Alzheimer's Can Be Prevented & Reversed

[Music] come on we ready to go we are yeah thank you so much for making the trip all the way out here I'm delighted to talk to you guys the book that you have written the Alzheimer's solution is it's super powerful and I have no doubt that it's already helping lots of people and has the potential to really be a healing you know curative treatment for so many people like it's a it's an incredible work and I'm just so excited to unpack it with you guys so thank you for coming out thank you for everything right so we met at Rachel's of that initially right rachel abrams events so we share Rachel and Doug Abrams as common friends Doug I went to college with Doug oh my god yeah he was a college classmate of mine and I've had Doug and Rachel have both been on the podcast about a year ago so it comes full circle and here we are talking so I think maybe the best way to kind of launch into this is perhaps to define our terms a little bit you know what do we mean when we're talking about Alzheimer's and perhaps it would be worth explaining the difference between Alzheimer's and other forms of dementia mmm so Alzheimer's is a fairly new disease in the sense that it's it's beginning to be well known and it can in in our society especially first world society it's not a new disease and sense as far as a new infection or something of that nature and what's been known for a hundred years or so and defined by dr. Alzheimer's a lot of people it's like 1901 oh yeah exactly and but but from longest time even now in many communities they call it senility they call it part of just normal aging just today I saw a patient full-blown Alzheimer's advanced the family didn't know that this person had Alzheimer's and all the things they had to do either to prevent or even now that they have it to how to deal with it Alzheimer's is a subcategory of the bigger disease process which is dementia dementia is the big group which is like cancer and the Alzheimer's is a subtype of it but it's the biggest category 60 to 70% of all dementia is Alzheimer's and since 1990s when first President Reagan was diagnosed and from then on it became more known and more study than billions of dollars spent and and then research in the field so why you say it's a relatively new disease me it's discovered in 1901 and we're now we're seeing you know seeing it in epidemic levels and growth curves insane so what is you know why is it a recent disease why is it just coming online now and why is it accelerating it's such a rapid rate I was it was a play on words it's not a new disease in the sense that and the human experience it's a new disease as far as our understanding of it mm-hmm that's prevalence it's massive growth I mean we're talking about every other disease in decline pretty much every other disease or death from every other disease in decline yet mortality and death from Alzheimer's in just the last 10 years has grown more than 80 percent part of that is because we're aging Society we're doing better with yeah we have more diabetes we have more obesity we have more of all these other diseases but we're surviving them with machines with surgeries with these catheters all these things were living past what we would have lived with what we can survive diseases survive he used to kill us exactly but when it comes to what's left behind is our brain at the end of the day we're left with our brain and that's the cumulative problems over 50 60 years that actually end up in being Alzheimer's at the end or dementia in general Alzheimer's and that's where we bring the new kind of conversation that we have to approach it in that sense we have to approach it as a lifestyle disease and and that's why it's so important right and we're gonna we're gonna work our way towards that but just to kind of lay a little foundation when I was going through your book I mean this the statistics are staggering six leading cause of death but perhaps as is third because it's so underreported 226 billion dollars are spent in the US to treat this and it's looking like all right and 604 billion worldwide it's working its way towards the trillions by 2050 we're looking at one hundred and thirty five and a half million people suffering from this disease I mean this is something that's if it's not touching you directly it's certainly touching you indirectly absolutely I think it's probably one of the scariest things out there and you know you quoted the numbers and it's so sad that all this research throughout the years by big organizations whether it's Alzheimer's Association or others they haven't really done much there there's really no medication for this for this disease there is this incredible failure rate for for finding a treatment for Alzheimer's disease about a ninety nine point six percent failure I can say call it like a medication worth even considering with that level of failure rate so there is no there is no treatment for it and you know the the minut number actually our medications that are used for laying some of the symptoms for a few years yeah just for a few years it doesn't work long term at all so and there is the reason is because everybody's been focusing on one molecule on one small process instead of stepping back and looking at the bigger picture and the complexity of therapies so yeah I think I think there's a lot to be done in that area yeah I mean it was basically a death sentence you would go to your doctor and the doctor would say well we'll try to make you comfortable and here are some options in terms of places where you can get assistance with your lifestyle but you're good you're just gonna ride this out and that's it and we see these pharmaceuticals that are available now but they really just don't they're just there they're not effective not at all not at all it's so depressing being a neurologist in that field because you know we went through it in the past a person would come in we would diagnose them with Alzheimer's disease or supervisor whoever the neurologist was and the next conversation would be you need to get ready to let go of your finances you need to find a nursing home you need to bring your family members so that they're aware of how you're going to lose parts of yourself as you move along and that that was basically it oh my god you handle that as a as a doctor having to have that conversation over and over and over it has it's worse than a sentence for a great majority they've done studies and from for many Americans it's worse than death to know that you're having Alzheimer's and and the approach from the medical field is actually even worse it you have 20 minutes with a patient hi how are you doing how's it going you do the cursory check for the heart tapping the knee and then I didn't you know last five minutes you have Alzheimer's and this what you have and this is what you have to do and here are some pills and the pills don't change the progression of the disease they just help you with the symptoms mm-hmm this is this is a process that's going to increase accelerate every family every family in America will be affected by it directly or indirectly and we need to do some something to kind of either curb or have a new approach to it and what we're doing is actually we whenever we bring this topic they tell us but are you blaming the person it's not about that it's about giving hope it's about starting a new process a new direction that was the whole goal and came from our experiences in the communities we live in loma linda write the story of how you evolved into this perspective for for treatment and you know prevention is unbelievable right because you're coming you know you're hard-nosed scientists you know immersed in the scientific method you know raised to be doctors in the in the Western tradition and had your experience with that and then kind of evolved into what you're doing now but to give it some context maybe let's explain a little bit of your background I mean I know you met in Afghanistan which that's problem he'd spent two hours on that row but I mean deed you are you are at NIH yes and I usually you or is it Aisha how do I say it I saw you were at UC San Diego correct yes both practicing neurology absolutely yeah we actually came into this field because we both had grandparents who had dementia severe dementia and you know there were incredible human beings and there were our heroes and I remember having my grandfather's picture on my desk throughout my medical school because I wanted to be like him and I saw how slowly and gradually grandfather lost himself to the point where he didn't recognize his children didn't recognize any of his grandchildren and that was just devastating I saw the pain that my parents go I went through and for this brilliant person to slowly and gradually become a child again so it affected us and we wanted to study neuroscience in the brain and its beauty and its complexity but you know as you go on through the period of you know getting educated in medical field you come to a point where you're in a clinic with a dementia patient and there's really nothing you can do about it and that was just depressing yeah well that's a powerlessness it's you CSDs than when at the time with Leon where I was number one in neuroscience program in the country NIH as NIH and we were we were actually at UCSD and study after study after study billions of dollars a mouse model had worked on mice so let's apply to humans again a failure that's at least a hundred to three hundred billion dollar a million dollars per study you know and it was just incredibly frustrating first of all the muscle mouse models 50 60 things have worked on mice for even blueberry's work on mice I mean I think if you just look at them in the right way they will work on them mice mice do not men make and after a while we just said this is this is just too much so we decided to look for an alternative we looked around Dan Buettner write about him in his book and we found that by the Loma Linda and then the rest just followed and but but that transition was painful and scary right there are a lot of impediments in the way it's hard to catch you know please go because you know the way you're trained in the medicine world is to look at cause and effect and look at Alinea path up how a effects be how does a influence be and what are some of the other factors that come to it it's very very myopic in the way research is funded by NIH or other governing bodies is just that to have a linear model of looking at associations and studies after studies after studies have just looked at very small things at a time and not the bigger picture and we were so excited to see studies from Loma Linda or the Blue Zones coming and showing that there is a different perspective to look at there is lifestyle there is you know this complex nature of the foods that you eat or whether you exercise or not envy interactions between these lifestyle factors they matter and it was painful because I remember clearly when we were showing interest in doing something of that nature of studying populations we were told by our mentors and you know some of the prominent people universities things like oh you're this is career suicide for you you do know that there's no future in this if you decide to leave UCSD and this fabulous say for example a molecular molecular research that you're doing and you're going to go and study epidemiology and population studies nobody's going to fund you right yeah yeah you're breaking ranks with you know with with core tradition and that's a frightening thing and you know just to touch on what you said earlier you know that is the by its very nature the reductive nature of the scientific method right and there's reason and rationality for that and it works in many cases but it's inherently flawed with respect to some ways of approaching problems right because it's not just one thing it's a it's a matrix of an infinite number of cofactors that interrelate and this interplay of things that coalesce to you know create this situation you can't you can't extract out the one variable that me 12 or the beta-carotene exactly and come up with a solution for this so so that's interesting so the solo Melinda comes onto your radar and Dan Buettner in his you know amazing books and all the incredible work that he's done and you decide to pack your bags and head out to the one blues out and he knighted States and hang out with the seventh-day Adventist was frightening endeavor I was the director of the brain Health Center she did her she said we're gonna go all out so she did a preventive medicine residency and neurology residency and then with two kids with us I was in normal and as the director of brain health center and I should have went to Columbia University to study vascular and epidemiology at Columbia University two years flying back and forth every two weeks we said we're gonna go all out Mike ever gonna go all that Wow and study and at night she would study culinary I went to cooking school right I know do you did that you did the Roubaix school I did no I actually went to Nashville gourmet Institute uh-huh and then I went to Ruby I did there would be online as well you're just like collecting all kinds of degrees fun yeah I think you know I probably would make more difference talking to some of my patients about changing their dietary patterns than just pushing aspirin and statins mm-hmm I found that useful in so many occasions and just you know personalizing lifestyle for them so I think it was a great decision and what is the rationale behind getting a degree of Columbia in what was it vascular yes it was vascular neurology and epidemiology so it was a combined training in stroke understanding diseases of the brain especially vascular disease of the brain and the epidemiology side highlighted prevention and understanding how disease patterns exist in population it was so funny that then while she was there in first year they they want to get you into research molecular research and she said no I'm going to study population of researched it okay there was this study and California Teachers study why don't you to look into that data so she flew to California collected the data and that study with Mediterranean diet plant-based component of it and Stroke and lo and behold she that paper was highly touted she won the youngest researcher award for American Heart Association and the Colombia people all Center no offset so everybody was excited so she was the youngest plenary speaker in the American Heart Association talking about lifestyle and Stroke hmm so the very thing that they thought that would not really make it amount to anything all of a sudden turned out to so every step we've taken completely non-traditional has turned out to actually resonate and make a difference and hers the show that what the more people lived a plant-based lifestyle closer adherence yes as low as forty four people had low I had about you know forty percent lower risk of having strokes forty percent forty that's amazing so when you're in this situation