Ayesha Sherzai, MD - Brain Health: Prevention is the New Cure

[Music] you [Music] I'm very happy to be here thank you I'm sad that my husband couldn't join us today he's in Boston sometimes we have to you know split tasks whether it's children or lectures or work but thank you for the kind introduction I'm a neurologist vascular neurologist and along with my husband we run the Alzheimer's prevention program here at Loma Linda University I see patients in the clinic and I also see patients at the hospital I'm a stroke neurologist and my passion is prevention of neurological diseases I think I probably am my husband and I were probably the only people who coined the term preventive neurology and our focus whether it's in the clinic or in the hospital or in our research is to prevent degenerative diseases of the brain like Alzheimer's disease and Parkinson's disease but also vascular diseases of the brain so today I prepared a few slides for you to go over the general concept of what dementia is where we are as far as research is concerned for treatment for prevention and you know most of the time will be spent on what are some of the lifestyle risk factors that can prevent neurological diseases well fail we'll focus on Alzheimer's disease and stroke today because then it's going to be a very long lecture if we include other neurological diseases in it let me see if I can point it to the right place I'll figure this out sometime all right no worries okay so this is the topic of our discussion today the brain sorry cardiologists and other specialties but you know the brain is in my opinion the most important organ in the body and you know we always joke around with our cardiology friends who say the heart is there to support the brain but the rest of the body is there to support the brain because you could you could do a heart transplant but the moment you transplant the brain you're changing the whole person and the the personality but the brain is an incredible oregon they've actually done a lot of studies to find out how many brain cells we have and we now know that we have about 87 billion neurons brain cells and these neurons can have as little as two connections which confers you know information transfer and resilience or 30,000 connections and even though we don't grow neurons after a certain age after age five we continuously make these connections and these connections can be broken down with disease and environmental factors as well and so those connections are the main reason why there's been a lot of research on brain resilience and cognitive resilience which I will talk about at any moment the brain consumes about 20 to 25 percent of the body's energy and for such a small organ it's only about three pounds it's only about you know two percent of the body's weight but it continuously consumes 25 percent of the body's energy so that gives us a window of all the processes and all of the metabolic needs of this this needy hungry Oregon and you know whatever we do whether it's certain medication given to us or our environment it continuously affects that energy metabolism and the infrastructure of the brain I guess we're out of batteries but before we actually go and talk about the amazing function of the brain it's very important for us to talk about the other end of the spectrum which is the disease spectrum dementia which is the area that you know my research is focused on and we see patients in our clinic now dementia as you may know is the umbrella category dementia is defined as a condition where cognitive function is affected to an extent where people have difficulty doing their activities of daily living whether it's doing their finances or driving or taking care of complicated complex activities in life and there are multiple types of dementia Alzheimer's disease is the main type of dementia but 60 to 70 percent of all dimensions are Alzheimer's disease and then we have vascular dementia which is another 10 to 20 percent and then Parkinson's dementia Lewy body dementia frontotemporal lobe dementia which are smaller percentages but we'll use the word all farmers and dementia interchangeably in this talk because that's the main type of dementia that we see on a regular basis and the numbers are pretty scary and you know the saddest thing is that every time I have to speak to faculty or to a community we do a lot of community talks to different churches and community centers every time we do so we have to change this slide because the numbers are growing and then that's the scariest thing right now in the United States we have about 5.8 million people who live with dementia and a lot of a lot of scientists and a lot of epidemiologist think that this is an understatement thank you because it's not reported it's you know we still have communities where cognitive impairment and dementia are assumed to be a normal part of Aging as a matter of fact there are a lot of community doctors who don't even use the term dementia they call it senility which is you know an obscure term and we don't use it anymore and it is the third leading cause of death in the United States you know it's usually touted as the fifth but when you look at the mortality and the mortality rates right now they're not coded appropriately a lot of people who go into the hospital for Falls are for pneumonias they're listed under those conditions but the underlying condition is dementia and I'm afraid that it is soon going to be the number one reason of mortality in the United States as the number one reason of mortality in Japan and in the UK and soon it will be the same here as well now as mortality from other diseases such as breast cancer prostate cancer heart disease stroke HIV are on the decline the only disease that is rising mortalities rising is Alzheimer's disease and in the last 15 years mortalities have risen to a hundred and forty five percent which is incredibly large number one in ten individuals over the age of 65 are suffering from Alzheimer's disease here in the United States there's a gender disparity women tend to be at higher risk of developing Alzheimer's disease compared to men it's one in six for women compared to one in eleven and it has to do a lot with obviously some the way women actually have you know processing they process fats and they process glucose differently vascular cognitive impairment and vascular risk factors affect women differently compared to men we're still trying to understand better whether hormones menopause and pregnancy have an effect there's no concrete evidence so far but we're still trying to understand that better there is also a hypotheses by you know someone in rush University who did a research and found out that the women who are having cognitive impairment at this stage when they look back at their lives they were never involved in complex cognitive activities earlier in life most of the time men were but women weren't and so there is a theory that maybe perhaps cognitive resilience was not really built in women at that stage and that's the population that we're seeing right now but that's just a hypothesis so there's a lot of interesting research going on to find out why is there a parity between men and women and it's not because of survival rate it's not it's not that fact there are racial disparities as well african-americans have four times higher risk of developing Alzheimer's disease compared to Caucasians and it's 2.7 times higher among Hispanics and again it has nothing to do with genetics epidemiological studies have shown that it is all about access access to information and access to resources and the culture of understanding dementia and accepting the fact that it's not a part and parcel of Aging there are a lot of times when we go to different you know African churches African American churches and you tend to see women mostly there in the leadership and the men aren't and the numbers are just incredibly crazy because you know more than more than about 30 percent of individuals male members of the church may have dementia have vascular dementia of some sort and so you know that Ridge that increases their general mortality and they don't seek help because it's assumed that that's just you know what happens when people get older the cost is astronomical the direct cost of Alzheimer's disease currently is 290 billion dollars and in comparison if you look at the cost of heart disease it's a hundred billion dollars cancers all of cancers put together the cost is about sixty billion dollars and so the numbers for Alzheimer's disease are exponentially higher and this is just the direct cost there's another 240 billion dollars in direct cost of people losing their jobs spending time with their loved ones caregiver support that is not taken into consideration in this number and it is assumed that this number is going to reach to one point one to three trillion dollars 2050 if we don't make a dent in the way all farmers disease is growing in our communities and by 2050 16 million people will be suffering from Alzheimer's disease so it's critical for all of us to have conversations about prevention if not treatment of this disease and it has to start now so there are a few myths there are many myths but I just chose the salient once here to speak to you about because I think this is the reason why we're slowed down this is the reason why we're not making a difference the first one is Alzheimer's disease cannot be prevented that has changed thank goodness and I'll show you some of the slides from the Alzheimer's Association international conference last year most most healthcare providers feel that Alzheimer's disease cannot be prevented and there were you know papers after papers and statements after statements from the Alzheimer's Association from the American Heart Association stating that you know once the disease starts there's really nothing one can do about it the other myth is all summer starts with the symptoms of forgetfulness and that's not true the process the pathogenesis of Alzheimer's disease and dementia starts at least 20 to 30 years before manifestations of any symptoms so you have those inflammatory conditions the oxidative byproducts that accumulate in the brain and damages the infrastructure of the brain very very early before any of the symptoms show themselves the third myth is there will be only one medication treatment for Alzheimer's disease and this one has slowed us down significantly everyone every PhD and every neurology resident getting out of residency wants to get on the next grant from NIH to start damaging and getting rid of amyloid protein everybody and their uncle and cousin is focused on amyloid and tau tangles were zapping it with laser we're melting it with acid we're throwing medications at it we're sprinkling blueberries at it trying to do whatever we can to try to destroy that and find a treatment for it and that is the worst approach I think that has completely shut down the bigger picture we're focusing on the end product on the downstream effects of amyloid and tau yes they are involved in in the disease but they are not the reason why individuals get dementia that is not the reason why Narns are damaged and so a lot of universities have started to realize that and I don't know if you heard but last year Pfizer which is you know one of the largest pharmaceutical companies in the in the world they would drew their entire team of Alzheimer's science and research because they realized that they were looking at the wrong model and people who are involved in Alzheimer's research have now understood the fact that we can't only focus on the downstream effect we have to go back and see what we were doing wrong where are we catching individuals that are wrong time where are we looking at the wrong population to begin with are we not looking at other processes at this point they just turn this off oh yeah I did sorry so thank goodness I'm actually very optimistic today this talk was very different five years ago I had a little bit of anger in me but thank goodness that has gone away because I think we're realizing that it's about time for us to look at the bigger picture and the last one that I put here was you know the fact that people feel that Alzheimer's disease it's a purely genetic disease oh my mother had it my grandfather had it and I'm bound to have it and I'm not going to do anything I'm just going to enjoy my life I hear that all the time in the clinic for me I think I went into this field selfishly because I had two grandparents who had Alzheimer's disease my grandfather incredible human being he was my hero he was a cardiothoracic surgeon from Columbia University and he had a master's in public health from from Johns Hopkins highly educated individual wonderful human being and we saw how this disease slowly and gradually took parts of him where you know he forgot his children's name and then he forgot our names and he would get scared of us when we would go in to help him out and to see this incredible man slowly and gradually become like a child was the most painful experience I have ever had and my grandmother also had Alzheimer's disease and I saw how it affected my parents and so you know having two individuals actually three individuals who had Alzheimer's disease I should definitely have the chance I think I do have it but I live my life as if you know I do have the risk but there's a lot that I can do to to prevent it and we have signs