DOCTORS REVEAL The Steps To Prevent & Treat DEMENTIA! | Mark Hyman

I mean, this is almost 100% preventable and reversible disease by changing our diet.

People should start. They can change their diet today. They can start exercising today. They can do yoga starting today. They don't need to wait.

That is the inconvenient truth people don't want to embrace. The ball is very much on your side of the net. It's not up to me on the other side of the net. The doctor fixes.

Let's talk about the disease a little more in the medical.

Because.

The understanding was, from my training, was that the brain seemed to be disconnected from the rest of the body. We learned about this barrier called the blood-brain barrier, where nothing except some nutrients got in.

That's correct.

It was like this thing that disconnected our head from the rest of us. Turns out that our body is one system and then our brains are connected to everything else that's happening in our gut microbiome, in infections, what we eat, everything is actually influencing our brain function. So can you share a little bit about how this understanding has changed the way we think about the brain and how some of these factors that are driving inflammation are actually causing this disease? 'Cause it's a disease of brain inflammation. It is.

So the conventional wisdom that we're trying to look at is that inflammation is a response to an injury. or is it the injury itself? At the end of the day, you know, a lot of people think that there's an amyloid triggered event and then the inflammatory events occur because of the production of the amyloid.

And amyloid is this sticky gooey stuff that gums up your brain.

That is correct. And importantly, but we used to think, as you said, there was north of the neck and south of the neck, right? And that everything in the Alzheimer's was north of the neck and nothing south of the neck was related to it. When in fact now we know that things like gut microbiome can alter your immune system and having a healthy microbiome can keep you healthy and by the innate and you can boost your innate immunity which might reduce inflammation across the body including the brain.

Yeah, and exercise helps reduce inflammation?

And BDNF. So the exercise, I have to tell you, I hated running.

Oh no.

But I've taken up running. because of BDNF. So what is that? That's brain-derived neurotrophic factor. It's like miracle growth for the brain. Miracle growth for the brain. And the funny part about it is almost neuroscientists are runners. They don't do anything but run. They have to have something to it. It's the fastest way to raise your BDNF.

Which is basically this growth factor that connects your brain cells together. So it calls neuroplasticity, which increases connections, and helps neurogenesis, which is the development of new brain cells. That is correct.

So we never thought that was possible. We never thought it was possible. was possible. They said once you're born with your neurons, you're gonna get it. But we now know that the brain.

Is making neurons throughout their life. Yeah, I mean, I read a study where they studied terminal cancer patients and they gave them this dye that only goes to dividing brain cells.

And they found even at the point of death, they're making new brain cells. That's correct. We did a, when I was in Sun City, Arizona at the Banner Sun Health Research Institute, we had a brain and body donation program and we had scientists that could take brains of patients who just expired and culture out, bring out the stem cells that were still left alive in dead brain.

That's unbelievable.

That's pretty cool stuff.

So these things like diet and exercise and optimizing your gut microbiome and stress reduction, they all in a sense work by regulating this inflammatory process.

That's correct. That is correct. The inflammation, of course, is the unifying common pathway that we can manage. and you know, at the end of the day, that's what we want to do as researchers.

The studies taking Advil never really worked.

They tried it, right? Well, COX inhibitors have not worked. So then the questions are scientifically, is it that pathway of inflammation? People are now looking at different pathways of inflammation, you know. Now looking at TNF-alpha, which is tumor necrosis alpha, they're looking at the fact that TNF-alpha might trigger enzymes related to Alzheimer's called base. So we think that there's a link that inflammation is not just a broad category, but there's specific segments that seem to work and others that we've tried, like you said. We tried anti-inflammatories for years to treat or prevent Alzheimer's. It didn't work with the darn.

Right.

Well, that sort of goes back to the thinking in functional medicine, which is what's causing it in the first place. So, if you're standing on a tack, it takes a lot of aspirin to make it feel better. Pull the tack out. So, it's not necessarily the best logic, but it's it's something that we have to sort of begin to wonder about. I'm talking to one of your colleagues, Rudy Tanzi from Harvard, who said to me that they've done studies of patients who had brains full of this amyloid, but they had the gene somehow that didn't let them create inflammation and they weren't cognitively intact.

They didn't have dementia. Right, and that's the amazing thing is that you can go to your grave with a brain full of amyloid and not develop dementia. And we wanna study those people 'cause there's something that's protecting them against the development of symptoms.

And of course, they may have just less inflammation as you commented.

Rudy Tanzi would be the guy to figure that out.

Yeah, and he talked about the microbiome of the brain. I don't think they're still trying to figure it out, but they're finding microbes in the brain. Right. We thought it was sterile up there.

But turns out it may not be.

It may not be.

There's a new one that you probably have just hearing about. There's a company out of the Bay Area that found there's an oral bacteria called P. gingivalis, which creates a protein called gingipain, which may be a neurotoxin and neuro trigger of neuroinflammation, and so.

They'Re looking at a drugs to stop that.

Maybe brushing your teeth, flossing, and getting.

Them clean is a good idea. That's good for the heart. Not just good for the heart, it's good for the brain as well.

That's right.

I mean, people don't probably know that, but one of the biggest triggers for heart disease is gum disease, right? That's correct. So let's talk about the genetics here for a minute. So, you know, most people think you get your genes, they're fixed, your fate is sealed, there's nothing you can do. Right. It's not actually how genes work. you can modify these genes expression, which ones get turned on and off and how they work. And I remember having this patient years ago, who was a 90-year-old woman. She was a dentist. She had APOE double four, meaning she had two of the worst genes you could have that are triggers or maybe predisposing to Alzheimer's. And she was 90 years old, she was still working, and she was completely cognitively intact. And she was a health nut her whole life. She ate a perfect diet, she exercised, she never smoked, she never drank, she took her vitamins. It was remarkable to see that. Yeah. That's impressive. And this is what you talk about in this book with this woman, Jamie, she came to you because she had a family history of Alzheimer's. Yeah. And you checked her genes and she had that dreaded APOE4 gene, which many people are afraid to test because they feel like it's just a, why bother? So you talk about why bother. Tell us why bother. So.

I'll answer the why bother in a second, but Jamie is like your dentist patient. She's a 4-4. She found, her story of course, she found out her genetic risk by accident. Now you and I know that if you are two copies of the APOE4 gene, your lifetime risk is 91% that you're gonna develop it. It's almost a matter of when, not if. And the problem is that fortunately there's only 2% of the population that are double copy, 20% of the population is a single copy of the APOE4, But people are now finding out because there's commercial genetic testing by accident.

23 and me.

23 and me, right? And then they go to Dr. Google. It's me and my friend, Dr. Google. And they're like, well, what does this mean? And they go and so the Jamie's of the world are finding out day in and day out by accident. And they're trying to figure out what does this all mean? So the story is, on her half, is how she found out by accident and how it affected her. My half of the book is, is it a good idea to be tested? What are the consequences of being tested? What does it mean? And so that's what my half of the book about. It's a nice convergence of two storylines that help people to become informed because this is happening every day of the week.

It's happening anyway. But what your book, Fighting for My Life, suggests is that by knowing that it can motivate people to take control of their life and their lifestyle and address the modifiable risk factors.

That is exactly right. And I want everybody who reads the book to be like your dentist patient, right?

Yeah, she was amazing.

I have to say to you, I had one other.

Not sure I would go to her at 90 years old to clean my.

Teeth, but... Sure, but... She got to 90.

She was, right? And working, still working.

And I've seen only one other elderly person get to late 80s, 90s, a 44 who was unaffected. In my career, I've always said that if you have that genetic profile, it's almost a foregone conclusion you're going to get Alzheimer's dementia eventually. But there was one exception to that. So we want everybody to be the.

Exception, not the rule. Now, one of the things we haven't really talked about yet is the role of sugar in the brain. And many people may remember Ronald Reagan's favorite food was jelly beans. And he got Alzheimer's. Now, maybe there's a correlation. It turns out that diabetics have four times the risk of getting dementia. That is correct. we sometimes talk about Alzheimer's as type 3 diabetes.

This is Susan Delamonte from University of Rhode Island.

Brown, yeah. Yeah, brown, yes. And the truth is that we all have control over whether or not we get diabetes. This is almost 100% preventable and reversible.

Disease by changing our diet. Right. And you know that insulin resistance, of course, is the hallmark of type 2 diabetes and that we can see insulin resistance in the brain and that's what the type 3 diabetes, even if you're not having insulin resistance in the rest of your body. And we think that, of course, and I strongly I strongly believe, like you, that that's a modifiable risk factor. We can alter that. We can alter it, of course, the epigenome, which we're going to talk about, I hope we're going to talk about epigenetics. But the diet and reducing the sugar intake and the diabetes risk is something we can alter and have a positive effect on. So we all learned, I mean, I.

Learned in medical school that your brain uses 25% of your glucose and it needs sugar to run.

Yes, it does. And the PET scans, show that you need sugar to make your brain light up. So the rule of thumb on a PET scan is you want your south of the neck, you want to be dark, north of the neck, you want.

To be bright on sugar PET.

Because if it's dark below, you got cancer. If it's bright below, you got cancer. If it's dark, that's why you put it in the brain, you want it to be nice and bright.

You want that brain to light up because it can so much of the sugar metabolism is in the brain. But you also say in your book, in patients who have Alzheimer's, that people are exploring the role of ketogenic diets, which means no sugar and lots of fat and the brain running on ketones instead of glucose.

