How To Heal The Brain And Prevent Alzheimer's Disease

Coming up on this episode of the Doctor's Pharmacy.

Alzheimer's is not a brain disease. Correct.

It's a systemic disease that affects the brain. Hey everyone, it's Dr. Mark. Now something I get more and more excited about every year is personalized medicine. Now when I began practicing functional medicine.

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Episode of the Doctor's Pharmacy. Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. Alzheimer's disease adversely impacts millions of lives, but the process of aging doesn't have to be accompanied by cognitive problems. And age-related cognitive diseases like Alzheimer's can be prevented and even reversed. They no longer have to be the death sentence so many of us have believed them to be. It starts with taking a good look at your entire body, not just your brain, to determine where imbalances might be. In today's episode, we feature three conversations from the Doctor's Pharmacy on how we can improve our brain health and even prevent Alzheimer's. Dr. Hyman speaks with Dr. Richard Isaacson on why Alzheimer's is not just a disease of the brain, but of the entire body. With Drew Proett on five things you can do right now to protect your brain from Alzheimer's. And with Dr. Dale Bredesen on what to look at in your body to.

Reduce your Alzheimer's risk. Let's jump in. 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's like when you have medical conditions, it 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. 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. 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, yes. 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'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 four pillars are huge. And then there's the fine-tuning with 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, 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 rubble, and they excavated it. But there's still figuring, they're still 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? Heavy metals, 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 may be 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. 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 gonna take like two seconds. I know it's your podcast, but you're talking, but I'm just gonna just talk about this one patient 'cause 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 gonna 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 1%. 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. 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 and 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 stelazine 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 that I was just shocked. And so, I think that 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 every story is instructive because this is...

I'll send you the article that I described as an editorial I wrote for a medical journal.

I'll just... because you'll go, wow, 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, E4/4s may be, you know, for example, E4/4s 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.

Like, smuggling my Turkish delights back to America.

And he's 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, I was at Weill Cornell Medicine for 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. Yeah. 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, you have to treat someone in a certain way to try to make them better. But we don't always have all the objective, you know, evidence. And, and the types of work that we do on patients, it's really hard to study. Like, I have empathy for people, you know, in our boat who are trying to study the rigorous, you know, rigorously study, because what's moving the needle to me? I don't care what's moving the needle. People were criticizing, you know, 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 symptoms. There's no drug that can improve symptoms. 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 as clinicians, I think we just have to do the best we can. And we want to 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, yada yada, but I'm going to try all the usual things. and, you know, something worked. So I think as long as we have honest conversations with our patients and, and, and do the best, you know, people like us that have academic appointments and are, are in that, you know, realm, I think we, it's, it's, you know, it's, 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, 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, you know, what's happening now is, 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, you know, look at different Diagnostics than we ever did before and find things we never found before. And, and within the diaspora of medicine, which is where I've been most of my life, there, there has, 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. But the question is, as clinicians, we never learn, well, how do we repair a microbiome that's off? 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 if we do, the average practitioner has no clue what to do with it. And I think we're all gonna, where all that's gonna 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, metabolomics and, you know, the understanding, 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, you, you know, we have 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? You know, it's got to be frustrating for you, too, because you see it, you see your patients get better and you go, hey, guys, like, why don't you try this? And what do your friends say who are also neurologists or memory specialists?

Do they think you're a quack or they like listening? Are they You know, I'm a pretty resilient guy. I gave my first talk in 2007 about, you know, how MCI, mild cognitive impairment due to Alzheimer's and, you know, in this pre-symptom, I didn't like that term. I just felt it should be, you know, prodromal at risk, you know, 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. You know, I started seeing Alzheimer's prevention patients in 20, 2009. Dr. Arthur Agatston was one of my mentors. Oh, yeah. Arthur.

Yeah.

Amazing guy. You know, he was my By attending at Mount Sinai Medical Center when I was an intern. Yeah, before the South Beach Diet, before he's known as the South Beach Diet guy. But to me, he's the Agatston 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 the big vine-ripe tomatoes. Now, I don't know if my reflexes are better. 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 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.

Now.

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, you need to follow people for years rather than six months or nine months or a year. So, 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. And if someone isn't willing to sit next to me and 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 then you see it again and you see it at Nine o'clock, 10 o'clock, 11 and then one o'clock, two 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 science, but you could 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, Richard, I'm gonna push back pretty hard on this for you because you keep talking about preventive neurology and preventing Alzheimer's, and yes, we should do all that. But your study, your own study, showed that you can not 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? You know, 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'll 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, you know, 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 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 even.

Though I I I I know where you're coming from.

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

And mind 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.

Oh, and 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, he 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 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 I think 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 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. Our goal is to do what we're trying to plan is more of a telehealth telemedicine study 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 site because we were the main site that enrolled it in New York, we're gonna 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, you know, we're, we're, the, the naysayers aren't going to have any tomatoes to throw because, well, I.