that backs that up so this is the reason why we slowed down these two these two proteins we have the amyloid plaques which are you know fluffy proteins that are deposited between neurons and then we have tau tangles hi-pro the hyper phosphorylated tau tangles which are abnormal proteins that deposit inside neurons so these proteins outside and inside they start damaging the infrastructure of the brain the neurons themselves as well as the connections between these brain cells and that's how the neurodegenerative process is promoted and there's atrophy of the brain and individuals end up having symptoms of cognitive impairment and dementia so this is what we've what will not knee but this is what the world of dementia and neurology has been focused focused on all these years and after billions and billions of dollars after millions of grants given to multiple universities around the world incredibly smart people looking at everything we have zero treatment we have no treatment whatsoever every medication that was tested was fine when it was tested on mice mice got better but when it was tested in human beings and multiple clinical trials didn't make any difference and I think one of the many things that we were doing wrong was you can't just you know put a hole in a mouse brain and assume that that's Alzheimer's disease you can't just you know genetically modify mice and then start treating it assuming that that would be the same thing as in human beings mice are not men and so that is one of the reasons why we have to change our perspectives about treatment yeah and we had almost 400 clinical trials to date that tested medication on human beings and it was a complete failure the medication that we have right now that our FDA approved aricept and namenda they're not disease modifying medication they only work for a certain period of time to ameliorate the symptoms of dementia they basically stabilize memory or maybe improve it a little bit only for about six months to a year mostly to a year and that's basically it so it's a pretty devastating disease and it's very depressing to see people coming in over and over again at a very late stage and there's really nothing that we can do for them jeans you know jeans are not our destiny it actually gives us a range of how the disease manifests itself scientists have done multiple you know analyses of genetics this one is called the gos or the genome-wide analysis of the genes that are responsible for all service disease and as you can see it's not one gene it's not two genes it's actually a poly genetic disease the number of individuals are the percentage of individuals with Alzheimer's disease that have a purely genetic background is can someone guess what's the percentage of Alzheimer's patients that are purely genetic well close yes three three percent of all Alzheimer's disease are purely genetic and these genes are represented right here in the top left corner priests on ln1 priests on Ellen - and amyloid precursor protein a P P if individuals have pre Snell in one or personnel in two they're bound to get Alzheimer's disease very early but we don't see that often we like I said it's only 3% they're very small places around the world especially in southern southern American countries where you go into a village where you know the father has it the daughter has it the brother has it and then you see clusters of these diseases and commune but you know in the United States and in the rest of the world you don't see those kind of purely genetic models the next one that we always hear about is the April efore has anybody heard of the apoe4 gene yes so the apoe4 can be heterozygous or homozygous so depending on the number of alleles you get from your parents if you get one a boy four allele your chances of dementia goes up by five percent five times so far you have five times higher risk of developing Alzheimer's disease if you have one if you have two copies then the chances go up to 15 to 20 times but guess what 50% of the population who have even two copies of those alleles never develop Alzheimer's disease why it's because of the lifestyle and environmental risk factors for them the rest of the genes these atom ten or the pledge three the trem - these are genes that are responsible for various functions in our body such as endocytosis endocytosis getting rid of waste products getting rid of inflammation getting rid of oxidative byproducts in our brain getting rid of you know all of the cytoskeletal debris that is accumulated remember the brain is a very active organ you know working constantly never sleeping using 25% of the body's energy you can imagine the amount of byproducts that is created in a day so if there's something wrong with those jeans or if our body is actually overwhelmed if our brain is overwhelmed they stop working properly so the answer is most of these tend to be related to what we do on a regular basis our lifestyle even a poly for it's actually a lipid regulating gene which essentially means it helps the process of transferring lipid from the membrane of the cells from one cell to another from inside the cell to outside the cell and if we have dysfunctional a belief or it means we have to be wary of our fat consumption of being aware for cholesterol levels and things of that nature and that's why a lot of studies have actually shown that people who have skill or risk factors they tend to have higher risk of Alzheimer's disease so if anybody asks us you know I have the genes we have to tell them well that really doesn't matter because it's apologetic disease and you know only people who have early onset dementia that's where you see a purely genetic manifestation of the disease let me tell you about the AP P amyloid precursor protein so amyloid precursor protein is very high in Down syndrome individuals and if you recall from some of the studies that are that were done on all of the all the these individuals who have down syndrome they usually tend to have higher risk of developing dementia of Alzheimer's type early on you know after age 40 their risk actually goes up and one of the studies that we're doing right now based on a database showed that when Down syndrome individuals have good control of their vascular risk factors say for example if they have diabetes and they have better control diabetes if they have well control cholesterol levels if they have well controlled blood pressure and if they don't get overweight during their midlife they actually are able to push dementia significantly they don't develop dementia earlier on that's the significance of the vascular risk factors on this disease so we say and now thank goodness Alzheimer's Association says that prevention is the new treatment with no medication available with a different perspective of the disease process of how it starts and where we catch it in the disease process and the immense amount of information we have from studies on diet and exercise and stress and sleep this is the statement so last year Dean and I went to the Alzheimer's Association International Conference and I have to be honest it gets very boring after a while you know you're there with you know incredibly intelligent people but it's about molecule after molecule on mice after mice and animal studies and perhaps some few imaging studies here and there and at the end of the the the very posh conference we really don't have any options yes there there was good work done but not a lot of progress but last year last year the first session of the plenary program where all five thousand individuals were there in Chicago the main talk the first talk was by dr. Mia Cuba Paul toe she is the PI of one of the largest said it's a finger study in Finland she came in and she presented this this slide it started the whole theme of the conference started with the prevention is the new cure and I don't recall ever giving Dean high-fives during a conference but we were we were so happy because finally you know we while we are here and we're realizing that it's more complex so wanted to kind of go over some of the studies that were presented at last year's conference like this one this was actually a statement that came out in Scientific American Journal Alzheimer's meeting lifestyle factors are the best and only bet now for reducing dementia risk and let me show you some of the papers that point it to this statement like this one can dementia risk new to genes be counteracted by adherence to a healthy lifestyle again concern about genes so let's see what this said so this study was done on a large UK biobank on about a hundred and fifty seven thousand individuals who were older than 60 years of age they were followed for a median of six years and about 668 dementia cases were identified and they found out that individuals who had high genetic risk probably a combination of April efore with some other genes their risk of developing Alzheimer's disease went up by 60% but guess what if the same kind of genetic risk factor was seen with unhealthy lifestyle the risk went up by 360 percent that's the that's the effect of lifestyle on the genetic picture and then in different modeling on and on seeing a different side of pop nation they found out that when individuals have high genetic risk but they actually had a very healthy lifestyle they reduced their risk by less than 30 percent and so the statement was yes adherence to a healthy lifestyle care and offset genetic risk so we don't have to worry about the genes that we have from our parents or grandparents it does not determine Alzheimer's disease here's another paper so this one was done by an individual at Columbia University from where I come from they wanted to find out to what extent does the combination of lifestyle factors reduces the risk of Alzheimer's disease you know you always have an individual who says I can't change my diet I can't exercise but I'm going to stop smoking or maybe I will walk around the neighborhood once in a while so how much of lifestyle do we have to adhere to to reduce the risk of Alzheimer's this was my favorite study so they looked at two databases the chicago health and aging project and the rush memory and aging project so they combined these two populations and they were followed for about 9.1 years it was a retrospective data analysis and they created a healthy lifestyle score the healthy lifestyle score looked at the mind diet does anybody know what the mind diet is mine diet is a combination of Mediterranean diet with the DASH diet dietary approach to stop hypertension so a mostly plant-based Mediterranean diet with low salt consumption exercise was defined as exercising more than a hundred and fifteen minutes per week moderate to vigorous so it's not just a walk around the neighborhood smoking cessation focusing on behavioral modification minimizing alcohol not really you know asking people to drink wine because now we know that no amount of alcohol is actually good for the brain so focusing on minimizing alcohol and cognitive engagement which was defined as mental and social engagement something that you guys are doing right now and they found that that compared to individuals who would here two maybe one of these healthy lifestyle risk factors to none people who adhere to two or three of these healthy lifestyle factors reduce their risk by 39% and people who adhere to four or five of them reduce their risk by 60% so 60% of Alzheimer's disease risk can be avoided if individuals adhere to a healthy lifestyle this is new this is coming from an association that kept telling us five years ago that there is no prevention of dementia that there is nothing that can be done for individuals to prevent cognitive impairment this is huge with you it was a great news for all of us so the way Dean and I have looked at it together and this is actually from our book the Alzheimer solution there are several different processes that are involved in the development or the pathogenesis of Alzheimer's disease but the main ones are for inflammation oxidation or development of oxidative reactive oxygen species that destroy the neurons and it's connections lipid dysregulation which has to do with cholesterol metabolism and glucose or energy metabolism metabolism or dysregulation which has to do a lot with insulin resistance in the brain and development of pre-diabetes and its effect on cognitive state and these processes are governed by our daily risk factors you know the foods that we eat the kind of exercises or movements that are we're involved in sleep patterns head trauma infections blood pressure other vascular risk factors and so you know it seems a bit magical initially when you say over the word inflammation and oxidation it seems obscure but it actually is related to lifestyle and so what are some of the things that we can do that has been shown to affect these four pathways are nutrition exercise unwind or stress management stress has to do a lot with with brain health and with talk about that in detail restorers sort of sleep not the kind of sleep where you're knocked out by you know trazadone or some other medication but the kind of state that allows us to go through each and every stage of deep sleep because that's when the brain consolidates its memories and that's when the brain cleanses itself that's where the microglia get activated we'll talk about that and the fifth one is optimize or optimizing cognitive activity improving cognitive reserve and resilience