Latest / NHA Today Podcast / What You Can Do Now to Protect Your Brain from Alzheimer's with Dr. William Nields
Transcript
- Stephan Esser MD: Hello and welcome to another NHA Today podcast. I'm your host, Dr. Stefan Esser. Today I'm joined by Dr. William Nields. Dr. Nields is a primary care physician focused on improving the health of individuals and communities. He completed his medical education at the University of South Florida and Mayo Clinic. He's worked extensively in the ambulatory care setting and integrating intensive preventive and lifestyle interventions to address chronic disease. And over the last few years, he's particularly engaged in efforts to slow and reverse cognitive decline using a combination of proven lifestyle interventions. And cutting edge technologies. Dr. Nields, welcome to the podcast. Will Nields: Thank you, Stefan. It's great to be here. Stephan Esser MD: you've been working in this preventive and functional medicine space for around, what, a few decades at this point. What attracted you into working in this space? Cause certainly you did not learn it in your medical education. What brought you to this place? Will Nields: That's very true. I think I I came into medical school. I always tell people I'm a a naturopath that went to medical school. I'm not really trained as a naturopath, but my mind frame has always been natural. And I inherently understood that people are sick not because they have a lack of pharmaceutical products in their body. And so in medical school, fantastic education. I learned about all about the disease processes, but was not really satisfied with the toolkit I was given to treat those disease processes. So rather than write prescriptions all day in run for the door, which I felt would have been very dissatisfying as a career, I started educating patients on lifestyle factors that could help them resolve their problems at at what I believe is the root, which, you know, as I believe it was Cats said it's the feet, the forks, and the fingers that drive 80% of premature mortality. Stephan Esser MD: Right. So that really resonated with you. you and I met probably ten plus years ago and at the time you and your wife were running some lifestyle intervention group classes. how did you start working in that area? Will Nields: Well, in the clinic, when you're seeing twenty, twenty-four people a day, there's not much time to really educate people. So I had a I needed more time with people. And then there's the economic efficiency to do that. So we we started doing group sessions. So we kind of had a a little homemade group class that we did, and then we came across the chip program that Hans Stephan Esser MD: Nice. Will Nields: Deele had come up with. And that was a great program that had, you know, really beautiful videos and a nice format to follow. So that was the chip program that we were doing back then. Stephan Esser MD: Awesome. over the last couple years, you've transitioned and working into this anti-aging space and and and also heavily in the kind of neurodegenerative disorders space. You know, how did you enter into that space and how has it influenced your general practice of medicine now? Will Nields: So that really was an evolution out of necessity. In doing those lifestyle courses, I had all kinds of pleasant surprises. You know, all these other ancillary disease processes were getting better, heartburn, arthritis, even depression, especially depression. When you when you would teach people these lifestyle changes, inflammation comes down. But the one patient group that really still continued to suffer were the dementia cognitive decline patients. Well People heading towards dementia. So I watched a few people drift away and it was really heartbreaking. So I was looking for something to add because I needed more tools. And I came across Dale Bredison's presentation at Cleveland Clinic's Grand Rounds, and he had presented 10 cases of improvement in cognitive function in patients with dementia, which is truly a medical miracle. So I looked into him a little bit. The first thing I said, okay, well, we're aligned dietarily. He said plant based principles and you know, all the rest of the things look pretty good. So I got trained in his protocol and that opened up a lot more to me and the other gave me other tools. So looking for toxins, looking for chronic infections, looking for some other things that drive cognitive dysfunction. does that answer the question? Stephan Esser MD: It does. it sounds like a pretty comprehensive program. Tell me a little bit about what you do when you see somebody, what sort of taste testing, right? Because you walk into the the basic primary care doctor's office, they're just gonna, okay, let's get your annual labs and maybe ask you a few questions, do a little neurotest and we're done. w how does that compare to what you do? Will Nields: Well, a lot of it is patient driven. now people are looking for this kind of protocol. And so many people come in and the ideal patient is gonna be proactive and preventive. So I say those patients have a lot more wiggle room. As you said, the the protocol is comprehensive and that's you know, this is the the hard part about the protocol is it's a full time job to implement everything. Because it's diet, it's exercise, it's sleep optimization, it's stress management, dealing with toxins and infections. there can be a long list of supplements that you know, the