Stay Young: Daily Protocols To Boost Brain Health & Prevent Cognitive Decline | Dr. Majid Fotuhi

If you improve the biology of the brain, your cognitive performance improves. You can do things to heal it and make it healthier.

What are the things that are causing our brains to not function?

Yeah, the common culprits are poor sleep. Some people have difficulty falling asleep, some have difficulty staying asleep. And unfortunately, a lot of people think, well, sleep problems are common. I'm just I have sleep problems like everybody else does, but that's not true. Sleep problems are totally treatable. The other part is sleep apnea. When people sleep is fragmented because they snore or wake up, you know, sometimes they wake up 40 times or 60 times in an hour and it's terrible. They don't know because they're so knocked out. But when they wake up in the morning, they're tired and they're foggy and everything is sedentary lifestyle. poor diet and too much stress, too much anxiety. These are the common culprits. And of course, when I do blood tests, I do see vitamin D deficiency quite often. And after that, I see low B12 levels.

Low B12, elevated homocysteine, which is, you know, full A, B6.

Those are the common things I see. You know, it's interesting to me that people who come to me and they they're told with other doctors or they think themselves have Alzheimer's disease. They have bed and butter conditions. They just have multiple of them at the same time.

Yeah, that's right. You have to treat everything.

They see a therapist. Therapist talks to them about, you know, you should settle things and, or they say depression and they say a psychiatrist who prescribes a medication for them. Then they go to cardiologist because of their obesity and a cardiologist prescribes medications for their high blood pressure. and they may have sleep problems. They see a sleep specialist who tells them about sleep hygiene and may prescribe a medication for them. And, you know, so they have a whole bunch of medicines and they feel horrible. And what needs to be done is for them to take fewer medicines and do the things that increase blood flow to the brain, that rejuvenate your brain. You know, you saw your podcast, you talk about the garden we have inside us. I think that's great analogy because we have also garden here. And I think this is, you know, the, you know, everybody is biased about which is the most important organ. But as a neurologist, I tend to think that the garden here, and it's like, you know, when you garden, you flower your tomato plant, and, you know, three weeks later you see a tomato or two months later you see a bunch of tomatoes. And it's so rewarding because it wasn't there and it's there. And it's definitely because you took care of it. And what I see in my neurology practice is equally rewarding because we see these people who are tired and worn out and hopeless and they're just frustrated with things. And they say, Listen, we can do this for you. We've done it before. We have about 80% success rate. You will get better. And we go through this program with them and at the other end, they come back, they're dressing nicely, their skin glows, they're sitting upright. and I love it. That's the joy of my practice to see these people who look like a wreck and not six months later, not a year later, you know, six weeks later, they have some improvement. And by 12 weeks. Yeah. No, it's true. It's amazing how just, you know, 12.

Weeks can reverse off in a lifetime of insults. And, and, yes, I think, I think what you're saying is that, is that, you know, there's so many different factors that can cause brain dysfunction. You mentioned a number of them, but in my practice as a functional medicine doctor, I, I see even more things, whether it's heavy metal toxicity, Lyme disease or tick infections, mold exposure, leaky gut, inflammation from the microbiome, gluten sensitivity, and the list goes on. So really, it requires a very deep dive. And what's quite amazing about your program is that you do just the basic stuff with a little bit of tuning up here and there, and you still get remarkable results. And it's just so powerful. And there's so many other things you can stack onto that that now we're learning can help the brain, whether it's hyperbaric oxygen therapy or things like NAD. And there's a lot of stuff that's actually merging that and probably even accelerate your results, I would imagine.

Yes, I did check for Lyme disease in many of my patients. And, you know, I did not check for mold in all my patients. I would listen to hear a correlation. And, you know, I think you see a lot more of those kind of patients than I did. People who have this hyper inflammatory state, they have this tired look in their faces. it just comes, you know, again, I've seen patients for 25 years now. I get a feel for what this person's issues are. And, you know, I, of course, we do testing, and every once in a while, I get results I don't expect. But, you know, people who just have this totally worn out face and they're just sitting there barely talking. They're frustrated because they've been seeing so many doctors. I do find that those kind of patients, I asked about mold exposure or when did the symptoms begin? You know, they were fine until 25 and late 20s started. There's something new that happened to them. And so I do have a panel that serve I do level two for patients who didn't get better with my initial intervention.

And what do you do with that? What's level two?

Oh, so these are kind of things you just said, you know, check for mold. Dig deeper for possible infections, check inflammatory markers. I didn't get MRIs for everybody. I would get MRIs for them. A lot of our patients had the EEG. We look at their brain's electrical activity. That was very helpful for me because somebody sitting in front of me and the EEG was all blue. We use the color coding where red and yellow was hyperactivity. Green was normal and blue was, you know, lower level activity in different brain regions. So they were sitting in front of me and look at their EEGs, all blue. And I think, wow, that's abnormal. And then I would ask them, no, I would say, if somebody came to me with memory problems, the EEG was normal and somebody would come with the same degree of memory problems, but the EEG was blue, I would wonder what's wrong with this second person. you know, what's wrong with them? And that's where I find that they would have other things going on with them. And I think, you know, I said my program is 80% success and I think that 20% and 100% of patients get better. Like nobody comes and says, oh, I didn't see any improvement. Everybody who comes there gets better. And we have glowing remarks, you know, reviews on Google reviews that people say, you know, I changed our life, this and that. the 20 are people who did not statistically significant results on your objective testing. And that's the 20 that's not there. But, you know, pretty much everybody. And that's a no-brainer obviously. I mean, if you get somebody who doesn't exercise and you get them to, you know, tweak their sleep so they sleep better and, and change their mindset, I think one of the things I did for my patients. it was to help them change their mindset that, yes, we're gonna do this. You know, yes, I've had these problems for, you know, 10 years, 20 years. But brain is very malleable. And your brain is a tissue, is an organ, just like your skin, just like your heart. And you can do things to heal it and make it healthier. And those things happen to be the same things that are good for your skin and they're things for prostate and. For your eyes.

