on
24:46like the Tik Tok and Facebook and
24:49Instagram and all those things. I am I
24:52am I don't know. I'm a generation Xer,
24:53but I just missed the social media
24:55thing.
24:56Um, here's what I'd say. Uh, there's a
24:58guy named Bill. I'll just say that. Bill
25:01sends me a lot of messages from Twitter
25:03and he texts me and then I got to like
25:05get back to him and he sends me this
25:07garbage that sounds like it's real. It's
25:10like this MIT this and this person made
25:14created this thing and it saves
25:16everything and Alzheimer's is
25:18underfunded and this should be ready for
25:20prime time. This was a finding from 15
25:22years ago. And I'm like, no, that's
25:24garbage. that was in mice that never
25:25translate into anything. They did a
25:27human study, they changed their
25:28whatever. Like this is all bunk. I I
25:31think the challenge, you know, with with
25:32social media and in Instagram and and
25:35all these things is like you get these
25:37snippets and then people take it as fact
25:39and then it gets shared and then for
25:41some reason like 12 people send me the
25:42same exact link because it's like this
25:44like whatever the algorithm was, you
25:46know, I don't know. I can just see
25:48through it, you know. Um so it's hard.
25:51It's just a lot of garbage out there.
25:54>> Jason Walab here, founder and co-CEO of
25:56MindBody Green and the host of the
25:58MindBody Green podcast. Please
26:00subscribe. You'll never miss a show and
26:03you won't regret it. So, so let me ask
26:05you this. It sounds like if I want to if
26:07I'm concerned about my risk, there's a
26:10lot that can be done by just being very
26:14healthy metabolically,
26:16sleeping well, exercising, lifting, you
26:20know, body comp all I would say like a
26:22very strong foundation testing. I hear
26:25you like it's something but we're
26:27learning.
26:29So, we'll put that aside. What if I'm in
26:32the thick of it? Maybe I I you know I
26:36it's not me or it's a loved one where
26:38they're showing early signs.
26:42What can be done there? I see this
26:44coming. What do we know that can be done
26:47to stop cognitive decline in its tracks
26:51and potentially reverse it? You hear a
26:53lot of I'm going to bring up noise of
26:54treatments. There's Ebo, you got Ebo and
26:56all these blood transf.
27:00>> Yeah. So, so, and and by the way, I
27:02don't want anyone listening to say,
27:04"Okay, Isaacson says I I'm doing all the
27:06right things. I'm fine." I don't if
27:08there is someone out there who's
27:09proactive and wants I mean, I'm in like
27:11I get my blood drawn. I get my I know
27:13everything about my biomarkers. Like,
27:14I'm doing everything right. I'm running
27:16and I'm tracking my body fat, but I'm
27:17still getting my blood biomarkers tested
27:19periodically. I have multiple family
27:21members with this disease. So, I don't
27:22want to totally turn people off to going
27:25deeper and and getting screened and
27:27doing the thing. I just just want to be
27:29just transparent that like there's a
27:31right way to do it and a and a possibly
27:33a wrong way to do it and many many ways
27:35in between. So I just I just and and
27:37just like if if someone out there gets a
27:39blood test, you know, in the wild um and
27:42if it's worrisome to you, just trust but
27:45verify. It needs to be repeated and try
27:47to find a doctor or a group that is
27:49better. Um you know, we have again a lot
27:51of free resources online about this
27:53stuff. Um ind.org/bloodest
27:56or ind.org/ /arn our foundation
27:59institute for neurodeenerative diseases.
28:00All free education about blood
28:02biomarkers and brain health. Lots of
28:04videos on there. Retainyourbrain.com.
28:07All free access education. And and what
28:09I want you to do is just become citizen
28:11scientists. Don't just go out there and
28:12get a random test and think you're
28:13doomed. That's let me just put a bow on
28:15that. When someone has
28:18symptoms, it's a it's kind of a
28:20different egg. So, so you know
28:21Alzheimer's disease and other
28:23neurodeenerative disorders you know
28:26begin silently decades you know before
28:29that first memory symptom happens. So by
28:31the time a person has memory loss you
28:34know it's been going on for decades. So
28:36the first thing I would say is um don't
28:39wait you know my dad's cousin had
28:42symptoms like she kept repeating herself
28:44in 2007 it took years for her to get a
28:46diagnosis even with like me talking to
28:49her primary care doctor in New Jersey
28:50like I was in Florida I was like talking
28:52to him like can you do it can you do
28:53this like it should that's normal aging
28:56that's fine so so number one of the best
28:58things that we can do is just see a
29:00doctor early uh and not wait and don't
29:03just dismiss signs of cognitive glitches
29:05as as you know senior moments. Get
29:08educated, get informed, see a doctor, do
29:11a basic screen like is there a vitamin
29:13deficiency, a thyroid problem, is the
29:14hormones are off, is there an infection?
