EAT THESE FOODS To Prevent Alzheimer's & Boost BRAIN HEALTH! | Max Lugavere

All of the medications that are prescribed at this point to treat dementia have no effect on the progression of the disease. They basically just act like a chemical Band-Aid of sorts. So my background is as a TV presenter, producer and journalist. I got my start in TV working for a network, and my role in the network was really to find a way to tell stories that nobody else was telling in a way that was sort of accessible and approachable to young people. The network was sort of like MTV meets CNN. And so my duties ranged from covering breaking news to more heavy-headed heavy hitting journalism stories to lighter topics that were peppered in. And ultimately I was able to have free reign to cover stories that were important to me. Oftentimes my passions would steer me in the direction of health and how technology is augmenting health, nutrition, things like that. And I really got to sort of cut my teeth journalistically with some of the top storytellers that were working in Hollywood when I had this gig. and it also allowed me a really powerful calling card because I was on TV, I had a verified checkmark on Twitter. It allowed me really to access people that very few people get to do. And so when I left that job, you know, with this sort of background in journalism, I was exploring where I wanted to go with my career and I really wanted to go in a direction that was more sort of honed and narrowed to the topics that I was really passionate about, which are, you know, which have always been health and nutrition and things like that. Around that time, in my personal life, my mom started showing early signs of memory loss. And I didn't have any prior family history of any kind of neurodegenerative disease. Dementia wasn't even in my vocabulary at that point. I didn't know what Parkinson's disease was. I really didn't know what Alzheimer's disease was other than this thing that old people get sometimes. And so I became On the one hand, it was a traumatic experience. I went with my mom to some of the top neurology departments in the country, Johns Hopkins University, the Cleveland Clinic, and what I experienced there was what I've come to call diagnose and adios. Basically, you get these sort of chemical band-aids prescribed that when you do even a cursory dive into the research, you realize that the medications seldom work well and they have no disease modifying ability. What that means in English is that all of the medications that are prescribed at this point to treat dementia have no effect on the progression of the disease. They don't slow it, they don't cure it, they basically just act like a chemical band-aid of sorts and not a very good one at that. That sort of compounded the trauma that I was experiencing coming to terms with the fact that my mom had some kind of neurodegenerative disease bubbling underneath the surface. And at that point, I was in between jobs and I had the time to really sort of do a deep dive into the medical literature. And I became obsessed with learning everything I possibly could about dementia and specifically Alzheimer's disease. My mom wasn't diagnosed with Alzheimer's disease at the time, but I intuitively realized that Alzheimer's disease being the most common form of dementia, might impart some insights that I might be able to use to, on the one hand, help treat my mom with food and with, you know, lifestyle, exercise, you know, seeing maybe if she could, you know, if improving her sleep might help, you know, reducing stress, things like that, meditating. But then also simultaneously, I became really obsessed, even more so probably with the notion of prevention and with trying to understand what I might do to prevent myself from ever developing dementia because, you know, I'm a creative person. My intellect is my capital, you know? So, what I realized is that this is a very new area of research. Back when I first discovered this insight, you know, that changes begin in the brain decades before the first symptom. In my research, I found that nobody was talking about it despite the fact that the medical literature was filled with links and associations that were made between various risk factors and risk for neurodegenerative disease. So I began putting all the pieces together and looking at research both at the population level and sort of more mechanistic research, animal studies, randomized control trials. I put it all together, you know, because research, you can't look at any one study in isolation. Research has to be viewed in the context of the larger body of work that exists. And I realized that if I really try to check all of the boxes, that I have a really strong chance in preventing this from ever happening to me. And so that was like a light bulb went off in my head. I just became obsessed with that topic. It helped me sort of diffuse the trauma that I experienced with my mom. and turn it into something really sort of positive and proactive. I felt like I was really doing something to fight the disease really at its core, you know? And then at a certain point, I realized that, I basically realized that I have something that very few people have, and that is, access, media credentials. And I really wanted to use my skill set that I honed in Hollywood over six years as a storyteller to help spread this message of prevention. And the way that I conceived of doing that at the time was to create a documentary. I'd never done a long-form documentary project, but it was an area that really interested me. And I also realized that by doing a documentary, it would give me this sort of excuse to reach out to scientists all around the world. the top, top, top researchers in the field.

And.

They, you know, scientists really tend to be very isolated. They tend to work behind closed doors and to be kind of camera shy. And what I found when talking about this topic was that nobody was shy. Everybody wanted to be involved. I basically got yeses from everybody. And so I then did a Kickstarter campaign to raise, you know, initial funding for this project and subsequently went around the world interviewing researchers and scientists and having conversations with them, becoming friends with them, and then doing my own research and, you know, sort of experimenting with my own biology, getting my genes tested, you know, changing my diet, going to get labs, tinkering with my diet, going to get new labs. And it really just became this passion of mine that I've been able to sort of transition into a career, you know? So I've got this documentary coming out called Breadhead, and, Breathhead is really, it's the first ever documentary about preventing dementia and it's aimed uniquely at a young adult audience, millennials, because again, changes begin in the brain decades before the first symptom. And then in tandem with that, which I'm really excited about, I am writing a book that's coming out very shortly called Genius Foods. And if you consider Breathhead the sort of prequel and my sort of origin story, you know, how a guy who's not an MD or technically a scientist was able to gather all this expertise in this topic, Genius Foods is really everything that I've learned. So it's all of the hyper actionable, hyper accessible, approachable things that people can do to really optimize their cognitive function and make their brains work better, think more clearly, think faster. I really think it's a game changer. So I'm super excited for that. I mean, I think the response that I got from scientists is really, you know, I think there are a few reasons. For one, I think, you know, Scientists are not trained to interact with the public. We need some, we love scientists, right? But they're very much focused on these really niche areas of research. And oftentimes, it causes them to intentionally or not, lose sight of the forest for the trees. And as somebody who had no prior training in medicine or or science, it allowed me this ability to sort of get a 30,000-foot view on the science and connect dots that, you know, I think it's very rare for clinicians and scientists alike to connect. So when I came at them with this idea, and especially the idea that this is a topic that I was going to make relevant to young people, they thought that it was a project that really needed to see the light of day. that they thought was really important. The other thing is that it takes on average 17 years for what's discovered in science to be put into day-to-day clinical practice. So there's a huge lag between what we discover in research and what your average primary care physician knows about and puts into practice in the clinical setting. So I really wanted to be a catalyst because I felt like, you know, that's not, you know, 17 years is not time that we have to lose where our brain health is concerned. And, you know, I think that my passion, my personal story, my dedication to responsibly communicating science, which is evident in all of the content that I create, I think really, you know, made me a trustworthy character for these researchers to really feel comfortable that they could open up and communicate their science and that their research wasn't gonna sort of get mangled. To that end, I think we see a major problem in, I sort of have one foot in science and one foot in media, and so I can speak for media, and I can tell you that media more often than not mangles science. And that was evident with the recent USA Today headline that went viral, which was sort of an interpretation of this American Heart Association statement that we should all avoid saturated fat. Media does a terrible job of covering science. There's no question about that. They want clicks more than they want anything. and that was very evident in the USA Today headline that said that coconut oil isn't and has never been healthy. And, you know, that's not my passion is not to drive clicks to my website. It's to really sort of get this, the truth out there. And so I think that researchers kind of saw that and, you know, they, I think they're aware that media does generally a very poor job of communicating science and poor at best irresponsible at worst. And my passion really is about communicating these ideas responsibly more than anything else. So a lot of people consider millennials the caregivers on deck, and that is why millennials should be interested in this topic. But I see millennials as patients on deck because I know, based on my research, that Changes begin in the brain decades before the first symptom of memory loss, 20 to 30 years by some estimates and even longer by others. So, to me, this is what will ultimately manifest as the clinical presentation of Alzheimer's disease and dementia really is a sort of lifelong cascade of events that builds up in the brain. And to me, it's something that young people really should be conscious of their whole lives, the same way that we want to do certain things so that we look better come summertime and we're at the beach in our bathing suits. I think that our brains really are who we are. Our brains make our minds the same way that our joints produce movement. And so to me, there's no question that if there are steps that we can take to make our brains work better, to make us think better, to make us be less depressed and less anxious, I mean, the world is already an anxiety producing place. We don't need to be made more anxious by our diets. so to me, you know, this is just something that is relevant to every single person if, you know, that person has a brain. And, and so, yeah, so I, you know, I have no, I have no doubt that roping in young people is going to be something that my projects do. And, you know, I've already been able to see that, you know, a lot of my followers are young people, which is surprising because I do talk quite a bit about dementia and aging. So, my interests were really in, I was never an athlete, but I became really interested in weight training and physical performance because I really enjoyed going to the gym. I saw profound mental benefits from exercise from a very young age. And to me, it was just a bonus that it also made me look more athletic, even though I was always terrible at sports. but since I started going on this journey to really figure out the optimal diet for brain health, I've really lowered my consumption of carbohydrates, both in the form of overt sugar, but also in the form of grains. You know, I used to believe that the more grains we ate, the healthier we would be. I would avoid white rice like the plague, but if you put a huge bowl of brown rice in front of me, I would eat, you know, every grain of rice in that bowl, because I thought, more brown rice, more health. The same thing for bread. I would eat lots of whole wheat bread. I would eat copious amounts of bread if it were whole grain, but if it were white, I wouldn't touch it. In reality, the impact that these foods have on your blood sugar is very similar. And when I really started doing the research into how sugar affects the brain, my consumption of these kinds of foods really dwindled to the point where I rarely eat grains, if at all. I don't avoid them completely, but my consumption of them has dramatically lessened. And what's interesting is that by adopting a brain healthy diet, not only do I feel like my brain and my memory and my energy levels are better than they've ever been, but so is my body composition. So as a side bonus, I'm actually leaner and stronger than I've ever been. and that's not my focus. My focus is brain health. So there are really interesting associations made between blood sugar and brain health. Depending on the marker of brain health that we use, there have been associations made between even slight elevations of blood sugar, both fasting blood sugar and a marker called the A1C, the hemoglobin A1C, which is basically a three-month average of your blood sugar. and brain shrinkage. The higher your blood sugar, the smaller your brain. And what hasn't really been known.