brain is complex. And so when you come in preventatively, you don't have to be perfect in all these things. And s and so those patients, and this is what really we're advocating for for the entire country, is to do a cognoscopy and That would be an evaluation of your risk factors. So just like with your standard doctor's gonna look for risk factors for heart disease. He's gonna look at lipids and sugar metabolism and lifestyle factors. The cognoscopy is quite a bit more expansive. There's I think 17 tubes of blood that we draw. There are thirty-six different factors that Dale Bredison originally described that drive the biology of Alzheimer's. those are things that, He found in his Mouseheimer's model. so we don't have to get into all those details, but there's many different factors that can contribute. And you can't just treat one of them most of the time, that doesn't move the needle. And that's probably why treatments for Alzheimer's have failed so much because people are trying to do a reductionist kind of one intervention. Well, if you've got 36 different problems, just fixing one of them is not going to move Stephan Esser MD: Right. Will Nields: the needle. So the second part of the cognoscopy is a questionnaire. So we're sort of fishing for other risk factors. Have you had concussions and head trauma? That's gonna make me think about different biological processes. Have you had exposure to toxins, infections, anesthesia, a lot of different things? And we're also screening for other types of neurodegenerative disorders that can mimic or can be difficult to dis differentiate. So Louis body Stephan Esser MD: okay. Will Nields: disease, vascular dementia. And so the the history is important, the lab work is important, and then we look at volumetric MRIs. So a brain MRI is good, it gives us some information, but when you use a computer to look at the different different structures of the brain, the hippocampus, especially where memories are recorded and retrieved, you know, somebody may be born with a hippocampus that's in the 95th percentile. They can have a significant ongoing disease process. They come in and that's in the 45th percentile. And everybody's telling them that hey, you're normal, right? But they know Stephan Esser MD: Right. Will Nields: they're not normal. They've lost a lot of ground. So we want that baseline MRI. So down the road we can watch Stephan Esser MD: okay. Will Nields: the progress. and then when oftentimes if we can get it covered or is a quantitative EEG is helpful, and we're looking at provoked they're called evoke potentials so we're sending a signal to the brain whether it's a visual or auditory signal and we're measuring the neuron's processing capacity. So there's this would be how does that signal process through the brain on the millisecond level? Those are called evoked potentials. and that gives us an indication certain other frequencies and things. It gets a little bit technical, but you can watch people progress or improve with those quantitative EEGs. And interestingly, I'm learning we're finding a lot of other ancillary pathologies. So many people with cognitive dysfunction actually can be driven by attention and and focus problems or anxiety is a big one. So we Stephan Esser MD: Mm. Will Nields: treat the anxiety and the the cognition improves greatly. So the quantitative EEG sometimes gives those other clues. So that's a that's a cognoscopy. And ideally, like I said, we're gonna find people before they start to have significant dysfunction Stephan Esser MD: Right. Will Nields: in their life. But as we know, in our society, people tend not to seek medical care until there's a significant problem. So we do a lot Stephan Esser MD: Right. Will Nields: of work with cognitively impaired people. They go through that process and we develop a care plan for them. Stephan Esser MD: Very nice. the the volumetric MRIs. let's say somebody is very focused on prevention, would love to know, be able to track things. What age is a good time to do that volumetric MRI? Will Nields: Yeah, that's a great question. The whole cognoscopy, including the MRI forty-five, if you look at the function of the brain over time, and when we're born, there's this huge explosion of cognitive performance. And, you know, we hit our our teens and it sort of stabilizes, but continues to improve and it tops out maybe twenty five, thirty. the frontal cortex maybe continues to develop. And by 40, 45, you're hit your cognitive peak, right? And then there's a slow, steady decline. That slow, steady decline can be pushed faster by certain processes. Those are the things we're looking for to try to bump up that cognitive function, push that curve out long enough to avoid the disease. And so forty-five is a a good age. You know, since COVID, since the pandemic, we've seen some Earlier cases, and perhaps they've always been there, but I've noticed them more since COVID. We have three or four patients in their mid fifties with full blown advanced dementia. so hopefully we won't see the need to push that cognoscopy earlier. But I would say if you're having symptoms, you should probably be evaluated. Stephan Esser MD: Have that baseline. Yeah. Yeah. Will Nields: Yeah, but otherwise forty five forty five is a good age. Stephan Esser MD: So you talked about a lot of different measures, a lot of different factors that influence it. If you had to to choose the top three, four, or five