Right, right. It's not like there's one lifestyle that's good for your brain, but not good for your heart or for cancer or for your immune system.

Yeah, you do have to tweak some things for your skin versus your heart versus your hair versus your teeth. But the overall interventions that are good for the brain are good for prostate. And I was watching a documentary once about prostate cancer and things you could do to reduce prostate cancer. And the person talking was talking about exercise and diet and homocysteine fatty acid and meditation. I said, wait a minute, I tell those to my patients and you tell them.

Exactly. Exactly. It's actually just one human body and everything is actually designed to work well. And what we often do is do all the things that make it not work well. And by doing the basic foundational things of diet, exercise, managing sleep and stress just as foundationally and maybe a few supplements, it can have a profound effect on so many people. And it's more powerful than most medications we have to treat disease, and yet it's not being applied. And that's what's so great about your work. And you're not the only one. I mean, there's, there's many others in the neurology space, like Richard Isaacson from Cornell, who published data that was really compelling about the same approach, which is a kind of multimodal intervention approach based on addressing the particular findings in each patient on a personalized way. Dale Bredesen does the same thing. He's book called the End of Alzheimer's. He was at Cleveland Clinic with us on stage when we did our presentation. And so, yeah. And so I think, I think that sort of, there's a Zeitgeist change, and I think we're, we're kind of still stuck a little bit in the whole amyloid hypothesis or in the, you know, chemical imbalance hypothesis for depression. And, you know, it's really, it breaks my heart. You know, I have a, a very close friend whose mother is very severely depressed, and there she's on a pile of medications, and she's a zombie and really not better. And I'm like, wait a minute, depression's just a symptom. It's not a Let's figure out what's causing the depression and let's get her better. Our brains tend to not function as well and many people walk around with brain fog, with trouble concentrating, with paying attention, and even with significant memory loss. So you really pioneered a whole approach to rethinking how we take care of our brains. And I'd love you to sort of share as a neuroscientist how you first came upon this because typically as doctors, we're trained to essentially just, you know, treat and street, right? We basically, we have a terrible, terrible thing we say. What we say, we treat them, street them. Basically give them the medication or the treatment and not really figure out how to get people healthy, but just treat the disease. Or in neurology, the, the other thing we often say is we adios and diagnose.

What?

Diagnose and adios, right? We diagnose someone. Okay, Parkinson's, you have dementia, you have ADD, you have this. we basically say goodbye because there's not much we can do about fixing the brain. But the truth is, there's a lot we know. And, and I created a broken brain documentary a number of years ago that many of you can watch online. It's part of our Dr. Hyman plus community. And I think there's other ways to access it. Well, but it's really a map of a different way of thinking about the brain and how we can optimize our brain function. So let's kind of Jump Right In. You know, we're one of the things we're seeing is this rapid explosion in dementia in America and globally. I think six or six million or so are living with Alzheimer's now. It's projected up to 14 million in a decade or two. And the cost is, you know, half a trillion dollars a year to America. This is a massive cost because of the cost of taking care of these patients. It's the number one costly disease. And, and yet there are no real therapies for this or no real therapies that conventional doctors actually will will recommend other than drugs, which don't really work. There's been, you know, $2 billion plus spent over foreign studies, and not a single drug really has any real impact. Maybe they mitigate things a little bit. Maybe they delay your admission to nursing home for a couple of months. That's a successful study. So I think we really, we really need to rethink this whole approach. So what, what are the top things that people can do today to prevent cognitive decline and to optimize their brain function? What would be your highlights? Then we're gonna kind of dive into all of it?

I think it will help for me to explain how I got to where I am now.

Yeah.

I've been able to help a lot of people with brain fog or brain dysfunction, memory loss, attention, and we have seen remarkable results in the program that I have developed and is actually available on my website. But let me just tell you how, you know, ask me how I got to this point. You know, when I was in Harvard Medical School, I became really interested in brain and what happens to our brain with aging. And when I went to do my residency in neurology at Johns Hopkins, as a part-time job, I work in the Alzheimer's Disease Research Center. My job was to just see these patients who come every year and for us to monitor their progress. One of the study, looking at people for 30, 40 years that would come every year, we did questionnaires, testing, MRIs, and so forth. and I was curious that many of them who came with the diagnosis of Alzheimer's disease had diabetes, hypertension, sleep apnea, the things I knew would cause memory loss. And I was wondering, well, why do we call these people as having Alzheimer's disease? They don't have Alzheimer's disease. They have vascular cognitive impairment. So I digged in to see, like, you know, where do people talk about these things? And back then, you know, it was 1997, 1999, there wasn't much. And I was surprised. I said, well, this is so obvious. Yeah, I wrote some articles about how we are over diagnosing Alzheimer's. And then I wrote a book about this thing. It's called the Memory Cure. And in it I explained that a lot of things we call Alzheimer's is not really a single disease. There's a soup of different things happening over time. your, your blood vessels shrink and become hardened. You know, dementia is to be called hardening the arteries. And I remember from my medical school days when I actually helped brains of people who died and those who have vascular risk factors, had very crunchy arteries. You can actually. Yeah, yeah, yeah.

Yeah. Such Vision.

I never forget that I would hold their blood vessels and they were hard, like little pipes. As a healthy person's blood vessels are more malleable, you can move them around. And that book actually did very well considering that I was just a resident and fellow, you know, I was very happy. And I continued to work at Alzheimer's Research Center and I was an assistant professor of neurology at Johns Hopkins Sinai Hospital. I opened a center for memory and brain health. You know, back in 2002-2004, the idea that you could do things to improve your brain health was still quite new. Yeah, it was quite obvious. And I was like, you know, I can see sometimes you're frustrated about the fact that people don't know how important food is. And if we take care of people's diet, we can have such a huge impact on our country's healthcare and economy. And it's frustrating, like, come on, guys, this is so obvious, you know? It is. So I did that. I wrote several articles. I published an article, Nature Reviews Neurology. about how we have changing perspective about Alzheimer's. It's not just plaques and tangles. There's a lot more to it. And, you know, I wrote. And then meanwhile, I was following the literature, and some recent studies at the time, 2005, showed that you can actually grow your brain.