in San Diego being frustrated with you know the sort of standard operating procedure of treating these these patients with dementia did you I mean were you already looking at lifestyle and getting interested in that and where you sold on that and the plant-based diet and all of that or did that come in turn with coming out to Loma Linda and kind of immersing yourself in in the way that they are tackling these problems and looking at how people are living in that and that part of the world yeah as a scientist you want to make sure that your your personal biases do not bias your sign right that's kind of what I'm getting in yeah yeah I know and and and we were already vegetarians for other reasons we are for ethical reasons and all that and this came in the middle of Afghanistan of all places we decided that we're gonna turn on Sun yes and that in itself is a another book of this slippery slope of you know I was the Deputy Minister of Health I went from an IH to Afghanistan I'm the youngest Deputy Minister created this whole women's empowerment but my downfall was that I became vegetarian aha nothing else political suicide yeah but but but that aside when we came to Loma Linda we really even now we for example some of the things we say is sugars worse mm-hmm but we we let the science do the talking we as a scientist you can't let your personal biases direct the science but the science is just overwhelming it's not just us it's you know yeah you get these little blurbs of fad diets here and there let's do keto he goes through this let's do that plant-based living has been proven over a hundred years thousands of papers validated papers it doesn't mean that somebody just did one little paper five other people repeated it this has been powerfully shown that haven't self study showed that people who live a certain life more plant-based live 10 years longer and healthier than everybody else in JAMA not just a regular Journal top journal in the world that was published and many other things cancer risk is lower and everything else the only thing that was left to show was brain so we study the brain and while there we actually looked at my clinic or our clinic which we saw thousands of people and this is at the center of this Seventh day Adventist community there's nowhere else for them to go right either they come to me or they just stay home or as far as yeah you're looking for candidates to study there's nobody to study because there's you go to the gym and everyone's 90 and they're doing push-ups doctor Wareham did surgery at 95 some saying it is and he's still running around you know is it yeah he's not taxing medicine anymore yeah he retired because you wanted to travel right yeah because he had a tremor or he was feeling tired he's just an incredible strong and very very healthy I had pensions 80-something saying that you know I'm running the marathon in LA are you joining I was embarrassed I was like no not this year this is 80 something you're all running a marathon I mean that's an easy not unusual to see that on a regular basis absolutely so so this is and then the clinics were more people from outside right so beyond ten so yeah so you come to Loma Linda we're gonna study brain health we need all these people that we can evaluate to create this population study no one's showing up at the clinic and ultimately you have to kind of go across the tracks over to San Bernardino where there's a lower lower socioeconomic class of people and people are suffering terribly there from all manner of lifestyle illnesses absolutely the disparities just enormous and the devastation that you see from Alzheimer's disease another you know all the other risk factors for Alzheimer's disease is just incredible and so it you know of course you know they're the same population they were living under the same Sun and probably the same zip code and they have the same supermarkets and restaurants so it had to be something else and that gives us a very good opportunity to compare the population since study lifestyle and how it affects brain health it's so crazy yeah like on over here you have people in Loma Linda who are living crazy long lives active lives and you know literally you know right next door you have a population of people who are having an extremely different experience that that's that's a great place to begin a study right yeah I mean that juxtaposition is quite potent and I would go to some of the churches and some of the synagogues in the area to speak about brain health and know how many talks have we done yeah over 100 toxin I say that I've given more talks in churches than some of the ministers I mean we we went to church after church after church in order to draw people because I think it's a great place you know and they were very willing the Catholic Diocese and everybody to willing to listen and it was overwhelming yeah yeah most of their male leaders faith leaders were not there it was mostly run by women because they would pass away you know after say for example a 65 you wouldn't you would barely find anyone beyond age 65 there and the ones that were there were you know had a lot of health issues so it was quite prominent even without doing any research just by having conversations with you know the the society the communities that there was this incredible amount of need for health awareness and disease prevention mmm-hmm so you then spend the better part of the next like 15 years studying studying these right all right all right absolutely I mean my PhD thesis was on seeing how you can get information into different communities and this is a little bit of digression but we looked at african-american Hispanic and Caucasian population org it's not even and we realize that's not even the race thing it's socio-economic and availability and access access is always access to information access to right foods and all that and in certain populations this lower socioeconomic the information knowledge about stroke about dementia but all these disease was non-existent it was just disease of aging just a clump and access to the kind of foods the kind of environment to walk the kind of communities that actually build around health the blue zones were that was not available and and then most importantly where they deemed where they thought that that information could be given to them they could be receptive we had it all wrong you know a survey that was created in Boston and in Harvard or Harvard and and then applied the bottom you know 60 year old 50-year old men to 70 year old Hispanic women doesn't make sense yeah so we realized that that's not where you do the training that's not where you do the education the clinics it's in the communities that's where actually that's where this whole book we created a community driven brain health or healthy Minds initiative and all the profits from the book will go into building community awareness in different communities throughout the world as brain health hmm so these people start coming into your clinic and the idea was what like we want to understand how all of these people are living what is contributing to this disease of the brain and start experimenting with protocols to reverse it or prevent it corsets are the the master statement behind this that's exactly right yeah and what do you start to learn so we collect data on nutrition exercise the things that we know I'm you know the only thing that we didn't collect was stress but as far as physical activity as far as you know all these elements sleep and mental activity not profound data just superficial data every just conversational we collected it and over and over again we realized that the people that were healthy ninety-year-old that just had minor memory well they were the people that kept their mind active they walked all the time they were more plant-based diet consistently that was the component and we realized up so this is yeah genetics but that aside that cannot be genetics it cannot be driving and driven by genes it had to be environment and thousands of patients so we started applying it we didn't apply to all sovereign's patients we applied it to people what they called mild cognitive impairment people who have or at risk very high-risk people who were mild cognitive impairment they have a 50% of them go on to develop Alzheimer's so we applied these these changes small changes according to what they could do and even small changes affected their livelihood their their progression this was miraculous remarkable so from there we we decided to do something bigger and that's where we are now and when you were seeing those changes like how are you quantifying like cognitive degeneration versus improvement so there are measurable metrics for example the mocha and the mini mental status and then there's these bigger neuro psych batteries which is two hours where you do really long paper and pencil and find out where people's changes are repeatedly you would see differences and there are other measures such as MRIs which actually measure the volume of the brain and even those you saw some changes when it comes to human brain what's interesting it's not the volume you know we have 87 billion neurons yes and one quadrillion potential connections so this machine what they say one time ten to the fiftieth power it's not the cells we could lose a billion cells of course not all at once that would be bad but slowly we lose a billion cells but the rest is what matters and that's the concept of cognitive reserve which is incredibly exciting and that basically means that it's not the number of cells that determine your cognitive prowess it's actually the connections and the exciting thing is those connections are made and broken on a daily basis it's up to us what we do to create those connections and it's like putting money in a bank account for a rainy day you know making more connections actually staves off disease but at the same time built a better brain so you feel sharper better and you know bring forth the full capacity of the brain and I think you know this is this is the language that we use in our clinic and this is a language that we've tried to use in our research as well to make people understand that it's in their power to actually make it happen in their lives yeah the brain is so mysterious okay in so many ways and and that idea that you know I don't know whether it's apocryphal or to what extent it's true that we're only using a small portion of it and that we could lose all these cells but that it's more about how we're using what we have yeah they're saying that we use 10% but actually we use all of the brain but we use it incredibly inefficiently so we let's the a lot of people compare the brain to a muscle and I say what did this service to the brain to prepare to muscle weight were complicated wait I mean way more powerful and resilient so the biggest guy we know let's say our no choice thing that's the only one I can think of it's been there many other kind of that that he built his muscle four times the average mass let's it so an average brain an average neuron can have a few connections but at or as many as 30,000 connections that's not four times that's 30,000 connections so the ideas here's of neuron and of course this metaphor and here's a memory you're trying to get to if it's a couple of connections to that piece of memory one of them at age 70 is severed by a little micro vascular infarct and another one by an amyloid plaque there it is memories gone of course I'm making it imagine there are 30,000 neural connections to that piece of information it will never be severed that's the power that you have by building these connections and actually they've done experience where they can see it grow on a daily basis that's what we can do on a day so and we understand how to grow those I have a strengthened how to create more of those connections you and I are doing it right now with the longer we talk the less likely we are to forget each other back challenge so one of the things that sorry I'm gonna digress but one of the things people say what do I do for brain activities I said not Sudoku I hate to do if I have to do Sudoku I'm going to get dementia uh-huh no there's anything wrong with you it's too if you like it it's great but it's not complex it's you know your brain did not evolve with adding numbers to nine I mean when did that happen while we were being chased by by by saber-toothed Tigers no our brain is evolved through complexity so one of the things we said you want to build your brain get a group of friends play cards the act of me listening to you having sense of your emotions and that's brain is being processed right and so are your brain is processing this your mirror neurons is checking your emotions and my frontal lobe is processing what you just said my memory centers goes back and sees what what that what relevance that has then comes up with an answer then the motor cortex you've just used the entire brain brain plus the emotional component that's not Sudoku that's a that's a complex behavior building connections so music music is to me is my favorite eye shows a professional singer I'm I say I'm the worst guitarist in history of mankind but the cacophony I create is you know you're listening to your own music you're playing which is motive cortex or the fingers you're memorizing remembering recalling some tunes or some notes so that's your memory centers you're processing that through how it's supposed to be played and my case is just simple and that involves then tired brain plus the emotional component that's building connections and in fact they've done studies fMRI studies that have shown that this makes the connections the taxi-driver study people have heard about this so let's go to that the London taxi drive we just came from London yeah our book tour and and I can understand why it makes more sense not in the world in the in the realm of GPS anymore but a while ago if you needed a nice a taxi license you had to memorize all the streets in London my goodness Wow so the average person doing this study was 50 something so not a young person and they all did it they did studies volumetric studies the volume of the hippocampus the memory centers before they started studying and after the brain had actually grown after this groanin for a short period a very very short period so that tells you that your brain is active at any age and can grow connections of course the cells didn't go although now we know that even they grow to some extent especially the exercise with neurotrophic factors and all that you've done a lot of good to your brain would exercise yeah I probably damaged it many other ways but but those connections grow and we see them by volume so it's wonderful so it's a book of hope you know that you can do something and it's not even about Alzheimer's now here's a talk about the the dropping ball it's it's about avoiding Alzheimer's it's about resilient fulfilled vibrant brain activity late into your 80s 90s and Beyond using the full potential of the ring right so when you begin this journey 