#MoveForMinds 2018: San Francisco

If I give you my card, would you be able to send me that? Sure, sure, please. Thank you. I'll get the point of these others is really starting from a place of what do we know today? What did we know last year? What is new? What is exciting? And then what in particular for women do we know today? So because I think what's been really good on the other ones is, you know, it started with like, you know, 6 months Without studies, it's hard to practice. And everyone just wants to talk about bioactivity.

Yeah, perfect. The other thing is, Keiji does not teach yoga. She practices yoga privately.

She teaches meditation.

I said that.

Yeah, okay, okay. Just that I had said to you she teaches yoga.

Oh yeah, no, but I told you we're gonna do it. And I think I would like to say I struggled with that diagnosis. All of my kids were already in their 20s. I love that. You were anxious. Yeah, I did. I am. Yeah, and it's really good for us to ruminate, to stress. Why are you anxious? Dude, yeah.

We spend part of the time down in UCLA, and we're now going to be spending part of the time up here in Seattle.

Okay, can I ask everybody to take their seats? Can I ask everybody to quietly take their seats so you can hear the latest and the greatest information from the latest and greatest experts who have come here to tell you the latest and the greatest? So everybody could take a seat. That would be awesome. We're going to be streaming this conversation on Facebook and Instagram, where we've had on all of these discussions 30,000, 40,000 people have joined us. So we like to start on time. So if everybody could take their seats. Sandy Gleisstein, will you let me know when we're ready to begin? If everybody could take their seats. Carol Middleton, thank you so much for your support. First Person. First Person. First Person with Carol Middleton. First Person. As my son says, the First Person is more important than the leader. That's because if there's not a first person, there's no movement. First person. Okay. Everybody take their seats. That would be super helpful. Okay. Before we stream our conversation, Sandy Gleistein, who's the producer, is going to announce the winners.

Hey, guys.

I hope the workout was fun. I just wanted to say we are here for fundraising purposes, and you guys did a fantastic job. Fantastic job, San Francisco. Thank you. The number 3— and by the way, you're all getting really great prizes. The next 3 names that I'm gonna mention, we just didn't have the capacity to bring them up, but they're being shipped to you, so hang tight. Number 3, Kathleen McIntosh, are you here?

Woo!

$1,682. Shannon Smith, are you here?

What?

Shannon Smith. Is Shannon here today? Where? Okay, $2,310. So yay, Shannon! And then as you heard, Carol Middleton with a whopping $11,230. So thank you, Carol Middleton. And now we're Okay.

So tell me when we're ready. If everybody— we're going to feed you, I promise, afterwards. But this is intermittent fasting. So we're doing you a favor.

Right?

Right. Ketosis is happening in your brain. You're hopefully thinking clearer. Your brain is pumping blood. There's a monitor in the back as well.

Okay.

There is a monitor in the back for the people that are standing. You can watch the monitor, which isn't as good as watching us, but you can watch the monitor. Okay, we're live. Ha! Anyway, good Sunday morning to all of our friends who are joining us online. We've had thousands and thousands of people at these conversations in New York and Boston and Los Angeles, which is really great because our goal is to try to educate as many people as possible, empower them with the latest and greatest information, and then ideally ignite you to go out and repeat this information to people that you think might be interested in it. And even if they're not, tell them anyway because they should be. Anyway, I want to introduce Dale Bredesen. Dale is here at the Buck Institute, also at UCLA. Don't worry, I'll get it. And has written a book, a big bestselling book called The End of Alzheimer's, and is teaching doctors across the country, primary care doctors, functional medicine doctors, about how to spot people with cognitive impairment and then obviously how to help them. That I hear all the time is my doctor can't help me. So Dale is going to talk to us about how we can help everybody. Lily Sarafan here is the head of home care assistance. Lily has been our partner in this from the very beginning. We're giving out 100 caregiver relief grants because of her. So I want you to really— As we have mentioned, 15 million unpaid caregivers just with this disease alone, not to mention all the millions of other caregivers for all sorts of other issues going on in families across this country. 2/3 of the caregivers are women who are also working. And caregivers often put their own health on the back burner to care for somebody with Alzheimer's. And we're going to give them relief grants because what they need is time off. If you could be quiet in the back, I'm going to use my indoor nice voice to ask you to be quiet, and then I'm going to turn into something else.

So—

which isn't pleasant, and people have seen it, so don't bring it on. I'm only kidding. Sharon Shaw is from Stanford. and has done some really exciting research on the brain and has also seen patients and will bring us up to date about that. And also on the far end, Bruce Miller, who from UCSF was going to join us, who has been a partner, and he got sick this morning, so he's unfortunately not going to be here. And Nkeji over here— did I pronounce it?

Nkeji.

Nkeji. I was practicing it all morning. Nkeji, who has a program called City Matters, is going to talk to us about anxiety, meditation, and the importance of meditation and what it does for the brain. So let me begin. So thank you all for joining us today. And if these conversations, as I say, interest you, there have been others, so please share them off of Facebook. The Women's Alzheimer's Movement has them all in totality, and so they've been different at each location. So Dale, tell us, you know, so many people think the Alzheimer's space is hopeless. We hear about all these trials that fail and fail and fail, and we hear every 65 seconds a new brain is being diagnosed, and people feel somewhat hopeless. I say there is hope. You're seeing it on the ground. What can you tell us today that you couldn't have told us a year ago?