And the issue that people are trying to decide is can you bypass insulin pathway mechanism? So if you're relying on insulin and pathways related to insulin to nourish your brain and you have insulin resistance, either you can pharmacologically improve that or you can dietarily improve that.

I mean, you know, I remember this patient I had at the Ultra Wellness Center, my practice in Lenox, and she came in to about 78 and she started having what we call MCI or mild cognitive impairment, and she had a whole bunch of things wrong with her. Fibromyalgia, bad. She had gut issues. She had low vitamin B12. She had heavy metals and mercury, but she was able to fix a lot of these things and do a lot better for many years. And then she started to decline, and I'm like, well, let's try a ketogenic diet. and we got someone to work with her and cook for her. And it was like the lights went on again. It was pretty dramatic. And I think there are some preliminary studies that are showing that.

And people have been looking at, so the ketogenic diet all starts with the whole coconut oil conversation, which is coconut oil is controversial by itself. But the story behind ketogenic diets is that we do understand there's insulin resistance. NIH actually funded a study looking at the ketogenic diets. So I think the science is there. It's just a matter of being able to prove it and more importantly to adhere to it. Ketogenic diets. Not easy. Not easy. It's not new to neurology. We've been using ketogenic diet to treat childhood epilepsy for 30 plus years. So it's new to Alzheimer's but it's not new to brain disease. It's been used to treat other brain diseases for a long, long time. But fundamentally it's really hard to diet to stick to.

Yeah, we're finding more and more people are doing it. It's one of the hottest diet trends out there. If you look at all the best-selling books, it's not mine, it's the keto books. And we're seeing much more interest and we're running keto programs at Cleveland Clinic. They're our most popular programs, which is pretty amazing.

So people seem to be willing to try it. I know you had Dan Pomerleau on a few weeks ago and Dan and I have- David Pomerleau. He and I have had an internet debate about this.

And.

I will say to you that I think it's more nuanced. I think that ketogenic diets that are insulin sparing make more sense in the symptomatic phase of the disease. And I have to tell you, I look at Alzheimer's disease in a dichotomous way. There's the pre-symptomatic and then there's the symptomatic. Symptomatic disease means mild cognitive impairment and dementia. And I think there is some logic to a ketogenic diet in the dementia phase.

I agree. I think an ounce of prevention is worth a pound of cure as Benjamin Franklin said.

Correct. I think that the ketogenic diet is a pound of cure. It's a pound of cure. But I would not necessarily advocate for it in the mild, in the pre-symptomatic phase. I'm more advocating for the Mediterranean diet.

In the pre-symptomatic phase. And that's the beauty of your book, is you talk about how to create resilience. and health, so you don't need the pound of cure.

Correct.

Because the hope for life isn't to be restricted and restricted, it's to actually be more resilient, healthy, so you actually are resistant to these diseases. That's correct. Right? So it's actually exactly the right idea. So let's just dial back a little bit to the genetics. You kind of mentioned epigenetics. Right. I don't know what that is. I want you to explain it. Okay. And it sort of speaks to the modifiable ways that we can alter our genes to improve our health outcomes.

Tell us about that. this is an area of great controversy and frankly, I'm not sure we have a clear answer for this. The idea that people said in your remarks is that what your genetic profile that you're born with, it's like your fate in life, right? And people are starting to challenge that idea. And really think about it, can I take a genetic risk for Alzheimer's and and create a life program that offsets that genetic risk. So if I'm genetically prone to getting Alzheimer's, can I create an intervention program that would buffer or mitigate or offset that risk? And that's the questions about it. Precision health or precision medicine.

Precision medicine is a great example of that.

And that's a really critical point because if that's true in Alzheimer's, we could try that across the board, right? In diabetes, heart disease, cancer, All those disease states could respond in a, maybe not in the same paradigm, but in a similar paradigm to alter those risks as well. And I'm not sure we've answered that question to the greatest answer that we could have, but we're still working on it. And I think there's people that would say that's possible. So epigenetics is a fairly new field. It's very exciting. And the idea is that we can say that to things like diet, exercise, lifestyle, stress, sleep, lack of sleep, that you're turning genes on and off. And that we want to, in many cases, turn genes off, but in some cases we want to turn genes on, and that would alter our health.

Yeah, and it's so possible. I mean, food is one of the most important and prevalent things that we are connected to every day that alter our gene expression. And this is one of the fundamental ideas of functional medicine. So you eat broccoli, it tastes good, but it also upregulates genes that increase glutathione, which helps you detox. and helps the liver work better. And you have green tea catechins, but those upregulate genes that increase your ability to get rid of heavy metals. So, there's incredible research on these components in food that have these biological effects on our genes. And I think it's one of the fundamental tenets of functional medicine, which is that your genes interact with your environment to create who you are at any moment. And when you say environment, I mean food, exercise, stress, Relationships, connection, love, meaning, everything. All those things are things that we have control over. People think that you go to the doctor, they're gonna fix you, but the truth is 80% of your health is determined by what you do, not what the doctor does.

That is correct.

We have an amazing opportunity, and that's just such a great message that you have in your book, Fighting for My Life, because you talk about this woman who otherwise would be in a way facing a death sentence, who has a plan, a hope, a roadmap to slow, prevent, and maybe never get the disease.

And I hope that we'll have this conversation 10 years from now and say she's still fine.

Yeah. Now, this is super exciting. And there are other things that are sort of being looked at. And one of the things that has been linked to brain injury is neurotoxins. Toxins, as you mentioned, from your mouth. But we're exposed to all sorts of things, whether it's pesticides or heavy metals, viruses. We know, for example, in Parkinson's that it's pretty well accepted that environmental toxins like pesticides increase the risk significantly. And farming is probably one of the worst occupations in terms of risk of death. You're seven times more likely to die if you're a farmer because of some of these use of pesticides. So how do these things play a role in Alzheimer's? There's been mixed research. What is your take on the idea that things like mercury, environmental toxins may play a role?

Yeah, so that's been looked at and the associations are very clear in Parkinson's. There's no question about that. The associations with heavy metals and pesticides, we do know that some heavy metals impair cognition, maybe an impaired development.

You know, like lead and kids, we know that, right?

But they don't necessarily have been strongly, they have not necessarily been strongly associated with the development of Alzheimer's, but it's still being looked at.

But in a sense, it's All these things that are sort of coming together to create this stress on the brain, right?

Well, there's so many things that stress the brain, right? So I also talk about not just the risk factor for developing Alzheimer's, but I talk about the cognitive killers, right? Sleep deprivation is a cognitive killer. Mood disorders, depression is clearly a cognitive killer. And substance abuse are cognitive killers. Alcohol. Alcohol, yeah. So the reason I say this to you is that, and we'll talk about alcohol. The J-curve, we need to talk about.

The J-curve in alcohol.

All right, so I can have wine tonight.

Not too much.

That's exactly right. That's the J curve. So, the reason I say this to you is that, you know, a lot of things can help your brain function. A lot of things can make your brain function worse.

Yeah, and I like to call them dementogens.

Dementogens, I never used that.

Yeah, that's a good one. Dementogens, because it's, there's a lot of them. It's our inflammatory diet. Right, inflammatory diet is a cognitive killer. You know, processed food, lack of fiber, things that don't help our microbiome be healthy. Right. you know, like you said, lack of sleep, stress, fascinating research on, you know, improving immune function in the brain just through meditation. Right.

You know, and, you know, I started.

Meditating this year, 2019, first time I ever started. Unbelievable. That's so good. You know, when you start to look at the data, it's like, okay, it's pretty compelling. Right. It's, it's, it's a very hopeful message. So you talk about things like bdnf and yoga helping with. Correct.

I mean, yoga helping with bdnf and meditation. So those are really things that people can do. It's not just a hopeless thing. And that's the thing I want people to take away from this is that you can engage in your own life plan to alter your risk. Don't wait. You know, people should start, they can change their diet today, they can start exercising today, they can do yoga starting today. They don't need to wait. And I, you know, I emphasize over and over again that by the time somebody walks in my office, it's been going on in their brain for a while, so. Now, today is the day, not later, not Christmas, not New Year's of next year. Today is the day you alter your diet.

Yeah, so you've changed your diet. You started running, you started meditating. I did.

And I was eating pretty healthy to begin with, but I said there's more that I can do.

Yeah, and as one of the world's leading experts in Alzheimer's, you're reading all the science. You're going, holy crap, I better get started on this.

Oh, yeah. Even if I don't have the APOE.

I do not have it.

I'm an APOE 3-3, I found out, but I'm still... I'm a 2-3. which. Oh, you're gonna live forever. I know.

And you will not get Alzheimer's. The two is the longevity gene. These are the people who can smoke and drink and eat whatever they want and live forever. That's correct. And the ones with the double four, they gotta, you know, basically monastic. That's true. So it's really true. Now, one of the studies that came out a few years ago was called the mind study about the Mediterranean diet. And you mentioned that a bit. briefly. First of all, no one knows what a Mediterranean diet is, but there are certain characteristics of that diet that I really want you to talk about that really help the brain.

So the Mediterranean diet is a convergence of fish, whole grains, legumes, olive oil, extra virgin olive oil, antioxidant spices, and a little bit of red wine.

Little bit. Tequila. Tequila. Tequila.

You know, tequila is kind of selling themselves as helping your microbiome, so we'll see.

Oh, really? Oh, yeah. But.

