Lower Your Alzheimer's Risk, with Dr. David Perlmutter

One of the most powerful and very sophisticated tools that we have for predicting Alzheimer's risk is a very expensive piece of machinery called a tape measure. You put it around your waist and right off the bat you can determine to some degree what is your Alzheimer's risk.

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Hello and welcome to this episode of the Feel Freakin amazing podcast. I'm Dr. Wendy Trubo. My co host is Dr. Edward Levitan. And I'm always saying this, but our guest today is Dr. David Perlmutter. And I am so psyched to interview him.

Me too. Me too.

Me too. Well, I'm psyched to be here.

Delighted. Let me tell our listeners, I don't know who'd be listening to our podcast who wouldn't know about you, but let me tell anyone who's listening. He's a board certified neurologist. He's a fellow of the American College of Nutrition. He's a frequent lecturer at symposia sponsored by institutions including the World Bank, Yale, Harvard. He serves as an associate professor at the University of Miami Miller School of Medicine. I've seen him speak. He's brilliant. He's also a five times New York Times bestselling author who has published books such as Brainwash, Grain Brain, Brain Maker and his latest book, Drop Acid.

So diabetes, Alzheimer's and uric acid. And just how does that work? Because everybody's so worried about Alzheimer's as the population gets older, that is just on everybody's mind, at least on our patient's mind.

