How to Protect Your Brain and Reverse Cognitive Decline

Coming up on this week's episode of the Doctor's Pharmacy. If you're gonna design a brain healthy diet, it would be extremely plant rich. If you're a healthcare practitioner like I am, you know how hard it is to keep your medical knowledge up to date, especially when it comes to functional and specialty lab testing. You could spend a ton of time wading through the latest medical literature, but that can be hard to fit into an already busy schedule. A better answer is Rupa University. Rather than spending countless hours combing through reports, Rupa University hosts a free training session every week, led by an industry expert who provides up-to-date overviews of the labs, topics, and health concerns that you want to be focused on. Rupa University is the number one educational institute where over 20,000 practitioners a year learn about functional and specialty lab testing. If you want to level up your knowledge on functional lab tests, make sure to visit rupauniversity.com no matter your genetics or lifestyle choices. As humans, we all share the same basic needs like adequate nutrition, for example. But with the industrialization of agriculture and toxins in our environment, it's getting harder and harder to get your body the nutrients it needs through food alone. and that's where AG1 comes in. AG1 is a foundational nutritional supplement that supports your body's universal needs for things like gut optimization, stress management, and immune support. Since 2010, AG1 has led the future of foundational nutrition, continuously refining their formula to create a smarter, better way to elevate your baseline health. I drink AG1 every morning and I consistently feel more energetic throughout the day. I even recommend it to all my family and friends because of the results I've seen myself. If you want to take ownership of your health, it starts with AG1. Try AG1 now and you'll get a free welcome kit that includes a shaker bottle, canister, and metal scoop, along with 10 free travel packs with your first purchase. Go to drinkag1.com/hymen. That's drinkag1.com/hymen. Check it out. And now, let's get back to this week's episode of the Doctor's Pharmacy. Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy. There's a powerful connection between the body and the brain. What you do to the body has a strong effect on the brain and vice versa. Inflammation, insulin resistance, and stress in the body are three modifiable factors contributing to brain disorders like dementia and Alzheimer's. In today's episode, we feature three conversations from the Doctor's Pharmacy about how the brain can change when we adopt a healthy lifestyle. Dr. Hyman speaks with Drew Prodeau about the most important factors that impact brain health. With Dr. Elizabeth Bohm about two case studies of patients with brain disorders and how they were treated successfully. and with Dr. Dale Bredesen about the role of the microbiome in a healthy brain. Let's jump in. 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 wanna have it as a treat occasionally, fine. Not staples. Increase the phytochemical richness of your diet.

And a great starting place for that.

Would be the Pegan diet, would you say? The Pegan diet. 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. Eight 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 effect of stress on the brain, but meditation. hugely important for brain function. And I think 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 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 75, 80 is good. you have to measure, sometimes people need a thousand, 5,000, 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 forth. 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. 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 we call these things dementogens. I call them dementogens. And my friend, Dale Bredesen, 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 dementia 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 things 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 friggin scary, Drew. It showed a really dramatic under functioning, hypo, hypo functioning of the brain. And when you see this is 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 who've 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 drank too much and party 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, I'm 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 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. What were some of the lifestyle factors that were going on? We'll get to environmental factors and we'll get to, you know, 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, 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, the truth is, Drew, that wouldn't have caused the level of cognitive dysfunction that I had. 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. 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. I tried to meditate, did yoga. I was. 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 of most.