29:16Like there's 5% of the time at least
29:18there's something that may be reversible
29:21in terms of a cause of cognitive
29:23decline. So that's what I would say is
29:24number one. Number two is um you know
29:27that's when someone has cognitive
29:28changes that's when you can do a blood
29:31test to do a screen to see are those
29:33cognitive changes related to Alzheimer's
29:36pathology Alzheimer's disease and then
29:38then a person needs to get cognitive
29:39testing maybe a PET scan a spinal tab
29:41see a neurologist and um you know
29:43there's treatments out there both
29:44symptomatic treatments and and there's
29:46these infusions a little controversial
29:47but you know in the right person at the
29:49right dose um anti-amaloid drugs maybe
29:51may be a decent option I think again
29:53controversial But patients, I use these
29:56in in in certain patients. Um, you know,
29:58can can can you reverse Alzheimer's
30:01disease? Like to me, I don't use the R
30:03word. I'm just really conservative. Have
30:06we improved people? Oh, yeah. Have we
30:10normalized
30:11their amaloid and tao in their blood?
30:13Oh, yeah. Have their brains grown? Oh,
30:17yeah. But I'm still conservative cuz
30:20like who am I to know, right? Like I
30:21don't I don't know if I reversed
30:22anything. Like maybe in a few more years
30:24they're going to get worse. And all I
30:25did really was improve. I don't know if
30:27I'm reversing. People say reverse
30:28diabetes, reverse Alzheimer's. Like are
30:30you treating? Are you improving? Are you
30:32normalizing? And is it just going to
30:33like get worse later? So to me with a
30:36word like Alzheimer's, I'm I'm real
30:37cautious because I don't even know what
30:39Alzheimer's is. But I think, you know,
30:41what can people do? Um people can manage
30:44their risk factors related to cognitive
30:46decline when they have symptoms or not.
30:48They can exercise. they can get their
30:50blood sugar and whatever else in check,
30:52see a doctor on a regular basis, and
30:54there are symptomatic and possibly
30:56disease modifying therapies.
30:57>> One, that's very empowering, I think, to
30:59the listener. And just to go a bit a
31:02different a slightly different
31:04direction, when someone says they're
31:06worried about cognitive decline,
31:09how many times is it actually, you know,
31:12Alzheimer's or dementia or or something
31:14else? So like for example, is it you
31:16know I I I I forget names sometimes like
31:21or you know something I read and I'm
31:23curious if this is noise or not. So when
31:25I read that if you're if you you
31:28maintain very strong facial recognition
31:30that's more important than forgetting
31:32names and I'm like oh is that true? I
31:34don't know. I read it online. You know
31:36what's your take on what is real, what
31:41isn't? Cuz my overall take is a lot of
31:45people
31:47are potentially very concerned and you
31:49want them to take action, do the test,
31:51do the work and so forth, but it's not
31:54Alzheimer's and dementia. It may just be
31:56like uh selective memory or
32:01prioritization in their brain. But you
32:02tell me.
32:04>> Yeah. So, uh you and I have small kids.
32:06Uh you and I have a lot of stuff going
32:08on. I have empathy for both of us. Like
32:10you got the screaming kids, you got the
32:12phones going off, you got the the emails
32:16popping. Like 24. We live in a really
32:20unhuman, inhumane, technologically
32:22always connected society. Like it's hard
32:25enough to manage the family, the dogs,
32:27the cat, the whatever. Then we got the
32:29emails popping like I got I got 14, you
32:31know, I got 14 email addresses. You know
32:32what that's like? I got two phones,
32:34three phone numbers. Like this is none
32:36of this is normal. And like the brain
32:38wasn't like built for this. So I think
32:41what happens is a lot of people like
32:43aren't able to pay attention or they're
32:44they're getting just like you know it's
32:46like you know data information overload
32:49and they mistake something for memory
32:53loss or Alzheimer's when they just just
32:56are overburdened with information. So I
32:58would say that is a big part of it. um
33:01you know if something someone's not
33:03paying attention like right like my my
33:05phone's aren't silent I hope anyway like
33:07what if my someone texted me right now
33:09and I like look down and then I like oh
33:11and then you ask me a question oh I
33:13don't oh I'm sorry I don't remember what
33:14did you say like that's that's an
33:16attention problem that's not a memory
33:17problem right so if you can't pay
33:20attention to something you're not going
33:21to remember it so the take-home point I
33:23think with all of this is you know
33:28getting a cognitive nitive assessment.
