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Duologue with Leslie Heaney
[Part 2] Alzheimer’s and Brain Health - feat. Dr. Kellyann Niotis
00:49:52
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- [00:00]
Dr. Kellyanne Niotis
Foreign.
- [00:05]
Leslie Heaney
Hi everybody, this is Leslie and you're listening to the interview with Leslie Heaney. This is part two of my episode with Dr. Kellyanne Niotis. As I mentioned, June is Alzheimer's and Brain awareness month and Dr. Niotis is a true expert in the space of neurodegenerative diseases and what we can do to hopefully prevent them and reduce our risk. In part two of this episode, we talk about the modifiable risk factors for dementia, meaning risk factors that you can actually modify or reduce and they could be everything from controlling your cholesterol to getting the shingles vaccine. It's really such a fascinating conversation and really gives all of us the information that you need to make better decisions and to take control of your healthcare to ensure that hopefully you do not develop Alzheimer's, Lew body or Parkinson's. A really great conversation. But before we get to part two of this episode with Dr. Maiotis, just a few words from me about our sponsor. I'm so excited about this week's sponsor, the 10 Mile Distillery. 10 Mile is an American single malt distillery based in the Hudson Valley about 90 miles north of New York. And it is the maker of the award winning Little Rest Whiskey made through a slow distillation process with all New York State grains by master distiller Shane Fraser from Scotland. And when I say award winning, I mean it's earned a 95 out at the whiskey competition in San Francisco and a 96 at the New York International Spirits Competition. This is delicious. If you do not believe me about how delicious this is, the good news for you is that if you're in the New York area, you can go visit this incredible and beautiful distillery yourself. It's set among the most beautiful apple orchard with beautiful views of the mountains behind. Stop by for a leisurely tour or tasting or even enjoy an expertly crafted cocktail. They also have gin and vodka available. They also have this incredibly delicious Thai restaurant that is in residence there from Thursday through Sunday. To learn more about the distillery, you can Visit them at 10mile distillery.com theinterview. I should also mention that in honor of Father's Day, all orders made from today through next Wednesday, June 18, will receive 10% off if you put in promo code the interview at checkout. So go to www.tenmiledistillery.com theinterview to get that discount, that 10% off. I promise you you will not be disappointed. So thank you again to 10 mile. And with that, here is Dr. Kellyanne Niotis. Whether you test positive for the three or the four. Right. Or you don't test positive, but you have family history, you're just concerned or you just want to reduce your risk. Can we talk about. This is your area of expertise, right?
- [03:04]
Dr. Kellyanne Niotis
This is what I do.
- [03:05]
Leslie Heaney
This is what you do. Which again, as I mentioned to you before we started, it's just so important what you're doing and so impactful because giving people. My mother in law, as I mentioned to you, had dementia and she, you know, by the time she was formally diagnosed, she was sort of too far along for there to be any steps that she could take to reduce her, you know, to sort of mitigate her symptoms and allow her to have a different outcome than she had. So it's just so empowering to be able to say to people, you know, even if you have these genes or you are empowered, you can be proactive to tell your story in a different way, to have a different, a different outcome.
- [03:46]
Dr. Kellyanne Niotis
For sure. I mean, knowledge really is power. So the first thing, and you know, one big key takeaway from for the listeners tuning in is really understand your family history. You cannot fight what you don't know you're up against. So ask your relatives what diseases they came down with, family members had, what the age of onset was, what their symptoms were. It is, as I mentioned, Alzheimer's disease is the most common form of dementia. So it is really common for a loved one to be diagnosed with just like standard unspecified dementia.
- [04:26]
Leslie Heaney
Right.
- [04:27]
Dr. Kellyanne Niotis
Or Alzheimer's disease. But if you listen to the symptoms, you start to uncover that, you know, they also had a tremor, probably wasn't just Alzheimer's disease. So really understand what symptoms they had and also what other diseases they had. Did they have sleep apnea? Did they have a lot of head injuries? Did they have a very stressed life? Were they really anxious? Do they have trauma in their life? All of those things impact one's risk. So understanding and the best look at yourself is through your family. Like those are like the most direct, the best mirror into what your future is. So understanding what risks and medical conditions they had can help you try to remove those potential contributors to disease in, in yourself.
- [05:18]
Leslie Heaney
Tell us what, what those things are.
- [05:20]
Dr. Kellyanne Niotis
Yeah, so, and I've spoken about this extensively. I love lecturing doctors and other medical providers about this. There are 14 fully established modifiable risk factors for dementia. I believe there are more than what is formally established, but we can talk about some of those. We already mentioned high cholesterol, that's a big one. That's really big. For people who carry this APOE4 gene treating cholesterol early. And there's a lot of hesitancy about treatment of cholesterol and taking pills and, like, what to do.
- [05:58]
Leslie Heaney
I have a very, very close friend who's has high cholesterol and is. Doesn't want to take any medication. Cholesterol medication. And, you know, I'm gonna send this episode. Would you just explain, like, why taking the pills are important?
- [06:12]
Dr. Kellyanne Niotis
Yeah. So, you know, diet, like Lipitor and.
- [06:16]
Leslie Heaney
Those sorts of pills. Yeah.
- [06:17]
Dr. Kellyanne Niotis
Diet and exercise can only go so far, especially in people who have genetic predispositions to have high cholesterol. Your body's handling it differently than somebody else, and you can eat the best possible diet and still have issues with your cholesterol. So at, at this point, you know, we have to acknowledge that thankfully we have medicines that can help us, help us overcome what we cannot overcome ourselves. And these medicines are safe and they work really, really well. There are lots of options available. I shouldn't say lots, but several options available for treatment of cholesterol. And it really depends on what we see in your blood for what medication we may want to put you on first. Things like statin medications work well in some people and not so well in other people. Zetia or ezetimide is another big one that blocks cholesterol absorption. There are now injectable versions called PCSK9 inhibitors. So there's lots of options available. So one common situation that people will bring up to me or patients will mention is, you know, well, I do have, like, slightly high cholesterol, but I did a heart scan or a coronary calcium scan looking at plaque buildup in my heart, and I don't have any. And we don't see any evidence that the cholesterol is causing any harm in my brain. So, like, why should I treat it, like, now or why should I treat a. Period? And, you know, that's the whole point of prevention, I guess. We found this risk factor, and if we don't want it to cause problems later, let's intervene on it now. Let's not wait until it causes plaque buildup in your heart or your brain. We know that eventually that's going to happen.