Mean, not, 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.

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And now let's get back to this.

Week'S episode of the doctor's Pharmacy. So give us three things that pretty much everybody can do.

Only three? Can I do five?

Do five.

Let's do five. Let's do five.

Okay, the first one is just upgrade your diet to food as medicine. Upgrade your diet to food as medicine. Cut out the processed foods. Cut out the sugar and starch. You know, you want to have it as a treat occasionally, fine. Not staples. Increase the phytochemical richness of your diet.

You know, and a great starting place for that would be the Pegan diet, would you say?

Yes. Pegan diet is way to go. It's just, it's all the Pegan diet essentially is, is non-denominational it's sort of like the, it's sort of like the Unitarian Church of Food. It's essentially, it's essentially like eat real food. Don't eat crap. Increase your phytochemical richness of your diet. Think of food as medicine. Personalize your diet. Eat whole foods. That's it. It's pretty simple. And second would be exercise. Do something walk, you know, do jumping jacks, burpees, do some weight training, do some yoga and stretching, just simple stuff. Sleep. Make sure you prioritize sleep. Super important. 8 hours. Make sure your quality sleep is good. And there's all sorts of great resources on how to sleep. And we've we've had podcasts on that. We have a lot of articles on that. and the last, obviously, is, is stress. And I, I think we talked about the effects of stress on the brain, but meditation, hugely important for brain function. And I think I was, I was talking to someone about a study that was just done in meditation and how it actually regulates biological age. So I think it's really cool. And then lastly, I would think, you know, in addition to the, the four basic foundational lifestyle factors of diet, exercise, sleep, and stress management would be taking a few of the right supplements. And what are those for your brain? Doesn't have to be crazy. Get a multivitamin with good levels of methylating nutrients, B12, folate, B6, and make sure that they're bioavailable, make sure they're the right forms of nutrients. Also, fish oil. Make sure you take fish oil. Your brain is 60% DHA, which is basically fish oil, omega-3 fats, or eat sardines, you know, three or four times a week. make sure you take a good level of vitamin D. You want your vitamin D of 50 or more, 50 to 7580 is good. You have to measure. Sometimes people need a thousand, 5000, 5000, 10,000, depending on your genetics and what you can absorb. But vitamin D is critical. And then, you know, that will be good for most people. If you want to go a little more, you can add magnesium. Magnesium is great for your brain as well. And relaxing a lot of your nervous system and it's great for sleep and stress reduction and so so those would be the five things that I would say would be critical. And those are things that are easy to do, they're inexpensive, and they're available to almost everybody. I mean, the supplements can be a little more, but everything else is stuff that you really don't need any money for.

Fantastic. I love it. So can you talk to us about the few things that we could be doing early in our 20s, 30s, and 40s to help us prevent dementia and Alzheimer's?

Absolutely Drew, I mean this is an extraordinary era to be alive. I mean thank God we're alive now and not 20 or 30 or 40 years ago because the science of brain health and the science around dementia and Alzheimer's has just exploded and it's taking a very different tack than the pharmaceutical approach which has been so focused on and literally there's been over $2 billion and probably 400 plus studies, all of which on pharmacology, all of which have basically failed. There's a couple of drugs that squeak through that have marginal benefit. Like, okay, well maybe you end up delaying admission to the nursing home by three to six months. Is that a win? Hell no. So what is actually emerging in the science now that's helped us understand a different way of thinking about Alzheimer's? the first is our understanding of what the etiology, the cause, the causes of Alzheimer's. And, and we call these things dementogens. I call them dementogens. And my friend, Del Bredeson, came up with a wonderful concept called a cognoscopy. It's like a colonoscopy, except for your brain. And it's the idea that there are a lot of biomarkers and things we can measure and look at that will determine your risk and trajectory around brain health and obviously even general health. so what we've come to understand is in your 20s, 30s and 40s, it's a critical time to act because when we look at the imaging studies and we look at early diagnostic studies and we look at the processes that are happening in the brain, we can often detect changes 20, 30, 40 years before anyone has their first symptom of memory loss. And that's staggering. And it sounds scary, but it's actually great news because if you detect it early, and you modify the risk factors and you optimize your biology, you literally can stop and even reverse this process. So it's obviously the things that we know as foundational for health, right? Healthy diet. And we'll talk about what that is. So what is a brain healthy diet? What's the importance of exercise and what kind of exercise works for your brain? Sleep, stress reduction, because stress literally shrinks your brain and causes dementia. No joke. The memory center in the brain called the hippocampus literally shrinks when you're under chronic stress. So foundational lifestyle factors are so key, and there's tweaks to them that are unique to keeping your brain optimally functioning. And then, of course, there's deeper layers on the cognoscopy to look at. What are your heavy metal levels like? What's your microbiome like? Do you have inflammation? Are you exposed to mold? Have you had tick infections? Do you have allergies? Are you sensitive to gluten? What's happening with your mitochondria? What's happening? with your detoxification process. All of these things are things that we can look at and measure and see where they're at. What's your nutrient status? I mean, just, just for example, if you are low in certain B vitamins like B12, folate and B6, and you have a high homocysteine of, let's say 14, which is even in the conventional Labs is considered, quote, normal. It should be like six to eight. But if it's 14, your risk of getting Alzheimer's is 50 higher, and that's just you know, multivitamin, basically. So we have so many amazing tools and techniques to use now to one, evaluate the dementions through a cognoscopy and to create a science of brain health and optimization, which is really what we need to do.

