Dr. David Perlmutter | Rethinking Brain Health Belief, Behavior & Breakthroughs

We do not have a single drug available on the planet to treat diabetes, to treat high blood pressure. None. Now, that's going to raise eyebrows. We have drugs available that are the biggest sellers of all, that people who are diabetic will take to lower their blood sugar. I'm in favor of that for sure. But they're not treating the underlying problem. They're treating the smoke and not the fire. Let's call it like it is. You stop your Metformin, the next thing you know, your blood sugar goes up. Same thing with high blood pressure. You know, you stop your Toprolol or hydralazine, whatever you're taking for your blood pressure. That was keeping it in a good place. Place. Next thing you know, blood pressure skyrockets. So we're not focusing on the underlying disorder. We're only focusing on its manifestations.

Welcome to the Radical responsibility podcast. I'm Dr. Fleet Mol and I'm excited to guide you on a journey of authentic transformation. In each episode, I'll bring you insights from leading experts to explore trauma recovery, mindfulness practices, positive psychology, and innovative breakthroughs in health, wellness, and life optimization. This is a space for real conversations that inspire meaningful change, helping you find alignment with the person you were always meant to be. Let's get started. What if the key to lifelong brain health isn't just in your genes, but in your daily choices? Dr. David Perlmutter, renowned neurologist and best selling author, joins me for a powerful conversation on the science of neuroplasticity. The impact of diet and lifestyle on brain function and and how we can take charge of our cognitive destiny. We explore how beliefs shape our biology, why inflammation is at the root of neurodegenerative disease, and the incredible role of the prefrontal cortex in guiding our decision making. This episode is a wake up call. Your brain is not hardwired for decline. The choices you make today can protect, heal, and even rewire your brain for greater clarity, resilience, and vitality. Let's dive in. My name is Dr. Fleetmall, your co host for this session. And I'm really thrilled to be here today with Dr. David Perlmutter. Welcome, Dr. Perlmutter.

Delighted to spend time with you.

Your work has focused a lot on the intersection between brain health and overall lifestyle and a lot of the chronic, almost epidemic illnesses that plague our culture today. We're really focused on beliefs and obviously we can look at this, you know, psychologically talk about beliefs so we can look at it neurobiologically and talk about it that way. And territory you're very familiar with. But what would you say about beliefs and how those influence our brain health, our lifestyle choices, the biological processes that impact longevity and health span and so forth?

Well, I feel like I'm in one of the presidential debates because I want to answer another question first and then get to the one you asked. But you said almost epidemic in these chronic diseases. It's well past being an epidemic when we have 50 million people on the planet with Alzheimer's. That's a global, that's by definition a pandemic. And you know, as it relates to things like Alzheimer's, we all know a cancer survivor, but I would challenge anyone to tell me about an Alzheimer's survivor, you know, almost a uniformly fatal situation. So it is, you know, a clear and present danger. And to get now to your question about how do our beliefs influence the world in which I live, the world of chronic degenerative conditions related to the brain, I think that ultimately our beliefs connect to our destiny, that our beliefs are strongly related to our destiny. And that's a shortcut, I guess, when you look at a quote, for example, from Gandhi who said that our beliefs create our thoughts, our thoughts create our words, our words create our actions, our actions create our habits, our habits create our values, and then our values create, manifest as our destiny. So it really allows us then to connect what we believe in to our destiny, in this case our health destiny. And as I take a step back and look at what's going on around us, we see people who really put their belief in the notion of offloading or outsourcing their health related issues to a third, possibly disinterested party. And if you watch television, watch the evening news, all you see is the attempt to convince you to live your life however you choose, whatever is you feel you want to do. And there's going to be a wonderful new medication whose name you cannot pronounce that's going to help you. Whether it is with your autoimmune condition, your liver situation, or even your brain situation, There are drugs out there to help. And the reality is, as it relates to my world, the neurodegenerative conditions, we are at a loss from a pharmaceutical perspective to come up with something that can meaningfully alter the time course that relates to the degeneration of the brain in Parkinson's, in Alzheimer's. And yet, you know, that's a belief that I think is being instilled in people. Again, do whatever you want. We're here to fix it. And it stands incredible contradistinction to the notion that we are the arbiters of our destiny. Again, the connection ultimately between belief and destiny, that we are the arbiters of our brain future. We are the architects of our brain's health, resistance to disease, and functionality based upon what we choose to do day in and day out in terms of our lifestyle choices. Now, that's a narrative, that's a paradigm that doesn't get as much traction in our modern world as the former, as the idea that, hey, I'm going to do whatever I want, eat whatever I want, stay up late, and when, you know, I start firing on less than full cylinders, there'll be a way of fixing it. Because I saw the advertisements on television, and that's the mission for me. And hopefully that I can portray to your viewers that if that were the case, I would be all in. I absolutely would be all in. And perhaps in the time we have together today, we can talk about where the pharmaceutical approach may be leading in terms of the future. And it's actually a bright future. But currently, we really have to focus on two important things. Number one, our lifestyle choices are fundamentally relevant as it relates to our brain functionality right now. And number two, we must embrace the notion of prevention as it relates to our most challenging brain disorders.