- [08:03]
Leslie Heaney
Right.
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Dr. Kellyanne Niotis
So let's.
- [08:04]
Leslie Heaney
So what you're saying is when they do, because I've had the, the. The sono and. And whatever this vein is.
- [08:10]
Dr. Kellyanne Niotis
Carotid.
- [08:10]
Leslie Heaney
The carotid artery. Right. And that might even been my friend's defense, was that those things were clear.
- [08:15]
Dr. Kellyanne Niotis
It's always the defense.
- [08:16]
Leslie Heaney
But your point Is that eventually it's not going to be clear. And in the meantime it's doing this cholesterol dance with the cells in your brain. So you want to forget about the cardiovascular risk factors by having the high cholesterol. But it's also your brain's health in the meantime too.
- [08:36]
Dr. Kellyanne Niotis
Along the lines of cardiovascular disease risk factors, we have things like high blood pressure also too low blood pressure. You really want your blood pressure in a nice optimal range. You want the top number somewhere between 90 and, and 120, somewhere between there systolic blood pressure. The top number is really the big one for brain health. Although the bottom number is also important, a little less studied. So monitoring your blood pressure at home, a lot of times your doctor will check your blood pressure once a year and when you go into your doctor's office, you're flustered or nervous. There's really common to not have a very accurate blood pressure recording. So I always recommend people buying their own blood pressure cuff and just checking their blood pressure when they're at home, in their own environment and feel comfortable, because that's when you're going to get the most accurate measurements. And blood pressure can fluctuate. So you might wake up and your blood pressure is normal, but by the end of the day your blood pressure is high. And there are certain medications that we can use that are shorter acting, that we may want to use later in the day if your blood pressure tends to run high later in the day and so forth. So high blood pressure, another easy one that we can take care of without issues and too low blood pressure. If, if you have too low blood pressure, you should really see somebody, especially if you're having symptoms, symptoms including dizziness, especially lightheadedness when you're standing up. That's essentially your brain not, not getting enough blood flow.
- [10:04]
Leslie Heaney
Interesting.
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Dr. Kellyanne Niotis
Which you can imagine how that could cause issues. And that's really common, especially in the elderly to have that issue. Insulin resistance or diabetes is another big one. So watching how much sugar you're taking in, refined sugars, processed carbohydrates, anything that's going to cause glucose spikes is going to contribute to poor health collectively, but also poor brain health. And you know, the test unfortunately that we check for diabetes is not the most sensitive for the earliest signs of diabetes. So it can often miss people who have this more pre, pre diabetes stage or just the earliest signs of insulin resistance. Most insulin resistance really comes from our diet and our body composition. Although there is a lot of genetic predispositions that put people at risk to develop.
- [11:04]
Leslie Heaney
So two follow up questions to that. One is what about things like Ozempic and what's the name for them?
- [11:12]
Dr. Kellyanne Niotis
The GLP1.
- [11:14]
Leslie Heaney
GLP1. But what is the street name? The semi glutide.
- [11:20]
Dr. Kellyanne Niotis
Generic.
- [11:21]
Leslie Heaney
Okay, generic. Yes. The semiglutides that is leveling your blood sugar. Are you seeing, is there any research to showing that that might actually be a positive?
- [11:31]
Dr. Kellyanne Niotis
Yeah.
- [11:31]
Leslie Heaney
Second question along those same lines is those monitors that check your blood sugar spike. So having your blood sugar be level, that should be a goal. I know that people talk about that for just sort of overall health, but is it also something that you want to be mindful for? No pun intended. On the. I love it on the brain front too.
- [11:53]
Dr. Kellyanne Niotis
Yes, for sure. So glucose variability. Okay, so the differences in how higher spiking in your lows is kind of what you're saying. We want it to be very level. I think, you know, a continuous glucose monitor wearing something on your arm or belly can be very helpful for some people if they're very data driven. It can also be just helpful because you just don't know how your body would respond to certain foods. So it could be very educational for some people. But again, not all tools work for everybody. I'm not saying everyone should wear it, but it can be helpful for some people, especially if they're really trying to figure out where to go with their diet and they're really not sure. To go back to your question about the GLP1 receptor agonists, so lots of of science is evolving in this space. These drugs hold so much promise for a lot of different health conditions in my world, a lot of promise for neurodegenerative diseases and whether that's related to the way that they affect peripheral levels of glucose and peripheral insulin signaling, which we understand is a risk factor, or if that relates to the way they change insulin signaling in the brain or have other downstream effects in terms of inflammation, we don't fully know. We do see, and in the research that I do through the Institute for Neurodegenerative Diseases, which is in Boca, we are studying a lot of different pharmacological interventions and its impact or their impact on blood based biomarkers for neurodegenerative diseases. And when used in the right person at the right dose, carefully monitoring things like their body composition because we don't want them to risk losing too much muscle mass. There are downstream harms that can come from using these medications, so they have to really be used carefully. But when used carefully in the right person. We've actually been seeing really promising results in terms of their impact on neurodegenerative disease pathology, specifically tau pathology, and this has been shown also in other research sites or throughout other research studies that these medications seem to change the way these toxic proteins can accumulate and form in the brain, and they reduce the accumulation of these tau proteins, which can be problematic for Alzheimer's disease.
- [14:22]
Leslie Heaney
Wow. Interesting. One question about that too. Sorry. And I don't. Let me go too far off piece, but we talked about the Genesis.
- [14:31]
Dr. Kellyanne Niotis
Mm.