But I will say to you that that's kind of the Mediterranean diet. And the reason I have to tell you is that of all the places that they looked at the Mediterranean diet, they looked at it in New York City. There was a company, there was... Down in Little Italy or what? Columbia University. At Columbia University, they did something called the North Manhattan Aging Project and the Y-CAP study, Washington Heights study, and basically showed that people who had adhered to the Mediterranean diet, 2,200 people who adhered to the Mediterranean Mediterranean diet had lower risk of progression from mild cognitive impairment to dementia, had lower risk of developing mild cognitive impairment, and were stable more stable over time. And of course the question is what of that element is it? And other people ask is it an epiphenomenon because the people live in the Mediterranean but it's not because we studied in New York City. So I think that it is a diet that's easy to have and...

Delicious.

Delicious. But I also want you to know that there was a paper published, I think in 2019, just a few weeks ago, comparing the dash, the mind, and exercise, and the combination, and showed that the combination worked best, but exercise beat diet for brain health.

That's good. That's glad I worked out today. Yeah, it's pretty mild. So, there's a number of medication trials that are going on, preventive medication trials. like the A4 study, tomorrow study, the early trial. Share with us what that research is, because it seems kind of a new approach rather than waiting until you get it.

So the idea is that we can find people, identify people who are at risk, either through their genetics or through their imaging. You take a scan of their brain and say they already have Alzheimer's changes or other risk factors and say, okay, on the basis of some risk profile, we know these people are very highly likely to get Alzheimer's. and then you try an intervention, whether it's a drug. So the A4 study is trying an IV infusion of a drug that's trying to clear out the amyloid before you develop it in your brain. And so that's going on. We think that's going to be a common platform to do this. You know, you saw the Columbia South America, who are very highly risk for developing Alzheimer's, were trying treatments on them. That's the Alzheimer's Prevention Initiative. There's the generation study looking at 44s, people like Jamie, and see if you can do a prevention. on people who are genetically... With what kind of drugs? Either, I'm not involved in that study. I think they were going to do a vaccine and a base inhibitor, beta-amylase cleaving enzyme inhibitor.

So there's a lot of different approaches being tried. Well, it seems to me that the most logical approach would be, you know, sort of reminds me of an article that I read in a medical journal years ago was, Diet and exercise double the effect of statin drugs. You know, I'm like, well, okay, maybe combining the kinds of things we've been just talking about, creating a better foundation of health will allow these drugs to maybe work better. Yes, exactly.

Right, exactly.

But the problem is we don't study in that way. We just study the drug and we let people eat whatever they want and.

Do whatever they want. And the funny part when you're talking about stans is that people think, you know, I'm on a statin, that's good.

I can eat whatever I want.

They want it to be a screen card. They think it's a pass. behave.

Yeah. Have bad behavior. Yeah. In the UK, I think they wanted to sell them at McDonald's over the counter. Like, are you serious? Yeah.

Oh, my goodness. Serious. So that's the, that brings up the.

Very important point, is that people have.

To understand you just can't go to Costco and buy the whole row of supplements and have a terrible life and think that just because I'm taking the supplements that it. Absolutely. You have to buy, you have to drink the Kool-Aid. You have to. exercise, you have to eat right, you have to sleep, you have to reduce your stress, you have to take the supplements, you've got to do it all. You can't just say one thing like it's taking a statin. Cures everything else and you can just.

Be bad, you know, have bad behavior otherwise. Yeah, it's so true. So combining the drug research with these kind of finger pointer kind of studies seems like a logical way to do things. Absolutely. It's some of the things we've been talking about, collaborating on at Cleveland Clinic, which is really exciting. I'm really excited. bring together functional medicine and the systems thinking and lifestyle issues with sort of the rigorous science that you do. It's just, I'm so excited about it.

I'm really excited about it too.

Yeah, it's great. And you also been thinking about creating a preventive clinic for summers.

Correct. There's not many out there, right? There are not. And we've been in discussions with very important people in the universe who really.

Want to see a prevention clinic.

Not in America, but in the whole universe. Well, my universe. Who are really vested and invested and seeing prevention clinics move forward. I know it's kind of out of the box thinking, but I think this is the time to have those kinds of out of the box ideas.

Yeah, I think it is important because what we've been doing doesn't work. It doesn't work. It's like what Einstein said, you know, you can't solve the problems with the same level of thinking that created them or that we use that aren't fixing them.

But this is a paradigm shift. As we started earlier in our conversation, we're going to go from treating disease to treating health. This is like, this is the gospel for me.

I know it is. This is exactly what I spent my last 25 years in medicine doing, which is thinking about how do you create a healthy human? What are the impediments to health? How do you get rid of them? And what are the ingredients for health? And how do you provide them? And it's really a very simple notion. I mean, it's, you know, one of our mentors, Sid Baker, was one of, I think, one of the greatest thinkers in medicine ever, was a Yale professor. He said, you know, just ask two simple questions when you see a patient. What is it in their life that is disturbing their health? Like what is it that doesn't agree with them? Right. Is it their diet, lack of exercise, stress, a toxin, microbes, allergen? And what are those things that the organism, the human needs to thrive? Their particular unique needs. Because some people might need, you know, 400 micrograms of folate that you can buy over the counter. Some people might need five milligrams of methylfolate, a special kind because they have this unique gene. So it's really about finding the unique needs, optimizing what each person needs, and creating the opportunity for the body to heal. Yes. You know?

And that's where I think precision medicine is going to come on board, is that we are not all the same.

Yeah.

And that we can now, with using molecular diagnostics, determine the differences between you. You're right. You might respond to folate. I might respond to methylfolate. because our genetics are different.

Right, and so this is really, it's precision medicine, but it's also precision health.

It is precision health.

Something that has to sort of upend medical education, upend medical practice. It's not what we're trained to do, but it really is how we're going to solve this epidemic of chronic disease. Practicing functional medicine at Canyon Ranch, I just was treating all these people for body issues.

Right?

So for their gut or their heavy metals or their metabolic syndrome, their prediabetes and nutritional deficiencies and folate and B12, which find all these physical things wrong with people. And then I would treat them and then they'd report to me, my memory's better, my depression's gone, my panic attacks aren't anymore happening. I have the ability to focus and pay attention better. And I'm like, what is going on here? And I wasn't, you know, focused on treating the brain, but as a side effect of fixing the body, the brain would get better. And that's when I wrote the UltraMind Solution, which is how the body affects the brain. And it was like over 10 years ago now, and we're just sort of catching up with what I was observing back then. And when even the literature back then, you could see there was evidence that this was true. Again, it just takes 17-20 years for scientific advances to end up in clinical medicine. But functional medicine shortens that gap. And I remember this one patient, and we're going to talk about your patient soon, but this one patient I had who was this sort of striking. He came in with his wife, and he was a CEO of a major company. It was his family business. He was unable to function. He was 70 years old. He basically was depressed and cognitively impaired, memory loss, basically sitting at home in a corner doing nothing and has had, you know, mood changes because a lot of times people with memory issues and dementia get a lot of mood changes, their personality changes, nobody wanted to be around him, his grandkids didn't. And I'm like, well, I've never treated this before. But I'm gonna just try to get you physically healthy and see how it affects your brain.

Yep.

Because at that time, there wasn't a book on the end of Alzheimer's or any of this stuff.

And.

Although David Perlmutter, you know, talked a lot about how to treat the brain with neurology and we really learned a lot from him.

Yes.

And this patient turned out he lived in Pittsburgh. He had super high levels of mercury because. And he also had a lot of dental fillings. And in Pittsburgh, all my patients from Pittsburgh have super high mercury.

Oh, interesting.

And the reason is, I believe, is that it's the steel capital of America, and they use coal for the steel plants. And coal has mercury and lead. And it's used on everything. They put it on the fields. They use coal ash for instead of like sand on the icy roads in the winter, they'll use coal ash. so it's everywhere. Right. And he also had pre-diabetes, which was undiagnosed. He wasn't really overweight, but he had kind of a little belly. And he also had severe irritable bowel for 30 years. It was on stellazine, which is a sort of anti-psychotic, you know, relax, like tranquilizer, basically, which is kind of strange.

Yeah.

And he also had severe. Folate and B12 deficiency. He had high levels of homocysteine. He had a lot going on, huh? And methylnolic acid. So he had gut issues, he had vitamin deficiencies that affect the brain, he had heavy metals, he had pre-diabetes. And he also had genetics that set him up for this. So he measured his genes, something called APOE. And if you have APOE4, you're much higher risk for dementia and you also can't get rid of metal. So he had APOE double four. which is the worst risk. He also had genes that affect his folate metabolism, like MTHFR. So, he wasn't able to process the folate he was getting from his diet, so he was sort of functionally deficient in these nutrients. And he had terrible gut issues. So, we looked at all these things and I just treated his diet to get rid of the insulin resistance. I treated his gut with the 5R Program, which we've talked about on the podcast to reset his gut. I gave him the nutrients he needed in the right doses. I detoxified him from heavy metals and he literally came back to life. That's beautiful. Treated him for years and years and his memory was good, his mood was good, he was able to go back to work and function running his company and you just don't see that with traditional medicine.

And I think you bring up a really important point that sometimes people want to know the underlying root cause, the one thing, right? They want to know what is the thing that's causing this this problem, this cognitive decline, for example, or whatever problem that person has. But many times, many times it's a little bit of multiple different things that come together, right? So he had six different things that you were focused on and they were each contributing to his cognitive decline. And so you have to work on all of those different pieces for him to start to feel optimally better.

