Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join us on this episode as we welcome Arnold Eiser, an internal medicine physician, as he shares his insights on Alzheimer’s disease. Arnold believes that Alzheimer’s may be largely preventable, despite conventional wisdom suggesting otherwise. He argues that the pathogenesis of Alzheimer’s is largely extracranial and that environmental toxins play a significant role in its development.

Arnold has written a book, Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health, as well as several scholarly articles, to share his comprehensive view on the complex interactions between gut-brain, liver-brain, gut-immune, endocrine-immune, and nutrient-immune systems. He believes that a Mediterranean or Japanese diet, exercise, avoiding biotoxins and toxicants, and avoiding tobacco and excessive alcohol consumption are key to preventing Alzheimer’s.

Tune in to hear Arnold share his ideas on how to preserve brain health and prevent Alzheimer’s.

Arnold R. Eiser is an internal medicine physician and author of Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health.

He shares his story and discusses his KevinMD article, “Challenging conventional wisdom: How to reduce the risk of Alzheimer’s disease.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

With so many demands on their time, physicians today report record levels of burnout. Burnout is caused by many factors, one of which is clinical documentation. Studies indicate physicians spend two hours documenting care for every hour spent with patients.

At Nuance, we are committed to helping physicians do what you love – care for patients – and spend less time on clinical documentation. The Nuance Dragon Ambient eXperience, or DAX for short, is an AI-powered, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.

Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/HNlW2l

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME by clicking on the CME link in the show notes. Today we welcome back Arnold Eiser. He’s an internal medicine physician and author of the book Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health. Today we’re going to talk about his latest KevinMD article, “Challenging conventional wisdom: How to reduce the risk of Alzheimer’s disease.” Arnold, welcome back to the show.

Arnold R. Eiser: Thank you very much, Kevin. It’s good to be here.

Kevin Pho: Now, for those who didn’t listen to our first episode back in May of 2022, just briefly share your story and journey to where you are today.

Arnold R. Eiser: Sure. I was starting my career as a nephrologist working for the Mount Sinai School of Medicine in New York City, caring for patients with renal failure and trying to prevent it as well. I then switched to general internal medicine divisions that I ran, first there and then at the University of Illinois in Chicago as chief of general internal medicine, and at the same time I did health services research and bioethics research.

Then, coming back to the East Coast in the Philadelphia area, I became a vice president of medical education and oversaw graduate medical education programs for the Mercy Health System and Drexel University College of Medicine. Now, since I’ve written this book, I have added two additional things. One is as an adjunct member of the Environmental Neuroscience Group of the Center of Excellence in Environmental Toxicology, and a senior scholar at the Penn Center for Public Health, both of them at the Perelman School of Medicine at the University of Pennsylvania.

Kevin Pho: All right, so we’re going to talk today about Alzheimer’s disease, “Challenging conventional wisdom: How to reduce the risk of Alzheimer’s disease.” Now tell us, how did this article come together?

Arnold R. Eiser: It all happened after I had written an article that appeared in the Journal of Alzheimer’s Disease, which was just published in the last week or two. It’s called “Alzheimer’s disease is a multi-organ disorder: It may already be preventable.” So I thought it was important to get out the word that there are steps that you can take, starting in middle age and thereafter, to help significantly reduce one’s risk of developing Alzheimer’s.

And the other thing that provoked this is that the FDA keeps approving monoclonal antibodies for the treatment of Alzheimer’s, which unfortunately are not likely to provide them much relief, nor have the studies that they based that approval on shown any improvement.

Kevin Pho: So, a couple of things to unpack there. You mentioned that there are some preventable risk factors that can help prevent those from getting Alzheimer’s. So what are some of those prevention tips that you have?

Arnold R. Eiser: Well, first and probably foremost is the diet. The importance of a non-inflammatory diet is huge, because the cause of Alzheimer’s is neural inflammation, and the gut is closely linked to both the immune system and the brain function. So it’s important that the diet be one that’s non-inflammatory.

Kevin Pho: So what do you mean by that when you say a non-inflammatory diet?

Arnold R. Eiser: Well, some items in the diet can actually provoke inflammation. Processed meats are probably the best example of an inflammatory diet, and probably the best example of a non-inflammatory diet is typically plant-based but also involves the consumption of fish. So the most famous instance of a person consuming a non-inflammatory diet is none other than Tom Brady, who happens to be able to excel at his sport 10 years after most other people have stopped excelling at it, and I have to consider that that diet had something to do with it.

Kevin Pho: Now, when you talk about switching over to a non-inflammatory diet, short of going vegan or completely eliminating processed foods and meats, what would you say is the most realistic tip that you could share with my audience in terms of decreasing the amount of inflammation in your diet?