- [14:31]
Leslie Heaney
You were just talking about these other proteins. Are there certain proteins, like in. In people's blood that you can measure to see if they have a higher risk of. For Alzheimer's or Parkinson's or Lew body?
- [14:44]
Dr. Kellyanne Niotis
Yeah, there sure are more. So along the Alzheimer's and Lewy body spectrum.
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Leslie Heaney
Okay.
- [14:49]
Dr. Kellyanne Niotis
Less is known about blood tests for Parkinson's disease, although lots of people are working on them. There's nothing that's really, really, really reliable right now. But, yes, we can test for amyloid proteins in the blood. We can test for different forms of tau proteins in the blood.
- [15:07]
Leslie Heaney
Now, would you want to do that blood test instead of doing the genetic testing? So you don't have the insurance risk. You don't have that fear, but you actually are looking to say, okay, because wouldn't you need to have those.
- [15:20]
Dr. Kellyanne Niotis
You still have the insurance risk because these are clinical tests.
- [15:24]
Leslie Heaney
Okay. So it's not like the gene's not necessarily being triggered unless you. You wouldn't see that it's being triggered unless you had these particular proteins or Is there no correlation necessarily?
- [15:34]
Dr. Kellyanne Niotis
Okay, there is a correlation between the proteins and having the gene. We do know that. Of course, just based on what the gene does that people.
- [15:43]
Leslie Heaney
I'm just trying to get away from having your life insurance. Cancer.
- [15:45]
Dr. Kellyanne Niotis
Yeah, I know. I know. Everyone's trying to. There's no way they will get you.
- [15:49]
Leslie Heaney
Okay.
- [15:50]
Dr. Kellyanne Niotis
They want to find it.
- [15:50]
Leslie Heaney
Can we just test for these proteins and not find out that you have a four?
- [15:54]
Dr. Kellyanne Niotis
No, no, because they're clinical tests. I mean, we do a lot of research, so there's ways to get the test through research protocols. And in those situations, then it's of course not a part of your health record because it's research. But for most people, things. Places like LabCorp will test them. I think the panel is somewhere around $800 are, give or take. And you can get them tested yourself and learn about whether or not you have high, high levels of these proteins in your blood. And.
- [16:23]
Leslie Heaney
But you would need some doctor who knows how to translate what that means?
- [16:26]
Dr. Kellyanne Niotis
Yeah.
- [16:26]
Leslie Heaney
And that might not necessarily be your general practitioner.
- [16:29]
Dr. Kellyanne Niotis
That probably is not your general practitioner.
- [16:32]
Leslie Heaney
If people wanted to look to see if they had higher levels of these proteins, that might mean that they're at higher risk of an Alzheimer's. And also our biomarkers that you can then, because this is your area of specialty, based on changes in your lifestyle, actually see these proteins decrease.
- [16:53]
Dr. Kellyanne Niotis
Right, we have seen that.
- [16:56]
Leslie Heaney
So who, who do you go to to have the. Besides you?
- [16:59]
Dr. Kellyanne Niotis
I know. It is an impossible feat. Unfortunately, at this point in time. A couple of months ago, there was this article written in Neurology Today which really got under my skin. It was two working groups that were talking about, you know, the advent of these blood biomarkers and what they mean and what whether or not neurologists should be testing or offering patients these tests. And the consensus among these working groups was that, no, we should not be testing these proteins in people because we are causing unnecessary worry and there's, quote, nothing that we can do about it. And, you know, to hear that again in 2025 is a little heartbreaking because we do know that 45% of dementia is preventable. 45%. And, you know, maybe they mean that there aren't cures for Alzheimer's disease, and that might be true, but to say that there's nothing that we can do about it, well, that's just frankly not true. We're talking about all the things that we can do about it now. And these things are pharmacological and lifestyle based. Um, I would say treating your cholesterol is something that you can do about it. And to have the opportunity to actually monitor these biomarkers on an individual level, because like I said, you know, there's no one size fits all. This is all pretty personal. What works for one person, what medication works for one person, might not work for another. For example, you know, we mentioned these GLP1 drugs and there's some evidence that they may benefit Parkinson's disease. And then some studies that show that they may not do anything or maybe even lower dopamine levels, which may be harmful or maybe not harmful, we don't know. But to be able to really, in real time monitor in a given person, like what a statin is doing or what a GLP1 is doing to these biomarkers is such a powerful way to actually make progress. Unfortunately, it's going to take the field of neurology a long time to really get there. And there are very, very few providers that are doing it that are doing it.
- [19:16]
Leslie Heaney
So you and I got connected through a mutual friend and also a patient of yours who did have some of these protein markers does have, I think she's a four, has one of these two and through working with you has reduced those proteins and reduced her risk. And CNN just, you just were featured on cnn. You both just co wrote this article together. So I want to get to that because I think it's so empowering for people listening, you know, after we've just really at least for me bummed everybody out. You know, I want to get tested, but I'm scared I'm going to get dropped by my life insurance company. But that there are things that we can do and if actually if you do these things and you are proactive, you can kind of take control over, over your, your health and, and, and your, your risk of developing some of these neurodegenerative diseases.
- [20:05]
Dr. Kellyanne Niotis
Okay, so let's talk about some more.
- [20:07]
Leslie Heaney
Alcohol diet and you mentioned muscle mass. I want to talk about that.
- [20:11]
Dr. Kellyanne Niotis
So alcohol, you know, there are people out there who will say all alcohol is toxic. And you know it is probably true that alcohol is a toxic, a toxin. It's a neurotoxin. We know high levels, high excess alcohol use is one of these risk factors for dementia, maybe Parkinson's too. Less is known there is that because.
- [20:33]
Leslie Heaney
Of sort of the link between alcohol and inflammation and sugar or it is.
- [20:38]
Dr. Kellyanne Niotis
Directly toxic to brain cells. Okay, so it is.
- [20:41]
Leslie Heaney
Right. It's like your brain on drug. It's the, it's killing brain cells. Okay.