which is a concept that is that has been studied for for many years specifically by dr. Stern and Columbia University that's the reserve that we billet bill during life and so we created the self-serving acronym neuro and being neurologists and is for nutrition is for exercise use for unwind ours for restorative sleep and always for optimizing cognitive activity so the application of neuro to prevent dementia and Alzheimer's disease is incredibly important and so because we have a lot of time although I'm not an agreement two hours is too long for a talk I think we all have to stand up and probably stretch a little bit in between but I wanted to go over some of the research that has been done in this field and not you know spend too much time but show you some really salient papers that have shown us the effect of these lifestyle risk factors on brain health we'll start with n nutrition now I'm very passionate about nutrition and you know you were saying earlier as a vascular neurology fellow at Columbia University you know I round in the morning at the ICU with my attendings and see patients in the ICU and then in the stroke wards and as you may know you know when somebody comes in with a stroke they come with sudden onset neurological deficits whether it's blindness or paralysis or inability to speak and it's devastating because it's sudden and most of them don't make it on time so TPA or you know tissue plasminogen activator the clot busting medication is not given on time and so most of these individuals end up having permanent neurological deficits and the only thing that we could potentially do for them was to make sure that they don't have another stroke and at the end of the day after you know thousands of dollars of MRIs and CT angio grams and Andrew grams and mechanical retrievers to see if we could get rid of the clot you know multiple days of stay at the ICU at the hospital physical therapy occupational therapy speech therapy cognitive therapy and all we did was send them home with an aspirin and a statin and that's it and it's happened over and over and over again day after day after day and thank goodness I was from Loma Linda with a concept of preventive medicine and preventive neurology going into Columbia University I convinced my my mentors and my professors to allow me to study epidemiology of stroke and prevention of stroke so I got involved in studying prevention of stroke and I did a lot of my work there and I published a few papers and I found out that 90% of strokes and 90% of cognitive impairment as a result of stroke can be prevented and you know what the most important factor was food food was the most important factor because food determined our cholesterol levels food determined our glucose regulation and how it how it you know manifested into disease and food determined what kind of nutrients we were you know we were introducing into our body and so you know I I printed out a whole lot of pamphlets and paper from the Adventist Health Study and I had my own stack in my clinic room and I would give it out to patients but then I realized that you know information is important but people are never going to change if the food is not delicious you really was as simple as that and so I started collecting some recipes and my passion for a nutrition grew to the point where I wanted to learn how to cook so I would be in the ICU and my scrubs seeing patients in the morning and then at 7:00 p.m. I would take the train downtown and in two years I went and I got my culinary degree and so I created my own recipes and I would have thank you it was probably one of the best things I've ever done it was so much fun too you know you know you go there with your scrubs and you're all nervous and you're excited and then you're cutting onions and potatoes it's almost like meditation where you're not talking to anyone and you're just focusing on how you're cutting onions and you're doing it wrong and you have to do another one and another one until you get better at it it was amazing and so I set up brain health workshops I would have 15 or 20 of my patients come in and I would just cook for them and I would show them how to avoid cheese or how to you know avoid butter and how to incorporate more greens you know greens can be delicious you hate kale that's okay we'll make it delicious for you so it became a passion and so I got involved in the northern Manhattan study which is one of the largest databases at Columbia University I looked at dietary patterns among Hispanics in the northern Manhattan study and right now I'm working with the California Teachers study which is one of the largest studies that has been going on since 1995 and I look at dietary patterns and brain diseases so just kind of giving you a little bit of a background so I'm passionate about nutrition and we know from multiple studies that there are certain things that promote that inflammation and oxidation that we talk about it's the cholesterol level it's the sugar levels and it's the amount of processed foods that people are exposed to and so we want to change that into a more whole food more plant-based diet because that has been proven to be the healthiest dietary pattern for brain health especially when it comes to Alzheimer's and stroke prevention now when you look at the neurovascular unit you know everybody talks about brain cells and we live in an age where you know Twitter and and youtubers actually give a lot of health information to people and most people listen to doctor often not really listen to their doctors or nutritionists but you know sadly most of the doctors not really trained well in nutrition but when you look at the brain the brain is the most vascular organ in the body I read a a statistic a number a couple of days ago in one of the papers I forgot to actually put it up here but they actually measured the amount of brain vessels or the arteries that we have in our in our cerebral cortex and they said that if you put all the arteries and to end it would spend 400 miles which is incredible so all these small arteries they're surrounded by neurons and we have a very tight barrier called the blood-brain barrier that is impervious to you know microbes due to chemicals and this gets damaged over time so no matter what we do I think the most important thing is to address vascular health of the brain that is not usually addressed when it comes to the concept of Alzheimer's disease and now more and more individuals more and more scientists are looking at Alzheimer's disease in the context of vascular impairment in the brain and so there you know it's a combination of multiple things that actually ends up in neuronal dysfunction manifesting in dementia we have genetic factors we have vascular factors environmental factors and all of these are essentially affected by the kind of lifestyle we have and that causes damage to the small arterioles and the brain capillaries and the dysregulation of cerebral blood flow the dysregulation of the metabolism of lipid and glucose in our brain ends up causing inflammation and oxidation and ultimately dementia so it's important for us to look at vascular risk factors and how food actually affects these risk factors as far as dietary fat and Alzheimer's disease is concerned it's important for us to talk about that most because there is a great deal of confusion about fat intake and brain health you have individuals and even doctors and scientists who say don't worry about saturated fats it doesn't really damage brain cells it doesn't cause any harm the brain is about seventy percent fat you have to take fat and I think they forget that that fat actually has to traverse so much of endothelium and our vasculature to get to the brain and that it's going to damage the vasculature and end up in vascular cognitive impairment from one of the latest studies by dr. Martha Morris in 2004 this was a very comprehensive beautiful review on all of the studies that are that have been done on fat consumption brain health matter of fact I'm actually doing I'm working with her right now to renew and add more papers to that systematic review we know that cholesterol it plays a very important role in Alzheimer's disease pathology so cholesterol levels especially during midlife is incredibly important to address people who have high blood cholesterol increase their risk of late onset Alzheimer's disease consumption of saturated fats which are derived mostly from animal products such as butter and meat and cheese and dairy and even coconut oil which is 90 percent saturated fat it increases the risk of Alzheimer's disease trans fats that are found in processed foods obviously anything that's boxed that can stay on the shelf for years without looking bad increases the risk of Alzheimer's disease and on the contrary they've looked at different populations especially in the Mediterranean areas when people consume poly and monounsaturated fats that are derived from nuts and seeds and avocado is an extra virgin olive oil they actually have a lower risk of developing Alzheimer's disease so it's not fat fat is not bad it's the type of fat that matters and we know that plant fats poly and monounsaturated fats are protective while saturated fats and trans fatty acids are very harmful here's a study that was done in 2002 I really like to study this was done by dr. Mia Kevin Peltier from Finland she looked at 140 a one thousand four hundred and forty nine individuals who were 65 to 79 years of age and these individuals were identified to have April efore which is you know one of the risk factors genetic risk factors for Alzheimer's disease she found out that if they had a belief or there is growing up by twofolds but if these individuals had elevated midlife cholesterol they went up by three times and if they had high blood pressure there was gone up by two and a half times and if they had a combination of cholesterol and high blood pressure which we usually see it's a trifecta usually high cholesterol blood pressure and diabetes the risk went up exponentially which supports the the theory of cholesterol the Chicago Health and Ageing project again dr. Morris in 2003 this was a longitudinal study they looked at 2,500 individuals and they found out that people who consumed higher amounts of saturated fats and trans fatty acids over six years period they had a higher risk of developing Alzheimer's disease but then compared to individuals who had lower consumption of saturated fats and who derived most of their fats from plants poly and monounsaturated fats they actually had a lower risk and there was a follow-up study from this she went ahead and she looked at neuropsychological scores so memory testing and they she looked at their MRIs as well they actually had better brain function and better looking rate a beta brains they had less vascular damage to the brain - this is from dr. paul geum from the adventist health study back in 1993 yes it's good to meet you oh my goodness okay I'm starstruck I need to talk to you later okay dr. Jim it's lovely to have you here back in 1933 you've told us that you you published a paper on the incidence of dementia and the intake of animal products and you showed us that people I'm getting starstruck here in about 300 individuals people who consumed meats including poultry and fish which are sources of saturated fats had twice the risk of developing dementia compared to vegetarians and I think this has been one of the most important papers wherever we go because you know promoting the concept of lowering cholesterol and lowering processed foods and increasing plant-based diet this is this is the crucial paper that actually puts everything into perspective I have to talk to you oh my goodness I am so happy you're here so that was the paper and you know after this multiple other papers from different universities and from different populations came as well this one is a most recent one in 2009 by dr. Solomon he's a good friend and Kaiser Permanente in Northern California group he at about 10,000 individuals 9900 patience and he found out it was cross-sectional that people who had high cholesterol levels during their midlife had a 57% higher risk of developing Alzheimer's disease later on so you know this actually pushes us neurologist and us neuroscientist more and more to understand that it's not about that tau tangles and amyloid proteins only he have two Brydon you know widen your scope you have to look at the upstream processes that cause you know damage to the brain that end up causing accumulation of amyloid and tau protease and even borderline high cholesterol increased the risk of Alzheimer's disease by 23% so we take that very seriously if somebody comes into the clinic if they have borderline and high cholesterol we don't let them go we have to address it we have to lower it and we're very stringent very serious about lowering cholesterol and it has to be with a combination of diet as well as medication a lot of individuals can't just do it but diet and I'm that's what I'm a proponent of statins if I need to another study women's health study from from Harvard University in 2002 6,000 women were followed for over four years higher saturated fat intake was associated with a portrait trajectory of cognition so they had a faster decline in their cognition compared to women who had the lowest intake in saturated fatty acids and when they looked at neuropsychological scores the women with the lowest