Now, you said 20s, 30s and 40s, but there's going to be a lot of people that are listening here that are 40 and above. Are they out of luck?

Or are they still big? That's me.

That we could be doing so that there may not be a diagnosis yet, you know, knock on wood. but are there still, is there still hope for people in the 40 plus crowd?

I hope so, because I'm in that crowd. And actually, a number of years ago, when I was 40, I had a brain scan, and it was freaking scary, Drew. It showed a really dramatic under functioning, hypo, hypo functioning of the brain. And when you see this, this hypo functioning, it has to do with various insults to the brain that can be reversed. And at the time, I had mercury poisoning, mold toxicity, Lyme disease. All these are reversible causes of cognitive dysfunction and decline. And so I worked really hard on myself to clear all these things, to get healthy, to get rid of my lime, to get rid of my mold, get rid of my mercury and many other things, get my microbiome healthy. And I repeated the scan, you know, about 10-15 years later, and my brain had completely healed. It was really amazing. All the brain blood flow is back, my brain function centers were working. And it was like, you can at any age. And I can tell you case after case, and we can get into it a little bit later. I can tell you case after case of patients have come to me with cognitive dysfunction, memory loss, early dementia, even more advanced dementia, and we see dramatic changes. So the brain is able to repair and heal at any age. And you always think, oh, you know, you have, got so many brain cells. And basically that's it. And if you drink too much and partied too hard in college. Well, you're, that's it. You're just kind of screwed and you're never gonna get it back. Well, that absolutely is not true. We know from actually autopsy studies, they've done, for example, on brain, I mean, sorry, on cancer patients, and they found that they, they gave them these radioactively labeled dyes that were only inactively replicating neurons. In other words, in new brain cells, you only see these, these, this thing being picked up if they were making new brain cells, and they literally were dying of cancer and they were still making new brain cells, which you could detect on imaging. That's really remarkable. And we know there's the whole field of neuroplasticity and neurogenesis, meaning we can make new brain cells, we can actually increase the connections in the brain. You know, I'm, I'm, I'm learning tennis. I'm, like, been in, and I'm 15 years or so into it. I'm keep improving and improving and working on it. And my tennis coach was like, yeah, this is really good for your brain and learning new connections. In fact, tennis players live an average of seven years longer. And part of that is you're constantly.

Working on different aspects of motor coordination, visual. It's like, it's a, it's a thing, right? So it's like you, you absolutely can modify this risk at any age. Just for clarification for the audience, what was the brain scan that you did? What was the type of brain scan that you did? And, would you recommend it to individuals who are listening today if they're trying to get a sense of where their brain health might be?

Yeah.

So, there are many types of brain scans. A typical brain scan for Alzheimer's is an MRI, which can look at both brain volume, overall volume of the brain and shrinkage. It can look at hippocampal volume, which is the size of the memory center of the brain, which shrinks with dementia and actually can grow back when you apply some of these principles of functional medicine to brain health. And that's sort of the standard test. And it can also look at amyloid. There's actually imaging that looks at amyloid plaque in the brain. So you can see various amounts of amyloid, which is the thing that actually seems to cause the gunking up of the brain. The question is, what is the amyloid? What's it doing? Should we be trying to deal with it? There's a whole deeper conversation we can have. it's kind of a rabbit hole, but essentially it's inflammation. And then there's even more advanced scans that can look at early inflammation in the brain. Now there's a sort of more advanced functional MRI scans that can look at inflammation. And those are really emerging. I, I honestly, if, if those were readily available and, and the cost was reasonable, which I think it will be eventually. Right. All the, we're seeing exponential Technologies where, where the price goes down and the, the power goes up, and we're seeing that across the spectrum, including imaging. When that happens, you know, we're going to be able to sort of really early assess these patients. What I had was a little different. I had a SPECT scan, which is essentially a blood flow scan looking at areas of the brain and blood flow. And it's, it's a more general test, but it really showed hypo functioning of many areas of the brain. And so you can actually modify that. I had another patient with early cognitive decline, and he had really impaired hypo functioning of his whole brain. And when we, when we treated him, I sent him back to Harvard, where he had the initial scan at the memory disorder unit, and, and it got better. And the neurologist there who was the head of the memory disorder center was so inspired that he started a brain health, brain health clinic because he's like.