- [20:44]
Dr. Kellyanne Niotis
It is directly toxic. Like I said. I posted this picture of a brain on social media of a 72 year old woman who, who abused alcohol compared to a 72 year old woman who did not use alcohol. And it's pretty startling how much brain atrophy there is there. So yeah, excessive alcohol and for women that is defined as more than one drink a day which is, you know, that's a lot of alcohol.
- [21:09]
Leslie Heaney
Yeah.
- [21:10]
Dr. Kellyanne Niotis
I'm not saying that, you know, you should never drink alcohol. Definitely. It's okay, you can indulge.
- [21:15]
Leslie Heaney
I actually have a girls night tonight. I'm in just for the night. So I might have to revisit this that fact tomorrow. But I've got to.
- [21:22]
Dr. Kellyanne Niotis
You have to balance it with the other important modifiable risk which is the risk of social isolation and loneliness. Alcohol is often in our culture at least something that you enjoy in a social setting.
- [21:35]
Leslie Heaney
Right.
- [21:35]
Dr. Kellyanne Niotis
And it's important to make that distinction between when you're enjoying alcohol socially and potentially when you're maybe just using it for treatment of your stress and anxiety and having some wine alone at home, like that's probably not the healthiest use of the alcohol. So just really evaluate the way that you're using alcohol. I have said before I've recognized that alcohol is a risk. I enjoy alcohol socially. I try to limit the amount that I drink. But it's not that you can't ever drink. It just really be mindful of the occasions that you're. You're consuming alcohol. And this might be less relevant for future generations as, as I think the younger generations are drinking a lot less and they're.
- [22:19]
Leslie Heaney
Because they're smoking pot or doing gummies.
- [22:22]
Dr. Kellyanne Niotis
Edibles all the time.
- [22:23]
Leslie Heaney
What about that? What about thc?
- [22:26]
Dr. Kellyanne Niotis
Good question.
- [22:27]
Leslie Heaney
It's just there's not enough research there.
- [22:29]
Dr. Kellyanne Niotis
Well, well the research that we have is so most of the way that THC was consumed was through inhalation, which is a little bit different than eating it. So we don't actually have a whole lot on the effects of THC that's consumed through consumption in terms of brain.
- [22:51]
Leslie Heaney
Or increasing your risk for any of these.
- [22:53]
Dr. Kellyanne Niotis
Well, what we do know is of course in the short term THC is going to impact your cognition and the effects of that can last a couple of days. Fortunately, that seems reversible. So if you can see if you stop using thc, you should recover your brain function if used early in adolescence. There was actually a study that showed brain structure changes.
- [23:17]
Leslie Heaney
Oh right. I remember this. Okay.
- [23:19]
Dr. Kellyanne Niotis
Probably matters when the consumption started. Anything that you start while your brain is still developing is going to have much more profound impacts on you later in life versus when you're a child or when you're an adult.
- [23:34]
Leslie Heaney
Adult. Okay, well, you talked about muscle mass from the semi glutides being being of concern and the link there with muscle mass and neurodegenerative disorder. So talk about that and lifting weights and the importance of that and how often.
- [23:52]
Dr. Kellyanne Niotis
And so obesity is obviously recognized as a risk factor for our health. Collectively we know that it increases risk for heart disease. We understand that it is a modifiable risk factor for dementia. What is less spoken about is the risk of sarcopenia, which is age related decline in muscle mass and strength. Everyone's muscle mass will start to decline naturally as we get older. What's extremely problematic is when obesity is combined with sarcopenia and it leads to sarcobesity, that is doubling that sound like.
- [24:33]
Leslie Heaney
That could be like a, like a summer horror blockbuster. Sarco.
- [24:36]
Dr. Kellyanne Niotis
Obesity Sarco obesity. You don't want Sarco obesity. And unfortunately a lot of people who are using GLP1 drugs are developing Sarco obesity because they're gaining, losing muscle.
- [24:49]
Leslie Heaney
Okay.
- [24:50]
Dr. Kellyanne Niotis
Mass and gaining fat. Yeah. And unfortunately disproportionately losing muscle mass compared to fat. So at the end of the day they have a really problematic body composition profile. And we understand that there's a huge link between sarcopenia and risk for neurodegenerative disease. But more so Sarco obesity, that's doubly bad.
- [25:13]
Leslie Heaney
Interesting. So for people like obesity, would that, would you. That'd be like your body mass index is 25% fat or more. What is, what are 30. What, what, where should people. What's a healthy range?
- [25:27]
Dr. Kellyanne Niotis
Yeah.
- [25:28]
Leslie Heaney
So for the mat, should people have their muscle mass tested? And then just like we talk about the ways you can reverse, you know, these proteins in your blood, is this one of the ways like actually looking to see what your, what your muscle mass is and working to build that to get to a healthy level.
- [25:45]
Dr. Kellyanne Niotis
So unquestionably, obesity and managing obesity is a recognized. The Lancet recognizes that as it as a modifiable risk factor. Sarcopenia, sarcobesity not recognized yet. I personally believe there are risk factors. There's definitely studies that show that they're harmful for overall brain health. One day, hopefully they'll be added to this, this list of 14 that the Lancet. That the Lancet is published in 2024. But I try to stay away from using BMI as the definition for obesity.
- [26:23]
Leslie Heaney
Interesting. Okay.
- [26:24]
Dr. Kellyanne Niotis
Really, I like to say monitor your waist, not your weight because it's really waist circumference. That is.
- [26:34]
Leslie Heaney
Is that because of visceral fat?
- [26:36]
Dr. Kellyanne Niotis
It's because of visceral fat because the fat that's in your abdominal region, the fat that's around the organs, is metabolically different than the fat that accumulates subcutaneously or under the skin in our arms and legs. Although aesthetically we don't like to see fat there. Yeah, really the problem is the fat that is centrally. Because that' that's really pro inflammatory and it's very difficult based on BMI to understand that metric. So I really shy away from using BMI as, as kind of like a mental cutoff for obesity. There are lots of ways that you can rudimentary test your body composition. You know, there are certain scales that you can purchase that have varying degrees of accuracy that'll give you muscle mass composition and body fat composition. Those kind of are variable to pace depending on your hydration status, you can get a DEXA scan with body composition. Those are actually pretty widespread now. They're not, they don't cost a whole lot of money.
