The Science of Preventing (and Reversing) Dementia

you can engage in your own life plan to alter your risk [Music] [Applause] welcome to the doctors pharmacy I'm dr. mark I'm Matt's pharmacy with an FSA I'm Acy a place for conversations that matter and today's conversation is going to matter many of you because it's about dementia something we'd rather not have and talk about but we have today with us an extraordinary guest dr. Marwan Sabah who I've gotten to know recently at Cleveland Clinic where I work and he's considered one of the leading experts in Alzheimer's and dementia in the world he's a Sports certified neurologist he is now the Camille and Larry Ruvo endowed chair for brain health and the director of the Cleveland Clinic Lou Ruvo Center for Brain health in Las Vegas where I'm gonna go soon to share some of our thoughts in functional medicine and figure out how we can collaborate together he's dedicated his career to finding a cure for Alzheimer's something that people actually have tried but failed at and we're gonna talk about why that path may be different and going forward and he's also interested in other age-related neurodegenerative diseases like Parkinson's and other kinds of dementia now he's got quite a pedigrees graduated from the University of California Berkeley which explains his open mind he's got a medical degree from the University of Arizona in Tucson he received his residency training in neurology at Baylor College of Medicine in Texas and completed fellowship in geriatric neurology and dementia at the University of California San Diego School of Medicine where he was an assistant professor he's a leading investigator for many prominent national Alzheimer's prevention and treatment studies he's a hardcore scientist he's on the Editorial Board of the Journal of Alzheimer's disease in BMC Neurology he's the editor in chief of neurology and therapy and is authored and co-authored more than 330 medical and scientific articles on Alzheimer's that is a lot of paper that's like I don't how many years I took my was a lot you don't looked at all he's the author of the Alzheimer's answer reduce your risk and keep your brain healthy and the Alzheimer's prevention cookbook where he paired up with a celebrity chef to create a hundred recipes to boost your brain health and his latest book fighting for my life how to thrive in the shadow of Alzheimer's is an extraordinary story of a woman who has the gene for Alzheimer's who work with you to find a way to prevent it which is an extraordinary story because most people don't think you can actually prevent it so welcome to the doctors farmer snow diamonds that was a long intro that's so busy I wouldn't have so you know you grew up in Arizona I did I did and you had a family of doctors I do and you at eight year old years old knew you wanted to be a doctor which is pretty amazing and your dad encouraged you by giving you a copy of this Anatomy textbook called Grey's Anatomy he did it for 14th birthday which is crazy and then eight years later at 18 you started doing research in Alzheimer's when most people were thinking about what party they're going to know that's great so how did you get to go into medicine and this particular field which is kind of depressing in a way because it is not the thing that we can do at this point and hopefully that's changing thankfully I'm a perpetual optimist yeah but know what they say optimist live longer even though even if they're wrong then I'm gonna live a long time but the reality is is that and when I was 18 I was afraid of getting old very afraid of getting old and I thought about the idea that Alzheimer's the embodiment of everything sad and destructive about getting old mm-hmm and so I decided a very early age that I just gravitated to doing research around that I was working in research labs in Berkeley and Karolinska Institute on the summer and to the point where I was able to say this is something I wanted to dedicate my life to my career too I was a singular in my path to medical school I wanted to do a brain I want to be a neurologist and that's it I've just been following that path ever since neurologist is a brave specialty in medicine we have a joke we often say which is for for neurology the basic practice is diagnosed in adiós basically they said when I was in medical school meaning you can be great at diagnosing diseases but there's not a lot of great therapies for things like Parkinson's and Alzheimer's and all these horrible diseases but that's changing which is kind of exciting so in one generation in fact when I graduate from Medical School in 1991 that was the diagnosis and adios was the kind of the recurring theme the refrain that I kept hearing but in one generation neurology has gone from a mainly diagnostic field to a mainly therapeutic field we now have great treatments for stroke we have great treatments for migraine headaches we have great treatments for multiple sclerosis these are drugs diseases that people didn't have any for yeah so next on that list of things to take care of as Alzheimer's and it's important because six million people in this country either have pre Alzheimer's or Alzheimer's and it's projected to be up to fifteen million by 2060 that's grand many people suffer from all kinds of brain dysfunction that is often occurring decades before they even get their first symptoms and the cost is staggering you know we we think that you know heart disease and cancer are the most expensive diseases but it's actually Alzheimer's that's great and we spent billions and billions of dollars on hundreds and hundreds of studies and it really struck out which is terrible and and often drug companies never giving up and just pulling the plug and said we're not making any progress we're gonna cut our research budget on this and now you wrote a book called fighting for your life which is actually a different story about how to think about this disease and you actually present a path to preventing it and you're even talk in there and you hint about how to actually begin to start treating it in a new way and there's some really interesting studies that have just been published looking at how we can use things like lifestyle which seem like low tech interventions not some fancy drug received surgery to actually slow or even reverse some of this so it's great how are these factors playing a role what are the things that we can actually think about doing to help us prevent this disease and to maybe even start to think about how we treat it right so this is a area that is a garnered great interest in the in the public consciousness and it's you know the idea is that we've been so focused on pharmacological interventions to treat the disease when we now know that the disease starts 20 years before the first day of forgetfulness so by the time somebody walks into my office with memory loss they've had disease changes in their brains for two decades and we understand that biologically now so