So his unique genetic susceptibilities made those things worse for Absolutely, right. So, not everybody with prediabetes gets dementia, not everybody with mercury gets dementia, not everybody with gut issues gets dementia, right? But when you add all the up, it actually all makes sense. And I think, you know, we are often really focused on the pathology in medicine, right? We focus on the amyloid or the tau proteins, all these things that we see in the brains of people with Alzheimer's. But it turns out that Those are so downstream as a consequence of all these other factors that nobody's treating. Yes. Right? And we know that memory issues and the brain issues, whether it's depression or autism or ADD or Alzheimer's, are inflammation in the brain. Right. And there's amazing studies of people who have terrible amyloid in the brain, but their genes for inflammation are different and they don't actually produce inflammation and they die completely cognitively intact with a brain full of amyloid. And everybody, all these billions of dollars of drug studies on amyloid have failed because we're just going downstream instead of.

Upstream, which is what functional medicine does. Which is so fun to practice, right? We're just spending that time to really get to know your patient, get their personal history, figure out for them what are the things we need to remove, what are the tacks we need to take away to help their body heal. And I think you're right. There's so many situations where we see people have huge improvements in their memory and cognition when we address what are their underlying root causes. Like I had a 75 year old gentleman who came to see me and he was a professor and so he was, you know, his brain was really important to him. You know, he spent a lot of time up there in his brain and he noticed that it wasn't working as well. He was having a hard time with paying attention to when he was reading, he was getting lost when he was driving.

And.

He was really frustrated and scared. And so we started to get his history from him. And, you know, I got a good detailed history. And one of the first things I noticed, even outside of the history, was we did his anthropometrics, right? So he comes into the office, right? He comes into the office and We measure his blood pressure, we measure his weight, but in our office we also measure the waist to hip ratio. At the Ultra Wellness Center, we always are looking at that waist to hip ratio, right? So we get so much information when we look at somebody's waist to hip ratio because if you're holding onto too much weight around the belly, that visceral adiposity causes a lot of inflammation in the body and it's a sign, it's a signal to us.

That's all the organ fat. It's a different kind of fat than the fat on your butt or on your legs. It's really dangerous and drives so much inflammation.

And we can't just liposuction it away because it's deep in there.

Actually, that's so funny you mention that because I have a slide that I use in my talks which was of a study in the New England Journal of a woman who had 40 pounds of liposuction who was really overweight. And they did a scan of her belly before and after and they found that, yeah, all the subcutaneous fat was taken out. But all the visceral fat was there and none of her blood markers changed. With loss of 40 pounds of fat, not her blood pressure, not her inflammation levels, not her insulin, blood sugar, cholesterol, nothing changed.

Right, because we know it's that deep visceral fat that's so pro-inflammatory in the body. What's visceral? It's the deep fat. It's the organ fat, right? That's deep in our belly and we know that it's not just sitting there. It's an active endocrine organ. It is producing It's producing inflammatory markers, it's producing cytokines. It itself is increasing inflammation in the body.

So, your fat cells are not just there holding up your pants. No, they're actually dynamic and they're producing hormones, they're producing inflammation and it's affecting.

Everything in your body, including your brain. Including your brain. And you were just mentioning earlier about how, you know, cognitive decline and memory loss is often an inflammatory disorder. And so we did his waist to hip ratio and for men you want to be less than, in general you want to be less than 0.9, your waist to hip ratio.

I'm more severe, I say 0.8.

Yeah, yeah. And it depends on somebody's ethnicity where, you know, how strict we want to be, but at least less than 0.9. And he was like 1.04. So he was holding onto too much weight around his belly. And so we said, I said, okay, this is an area I know I have to focus on. Because even if somebody can't do tons and tons of a workup and tons and tons of testing, we know that that insulin resistance, that weight gain around the belly, that metabolic syndrome that's- Pre-diabetes. Pre-diabetes that's associated with that visceral adiposity, right? So that weight gain around our belly is associated with what we call pre-diabetes or metabolic syndrome, insulin resistance. We know that that is associated with.

Dementia or memory loss. Pre-diabetes. causes pre-dementia.

Yes.

So, you don't even have to have diabetes to have a problem. And if you have diabetes, your risk of dementia is four times greater than the average person.

Right.

Which is staggering.

Staggering.

Especially since the fact that 75% of us are overweight. Right. And 42% now are obese and it's all connected. Right.

And at least half of us have metabolic syndrome, right? In this country.

One out of two people in the country country have pre-diabetes or diabetes.

And people are always like, oh, is there anything I can do to prevent this dementia? And this is an area that we really, really can attack. It makes a huge difference when you work to get down the waist to hip ratio. And so what we did with-- and.

People don't connect the belly and the brain. I mean, the belly fat, the bigger your belly, the worse your brain off. Brain is off. Like, right, you're more likely to have Alzheimer's or you're actually literally shrink your brain. The bigger your belly, the smaller your brain.

They're calling it type 3 diabetes, right? That is dementia or Alzheimer's disease because we know there's such a connection with how well the insulin works in the brain. So it's really critical that people understand that there's so much you can do by just improving your waist to hip ratio.

The professor's diet wasn't terrible, but- no.

He didn't think it was terrible. It was kind of high in starch and sugar, right? He's like, he said, well, we always ask, We always have people actually fill out their diet diary. But I always ask and people are, they're like, oh, no, it's not bad. We're trying to be healthy. You know, he was, he had the money and he was educated, but for breakfast he wasn't even having junk food. He wasn't even having junk food. But he might have a piece of toast. He'd be like, well, it was wheat toast for breakfast with my coffee. And then at lunch he might grab a turkey sandwich and had a salad. And then at dinner he might have pasta with his, his, his fish or chicken. So he didn't have an awful diet. but for him, he had gained like 30 pounds over the last 40 years or so and he had gained it, as we mentioned, in his belly, which is a sign to me, which is a sign to me that says, okay, he's more carbohydrate intolerant. He's got this metabolic syndrome, which means he's not tolerating these carbohydrates that well anymore. And that's where we need to focus from a diet perspective.

So, yes to that. be clear about carbohydrates. So like broccoli is a carbohydrate, but you're not talking about broccoli. No. So plant foods are all carbohydrates. That's what they are. Any plant food, whether it's orange or broccoli or a potato, but they're not all the same. Certain carbohydrates are super bad for your blood sugar and insulin. Others are great. Right, so I always just joke and I say carbohydrates are the most important food for health and longevity. Why? Because we need a plant-rich diet full of lots of colorful fruits and vegetables that are low in starch and sugar. But if people are eating potatoes and bread, which you think, oh, that's fine, whole wheat bread, but actually that's worse for your blood sugar than table sugar. And sandwich bread and potatoes and pasta. It may not seem terrible, but if you are someone who's carbohydrate intolerant, which by the way affects about 70% of Americans. Then the ones who are overweight, then you've got to deal with that. Right.

And I always tell people, take away anything with flour in it, right? Even if it's gluten-free flour, because some people are like, well, it's gluten-free. But if they've taken a grain and turned it into a flour, then like with pasta or bread, then it's something that's it's easily digested in your body and it causes your blood sugar to spike, which causes your insulin to spike. And then that insulin causes us to.

Gain weight around the belly.

And remember that belly. You get hungry and crave carbs.

That's for sure, right? And that makes you lazy. Yep. So we think people are lazy, they don't exercise. They're often feel like crap so they don't want to exercise. It's like a vicious circle from the food causing you to be hungry and.

Lazy as opposed to the other way around. The fact that you eat too much and you don't exercise enough causes weight gain. It's the other way around. Absolutely. And then that weight around the belly is causing inflammation in your body to go up and that inflammation then is turning into for some people dementia and cognitive decline, which was happening with this gentleman. And so when we did further testing, we could see more things that went along with this waist to hip ratio being high. We saw that his blood sugar was fine, his blood sugar was fine, but his fasting insulin was high.

Right?

So, I always recommend people have your doctor check your fasting insulin.

Which, by the way, most doctors never do. They check your blood sugar.

Right, right, right. And so, his fasting insulin was 15.

Wow, that's high. It should be like less than five.

Yeah, we like it less than five.

You know, definitely- I can brag, but mine is two.

So, we knew it was way too high. And we also saw the other things that we typically high triglycerides, low good cholesterol. He had a lot of things that high C reactive protein. It's a marker of inflammation. Which you can have your doctor check as well. And all of this sort of came to say, okay, we've got to really focus on his pre-diabetes, on his insulin resistance, Metabolics Syndrome, whatever we want to call it, right? And so what we did is we shifted his diet and we pulled away those refined and processed carbohydrates. We just focused on the non-starchy vegetables for his carbohydrate source as you were mentioning. And more fat, right?

So talk about fat in the brain.

Well, you know, we know the brain is fed by good healthy fat. And the fat also really helps with balancing blood sugar.

And the fat is like 60% of your brain is fat. So you need to be- Omega-3 fats, right?

Yeah.

So we really focused on giving him more, we gave him fish oil as a supplement. But we focused on him getting more Omega-3s from his diet too, from ground flaxseed, from the fatty fish like sardines, which I love, salmon, and really focused also on just giving him more fat in his diet. And that helped him. That is what helped him feel more satiated.

Yeah, because when you eat fat, you feel full. Right. So he wasn't hungry anymore.

Right, he wasn't looking for food all the time.

Yeah, people cut the starch and sugar and they don't eat the fat, they're.