15 some odd years ago I would imagine you know like you kind of alluded to earlier your colleagues are like this is career suicide what are you doing you're gonna start looking at you know lifestyle medicine for this and so I think it would make sense to kind of explain or at least talk through some of the myths and the misconceptions about this disease particularly this notion that it's a purely genetic situation like if you have the gene this is what's gonna happen and there's nothing you can do about it right um that has been the misunderstanding for such a long time and you know there are there are a few genes and Alzheimer's disease may be less than 5% of the genes that you know completely determine whether somebody gets Alzheimer's or not as a matter of fact if you have those genes you're definitely going to get it but even for those you can push it off for a very long time for the rest of them for you know the 95 plus percent of the genotypes it's it's quite clear that what you do in your life the type of food that you eat whether you exercise or not or the level of stress that you have determine whether you're going to get the disease in your early 60s or in your late 90s right so this as I understand that this this gene the primary gene is the AP o4p4 yes right and and this can be expressed in a variety of what like you either you have it as like a recessive allele right or you have it as like I don't know how you describe domina dominance yes and then if you have it like what is it twice over how did you describe that yeah if you if you get a certain the leads from your mom and dad right which is actually a rare 2% of people your risk goes up 20 fold but even of those that have the two alleles only 50% of get outside so yeah it increases your risk but it doesn't mean it's it's it's destiny genes and Alzheimer's do not make destiny so I was talking about the 5% that are very heavily driven but the other ninety or ninety plus percent or we know now there are like 30 genes will probably identify further that increase your risk of Alzheimer's and those plus a 44 now what are these genes these other genes for the ones that we think we can reverse now we know that a proportion of them are genes with vascular response others are immune response others are garbage disposable meaning that as you gauged you accumulate this garbage in the cells and how well does your garbage disposal and then the apoe4 is lipid and inflammation so there are lifestyle chains mm-hmm so these genes give you a range of anywhere between ten to thirty years what you do in life the term decide determines if you're gonna forget it early on or as late as 90 or beyond right so the magnitude of how these genes are expressed is contingent upon what you're eating and how you're moving and how you're living your body completely completely and and what's interesting let's let's get into like the contributing factors before we get into the solution because you kind of broke this down into four categories we have inflammation we have oxidation we have glucose deregulation and we have lipid dysregulation right so these are the four main things that are driving the expression of this absolutely so when we're talking about inflammation let's just go through these like seriatim if we could quickly and explain what these mean yeah so inflammation is a normal part of the body yes yeah it's a constant process that goes on and we have mechanism in place that get rid of them in Alzheimer's disease and so many other diseases and that actually shows us the the commonality between you know degenerative disease of the brain and vascular diseases of the brain and the body right because sorry I don't mean interrupt if you could indulge me yeah what's amazing is how much so much of this tracks what we know about heart disease and diabetes like when we're looking at chronic inflammation and the incidence of the it's like completely overlaps the Venn diagram with what you guys are talking about with the brain and and that is something that we have been focusing upon and it was almost a Eureka moment for us we knew it but the fact that you know the processes that are going on in the brain goes on in the body as well for such a long time people always people in scientists specifically always thought that the brain was a black box there was a separate organ that a completely different type of physiology and you know the things that affected the heart say for example the kidneys the lungs couldn't define the brain but that's not true it's the same process and we talked about inflammation you know there are certain mechanisms that are not working very well and inflammation builds and that's how it starts destroying the brain structure whether it's the cells that connections the supporting structures of the brain and and the inflammation is actually associated with the other process you with glucose dysregulation which is essentially the glucose not being able to used properly by the cells lipid dysregulation where the proper fat cells that create and metabolize cells they stop working and then you know all of them together start you know depositing the bad proteins which is essentially what all the sciences have been focusing on but not looking at the upstream processes yeah yeah so it's almost like all these paths lead to one point the amyloid which actually starts twenty years ten years before and then everybody just focuses on that end point we we've made an animation hopefully coming out - it's a it's a little boat you're at your 30s and your thirties you start having some blood pressure so this is an analogy of a person or the brain and then there's a little hole in the boat and then there's inflammation because of overwhelming bad food and things of that nature so that's a crack in the boat and then oxidative byproducts because of the the fact that you had certain trauma or because of head trauma or other things and so by 50 or 40s the amyloid which is water starts seeping it and the holes are accumulating because of all these other things and then I'm at 60 or 65 the person sitting on the boat and they filled the water that but the boats already one-third full of water uh-huh and for the last 30 years all we've been doing billions dollars taking a little cup trying to get rid of water uh-huh you could get rid of all of the water but if you don't address the inflammation the crack you don't address the glucose dysregulation they're both still gonna finish a sink that's the the mentality the the concept is wrong because we're looking at it completely in the wrong end should be looked at at the lifestyle side right and not only that not even really looking at it or addressing it until the boats have full exact well now that you have this thing it's like well actually this has been building for the last you know 20 years exactly you know and it's not any one of these for a fact I mean these are all interrelated I mean if you if you are chronically inflamed then you're gonna have problems with oxidation and free radicals and no glucose deregulation leads to insulin resistance these are all related to the foods that we're eating and how we're living our lives and how we're sleeping or not sleeping and the stress and all of that plays into that and these are the same four factors that are contributing to diabetes and and heart disease and to make it a little anti-climatic take the power away from the book whatever you knew about heart disease apply it to brain disease you're talking about amyloid you're talking about the plaques that the amyloids create in the brain right and so I mean is it fair to draw an analogy to the plaques that are in our arterial system with heart disease is there there a rationale and comparing those two or is it completely if it's a different kind of plaque and amyloid although you have amyloidosis and other diseases that happen systemically as well but the amyloid in the brain is a little different but but but in reality it's the same process the body is overwhelmed because of inflammation because of oxidation and everything else so it actually starts making bad proteins simply that bath point protein in one place is tau and other places synuclein in other places amyloid but it's because it's been overwhelmed by inflammation glucose dysregulation lipid this regulation it's time for us to just say the brain is complex great but the mechanisms are the same but just much so much more I mean this little three pound organ 25% uses 25% of the body's energy of course is going to be overwhelmed more it makes it one of the most susceptible organs in the body as well as the most resilient one because of its activity because it's always trying to consume so much energy so whatever we do you kind of joke about it in our talks with a sorry cardiologists the heart is there to support the brain but it is so whatever we do - it actually affects it first and then the rest of the body right but in the same way that that a cardiologist is is sort of focused on stents and bypass they're looking at the end product of this disease in your field it's all about amyloid and how do we get rid of this stuff ER as opposed to looking at the factors that are contributing to the production of it in the first place we think that actually even exponentially more for the brain if you take care of your brain you've taken care of all the body because now this this thing that we're trying to create living mind kind it's about the mind mindful living and so this affects the totality of your body for brain it's something more than that because you hear you have emotions as well you have motivation you have all this so one of the elements of our book is not just saying this is bad and this is good but where we have failed people is we just throw that them without giving them the tools of how to apply to their life so mindful living is as the unique thing about our book more didn't even the science and it's a vicious cycle if you feel good you know based on the good neuro chemicals being produced appropriately if you take care of your brain and if you have a healthy mind that owning that mindfulness in your life and applying it on a regular basis can help you take better care of yourself so there you go you have a healthy brain you have the tools to take care of your heart and the rest of your body and everything follows depression recently papers came several I mean whenever as a science we don't say the paper came a paper means nothing it has to be multiple and validated otherwise you everyday you say science says this who's this mr. science that keeps saying these things that would be you got to give me more than that lots of papers say that one of the major causes of depression inflammation yeah so it keeps coming back yeah we keep slipping I call it logic slip and a lot of times when you have debates you keep building these logical sequence and you work past the the fallacies and I mean and then it slips again mm-hmm that's what's happening in nutrition and lifestyle and and and you make the case I mean the case for diet has been made over and over again and then all since slipping it now we know inflammation and all these things actually even affect the depression anxiety everything all of these diseases right you can't you can't extract one thing from the other right and it seems like the the advent functional medicine lifestyle medicine is is growing and people are starting to embrace this idea that it's not just one treatment protocol that we have to kind of look at a person in a holistic way and you know treat them you know all the way down to you know how they how they interact with their family members and at work and what's their relationship with their boss and you know all of that stuff is crucial right kind of solving this problem well let's talk a little bit about the path forward in terms of prevention and reversal like you break this down into five categories right nutrition exercise unwind restore and optimize so maybe we can spend a little bit more time in in in unpacking the nutrition part of this in detail yeah absolutely it's it's been quite clear from studies coming from the Adventist Health Study and from the Women's Health Initiative and you know decades of data that show that a whole food which is unprocessed plant-based diet low in sugar seems to be the best dietary pattern for for the brain and it affects all those processes that we just talked about lowering inflammation managing glucose metabolism managing lipid metabolism providing the best source of macro and micro nutrients for the brain to thrive to grow to heal itself and you know study after study shows the same thing over and over again and by just looking at populations in the seventh-day Adventist population you rarely see dementia and the ones that do have dementia either have it very late in life or they've had other uncontrolled risk factors in their life and so the idea of nutrition you know we try not to tell people to become vegetarians in the in the clinic and but it doesn't work that way and especially for people who have not been vegetarians throughout their lives now hit him with that right over the head right and I think as a scientist and this doctor we failed over and over again because we have this cookie cutter approach variability just do what I just do this and you'll become better it doesn't work that way it has to be tailored according to their resources to their likes and dislikes to what they can own at that moment in their life and move forward with it so it's making small incremental changes on a daily basis we one of the talks we gave to one of the African American churches afterwards they invited us and it was all women of course and wonderful and said that shares I it was wonderful talk we love you so much but if you expect us to go vegan overnight it's not gonna happen I said no no no that's not the aim the aim is to work towards so in the book we said wte WTI work towards eliminating work towards increasing its small incremental changes and and the the most interesting thing is and and that research project that I conducted in the California Teachers study we we essentially created a statistics to look at adherence levels to a plant-based diet and every incremental change every increase in the score of adherence to the best diet Lord risk of stroke Lord risk of brain diseases and you know to tell people that even if you replace you know an unhealthy meal with a small salad or just replacing small making small changes actually makes a big difference and we've seen that in the clinic and I think that's that's empowering the corner this is motivation and the word motivation is is a terrible word and my daughter reminded us how terrible it is that my ten-year-old daughter or their both my son is fairly driven he's 12 years old and he she came to us you know and she's actually very good she's ten years old she's in ninth grade and she said she's in ninth grade ten years old and in ninth grade and our son is already ya know but but alright but she comes in so I gotta know more about that mom is