you seen now a whole and you can see that on imaging we can see that on whole and imaging scans so we're now seeing now a big push to move the calculus beyond the time of symptoms to much earlier and try to find people and identify people at risk along the way so but most that research has been focused on drug interventions to prevent or prevent delay or forestall the onset of symptoms but along the way of course if I'm gonna implement in my 70s and I know my disease started in my 50s or 40s we can change beyond drugs we can change to say lifestyle interventions have benefits and there's now a whole new area of research exercise has really emerged as one of the areas that has grown with real biological evidence that it can prevent and improve brain function and brain health and beyond the we seen now people are looking at things like diet and supplements and other ways to manage their disease and so I think this is an area as just grunt you know relatively new but very excited yeah I mean there was a recent study called the finger study finger studies which I talked about the book yeah I know and and this study was done in Europe and it was a very large study where they did an intervention with diet and exercise and stress and in caucus dancing yeah addressing cardiovascular risk factors and tell us about the study what are they find yes so uh this study is done at the Karolinska Institute the the geriatrician her name is MIA Kiva pelt oh really really sharp very very thoughtful physician scientist and she said we're going to create a multimodal intervention including diet changes managing health conditions improving exercise improving all their parameters and one group was randomized to the intervention in one room group was randomized to just kind of passive intervention and in an objective way followed for over two years with aggressive intervention the treated group did much much better over the two years not only did they not get declined they actually got better Wow and so and these are people not young they were starting in their late 60s into their 70s so these aren't people in the middle of life they're kind of in the senior running into the senior age and they actually got better and this has been published in the journal Lancet so it's a very respected you know peer-reviewed scientific journal well this is really remarkable I want to pause here because what you just said is pretty radical now like I said we spend billions of dollars on hundreds of studies and none of them are show this we can't slow it score reverse now you're seeing just by eating better exercise optimizing your health we literally can slow and even start to reverse the disease's correct in fact the u.s. as taking the finger study and in 2019 2020 there will be the US version of it called the pointer study which will come which is beings Ronna rolled out in about six sites the United States this year and and the government has to pay for it because there's no drug in well the the gut well to be very clear point our study so far as I know it's being funded by the Alzheimer's Association I don't know if there will be federal dollars behind it but the fundamental issue is not a drug company it is not a drunk company but the fundamental issue is we want to answer an important question do these things objectively work the signal the way the evidence suggests the answer is yes and so having more evidence because I have to tell you you and I are both physicians part of our day job is taking care of people with disease right so we're here we are saying let's step back from that let's say instead of treating disease let's treat health yeah and what did you did you take the course of medical school called creating health I did not I did not speak that course but you know but the advantage of that is that it's not prescriptive then you can coop health recommendations that come up from consensus panels and then I can I have effect change it at a larger level this is actually easier to roll out if we can prove there's a signal than it is by just writing a prescription it's unbelievable yeah I think you know what you said is really remarkable that we need to focus on how do we create health rather than just treat disease or symptoms or pathways or some pathology and that's essentially what functional medicine is it's asking the question how do you create a healthy human being what are the factors that knock you off that path and one of the things that actually helped create health and in those studies the fingers study the point study are looking at those factors and there and there are more right there are more and I think that's the exciting thing is that I think you know I I have to be tell you I've been involved in all these clinical trials every time there's a failure it breaks everybody's heart yeah it's there is no there is no ego involved it's not like haha told you so because I will say to you whether the work or not I'm going to Clank tomorrow or the day and I still got to look these people in the eye and say you know something good is coming we just kind of hope that it's coming soon yeah and so I say this to you because if I can see a path forward whether it's a drug a device and a lifestyle intervention any way forward to help my patients either prevent postpone or delay hmm well let's talk about the disease a little more in a medical way because the the understanding was from my training was that the brain seemed to be disconnected from the rest of the body we learned about this right this barrier called the blood-brain barrier were nothing except you know some nutrients got in and it's correct it was like this thing yes can disconnect at our head from the rest of us yes turns out that our body is one system and then our brains are connected to everything else that's happening in our gut microbiome right in infections what we eat are everything is is actually influencing our brain function so can you share a little bit about how this understanding has changed the way we think about the brain and how some of these factors that are driving inflammation right are actually causing this disease because it's a disease of brain inflammation it is so this so the kind of the conventional wisdom that we're trying to look at is that inflammation is and is a response to an injury or is it the injury itself at the end of the day you know a lot of people think that there's an amyloid triggered event and then the inflammatory events occur because of the production of the animal in amyloid this sticky gooey stuff tips gums up your brain that is correct and importantly but we know weaves to think as you said there was you know north of the neck and south of neck right and that everything in the out sandwich was north of the neck and nothing south of the neck was related to it yeah when in fact now we know that things like gut microbiome can alter your immune system and having a healthy microbiome can keep you healthy and by and the innate and you