Overcoming the Top 4 Healthcare Headwinds

In the first article in this Brain Health Series, I shared something many people don’t realize: your genes may increase your risk of dementia, but they don’t determine your fate—not by a long shot. (If you missed that article, you can read it here.)

The second article explored how to establish your brain health baseline, including genetic screening, key blood markers, cognitive testing, and a review of modifiable risk factors.

While your primary care doctor is often your starting point on this path, our healthcare system isn’t always designed for prevention—it’s mostly structured to respond to signs and symptoms. But when it comes to dementia, our goal is to avoid symptoms in the first place.

That’s why I refer to the barriers built into the system—including those from insurance companies—as healthcare headwinds. This third article focuses on four common headwinds you may face when seeking proactive brain health care—and how to push through them by advocating for yourself.

Healthcare Headwind #1: “You’re not experiencing memory issues, so there’s no point running a bunch of tests.”

There’s an old saying: “If it ain’t broke, don’t fix it.“ This sounds reasonable at first, but we should not manage our health by this axiom. We don’t even manage our cars by this axiom! Preventative maintenance is a much more effective approach for both. I prefer the saying, “An ounce of prevention is worth a pound of cure.”

Why isn’t your doctor taking a more “preventative maintenance” approach when it comes to your brain health? Why not see if there are some underlying issues that might cause symptoms in the future?

Doctors often focus on treating symptoms rather than preventing issues that haven’t appeared yet. We typically only visit doctors when something is wrong, so it makes sense that the limited time a doctor spends with us is focused on addressing the current problems. However, just like with your car, trying to prevent big problems is a better approach. Here’s how to advocate for preventative care in brain health.

Your Response

You have a long-term perspective—decades, perhaps—and your cognitive tests or blood tests may show markers of avoidable risk that won’t result in symptoms for a long time. The key is to avoid symptoms. We know how challenging it is to make a difference for someone who is already experiencing symptoms of dementia.

You need to frame your request in a way that advocates for early detection and proactive care, even when not experiencing symptoms.

• Ask your doctor to include cognitive and blood tests in your routine checkups as part of a proactive approach to brain health. Be clear that you’re investing in your long-term well-being, even if you’re not experiencing symptoms. Share specific test ideas from this article:Establish Your Brain Health Baseline.
• Make sure your doctor appreciates that you are willing to invest some time and money to understand your brain health to reduce future risks. It’s your time and money, after all. (Insurance probably won’t cover much of what you need to do.)
• Let your doctor know you’re investing in your future brain health and want to do this even if the tests show no immediate concerns (which would be fantastic!).

Even if you convince your doctor to test the health of your brain, you might encounter another challenge—the lack of standard studies or guidelines supporting certain interventions. Let’s explore how to handle this next roadblock.

Healthcare Headwind #2: “There’s no study or standard of care that says we should do something with the information we’d get from these tests.”

It’s true that not every intervention has the perfect scientific study behind it, but we don’t have to wait for perfect evidence to act on what we know. If your doctor is hesitant about certain tests or treatments, ask about starting with safe, low-risk interventions, like dietary changes or supplements whose impact can be monitored over time.

Your Response

This headwind comes from a good place. Well-run studies show that something is safe and effective. Our medical system obviously wants to promote safe and effective courses of action.

Here’s what you can do to address this headwind:

• Acknowledge that you would prefer evidence-based decisions backed by solid scientific studies that show an action is safe and effective, but you don’t want to wait for those if there are low-risk opportunities to address areas of risk.
• Let your doctor know you’re not looking to take unnecessary risks—you’re simply hoping to start small, monitor the changes, and build from there. This proactive approach could make a real difference.
• Request that your doctor help you create a personalized health plan with low-risk interventions (certainly to start), such as certain supplements, while monitoring your progress with follow-up tests.

I am not encouraging you to experiment with dangerous, untested pharmaceuticals. What if your Vitamin D is low, however, and a widely used and safe supplement can easily address this risk to brain health? This is about looking at your test results, seeing where there could be improvements in areas that are tied to your brain, and implement interventions to address the opportunities.

After you’ve addressed your doctor’s concerns about testing, the next hurdle might be what to do with the results. Even if your results come back “normal,” there may still be more you can do to optimize your brain health.

Healthcare Headwind #3: “You don’t need to do anything because your test results fall within the normal range.”

This headwind relates to any “normal” test results. Being in the normal range is better than falling outside the normal range, but can you do better, and in which areas might it be important to do better?

Being in the “normal” range doesn’t always mean things are ideal. For example, the normal range for total cholesterol is between 100 and 199 mg/dL. A level of 110 and 190 are both considered normal, but lower is often preferable for better health. I use the term “optimization” to refer to the process of trying to be on the better end of the normal range, when that’s important.