Going to be hungry all the time. Right, right. So that really helped him just helped him balance his blood sugar. Over time, he lost some of that 30 pounds. He lost most of the 30 pounds. We got him exercising because we know that can improve BDNF, that brain-derived neurotrophic factor.

It's like miracle grow for the brain, right?

Yeah, yeah. And he really wasn't, you know, he's kind of a sedentary kind of guy, so we got him moving and exercising. And it was phenomenal. Just by lowering his insulin, lowering that waist circumference, getting him exercising, he saw a great improvement in terms of his energy and his memory.

Yeah, memory.

That was most important to him.

I remember those studies where just walking prevents Alzheimer's.

Right.

Because it increases this BDNF brain-derived neurotrophic factor, which is stimulated by exercise.

Yep. And we can also stimulate BDNF through intermittent fasting, which is kind of interesting, a more ketogenic diet, which is that low carb, higher fat diet through meditation, through the good healthy fats, the omega-3 fats. So we can stimulate that BDNF.

Meditation also does it. So you can either run or you can sit on your butt and both do it if you do the right thing.

Right, right.

Yeah, so powerful. So we really have to focus in on this because traditional doctors don't measure insulin. They don't look at insulin. I mean, this is the most common condition, period, in medicine today, without a doubt. And yet, doctors don't know how to look for it and diagnose it or treat it, which is just stunning to me because this is just basic. This isn't even just functional medicine. Right. Right. So we, the literature describes what this syndrome is, metabolic syndrome. It describes pre-diabetes you can use a tape measure, your waist to hip ratio. You can look at your triglycerides, you can look at your good cholesterol, the good cholesterol goes down, the triglycerides go up, you can look at inflammation, you can look at insulin. If you wait till your blood sugar's.

Up, it's too late.

By the time your insulin is so much harder to reverse it at that point. I had a patient who was really overweight and she had big, big belly and it was such an eye-opening case for me because not only did I do a insulin, I did a glucose tolerance test. also with insulin. So you give someone a load of sugar, equivalent to two Cokes, and you measure their blood sugar and insulin before and after one and two hours, and you see what happens. She had the most perfect blood sugar. She never went up over 100. Her blood sugar was perfect. Her A1C, which is the average blood sugar, was normal. But her insulin was like 200. Not 15, not five, but like 200. And I was like, whoa. And so she is just packing on this belly fat because the insulin, everything she eats just turns to belly fat.

And as you mentioned, people just feel so tired and lethargic. So we need to really help them drop that insulin.

Yes, and so it was just so easy to treat this patient. And I think with typical cases of memory issues, it's such a big factor. And I think the food is such a big factor. And I think the diet, there's a lot of research showing Mediterranean diets, for example, help with that. They called it the med diet. And it was just basically things like salmon and greens and chocolate.

Olive oil and olive oil.

They even had red wine in there. And I think we have so much power and people feel afraid and powerless about memory loss and dementia. Like, I can prevent heart disease and diabetes if I eat better and exercise. But they don't get that the brain is just connected to the body and you have tremendous control and power over what happens if you deal with all these variables.

Absolutely.

So the other thing I want to sort of talk about was this other case you had.

Yeah.

Which was a woman who had memory issues and her brain was super foggy and wasn't having any energy and she gets sick easily. So what was going on with her?

Right, so she was around 60 and so she was kind of scared. She was scared that she was struggling with her memory and she was having a hard time recalling things. you know, remembering that person's name or what was she supposed to be just doing or why am I in this room? And, and, and so she was, she was, and she's like, I'm 60. I, you know, this is, this is really scaring me. So I got a good, detailed history on her, and I realized she's also been really sick a lot. She was getting all the colds and flus that were going on. You know, I'm like, okay, now that's concerning. So we, we did some testing on her, and we found out. And when I did an exam, right, when I did an exam, I saw that she had a mouthful of silver fillings. And so I got concerned, as you were mentioning earlier, we know that mercury is a neurotoxin, right? It can cause damage to the brain. We also know it can cause damage to the immune system. It can decrease the functioning of our immune system. And so we did this special test with her that looks it was a quick silver test that looks to see her mercury and her blood, how much of it was coming from the fillings. Yeah, you know, it's so interesting because.

There'S such controversy about this and dental groups go like, there's no issue, it's safe. But it's so funny to me that if you go to a dentist and you have fillings and they remove them from your mouth, they have to put them in a special toxic waste disposal system according to the EPA. So why is it safe? to put in your mouth, but not to throw in the garbage. I don't get that. And the truth is that we know that it off-gasses, that you grind your teeth or you chew and anything gets stable, but it actually releases mercury slowly into the body and it can be absorbed and cause all kinds of issues. Now, some people are great at getting rid of it, but others are terrible. And this kind of test, you just don't get it, your doctor. We look at hair, urine, blood, we see what's going on, how you're detoxifying. It's such a big issue. And then we do challenge testing to see what your your body load is of mercury. And there's good evidence for this, but again, this is not something that most doctors look at or do. And that's what we do in functional medicine, so different at the Ultra Wellness Center where we treat all sorts of patients like this. And we see, when we start to pull the hood back and look underneath, we see an incredible array of things.

That actually are treatable.

Right. Right.

So for her, her inorganic mercury, which is telling us how much mercury is coming from those amalgams, was really high. So I said to her, you know what? We need to work on getting these fillings, these mercury amalgams.

They call them silver fillings, but they're actually mercury.

Yeah, right. Safely removed. So safely, which I think is important. You don't want to just yank them all out without using precautions, right? So like a dam, a dental dam in the mouth, oxygen, high speed suction.

I mean, I had a patient, we're not a patient, a doctor, who talks about this was sort of a chronic fatigue doctor and he started, you know, wanted to get the mercury out of his mouth and he had a lot of it and he went to the dentist and they didn't do it right and he ended up getting heart failure. Oh, wow. From the mercury poisoning. Yeah. Which is actually documented literature, it's one of the causes of heart failure. So you have to do it safely. You have to go to a biological dentist or an integrative dentist. There's a website called I-A-O-M-T.org where you can and see people who've been certified to do it properly to make sure you don't just go and rip these things out because it can be really bad for you.

Yeah, you wanna work with somebody, I think, on this, especially if it's a big issue for you because you also wanna make sure the body is supported to detoxify. Like the body has this tremendous ability to detoxify. It's set up to get rid of these toxins we're exposed to. As you mentioned, some people are better at it than others. I suck at it.

Yeah, me too.

But all of us can support our natural body's ability to detoxify by drinking good water, having regular urination, making sure we're having regular bowel movements, eating a lot of fiber, sweating with sauna and exercise.

Yeah, poop pee perspire.

Yeah, oh I like that, poop pee perspire. Yeah, so you wanna support that and for some people, depending on what their levels are like, so for this woman, her levels were really high and she wasn't very, she wasn't well when she first came to see me. So, we needed to support her a little bit more. You know, we actually gave her some NAC, N-Acetyl Cysteine, which helps the body with production of glutathione.

Which is a main detoxifier in the body.

Yeah, I actually gave her glutathione. I gave her IV as well as liposomal glutathione to help her body detoxify and mobilize these toxins and to help her through that process of getting rid of this silver in her mouth. And that really helps the immune system too. I always find that so fascinating, right? When I first learned about the connection with the detoxification system and the immune system. So when you really support the detoxification system, then somebody's immune system works better. And so, you know, that was very helpful. And we do those IVs all the time at the Ultra Wellness Center. and it really helps with mobilizing heavy metals and toxins from the body. And of course we focus on those cruciferous vegetables, the broccoli, cauliflower, cabbage, kale, which really also they have glucosinolates in them which help the body with production of glutathione.

Right. These amazing plant chemicals that act like.

Medicine in the body, right? Right, right. It's phytonutrients that help the body with production of the glutathione which is this amazing detoxifier, the substance that helps the body detoxify.

And then we use fibers and binders.

In the gut so you don't reabsorb it, right? Right, right. So for her, we actually, her levels were at a point where we definitely had to use some binders to help them get down safely. But when you're doing that, you want to work with a practitioner who really knows how to do that.

Yeah, to be trained in functional medicine. And we do this at the Ultra Wellness Center. We've been doing it forever. And I personally had mercury poisoning. talked about it before, but I had cognitive impairment. I couldn't focus. I couldn't concentrate. My memory was terrible. I literally was reading my kids a book at night and I couldn't remember what I was reading. I just could like read out loud, but I actually couldn't understand it. I was like, I literally had a broken brain. And it was a mercury. And so it's so impactful for so many people and I've seen this over and over again. And then you have to learn how to do it right. And all the things you're talking about, we have a very specific methodology. that basically takes out the bad stuff and puts in the good stuff. And so you support the body's natural system, so fibers and the right foods to help detoxify and the right nutrients like selenium and zinc and all these things are really so necessary in acetyl cysteine and lipoic acid and we use all these supplements and diet and sometimes even medication to help get the body to rid itself of these metals. But it has profound effects. For me it did. And this patient that you saw, It was amazing.

She stopped getting sick so often and then most important for her is her cognition really improved. That brain fog went away. She wasn't having a hard time when she'd walk into a room and forgetting what she was doing there. She really was noticing that her recall was better and that she just felt more clear in the head. It was really exciting to see.