all motivated and you're motivated and Alex is motivated so what's going on why not do more if you want of it yes as you told us is that so I realized wait a second what is this motivation thing what so because we throw it at children and they if they don't own this big monosyllabic thing like as if you know what those movies were you you're charged or you're Tony Robbins yeah exactly you're not doing the right thing there's something wrong with you said there's no motivation motivation and small increments of success in a direction that you've said that incidentally your brain and new brain always this does this I'll give you a perfect example that you have a blind spot we can do experiment and we can figure out where your blind spot is your brain fills in that space and hundreds of experiments like that where you bring fills in information fills in color fills in and knowledge when somebody's drunk they can fabulous beauty all the he's lying no your brain is forced to create a story so this filling in is a natural part of human brain to make itself comfortable so when you have a series of successes in the direction or the vector with a purpose purpose purposes the key your brain creates an emotion to it and that emotion has a direction that's motivation so we just operationalize motivation and so if you want change people's behavior you don't just throw that then in fact the reason that most of health care is a failure because it's sick care in medicine we don't learn behavioral modification at all four years of college highly driven people whose mom with that told them to become a doctor I've just offended a bunch of people five percent pretty much exact and then so it's like study study biochemistry this and this but nothing about lifestyle and all this and then yeah understanding human behavior and how to relate to another human being no because they're hyper driven people the rest of the people you know medicals who worse so it's just biochemistry anatomy histology memorization then four years of residency my gosh that was until recently that was just going to you know military school so that's twelve years and then fellowship so you come out as a leader now your doctor patients come to you and by the way 50% of your pay is going to be how to train them and train the patient or teach the patient about lifestyle never happens you don't know so what do you do you at the door you've done the check you've done the knee thing you've said and that's how healthcare reimburses you they reimburse or more on the notes and your examination and what five minutes of counseling yeah and then a door at the door you say by the way eat healthy and most of the doctors don't know about what that means so they've googled like everybody else so it's either this gimmick or that get my ketogenic diet or paleo and then the person is left at the door in the clinic lost so they look at this this is incredible if I I want to actually create controversy so that there's conversation controversies great conversation what happens is the patient's left a blood pressure have diabetes and I know that it's related to my diet and he said I have to eat healthy there's no information forget about information forget about behavior they give up on it not only do they give up on that they also give up on their medicines mmm you've done double damage it's time to change the conversation towards how you truly empower patients you go to their communities or in the clinic give them one behavior we gave one behavior yeah we know what sugar is cut your sugar we know what saturated fat is you eating this much cheese for in a week how about here's a plant-based cheese that you can get from this place just change that for a week write something very specific and do a vault that they can that they can master or they can work on exactly something to check off on a regular basis so that it becomes a deep bound habit and they feel success in doing it and then we'll have to think about it right that's when you try to introduce the next step yeah just get almond milk not regular milk exactly just make that one change you know getting back to your earlier point it's it's a systemic problem I mean these doctors are well-intentioned you know whether they understand nutrition or not like everybody wants to help their patients they're under their own pressures right they got to move on to the next person and you hear time and time again well I could tell them to do this or that but they're not gonna do it right and they're there's sort of a pessimism I think in a condescension that's built into that but there's also a truth right because if they just tell them to do something but there's no accountability and there's no community and there's no follow-up and there's no structure in place where you know that that doctor's office can reach out and check on that person or they're supposed to come back and there's a program that they can where they have support for making this change you know if that's not available then they're right like just telling them to do that thing is probably not going to work so it's bigger than just get involved in the community it's sort of like well how do we create a system where the doctors can be incentivized and taking care of for taking that you know step and making that effort absolutely that you hit it right on incentivize I mean they have to make a living and not only forget about living the doctors are willing to sacrifice their money their time but there has to be time allotted and a system created that where even the doctors see their behavior coming to a success so the doctors are motivated so the first step in everything is conversation I think one of the most important things we can do and it started it has started he has to say the way we're doing medicine now is not healthcare it is important sick care is important when a person comes with an infection they need a medicine when a person comes with a blood pressure of 200 you're not gonna say go II you know this that's that's a long-term thing you have to take your medicine that's sick care it's important but there's another side which is health care which has to be incentivized there has to be a mechanism people can't just rely on goodwill where I'm gonna go out nights to the clinics or this or that or to churches there has to be a system created where we can prevent but you know what that system when it's created will reduce the cost of health care by 80 to 90 percent by itself right that's pretty staggering statistic so we just have to make the choice as a society and even the choice you know we get caught up in the politics of right/left know once there's enough information that overwhelms and and and everybody sees the benefit in this for their kids I mean we don't what this book is not about just Alzheimer's end-of-life I mean our kids are overwhelmed by sugar and then we tell them they have ADHD well they might but a great proportion just have a lot of sugar yeah there's no question about that and also you know I want to get back to the nutrition piece in a minute but you know what I took away from it is that it's a book about how to live your life now so that you don't have to deal with this when you're like if you're you could read this book as a 20 year old and say well I want I want to take care of my brain and this is the way to do it because those amyloids and all the sort of stuff that goes into creating you know the dementia and alzheimer's this is going on all the time right so it doesn't just suddenly strike you at age 65 like it just like heart disease like you're working on this your whole life and it has to do with the diet and the lifestyle yes so on the nutrition piece so as just so we're totally clear as scientists who have you know study this disease for a long time and treated a lot of people you're sold on the whole food plant-based diet this is that this is the way to go as a scientist we say to the best of our knowledge today I that to me is the most powerful the most humble statement in English language I think forced certainty is the cause of a lot of our conflicts science is open to change I mean tomorrow if they say if you eat a steak I'm not going to because of other reasons but I would say okay it's this show I doubt that it's going to come come but today right now the data is just overwhelming hmm and a lot of times in discussions or any discussion they fail you by by falsely holding you to absolutes saying but there's not cause and effect science cannot create cause and effect it can create strong correlations very strong even now we can't create cause and effect with cigarettes because you can always talk your way out of it you know even if you give people even if it was ethical but there is a tremendous amount of data that a plant whole food plant-based diet is overwhelmingly protective yeah is there any positive benefit with respect to brain health or is there any argument that there's something healthy about eating meat when it comes to cognitive health like is nutrition sciences you know has its flaws and the way we're recording diet right now is through food frequency questionnaire Zoar diet food diaries and things of that nature and you know it has its strengths when you look at the different components of meat the saturated fats and the animal proteins you know whether it's animal studies are human studies they're not good I mean the data over and over comes back and shows us that saturated fat actually causes those plaques in the arteries in the brain that supply oxygen and nutrition to the different areas of the brain and they get clogged once that rated fat is very high in your diet plus inflammation and everything else plus inflammation plus affecting glucose metabolism as well and on the contrary so in comparison to you know other types of fats such as polyunsaturated fats and settar agha they're actually beneficial the most important element of the Mediterranean diet that everybody's been talking about for heart health and for brain health are those you know poly and monounsaturated fats and they come from plants so you know when you look at different different comparisons of whether it they're the types of fats that you eat or the antioxidants that you get from plants it's it's quite clear and you know when you look at meet me other than fat and protein doesn't have anything other doesn't have any fiber and some of the minerals that are there they're just minimal so you get more benefit from eating whole food plant-based diet the two things that they always talk about is protein and how about lean meat okay so these are oxymorons lean meat because it's the fat not that you see and you strip away the cells and their cell wall have these kind of saturated fats that's the component that we're talking about so when they say chicken is lean meat well first of all we're eating three times more chicken than anything else actually much more so therefore by balance of chickens is a big problem it is it is but at the same time the fat is not what you see as white streaks it's what's in the cell walls the cell wall structure is different so that's one thing the second thing is protein it's as if plants don't have protein the protein the majority protein we get is not in the form of muscle the majority protein we get is in the ribosomes and proteins within the cells so to say that plants have don't have protein is that not and understanding the mechanism of the cell so we have plenty of protein and within the cell and then we have other plans that have protein even outside you know like beans and others so those are the two of contradictory things the one thing though that we always talk about that we they've seen in vegans is lack of b12 b12 and the way it's bound to meet and he you know it's actually much more bioavailable in the meat form than it is in the plan form right so anybody who's purely vegan should definitely supplement themselves with b12 and then what we say is along with b12 everybody not just vegans that DHA omega-3 should be because the synergy between b12 and Omega n meat the h.a seems to be pretty powerful more will be coming out on that we're big-time about synergy of vitamins not singulated in other words like taking those together to increase the bioavailability of trials right exactly I haven't heard that before not so much that bioavailability but they seem to work together more in the body and many studies we did four reviews which is the collecting all the papers and then coming out with what doe said so which is the most painful kind of research and and on nutrition in Parkinson's nutrition and Stroke and nutrition and dementia and the thing that stood out the most was synergy absolutely so these micronutrients whether they're vitamins or minerals they don't work alone you know it's actually the combination and the levels of the different kinds of micronutrients that matter and they synergize each other's availability so and that makes sense and that's why you know hundreds of studies on say for example vitamin E and brain health or vitamin C and Alzheimer's or Parkinson's disease have come back with no results with no particular correlation and effect but and and when you eat it in a whole form when you eat it in a you know plant form all of these micronutrients are well balanced and they're bound to other micronutrients their bond to the fiber as well which increases their bioavailability one of the things that you hear is is that you need healthy fats for brain health like the brain needs good fats right so that's true correct so when we're talking about healthy fats what are those healthy fats what are the you know we talked a little bit about saturated fat an animal fat but like how do we parse the difference between a healthy fat and an unhealthy fat we say focusing too much on fat or one food product getting reductionist you've heard that many times like Oh to combat Alzheimer's or if you don't want to get dementia like you have to make sure you're getting enough of your omega-3s and your healthy fats and your diet right I I think just focusing on eating unprocessed Whole Foods mostly plant is the best way to go about it because you get your protein you get your carbohydrates you get the best types of fat by just eating those normal foods if we focus too much on one micronutrient and macronutrient it doesn't teach you all of each avocados and you got your fats here and there and your father there was much ado about coconut oil recently and the impact on brain health and you you are pretty unequivocal in your book about that and and you want that we've been attacked but it seems to be cleansed there's the people are very passionate you know there's there's certain things that people get really very passionate was one of them we learned very early well it goes back and forth on coconut oil to but go ahead sorry right no it's interesting because you know all of this started with with one study and fanuc study one person one person giving coconut oil to her husband who had Alzheimer's disease so know supposedly had all supposedly had