Absolutely. So, you know, there are many unifying so called theories of Alzheimer's disease. Some would have you believe that Alzheimer's is simply the manifestation of the accumulation of a particular protein in the brain that is called beta amyloid. Therefore, if we can rid the brain of beta amyloid or reduce its production, why, that might be something really very valuable. And I think this amyloid hypothesis has really now been aggressively questioned because we recognize that hanging our hats on one idea here, we are kind of molded to appreciate that approach because it lends itself quite handily to the production of a single pharmaceutical intervention based upon whatever that paradigm may be. And that has failed dramatically. And that has Failed in a heart wrenching way for families of Alzheimer's patients and for clinicians dealing with Alzheimer's trying to treat, trying to treat patients using so called monotherapy. We don't have a pharmaceutical fix for Alzheimer's today. So we have to ask ourselves, well, who's getting Alzheimer's? Who's at higher risk? We know, for example, that two thirds of Alzheimer's patients are women. And that should cause us to explore, for example, are there hormonal influences that differentiate between men and women that might explain it? Are there other things that are carried on the X versus Y chromosome, for example, that may be at play here that are underlying this incredible disparity that women are 50% more involved with Alzheimer's than are men? Unfortunately, as I will digress for a moment, that relationship doesn't get much attention and we could speculate why. Because it's primarily a women's disease. We don't talk about it as much, but we should, from the perspective of women deserve it, number one. Number two, they're much more involved. And number three, there's some valuable information there if we would take the time to look. We know that diabetes. To get to the root of your question, having type 2 diabetes, by and large a preventable disease, a disease based upon lifestyle choices, is associated with a dramatic increased risk for Alzheimer's, a disease for which we have no treatment. It's as if the population is being told and mesmerized to believe that you should live your life however you choose. And then when your A1C is above whatever that magic number may be, then we have something to fix that, to bring your A1C below 7. As if 6.5 is a reasonable goal. It is not. The change is the risk for Alzheimer's begin at a level of 5.3 and 5.4, as published in the New England Journal of Medicine in 2013. So the whole notion of getting my A1C below 7 by taking this wonderful drug is kind of a perversion of reality in terms of what's best for people. Now, elevated blood sugar, by virtue of its ability ultimately to compromise how our bodies and specifically brain cell are able to respond to the hormone insulin is very, very important. The important concept underlying Alzheimer's causation is one of what is called bioenergetics. And there are many other things we need to talk about. We know that inflammation, excessive free radicals are important as well. And yes, misfolded proteins are of course important, but really a central player seems to be the bioenergetic theory. And this supposes that because of insulin resistance, the brain cells, which require glucose, by and large, to work day in and day out. And we can talk about how brain cells are able to utilize ketones, perhaps later on. But primarily, the main source of fuel for brain cells remains glucose. Either the glucose that is consumed in the diet, or the glucose that our bodies are able to produce, either by breaking down glycogen or de novo synthesis, what we call gluconeogenesis, where liver is able to actually make glucose when we need it. Brain cells need glucose, and many important parts of the brain depend upon insulin so that that fuel can get in and power those brain cells. When brain cells are not powered appropriately, they don't work well, as would your car not work well if you gave it the wrong kind of fuel. The problem is that when brain energetics, meaning the utilization of fuel, are compromised, ultimately those cells will die. And that is certainly not a good thing. When we compromise energetics, we're compromised the function of the little energy factories in each and every brain cell called the mitochondria. And any given brain cell may have several thousand of these mitochondria that are depending upon fuel supply to create the currency of energy in the brain called ATP. But that said, this is the relationship then, between the functionality of insulin and brain function and brain risk for degenerative disease. But it goes beyond just the brain energetics in the brain. Insulin, which we need to work, which we need to be sensitive to, is what we call a trophic hormone. It nurtures brain cells. If you take brain cells, human brain cells, and put them in a dish, if you want them to grow and function appropriately, you add insulin to the petri dish and lo and behold, that will nurture the brain cells. So we need to get away from just thinking about insulin in terms of its role, in terms of allowing glucose to get into the cell and therefore power the cell, it's a trophic hormone as well. And this is actually very, very important. And interestingly, just last week, a very important study came out of Germany demonstrating that individuals who are overweight, obese and sedentary, meaning they don't do much, they don't exercise, they don't get around much, are generally at great risk for having insulin resistance in the brain that can be easily quantified. How do you quantify that? The beginning of the eight week study, the 21 people had an MRI, what's called a functional MRI of the brain. But prior to undergoing this brain scan, they shot some insulin in their noses. And then they were able to evaluate how the various parts of the brain were able to use the insulin and therefore work. When the brain cells work, they demand more blood supply. So they're basically measuring blood supply after people get insulin and seeing if insulin is working. And what they found was that these individuals were at risk for having multiple areas of the brain not respond very well to insulin, not able to utilize glucose. They were insulin resistant in their bodies and brains. The intervention then was really quite powerful. The intervention had these individuals, 21 individuals, 14 female, seven male, exercise for eight weeks, and then the researchers shot some insulin in their noses again and repeated their brain scans. And lo and behold, those areas that were not functioning as well came back online, meaning that their brains regained insulin sensitivity by this bizarre medicine they used called exercise. That exercise was able to restore insulin function in the brains of these people in whom it wasn't functioning very well. Mitochondrial function improved as well, even cognitive functions. We know peripherally that exercise is really very handy in restoring insulin functionality as well. But now in the brain. So that's kind of a bit of a circuitous, but certainly long winded answer to the question of how does it relate, how does glucose and diabetes and insulin functionality relate to the brain in terms of how your brain is working right now, but also in terms of an individual's long term risk for developing brain degeneration. You know, ultimately Alzheimer's itself.

So you're saying you're having this radical. You're saying something really radical. You're saying that exercise can actually help prevent Alzheimer's disease. Completely radical.