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 presenilin genes, who 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 us. 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 with 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 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 somebody's For breakfast, you have like 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 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 on a bread or a crispy chicken skin. Those are proteins and sugars combining to form this crust. That's what happens in your brain. And, and you end up having this, 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, it's 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-3 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 a high dose of methyl folate and B6 and the whole cocktail of methylation support, which is this 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 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. You know, sometimes people have tick infections or mold or they have mercury or they have other issues. But hers was relatively straightforward. So we look at all those things in food, how do we upgrade those nutrients through colorful cruciferous vegetables that are full of folate, Vitamins, how do we maybe eat liver? Liver is probably one of the greatest brain foods. I know people go, Ugh, liver, but, you know, I thought liver was like a gourmet food. Cause when I was in, in, a little kid, we lived in, in Queens and my mom, my sister and I in a one bedroom apartment and we were very poor. I mean, she worked as a teacher in Harlem and for dinner we'd have, fried onions and chicken livers, over rice. And I was like, this is a gourmet meal. It was so good. But if you, if you actually, it's, it's actually surprising. you know, we all think plant foods are the most nutrient dense foods, the most vitamins, the most minerals. If you look at liver and then you look at the best vegetables on the planet and you compare them side to side, basically the liver looks amazing and the vegetables look like, you know, chump change. And it's, it's pretty impressive to see. It's like, if you look at a bar graph, all the nutrients on the liver like this and all the rest are like down here. So, you know, there's a lot of ways to get these nutrients through food. obviously for supplements can be helpful, but the diet is so key. So lots of good fats, lots of phytochemicals, very low starch and sugar. And obviously, microbiome healthy diet. The microbiome is super important. So I've written a lot about this, but how do you create a healthy microbiome? It's really a critical factor through tending your inner garden. We're coming out with a new product called Gut Food, which is sort of a one-stop multivitamin for your gut. to help the bugs grow good and have good bugs in there. But there's a lot of ways to tend your inner garden through eating pre and probiotics, through eating lots of fiber, fibrous foods that actually help fertilize the good bugs. So that's also really important. So you gotta kind of look at the whole spectrum of your diet. How do you optimize for immunity? How do you optimize for insulin? How do you optimize for your microbiome? How do you optimize for your mitochondria? How do you optimize for methylation? So as a doctor, I'm thinking, I got this whole like pharmaceutical cabinet, full of powerful drugs that is basically what ends up on the end of your fork. And that's the stuff that actually really works and it works better than most drugs. And there's many studies on this. There's the men diet, which is showing really amazing results in terms of dementia. And it wasn't even that great a diet, honestly. It was like kind of a Mediterranean diet, a little bit healthier than most people eat, but they showed significant improvement in cognitive function. Hey everyone, it's Dr. Mark here. Now, a good diet is foundational to living a long, healthy life. But because our food just isn't as nutritious as it once was, most of us have to supplement to get all the vitamins and minerals we need. Unfortunately, finding a high quality, no filler supplement used to be a real challenge, but not anymore. 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So check out your area sweet green or go to sweetgreen.com and use the code code Mark five to get five dollars off your first order after signing up. And now let's get back to this week's episode on the doctor's Pharmacy. When you push the envelope, and I, I just did a podcast with my friend Kara Fitzgerald. It was amazing. They, they did a functional medicine, food is medicine intervention, very, very nuanced selection of different foods that specifically contain nutrients that regulate aging and your biology. And they were able to do this. really in a very prescribed way using food as pharmacology and actually reverse biological age by over three years within an eight week period, which is staggering. I mean, nobody's ever to show that even in these other drug studies, intervention studies, it's, it's, it's, it was mind-boggling and basically they didn't have supplements. All she did was basically use foods and identify the most important nutrients. around regulating biological aging. And she gave those nutrients in the form of food and it worked so much and it was so much more powerful than any other intervention. So that's the kind of thing we think about when we look at food and diet.

One of the things, including that study, which I'd love to have you talk about a little bit, was targeted spices, things like spices and herbs, like rosemary, other things. How important are spices and to be including in our repertoire when it comes to our brain health?

It's huge. I mean, you're Indian, Drew, and India is just like the king of spices over there. It's a country of spices. And I think it's a very powerful way to upgrade your diet with extremely powerful phytochemicals that are found in things like curcumin and cumin. I mean, for example, nigella seed, black cumin seed, is very effective against viruses and it's being used in poor countries, for example, for treating COVID. So, we really have to look at the world of spices as an adjunct to our, our pharmaceutical cabinet of food. So I have, if you look at my, I have, like, a giant drawer at home. It's like, literally, it's like this big, and it's, like, really deep. And I've got, like, rows and rows of spices. And I, I'm a very big spice guy because they're so powerful in regulating inflammation, detoxification. They're made the polyphenols in them can be great for your microbiome. So it's really important to think about using some of these things, like Rosemary and curcumin, like Peppers, chili paper, Peppers are amazing. So there's all kinds of things you can use, but I encourage people to really focusing on spices. This one patient I had who was just sort of striking. He came in with his wife and he was a CEO of a major, you know, company. It was his family business. He was unable to function. He was seven years old. He basically was depressed and cognitively impaired, memory loss, basically sitting at home in a corner doing nothing and has had, you know, mood changes because a lot of times people with memory issues of dementia get a lot of mood changes, their personality changes, nobody wanted to be around him, his grandkids didn't. And I'm like, well, I've never treated this before, but I'm gonna just try to get you physically healthy and see how it affects your brain. Because at that time, there wasn't a book on the end of Alzheimer's or any of this stuff. And although David Perlmutter, you know, talked a lot about how to treat the brain with neurology we really learned a lot from him. And this patient turned out, he lived in Pittsburgh, he had super high levels of mercury. And he also had a lot of dental fillings. And in Pittsburgh, all of my patients from Pittsburgh have super high mercury.