So I would like to circle back to the future of pharmaceutical approaches. But first, I'd like to continue where you began. One of the things that I think can be, provide the most hope for people kind of empowering message is the reality of neuroplasticity that we've known about for a number of decades, and the fact that we, you know, can be not only the architects of our own destiny with the beliefs that we cultivate and hold and build on, but we can actually reshape our own neural architecture to have a healthier, higher functioning brain, and also, very importantly, possibly to prevent some of these neurodegenerative diseases. So I wonder if you could talk about that and some of the latest research around what neuroplasticity actually empowers us as individuals to do through our lifestyle choices.

Neuroplasticity is a word that means the brain is plastic. And I'm going to digress for just a moment. Please forgive me, because a recent study came out about three weeks ago indicated that the human brain now is about 0.5% actual plastic as a consequence of the microplastics to which we are exposed. That's not. What is the meaning of neuroplasticity. Plasticity means the ability to be molded to Be changed. And one should expect that of the human brain, that it would be adaptable to environmental exposures, to change, and allow us to be malleable and to be able to respond to changes in terms of the things to which we are exposed. That's a very important characteristic of the brain that declines with age and declines much more rapidly when we are challenged by a degenerative situation of the brain. So neuroplasticity is really predicated on the ability of neurons to make new connections, to seek out their neighbors and extend a hand and shake hands and make connections to neurons. It allows us to develop new pathways. And interestingly, and I think it kind of segues back to your original question, the strength and the durability of these connections, once they are made, Is really predicated on repeated use. As Donald Hebb said in what ultimately became known as the Hebbian theory, Neurons that fire together, wire together. Now, he said it in a much more eloquent way, but that's how, over the years, it has become simplified, Meaning the more you do something, the more indelible those connections become. You know, some have called, for example, called it muscle memory when you're learning how to swing a tennis racket, Learning how to play the piano, Learning how to be compassionate, Learning how to recognize the fact that we are all connected on this planet. These are all changes in the brain, Structural, physical, and therefore functional changes that happen in the brain when we are engaged repeatedly in an activity. Now, there are certain things that we can do to enhance that functionality of the brain, to enhance the plasticity and make those connections more sturdy, more indelible, and actually protect them. And there are things that we can do commonly that threaten the variability that the brain has to not only make these connections, but to maintain them. Learning requires that we strengthen the connections that we make every moment of the day and night, even the dreams, that we have an effect on brain plasticity and leave, to some degree, indelible marks on our consciousness. So certainly it speaks to the notion that if we want to achieve better things in our lives, become better people, Raise our level of consciousness to a higher level, that we need to engage in those types of activities that will foster those connections in the brain and therefore pave the way for us to more easily access that level of consciousness. It means that practicing compassion is a way to become compassionate. And, you know, this is something the Dalai Lama spoke about, that if you want to be compassionate, practice compassion. So these activities that we do day in and day out, Practicing gratitude, for example, makes us A more grateful individual. Practicing compassion makes us a more compassionate individual. And there are areas of the brain that benefit from this that can be visualized with functional study of the brain. Functional mri, for example, can image those parts of the brain that are used to engage in those types of activities. This is very meaningful, this conversation that we're having right now, because it really speaks to the notion of recognizing our connection to the natural world, our connection to one another, and this whole notion of connectivity and the idea that we are connected to the microbes that live within the gut. The idea that we are physically, in a very real sense, connected to every living being on this planet, not just people. When we take a step back and can get our arms around that notion and recognize that once we do that, then changes in the brain occur. Back to your original question. That allow us to more further embrace that notion moving forward in our lives. So neuroplasticity is something that is happening day in and day out in our lives. Similarly, an incredible notion is that the functionality of our brains requires that we lose connection. The opposite of neuroplasticity. We undergo what's called synaptic pruning, where the brain quite aggressively sheds itself of certain connections that are not being used frequently. The corollary, or maybe the contrapositive to Hebbian theory, that connections that are not used frequently will be shed. And that's a way of refining the brain. You know, when you look at the density of the gray matter of the brain peaks out around age in our early teens, and then by the age 18 to 20, we see a pretty dramatic reduction. Those connections, again, we call this synaptic pruning. And there's some very specific activity in the brain that's happening to prune the brain of those synapses and to foster the connections as well. And they are very much influenced by a very specific type of brain cell called the microglial cell. I'm getting very deep into the woods. There's so much that we can talk about over the next four hours. I'm glad we've been given that length of time, but for your viewers, I'm kidding. But the point is, though, that we are again, the arbiters, the architects of our brain's destiny, not just in terms of health, but in terms of the sophistication of our brain's wiring that allows us to be more present in this world and more connected to all that is going on.