Yeah, what I can tell you today— let's see if this is— can you hear me okay? There we go. What I can tell you today that I couldn't tell you a year ago is that Alzheimer's disease has moved out of the clinic. Alzheimer's disease is now part of our lives. And in fact, there was a very interesting paper published recently in which pathologists looked for the earliest changes in the brain that are on the way to Alzheimer's disease. And what they were finding is that they were seeing this in children. So what we used to think of as a disease that's of the 70-plus people that you go to a clinic, that you get a drug, and that there's no hope has changed completely into something where you have to think about this your whole lives, and what you're doing today is helping everybody. Secondly, it's a lifelong process. So how many people here know their fasting insulin? Okay, a couple of people. How many know their ApoE status? Okay, a number of people here. There are 75 million Americans who have a single copy of ApoE4, which puts them at increased risk, There are 7 million Americans who have 2 copies, which unfortunately suggests that they will likely get Alzheimer's within their lifetimes. How many people here know they're C4A? Okay. So this and a number of other things, critical to know. So we now know that this is something that is occurring for a long period of time and we know—

Just repeat that, would you please? Because one of the other conversations we were saying that people need to know their blood pressure.

Right.

They need to know their cholesterol. This is as important as knowing like how many followers you have. Or how many likes. No, seriously, because that's what everybody's focused on, their likes and their followers. I'd like to get you, if you could just leave here with one thing, is knowing your fasting. Tell them 3 things that they should know in addition to how many followers they have.

Yeah, so it's helpful to know your fasting insulin. It's helpful to know something called your hs-CRP, and it's helpful to know your vitamin D. Those are— and there are about 35 things that we suggest that people know, but those are 3 that are helpful to know because they all play into something where we understand now that there are subtypes when people actually develop Alzheimer's. As we've been studying this in the lab for 30 years, we can see that there are people who have mainly an inflammatory process that leads to this thing we call Alzheimer's disease. But of course, We know it's coming for many years ahead of time. There are people who have this because they don't have the support for their brains. That's what we call type 2. There are people who have this because they have insulin resistance, because of the American lifestyle. So it turns out it actually is really important what you eat. How many people here know if they have a leaky gut? That turns out to be really important because it's a contributor to inflammation. So the reality is we should be able to make this a rare disease.

So tell— and if we could cut the music, that would be like really helpful. Sandy or anybody, if we have music going, that would be helpful if we could just tone that down if possible. So, you know, Pam was talking earlier about going to her doctor, about telling people that she was having issues with memory, and doctors were telling her there was nothing wrong with her. People tell you you're stressed out, don't worry about it. And you talk about leaky gut, knowing these numbers, so many people say, I go to my doctor, Sharon, and they don't know anything, which is why you need to know. But when you know, what do you tell your doctor? How do you get help out there? Because the brain begins to change at the age of 30, right? So how do people begin to get their doctors to think about their brains?

Hi.

Hello, everyone. It's really important to think about what's changing in your brain. And if you feel like there's a change in your brain, it's not just yourself who might notice these things, and it's— the brain is so remarkable that we may not be able to have the insight or the recognition of the changes that occur. So it's helpful to have, when you see a doctor, the neurologist, the primary care doctor, to bring a family member, a friend who knows you very well to understand the changes, to reflect those changes as well. I often do neuropsychological testing in the clinic so that we can really see if there's objective changes as well. Is there a functional change? Do people have problems with doing their day-to-day business? And then what we need to look for, things that can be fixed and treated. So are there sleep problems? Are there anxiety? And I rarely think that it's just anxiety that's causing cognitive problems. That may be a component of Alzheimer's disease. So we have to look for those things. Sleep apnea. Are there problems with your thyroid, your B12? Things that can be fixed. And then, as we are doing every day, working on ways to slow down the aging process.

Thank you.

slow things down. So there's so much more evidence that we've learned in the past year, in the past several years, about how exercise— what we've done today— can really help enhance cognitive function. There have been several studies at how it enhances memory for people who don't have cognitive problems. For people who do, it can slow down the process. So I'm really hopeful about what we've discovered in science in the past 6 months to a year. Partnerships, not with just pharmaceutical companies, but with industry, academia, private foundations to support the research for a— finally, a disease-modifying therapy. I'm very excited about what's on the horizon. So you said people are kind of hopeless. I'm very hopeful about what we can discover.

And I think also something that Dale had talked about originally, that it's not going to be one— everybody comes up to me all the time and says, are they going to get a cure? Is there a pill? And it's not going to be one thing, right? It's very often it's insulin resistance. Very often maybe somebody thinks they have cognitive impairment and they really have sleep issues. Sometimes people think they have cognitive impairment and they have a lot of anxiety. And they don't know these basic things that you were talking about. You did a study that I thought was fascinating where you injected the blood of a young mouse into an older mouse and that that changed the older mouse. And there's a lot of biohacking up here. We talk about intermittent fasting, people fasting for a whole day, intermittent fasting, taking all kinds of stuff to improve their cognitive impairment. Do you advise that? Is that like smart?