Yeah, so true. I remember this patient I had was like, about 75-80. And she was, you know, a very prominent woman in her community, was on the boards of many boards and, and fairly wealthy and was just struggling. And she was told that she had early dementia and there was nothing she could do about it. And I actually tested her and she had normal B12 and folate. But she had, when we checked these things called homocysteine and methylmalonic acid, which are special tests to look at the function of these nutrients. They were terrible. And so I gave her a B12 shot and some high dose of folate, and she literally just came right back online. Her depression, her fatigue, and her memory loss went away. And about five years after I got a call from her, I'm like, I was like, oh boy, maybe she's not doing good. And I had her on my schedule. I talked to her and she's like, oh, Dr. Hyman, I just wanted to find out what do I need to do because I'm going to Bhutan trekking and I want to know what I need to take before I I was like, what? And I see this over and over and I think that, we talked about a few things like in some resistance, we talked about heavy metals. But dementia is simply the name of symptoms of memory loss. It doesn't tell you what's causing it. People say, oh, you have memory loss, you have dementia. That's what's causing it. No, no, that's just the name of the problem of you can't remember anything. and functional medicine helps to figure out the why. And if you have a diagnosis, then you need to start thinking about the cause. And in dementia, it's a lot of things. It's like we talked about. It could be the metals, it could be the insulin resistance, it could be the nutritional deficiencies, it could be Lyme disease. Right. Like Chris Kostofferson had dementia and treated with Lyme disease treatment and he got better. I've seen many cases like that. Yep. Infections, right? It could be mold in your environment. It could be, you know, other toxic influences. So there's so much we know about this disease now and if we applied it, we could help so many of these millions of people who are suffering. And I think people just need to understand that it's not just about getting the diagnosis and getting your affairs in order anymore. We actually have so much we can do. And at Cleveland Clinic, we've been working with the the Memory Center there, the Lourie Center there. So excited about these ideas. They're implementing them. We're seeing this in academic centers in New York City with Richard Isaacson, which is funded by partly Maria Shriver, whose father had dementia. So we're seeing this incredible advances, but it's just people aren't getting access to it. So, and at the Ultra Wellness Center in Lenox, Massachusetts, where we treat these kinds of problems, we see incredible results and we check all these things. we check metals, we check your gut, we check your insulin resistance, we check your nutritional levels, we check for lime if needed, we check for mold, and these are the things that your traditional doctor just doesn't do. And then we learn how to fix the diet. We talked about things like intermittent fasting or ketogenic diets or caloric restriction. All these things can help actually help the brain. And then we figure out what foods are good for the brain, like the fats, and we apply that. And then of course, will actually treat the specific things as needed, right? If people need different things. And we focus on sleep and stress and gut and diet. So it's really a comprehensive approach that you just don't get when you go to the doctor and you say, I'm having memory issues. And it's terrifying for people because they think there's nothing you can do. You just want people to have hope that actually there is a lot you can do. There's so much we can do, right? I don't want to... I mean, I'm sort of skeptical that you can have an impact when people are pretty far gone. gone. You know, it's better to get it earlier, like when you're pre-dementia or even before that. But I just want to end with a quick story, which is of a nursing home in Cleveland where the family got very focused on my book, UltraMind Solution and Dr. Bredesen's book, the End of Alzheimer's, talking about lifestyle, diet, various things with their patients. And these were patients who had moderate to severe Alzheimer's. and they were in a nursing home and they said, you know, they hired a chef, they got all the gluten dairy out, all the sugar processed food, they fed them whole foods and within two weeks these patients were coming back online. They were talking or they hadn't been talking. They were having less, you know, need for restraints and less need for this and that and medications and I mean they weren't cured but their cognitive function got significantly better and I see this over and over again. So I just want people to really feel like it's not a hopeless case, that there is something we can do and that there's a way forward to think through this together. And I think, you know, people are struggling. We do this all the time at the Ultra Wellness Center and Lenox Medical. We have a great team of providers, you know, four doctors, two PAs, a whole bunch of nutritionists, and great team. And we're really good at actually navigating through these complex stories and coming up with what to do and how to help people.

I agree. It's a fun place to work because there's so much, we see so much improvement all the time. And it's really fun to dive deep and figure out for that individual person what is going on.

It's a miracle. It's not a miracle, it's just applying good science.

Yeah, absolutely.

Functional medicine, for those who are listening, is not a specialty. It's a way of thinking about complex diseases using a systems approach. approach and getting to the root cause and actually thinking about how the body is one integrated system. Because often you go to the cardiologist, the neurologist, the rheumatologist, the gastrologist, and they're all treating their body part, but it's one system.

And so functional medicine helps us really deal with that.

The other issue people are concerned about is saturated fat. And particularly in the context of Alzheimer's, the APOE4 gene, which is a gene that may increase your risk of Alzheimer's. Well, it does, depending on how many copies you have and so forth. Is this something we should be worried about? I mean, Bulletproof Coffee and everybody's- yeah, let's- let's- Cover of Time Magazine says eat butter. Like what's the deal here?

Butter is back. And let's take that apart a little bit on pack up just for your viewers to be really clear that there are some genes that help increase a person's risk for Alzheimer's. And one of them is the so-called APOE4 allele. And you can learn about it by having an at-home genetic test that anybody can do. And 20% of Americans will carry the APOE4 allele.

One copy.

One copy. And some carry two copies, which is clearly associated with as much as a 12-fold increased risk for developing Alzheimer's disease. The APOE genes are involved in the production of apolipoproteins, and that's a big term, but it has to do with proteins in the body that carry fat, deliver fat, to where those fats might be needed. There is some indication that the benefits of saturated fat for the brain, we'll talk about that in just a moment, and even the benefits of a ketogenic diet, and we'll talk about that as well. I guess I'm putting a lot of things on the plate here.

It's okay, we got it.

We got it.

It might be a little long here.

We might have to add another memory card. But those things are less beneficial in the APOE4 carriers. meaning that they're not going to gain as much benefit directly from ketogenic diet or a diet that's higher in saturated fat.

Is there harm?

Doesn't look like there's harm. And that said, I think that there are benefits that everybody gains that I believe if there is some sense of harm would offset those potential issues, which are very minimal to begin with. And that is, What the benefits are from consuming saturated fat is the types that we recommend, MC2 oil, coconut oil, the saturated fat that's found in eggs, for example. The benefits are that we enhance our body's ability to produce these important chemicals that are called ketones. There's this huge interest these days all over the internet and certainly in various venues for lectures, etc. in what is called the ketogenic diet.

The number one diet books in the world.

You bet, and with good reason. And it's a brand new phenomenon for humans. It's only the type of diet we've been on for a couple million years.

So we- Physically on and off of it.

Right, but we've been in and out of ketosis for a long, long time. So it's got a heck of a track record. And we can talk about that, but basically it's a diet that counters inflammation, that enhances energy production, that activates this BDNF gene pathway to create more of that growth hormone to grow new brain cells. That helps reduce the production of free radicals. That helps get rid of damaged energy producers called mitochondria. That helps us with our ability to rid our bodies of cells, for example, that are damaged. So in multiple arenas, being on a ketogenic diet is really a good thing. So I think that the ability of the coconut oil and the MCT oil to make that happen really is very, very powerful.

And there's data that's showing that those actually help improve outcomes in Alzheimer's patients.

There's actually a data that indicates interventionally that simply using MCT oil improves cognitive function in established Alzheimer's patients. And what did I just say? There's data that shows that a nutritional intervention is effective in turning dementia around. There's also data from Iran that demonstrates that probiotic intervention demonstrates improvement on the Mini-Mental Status Test, which is a standardized test doctors use in the office to determine how well a person's brain is functioning.

It's impressive. I just reviewed a book by the new head of the Lou Ruvo Center at Cleveland Clinic, which is the Alzheimer's research program there. And I was shocked to read he talked about using ketogenic diets in patients with Alzheimer's as a way of treating the problem, which is pretty radical. You've got the head of a major academic medical saying there saying, yes, we can use food as medicine. We're seeing this trend.

Food as medicine, who knew?

And yet there's this incredible backlash about this. We're going to get into that in a minute. There was an article in the Journal of the American Medical Association called the Rise of Pseudomedicine for Dementia and Brain Health. And you and I would be considered in the pseudomedicine quack category. I think for me it's a personal badge of honor that I'm on Quack Watch.

Me too, along with most of our best friends.

But the saturated fat thing, I just want to come back to.

And the founder of Quack Watch commented on this article in JAMA. You need to see that.

I'm sure, I'm sure. I feel like I'm doing a good job when I get more people attacking me from certain categories of like Monsanto and the farming industry. But the saturated fat thing is fascinating because I want to be able to hear that saturated fat is not necessarily bad, that it is something that can be helpful in many conditions. But that's with one big caution, is to avoid what I call sweet fat. And the reason that saturated fat, I believe, causes, and I want to hear your opinion on this, causes problems in the research which can correlate saturated fat with disease like heart disease and other problems. is that when those studies were done, they're done in the context of people eating saturated fat in a high starch sugar diet. I call that sweet fat. Think of donuts, french fries, ice cream, cookies, these are high fat, high sugar combos that are deadly. So the caution is if you're going to eat saturated fat, you can't eat a diet high in starch and sugar. Yes, high in carbohydrates, plant foods. I always say 75% of your diet should be plant foods in terms of starch, not in terms of starch, in terms of vegetables. In fact, most of your diet should be plant foods by volume, but they have very little calories and most of your calories should be fat, but it's not much volume. Can you comment on that?

