Optimize Your Brain & Fight Cognitive Decline: Team Sherzai | Rich Roll Podcast

hey everybody welcome to the podcast my guests today are doctors aisha and dean cherze who are a husband and wife neurology team together they co-direct the alzheimer's prevention program at loma linda university where they study all things brain health with a very specific focus on lifestyle interventions to prevent cognitive decline and neurodegeneration i think this is an important conversation because chances are you have somebody in your life who's suffering from alzheimer's it's a disease that afflicts over 47 million people worldwide right now and that stat is predicted to triple by 2050 and although there's currently no cure for this disease the truth is and this is amazing 90 of all alzheimer's cases can be reversed and that's what we're going to talk about today because what distinguishes the sure's eyes from many of their colleagues is this unique focus that they have on prevention and they've had tremendous success significantly reversing cognitive decline and adding vibrant years to many many of their patients lives the shersey's first graced the podcast a couple years ago back in episode 330 to talk about their first book which is called the alzheimer's solution it's a must read you got to pick this thing up it's amazing so today they returned to bring us up to speed on the latest science on brain health to discuss their brand new book which is called the 30-day alzheimer's solution and of course to provide you with all the information and the tools and the lifestyle prescriptions that you need to avoid these neurodegenerative diseases that devastatingly afflict far too many people so this one is super powerful it's potentially life changing but before we dive in today's episode is brought to you by the plant power meal planner everything and i mean everything you need to treat your brain and your body correct and once and for all dial up your nutrition for 2021. for just a dollar ninety a week it serves up unlimited access to thousands of highly customizable delicious nutritious and easy to prepare whole food plant-based recipes updated regularly with built-in automatic grocery delivery so everything you need just magically shows up at your doorstep you'll also get access to our team of amazing nutrition coaches ready to answer all your questions seven days a week and lots more features so to learn more and to sign up visit meals.richrol.com and literally for the price of a cup of coffee you can watch your life change again that's meals.richroll.com okay please hit that subscribe button and without further ado let's get into all things brain health with doctors dean and aisha sherze what is it about age or maybe neurology that makes people set in their ways as they get older it is a weird thing right it really is becomes more difficult to entertain new ideas yeah i i i think it varies from person to person but in my experience it's just comfort you know when once you set a path and you're comfortable with it your brain doesn't really allow you to change that path it's like walking on a snow track it's so deeply set and the walls are so solid that it's difficult for you to actually make a new path again right and it requires a lot of reflection and judgment and being okay to make mistakes and the discomfort in being uncomfortable the comfort and being uncomfortable right right right they can help you set new ways but yeah i mean yeah it does seem like that becomes much more of a challenge it does it does um yeah we the whole idea of change is not normal i'm talking about chronic change acute change we're good at it because an acute change we had to for millions of years there's a tree there's a line you know i better make change in my decision making i'm not going to go down this path long-term change we're not designed for that we're not our brains are not designed for long-term change that's a completely different mechanism and and if we and if we don't address that i mean to be honest i know that it's not being our political stances everything is around this concept of being okay with change i always say about five percent of population is future seekers the other 95 is past protectors and you have to be past protector in many ways because past protection has worked whatever has gotten you here is you depending on the past patterns right but all the change in this in society in the world around us is by those five percent of whatever i'm using arbitrary number that are comfortable this is weird people comfortable with change with the unknown the 360 degrees of unknown you're willing to go there and yet this house that's comfortable you're willing to leave it to go to the next place that's an unusual concept um which comes with the frontal lobe but but that's why as we get older we become more set on all the strings that connects us to the past you want us to sever server server cyber server to go to a new path that is not known at a time where i'm already vulnerable yeah that's too much risk yeah yeah is there a genetic piece to that when you look at that five percent can you isolate out what it is that distinguishes them neurologically from you can tell very early you can tell there's a genetic component environmental component the genetic anxiety is that the core of all this stuff or a term that is like anxiety we're using anxiety as a juxt as a word that's as a filler but it's a little more than that our ability to deal with the world around us for the most part for the at the beginning is genetically you can see the children we have two children uh both trust me we're going to talk about them go ahead but they're both very precocious yeah incredibly but that's the understatement of the century go ahead very kind very different though very different alex is what you could see when you when you were uh i'm not putting him down because this is not a weakness this is just our proclivities we can change him when you put him on the sand when he was six months old you saw him do this he hated sand sophie would crawl to the ocean i mean right right away i mean that's a threat why are you not threatened by by the very thing you're supposed to be threatened by no threat so that threat aversion versus not forever part of it is intrinsically um ingrained in us part of it is actually data shows part of it's actually programmed how your mother reacts to anxiety provoking moments mother because the mother's there all the time whoever you're around the most and how they react no how they promote challenging situations an anxiety-provoking situation how they react with it and how they deal with it is the forget about leadership masters i got a phd only forget about that it ends and starts there yeah you create situations that are a little bit anxiety provoking you fail nothing oh my parents didn't react badly you succeed great how you react and how those micro environments of threat aversion threat response threat creation and response is the foundation of all leadership yeah i would think from an environmental perspective or i mean an evolutionary perspective that um you know maintaining your membership in good standing with your community is paramount right so if that community is welcoming to people who push the boundaries and try new things that's one thing but if that sort of thinking outside the box is going to alienate you then um there's going to be some pushback right there's a disincentive that's that's uh butting up against somebody's willingness to entertain new ideas or try new things yeah and and the culture that's been set in place that creates an aversion to change the language the micro languages that anything that somebody brings that is a little threatening to the status quo you have things that are out this is um this is arrogant the word arrogant to push away people who have new ideas is universal it's such a ubiquitous silencing technique and when you look at when you look at the main reason why people are not willing to change is the fear of being ostracized like you said nobody wants to get out of that comfortable zone because it's really difficult to be alone in your way of life in your new methodology and your new habits and that's that's the first step that people have to um challenge themselves to take over right given that though it's interesting that most environments are not really that permissive when it comes to free thinking and you know creative expression most are pretty regimented around what's okay and what's not but it would it would seem like we should be more encouraging to that permissive environment and you know why is that why are we not able to kind of make that more the case as opposed to you know the the slim five percent or whatever it is um yeah well we met in afghanistan with taliban around us yeah yeah that same mentality exists here in the medical community and by the way this is me not bashing the medical community be careful no no no no no we love the medical we're part of them you know you're not comparing the medical community here to the taliban no no no no no no clear that up just their mentality that's all okay no but but the stagnant comfort with the status quo right is the same thing i mean the hallways of your limbic system are the same you might have put it better clothes and better beards and you know my beard was shaving a little better here than but if the mentality is i must maintain it's not always overt i must maintain the status and i don't know even why because but it makes me uncomfortable it's the same yeah i mean in 2002 before we met two months earlier i'm at nih experimental therapeutics branch that's as wonky as as experimental as it gets speaking with nobel prize winners two months later i'm in afghanistan speaking with taliban leaders both places trying to bring change and i can promise you the the the the language was much more sophisticated but the blockades were the same protection of the status quo that's why i mean when we we talk about dementia we talk about stroke we talk about mental health even now the the repetition of the same patterns over and over again and now some other studies are starting with clinical trial and with 100 people 50 people six months we're done we know it works we're whole food plant-based right but reality is if you go 20 better than what the standard of american diet is you will do 20 better in your health care what does that mean that means in alzheimer's that's 80 billion dollars saved per year right right well it's been a couple years since you guys have been on the show and in that intervening period of time have you found that the sort of conventional medical community has been a little bit more embracing of you than in years past given the success that you're having and the results that you're seeing in your patients or what does that look like right now they have um we are seeing a lot of um open-mindedness to the idea that lifestyle works that it's important that it should be a part and parcel of the bigger conversation about health and wellness in general and you know everywhere we go to the conferences medical conferences and it was always focused on molecular research which is very important but lately there's been a lot of conversation about the importance of community-based research and lifestyle and addressing our environments which is wonderful so yes they are very welcoming and i'm very encouraged to see that still contrived still not as as intensive as it needs to be i think there's a lot of need for improvement for better communication and that's what dean and i have been working on reaching out into the communities to see what fits there because the cookie cutter model of something that fits say for example you know 50 to 60 year old bostonian white men wouldn't really be applicable in san bernardino in a hispanic community for example so finding out specifically what is applicable what works long term and what people can accept is the part that we are working on right um so many things i want to get into with you guys first of all thank you for coming it's our pleasure thank you for having us see you guys i'm delighted that you're here today we're going to pick things up where we last left off with them a couple years ago but i got to get this out out of the way first i got to talk about your kids because i'm obsessed with how accomplished these two young people are um you've got your son alex he's is he 15 now he's 15. he's in college yes right sophia is how old is she 13 13 yes they've written this book walk like an elephant which is all about protecting wild elephants from poachers um but just to give listeners or viewers a sense of what's going on here alex mastered calculus at eight correct okay uh he wrote this book he completed high school at 10 with a sat in the 90th percentile he's the youngest person to have his research abstract be accepted to an international neuroscience conference true or false yes true okay he's a pianist he's a composer meanwhile sophia was reading fluently at two and a half who she was yes good lore and she co-wrote this book when she was eight she finished high school when she was 10 with a 90th percentile on the psat and has been a speaker at science la in 2017 and 2018. both all right so i don't even know where to begin with this but as neurologists you're doing something right here like how do you account for this there's a nurture aspect to this there's a nature aspect to this i mean this is extraordinary i've never heard of two young people in the same house excelling at such a level in terms of like their their brain health which is what you guys are all about so help me understand what's going on um and congratulations by the way unbelievable i'm feeling very insecure oh my god no no no not at all the most important thing is so i i'm sorry if you uh the mother should she's she's actually the reason no no it's not no i think it's teamwork and i think i just want to say something first and um i you know there are a lot of times it's tough to talk about your children and because it's a work in progress i always tell my friends ask me in five years after they go through their teenage years but um just really proud of their accomplishments and i don't really consider them as mine they're just these amazing individuals and i we feel like we're their guardians and it's been such an amazing process of self-correction and reflection earlier dean was talking about the importance of anxiety management during childhood and no matter how many books you read no matter what scientific papers you read about and how much you know about how the brain works when it comes to the application of that knowledge it's it's a whole new experience so it's been a growing period for the for both of us as well while raising these kids no it's a challenge even now i mean um the expectation so i said sometimes bombastically that the secret to life is management of expectations but it's micro expectations minute by minute expectations from uh so early on it wasn't about them following a curriculum throwing things in front of them i mean the the shower curtain was the periodic table and the wall was the map and so throwing in front of them and seeing what which proclavities and then you build around that and build around that small micro almost like um you know skinners uh reinforcements so you saw a little bit of improvement here or attention and then you you moved it along or moved it along and then before you knew it i mean alex had so one of the his proclivities early on was and it doesn't matter what it is if you find that little nidis had just grows and was memorizing uh capitals of so by two and a half three right he had memorized and we have video memorize all of the world's capitals all the state's capitals and i couldn't even i am terrible arriva remember yeah so i mean you would show him a shape and he would say oh this is this country and the cow remember when we used to go to a restaurant and you know we would they would bring some chips and salsa or some bread and he would take a chip and bite it off