Yeah, so very good question. So let's— I'll first talk about the work of Tony Wyss-Coray, one of my colleagues who did this young blood study. So he did what sounds very Frankenstein-ish. He connected the circulatory systems of young mice and old mice, so they shared the same blood. And what he found was that old mice who got the young blood had improved memory. And in their brains, there was synaptogenesis, so there was sprouting of these brain cells. So as we see that mice age and they might have changes in memory, we thought we can get young blood for other reasons. So I ran a study where we gave young plasma to people with Alzheimer's disease to see if it was safe. You start off with a small trial to make sure that people are safe and tolerating this, and it was safe. But what we were surprised by was that there was statistically significant improvement in functional ability. So one of the hallmarks of Alzheimer's disease is that people have less independence. And so what we found is that these patients who got the young blood had improved independence, which was amazing. So it was a very small study. And so what I say, we don't say, okay, let's all get young blood. You know, we kind of feel like, oh, that might be exciting, but we have to start off small and do rigorous scientific studies. So we have to be blinded to the procedure, the patients have to be blinded to what they're getting, and it needs to be large enough to have a statistically significant response to That's right. So when we talk about biohacking and what's proven, I want to give people hope. I want to say, okay, you know, if you want to try this supplement, if you want to try intermittent fasting, number one, is it harmful to you? You know, is a small amount of fasting helpful?

Maybe.

But we want to make sure we're not harming ourselves. And that could be your wallet if it's too expensive, we're spending too much money. But I want to make sure if I'm going to recommend something to my patients, that it is proven scientifically. And if it's not proven, but we're not sure if it's harmful, but it potentially has benefits, then I say, okay, go ahead and try it, but let's make sure that it's safe.

You brought up anxiety, and KG, I know you have spoken openly about struggling with that, found meditation to be very helpful. I find that, you know, I have 4 kids in their 20s, and all their friends, they're more anxious than I've ever seen any generation ever. And I might say that I I talk to a lot of women my age and stuff who are anxious about their kids being anxious and anxious about them being anxious and anxious about their health and anxious that they're going to get Alzheimer's. And so we do know that meditation helps with anxiety. How did that help for you? And what is the science that gets you excited about what meditation could do for the brain and the body and the central nervous system?

Is this on?

Oh, yes, it is.

Hi, everyone. Yeah, so I too struggled with anxiety growing up. It actually started probably around age 16, and then it led me to actually study the brain. I thought if I could figure out what was going on, then I could understand my anxiety. And long story short, found myself doing research in bringing meditation and mindfulness to different clinical populations, and that included depression, anxiety, and chronic pain. and addiction. And basically, what excites me about meditation is that it really does slow down your nervous system and your parasympathetic nervous system and trains the body to be in a place of response versus reaction. And all this is to say that when we're more present with ourselves and what's actually happening, there's a better way that we can be in the moment. And so that's what I teach now, mindfulness.

That's great.

is presence and being in the moment.

But to so many young people who are all trying to be the next Mark Zuckerberg, who, you know, and I said, my son's like, I don't have time. I don't have time to teach me the meditation. I don't have time. Can you do it to me in a minute? I'm like, no, that's the whole point why you need meditation. So what do we— and the younger, obviously, you can start this, obviously, the better. So you're here in San Francisco dealing with a lot of people who are in the startup culture, working 24/7. 24/7, as I hear all the time. How do you advise somebody or encourage them that they can start?

Yeah, it's funny what you're saying because I do a lot of corporate meditation in tech companies. And the thing is that you can't really hack meditation. Like, you just kind of have to do it and sit and be with yourself. It's not like a quick fix. But I think the important part of how it relates to anxiety is that we're usually anxious about things that are causing us stress, and we haven't quite figured out a way to deal with it. And I think stress is degenerative. And so if there's anything that I learned in my research and in my practice and in working with different clients is that when we mitigate stress, we actually are improving our bodies and our ability to be with people and ourselves. And so that's like the first So, like, not having time, it's like, really, well, if you make time for meditation, you'll actually start to see where you— what doesn't need to— you know, what you don't need to be focusing your energy on. So it really helps with prioritizing.

Speaking of stress, the role of caregiver is probably one of the most stressful roles in the country. And people like Bob and others who are experiencing caregiving— I'm just doing a story for the Today Show that's coming out in a week or so about the millions of Millennials who are now finding themselves caregivers having to drop out of their careers to take care of their parents. And they— the economic hardship, the physical, emotional, spiritual hardship. What are you seeing, Lily, out on the front lines today that you didn't see a year or 2, 3 years ago?