So a couple of follow up questions there, and you can kind of go where you would like with this. But there are kind of two different directions. One is a little more about the specifics of neuroplasticity. So, you know, we generally hear that when we're very young children, our brain is more fluid, more changeable, more neuroplastic. I've seen some research, I can't give you the exact references, just something I was heard referred to recently, that actually new synapses and new neurons can be created more quickly in the adult brain and then the young brain. So what is the difference between the changeability of the brain when we're adults versus when we're young? Is one question. And, and then when you look at neuroplasticity or just changes in our neural architecture and our ability to impact that, there's the new connections that you were talking about, and then maybe the pruning away of connections that are no longer needed. There's also the importance of myelinization and keeping myelinization healthy and effective, which improves the connectivity of the brain. And then there's neurogenesis, the actual creation of new neurons. And I think previously it was in question whether the brain actually creates new neurons. Then it was like, well, certain areas of the brain you can. And maybe that's even being questioned now a little bit. So those questions about, you know, these different forms that allow the brain to be reshaped and based on our own lifestyle choices and beliefs. And then the other aspect, what you brought up is compassion. And if you're familiar with Richie Davidson's work as a friend and a colleague, really looking at well being and understanding some of the constituents of well being and then identifying the neuronal substrates of that with functional MRI studies and so forth. And you know, some of those, attention or mindfulness is one, but generosity, gratitude, compassion, things like this. So is cultivating compassion. I think it's probably good for our own happiness, it's good for the culture, it's good for the world, but is it actually good for the brain in some specific way? So that was. These are two different kind of questions. But understanding, you know, what we're really talking about with our ability to reshape the brain at any age, and then the possibility of cultivating certain mind states that actually not only are good for us and good for the planet, but actually will also do they actually improve the health of the brain in a way that cultivating other mind states might not?

Well, I'm going to hold on the latter and first address the former because I think it sets us up to understand the latter. And having said that, yes, we continue to grow new brain cells. And I do have the reference. That would be Dr. Kirk Erickson of the University of Pittsburgh. His work was originally rejected by multiple journals when he put forth the idea that indeed, you know, we maintain this ability of neurogenesis, the growth of new brain cells throughout our lifetimes. And it's actually a fascinating story how that was discovered, but I don't think we have the time for that. Nonetheless, I think that it's quite empowering to think that we can repopulate our brains with new cells. I mean, in my early life, the teaching was you were given your complement of brain cells and then every beer you drank you lost 80,000 or 20, whatever the number was, never to be repopulated. Well, we know that's not true. We certainly have known for decades that mammals can repopulate their brains then that primates can repopulate their brains. But there was pushback on the notion that humans could repopulate with new neurons with almost religious fervor that that just cannot happen. Nonetheless, it's clearly been demonstrated. So the question then becomes, how does it happen? If we can understand how it happens and where it happens, then what can we do to enhance that activity? Because clearly increasing the population of functional neurons is going to be in our interest as a hedge against degeneration moving forward. And fortunately, one of the most important areas in which neurogenesis occurs is in the hippocampus, which is an area that plays a fundamental role in memory, with memory decline being one of the things that we fear the most, one of the, you know, certainly the cardinal signs of Alzheimer's dementia itself. So the way that these neurons are generated in the brain is via their stimulation by various, what are called trophic factors. Miracle grow being a trophic factor for your plants. How do we fertilize the brain in such a way that we enhance the growth of these neurons? And one of the primary areas that people look in is focusing on one of the neurotrophic factors called brain derived neurotrophic factor, or bdnf. There are multiple things that will enhance the production and availability of and functionality of BDNF in the brain. And one of the most powerful things that we can do is physical exercise. That's the work that really led Dr. Kirk Erickson into the understanding that the brain does repopulate itself. He was able to study people over a one year period of time, giving one of his study group stretching exercises and the other group a more aerobic active exercise program. And demonstrated growth of new neurons in the brains and actually increasing in size of the brain's memory center, the hippocampus. The work revealed originally the growth of these brain cells in the hippocampus of humans, interestingly, was done in individuals who were receiving a type of therapy, a type of chemical that would mark the division of and the production of new cancer cells. For people who had squamous cell carcinoma of the face, they were given a chemical that allowed labeling of the newly divided cancer cells. When some of these individuals died, their brains were examined and lo and behold, it was found that there were that cells in the brains, in the hippocampus specifically, were marked with this chemical, indicating that they were growing. Fascinating research. Again rejected initially. So the question then becomes, what can we do to enhance activity? First and foremost is physical exercise. We know that BDNF is enhanced by meditation. It's enhanced by certain nutritional supplements like turmeric, like DHA, which is an omega 3. We know that when these microglial cells, I alluded to them earlier, the brain's immune system, when they are in a certain phenotype or a certain configuration, if you will, that's nurturing to the brain. It enhances the growth of the production availability of BDNF and is associated with the formation of new brain cells, the formation of new connections between brain cells called synaptogenesis, like neurogenesis, the preservation of neurons, the preservation of their myelin that you mentioned earlier, and even preservation and protection of what is called the blood brain barrier. So what I'm getting at now is that the brain's immune cells seem to be doing a whole heck of a lot more in terms of what's going on in the brain than we had previously ever imagined. When we think of immunity, I want to have a really good immune system, we usually think about that in terms of, oh, to be able to fight the next Covid or upper respiratory infection or heal my wound and maybe if you stretch a little bit, maybe to help me screen my body for cancer or even help the body rid itself of cancer cells. We now are understanding that the immune cells are playing a central role in brain connectivity. Neuroplasticity, synaptoplasticity, in regulating our metabolism. And the corollary of that notion, which is really quite fascinating and will be empowering in our conversation further, is that these incredible cells in the brain are highly influenced by our body wide systemic metabolism, such that when we become metabolically dysfunctional, in other words, overweight, blood sugar goes up, blood Pressure goes up, we have changes in our blood lipids. All of these metabolic changes threaten the good function of these brain immune cells such that it threatens our ability to form new connections, synaptogenesis. It threatens our ability to form new brain cells, neurogenesis. So what I've just said then is that our body wide metabolic health is playing a central role in what you and I are talking about right now. Ability of the brain to form new and wonderful synapses and the ability of the brain to form and new brain cells and repopulate itself with new brain cells based upon our metabolic health, which is a downstream manifestation of our day to day choices, which ultimately is a reflection of our beliefs. So when we get back to where we started today, our beliefs ultimately become our choices, which ultimately becomes our destiny in terms of health in general. And through the connection of metabolic health based upon our lifestyle choices. How well we sleep, how long we sleep, the foods that we eat, the exercise we get or not, the meditation that we pursue, the nature exposure that we get, our social contact with others, all of these play a pivotal role in determining the set point of our metabolism, which dramatically influences what's going on in our brains.