saturated fat intake had the brain function of women six years younger an MRI studies actually showed a bigger larger brain with less atrophy and vascular disease in the two so you see the variation in the same theme don't we and I could probably present to you like 30 or 40 different papers talking about the same concept of how important it is to address vascular risk factors in the prevention of Alzheimer's disease this is one of the projects that I was involved in Columbia University so we looked at participants who ate a plant-based diet in that population we looked at food for Quincy questionnaires and highlighted people who completely avoided me for certain reasons and we found out that they actually had a lower risk of cognitive impairment and cognitive decline specifically vascular dementia over a span of six years compared to those who ate a standard American diet Rush University memory and aging project they are leading a lot of the nutrition research on Alzheimer's disease again dr. Morris back in 2015 she looked at 1,000 people ages 58 to 98 and she was the one who created the mind diet score so the mind diet is a dietary pattern that is Mediterranean and it combines some of the elements of the DASH diet which means lower sodium more plants no processed foods very little meat if at all me then it's fish but it's mostly a plant-based diet and she found out that people who adhered to the mind diet they reduced their risk of Alzheimer's disease by 53 percent 53 percent people we have this is a disease we're talking about that has no treatment and if we're able to reduce the risk by 53 percent that's incredible and honestly when you look at the supplemental material of these studies it's a basically washed down version of what the optimal diet is so I think we can even do better and we say you can you can from a 90 percent of Alzheimer's disease if you do lifestyle right well look at the wonderful numbers and the good news was it's not an all-or-none phenomenon even moderate adherence to the diet reduce the risk by 35% which is incredible and participants who had high adherence to the diet had the cognitive functioning equivalent to a person who was seven and a half years younger so better food better brain younger brain again in the Adventist Health Study Dina and I actually looked at the California verbal learning test it's a it's a type of a neuropsychological test that looks at verbal learning speed of processing and we found out that in this population a plant-based diet lowered the risk of vascular dementia by 28% we're still in the process of publishing that but that was an incredible revelation now I work with the California Teachers study like I said earlier 130 3479 female public teachers and administrators that are that were followed since 1995 so we have a lot of information from them we have food frequency questionnaire we have questionnaires about their exercise patterns and stress patterns and hormone intake and all other risk factors that can affect vascular health and cognition and so what I did was I linked the database to California Cancer Registry and the California Hospital database and I wanted to look at the risk of stroke among these women and wanted to parse out the concept of Mediterranean diet because every time someone says Mediterranean diet we think it's probably you know a lady sitting on a gondola eating some cheese and wine and pasta with a little bit of music in the background and you know every time you open up Time magazine or the news the the concept of Mediterranean diet is completely skewed so I wanted to see what makes this Mediterranean diet score and here it is individuals get a high score if they consume vegetables fruits whole grains nuts and seeds legumes you know beans and lentils and a higher ratio of polyunsaturated fats to saturated fat - meaning more fat from plants compared to animal products and you got a low score if you eat meat poultry and dairy so that's almost a vegetarian whole food plant-based diet isn't it it's a doctor game that's we're talking about the same thing and you know obviously these are sources of saturated fat so when I did an analysis to find out the hazard ratios of adherence to the Mediterranean diet and Stroke I found a stepwise decline in the risk of stroke as people consumed more and more of this dietary pattern and it went down to about 44 percent the rate lower risk of developing total strokes both ischemic hemorrhagic strokes and total strokes were increased again incredible and this is just diet we had just it for other risk factors like exercise hormone intake stress education socioeconomic status everything that you know changes or is a confounding variable in the formula so though so that was the studies now as far as supplements are concerned you know we live unfortunately we live in a society where everyone is looking for a quick fix I know that you probably some of you might see patients but I have a plastic bag sign in my clinic if I see someone coming in with a plastic bag I know they have a lot of supplements with them and they come in with 30 or 40 different kind of supplements and we just spread them on the table and I go through all of them and 99% of them are useless and they are in some sort of a subscription program paying $300 or $500 thousands of dollars every month because they want to get things like I don't know ashwagandha for brain health but you know as far as clinical trials are concerned and as far as information about supplement is concerned we know that there is no supplement that can prevent cognitive decline or dementia that vitamins should be taken in deficiency states if someone is deficient in vitamin b12 or D or anything of that nature it needs to be replaced but you know studies haven't really shown any good outcomes in people who have optimal levels and I wanted to go over one of the most prominent studies that was done to look at the effect of vitamins specifically B vitamins on cognition and it was the Vitacost study the vitae coq study which was conducted in 2014 looked at the effect of B vitamin consumption in people who had mild cognitive impairment which is the early States stages of cognitive impairment and they found out that regardless of what the B vitamin levels were if the homocysteine level was high B vitamins seemed to help so high homocysteine was actually a risk fact therefore cognitive impairment which is an inflammatory marker and in this study hideauze b-vitamins which included folic acid b6 and b12 were given to patients with mild cognitive impairment for two years they saw a 30 percent reduction in brain atrophy in the B vitamin group compared to placebos and in patients who had a homocysteine level in the upper quartile which was very high the atrophy rate was actually reduced by 53 percent so it's important to address that high homocysteine and inflammation and memory decline was almost halted in the treatment group and that's when it's important to check homocysteine levels and vitamin levels on a regular basis and people who are higher risk so the conclusion was in patients with elevated homocysteine and mild cognitive impairment treatment would be vitamin significantly reduced the risk of dementia the another paper that came out in 2010 showed us that it's not just one vitamin or the other that it's actually the synergy between vitamins that is very very important so they what they wanted to look at omega-3 fatty acids specifically now omega-3 fatty acids are found in fish but they can also be found in plant sources as an ala like chia seeds and Omega seeds I'm sorry yes and and flax seeds and they found out that the concentration of DHA which is an omega-3 fatty acid is lower in the brain of patients with Alzheimer's disease compared to age matched controls and regardless of what the the levels of DHA was in their blood if their B levels were low DHA consumption didn't really make any difference and it was the combination of the two that that was very important which kind of gives us a window into the idea of synergy that it's the synergy between the micronutrients that determines optimal brain health and how do you create synergy by eating food by eating by getting our nutrients from food because our body it recognizes them very well they're more bioavailable so expanding you know our our culinary plater or palate by including more vegetables by fruits by more seeds and nuts that's the way you can increase the micronutrient content of food and not just by relying on pills and vitamins this is the paper that we published Dean and I published in 2017 I believe yes mm you have 2018 it came out in 2018 and we looked at insulin resistance now insulin resistance in in the brain is a state where brain cells have a hard time using glucose as a fuel molecule we all know that the unit fuel is actually glucose it's not fat its glucose and when people have insulin resistance due to inflammation and oxidative byproducts brain insulin resistance can reduce cognitive cognitive health and in this population in the in Haynes population which was very very large we found that people who had insulin resistance had lower cognitive state so regardless of whether someone has demand diabetes or not even pre-diabetes are some markers of insulin resistance can be a risk factor for the development of Alzheimer's disease so how is nutrition and the summary is diets that are made from whole unprocessed mostly plant foods are the best diets for the brain whether it is for Alzheimer's prevention or stroke prevention and even even for Parkinson's prevention hopefully maybe next year we can talk about Parkinson's disease and the effect of insulin resistance on Parkinson's dementia but now we know that we can actually prevent 80 to 90 percent of these diseases in our lifetime saturated fats are associated with insulin resistance and inflammation in the brain and vitamin and nutrients are best derived from foods and not supplements there are certain supplements like vitamin b12 which needs to be taken if somebody is taking you know only a plant-based diet because we don't get it from plants but other than that there's no other multivitamin that seems to be necessary and we can get it from foods let's talk about exercise now I think we have a little bit of time it's funny that there's really no there's no argument about whether exercise is good or not but when you talk about food there's people fighting over Paleo diet and keto diet and this diet and that diet well we know why there's really no money to be made in exercise I suppose that we've known for a very long time that exercise is incredibly important for health in general but for brain it's incredible from the Framingham longitudinal study this woman was published in 2010 just a daily brisk walk just a daily brisk walk especially in the morning because we're exposed to the Sun can reduce the risk of developing Alzheimer's disease by 40% just a daily brisk walk which actually tells me about the importance of incorporating this on a daily basis this was a very interesting analysis of meta-analysis which is the most painful study ever because you have to get studied from everybody else and put it together 15 studies nearly 34,000 individuals found that high level of physical activity reduced cognitive decline by 38% and even moderate physical activity reduced it by 35% now the focus is not on the percentage the focus is essentially on the level of activity or the intensity there was a time when people you know when scientists would say okay some loved any level of activity is good for you but we know that now it has to be strenuous and you know we don't necessarily have to measure our heart rates I think the main thing that we tell our patient is you have to get tired 30 minutes of tiring exercise where you have a difficulty finishing a sentence and you break a sweat is incredibly important and it can reduce risk of dementia and in this particular study they found out that people who engaged in less intensive studies more moderate form of exercise they still benefited from it but not as much I guess you know 38 versus 35% is not much of a difference but now we know that it has to be intense this is probably my favorite study this was in 2016 by dr. Mavros he looked at resistance training we all talk about cardio cardio cardio but when it comes to resistance training and weight training there wasn't much information now so he looked at resistance training in a group of adults who already had mild cognitive impairment now mild cognitive impairment is the pre Alzheimer States so people do have memory problems but they can take care of their activities of daily living and they were put in the this program to exercise two to three times a week for six months and guess what 47% of these individuals who had mild cognitive impairment they reversed their disease they reversed their scores they got better they got normal again and they stayed quote-unquote normal meaning normal neuropsychological scores 18 months after the study ended - that was the impact of the resistance training and they also found out that people who had the most buildup in their leg muscles girth and their muscles when their muscle mass grew they actually had the biggest hippocampi as well so bigger legs bigger brain can I say that is that okay if I say that and it makes sense when we exercise there is a hormone called BDNF brain-derived neurotrophic factor that is secreted it it just skyrockets