and then he would look at it oh molly i was like who's molly honey no country molly and he would just take another bite like look kenya he was just like a visual learner it was so amazing to see him absorb all this information again like work in progress yeah we have the teenage periods where they get you know the frontal lobe and we tell them there it is there's the the emotional brain taking over but reality is um i think and it's not because of us or it i mean the potential of human brain i mean 87 billion neurons we're talking about each of them making a couple of connections or 15 000 to 30 000 connections one quadrillion connections one times 10 to the 50th power now the answer to that is not sit down and memorize that's that's the worst thing you you narrow the funnel to a point yeah you push through that funnel they will get through they'll get to the college maybe even ivy league but you've just killed all the 360 degrees of potential and creativity the answer i think and we might be wrong is throwing and systematically seeing where the proclivities and reinforcing takes a lot of work but the human brain is absolutely remarkable which speaks to both ends of the spectrum from aging brain which we are actually under we're dealing we keep talking about avoiding disease i'm talking about profound growth of cognitive capacity well into our 60s 70s 80s and beyond and then for children the brain is growing so fast and the best argument on the internet is oh are they choline deficient because they're not getting you know aids or something are you kidding right so did you did you guys homeschool your kids or how did you navigate the educational system to prevent them from you know the best parts of them getting hammered out it was challenging and especially because when i was when i had sophie i had just started my residency program so it was a very intense time and we explored different schools different systems they did very well initially for a few years in the montessori system which was kind of aligned with what we wanted them to be exposed to you know thrown in an environment to see what works for them and have have the option of absorbing oneselves in one subject at a time rather than you know having a couple of hours each and every subject every day just the mind doesn't really work that way um and after a while we saw that the um the speed with which they were learning was probably inhibiting them to be creative in that environment and there were a couple of stories um where you know the kids didn't feel very comfortable expressing their creativity and their knowledge because of the peer pressure because of just the general setting and when we realize that i think dean is fearless and he's way more fearless than i am he said no i think we should withdraw right now and we should create an environment for them at home and we were traveling quite a bit too i was i actually got into a fellowship program at columbia university so i was going back and forth between home and new york and we wanted the kids to have a constant creative environment and so we homeschooled them and my mother helped his mother helped we had a really good system going and before we knew it the kids were and this is not just you know bragging about them it was just an amazing example of how the brain works where they would just you know go deep into a subject and progress so much into it that a point came where we weren't able to help them with their homework any anymore then for example alex went to algebra and then went to calculus sophie was so far in linguistics we were just amazed and so we quickly understood that the conventional model doesn't doesn't help at all and um they took their sets and they did very very well and we were seeking for our programs how old were they when they did the sats they were 10. they both they both did i remember we um we went to the um uh was it the beverly hills beverly hills high school we were living in beverly hills in los angeles then and a day before the exam we took alex up the stairs and we went to the hallway because he was little and we wanted him to see the environment and visualize and sit on the chair and we were just waiting the hallway for him and we were so scared he said you know we hope that he doesn't feel uncomfortable and i remember the chair was so tall for him that he decided to stand and write on the chair but um all in all he he just aced it and it was wonderful i feel bad for the kids that were flanking him on each side looking at a 10 year old taking the test next to them the thing is i mean it's not about so much them getting high school at 10 or it's about our it's not even about school or college i mean i where i think we're the only parents although they're in caltech at cal state la right now it has a special program called uh we we tell them you know if you drop out of college it doesn't matter to us yeah i mean for somebody you know my cousins say that we have more degrees than a thermostat it was useless all of them it's not about that it's about creativity it's about this incredible potential of the brain being off in college and i might get pushback on this actually kills creativity these narrow hallways of thought can absolutely demolish creativity so it's not even about high school finish finishing a high school early or college or great what can you do to bring this incredible potential of the brain to its full fruition um that's that's the goal yeah and creating uh a love of learning lifelong learning and there is something to touch on something you said a second ago about um about depth versus breath like the idea of taking one subject and just immersing yourself in it and going all the way to the end right and learning it as you go where you're it's so it's so 360 degrees that you really learn it as opposed to catching the major concepts and then constantly switching gears in between subjects and really just hitting the surface level of everything to check a box on on a test yeah absolutely we've we've witnessed it uh firsthand with the kids where um whatever subject it was we would just allow them to immerse themselves in that subject and it becomes a part and parcel of your fiber eventually i remember when sophie was into social sciences she was into social sciences for three months straight and then we went to where did we go we went to santa barbara to show her the the missions and she was learning about the california missions and the history of spain and how they came to the to the americas and it was just three months of complete immersive experience into that and i think it it really becomes a part of your experience as a person as well right yeah you're not going to forget that no right amazing yeah um all right well i think it would be worth taking a few moments to just uh um share a little bit about what you do and your experience i mean as i said earlier you were on the show a couple years ago but there's a lot of new listeners and viewers and i think it would be helpful in terms of contextualizing everything that we're going to talk about yeah absolutely so we're both neurologists husband and wife um we initially started in this field and this in this journey because we were affected by an experience with our grandparents who went through alzheimer's disease and they experienced it and i remember the first conversation dean and i had we met in afghanistan by the way when he was there from the world bank changing the health care system in that country and i was in medical school and i volunteered with doctors without borders and because i'm a polyglot i speak many languages they would hire me and have me go to the harems in different villages to talk to women about health care and child care and prevention so on and so forth so we met at a party and the first conversation we had was about our grandparents and he has sat next to me right this is a very cinematic meet cute out of like a rom-com right okay i'll tell you the true version yeah no but i was i was amazed at him with all the amazing uh community work that he was doing which is a whole another story um and we talked about our grandparents and we were just so amazed at how these incredible human beings our heroes intelligent um uh just amazing humans lost parts and parcels of themselves to the point where they couldn't recognize their children they couldn't recognize their grandchildren and these giants of human beings were just limited to nothingness and we wanted to study it we actually went into the field thinking that hopefully will be a part of finding a treatment for diseases of the brain like dementia and alzheimer's and it just kind of started from there absolutely the first meeting um we we we talked about them and and we were kind of blown away that these these people with this kind of my capacity would actually succumb to alzheimer's and and so we came back to ucsd which was the main dementia number one neuroscience program with leonthal and who was a giant and we we worked in his clinic and his lab actually did some amazing work with the fmris and published there and quickly we realized that study after study after study is failing the mouse models would work those poor mice thousands upon thousands you know you throw blueberry at mice they will get better i mean every day you see a publication you know this drug work and then when you look it's a mouse model it never translates to humans so around the same time we looked at some other people's work and said we got to find a different path and we had a conversation we were risk takers and we said we're going to go to loma linda because most of the lifestyle stuff that were coming to us the work that elizabeth barrett-connor and others were doing which we were working with was congruent with loma linda which is a seventh-day adventist institution where they've shown lifestyle has profound effect on brain health so it was 60 miles away or 80 miles away we called like like you i cold called the the the dean of the university i said you know i'm coming from ucsd can i start a brain initiative brain center here absolutely we went in and started a brain health institute i should have double fellowship double residency preventive and neurology yeah i went to preventive medicines i think i think you and i coined the term preventive neurology and that's what our focus has been prevention of neurological diseases and what we found was remarkable here so here in loma linda not loma linda the seventh-day adventist part of alumni which is about a third of the population you have the healthiest people in the world there's no question of that the data is fairly clear nobody's contesting that fact five miles away across ten you have san bernardino one of the unhealthiest place so it's not environment it's not even socioeconomic and racial there's a little bit of social it is it is the most important thing in public health access access to information access to resources access to healthcare there's a huge disparity whereas seven-day adventists are health-centered from the religion perspective and everything in san bernardino we work in free clinic even now half a day a week we work there 40 year olds with stroke by the dozens we see right i mean that much disparity so we started shifting and working and doing research quite a bit of publication and we we realized that alzheimer's stroke dementias can be prevented and initially when we came out like 10 years ago incredible pushback whereas two years ago it was a you know alzheimer's international conference and the big plenary talk big sign was prevention is the new treatment it was amazing that's amazing yeah i don't think we ever high-fived in a conference but we were just so happy that finally they're they're recognizing the importance of lifestyle how many practitioners are there in neurology right now that have uh prevent a preventive focus goodness um i don't i don't know of many we don't know speech from somebody but not so many people doing it other than you guys and it is interesting like when you started uh it was considered career suicide it was and to you know plant your roots in in loma linda which you know for people who don't know that's one of the blue zones people live very long there they tend to have happier more fulfilling lives and that's attributable to their faith community their fidelity to healthy lifestyle exercise predominantly a plant-based diet there for the most part all of these things contributing to not only living longer but as you immediately begin to see better better brain health and what makes it so amazing almost like this perfect petri dish for the studies that you do is that disparity because the community just outside you know the sort of boundaries of of that seventh-day adventist community is you know a an impoverished lower socioeconomic situation of people that don't have access to all of those things i just repeated everything you said but i don't know um but that makes for you know uh you know a ripe environment for doing the kind of work that you do to kind of a b test yes these populations absolutely um i think we've learned so much about this concept and one of the things that stands out is is all about access access not only to um to healthy factors healthy lifestyle factors whether it's food and opportunity to move naturally or stress manage so on and so forth but access to information and access to resources to apply that in their lives to have health as a part of your language every single day where you see left and right and front behind you there's health everywhere that is what differentiates between two communities you know when when the seven-day adventists like dean said it's a part of their religion when they walk when they speak when they wake up in the morning when they go to bed when they interact the the core structure behind their action is the outcome is is good health the outcome is preservation of the mind and the body but when you veer away five miles across highway 10 into san bernardino it's almost as if people are completely blind to that concept that it is possible for them to be the best versions of themselves and you see this their life just moving forward like automatons not really aware of how bad their lifestyle factors are and how destructive it can be to their health and it's not a judgment i mean no we want to make sure that we it's it's situation i mean all of us get caught up in the in the cycle especially when when you have to work continuously the closest healthy resources 20 miles away right so it's so with that in mind initially we went to cedar sinai as the director of the brain health uh program there prevention and and then an opportunity arose where in beach cities which is manhattan metro down the beach hermosa beach they had this program that dan buettner our friend dan right had started yeah it's one of redondo's one of the blue zone cities that's right yeah it created blue zone and they had done such an amazing job as far as making it a lived concept that they offered us the uh the option of coming there and creating an initiative brain health initiative and also the largest research protocol in the country community based so we left everything again risk taking who leaves cedar sinai one day of clinic for hollywood you're insane yeah but it's been uh so since the two years that we talked we've been actually growing that program it is there are there are other studies like pointer and others that are doing clinical research on lifestyle and brain health but it's again more of a laboratory kind of a thing this is a lived concept i think we don't need to we don't need to recreate uh whether you know what is it broccoli works versus uh um uh you know beef jerky we know yeah i think i think we know that already yeah there's enough information i don't know there's some people that are confused about that there are yeah there's always going to be noise there's always going to be people who are going to say the earth is flat we'll leave them at that you know they can they can go to the edge but but it's it's critical that we