Up.

Until, I think, recently is the direction of causality. Do we have smaller brains and that causes us to reach out for more sugary foods? Do more sugary foods actually shrink our brains? But there's a lot of research, a lot of science really, tying various dietary patterns that are higher in fat to better brain health. The Mediterranean diet, for one, is a dietary pattern that's inherently higher in fat. It's rich in extra virgin olive oil and fatty cuts of meat, fatty fish, things like that. And they tend to have significantly reduced risk for developing Alzheimer's disease and dementia and also cardiovascular disease. There have been randomized control trials, which is hard data showing that when you consume more fat in the form of nuts or extra virgin olive oil, it actually leads to improved brain health outcomes in terms of cognitive function. Cognitive function is improved and things like that. And also going back to my, originally what I was talking about, trying to figure out this direction of causality and Does having higher blood sugar make our brains work less efficiently? There have been very large trials which have shown that by improving metabolic health, we can actually significantly delay cognitive decline. So, when we talk about improving metabolic health, this is a really complex topic, but the best way that you can improve your metabolic health is without question avoiding sugar and avoiding processed carbohydrates. You know, it's not just sugar and carbs. We need to sleep better. All of us need to get better sleep. You know, even a healthy person, if you have one night of poor sleep, the very next day you're essentially pre-diabetic. Your insulin sensitivity is handicapped. And, you know, that's not something that persists, but, you know, sleep is incredibly important for fixing our, making sure that our hormones are working properly. And insulin, one of our body's chief metabolic hormones, which is sort of like the gatekeeper to allow cells to process sugar, is highly affected by sleep and stress, another one of those things that's really important for metabolic health. And exercise. A study was just published showing that young people today are as sedentary as 60-year-olds. So, you know, leisure time physical activity is at an all time low. And, you know, exercise is an incredible way of bolstering metabolic health, especially building muscle, which is something that I really focus on in my workouts. You know, one of the big buzzwords in the wellness community are superfoods. And superfoods is not a very scientific term, you know, but it's basically a term given to foods that are pretty healthy. And what I've done with my work is I've isolated foods that I call genius foods. And these are the foods that really have a a strong body of evidence to suggest that they're very good for cognitive function and brain health. And just to name a few of them, I consider eggs to be a genius food. For decades, eggs were demonized. The yolks are rich in cholesterol, and for that reason we were told to avoid them because we were told that by eating cholesterol, the cholesterol in our blood would go up, which is actually completely inaccurate for the vast majority of people. And so, yeah, so I am a huge fan of eggs and I consider egg yolks to contain everything required for the development of a healthy brain. And this makes sense when you consider that one of the first structures to develop in an embryo is the nervous system, which includes the brain. So an egg yolk is literally designed by nature to have everything needed to grow a healthy brain. So eggs are definitely a genius food. I also consider dark chocolate a genius food. Chocolate that has above 85% cacao content is rich in a kind of plant compound called polyphenol. And specifically in chocolate, these polyphenols are, the form of them are called flavonols, and they are really beneficial to the brain. They've been shown to improve the functioning of the hippocampus, which is the brain's memory center. It's a very vulnerable structure in the brain. It helps our brains process memories and it's one of the first structures to be damaged in Alzheimer's disease. So chocolate actually makes your hippocampus work better. Again, it's got to be dark chocolate because the darker the chocolate, the less sugar. And even better, you know, I like to snack on cacao nibs, which are basically pure cacao. So eggs chocolate and I mentioned extra virgin olive oil. Extra virgin olive oil is profoundly good for the brain. Again, it's rich in polyphenols that reduce inflammation. Extra virgin olive oil can reduce inflammation on par with low dose ibuprofen without any of the negative side effects. There is lots of research now connecting ibuprofen, which is a very common pain relieving drug, it's an anti-inflammatory drug, but it's not without its side effects. There's a lot of research now connecting ibuprofen use to cardiovascular events. Extra virgin olive oil actually makes your heart health better and it makes your brain function better.

So.

Definitely very healthy. And I think it's no secret at this point that fatty fish is very beneficial to the brain. Fatty fish like salmon, wild salmon and sardines are rich in the building blocks that the brain uses to create new brain cells. I try to eat fatty, you know, a good portion of fatty fish two to three times per week at least. So the question is, does the diet need to be high in fat to be good for the brain or does the diet need to be low in carbs? My perspective is that the diet really needs to be generally low in carbohydrates and so by necessity you're going to end up eating more fat because when you reduce carbs you're going to end up eating more fat. But I think the real benefit in that sort of diet is the reduction in circulating insulin. So it's not eating more fat, it's not that we need to eat more fat to produce more ketones, it's really that fat doesn't raise levels of insulin and insulin interferes with a lot of the body's housekeeping processes. That being said, when we do replace carbs with fat, there are some fats that are healthier than others. So as I mentioned, we really want to consume more extra virgin olive oil. You know, a lot of people now talk about coconut oil, and coconut oil is definitely good for you in moderation, but the evidence surrounding fats and oils really is in favor of extra virgin olive oil as the oil that we should be using the majority of the time in our kitchens. I think coconut oil is great to cook with. It's a saturated fat, so it's very heat stable at higher temperatures, and it also has a kind of fat in it called medium chain triglyceride. So the medium chain triglycerides in coconut oil, I think there's a lot of really exciting research surrounding them and how they might potentially benefit the brain by supplying a sort of alternate fuel source to ailing brain cells. So in that capacity, I think, you know, coconut oil and specifically MCT oil could be very beneficial to the broken brain. But again, in terms of the weight of the evidence and the oil that I use mostly in my kitchen, it's really extra virgin olive oil. So I definitely think that if you want to prevent dementia, you should cut out the added sugar and the sources of refined carbohydrates in your diet. That's step one. That's like the bottom of the broken brain food pyramid is cut out added sugar, no sugar sweetened beverages, and that includes fruit juice and definitely eliminate processed carbs from your diet. You basically want to avoid the aisles in the supermarket and avoid food-like products and stick to whole foods. Vegetables, dark leafy greens, meat, fish, eggs, nuts, really those are the foods that you want to concentrate on. When it comes to grains, I think the vast majority of people consume too many of them. so I would say definitely cut down or eliminate grains from your diet and see how you feel. Some people do better with more carbs than others. If you're insulin sensitive, which is like the minority of the population, sadly, in the United States, then you can sort of reintegrate carbohydrates into your diet, I think, post-workout, maybe once or twice a week, because, you know, I think carbs are Carbs are not evil, you know, they're just over consumed. We misuse them today. I think in the post-workout window, carbs from a, you know, sweet potato could be actually beneficial because they help your muscles store sugar, which can be used for the next workout. Unfortunately, 75% of the population in the United States is either diabetic or pre-diabetic, and therefore for that population, that's an essentially carbohydrate intolerant population. So for them, I think recommending grains is irresponsible. I think they should actually cut out grains, which are generally very energy dense and nutrient poor.

So.