Alzheimer's disease and supposedly got better but then we found that later that he got worse later as well so we don't know whether it was cooking at all or whatever it's right this guy's like patient zero like B for this whole story it's like a sociological experiment like what did that happen it happens because people are looking for anecdotes and fallacies so why are we keep why do we keep struggling because we're where our brain is designed to hear stories and if somebody tells a good story that's more powerful than a thousand studies and because the studies don't have stories in the men they're not associated with faces yeah they should yeah maybe they should do a little storytelling in JAMA I think I think that would I would actually said with the population much better but it's just you know you pointed it out when you like we're storytellers when you don't associate a cause and an effect with a person or with a a particular situation it's very difficult to see I mean the thousands of people that have been studied and you have these phenomenal results they don't have any faces they're just numbers and people don't see themselves be a part of that yeah this is this or this study although there were some data so let's just talk about science of the coconut oil medium chain fatty acids and coconut oil has been studied in many things and there's some some signals that people get here and there there's some evidence to the best of our knowledge today that the medium chain part which is about 88% of the total fat the other 90% is ninety to ninety two percent is saturated fat but the medium chain when people have looked at that seems to have some benefit and and even that has to be reproduced and shown so we're okay with that I mean that's we have no we have no skin in the game on one side or the other what works and so what we say is to the best of our knowledge today with the data true data there doesn't seem to be a strong relation between coconut oil and and and brain health the medium chain part there seems to be some what we say qualitative and further study does need to be changed done and that that is being done and we welcome that but to extrapolate from one case and from few studies to say that it's beneficial for your heart for your brain don't you think somebody would have shown those cases in a much better way they would have made millions by now yeah but that would require us to actually read yeah right yeah you don't want to do that no no no no no a lot of the it seems that a lot of the research that that you know you kind of plow through in the book and has kind of informed your your you know your protocols some of it comes from looking at the Mediterranean diet right versus like a whole food plant-based diet and probably because there's just been more Studies on that I don't know so how does that play out in terms of meat intake and and also you know things like olive oil processed vegetable oils what are you looking at oil it actually has helped us it has actually helped us understand the nuances of plant-based diet and its benefit because the way the dietary scoring system for the lack of better term is structured is you know you you get positive scores for a plant-based diet and you get negative scores for sugar meat and dairy things of that nature so the higher you go on that scale means the more adherent you are to a whole food plant-based diet but because this this Mediterranean diet was structured and it was given a label and it was started in an area where people had the least amount of cardiovascular disease it just stuck that way but we now know that you know different scientists and different doctors at different universities have actually come up with a better definition of dietary patterns and their different statistical processes like factor analysis to see you know what dietary pattern stands out in the healthiest population and we see this this picture being translated in different populations that a plant-based diet seems to be to help this and the factor analysis is looking at what component of this thing is most beneficial and it's not the fish right it's the place over and over it that's the beans that's that that component so even though it's not completely a let's say plant-based diet but we can actually distill because they use a large studies 144,000 not you know we can that's large enough we can actually then break it down into what component of the diet will have the greatest benefit because this group ate more of this versus this so we now have enough data from all these big studies to strongly consistently say that it's the plant-based component of even of the Mediterranean that's most most beneficial that's interesting but by far in a way the large culprit here is sugar correct correct we even us I mean meat is bad saturated fat is bad let me actually take a step back so let's get back to the disease diseases of the brain when it comes to stroke it's fair well known stroke is vascular so it's going to be a mostly driven by saturated fat and sugar then for Alzheimer's it's a it's a catch-all category in a few years we will realize that there are many types of Alzheimer's those that come to it from vascular side those that come to it from inflammatory side those that come from it from other sides the football players that have been hit multiple times a trauma right that's more inflammation versus those who have lipid dysregulation so to talk about that there are those that are more driven by sugar and glucose this regulation but there are others especially the ones with a point for that we believe that are driven by sugar and everything and information but but dominant feature is fat and saturated fat so it depends which direction and I say since we don't know that yet although we can get a good picture of it especially in our clinic and others and others it would behoove us to kind of limit all of those bad things you know sugar and saturated fat and steps right what about gluten but it didn't seem like was it I didn't see it in the book you guys make a decision to not dress that well because there really isn't any data that supports the idea that gluten is you know causes harm to the brain there's you know probably one or two percent of the population that are sensitive to gluten and they have specific allergies right and and that creates inflammation it creates inflammation and it actually has other repercussions in the body gut health and skin health and musculoskeletal issues as well so it's a constellation of problems that people suffer from her glutes just affect the brain there's really no there's no data that supports that and you know there have been some authors that have actually made a lot of fortune pushing the idea that gluten is bad for you and that you have to stay away from it and that you just have to eat a lot of fat and protein and that's just not true yeah the important thing is here is I always said it's not the struggles we have as humanity is not truth everybody has their truth it's the weight of the truth if someone overstate something of a truth that they're creating fallacy if they're understating it's creating fallacy it's gluten bad for people who have celiac disease absolutely they should avoid it it's gluten bad for another percentage which we we still don't fully know I mean look at this we we don't know something fully yet we were making these huge public health actions and I'll tell you where the public health component comes in let's say that that other group beyond celiac disease is at 3% we don't even know that let's say it fits that bad for them they should be studied identified and they should avoid it but to say that gluten is bad which actually what's now the common law or language out there means that 90% or more have to avoid gluten which means that with that comes what they have to avoid because we don't have a good way of doing that so we blunt we want mechanism we give up on all whole grains whole grains so look at weight of truth with this 3 percent benefited the 3 percent that was supposedly good says it but the 95 percent or 90 whatever percent that would have benefited from a whole wheat and and you know they're going to suffer because of because of over generalization of 3 percent that's a common problem in science yeah no I get that I get that and I think it gets even more complicated because we've hybridized our wheat and most of the wheat is it's so stripped of any of its nutritional value in any way and it ends up in these packaged foods I mean I just know if if I eat like crappy pizza crust like my eyes get puffy and like I feel terrible like I know I'm like that's not good for me like my research is done like I know like I don't know where I fall on the spectrum of gluten sensitivity but I can tell you straight up that it's creating an inflammatory response in my body and that can't be good and I feel terrible absolutely I mean and then I keep eating it so it's like it's like what is it our wheat and is it the gluten or is it something else about like how we've you know kind of you know hybridize than these foods that are staples because at its core of course whole grains are great and now it's almost it like if you say well you should eat whole grains you were like whole grain like they're afraid of all grains yes so that 3% 4% 5% let's say is dictating health for the 90% that would have benefited from whole grain I mean if we give up fats saturated fats and especially let's say fats sugars and then grains as well what are we going to eat right people throw up their hands I get to speak and oh and that's what I was getting to one of the things that not to be a conspiracy theorist or anything like that one of the ways you fail people is by throwing so much information false and and play with the weights of truth that people just finally give up and say I'm gonna do whatever I have to and we can't afford that so you operate with what you know to the best of our knowledge and say I'm fully on board to study coconut oil but am I going to make public health decisions for general population on that no not yet I'm fully on board to studying gluten absolutely are we at the apex at the full knowledge of all of nutrition not no but what do we make public policy on is what the best data we have right now otherwise you're going to be all over the place and people give up and then there and we know that diet kills and diet saves and we so we have to operate with what we know and leave the rest open to research on the subject of research and diet what is your perspective on the ketogenic diet because this is getting a lot of attention and a lot of press and there's a lot of talk about the impact of being in ketosis in terms of disease prevention and reversal etc so like what do you know about it what is your understanding of it what's your perspective so the process of ketosis is a sin a period of starvation for the body and for creating alternative fuels that the body can use and it has been studied specifically we'll talk about the brain diseases you know for certain epilepsy diseases of children there's certain at our lab season it it's helpful it actually makes them have less seizures and it makes them function better in their lives but usually it's a very short period a very quick blunt method of controlling seizures in that population beyond that ketosis hasn't been studied in any other disease and it hasn't really generated you know a large amount of evidence for us to apply it in public health for individuals with Alzheimer's disease or cognitive impairment you know the the studies that have actually shown that ketosis or a ketogenic diet is you know showing some benefit they were done in a very small population and the amount of ketosis wasn't measured well and it was studied for a very short period of time it makes sense when you look at the cellular structure for the ketone bodies to provide fuel for ourselves that can't use glucose anymore for advanced stages of the disease because the cell structure has been you know has been destroyed and there's been a lot of inflammation and dysregulation going on however to use this particular technique or this approach for a long term I mean we know that down the road they will have plaques in their arteries if they keep up the ketogenic diet they will have glucose disregulation they will have lipid dysregulation all these processes that we just talked about and it causes a lot more inflammation so it doesn't make sense that this diet would actually work long term do people feel good on using it initially absolutely and I'll tell you why and do people lose weight absolutely because if you're going to stay away from carbs let's say you hold about two to three pounds or more of carbs in your muscles and as that gets burned away use and the water that's connected to it anywhere between six to ten to twelve pounds of weight is lost so I just lost weight absolutely great why do you feel good because here's a cell that needs glucose it needs energy I mean we talked about how much energy it needs the usual mechanism of the usual energy source is glucose the most effective way the the functional energy source but in order for glucose to get in it needs receptors it's not it's a very fickle process it has to find a receptor and if there's too much sugar in the body what happens to cell internalizes the receptor because it's shot so now there's it's swimming in sugar but starving of energy so it's very difficult process of getting not difficult but more complex than the ketone of getting sugar into the cell well ketones its small set of a molecule gets right into the cell so it has the cell has energy so what so people say I feel better I feel more awake of course you do it me initially and for a while but that doesn't mean that long term benefit is there now let's look at how you achieve ketosis it's not a natural state you have to have this incredible diet that is also sort of high in saturated fat and or fat and very little in carbohydrates less than 5 percent of carbon initially there is even reduction in for inflammation with ketone studies but long term it's always about the long game if people want short game I'll give you 50 different ways where you will lose weight cut off your arm they will actually they won't they will actually feel better I have lots of pills out there they'll make you feel better long term game everything we were talking here is about long term game the long game I'm a Pittsburgh Steeler it's a long game it has to think about what could truly how did you body evolve that it really evolved in this way they said they'd bring paleo really you're going to bring example of people who only lived up to thirty years of age to give me healthcare for me living at 80 years of age does that even make sense and if you think meat was the way to go I was a hunter we had a farm in Virginia with a shotgun I barely shot anything weekend after weekend go chase a rabbit without a gun I can't see I'll try to picture you with a shotgun yeah but but so the science they pill yeah you know the Anthropology