Thanks, Maria. Well, first I want to start by saying that I think that as the fellow panelists have shared, the story of neurocognitive health right now is a story of hope. Everyone living in the Bay Area is a stone's throw away from the Buck Institute, from Stanford, from UCSF, where all of these pioneers are creating a change. The thing that I'm most excited about is the shift in our national conversation from genetics to epigenetics. What are we doing through our lifestyle factors and wellness to impact our gene expression? And that relates a lot to caregiving. Like Maria mentioned, 15 million individuals in the United States are caring for a loved one with Alzheimer's. 1 in 4 American adults is caring for an aging loved one in general. But those caring for a loved one with Alzheimer's are 7 times more likely to experience symptoms of physical and cognitive health issues. And so it's really critical, the advice we're hearing here, it's not just about treating perhaps the 85-year-old patient, it's about their adult children who are spending 20 hours a week or more So what do people do?

Because people come up to me all the time, people in their 20s, their 30s, their 40s, who are trying to find a caregiver, trying to know how to find an educated caregiver. How do they afford a caregiver? How long can they keep a loved one in their home? What is the advice you want to give to people about caregiving?

Sure. So Home Care Assistance, we're the leading provider of in-home care across the country for seniors.

And what we really share with people care is that there are a lot of options.

is we want to be a partner to the family caregivers who are doing this work. We're providing a lot of educational resources. We've published 7 books, all sorts of pamphlets. You can walk into our offices and speak at no cost with any of our care managers about what you can do to augment the caregiving that you're already providing at home. But if you need additional help, I'm here to tell you that those resources are out there. You know, our organization as well as others helps you by providing professional care for your loved one, because often it's very stressful to go through that role reversal and go from being the adult daughter to being the full-time caregiver. And so I would say to take advantage of those resources that are out there. And like Maria mentioned, we've made available caregiver recharge grants. So if you go to homecareassistance.com/womensalzheimersmovement, you can apply for yourself or for a family member or friend for a couple of days off from caregiving to attend to your own health and wellness, to do meditation, to attend a nutritional conference, to meet with your own doctor, to go to, you know, some sort of retreat. And I think that that's really critical for the health and wellness of our country. We're adding a lot of years of lifespan, but it's just as important that we focus on the healthspan of the generation that's providing care.

And this is a really important thing, what we have found in all of these events that we have done around the country, what you're learning today, the way you exercise today, which was not only good for your physical body but also your cognitive health, meditation, right? Supplements, knowing your A1C, knowing these things, they're really non-negotiables. You like can't like think about, oh, I'm gonna get to that when I'm 70, when I'm my age. This is something your kids need to know. your kids need to do, and you need to do when you go out from here today. It's like not like I'll get to it later because your brain is changing and you're going to either lose it or you're going to use it. And so every day actually counts and every day matters. And Dale, you've been really kind of progressive in this space because when I started working with you and having you on my conversation, people are like, whoa, you know, Dale is like out there. And I was like, well, you know, and it's true, you know, they're like, do you know? And, but you've really had a lot of tremendous success with your protocol. And you were the first one that kind of talked to me about the brain being like a roof with a lot of leaks in it.

Right.

And that it's not gonna be one thing and you're gonna be fine. And so the brain is so complex that people, I think, have a hard time making friends with it, understanding it, or even understand the concept of how do you keep it in shape and the fear of like when I can't remember something, I'm doomed.

Right. So, you know, this is a— this is, as we said earlier, this is now expanding and you're absolutely right. So I, as a lifelong scientist and academician, I've had to become an activist. I did not start out to be a hated activist, you know, out there Yeah. But what I found is, in fact, when you look at the truth, when you look at what's come out of the test tube in the last 30 years, what it says is that the disease that we call Alzheimer's is not what we thought it was. And in fact, global cognition and cognition for our lives is critical. And as you said, what we found is that there are 36 different contributory mechanisms, We know about a few more now. If you look at what a single drug can do, a drug can do 1 or 2 things. It can't do all the different things we'd like it to. So, in fact, we do have to look at additional things. What you eat is important. Whether you have a leaky gut is important.

Whether you exercise— How does someone know if they have a leaky gut?

There are a couple ways to do it. Excuse me. There's a simple test called a Cyrex 2. Array. That's one way to go, but there are others.

Ask their doctor for that.

Go to your doctor and say, do I have a leaky gut? And especially if you have gut symptoms. And so, you know, there are— you're absolutely right. It's one of the reasons that so many of us have it and don't know it. Find out if you are sensitive to certain things. And in fact, it is a very common problem, and it is one that contributes to everything from inflammatory bowel disease to rheumatoid arthritis to lupus and And so many of those things you just mentioned are dominant with women.

And what we have also learned in this past year, and some of it coming from the Women's Alzheimer's Movement grants, is that the brain of a middle-aged woman is very different than the brain of a middle-aged man. And that a woman going— who is pre-perimenopausal, perimenopausal, and menopausal, the change in a woman's brain is dramatic, even alarming. So what can you tell women who are out there who are, let's just say they have not experienced menopause, they're not even perimenopausal, and what hope can you give to those who are menopausal? That's really serious. I'm not kidding because women are used to being called crazy, out of control, all of these things. And that's a joke because it's serious. brain changes that is causing you to feel that way. So I always say if somebody says, like, you know, my kid, yeah, you're crazy, I'll take him by the neck. What is he, crazy? No, but, but, but that— it's a real serious— that is real neurological changes going on.