Oh, interesting.

And the reason is, I believe, is that it's the steel capital of America and they use coal for the steel plants and coal has mercury and lead. and it's used on everything. They put it on the fields, they use coal ash for instead of like sand on the ice, icy roads in the winter, they'll use coal ash. So it's everywhere. Right. And, and he also had pre-diabetes which was undiagnosed. He wasn't really overweight, but he had kind of a little belly. And he also had severe irritable bowel for 30 years. It was on stellazine, which is a sort of anti-psychotic, you know, relax, like tranquilizer, basically, which is kind of strange. Yeah. And he also had severe folate and B12 deficiency. He had high levels of homocysteine.

He had a lot going on, huh?

And methylnolic acid. So he had gut issues. He had vitamin deficiencies that affect the brain. He had heavy metals. He had pre-diabetes. Yeah. And he also had genetics. set him up for this. So he measured his genes, something called ApoE. And if you have ApoE4, you're much higher risk for dementia and you also can't get rid of metal. So he had ApoE double four, which is the worst risk. He also had genes that affect his folate metabolism, like MTHFR. So he wasn't able to process the folate he was getting from his diet. So he was sort of functionally deficient in these nutrients. And he had terrible gut issues. And so, we looked at all these things and I just treated his diet to get rid of the insulin resistance. I treated his gut with the 5R program which we've talked about on the podcast to reset his gut. I gave him the nutrients he needed in the right doses. I detoxified him from heavy metals and he literally came back to life. That's beautiful. And, I treated him for years and years and his memory was good, his mood was good. He was able to go back to work and function running his company. And you just don't see that with traditional medicine.

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

Things worse for him. Absolutely, right. So not everybody with pre-diabetes gets dementia, not everybody with mercury gets dementia, not everybody with gut issues gets dementia, right? But when you add all the up, it actually all makes sense. and I think we are often really focused on the pathology in medicine, right? We focus on the amyloid or the tau proteins, all these things that we see in the brains of people with Alzheimer's. But it turns out that those are so downstream as a consequence of all these other factors that nobody's treating.

Yes.

And we know that memory issues and the brain issues, whether it's depression or autism or ADD, or Alzheimer's, are inflammation in the brain.

Right.

And there's amazing studies of people who have terrible amyloid in the brain, but their genes for inflammation are different and they don't actually produce inflammation and they die completely cognitively intact with a brain full of amyloid. And all these billions of dollars of drug studies on amyloid just have failed.

Because we're just going downstream instead of upstream, which is what functional medicine does. Which is so fun to practice, right? We are spending that time to really get to know your patient, get their personal history, figure out for them what are the things we need to remove, what are the tacks we need to take away to help their body heal. And I think you're right, there's so many situations where we see people have huge improvements in their memory and cognition when we address what are their underlying root causes. Like I had a 75-year-old gentleman who came to see me and he was a professor. And so he was, you know, his brain was really important to him. You know, he spent a lot of time up there in his brain, and he noticed that it wasn't working as well. He was having a hard time with paying attention to when he was reading, he was getting lost when he was driving, and he was really frustrated and scared. And so we started to get his history from him. And, you know, I got a good detailed history. And one of the first things I noticed, even outside of the history, was we did his anthropometrics, right? So he comes into the office, right? He comes into the office and we measure his blood pressure, we measure his weight. But in our office, we also measure the waist to hip ratio. At the Ultra Wellness Center, we always are looking at that waist to hip ratio, right? Right, so we get so much information when we look at somebody's waist to hip ratio. Because if you're holding onto too much weight around the belly- Dr. Belly fat. Dr. That belly fat, that visceral adiposity, causes a lot of inflammation in the.

Body and it's a sign, it's a signal to us- Dr. That's all the organ fat. It's a different kind of fat than.

The fat on your butt, on your legs, right? It's really dangerous and drives so much inflammation.

Dr. And we can't just liposuction it away.

Right, because it's deep in there.

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

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

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

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

I'm more severe. I say 0.8. Yeah. Yeah.

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

Pre-diabetes causes pre-dementia.

Yes.

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

Staggering.

Especially since the fact that 75% of us are overweight.

Right.

And 42% now are obese. And it's all connected.

Right, and at least half of us have metabolic syndrome, right, in this country.

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

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

Don'T connect the belly and the brain. the brain. I mean, belly fat, the bigger your belly, the worse your brain is off. You're more likely to have Alzheimer's or you actually literally shrink your brain. The bigger your belly, the smaller your brain.

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

Yeah, the professor's diet wasn't terrible, but- no, he didn't think it was terrible.