everything is so wrong I still say we're open show us the data let's not jump ahead of ourselves because it has public health implications we're just beginning as physicians we're terrible with this prevention side we're just beginning to accept some of the things that have been proven to apply behaviorally now all of a sudden because somebody wants to sell the book of the day and by the way you know plants are poisonous to you and the first reference is wrong in the book I mean so that's why it's and I think I know what book you're talking about yeah but we need to say what works what has been proven we're open let's apply this and if anybody brings newer ideas like eating paint off the wall is going to you know give you less Alzheimer's let's study that but I would like you to try that first right so the research right now is pretty unequivocal like a dog being a whole food plant-based diet is gonna have a big impact in a positive way are there if I'm not mistaken are there studies being done now on psychedelics on brain health and dementia is that true marijuana is what order all the components of it it's enm yeah and all the other components are being studied and and and and you know we're excited because for a long time social biases were stopping these powerful drugs from being studied again either this way or this way we don't know but a chemical that directly binds to specific receptors is going to have consequences so that should be studied and then many other drugs should be studied and in a very scientific and responsible way right all right so we we went through the nutrition part but we there's four other things here in your book right we got I mean exercise is kind of self its self evident right all right well what do you mean by that so everybody comes to us and says what I walk I walk my neighbor have an inflated sense of what of what you're actually I want my living in all day long and we tell them well that's wonderful but that's not exercise that's meditation and walking around the neighborhood may be good for you you're moving naturally but for brain health it has to be strenuous there has to be some level where you're breaking a sweat and you're not able to finish a sentence when you're speaking and there's been studies that actually show that in those moments where your strenuous activity comes to that moment where you know your heart rate is raised that's when the chemicals start being released in your blood whether it's brain derived neurotrophic factor or others and those are the ones that make those connections those are the ones that increase the size of your hippocampus as a matter of fact it was a study a couple of years ago where were actually yeah one particular one in a large sample population where they compared individuals who just you know did stretching and some Pilates and yoga and the others were working with a physical trainer and they did strenuous physical activity three to four times a week and after two years they had they literally grew the size of their hippocampus that's crazy you know Wow yeah and these are individuals who are tomato in their in their midlife and that's I think that's such an incredible random staggering a piece of information for all of us when you're talking about exertion can we get specific in terms of whether we're we're talking about aerobic exercise versus an aerobic exercise so the data is still coming some of the data is kind of interesting exciting and and kind of throws us for a loop for example people with bigger legs had lower dementia at 20 study really studies I think weaker meaning more muscle the ones were more active actually had a bigger brain sustained genetic background yeah so it was it so and research they have bigger legs cuz they're exercising more already yeah exactly so it has to be something else but directionality and science is important were they healthy therefore they retain their muscle more it's a but then other studies show that leg strength has correlation with brain brain health and kind of makes sense because your blood gets to your heart well your blood gets to your heart because your legs have the muscles have to pump the valve the veins to get it to the heart to the brain so that seems to be so even an aerobic exercise seems to have relationship with brain better brain health but definitely aerobic exercise repeatedly has been shown to have a tremendous positive effect on the brain so that's that's one thing that our as much as what was the one study was forty percent is nearly forty percent reduction in chance of getting Alzheimer's yeah forty percent that's these are not small numbers forty percent right but when you're when you were kind of chagrined at the person who said well I walk around the block I mean that's kind of a Blue Zones thing right like it's it's not about exerting you know over exerting yourself it's just these are populations of people that are just kind of in slow perpetual motion throughout the day so so it's not one thing so they use that you hit it on a very good good point so a lot of people are highly educated yet to get dementia or others who have very little education yet they didn't get the measure because they ate well and others who didn't you know their diet was okay and their education was okay but they just did lots of exercise and others who just had complex jobs so my grandfather and her grandfather were probably the most brilliant people you can imagine yet they got the Alzheimer's for them it was diet and lack of activity and these kind of things so it's it's the different contributor so that's why we say it's a whole person component it's not just diet right not just this it's the being mindful of a life that encompasses all of those things so the more of those things you do the more protected you are but even if you do some of them that gives you a measure of protection can you exercise too much does it become bad I'm asking for for a friend oh I don't know IIIi think it like like Dean said it just depends on everything else if the too much exercise is causing stress than you probably you know not doing yourself a favor I just wanna make I don't know if I just want to make sure I'm not injuring my brain by running long distances I'm not banging my head against any that's the balance is probably better than 99% of people that know but if you're doing like boxing and that kind of exercise is absolutely that's getting damaged there's no right on a regular basis inflammation inflammation your legs and then your arms during physical activity that definitely yeah you know causes some level of damage do you see patients with TBI regularly it's interesting how like that's really come come into the conversation as a real thing and impact on the NFL and kids playing football and everything you know we actually are in the process of trying well it's with the NFL the retired NFL group bringing them into our clinical it hasn't no analyze or anything but but there's no doubt that people who get hit or not even hit to the head sudden deceleration you know this is a bony structure I mean if you ever get a skull you actually be worried that you know there are bony edges there and the brain is floating in a liquid and it's not even a gelatinous liquid it's a liquid that easily moves the brain it's a little more discuss this case than water but but it still moves easily so anytime you come to sudden stop that brain is still moving so they say oh we created this new helmet and listen how's the helmets going how is that helmet going to stop the brain from moving within this call right yeah and my son always comes up with these things when was this the superhero where the the girl is falling it you know as fast speed and this super picks him up that no there she's she's dead the brain stuff I'm watching Marvel movies with him in brain damage oh yeah you're like buzz killing every time so so repetitive trauma or so repetitive deceleration absolutely the small bridging veins are going to be cut at the inflammation that builds up absolutely you never lose consciousness necessarily you get brain damage even you know the lack of and do these five factors of nutrition exercise sleep stress you know engagement all of that can those work too you know when you when you have somebody who has TBI traumatic brain injury can can these factors work to you know prevent the further development of that turning into more profound dementia or Alzheimer's or can it be reversed or are those people just it's about managing it that's a great question and that's where the idea of personalization of brain health comes into you look at the factors that affects them the most and you address that aggressively and of course you know bringing in the whole comprehensive life stuff for example if somebody has we'll talk about it later but if somebody has sleep apnea you know they're not sleeping well and there are moments during their sleep where they're not getting oxygen into their brain you give them blueberries and the healthiest diet in the world and they're not going to benefit from it so it just depends on what areas need to be attended first yeah addressing that's one this cookie cutter concept that's where we go wrong when it comes to brain health it's complex not to four separate and repeat what you said but we have to every person comes to this journey of brain aging on their own terms we have to identify that that that focus that area that is affected their bein brain negatively and that area that they can actually create success that's where the personalization takes place so unwind this is the next category right and this is about this is about stress reduction mindfulness and specifically meditation yeah yes it's not stress reduction it's identifying your stresses in life and there is there's a definition that we use you know good stress and bad stress and it kind of sounds funny but we do believe that there is actually a thing such as good stress and you know those are the activities that you own those are the situations that you understand and you can manage from other regular basis and it is bound to a purpose in life and that's necessary because that keeps you challenged that keeps you on the edge that keeps you awake and that keeps you motivated enough to do something about your life to move forward right like I'm thinking about sorry I interrupted yeah yeah like I'm thinking about the person who's retired right and then suddenly finds himself in the lazy boy chair bored and unchallenged right is lacking that good stress that leads to you know the advancement of of Aging in fact that's the one state that has shown to be the biggest determiner of decline that a person on a high-level job by the way the most protective thing even beyond food and everything we would love to say food it's the level of complexity of the job if they had a complex job that they loved all their life that was protective even beyond bad food and everything else mhm I'm not saying that people should just you know do that but but it's protected but if they had a high level job and then they retired and they didn't do anything that determined the highest rate of decline in brain health that's interesting that's very interesting life would permit me yeah sorry I should I interrupted you right right where you were we're flowing okay yeah so keeping keeping yourself stimulated while also reducing the bad kind of stress yes yes it can literally eat away your brain I mean we have studies that show that people who had a rough childhood whether it was physical or mental abuse they actually have a higher risk for developing dementia later on in life and it makes sense when you look at people going through stress there's specific hormones that are secreted in the brain the cortisol and others that change the physiology of the brain that changed the amount of blood supply it goes going into the brain and it actually causes formation of a lot of oxidative byproducts that you know reduce those connections that jeopardize the structure of brain cells and they're thinking there's literal shrinking of the brain during stress and so identifying what stresses and getting rid of it and you're not in a magical way we don't ask people to just sit down and not do anything but to try to focus on managing our lives and managing and being organized like for example and trying to minimize things and attending to all of them to present that you can yeah just being in the present and that's the best way to go forward this is the one chapter that's a little different than the other chapters we go into why meditation why mindfulness what it does it actually gives you ability to step back from the moment we live people think that urgent living so living from minute to minute a minute it increases cortisol levels and all that sup the ability to step back be it consciously or through gives you a higher view of everything and and actually completely reduces those hormones and they've done study after and increases oxytocin levels at Paul Zak and is oxytocin you know the happy hormone the love hormone so it increases that these are important things the moments that you can actually create that actually increase the oxytocin and positive hormones and reduce the negative hormones determine the shrinkage of the brain literally so we've instituted this in our household with our children Sophie 10 and Alex and so we what we do with them is mindful breathing and I do this and we do this in lectures yes well huge we did this in the Sinai temple a 500 I said close your eyes so they closed I said something very simple you'll see it's can so breathe in breathe out just be aware of that breathing in and Beria next muscles you don't you know how it is the muscle relaxes you then put yourself in a beautiful place the next focus on one item and we did this for 15 seconds yes I said open your eyes and I mean this incredulous population the elderly in the churches and the community centers every time they say this was amazing for 15 seconds so the other day we do this twice a day with the kids and my daughter came and said dad my life has changed every were like laughing is it you have no right to say that you're changes but but but this is important and Beach city's been happier than though they do this in schools do they realize yes yes yeah we've part of that project we're actually implementing them how are the Blue Zones stuff that's outside and they've done this way way before us imagine teaching kids to manage stress what better gift yeah that's a beautiful thing yeah and it's really cool you know to hear that coming from you guys from and from the perspective of neurologists right who are like rooted in the hearts I expect that from cardiologists did you know like two days ago I was doing a podcast with guru Singh who's like a Kundalini master I talked to I got a lot of guys like that it's like I can you know I expect to hear are these sorts of things from them but like to hear to hear it come from you know hardcore scientists like it's it's cool right so in that in that vein are there studies where