- [27:42]
Leslie Heaney
And when you get a DEXA scan or something like that, are you going to get the information? Will someone tell you? Obviously someone needs to be, you know, have some expertise and being able to guide you and explain to you what the results mean. But what they say to you, like your muscle mass shouldn't, isn't where it should be. You need to gain 10% more muscle and we're going to come track it and we're going to look at you again in six months or, and give you some action steps you can take away from that kind of a, of a test.
- [28:10]
Dr. Kellyanne Niotis
Well, it's always helpful to be working with someone who could kind of give you more targeted advice. But depending on where you get the DEXA scan, they usually give you percentiles. So you'll know where your, for example, appendicular lean muscle mass index is. That's the muscle in your arms and legs. That's a really good surrogate for total muscle mass. It'll tell you.
- [28:30]
Leslie Heaney
Yeah, I've had those pincers done to me it's, it's a real eye opener.
- [28:35]
Dr. Kellyanne Niotis
Yeah.
- [28:35]
Leslie Heaney
And I always get the arm and.
- [28:36]
Dr. Kellyanne Niotis
Yeah, but it'll tell you where you are percentile wise and sarcopenia and don't quote me, but I think it's an aluminum 5.7. I'd have to look that up but you could kind of see how close you are to that. And then they give you percentiles for body fat and so forth. So, you know, it takes a long time to change your body composition. Six to 12 months is really, you know, closer to 12 months is probably how frequently you should check it. I do like the home scales after you have had a DEXA because while they may not be the most accurate, they do help you with trends and trajectory. So for our patient that we alluded to, I had her get a home scale that measured body composition because we did put her on a GLP1 agonist because she had excessive amounts of body fat that really needed to come off. It was metabolically unhealthy for her. We did so, so carefully with measuring her muscle mass every week, body fat every week. And we really dosed her based on what we were seeing. And she was very, very dedicated to muscle building. She's one of the very few people that ended up putting on muscle mass on one of these drugs. So she's a specialist.
- [29:57]
Leslie Heaney
And part of that too, from what I've read and understand. And this is also important for women who are, you know, menopausal or perimenopausal. Is eating enough protein.
- [30:06]
Dr. Kellyanne Niotis
Absolutely.
- [30:06]
Leslie Heaney
And it's actually like an absurd amount of protein.
- [30:09]
Dr. Kellyanne Niotis
Especially as we get older. It is an absurd amount of protein. Yeah.
- [30:12]
Leslie Heaney
And I don't even know how you can do that. Yeah. And without doing protein shakes or things like that.
- [30:17]
Dr. Kellyanne Niotis
Absolutely.
- [30:18]
Leslie Heaney
Besides the risk factors that we want to. Things we want to avoid or be mindful of, like what proactively should we be doing to protect our brain? You said sleep. I know. Is one.
- [30:27]
Dr. Kellyanne Niotis
Yeah. Well, three very easy ones that everyone listening should do. Because if, you know they're so easy and it's silly to not do them, get a hearing test. Screen yourself for hearing loss. That is one of the biggest modifiable risk factors for dementia. And we do recognize that wearing hearing aids mitigates that risk. So easy. You have hearing loss. Get hearing aids.
- [30:52]
Leslie Heaney
Wait a minute. Seriously?
- [30:54]
Dr. Kellyanne Niotis
Seriously.
- [30:55]
Leslie Heaney
Because if you're not hearing, it's actually affecting your. Your, your. I mean, I know it affects your ability to understand people around you of what's going on, but I never thought about the. The effects to your brain by you not being able to hear what's going on.
- [31:07]
Dr. Kellyanne Niotis
I mean, just how these things are all so tied together. Of course, hearing loss, you're at risk of social isolation.
- [31:15]
Leslie Heaney
Right.
- [31:16]
Dr. Kellyanne Niotis
Can't hear, can't follow conversations. But hearing is processed in the region of the brain that's impacted by Alzheimer's disease. It's processed in the temporal lobe. And I always like to say the brain is a use it or lose it organ. It's the best way to understand this. So the brain needs sensory inputs to stay active and healthy. And hearing is a major source of sensory.
- [31:37]
Leslie Heaney
I'm sending this to my father, who will be 86 this month. And, you know, his hearing's not great. He refuses to wear a hearing aid because it's like a sign of weakness.
- [31:48]
Dr. Kellyanne Niotis
I know.
- [31:48]
Leslie Heaney
Now they're like so small, so discreet. Yeah.
- [31:51]
Dr. Kellyanne Niotis
The vanity concerns are real. I get that. And it is annoying. It's annoying to have to think about it and take it out anytime you're in the water. So I get it. But the impacts on your long term brain health are so worth it.
- [32:03]
Leslie Heaney
Okay. And the same thing for eyesight.
- [32:06]
Dr. Kellyanne Niotis
Yeah. So vision. That's the other. Like we said, there are three really easy ones that everyone should do. And it's stupid to not do. Screen for hearing loss. Screen for visual vision loss. Any visual impairment should be really treated early. That's a new modifiable risk factor according to the Lancet as of 2024. I recognize that as a risk factor.
- [32:28]
Leslie Heaney
For a long time. These are my Amazon size 2 readers. I definitely. I think I might be going up. I need to get another eye check. Very important because I didn't think about it with the links between your eyesight and your brain.
- [32:40]
Dr. Kellyanne Niotis
Yeah. And I really think that one's super important for Lewy Body and Parkinson's disease as well, because part of what is impacted in those particular diseases is a part of the brain where vision is processed. So really get your vision checked. And then the third so easy one is wear a seatbelt and wear a helmet. Head injury is a huge risk factor for all neurodegenerative diseases. I can't tell you how many times I've heard the same story from a family member who would say, you know, my mom was okay and then she had a pretty significant fall. And then symptoms.