move on and apply it not to these contrived clinical trials of 100 people over six months or a year to real communities so we're doing three of the largest projects in the country but it's a lived model of brain health and collecting data and collecting brain health and information yeah and we're really excited about that because i think um one of the things that um what one of the things that failed in most studies is um again not understanding what works for at an individual level and at the community level um i think if if we find out specifically uh what the limitations and what the strengths are in any community and then find resources around them in their environment that would help them create a vector towards better health that's the key and it has to be long enough where they have support where they have contact with the human experience of speaking with someone else or being around a supportive group to um acclimate to that new healthful environment it sticks otherwise it's just me giving someone a brochure and say broccoli is good right right i mean that that's that's a play right out of dan buettner's playbook which is you have to create the environment that's conducive to the healthy choice so then it becomes rote as opposed to some sort of burden or something that somebody has to think about in order to do right it's just there in front of them and you know the kind of resources of the community are pushing you into the correct lane right right and especially for a condition like cognitive decline which is it's tremendous it's scary um you know everybody talks about alzheimer's and dementia as if it's a disease that just starts at one point you know you are diagnosed with alzheimer's disease there that's it that's not the start right before that you know decades earlier there is a continuous cognitive decline that people experience and you know dean and i go to different communities for talks and before all this pandemic when you go into communities where you know their their health literacy is lower for example they haven't had any resources you actually experience the cognitive decline when speaking with individuals in their 50s and 60s before they even are diagnosed with alzheimer's disease and it's it's scary and the numbers are scary and we never address that and it's not just brain health you know you you hear about brain health all the time you hear you read great books but it's that self that is under attack it's that um us it's that us-ness you know it's it's the sense of uh being aware and being present and being able to experience life that is we're being robbed of that you hear brain fog you hear memory problems but not being able to be present for each and every moment in your life that's what's taken away from people and that's scary and if we have a way of making people attuned where we alarm them that listen there is something that you can do where you don't have to go through this i think that would be a great opportunity and it's a great gift for us to be able to serve people that way right so conventional medical wisdom at least until recently is or was that alzheimer's is something that is going to be visited upon many many people when they reach i don't know late 60s 70s something like that it's basically a genetic predisposition in more cases than not it's a death sentence there's not much we can do about it we can't cure it we can't prevent it we can kind of maybe manage it with some drugs but really there isn't much that we can do and we're working on a cure but we aren't very close so how much of that is accurate and where does your work fit in to kind of upend that paradigm so the genetic component let's start with that we know the genes that are involved in alzheimer's with new techniques like gus analysis and others where you take large populations who have alzheimer's and those that don't you look at the genetic differences we know about more than 30 genes that are involved in alzheimer's of all alzheimer's cases the percentage that's driven by genes 100 percent dry driven by genes meaning that if they have these genes they will get it and and in genetic terms it's called 100 percent penetrance like huntington's disease if a person has the huntington gene on that chromosome 4 they'll get it right but the percentage of alzheimer's cases are that are like that is only up to three percent the other 97 are affected by genes but they're they are only risk genes meaning that those genes increase your risk but they're not a foregone conclusion it doesn't me it doesn't mean that you will get it the the next highest risk gene is apoe4 about uh two percent of population has eight four is eighty four positive so if you have one of those genes coming from one parent your risk goes up four times if you have two one from each parent about 12 times that number varies but roughly those are the numbers so even if you have two genes fully loaded with these bad genes 50 percent of people get the disease the other 50 don't get it why and when you look at the data coming from nigeria where the population had higher proclavity for apoe when they came to u.s then disease went up when you look at the studies that came from uk which lifestyle increased risk six times even in lieu of a e4 you realize even with the higher genetic risk of apoe4 lifestyle is a way bigger factor by far so all of the genes involved in alzheimer's except for those three percent or three genes it are all our lifestyle genes how your lifestyle affects those genes which means you have control over it even the most benign studies the ones that had minimal effect the mind study and others mind study just looked at diet very well done study just a diet adjustment reduce your risk of alzheimer's by 53 wow and that was a watered-down version of the diet we think is optimal how how how long would you need to be you know eating and eating in that certain way leading up to it it varies from person to person their their background other things like if they had multiple head traumas uh childbirth like multiple variables but in reality if you're on that diet for several years you continually reduce your risk like smoking if you've smoked all your life and if you come off of smoking come off of that bacon and come off of that you know uh well let's then the more years you pass i believe in smoking it's after five years five to seven years you're back to baseline right meaning you're back to the lowest risk factor um so the longer you stay on a healthy lifestyle which is exercise and all the things that we say and especially if you do all of them the reason i say all of them let's coming back to our grandparents one of the elements is cognitive reserve or what the term you and i love idea density you know we say that if we have a musical band that's going to be called i'd idea density they had idea yes it's a great great concept they both both our grandparents had immense idea density and and philosophers think but they succumb to alzheimer's why the other elements weren't taken care of they had diabetes cholesterol high blood pressure sedentary bad food didn't exercise philosophers are not supposed to exercise for some reason but so you have to do all of it right so we're going to get into these lifestyle interventions but before we do that let's talk about the brain more generally we sort of think of the brain as this mysterious black box that is unknowable and something that sits outside of our body right like there's our body and then there's our brain and these things don't really overlap but in truth brain health is really uh it's about vascular health in the same way that heart health is right like we're dealing with i don't know how many zillions of of you know arteries that are going in going into the brain you know you know putting things into your brain and taking them out et cetera um and and when you think about you know heart disease we we all know we're trying to not have plaque in our arteries and keep those pipes running clean and brain health is really not that different is it that's very true you you put it beautifully um when you look at the brain it's about three pounds like jello it's like hard jello when you hold it in your hands and it's about two percent of your body's energy and when you look at the tissues and the vessels they're the same vessels that are in your heart and in your kidney and your body i'm a vascular neurologist so i teach a lot of anatomy to medical students and residents about the vasculature of the brain but basically you know you have arteries shooting from your heart going through the neck there's two major ones in the front the carotid arteries and the vertebral arteries and these are the major vessels that take blood to your brain and there's just branching of these arteries and somebody actually calculated this but if you put the vessels in your brain end to end it would span about 400 miles so just imagine all these tiny hairline arteries taking in oxygen and nutrients to the susceptible areas of the brain for this this incredible organ to function and at any moment our brain as little and as small as it is it can consume up to 25 of the body's energy so just imagine the amount of work that it does and if we don't address vascular health and if we don't really take care of it it will succumb to disease you know we we always say and our cardiologists friends don't really like that but we say the rest of the body is there to carry the brain and it essentially comes down to the same pathological processes that affect the brain that also affects the heart the kidneys and the other systems as well in fact recently there was a publication by dr hchinsky from canada uh and he summarized the concepts but uh the vascular factors actually predate you know the popular thing that we hear amyloid plaque and vascular pathology predates those things with the newer tools with newer more sophisticated mris you can see 20 years earlier when somebody starts having some pathology and the microvascular disease started way earlier so if we take that into consideration that in your 20s 30s 40s you know the things you do isn't going to just avoid alzheimer's and we think absolutely for a great majority 90 plus you can avoid alzheimer's but more importantly sustain cognitive capacity and grow cognitive capacity um we we know that our we don't use the full potential of the brain in fact as we get older one of the areas that's affected the most is focus for two reasons one is the focus center shrinks as well as the fact that we're overwhelmed multitasking which we say there's no such thing as multitasking it's doing multiple things badly right it just accumulates and accumulates but if you manage and control focus you can actually grow your cognitive capacity as you get older that's our goal because if you do that if we address the this is critical if we address the vascular factors and the fact that we can grow the brain we can hit all these communities that are now devastated with cognitive decline and we see them all the time right so neuroplasticity then becomes a function of vascular health absolutely yeah apps super interesting um when we think of again back to the the kind of heart analogy we think of uh plaque buildup um in terms of deteriorating heart health with with brain health it's amyloid plaque right which is different but kind of the same like it's blocking these passageways and that's ultimately what leads to stroke correct right so no with stroke it's it's uh atherosclerotic plaques it's different amyloid actually accumulates outside of the neurons and stops the communication between the neurons so it's a little different in between the neurons in between neurons right okay the neurofibrillary tangles which is the tau is inside the cells there are two things happen one is the amyloid plaques and the neurofibrillary tangles they're connected in many ways we're learning more and more the neurofibrillator tangles are really interesting there are these scaffoldings that hold the microtubules inside the cell steady the microtubules are it's it's almost like uh we're doing we just got the oculus and we i was doing the um and it's a crazy thing we're doing the the roller coaster thing and you see this roller coaster throughout the planet go and the microtubules are these pipelines throughout the cell for transport for structure and everything and the tau molecules hold them together all of a sudden they get phosphorylated and they come off and then you see these scaffoldings fall apart and clog together so from for many years we've thought that that's a separate process it's a genetic proclavity and there is there are those three percent variety but we know that inflammation also attributes to that multiple traumas to the head infections multiple pathways to trauma oral hygiene and all of that as well as vascular factors so wait a second so if vascular factors and inflammatory factors are contributing to even those tau and amyloid cofact we have control over those right right yeah so um that's amazing yeah like just just just the realization that we do have some domain over this thing that we've always kind of thought of as just looming out in the distance and it's either going to happen or it's not going to happen oh absolutely just understanding that our day-to-day habits affect those small little arteries in our brain you know when when you when you have sustained uh damage to the arteries or sustained attack let's just say you know an attack to the system so the body and the brain especially is constantly trying to revert any damage you know we have damage control mode and we have a thrive mode and and the goal is to be more in the thrive mode rather than damage control and the damage comes from say for example vascular damage comes from sustained high blood pressure you know blood pressure is one of the most important risk factors for so many chronic diseases that we're dealing with when we have uncontrolled blood pressure the small blood vessels in our brains they essentially collapse on themselves and on mris what we see is these patterns called white matter disease white matter disease is when there is damage to the blood vessels and so those parts of the brain are inflamed or they don't really function very well a lot of times they were called non-specific white matter disease but we're actually learning more and more about them and they have been correlated with cognitive decline they've been correlated with strokes and we know that lifestyle factors can can really alter them can change them diabetes is another risk factor damage to the inner linings of the arteries can cause damage and you know there are parts of the brain that require all parts of the brain but specifically the ones that are responsible for say for example encoding memory the hippocampi or the frontal lobe where the judgment sits or or the emotion centers when they when the damage when the blood vessels are damaged in these areas we really can't function anymore and that's when you see cognitive decline um yeah it's it's it's interesting with blood pressure you know that's something that you get checked you know i don't know what i mean when you're younger barely ever when you go to the doctor for your checkup but it feels like something that should be monitored much more regularly absolutely absolutely because it's a variability in high blood pressure that matters as well and i'm so excited about you know new technology coming up whether it's you know the watches or you know any wearable devices that can give um just a quick update on how someone is doing a live update right i think that's the most important thing you can't really wait for every three months or every year to get your blood pressure checked we see people in their 40s and 50s coming in with extremely high blood pressure and we have to treat it rapidly with medication to prevent strokes and damage to their body it's quite ubiquitous before we get into the the lifestyle interventions i want to talk about this neuro paradigm that you guys have come up with perhaps it would be good to