When you go one step up on that, on the broken brain food pyramid, I think, you know, definitely eliminate grains if you're having metabolic problems, as most people are today, and eat more healthy fats, you know, add fat back to the diet, you know, don't be afraid of grass-fed butter. don't be afraid of coconut oil, especially when we're talking about cooking with it. You know, it's a very safe fat to cook with, unlike the, you know, the industrial seed and grain oils that we've traded saturated fats in for, which are very unsafe. They're very prone to oxidation. Drop the soybean oil, drop the vegetable oil, drop the canola oil, drop the corn oil, bring back, you know, grass-fed butter, coconut oil, extra virgin olive oil, consume copious extra virgin olive oil, lots of it. We want lots of it because that's what the research shows really benefits our brain health. You can consume a liter of it a week and it seems to really improve cognitive function. But attaining an optimal brain is not just about diet either. It's about making sure that you're sleeping well. And I'm not just talking about getting more sleep, I'm talking about higher quality sleep. We really want to cut down our use of smartphones and technology at night because the blue light from those devices, whether we perceive blue light or not, tells our brains that it's daytime. Our brains are operating on operating system 1.0. And when we're looking at bright light, whether it's from our TV screens or our smartphones or our laptops, that sends a signal to our brains that it's daytime. And our brains don't want to wind down when it's daytime. Our brains want to forage for food and procure a safer environment for our tribe. So, you know, making sure that we're sleeping better, I think, is really important because many of the brain's sort of custodial efforts occur while we're sleeping. You know, exercise is one of those things. The body of evidence right now is like so strong that, you know, your average neurologist really should write exercise on a prescription pad before he writes anything else. exercise is the chief way that we can actually, it's, unlike any drug that's on the market, exercise actually has a disease modifying ability. It can slow the progression of many of these neurodegenerative diseases that we're talking about. I like to incorporate movement into nearly everything I'm doing. So in general, I like to keep my workouts either low and slow or hard and fast. None of this middle ground stuff which doesn't really accomplish anything very well in my opinion. I like to just move more and do aerobic exercise throughout the day, whether it's taking the stairs instead of using the elevator or biking to work or just walking around more. Just walking was shown recently in a trial, a randomized control trial, to improve cognitive function and vascular risk factors in people with vascular dementia. So walking is truly medicine and it's very simple, it's something that we can all do. At the other end of the spectrum, I'm obsessed with high intensity interval training. So, you know, exercise that really pushes your body to the limits. And that limit is going to be different for me than it is for you. Everybody has a different threshold of what constitutes high intensity. But whatever that means for you, you really want to make sure that you're pushing your body to that threshold because when you work out at that level of intensity where you can really only sustain 20, 30, maybe 40 seconds of exercise, you're literally sending a text message to your genome to adapt, to cause yourselves to adapt and grow stronger. And that's not something that we get with a lower intensity exercise. And that adaptation, that stress response occurs both in our muscles and in our brains. So, I mean, high intensity exercise is profoundly important. So, neuroplasticity is the ability of the brain to change throughout life. It was once believed that, you know, the human adult brain reached its peak level of performance at around age 25 only to begin sort of a slow decline until death. And, you know, if you were a person that developed dementia or had a learning disability, there is not a whole lot that you can do to improve the way your brain worked. As of the early 90s, if I recall correctly, we now know that the human brain is able to grow new brain cells in the memory center of the brain throughout life. This is something that was previously considered impossible. We're able to make new connections, we're able to rewire the brain under certain circumstances. And, you know, this is something that I think is profoundly empowering, that our brains are actually plastic. Neuroplasticity really, what that implies is that the brain, rather than being like this sort of static thing carved out of stone that we really inherited and couldn't do much to change, is actually more like plastic. It's malleable. And the way that we can sort of change the way it functions and manipulate it is through our diets and through our lifestyles. And eating a brain healthy diet really promotes the neuroplasticity of your brain. Neuroplasticity tends to decline with age, but it's not necessarily inevitable. We can really have a positive impact on our brain health and our neuroplasticity at any age. And the research really shows this, thankfully, now. So again, it's a profoundly important idea and and I think, you know, at the end of the day, in real human terms, what that means is that we're no longer helpless. You know, we no longer have to settle for the brain that we think we have. We can transform our brains at any age into our biological best, whatever that means for you, whatever that means for me. It's different for everybody, but at least at this point, we don't have to sit on our hands. If you're like me and you have a parent that has dementia, You know, I think what I've learned is that you really have to be vigilant in your own self-education, learn what you can about the ways in which diet and lifestyle can modulate brain health, and do your best to lead your parent to a healthier lifestyle. A lifestyle that includes more exercise, better sleep, less stress, you know, maybe sign them up for a meditation course. Go through their kitchen with them. Tell them, explain to them why certain foods are bad for their brains and why others are really good for their brains. And then at the end of the day, and this might seem counterintuitive, I think at a certain point you have to detach because stressing yourself out over what your parent is doing can compromise your own brain health. because again, stress is the enemy of the hippocampus, which is the vulnerable memory processing center of the brain. To use a line that everybody knows, you can lead a horse to water, but you can't make it drink. Ultimately, everybody is going to live the life that they want to live, whether or not they have dementia. So, I think it's really important to do your best to get your parent on a track that promotes brain health, no matter what age, but then Also realize that if for whatever reason they don't listen to you or they don't take as much of a proactive approach as you, that you have to kind of separate yourself because what I found is that that can be really stressful to the caregiver. And again, stress is very damaging and I'm all about that prevention. So, I think we have to do as much as we can to inform our loved ones. But then there's a certain level at which, you know, there's a certain point at which we have to detach. Know that we've done our best. We've given the information. We've been teachers to those that matter in our lives. But at the end of the day, you know, people live the way they want to live.

Yeah.

So Breadhead is my documentary. It is basically the world's first ever millennial focused film about preventing dementia. And, you know, my goal in the film is not to pick out bread as the sole smoking gun when it comes to Alzheimer's disease because that would be inaccurate. That's not my goal. My goal, though, is to expose the relationship between hyper-processed foods and our risk for developing dementia and Alzheimer's disease. And what I think might surprise some people is that I consider bread a processed food. It's humanity's oldest processed food, but it's a processed food nonetheless. You know, when you walk down the street, you don't see people eating stalks of wheat. They're eating sandwiches. You know, wheat has to be processed into the form of bread, and bread, your average slice of whole wheat bread elevates your blood sugar quicker than table sugar. So, you know, it's very energy dense in a time when we are less active than ever. It is rich in carbohydrates, which we know that we need to be eating less of. It contains gluten, which presents a problem for many people because it just happens to be everywhere. And eating more bread is just adding insult to injury. So I consider bread to be a processed food. And the film really looks at the role of sugar and the advice that we've gotten through the years to consume seven to 11 servings of grains per day and how that affects the health of our brains. So I'm super, super excited to debut that. It also goes deep into the notion of Alzheimer's disease as type 3 diabetes, as many researchers are now referring to it. And this is no longer a sort of niche idea. The medical literature is just packed with references to metabolic dysfunction in the brain as playing a role in the worsening and maybe even the development of Alzheimer's disease. So, this is a very compelling idea to me and it's an idea that the type 3 diabetes hypothesis I think is really compelling and when you look at the research now that's coming out by the day showing the link between our diets and our lifestyles and our brain health, it seems to be a really strong hypothesis. Indeed, in trials where patients are put on plans that help improve their metabolic health, cognitive function also seems to improve. Whereas Alzheimer's drug research, when drugs have reduced amyloid plaque in the brain, have turned up nothing but failures. It really strengthens this notion that Amyloid is sort of like a bystander in a more fundamental problem in the brain. And the latest research really seems to show that the problem that begins more than any other problem in the Alzheimer's brain is metabolic despair. And if that's true, I think eating a diet that preserves the metabolism of the body and thus the brain is really the way to go.

Let's just get right into it. We're in a kind of a pickle. Our brains are getting better, not worse. There's 46 million Americans that have Alzheimer's that is actually starting up in their brains and that don't have symptoms. Most people don't even know that you can actually detect the changes in the brain with Alzheimer's 20 to 30 years before you forget your keys, right? So we're going to get into your research, which is really extraordinary that shows that, and I'm going to sort of give the punchline away, that that a disease that we previously thought untreatable is now potentially treatable, but not in the traditional ways we have thought, which is medication or typical medical treatments that manage the typical things that we do. It's really a radical approach using a systems model, what we call functional medicine, which is essentially looking at multimodal interventions, dealing with multiple causal factors applied at the same time in a personalized way, to radically change your biology, which changes your brain. So your body affects your brain and you're treating all the factors that affect the brain. And as we learned in medical school, the brain obviously has nothing to do with the rest of the body, right? Richard, it's just disconnected. There's this brain blood-brain barrier and nothing passes between it except maybe some sugar. We've learned that's just nonsense. So take us down. What are, just to get right here, what are the top things that determine a brain healthy lifestyle and a brain healthy diet that people can do to prevent preclinical or pre-symptomatic Alzheimer's. In other words, what is this whole field of preventive neurology that you're talking about?

Yeah, and you use the term radical, right? And it's not radical, it's just like straightforward. And, you know, there's all these terms that are flying around. You know, like when we publish, we talk about precision medicine and we use the terms individualized care. And there's all these terms and you can call it what you will in semantics, but it's just regular, what should be regular medical care. It's just, it just, it doesn't, it doesn't turn out that way because our medical system is, you know, sideways and you can't spend time talking to patients. You know, I'm actually like you. I'm a clinician. I talk to patients. I, I wasn't really a researcher. I kind of got, went into the research through the side door, this academic Academia kind of thing kind of just, sprouted upon me. But, you know, what can people do? I think people can grab the bull by the horns and say, I can make a difference in my brain health by making incremental changes today. And you don't have to start tomorrow. You don't have to start next week. You can start today. And there are little incremental changes people can make to really promote their brain health over time. And I just want to just reiterate something you said. Alzheimer's disease starts in the brain over 20 to 30 years before the first symptom of memory loss begins. This leaves an ample amount of time, this critical window of opportunity for people to just, you know, get educated and get informed. So if someone had to do something today, I would first say take a deep breath. There's a lot to look.

Okay, deep breath.

There we go. Deep. Right before we were starting the podcast, we each took, we had some difficulties. Happens to the best of us. We took some deep breaths. Everything was cool. We're Zen. But take a deep breath, because Alzheimer's is among America's most feared diseases. It is a terrible condition. It's sad, I have four family members with Alzheimer's. It's a sad, terrible, horrible, I hate the disease. It's a strong word, but I hate Alzheimer's. I hate what it's done to my family members, my patients, and their family members, their caregivers. But I think it's important to take a deep breath and understand that there are so many things that we can do to put the ball back in our court, to write this script and tell our own story, Can you definitively 100% prevent Alzheimer's in every case? Well, no. There are certain pretty rare genetic causes where basically just about anything you're going to do, you're going to get Alzheimer's and it's going to probably start early and that's unfortunate. But that is an exceptionally rare number of cases. Most cases of Alzheimer's, you can do something about it. Based on the 2020 Lancet Commission, an amazing study. Based on 12 modifiable risk factors, we can, the person makes brain healthy choices, prevent four out of every 10 cases of Alzheimer's disease.

Wow.

Like, we didn't learn that in med school. Medical students now aren't learning that in medical school. It takes 10, 15, 20 years for something to be learned in medical science, to be translated into clinical practice. And, I think it's important for this podcast and people like us to share this news because there are so many things a person can do. So, you asked me, what can a person do? I want them to know there's so many things. At least 12.

At least 12.

So, you know, in our study, I.

Think there's more, but there's at least 12.

At least 12. You know, in our study, we recommended on average 21 different things that a person can do, and those were individualized per person. In our whole universe of our study, we recommended almost 50 things that a person can do.

50 things that influences the brain that you've identified.

Yep. And it's, you know, this isn't radical. This isn't rocket science. This isn't like, I'm a simple man. I did not graduate first in my med school class. I did pretty good and I worked pretty hard, but I try to just see things from the patient's perspective. There are so many things that are evidence-based and safe. The two categories I would start with just to kind of set the stage are pharmacologic and non-pharmacologic. I want to get granular because the word pharmacologic doesn't just mean drugs and prescription drugs. It also means food is medicine. Well, food is definitely medicine. definitely medicine. Although that got, that got sidetracked to.

Non-Pharmacological but I can sugarman's are medicine.

Oh, yeah.

Well, we challenge you, Richard, because I, I think that food is actually real medicine. The phytochemicals, right. Compounds in food are biological response modifiles. They're single transduction Trend changers, and they have a similar effects as drugs. In fact, many drugs come from the phytochemicals. in plants. So I would just kind of make us think about that a little bit.