Well, that's been demonstrated for, actually for quite some time. You know, the epidemiologic studies have clearly demonstrated that people who are less sedentary have a dramatic as much as 30% reduction in risk for developing a disease for which there is no treatment. Alzheimer's, that's been known for an awful long time. As a matter of fact, research from the University of Pittsburgh that came out about 14 or 15 years ago now demonstrated that in comparing two groups of elderly individuals, one group got a stretching program and one group got an actual aerobic exercise program to perform that. In the non aerobic group, the stretching group, there was shrinkage over the course of one year of their hippocampus, their brain's memory center, whereas the hippocampus actually increased in size in the exercising age matched group over the period of one year. The researcher's name, Dr. Kirk Erickson. And what we know exercise does, in addition to now looking at the incredible results that were published this week with reference to insulin sensitivity. Exercise increases the production in the body of something called bdnf, brain derived neurotrophic factor. And what BDNF does is it turns on the growth of new brain cells and also the connection of brain cells, how they communicate to each other. We call that synaptogenesis. It protects brain cells against trauma. And it's really something we want to have a lot of. So we've known that exercise increases BDMF for an awful long time. And that study now, 14 years ago, demonstrated that, oh, here's the payoff, a bigger memory center, better cognitive, better executive function, better memory. My gosh, why doesn't everybody talk about that? Well, because it's not a. We can't patent it, you know, but what you hear about are, you know, the wonderful new drug developments that are coming soon. Just hang on. And I. Yes, there's something I'm going to tell all of your viewers. They need to buy and that is a new pair of sneakers. And I don't even think they use the term sneakers anymore. I don't know where that term came from, but a new pair. Go and buy some athletic equipment. You can walk, you can jog, you can bike, you can whatever. And you know, for a long time we've been talking about aerobic exercise. And you know, I still pretty much hang my hat on that. But resistance as well. We know when we, when we challenge our muscles that various things we increase BDNF and cathepsin B, which also is a tonic for the brain. And you know, again, this is, as you just said, this isn't. We haven't even gotten to the nutrition part of our discussion yet. If we could end by saying to everybody, you really must exercise six days a week, why not make it seven days a week? And if you find it very difficult to walk to the, to the mailbox. Okay, walk halfway to the mailbox tomorrow. You'll go the whole way to the mailbox. Not saying everybody needs to run a half marathon tomorrow. Find out what works for you. Get your heart rate up. A target might be the number 180, minus your age or who knows what kind of shape a person's in. Work with a trainer. But you got to get started. And it's not just to keep your body in shape. It's the most important thing you can do for your brain. We could end our podcast right now. That's a home run message that everybody needs to get the number of diabetic adults and pre diabetic adults in America is a very, very small number. We're only talking about 45% of adults. I mean, it's incredible. So, you know, we're talking about near 100 million individuals. And, you know, the reality is, if you were to do any sort of more sophisticated testing than simply a morning fasting blood sugar on people, you'll find that at least as it relates to insulin resistance, we're talking about, you know, a lot of people and a lot of adolescents and even a lot of children. So it starts young. And from the metabolic perspective, we've got to do everything we can to improve that. Because if these are individuals on the insulin resistance spectrum who are paving the way for what I just explained, issues related to the brain and diet is playing a fundamental role. We definitely need to be more involved in getting towards being in ketosis, a more ketogenic diet, recognize the incredible detrimental role that highly processed or ultra processed foods are having, or even minimally processed foods are having on our blood sugar, on our insulin response, on our insulin sensitivity. And, you know, it's very unfortunate that this is not mainstream medicine. Mainstream medicine will say, you're fine at, you know, fasting blood sugar at 105, but what am I in the afternoon? What's my postprandial glucose? In other words, what's my glucose after I eat? And how would anyone ever know that? Well, you know, there's a time and a place for wanting to go a little bit deeper. The time is now. The place, in my opinion, is everywhere. We need to get better metrics on adults to intercede at a time before they're even minimally insulin resistant and nip that in the bud. Because mainstream medicine functions such that they look upon it like pregnancy. Either you are or you're not. And that's, you know, diabetes is not binary. Everything's not great until you suddenly have a blood sugar, a fasting blood sugar of 120. Now everything's terrible. Or your A1C is suddenly 6 or above. Now everything's terrible. Or 6.5. Whatever the number is, chosen that once your A1C begins to creep up or your insulin resistance begins to increase with time, or your fasting blood sugar increases. I mean, I haven't even gone to continuous glucose monitoring yet. We hopefully might have time to go to that. But this is the order of the day, because the downstream manifestations of this blood sugar issue, insulin resistance issue, span every organ system in the body and are really at the root of our chronic degenerative issues which are continuing to expand and to consider that adolescents, now, young people, can expect to live a shorter life than we did. That gets to what some people being genetically predisposed to having an elevated blood sugar, insulin resistance, diabetes, and even Alzheimer's. Yeah. While that's important, in my opinion, it's minimally important. There are polymorphisms that relate to Alzheimer's risk, I will grant that. That relate to higher risk for insulin resistance, that's for sure. That relates to even higher risk for having a higher uric acid level, I will grant you that. But by and large, if that were the case, then we wouldn't be suddenly, in the past 100 years, seeing such a dramatic increase in rates of obesity, you know, that 50% of Americans will be classified as being obese by the year 2030. 30. That's not the distant future. You know, we're talking about eight years from now, half of American adults, not just overweight, but obesity by BMI standards. Man, oh, man. And when we look at what are the risk factors that are downstream from obesity, it's devastating. Including the brain. You know, the bigger the belly, the smaller the hippocampus, if you really want to know. I have been on record as saying for a very long time that one of the most powerful and very sophisticated tools that we have for predicting Alzheimer's risk is a very expensive piece of machinery called a tape measure. You put it around your waist, and right off the bat, you can determine to some degree what is your Alzheimer's risk. And with the proposition that half of adults will be obese eight years from now in America, it's worrisome, that's for sure, because our, you know, our shared brain bank, our shared cognitive ability as a nation is threatened by this statistic. Our genetics involved. Of course genetics are involved, but most of it is lifestyle. And, you know, we talk about how important exercise is, and it is, but these things work in concert. You cannot exercise away a crappy diet. And people try, oh, I spent two hours on the treadmill and I'm still fat, you know, and it's not a calories in versus calories out proposition by any means. There are so many more factors involved that are important in terms of maintaining health and disease resistance moving forward. And it's a long game.