differentiate between cognitive decline dementia alzheimer's and strokes like let's let's get clear on like the different with the difference between all of these terminology yeah so dementia is the umbrella category and dementia is the the rough definition of it is when a person is having cognitive decline to the extent where they can't do some of their activities they could do before not because of physical limitation because of cognitive limitation be it memory or processing capacity or things of that nature for example if they could drive before now they're having difficulty driving because they can't think their way through the the directions uh if they could take care of their medications they can't take care of their medications now if they were doing the finances they can't take care of the finances you have to be careful there because as we get older without knowing you kind of pass off your activities to others and when you've asked the family oh i don't know i don't see a difference but what happened is over time that that responsibility was passed on but when you truly check them they've had loss of capacity that's dementia it's an umbrella category alzheimer's is a subtype of that dementia it's a major one 60 to 70 percent of all alzheimer's dementias is alzheimer's but there are other types of dementias such as frontal temporal lobe dementia lewy body dementia vascular dementia parkinson's dementia and many others huntington's dementia but alzheimer's is the biggest one they manifest differently and the causes are somewhat different although we think that all of them are affected to different degrees by lifestyle some of them are more genetically driven like frontal temporal lobe dementia is more genetically driven that dementia is early in life sometimes it affects language so like primary progressive aphasia the person is can think but their language is affected disproportionately early on lewy body dementia is more movement and hallucinations and visual spatial changes and it's a different pathway it's a nuclear body it's a different kind of protein alzheimer's and this is something that everybody's familiar with i'm going to say but i want to state it ahead of time don't be scared we all have some of this where short-term memory early on is disproportionately affected compared to long-term memory so a lot of especially men they say oh i'm fine dean i'm fine i can remember 50 years back when i was in you know and but i just you know i'm having difficulty with breakfast well that's what's happening right the short-term memory which is in the hippocampus is affected disproportionately and it's the fastest growing epidemic well outside of covet now in the west we're talking about about 6 million individuals in u.s 35 million worldwide and this number we have to re we have to change the number every time we talk every time we have a powerpoint presentation we have to change these numbers unfortunately we've read recently 47 million people worldwide yes so we have to change it again yeah yeah yeah and and and estimates are that it's projected to triple by 2050. yes it is yes and and so everybody's going to be impacted everybody in fact even now if you if you ask families well i did my phd thesis around community-based but uh participatory research and the in the uh minority populations and and in those populations or in low-socioeconomic populations every family has been affected but they haven't called it dementia or alzheimer's that's that's how ubiquitous it is already now the numbers as far as cost is even i mean the human component is incredibly bad because it's affecting everybody and and we'll talk about what what kovit did this in the tsunami um they this population was the most affected population in the world the alzheimer's population but the cost the second costliest disease is heart disease at 120 billion cancers 70 billion combined alzheimer's direct cost 305 billion indirect cost 240 billion right now and it's climbing up to 1.1 to 3 trillion dollars directed indoor by 2050 which will collapse our system all together yeah the system's already broken it can't bear that kind of load but is that is that excessive cost attributable to the slow burn nature of this and the extent to which kind of live-in care is required for these people to live their lives or where is all that money going it's sad it's it's going well the direct cost is going to medicare medications which really don't do much not even the pharmaceutical companies claim that aerocept and amanda reverse or slow down the disease it doesn't they're just symptomatic the disease is continuing it's just doing a little bit of help with the symptomatics but a lot of money spent there and care nursing home and others the indirect cause is you should see the people the families that can afford it the least have to stay home to take care of the loved ones which means hours lost work lost and and all of that that happens right right devastating and on top of that we have covid right now and covet is is really drastically impacting the alzheimer's community right like i just i saw on twitter like two days ago there was a baron's article about this that was like trending you know that what does the future of alzheimer's look like and i know that you guys have have spoken about this what is it about covid that's disproportionately impacting the alzheimer's community in such a in such a bad way it's uh it's a multi-factorial like dean said um i mean the numbers are scary we were we're actually reading an article the other day and um alzheimer's patients are dying faster not because of the infection or covet-related consequences but because of their disease i think the number was 16 higher rate of mortality in that population and um it has to do with um loneliness disconnection isolation isolation from human experience and you know the brain is hungry for information and for connection and when that withers away when that's withdrawn you see patients succumb to alzheimer's disease and there's so many stories that we could tell you from our clinic and just talking with some of the caregivers where these lovely patients are completely isolated in a nursing home and they don't see their children or their loved ones and the mind is such where if they don't get that conversation even a phone call or you know it's a mundane conversation about food or clothes or just a normal walk in the park um the the the basically the brain just completely withdraws and withers away and there's profound um changes in a decline in their cognition to the point where they forget to do their basic activities of daily living they forget to eat they forget to take care of themselves and slowly and gradually that that causes disease and death and and we've seen that so many times unfortunately more than we would wish to see and this is a population that's most vulnerable right yeah right anxiety i say you and i i shall we treat anxiety more than we treat the memory component because it's a quality of life issue isn't it i mean um and and and and patients with alzheimer's anxiety is ubiquitous and rapidly growing i i give an analogy like and it's not and a patient with alzheimer's initially feels like they're in their basement now living in their basement not really but that that discomfort then in the neighbor's home then in a different city than a different country than ultimately in mars with martians coming because nobody's familiar that anxiety compounded with loneliness with isolation with separation is what forces the brain to actually collapse upon itself we think that the main the reason for the greater mortality is not so much that because they were in close environments therefore they suffered from alzheimer's from covet but because of the greater loneliness and the population that could afford that the least yeah i mean i've had some personal experience with with people that are are suffering from alzheimer's and my sense and this is just purely like anecdotal is well first of all you can you can read the anxiety coming a million miles away like you can tell these people are not settled in in who they are that there's some confusion and what i see more often than not is almost like a veneer of of denial or or an effort to like comport themselves as if they know what's going on like out of fear that somebody might know that something's amiss or awry and i'm often left wondering like what is the level of self-awareness that this person this patient has about the nature of their condition like are they aware that they're suffering and they're actively trying to put up a front or is this something that just occurs with this disease like what is their interior experience of what's happening it's tough to know because it varies but it's the fight or flight isn't it so i mean i've seen this repeatedly your your autonomic manifestation and behavior is fight or flight and my grandmother was a powerful woman and i actually in the last years of her life i actually shared the room with her and being a stupid teenager i didn't appreciate that that experience which was uh profound and important and i should have been more aware and but um but that that's uh she as powerful this person that would face you would talk to you with clear language because she was she knew that that in order to be in a world of men she had learned very early on to be very succinct and clear she started turning away from the world so the withdrawal so you see a lot of people just withdrawing not being as involved and in her case she actually turned around towards the wall she would actually start facing the wall that's a withdrawal push the others push away the fight and and it's not not often it's not a conscious awareness that something is wrong it's a discomfort that manifests in those two outcomes and and if people are aware of that then you realize that and that's why a lot of bad interpersonal relationships early on because people don't know that that alzheimer's is coming and the manifestation is this behavior and all uh and and turns out really bad and with my grandmother it was that that was the withdrawal but a lot of people actually then have this pushback right pushback which is the discomfort discomfort something is wrong and the only tool i have is pushing back right get away and let me leave me be right and what is the appropriate response like i'm sure you've seen all kinds of different dynamics with how people interact with somebody who's suffering is there have you come upon an appropriate kind of way of interacting with somebody who's in this space that's more productive than other ways yeah i i think again it it varies it depends on the history that the caregiver has had with the patient the the individual with alzheimer's and the support structure that they have but i think one of the most helpful things that i have had experience with with my patients and training the caregivers to take care of them is to let them know that it's very important to differentiate between the individual and the disease they're two separate things and entities and and that that actually makes everything fall in place because if say for example sally is someone who has alzheimer's disease and sally used to be an amazing human being had her own job raised a family fantastic in the community she sang she was part of her church so on and so forth then slowly she started forgetting things and now she can't do any of those things so the family and the caregiver should make sure that they remind her of who she was and who she is those stories of the things that she did are essentially her medicine and her a reminder of who she is and how she's contributed to this world and the symptoms of forgetfulness of making mistakes of saying strange inappropriate things or acts that are inappropriate that's the disease that's not her and i i i that that um resolves some of the anxiety within the patient uh with the caregiver um caregivers tend to have this need to fix things we always want to fix people we want to fix patience there's no need to fix anything and and somehow when you differentiate the two then that desire to fix goes away and you just focus on the beautiful stories and the memories that that patient has already had and focusing on the moment beautiful and dean actually um has this beautiful i love that um that you do with yeah the islands of consciousness so my attempt at defining consciousness if there is such a thing is there are islands of consciousness so the first island is when you're three years old or so and you become aware of yourself as separate from the universe from the world and then there's the island the mother and the island of the father and the island the family and islands of job and so on and so forth some of them are more powerful than others that's why the most lovely thing you see is when a husband has dementia and they don't recognize anything and then the wife comes in and you see this it's almost as if the greatest party in the universe just opened up doors you know because that island that this wife is still the island that central island that's connected so uh can keeping those islands connected early on with cognitive decline is critical getting rid of the damage which is the food and exercise and also building connections those billions of connections that we can't create so we can keep the tedders into the different islands that's why people remember long term better than short term so one of the things we can do to stabilize at least for a while is have 20 great stories from the past that you've lived those those experiences when you went to some island as a family or some some you know some resort or somewhere um and you had that enjoyment and he or she remembers it build on that you know even even embellish it more you know and you have those 20 stories the greatest anxiety-reducing tool that i've ever given my patients had nothing to do with a prescription although i write this in prescription actually is build those 20 stories and whenever you see the first signs of anxiety throw that in that long-term island that big island takes over and i've never seen anything like that where the conversation just goes there and the anxiety is just rested yeah and you build on those islands especially early on build on those islands of memory and connect them further on and that becomes your best anxiety reducer you know what's another great island which actually passes way beyond the loss of language music repeatedly we've seen where this person can no longer connect with anybody and now they can't even remember their their partner you put that one piece of music from the 40s or 30s that they loved and then you see them just moving their fingers to the music and just calming down so you can build around those islands for the people different individuals that are more advanced for those who haven't developed alzheimer's is building those connections so that the islands can keep connected that's where the ultimate consciousness we believe that consciousness as we define it is when multiple of these islands are connected so you can see a meta version of yourself within all these islands so you use those stories to create a lattice work or like a matrix that forms the underpinnings of identity and that gets rooted in that this is not fair and all i'm doing is repeating it no but you do it so much better beautifully put in there right absolutely nobody nobody wants to befall this fate right and and you know when we're young and vital we think we're bulletproof and this is never going to happen but these diseases start to take root early in our lives we don't see the symptoms for many years so it's all about these habits that we form around diet and lifestyle so set us up with this this paradigm that you guys have come up with and we can walk through some of these habits that you guys have realized have been extremely helpful in managing symptoms and preventing people from headed down this path sure so not to go into the depth and details of the science which we could do and we probably will spend some