It was kind of high in starch and sugar.

Right.

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

From a diet perspective. So, just to be clear about carbohydrates. So, like broccoli is a carbohydrate, but you're not talking about broccoli. No. So plant foods are all carbohydrates. That's what they are. Any plant food, whether it's orange, or broccoli or, you know, a potato, but they're not all the same. Right.

Right.

Certain carbohydrates are super bad for your blood sugar and insulin. Others are great.

Right.

So I always just joke and I say carbohydrates are the most important food for health and longevity. Why? Because we need a plant-rich diet full of lots of colorful fruits and vegetables that are low in starch and sugar. But if people are eating potatoes and bread, which you think, oh, that's fine whole wheat bread, but actually that's worse for your blood sugar than table sugar. And sandwich bread and potatoes and pasta. It may not seem terrible, but if you are someone who's carbohydrate intolerant, which by the way affects about 70% of Americans, then the ones who are overweight, then you've got to deal with that.

Right, and I always tell people, take away anything with flour in it, right? Even if it's gluten-free flour, 'cause some people are like, well, it's gluten-free. But if they've taken a grain and turned it into a flour, right? Then like with pasta or bread, then it's something that's easily digested in your body and it causes your blood sugar to spike, which causes your insulin to spike. And then that insulin causes us to gain weight around the belly and remember that belly. You get hungry and crave carbs.

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

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

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

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

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

Yeah, we like it less than five.

Not to brag, but mine is two.

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

So talk about fat in the brain.

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

So-: and the fat is like 60% of your brain is fat. So you need to be-: so it's omega-3 fats, right?

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

Because when you eat fat, you feel full. Right.

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

Yeah, people cut the starch and sugar and they don't eat the fat. They're gonna be hungry all the time.

Right, right. So that really helped him just, it helped him balance his blood sugar. Over time, he lost some of that 30 pounds. He lost most of the 30 pounds. We got him exercising because we know that can improve BDNF, that brain-derived neurotrophic factor. It's like miracle grow for the brain, right?

Yeah, yeah.