can boost your innate immunity which might reduce inflammation across the board across the body including the brain yeah an exercise helps reduce inflammation and B D and F so the exercise I have to tell you I hated running but I've taken up running because of BDNF so what is that it's brain-derived neurotropic factor because like miracle-gro fish it's rare kill grope for the brain and the funny part about it is I almost neuroscientists are runners they don't do anything but run okay they have to have something to it it's the fastest way to raise your BDNF yes which is basically this growth factor that connects your brain cells together so it calls neural plasticity which increases connections and helps neurogenesis which is the development of new brain cells that is correct so we know we never thought that was possible you never thought it was possible he said once you're born with your neurons you're gonna get it but we now know that the brain is making neurons throughout their life yeah I mean I read a study where they studied terminal cancer patients and they gave them this dye that only goes to dividing brain cells and they found even at the point of death they're making new brain cells that's correct we did when I was in Sun City Arizona at the banner Sun Health Research Institute we had a brain and body donation program and we had scientists that could take brains of patients who just expired and culture out bring out stem cells that were still left alive in dead brain that's unbelievable so do cool stuff so these things like diet and exercise and optimizing your gut microbiome and stress reduction they all and since work by regulating this inflammatory that's correct that is correct that the inflammation of course is the unifying common pathway that we can manage and you know the end of the day that's what we want to do is but studies kid taking advil never really work they tried it well Cox inhibitors have not worked so then the questions are scientifically is it is it that pathway of inflammation people are now looking at different pathways of information you know now looking at TNF alpha which attunement of course is alpha they're looking at the fact that TNF alpha might trigger enzymes related to Alzheimer's called base so we think that there's a links that inflammation is not just a broad category but there's specific segments that seem to work and others that we've tried like you've said we try to anti-inflammatories for years to treat to treat or prevent Alzheimer's didn't work for their own right well that sort of goes back to the thinking and functional medicine which is what's causing it in the first place right so if you're standing on a tack takes a lot of aspirin to make it feel better right attack out right so it's not necessary the best logic but it's it's something that we have to sort of begin to wonder about Ike are you talking to one of your colleagues Rudy tanzy from Harvard sure who said to me that they've done studies of patients who had brains full of this amyloid but they had the gene somehow that didn't let them create inflammation and they were cognitively intact they didn't have dementia right and that's amazing things that you can go to your grave with a brain full of amyloid and not develop dementia and we want to study those people because there's something's protecting them yeah against the development of symptoms and of course they may have just less inflammation as you commented Rudy tends it would be the guy to figure that out yeah here you talk about the microbiome of the brain I know I don't think they're still trying to figure it out but they're finding microbes in the brain right we thought it was sterile up there but turns out we not may not be okay there's a new one that you probably have just hearing about there's a company out of the Bay Area that found there's oral bacteria called P gingivalis which creates a protein called ginger pain which may be a neurotoxin and neuro trigger of neuro inflammation and so they're looking at a drugs to stop that maybe brushing your teeth flossing and getting them clean as a good idea not just good for the heart it's good for the brain all right I mean you probably know that but one of the biggest triggers for heart disease is its gum disease that's correct so let's talk about the genetics here for a minute so um you know most people you get your genes they're fixed your your fate is sealed that you can do right it's not actually how genes work no you can modify these genes expression which ones get turned on and off and how they work and I I remember have his patient years ago was 90 year old woman she was a dentist she had a PO a double four meaning no way she had two of the worst genes you could have that our triggers are maybe predisposing to Alzheimer's and she was nine years old she was still working and she was completely calmly intact and she was a health nut her whole life she ain't a perfect diet she exercised she never smoked she never drank she took her vitamins I mean was it was remarkable to see that yeah and in this way you talk about in this book with this woman Jamie she came to you because she had a family history of Alzheimer's yeah and you checked her jeans and she had that dreaded apoe4 gene yes many people are afraid to test because they feel like it's just a bother so you talked about why bothers right so why bother so I'll - I'll answer the white bar in a second but Jaime is like your dentist patient she's a 4 - 4 she found her story of course she found out her genetic was by accident now you and I know that if you are a two copies of the apoe4 gene your lifetime risk is 91% that you're going to develop it it's almost a matter of when not if yeah and and the problems with is that fortunately there's only 2% of the population that have our double copy 20% of the population is a single copy of the apoe4 but people are now finding out because there's commercial genetic testing blacks and 23andme 23andme right and then they go to dr. Google it's me my friend dr. Google and and they're like well what does this mean and and they go Undead and so the Jamey's of the world are finding out day in and day out by accident and they're trying to figure out what does this all mean so the story is on her half is how she found out by accident and how it affected her my half of the book is is it a good idea be tested what are the consequences of being tested what does it mean and so that's what my half of the book about it's been a it's a nice convergence of two two story lines that help people to become informed because this is happening every day of the week it's happening anyway but what your your book fighting for my life suggests is that by knowing that it can motivate people to take control of their life and their lifestyle and address the modifiable risk factors that is exactly and I want everybody who reads the book to be like your dentist patient right yeah she was I asked to say to you I had one other letter