you know, personal choices that people can make to kind of decrease their risk of Alzheimer's or or of dementia, you know, what what would you say? What if somebody says to me, What can I do, Doc? Top three or four things that I can do to kind of prevent. Will Nields: Can I can I pick seven? We have seven pillars. But I but Stephan Esser MD: Let's do it. Hit it. Go. Will Nields: but I guess you know, there are three or four that are really important. So, you know, diet is critical. And so you you wanna eat an anti inflammatory diet, a nutrient rich diet. And you know, I think it's important to mention fatty acids. So the The work of Diane Goodenau is he wrote a book called Breaking Alzheimer's. It's very interesting what he showed. He's a really brilliant biochemist, and he found that these fatty acids in the lipid membranes of your cells are very protective against the inflammation and oxidative stress. So omega-9s, which avocado and olive oil, right? Omega-3s, which you can get from nut seeds and or marine lipids, right? so Those fatty acids have a special bond that quenches oxidative stress very quickly. It prevents a cascade of oxidative stress, which causes rust in your car and your body, it causes aging. So he was very bright, said, okay, well, if this is important to humans, it's going to show up in the brain. He went to Chicago Rush Aging Project and he got 500 autopsy samples. he first thing he did is he correlated that the blood levels that you measure are correlative to what's in the brain. So, what you see in the blood is telling you what's happening in the brain. And then he looked at these 500 patients, which was a longitudinal study. These people died in their 70s and 80s, and they knew their cognitive function. So if they were in the top 20th percentile for these omega-3s and nines, their dementia rate was zero. Okay. So Stephan Esser MD: Mm. Well. Will Nields: if they had low they're called plasmologens, these derivatives of threes and nines, they had a very high dementia rate, and it was a direct correlation. So if you're gonna do just one simple intervention, it sounds like threes and nines are really important. but the overall Stephan Esser MD: And I was just gonna say, do you have a preferred way of testing that? I know there are a couple of different omega three tests out there. What what what what do you recommend to people? Will Nields: my world where we're doing so much testing, we're always looking for what's covered. And so I know people don't love the omega check from Quest, but that's largely what I'm running. but there's a couple companies out there where you can purchase an omega three test that might be more accurate. But I find it pretty helpful. It it tells me omega sixes and threes. We I see omega nines, and actually also something called C fifteen pentadecinoic acid. That's an interesting thing to look up. It's a little bit in the weeds, but these are shown on the Nutra eval from Genova. But just because I mentioned it, petit pentadacinoic acid was a fatty acid that's important for cellular structure. And they found that it was the one thing missing in this pot of dolphins that were getting early neurodegenerative disease. So the Navy did like a bunch of research and then it it was carried on by some other researchers course they have a product that replaces it. but that's that's pentodeconoic acid. I would put that down on the list. It's it's helpful, but I think the O threes and nines are are really the one that we find most people are pretty low in. Okay. Stephan Esser MD: Let's say somebody gets the test and they're pretty low, how and then they start, repleting, supplementing and changing their diet to try to get more. How soon after that should they recheck? Will Nields: it's a good question, and we're usually rechecking in about three months. I mean, I've I've done a lot of this work, so we're shooting for an omega index of about eight percent, eight to ten percent. And so you're gonna want to get two to four grams of EPA and DHA a day, and that's usually gonna get you there. So these are pretty big doses. we better mention that you know. omega-3s can be a little bit of a platelet. It interferes with platelet function a little bit, not a lot. So two to four grams is considered generally recognized as safe. Shouldn't cause a problem. But if someone's on blood thinners or has a bleeding problem, they have to be aware of that. And then they'll probably hear and see this is a very weak and small signal for atrial fibrillation with high dose fish oil. So it showed up first in the visipot trials. Then it disappeared and people didn't think it was much. But then I don't know remember the author, but they did a huge meta-analysis that found there's a very small signal of AFib with omega-3 use high dose. that didn't increase the stroke risk, but it's there. I don't think, based on what we've talked about, that that risk is outweighed. I think that risk is outweighed by the benefits. But Stephan Esser MD: Okay. Will Nields: people need to be aware of that. So and then two tablespoons of olive oil a day is what we shoot for. Hi high quality Stephan Esser MD: Interesting. So Will Nields: olive oil. Stephan Esser MD: do you believe when you think look at some of these neurodegenerative disorders, do you believe that these disorders are kind of like let's say Alzheimer's dementia, do you think that it can be reversed or is there a point at which there's