Whoa, we can actually do something about this. So it's really, it was great. That's fantastic. And so just, again, clarification, because I know people are always curious.

So the spec scan, was that through, like, the Aman clinic or something? Yeah, that was for the Aman clinic. Yes, the Daniel Amen has really pioneered a lot of the work on the SPECT scan. And I did it at the Amen Clinic, so I did it twice there. So it was really great.

Fantastic. Now, let's go back to the common root causes of Alzheimer's and dementia. And let's talk about your brain and what you were seeing in that scan that you did when you were younger than you are right now, and that you were seeing that your brain wasn't optimizing and wasn't operating in a functional in the best high functioning way. So what was causing, what were some of the lifestyle factors that were going on? We'll get to environmental factors and we'll get to toxins and heavy metals and other stuff in a second. But what were some of the other things that you were doing that you think were that were causing your brain to shrink and not perform at its best?

Well, you know, I mean, I've led a relatively healthy lifestyle my whole life. Eat mostly clean. I surely was eating more carbohydrates back in the day when low fat was bad, was good, and pasta was the health food. So I was definitely on that train early on in my 30s and so forth. I exercised always, did yoga. I did have sleep issues. I think that may have affected it just working the emergency room, working long hours, not sleeping for days, being a single father. high stress. So it wasn't so much the diet and exercise part for me. It was more the sleep and the stress part. But but the truth is, Drew, that wouldn't have caused the level of cognitive dysfunction that I had. It really it really was these outside factors. And the truth is, for most people, though, for most people, it's the fundamental lifestyle factors. It's not the things that I had. And there's a subset of people who have, yes, who have heavy metal poisoning, who have mold exposure, who have Lyme disease, like Chris Christopherson had Lyme disease. was diagnosed with dementia, they gave him antibiotics and boom, he was better. So I think mine was a little bit of a unique case. It wasn't insulin resistant. I wasn't overweight. I exercised. You know, I tried to meditate, did yoga. I was working on stuff. But it was these other outside factors that are often ignored. And I wouldn't even just say ignored, but I would say that are, you know, not even on the radar. dismissed sometimes. Yeah, they're dismissed or not even on the radar of people who are actually fully engaged in the Alzheimer's research. However, there are leading Alzheimer's researchers that are on board with this 100%, like Rudy Tanzi at Harvard who discovered the PSEN1 genes, who's was one of the key sort of, it's one of the key researches in all of Alzheimer's research. He's on board with this. He completely gets it. So, there's a lot of opportunity for real change and I see more and more of this happening within the space. I see guys like Richard Isaacson, who's amazing. He's a, formerly at, I think, Weill Cornell. And he's actually done some incredible research looking at simple lifestyle interventions that are personalized based on biomarker analysis to what he was trying to do was just delay or slow the progression. I think they were shocked to find that by aggressively optimizing diet, exercise, sleep, stress, the nutrient levels, treating homocysteine, dealing with insulin resistance, dealing with all the variables. And by the way, he wasn't even dealing with all the things we deal in functional medicine. He was just doing the first pass, which is way more than most doctors do because they're looking at a single drug, a single intervention. They're not using multimodal, multidimensional interventions, which are, you know, lifestyle, broad lifestyle approach and so forth, and personalization. And he found not only did they not progress, but they actually reverse cognitive decline, which is incredible. There are other studies also that have been done. His was the most personalized and specific and had the most impact. But there are other trials like the finger trial, it's another one called the pointer trials coming up. These used lifestyle interventions for people with cognitive decline, optimizing risk factors, and they found significant improvement in cognitive function in pre-dementia patients. We call it pre-dementia or MCI or mild cognitive impairment. that's impressive because there is no drug that can do that.

Well, you were mentioning some of those lifestyle factors that are there for most people. It wasn't the situation in your case. Let's walk through them. What could a diet look like that was designed? If you had to design a diet that was supposed to shrink someone's brain and eventually lead to Alzheimer's and dementia, what would that diet look like? Again, this is a diet designed to.

Shrink some of these. For breakfast, you have a glass of orange juice, some fruit loops, a muffin, a bagel, and French toast with some maple syrup. And then for lunch, you maybe have a big bun with maybe some American cheese and processed meat. And then for dinner, you have a big bowl of pasta, a giant glass of a bottle of wine, and a side of bread and potatoes. And then for dessert, you got ice cream and cookies and, yeah, pretty much that's what you're going to be eating, which is a very inflammatory, high carb, high starch sugar diet.