So looking at it in this global way, and then maybe even going a little bit deeper to the cellular level, basically at some level we're talking about mitochondrial altogether. And then we can look at environmental factors like what can we do to improve the environment that we're living and operating in? Then that's both the physical environment in terms of, you know, lessening our exposure to pollutants, to mitotoxins and so forth, as well as our social, enriching our social environment. So things we can do with that environment. Then what are kind of mindset things that can impact that overall global metabolic health as well as mitochondrial health. And that could get back to that question about compassion and cultivating compassion. But of course, the other generally about our, you know, even if we have an optimistic versus a pessimistic mindset, or if we have a, you know, a growth mindset as opposed to a fixed mindset, these things could impact that. And then, you know, we can get into our belief structures about aging altogether. But I wonder if we could just talk about. Well, let me ask you this question as you're referencing. Our human body is a very complex system, and we're understanding more and more how holistically interconnected and complex it is. Not only within the body, the idea of isolating parts and just talking about how that works becomes less and less meaningful as well, as we're profoundly interconnected with our environment, everyone else, and each other in the world and so forth on so many levels. So with that complexity, and then the more we hear about all the things that can pack the functionality of that, for better or worse, we can start to develop some kind of a fearful, almost paranoid approach to life, which is not a helpful mindset for our metabolic or mitochondrial health either. So because we're surrounded by media influences which are, you know, trying to condition us in the wrong direction, we're surrounded by a lot of pollutants in our air and our water and our food. We have our own struggles that we're dealing with from childhood forward of trying to, you know, manage ourselves emotionally and so forth. So how can our audience, you know, approach embracing the insights we're getting from the current science that's giving us a deeper window into the complexity and the blue and the beauty. I mean, even just the immune system itself is such a profoundly intelligent system. So in ways that are empowering and help us can start making good choices rather than just feeling like, you know, I'm in the middle of an enemy camp here and I don't know what to do first.