you can see the before and after MRIs and kind of really gauge the impact on on brain health with somebody who is you know performing a consistent meditation practice there hasn't been a lot of studies but yes there are studies that have looked at say for example Buddhist monks who meditate on a regular basis and they have lower risk of brain diseases but I think it's an area that is expanding more and people are very excited about it and thankfully we have tools we have functional MRIs and other MRI sequences that actually goes deep down and survey to see how meditation effects right those those solvent connections I should at two years a year of research at UCSD fMRI these are MRIs that actually look at your brain while you're thinking you're doing things so they've done all these kind of studies at free-willed studies and other things that have done with these MRIs I love you functions like memory cards and things to learn and listen to music and you see how the brain functions right yeah so they've done that with meditation and and repeatedly we know that the different parts of brain are brought into function the brain actually works at a different level the greater detail has to be worked up as far as how this has to have works for your long-term health and as far as brain health why is it not being done because the first of all it's costly second of all you have to get rid of a lot of what in science we call confound other things that could be contributing so if you bring a Buddhist monk and put them on fMRI and you see brain has changed then you have to say well this guy is doing a lot of other things that are beneficial as well mm-hmm so all right there's a lot of co-founding factors exactly exactly I know sleep talk about sleep a little bit it's big big part of our book it's it's something that's not really discussed much and you know we we lived in Los Angeles and gene and I joke about this all the time you know you there's always some detox going on you know detox of the day eat this or do that and our opinion the best type of detox people talking about that in LA they didn't know and the best detox is just sleep the restorative sleep yes so so what does that mean that means that one is able to go through all the stages of sleep without any interruption and there's been studies where one night of sleep deprivation has increased the amount of amyloid in the brain and this or spinal fluid or the fluid that surrounds the brain exponentially and Wow it's an inflammation of bat-sleep for anybody or is that like a function of whether you have the proper gene or disposition to dementia or no no we're actually taken into consideration during during the analysis and that's just incredible and you know they've done studies among nightshift workers who have completely challenged their their cycle their their biology and they seem to not do very well in a lot of memory testing and even among college students you know a good night's sleep actually tends to increase their their scores if they study very much even if they sleep well they have higher screw up the compared to those who don't sleep well the all-nighter increment yeah and and when you look at the physiology and you know sleep is a mechanism where your memory is consolidated or just to put it in simple terms you know they're files and folders created in the brain where all of these memories are placed so it's easier for one to go and retrieve it later and it also gets rid of all the quote unquote garbage that is deposited in the brain during the day so it's essentially you know a garbage cleaning system and it consolidates memory in the brain and it's it's a very very important thing to talk about and so what are some of the things that affects sleep yeah maybe you know not not having the time to go to sleep or a job but even you know things such as sleep apnea which is just crazy sleep apnea is a disease where you have number of periods during your sleep where you stop breathing and your brain doesn't get oxygen and in one population sleep apnea increase the risk of Alzheimer's disease by 70% Wow yeah yeah and how many people suffer from sleep apnea way more than you would expect especially as we get older or people are a little overweight or have these other chronic diseases sleep apnea is very common finding and unnoticed that time because it's you know people don't actually say hey I snore or I wake up multiple times and I have hard time breathing or I slept eight hours but I was still tired the whole day I feel terrible exactly that's sleep apnea so it prevents you from entering that deep restorative sleep slowly and then the other thing about medication you know as physicians we all we are so quick on giving medication to make sure that you know one sleeps medications don't help because yeah it knocks you out but again all of that sleep rhythm and the sleep cycles are known as like yeah you're not you're not like going through the proper exactly exactly so so many people are on those pills yeah so these are again easy remedies easy remedies do you want to knock somebody out I mean we saw Michael Jackson I mean pop all right this isn't medicine you give for surgery and I see you and I see you so you can knock people out but it doesn't mean they have restorative sleep sleep cleans the brain and when people do another thing that don't sleep if you're not getting good sleep these microglia these are the molecules that I should clean up a brain they start eating away at its own brain a good brain or at least the connections the axons so one paper we wrote and some others that if you don't get good sleep the brain starts eating itself what do you mean eating itself so microglia are these MA these cells that actually clean up their the clean up molecules ourselves and the janitor some janitor cells and their job is at night you have good night's sleep the connections that are bad connections that actually goes and eats those connections away or breaks them up and eats the and other garbage that's there it starts eating them up if you don't have a good sleep they've seen that actually these microglia go and break up good connections in the brain and eat up cells so it is actually destroying its own literally cannibalizing if you cannibalize myself because it likes waivable so sleep is important sleep we don't talk about it because it's what did you know you just go to sleep go in the night you know in a room and get knocked out one of the most common problems in our population is sleep problems and the ones that have good sleep they think that I've got sleep because they have they're taking medication so if we could do anything beyond diet and everything else would be create a sleep center that teaches people simple things sleep hygiene you know we don't recognize that as we get older we don't digest food as well then we might not hear it hear the sound or the gurgling and all that but you still your stomachs funk working so eating an hour before sleep but that's me your your that's going to keep you awake let's go necessarily have to be caffeine it can be anything yes the process of digestion keeps us awake I do that all the time yeah I did that I mean I read in the book that was a common thing and when I stopped at and a couple of other things that my sleep became a lot better now the book is keeping me up the cult yeah yeah they don't agree with you they started well it's very you know this this whole diet thing is very tribal you know I just watched a video earlier today our friend Garth Davis who bravely went on the doctor oh my god I didn't watch it at the time and I I saw Garth write about what the experience was like for him and his frustration about it and then plant-based news which is a big YouTube channel like he put together kind of like a whole video where he goes back and forth and does some analysis on it to kind of try to explain what's going on and and it's just it's like wow this is so emotional on both sides you know and and and we're so dug in you know and and you know these debates where we're putting you know the Garth's and the Lustig's or whoever it is and pitting them against each other it's like it's like dog fighting you know and it's like it's not it's not leading to a greater understanding it's just creating tribalism in the same way that we're seeing it being played out politically and you know it's it's a tricky thing like I don't know what the way forward is the way that we're kind of navigating it right now it doesn't seem to be functioning in a hopeful way it's a confirmation bias one of the biggest problem we have and as human beings our brain was designed what they call type 1 error if you're running around let's say Paleolithic time and you're just worried about survival and reproduction mostly survival and there's a bush there and you look at the bush and you say if I do this and I do the safe thing it's you know walk away or the the tiger is going to attack me or the saber-toothed our decision is is to do what we want to confirm what we know so our brain is designed to confirm the things that we're comfortable with at any cost doesn't matter how much education you have in fact the education just creates language to better that confirmation bias so I think that way out if possible is to step back and not argue the thing but the way to the thing and it's almost like philosophy now you know it's what is the method we're using to come to conclusions so the paleo people attack that but I have you know we had 20 people in your I have 5,000 people following me I said that's appeal to masses but I have these doctors that said that's appeal to Authority but but you know this person did this and that's an anecdote appeal to anecdote the only way we can make decision is not absolutely cause and effect who has the most data that shows and the right kind of data that shows an outcome let's follow that for now and test the rest of them yeah I think so I think that what's so like baffling about the whole thing is that everybody's a scientist right so it should be about data and facts and yet and and we're and we're expecting it to play out that way and we're under appreciating some of the things that you just reference like the the level of emotion that goes into this and the confirmation bias on both sides you know this gets played out but it's like these are the guys who are supposed to be above this like you're not supposed to get emotional about it is supposed to be about the data and it's just more complicated you know absolutely all right optimize what are we talking about here this is the fifth pillar in your protocol your part I love the concept of optimization because that's again probably the core the core of personalization optimizing cognitive activity what does that mean keep yourself on the edge keep yourself motivated and keep yourself challenged at all times and you know we see brain games and crossword puzzles and Sudoku which you don't like very much being thrown to people but that's that's not what makes the brain it has to be something that one can own and it has to be personalized so for example when Dean and I see some patients we ask them so what did you do before you got to this point in your life you know what what were your hobbies and and for example we had we that we had a patient who was a car mechanic and he hated his job and he had retired and he was having some cognitive impairment and we talked him into getting back into something that he loved and it was making cars so he just got some cars in his garage and he started fixing them and he felt so much better and hangover over a couple of years his his scores cognitive scores actually got better so it has to be something that one can do on a regular basis that brings a lot of fun and it has to be something that involves all of the domains of the brain whether its vision whether its hearing whether its judgment decision making and all of these have to come work in concert yeah getting back to Blue Zones so yeah they ate well they walked naturally so that might have helped it not better than not walking you know that's a better than driving all the everywhere but the mental activity there is the social activity right it's a it's the social engagement right that's really at the core of this whole that's exactly right yeah it actually maximizes the cognitive activity right so if you're not you you're just sitting alone at home in a dark room doing crossword puzzles and that's not that's not what you're talking about another measure of this engagement was once a couple of studies came as far as hearing and we see this often yes as people get older as their hearing diminishes not only deafness even minimally there's a correlation between loss of hearing and cognitive capacity so even if it's not even social just ambient noise seems to keep the because on unconsciously if your your brain is doing things the exactly where so as you lose hearing of course your your connection with the people goes down you have a conversation with somebody and you're a millisecond off because of hearing that's going to make you without thinking that that language you remember I said earlier you you come out I don't like this anymore so to become disengaged from community it's almost a surrogate of loneliness it is it's it's you being completely described it yeah and ten percent increase that just hearing loss contributed to ten percent of dementia so one of the first things we do is check the hearing I mean they think they're not having bad hearing but as we get older we do the most shocking statistic in your book was the statistic that the spouse of someone with Alzheimer's is six hundred percent more likely to develop the disease six hundred percent incredible isn't it and it plays to that social piece right I mean what is going on with that yeah well that is a phenomenal example of you know the complexity of the disease I mean obviously it's not genetics that causes it so it has to be shared environment and after all living together you eat the same thing you move the same way you sleep your sleep patterns are similar you engage in the community in the same way obviously because because the unhealthy environment caused Alzheimer's in one partner it affects the other one is where stress levels the stress of this imagine stress levels that I she causes in my life she's the anti-inflammation no but but I stress no it's that it's the shared environment I mean repeatedly you start eating the same foods even though well you were a chocolate person I was a steak and cheese person but now we are kind of well we're plant-based now but very much the same activity level we exercise together right so that's critical in fact in our program we we encourage people that husbands and wives are partners to come together because it's impossible for us to apply diet change to one person right and the other person's doing whatever they want no it's I have two children of course divorce makes it a disease of the family you know if your kitchen has not changed entirely now obviously there'll be times when you will eat