Yeah, sure. And I would say let's even take this unpracticed further. And it doesn't even have to be in the in relationship to eating carbohydrates, simple carbohydrates. because the data comes from these studies that look at calculating the amount of saturated fat in somebody's diet based upon the foods that they eat. And they calculate, well, this person eats a bunch of beef, they eat a bunch of bacon, et cetera, they get a lot of saturated fat. As we talked about earlier, those are the wrong kinds of foods for many, many reasons. So this is a calculated determination of saturated fat. It's not a biochemical demonstration that saturated fat does something in the body. It's people who ate a diet higher in saturated fat, which delivers lots of toxins because these are foods from animals that have been fed, as we said earlier, garbage. That's where those saturated fats, how they're delivered to the human body. So it's not a clean type of study. It doesn't relate to telling a person to take a tablespoon of organic coconut oil. no relationship whatsoever. Look, 50% of the fat in human breast milk is saturated fat. Saturated fat?

Wait a minute. So basically breast milk is almost as much saturated fat as pure butter.

You bet. And why is it there? Because it helps for brain development, helps for immune system development. It helps prime the- It was 25%. 50% of the fat. It helps prime.

25% of the calories in breast milk is from saturated fat. We're told to get less than 5% by the American Heart Association. So according to the American Heart Association.

We should ban breastfeeding. I think it needs a label. They need to go around and stamp breasts all around the world saying, this is not hard- I'm not hard-avoid this. I mean, you know, it wasn't long ago when we were told not to eat avocados are nuts.

Yes.

Because they had high levels of the dreaded fat. That was about the worst, and we know where that came from now. We know how medical literature in the late 1960s was tainted. by industry, by Sugar, who wanted to influence what was published in the New England Journal of Medicine, as recently revealed in the Journal of the American Medical Association and ended up on the front page of the New York Times. And doctors bought into that. We bought into what our journals were telling us and it was patently wrong. Now you bring up a journal article from the Journal of the American Medical Association that is castigating Our approach is to dealing with brain health, calling it pseudoscience.

We began our- Pseudomedicine.

Pseudomedicine. We began our conversation today with a discussion of the publication in the same journal, I'll have you know, in November of this year, wherein it was revealed that the so-called Alzheimer's drugs that this article is a proponent of don't work but actually make people worse. which is the pseudo medicine?

Exactly. Well, I think part of the problem is that our type of medicine has not had the funding to study these interventions. Nobody's funding dietary interventions because they're expensive, they take a long time. Nobody's looking at these complex systems approaches to treating dementia, which you and I have done for decades. It's not just treating one thing. Like our friend Dale talks about medicine. maybe there's 36 different problems or 54 or 12. And if you don't deal with all of them, you're not going to get better. And our colleague and mentor, Sid Baker, says if you're standing on a tack, it takes a lot of aspirin to make it feel better. And if you're standing on two, taking one tack out doesn't make you 50% better, right? So if you have mercury poisoning and gluten sensitivity and you just deal with the gluten, the mercury still might be a problem and you don't get better. And I think that's a really important lesson. I think this article is very disturbing to me because it didn't really analyze the data behind it. And there's so much data behind the kinds of things we're doing, whether it's optimizing our diet or exercise or restoring sleep or meditation or using nutritional support, which is the B vitamins and methylation or getting rid of mercury or fixing the microbiome or balancing hormones. These are the things that we use in constellation to help optimize brain function. And what we know is that these things work. I mean, the only study that's ever been shown at a scale to reverse or slow cognitive decline is called the Finger Study, which was basically using multiple interventions, diet, exercise, stress reduction, addressing risk factors for the heart, for example, insulin resistance.

And therein lies the criticism. But therein lies the criticism because the notion of leveraging multiple inputs into a system and looking for an outcome is absolutely at odds with the current model of how science as it relates to medicine is carried out. You mentioned Dr. Bredesen has a new book coming out where he actually reviews case studies of reversing Alzheimer's disease. And I had the opportunity to write the foreword for that book. And I talked about how this is unprecedented that he is not looking at what we call monotherapy to find the golden single drug that can be monetized. you know, and yet he's looking at using multiple, but getting a great result. So why would we argue with that? But, you know, it is an inconvenient truth for people who want to believe otherwise, that we need to create single approaches with monotherapy, and that can be the home run, billion dollar product that makes the investors very happy.

Well, it's exciting. Maybe you'd be excited to hear that I'm working with some of the top scientists at Cleveland Clinic, talking about how do we study these systems approaches? How do we break the paradigm? How do we actually design a trial where we can test this theory, instead of calling it pseudo-medicine, calling it the future of medicine, which is really what it is.

So I have to say that as I get older, I'm less offended by these.

Yeah.

And I really find it to be almost complimentary. It's sort of like complimentary medicine, because to be the outlier and to be, you know, disruptive, I think is really a good thing these days, because the status quo is not where we want it to be. and we need to challenge the status quo and it's why people call us out. It's why you appear on the various videos and so do I and some people put a thumbs down and comment, well, I read the China Study and it said we should all, we shouldn't, you know. It's great, people want to believe because it's an inconvenient truth to tell somebody, you need to stop drinking diet drinks, you need to stop eating as much sugar as you're eating because it's going to compromise your health. Most people don't want to hear that message, they'd rather as I mentioned earlier, hope for the magic bullet. As it relates to Alzheimer's, it's interesting that in February of 2018, one of the world's largest pharmaceutical companies, Pfizer, gave up.

Gave up, yeah.

A lot of companies have given up. We're not gonna chase down the magic bullet for Alzheimer's anymore because it's not.

It doesn't have a good enough ROI. We're gonna turn out hundreds of studies, billions of dollars spent going down this rabbit hole that is the wrong strategy for identifying the risks, the causes, and the treatments for cognitive decline or Alzheimer's. It's pretty stunning and everybody's failing and now people are starting to pay attention to what we're doing.

I have a slide that I'll show you at a conference you and I will be attending in a couple of days. And it's really quite interesting because it shows, it measures a group of people in terms of insulin resistance, whether they have insulin resistance, which is the consequence of diet, or not, over time who collects the most beta amyloid, this sticky protein in the brain that is associated with Alzheimer's risk, who collects more beta amyloid? And it's dramatic how much more amyloid is in the brains of people who are insulin resistant. The reason I mentioned in the context of our discussion right now is because the amyloid in the brain has really been the focus of the pharmaceutical industry trying to create an Alzheimer's drug. Amyloid does or doesn't play a role.

Whatever, but sort of like sticky toffee that comes up.

Right, but developing drugs to get rid of amyloid or to keep it from forming in the first place has been the focus of billions of dollars of research. Because if you could get rid of that protein, that might cure Alzheimer's. It doesn't. But the point is that we can determine on the front end how to lower our risk for developing amyloid in the brain in the first place.

It's a reaction to something. It's driving inflammation.

That's right. It's an overreaction. It's an overreaction to infection, for example, to herpes simplex virus, to chlamydia, to various organisms that do in fact colonize the brain. The microbiome of the brain. There is a microbiome of the brain. In fact, in a book we have coming out, there's a title, I mean, a chapter dedicated to that from Dr. Tansy's group at Harvard.

Yes.

So it is really quite incredible to realize another slide, series of slides looks at the degree of brain shrinkage if you carry the Alzheimer's gene in comparison to the degree of brain shrinkage in one year, plotted against your hemoglobin A1C or your average blood sugar. And it turns out that the rate of shrinkage of your brain is greater with a higher A1C than it is carrying the Alzheimer's gene.

You can't change- It's pretty frightening.

You can't change the Alzheimer's gene.

If you got it, you've got it.

You can change the expression of the gene. You can, but you can sure as heck lower your A1C by simply making some dietary changes. Yeah, low sugar start. You bet. More carbohydrates in the form of fiber. And more good fiber. Nourishing your gut bacteria, reducing inflammation. But again, That is the inconvenient truth people don't want to embrace. The ball is very much on your side of the net. It's not up to me on the other side of the net, the doctor to fix this. It's up to you to hit that ball appropriately with some topspin so that I can't return it. Give it a good shot. And here's how to do it.

How?

Lower your consumption of simple carbohydrates. Eat more healthful fat. Eat more dietary fiber. Exercise. Make sure that your sleep is restorative. really important, very much underrated. We spend a third of our lives sleeping or trying to sleep, and we recognize that so much is going on during that activity, which we used to think is simply passive, but that we understand that this is hugely involved in reducing inflammation, in enhancing the brain's ability to take the garbage out through the activity of the lymphatic system, to triage.

Our daily lymph system of the brain. David talked about the lymph system. Exactly. work at night and it's got the night shift garbage out of your brain.

So that you're ready to go the next day. And to triage our day-to-day experiences and put them where they will be meaningful for us to rely upon in terms of leveraging new information to make decisions. So underrated.

I want to come back to something we were talking about before because I think we kind of glossed over it, which is this study on the low carbohydrate versus high carbohydrate diets and what it showed and what it didn't show. and challenging the very notion of grain brain, which is that we should be eating a low starch sugar diet. When I looked at that study, and I actually am giving a talk at this conference called the Failure of Nutrition.

Science and Tomorrow you are.

Tomorrow, yeah. At 10:15.

At 10:15, which will not be when.

This podcast is airing. No, this is evergreen. But the extraordinary thing is when you start to dig a little bit, the headlines were, low carbohydrates kill people. They're not safe. and everybody reads the headline and go, okay, it's science. It's published in a major journal. It's top Harvard scientists. It must be true. But when you actually look at the data, first if it's a population study, which doesn't prove anything, it just shows a correlation, yes or no. You know, I wake up every morning.