Yeah.

You exercise, you grow your brain, you increase neurogenesis. I was just amazed.

I said, you get new brain cells.

New brain cells. And then I read that meditation can grow your brain. And I thought, really? Just sitting there breathing slowly, meditating for like 15, 20 minutes for three to six months, you have anatomical changes in the brain. There's one thing for you to feel better, is one thing to change the level of neurotransmitters in the brain, is another thing to grow the brain to the extent you can see on an MRI. It's not microscopic, it's macroscopic. And then I was just blown away by the fact that an otherwise healthy person, we don't have to work with a diseased person, an otherwise healthy person can grow his or her brain. And the hippocampus, which is the memory center of the brain, is the part that grows the most. Hippocampus is the size of your thumb. You have one on the right, one on the left. And this part of the brain is ground zero for learning and memory. and this part of the brain shrinks by about 25% per year after age 50 on average. But there are things you can do to grow it by a lot. And as I will explain to you in a minute, we did it for our 12-week program. On average, people grew their hippocampus by 3%, which is equivalent to six years younger in brain age within three months.

Wow.

So then I wrote another public paper, and I published in Nature Reviews Neurology, which, as you know, is a very prestigious journal. And one thing I remember from back then, I think it was 2009, where I read that paper, I sent it for reviews. And you know, when you send paper for reviews, usually one likes it, one doesn't like it, and one is in the middle. When I sent that review article, I got three very positive feedbacks. Like these people said, yeah, he's right. This is right. And yet nobody else was talking about these things. And to me was, surprising that my neurology colleagues are too busy doing the same old things with the EMG, MRI, thread prescription go, where we need to hit the pause button and say, wait a minute. What we call Alzheimer's is really not Alzheimer's. It's the super problems.

And then a soup of problems. I really like that. It's a soup of problems. And I, I think, I just want to say something really important here. In traditional medicine, the diagnosis is King. You know, once you set these criteria for a bunch of symptoms, we say, oh, we know what's wrong with you. You have got Alzheimer's. But the truth is Alzheimer's is the name of people, of the thing that happens to people who have certain symptoms, right? You have memory loss and so forth. So it's not actually the cause. Alzheimer's doesn't cause your memory loss. Something is going on in your brain. And so there's many, many causes that.

Many different people will have different causes for their dementia. Yeah, it's interesting that Dr. Alzheimer himself, Alois Alzheimer in 1903 wrote a paper that talked about aging and dementia in people is because of multiple factors. He never said, I've discovered a disease. He just said, Hey, I saw these few cases. They have these unusual abnormalities. I don't know what they are. But the chairman of this department at the time wanted to make his department look better. you know, it was Berlin versus Prague back then, Hopkins, and he called it Alzheimer's disease. So he himself, he himself, I have a quotations that says that the convolution of the brain is because of multiple reasons. But anyway, you know, as I went along, I decided to start my own brain center and provide all the things that I know grow the brain for our patients and teach them, educate them about all the things they're not supposed to do. Because if you can stop the things that shrink your brain and do more things that grow your brain, then you're good. And if you understand why things are the way they are, you will continue that lifestyle for the rest of your life, which means you change your trajectory from getting demented at 75 or 79 or 82 to no 95.

Because a life of 105, right?

Exactly 105 things that you do actually affect telomeres. The same things that are good for the brain are also good for epigenetics and genes, as you know. So then I started this program and I published a paper in 2006. You know, when I came to Cleveland Clinic at the time, I had finished the paper and you got published 2006 in the Journal of Prevention of Alzheimer's disease, where we provide this 12-week program, which had three elements. It was an element of lifestyle modification, all the things you tell people to do, and had an element of brain training. And we provided targeted brain training for people. So someone had memory loss, we provided them with memory training. If they were slow to think, we challenged their processing speed with games, all fun games, and we provided biofeedback, a form of biofeedback called neurofeedback and other forms like HRV biofeedback. and we saw that people who came to our clinic twice a week for 90 minutes at a time over a period of 12 weeks had improved their memory. You know, a lot of the drugs you talk about, these are people who are like 60s and 70s and some 80s. Most interventions that are done for these drug trials look at the rate of slowing change in rate of decline. Not that people get better, is that they help to a certain percentage of patients get worse slower. They don't actually help patients get better from zero. You know, instead of going minus eight, they go to minus five, but nobody goes plus two. In our program, 84% of patients had MCI, mild cognitive impairment, which is the stage between normal and Alzheimer's disease, got better. They had objective improvements in the cognitive tests. So I was very encouraged with that. And then I thought, by the way.

Just to stop you there for a minute, Yeah. Okay, there's really no drug that has ever shown reversal or improvement in the treatment of dementia. There is no drug. There has been a trial called the Finger Trial, which is a large clinical intervention that looked at aggressive lifestyle intervention, optimizing person's health with diet, exercise, sleep, et cetera, aggressively treating all the risk factors, blood sugar, blood pressure, and they saw not only a slowing, not only a stopping, but actually a reversal of cognitive decline in these patients who already had early memory loss. So, this is really important people understand that you can go to the doctor, but they're not going to be able to give you anything that's going to address your memory. You have to do the things that Majid is talking about, which is essentially addressing brain fitness.

Absolutely. And the person who runs that program, Mia Kivimaki-Palto, is a friend of mine. We've been talking about how people got things wrong since late 1980s when we were in the Alzheimer's conference and we have sort of, you know, we see each other every year at the Alzheimer's conference. And I'm so proud of her for, you know, putting this large program in this program, this finger, conga trial is done in Denmark and Sweden where people already have a good lifestyle. You know, they are not in a place where obesity is a fun, you know, everywhere and people have poor diet. These people on average, eat well and exercise and are healthy on average person. So to provide a program to do, make them better and see results is really remarkable. If you do that program in a small town where people are obese and sleep apnea is common and smoking is common, drinking is common, you would see much, much more robust results. And my program is very similar to hers. Except that the difference between my study and her study is that we provided this in a real life clinical setting. This is not a clinical trial in an academic center where people come to the center for the purpose of clinical trial. This is a real life neurology practice where average person shows up and we provide this treatment for them. And the only exclusion criteria was that at the time they start, they wouldn't have schizophrenia or dementia when they start. they could have MCI, they could have memory loss, they could have everything else, but they didn't have a major psychiatric disorder. And I saw a few people just because in neurology practice, people show up. So the other thing we did, which was really fascinating to me, I mean, I knew that my program would work, but we did MRIs and half of our patients had a growth. in the volume of the hippocampus as I had expected. I knew it would happen, but the fact that actually happened for real, I remember the day I saw the MRI, I was just jumping up and down, oh my God, we did this. And, you know, one of our patients-.