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

Now, one of my patients came to see me with a really pretty significant case of cognitive decline and dementia. And, he didn't pre-dementia, he had Alzheimer's, early Alzheimer's. His name is George. I'm using that, making it up, but anyways, it's a pseudonym. and he came to see me with his wife and he couldn't really manage his Affairs. He was less able to function at home. He had to withdraw from his family and social relationships. He had mood just changes. He wasn't really his grandkids didn't want to be around him anymore. And he was pretty desperate. And so was his wife because he felt himself slipping away. Now, we found a lot of different things. He had significant insulin resistance. You know, he wasn't really that overweight, but he had, like, big belly, like a little pooch in there in the front. And that, that was really a sign of visceral fat, organ fat, insulin resistance. So pretty significant insulin resistance, kind of pre-diabetes and, and that was a big factor for him. We also found he had high levels of mercury, and he had a lot of fish in his diet. He had a mouthful of fillings, so we, we had to get the mercury out of him, and we helped him detoxify with foods, you know, using kale, Water Crest, cilantro, all the Cruciferous vegetables, we use milk thistle, we use nutrients like selenium, zinc and some medications because we needed to actually pull the metals out of his system. We use something called DMSA. So, we got his mercury way down. It was extremely high, like 350, which is something that we never see on a urine challenge test. I mean, I think it might have been the worst I've ever seen. And then we kind of cleaned up his diet. We put him on a high fat, low glycemic diet with lots of phytochemicals. we actually also found he had methylation problems. So high homocysteine, low B12, folate B6. We got him on the right dose of folate B6 and B12. And we know that people have a high homocysteine of over 14 have a 50 higher risk of getting Alzheimer's. So this is a well-known phenomena in the research. Again, you know, doctors will check for B12 levels when they're checking for dementia, but that's kind of about it. After aggressive therapy for a year, which, which was matched to his genetics, we did his genetic profile. We found he had example, problems with genes that affect his detoxification, that affect his methylation, which is the B vitamins we talked about. We also found he had the APOE4 double four, which is a big risk for Alzheimer's. But even if you have these high-risk genes, you can actually change therapy to modify your diet or take the right supplements or do different treatments that actually help to address the genetic deficiencies. So we had, we had an amazing recovery. I mean, I was sort of shocked. I mean, I, I basically did this early on in my practice, and I was like, you know, I don't really know if this is going to work, but I'm just going to get everything tuned up. We treat the system. We don't treat the disease. We help the body restore balance. That's what functional medicine is. It's helping people get to a healthy ecosystem, so. Before I saw him, he couldn't manage his business. His grandchildren didn't want to be around him. He was really weird. When we basically optimized his biology, he was able to function again. His grandchildren loved being with him, and he got his life back. I mean, it was pretty amazing. He was able to manage his business again. And it was a shock for me because I was like, Wow, if this is true in this one patient, what is possible? And why aren't we focused on this? And why aren't we spending billions of dollars on researching these types of interventions based on functional medicine to help these patients. I mean, even if one person can reverse dementia, it's worth asking why. Now, people say, oh, it's an anecdote. Well, anecdotes become anecdotal and enough of them become actually, when done properly in a research study, proof of concept and actually something we should be doing. So we thought, you know, we couldn't reverse heart disease. We now we know we can. We couldn't reverse diabetes. We now we know we can. Same thing with dementia. We can actually reverse it if we get it early enough. and of course, you know, it's really important to get early. If you're way too late, it's pretty hard. But, you know, we can deal with all the factors that affect the brain, diet, exercise, stress. I mean, stress causes dementia, too. Lack of exercise. I mean, if you just take a walk every day, you reduce your risk by Alzheimer's dramatically. Right. A lot of nutritional deficiencies, environmental toxins, mold, lots of hormonal dysregulation can happen as you get older, lots of inflammation, even the gut. We now know that, you know, the gut microbiome when it's off can cause cognitive decline. We know that even oral, the oral microbiome can be bad if you have bad gum disease. So we know this stuff. I wrote this book 15 years ago, Ultramind Solution, and in it I talked about the microbiome and the brain, which at the time barely anybody was talking about. And now it's like, oh yeah, well of course. So basically the basic principles of functional medicine are quite simple. It's basically take out the bad stuff, put in the good stuff, optimize your biological systems. It's the science of creating health. So your body knows what to do when you basically unburden it from the things that are causing disturbances. For him, it was heavy metals, it was sugar or starch, it was, you know, problems with his, his microbiome that we had to fix. He had terrible irritable bowel for years as well. And so then we gave him the things he needed, the right B vitamins and so forth and the nutrients, and he basically recovered. One of the big topics that you cover is the microbiome, leaky gut, inflammation, Alzheimer's. And so most neurologists aren't saying, well, let me look at your digestive system. Let me look at your gut and seeing if there's inflammation there. And how does that connect to the brain? And then we talked to a colleague of ours, Rudy Tanzi, who's been pioneering some of the work around finding microbes in the brain. We thought the brain was sterile. We thought the brain had a blood-brain barrier that prevented anything bad from getting in. Well, it turns out that barrier is only semi-permeable and that things can get in. and they can be even microbes. So can you talk about this amazing research on the gut and the brain and the microbiome and how that impacts what we have to do with patients with Alzheimer's? And by the way, that patient that I had who had really had brain dysfunction, her main issue was her gut. And we fixed it up after decades of being constipated, needing enemas to go to the bathroom and laxatives and tons of bad bugs growing in there. It was just amazing what happened. We fixed all of that.

Absolutely. I think that when your 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. We have to give the drug and watch you go downhill, which is really unfortunate. I think that's going to change. Absolutely, the gut is a driver. 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 diseases. So the bottom line is our brains are communicating with the periphery much more than anyone thought before. 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. But, 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? Right. 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 each patient is different and some may have gut issues, some may have other issues. One of the other issues that really affects people is heavy metals. And there's been a lot of talk in the past about aluminum and Alzheimer's, but it was sort of sort of ignored. 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 has been diagnosed with Alzheimer's dementia. I have no clue if anything I'm gonna do is gonna work, but I'm gonna 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 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 and functional medicine, you know, you see a level of 20 or 50. That's like, you worry about that. That's high. Yeah. A hundred, you know, I've had, you know, maybe 20 in my whole life of doing, pay me 10 to 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 him 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 irritable 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 Rip Van 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. And I'm like, and this was like 15 years ago. And I'm like, what? And, and, and it was, 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 in the metals and how these affect the brain, because this is, this is not to say that everybody with Alzheimer's has heavy metals or 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 3 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.

5% 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. Eat some sushi.

Exactly. Sooner or later.

But the funny thing is, you know.

That not everybody accumulates the mercury and it's a lot has to do with genetic variation. 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, 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, and it's just, 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 thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman. And we'll see you next time on the doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introduce to you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week. week on Fridays, nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. This podcast is separate from my clinical practice at the UltraWellness Center. My at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. It's not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner now. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. And in keeping with that theme, I'd like to express gratitude to those sponsors that made today's podcast possible. Don't forget, there's a way to listen completely ad-free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap Try Free to start your seven-day free trial.