33:31There's a screening test that takes 15
33:33minutes in a doctor's office. There's
33:35different there's a Montreal cognitive
33:36assessment. There's an MMSC mini mental
33:39status. None of these tests are perfect,
33:40but some are better than others. There's
33:42full neurosychological testing, which
33:46which can be helpful, of course. Um, but
33:48long story short, you know, you need to
33:50see a doctor, get a physical exam,
33:53neurological exam, maybe a brain MRI to
33:55see if there's shrinkage or if there's
33:57like, you know, many strokes that are
33:58building up from vascular whatever.
34:00There's a lot of cognitive changes out
34:02there that are not truly related to
34:04Alzheimer's. And the only way to truly
34:06know is to test the memory, get a more
34:09detailed history of like exactly what
34:10the issues are, and then do the
34:12confirmatory testing afterward. And so
34:15with regards to testing,
34:17it feels like we're early in
34:20a sense of optimism from you. Where
34:23where are we going to be in 3 to 5
34:25years? This is a horrible disease.
34:28People are, you know, obviously scared
34:30about it. Has severe impact on families,
34:33but I'm getting the sense there's
34:35optimism and we're going to get to a
34:37place in in the near future where this
34:39is treatable.
34:40>> I'm at a very unique advantage. I'll
34:43I'll just say that I am privileged.
34:45[clears throat] I'm blessed. I'm also
34:47working very hard and it's not easy. You
34:50know, we have a lab like we process
34:52blood samples. We look at I can look at
34:55over 400 brain proteins right now. Like
34:57you know the man behind the curtain.
34:59Well, we get I'm behind the curtain
35:00looking at all the stuff like I am very
35:04optimistic about you know we are trying
35:06to develop you know what I colloquially
35:08call the cholesterol test for the brain.
35:10So instead of the HDL and the LDL and
35:12whatever like we're trying to put
35:13together like what is the panel that
35:15everyone in their 30s 40s 50s 60s 70s
35:1880s whatever asy no symptoms like before
35:21they have symptoms what screening tests
35:23should be run what panel of proteins
35:25never one test should be assessed for
35:28risk and then when a person does
35:29something to reduce their risk just like
35:31we use a cholesterol test did the statin
35:32work or did the exercise work or did the
35:34or pathetami or omega-3 fatty acids did
35:37that lower the cholesterol like we need
35:39biioarker tests to not just assess a
35:41person's risk, but also assess response
35:44to therapy. To be frank, I actually
35:47believe in the current tests that are
35:49available cuz I know how to use them in
35:50a way that's responsible and
35:53comprehensive. It's those eight markers
35:54plus the four ratios. Four of those
35:56eight markers I run twice in a panel of
35:59whatever with dry ice and whatever. I
36:01believe that the panel we have now is
36:03seventh inning.
36:04>> And what is that panel? Can you can you
36:05share what's in it?
36:06>> Oh, yeah. Yeah, of course. So, it
36:07includes, you know, multiple tow
36:09markers. It includes PAL 181 and 217. It
36:12includes uh amaloid a beta 42 and 40 in
36:15the ratio. It also includes the
36:17different ratios 181 to 42 and 217 to
36:2042. And there's a whole millu of of
36:22stuff. We also look at APOE4 protein um
36:25uh levels. We look at and this is again
36:26I think I think we may be the only lab
36:28doing this clinically but I'm I'm not
36:30certain. We look at APOE4 protein levels
36:32and then we do a ratio of like the how
36:34much APOE is protein is expressed E4.
36:36It's kind of like the engine light of
36:38the car that I that that I kind of think
36:40about. A person's DNA is the engine. So
36:42we also look at by the way APOE4
36:44genetics. We look at the cloth because
36:46cloth is this everyone says oh it's a
36:47longevity gene. It also um you know
36:50calms down the um it also like actually
36:53attenuates the risk of APOE4 also. So,
36:56long story short, we look at um you
36:58know, you can look at the DNA, which is
36:59the engine of the car, or you could look
37:00at the the dashboard, the panel, the uh
37:03the the engine light, and the APOE4
37:05ratios and the protein ratios is more
37:07like an epigenetic way to understand
37:09what a person's real-time APOE4 induced
37:12Alzheimer's risk is. So, those are two
37:15tests that we use. We also um look at um
37:17GFAP, glyopibrillary protein, which is a
37:20marker of neuroinflammation, brain
37:22inflammation. We look at NFL
37:23neuropilament light marker of
37:25neurodeeneration. We put these all into
37:27like a formula and different ratios and
37:29like and then we use we have we have a
37:31whole other you know nasal swab stuff.