And I'm sure there's some people that are listening today that are like, whoa, he just described my diet. Okay, so walk us through that. What is the common themes? What are the common themes?

Okay.

Of that diet that you just described and. and what's missing from it that makes it so detrimental to brain health.

So when I was in medical school, we were trained that your brain is the number one utilizer of energy in the body, the number one utilizer of glucose. It's, you know, it's like, I don't know, 2% of your weight, but 25% of your glucose consumption. And so you need, you know, the whole idea is you need sugar for your brain. Turns out it's not true. It turns out that your brain runs much better on fat particularly ketones, your brain is about 60% fat and that there's brain phenomena which they're calling type 3 diabetes, which is really what they're now calling Alzheimer's because inside the brain you get insulin resistance. Think of it as diabetes of the brain. And when you get that, you get increased inflammation, you get increased oxidative stress, you get the production of what we call AGEs or we call advanced glycation end products. Think of it like the crispy thing on a creme brulee or the crust of bread or the crust on a bread or crispy chicken skin. Those are proteins and sugars combining to form this crust. That's what happens in your brain. And you end up having this really terrible inflammatory brain degrading process called insulin resistance within the brain. And so you want to design a way of eating that keeps your insulin levels as low as possible. If there's one single thing that we know about aging and all age related diseases, the single common denominator across almost all of them, and there are exceptions, but pretty much for the common stuff, it's insulin resistance, meaning your body makes too much insulin in response to the carbohydrate load that you're eating. And it gets worse and worse over time. So it's a vicious cycle where you eat more carbs, you get more insulin resistance, you can eat more insulin, you eat more carbs because you're hungry and crave them, and you end up actually getting very high levels of insulin. That is just a disaster because when that happens, you're getting not only belly fat storage, you're getting increased hunger, increased cravings for carbohydrates, you're slowing your metabolism, you're causing your brain to get demented, you're causing heart disease, you're causing cancer, you're causing kidney failure, you're causing high blood pressure, you're causing all the things that we think of as disease of aging, and we treat them in silos. We treat them all as separate problems, but they're not. They're all connected by this underlying mechanism. So insulin resistance, I've written many, many books about it, but essentially, if you're gonna design a brain healthy diet, it would be extremely plant rich. So you'd get all the colorful plant compounds that you see from colors of reds, blues, yellows, greens, orange, purple, all in fruits and vegetables. So eat as many deep colored varieties of vegetables as fresh as possible, as local as possible, as nutrients dense as possible. Second is you need a lot of fat and fat is really important for the brain. So you need olive oil, avocados, nuts and seeds, and something called MCT oil, which is really a super fat. And the brain loves this fat. It's great for mental clarity. great for focus, it's the preferred fuel for your mitochondria, which is the energy production organelles inside your cells. So that's really key. And you also want a diet that's high in omega three fats. So you want sardines, mackerel, herring, small fatty fish, not the big fish, because that has mercury and that's gonna cause a problem. And you could even take fish oil. You also want a diet that's very rich in choline and B vitamins. So choline comes from eggs, comes from sardines, and also the B vitamins, B6, B12 folate, which are critical in this particular pathway called methylation. And I, I just tell you a quick story of a patient who was about maybe 75-ish and she was diagnosed with early dementia by her doctor and told to get her affairs in order. She was a very wealthy woman. She was on the boards of all these companies, but she couldn't function anymore, and she had to pull back everything. And she came to see me, and she had a relatively simple problem to solve, which is what she had. homo cysteine that was really high and a methylmalonic acid that's high. And those are blood tests that measure your a more accurate functional measurement of B12 or Folate and Folate. And so I gave her B12 shots of methyl B12. I gave her high dose of methyl folate and B6 and the whole cocktail of methylation support, which is critical cycle in your brain and in the rest of your body. And she was completely cured. And about maybe five, six, seven years later, she was like 84 or something. I got a call from her. I thought, you know, you know, because the thing is, with functional medicine, you're like, you get people better. You teach them how to take care of themselves, and you may never hear from them again. Right. So. Which is actually the good thing. You don't want an annuity of patients coming back for their refills on their blood pressure or cholesterol or, or their dementia medication. And I was like, oh, maybe she went downhill. Is she all right? So I was worried about her. So I got on the phone with her. I'm like, hey, how's it going? You know, she's like, well, I'm planning a trip to Bhutan trekking and I just want to know what I should take with me from a medical point of view. I'm like, oh God, okay. So, you know, sometimes it's as simple as that. Sometimes it's more complicated.