So tell me something. Where do toxins fall in all this? Because we're all about toxins, and I feel like those are huge factors that alter your development of metabolic syndrome and obesity. And you haven't. And Alzheimer's, but you haven't really mentioned that. Is that something that falls into your conversation?

Yes. When I was a little kid, my father challenged me. He said, what are the causes of disease? I don't know. He said, infectious, neoplastic, toxic, metabolic, degenerative, traumatic and so toxic? You bet. And ours is a toxic world. And again, it gets back to this evolutionary environmental mismatch whereby, yes, we have evolved detoxification enzymes to deal with toxins that are in the environment. And there are plenty, you know, aluminum is I think, the second most common element in the earth's crust. So we have mechanisms on board to deal with things, toxins made by mold that we might be exposed to, for example. But to think that we're suddenly going to evolve a detox system to deal with what we're being confronted by, with you thousands of new chemicals being unleashed upon us every single year, we don't have time to evolve those detox mechanisms. And I would say that one area that's getting a lot of attention now, and I'm glad, is the particulates in the air that we breathe, these so called 2.5 micron particles. Because we're now seeing relationships between exposure to these 2.5 micron particles and dramatic risk for a slew of chronic degenerative conditions, including things like even weight gain. But certainly brain degeneration like we see with Alzheimer's research that shows the closer you live to a highway, for example, so, you know, everybody cannot move to live in the country and drink reverse osmosis water and live that type of life. But when we eat more appropriately, we do allow ourselves the opportunity to enhance the functionality of our endogenous detoxification systems, which are pretty functional. We can enhance the ability that we have to deal with many of the toxins to which we are exposed. Cruciferous vegetables, for example, activate a system called the NRF2 pathway. That'll be on the quiz. And what does the NRF pathway do? Well, it enhances our body's production of some really important detoxification enzymes and pathways. So there are things that we can do that relate back to other lifestyle choices that can help offset the damage posed by the various exposures that we have. You know, there's a lot being talked about these days. In fact, I'm interviewing somebody I think on Monday, next week on how so many humans, mostly in Western cultures, are suffering from mold exposure and the toxins that are made by mold. But when you think about it, we've been in moldy environments always, whether we're talking about living in a cave or you Know, a thatched hut that's, that's wet. So we've been exposed to mold for an awful long time. It's just lately that is become, it's becoming an issue. And I think that gets back to our environment. It gets back to perhaps this so called hygiene hypothesis where we're not equipped anymore to deal with environmental things like mold and various types of bacteria, et cetera, that had really challenged us for, you know, hundreds of thousands of years. And we did well in those situations because we are no longer challenging ourselves with those types of exposures, those types of infections.