I would go to her nine years old she got tonight she was right yeah cuz working still working and I've seen only one other elderly person get to late 80s 90s for four who was unaffected that and my career if I've always said that if you have that genetic profile it's almost a foregone conclusion you get summer dementia eventually but there was one exception to that so we want everybody to be the exception you have to rule now you know one of things we haven't really talked about yet is the role of sugar in the brain yes and many people may remember Ronald Reagan's favorite food was jelly beans yes and he got Alzheimer's now maybe there's a correlation but it turns out the diabetics have four times a risk that's correct dementia that is correct and that we sometimes talk about Alzheimer's is type 3 diabetes that's the Susan dellamonte it from universe around yes and the truth is that we all have control over whether or not we get diabetes this is almost 100% preventable in reversible disease by changing our diet right and you know that insulin resistance of course is the hallmark of type 2 diabetes and that we can see insulin resistance in the brain and that's what the type 3 diabetes even if you're not having insulin resistance in the net rest your body and we think that of course and I strongly believe like you that that's a modifiable respecter that we can alter that we can alter it of course the epigenome is which we're going to talk about I hope look in Douglas genetics but the diet and the reducing the sugar in taken and the diabetes risk is something we can alter and have a positive effect so we all learned I mean I learned in medical school that your brain uses 25% of your glucose and it needs sugar to run yes it says Andrew pet scans show that you need sugar to make your brain light up so the rule of thumb on a PET scan is you want your south of the neck you want to be dark north of the neck you want to be bright on sugar pet because if it's dark below you got cancer if you got if it's bright below you gets dark because that's why you would have put a in the brain you want it to be nice and bright you want that brain to light up because it consumed uh CH of the sugar couldn't metabolism is in but you're also say in your book in patients who have Alzheimer's that people are exploring the role of ketogenic diets which means no sugar correct and lots of fat and the Brun rain brain running on ketones instead of glucose and the issue that people are trying to decide is can you bypass insulin pathway mechanisms so if you're if you're relying on insulin and Pat and pals related insulin to admit to nourish your brain and you have insulin resistance either you can pharmacologically improve that or you can diet I improved that yeah I mean you know I remember this patient I had at the Altru Wellness Center my practice and Lennox and she came in to about 78 and she started having what call MCI or mild cognitive impairment and she had a whole bunch of things wrong with her fàbregas bad she had gut issues she had low vitamin b12 she had heavy metals and mercury but she she was able to fix a lot of these things and do a lot better for many years and then she started decline and I'm like well let's let's try a ketogenic diet yeah and we got someone to work with her and cook for her and it was like the lights went on again it was pretty dramatic huh and I think you know there's some preliminary studies that are showing that and and you know people have been looking at so the ketogenic diet all starts with the whole coconut oil conversation which is coconut oil is controversial by itself but the story behind ketogenic diets is that we do understand there's insulin resistance the NIH actually funded a study looking at the ketogenic diets so I think the science is there it's just a matter of being able to us to prove it and more importantly to adhere to it ketogenic diets not easy not easy you know it's not new to neurology we've been using ketogenic diet to treat childhood epilepsy for 30 plus years yeah so it's not new it's new to Alzheimer's but it's not new to brain disease it's been used to treat other brain disease for a long long time but you know fundamental is really hard to diet to stick to yeah we're finding you know more and more people are doing it it's like it's one of the hottest diet trends out there right if you look at all the best-selling books it's not mine it's the key to pop right and and we you know we're seeing this much more interest and we're running keto programs at Cleveland Clinic they're our most popular programs which is pretty amazing so people seem to be willing to try it I know you had Dan Perlmutter on a few weeks ago and Dan and I have David Palmer he and I have had an Internet debate about this and I and I will say to you that I think it's more nuanced I think that ketogenic diets that are insulin sparing make more sense in the symptomatic phase of the disease and I have to tell you I look at dizzy at Alzheimer's disease in a dichotomous way there's the pre-symptomatic and then there's the symptomatic symptomatic disease means mild quadrant in dementia and I think there is some logic to a ketogenic diet in the dementia face I agree I think you know an ounce of prevention is worth a pound of cure is Benjamin Franklin I think we you know that the key to Jack that is a pound of cure it's a pound of cure but I would not necessarily advocate for it in the mild in the pre-symptomatic phase I'm more advocating for the for the Mediterranean diet yeah in the priests and that's the beauty of your book is you talk about how to create resilience and the health so you don't need the pound of cure cuz trick the whole first life isn't to be restricted and restricted it's to actually be more resilient create healthy so you actually are resistant to these diseases right so it's it's actually exactly the right idea so let's just dial back a little bit to the genetics okay you kind of mentioned epigenetics right so I don't know what that is I want you to explain it okay and and it sort of speaks to the modifiable ways that we can alter our genes to improve our health outcomes well tell us about so this is a area of great controversy and frankly I'm not sure we have a clear answer for this the idea people said in your in your remarks is that what your genetic profile that you're born with the kind of it's like you're faint and laugh right and people are starting to challenge that idea is that idea and really think about it can I take a genetic risk for Alzheimer's and and create a blithe program that offsets that genetic risk so if I'm genetically prone to getting Alzheimer's can I create a intervention program that would buffer or mitigate or offset that risk and that's the questions about it and we like precision health or precision this is a great example of that and that's a really critical point because if that's true in Alzheimer's we could try that across the board right in diabetes heart disease