When a neurologist makes a diagnosis of Alzheimer's or pre-Alzheimer's, the best thing the neurologist can do is refer the patient to a functional medicine doctor to deal with all the things that are driving this problem. But of course, the neurologists have felt like, oh, this is our province. You know, we have to give the drug and watch you go downhill, which is really unfortunate. I think that's going to change. so absolutely, the gut is a driver. And I think one of the most interesting studies that was done in the last couple of years was a group, they were actually studying rodents, but what they were doing was injecting Candida. And they wanted to see how long does the blood-brain barrier keep the Candida. They injected it into the blood vessels and asked, okay, what happens when it goes by the brain? How long can the brain keep it out? And the answer was it went in immediately. So there is, yeah, Candida, this is in a normal animal. So the fact of the matter is there is much more communication just as you pointed out, and as Rudy has been pointing out, there is much more communication between the brain and the periphery than anyone thought possible. And what have the pathologists shown us? When they look in the brains of patients with Alzheimer's, what do they see? Herpes simplex in the brain, they see Candida in the brain, they see Borrelia in the brain, they see P. gingivalis from your dentition in the brain, all these different gum disease. So the bottom line is our brains are communicating with the periphery much more than anyone thought before. And as you said, we actually probably have a normal brain, as much as that kind of blows my mind, we actually probably do have a normal brain microbiome and we're going to have to have probiotics for our brain at some point.

Cognobiotics, right?

Cognobiotics, yeah, there we go.

Wow, that's incredible. Well, you know, the approach also that is needed is something we don't do in traditional medicine, which is how do you restore a healthy microbiome? And this is what the focus of functional medicine is, how do you take the symptoms that people have, or even they may not have any symptoms in the gut, but look at the environment in there and optimize it by taking up the bad stuff, putting in the good stuff, and using the functional medicine approach to really heal the gut. So I think what you're saying is that, is that each patient is different and, and some may have gut issues, some may have other issues. One of the other issues that really affects people is heavy metals. And, and there's been, you know, a lot of talk in the past about aluminum and Alzheimer's, but it was sort of, you know, sort of ignored. And, and I remember a patient I had, one of the first patients that I was like, I don't know what I'm doing with Alzheimer's. This patient's been diagnosed with Alzheimer's dementia. I have no clue if anything I'm going to do is going to work, but I'm going to try my basic framework of functional medicine to see if we can just take out the bad stuff and put in the good stuff. So I did a cognoscopy of sorts, got rid of the dementogens. And what was really striking about this guy, Dale, was he was seven years old. He was a CEO of his major family business, couldn't function at all. So it was in the corner, basically depressed and not functioning. Nobody wanted to be around him. and he had pretty significant dementia. But when I looked at his story, he grew up in Pittsburgh and he lived in Pittsburgh and there's a steel plants there. And almost every patient of mine from Pittsburgh is mercury toxic because they put coal ash on the streets, they put it on the fields, gets in the food, it's in the air, and he had a mouthful of fillings. And normally, you know, normally when you do a challenge test for mercury with a patient in functional medicine, you know, you see a level of 20 or 50, that's like you worry about that. It's high. Yeah. A hundred, you know, I've had, you know, maybe 20 in my whole life of doing, pay me 10, 20, 000 tests. His was 350. I'd never seen anything like that.

Yeah.

One other patient, I think I had 400, but almost nobody like that. And, and I got rid of his fillings. We detoxed it from the Mercury. He also had all these genes, like APOE double four. He had methylation Gene problems. It has to be vitamins. He had genes that affect insulin resistance. He had years of gut issues. He'd had, I eral bowel for decades and was on stellazine for his gut. And so he had all these, all these issues that we treated. So we fixed his insulin and blood sugar, we fixed his gut, we fixed his B vitamins, we got rid of the mercury. And the guy literally came back, like, ripped and Winkle from the dead. And it was the most striking thing I'd ever seen in my life. I was like, holy cow. Like, I just cured Alzheimer's.

Yeah.

And I'm like, and this was like 15 years ago. And I'm like, what? and that was really began the process of me going, wait a minute, the brain is so fixable if we understand the insults, which you have mapped out so well in the end of Alzheimer's, and if we understand how to actually repair and heal the system. So talk about mercury and the metals and how these affect the brain, because this is not to say that everybody with Alzheimer's has heavy metals, so they don't. But I've had a number of patients that makes a huge difference when you deal with it.

Yeah, but as you said, you know, a certain number of them, that is the key piece. And here's the thing, you know, I mentioned earlier, your brain makes amyloid when it is under attack by microbes because it's trying to kill the microbes. But interestingly, the gene itself that amyloid comes from, which is called amyloid precursor protein, is a gene that is responsive to metals. So there's literally a metal binding region on the RNA, this piece that's going to be making the protein. So it is, it responds to mercury, it responds to copper, zinc, iron. So this thing is part of what's binding up those metals. So it actually binds up. So what happens is you can actually give mercury. And as you indicated, mercury is literally a cause of Alzheimer's, not in everybody, but in a small group of people, probably something like three to 5% of all Alzheimer's patients, which still, it's a lot of them, there are going to be 45 million people with it who are the currently living Americans 45 million of us will develop Alzheimer's during our lifetimes.