as soon as somebody starts exercising and brain-derived neurotrophic factor is responsible for making neuronal connections and these neuronal connections they translate into better brain health and reduction of cognitive decline so for summary exercise specifically strenuous or even moderate exercise can grow the brain and it can reduce the risk of cognitive impairment sedentary behavior nullifies any activity that we do and that's why I'm scared of you guys sitting here for such a long time today because you know we would be exercising 30 minutes a day but then if we're sitting behind our desks for say 4 6 8 hours it completely nullifies the benefit of that brain and we have evidence for that so standing up moving around stretching every hour is key and then leg strength is actually associated with a bigger hippocampus and a bigger brain and the idea that it's about muscle training and muscle strength building is is also very very important let's talk about stress I put a gentleman's picture here because stress is always associated with minam and I was like no men also get stressed so let's talk about the importance of stress management now there was a time when stress was pushed aside and it was usually you know said that people have to control themselves and stress doesn't have to do anything with anything but now we know that people who have chronic stress which is nothing but worrying on a daily basis just worrying about small things over and over again and not finding time to get rid of those worries not finding time to completely get rid of that noise in our minds they have a higher risk for brain atrophy in this study there was a 14% reduction in the volume of hippocampus in people who had chronic stress and when when we are under stress there is an abnormality in the amount of cortisol adrenaline and other stress hormones in our bodies and we know that cortisol is actually damaging to the hippocampus so our hippocampus our two small areas in our brain that are responsible for encoding memory and they're very very sensitive but they're very resilient too you can make a lot of connections if you build your leg muscles but any amount of cortisol or adrenaline or a lack of sleep damages that hippocampus which is the center of memory consolidation and in studies and volumetric MRI studies we know that there's shrinkage of the hippocampus in people who have high stress people who have been exposed to bad families childhood abuse physical abuse verbal abuse all of that have been associated with smaller at bootcamp by an increased risk of cognitive impairment later on in life in this study so they looked at you know activities that reduce stress so in UCLA they looked at meditation meditation actually increases the risk in the volume of the hippocampus it decreases the risk for cognitive impairment so they put a couple of meditators you know people who were able to calm themselves down and get rid of stresses in their minds inside an MRI machine and they looked at the volume of their hippocampus and compared to non meditators they actually had bigger hippocampi and so it's all about perception of stress they've been studies that have looked at populations where they were given a task so say for example you know there are two populations they're given the same task one population was told that this is a very stressful time for you this this task is incredibly difficult it's gonna be hard for you but try to do it as much as you can the same the same task was given to the other population but it was presented in a different way it was defined in a different way the other population was told that this is a hard task but you're going to be able to do it it's not difficult at all your body is going to prepare itself to take on this challenge and at the end of it you will feel great so the only difference was labeling the only difference was definition how did you define one task to one population versus the other and they checked their blood pressure they checked inflammatory markers and they checked some markers of you know like sweat and physical markers of stress sleep damage and things like that and after the end of the study they found out that people who had the negative perception about the tasks they had higher blood pressures they had more vascular constriction which actually promotes high blood pressure and promotes less blood flow to the brain they had more inflammatory markers their sleep got worse and their sense of self-worth was actually plummeting but when they looked at the other population that had the good definition where they thought that all of these bodily changes that they were feeling the tremors in their hands the dry mouth the anxiety you know just like me walking in here and speaking to you guys that feeling was just a way of my body preparing itself to grow that was me getting ready to take on this challenge and growing my brain and to kind of you know putting a positive spin to it they had lower blood pressure they had lower inflammatory markers they had no blood vessels striction they slept well and guess what they wanted to do it again which was interesting the others just wanted to go take a vacation so it's all about perception of stress we know that good stress the kind of stress that grows the mind boots new cell connections speeds up our learning system it creates brain resilience the kind of protection that we need to avoid Alzheimer's disease and it sharpens our memories and then bad stress the kind of stress that we have no control over that we defined it in a negative way it damages hippocampal cells there's hippocampal atrophy there's amygdala atrophy and frontal lobe atrophy impaired learning people tend to have lower scores and exams when they have bad stress it causes blood vessel constriction and damage to it ultimately and obviously impairs motivation and energy levels as well so it's all about perception of stress and that's why there's a lot of focus on making sure that people are equipped with resources and behavioral activities they can help them modify bat stress into good stress all right let's talk about sleep we don't sleep like that but I thought that was a very cute baby we know that sleep deprivation harms our brain but we didn't know how much and we're getting a lot of great information now there's two functions of the brain there are two things that happens to our brain when we sleep the first thing that happens is our memories are consolidated so when we get information throughout the day it's like scribbles on a notepad or on a sticky note everywhere that's our information we get when we sleep this scribbled note gets typed in into a beautiful Word document and it's placed in a file and a folder and a cabinet so that we can retrieve it the next day it's easier for us to know where it is well when we don't sleep those sticky notes they get scrambled they you know you pour tea or water on it and you can't read it anymore and that's why all of our memories are scrambled the next day if we don't get enough sleep the second function of sleep is cleansing of the brain we have these cells called microglia the microglia that are the brain's specialized cells to clean the brain they're essentially the janitor cells of the brain and they get activated when we go into the deep stages of sleep and what they do is they start getting rid of the oxidative byproducts during sleep and so our brain is able to function better and the next day now dear micro grandma microglia are a little finicky if we don't sleep instead of getting rid of the byproducts they starting eating away at the brain they start eating away at the neurons the neuronal connections and they found out that people who have chronic sleep deprivation actually have smaller brains even one night of sleep deprivation can damage the brain so you know they've done studies where they check amyloid protein which is a byproduct again in the cerebrospinal fluid one night of sleep deprivation can actually increase the amount of amyloid in the brain and it doesn't get extruded into the system our brain is not able to get rid of it properly so sorry we can't make it up during the weekends and the damage is cumulative over time and that's why this actually explains brain shrinkage in people who have chronic sleep deprivation the other thing that is very very interesting is the effect of sleep apnea on brain health and specifically in the risk of development of Alzheimer's disease they did a study in 2015 in University of Florida and they found out that in this was a systematic review and a meta-analysis 13,000 participants they found that untreated sleep apnea increased the risk of Alzheimer's disease by 70% 70% so we'd be eating all the sweet potatoes and spinach in the world but if we have untreated sleep apnea it's definitely damaging and it makes sense with the lowering of oxygen saturation in the blood with the vascular damage to the brain it can actually promote the deposition of amyloid and damage to the blood vessels and of the brain itself so as far as summer' is concerned sleep apnea increases the risk of all disease by 70% sleep is important for cleansing the brain and for memory consolidation and medication is not the answer true there are times when we have to rely on medication because you know we have to quickly fix some behaviors and help individuals get some rest but over time it's all about cognitive behavioral therapy and addressing sleep hygiene so things like environment and food and sleep patterns getting rid of worrying getting rid of stress right before sleep and it's not something that can be done in a short period of time it's probably the most difficult thing and it tastes the longest as well but that's the key for a better brain health alright we're reaching the the last aspect of brain health which is optimization of cognitive activity now we know that the connections between the brains the ones that I was talking to you about each brain cell can have as little as two connection or as many as 30,000 connections these connections confer protection these synaptic connections are made and broken on a regular basis the concept of cognitive reserve was defined by dr. Stern back in 2002 and he's a scientist and neurologist in Columbia University that looked at different populations who had very complex and challenging lives - say for example you know a CEO of a company or you know Richard Branson the CEO of Virgin Airlines or you know a a doctor who sees a lot of patients or you know a mother who has three different jobs and is raising children and he found out that people who have complex cognitive lives are very well protected regardless of their vascular risk factors and so we coined the term idea density idea density means how much does an individual come up with new ideas and new thoughts how much do we challenge ourselves on a regular basis and that seems to be very protective anybody heard of the London taxi driver study the very interesting study so in London they wanted to look at the brains of taxi drivers after they took a gruesome test I don't know if you guys have been to London I think you probably have but it's no Chicago it's no New York the streets are a disaster it's like a kid just took some yarn and just you know glued it on a piece of paper so back in the days when nobody had GPS taxi drivers had to go through a very very difficult test it took them years to memorize each street each house each neighborhood and so they were given books and textbooks and they had to go through this training and they were all just were wondering like wow this is a great opportunity for us to see before and after of their brains after they go through this test and they compared them to bus drivers who basically had the same route they would start one place and up in another one and get back so there was no memorization involved and they got their license very easily and what they found out that taxi drivers who passed the test by the way and their pass rate was really low it was 50% basically they consistently had a larger hippocampus which is the part of the brain that I was telling you about that consolidates memory their hippocampus was larger and these were in individuals in their 20s and 30s there were 50 plus there are 50 to 75 years of age so even at that age they were able to grow their hippocampus and I think that's such a wonderful wonderful news for all of us and it's so empowering and they found that more complex navigation you know going around this city led to more complex spec knowledge which in turn led to a bigger more resilient brain and that's why cognitive activity are optimizing kind of activity is so important anybody knows about the nun study yes the nun study so the autobiography of non studies were were taken and this was a study that was done in Minnesota and the scientists wanted to see the effect of lifestyle especially cognitive activity on brain health so these amazing nuns they dedicated their brains and their bodies to science and after they passed away they had brain autopsies done so they they were able to look at the pathology of brain diseases in them as well and they found out that you know there was a group of nuns that had you know very very bad looking brains there it was just riddled with Alzheimer's kind of pathologies with with tau proteins and tangles but yet right before death they were absolutely fine they did not have any of the manifestations of disease which