hours just going into it but when you look at the basis of the patho pathology that takes place in the brain and the body for that for that matter is you know just a few processes these are inflammatory processes oxidation abnormalities and metabolism of glucose or energy and abnormalities in the metabolism of lipid these are the four main pathways that cause damage to the vasculature the blood vessels in the brain and it causes damage to the neurons and the neural connections as well and when you look at the mechanism of how these come about they're very closely linked to your lifestyle so it has to do with food with the way you move and exercise with stress management with sleep my goodness sleep such an important part of our day and also how we connect socially emotionally to our communities and whether it's you know studies coming from say for example in columbia university where i trained from the northern manhattan study or from the russia university studies or from the adventist health study different studies from around the world when you look at the factors that stand out that contribute to better brain health it's nutrition it's exercise it's stress it's sleep and the one that we added it's cognitive activity so that's the oh the optimization that's right so when we wrote the first book we came with this um acronym neuro n-e-u-r-o of course it's self-explanatory and it was good because we're neurologists and helped us a lot too it all came together it came together and um you know n is for nutrition ease for exercise used for unwind which is stress management not just getting rid of stress but increasing good stress and getting rid of bad stress and rs for restorative sleep deep restorative sleep that helps cleanse the brain and has its own function and optimization of cognitive activity right some of these if not all of them feel like common sense uh and yet also i mean i think the nutrition piece everybody knows you gotta if you wanna take care of your body you gotta be right right sleep exercise um challenging yourself mentally being in a community of people that you're connected to these are all things that we we kind of intuitively know are good for our health the nutrition piece would you say that's is there one that stands out as more important than the others or do these all awards work obviously this is a holistic thing so they're all interconnected but um if you had to pick one is that even possible i don't think it's fair i guess if you don't sleep at all and you eat a perfect diet it's not going to matter no no i think it's the multifaceted nature of this that actually makes a big difference and when you look at different communities and individuals as well you know they might excel in one thing but they might be falling behind on others and i mean it's understandable we can't really control everything but all of them are important what would you say no i i fully agree with you um i think all of it has to be done and it's incredibly empowering to know that because every time we say that somebody says oh my you know my friend did all of it but no none of us did all of it and we're talking about living a uh let's i'm not go the food part is pretty specific i mean not we don't have that many communities that lived in the way that we were talking about it and we'll talk about it you know as far as whole food hopefully plant-based we're talking about exercise significant exercise we're not talking about whenever we talk to our patient i'm fine i i do the gardening i do the walking no or for example my patients when they say wow i'm walking all day long from my living room to the kitchen back to the living room yes that's not excellent it's got to be a significant amount of exercise and then um stress management it's not about just getting rid of bad stress by the way we none of us are doing that well it's not just because you meditated meditation is phenomenal but it's got to be an all day but also about good stress which is a one of the things that actually gets people to the dementia stage fastest is what they did throughout their life as far as cognitive activity and challenge that's profoundly important sleep none of us do sleep well just because we took some medicine we're talking about restorative sleep where people go through the circadian you know the the four phases of sleep four to five times at that night deeply we invest in incredible resorts we've been invited to different venues i say take that money and we're not gonna tell put it in a in your bedroom there's a reason why we're knocked out evolutionarily how would it make sense that you're subject to being mauled by bears and lions for one-third of your life unless it was that important so sleep and investing in sleep is profoundly important we study we're doing the largest one with the sleep study is it shows that 70 increase risk of dementia for those who have bad sleep and then there's optimization which is challenging mental activity if you think you're retired and you can go slide out on the beach that's great for a few months but if you continue that's going to be the fastest point of decline for cognition because if this brain which is consuming 25 of your body's weight and realizes oh i'm not being used especially at a time where you're aging you know what it will do it will actually shrink more rapidly so all of it has to be done and all of them have to be done together but the beauty is if they're done and it's not just a diet du jour or the new resolution run or walk and if it's lifestyle and especially if it's lived lifestyle which is what we're trying to do in communities we're talking about 90 reduction in alzheimer's dementia stroke without any biohacking or vitamin du jour or any of that stuff what regular things you have in your you know in your environment and i think one of the focus of our study which is you know the largest community-based study in the country now in beach cities is the applicability of this knowledge i think we have tremendous amount of information about the kind of diet and the kind of exercises that are good for the brain even stress management so on and so forth but what we haven't really focused and what i don't see much of is bridging that gap between the knowledge that we have the incredible amount of information that we have and how people apply it at their homes that's always the trick it really is it really is and so i think um more focus needs to go towards that the translation of all this amount of information we have and people aren't very good at at estimating or calibrating you know how they how they're adhering to any of these things anyway most people tell you i exercise like you were saying like i exercise or you know i i i pretty good like you know everything in moderation and you know these things are divorced from reality more often than not yeah absolutely my two least favorite words in language is motivation and moderation motivation is a top-down word that has no denominator what is that it's almost like puts pressure on kids like if i don't have it all the time something's wrong with me i don't have motivation all day yeah i i it's so it's important to operationalize motivation in small successive successes that get you that little dopamine and serotonin release so it's not about the goal it's not about a it's about the process if it's not reduce the process that's in your lived life and you don't enjoy that process it even if you achieve the goal it then becomes anticlimactic okay i just did this now what oh i fall down to the baseline so we have to create environments where the process is the thing in itself i don't want to sound like those philosophers the thing in itself is the process not the goal not the diet not that so that's where the change has to happen and then the other word is moderation moderation is a word people use to get out of doing things let's be honest you know as soon as you say oh dean it's all about moderation but you just had four stakes where is the what part of moderation i'm not judging people but but we have to say this is the optimal that we know to the best of our knowledge today and that's where the humility of science comes and we you know people say but dean you just change your perspective on olive oil yeah because it's not about me it's not even it's not even about neuro you can throw away neuro it's whatever science gives us and that might not be perfect but it's a methodology that's changeable with not with people's ideas but with a process and and if it changes tomorrow my ego is not affected so we have to kind of move that and if we do that i think we we can we can really address this this calamity which is cognitive decline which is affecting every community we're seeing right so let's dive into the nutrition piece uh whole food plant-based diet is your preferred protocol here so of all the you know the within the acronym neuro perhaps that might be the most controversial for you know for the average person to get get their head around so how did you arrive at this being you know the diet that you're recommending right so when you look at different epidemiological studies and even clinical trials um on diet and brain health the elements that stand out they're all plants you know whether it's um studies coming from northern manhattan study or adventist study and all these other epidemiological studies that i mentioned earlier um the the the foods that have the most anti-inflammatory agents that have antioxidants that have a proper synergistic combination of micronutrients and macronutrients happen to be plants and you know as much as we try to stay away from calling food super foods or you know good foods and bad foods there are some that seem to be more beneficial and there are some that seem to be harmful and so when you and and i've had the opportunity and the the privilege to work with some databases the california teacher study and what i did was i i studied how the mediterranean diet which everybody talks about is is structured and made and when you look at the mediterranean diet or the mine diet again the food that come on top are our vegetables and plants they're fruits and legumes and nuts and seeds and whole grains unadulterated plant-based foods and the more of these people consume in different communities the less stroke they have the less alzheimer's disease they have the less chronic diseases of aging they have and they've been associated with vascular risk factors like high blood pressure high cholesterol diabetes so lower of these tend to actually improve brain health now i know that there's a lot of noise out there and there are different dietary patterns and you know there's always this this this fight there's a lot of diet wars going on but when you look at the science and the mechanism it always comes towards plants um and it's it's a spectrum right so how much do you want to stay how long and how much do you want to stick to the healthier foods that's what determines better brain health when i hear mediterranean diet i'm always befuddled because i'm not sure whether that's they're referring to you know a robust um you know panoply of fruits and vegetables and nuts seeds and legumes or we're talking about wine and cheese and olive oil like as as somebody like in at least in the scientific context when you're doing these kinds of studies like how do they define that oh it's it's not that difficult actually so there's there are different processes and they're mechanisms and statistics and in science where you do factor analysis and you see what food stands out and that's one of the things that we are actually doing in one of our studies to see you know what is the effect of specific foods on brain health and yeah wine cheese pasta when you see the mediterranean diet advertisement on the magazine it's a you know pretty lady sitting next to a lake drinking wine but it's not that it's actually it's actually the foods that are unprocessed and plant-based that seem to stand out but again you know even even science has its flaws and there are some studies and some study that we were actually reading about a couple of days ago just came and it was published in a reputable journal saying that cheese daily consumption of lamb and up to a bottle of wine seemed to reduce the risk for alzheimer's disease and that plants were actually bad for you so it's just this manipulation of data to what like how was that study set up the study was well designed the source of funding is questionable so we won't go go there but but so it speaks to how science can be manipulated right even in in the right environments that can be manipulated depends on what variables you throw into the formula right if you don't take into consideration the socioeconomic status i mean who eats cheese wine and lamb higher socioeconomic population which means that they probably took care of themselves and who did you compare against people who had very low socioeconomic and therefore they had low resources that they actually had other vascular risk factors and other things so data can be manipulated but the massive massive body of evidence and a california teacher study actually actually was the main author of this 133 000 people over 20 years i have in this health study 97 000 people over 50 years we're talking about you know the harvard study and women's health study large studies the massive data shows at rush studies same things and a large study that the dominant things that are helpful are the plants and vegetables and less processed food so at the minimum if people want to do something towards health and if they don't they don't even agree or they can't make the changes which i then they should reduce the processed food you know we know that even among the meats which if you go from beef jerky towards fish you're more healthy so we actually say you know we are plant-based and we think that that's the best and even plant-based we don't say vegan because vegan can be unhealthy right that's like saying mediterranean diet can mean different things exactly that's true we say plant-based but thought out planned for example um that we are now pushing a little bit more olive oil and even there quantitatively less on the left side because we think it can help with both consumption of the food as well as absorption of vitamins and also the data shows that we were just at the end of a a big review we we as far as supplements we don't push a lot of supplements but for certain populations developing brain and aging brain and those who are going through pregnancy omega threes whatever your source seem to be there's trend against science that there might be need for it so there's data you go with the data we do but it looks like the whole food plant-based diet seems to be by far most beneficial because of two reasons it gets rid of the processed and all the negative elements the vascular stimuli the inflammatory products and also it gives you all the nutrients you ever need all the deficiencies that you hear in the media iodine deficiency or b12 division either they're not real or they can be easily mitigated while retaining all the benefit that's why the diet has been shown repeatedly to be beneficial right well let's dive into that a little bit more more deeply and and maybe we could start with fish i mean you hear all the time especially in the context of brain health like oh fish is good for brain health and you know there are studies that say fish is part of a healthy diet typically those studies tend to be using fish as a comparison to beef and chicken so it's not being compared to a whole food plant-based diet but is it possible to maintain appropriate brain health without fish what is it in fish that this is referring to and if we're gonna take fish out off the plate you know what do we need to make sure that we're taking in that we're pushing all the right buttons yeah i think that's a very important question and you're right fish has always been compared to consumption of meat and chicken and other animal proteins and so it seems to be better and the reason being it has lower