Well, you touched on a lot of ideas, that's for sure. And I think I'd like to take the conversation to the idea that our mindset. Is the world friendly or is it aggressive? Do people feel threatened day in and day out based on experiences like media like you mentioned, or not? I mean, those things, a lot of things are threatening in the world today, that's for sure. From a climate perspective, from a, you know, a war perspective, certainly, you know, around the world, there's a, you know, the potential for things to go south very quickly. And having said that, okay, the question then becomes, how does that impact me? And how will the way it impacts me affect my physiology and how will that affect my immune system? And we can choose to bear our heads in the sand and not sure how we are fully able to do that. We can choose not to engage, which is not as difficult. But ultimately, I think it's helpful to recognize that we can actually change the functionality of the brain. We can do it fairly in a very simple way. If I can unpack a little bit of neurophysiology for your audience first, we have an. In the brain, a fear center called the amygdala. And this amygdala, when it lights up, has an effect on how we feel in that moment, but it also has an endocrine effect so that we can Light up our fight or flight response, such that we are ready to confront whatever the real or apparent danger may be. And it's important to recognize that we are the arbiters of the set point of that amygdala. Is it constantly lit up and keeping us on edge day in and day out, or are we able to contextualize the experiences that we have day in and day out and compartmentalize them and really just put them away and deal with them in an appropriate way at an appropriate time? So the neurophysiology of this discussion is such that we understand that we as humans have a very large, what is called prefrontal cortex, the area behind the forehead, very large in comparison to other animals. And this prefrontal cortex exercises a top down control over this fear inspiring amygdala. And we really kind of depend on this connection from the prefrontal cortex through what's called the anterior cingulate to calm down the influence that the amygdala has on us day in and day out. Some people are pretty well dialed into the amygdala all the time. The world is always threatening and their responses are always, you know, not thought through. They're quick and they are generally fairly involved in self preservation. What's best for me, as opposed to allowing the prefrontal cortex to take a step back and evaluate the situation in terms of what does it mean right now, what does it mean for the future, what does it mean not just for me, but other people, and what does it mean for the planet and everything I'm connected to? So this top down control over the fear center develops in adolescence. It is really the reason that we wait until kids reach a certain age before they can drive a car and act responsibly, or until you can vote or run for whatever it may be. The point I want to stress is that this connection, this adult in the room in the prefrontal cortex that control the influence of the amygdala in terms of how we perceive the world, this connection is something over which we have control in terms of its functionality. We really need the adult in the room to tell us that, yes, there are some things going on around us, but here's a rational way to deal with it, and a rational way to experience it, and a rational way to think about what it may portend for the future. We really need that influence controlling the amygdala. Let me digress for just a moment to say that there is a time when the amygdala needs to do its job. We need to act instantaneously at times in order to do the right thing. Let me give you an example. You're backing up your car, you look in the rear view mirror, there's a kid on a tricycle, you hit the brake. Now you don't need the prefrontal cortex to come in and say, well, now there's a child there on a tricycle. And probably be a good idea, considering the options here, to slow the car down and put your foot on by that time you've hit the kid, right? So there's a time and a place when amygdala responses are appropriate, but they're not appropriate day in and day out, when we're dealing with other people, when something may feel a little bit confrontational and we shouldn't fly off the handle, we shouldn't be launching weapons against a perceived threat from our neighbor. On and on. We need to bring the prefrontal cortex in and say, hold on a minute, what's really going on here? And how can we work it out? That's bringing back the adult in the room. Now here's the part we can leverage. That connection between the prefrontal cortex to the amygdala that we so vitally depend on is threatened by inflammation. When we raise the set point of inflammation in our bodies, that ability that we have to use the prefrontal cortex and keep the amygdala in check is threatened. What is it that increases inflammation in the body? When we become metabolically disturbed, when our blood sugar goes up, when we're not exercising, we're not getting enough restorative sleep, when we're not eating foods that help tamp down inflammation, when we threaten the gut microbiome, the organism living with than the gut and so many other things increase inflammation in the body, it changes our immune system, it changes what's going on in the brain in terms of those microglial cells. And yes, it threatens the ability that we have to bring on board the adults in the room and the prefrontal cortex, keep the amygdala in check and make better decisions. So now what I've just done is connected our lifestyle choices with ultimately how we perceive the world and how we respond to what's going on into the world. And basically it gets back again to our original discussion about our beliefs, charting our destiny, our beliefs in terms of our ability to bring on board changes, make better changes based on what we believe to be true, whether we're going to live our lives and hope that pharmaceutical companies are going to come up with a cure, for example, or not. And certainly other beliefs as well. And how they influence our choices are very relevant in terms of our health outcome and in terms of our perception of the world around us. And let me consolidate what we've just discussed. And that is to say that one of the biggest issues raising inflammation and therefore threatening our connection to our gift, the prefrontal cortex, and therefore locking us in to fear based activity, is the widespread consumption of ultra processed foods. The worst thing that these ultra processed foods do is not that they don't contain good nutrients though, they don't. But the worst thing going on with respect to these ultra processed foods, now making up about 60% of the calories consumed by Americans, is they are powerfully pro inflammatory and therefore they distance us from the ability to recognize our connection to everybody else on the planet. And now the consumption of these foods has become global. So through the window of food and these types of foods, we could see it helps us understand why so many changes are happening in the world today in terms of how we're treating each other.