cancer all those disease states could respond in a maybe not in the same paradigm but in a similar paradigm to alter those risks as well and I'm not sure we've answered that question to the greatest answer that we could have but we're still working on it I think there's people that would say that's possible so epigenetics is a is a fairly new field is very exciting and the idea is that we can say that two things like diet exercise lifestyle stress and sleep lack of sleep that you're turning genes on and off and that that we want in many cases turn genes off but in some cases we want to turn genes on and that would alter our health yeah and it's so possible I mean if food is one of the most important and prevalent things that we are connected to every day they alter our gene expression and this is one of the fundamental ideas of functional medicine so you'd broccoli it tastes good right but it also up regulates genes that increase glutathione which helps you detoxify and liver work better yes and you have green tea catechins but those up regulate genes that increase your ability to get rid of heavy metals so there's incredible research on these components and food yes have these biological effects on our genes and I think it's one of the fundamental tenets of functional medicine which is that your genes interact with your environment to create who you are that's a great moment and when you say environment I mean food exercise stress relationships connect in love meaning right everything's right all those things are things that we have control over right and people think that you go to the doctor they're gonna fix you but the truth is 80% of your health is determined by what you do not with us that is correct okay we we have an amazing opportunity that's just such such a great message that you have in your book fighting for my life because you talk about this woman who otherwise would be in a way facing a death sentence yes who has a plan a hope a roadmap to slow prevent and maybe never get the disease and I hope that we'll have this conversation 10 years when it's AG's still fine yeah now this is super exciting and and there are other things you know that that are sort of being looked at and one of the things that has been linked to brain injury is neurotoxins toxic you mentioned from your mouth but we're exposed to all sorts of things whether it's pesticides or heavy metals viruses viruses we know for example in Parkinson's that it's pretty well accepted that the environmental toxins like pesticides increase their risk significantly right and you know farming is probably one of the worst occupations in terms of your risk of death you're seven times more likely to die if you're a farmer because of some of these use of pesticides so how do these things play a role in Alzheimer's you know there's there's been mixed research what is your take on the idea that things like mercury and our mouth Hawks and this may play a role yes so that's been looked at and that the association's very clear in Parkinson's there's no question about that these associations with heavy metals and pesticides they we do know that some heavy metals impair cognition maybe an impaired development like letting kids we know that right but they don't necessarily have been strongly they have not necessarily been strongly associated with the development of Alzheimer's but it's still being with that but but in a sense it's it's all these things that are sort of coming together to create this stress on the brain right well there's so many things that stressed the brain right so oh I also talked about not just the risk factor for development service but I talked about the cognitive killers right sleep deprivation is a cognitive killer mm-hmm mood disorders depression is clearly a cognitive killer and substance abuse are cognitive alcohol alcohol yeah so the reason I say this to you is that and the calm the j-curve we need to talk about the Jake curve and not too much that's exactly right that's the Jake so the reason I say this to you is that you know a lot of things can help your brain function a lot of things can make your brain function worse yeah and I like to call them to maintenance dimensions I've never used that because it's there's a lot of them it's yeah our inflammatory diet right your daughter's a cognitive kill you know processed food yeah lack of fiber don't help our microbiome be healthy right you know like you said lack of sleep stress fascinating research on you know improving immune function in the brain just through meditation right you know and I started meditating this year 2019 first time I was terrible that's so good you know when you start to look at the data it's like okay it's pretty compelling right it's it's it's a very hopeful message so you talked about like BDNF and yoga helping with I mean you know yoga helping with beat enough and meditation so those are really things that people can do it's not just a hopeless thing and that's the thing I want people to take away from this is that you can engage in your own life plan to alter your risk don't wait you know if people should start they can change their diet today they can start exercising today they can do yoga starting today they don't need to wait and I you know I emphasize over and over again that by the time somebody walks in my office it's been going on in their brain for a while so now was today's the day not later not Christmas not New Year's of next year today's the day you alternate yeah so you haven't changed your type you started running you started meditating I did as a and I was eating pretty healthy to begin with but I said there's more that I can do yeah you know as one of the world's leading experts and Alzheimer's you're reading all the science crap I better I do not have them an Evo III 3 I found out but I'm about to 3 which oh you're gonna look forever I know and you will not get out there the 2 is the longevity genes smoke and drink and eat whatever they want and live forever that's correct and the ones with the double for they got a you know really basically monastic it's really true now one of the studies that came out a few years ago was called the mind study about a Mediterranean diet you mentioned that a bit briefly first of all no one knows what a Mediterranean diet is but there are certain characteristics of that diet that I really want you to talk about that really help the brain so the Mediterranean diet is a convergence of fish whole grains legumes olive oil anteater virgin I'll extra virgin olive antioxidant spices and a little bit of red wine Keela you know tequila is kind of selling themselves is helping your microbiome so we'll see oh really oh yeah but that's why I will say to you that that's kind of the Mediterranean diet and the reason I have to tell you is that of all the places that they looked at the Mediterranean diet they looked at in New York City there was a company there was a Columbia University they did something called