unhealthy food so we have we once involved what how many family members in your 14 yeah remember like 14 individuals came to this clinic because they all wanted to invest in this lifestyle and that's how it works I love the grandchildren to be involved because if we want culture change we know now no data shows that if you start earlier they're the the teenagers actually changed the food in the household more than the other way around so I had the the grandchildren there and giving them speech and giving them you know kind of coax them into it and say you have the power to change the family and and and that's a good way to learn empathy where your grandfather is suffering from Alzheimer's yeah and you don't preach empathy you live it yeah so we love the involvement of the entire family what have been some of the success stories that you've experienced with some of your patients that you've put through this program many oh my goodness they're they're many they've been particularly with this whole comprehensive approach not just diet not just exercise I mean there are there stories in particular ones as well but you know we remember that lady who was a high functioning person professor very knowledgeable and she was stunned that she you know the experiencing cognitive impairment but we found out that she had sleep apnea and we found out that she had incredible amount of stress in her job I mean there are things that were completely out of her control so just to identify those you know treating her sleep apnea modifying her diet and for her to look into other venues that were close to her job into her you know her level of education or qualifications she completely turned around and she actually became an advocate for for brain health wow that's amazing yeah those to me I like the ones that were that it's not that that magic thing that we find sleep apnea is easy you find that you correct that you you see a huge difference you can you see people who are in the wrong diet and they think they're on the right diet and you change that and you definitely see for example sugar first three weeks four weeks people have a hard time giving up sugar I mean very hard time by the fifth week sixth week that comes it I feel a fog lifting so Claire that's not one case Oh multiple cases of this I mean over and over again but the cases I love is that when we applied one little thing here one little thing here one you know and each of the domains and and and of course you saw the difference but you see a change in level of motivation these people become they want to be a coaches they want to be your coaches out there at school so that makes medicine completely different than cutting and pilling you know giving pills here's a prescription and it makes it so much more fun I just lost my train of thought what was I gonna ask I had this awesome question oh no one thing well it'll come back to me in a minute but but one another statistic that I thought was interesting was that two-thirds of the people that suffer from this are women yes and and that we don't really know why that's the case is that is that correct that's true there are some theories out there that explain some part of of that picture so you know people have looked at hormones and you know after menopause the physiology of a woman changes or the effect of multiple pregnancies on brain health and body health in general but you know one of the strongest and most interesting concept that has surfaced is the fact that women who have Alzheimer's disease now and have been detected to have cognitive impairment come from a time where they were probably not as challenged as men were as far as their job is concerned and the amount of stress that was put on these women was much higher than women now we've evolved as a society and so we're trying to find out you know what were the differences as far as education level is concerned as far as cognitive reserve and as far as the amount of stress and other physiological determinants that made these women have more Alzheimer's now so still we're still trying to understand what about her yeah but the crazy number and you know more women are suffering yeah it's I was not aware of that that's crazy and then two-thirds of caregivers are also women yes so and and and they suffer from the consequence of taking care of a father and mother that has them at higher what is your opinion on people who go and get their genetic testing done the 23andme x' and all of that and you know come to you and say I have the gene or I don't have the gene or what have you yeah that happens a lot so I have two grandparents or Alzheimer's and you have had and but and I forget a lot of things I lose a lot of things I pretty name is larsa it probably would be a rapid decline no it's so at this point and and it's evident that's because we're we lived the most crazy busy and passionate and loving you know lovely life I mean but but it's very busy multiple lines a lot of elements very colorful and but if let's say I take the gene genetic test and I find out that I have a point four and another April 4 and some other genes so now I forget my something what do you think I'm gonna do I'm gonna tribunal to work immediately leap - oh this is in here it's happening yeah you know and that that's not just me being morning so a lot of yourself that's good for me because I'm gonna be motivated no that's not motivation that is going to be at a level of stress and anxiety that you that is going to be damaging until becoming yourself in whatever you do you attribute it to that core I think people do that all the time exactly so I say live as if you have the genes and let the outcome speak for itself because if you find out that you have the genes the anxiety because we don't have a cure for the genes at this point maybe in a few years where this CRISPR thing and all these genetic manipulations that we can do and it will happen no matter how many people say this is not natural that's stuff like it's gonna have Saluki mia and other diseases and and sickle-cell I mean we've seen children suffer from sickle-cell like yeah I don't know yeah the forefront of these things right now but even with these genes it will happen but until then do you want to live with that kind of anxiety every time you forget where you park your car it was part last night so I say if it's not in the research setting there's no benefit at this point live as if you have the genetic risk change your lifestyle because not just for Alzheimer's that lifestyle is gonna affect your heart your your immune system your mood depression anxiety and the studies have shown that the best form of treatment of depression 300 percent better than any drug out there is exercise society so live it and then let the genes play themselves out among these these five factors nutrition and exercise sleep stress management engagement is there one that's more important than the other is it the interplay of the five like if somebody had to you know pick one thing to begin with and they're overwhelmed by the five like what is the most importance of all of these two kind of catalyze that journey I think for the majority is food without a doubt because not be it's something that we put in our bodies three or four times a day it's the most important environmental factor for us it makes or breaks your brain but then again it depends on you know what are some of the proclivities for Alzheimer's disease or for brain diseases in general and to focus on the one that is the most effective mm-hmm I agree with you totally I mean let's take the personal thing out let's say that we don't find something unique in this person that that we need to address right away in general would say food definitely and then the easiest one is exercise and for me exercises not going to the gym I mean I say to people some of these gyms you have to get dressed up more than some clubs you know it's just anything that takes away impediment towards exercise they say all you you want exercise run to the gym I said no I want a limo to come and pick me up nobody does it maybe when you were at cedars-sinai no we were we were the directors of the brain health program and we were the only one with a Toyota Sienna that you saw but but but the most important thing is that it Institute's do something that's proximal and easy so I say if I was Secretary of Health and Human Services I would have connected everybody's TV to a recumbent bike so it wouldn't work unless they're rolling mm-hmm that would have reduced healthcare cost significantly nobody's going to but but it is important to bring it to your living space and then whatever else you do extra is fantastic so for my 60 year old and 50 year olds I said get a little foot pedal exerciser or a recumbent bike watch your news and then go slow roll slow yeah you know two miles an hour an hour and mile an hour and then every few commercials just rev it up you've just changed their psyche use the commercials to do your intervals yes I mean I hope how beautiful is that so you know aerobic and the animal exactly so there's no balance problem because you're sitting there is no clothing you know you can do it naked if you want that I would rather not if they do but they can they can do it in the privacy of their home they can read something while doing that they can watch and learn something on YouTube it so to me that would be wonderful and it's cheap you if you can't afford the recumbent bike get one of those foot pedal exercisers and put it on your beautiful comfortable seat so the seat not uncomfortable and you just do that and you've done aerobic you've done anaerobic and you know it's wonderful that's my easy addition description I think you you usually the way that I we got to wrap it up the way that I end conversations when I have doctors on the show as I asked them if they woke up in a parallel universe and found themselves to be the Surgeon General what would be the first order of business or what what are the policies the the legislation that you would like to see get pushed forward so we have the bike power and the TVs we're gonna put that into motion we're gonna pass that law what else would you do if you were in that capacity a lot of things I would I would probably make every restaurant offer one healthy dish one heart healthiness that has been approved for for the brain mm-hmm I think people need to have choices a lot of us want to be with friends want to be with family members but health doesn't necessarily have to be synonymous with deprivation absolutely and and I would focus on prevention I would actually create incentivize prevention so doctors healthcare systems would have educational programs for what prevention means first of all and then incentivize it financially both at the public health side which is the community and in the hospital and clinic side to actually do prevention instead of sick care only that would be wonderful and in a way if you can if you do the lump payment where this person's life is let's say $8,000 and if if that actually incentivizes that meaning that if you keep them out of the hospital you get more of the money mm-hmm so how do you keep them out of the hospital is teach about - how to prevent the disease yes I mean I think the keys of the kingdom really are and finding a way to revolutionize our healthcare system to prioritize prevention you know it's like it's just not set up that way right now and until we shift focus we're gonna continue down this path that we know is not working yeah absolutely well thank you for doing this and sharing your message you know I think as a sort of primary takeaway from your book I think it's really empowering you know because it's basically telling people like look you can control this like whatever your genetic disposition is you know that gene need not be necessarily expressed and here are the things that you can do that we have seen and that has been proven to maintain your brain health and take you know - you know set you up in the best position to avoid having to go down this road because this really is an epidemic that it's just decimating lives everywhere we look and and the rate at which it's accelerating is beyond alarming right so to the extent that we can all you know take to heart these measures and start to implement these changes in our lives and try to you know serve as a lighthouse or a source of inspiration for our loved ones who we see heading in this direction I think this is really important work and I thank you for writing this book and for the work that you do beautiful what are you go what's up what's next for you guys are you writing another book and what are you doing we are yes you're working on that really putting in a lot of effort to expand this into different communities whether it's in San Bernardino or the beach cities and involving and training community members to take it upon themselves to spread the message yeah and like I said most of the actually all of the profits go to this foundation and if anybody wants to partner with us for us to come there and give workshops or on lifestyle and prevention we're willing to pay out of our own pocket to come and fly there and help the classics so if somebody's listening to this and they want to take you up on that how do they get in touch with you yeah they can get in touch with us through our website and our social media we are team shares i.com and we would we're very responsive would we'd be happy to you know set something up with them right team shares ishe are zai doclock okay that's cool have you I know you know Dan Buettner have you spoken to him about perhaps collaborating with the work that he's doing with Blue Zones in some kind of official way like it seems like it would be there's a natural fit we have we have and we will and so far we're actually picking the fruit stuff that he's laid down which is in beach cities we're doing the brain outside of it but we would love to because I told him several times we told him that's the public health that that he's doing is more beneficial than a thousand doctors because it makes it so easily palatable I mean shows that in populations people people you said it they don't see it in this story format they're not gonna believe it but he shows the stories and thousands of people in regions it's wonderful it's unbelievable alright thanks you guys thank you sorry I am the show by saying peace and plants at the very end I thought since there's two of you usually I'm just talking to one person you guys can like take us out by saying that peace thanks you guys [Music] you [Music]

Channel: Rich Roll

Views: 98,818

Keywords: rich roll, vegan, health, fitness, diet, nutrition, athlete, podcast, inspiration, motivation, plantpower, plant-based, wellness, mindfulness, meditation, self-help, alzheimers, dementia, brain health, cognitive function, medicine, science, research, sleep, exercise, neurology, neurologist, genetics, lifestyle, team sherzai, dean sherzai, ayesha sherzai, loma linda, blue zones

Id: --9OZQEcUIg

Length: 129min 18sec (7758 seconds)

Published: Mon Nov 27 2017