Absolutely. You know, I've been involved in bringing mindfulness and consciousness into our criminal justice system and public safety systems for a long time. And there's been some really interesting work done around behavioral issues that get people into our criminal justice system and the type of lifestyle and food and diet choices that you're talking about, and even some efforts to get involved in organic food and organic food production and gardening stuff amongst people who are incarcerated and how that's created radical shift, not death, because it worked beautifully in a few pilot programs and they have not generalized it, unfortunately. But these things do provide a lot of windows into hope and possibility. So you were talking about the power, our gift as human animals, this incredibly developed prefrontal cortex. If my understanding is correct, that the size of our prefrontal cortex generally reduces over the lifespan, it's one of the challenged areas of the brain through normal aging. Now, maybe normal aging needs to be put in quotes because we'd have to go maybe compare to people before, you know, all the processed foods and all the things that are creating systemic inflammation in our bodies and our nervous system. Before that, what was normal aging and what was normal reduction of the prefrontal cortex? But my understanding is that it does reduce in size over the time, and I suppose even worse. So I mean, if you see brain scans of people with Alzheimer's, the prefrontal cortex, in terms of its overall mass is. It can be greatly reduced. So what can we do in terms of keeping us focused on beliefs and mindset that around aging and longevity that can get us moving in the right direction with some confidence. I mean, you mentioned very basic things like exercise. And we know there are certain types of exercise that increase BNF and thus neuroplasticity and neurogenesis even more than other types of exercise. And it doesn't require us to live in a gym. We can be very sort of targeted about that. Getting enough sleep, there's basic simple things, avoiding processed foods. But I wonder if we could talk about maybe for a minute just overall mindsets around aging and longevity and what maybe even reasonable expectations are a view to have of that. You know, some of the spiritual traditions almost encourage us not to cling to life, but to have a less fear based attitude about to, you know, embrace the reality that we are finite beings who embrace death as part of having a healthy attitudinal qualities. But at the same time now we know we can extend our lives much more than maybe we thought possible. So I wonder how these overall attitudinal qualities impact us as well as this question of how do we preserve that top down control so that we're not pushed into that fear based posture.

Let me respond by saying, you know, it takes us to the conversation of lifespan versus health span. We all know that life is finite for each and every one of us. That's the only given here. But I think that what your audience would like to know is okay, I'm going to have given number of times around the sun, but I want to be as healthy as I possibly can during that journey. And certainly if we can extend the time that we have here, so much the better. But I really think that, you know, what we can achieve clearly is that the health span can be expanded and we can square off this curve, the longevity curve, such that we can live a pretty healthy life until it's time to. Until our number is called. And you know, the number one issue that's leading to people dying on the planet are the chronic degenerative conditions. Not wars, not Covid, not other infection, not trauma. It's the chronic degenerative conditions that are beyond pandemic in their scope these days. These are things like coronary artery disease, Alzheimer's disease, obesity, diabetes, hypertension, et cetera. These are the chronic conditions, issues that lead to the body basically falling apart over time. The wear and tear becomes cumulative and ultimately sets up what's called a feed forward process, whereby it engenders further decline and then we fall off the cliff and we decline quite quickly, certainly, as it relates to Alzheimer's disease. We see that once the diagnosis is made, people kind of tend to hang on for, you know, a number of months and then begin their steep decline. And, you know, parenthetically, the new drugs that have been approved for the treatment of Alzheimer's do not address that. The decline begins and is very steep whether a person is treated or not. So we're hopeful that there'll be some changes relating to metabolism in the world of drugs that finally targets what is going on in the brain. But that said, I think it takes us back to this, you know, the fundamental role of the immune system as it relates to the decline of the body and really the loss of health, of functionality that we experience both physically and cognitively. And the simplest way to recognize that gets back to something you mentioned earlier, and that is mitochondrial function. So mitochondria being the energy powerhouse of the cell, recognizing that, at least in the brain, that there may be as many as a thousand mitochondria in a single neuron. But, you know, the notion that these mitochondria are there simply to take in fuel, generally glucose, and make energy currency, ATP, is clearly myopic in that we now know that mitochondria wield the sword of damocles. They determine in a cell whether that cell is going to live or die. Many other things between that and the energy production part. But really it's the mitochondria that are the central players in cellular metabolism. Metabolism being what the cell does when it's presented with fuel, how that fuel makes its way into the cell, and then how mitochondria or other energy utilization pathways are able to deal with that fuel. That's what metabolism does, and that's why it's important. And therefore, if we are talking about whether a brain cell lives or dies being influenced by metabolism, it really makes us want to do everything we can to keep those mitochondria healthy and functional. And these are all of the things that your audience knows about already as being important for health. Everything we've mentioned, that's for sure. Now, there are some other esoteric things that directly target mitochondria. Things like nutritional supplements, creatine, coenzyme, Q10, urolithin. We know that a ketogenic diet does that. We know that time restricted eating can do it, and even fasting can do it, can help mitochondrial function, can help the body rid itself of defective mitochondria. We call that mitophagy and can allow the body to grow new Mitochondria, we call that mitochondrial biogenesis. But this really sheds a light on this relationship again between our beliefs, the most fundamental aspect of our health, and that is mitochondrial function. Alzheimer's is an acquired. We call it mitochondripathy. We acquire Alzheimer's in a way that it threatens our mitochondria and brain cells ultimately perish. Synapses perish before that because of the lack of functionality of the microglia. This happens in Parkinson's as well. Based upon head trauma, based upon exposure of environmental toxins and. And all of the very important systems in the brain that need maintenance are threatened when the mitochondria are not functional. The immune system in the body is threatened when there's a mitochondrial dysfunction which is brought on by lifestyle choices, allowing that immune system to be less able to scrutinize cells in terms of determining whether they're malignant or not, less able to find those malignant cells, less able to deal and get rid of malignant cells, specifically immune cells called NK cells. So, so much depends upon our beliefs, our paradigms, how we view the world in terms of offloading our decision making process or onboarding a decision making process that can lead to better metabolic health, ultimately nurture those mitochondria, all of which are derived from mother. Therefore, I tend to look at them as being feminine and nurturing and good energy. You know, the question is, do we make those choices? Those are choices that we each can make for ourselves. The question is, A, do we believe that those choices are valuable and B, do we commit to making those choices?

