#306 - AMA #60: preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more

Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast. I'm your host, Peter Atiyah.
At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peteratiamd.com forward slash subscribe.
So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask Me Anything episode number 60.
I'm once again joined by my co-host, Nick Stenson. In today's AMA, we're going to do something a little different.
While often our AMAs dive deep into one or two subjects, today will be more of a rapid style question where we cover many topics and many questions. We've done this in the past and it's been quite popular, so we'll do it again here.
In today's AMA, we cover topics ranging from the prevention of cognitive decline and the relationship between cardiovascular disease and Alzheimer's disease, how you can lower your blood glucose, insulin, and ApoB, three biomarkers we talk an awful lot about, a variety of questions around nutrition, including its relationship to weight loss and longevity, and how a person can identify the best diet for themselves, along with tackling a number of what we think are the most common myths around nutrition. We talk about blood pressure, step requirements per day, standing versus sitting desks, and more.
If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. And if you're not a subscriber, you can watch the sneak peek of the video on our YouTube page.
So without further delay, I hope you enjoy AMA number 60. Peter, welcome to an AMA.
How are you doing? Good. Thanks for having me.
Are you feeling old today? I feel my usual old age. Yes.
No. Should I feel a little older? Do you want to let people know what we were just talking about on terms of how your age is starting to catch up to you? Oh, no, no.
That's been going on for a while. Yes.
My vision is painful. And yes, before we were live here, I was lamenting the increase in font size I need to be able to read my notes if I'm not willing to put on readers, which I guess glare off lights.

Love it. Love it.
Well, for today's AMA, we're going to do something a little different.

So traditionally, our AMAs can be kind of deep dives into one or two subjects, and we kind of go into them in detail.

But for this AMA, we're going to do a little more of a rapid fire Q&A style. We've done this a few times in the past and the reception has always been really good.
And so through this, we're able to cover a variety of topics, variety of questions, and the answers will kind of be a little more how you would speak to a patient about it as opposed to let's dive into 10 studies and kind of go about it that way. And so through this, we'll talk about things like preventing cognitive decline, a bunch of nutrition questions, relationship between cardiovascular disease and Alzheimer's disease.
We have questions on weight loss and longevity, fasting, blood pressure, step requirements, a really big, wide range of content that I think anyone will find value and hopefully enjoy it. So with all that said, before we get into it, anything you want to add outside of how excited you are to talk about nutrition again? You know what this feels like is since the book came out a year ago, I've been doing more public speaking and by public, it's really private speaking, meaning someone or company might say, hey, can you come and speak to our team or whatever? And because I just actually don't like standing up and giving lectures, some people do a great job of it.
I think I do a fine job at it, but I don't enjoy it as much. I enjoy discussions more.
The way we've structured those talks has been a Q&A. I just got back from one that I did yesterday.
To me, a well-moderated Q&A is generally more interesting for the audience. I actually think that's exactly what we're going to do here.
This is exactly the type of stuff I have been doing more and probably will continue to do more of in lieu of my more traditional thing that I used to do, which was kind of stand up and just give a lecture for an hour and then take a few questions after. I think these Q and A's followed by audience Q and A's are more my jam.
So this is starting to feel more and more familiar and enjoyable. If you had to give a lecture right now on a topic not related to longevity, what would that be? If it was just based on my interest, I would love to talk about the evolution of Formula One.
I think that would be a really fun talk to talk about the evolution of that sport mechanically and in terms of the drivers, the history of the sport, who are the greatest drivers of all time and what were their strengths and how do they stack up? And I think that would be a super fun thing to talk about. All right.
Maybe we'll do a random one-off episode then on F1 and dive into that, but not today. First question today, something we see a lot come through.
And if you look at how you talk about longevity, lifespan, healthspan, on the healthspan side, you have physical, cognitive, and emotional. And we do a lot on physical health.
There's a lot of exercise podcasts, bone health, everything on that. We've done a lot on emotional health too, but cognitive decline is something that has come up in various podcasts, but not as much as others.
And so one question we're often getting is people who are worried about as they age, or maybe they see their parents aging, and they see that cognitive decline start to happen. So if someone came to you and said, you know, what's the best thing I can do? How can I prevent cognitive decline in my life? What would you say to them? So this is a question we do get asked all the time amongst

our patients, and it is something that we in the practice work very hard on. What differentiates

this form of decline from physical decline, emotional decline, there are a couple of things.