Yeah, this is so important. And I think that, again, I've been doing this research for 30 years. I've never been so enthusiastic that there is so much to do. And in fact, we can all together reduce the global burden of dementia. So if you are in perimenopause or in menopause or in pre-perimenopause and you are noticing changes, don't just simply ascribe, oh yeah, this is just the normal thing, I'm going through the change. Talk to your doctor, talk to your other healthcare providers, nurses, what have you. And if they don't listen to you, You've got the wrong doctor. So you want to tell them the truth. Tell them what's actually going on. And by the way, there are many good ways to document changes now. You know, CNS vital signs, CogState. There are many, many ways to look at your cognition. And of course, mood and anxiety. These are all part of this. So again, be heard.

And be believed.

Yes.

So a big part of also for women, hormonal changes. So many women that I've come up to and questions that have come through here is the role of estrogen as a neuroprotector versus the decision that it could increase your chances for cancer. What advice do you have for women in this space?

Yeah, I think it's an individual response. Unfortunately, like we said, we try to say generically we must exercise, we must eat right, we must do this. But like we're talking about, Someone who gets Alzheimer's disease at age 50 versus someone who's 85, there's something different about them. So if someone has a family history of breast cancer or other types of cancer that we're worried about estrogen increasing that risk, then that might be a different sort of conversation in terms of risk-benefit versus cognitive health for someone else who says, well, I don't have that history, but we know that the data is now showing that being on hormone replacement therapy perimenopausal might be Repeat that.

Repeat that. That's big.

So to be on hormone replacement therapy perimenopausal time can be neuroprotective in terms of cognitive health versus being postmenopausal and then taking the hormone replacement therapy. It's been sort of controversial over the past several years because I don't think it's been studied as well. So, and it's always retrospective too, so we need a good prospective study to understand that better, but the evidence is now suggesting that perimenopausal time, being on hormone replacement therapy can be beneficial.

We're also seeing a lot of kind of what the American Western diet, very bad for the brain, right? The way people are working at desks, you have an organization called Sitting Matters, right? The actual lifestyle, our work style in this country is actually really detrimental to the brain. So what do people do that are sitting at a desk, that are in a startup, that are being asked to work 24/7 on email, who are stressed out, what suggestion do you have for them?

To sit. Sitting does matter. So what I think is important to mention with some of the research that I have been doing and also in my practice is that when— so we use meditation to treat different things like anxiety and depression, but it also can be used to prevent health-related things. And so I think even if it's just taking a moment out of your day, something that's very, like, ritualistic, like brushing your teeth or getting coffee, like just taking 3 minutes, 5 minutes in the morning, you can also take that space anytime you enter into a new space. So even just being thoughtful and conscious of the way that you're transitioning from one thing to the next thing is a way of being Mindful. And the reason why mindfulness, which is around the idea of being present, is so important to this mitigation of stress and anxiety is because when you're present, you really are only with what is happening in that moment versus when we're anxious, we're either worried about something that may or may not happen or something that has already happened that we're kind of reliving over and over again. And that's catastrophizing and horrible and kind of— Not helpful. So if we can find ways to just be with what is happening, whether it's I can feel my heart beating or I can feel my breath going in and out of my body, like, that's— those are very simple ways that we can be mindful and practice.

And what we've also found is that people can go to, if they're in a corporation, ask for meditation space. A lot of corporations— I just did a story on Marc Benioff here at Salesforce— has meditation rooms on every floor. And that's not just in California. That's something that different companies are implementing because they understand that people are stressed out. Talk to your company about, you know, preventative health. Talk to your company about sitting, standing desks, all of these things that we're now learning that are good for the brain. So I want to open this up to questions. We have a microphone. These people— Don't come together all the time. So if you have any questions, particularly about the Bredesen Protocol, if you have a loved one dealing with cognitive impairment or yourself trying to understand whether it's a sleep issue, it's a supplement, Dale. So does anybody have any question? Dale, can you talk about supplements as we find someone to have a question? So many people come up to me and say, you know, do I take DHA? Do I take vitamin D? Do I take estrogen? Do I take testosterone? What do I take? They're There's so many, you know, people lay out supplements and I know you're a big believer in that.

Yeah. So, please remember that supplements are by definition supplementary, right? So, a lot of people come to us and say, just tell me what supplements to take, and that's not the way this works. So, the idea is we are driving you toward a biochemistry that supports your brain. And as we understand what that is better and better, We understand that, for example, most people do best with an organic, plant-based, ketogenic diet, with appropriate sleep, with a lack of sleep apnea. And I don't know how many people have been checked for sleep apnea, but we find it all the time. 70%— it's exactly what Sharon was talking about earlier— 70% of people with sleep apnea go undiagnosed during their lifetimes. So supplements are helpful. If your biochemistry needs them. If your vitamin D is 18 or 19 or 21, you want to push it up. If you have a suboptimal homocysteine, you want to bring it down. If you have a suboptimal B12 or vitamin D or vitamin E, these things turn out to be important. When I was in medical school, we— there was only one course on nutrition and it was optional. You didn't have to take it. That's how bad it was back in the late '70s. So, we now know these things are absolutely critical. And part, no surprise, part of your being able to make synapses, to make memories, to keep them, to have a functional brain is to have an optimal biochemistry. And so, absolutely. So, it's not supplements for supplements' sake, but it's supplements to drive you to an optimal neurochemistry.