saturated fat content which saturated fat is a major major reason for damage for arteries in the brain and in our bodies and especially causing inflammatory changes in the brain and insulin resistance on and so forth so there's a whole cascade that has been associated with saturated fats and you know from a public health perspective there's consensus that lowering the content of saturated fat in our diet is very important for better brain health so that's one aspect of consumption of fish but you're right there has been no study to show that compared to a healthy whole food plant-based diet fish a diet that contains fish is better we don't have that information as of yet we don't have it either way right we don't have it either way we are concerned about um animal proteins being a biomagnifier you know animals tend to retain elements that are they're surrounded within their environment so you know all the the lead and the mercury and other um organic compounds that we're dumping into the oceans unfortunately nowadays they get concentrated in the in the flesh of these marine animals and if people consume fish they consume those elements as well and we believe that that could be a an important factor for brain diseases and we think that a well-managed hopeful plant-based diet eliminates that risk and that we can get the omega-3 fatty acids that are that come from marine animals with a plant-based diet if we take supplements say for example at specific times during our life when our body needs it so as a child when a child is growing or for example when a woman is pregnant or for example when somebody is at a higher risk for developing mild cognitive impairment supplement with omega-3 fatty acids derived from marine algae which doesn't really absorb much of those uh the the the elements or the trace minerals could be very helpful so we believe that one can actually have a very good diet and a healthy diet without it the idea being that everything that you would get in a fish oil supplement for example you can get in an algae-based supplement you're just getting it lower on the food chain you're basically taking what the fish would filter through through its body um and and supplementing it in a condenser exactly the fish actually get the omega-3s from the marine algae so what you hear a lot of and i'm interested in in how you're thinking about this is that given the importance of omega-3 that um that there is something about plant-based omega-3s that aren't as bio-available or aren't converted in the proper way that they are when they're found in animal foods hence why you should be taking fish oil or these other things and i know you did a whole podcast with our mutual friend simon hill you've done many podcasts with him on his wonderful plant-proof podcast we did like a whole episode on omega-3 so we're not gonna spend two hours on omega-3s but like i do want to get this right sure sure yeah so we we don't know the total picture i mean this is i the humility of science is to say this is how much i know this what we don't know and i i i we hate this battles but absoluteness absolutely not needed or absolutely needed we don't we don't have damage so we did the complete review two papers one on developing brain and omega and the aging brain and even there we didn't have conclusive evidence but there are trends especially in population that are more vulnerable the trends are saying repeatedly especially if the studies were done better and more that there seems to be need for omega-3 given the risk factor although there are some people talking about prostate cancer all those studies are weak and the data is weak so far but especially in populations that are vulnerable the cost benefit for us it appears to be on the side of using it not for everybody i think if you're a young man or a young woman in your 30s and 40s if you want to take supplements that's fine but i we think that there's enough data that if you have enough chia and flaxseed and you know a walnut that you can you can do fine with it but for a person that's pregnant especially going from plant-based omega-3 for developing brains where it's doubling every you know other week in size and numbers and and the one thing you need for brain development that can't produce is dha and omegas we think that's definitely needed and for a brain that's under attack from vascular reasons inflammatory reasons when it's aging we think it's needed the cost benefit actually speaks to it the studies that are that would be there that would be conclusive have not been done but having looked at the breadth of data with when we did this research we think the trends speak towards benefit mm-hmm and speak to this this uh conversion issue when we're talking about omega-3s we're talking about dha ala eppa it all gets very confusing very quickly here but the idea is that yeah when you're taking those in on a plant-based diet they're not converting in the right proportions or you're losing out on some bioavailability here and it just doesn't work out yeah first of all i think we i've never heard this but i thought about it the other day i was like wait a second why are we worried so much about conversion do we have enough or not for example nothing in our body gets converted at 100 percent we don't have 100 bioavailability for anything unless you inject it into the artery you don't have bioavailability 100 for anything much of what's actually ultimately bioavailable is in the lower teens lower 20s i mean you eat it it gets consumed a lot of it just gets you know thrown out with the with the rest of it and then but whatever is bioavailable with ala the percentage varies some people say five percent some people say eight percent others say up to that's not about what they say studies show up to 12 percent or more but that's plenty if you have one or two tablespoons or two tablespoons of you know chia which has it's a great food chia or flax seed or hemp the one of the few foods where the omega-3 ratio compared to omega-6 is higher right you don't even have that in animal food so you have much higher absorption of ala now the conversion of that to epa and dha is slower but you can still get plenty the the the problem is when you need more we think that when your brain which actually incorporates rapidly dha you might not be getting enough with just those sources and is there some idea that if you're beginning to experience cognitive decline or if you're at a particular risk for that that supplementing with omega-3s is a good idea yeah i mean the studies that were actually the strongest were in the mci's or mild cognitive impairment yeah there was even slow slowing of the progression of mci and even reversal some of the symptoms of patients who had mci that took supplements and high doses of supplement that worked well for them so yes we do have evidence for that but we also want to couch this by saying better studies need to be done right lack of better studies does not negate trend and and risk benefit analysis given that this is the most important my one of the most important micronutrients in the body dha well the omega-6 omega-3 ratio thing is super interesting because sort of if you look back 50 years our ratio of six to three was very different than it is now because we didn't have this proliferation of processed foods that are so high in omega-6 so now we're all taking in tons of omega-6 not enough omega-3 and so how much of our omega-3 intake or supplementation how much of that is to kind of calibrate that ratio versus what we need independent of omega-6 in other words if we're eating tons of omega-6 it it it seems to follow that we would then need to take in more omega-3 to create that correct ratio there's a bigger problem which speaks to why we have to go whole plant-based so if you're eating omega-6 the pathway of conversion of dha epa is actually a great limiting step so if you're having more omega-6s you actually convert domain you can't get enough dha conversion so one of the things you have to do is reduce the omega-6 conversion as well because the same enzyme that actually does the conversion is limited by both of them if you have more omega-6 it stops it's that becomes the rate-limiting step of conversion of ala to dha correct so it's critical that not just to increase omega-3s ala and others but also reduce omega-6 resources as sources and what are those sources all the foods that have increased in the last actually every 70 80 years which are the processed meats and cheeses and butters and and actually all processed foods that are out there have profound amounts of we're talking about some foods have 4 000 to 8 000 as much omega-6 to omega-3 we weren't like that so you'll never be able to correct that ratio the only way is to eliminate those foods and by going whole food plant-based you're getting rid of a lot of those nasty omega-6s that you don't want and the benefit is exponential you're reducing the harm fast rapidly and and this rate limiting inflammatory and co so let's talk about omega-6 omega-3 quickly so these are not unnatural pathways your body needs omega-6 your body needs omega-3 one and of course that's simplification but omega-6 is the pro-inflammatory pro-coagulation pathway you need clotting don't and you need inflammation and omega-3 is the opposite as it happens that as we get older we need more anti-inflammatory because there becomes a chronic process of inflammation which we have to counter right and actually a baseline higher than normal and the fact that our diets have changed so now we have much more pro-inflammatory coagulation that's why we have more strokes that's why we have more inflammatory diseases including autoimmune diseases so if you don't lower the inflammatory pathway you can pump this up first of all it won't go through yeah it doesn't matter right all right let me throw this one at you uh the brain is made up of fat it thus needs lots of fat in the diet saturated fat and also cholesterol that drives me crazy walk us through this one that drives me crazy but um i think if you look at the structure of the brain um yes the brain is made out of a lot of fat um the numbers uh vary they say you know 60 70 fat but that calculation doesn't really separate the amount of fluids that are in the brain too so it's actually less than 60 but we'll leave that alone the important thing to remember is that fats actually don't cross big molecules of flat like cholesterol and saturated fats they actually can't cross through the blood brain barrier which are these tight junctions between cells in the endothelium of the cells that allow specific things to go in and specific things to come out so the fat that is in the brain is structural fat the only fats that are needed by the fat on a daily basis by the brain by the on a daily basis are omega-3 fatty acids and those are small enough to actually go be used and that's basically it the rest is just structural fat and it's maintained by all the other micronutrients and by all the other food elements that we consume so we don't need cholesterol for our brain to maintain its function at all even under the worst circumstances your liver and your body makes enough of the rest of the fat for the brain if it needs it great it's not a problem and the brain as well any access actually just gets metabolized or they sit on your arteries and they start the process of just plaque formation unfortunately so nothing to that one no not at all right and and talk about saturated fat uh more broadly in terms of of brain health i mean we are look there are these crazy diet wars going on right now everybody's you know planting their flag in various corners of the internet we've got the carnivores and we've got the keto people and you know you will i see this all the time like keto people will say you know i've adopted a ketogenic diet i can focus better my brain is working better i'm able to work longer in a more productive way than i was able to previously of course that's anecdotal but there's a lot of people who feel pretty strongly about this so speak speak to this a little bit i i think that um they do feel more focused and i believe them i think that short term they actually do better cognitively not better than any other diet but they do better than what their baseline would have been and that's why but but long term there's no data i mean if you look at ketogenic diet data there's nothing more than six months nothing meaningful longer than six months ketogenic diet came from our field neurology where children with a particular type of seizure which were not controlled by multiple medications they were put in a shock state to control seizures why would we think that that's representative of a brain that's not undergoing shock they're putting they're changing the acidic state of the brain so that the seizure is stopped that's not representative and then the other thing is how long how how long can you maintain that under normal circumstance these children were kept in special wards or with special diets maintaining a ketogenic diet a true ketogenic diet and i can tell you it's a lot harder than maintaining a whole food plant-based diet it's crazy different it's very difficult most of the people that said they say that they have their own ketogenic diet they they've never achieved keto ketosis they're just eating more meat and that that they call that ketogenic diet it's much harder than that so short term they do better they do very well with glucose and insulin resistance they do well as far as focus and they even do some better with certain cognitive testing which has been done short term but nothing has been shown long term there are no populations that have lived this life that can give you long-term benefit the one population which has these seizure patients have had many multiple medical problems side effects as a result of it so we are open we're absolutely open because there are there are plant-based versions of ketogenic diet so we're open to see if long-term anybody can show evidence but nothing so far right but the brain runs on glucose brain runs right and so on a ketogenic diet you're depriving it of glucose and it's being forced to run on ketones correct correct so is there some scientific sensibility of how the brain functions on ketones versus glucose well the analogy you want to tell them the analogy we'll go ahead you tell your name i'll let you tell this i'll i'll do the nicer part i i i call a ketogenic diet as of now it might be pejorative but almost like a cheating on on your wife kind of a thing so how dare you i know i mean terrible but uh um so glucose is the main molecule that the cell requires if there's a fuel preferred fuel we did a study in haines one of the largest databases looking at even insulin resistance not the diabetics we took them out and looked at the insulin they had lower cognitive state so insulin resistance is what we're looking at if you have too much glucose with food that rapidly rises glucose what happens is the cell notices that there's too much of this and actually the receptors go in so it's the analogy i give is like somebody's coming as a suitor for your son or daughter and and they knock at the door and there are too many people the door just closes and comes out and but if it's accepted if it's the right amount of glucose the door opens then it has to go to the father to the mother this is an old-fashioned story yeah but it's okay well and uncle and there's a huge family there that you have to go glucose has to do a lot of work to ultimately get to the mitochondria imagine what mitochondria is so it has a lot of work to do six seven ten cycles of processing first of all it actually has to get through the blood brain barrier through it active transport a lot of work and that is designed to be like that it's evolutionary designed to go through this hard work for glucose to get into the cell and be functional because that's how it manages it long term now let's look at look at keto bodies ketone bodies they're small molecules they're cheating they're going right through the window and right