In addition, not only are we cleaner, but we're also eating differently, sleeping less, stressing more, moving less, and exposed to a boatload of other environmental toxins. So you put this into that whole sort of here's you. And it's not only that you, it's not only that you've just been exposed, it's all those other factors too that play a role. It meshes in.

It's true. And let me give an example that I think will resonate and that is not everybody who got, who was infected with SARS CoV2 virus had a bad situation, had a bad outcome, who did well. You know, by and large people with underlying metabolic problems like obesity, like type 2 diabetes, tended to do worse. And those are individuals whose bodies are chronically in a state of immune dysregulation, have higher levels of inflammation, for example, and their ability to respond in a balanced way to a challenge to the immune system is compromised. They suffer from a degree of what we call immunosenescence, whereby their immune systems are older, senescent and less able to mount an appropriate response. And the default is increasing inflammation. Hence the so called cytokine storm, for example, that can be a lethal event where individuals get with COVID 19 suddenly have an explosion of inflammation in their bodies, damaging their heart, their lungs, other organs. And that can be a fatal event. But at the same time, I think we should embrace, because people have gotten this idea of the cytokine storm, an explosion of inflammation. We should think about something, call it the cytokine drizzle, whereby even a low grade elevation of inflammation, not acutely but over time, can also become an issue for the human body. We know that Alzheimer's has a profound inflammatory component, as is coronary artery disease and even various forms of cancer are inflammatory at their core. What is it that's dysregulating the immune system and leading to increased inflammation? We know that insulin resistance is responsible, that glycation or sugar when it's elevated, binding to proteins. But really important to get back to our conversation a while ago is that changes in the gut bacteria can lead to overall increased inflammation in the human body by threatening the integrity of the gut lining. Let me walk that back a little bit. The integrity of the gut lining is maintained by our gut bacteria. That's one of their important jobs that they lovingly do for us because we feed them, we give them a nice warm place to live in return. They do many things, but one of their tasks is to keep the gut lining intact when we threaten our gut bacterial friends by eating things that are wrong, certain medications, not getting the sleep that, as you mentioned earlier, et cetera, exposed to chronic stress, they can't do their job. And when they can't maintain the health and integrity of the gut lining, it becomes permeable or more permeable and leaky such that things in the gut get across that lining and get into the systemic circulation. Our immune system sees that and says, whoa, this isn't supposed to be here. And what does that do? It turns on inflammation. So what I've just done then is related our lifestyle choices and diet certainly at the top of the list here to ultimately changes in the gut bacteria, increased permeability, increased activation of the immune system, inflammation, opening the door to things like Alzheimer's and heart disease and some forms of cancer. That relates then the foods we eat to the risk of Alzheimer's disease. Who knew? I mean, it's. It takes a little bit of unpacking. It takes some dot connecting. I'm aware of that, you know, but we've known about this and it gets back to our original conversation when we started today about, you know, the notion of a more ketogenic diet being a good thing for a lot of people vis a vis diabetes and, and Alzheimer's. There's a wonderful paper that recently came out from a Dr. Matthew Phillips in New Zealand. An interventional trial putting Alzheimer's patients on a ketogenic diet and demonstrating improvement in their cognitive function. Black and white, objective testing, wasn't it? You know, the doctor said, I think these folks are better. Or their family said, you know, I think they're better after going on this crazy diet. No, they were tested with objective testing and verifiably improved. Think about that. We don't have a pill that can do that.

No. Appreciate it.

Awesome.

Where can people find you?

Yes.

DrPerlMutter.com is my website. DrPerlMutter.Com that's probably the best place to start. That then segues to Instagram and Facebook. And the Empowering Neurologist is my podcast, the Empowering Neurologist. And I have a great time interviewing smart people like you guys and getting information out. People write books, we talk about their books. So I have a lot of fun with that. So that's where I am.

Awesome. Thank you for joining us for another episode of the Feel Freaking Amazing podcast. Our guest today was Dr. David Perlmutter. Thank you for being here.

My pleasure.

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