Well, actually, so I'm glad you brought that up. I would say that traditionally speaking, and let's talk through this. This is a great opportunity. So traditionally speaking, I've always framed it and I'm open-minded. So this is great.

I'm just teasing.

This is exactly why we're doing this. This is exactly a meeting of the minds. Gloves are off. Let's go. So drugs, vitamins, supplements, and medical foods are the classic things that I personally have categorized in the pharmacologic session. And then in the non-farm section, I've included diet, exercise, sleep, stress, a whole bunch of things, learning new things. But what you bring up is, is important. And, you know, I have a colleague named Dr. Robert Krikorian, and he's an amazing guy. He's a neuropsychologist, and he's fought the good fight, you know, kind of like us. He's, I don't want to say he's had, yeah, in some ways, that contrarian views, because he's tried to do randomized studies using nutrition. He's done studies on the ketogenic diet and Alzheimer's and Parkinson's and he's done, you know, studies on blueberries and Omega-3s and what he's done is he's taken the food and he said, okay, it's not just about the blueberries. We did the study in wild blueberries are better. Well, why? Because of this thing, it's called anthocyanin and then he gets down deep into it. So, I completely agree that food is medicine, 100% agree. I completely agree that the specific chemical nutrient compounds can be isolated, but I think it's too reductionist to just say, let's just put a pill of anthocyanins and prescribe them. 100%. Because it's the milieu. It's right. It's like with caffeinated coffee is good for brain health. Well, is it the caffeine? Is it the coffee? Well, no. They think it's like some substance X during the brewing process, right? So, depending on which way you look at the science, I would prefer that food is medicine. It's just sometimes I understand the bucket.

I'm just kind of playing with you.

But I love it.

I think, I mean, when I put a patient, for example, on a ketogenic diet with Alzheimer's and they wake up and their brain becomes alert and they remember their son and their daughter, and I'm like, well, how is that less a drug than some other drug that doesn't even work that we're using like Aricept, right? It's impressive.

Yeah, no, I mean, I just feel like all of the different paths, some people call nutrition, I don't know, not mainstream medicine. To me as a Western doctor, that doesn't make any sense to me. Nutrition is, I got very little nutrition education in medical school, and I think that's a terrible thing. I learned a ton and I had to, my better half has a master's degree in nutrition from Columbia and she's taught me a lot, I think through osmosis.

She explains everything.

Ah, there we go. It's always the better half and she informs the less enlightened one. So, you know, I guess what I'm trying to say is nutrition is the cornerstone of how we practice. physical exercise and precision exercise, precision nutrition. These are all the things that are developing and really become the cornerstone of our care.

So, you're talking about the 12, then the 21, and then the 50, and maybe there's going to be 100. Tell us more about the granularity on that.

Sure.

You were using these, and I just want to sort of frame it for people. You did a study that you published I think in 2019, which surprised even you, were using this approach looking at a personalized assessment of these biological factors that could be modified and then individualizing the treatment that you not only slowed the decline, you not only stopped the decline, but you reversed the decline, which is something that has never really been seen except in a couple of trials like the finger trial, and I think there's a new one coming out, the pointer trial. So those are, those are also lifestyle trials. Yeah. And, and so you, you really have, have sort of cracked the egg and published something that should have been on the front page of every major newspaper, the lead story in every evening news, and yet it was like frickets.

Yeah. Well, I, I mean, we got the Wall Street Journal and CNN and the Smother, so I'm, I'm okay. I'm, I'm okay with that.

But for me, it was like, It was it should have been like the NIH should have gone, oh, Richard, here's $10 billion to get going on this. Like that's what it should have.

I have to be careful. But, you know, the NIH doesn't really fund what we do. And that's been it's very hard. And listen, the NIH, I've engaged with the NIH over the last year or two, and there's definitely been more interest. But, you know, I, you know, talk about crickets years ago, a decade ago when I started this whole thing, a more 15 years ago, there was nothing. there was no funding for any of this. So, you know, what I would say is what our work shows is that when you individualize care and you give people a plan, and I know you've asked me at least three times now, what should people do? What I'm trying, why I'm delaying things is because it really truly needs to be individualized. And what we use is a term called the ABCs of Alzheimer's Prevention Management. Based on the data, we get data on A's, the B's, and the C's. A stands for anthropometrics. Anthropometrics is basically a fancy A word for body composition. What is your body fat? What is your waist circumference? What is your muscle mass? Depending on these factors, we're going to change the recommendations we give. The B stands for blood-based biomarkers. We're going to look at markers of lipids, cholesterol markers, also advanced markers that preventative cardiologists use, for example, that you know, most neurologists honestly don't really pay attention to. We look at metabolic markers, insulin resistance, we look at inflammatory markers, we look at nutrition markers, you know, instead of, you know, saying, okay, well, go eat fish, it's good for you. We're gonna look at the markers in the blood. We're then gonna tell you based on your blood and based on your genetics how much fish you should be eating, what types of fish. So, so the take home point is we're gonna get granular with every patient. The other thing we do is in the blood based biomarkers, we look at genetics, we look at the APOE4 variant. It's the most common risk Gene doesn't mean you're going to get Alzheimer's if you have the variant, but it increases your risk. Well, if I know that you have the APOE4 variant, they checked for this in 23andMe and millions of people have gotten this checked. I'm going to personalize your care differently. If you have the variant, I'm going to give you plan A, B, and C. If you don't have the variant, I'm going to give you a little bit modified plan X, Y, and Z. If you have two copies of the variant, you have a different plan altogether. That's only 1% of the population. So, you know, the take home is we take all these markers and then the C is cognitive function. And we understand a person's cognitive baseline. We look at memory function, language abilities, learning abilities, speed of processing, attention, and executive function, which is higher order processing. We take all of this and the patient's medical history. We learn about the patient. We learn everything we can about them, about their family, and then we personalize a plan. So there's 21 different things are based on that person individually. And there's a lot of overlap. If you want me to say, okay, well, what are the core things? exercise on a regular basis. Okay, well, exercise on a regular basis is good, but every person gets a different plan. If we're putting someone on a plan for body fat loss, we're going to give them a different plan. Steady state cardio, for example, some people would call that zone two training. Steady state cardio at 60 to 65% of your heart rate. There's different ways to do this through lactate testing, through a variety of things that we do, you know, more precisely in our clinic, but we put people on these steady state cardio plans fasted in the morning as long as they can tolerate it because that way it jumpstarts body fat loss. If we have people that don't do any muscle strength training because they don't like it, we educate them to say, I don't like it either. I'm not, you know, Mr. Big Muscles over here, but I have to do strength training once or twice a week minimum because if you don't have muscles, you can't boost metabolism. So, we put people on these very specific plans. high intensity interval training. I really believe that high intensity interval training is almost necessary for people with at least one copy of the APOE4 variant. And this is what has been studied down in a couple of studies. And, yes, we need more research and the studies out of Norway were good, but we need to personalize an exercise plan. We need to personalize a nutrition plan. We need to personalize a vitamin and supplement plan. In some people, we do use drugs. Drugs are actually not commonly used at all in our research. although we do use them on occasion. We'll use a variety of drugs, usually at much lower doses than maybe the regular community uses. But when it comes to management, equal opportunity, if there's data and it's relatively safe, I'll entertain it. So we recommend cognitive activities that will have a spillover effect, learning something new, learning how to play a musical instrument, learning a new language. These are things that may have a protective effect, build backup pathways, Believe it or not, even learning how to play a musical instrument in midlife has protective effects on cognitive outcomes in late life. And that's, there's hope for me yet. There's hope for you yet. I got my bass guitar over there. I got blisters on my fingers.

I'm gonna learn how to play the guitar. I don't have, but I just, so, but my big problem is I don't know how to tune it and I don't, I, I am so musically inept that I, I probably there are good.

Apps and things to do it. There's, there's a website.

It's called, you got a pen, it's called YouTube.

YouTube.

You may have heard of it.

Almost as many people watch YouTube as listen to your podcast. So you can learn how to play guitar on YouTube. I I think you can do it. Okay, I'm gonna try for sure.

That's my December.

Excellent. And January and February and March. So the take-home point is engage your brain. Treat your brain with respect. Love your brain. Make a plan for your brain. What does that mean? Make a plan for sleep. if you exercise and exercise and exercise, some people say colloquially that that loosens the amyloid, the bad protein that gets build up in the brain of a person with Alzheimer's. But if you're burning the candle at both ends and you're not sleeping during sleep, especially deep sleep, that's when a person has the trash come. The trash man comes, they pick up the garbage and they take it out and they take it to the trash heap. That is the restorative part of sleep. And if someone is an sleeping at least seven, seven and a half, eight hours of sleep is usually the goal. As we get older, it's harder to sleep that much. But making a plan for sleep, prioritizing sleep, we have people that track their sleep, that track their exercise. I'm wearing a wrist device here. I have nothing to disclose, but we've done several research using this device. I track people on my phone. I have my phone right here and I can check how much exercise they've been doing, how their sleep, how much deep sleep, I can see their blood sugar control. I can see all these different things on my phone because my patients share their data with me. And when I talk about data sharing, it's not just about tracking sleep. It's not just about doing exercise. It's about tracking it, determining the response, talking to your physician about it. Granted, it's hard to find physicians that will take the time to talk to you about this kind of stuff. Tracking your blood sugar, there's at-home devices called continuous glucose monitors. In our program, we take a very, very deep dive and we learn about all of these different metrics and we refine or fine-tune the plan that we give them based on their real-time measurements. So, I can keep going. There's stress modification. Transcendental meditation. Bob Roth taught me a ton about this. What about mindfulness-based stress reduction? You can take a course online. Mindfulness-based stress reduction has amazing outcomes when it comes to brain health. The list goes on and on. There's no one magic pill or one magic cure, but there are a variety of, I was going to say pharmacological and non-pharmacological, but you're reevaluating how I say this now. There are a variety of interventions that are evidence-based and safe that I think all of us need to learn about. Whether we talk about fasting, and I like the term time-restricted eating better, meaning not eating for 12, 14, 16 hours overnight, so at least four or five days a week, I use the term fasting for a more prolonged fast, 24 hours or more, and that's a different discussion. There's the ketogenic diet, there's the Mediterranean style diet, there's the mind diet, there's components of each diet, green leafy vegetables, wild salmon, grass-fed beef better than non-grass-fed beef because of the omega-3s. There's so many devil is in the details. Half a couple blueberries and strawberries two to three times a week. leads to better brain health outcomes and cognitive outcomes in the nurse's health study many years later on. There's dark cocoa powder. There's so many things that I can drop in as key things, but the take-home point is all of these things need to be individualized.