- [33:18]
Leslie Heaney
What about concussions? Younger people who have a lot of concussions, are they at a higher risk of developing okay?
- [33:23]
Dr. Kellyanne Niotis
Yes. So even a mild head injury can increase your risk. And the more head injuries you have, the higher your risk gets.
- [33:30]
Leslie Heaney
Okay.
- [33:30]
Dr. Kellyanne Niotis
Of course we can't undo the damage from your past concussions. There are things that of course we can levers we can pull and try to modify all the other risks that we can. But not developing another concussion is huge. So if you partake in high risk sports like skiing, snowboarding, even surfing. Surfing, you could get hit on the head. I know it's not cool to wear a helmet, but it's important.
- [33:56]
Leslie Heaney
Okay, Interesting. Okay. And then sleep. How many hours do we need?
- [34:01]
Dr. Kellyanne Niotis
Yeah, sleep's another big one. And you know, there was also a very interesting study. Exercise is huge, of course, and we can talk about that forever. But there was a very interesting study that mentioned that if you exercise, if you haven't slept well, you negate all of the benefits of exercise. So always prioritize sleep before exercise if you haven't been sleeping well.
- [34:25]
Leslie Heaney
And does everyone have their optimal number of hours? I would say seven to eight, but it might be. I just saw Rob Lowe interviewed in the Today show. His number is nine and a half hours and he looks great. So is. It just depends on who you are. Right.
- [34:38]
Dr. Kellyanne Niotis
It's variable. And, you know, you should just base it on how you feel after that many hours. Right. If. If you wake up after seven hours and you don't feel refreshed then you probably need some more sleep.
- [34:50]
Leslie Heaney
I see. Okay, so it is just like, that's just logic.
- [34:54]
Dr. Kellyanne Niotis
It's just logic. It's kind of common sense. But you know, there isn't like a perfect number. What we do know is that sleeping less than six hours seems to be problematic. And maybe there are rare exceptions where people can get away with sleeping less than six hours, but that doesn't seem good for a long term health period. Mortality risk period, but also not good for long term brain health.
- [35:18]
Leslie Heaney
So the, the things that you've mentioned to protect brain health. Right. We just talked about sleep, getting your vision and hearing screenings, exercise. You also mentioned sort of prioritizing or maybe to me before we started speaking, prioritizing mental health and your sense of purpose. Yeah, but what about nutrition? Like really quickly? Because I am, I know we, you and I are ready to like we.
- [35:41]
Dr. Kellyanne Niotis
Gotta do part two on a trip together.
- [35:43]
Leslie Heaney
But nutrition, you know, how do you obviously like eating lots of fruits and vegetables, lean meats, you know, nuts, all those kinds of things. But should people be having their gut biome tested? Like is that. Or looking to see if we're low in certain minerals and vitamins? Like on the nutrition front, what kind of supplements would you, do you recommend people take to protect their brain health?
- [36:07]
Dr. Kellyanne Niotis
Great questions. So in general, again, nutrition and diet so personal, no one size fits all, but a Mediterranean based diet. Avoid processed foods, avoid super processed foods, high in extra virgin olive oil, fruits and vegetables, lots of leafy greens, fatty fish is a primary source of protein or other leaves, lean sources of protein, avoiding, you know, the refined carbohydrates as we mentioned already, nuts, legumes, et cetera, like all those things are going to be beneficial for the brain.
- [36:41]
Leslie Heaney
And you can test, a person can test to see what their, you know, because I think vitamin B is important for the brain. Is vitamin D also?
- [36:50]
Dr. Kellyanne Niotis
Yeah.
- [36:51]
Leslie Heaney
And then what about omega 3s?
- [36:52]
Dr. Kellyanne Niotis
Omega 3s are super important for the brain.
- [36:55]
Leslie Heaney
I know vitamin D is sort of on your regular physical panel, right. I don't know if B is, but can you ask your GP to add Omega 3s to that B? Or is there a special place you have to go? I mean, I want to. When people at the end of this conversation go home and besides people who feel like they've gone on vacation with us because we've been talking for so long, but I want them to know sort of where they can go, right. To get some of these tests, tests done if they want to pursue it.
- [37:23]
Dr. Kellyanne Niotis
You can check your omega levels yourself. Which is amazing. And not only is it amazing, the test itself is more accurate than the test the doctors will check for you in general. So there's a test called Omegaquant. You go to their website. I have like no financial disclosures or any connection to them. I just think their test is really good. You go to their website, you order it, it's about 99 or so.
- [37:46]
Leslie Heaney
Okay.
- [37:47]
Dr. Kellyanne Niotis
And it's a little finger prick card. They send you a card, you prick your finger and they'll tell you the.
- [37:51]
Leslie Heaney
Results will tell you. They'll say like you're in a normal range or you're in a.
- [37:54]
Dr. Kellyanne Niotis
It' tell you if you're in a normal range. And this is.
- [37:57]
Leslie Heaney
And do you want to be in like an optimal range? I know that's one of these things with doctors. They'll say, oh, you're. It's in a normal range, but normal isn't always optimal. Optimal.
- [38:06]
Dr. Kellyanne Niotis
So agree.
- [38:07]
Leslie Heaney
Well, does it give you that information?
- [38:09]
Dr. Kellyanne Niotis
It does. It gives you kind of a spectrum of where you are and what this test is. Testing is your omega composition in your red blood cell membranes, which is more accurate than what's floating around in your blood. Testing in your actual red blood cell membranes tells us are the omegas actually getting to the place that we want them to be.
- [38:27]
Leslie Heaney
I see.
- [38:27]
Dr. Kellyanne Niotis
So it's. It's better.
- [38:29]
Leslie Heaney
And if you're not, then your supplements besides obviously diet like fatty fish and nuts. We. If you might want to look into supplements too.