was you know very surprising and yet they looked another group that had okay looking brain their brains actually were very nice looking and they didn't have the pathology of Alzheimer's disease and yet right before death they actually had fulminant Alzheimer's disease and so the discrepancy through all the scientists often what is going on how is it possible that a person could have this kind of a brain and yet not have any symptoms but in a good-looking brain and have symptoms they went back and they looked at their life they went back and they looked at their diaries and the ladies are the nuns who had brains riddled with pathology of Alzheimer's disease and yet they didn't have any signs they had very complex lives they were involved in their communities they were involved in service they were best communicators they had very high vocabularies and when they looked at the other group who had Alzheimer's disease they were they were were drawn they were not very involved they were not involved in very complex lives and so that supported the concept of cognitive resilience that one can build during our lives so we came up with this Venn diagram with all the data that we have if we live right here at the center of these three concepts which is complexity challenge and purpose that's where cognitive resilience is built most challenge ok let's start with complexity the complexity means having complex life having something that challenges our brains having good stress in our lives whether it's school whether it's being involved in church whether it seems via volunteering in the community whether it's speaking at all times whether it's lifelong learning all of that is complexity challenges pushing it to the next level you know if somebody knows how to play the piano and if you know a couple of songs after a while you can close your eyes and you can play the song and you you'll get it so the next step is to learn something different learn another language go to the next level of your job take on another project take on another degree I'm not doing that Dina's I tell Dean you have more degrees than a thermometer but so you're challenging yourself more and more is incredibly important and all of that is meaningless if it's not connected to our purpose I know it sounds soft I know this is probably not very scientific but I think purpose is the binding component of everything that we just talked about when we have a purpose in life when we have a vector in a direction to follow the complexity and the challenge they fall in place people tend to have better nutrition's if they have purpose they have better exercise patterns of they have purpose their stress is managed better at if they have an important purpose in life and it can be as small as helping people or as grand as helping the world it doesn't matter but something that keeps us in line and so this is this is the the most important and we believe the most helpful model of achieving optimal brain capacity and preventing this devastating disease of the brain so with that I come to the end of the talk we believe that brain health starts at home and it starts at work and it starts in our communities it starts right here every single decision we make whether it's the kind of foods we eat or the kind of activities that we are involved in or the purpose we follow or we choose determines our brain capacity and our brain health and that's why I'm here that's why I am part of this amazing University and hoping to make a difference in this world thank you so much very time thank you very very much time Fisher's eye we have a lot of time for questions last year there were many many many many questions so hands are shooting up we'll get started right in the front in Blue Zone Aries do you find the incidence of dementia is substantially substantially less has that been documented yes definitely definitely in Loma Linda some of the other ones haven't really been studied and they're they're just you know reports but the ones that have been published in Loma Linda they you know we definitely do see a lower risk of dementia and Alzheimer's disease and results yes more questions thank you for your presentation dr. shores I you know the statement that cholesterol leads to Alzheimer's it seems that like not all the authorities agree with that I know a lot of studies a lot of these days are their cohorts and so sometimes the confounding factors are possible to rule out how can we be sure that confounding factors don't account for this finding well they're adjusted in different studies and the ones that I presented to you have you know have been published in peer-reviewed journals and the confounding factors have been addressed and I know that you know there's a lot of debate going on as far as cholesterol is concerned but when you look at the largest populations in the world and it's not just necessarily one study you have to look at the combination of different studies so from epidemiological studies and observational studies and even the studies that are done you know on few individuals I know that that's small we know that cholesterol not necessary the cholesterol intake but the levels of cholesterol that are affected by saturated fat intake can increase the risk of Alzheimer's disease and that's been known and when you look at other models of dementia vascular dementia and minor strokes cholesterol levels actually increase that as well so when you look at the different lines it completely makes sense how it can damage brain cells and result in Alzheimer's disease we seen any randomized controlled trials that have that have kind of settled that question once and for all they're very small there was one that was done a couple of years ago it's very difficult to do randomized control trials of food on individuals I mean you have to understand that you know how do you make sure that people eat what you tell them to eat and how do you make sure that you see it for a long term and especially for a disease like dementia there's you know there's a there's there's some physicians that are doing studies that want to look at cognitive outcomes within six months you're not gonna see any cognitive outcomes within six months you have to follow them for a good three to five to ten years and there's no funding to do that and I think you know people don't don't eat that way though they can't really control themselves to eat that cleanly for a long period of time so what we rely on is the amount of data that comes from observational studies and you know the smaller studies and it indicates that yeah it's a very important risk factor question over here once symptoms develop is there any possibility of reversal reversal if you do drastic changes in these things that you've described if I understand it properly you're saying is it possible to reverse when the disease develops and once people develop symptoms yes yeah thank you for that question I think I forgot to mention that it's very important for us to know that once the disease develops it's very hard to reverse it you can reverse it in the mild cognitive impairment stage and we do have evidence for that but in the moderate to advanced stages of Alzheimer's disease there's nothing that can be done because by then 60 to 70 percent of neurons have been affected and I know that a lot of people are trying to push the concept of Alzheimer's reversal and I think that's borderline criminal you know they're selling vitamins and minerals to them and we see several programs and protocols floating around in the country and there's no there's no objective evidence that that's helpful question up here to the left any studies then about the vegetarian meat I mean they have a lot of chemicals yeah and everything anything right no not yet we're actually hoping to do that we were talking to the CEO well the the group that manages beyond meat you've heard of beyond meat that the process meat and you know with with a concern that people have for animals and for the environment you know a lot of people are moving more towards beyond meat and beyond burgers and the impossible burgers they're highly processed they do have saturated fats yeah maybe they're a little better than meat and what we say is it's a better it's a good transition to go plant-based but no no studies yet but we're hoping to do that soon we're actually in the middle of all conversations yeah yes sorry yes you know could you comment on the role of hormone I'm talking about estrogen testosterone DHEA you know young you know optimal life levels versus the age-related decline in these hormones and how does that contribute to and what role does that play here definitely so we do have evidence that you know a decline in estrogen levels and especially in women after menopause that increases the risk of cognitive impairment and multiple studies have shown that it's important to address the changes in hormones and maybe starting hormone replacement therapy as soon as possible and it's the timing that matters more it's actually the earlier you start the conversation and the the hormone replacement therapy the better but still you know as first testosterone and no hormones are concerned we don't have a good objective evidence but for women there is there seems to be some benefit of starting hormone replacement therapy early that in indefinitely so far but again you know that has to be determined with better studies no studies so far could you address the issue of soy-based protein foods and is there any relationship to Alzheimer's soy so there is no no harmful effect of soy that has been seen beneficial definitely yeah people who consume soy proteins specifically tofu edamame and I'm forgetting the other one tempeh so the unprocessed soy products they tend to do better there's no studies in Okinawa Japan and in China and from the China study you know they actually tend to do much better they haven't looked at neuropsychological test scores specifically and soy consumption but for brain health in general and better vascular health yes what protein is great yes what do you do for the patient with a normal b12 and folic acid levels but they have a rather high homocysteine in at ten to fifteen range using lmf of folate or test them for the MTHFR mutations that that's the time to go into some of the esoteric testing then yes to find out why is it that there they still have high homocysteine levels question here yes I was hoping you'd say some positive words about chocolate oh I forgot I actually forgot no chocolate is grade they've been multiple studies that showed that chocolate without the sugar you know the pure dark chocolate actually improves blood flow serveral blood flow and there was a small study that showed that chocolate consumption was associated with lower risk of stroke so chocolate is good it's watched the cocoa powder yeah it's it's the sugar that kind of you know negates the beneficial effects yes I believe it was about a month ago there's an article I think it was in JAMA that I was done in the Netherlands showing that b12 supplementation increased all cause mortality I guess yes I looked at that paper and I think they didn't really address the confounding factors very well that population had so many holes in the data we didn't know anything about their exercise pattern we didn't know much about their dietary patterns we just knew that they were taking vitamin b12 supplements and they actually had underlying morbidities that weren't accounted for so I just put a big question mark on that paper because it wasn't done very cleanly and there are a lot of papers like that that show associations between one thing and another but when you go down deep and see whether they addressed all of the factors they usually don't so question here yes um do you have any thoughts about the levels of HDL vs. LDL cholesterol then I have a vision I know somebody with a with mild cognitive impairment yes the HDL cholesterol is very high over 80 and the LDL is about 130 all right so unlike cardiac or heart disease the role of HDL for brain health is unknown and more emphasis is placed on reducing LDL LDL no matter you know no matter how high HDL is if your LDL is above 100 it doesn't matter so the focus is always on lowering LDL as much as possible ideally between 70 to 100 for people who don't have vascular risk factors like diabetes and high cholesterol pressure but lower than that if they do question over to the right yes like your comment on ground nuts and tree nuts they're amazing both both so the type of nuts that have been studied for brain health pecans have been studied and walnuts have been studied a lot and walnuts seem to have so it's it's the it's the ratio of omega-3 and omega-6 the higher omega-3 the better the lower don't make it 6 the better and walnuts seems to have that ratio so yeah walnuts are great well as the Trina yes peanuts are actually higher in omega-6 fatty acids and so when you look at it's all about a spectrum right which one is better than the other so when you see the spectrum you have walnut or the top and you have pecans hazelnuts and I think there are a couple of other you know Brazil nuts and cashews and almonds yes and then peanut is right at the bottom yeah so some more walnuts I suppose another question over here yes you didn't mention anything about social interaction the what did it when you have social support and that sort of thing and how that helps prevent it yes well I'm I was hoping that