Hold on for a second, Majid. So just for people listening, what he just said was nothing short of revolutionary. The hippocampus is the part of the brain that's the memory center. It shrinks often as we age, and it's very shrunken in people with memory loss. we've never seen anything that actually makes it bigger or grow. And now, this is what Dr. Fatou's talking about, which is this incredible science that allows us to intervene with people and actually help them not only slow and prevent the disease, but actually potentially even reverse all sorts of brain diseases.

And, Mark, if a drug had done this, it would be then vaccines for COVID. if a drug had done half of this, a third of it, a tenth of it, the drug had done a 10th of what we did, which is just improve people's cognitive performances or objective testings. You know, that never mind that actually grows the brain. And by the way, all the drugs that are current drugs for Alzheimer's disease all shrink the brain. And this is something that people need to figure out what happens. Anyway, so back it was, you know, 2007, 2008, I was so excited. I was providing this program. but since I had a neurology practice, I would also get patients who had concussion or other things. And some people have persistent concussion symptoms, something called post-concussive syndrome. And these are people who have had headaches or memory problems, they can't work, they can't think, they have irritability for months to years. And, and they've seen multiple doctors. Nothing has worked. So I had some of those patients, and I put them in the program, and I saw that our program worked for them as well. And the reason I think the program was so successful is that we had a multidisciplinary intervention. We didn't just say, here's a prescription for your memory or your headache or your sleep. I actually took the time to do an inventory of all their problems and then we addressed them. We addressed their memory, I mean, their sleep, their anxiety, their irritability with non-medication interventions. like things like meditation, counseling, exercise, diet, stress reduction. And we saw again about 80% of patients improved. We did objective testing, which is, you know, standardized neurocognitive evaluation. And we did a series of four or five questionnaires. We did like Pittsburgh Insomnia Assessment, we did up for sleep apnea, we did back anxiety, we did back depression. scales and we did my own questionnaires for brain fitness and multiple other questions.

And these are standardized, legitimate peer reviewed validated metrics for looking at mood, brain function and so forth. So it's not like this, hey, I think my memory was better. It's literally how we measure success in.

We used validated standardized tests and I felt that I needed to do my own. So I made three questionnaires. And one of the things that we found is that the questionnaires I developed for brain fitness paralleled with the results we saw in the standardized. And so this study also validated my questionnaires because we saw results in our own patient population. So it was exciting. We published that in Journal of Rehabilitation in 2020. And again, being a neurologist, I saw patients would come for attention problems. I had many patients with ADHD, whether they were teenagers, kids, or adults, or people in their 40s, 50s. The one thing I learned, and you referred to this earlier, is that we put a label on people. We say you have ADHD, but it's not like cancer, where you look at the mutation and you say you have colon cancer because of this. These diagnoses are based on a group of experts sitting together, making a list of criteria, and then calling it this and that. There's nothing absolute about ADHD. It's just a group of experts coming together and deciding this 5 out of 9 here, 5 out of 9 here, and they put a label on people. A lot of times people who have attention deficit disorder in my practice had poorly treated or untreated sleep apnea. Yes, they had attention problems and they did say yes to all the questions, but the real problem was sleep apnea.

Yeah, I mean, I think this is such an important point because people don't understand how screwed up medicine is and most of the diagnoses we have are really just description of symptoms and don't tell you cost. So when you say, I have depression or I have ADHD or I have Alzheimer's or dementia, it's like saying about headache. Why do you have a headache? Did someone hit you in the head with a hammer? Did you not sleep? Did you eat gluten? Are you having a hangover because you drank too much last night? Do you have a brain tumor? Do you have an aneurysm? There's a million reasons why you could have a headache and headache is just means my head hurts, right? And so the same thing with depression or ADHD or dementia, we have to really start to look at the personalization of healthcare and the individual individualization of our treatments that address the root cause or causes. And, and you're, you know, what you do is really radical, which is what we call multimodal set of interventions. Typically, doctors and science is all about the one thing, you know, one drug for one disease. Try to find that magic bullet, right? The silver bullet that's gonna fix it. And that's what most drug research is about. What you're talking about is, you know, doing all the things we need to help our brain. We need the right diet, we need exercise, we need sleep, we need stress reduction, we need all sorts of different things that we're gonna talk about that actually help to optimize your brain function and address through causes. So we really have to start to get this paradigm shift that's happening. And it's not just sort of on the margins of medicine. This is in peer-reviewed journals. But you're right, like if this was a drug, it would be the biggest blockbuster, it would be bigger than Viagra or bigger than Ozempic or any other drug, because it's basically doing something that nothing else can do about a disease that is devastating our society.

Absolutely. I think the key word you said is paradigm shift. We need a paradigm shift in looking at patients with common memory loss and realizing that it's not just the plaques and tangles, and as you mentioned, there will be several hundred clinical trials on eliminating amyloid, and we still don't have a cure. Yes. The newest drug that was presented in Alzheimer's conference does seem to have slowing of the worsening. One of my colleagues said, yeah, it's great. You get a drug that's going to help you stay in that confused state for a longer period of time. Yeah.

And by the way, it's like fifty thousand dollars a year or more.

And we discuss of death as one of the side effects.

But anyway, oh, by the way.