no reversal potential? Will Nields: It gets tricky with reversal. you know, we can I mean, Bredison did a proof of concept trial where people's cognitive function improved over 18 months, significantly improved. He has many, many cases where people have been significantly impaired and they've gone back to work. Okay. So when you talk about the spectrum of Alzheimer's, you know, have amyloid and tau pathology happening for years, if not a decade, before you start to have neuronal death, atrophy of the brain, and then you start to get significant symptoms, which we've called mild cognitive impairment in the past, which as Dale says, that's kind of like saying mildly metastatic disease. that we don't want to start treating people at this quote unquote early stage. We want to prevent that from happening. but mild cognitive impairment just as a really kind of thumbnail sketch would be other people start noticing that you're having problems. You might be scaling back work because it's too hard to function efficiently or making mistakes. By the time you get to dementia, the next st diagnostic step, you're you're needing help to do activities of daily living, instrumental activities of daily living. So paying the bills, shopping, etc. So it's really significant impairment, is a is ten years into the process, the biology, okay. Stephan Esser MD: Yeah. Right, right. So so so in order to see meaningful change, it may A take a long time, it sounds like, and B, what I'm hearing from you too is there are multiple different inputs and for each individual that varies. And and there may be a certain level of level of dysfunction of the brain that may not be reversible if it gets too far along. And that's why the focus needs to be on prevention and early response. Is that correct? Will Nields: Yes, prevention, an ounce of preventions worth a pound of cure is absolutely the way to go. That's the sweet spot for all of this work. Stephan Esser MD: Yeah. Will Nields: It's much more manageable. and I'm glad that you brought up the this is one of the hardest things about Alzheimer's for people to understand is that you there's many different paths to Alzheimer's disease. All the all the amyloid plaque is is not the problem in our model, it is the body's response to the problem. And for one person that problem could be blood sugar abnormalities and vascular blood flow problems. And for another person, it could be lead, mercury, and mold, or a chronic infection. Stephan Esser MD: okay. Right. Will Nields: dental infections are a cause of amyloid plaque to build up. It's you know, in am and Alzheimer's patients, there's studies that showed ninety-five percent of people have microbe, these dental oral pathogens in their amyloid plaques. So Stephan Esser MD: Interesting. Will Nields: so Each patient's going to have a little bit of a different protocol. Stephan Esser MD: Right. Will Nields: And you find somebody like that has a mercury toxicity and you deal with the mercury toxicity, and yes, they're going to be cured, but the critics will come along and say, well, that wasn't Alzheimer's, that was mercury. Okay, that's semantics because the mercury was causing the Alzheimer's process, the amyloid plaque, the body's immune system, this amyloid was responding to the mercury. Stephan Esser MD: Right. that makes sense. I hear what you're saying, there are multiple different pathways, multiple different pathogenic processes that can lead to the same result, which is this cognitive impairment, which is related to then the inflammation of the brain level and this amyloid development. So which makes sense why you need seventeen tubes of blood and all this full cognoscopy, right? To kind of try to get to the heart of the matter about what you can change. And I heard you say a little bit about blood flow and perfusion. And a lot of our listeners kind of know about heart disease, natural, sclerotic disease, et cetera. But I don't feel like a lot of people know some of the newer stuff coming out. And I wanted you to share a little bit about kind of endothelial glycocalyx and, you know, kind of what the heck that even is, what it's involved with, what it does, and how do we keep it healthy? Will Nields: That is a really interesting area. And so I think there's been a hundred and seventy-five papers published on this camera device that can look at people's endocalyx in the clinic. And so, you know, that sounds like a lot, but it's very much in the infancy. So I have to put that caveat out there. but it seems to be that the endocalyx is very, very critical. To the health of our arteries and probably many, many, many disease conditions. So the blood vessel system, we've always been taught and focused on the macrovascular transport vessels. So the aorta, the big arteries, even the smaller transport vessels like the coronary arteries, right? Or the carotid arteries to the brain. So that's macrovascular disease. That accounts for 1% of the body's arterial system. or the or the vascular system, 99% of the vessels in our body are tiny little microscopic capillaries. We're talking about they fit one blood cell through at a time. And that's where all the action happens, right? That's where oxygen is exchanged and waste product is exchanged. And if those capillaries are dense, if the tissues are dense with those capillaries and those capillaries are healthy, the organs and the system functions well. If they're impaired and if