So let me ask you this because first I want to just kind of feedback because what I'm listening to you thinking, you're a neurologist, but you're also an immunologist, a cardiologist, an endocrinologist, a gastroenterologist, a nutritionist. I mean, right? Yeah. you're breaking down the paradigm of medicine, which is we should stay in our lane, focus on our organ, and leave the rest to everybody else. And, your insight here is that the body is a system, that everything's connected to everything. You can't just pick out one thing and work on that like amyloid or tau or whatever and get to the problem. It's sort of like trying to bail the boat while there's holes in it. to fix the holes. And essentially the holes that you're talking about are all these ways in which our brain gets injured by our lifestyle and by our environment. And you didn't mention toxins, but that also plays a large role. And so all of a sudden we have to sort of rethink our whole approach, which has really been a reductionist approach. Single disease, single drug with a single outcome. There was an article in Jam a number of years ago called Shifting Thinking in dementia. You probably saw it. And they said in that article that we combine categorical misclassification with etiologic imprecision. And in English, for those listening, that means we categorize dementia according to symptoms, not the causes. And we are not very focused on the etiology or the causes. We're focused on the symptoms. And we said, well, you can't remember this and you fit this profile on your neurocognitive testing. you have Alzheimer's, you have this kind of dementia, or Lewy body, or blah, blah, blah. And the reality is that you could have 10 people with Alzheimer's who need 10 different treatments. And that's exactly what you're talking about. That's heresy, Richard. That's heresy in medicine, honestly, because we really have a very, very restricted reductionist view of disease that doesn't let us actually even study these things. And I've literally had arguments with top leading researchers, like heads of research at major institutions saying, these are all the factors that affect the brain. We want to study them together. So, oh, no, you need to study one thing at a time and then see how that works. Then one thing. So study exercise and then study nutrition. Then study vitamin D. Then study fish oil. I'm like, no, that's not how things actually work. It's like, it's like you have to use all the whole picture. the other thing I sort of wanted to sort of touch on was that you're sort of introducing a concept of the personalization, which again is very different in medicine. It's not one size fits all and you're talking about very sophisticated personalization based on a whole set of biomarkers and tests and things that are easily accessible, but that aren't normally looked at and that aren't normally tested. you know, you get your typical panel, you get your thyroid, your B12, you get your spinal fluid done, you get your MRI, and you go, okay, you got Alzheimer's. It's sort of a little bit more complicated than that, but it's, it's really a fairly narrow window of biomarkers and metrics, and there's bazillions of them. And, and I think we're just sort of touching, touching the, the sort of tip of the iceberg on this. And I, and I've seen in my patients when you start to apply these concepts of personalized care around food, around exercise, around sleep, around stress, around supplements, around everything that you really begin to see dramatic changes in brain function.

Yeah, I, you know, I often joke that I'm like a one-third neurologist, but a preventive neurologist at that. I'm a one-third make believe. I will full disclosure, I'm not a preventive cardiologist, but I may make-believe preventative cardiologist. I'm a one-third primary care doctor and make-believe preventative endocrinologist. I don't even know any preventative endocrinologist. If you find one, introduce them to me. I was trained in an environment. I went to a six-year medical program where I was in med school from day one, University of Missouri, Kansas City. I knew I wanted to be a doctor when I was five, 17 years old, wearing my white coat, and I did so much internal medicine during med school. I had, like, an extra year of medicine because that's the way our training was. And I don't know if it was that, or I'm not sure exactly what it was, but Alzheimer's disease is a medical disease.

Yeah.

Full stop. That's it. There's this thing called the skull, and it's a hard thing that protects you when you fall. But it's just like it. It. It's like when you have medical conditions, you can affect your kidneys. When you have medical conditions, it can affect your eyes, it can affect your heart. The same thing, it can affect your brain. And I couldn't agree with you more. People can take different roads to Alzheimer's. and you have to figure out what world they're on and get them the heck off that road. Women, for example, are unfortunately many times in the fast lane to Alzheimer's. Women, two out of every three brains affected by Alzheimer's are women's brains. And five, 10 years ago, I would say I didn't know why. And now I think I can answer that question. And it's related to the perimenopause transition, it's related to specific life factors. It's related to women being maybe a little bit more at risk. if they have the APOE4 variant. So the take-home point here is if you understand a person's individual risk factors, whether it's biological sex, whether it's medical conditions, whether it's what's floating around in their blood, whether it's what is their cognitive function at baseline, you have to figure these things out and then you have to target that plan and personalize that plan. And I mean Alzheimer's disease and brain health needs to be treated in a medical way. Because if it's not, if you're just targeting amyloid, you're missing the boat. Amyloid's a marker and I think hopefully one day we're gonna have just like we treat diabetes with lifestyle interventions and exercise as well as certain targeted drugs that honestly some of them actually do tend to work pretty well. I'm not the biggest fan of insulin. That's maybe band-aiding to me. That's probably too late. I mean, I'm not the best whatever. some of these new things that are pretty interesting. I won't get into specifics, but I hope that one day we treat Alzheimer's disease and cognitive decline like any other chronic disease of aging where we hit things with a multimodal evidence-based and safe approach that requires a medical intervention. So essentially what you're saying to paraphrase.

Is that Alzheimer's is not a brain disease. Correct. It's a systemic disease that affects the brain.

Yeah, I really believe that. I have to be careful saying that. Is this being recorded? Oh, no.

And it's gonna be broadcast to billions of people around the world.

Great, great. My field, I was just trying to, I was just gaining some fans in my field and now it's all last decade of work.

Oh, no, no.

What are you gonna do?

You are at the forefront of a paradigm shift that's happening throughout medicine, which is the breakdown of the old concepts of disease from simply this reductionist, organ-based, symptom-based model to systems thinking and network medicine. And that's really all you're talking about. And, you know, you've touched upon some of the most easily accessible and modifiable factors, which is what we eat, how we exercise, how we handle and manage stress, how we sleep. Those are, those four pillars are, are huge. And then there's the fine tuning with, you know, managing metabolic risk factors or getting their nutrient levels up to a certain level. but there's a whole treasure trove of stuff that we, I think, still haven't even dug into. It's like, it's like I visited Ephesus in Turkey, and it's the largest Roman city during the Roman Empire. It was incredible. It was all buried under dirt and, you know, rubble, and they excavated it, but there's still figuring, they're still, you know, excavating it 100 years later, and it's just fascinating to see that there's so much we don't know. And I would say, in my experience as a functional medicine doctor, I've seen things that have impact on the brain that aren't really included, like heavy metals. Do we even have a way of testing that is in conventional medicine? Not really. We just do a blood test and then we don't worry about it if it's okay. But there may be total body burden of toxins we don't look at. The microbiome is another huge factor that affects the brain and Alzheimer's. And mitochondrial function is something we talk about, but it's often ignored. and we have latent infections that may be affecting the brain that cause inflammation, whether it's herpes two, maybe linked, but there may be other things. I mean, Chris Christofferson had Lyme disease and got diagnosed with dementia. There may be environmental factors like mold that have impact on inflammation. So we know that the brain with patients with dementia is inflamed, and then the causes of that inflammation can be multiple. And so, part of the diagnostic dive that you're doing, and I would just sort of encourage you to think about this, is that you're getting to all the stuff that we do know that's so clearly evidence-based. But then there's a whole treasure trove of things to look at that we're kind of ignoring. And I'm just going to take like two seconds. I know it's your podcast, but you're talking. But I'm just going to just talk about this one patient because it was the first patient I had where I'm like, came in the guy with Alzheimer's, I'm like, can you do anything? I'm like, I have no clue. I don't know. But I'm just going to apply the model of systems of biology and functional medicine. Let's see what we do. We found he was severely insulin resistant. He had, which is, you know, we talk about Alzheimer's type 3 diabetes in the brain. He had very high homocysteine levels and methylation problems. So his, his genetics were off around metabolizing B vitamins in the right way, which we know is a risk factor for Alzheimer's. He had the APOE4 double4 Gene. So he's the one percent. he was seven years old, cognitively impaired, diagnosed with Alzheimer's, basically at home, not able to do anything, depressed, not functioning. It was the former CEO of his company. He also had other nutritional deficiencies like vitamin D and he had been living in Pittsburgh and in Pittsburgh, it's the capital of steel. And for a century, they've been burning coal for the steel plants. and they use cold air for the streets, on the winter for ice. They put it on the fields for fertilizer, what they do. It's, it's everywhere. And all my patients in Pittsburgh have high mercury levels. And he had very, very, very high mercury levels. When we did a challenge test, he also had a mouthful of fillings. And we know that if you look at, you know, amalgam scores, surface area, and you look at animal studies, the more amalgams you put in their mouth, the more Mercury ends up in their brain. And, and so I said, well, I don't know, I don't know if anything I'm going to do is going to work, but let's fixture in some resistance. Let's fix your also, he had terrible gut issues. He had irritable bowel for 30 years and was on stellazine for his stomach, which is a psychotic, anti-psychotic drug to kind of calm his stomach down. And I fixed his stomach. I cleaned up his diet, fixed the insulin resistance, I fixed the B vitamin thing. I got rid of the metals, and the guy came back to life. And it was really, really remarkable. And he was able to go back to work and function again and be part of his family and be part of his society in a way. I was just shocked. And so, I think that, you know, there's a level of stuff that we're looking at and then there's a whole bunch of stuff we're not looking at. So, I'd love you to comment on that and what your thoughts are about.