And the sun comes up 100% of the time.

That means that if Mark doesn't wake up, the sun's not going to come up. That's right. So, they're correlated 100%, but there's no correlation, cause and effect.

That whenever people's windshield wipers are going, it's raining. Obviously, the windshield wipers make it rain.

Absolutely, absolutely. But what was fascinating about the studies, when you look a little bit deeper, first, it wasn't really low carbohydrate. The low carbohydrate group was 38% carb, which is not low carbohydrate. And second, when they did the study, it was thousands of people, tens of thousands of people over 25 years, they gave them two questionnaires separated by six years of what did you eat last week? And people actually don't tell the truth. It's well documented. In fact, in this study, the average caloric intake was 1,500 calories. Now, the average person is about 2,220 calories. Where are the other 700 calories? Could have been all sheet cake and we don't know what they were eating. So, the study may be suggestive of certain things, but it's really not proving anything. And people get all caught up in the headlines and don't really look critically at the studies. And that's part of the problem.

I had a similar experience recently when a study came out and the headlines were a gluten-free diet increases risk of heart attack. All you gluten-free people, you're all gonna die of a heart attack. And again, Harvard researchers and I had to respond to this and the answer is read the study. And what the study showed was that people who adopt a gluten-free diet by and large, have much less dietary fiber. They don't know what's gluten and what isn't gluten, so they're eating less dietary fiber.

Or they're eating gluten-free cake and cookies.

Exactly, and what the authors commented on in their conclusion was that they fully recognized that there was less fiber consumption in the gluten-free group. It had nothing to do with, but the way they spun the article was that gluten was a toxin. Yeah. It was, I mean, going gluten-free was somehow toxic.

Toxic, right.

And you wonder, how could avoiding something make it a toxin in the first place?

It's very confusing.

But the headlines gets fun, case in point, what you have here, the pseudo medicine, my goodness.

Yeah, so it's pretty exciting where we're at in terms of the brain. And I think that you've clearly been out ahead of this for decades. In terms of the newer ideas around fasting and intermittent fasting and fasting-mimicking diets, there's a lot of noise about this. And ketogenic diets are part of that spectrum, which is like a fasting state. When we don't eat, we get ketogenic. And when we eat a high-fat, low-starch diet, we get ketogenic. So, what is the utility of these? What do you think about these things? Is this really where we should be going? and what are the differences?

First, I'll say that the beauty of this coming into the forefront, which it really is right now, at least we think so because we're seeing it day in and day out, is that these are approaches that emulate our ancestors, meaning that our ancestors had times of caloric scarcity and that would do things to their physiology that would allow them to survive. That's a very important fundamental premise because it plays into the gene activation part of that story plays into why researchers like Dr. Walter Longo, I know you're going to interview him, why they're getting really incredible results across a huge spectrum of our modern day maladies, be it cancer, heart disease, and even dementia.

They're treating the root causes of all of them.

Yes, and you're harvesting pathways that lead to good gene expression. you're tinkering with the expression of the life code in a positive way and offloading some of the negative expression of DNA that would have otherwise happened based upon how people were otherwise eating. So there are, first of all, there's a term intermittent fasting, which I think is clearly a bit nebulous. Does that mean fasting for a couple days every month or does it mean just deciding not to have breakfast till noon.

Time-restricted eating.

Yeah, it's, well, it's actually, that's a little bit different. We'll get to that in just a moment. But, you know, when we have our last meal in the evening, there's a period of time that we don't eat generally, unless we're getting up in the middle of the night and hit the refrigerator. But that time, people do. And Klein-Levin syndrome is one. Don't ask me. But people, go to sleep, they wake up in the morning, and then that first meal is called the break fast. You break your fast. And if you can protract the time till you do that, then your body will indeed produce more and more of these chemicals we talked about earlier that are good for us called ketones. So protracting that, I find until maybe noon, one or two o'clock, I think is a good thing.

I knew you were coming today, so I didn't eat breakfast.

Well, I did, because I don't think it may well be the, I thought it was gonna be the only meal I was gonna have today, but turns out that that's not the case. But typically, if you want to know what I do at home, is I don't eat until about 1 o'clock or sometimes 2 o'clock or sometimes not at all or sometimes just the evening meal. And people wonder, well, how do you function? I function really well as a matter of fact. I mean, I may add to that a little bit of MCT oil just to get my ketones a little bit higher. So the fasting mimicking diet that you will obviously learn more about when you interview the person credited with inventing that, Dr. Walter Longo, is a technique to gain the activation of the genes, the positive aspects of this approach, while at the same time making it more tolerable and available to the masses.

So, it's like eating 800 to 1,100 calories a day, which puts your body into a semi-starvation state that activates all these anti-aging reparative mechanisms.

And let me just say that the other thing that fasting does that I think is underrated but nonetheless really important is that it enhances a sense of gratitude, which I think is hugely important. When you realize suddenly that you've taken food for granted in our society, we all do that because it's plentiful. But when you're not eating and for a day or two and you suddenly realize that Wow, we live in a time when I can eat when I want to. It raises your sense of gratitude and that through what we talked about earlier, the rewiring of the brain, the more gratitude that you experience in your life, the more it wires your brain into the gratitude center.

Yeah, powerful. So part of the theory of the Fast Mimicking Diet, if I want to get into that for a little bit, because it is confusing even for me, someone who's been studying this forever, different opinions. He's no saturated fat. He's very low protein, no animal protein. And the theory is that saturated fat is inflammatory and promotes aging. And he's found this in mouse model.

In mouse model, yes.

Which may be certain kind of mice and does it apply to humans and what do we mean? And then he also talks about the role of protein activating a particular pathway. It's called mTOR. which is a protein that actually causes activation of this pathway that seems to lead to accelerated aging. So he's saying no animal protein and that we should eat a low protein diet and that the fasting mimicking diet is extremely low protein. How do you reconcile that with the rest of sort of the science of what we know around protein and aging? In fact, he even suggests that as we get older we need more protein.

I'd say first of all that we have to always keep an open mind that my position on animal protein has changed over the years and will likely continue to change. I eat less and less of it. I eat more of a plant-based diet for many reasons, not just with respect to my health. But beyond that, there are two sides to the mTOR story, as you well know. Rhonda Patrick, I think, has done a terrific job in talking about the upsides of mTOR in terms of building muscle mass.

Yeah. So, it activates when you exercise.

Exactly.

What we know is a great thing.

So, I would say that we have to keep an open mind and these are still some unanswered questions that we are going to leave on the table. We're not going to be dogmatic and say it's this way and a story, but rather we will need to study it further. The broad strokes are more dietary fiber, less simple carbohydrates, and changing the quality of the fat that we eat. I think those are nothing's indelible. But I think, you know, those are important bullet points that if we could just get that message across, that's really very, very fundamental. The other lifestyle issues that we talked about earlier, I think are important as well. But, you know, we have to really respect a researcher like Dr. Longo. And then a caution would be to recognize that we cannot always extrapolate. from the mouse model to humans directly. Though we do it a lot, I do it a lot, but for example, the glymphatic system was demonstrated, we talked about it earlier, the clearing of the brain during sleep, if they were able to get the rodents to sleep on their left side, does that mean people should sleep on their left side? I don't think so.

I sleep on my left side. I sleep on my right side usually.

But maybe there's some knowledge there. But again, so we will follow the of a terrific researcher like Dr. Longo and watch what he comes up with. I mean, with a person as dedicated as he is, he deserves a lot of attention.

Yeah, it's extraordinary to look at the work because the question is always compared to what, right? Things can be looked at in isolation and seem to be good or bad, but when you actually look at comparing things to other things, what do you find? I mean, you can find, for example, that a plant-based diet is much better in creating better outcomes than a diet that's a typical American diet. Even a low-fat vegan diet is far better than a typical processed American diet, right? That is not a surprise. But what about comparing a vegan diet that's low fat to a, for example, a paleo diet that's very high in starch from carbohydrates that are good, like the the vegetables, right, and higher in fat and a little more animal protein and see what happens comparing the biology of these things, how do they affect the aging process. It's very fascinating. One of the things that I found challenging with Dr. Longo and I'm going to chat with him about this is that he says, yes, even a low carbohydrate diet will lose weight, you'll change all the biomarkers of diabetes and insulin resistance, but that doesn't matter because it promotes aging.

It activates all the aging mechanisms. and I- Great conversation to have. A thought that comes to mind that maybe you'll bring this up with him, and that is, in a sense, his fasting mimicking diet program resembles Dr. Bredesen's approach in that he's incorporating this program into cancer therapy where people are receiving chemotherapy, for example, much as Dr. Seyfried and wrote the Metabolic Basis of Cancer, talked about using a ketogenic diet in correlation, I mean, along with chemo. In conjunction with chemotherapy, radiation therapy, and even surgery, but doing your best to avoid steroids if possible. So not that the fasting-mimicking diet is the end all, nor is ketogenic diet, as Dr. Seyfried describes the end all, but could be looked upon as adjuncts to amplify the effectiveness in a more comprehensive way of more standardized approaches.

Hey YouTube, if you like this video, you're gonna love the next one. Click on it to check it out today.

There's very strong compelling evidence at this point that bacteria are the cause of neurodegenerative diseases.

Not my- yeah, we talked about Rudy Tanzi, who's a Harvard scientist, one of the discoverers of some of the presenilin genes, which are the genes that show that.