One of them is kind of a gift, which is that all of the things that an individual puts into the effort around reducing the risk of neurodegenerative disease, dementing neurodegenerative diseases and non-dementing neurodegenerative diseases. So let's just think of dementia as the overall bucket.
We have a playbook for what do you need to do to reduce your risk in terms of modifiable behavior. So we of course acknowledge that, look, there are certain people out there that have an APOE4 gene or two APOE4 genes or a family history that probably with it comes with some genes that maybe we don't even know about yet.
Or there are other genes that we've talked about on the podcast that have even a higher or lower signal of risk than ApoE4. Okay.
Outside of that, what can you do with respect to your behavior to reduce the risk? Well, you take that entire suite of tools and guess what? Applying those things full force is also going to prevent cognitive decline. So the overlap between reducing the risk of a disease known as dementia is virtually identical to the steps you take to reduce the risk of cognitive decline.
Are there differences? Sure, there are. If you're talking about patients in whom we're trying to reduce the risk of dementia, and for example, we see serum markers of low amounts of amyloid accumulation, we may actually turn to pharmaceutical agents that reduce the amount of amyloid there.
So that's something that wouldn't be in the playbook. Okay, so let's not talk about cognitive decline in the non-pathologic sense, which is really what we're talking about here.
So you can't overstate the big ones. The evidence is very clear here that the most powerful in terms of magnitude effect size, the preservation of cognitive function is exercise.
And again, both forms of exercise, whether you want to talk about strength or cardio, both matter. And the answer shouldn't be which one, it should be both.
It's not an or, it's an and. I'm not going to go into great detail here because we've already done that, right? I mean, we've got so many podcasts where we go through, you know, we have an entire podcast dedicated to brain health, but I just want to highlight the points here.
The second one is metabolic health. So if you think about it this way, which is think of the fact that the brain, this tiny organ, people have heard me say this before, roughly 2% of your body weight and yet approximately 20% of your metabolic demand.
So if you think about that enormous asymmetry, it tells you that anything that plays a role in fuel partitioning and energetics is going to have an outsized impact on your brain. And all of that points towards having remarkable fuel partitioning, being very insulin sensitive and being very metabolically flexible.
Luckily, those things all go hand in hand. If you dispose of glucose very efficiently, you are by definition very metabolically flexible, which means you are able to access as substrate both fatty acid and glucose for ATP production.
Again, the most obvious example of this is if you look at people at the far end of the spectrum in terms of metabolic inflexibility, we see that in the disease state of type 2 diabetes. And in people with type 2 diabetes, the increase in the risk for Alzheimer's disease, depending on where you look, could be anywhere from 40 to even 100%.
So once you get to the point where you're metabolically inflexible, with that comes a lot of other risk factors. So again, if we want to be exercising a lot, we also want to be very metabolically flexible.
And the good news is those go hand in hand. Exercise is one of the most important tools to increase metabolic flexibility.
A third thing that we can't ignore here is sleep. The epidemiology here is very clear, right? The epidemiology would suggest that if an individual is not sleeping in appropriate length or stages, their increase in Alzheimer's disease specifically, but probably in other forms of dementia also goes up.
This is one that I think fortunately we don't need to spend that much time on today because I think the world has really, over the past decade, I think the work of Ariana Huffington more recently and more robustly, maybe Matt Walker, have shed a lot of light on the importance of sleep with respect to health, right? Sleep is not a passive thing. It's actually an active thing.
It's an active form of recovery for the brain, even though we're obviously looking pretty passive when we're doing it. So after those three things, what would we talk about? Well, I would say that the next most important thing is what you actually do with your brain and body.
You know, we talked a little bit about this in a previous podcast, but people often ask like, hey, how important is it if I'm doing crossword puzzles or playing games like that? And I think those things are probably less important than more complicated things that combine brain and body. So it seems that the brain body exercises are more important.
So dancing I use as an example because you are having to coordinate your movement, you're having to coordinate it with another person, you don't necessarily know exactly what they're going to do, especially if you're learning. I mean the whole goal here is to be learning something.
Learning a language is another thing that's a little bit more cognitively challenging than, say, doing a crossword puzzle. My hope on a personal level is that driving is one of those things.
It involves so many senses. So your eyes, your ears, and your proprioceptive vestibular system, and your, I call my butt dyno, right? So the ability of your butt to sense changes in movement and gravitation, to sense yaw in the car, all of those things have to be working on a hyper overdrive.
My hope is that that's the kind of thing that keeps your brain sharp as you age. When people ask me, what do you think about retiring at such and such an age? We should think about retiring as a time when we don't work for money anymore.
But I really think it's probably important that people are working throughout their entire lives, meaning they're working on something that is keeping their brain challenged. As of this recording, my dad is almost 87 years old and he still works every day at a quarry.
Now, I have no idea why. He doesn't need to be doing that, and it poses such an enormous risk to him.
He's not stable when he walks around. He's walking on these rocks.
I'm worried every single day he's going to fall and smash his head open, but I've stopped telling him to stay home because I realize that he has to be doing that and doing deals, selling stone is so important to him. Fortunately for all of my father's health problems, his brain is by far the best part of his body.
So I think there is something to that. That I think is the playbook.
Now you'll notice, Nick, there was something I didn't talk about, which is I didn't rattle off a list of 57 supplements. Is that because there are no supplements that could possibly improve cognitive performance? No, it's because none of them will move the needle nearly as much as what I just said.
So everything else is a rounding error of basis points compared to the enormous percentage swings that you're going to see from all of the above. Yeah.
I do respect how you don't drive because you love it. You just drive because of the brain health component.
You're just trying to stay healthy cognitively. I have no enjoyment when I drive.
In fact, it's a chore. I don't enjoy it at all.
It's taxing, but you do it for like the health of your brain, which is important to do. So that's what I tell my wife who fortunately doesn't listen to this podcast.
She will never know the sarcasm in your voice. So the next question that we get a lot kind of fits into that.
Cause you mentioned metabolic health being important. One question we get a lot is how do you lower your blood glucose or insulin? And I think this comes up a lot because every annual physical, those are getting measured.
So I think every time someone gets blood work done and they get biomarkers back, those are usually always included. And those are what people look at almost as a baseline for their metabolic health.
And I know we've talked a lot in depth about other ways to measure metabolic health in more detail and how you can really see that. But given that it's a metric that so many people see, it's a question that we get asked a lot.
So you're talking with a patient, they see their blood results and they're like, you know, Peter, I'm worried about my glucose insulin. You say it's a little high.
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