their density is decreasing, obviously the organs are not going to function well. And that's really important in the brain. we you know, we think about energetics and in the brain and blood flow is the supply to all of that. There are researchers that believe that all dementia is largely the primary factor is blood flow. but the glycocalyx is a glucoprotein moity or if it's like a little fuzzy lining on the inside of these tiny little capillaries and it's actually throughout the whole system. And what it does is it provides a barrier for the vessel. You can think of it as a protective barrier. It's it's long and strong and healthy and you have this thick glycocalyx barrier, the cells will zoom through there. The the clotting proteins, the lipid, the atherogenic lipids, they don't touch the endothelium. They can't Plant and there's no atherosclerosis in these vessels. When you look at atherosclerosis in the glycocalyx, you'll see these divots in these pockets where that glycocalyx has been injured by maybe high blood Stephan Esser MD: Mm. Will Nields: sugar or other things. And COVID really hurts the glycocalyx. And in those areas is where you'll see these atherentic blocks. So if you can picture a tube and where a little bit of atherosclerosis is developing. In adjacent part the artery, there's no atherosclerosis, you'll that glycocalyx is divided, it's diminished where that atherosclerosis is developing. And same with clots, you'll see the fibrin start to deposit, etc. So the theory is that if we keep this glycocalyx healthy and strong, there will be no heart disease. Okay. so this camera that's developed, it measures that glycocalyx by looking at the Blood cells variability as they flow through these tiny vessels. So it's a high rate magnification camera. You measure the blood vessels under the tongue. Okay. And you're looking at how much are these blood cells bouncing around as they go through these tiny capillaries? Four, five, and six micron capillaries. And it's also measuring the density of these capillaries. So if the glycocalyx is healthy, you'll see those cells just zipping along straight. And where the glycocalyx gets injured, there's a variance that they can measure and extrapolate that and calculate the health of the glycocalyx. Stephan Esser MD: Amazing. Will Nields: It's really cool. And it seems to be very predictive. And it, we've been using this camera only for a few months, but it's correlates with kind of what you expect with people. And it's a lot of fun because we're finding all kinds of different associations, and it's a nice way to measure what are you, you know, what your interventions are doing. At the vascular level. Stephan Esser MD: fascinating. there's so much more that we could talk about. I love learning from you always. as we're running out of time, I want you to leave our viewers, though, today with some tangible sort of things that they can do. I like every one of my interviewers to share maybe three or four things that you say. I want you to focus on these. So three or four things you want our viewers to walk away with, healthy choices that they can make to prolong their mental and functional. Will Nields: Thank you for that question. So exercise is really, really big medicine. It's a big, big lever. When you exercise, you're improving blood flow, the vascular reactivity, and you're creating certain neurotransmitters and neurochemicals that provide brain growth. So you can read about BDNF, brain derived neurotrophic factor. When you exercise, that goes up. What's very interesting, a lot of people don't know this. There was a study showing that high-intensity interval training, when you develop lactic acid in the burn in your muscle, you create a 500-fold increase in the BDNF. So compared to maybe 30% with a long, slow, steady distance, or maybe 10% with some of the supplements. So exercise, you can see especially high intensity, massive increase in these neurotransmitters and growth factors. So exercise, we talked about diet that and then sleep. Sleep is when your brain cleans house. So it's not just being unconscious for eight hours. I want to know my patient's deep sleep. Okay. And also REM, REM, we consolidate memories and process, emotions and things. But in deep sleep, the blood flow diminishes, the brain volume shrinks. That allows the cerebral spinal fluid to circulate, Stephan Esser MD: wow. Will Nields: wash out the amyloid and those other proteins. So we've seen marked, marked improvements in people's health when we improve sleep. I'm gonna mention microbiome. It's very burgeoning research, but the microbiome is very important for brain health. We want diversity there. So a lot of those resistance starches and soluble fibers and all Stephan Esser MD: Yeah, yeah. Will Nields: of that. and there are, you know, an individual tailored, everybody should get a cognoscopy, in my opinion. I mean, yeah. Stephan Esser MD: Love it. Well, and we're gonna have all of your information below in the show notes. So folks, if you're especially in the Florida area or if you want to travel, Dr. Nields will be available for further consultation or conversation. So thank you, Dr. Nields, for joining us today on the NHA Today podcast. Appreciate you taking the time to to join us. Will Nields: Thank you, Stefan. Thanks for having me. A lot of fun. Stephan Esser MD: Absolutely. All right, everybody, look forward to seeing you again at the next NHAH Day podcast.