It’s impractical to optimize everything related to brain health. That’s why getting a baseline for your brain health is so important. The results will tell you the (hopefully) few areas you might consider optimizing, and it’s up to you to choose which of those to pursue.

Being in the “normal” range is good, but sometimes aiming for optimal levels can be better, especially if you have risk factors like a family history of dementia. Here’s how to discuss your results with your doctor and ask about optimizing certain markers to support brain health.

Your Response

Tell your doctor you are particularly interested in brain health, and you want to review test results where you were in the lower end of the normal range (I’m assuming your doctor will naturally focus on areas where you are not in the normal range).

Ask questions like:

• Which tests are most important for brain health?
• How can I optimize markers even if they’re in the normal range?
• Is pursuing that safe for me? What are the risks, if any?
• Ask your doctor how frequently you should retest to track changes.

After working through general brain health testing, you might face one final challenge: the decision to test for specific Alzheimer’s biomarkers. Here’s how to approach this conversation with your doctor.

Healthcare Headwind #4: “We don’t recommend testing for any Alzheimer’s biomarkers because there’s no cure and the tests won’t tell you for sure whether you will get it.”

Your doctor is correct that there is no cure (yet!) and there’s no test that can definitively tell you whether you will get Alzheimer’s. What they are wrong about, however, is their conclusion that because of those facts, no one should test for an Alzheimer’s biomarker, like APOE.

Your APOE status tells you if you are at a higher risk of getting Alzheimer’s disease. Deciding whether to test for Alzheimer’s biomarkers is personal. If you’re uncertain, weigh the potential benefits—such as motivation to make lifestyle changes—against possible downsides, like increased anxiety.

I am a quick decision-maker and focused on my brain health, yet it took me more than a year to decide to test my APOE status. I eventually did it. Although there is no cure yet, there’s still a lot you can do to decrease your risk of dementia. Knowing this was a big factor in deciding to get this test.

Your Response

If you’ve made the decision to test, here’s how to navigate the conversation with your doctor:

• Acknowledge your doctor’s concerns about the limitations with this test.
• Tell your doctor you’ve carefully weighed the pros and cons of knowing your APOE status. Ask for their support in developing a preventive action plan based on the results, even if the information isn’t definitive.
• Clarify that knowing your risk level, as imprecise as it may be, could encourage you to be more diligent with interventions, such as diet and exercise, or plan differently for the future.
• If you’re worried about how you might react to an unfavorable test result or you’re nervous about taking the test in the first place, talk to your doctor about mental health support or counseling options. Knowing your status can be empowering, but it is smart to seek support if you need it.

By showing your understanding, you will build a stronger case for getting tested.

Options Outside the Conventional Medical System

I hope your internist listens to you when you talk about wanting to improve the health of your brain, even if you don’t show any symptoms of cognitive decline. If this isn’t the case, however, consider adding another medical professional to your care team. This would be akin to getting a second opinion like we routinely do for any major medical decision.

If your current doctor isn’t supportive, consider learning about functional medicine professionals. Functional medicine focuses on treating the root causes of disease. You could also consider direct primary care (DPC) or concierge medicine, where doctors are able to provide more personalized care. Both options likely provide more time and attention to preventive brain health measures. They also, however, cost money that may not be covered by insurance, so keep that in mind.

Functional Medicine

Functional medicine practitioners often run in-depth tests to identify nutritional deficiencies, hormone imbalances, or inflammation markers that can affect brain health (and overall health). For example, they might recommend advanced testing for omega-3 fatty acid levels, which are linked to cognitive function, or cortisol testing to assess stress impacts on your brain.

Functional medicine attempts to offer a holistic approach and treat the body as an interconnected system.

Direct Primary Care (DPC) or Concierge Medicine

You may also want to research direct primary care (DPC) services or concierge medicine. These types of healthcare organizations offer monthly subscriptions and operate outside the insurance model. For these healthcare models, you typically pay a monthly subscription that includes a set of services.

These approaches provide more transparency than traditional medical practices when it comes to the costs for services. DPC and concierge professionals also offer more personalized care and can (and like to) spend more time with patients. This creates greater opportunities to collaborate on prevention. They’re also often available through direct email and texting.

Conclusion

Proactively managing your brain health is not always easy, especially when facing resistance from the healthcare system. However, by advocating for yourself and exploring alternative care models, you can overcome these challenges.

This takes a lot of work. Be prepared. It’s a lot easier to sit back and let your doctors tell you what to do and not do, but when it comes to your health, you are in the best position to lead the way. Take charge of your brain health journey now by talking to your doctor about the proactive steps you can take. Don’t wait for symptoms—get ahead of them.

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