it was you know creating I created a good picture about that with a nun study social I mean we're social beings people who are detached who are not engaged with the society that might offend some introverts here but now no offense but people who are not really engaged with other human beings have low complexity of their cognitive activities the most complex cognitive activity believe it or not is talking to each other and being involved with each other because it's not just speaking to each other it's about me making sure that I'm addressing your concerns me making sure I'm not boring you me making sure that I make sense so all of the cognitive domains are working together I mean Dean always gives a really good example of you know Sudoku I don't know he talked about Sudoku but he hates Sudoku he says you know Sudoku will give me dementia because it's you know just adding numbers doing this and you know it's just a couple of numbers and that's it but if you're if you're you know involved in a project it's your memory centers it's your language center it's your visual cortex it's your amygdala which is your emotion it's your brain on fire it's all of it together at the same time and that provides the most cognitive resilience and reserve they've actually done Studies on people who have hearing deficits people who can't hear very well not necessarily death but just have some level of hearing deficit where it creates a lag in the conversation where they don't really keep up with conversations with their with their family members and friends they have a higher risk of developing cognitive impairment so that also you know talks about having you know this engaged brain either its ambient sound or conversations or being around people that keeps the brain active as well so yeah it is very important we have lots of questions and a lot of hands we'll get to I'll try my best next one is over to you right there yeah we're putting post stroke patients now on intensive statin medications and I wonder you know the past week we thought of stands is usually for middle aged people and now where it seems like we should put it in the water and everyone should have a statin so how long do people stay on statins so um there's no source from the studies that look at secondary stroke prevention which means you know when somebody has a stroke and you want to prevent another one or even after TIAA they have to be on statins indefinitely until their cholesterol levels are lower than 100 between 70 to 100 and yeah no I I am a big proponent of statin therapy during acute stroke because it knots it's not just about lowering LDL the bad cholesterol it's about the plio tropic effect of statins which is the anti-inflammatory effect it reduces the size of the stroke the penumbra which is the stunned neurons around the stroke or reducing the size is very important and yeah again it's lifestyle its lifestyle and you know dean ornish has done Studies on people who go on a low-fat whole food plant-based diet and their LDL plummets within two to three weeks dr. Caldwell Esselstyn in Cleveland Clinic he's done Studies on his patients and he's published it when he put people on a very low-fat whole food plant-based diet with significant cardiac disease and he found out well some reversal of their atherosclerosis but also just a rapid reduction in their LDL so yeah we we put statin in everybody's water but at the same time we give them beef and chicken and cheese you know so it's like what is going on here I think I think we as a medical community we haven't really bought into the importance of changing lifestyle along with medication I think that's the biggest problem also you alluded to the Nutritionals of it every day patients asked should I take Prevagen or ginkgo and and then is there a link to low vitamin D levels with memory loss oh yes there is yes there is people who have low vitamin D are at a higher risk but when that vitamin D is replaced by just getting 5 15 minutes of sunshine maybe or just a you know over-the-counter vitamin D replacement they're fine don't have to buy provision and all the other stuff with it there's no study that actually proves that provision is good I get that in my plastic bag sign patients all the time question here yes it's probably worth emphasizing that that finding these things out is really difficult because as you mentioned it's not a study you can do in six months it's more like years sometimes decades and you have to collect all the information ahead of time because by the time they have dementia they can't remember what they the last six years it I remember when I was doing my study it was like pulling teeth and even even when I got done I would like to be able to say well fish is better for you than other kinds of meat but we just didn't have the numbers to be able to tease that out right absolutely I think thank you for that comment I think it's very important for people to know that it takes a very long time and the right kind of an approach to study cognitive function and cognitive health and human beings and everybody keeps on harping on the fact that well there's no clinical trials how can you say that but you know again yes there are no clinical tests but we have enough information to know which direction to go to we have enough information from observational studies from community studies that you know eating a certain way it's better and why should we do it I think that's exactly what happened with the smoking studies and the tobacco companies you know for years and years and years after thousands of papers available showing that smoking was associated with lung cancer and high cardiovascular mortality public health departments weren't ready to make any changes well obviously because of some lobbyists they're trying to you know cause some impediments but you know you you can't follow people for 70 years wait for 70 years see what happens and then make recommendations if you have to be able to look at cross-sectional studies and epidemiological observational studies and small you know anecdotes even and make a decision thank you for that statement yes what's your advice for a 30-year professional career of call every six nights and up up all night shifts what's what's the prognosis or the risk risk there well the good news is the cognitive reserve is going to take care of a whole lot of things and then you know life is not perfect so emphasizing more on healthy diet and exercising and finding meaning and purpose in those calls I think that's wonderful I mean I know a lot of people who don't sleep and who have extremely busy lives but they're the sharpest people I know because they've taken care of the rest of the aspects question up here lots of hands out we'll get to you we have plenty of time but our next question is way in the back here early on in your slide presentation you mentioned that the women were much more likely to have this problem is that age matched against the men yes it is can you kind of comment on what risks they have that would push them towards that trend so these are so one day when they write national reports and guideline reports like this they've looked at women who were born say in the 1930s and 40s and you know where who are elderly now and here they have higher risk of Alzheimer's disease things are shifting and changing for now we know that women have a higher proclivity for vascular diseases so you know if they have high blood pressure it affects their their brain blood vessels more than it affects men and they don't seem to have more reserve and resilience there been studies that have looked at and I mentioned it briefly that have looked at education as a proxy of cognitive reserve and it seems to have been lower in women compared to men back then and it's very interesting to see that shift that you know women are now more educated or as educated as men are and whether this cognitive reserve is going to be protected from here on so we do kind of see a little bit of a shift in that number slowly and gradually but so far with the population that we have right now it's mostly vascular diseases next question right down here could you speak to iron and how low iron has an effect on children does it have have any effect on adults low iron on children's brain so they haven't looked at specifically iron iron consumption there have been smaller tests but they haven't been associated with cognitive state per se there's been a couple of studies that looked at the quality of iron whether it's heme iron or non heme iron and heme iron seems to actually increase inflammation and oxidation and small vessels so meat products may be damaging because of the heme iron can paste compared to plant irons which are non heme but you know we still need to look at a little better we need to give the right side of the room yes I might hang out there I just wanted to know if you have any tips for helping patients change their lifestyle because it's a lot easier to take a pill than to change your lifestyle especially if your family is continuing to eat the same way Society is sort of the opposite yeah absolutely well that's that's our goal in our clinic the reason we came back to Loma Linda was because Loma Linda has the perspective and the heart to allow for a whole person comprehensive care that you can't really just push people out of your clinic by patting their back and saying just eat healthy and I'll see you in three months we have to hold their hands and we have to meet them where they are and that's why it's important to go out into the community so here in Loma Linda just making it shorter we have the Alzheimer's Prevention Program where we see patients we prefer to see patients who have mild cognitive impairment because unfortunately there's not much you can do at the advanced stages and we identify their risk factors and then we put them in a lifestyle program where I actually teach them how to cook and we address there some behavioral modification see where they are and what they can do can their exercise how are their stress levels are they able to address their stress levels how can we help them we've involved psychology psychiatry so it's a it's a multimodal comprehensive multifaceted way of addressing this and we're doing it on a regular basis and we've seen amazing results and I could you know I I don't believe in attic doats maybe I should include them in my talks from here on we're planning on publishing this but we've noticed that you know 80 to 90 percent of dementia can be prevented by just addressing these and even people who have mild cognitive impairment they have reversal of their symptoms in the early stages if they address lifestyle so it's all about small steps of success we've actually brought in like the business model of SMART goals specific measurable attainable relevant and time-bound and making short successes and following them over time next question right here I know some church against the meditation and I'd like to know how how my patient health brain is not challenging and not complex anything anything that focuses us on our purpose in life whether it's prayer whether it's meditation whether it's engaging with with human beings in our community in our church that's the most important thing the reason I brought up meditation is because it's been study they basically just stuck people and there and ask them to meditate inside the MRI I'm pretty sure if you really need to look at you know the effect of prayer on brain health and studying that on MRIs but I'm pretty sure that that we will see effect so it's all about being able to cut down the noise in our minds and being able to focus on on a particular concept or an object or whatever it is and get rid of stress focus is the gateway to memory so the focus the areas in the brain that is responsible for focus is called the pre Kunis they found out that people who are involved in some sort of a mindfulness project whether it's prayer or mindful breathing or meditation they have larger pre Qi and they can memorize things better because of being able to focus on something is there a push to you know we seem to focus on the adults is there a push to bring any of this information to kids start the cycle because otherwise we just absolutely absolutely there is I'm glad you asked that question about a month ago a paper came out and this paper will give you an idea of how important it is to address brain health in children they looked at adolescents 12 to 16 years of age who had poor health who had poor lifestyle and they were they were obese and they found out that these children actually had insulin resistance and white matter disease in their brain when they did MRIs at that young age and when they did some testing they had lower IQs and they compared them to children who didn't have white matter disease and didn't have obesity and a vascular risk factors and they did much better in their neuropsychological tests and there was another study that looked at the effect of April efore which is the gene for Alzheimer's disease children who had the April efore gene they actually tended to have a little lower neuropsychological scoring compared to children who didn't have it so even at that age look at metabolism can be affected because FIO genes and so it's very important to to you know talk about the importance of that stage where the brain is multiplying rapidly brain cells are being made connections are being made and if we are not