- [38:37]
Dr. Kellyanne Niotis
Yeah.
- [38:37]
Leslie Heaney
And then maybe have it tested again in six months or so.
- [38:40]
Dr. Kellyanne Niotis
Exactly. If you're improving, it takes about three months for your omega composition to change in your red blood cell membrane. So in three months after being on a consistent dose of omegas, you can retest. But fatty fish is really the best source of omegas. We've recognized that getting our omegas from whole sources rather than supplements is better. Better.
- [39:03]
Leslie Heaney
Also walnuts.
- [39:04]
Dr. Kellyanne Niotis
Yes.
- [39:05]
Leslie Heaney
Are very high in omega 3s.
- [39:06]
Dr. Kellyanne Niotis
Yes. But harder to get omegas through plant sources.
- [39:10]
Leslie Heaney
Interesting.
- [39:11]
Dr. Kellyanne Niotis
Truthfully, harder to get enough omegas. So testing to see where you are at baseline and then you know, everyone asks like how much omegas do I need? It's so hard to tell because everyone eats a different amount of fish. For a lot of people a supplement can be really a helpful addition. And it's extremely important for people who have this APOE 4, they seem to have reduced penetrance of a specific type of omega called DHA into their blood brain barrier. So they, they may need higher, higher doses of omegas to actually get to the brain and. And do all their important tasks.
- [39:49]
Leslie Heaney
Wow. Okay. What else besides omega?
- [39:51]
Dr. Kellyanne Niotis
We talked about B vitamins. B vitamins are.
- [39:54]
Leslie Heaney
How much should people be taking in a supplement or. I mean, should you be always supplementing if you're just not sure if you're getting enough or.
- [40:01]
Dr. Kellyanne Niotis
I always like to test. You know, there are risks with anything. And for omegas, there's a risk for something called atrial fibrillation, which is an irregular heart rhythm. So you don't really want to be taking excess amounts of anything if you don't need to. Also, bruising, bleeding, potentially increased risk with omega. So nothing is benign. That's why it's really important to know what you particularly need.
- [40:27]
Leslie Heaney
And how do you get tested for B.
- [40:29]
Dr. Kellyanne Niotis
B vitamins? Your doctor can check for. That one's very easy. You know, the one thing about B vitamins is a lot of people know that they need to take B12. It's a big vitamin. It's important for. There's also baby B1, 6, 9. There's tons of B vitamins.
- [40:45]
Leslie Heaney
So which one do you take? Because I.
- [40:47]
Dr. Kellyanne Niotis
A B complex.
- [40:48]
Leslie Heaney
A B complex, which has complex. All of them.
- [40:49]
Dr. Kellyanne Niotis
Okay. Which has. The big ones for the brain are B12, folate, and B6.
- [40:57]
Leslie Heaney
Okay. I always feel like people should keep taking their prenatal vitamins. You're so covered by the. That's true.
- [41:02]
Dr. Kellyanne Niotis
There's a lot.
- [41:03]
Leslie Heaney
They have everything.
- [41:03]
Dr. Kellyanne Niotis
You know, there is. There is. It's very easy to become toxic on some B vitamins, though. So that's actually important to know. B6 in particular, if you take too much B6, you can actually develop neuropathy or damage to the nerves in your peripheral nerves in your legs. And I've seen that happen in people who are taking really high doses. So try to stay under about 20 micrograms.
- [41:26]
Leslie Heaney
Okay. So you. But regardless, you want someone to get tested to have a baseline of what their. Of what their omegas, their D, their B levels are. Any other minerals like magnesium. What are there other things that people should be taking as supplements to help protect their brain health?
- [41:41]
Dr. Kellyanne Niotis
Great question. I mean, there are lots of different supplements. And like I said, I don't like to give general. Like, everyone should take this. Another supplement that I personally like that I think most people who have Risk could benefit from. I wouldn't say everybody, but people of risk is a specific type of curcumin called Thera Kerman. It is a highly. It is formulated so that it can cross through the blood brain barrier better than just curcumin Curcumin. It's called thera kerman.
- [42:12]
Leslie Heaney
Thera kerman, which is thera Kerman.
- [42:15]
Dr. Kellyanne Niotis
Yeah.
- [42:16]
Leslie Heaney
Okay. Which is like, we say that 10 times. I'm writing this down. Okay.
- [42:19]
Dr. Kellyanne Niotis
Which is a type of curcumin.
- [42:20]
Leslie Heaney
Okay. And you can buy this over the counter. This is a. Okay.
- [42:24]
Dr. Kellyanne Niotis
Yeah.
- [42:25]
Leslie Heaney
And can you test your levels of this?
- [42:27]
Dr. Kellyanne Niotis
No, you can't.
- [42:28]
Leslie Heaney
You can't. Okay. So what's. What would you recommend for a supplement? Or would you. Only if you have this risk factor.
- [42:36]
Dr. Kellyanne Niotis
If you have risk factors and honestly, evidence of inflammation. Some people have elevated inflammatory markers that are detected in their blood. I would recommend being on it because what this potentially does is reduces neuroinflammation and it can help improve cognition in the short term as well. But long term, one major mechanism by which neurodegenerative diseases form is through excess neuroinflammation, inflammation in the central nervous system. So anything that can kind of tamper down, inflame inflammation, which this can do, is important. I mean, this goes to why things like shingles vaccine, which we didn't talk about, is really important. Get your shingles vaccine. It is associated with a lower risk of dementia in certain. So many studies and so many well designed studies. And it makes complete sense because these viruses trigger tremendous amounts of neuroinflammation.
- [43:34]
Leslie Heaney
So wait a second, so people that got the vaccine are less at risk or people that develop shingles are more at risk?
- [43:41]
Dr. Kellyanne Niotis
People who got the vaccine are at a lower risk of dementia.
- [43:45]
Leslie Heaney
Wow.
- [43:46]
Dr. Kellyanne Niotis
Full stop. Like in multiple studies.
- [43:48]
Leslie Heaney
Interesting.