Five percent is a couple of million of people have mental issues.

Exactly. This is a big problem. So this is why, as you said, you want to check this on everybody because if that's one of the contributors, you need to deal with it. And when you do, they do better. And it does, it increases the production of the amyloid and it both, interestingly, it induces the amyloid and it induces the tau as well. So it is a great way, if you want to give yourself Alzheimer's, take some mercury.

Ate some sushi.

Exactly.

But the funny thing is, you know.

That not everybody accumulates the mercury and it's a lot has to do with genetic creation. I personally had mercury toxicity and I had cognitive dysfunction. I felt like I had dementia. Really, I did. My level wasn't 350, it was 187, which is bad enough. Still. Yeah. And still bad enough. And so, I understand from a personal point of view what this does and it's one of the most potent toxins on the planet, probably second only to plutonium. It is the most potent neurotoxin. And it's inconsequential to me that we don't as a profession really think about the role of toxins. We check the blood levels, but that doesn't really reflect the total body burden of these metals. And so there are ways through functional medicine and the approach you're talking about to really do this. Let's talk about the next topic, which is, you know, hormones. And I think, you know, I've seen some really interesting responses to hormones around thyroid, sex hormones. This is what we call a trophic factor. So it's not something that's hurting you is something that you're lacking that your brain needs to function. So talk about some of the big hormonal findings and what you're seeing with these patients.

Yeah, and there's some elegant work published out of the Mayo Clinic a number of years ago where they simply looked at women who had oophorectomies for whatever reason. Take their ovaries out. I'd say take their ovaries. Moved it up the ovaries, right, at the age of 40 or younger who did not get B HRT versus one who not get hormone replacement versus those who did get hormone replacement. And even though the hormone replacement has been imperfect for many of these, there was a striking difference. The ones who did not get the hormone replacement had a more than doubling of the risk for developing Alzheimer's, even though the Alzheimer's wasn't diagnosed till years later.

Wow.

It goes perfectly with the science that we talked about earlier. This APP is looking for support, and when it does not get that support, it's flipping over to the synaptoclastic. It's saying, we can't support this brain. And it goes beyond just estradiol to progesterone and pregnenolone and testosterone and and all these things, thyroid hormone as well. These are all critical. And so repeatedly, people have come upon the fact that you're getting this at the time often when you're losing those hormones or down the road from this. And we see a lot of people now, something I never saw when I was training, people who are in their 50s, women who are going through menopause or perimenopause who have their first symptoms at that time. So for a number of reasons, it's huge. Not only the support side, but also as as Dr. Chris Shade has pointed out, progesterone is one of the most critical parts for your detoxification apparatus. So when you now get this relative lowering of so-called, you know, relative estradiol excess or estrogen excess, this is because you've lost both, but you've lost the progesterone to a greater extent. You are at increased risk for toxin related Alzheimer's disease and you're now getting this synaptoclastic burst. You are re-releasing these toxins, including mercury, that you have sequestered for so many years. So by multiple mechanisms, having too low a support from your hormones is a critical risk factor for cognitive decline.

Yeah, and there is controversy about hormone replacement, particularly around cancer. Do you worry about that?

Do, absolutely. And so I think it's critical to have people see experts in this area. You know, Dr. Anne Hathaway, Dr. Prudence Hall, and many people who are BHRT experts. who look at, you know, when's the best time to do this, what are the best doses, where, you know, when, if you, can you improve, get you get the better outcome than this worry. And yeah, there is a worry about cancer, although some of the studies have actually shown reduced with appropriate use of estrogen and progesterone reduced likelihood of cancer. So, you know, you really want to stack those against each other.

And there's very personalized approaches to this, depending on your genetics or family history. what actually is going on with you, what your biology is, and actually helping women to personalize the treatment using the biological hormone replacement, not actually the kind that comes from Horseshoe, which is what a lot of the studies were done. So, we don't even have big studies on the good stuff. All right, let's talk about nutrition. We're going to talk about diet in a little bit, but I want to talk about the widespread nutritional deficiencies that you're seeing. and how those play a role in the brain and cognitive decline and what are the most important nutrients we need to be focusing on.