Arnold R. Eiser: Well, I’m following the Mediterranean diet. I find that fairly easy to follow. It has a lot of nuts, berries, and legumes, and those are three crucial areas, not only for gut health but for brain health. And of course it does have fish as well, it has some yogurt, and it has some cheese. It’s not exclusive of those items, and you know, you can occasionally have meat, but meat is not a mainstay of that diet. So that, I think, is very, I mean, I won’t say it’s very easy to follow if you haven’t been following it, but it’s fairly easy to transition to that diet from the standard American diet.

The other diets that are not inflammatory are the Asian diets. The Japanese is probably the best studied of those diets, and it’s not surprising that Japan, at least for the people who follow the Japanese diet in Japan rigorously, has a low incidence of dementia too.

Kevin Pho: So tell us, what other environmental factors can influence the rate of Alzheimer’s disease?

Arnold R. Eiser: Well, the other environmental factors are a variety of toxins, both manufactured toxins, or toxicants, and those that occur as a result of biological factors, or biotoxins. So, starting with the biotoxins, I think it’s important that people learn to recognize so-called blue-green algae, which is really not algae. It looks like algae; it looks like guacamole, actually. But you’ll find it in streams, you find it in slow-flowing rivers, you find it in lakes, and the cyanobacteria produce a toxin known as BMAA.

And this is a serious neurotoxin which can contribute to Alzheimer’s, but, even maybe worse than Alzheimer’s, it can contribute to ALS, or Lou Gehrig’s disease, which is obviously extremely debilitating. And although it doesn’t affect the memory as Alzheimer’s does, it does obviously incapacitate a person to a great extent, I’m sure, in their life.

Kevin Pho: So if you’re not around streams and lakes, would you say you’re relatively safe from being exposed to BMAA?

Arnold R. Eiser: Probably safe on that. But then there are other toxins, which can be ubiquitous. So if you’re in a building that’s been water-damaged, then you have to be concerned about mycotoxins, which are produced by the fungal elements that can grow in an area that has had water damage. That is another toxin which can lead to the type of neuroinflammation which, after going on for a number of years, results in Alzheimer’s.

So by the time the person meets the criteria for Alzheimer’s, they’ve had a disorder going on for usually about two decades, and most people get Alzheimer’s past the age of 75. So typically it’s starting, then, at roughly 55. So that’s the reason that I’m also recommending that a person be evaluated at about the age of 55, or 50 if they’ve had a family history of dementia. And that evaluation has been described by Dr. Dale Bredesen as a cognoscopy, sort of analogous to a colonoscopy, but an assessment of the things that are likely to damage your brain rather than cause colon cancer.

And that can be done, at least the tests themselves can be done, for probably less than a thousand dollars. That does not include the interpretation necessarily, but they’re not that high cost. That’s right, I mean, that’s less than what a colonoscopy is going to cost you or the insurance company. Typically they are not paid for by insurance companies today, but perhaps they will be in the future.

The other thing is, if you take these measures to prevent Alzheimer’s specifically, you may prevent other forms of dementia too, and you may prevent other illnesses, as it turns out that the toxins in the environment that appear to contribute to the development of Alzheimer’s in one person can also contribute to the development of cancer in another. So you can’t change your genome and therefore your susceptibility to these things, and that will to some degree determine what illness you would get from a particular toxin. But you can change your exposure to the toxins, and you can change your ability to resist them by having consumed the proper nutrients, so that your gastrointestinal system and your immune system can function properly, so that your brain maintains its normal function.

The brain is very dependent on other organ systems. One that I like to point out in particular is the liver. Why is the liver so important to the brain? Because the brain is 60 percent phospholipid, and those lipids, it can’t make all the lipid it needs, so it has to be supplied by the liver. Now, the liver is the major detoxifying organ of the body, in addition to the kidney; it is probably the number-one detoxifier. But more importantly, it’s also an organ that synthesizes phospholipids that then are taken up by the brain and used to maintain the structural integrity of the body. So if you do not have an intact liver, you do not necessarily have normal brain functioning. And so it’s important to do things that maintain liver health, gut health, and immune health in order to have a brain that functions throughout the entirety of one’s life.

Kevin Pho: Now, you mentioned the Mediterranean diet or other dietary changes that can help prevent Alzheimer’s. You mentioned the presence of toxins that may be associated with Alzheimer’s disease. What are some common-sense lifestyle tips that can help patients avoid some of these toxins?

Arnold R. Eiser: Learn to recognize their sources. I recommend that people consult the website of the Environmental Working Group to find out if there are toxins in their water supply, because they have an independent analysis of all the water supplies. If you have individual well water, you need to get that tested every few years, because it can change.

Kevin Pho: Now, another thing that you mentioned is some of the newer approaches to treating Alzheimer’s disease that have recently been in the news: very expensive, experimental, with questionable data behind them. Tell us what you think about that approach.