Very much so. I think that's the fundamental belief here, is to embrace that level of agency. And because we've all been conditioned to be passive consumers and just do whatever we want, and then the, you know, the kind of medical industrial complex is going to fix it for us. And it's understandable. There's a lot of people out there trying to fix, fix, find fixes for all these, this epidemic of neurodegenerative diseases and other chronic illnesses. Because, you know, our whole society is in trouble. So it would be unkind not to try to find fixes. But all the focus being there and so little focus being on preventive medicine is really a difficult thing. And I think for any of us individually, where we really have any real power is in educating ourselves and embracing some level of agency over our own lifestyle choices. And I think even some integrative medical practitioners today talk about lifestyle is medicine, that lifestyle actually is the intervention.

Well, I always resonate with the yellow emperor in the 4th century B.C. nejing said that prevention is the ultimate principle of wisdom. To cure a disease after it has manifest is like digging a well when one feels thirsty, or forging weapons when the war has already begun. So we need to have those wells up and running so we don't get thirsty and we're not challenged by these potential threats. And, you know, that's been my messaging for an awful long time in the face of our lack of weapons to deal with these really incredibly challenging neurodegenerative disorders. You know, I often think back about the times when I would be in my office meeting with a family, and they would say, you know, doc, you just don't know what it's like, what we're going through with mom or dad, you know, with Alzheimer's. And I would look out the window and while they were saying this to the nursing home across the parking lot in which my brilliant brain surgeon father was dying with Alzheimer's disease. And I'd look back at these patients, and I would say, you know, as a matter of fact, I get this more than you can ever imagine. And sometimes I would tell them why. But upside served to make me, you know, more able to understand what people are going through and double down on my efforts to do what I do these days and, you know, past many decades. And that is to hope that in our time together today, someone, hopefully a lot of people will become empowered and recognize again that, as John Kennedy said, the time to fix the roof is when the sun is shining and really get busy. When people know what to do. It's quite clear. And is it difficult to avoid the sweets, difficult to choose foods that are known to be salubrious versus those which are threatening? It is. Our brains are hardwired to seek out sugar, to seek out salt, and to seek out fat. Why? Because those are survival mechanisms. Eating sweet fruit allowed our bodies to make fat and survive the winter. We wrote a book about that. And fat being doubly dense in calories in comparison to carbohydrates and protein. Again, a survival mechanism. So we're hardwired to make the wrong choices. But that's coming from deep brain centers that we can override now that we know what's right and wrong, I. E. Bring that prefrontal cortex on board, make better decisions. How do we do that? Well, a, we reduce inflammation. B, we light that prefrontal cortex up with mindfulness techniques. And as we light it up through neuroplasticity, we're allowing it to preserve its Function, despite the fact that, as you pointed out, the prefrontal cortex does degenerate with age, but we can preserve its functionality by bringing it on board as much as we can. Neurons that fire together will wire together, as Dr. Hebb pointed out. So it's all about empowerment.

I'm glad you mentioned mindfulness, because I think there are so many things we do. Most of us know a lot of the things that are good for us, but one of the things that really helps us have the more robust prefrontal cortex and the ability to override some of those really instinctual, almost survival things that drive us to make the wrong choices is various forms of mindfulness and meditation and so forth. And there's some really interesting integrations now of neurofeedback and meditation that can really kind of get into that base level conditioning and kind of put a cushion between us and those very short term survival choices that our brain wants us to make sometimes.

