How is my brain?

If you’ve heard me speak about genetics, you know I recommend that my patients obtain their raw genetic data from 23andMe.com, choosing either the Ancestry package ($99) or the Health and Ancestry package ($199). Both options analyze about 750,000 genes out of about 3,000,000,000 (three billion!), a small but useful portion of your genetic material. With the raw data in hand, we can look at individual genetics that might suggest practical steps you can take for optimal health. The “Health” package is a bit of a misnomer, as the health data analyzed and reported by 23andMe is pretty limited. Only one of the tests I value is included in their health report, the gene that doubles your risk for late onset Alzheimer’s disease, the ApoE4 gene.

If you have that gene and learn of its existence before you get Alzheimer’s disease, what should you do? Say you’re 50 or 60 and you really think your brain is just fine.

I agree with Dr. Dale Bredesen who recommends that you request a “cognoscopy” for brain health just as you would have a colonoscopy for bowel health, but without the nasty prep. A cognoscopy includes a cognitive test: we test at two different levels and each test separates abilities into different areas. For instance, you may have no problem with short term memory but you’ve lost your “whiz” status in math. Particularly for an ApoE4 that might indicate an “inhalation” or Toxic type of cognitive injury. Even if you ace your cognitive test, there are lab tests to do. We focus on those lab tests that might show tendencies that have not yet become “conditions” but which are easier to alter before they do. Perhaps it’s early insulin resistance or a low serum zinc (and if so, what’s up with that we ask!) or low hormone levels or a high homocysteine: talking about correcting those lab values now now might spare you problems later on.

No matter the results of your testing, you can consider a cogni-cocktail, a simple array of supplements that can keep you in the normal to optimal range. You can take them and then stop worrying! A cogni-cocktail would include:

• a good multi-vitamin (real vitamin A, zinc but not copper, proper forms of B vitamins for you; if your vitamin includes “folic acid”, it’s probably a cheaper than optimal brand. My fave is Thorne Research Basic Nutrients III, and I recommend taking two capsules twice a day.
• Vitamin D3 and K2, the D as needed to keep your levels 50-70 ng/mL and 100-200 mcg of K2, depending on the health of your bones.
• Resveratrol and Ubiquinol can help with the common “energy problems” ApoE4 brains can face.
• A good fish oil with optimal ratios of EPA and DHA; my favorite is Barlean’s Omega Swirl: one tablespoon provides plenty of good nutrients and unbelievably tastes like key lime pie.
• And without swallowing anything extra, you can stop eating three hours before bed and continue your overnight fast for at least 13 hours, and you’re helping your brain.
• Other minor vitamin regimens for healthy brains, but brains a little at risk, are geared to each person’s individual situation.

Exercise, friendship, sunshine and good sleep can help feed an aging brain; testing your brain keeps it sharp and a meditative practice helps calm an overly busy brain.

The one stern warning I would offer folks with the ApoE4 gene is about insulin resistance. All of us as we age tend to develop a bit of insulin resistance. Those with ApoE4 not only have more insulin resistance than ApoE3’s, but they can suffer the consequences sooner than someone without E4. It’s a particular vulnerability.

That said, I think it’s fair to say that if you care about your health and are doing most things right, cover your bases with a good cognoscopy, that ApoE4 gene was just an excuse for you to get healthier! In an appropriate and healthy lifestyle, you’ll be using your brain well late in life, whatever that gene says!