Yes. So in 2020, when I did that and patients with ADHD or ADHD came to see me, whether they were teenagers or adults, we provide this program and we saw again about 80%. This was like our sweet spot. And so I just published a paper in the Journal of Alzheimer's Disease Reports in June of this year. where we looked at three groups of patients who completed this program. It's a 12-week program where people get a full assessment at the beginning, cognitive testing, blood tests, and questionnaires. They go to our program twice a week for 12 weeks, and then we see the testing results at the end. We check them every week, but then we do formal evaluation at the end. And the thing that was interesting to me is that we saw similar results in three groups of patients with three different labels. And both cognitive tests and response to questionnaires show dramatic improvements. And to me, it shows that if you improve the biology of the brain, your cognitive performance improves. And so the question is not for us to put a label on patients and say, you have this and that. The challenge for us is to figure out why aren't you paying attention. You know, for some people, sleep apnea, for some people, headaches. Some people have so much headaches that they can't pay attention. They're tired, they're irritable because they're frustrated. They're driving, wears them out. They can't sleep at night. They're sleep deprived. The headache is worse. They get into fights and they can't think it straight. Well, listen, they can't think it straight. It's not because they have Alzheimer's or they have ADHD. It's because their migraine is not completely treated. and the other thing I find fascinating is that we do four things for our patients overall into the principle diet, exercise, sleep and stress reduction. These four things seem to help this group of patients with different presenting symptoms. The other thing I found interesting was.

You know, people also use supplements or anything like that.

Yes, I recommend omega-3 fatty acids. You know, again, I published a study myself in nature. early 2000 where I reviewed and did a meta-analysis and I found that people who had high levels of omega-3 fatty acids were less likely to get cognitive impairment and Alzheimer's disease. So I recommend it to people. I take it myself. But in people who do like to take multivitamins or other things, I, you know, I have no objection. But the one that I, it's a part of the program, we recommend Mediterranean diet. and supplements. And I totally like your idea of a diet. You know, you don't have to be fully vegetarian or fully a carnivore. You can have a mix. And as long as you stay away from processed food and you have a diversity of things to eat and fruits and vegetables and, you know, a common sense good diet is really what I recommend. And surprisingly, not too many people do that. You know, the thing I found interesting is that when I sat down with patients, I always spent an hour in the first visit with my patients where I would educate them. Now I have pictures of the brain shrinking, the bigger the belly, the smaller your campus, the more stress, the smaller your campus. And how.

Wait, wait, I just want to emphasize what you just said. The bigger your belly, the smaller your brain. The bigger your belly, the smaller your brain. Can you kind of unpack that for a minute? Because that's a big statement. And because so many people have a big belly. Right? Or even a little, a little big belly, like you don't have to have a giant belly. It could just be like a little extra poochiness in there. And that, that's going to have an impact on your brain.

Yeah. So this finding was first published in 2006. And, I have a slide that shows a correlation. Uh, if you cat body mass index and the size of the campus, it goes down the bigger the belly on average. Now, there are some people. who do have a big belly, but hippocampus is good. And there are some people whose belly is small, but hippocampus is not good. And I think that sort of puts, you know, emphasizes the importance of multi-factorial basis of this. So if somebody has a big belly, but that person does exercise and does use his or her brain all the time, not stressed, that person may be better off than somebody who's thin but stressed out, doesn't sleep, and has a poor diet and so forth. But on average, on average, there's a very clear relationship between the size of the belly and the size of the campus. And now this year, at the Alzheimer's Conference in Amsterdam, which I attended myself, there was an article by my colleague Dr. Raji that showed if you do MRIs of body MRIs of people and look at their visceral fat, you can see a direct correlation between the visceral fat and the size of the brain overall and particularly the size of the hippocampus. So, you know, in previous studies, they just do a sort of gross evaluation of being overweight, the body mass index, which is not perfect, but in this study of 10,000 people, they saw that there was a correlation between measurement, exact measurement of visceral fat and the size of the brain. And they put some pictures side by side, and you would think this person has Alzheimer's disease. This is, you know, a normal person. And the degree of shrinkage in obese people, unfortunately, is sad.

Yeah.

And, you know, when I showed these kind of things to my patients, they would definitely think twice to eat the kind of food they ate before. And the thing is that I feel bad for people who are overweight because they didn't choose to be overweight or obese. They didn't say, looking in two years, I want to be 200 pounds heavier. I teach about these things in University for my students, and I explain to them that this process is slow. You know, first you have this sugary food that spikes your insulin levels, and then you have hypoglycemia afterwards. So you tired and hungry, so you eat more. And that extra food that you eat, especially if it's can of soda or cookies or things that are not good for you, high in trans fats and high in sugar, that contributes to more of these getting packed in your fat tissue. And then you still have not enough glucose for your eyes and your brain, your nerves. and this process is sort of a gradual vicious cycle that gets you. And the other thing that happens is that it worsens the brain and the cognitive part of the brain decide how much you eat. So you've had your meal, you say, okay, I had enough, you stop because your stomach is stretched and you have to stop. But, you know, you see a trimasoo and say, look, I have to eat this. And that's your reward system. And then your cognitive part says, no, we've had enough. We should stop. So there's a usual balance and people.

Usually.

Maintain a balance of their cognitive and their emotional decision making or how much to eat. But one thing that happens is that when you eat too much, this system breaks down and the reward system shuts down the frontal lobe. Then when you see the food, you just forget about thinking about it. You become blind to the whole idea that you had enough. So I feel bad for people who are overweight or obese and I sympathize with them, but I also explain to them that it is doable for them to lose weight and it's never too late. So anyway, in our program we did diet, exercise, sleep, stress reduction and we saw remarkable results because I think what we do is that we improve the biology of the brain. We do the investigative work at the beginning to find the five or six causes for a person's suboptimal cognitive function because their brain is not healthy, and focus on those things in a personalized, individualized program within the 12 weeks.