All that other stuff that's going on. Yeah. So, and thanks for sharing the story because, you know, every story is instructive.

Because this is- I'll send you the article that I described. It's as an editorial I wrote for a medical journal.

I'll just- because you'll go, wow, you know, this is interesting. So, you know, the thing that resonates me with the story is, you know, when you have people with APOE4-4s, those are just different eggs. And, you know, E44s may be, you know, for example, E44s may be preferentially responsive to vitamin D, for example. So, you know, some studies show that vitamin D, eh, maybe it's not really that preventative. Oh, some studies show, oh, maybe it is more preventative. Well, people with two copies of the E4 variant, which is, again, not super common, those people really need to have their vitamin Ds up. And that's, and, you know, that's just an example there. But, you know, people with the APOE4 variant, you know, pesticides, DDT and DDE, the interaction between E4 and pesticides increases Alzheimer's risk several fold. If people don't have the APOE4 variant, maybe they're not as exposed or maybe they're not as increased risk to Alzheimer's. So when you look at a whole population, you don't tease out for E4 positive versus negative, the studies may not show any correlation, but in practice we see the correlation and in other studies you do see the correlation. So I think you know, something I learned, I was at a conference in Canada. You have a lot of fans in Canada, by the way, just definitely.

Your name came up there. It's true. It's everywhere I go. I mean, I'm in Istanbul at the airport and some guy from the security comes running up to me, I thought I was gonna get arrested for smuggling something. It's like I'm smuggling my Turkish delights back to America. And you're like, Dr. Hyman, can I take a picture with you?

And I'm like, oh, fine, okay.

International.

So I was at this, I was at this thing in Canada and amazing people, just smart people and, and, you know, we were giving presentations and of course I'm like, you know, the science guy. And I'm like a, I'm a clinician. I'm like a, I'm like a regular doctor, I don't say Joe Schmo like you and me, but like, you know, but I was thrown into this clinical research thing and again, I had research resources, infrastructure, did work hard to learn, hired the right people. So yes, I've done research and when you do research, you need to have objective measures to follow that you can track. I was at this group in Canada, this guy named Gary and Elizabeth, Elizabeth's a naturopathic doctor and Gary is just really, really, really smart. And they were working together to present on a topic and it's kind of like a bulb light bulb came off of my head and I said, you know, I'm so focused in the objective because I need to be because I'm a researcher. If I'm going to say something and think it, I need to then prove it because if I'm in an academic environment, you know, I was at Weill Cornell Medicine New York Presbyterian for almost eight, nine years. And, now, I'm at Florida Atlantic University doing a really, really exciting program in brain health and Alzheimer's prevention, Parkinson's prevention, dementia with Lewy body prevention. You get to do some really cool things. Maybe I'm missing the boat a little bit because if I'm just focusing on the objective that I need to track and prove, there's a lot of stuff under the surface that I can't really track and prove because I don't have a biomarker to do that. So, I guess what I'm trying to say is as I've I know what I know and I don't know what I don't know. I'm consciously incompetent about things. And the story that you say is, yeah, no, I am, there are people that are unconsciously incompetent and those people drive me a little bit batty, but.

I am, I'm on your team. I know what I don't know.

Yeah, I know what I don't know and I'm willing to have my eyes opened. And, you know, the stories that you say, it's like, as a physician, you have to treat someone in a certain way to try to make them better, but we don't always have all the objective evidence and the types of work that we do on patients, it's really hard to study. I have empathy for people in our boat who are trying to study the rigorously study because what's moving the needle? To me, I don't care what's moving the needle. People were criticizing one of my research paper, oh, you recommended 21 things. What if 18 of them are helping and three of them are harming. You'll never know. And I said, okay, but look at the results. 18 months later, people with amyloid in their brain with mild cognitive impairment due to Alzheimer's disease that followed this plan, 18 months later, as long as they followed 60% or more of what I recommended, had better cognitive outcomes. 18 months later, we were able to improve symptom. There's no drug that can improve symptoms. at 80, slowing decline is one thing, improving symptoms. So, I'm Zen with not being able to precisely understand which of my 21 things are working. But I think, you know, as clinicians, I think we just have to do the best we can. And we want to, you know, promise not to over promise. I think that's important too. You said at the beginning when you were seeing that patient, I'm not 100% sure, you know, yada yada, but I'm going to try all the usual things. and something worked. So I think as long as we have honest conversations with our patients and do the best, people like us that have academic appointments and are in that realm, I think it's my duty in some ways at this time in my life and my career to try to prove as much as I can. But I think the field and I think people need to realize that some things are really hard to study and prove. Yeah.

And they are, but what's happening now is with the acceleration of our understanding of how to map biology and things we couldn't even measure before, we're able to start to look at different diagnostics than we ever did before and find things we never found before. And within the diaspora of medicine, which is where I've been most of my life, there's a lot of people doing really interesting diagnostics that are ignored, like heavy metal testing. For me, that's like a blood pressure when someone comes in and they have any kind of toxic or immune or cognitive or any chronic symptoms, I look at it because it's often an underlying factor. It was actually how I figured this all out was through my own mercury poisoning from living in China. And, I had severe cognitive impairment and also immune dysregulation and gut issues. And, I think the gut stuff is such a big deal. And, that's something we can start to understand with the microbiome and its effect. And, there's data coming out.

From.

But the question is, as clinicians, we never learn, well, how do we repair a microbiome that's off? Right? How do we do that? Like, that's, okay, well, we may know, okay, if you're low in vitamin D, take vitamin D. But, like, if we test the microbiome and there's all this inflammation and dysbiosis and, like, the average doc has no clue where to start. So I think that's part of the problem, is we just don't have one, some of the Diagnostics we need, or, or if we do, the average practitioner has no clue what to do with it. And I think we're, we're all going all that's going to change. I think what you're talking about is managing something that until now, I don't think has been able to be managed by the average doctor, which is, God, there's a hundred things we could find that could affect the brain. I think there's probably a thousand or maybe there's 10,000, but the average person and the average doctor cannot process all that and make the connections. But with the advent of quantified self metrics, which you talked about with the advent of advanced diagnostic metrics and metabolomics and the, you know, to understand even the microbiome metabolomics, for example, nobody talks about that, but it's the metabolome of the microbiome in your blood. There's probably 20 to 50% of the metabolites in your blood come from the bugs in your gut, right? And, and how does all that work? Well, that's going to require big data and machine learning and artificial intelligence and start to see the data and the patterns and connections. So I think that's where this all headed. And, and, you know, it, you, you know, we to stop this paradigm of being reductionist and saying, just take this one drug for Alzheimer's. And, I get so frustrated when I hear these studies come out and they had big news articles and, oh, this helps or that helps. I'm like, what about all the rest of the stuff that Richard's talking about? It's got to be frustrating for you, too, because you see it. You see your patients get better and you go, Hey, guys, why don't you try this? And, what do your friends say who are also neurologists or memory specialists? you think you're a quack or they're like listening?

You know, I'm a pretty resilient guy. I gave my first talk in 2007 about how MCI, mild cognitive impairment due to Alzheimer's and this pre-symptomat, I didn't like that term. I just felt it should be prodromal at risk. I felt like we should be treating people before they had dementia. And when I Kind of set that stage and I wrote about this in one of my books, names, not naming names, but and I didn't name the name there too, but one of the giants in the field was sitting there.

And like just I don't say rolled.

Their eyes, but just just but there's no evidence. There's just there's no evidence. There's nothing you can do. There's no evidence for die. There's no evidence for this. There's no evidence for that. But there was no impetus to even aim to study it. I started seeing Alzheimer's prevention patients in 2009. Dr. Arthur Agatson was one of my mentors. Oh, yeah, Arthur. Amazing guy. He was my attending at Mount Sinai Medical Center when I was an intern. Yeah, before the South Beach Diet, before he's gone as the South Beach Diet guy, but to me, he's the Agatson calcium score guy. To me, he's the visionary that was one of the first preventative cardiologists. and preventing disease and starting before there are symptoms, it was so, the tomatoes that were thrown at me were, you know, the big vine-ripe tomatoes. Now, I don't know if my reflexes are better. I have cat-like reflexes now have a cat behind me, but I can dodge the tomatoes better. My armor is thicker. The tomatoes are not being thrown as fast. But it's also because, you know, we've now published, we've published results. and I would talk to a journal editor five, six years ago and I said, well, this, this and this and this and this is what I see and it's clear. And he said, well, it may be clear to you, but you need to prove it and then you need your peers to review the article and accept that your thoughts and your observations are substantiated by evidence. And I feel like in the last five years, just eight years actually, we've been able to do about as good of a job as possible with the limited resources that we have. if that, if 1% of the billions of dollars or heck, 10% of the billions of dollars would have come in the prevention bucket. I can tell you if someone drops a very large sum of money in our research program to prove this, we can do it, but it's hard. Prevention studies are expensive because they take longer. Prevention studies need to follow people for years rather than six months or nine months or a year. I think the reason that my colleagues are coming around is because of the publications and building the body of evidence. I think the other reason that my colleagues are coming around is several of them have come visit. I've had over 45 other physicians and other healthcare providers come visit me and sit next to me. If someone isn't willing to sit next to me, if someone is willing to criticize the work we do but not willing to come sit next to me, and spend a couple hours and just watch. Just look. It's, oh, this is only one patient. It doesn't mean anything. When you see this once and you see it again and you see it at 9 o'clock, 10 o'clock, 11, and then 1 o'clock, 2 o'clock, and 3:30. You just, you know, like, okay, fine, prove it. I get that. But there are still skeptics out there. There are still skeptics and I still get criticism every day. And I don't want to say I'm jaded, but, you know, haters gonna hate. I'm gonna keep doing my thing.