So, people understanding that if they're having some cognitive issues, it could be sleep. It could be a vitamin deficiency, right? So go ahead, question.

Yes, thank you, Maria and panelists. I do have a question about sleep, which is one of the things that— how does sleep work into this? Because I come from a long line of bad sleepers, and one of the things I'd read was, and of course made me anxious, was that, that If you don't get good sleep, it could lead to Alzheimer's. So could you please address the issue of sleep? And how does falling asleep in front of the TV affect your brain in that regard as well? Thank you.

So certainly suboptimal to fall asleep. You want to have good sleep hygiene. And there's a wonderful book that just came out from Professor Walker that's called Why We Sleep. And I recommend it highly. I would check that out. Have you been checked for sleep apnea? That's a common thing. And then there's another related thing, which actually isn't often caught on the sleep apnea studies, which is called upper airway resistance syndrome, UARS. And what this leads to is basically you're secreting in small amounts adrenaline throughout the night. You're responding to this lack of perfect sleep, basically, lack of perfect ability to take in the oxygen that you need. And this is turning out to be important in a number of scenarios. So yeah, please check the book out and check out your sleep.

Go ahead, Cher.

So what I say to my patients about how important sleep is, you know, obviously if you have a bad night's sleep, then you can't concentrate the next day. So you can imagine consistent poor sleep just from your sleep hygiene or whatever reason, then you're not able to concentrate. When we're sleeping, we're also consolidating memories from that day too. Then you add to that potentially sleep apnea, where your brain is not getting oxygen that it needs. And so how can the brain function? And then we add to that the research that mouse models and human studies in which people have slept longer than 6 hours versus less than 6 hours, there's people who slept more had less of this bad amyloid protein that we see in Alzheimer's disease build up. So maybe something happens while we're sleeping that's helping get rid of that too. So there are so many reasons why sleep is important.

So, so many people who struggle with sleep, particularly women in their middle ages, but people who are stressed out struggle with sleep. So then guess what? They take Ambien.

Right.

They take all sorts of other things. And what is the effect of that?

Sleep architecture changes as we get older, number one, and with dementia syndromes and other neurodegenerative So it's very easy to go over the counter and buy an anticholinergic medication like Benadryl, Ambien, which is a benzodiazepine. Benzodiazepines are great for sort of emergency situations. It's like having some alcohol. It calms you down, but it's not good for the brain. So what do we say? Well, if you have sleep problems, talk to your doctor about what might be a good prescription medication that doesn't adversely affect cognitive health. And if it's an anxiety problem causing sleep issues, then maybe treating with an anxiety medication plus mindfulness too, right? I would recommend that because it's all intertwined. It's not just one perfect result.

Maria, if I could just share really quickly on that. It's one of the— if we're looking at the caregiver generation, one of the things that we're seeing lack of sleep due to caregiving causing is $50 billion of lost productivity in the US economy. Because people are going to work without the full mental state that they need. And so that's why this is not a niche issue for the people who are doing the caregiving. This is why Maria has catalyzed a national conversation. It's affecting society at all levels.

Great.

Thank you.

This one?

Oh.

My name's Linda, and we're dealing with early onset Alzheimer's, my husband Dennis, 8 years in. I appreciated your book and heard you speak, Um, talked about the 3 different kinds, but what he didn't say is many of us are dealing with parents and loved ones who have Alzheimer's. At what stage is it possible to do some of the things you talk about in diet, and at what stage is it really too late?

Yeah, that's a great question, and this comes up all the time. And as you might imagine, the earlier the better. So prevention is the best, and Then what's called SCI, subjective cognitive impairment, we see virtually all these people improve. We see most of the people with MCI improve. And we see some of the people who have Alzheimer's disease improve. We do have examples of people who had a MoCA score of 0, so they were very late, improve. But that's the exception, not the rule. There's a lot more to be done. And so what we want to do to reduce the global burden of dementia is to get people to come as early as possible. So what I recommend for people who are in the late stages is that all of their offspring come in and see if they should be on prevention.

Yeah, but you have like 15,000 people on your waiting list, so like— I mean, seriously, seriously. I mean, people tell me all the time, can you get me into Dale Bredesen's? 15,000 people on the waiting list. So I mean, you can buy the book, but how do we kind of deal with all the people So you, so you brought up a really good point.

So we have produced a network. So we have over 1,000 trained physicians in 10 different countries and all over the US. So there shouldn't be so many on the waiting list, and the wait should be relatively short. We have people who are coming in, and there are physicians in the Bay Area as well as all over California. So you should be able to see people who— and of course, there are national centers like UCSF and Stanford and places like that as well.

Can I say also— sorry, I think it's I mean, everyone's here because they really want to help make Alzheimer's and women Alzheimer's improve, whether it's finding a cure, treating yourself, a family member. So you've already done a lot by being here today, but participating in research so we can understand the differences— we've only started to learn a little bit more about how women are different than men in getting Alzheimer's disease, but we need more people to participate, whether it's research at UCSF, Stanford, anywhere else, whether it's clinical trials to find the cure, or volunteering yourself or family members to understand this disease. And so why the gut might be important, or why it's less important for you, for that individual, whether it's sleep, whether it's something else. I think everyone's studying different things.