the North Manhattan aging project and the Y cap study Washington Heights study and basically showed that people who had adhered to the Mediterranean diet 2200 here to the menu Mediterranean diet had lower risk of progression from mild carb impairment to dementia had lower risk of developing mild cough impairment and were stable more stable over time and of course the question is what of that element is it and other people ask is it epiphenomenon because people live in the Mediterranean but it's not because we studied in New York City so I think that it is a diet that's easy to have and delicious delicious but I also want you to know that there was a paper published I think less in 2019 just a few weeks ago comparing the - the mind and exercise and the combination and showed that the combination worked best but exercise beat diet you're a brain else that's good that's glad I worked out today yeah it's pretty mild right so there's a number of medication trials that are going on there are preventive medication for house like the a4 study tomorrow study there early trial share with us what that research is because it seemed kind of a new approach rather than wait until you get it so the idea is that we can find people identify people who are at risk either through their genetics or through their imaging you take a scan of the brain say they already have Alzheimer changes or other risk factors and say okay on the basis of some risk profile we know these people are very highly likely to get Alzheimer's and then you try an intervention whether it's a drug so the a4 study is trying an IV infusion of a drug that's trying to clear out the amyloid before you develop it in your brain and so that's that's going on we think that's going to be a common platform to do this you know you saw the Columbia South America who are very highly risked for developing Alzheimer's we're trying treatments on them that's the Alzheimer's prevention initiative there's the generation studies looking at for for people like Jamie and see if you can do a prevention on people who are genetically what kind of drugs either I'm not involved in a study I think they were gonna do a vaccine and base inhibitor beta amyloid cleaving enzyme inhibitors so there's a lot of different approaches being tried well seems to me that the most logical approach would be you know sort of reminds me of an article that I read in a medical journal years ago was diet and exercise double the effect of statin drugs like okay maybe combining the kinds of things we've been just talking about creating a better foundation of health right well allow these drugs to maybe work better yes exact right exactly but the problem is we don't study in that way we just study the drug and we let people leave whatever they want into whatever they want and if people think in the funny part you don't most stands is that people think you know I'm honest dad that's whatever I think it's a pass to be be you have bad behavior yeah in the UK I think they wanted to sell them at McDonald's over the counter oh are you serious yeah I'm serious so that's that brings up to a very important point is that people have to understand you just can't go to Costco and buy the whole row of supplements and have a terrible life and think that just because I'm taking the supplements that it absolutely you have to buy it you have to drink the kool-aid you have to exercise you have to eat right you have to sleep you have to reduce your stress you have to take the supplicant just say one thing like it's taking a s--t at cures everything else and you can just be bad you know have bad behavior otherwise yeah it's so true so so combining that the drug research with these kind of finger pointer kind of studies seems like the ideal logical way to do that since it's some of the things we've been talking about collaborating on at Cleveland Clinic which is really exciting and I'm really excited bring together functional medicine and the system's thinking and it's lifestyle issues with so the the rigorous science that you do it's just I'm so excited I'm really excited about it too yeah it's great and you also been thinking about creating a preventive clinic for correct there's not many out there they're not and we've been in discussions with very important people in the universe who really want to see it a prevention claim not in America but in the whole universe who are really vested and invested in seeing prevention clinks move forward I it's kind of out-of-the-box thinking but I think this is the time to have those kinds of out-of-the-box ideas yeah I think it's it is important because what we've been doing doesn't just like what Einstein said you know you can't solve the problems with the same level of thinking that created them more that we use that aren't fixing but this is a paradigm shift as we started earlier in our conversation we're going to go from treating disease to treating health mmm-hmm this is like this is the gospel for me I know it is this is exactly what I spent my last 25 years in medicine doing which is thinking about how do you create a healthy human yes what are the impediments to health how do you get rid of them and what are the ingredients for health and how do you provide them and it's really a very simple notion right I mean it's you know one of our mentors Sid Baker was one of the I think one of the greatest thinkers in medicine ever was a Yale professor and he said you know just ask two simple questions when you see a patient what is it in their life that is disturbing their health like what is it that doesn't agree with them right is it a diet lack of exercise is a toxin microbes allergen and one of those things that the organism that human needs to thrive their particular unique needs because some people might need you know 400 micrograms of folate that you can buy over the counter some people might need five milligrams of methyl folate a special kind because they have this unique gene so it's really about finding the unique needs optimizing with each person needs and creating the opportunity for the body to heal yes you know and that's where I think precision medicine is going to come on board is that we are not all the same yeah and that we can now with using molecular diagnostics determine the differences between you you're right you might respond to folate I might respond to methylfolate because our genetics are different right and so this is really it's precision medicine but it's also precision health decision something has to sort of up and medical education up in medical practice it's not what we're trained to do but it really is how we're gonna solve this epidemic of chronic disease and I have to say to you there's one statisti up to a third of dementia is preventable I hope that's true I would love to prove that yeah III would maybe be even more optimistic than that I think when we learned all the pieces together right you know you talked about this idea of a multimodal study that