And, well, you know, you know what Max Plank said, right? No, he said, he said, he said that. No, he said, he said science. But you can say medicine doesn't evolve by convincing your opponents and helping them see the light. Because they eventually die and a new generation grows up that's familiar with it. In other words, medicine progresses one funeral at a time. That's kind of mean, but that's what he said. And I think the other point is that the absence of evidence isn't the evidence of absence. If we haven't spent billions of dollars studying nutrition and Alzheimer's, how the heck do we know anything? We spent billions of dollars studying drugs that don't work, but not the right things. And the other thing, which I'm going to push back pretty hard on this for you, you keep talking about preventive neurology and preventing Alzheimer's, and yes, yes, we should do all that. But your study, your own study, showed that you cannot only prevent it, but reverse the symptoms. Now, how far can we go to reverse it? How much can we reverse it? How far can these treatments work? What if we added 10 other things that maybe we haven't even thought of that might be as or more impactful than the 25 things you're already doing? I would push back and start to encourage you to think about treatment studies, not reversal studies, because those you'll see outcomes much quicker. And if you can take a group of 10, 20, 50 people and be really aggressive, and it's not easy because changing, and I have these patients, I'm treating many of them right now, it's the roughest thing because if you have an engaged patient, someone had a heart attack and you tell them to change their diet and their vitamins and exercise, they go, I get it. But, you've got someone with dementia or who's cognitively impaired, they can't remember stuff. You need a full-time bodyguard literally with them, telling them what to do and helping them do it. But, if you did those kinds of studies, I think you would see dramatic changes.

So, I'm really cautious and I would use the term hesitant. And, actually, I would use the term, I don't use the term reverse. And, the reason is, and let me explain my position here. because, you know, I respect where you're coming from and I see—I see why that term has been used in the past. But until I have definitive biomarker evidence that I am reversing the signs of pathology, now if I would have done my study and we had the blood test, the amyloid blood test out, now it's out, now it's out. So of 2015, 2014, if we would have gotten the amyloid samples in the blood and then 18 months later we got them again, and if I would have shown—not only did we improve symptoms, so you you can either use the term symptomatic benefit, improve symptoms. You can use the term reverse symptoms. I don't like that term because I understand the term reverse to me implies neuropathological reversal and I want to be like, I'm trying to build bridges here and I'm trying to bring my enemies closer.

I know where you're coming from.

Yeah, but listen, if we can show that we can improve symptoms and amyloid goes down in the blood, well, that then we've just reversed Alzheimer. I will be the first person to plant the flag in the ground and say, we have just reversed Alzheimer. I would be the first person to do it.

And mine- Dr. And, there are studies that show that hippocampal volumes go up, that you can improve the neurocognitive testing, that you see all those hardcore biomarker changes. I mean, there's not enough of that data, but there's some of that data out there.

Oh, I mean, you're preaching to the converted here. I mean, I have this amazing guy in Italy who, you know, I the first, I got MRI baseline.

By the way, hippocampal volume, hippocampus is, for those listening, is the part of your brain that's the memory part that shrinks as you get older and shrinks a lot when you get dementia.

And, if it grows, it's not supposed to grow. Right.

Yeah.

And, so, again, this is an anecdotal story, but there have been studies that have shown this also. I remember one of the first times I saw a guy's brain, a guy from Italy, nice guy, came in this really fancy Italian suit, he was well dressed. He was skinny fat, though. He was skinny fat, meaning he had elevated body fat, although you couldn't see it because of the fancy clothes. And, you know, after a year and a half, he came back and we looked at his brain. This was, you could see it through the eyes, you could see it through computer automated software. The memory center in the brain, after following a comprehensive plan through exercise, I think exercise is a big driver of volume brain size, making the brain bigger. But it was, I think it was everything. But you could see with your own eyes, an untrained eye could see that the hippocampus got bigger a year and a half later. His cognitive function got better, memory function was better. He was no longer skinny fat. He gained muscle mass and lost body fat around the waist size. The bigger the belly, the smaller the memory center in the brain. He got rid of the belly fat, the memory center in the brain got bigger. Now, this is an anecdotal study and some of the naysayers out there would say, oh, stop already. You're just given this N of one, one study. But no, there's actual research that shows this too, that exercise increases hippocampal volume. so, you know, if, if, I think the, the, the holy grail and the next big study that we do, and it's going to have to be multi-site and we were just starting to, to work on this before COVID and then COVID, you know, really, really messed things up and obviously for the world, but also for Alzheimer's disease research. Um, our goal is to, to do, I, what we're trying to plan is a, is more of a, a telehealth telemedicine study where, where doctors can take care of people at risk for Alzheimer's and we can do a lot through telemedicine. So we can, you know, break down barriers, keep the cost low, but then get blood tests, get amyloid at baseline, get amyloid at follow-up, maybe get MRIs at baseline, MRIs at follow-up, and basically try to enroll people from all over the place rather than just one site, because we were the main site that enrolled it in New York. We're going to basically try to prove this time that not only are we improving symptoms, are we slowing decline, but I would love to be able to shout off the mountaintops that we were able to reverse Alzheimer's disease and prevent it from a neuropathological perspective. And if we have those data, I really believe that the naysayers aren't going to have any tomatoes to throw.

Well, it's not only about the naysayers, it's about all the people suffering to have finally hope. I mean, people with cancer have hope, people with heart disease have hope, people with diabetes have hope, people with Alzheimer's, it's like, oh, wow. It's like dropping a nuclear bomb on somebody.

Yeah.

And, and it's, it's kind of the worst diagnosis you can possibly get because you lose yourself. Yeah. You know, you could, you could be in bed with cancer and waste away to nothing, but your soul and your brain, who you are, is still there. And, and that's the hardest part about this disease and its impact on families and caregivers. And, I mean, you know, you experienced that. I've experienced that. It's, it's just. just devastating. And it's, it's scary how much it's increasing. I, I think, am I correct to say that it's not just because the population is growing, but the actual incidence per capita is growing? Is that true? So, you know, it depends on how you slice the data, but, you know.

We have an aging population. Age is the number one risk factor for Alzheimer's. I do think that some data actually show that, you know, in, in areas where blood pressure and diabetes is being under somewhat better control. maybe the incidence is coming down a little bit, but the data are what the data are. But what I would say is, you know, we have the power to make changes in our lifestyles today. We have the power to have conversations with our doctors today. You know, even like, for example, vascular risk factors, high blood pressure, high cholesterol, diabetes, these are things that fast forward Alzheimer's disease pathology. We can say it pathology as well as Alzheimer's you know, disease, but also cognitive decline. Diabetes doubles your risk of having Alzheimer's disease. When it comes to blood pressure, this is just, this is just, actually, I really want to share this because if your listeners take home one thing from this podcast, hopefully it's that they're not powerless. But if they take home two or three things, I hope that they take home the fact that everyone should know their blood pressure. Everyone should know their waist circumference. Everyone should know their body fat. Everyone should know these numbers. Yes. this is a lot to track, but these are these are things that are not expensive to track. Anyone can go to their doctor's office or go to the pharmacy and check their blood pressure and anyone can buy a scale at home that has a.

Body fat metric and yes, it's a.

Couple hundred bucks but it's a really good investment. It's a ballpark one.

It's not it doesn't. Exactly, they're not perfect.

Right, right. And there's there's gold standard. It doesn't tell you where the fat is if it's in your butt or your stomach. Correct. And actually anyone for no cost can measure their waist circumference and if their waist circumference is more than an inch or so greater than it was in their early 20s during high school and college, that probably means that there's a problem. So, that's actually the poor man's way to do it and we talked about this.

I think you actually have to pay for the tape measure. I have a cheaper one. It's called the Mirror Test. You look in the mirror, jump up and down, and if your stomach jiggles.

Then you probably have a problem.

Great.

You're hired. That's a great test. When it comes to blood pressure, if this is something that people remember because blood pressure is just so important, the Sprint Mind Study published a couple of years ago showed that people that had a blood pressure in the 140s over 80s, which back then was considered as normal. That's completely not normal, but that's a different discussion topic for another day. But this whole concept of normal versus optimal versus, you know, what 50% of the population has, there's a big difference. When we're talking preventative health, we want to go optimal. So when it comes to blood pressure, People in a randomized study that were randomized to 140s over 80s or 120s over 70s or below, okay? In just three years, they stopped the study early. In just three years of tighter blood pressure control, which is 120s over 70s, but goal was below that, people were able to reduce their chances of developing the earliest phases of symptoms related to dementia by almost 20%. in three years just by lowering blood pressure by 20 on the systolic, the top number, and 10 on the diastolic. When you add the blood pressure control, plus the nutrition changes, plus the exercise, plus the other stuff and the vitamins, and once you add all these different things, this is when we can really put a damper in. And listen, if we have again, I'm sorry to keep pandering to the naysayers out there, but if there are people that don't believe if you can even delay Alzheimer's, delay it from happening by a year, two years, three years or five years. And in that timeframe, a blockbuster drug comes, okay, great, that drug comes. Well, great, then that person prevented their own Alzheimer's. If we can delay it longer than that, and they, you know, unfortunately, if they pass from something else, then at least they lived a great quality of a better quality of life, and they never got Alzheimer's. So whether you talk about prevention or delay or reversal or symptoms. Let's not get caught up in the semantics and let's just all unite and say there are things that we can do today to improve our brain health tomorrow. And it's things that are tangible and available for everyone.