into the mitochondria skipping all the steps don't have to deal with dad and none of that crazy uncle initially a lot of energy a lot of fun a lot of other stuff this this analogy always goes awry but long-term it's it's you know you you feel so ketone bodies might work short term because it's a quick burst right even for the mitochondria but where does in in the biochemistry textbooks or any uh biochemical process does it say that doing the quick thing in the biochemical processes is long-term benefit from my reading and i just reading in our research and molecular pathways there's no evidence that anything that's short-term like that is going to be beneficial long-term like you said it's a it's uh it's under a shock state so you know and most of the studies that have been done on ketone bodies um have been done in individuals who have had advanced alzheimer's disease and at that stage there's a lot of damage that has already been done and there's the structural damage vascular damage and so ketone bodies act as an alternative fuel right so the the cells probably don't have the opportunity to use glucose as a fuel but ketones that don't require all these steps that dean mentioned you know they don't have to go through it and they go right into the cell and initially there may be some improvement in their cognitive skills and in their neuropsychological scores but long term i think the only study that we have is a feasibility study that was less than six months and that's basically it so we don't have any long-term um results and if we do i'll be excited to actually read about it and because it sounds very promising we just don't have the data yet it is it not an emergency state for the body it's like a survival mechanism that evolved over millennia to keep a human being alive if they were deprived of food for a certain period of time right so in that sense the the your physiology is in crisis is there a downstream impact on on your uh neurological functioning like are you in a in a you know a a uh sort of um sympathetic nervous system state of of high alert when that's going on right you we think so we think i think it's a survival state that's why survival states are short-term states that's why i mean when we talk about stress it's a short-term beneficial state that now has become chronic right we keep missing the evolutionary flaw here we keep addressing what's short-term benefit and think that that's long-term benefit it's not uh so we think that at least biochemically even evidentiary i mean we're looking at evidence from all the studies there's no evidence at this point that this is a magical cure for dementia or alzheimer's or any of these things it's just a short-term survival that long-term we think has consequences right rather than climbing in the window how about this analogy it's sort of like pulling an all-nighter and you can you're gonna you're gonna get away with the grade on the test but a month later you're not going to remember anything i can say that story much better than my story many um so so let's look at the foods that that are beneficial like when you look at the the plant kingdom what stands out you know i know we want to stay away from quote unquote superfoods but some foods are better than others like what should people focus on who are trying to enhance their brain health yeah i think if if i had to give a quick version of of what's out there as far as data is concerned um consumption of green leafy vegetables for example seems to be very helpful and it's like unanimous results that you see across different studies berries such as blueberries and strawberries they stand out whether it's the mine diet or the mediterranean diet or even in the adventist health study because these are foods that have the highest amount of anti-inflammatories spices like turmeric we actually wrote a paper and when we were in cedar sinai where we gave our patients high doses of turmeric and turmeric seems to have the curcumin part of it is a very potent anti-inflammatory and it seems to bind with amyloid which is the bad protein associated with alzheimer's disease and it it removes it oh wow and we measured um the amount of amyloid the amyloid load in retina and after giving them high amounts of turmeric we actually saw the turmeric binding to the amyloid and the retina just really really interesting and we're learning more about it as we speak um and yeah so high fiber green leafy vegetables and berries and spices especially turmeric seems to be on the top chi and flaxseed flaxseeds which are amazing sources of plant-based omega-3 fatty acids hemp seeds nuts like walnuts whole grains they seem to have the right kind of micronutrients whether it's thiamin or riboflavin or folic acid bound beautifully synergistically supporting each other's absorbance and bioavailability they all tend to reduce the risk for alzheimer's disease and we have studies that have looked at individual foods and risk of alzheimer's disease and the combination thereof too are there any plant foods to avoid i would say the plant foods to avoid seems to be coconut oil i know that that again is a controversial area and a lot of people are just yeah they love coconut i know i'm sorry but you know i i love well that used to be the thing coconut oil for brain health yeah you know and unfortunately the data was pretty flawed when it came out it was based on a couple of uh case studies and it as it happened somebody gave their loved ones some coconut oil and they seemed to improve but then there was no long-term follow-up but coconut oil and i'm happy to say that there's consensus on it and you know as a scientist i want to look at different sources of data whether it's clinical trials whether it's epidemiological whether it's case series and there's consensus between different scientists and doctors and physicians that coconut oil seems to increase our bad cholesterol ldl which can result into vascular damage and the reason being is because coconut oil is one of the few plant oils that is more than 90 saturated fat and so is palm oil and the the little nuance as the mct medium chain uh triglycerides that has to be studied and we're open to that i mean we think that if that's those studies come back and show some benefit we would be more than happy because we nee any anything that's out there that's going to help so far no data no tangible data but with coconut oil doesn't that uh that ldl saturated fat component isn't it fairly easily converted to like linoleic acid which makes it more available as an energy source as opposed to being stored it could but reality is that that number so that's a mechanism actually that mechanism exists for a lot of saturated fats but the reality is that when the studies are done over and over again what they see is when people consume coconut oil it is actually the anthrogenic and inflammatory component that predominates interesting yeah it is a processed food anyway so in the context of talking about whole food plant-based diet it's not even really part of that correct conversation anyway but you did shift gears with olive oil to some regard here's talk about controversial yeah we were actually ostracized by some communities for this which i never thought that there was a heated debate going on yeah people are very strong opinions about this it's so funny i you know we worked in afghanistan and and and were uh ostracized by taliban so some plant-based people ostracizing us doesn't scare us too much but yeah so please ostracize us away all we're not as well armed not as well aren't and so much lovelier people anyway so the reality is we're open to data it's not about dogma um there are a couple of lines of argument and it's not always because we looked at mediterranean diet we're actually in the middle of doing a meta-analysis uh the data is uh again trend and nutrition data is tough so you have to go with trends and multiple domains of trends and it appears that some and here's another controversial term some uh olive oil seems to help with cognition seems to help with health in general and and specifically evil you know extra virgin olive oil and and then the quantity is controversial how much we think that there is a point of excess so we say use as minimal as possible just to help with both digestion and with food um but but we just wanted to open up the the realm even though we might make people angry that's okay that's our life but it's if it's data shows this way we got to start talking about it and at the same time when we go to these churches and faith communities which we have another one of our projects is a woman-centered uh faith-based community uh brain initiative in african-american churches were just fortunately impacted by all this proportion and also more importantly as aisha's finished getting her phd in women's leadership focusing on women and health is the most effective money spent in health so if you're going to change bring a brain initiative it should be around women so especially african-american women or black women in their communities but we see and if we go to these communities and hispanic communities and other communities in appalachia or pittsburgh where i come from and say no meat no cheese no butter no salt no sugar no fat no oil no deen right so you're going to have a little bit of an adherence problem absolutely now that doesn't speak to the science and i spoke already to the science that there seems to be some trend that that's posi olive oil is fine especially cardiovascular data but it does speak also to compliance and since we work in the communities and we're not doing contrived 100 studies in in a lab we think that's as important well compliance is everything if you don't have compliance it doesn't matter exactly but you have to be careful right because you don't want to veer too far towards compliance then you're the practitioner who's like i'm not going to tell them about lifestyle because they're not going to do it exactly exactly it's a it's a balancing act it's a so we say what's the optimal especially people who have civ so complexity is you know somebody said i think somebody we know said that the the entire problem we have in in this world is i think that cats is about people not being comfortable with complexity there's a complexity in this and the complexity is we have to worry about adherence but at the same time we have to say what the truth is and here's another layer of complexity if somebody has a four vessel disease we say go all the way no fat because the data is there that if you have four vessel arterial disease you might as well go all the way as opposed to you know so so there's there's a bit of complexity there right uh yeah people don't like that i know i know it's hard i'm sorry the truth will set you free uh you have to be able to make room for nuance now more than ever things are so crazy out there and the only way to do that is to have you know conversations like this it's not going to happen on twitter and it's tricky and it's and it's people's identities are are wrapped up in these ideas and people don't like to be challenged with that because it threatens like it's almost like cognitive decline like you're you're like my sense of who i am is being pulled out from underneath me and emotionally it's very difficult right uh you controv one of the people we admire greatly we're not gonna name names don't worry um actually said they would not endorse our book even though we are in the communities by the thousands helping thousands of people with a whole food plant-based diet just because we say add a little bit of olive oil yeah everything gets more and more specialized it used to just be vegetarianism and then it's vegan and vegetarianism and then within those categories there's there's you know more and more silos until there's just one person left and nobody can talk everybody's got their own news feed you know and we can't communicate with each other anymore i mean that's where this is headed yeah it is it is sad um how many phds do you need no i i'm just i'm i feel so lucky well first of all i have this amazing partner that you know just allows me to to experience life in its fullest and um you know having so i have a masters in clinical research and i went to medical school and i've worked in clinics and i got a fellowship in vascular neurology but the more i the more i am in this in this field i realize that if we don't focus on the human component it's meaningless meaningless and having had the privilege of working in the communities meaning going there sitting down with them listening to them working in the community clinic where you have these lovely people coming in and telling like doc i know i know this is important i just can't do it right now i just can't do it because of this this this you can't really talk to a a woman who has two jobs is divorced has four or five children to take care of has a parent with dementia that she takes care of has tremendous amount of stress because of the situation in the world and tell them you know just meditate every day meditation is really good for your brain that is such an elitist statement that is such a flawed approach to health and so what do you do to make yourself available and what do you do to create an environment in their communities where they can have access to health and wellness in in their comfort and their comfort zones and so um having worked with different individuals and especially in the uh in the faith-based communities the one thing deena and i have noticed and this actually comes from our work in afghanistan as well where we've noticed that if if we invest in the women in those communities you've actually invested in the families and in the communities because women's are the best representatives of that unit in the community and um when you look at different models of success in the world one of them that came from dr eunice who was the nobel peace prize laureate he's the father of microcredits where he you know essentially helped women and their small businesses and he he made some profound statements he said when you help women you actually help families and you help change that society because no disrespect to men i love you guys but um women know how to invest in their families and in their units and so i i'm pursuing this phd in women's leadership because we believe that if women are ambassadors of brain health and mental health i think it's a game changer and we've seen that we've seen that in in afghanistan and dean doesn't talk about that but you know one of the things that is so such a profound story in our life was when um i'm going to say that story for you um when he was working for the world bank he was in afghanistan and he was running the ministry of health and one of the challenges was to make health available for all these provinces and villages that were away from the capital and there are not a lot of hospitals there i think we learned more about public health there than any course at columbia that any course at nih and ucsd and loma linda university combined together um so knowing um knowing the the politics and the bureaucracy what deen did was essentially a social jiu-jitsu where he trained he created the establishment to train 20 000 girls who were you know went to school up to a sixth grade because after that they they usually there's no education available for girls and the provinces and so he took sixth grade educated girls and he wanted to train them in just basic care how to give ampicillin when somebody has upper respiratory infection how to create oral rehydration solution which is you know one liter of boiling water one fist of sugar and a pinch of salt because one in five is it children under the age of five die from easily preventable diarrhea in those countries and to give them that oral dehydration solution you've actually saved a life or to tell the difference between spotting and bleeding in a pregnant woman because the hospital right is about five days on a donkey right right so just basic things and so there was a lot of pushback initially about this