was the finger study which is in a way not something well accepted in medicine no you look at the randomized clinical trial which is one drugged for one disease with one outcome correct and it's great for studying drugs but the truth is you know you can't just say oh I'm just gonna test diet but I'm not gonna care about people's exercise or sleep or stress that's great happy with almost you have to do with all that and I think that's what and that's why I started with the you know the the physician scientist she's very thoughtful very highly respected and that's the key here is that with the science was done rigorous mm-hmm I think people inject their biases and they they don't really kind of take an objective approach so that's why the rigor of the science matters are so important yeah and then and it's it's a tough thing to struggle with because you wait the way the NIH is set up a national inch of health where research is organized it's not around studying systems and complexity or now and the truth is the brain is infinitely complex it's influenced by complex factors it's not gonna be a simple one drug fix that's correct I mean we're just we've been just running down the rabbit hole and and and this is a huge message of hope it is and and in the book and I want to sort of I want to broach this subject because it's a little bit scary for people think oh I'm forgetting things or I about sums are my family I think my brain isn't as good as it used to be but I'm not gonna go to the doctor cuz what are gonna tell me I'm Alzheimers then I'm just gonna be depressed and miserable and I'm just gonna wait and they don't go in but you talk about ways in which you can assess people early and how important is to assess people early and what diagnostic things they should do so can you go through some of the Diagnostics that are available today that help people to become empowered to change the course of their health so I have to tell you early assessment diagnosis is paramount people as you said they kind of avoid delay going to the doctor when in fact we know that we believe very strongly the early interventions even something like a finger study could respond or delay the onset of or progression of symptoms so reverse or reverse it so that's why it's so paramount the fundamental issue is is that people and I have to say that I think the public well-informed would be interested you know people we did this with a generation ago you have chest pain you may be having a heart attack the public campaigns worked right now and then 25 years later that it was stroke you know brain health or what was a brain death I forget what the saying was about the stroke know the signs of stroke and then you get it so treatment you get treatment like correct clot dissolving drug time is brain I remember that's what it was the reason I say this too is that if we informed the public to be aware and mindful of what symptoms look like then we have to inform the medical system primarily particularly primary care physicians to be comfortable to assess screen diagnose and manage dementia and that's I think those are small issues but they're large issues because I think a lot of doctors don't feel comfortable with that and it's one things we need to do is educate physicians as much we need educate it's not that hard we can get into I want to get into more of the sophisticated diagnostics but I mean I understand a screening of my office had their day with a patient but all the MOCA tests wretches love the MOCA yeah which is a Montreal cognitive assessment tool where you have one sheet of paper with a bunch of questions and some drawings takes 5-10 minutes correct and it's pretty good it is very good pretty good it's not like a four-hour neuronal test but it's pretty good it's pretty hang out and it's something can be done by a family doctor by a nurse by you know a medical assistant my medical assistant does it before I walk in the door every time I see a patient's right and and then you can you can do that pretty easily as a primary care doctor that's why you here in New York to Train primary care doctors on how to do these earlier so that is correct so once they've done that then what then the the MOCA comes up and their scores low what do you what do you have available just start to look at for these patients to treat what we were trying to see now is a seat change in our approach historically the way we've approached diagnostic is what we call a diagnosis of exclusion right we do an MRI of their brain they don't have a stroke they don't have a brain tumor they don't have water on the brain we checked their thyroid we check their b12 they're normal so they don't have these other conditions by default they must have Alzheimer's dementia or Alzheimer's disease mm-hmm the problem with that is that that turns out to be grossly inaccurate Oh best case scenario that's only right seventy percent of the time so one out of three and one between one out of three and one out of four times we're just flat wrong even the experts like me were wrong three out of ten times so the reason I say this is that we're seeing now a transformative process in the medical field going on we're seeing the idea that we're going to go from a diagnosis of exclusion like I just told you Toye diagnosis of inclusion spinal fluid genetic markers PET scans the PET scan is a brain imaging study looking at blood flow blood flow but now we can actually manage as you don't see the the plaques themselves it's very expensive not covered by Medicare but we can have grand a pop it's about six Argan but I will say to you but it is allows us to be precise we are not not guessing anymore we can make a diagnosis with greater than 93% accuracy without the guessing elements so the reason that's important measure the volume of the memory center in the brain which is a campus that shrinks as you get all that is correct I had mine done I was like 90% I was and you're in good shape because you're to 380 mm gonna live forever and you're gonna think my wife's gonna be happy about that's good that's good so I will say to you that there's clear evidence that we can measure these things and not be guessing anymore and that allows confidence what you don't know that we may know what's very exciting the newest development in my field is that we're seeing now the possibility of a peripheral diagnosed a blood test yeah to diagnose Alzheimer's disease like a PSA yeah or like a hemoglobin they looking at they can now measure towel and amyloid in plasma in the blood in the blood and this is this is brand-new stuff there's a we are probably only two years away from a blood test or some people even looking at the library spit in a tube and you can tell if the family in there in the saliva so there is we're we're a couple years away from making a diagnosis put something simple like a blood test or saliva and how early can that pick it up is the amyloid scans the PET scans can pick up 20 or 30 years yeah for there