Arnold R. Eiser: I have read the articles by the group that’s led by Dale Bredesen, and I think the results they’re reporting, I found quite impressive. I think the data at this point is preliminary, but I think, based on what I know of their protocol, it does look like it is addressing a variety of factors, which I think you have to do, because there isn’t a single cause of Alzheimer’s disease. In the article that I published in the Journal of Alzheimer’s Disease, I named nine different categories of causes, and they include organic compound toxicants, air pollution, and the ones that we’ve already discussed.

And so I think it is an approach that is promising, but it is, as you pointed out, expensive too. So I’m not sure how everyone is going to access this, but as I indicated, at least the preliminary tests themselves do not have to be.

Kevin Pho: So in the primary care setting, if I’m in the exam room talking to a 60-year-old patient, tell me what kind of questions, what kind of things I should be asking them if I wanted to elicit a potential history of Alzheimer’s symptoms.

Arnold R. Eiser: Well, I’d start with the family history, because this is often multigenerational. There obviously is one particular gene which is well identified as being a risk factor in the United States, and that’s APOE4. And the APOE4 mutation leads to a lack of sulfhydryl groups in the lipoprotein, so it’s less able to pick up heavy metals. So a person who has a hobby or an occupation that brings them into contact with heavy metals, or who lives in an indigenous area, for example, southeastern Pennsylvania, Texas, and other parts of the country are known to have arsenic in their water.

So among the tests that can be done is a hair analysis for toxic metals. So if you have a suspicion that they may be going down that pathway, that is a test I think it’s important to consider.

Kevin Pho: What are your thoughts about genetic testing if someone has a family history of Alzheimer’s disease?

Arnold R. Eiser: I’m in favor of it. The APOE4 gene is not a sentence which is going to hang over your head; it’s a call to action, because there are a number of actions that you can take to reduce your risk. That includes, obviously, diet and exercise, but there are also other things that are specific for this, including some supplements that you would want to seriously consider. And if you don’t know it, you can’t take the defensive measures. And as I pointed out, the things that are helpful to prevent dementia also prevent other diseases that people don’t want to get, including cancer.

Kevin Pho: What are some of those supplements that you mentioned that potentially can reduce the risk of Alzheimer’s?

Arnold R. Eiser: Well, it might be in the category of the antioxidants. So probably the best known of these are the spices, spices like turmeric and oregano. They have, you know, strong antioxidant potential; however, they also are the spices most likely to contain heavy metals, because these are plants that just tend to take in the heavy metal. So it’s important that the source be a reliable source for those supplements. Zinc and selenium stand out. Zinc and selenium are essential to immune health, as is vitamin D.

OK, in the background I have Monet’s garden, but I point to it there because vitamin D is also essential for immune health and therefore for brain health, and there are about two dozen diseases that increase when a person doesn’t have enough vitamin D. Unless you’re eating a lot of fish or you have a lot of exposure to the sunshine, you’re going to become vitamin D deficient. And a vitamin D deficiency, it’s not good for your brain, it’s not good for pretty much any part of your bodily function. So vitamin D is one of the most essential vitamins, and you can’t get much of it; you can’t get it in fruits and vegetables. So our only food source is fish. So if you don’t eat a lot of fish and don’t get a lot of sun, you’ve got to seriously consider a vitamin D supplement.

But zinc and selenium are also hugely important for immune functioning. Now, I just want to add one caveat with both, with actually all three of them: Enough is important, and too much is toxic. So they have fairly narrow windows of safety, but it’s important to have enough of them. So I give the example with selenium that one Brazil nut will give you enough selenium for the day. You don’t need to take in any other selenium, and four of them will make you toxic if you take four Brazil nuts a day every day. Now, most nuts don’t contain that much selenium, so having nuts as a regular part of your diet is a good way to cover your selenium, and that contains some zinc as well. But not everybody has those in their diet, so it’s important to have them. Legumes are an important part of the diet for maintaining your microbiome health.

Kevin Pho: We’re talking to Arnold Eiser. He’s an internal medicine physician. His KevinMD article is titled “Challenging conventional wisdom: How to reduce the risk of Alzheimer’s disease.” Arnold, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Arnold R. Eiser: I think everybody should be paying attention, certainly by the time you’re in your mid-40s, to these measures, because they’re going to not only (not too many people in their mid-40s are worried about Alzheimer’s) but also help you prevent cardiac disease and help prevent other disease. But taking good care of your liver throughout your life is important, not putting it at risk of the virus, hepatitis, that is out there. Certainly moderation in consumption of alcohol. If you have a smoking habit, get rid of it in middle age, because smoking is definitely a risk factor for developing dementia; obviously it’s a risk factor for developing many other things.

But I guess the take-home message: Don’t start thinking about preventing Alzheimer’s in your 80s; start thinking about preventing it in middle age, and that will save you from other diseases as well.

Kevin Pho: Arnold, thank you so much for sharing your time and insight. Thanks again for coming back on the show.

Arnold R. Eiser: Thank you very much, Kevin.