Well, if anybody's listening is got a foundation, is a billionaire, has some, is somebody from the government or the NIH or or anybody listening to this, if what the two of us are saying, Dr. Isaacson's research is on the right track, how could we not put our resources toward that? How could we not focus on that instead of spending another billion dollars on another drug study that's going nowhere? Because there's a really simple rule in functional medicine, which is if you're standing on a tack, it takes a lot of aspirin to make it feel better. And the second rule is if you're standing on two tacks, Taking one out doesn't make you 50% better. You've got to deal with all the factors. You can't just say, we're going to study food or we're going to study exercise or we're going to study vitamin D or fish oil or flavonoids or blah, blah, blah. We've got to really look holistically at how do we optimize health. And, you said something that is also a little bit of heresy because in medicine, when your lab tests are in the normal range, you're normal. The doctor goes, you,'re fine. but what you're talking about is treating to a standard that's beyond normal, that's optimal. So if your homocysteine is 413, it's considered normal on most lab tests. If you look at the data, if your homocysteine is 14 and above, your risk of Alzheimer's is 50% higher than the average population. So should your homocysteine be 13 or 12 or 11 or 10, maybe it's six or and how do you treat to that metric? And I think that's what really we do in functional medicine is how do we create optimal function? I mean, people, what is functional medicine? It's pretty simple. It's learning how to create health through optimizing function in every aspect in all the areas of the body that are off balance. And that's essentially what your work has done. And it's really so groundbreaking. And I know you might sometimes feel like a lonely warrior out there with arrows in your back and and a bunch of bumps on your head and struggling. But I encourage you to continue because you are on the right track. And folks like you and Dale Bredesen, who's definitely got a lot of flak, you've shown that there is a possibility that this is not a disease that we can't tackle, that we can't learn more about, that we can't actually have an impact on and have hope for because that's the worst part. this devastating lack of hope. And I'm actually excited when I get to see a patient who's got cognitive impairment because I know there's stuff we can do. And I would say sometimes I see miracles, sometimes I try everything I know how to do and it doesn't work and I don't know why. But, you know, we're learning, right? So we're learning. And it's really, it's exciting moment in medicine, it's exciting moment in science, exciting moment in neuroendocrine, immune, Gastro ology.

Well, Mark, I mean, I really appreciate that. You know, it's striking to me that with the billions and billions of dollars invested in this field, you know, our study that we published again, I was psyched to make the Wall Street Journal, but it didn't make the first page. So, you're right. You're right. This is the Alzheimer's is the most costly disease to our society. It Yeah, one of easily one of the most challenging just sad damaging just just just obliteratingly terrible disease and you're right maybe that study should have made the front page I want you to know that that study was funded like barely between 10 and $12 million for a five-year study Like that's it. That's that's which is which is some $10 million is not not a trivial amount of money, but it's this was this was you know like, you know, paradigm shifting. This was a study that actually was, you know, move the needle and truly, you know, move things forward. So, if there is someone out there, you know, I'm not, you know, selling anything. I do have a book, but I just, I'm not trying to sell a book. I'd rather you help our research. I'm in academic medicine. I still have student loans. I live in a very small apartment. In academics, I don't make a lot of money. So if there's something, if there's somebody out there that wants to do something to help, please, we will make good use of the funds. I can give you a link. May I share the link?

What is the link? We'll put it in the show notes, but what is the link?

Sure. So it's an amazing opportunity because I just started a new position at Florida Atlantic University. I have an entire building that I can use. I have equipment. I have, I mean, this, now would be the time where a gift or support to our program could literally just fast forward progress. So the link, I'm going to give you the link, it's fauf like Florida Atlantic University Foundation, fauf.fau.edu/ALZP like Alzheimer's Prevention, fauf.fau.edu/ALZP. Sorry for the word salad, but if you remember that, it means that your brain's working pretty good.

That's okay, we're going to put in the show notes, so don't worry.

Excellent.

This is amazing. Do you want to know my secret for living a long and happy and healthy life? Well, all I have to do is check out my weekly newsletter, Mark's Picks, where I share my favorite tips for health, longevity, well-being, and lots more. Check it out and the link below. And who else is doing this around the world? Because there are other people also. And you've got the pointer study that was being done, the finger study that was done. There's people in Europe. Who else is on this?

Yeah, so, you know, in Europe, I think Europe's just a little bit more ahead in some ways. They have something called EPAD, the European Prevention of Alzheimer's Disease kind of program, and they're doing something pretty good. You know, I have collaborators throughout the country that I work with. It's not, this is, you know, I'm the one talking to you today, but, you know, we had, you know, 31 collaborators that we worked with on that research study. You know, we had a satellite program in Puerto Rico. We have collaborators in LA. You know, there's just the fact that there's only a handful of people that are focusing that, you know, if someone wants to go to a doctor for Alzheimer's prevention, Parkinson's prevention, Lewy body dementia prevention. We just started before I left Cornell, Parkinson's Disease Prevention Clinic. We're going to be starting one in Florida soon next year. But I think the fact that we're only having less than a dozen people focusing on the area of Alzheimer's and neurodegenerative disease prevention, there should be one of these programs and centers on every corner, in every community. Because if someone wants to talk to a doctor about how they can protect their brain health and be proactive, they should have every right to do that. And so while we do have a handful of people that are doing this, you know, we don't have enough. I literally have trained 45 or more people. I've been asked to consult for different programs in Canada and New York and Australia, three different programs in Australia. But we just don't have, I would say, the funding and the infrastructure to really make all these programs be able to talk to each other on a regular basis and we just haven't had enough, you know, support yet. And I think it's coming.

It's coming. It's paradigm shifting. And I just congratulate you. And I like to sort of close by having you share a story or two. And I like to share one and just give people hope and talk about what we've learned. And yes, it's an anecdote, but I think what's happening, and even the NIH is now recognized and funding what we call N of one studies, which is essentially looking at a person before and after treatment in a very sophisticated way that helps to validate the science about the change in their biology. And so to me, it's relevant. And in fact, that's how all good discoveries happen is through clinical observations and then extrapolating those and studying them and proving them. So tell us about your a few cases or one case that you'd like to share?

Oh boy. I mean, it's a beautiful thing that there are so many that I can't even think of just one. But, you know, I guess what I would say is after COVID, you know, COVID hurt us a lot because, you know, we were in person. We did the blood draws, we did the cognitive testing. And then when COVID hit, you know, we had to recalibrate. And what we did was we, basically put everything online. And now we do the cognitive assessments online. We can get the blood draws remotely. So if someone lives out of town, a third of our patients don't, you know, prior patients didn't even live in the state we were in. So, you know, we've moved to telemedicine, we've moved to remote care. And I guess what I would say is it also allowed us to take a deeper dive in some things like genetics. And what we've done over the last year is When we truly have the resources and time to go deep, and I mean not just as deep as you and I usually go, but go as deep as possible, whole genome sequencing, look at mitochondrial haplogrouping, look at polygenic risk scores, having a neurogeneticist, a PhD in Alzheimer's precision medicine. For a year and a half, we.

Went— Dr. Now you're talking, baby.

Dr. Oh, I got to share with you some of this stuff. We went deep on 17 patients and six of their family members. Now, remember, we spent a year and a half on 17 patients and six family members, which is not feasible in the normal thing. But what I can tell you is what we've learned in the last year and a half. Now, I have no publications yet on this. I have a draft manuscript on my desktop. I have Excel spreadsheets open on my desktop as we speak. At some point, I hope, in the next year to year and a half, we're going to publish a paper that has really, I think this will be my best or maybe second best contribution to science because there's a patient in his early 50s. Okay, so this is, I guess, where it comes down to. So, patient in his early 50s, this is the first patient we ever did this on. This guy is in his early 50s and he's got a young child, a couple of years old, and he was diagnosed with Alzheimer's disease. He was diagnosed with mild cognitive impairment due to Alzheimer's. and he's in his early 50s and he just had a child. Finally, he waited all this time and he has a child. We went as deep as any person science clinic research program could have possibly gone. And we found something in his genetics that explained, he's had high cholesterol since his 20s and 30s and his father passed away early as well. And we found the reason why he had high cholesterol. So he had been on a variety of different drugs. He was prescribed go eat a healthy diet, go exercise on a regular basis. That's what he was recommended. There was no precision, there was no details. What we did for him is we literally told him to do everything. He was insulin resistant. He didn't know it. His belly fat wasn't a big deal, but it was there. We literally did every single thing we told him to do. We changed one of his drugs. Now, this is again, this is one of the drugs we did use because of a genetic thing we found in his DNA. We added the drug, we took him off more drugs. Actually, he's on less drugs now than he was. We added some supplements and vitamins. We changed his entire framework. He doesn't eat breakfast anymore. He skips breakfast and he feels great. He's lost a lot of weight. It's not just about what you eat, it's about when you eat it. It's not just about how much time you exercise, it's about what you do and how you structure it. We put him on an exceptionally detailed plan. He's no longer having mild cognitive impairment. He still has preclinical Alzheimer's, meaning he still has amyloid in his brain as far as I know, but he has no symptoms.

Yeah.

He is functioning normally. He's now to the point where he decided to have another child when prior to meeting us he decided that he was probably going to retire early. We just created life by prolonging someone's brain health. And, you know, we have so many babies that have come out of the Alzheimer's Prevention Clinic because, you know, like women are coming to see us for brain health, but then they create life. And I guess what I would say is that we can really help people. And when you empower people to feel better and they go on living their life and they, you break the fear and you break the stigma. I had a young woman that said, well, I don't want to give, look what it's going through, look what I'm going through with my mom. I don't want to have a child. I don't want to do, I don't, I don't want to do this to someone. I don't want to give my child an Alzheimer's gene. and when you just have honest conversations and you explain, well, actually, that's not exactly how these genetics work. And Alzheimer's is going to be a different disease for you in five or ten years. For your child, that is the absolute furthest thing. So, you know, from whether it's breaking stigma, education or helping people in real time, I don't know. I've just seen, I mean, in some ways it's miraculous, but it's just, it's just, you good comprehensive clinical care.

If you love that last video, you should check out the next one for sure on getting to the root cause of all disease.

The idea that these diseases that are complex chronic illnesses are ineluctable, you know, you can't stop them, you can't see them coming, there's nothing you can do. But that is wrong. If you.