project i said nope you're not going to take our girls and educate them this is this is against our faith against our culture and tradition and ending said no no no no this is you know this is going to be done in your in your communities and in your villages and so they accepted it and that was a beautiful move because they created mud huts clinics for these girls in a very prominent place with a flag on it and it was just a very basic place with a chair and a table and maybe a a bed sheet as a as a curtain with a small little bed for the the midwife or the nurses versus the midwifery program to examine patients and guess who would get sick after a few days the men would get sick too right and there would be that girl and she would be the community doctor and suddenly you've completely flipped the relationship yeah that just up their whole mindset of the whole thing without so the jiu-jitsu here is you don't have to confront cultural paradigms you you jiu-jitsu around it and with most of healthcare thank you so much for telling that story that's amazing by the way like incredible we we wrote a paper together and now yeah it's actually in landsat oh wow how to apply it to other communities right and if we do that not so much jujitsu but use the resources of the community to build this paradigm around women i mean you your wife the the power we we know you know and also they're the leaders and even in even in those taliban infested places yeah they do all the yelling and jumping around the mendo but who runs the households right they're making the decisions about that they're making decisions and every community that's the case yeah women are the leaders women are actually the leaders and we can build a whole health care system brain health initiative around women so that's been our work for the last two two and a half years yeah so applying that template you know here in the united states going into these communities trying to pull some you know tweaked version of that jiu jitsu maneuver to you know empower these women and list them in this cause and in turn have them help create structures that trickle down into their families right absolutely beautiful yeah so that's the goal and it's been an amazing journey just you know experiencing that firsthand to see how wonderful of a communicator a woman can be and how easy it is for others to listen to a woman who is a sister a mother an individual in the community coming from a very empathic and a loving place but at the same time from a very powerful place um i i'm just so excited to be in that uh yeah the there there's there's no bounds to the upside of that i think right that's right well let's talk about the new book i mean you guys wrote this amazing book the alzheimer's solution that came out a couple years ago that's what brought you onto the show back back then um which is basically an incredible primer on all the research that you've done case studies uh your work with your patients in terms of implementing lifestyle interference to interrupt this brain dementia issue that is mushroom clouding in our society but the new book the 30-day alzheimer's solution right uh is more of a a tactile like very easy to use guide for how to kind of you know implement these tools in your daily life using this neuro paradigm of it's basically mostly nutrition focused you talk about the other stuff but it takes you through a program it gives you kind of tools for how to make these changes in your life and then you have all of these beautiful recipes to try to make it as appealing and delicious and and easy for people to to to do as possible so it's great i love it i my only complaint is that it was a digital version and i don't have the book yet but it's coming out soon so talk a little bit about why you decided to write this book and what your in you know plan for it is thanks rich that's very kind of you and we'll definitely get you a copy i think the pandemic slowed down everything but um we're very proud of it um it was it was difficult to put our experiences in a way where it's translational and palatable part of the pun but we wanted to focus in on the how part of brain health you know the first book was essentially the why and a lot of science but the applicability part has been expanded in this book and you know the title the 30 day was a little uncomfortable initially like what does that even mean does it mean that in 30 days i'm going to have the best rain no but i think it's a 30-day journey or a plan towards that direction and uh we're we're just really excited and i think one of the reasons i went to cooking school after going to fellowship was just because of that that the passion that i have for application of all the science and knowledge that we have already one of the key things and behavior changes process a lot of times people get focused on goals and goals fail us because once you reach as i said you feel and that climatic and and then what it's process that's important systems have to be established so the 30 days is attempting and i i never want to do hyperbole and is attempting to create an environment for systems in fact we with the book for those who sign up early this is a marketing tool but uh they get all kinds of bells and whistles my goodness i i never thought that nih i would be doing this stuff but in any case or uh but turn into a marketer right but nonetheless but it is actually i think it's uh it's helpful we are giving people by the way it's as we said if you if you buy the book early you get access but it's actually on our system you don't have to buy the book you can get access to a 30-day course that starts at the first of april up to the end where we have sleep doctors stress doctors nutritionists lots of data and equipment and cooking sessions and and courses where i should dance for free by the way takes them with the book through this process for a month not with the hopes that at the end they come out completely different but for them to be familiar with possibilities of where the changes the micro changes can take place you've spoken to an amazing um the atomic habits uh james clear clearly yeah i love the book i mean i've read a lot of books yeah it's those little incremental successes that change into habits would change into then culture so this month is about going through this process with brain and mind sorry that there's another one that came out that that actually takes them through and they're hopefully by the end of it they have enough of these little micro habits that becomes a process individualizing habits yeah yeah i like how you broke it all down and and you didn't sugarcoat it either you're like look this is gonna be hard you're gonna if you're gonna get off cheese it's gonna be uncomfortable like you're not trying to say it's all gonna be awesome all the time like it's it's you know making any kind of change is difficult and uh this is no different but what you find on the other side is is worth it and you give the right amount of like encouragement and you couch motivation in the right context and i appreciated that as well but you you paint with a broad brush so that you know anybody can pick this up and and you know get their head around what the right path is that was the goal that was the goal for and we basically wrote this for our caregivers and the patients and everybody that's that's been touched by by alzheimer's and i know the cover says alzheimer's but it's essentially brain health in general and cognitive decline which a lot more people are experiencing yeah i mean it's really hard to appeal to a young person to make changes in their life because they might get alzheimer's like that's talk about a motivation problem yes but if you if you instead rephrase it as cognitive enhancement or you know some sort of you know brain hack or something like that then suddenly you get young people's attention absolutely and you get them interested in taking care of their brains so that they don't fall prey to this later in life absolutely yeah i think i think it's important to say it that way right and and and for us uh we we have the healthy minds initiative which is a not-for-profit where our goal is hopefully that we can promulgate and spread this concept of coaching women-centered coaching throughout the country um and whatever comes out of this book goes towards that effort um whoever wants to help us out goes towards that effort and i think it's a worthwhile endeavor with ishan the lead and i'm the i'm the driver all right we're a team wow so all proceeds from the book go to the nonprofit all of yeah and and and that non-profit um healthy minds initiative is very involved in what you're doing in redondo where you live right now but the idea much like blue zones is to kind of scale this for and model it for other cities and communities absolutely that's right absolutely the beach cities health district is is is where our flagship healthy minds initiative study is going on we have one in arizona in south carolina and we're expanding it in other states as well and we're basically training um coaches who can be brain health representatives and ambassadors in their community and just move it forward right um awesome well we got to land this plane but i i got two more things i want to ask you before i let you go the first is obviously there's so much more research that needs to get done in terms of brain health and also nutrition and you know how lifestyle impacts brain health what is if you had your druthers like what is the study that you would set up like what is the big study that's missing right now like forget about cost just how would you do it what would it look at first of all it would be a little longer term it would be at least three to five years and it would actually have imaging and it would be community based that seems contradictory like this technology but it would be community based because if just like mouse models that work you know 400 boss models for alzheimer's worked zero worked on humans the same way this these little contrived hundred percent 200 studies on six months seven months means nothing if we don't do it in larger populations and we don't get good markers of cognition which is neuropsychological testing biomarkers and imaging that shows this change over time it's it's meaningless because you will get every diet will come up with a paper saying look at my study six months look at my study there will be many of them documentaries and everything put together but we need a larger study for going forward so we're doing the data capture in our national we'll take care of the funding there uh we don't have the funding for imaging we don't have the funding for blood tests and and the regular funding sources don't seem to get it they're not adjusting um saying look we'll take care of the educational component we'll take care of the resources the technology we'll take care of all of that but we need some help with the biomarkers and imaging component and we can have the best study for cognition and then we will have studies that we'll look at because it's a large population we'll know data on ketogenic we'll know data on plant-based whole food we will know data on omnivore or or even pescetarian that would be the optimal study that would be out there so essentially a massive population study community-based study of where people would be self-reporting or we have the methods of collecting data not on a once-a-year basis where the food frequency questions are but actually on a monthly or weekly basis we have the tools now we're actually using that in beach cities using ipads and computers we can collect the data on as far as that's concerned we have the tools as far as collecting sophisticated cognitive information on on the computers and we'll take care of all of that um so those two big components and as far as teaching them using zoom for us zoom was now actually yesterday we had a zoom session with our teaching population over over 100 people so that's even taken care of we'll take care of the education component on a weekly basis and the coaching training the only thing is needed is that biomarker funding that would really help us out because there's bigger costs we've taken care of um okay last question i can't remember whether i asked you guys this last time you were here if i did i'm gonna ask you again i don't remember what you said anyway um if uh if you woke up tomorrow and and realized you'd been appointed as surgeon general of the united states and given the kind of uh metastasizing alzheimer's problem like this you know apocalyptic number of people you know tripling by 2050 you know what kind of policies would you try to implement or legislative changes would you be thinking about that could move us in the right direction as as a nation that's a tough one you want to go first okay well i would say i would say um i would say more um more resources for communities about managing their lifestyle i think most of the funding goes into very specific molecular datas i think less is being focused on individuals in the communities and that's where i would focus whether it's changing lifestyle with behavior models whether it's nutrition education whether it's exercise education and fitting it according to their resources that would be the place to uh to focus on i fully agree yeah i mean we were talking about we talked about mind diet at one point which is not an optimal diet even the people uh the the main pi passed away recently martha maurice martha mars even she said it's not the optimal diet but yet 53 reduction in alzheimer's and and i'm sure that the same number would apply if not more for stroke and everything with this mind diet so why wouldn't we invest at all in this kind of an approach and especially in the community-based model so i would i fully agree with aisha that would be the investment yeah it seems like uh more um local based uh medicine uh an overhaul of healthcare to re you know sort of reconfigure it around prevention as opposed to diagnosis and prescribing people absolutely um but yeah we need a lot of changes don't we we do but you guys are playing a huge role in reversing this this tide and i really appreciate the work that you're doing you're you're truly saving saving lives and it's admirable and i wish you all the best it's amazing what you guys are doing thank you thank you for helping us disperse the message i mean that's this is this is truly important to help you guys out any time reach out um thank you that was amazing appreciate you guys appreciate you uh the new book is called the 30 day alzheimer's solution it's available march 23rd correct that's pub date right yes it is um practical guide to help you wrap your head around everything that we talked about today and more importantly implement those changes into your life if you want to dive deep into the science and geek out on all of that i would highly recommend picking up the alzheimer's solution their first book it's amazing you can find these guys at team sure's eye on the internet and anything else anywhere else to point people is there a website for your nonprofit if people want to learn more about healthymindsinitiative.org yes healthymindsinitiative.org and they can contact us and if they're interested in volunteering or having us come to their communities we would be happy to do that awesome all right and you guys are welcome here anytime thank you talk to me again okay thank you so much thank you peace peace [Music] you

Channel: Rich Roll

Views: 80,867

Rating: 4.9073925 out of 5

Keywords: rich roll, rich roll podcast, self-improvement podcasts, education podcasts, health podcasts, wellness podcasts, fitness podcasts, mindfulness podcasts, mindset podcast, vegan podcasts, plant-based nutrition, neuroscience podcasts, brain plasticity, team sherzai, dean sherzai, ayesha sherzai, alzheimer's, alzheimer's podcast, alzheimers podcast, optimize brain, cognitive decline, lifestyle medicine podcast, child genius, neurology podcast, brain health

Id: YUw5F4L_iaY

Length: 139min 5sec (8345 seconds)

Published: Mon Mar 22 2021