And we're trying to get people who are in their 30s, their 40s, their 50s to participate in trials. And I say that it's a national service. So if you work for a company, I'm trying to reach out to companies to ask, to say, would you allow people to take paid time off to participate in a trial?

I love this.

This is amazing. I read that about you. This is so fantastic.

Well, could you help me?

I would, yes. Bring me along. I'll go on your tour. But I think, I mean, I run all the clinical trials at Stanford, and so, and I want to really broaden the scope. And I think one thing you had said is that when is it too late? And unfortunately, a lot of times pharmaceutical companies and researchers say maybe there's a point when it's too late to intervene. So a lot of the trend now is to recruit people, participants, not just patients, who are in earlier and earlier stages. One of the studies that I'm running is a prevention trial. And most of the trials are targeting people who have mild cognitive impairment. But I wanna expand that scope so we have people for later stages as well. But we need people to participate. We need funds. We need people to really believe in it and offer those treatments And taking the time. A lot of times people say, well, I want my husband, my father, my mother, my sister to participate, but I'm working, especially for young onset patients. So how do we do that? I think getting partnerships with companies to offer that time.

It is a national service, so just FYI, if you're in a company.

I think it's my turn. My name is Pam Montana, and as everyone that was working out with me today knows, I am living with younger onset Alzheimer's And my question is, I know there's a lot of hope and I know there's a lot going on and I'm, you know, part of that and I'm in a clinical trial with this amazing woman right here at UCSF. But I'm getting a sense that a lot of what we're doing is to come up with like a preventative for folks that don't have it and not for someone like me that does have it. And so my question is, again, similar, you know, is there a chance in the next 10 years that that something could cure me versus somebody that doesn't have it, and so it would be preventative? Because I have hope and I believe in all that, but I'm really, I'm really kind of just doing everything I can while I can because I honestly don't think there will be a cure in my lifetime.

Well, I think you have to be very careful about using the term cure, but what you want to do is to improve your cognition. So we published the first examples of reversal of cognitive decline decline back in 2014. We published additional patients in 2016. We're now publishing—

That was a very small study though, right?

And we're publishing an additional 50 now. We have now over 2,000 patients who are on the protocol. But, and it's no question, it goes against the classical idea of a monotherapy of a typical drug because that's what the biochemistry drove us to. So there are— there is a difference of opinion now. among, you know, my colleagues and myself about the way that you should go after this disease. So no, we absolutely are not just dealing with prevention. We deal with many people who already have cognitive decline.

And you can talk to Dale. Dale has his bestselling book, as do others here, so you can talk to him afterwards.

Go ahead. My mother just died of dementia last July. When she first had her symptoms, we took her to 4 different neurologists and got 4 different opinions. One said Lewy body dementia, one said Parkinson's dementia, one said Alzheimer's, one said vascular dementia. When she died, we had an autopsy done and she had all 4 of them. I suspect this is happening a lot. So my question is, what we're doing, healing the leaky gut, all this other stuff, will be helpful for Alzheimer's, but I'm hoping that it will be helpful for all the other types of dementia too. And are they really all related? as far as we know.

Wow.

Wow.

Go ahead.

So one of the things in our Alzheimer's disease—

Is that common? You are nodding your head.

I'm nodding my head because there's definitely certain types of diseases that overlap more than others, Lewy body disease and Alzheimer's disease. So for those of you who don't know what Lewy body disease, it's related to Parkinson's disease. There's a protein called alpha-synuclein that builds up in the brain. These form what's called Lewy bodies. And pathologically, the neuropathologist cannot tell the difference between Lewy body disease and Parkinson's disease dementia. So they're very similar. And for some reason, people who have Alzheimer's disease often can develop Lewy body disease and vice versa. So they co-occur very often. So does vascular dementia. So these things that we can try to control, like reducing our vascular risk factors— high blood pressure, diabetes, etc., high cholesterol— those things can help prevent or slow the progression of vascular dementia. But we need to understand it better. So at Stanford, we have an Alzheimer's Disease Research Center. So does UCSF and several other centers that try to understand this. We specialize in understanding Parkinson's disease, Lewy body disease, Alzheimer's disease, and the overlap between them so we can understand it and see what we can do to implement it. I serve as co-director of the Lewy Body Center of Excellence at Stanford also because we want to implement clinical trials. There are very few clinical trials for Lewy body disease, and it's a It's a very nuanced disease because not only are there hallucinations that are less common in Alzheimer's disease, that happens early on, there's the Parkinsonism, the movement aspect, as well as fluctuations in attention and alertness that really plays into the sleep aspect a lot more in Lewy body disease. So we're understanding, but we still need to understand the interplay. So if we don't have the right diagnosis, we can't give you the right treatment too.

And so all of these, can you address what she's saying also? All of the, the brain begins changing at the age of 30, right? So all of these things are developing with time, and we're all living longer, and everybody wants to live longer, but they want to live longer like they're 30.