- [43:49]
Dr. Kellyanne Niotis
And there actually was a recent study that showed that they were at a lower risk of cardiovascular disease. I think this came out, like, literally last week.
- [43:56]
Leslie Heaney
Wow. So hot off the press, people.
- [43:58]
Dr. Kellyanne Niotis
Yeah, hot off the press.
- [43:59]
Leslie Heaney
Okay, so get your shingles vaccine after.
- [44:01]
Dr. Kellyanne Niotis
The age of 50.
- [44:02]
Leslie Heaney
Have your omegas, B's, D's tested. Make sure that you're at optimal levels there. Sleep, exercise, nutrition, hearing and vision screenings. Manage your stress and managing your stress. And might involve going on an ssri. Right. It could. If you're depressed, you need to. It's. It has physical effects. Right. And it can affect your. Your brain health.
- [44:23]
Dr. Kellyanne Niotis
Wearing a helmet and seat belt.
- [44:25]
Leslie Heaney
Don't forget that helmet and seat belt. Okay. And we are. We talked about my friend who's also your patient, and just for listeners, this is someone whose father died of dementia and has had. Was tested for. Genetically tested. She had the. The four. I call them three, four, two, as.
- [44:43]
Dr. Kellyanne Niotis
Opposed to three, four, apoe three, four.
- [44:45]
Leslie Heaney
Apoe three thousand four. And she went and Saw you because she was thinking, she was very interested in being proactive here. Right.
- [44:53]
Dr. Kellyanne Niotis
And was having symptoms and was symptomatic.
- [44:55]
Leslie Heaney
Yes.
- [44:56]
Dr. Kellyanne Niotis
She started to have concerning word finding difficulty, which is something that her father also developed.
- [45:03]
Leslie Heaney
Interesting. And then. So is that. So that's when she reached out to you and then you looked, tested her blood for these biomarkers, those proteins that we mentioned. She was very disciplined and took action right away and her diet started taking supplements and started exercising and focusing on developing muscle mass. And she has now not only is no longer symptomatic. Right. With some of those having trouble searching for words, doesn't have that problem anymore. And those proteins that we talked about declined. Have declined.
- [45:42]
Dr. Kellyanne Niotis
Yeah. And whether that will translate and I'm hopeful, you know, this is what our research is doing. I don't ever want.
- [45:47]
Leslie Heaney
Because she's part of one of your research studies. Right. Tell us a little bit about that because that's you. I know you both were you CNN covered this story and, and interviewed her for a piece about the work that you're doing and her being part of that research study.
- [46:01]
Dr. Kellyanne Niotis
This is such an important and as I mentioned, so it, it will help push the field forward. I truly believe that. I'm of course biased. But you know, testing for these proteins in the blood, yes, can be incredible diagnostic tools, but more importantly, they can potentially help us monitor the efficacy of the treatments we're offering patients and really be able to provide personalized care. But the question is how do these biomarkers change over time? What is considered, you know, normal, preclinical and actual disease, meaning, you know, someone who doesn't meet the clinical criteria but may have abnormal biomarkers. Like how do we define all these things and how do we follow these and what biomarkers do we follow longitudinally? That's part of what we're trying to study. And we did present some preliminary research at the American Academy of Neurology meeting, which was in April of this year. And we did show that these biomarkers can change. And we've identified some very interesting potential outcome measures to use for our next larger trial, which will really be powered better to test some of these impacts, for example, hormone replacement therapy and perimenopausal women. How does that impact blood based biomarkers? How do these GLP1 agonists impact biomarkers in very specific at risk patients? So we'll have more information.
- [47:28]
Leslie Heaney
Interesting to me, when you were saying that women are at higher risk than men, there has to be some hormonal I mean, again, I'm not a doctor or researcher, but I mean, it would just sort of, you know, stands to reason that there is some relationship between the two.
- [47:44]
Dr. Kellyanne Niotis
There's so much we don't know because, on the contrary, men are at a higher risk for Parkinson's disease. Oh, interesting. So the impact of biological sex is fascinating and poorly understood.
- [47:55]
Leslie Heaney
Okay, well, again, you and I could go on a cruise together. I mean, I have so many. This is definitely probably going to be a two parter here because we covered so much, but I just think it's so impactful and so empowering for people. I know it is for me talking with you to know what I can do to help hopefully prevent the onset of some of these disorders for me or for those who are listening, whether you're at risk genetically or not, it's really exciting research and such important work that you're doing and I just can't wait to see what's next. Yeah.
- [48:28]
Dr. Kellyanne Niotis
Thank you.
- [48:29]
Leslie Heaney
Thank you so much. Thank you so, so much. It was such a pleasure.
- [48:32]
Dr. Kellyanne Niotis
Thanks so much for having me, Leslie. This was so important and I'm so glad that we got to cover this topic. So many people need to hear this.
- [48:39]
Leslie Heaney
And where can people, if they want to find you? Where, where is your. You're practicing in New York. I know you're also in Florida.
- [48:45]
Dr. Kellyanne Niotis
I'm. My practice is in New York. I'm in Manhattan. Visit me at my website. You can just google my name and see it, but it's drkelly and.
- [48:53]
Leslie Heaney
Okay. Thank you so much Dr. Niotic. Thank you so much.
- [48:56]
Dr. Kellyanne Niotis
Thank you.
- [48:58]
Leslie Heaney
That brings us to the end of this episode of the interview. A huge thank you to Dr. Niotis for joining and as always, thank you all for listening. I'd like to also thank our sponsor, 10 Mile Distillery. Don't forget, if you visit their website and www.distiller10miledistillery.com theinterview you put in that interview promo code, you'll get 10% off of your order of their award winning little Rest whiskey or any of their other spirits. It's an offer you do not want to miss. And thank you all listeners for joining. If you enjoyed this episode, please rate and review us on Apple Podcasts or Spotify or wherever you get your podcasts will release a new episode on a different topic next week and until then, this is Leslie and thanks so much for joining the interview.