Yeah, you know, it's amazing to me because we've got so many things working against us. And obviously, you've written probably more on this than anyone, looking at the critical nature of nutrients for your health, you know, looking at all, you know, changing the world one bite at a time and all these fantastic things that you've done and this Again, it just fits perfectly with the science that we've studied over the years. And so, Paul Clayton from Oxford has pointed out that we don't even have the nutrients in the soils that people had 100 years ago, 200 years ago. When we were thinking, these people, wow, they didn't know what they were doing. They were doing much better than we are because they actually, he's pointing out that Henry VIII had better nutrition than we do. Of course, he ended up being obese and had problems with arthritis and things. But the key is that they actually had better soil. So we've got essentially a triple whammy. Number one, we have poor soils and therefore we have poor overall nutrition. Number two, we're eating food that's way too high in sugar, obviously, and way too high in processed foods, all these issues. So we're eating stuff that's toxic. And then number three, we're not getting enough, nearly enough fiber, nearly enough phytonutrients. So we have this system. It's as if you took your car out and you're trying to drive this car that needs appropriate fuel and you're putting stuff in that is very low octane. It's just sputtering, it's spluttering, it's having trouble getting out of the block. It's just, you know, you might go a little way, you might, and that's what we're all dealing with every day. So if you start- Crappy fuel. Crappy fuel. You optimize those things. You get people into some ketosis. You get them appropriate fiber for detox and for their microbiome. You get them appropriate low-carb diet. You do, you get the appropriate night of phytonutrients. And by the way, one of the most common Deficiencies, choline. As you know, choline is needed to make acetylcholine, which is a critical neurotransmitter for memory and is reduced in people with Alzheimer's. And I've checked myself on a chronometer and I realize I'm not getting enough choline in my diet. We should be getting around 550 milligrams or so of choline each day. Which you get from eggs and sardines. from liver, obviously, organ meats, things like that, from oysters, things like that, a number of vegetables as well. Or you can, if you're not getting it from there, take some citicoline. This is why Professor Wortman from MIT found that citicoline is so helpful for synapse formation.

Yeah.

So, you know, lots of ways to get choline, but please make sure that you get enough. So all of these things are critical.

So what besides choline is so important for the brain?

Nutrient.

What nutrients?

I'll take flavanols. Flavanols and flavonoids, those alone, a study that just came out showing that over thousands of people, those who were in the highest quartile of flavanols had a much lower dementia risk than those who were in the lowest quartile of flavanols. So things like strawberries and things like grapes and things like that are all helpful to give you the flavanols and then the flavonoids, things like blueberries and things like that, all critical.

So those are like 25,000 different phytochemicals in plants. Exactly. And flavonoids and flavonoids are part of those. And so eating a rainbow colored diet where half your plate is vegetables is a simple take home to protect your brain and pretty much everything else that could go wrong with you. So we've got choline, we've got flavonoids and phytonutrients. What other major nutrients are an issue?

Well, you know, the minerals. So the key ones that almost all of us are deficient, as you know, in zinc. And zinc has become a huge issue because of COVID-19. So many of the people who are deficient in zinc are reduced and have an increased poor outcome, increased risk for having a poor outcome from COVID-19. So zinc, magnesium, iodine, potassium, those are the big four that most of us are deficient in. And then of course, vitamin D, as you know, the study that just came out about 10 days ago showing if you take the people who are low in vitamin D, they have a much worse outcome in COVID-19 than the people who have sufficient vitamin D. And of course, Alzheimer's Alzheimer's is no different. The same thing you see, people who are low in vitamin D, more likely to get Alzheimer's, people who are sufficient vitamin D, and of course, same thing in multiple sclerosis, high vitamin D associated with better outcomes. So, as you said, it's multiple diseases that all depend on these critical factors.

Dr. Dean Some of the most important things I found are B vitamins. I once had a patient who was about 80 something years old. She was on multiple boards, very successful woman. but was noticing depression and really severe cognitive decline and been diagnosed with MCI or pre-dementia. Told to get her affairs in order. She came to see me and I'm like, checked her levels and found she had really high level of something called methylmalonic acid and homocysteine, which are things that most doctors don't check but reflect your status of B12, which is methylmalonic acid and homocysteine, which is the folate and even B6. So I basically gave her B12 shots, high doses of methylfolate, which is a particular kind. Saw she had some genes that made her need a special kind of folate. she called me back and was doing amazing and all of her symptoms had gone away. And then a few years later, maybe four or five years later, she called me up and I thought, oh, I saw my schedule. I'm like, maybe she's not doing well, she's declining. I kind of worry about her a little bit. And she's like, Dr. Hyman, you know, I'm going trekking in Bhutan and I want to know what I should do to prepare and what I should be taking with. So I was like, okay. and I think, you know, sometimes it's that simple, but it's not always that simple. But I think understanding the role of nutrients and nutritional deficiencies is huge. It's far more common than we think. You can't get everything you need from food. I think a lot of the reason the studies on vitamins have failed in March trials, whether it's for cancer or heart disease, is because they're not dealing with the, the whole system. They're just like, if you're eating, you know, donuts all day, you can take all the fish oil or vitamin D you want.

It's not going to do anything.

The fish risk of heart disease, right? So you have to look at everything together.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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