Right.

Yeah, absolutely. So we want to, we want the healthspan, and we want the sharpspan, right? We want to be sharp for many, many years. And I think that is achievable with what we're beginning to understand about when and what it It's not a surprise, perhaps, that it takes the appropriate things to support. And the fact of the matter is we are living in a situation with too much stress, with too much anxiety. We're living in places that have too much pollution. You probably saw just a few months ago the work coming out on pollution and its risk for cognitive decline. So, what you described, just as Sharon said, is relatively common. It's fairly common to see Lewy body pathology. About 40 to 45% of autopsies with Alzheimer's show Lewy bodies as well. So this is telling us that the processes that are producing this are similar. And the other thing it's telling us that's— it's very important is that what we're finding about the amyloid of Alzheimer's is that it is a protective response. We've been labeling amyloid the bad guy and spending billions of dollars in pharmaceutical companies to get rid of the amyloid. But guess what? Amyloid is an antimicrobial. It also binds specific toxins. So it is a response. It's a mediator. It's not a cause in the vast majority of people. So the insults, the various things from insulin resistance to exposure to chronic pathogens to all these things are causing your brain to make responses that include amyloid and include alpha-synuclein.

Do you think it's the, the American lifestyle, the work, work, work, work, the air we breathe, the makeup we put on our face, which is why I'm glad Beautycounter is one of our sponsors because they're doing clean makeup. And that's a big thing that my daughter is always in my room taking all my makeup out because she said, we don't know, is this bad for your brain? And changing all the cleaning products in our house because she thinks it's bad for the brain.

Let me tell you something, Maria. I do not wear makeup. Okay, so that's—

No, but, but this is a big thing, you know, with, you know, kind of our lifestyle, what we eat, how we work, how we stress, what we put on our face, what we put in our house, the air we breathe.

So this is what the epidemiologists have been telling us, that guess what, if you live in a polluted area, you are at greater risk for cognitive decline. And guess what, if you get exposed to specific toxins, if you have too much stress, if you have You know, cortisol itself is associated with shrinkage of your hippocampus. So all of these things are contributors. And again, that's why our research over the years suggested that this is not something where there's one cause. It's something where there are many contributors, and we can address those contributors. And sure, we hope that one day there will be a single pill that will do everything, but for now, the idea is whatever the pill that you're taking, do it on the backbone of a program that addresses the very things that are contributing this. We have tried to treat this disease without asking what's causing it. We keep saying, let's get a cure, let's get a cure. We really need to address all the things that are contributing to it.

Great question.

Hi, my name is Devin. Thank you guys for the insights you've provided today. It's been really wonderful. I imagine for the success of of this movement is going to require advances in science, but it will also require big advances in narratives and stories that we tell ourselves. Could you speak to the gaps that are needed in the advancement of the stories that we tell ourselves, both as individuals and a society, that can contribute to the success of this movement?

I'm so glad you asked that. So I spent yesterday with Lee Hood and his group. You probably know Lee is the one who invented the DNA sequencers. that powered the human genome. He won the National Medal of Science from President Obama a few years ago, and we are working with his group actively now because the whole idea is we have a complexity gap. Human beings are incredibly complex organisms, as we all know, and yet we've been trying to deal with human beings in the clinic getting very small data sets. We ask what your sodium, your potassium, a few other things, and then we say you've got this thing called Alzheimer's, We don't know why you have it, but there's nothing we can do about it. So 21st century medicine is about asking why instead of asking what it is. And so you will see more and more and larger and larger datasets and machine learning and things like this to determine all of the things. And having all doctors should have computer-based algorithms in their offices.

We're going to wrap this up. And as I said, everybody will be here. You can ask them questions. questions, but I want to ask each person to leave the audience here with one useful piece of information that could be life-changing when they go out of here. Lily?

Your genes are not your destiny, and there is never any shame in asking for help when you are caring for an aging loved one.

Great.

There is a tremendous amount of hope, more than there ever has been before. You are, you are in charge. So get— it is actionable. Get checked and do the best you can for prevention. Get a cognoscopy. I know you don't like that term.

I take a cognitive test, yes.

Yes.

Find out where you stand and get on optimal prevention.

And also understand if Alzheimer's runs in your family, that doesn't mean you're going to get it. And if it doesn't run in your family, that doesn't mean you're free. So everybody's got a brain. Everybody's vulnerable. Every 65 seconds. Know these numbers. Take control of your brain and its health.

Next.

Use your brain to protect your brain.

Use your brain to protect your brain.

Okay.

I always tell my patients to make healthy living part of their lifestyle. If we don't make every day a choice to be healthy in treating our brain, then we're not gonna expect it to work as well as we want to as we get older. So I think that's important. And my second point, I know you said one, is to really volunteer for research wherever you may be. This will really help expand and advance the science to understand why women are more affected, why people are affected at younger ages, and why there's 2 diseases that people might get.

Great.

And I have 2 points as well. The first one is that the body doesn't lie. And the second one is that Meditation does change your brain and your body.

I want to thank you all so much for coming here today. Thank you for joining us, and thank you so much. Now you can go eat.

Thank you, Maria.