And I wrote a book, gosh, I don't know, 2009 was published, so I probably wrote it in 2007 called the Alter Mind Solution, where I really mapped out a lot of this. And I didn't have chapters on Parkinson's. Yeah, I mean, I didn't write chapters Parkinson's or dementia or depression or anxiety or bipolar or schizophrenia. Didn't write or autism. I didn't write chapters on all these different problems because they all have common causes. So I talked about how do we optimize our biological systems? How do we optimize our biological networks and tune things up and remove the things that are causing damage to the brain and add the things in that are actually helping keep the brain healthy? And so that's what you've done. And it's really remarkable. Your work is this is, you know, listen, I'm a practicing physician, haven't published that much research, but you've been publishing research and designing programs, working at academic centers. And I think this is exciting. I'm wondering what your colleagues think. They go, Magi, that's nice, but let's.

Do real medicine or what are they saying to you? I tell you, you know, basically you said, you know, there are stat neurologists who are skeptical of with these things. And one of the questions I get is that, you know, you don't have a placebo arm in the studies. The one good thing about the finger study, I give credit to Mia Kubelt for doing that, is that they do have a, first of all, they have a large control trial, and they have a control trial where people just do the same as usual, which, as I mentioned, for European countries is pretty high. But I feel like as a neurologist, how could I have a placebo for my study? Like I teach this meditation, I tell people to do diet changes, sleep changes, improvements, and it's hard to really do a controlled trial for these things. And the other thing is that some things are so obvious. As I mentioned, they're no-brainers. If you improve exercise, you have increased blood flow to your brain, that's a good thing. You really need, I mean, at some point, things have been done so many times that are obvious. And I feel like the fact that I took a bunch of things that are, that have been shown by hundreds, if not thousands of our studies that are good for the brain and combined them into one program.

Yeah.

It's a, it's like obvious why, why why are you arguing with that? What is the, like, I mean, you know, you know what? You know why?

It's like we're stuck in this old paradigm where, you know, if we want to approve something, we have to just do one thing. Okay? We want to know if exercise is good for the brain. Just change that one variable. Get people to exercise, but don't change their diet. Don't get them to sleep better. Don't. People stress. Don't make sure their vitamin D levels are okay and their mercury levels are low and their thyroid is just do one thing or, you know, let's just do. Let's just do, you know, meditation and see if that works. And. No, nobody understands that the body is a system, and you have to do everything. You can't just do one thing. You have to tune all the dials. It's like you're. It's like, you know, if you want to just sort of grow a plant, I always say this analogy, but you can't just, you know, put it in the soil and have no light and no water, or you can't have no soil, you know? and light and water. And you need all the things, ingredients you need for health.

That's an excellent analogy that you need. And the reason is, I guess it goes back to a dogma that if you have memory problems, you have Alzheimer's disease, this is found in drug. If you have attention problems, you have attention deficit disorder. And, you know, we put a label as if we know what caused it. And then how could you come up with a single intervention when we know that most people's symptoms are because of multiple issues, that that is well established. I rarely had a patient. I mean, I think that early onset Alzheimer's disease is a disease. It's a unified bad thing that happens to people. And it's not because they didn't have good lifestyle. If somebody at 52 cannot operate their microwave, cannot drive, cannot do reading or do simple things. That's because they have a disease. They have, and you know, some of them have the genes that increase amyloid, and that is a disease. And I don't argue with that. But once you go to your 70s and 80s, only 12% of people have mostly amyloid and nothing else. And, you know, multiple studies have shown that multiple studies, one in 100 blue, one in Chicago. Several studies have shown that if you look at thousands of people who participate in this longitudinal study, similar to the one I did at Hopkins, and you chop the brain and look at it, 10 to 15% of the time you find only one thing. 85% of the time is a super problems. There's some amyloid, there's some vascular impairment, there may be some synuclein that you see in Parkinson's disease, and, you know, this increased inflammation, huge amount of inflammation. So, you know, an average 75 year old has at least four things in their brain that accounts for their memory or attention problems. So it's how could you expect that one drug work? And I think one reason the clinical trials fail over time is because different people have different issues. And I think one thing they've done recently that has increased the yield for the anti-amyloid is that they do an amyloid PET scan and they seek out a small minority of people who have mostly amyloid in their brain. This is the minority and they give drugs that reduces the amyloid and they see a slow reduction in the rate of worsening. And so they think if amyloid was everything, then they should be explored anyway. that in these studies, they do show complete clearance of amyloid, yet the persons are a little less worse. If amyloid was culprit, you, you cleared the brain. They have this impressive before and after slides that show the newest anti-amyloid drugs clear. There's like the brain doesn't have any more red on it. But if the brain is free of amyloid, why is it that the person is less worse? Why is the person not better if amyloid. Yeah, the culprit.

Well, Rudy Tanzi from Harvard is, you know, talks about patients, for example, have brains full of amyloid, but on autopsy, when they see my optic, but they have no inflammation, they have some weird gene that prevents them from having inflammation. And with no inflammation, there's no Alzheimer's. And they had perfect cognition at the time of death, even though their brains.

Were full of amyloid. So instead of, you know, Alzheimer's, you know, goes stages one to six. And there are several reports actually that there are people who have stage six Alzheimer's in their brain and yet in life they did not have memory problems. They did not have any reported problems. They just had a life and they did not act or appear to have dementia. And so that's possible. So I think amyloid is a particular thing on the side I would never have any of my family members try these medications that are recently approved by FDA. I think FDA approving it is a mistake because they don't make the patients better. These medications are expensive. That's fine. I mean, these drug companies do spend billions of dollars making these things. So let them have some money. It's fine. But the thing is, they're hardly effective. The effect size is small. you know, and also they have high side effects and increased the fatality and they have infusions. It's not like a supplement you take.

Yeah, no, it's super expensive too. It's really.