That's right. And it's the confrontation of our evolution versus our environment that these hardwiring issues in the brain to seek out sweet, for example, for almost the entirety of our existence served us very well. Seeking out sweet foods was an indication that those foods were safe and allowed us again to make more body fat so we could survive times of caloric scarcity. These days, that pathway is overactive, is feed forward. In other words, it enhances its own activity in an attempt to keep us alive. But this is, you know, the cornerstone for not just weight gain, but certainly importantly, the production of inflammation in the human body. What does that do? It threatens to cut us off from the prefrontal cortex such that we continue to make these inappropriate choices. That's a feed forward cycle. The mission is to interrupt that feed forward cycle and bring the adult back in the room, make better choices.

We're near the end of our time. This has been incredibly illuminating and empowering. And I wonder if, based on, you know, you have decades of experience of working with patients and clients, and I wonder if there were two of the most sort of common beliefs that you see in, you know, people holding one that's detrimental to our health span and longevity, and the other that would be a positive belief. What do you see people that are some of the most common, pivotal beliefs that people have that either take them in a good direction or not.

Well, in terms of the bad direction, I think we've certainly vetted this a bit, and that is the belief that my choices don't matter day to day or in the long run, and that Modern medicine is just the catch me out. I mean, there are so many wonderful drugs out there that are gonna help me. And, you know, that's what we see, that the typical 65 year old is taking a handful of medications. That's good for people who make those medications and sell them. It's good for insurance coverage because the difference between the price and what they're being bought for is profitability. The healthcare system just loves that people get sick and end up, you know, in their hospitals. So that's what motivates that. Am I sounding cynical? Yes, I am. I know that I am. So the point is that that's a belief that's inculcated quite deeply and remains continually inculcated as a consequence of what you mentioned. And that is media. So, you know, that works against us, the notion that we can do what we want and there's going to be a drug there to help us. And again, I think that there are some wonderful drugs out there and should be utilized. But understand, for example, that we do not have a single drug available on the planet to treat diabetes, to treat high blood pressure. None. Now, that's going to raise eyebrows. We have drugs available that are the biggest sellers of all, that we, people who are diabetic will take to lower their blood sugar. I'm in favor of, that's for sure. But they're not treating the underlying problem. They're treating the smoke and not the fire. Let's call it like it is. You stop your Metform and the next thing you know, your blood sugar goes up. Same thing with high blood pressure. You know, you stop your Toprolol or whatever, hydralazine, whatever you're taking for your blood pressure that was keeping it in a good place. Next thing you know, blood pressure skyrockets. So we're not focusing on the underlying disorder, we're only focusing on its manifestations. And so it is with Parkinson's. We have wonderful drugs to treat tremor and rigidity, but nothing has yet to treat the underlying degeneration in a specific part of the brain that makes dopamine. Same thing with Alzheimer's. We can treat, you know, some of the behavioral issues that arise, but we're not treating the fire, we're only treating the smoke. You know, that's a very important concept that many people are not really wanting or comfortable with embracing. And it is reality. Beyond that, the empowering part, the plus side, is this notion that your choices are hugely important in terms of your own physical, emotional, psychological and cognitive destiny. What you choose to do later today or tomorrow and begin programs that are involved in better choices will chart a better destiny for you across the board. And I really believe that most people kind of know what that means, kind of know that this is not a good food choice, that I shouldn't be up as late as I am, that maybe it's time to get off the couch and walk around the block. I think people get that. The problem is that, you know, the amygdala is really locked in terms of the day to day choices. It says, no, I want to watch another three hours of binge watch of whatever it may be. And you know, that bag of chips while I'm binge watching is going to be feel really good. I'm going to do it. Not that they don't know it. It's just getting people to push through once and be able to bring that prefrontal cortex online and that can be.

Done well again, this is incredibly helpful and empowering and one of the things that we know from the science of habit formation and so forth is if we can get a little momentum going and get in a virtuous cycle, then these things can work for us and with us if we allow ourselves get into that non virtuous cycle. So it's just a matter of taking action. And I think, as you're right, most of us at least know some things that we could be doing that would move us in the right direction. And so I really appreciate your very empowering message that we actually can be the architects of our own destiny. And I think that's something worth investing in for all of us. So thank you so much.

You bet. I like your words, the non virtuous cycle. I may have to pirate that from you. It's very well put. I appreciate that.

Thank you. Thank you so much, Dr. Promoter, for your work and for being part of our summit.

My gosh, thank you for having me and giving me this opportunity.

You're very welcome. Be well. Thank you for joining me on the radical responsibility podcast. Remember, real change happens when we commit to our growth, face our challenges with compassion, and stay open to transformation. If you found this episode helpful, I encourage you to subscribe and help us spread the message of healing and personal empowerment. Stay grounded, stay present and stay true to you. Take care.

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