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

**Peter Attia** (0:05)
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**Richard Isaacson** (1:05)
We try to keep it simple. So the ABCs of Alzheimer's Prevention Management. It sounds kitschy, but I really think ABCs actually fit. So A is anthropometric. We look at body fat. We look at lean mass. We look at visceral fat. Where is the fat?
I learned a lot of this stuff. We really take a deep dive. It's not just about weight and BMI. That's just like the worst. No, it's about body fat. Where's the fat? Metabolically active, yada, yada.
Then the B is for biomarkers, blood-based biomarkers, specifically cholesterol markers, especially the deeper dive.

**Peter Attia** (1:34)
I just want to take my hat off to you, Richard. You do more detailed lipid profiling than most cardiologists do. I remember the first time I sat down with you, I was fully expecting you to just whip out the LDL, HDL, triglycerides or this, and you went deep. You had APO-B, you had LDLP, you had particle subtype.
You really got into it, and I was like, why is the neurologist knowing all of this stuff when every cardiologist seems to still be in the dark ages on this?

**Richard Isaacson** (2:04)
And that drives me crazy. You know, it's interesting, we have four cardiologists now in the practice. Actually, one who listens to the podcast. I can give him a shout out. Probably shouldn't say his name.

**Peter Attia** (2:11)
Yeah, let's not say his name.

**Richard Isaacson** (2:12)
What's up? Really great guy. Actually, he's been a great, he's a patient, but he's been a mentor and a teacher to me too.
And we have cardiologists in the practice, and one who was totally anti, he's like, what are you ordering? And he's still anti all that stuff, but he really wants to know his numbers, and he really wants me to interpret it. But for his patients, I don't use this stuff.

**Peter Attia** (2:29)
What are some of the other biomarkers you focus on?

**Richard Isaacson** (2:31)
So the four main categories are cholesterol, but deep dive cholesterol. Inflammation, however, there's just four inflammation labs, and they're just not great, but it's just in our panel.

**Peter Attia** (2:39)
So what are you looking at besides CRP and fibrinogen? Do you look at IL-1 or IL-6, TNF?

**Richard Isaacson** (2:45)
Yeah, I wish. Yeah, baby steps.
It's myeloperoxidase and LPPLA2, which I don't exactly know what to do with. But yeah, fibrinogen, interesting, and high-sensitivity CRP. Now that I see all the results in our outcomes, HSCRP is probably the most informative. But something like myeloperoxidase is a risk factor for vascular cognitive impairment later. That's a new study. So I don't exactly know what to do with the inflammatory markers, but we're checking them.

**Peter Attia** (3:11)
And what stands in the way of adding some interleukins to that?

**Richard Isaacson** (3:14)
Some of the money, Benjamins.
I would love to get better nutritional biomarkers, which we'll talk about. We do it in the serum. We absolutely need to do it in the red blood cell, but we need to send it to a different place in a different FedEx account.

**Peter Attia** (3:26)
This is the thing. I'm just going to get back on my soapbox. God damn it. I'm allowed to do this, I guess. This is the one perk of having your show.
If you're listening to this, and you're in some way touched by Alzheimer's disease, either because you have a family member who's got it, or you're concerned about anything like that, and you're considering funding research in Alzheimer's disease, I can't emphasize enough the importance of funding the type of research that Richard does, whether that means funding Richard directly or somebody else, because Alzheimer's prevention is so underfunded, it is an embarrassment to this disease state. And I've had patients who have said to me, a loved one just passed away, and I'd like to throw $100,000 at something for Alzheimer's research. And I think to myself, luckily those patients like to give that money to you because you can do more with $100,000 in your clinic.