Yeah. So I think, I think the principles that apply to the brain are the same things that apply to skin and the heart and the bones and eyes, and they are well established. Nobody would argue, I don't think this day and age, anybody would argue with you that eating a healthy diet is good for you. I don't think anybody would say, well, wait a minute. I beg to differ. Nobody says that. I don't remember anybody said, I don't think that's a play. I think everybody unanimously agrees that a healthy diet is good for you. And everybody agrees that exercise is good for you. Everybody agrees sleep is good for you. And everybody agrees that stress reduction is good for you. So there's unanimity on the fact that these four things are good for you. and I think what we did is that we said, okay, let's coach people to incorporate these four things in their lives. Because if you're already tired, if you already have brain fog, you can't organize your days and your schedule to have some time for exercise, to have a better choice of what you eat and to do meditation. You just are overwhelmed already with your job and your kids and driving and everything else. So our brain coaches, they're like cheerleaders. They say, look at Miss Smith, we're gonna do this. We're gonna walk five minutes a day, just five minutes. We're not asking too much. Until next week. Next minute, no, please walk 10 minutes a day. And by the way, just cut french fries from your diet. Don't, we don't ask you to totally change your diet. You have a junk food, but just cut one thing. And the third week, I mean, and the thing was when people made those minor changes, even with those minor changes, they would see results in their own day-to-day life. They say, oh, I had difficulty memorizing phone numbers and now actually you can see, I don't know, I don't know what you did or just a coincidence. And then a week four, they say they would actually have seen some improvement in by week four. They even said, look, how about walking half an hour three times a week? And, you know, and then really don't eat junk food.

Food.

Don't change everything else. Just don't say no to cookies and no french fries and try to get your food from a farmer's market as much as you can. I love this pharmacy with an F that you put. And so, you know, by six weeks, when people came back, we had shown them some meditation a little by little, but that's not easy. And I think I think I give credit to my brain coaches who are so patient in dealing with our patients. And, and, you know, we had very small attrition rate. It only had only seven percent attrition, which is 93 of people who came to the program. It's a 12-week program and twice a week, very few people dropped out of the program and people drop out.

Is this something that you have to come see you or can this be online? I think you have program on the website.

We have it on my website, drfatihi.com, and I outline the questionnaires that people need to do.

And we'll put all this in the show notes so everybody can track it.

And, you know, the interventions that we did for operation, for our patients are available. I think what would help people who want to do this on their own is to have a partner, whether it's a spouse, their best friend, someone who would partner with them and they would do it together because they can encourage each other and they have some accountability. I think the most difficult challenge was the first two, three weeks when people.

Had to break away from- A behavior change, yeah.

Yes. People have routines. People have a routine for what they eat in the morning, what they eat for lunch, what they eat for dinner, what they do. And those routines need to change. But once the routines change, that's how it is from now on. You don't have to think about it anymore. Once you have a routine of just eating fruits and vegetables and legumes and high fiber, it becomes just a common way of looking at things. You don't have to think about it anymore.

Yeah, I mean, it does take... There's a lot of science around habit change, behavior change, there's a lot of supports, there's coaching programs. Be the Health is a great one where or you can get support or just, you know, getting your friend or your spouse or your partner or your kid or somebody to do it with you makes a huge difference. And I think there's books like Atomic Habits and there's no lack of resources, but it does require just setting the conditions up for success. If all you have in your house is junk food, then that's what you're gonna eat. I mean, I was listening to a podcast the other day with Bill Maher and he was talking about how, you know, he, he doesn't, you know, what's going on, obesity in America and the challenges and problems with it. And he understands, you know, he says what it's like to be hungry. And he, you know, he smokes pot and he gets the munchies. But he says he makes sure in his house he doesn't have any crap so that when he gets the munchies, all I can eat is nuts or something like that and not get into trouble eating a bag of cookies. So it's really making your home environment safe, setting things up for Success. You know, I, I have that in kitchen. I have on my counter all my smoothie ingredients out, all my supplements that I want to take all bagged up in little baggies so I don't have to like go sort through all the bottles all day. I have my workout station in my house where I have my bands and all the little things I use. I have everything set up so that it's not a huge effort or friction to actually do it is good for me. And I think that's really important for people to understand that you have to make it automatic and easy. And once you build those habits and structures in your life that it's not something you have to think about, right? I don't really think about it. It takes me five minutes. I do it. Not a big deal. So, I feel like what you're really sharing with people is a revolutionary idea, Majid, that actually our brains are fixable, that we often have broken brains as I say, and we have this sort of dysfunctions that are treatable, that are based on modifiable causes. And, I'd like you to sort of unpack a a little bit, you know, we know, for example, for heart disease that, you know, what are the modifiable risk factors? Your cholesterol, your blood sugar, smoking, exercise, you know, making sure, you know, sleep apnea. There's things we know that make a huge difference in preventing heart disease. And it's, there's been, you know, billions and billions of dollars spent on teaching people that, on educating people that, on teaching doctors about it. But doctors are clueless when it comes to how to fix brain and what we can do and what are the modifiable risk factors. So can you talk about what those are and what we need to be thinking about and how we start to sort through our sort of own personal history as well as our patients as doctors to really understand what are those modifiable risk factors?

I think one easy way to think of it is the things that are good for the heart are good for the brain. Many of the risk factors, the modified risk factors, that apply to the heart apply exactly to the brain as well. For example, stress affects the heart and affects the brain. Poor diet affects the heart, affects the brain, and poor sleep affects the heart and affects the brain. And the one thing that is different here is a degree of cognitive challenges that you put yourself up for. You know, a lot of people retire, stop using their brain as much and that accelerates their cognitive decline. And brain training doesn't have to be like, you know, using apps that you sit down and, you know, play chess or play memory games. I think one thing that can be done is for people to explore the world around them. Have a sense of curiosity, a sense of trying to learn something new. for example, a person can try to learn a new language or try to, you know, take a class for pottery, took a class for dancing, things that require multi-sensory involvement are actually better for the brain than compared to those that are just sit down.

So I'm not playing tennis because I'm like, I started tennis when I was, you know, 45, and so it's not easy for me. I have to really think about it and. I was working on my backhand yesterday and it's like you're kind of creating new pathways and it's constantly challenging. It's in multiple directions. So I really love that.