37:32We look at cholester we look at a whole
37:34panel of stuff um together. You know
37:36this is what we did in the Alzheimer's
37:37prevention clinic when at Cornell we put
37:39this together. We put someone on a
37:40targeted risk reduction plan and then we
37:42use the brain biomarker panel to
37:44understand are the things that we're
37:46telling a person do to do to reduce
37:48their medical risk factors is that in
37:51fact lowering their uh risk of of
37:53Alzheimer's disease by improving the
37:55biological markers related to
37:57Alzheimer's disease. So that's what we
37:59do. We put everything together. So uh in
38:01and in in the background we have another
38:04you know 300 and something 90 proteins
38:07that we look at from a research
38:09perspective. Now these tests are not
38:10ready for prime time. This is a research
38:12study where people consent and we look
38:14at brain proteins but we look at a host
38:16of factors from introlucans to cytoines
38:19alphasuclean proteins. I mean these are
38:22for people that are at risk of
38:23Parkinson's disease and um and
38:25Louisibody dementia. Um, you know, we we
38:27we look really deep and and
38:29unfortunately those measures are just
38:31for research and not enough not ready
38:32for prime time clinical use just yet.
38:34>> Fascinating. So, we're getting there.
38:36So, so one can reach out to you, go to
38:38your lab if and you're in uh South
38:41Florida or they can just kind of sit and
38:43wait because this is the future and this
38:44is this is coming down the pipeline in a
38:46couple years. Is that fair to say?
38:48>> Yeah. Yeah, I think I think so. I think
38:49you know um you know we're we're a few
38:52months away from being able to I would
38:53say launch this more broadly. We have
38:56doctors, you know, you know, I I have
38:57the fortune to work at at a place called
38:59Atria Atria Health Institute. It's a
39:01it's a medical practice that has sites
39:03in New York, Palm Beach, and um and LA
39:07opening uh pretty soon. Uh I mean, our
39:10our our patients, we have, you know, a
39:12few thousand patients, members of Atria
39:13that that get access to these tests and,
39:15you know, participate in research and
39:16stuff. We have preventive cardiologists
39:18in Miami. We have doctors in, you know,
39:20Redwood City and and Cape Cod. like we
39:22have doctors that proactively reached
39:24out to me and us or heard about this and
39:26said, "I want to offer these tests." So,
39:28right now they're not, you know, they're
39:29not, you know, baby steps. You know,
39:32we're a small mom and pop operation. You
39:34know, our NIH funding NIH funding ain't
39:36what it used to be. Um, and our grant
39:39that we uh were waiting for uh
39:41unfortunately was pulled off the website
39:42in January. So, we're we're we're we
39:44have our we're paddling we're treading
39:46water, I guess, is what you'd say. We're
39:48doing okay. Uh, but we're still a mom
39:49and pop operation. And um you know one
39:51day all these these panels and tests
39:53will be available I I hope more broadly
39:55and then I think you know for people out
39:57there you know and to get more
39:59information our our websites again free
40:01retainyoubrain.com is a free education
40:03website where one day people can get
40:04access to these tests. Um allslabs.org
40:07alzlabs.org is a that's where we're
40:10trying to uh create these at home
40:12testing. You know these for I hope $99
40:15one day we're going to have a little
40:16fingerprint card test where people can
40:18get a screen from their home. We mail it
40:19back and then we say, "Aha, you're at
40:21lower risk, medium risk, or higher
40:22risk." We're uh, you know, I would say
40:2412, maybe 18 months away from hopefully
40:27making that into a reality. So people
40:28don't have to spend a lot of money or
40:30time if they don't need to. You do a
40:32screening test with a finger prick to
40:34get a whole panel of proteins to see,
40:36aha, I'm at risk or not. I better do
40:38more. Get more work up, get more tests.
40:40So our our goal is to try to democratize
40:43access, give as much away for free as
40:45possible because that's that's our, you
40:47know, that's our mission, but then
40:48develop lower cost tests to uh to get
40:51people educated and informed.
40:52>> Amazing, Richard. Thank you so much.
40:55>> Thank you.

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