addressing their lifestyle their food their sleep their exercise patterns that could affect them negatively yes well besides the short-term memory loss what aspect of memory can be affected by aljahmeir dementia we know those difficulty recalling and naming and all of that are they just age-related questions about olive oil and coconut oil are they still good olive oil the second question was about olive oil okay yes so it sort of first part of the question was so so we know from from multiple studies I had a little bit of a difficulty understanding your question so I hope I'm answering it correctly but it looks like people who have very healthy lifestyles they tend to have better short-term memory better speed of processing better judgment and decision-making these are the different domains of cognition that get affected initially in Alzheimer's disease its short-term memory gets affected significantly more than other domains of cognition but then later on all the domains of cognition get affected but as we grow older we don't necessarily have to have memory problems the only thing that gets affected as we grow older is speed of processing getting information out you know quickly and the analogy that I give out in my community talks is when you're younger you're like a library yeah you're a smaller library you're a kindergarten library where all of the books are stacked on the wall and you know where things are and you go pick it up and you pick it up quickly and that's it right so picking up is the act the action of remembering but when we grow older we become like a New York Public Library so if you want an information you have to go all the way down to the basement find the right line and the file and the folder and then look at the means and then pick it up and then walk outside it's gonna take long that's how the brain works it takes longer for you to remember things but the amount of information continues to grow the amount of wisdom which is a soft term for just the amount of information that we have mixed with our experiences our judgment or decision-making all of that grows and it continues to grow and if we live a healthy life to make sure that the neuronal connections and the neurons stay healthy the only thing that will be a little affected is processing nothing else we will be sharp I know all of us yeah olive oil is good coconut oil is bad short answer sorry I just want to give a shout out to this young gentleman here he's had his hand up for probably 15-20 minutes no it's my fault I thought and he's been patiently waiting it's just the right time because I wanted you to talk about coconut oil and because I heard something that about Mead median chain triglycerides and the coconut oil just was almost I mean those anecdotal experiences but that they had dramatic reversals of you know those I don't know it was a CEO or something that could remember everything all the board meetings and what they covered and then suddenly sort of just went downhill couldn't find any any cause or it mm-hmm and he somebody told him two tablespoons of coconut oil twice a day and the guy was back to the home okay yeah but there was some talk about when somebody was commenting on it that yes it had to do with median chain triglycerides right yes so um so coconut oil is interesting coconut oil is 90 percent saturated fats and it has some other types of you know it has different types of saturated fats as well and the medium chain triglyceride is a type of fat that is available in coconut oil we know from a large amount of study that saturated fats seem to be unhealthy for brain blood vessels for the rest of the blood vessels as well it increases risk of heart attacks and strokes and things of that nature MCT oil is a part of it so taking coconut oil because it has MCT is almost like drinking coke because it has water you know there's a lot of other bad things too they've been able to separate MCT oil from coconut oil and study it separately but they've studied it in mice and very small number of individuals so we don't have enough data to refer to make any sense and for us to you know recommend it to everyone they've also looked at ketone bodies that are created when people eat or take Menma MCT oils so ketone bodies are a beta hydroxy butyrate and these are these can be fuel molecules for the brain if the brain is completely insulin resistant and they can't use glucose that's the whole idea of ketogenic diet is you're reducing glucose so much you're giving them beta hydroxy butyrate that the stunt neurons that are already riddled with disease they don't have the receptors for glucose to take it in as a fuel the the ketone bodies don't need any receptors and it goes right in and so it acts as a fuel for maybe you know a small amount of time but is it reversing disease no is it causing any beneficial you know environment in in the brain for it not to progress into more days no and the data is very very messy but we're hoping to get more information about that and most of the studies that have come out from Alzheimer's regarding Alzheimer's disease in coconut oil it started with one person an anecdote of one this one lady a pediatrician had a husband who had Alzheimer's disease advanced she said she gave him coconut oil and he got better but then he passed away and it was never published and so based on one story this entire movement of coconut oil industry started booming around but we have to be very careful because it can be really harmful my wife will be very happy to hear that you've taught me that coke and water are the same thing so thank you question two questions here you mentioned tofu well I assume you consider the fat it's not a processed food it's partially processed you're right but it's okay it's okay it's you know it's less process than other foods No what about gluten if you make homemade gluten is that processed it is I think the word process essentially means when you separate one element from another and you know you just eat that apart from everything else so white bread is processed you know pearl barley is process because you get rid of the brand but you know is it bad that's the question so as far as soil is concerned we know that no it's not it's not unhealthy and people who consume soy they do very very well but there's no study that looks at the consumption of soy versus consumption of soybeans and edamame do you know what I'm saying it's like a spectrum and we don't have any evidence and we don't have any evidence for gluten either except that it's bad for people who cook and glucose I'm sorry gluten insensitive sensitive but other than that there's no study that shows that it's harmful well apparently there's some room for processing food a little bit the manna even was baked and boiled right agreed agreed I mean you know it's minimally processed let's just call it that yes B D and F brain-derived neurotropic factor appears to come out of muscles what part of the muscle is actually producing it and are there other sources of it a striated skeletal muscles produce it but what part um B D enough yeah they basically haven't really gone into the details of finding out where it is we know that the brain actually creates BDNF to a certain extent as well so BDNF has created two neurons in stem cells and in skeletal muscles is it at any food no and people who are selling it in a capsule it gets destroyed in the gut so don't buy it another question up to the to your right so dr. shechet thank you so much for sharing a little bit about your education of patients and with regards to lifestyle the question over here kind of sparked a little bit more inquiry on my part my parents and i have partnered together and are doing community education I'm a nurse and enrolled down doctor of Public Health Program we've been volunteering in federal prison in Canada for two years we've taken a number of movies like Forks Over knives eating you alive code blue redefining the practice of medicine which I hope you wrote down because if you haven't seen those three movies I highly recommend that all of you go home and watch them and I have a question at the end of this for you but one of the things and we do a lot of work in the community we started a non-profit and so we've been working together for five years all volunteer in the community what we've been seeing with men in prison is an amazing it's a federal prison minimum security and there pre-parole yeah so we had a gentleman in November he gave permission for me to share the story who came to see code blue and had a new diagnosis of MS and he had asked me after well what should I do and I said I'm a broken record we go once a month with a meal we have a roughly 25 to 30 men show up they eat enough food to feed 50 at least when were there and we for an hour and a half present health education I said go plant-based and start exercising and the whole kind of new start thing he lost 55 pounds he has regained his vision and his mobility he was already having significant issues walking and he's a completely younger looking man completely reversed we've had type 2 diabetes reversed rheumatoid arthritis one of the employees would been in now to actually present to the employees there I think the question that she asked well how do you do it when people want a pill I think it's become a broken record and say whole food plant-based is lifestyle good health starts with nutrition but it doesn't stop there it's exercise its rest its air and so my question is to you and for everybody in the room for with your answer is what are some of your recommendations for people who are wanting to start I just shared some of what we do and that's only a snippet I mean we should do movies and we do cooking workshops and label reading things of the Whole Foods but what are your recommendations to help people we're trying to get started with their patients and teaching well first of all thank you thank you for everything you're doing for the community I am thank you for sharing the beautiful stories I'm not surprised that I've seen I've seen these kind of cases over and over again and it's very empowering to be in the world of healthcare and to see such results as far as the recommendations I think I think my my talk was all about that you know you don't have to buy anything you don't have to you know rent a protocol or be a part of the an entire program it's identifying risk factors and addressing them and you know for people who have risk factors it's about finding out you know what the next step of success is and then taking that step because you know New Year's resolution doesn't work it never has worked diets never work you all these programs that people go on these extreme changes it never works it's small steps of like success towards a particular behavior towards a model and taking the first step and then finding out from the community from the health care program that they're involved in anyone that can support them in that journey but it's all about behavior medications modification and small steps we have time for just one more question we appreciate you taking all this time that question a pleasure sir hi I just want to know about your thoughts in details about the keto diet keto diet yeah cuz I heard so much up and down so I don't know I'm actually in the middle of it I I've studied it I've I've written about it so the ketogenic diet for people who don't know is the kind of diet that is about 70 percent fat very very low in carbohydrates not less than 10% carbohydrates and the rest of it is protein and the idea is when you go in a ketogenic diet you're basically forcing your body to act as if it's in a starvation mode and there are certain chemicals that are created in our body ketone bodies beta-hydroxybutyrate and you know they've been some anecdotal evidence that people lose a lot of weight and they their brain fog goes away and so on and so forth but most of the studies that you see as far as brain health is concerned they're all feasibility studies which means they just wanted to find out whether people can do it or not and they couldn't it's hard and you know small populations to see if there was any effect in cognition and the cognitive function did not improve as a matter of fact after they stopped ketogenic diet they actually got worse and again it's you know it may work in people who want to lose massive amount of weight but my husband Dean jokes around all the time he's funny he says they're all with other ways of losing weight - if you want to do it an unhealthy way cutting off your arm you know cancer can help make you lose weight smoking it makes you lose what you want to do that so it's a very very unhealthy way because again we're exposed to a whole lot of saturated fats which causes damage to the endothelium some individuals are actually looking at plant-based ketogenic diets you know with very high poly and monounsaturated fats but again we don't have enough evidence and I think it just creates a little bit of noise and confusion when you have enough evidence knowing that a whole food plant-based diet can help the brain heart lower cancer risk diabetes high cholesterol high blood pressure how would you want to do something else that is harmful and that you don't have enough evidence for it thank you very very thank you let's give her a round thank you [Applause]

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Length: 120min 59sec (7259 seconds)

Published: Tue Mar 24 2020