Yeah. You know, my brother Omid Fatouhi is a psychologist and he told me something that's really interesting. And he said, you know, you need to look forward to failing. A lot of people don't try new things. They say, I'm not good at it. you need to say, look, I'm gonna enjoy failing the next hobby or challenge that I pick. And go for it. Go play tennis, mess up your backhand, and laugh about it. Say, see, I did it. And because a lot of people have this barrier to learning new things because they feel intimidated because they're not good at it. A lot of older people may not come Feel comfortable with the, all the, IT progress we've made in terms of the different gadgets on the phones and different gadgets to, you know, adjust the temperature in the house from remote to all these things. You could, you know, these days we have so much electronics all over, all around us. And there is still some LL who still have those flip phones. They don't want to try a new phone because they feel uncomfortable trying it. so I think a good way to do things is what my brother Omid said is, you know, look forward to failing, try new things. And if you fail, say, see, I did it. And keep doing it. And as, you know, your brain gets better the more you do it. One of the quotes that I always share with my students and my patients is that practice makes cortex.

Cortex without a.

That accounts for all your cognitive abilities, whether you do your taxes, type your email, have a conversation with colleagues, everything you do is your cortex, which is like a blanket on top of the brain. Here's my brain model here. You know, your brain here, your brain has this outer layer called cortex. And then your frontal lobes are important for decision making and planning. And the temporal lobe is important for memory and parts of the temporal lobe are important for regulation of emotions. And here's, you know, a primate lobe that's important for math and calculations, part of brain for navigation. So different parts of the brain, the cortex, have different functions. And what happens is that that when you do things that challenge that particular part of the brain, that part of the brain grows. So for example, let's say you decide to do a lot of math exercises or you decide to learn a new musical instrument, the parts of the cortex that are involved in doing that task grow just like your muscles grow. And the more brain you have, the more brain reserve you will have when you get to your 80s and 90s. So hippocampus is part of brain for memory and is the size of your thumb and sits inside your temporal lobe like this inside it. But all these other cortical areas are important for your abilities to do the things you do every day. And the more cortex and hippocampus you have, the more functional you will be in the future. And so, for example, one study showed that if you learn to play golf, the parts of the brain that are important for hand-eye coordination and planning your movements literally grow. They did MRIs at the beginning of this 72-hour golf lesson. And then, you know, after that, and they compared MRIs and parts of the frontal lobe actually grow. So I think that growing the brain is easy. It requires a good blood flow to the brain, good nutrition, low levels of stress, but brain training does make a difference. Let's talk about that.

What is brainer size? You know, we talk about exercise. What's brainer size? How do we exercise our brains? It's not something we think about. We know how to lift weights. We know how to go for a run, but nobody talks about that. Yeah.

Let me explain one thing, and then I will answer that question. You know, we're talking before that people say, oh, this. this intervention didn't work is because it was an isolated intervention and a patient has multiple issues. And that's why that isolated intervention didn't work. Whether or not brain training is good for you is controversial. Some people say, you know, studies show that people who played chess or did these brain games did not have any difference in the outcome two years later, eight years later. Well, I think the problem is that you can't do one intervention and see results on like outcome, like whether or not you're demented. Because if this intervention helps something 5-10% and the cutoff you've set up to see results require 80% or 60%, you did have result, but you failed to capture that result. And the other thing is that if you do that and somebody who exercise and do other things, then you will see results, but you're cutoff. So if you have sleep apnea, certain lifestyle and poor diet, and you just sit home and just do these brain games on your phone, don't expect that six months later you feel like so much sharper.

Right, right. Yeah.

Sleep apnea is your enemy. And you can't just do brain games and expect that six months later. So I want people to appreciate that you need to put things in the context of a personalized multimodal intervention. In our program, we provided coaching for diet, exercise, sleep, and stress reduction. And this was all in the category of lifestyle modifications. And then we had a category of brain training, and then we had a category of feedback. So brain training does work. Of course it works. Again, it's one of those things that are so obvious. There are at least several hundred, if not thousands of studies that have shown that if you do something that part of brain grows. And clearly, the more brain you have, the less likely you get demented. So that's a no-brainer you know, the thing to do is to realize that.

No, it's, it's called, it should be called a brainer, not a no-brainer.

I think we need to know that if you do, let's say a brain game that requires memory, don't expect that your processing speed or your executive function may improve. see, brain has different areas, different networks. And if you work on your biceps, don't expect your, you know, quads to be stronger. There is some subdivision of functions in the brain, and so don't expect that you do some things on these.

But there's ways to work the whole brain, right? With, with these programs. Yeah.

So the things to do, what I recommend to people is to do things that are body engaging. Like, you know, if you learn to play tennis, it's, it's, you keep track of scores, you learn how to do different things. And then if you really, you know, want a good at it, you watch some videos, you have an instructor to teach you and then do variety of things. Like, you know, for a while, do that and then try pottery and get a feel for texture, and, and, you know, how much to do.

And then I learned surfing at 61 years old. So, you know, it's never too late.

Yeah. I think, you know, the idea of, you know, enjoy failing is to try it. A lot of people say, I can't be sailing, but just do it and have fun with it. It's okay if you fail. You need to fail multiple times.

I definitely fell off the surfboard a lot, but I'm doing better now.

Exactly. Exactly.

I was told I'm intermediate. I was I was told by my, my serving instructor that I'm intermediate now.

Good for you. That's, that's awesome. That's the way to do it. Well, look, we're watching. And there are books for things like how to memorize a deck of cards or memorize words. You know, I do that for, we did that for our patients where we, you know, we showed them how to memorize 100 words, and most our patients did it. A lot of people say, no way, Dr. Pichu, I can't do this.

Then you memorize cards. You can go to Las Vegas and make a lot of money. Well, this is incredible. I I can't emphasize enough for people to understand that we're in a revolution in brain science right now, that we're in a moment where people like Majid and Dr. Isaacson and Dale Bredeson and others are really pioneering work that's helping us to rethink our approach to Brain Health. Dr. Aman also has been in this work. And, I think we need to take it seriously. Our brains are our most precious possession. It's who we are. It's our identity. It's how we basically go through the world. And, if we actually lose our brains, you can get a heart transplant. You can't get a brain transplant. So, it's really important to take care of our brains. If you love that last video, you're gonna love the next one. Check it out here. If you look, for example, just at depression, our modern tools really suck at treating it. I mean, if you have severe depression, sometimes medications can help. But for most people, you look at the data, it may be 30% effective, not much more than a placebo. And the question is, what's driving.