we're not sure how early that go how far back that goes but and I will say to you that I don't think that's gonna be an inherent diagnostic what I think it'll be as screening measures so let's say you have a little bit of memory issue you go to the doctor use you get a blood test it's normal then that would warrant more investigations they would not say uh-huh but it's like a mammogram that you do before you have cancer you could we're still making that determination it's very exciting and and you also look at other factors too right so so there's a lot of stuff in the book about how to map out your risk and to not be afraid of going to see a doctor in fact encourage people to go get help because there's so much that we can do that is exam that we didn't even know we could do you in just a few years ago that's exactly right so this is really a great message of hope you you quote a Desmond Tutu in your book yes South African cleric and Nobel Peace Prize winner you said hope is being able to see that there is light despite all the darkness so that some sounds sums up your message is pretty good it is there any last things you want to share with people about this condition and what they should know and I'm just grateful to be on your show I'm grateful that we talked about the book I do want to say to the your audience that you should go and engage in your health and try to alter your risk starting today don't wait don't wait and should we get tested for genetics so that's very controversial as you know and the American Academy Neurology and other bodies would not recommend testing of people who do not have symptoms and yet commercial testing now can be done without genetic counseling so it's controversial I would tell people not to get tested and the reason that we would tell people not to get tested is because of a law called the Gina act the genetic information non-discrimination says you cannot lose your ability to get health care insurance on the basis of your genetics but they exempted long term care insurance I have to taste a funny story on my 48th birthday I bought long term care insurance who I better do that I'm 59 and I was gonna say I'm 53 and the lady comes to her home and she's like you're awfully young to be getting long-term care insurance I said lady if I do what I do for a living you'd be getting long term cancers do so my point is is that you know people need to be careful when they manage their genetics if they're curious so again long-term health insurance first dentist that's exactly if they're curious you need to be careful on how you manage your own or genetics and and don't look back on something we didn't actually get a chance to talk about which is that there is no such thing as just dementia there are many dimensions right same dimensions like saying cancer right if I say cancer you say what kind if I say dementia you should say what kind right dementia just means a memory or cognitive decline severe enough to cause a functional impairment yeah so all Alzheimer's is dementia but not all dementia is Alzheimer's Parkinson's Lewy body dementia which is what Robin Williams had and I understand Ted Turner has been now you guys Lewy body dementia strokes vascular dementia and a variety of other conditions I will tell you Lewy body dementia is much much more common than most people think yeah there's a million cases of in the United States yeah but it's a it's a disease that nobody heard of but it's very common it's true and I've treated patients with it and I just wanna share a story of this patient who is was actually a very well known person who was in her early 80s and started having motor instead of a mixture like Parkinson's and Alzheimer's no way and she was having trouble walking she was having trouble running her business she her she was quite dysfunctional in real life and we identified all these factors you know that were fixable she's a terrible gut issues her whole life was constipated took enemas laxatives she had terrible irritable bowel she ate she had diabetes and no one had even diagnosed Oh blood sugar a1c was like nine I think and she she had significant B vitamin issues of b12 and folate and a few other little things and we just fixed all those little things but it was amazing what happened to this woman and I listened I'm not a neurologist I don't see all these patients like you do but I just follow basic principles right like follow the laws of nature right how to get people healthy and brush your fingers as I do and within a month she was significantly better within a year she was walking out of a wheelchair she was going up and she actually wrote a book Wow cool recorded an album well functioning better than she ever has in like and all her numbers got better at a paper yeah well maybe you can help me with I would love to right that's awesome yeah it's and I've seen these these one-off stories but what they tell me is that by applying these principles of creating health that we can really modify these diseases in real ways they have to tell you you know Alzheimer's so dominates the bandwidth that people don't even think about other conditions what if we could alter many of these dimensions not just Alzheimer's well there's a great paper that was in JAMA years ago was called shifting thinking and dementia and it says that we combine categorical Mis classification with etiologic imprecision and an English that means we categorize people according to symptoms not according to causes oh so I don't you've seen that but it's a fascinating paper because it's we're really good at naming diseases right and categorizing things according to the symptoms but not according to the actual cause yeah and functional medicine is much more inching the cause right and so that's that's what I go order there's common cause of disease inflammation its mitochondrial issues it's got issues it's you know hormonal regulation its toxins and we just work on that stuff nutrition and it's really it's really exciting so I can't tell you how excited I am that you now are leading Cleveland Clinic's Alzheimers dementia program that you have this incredibly open mind you know as Groucho Marx said keep your mind open but not so open that your brains fall out I think you can so I think you're one of those guys you're still critical and rigorous in the science but still open to ideas that could really change the world so thank you for being on the doctor you very much and you've been listening the doctors pharmacy if you love this podcast please share with your friends and family on your social media leave a comment we'd love to hear from you and we'll see you next time on the doctors pharmacy thank you [Music]

Channel: Mark Hyman, MD

Views: 63,694

Keywords: Dr. Marwan Sabbagh, alzheimer’s, dementia, parkinson’s disease, aging, brain health, diabetes, Dr. Mark Hyman, The Doctor’s Farmacy, preventative medicine, memory loss

Id: eWO0QlRCVUE

Length: 53min 3sec (3183 seconds)

Published: Wed May 08 2019