When you look at the factors that stand out that contribute to better brain health, its nutrition, its exercise, its stress, its sleep and the one that we added, it's cognitive activity. So when we wrote the first book, we came with this acronym, Neuro and Nutro, you know, and as for nutrition, E for exercise use for unwind, which is stress management, not just getting rid of stress, but increasing good stress and getting rid of bad stress and ask for restorative sleep, deep restorative sleep that helps cleanse the brain and has its own function and optimization of cognitive activity.

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. We're talking about a restorative sleep where people go through the four phases of sleep four to five times a night, deeply. So sleep and investing and sleep is profoundly important. And then there's optimization, which is challenging mental activity. So all of it has to be done and all of them have to be done together.

And it's not just a guide to shore. 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 percent reduction in Alzheimer's dementia, stroke without any biohacking or vitamin D or any of that stuff. Would regular things you have in your environment? I am Dr. Dean Shirzai. I'm Dr. Aisha Shirzai. And together we are Shirzai M.D. and this is the Rich Rural podcast.

The Rich Roll podcast. Hey, everybody, how you guys doing? Welcome to the podcast. My guest today, very exciting are husband and wife, neurology team doctors Dean and Aisha Shirzai. Together, this highly credentialed duo are co-director of the Alzheimer's Prevention Program at Loma Linda University, where they study all things brain health with a particular focus on lifestyle interventions to prevent cognitive decline and neurodegeneration. Here's the thing. Chances are there's somebody in your life who's impacted by Alzheimer's because it's a disease that is exploding right now, currently afflicting well over 40 million people worldwide, with incidence actually predicted to triple by 2050, which is very alarming.

And although there currently is no cure, what most people don't realize is that Alzheimer's is not a genetic inevitability. It doesn't need to be a death sentence. And in fact, 90 percent of all Alzheimer's cases can be prevented. And so what distinguishes the Sherpas from their colleagues is this unique focus that they have on prevention. And they've had pretty remarkable success, significantly reversing cognitive decline and adding vibrant years to many of their patients lives. Assures first graced the podcast a couple of years ago.

That was Episode three thirty to talk about their first book, The Alzheimer's Solution. And today they return to bring us up to speed on the latest science on brain health to discuss their new book, The 30 Day Alzheimer's Solution, and of course, to provide you with the information, the tools, the nutrition and the lifestyle prescriptions that you need to optimize your cognitive functionality and hopefully sidestep the neurodegenerative diseases that begin much earlier in life than most people imagine and ultimately and devastatingly afflict far too many.

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I should also mention that if you enjoyed this conversation, then check out their podcast, Brain Health and Beyond, which is available on all the podcast platforms.

OK, let's get into it. 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 more difficult to entertain new ideas.

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 in. The walls are so solid that it's difficult for you to actually make a new path. It moves right. And it requires a lot of reflection and judgment and being okay to make mistakes and the discomfort in being uncomfortable, the comfort in being uncomfortable.

Right, right. Right. They can help you set new ways.

But yeah, I mean, it does seem like that becomes much more of a challenge. It does. It does.

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 because our political stances, everything is around this concept of being OK with change.

I always say about five percent of population is future Seekers'. The other 95 percent is past protector's.

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 the system, in society, in the world, around us is by those five percent or 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 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 seven seven, seven seven to go to a new path that is unknown 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 or environmental component. The genetic anxiety.

Is that the core of all this stuff or a term that is like anxiety? We using anxiety as a jux, 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 is at the beginning is genetically.

You can see the children. We have two children.

Oh, trust me, we're going to talk about them. But they're both very precocious. Yeah, incredibly.

But that's the understatement of the century. Go ahead.

Very different. Very different. Alex, is what you could see when you when you were. I'm not putting him down because this is not a weakness. This is just our proclivities. We can change you 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 the very thing?

You're supposed to be threatened by no threat. So that threat aversion versus not the part of it is intrinsically ingrained in us.

Part of it is actually data shows part of it's actually program.

How your mother reacts to anxiety provoking moments, mother, because the mother's there all the time, whenever you're around the most and how they react, know how they promote challenging situations and anxiety provoking situation, how they react with it and how they deal with it is the forget about leadership masters.

I got to forget about that ends and starts there. Yeah. You create situations that are a little bit anxiety provoking.

You feel nothing. Oh, my parents didn't react badly. You succeed. Great.

How you react and how does microenvironments 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, 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 there's going to be some pushback. Right. There's a disincentive that's that's putting up against somebody's willingness to entertain new ideas or try new things. It's always. Yeah.

And the culture that's been set in place that creates an aversion to change the language, the micro languages that that anything that somebody brings that is a little threatening to the status quo.

You have things that are, oh, this is this is arrogant, the word arrogant to push away people who have new ideas is universal.

It's such a ubiquitous silencing technique. Yes. 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 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 creative expression, and most are pretty regimented around what's OK 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 of the case as opposed to, you know, the slim five percent or whatever it is?

Yeah, well, we met in Afghanistan and 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. We love the medic. Know we're part of the. No, I'm not comparing the medical community here to the Taliban. No, no, no. I mean, that's just their mentality, that's all.

Not just, you know, 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 there.

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 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 that the language was much more sophisticated, but the blockades were the same protection of the status quo.

That's why I mean, when we talk about dementia, we talk about stroke, we talk about mental health.

Even now, the repetition of the same patterns over and over again.

I'm now some other studies are starting with clinical trial and with 100 people, 50 people in six months, we're done.

We know what works. We're hopefully plant based, but reality is, if you go 20 percent better than what the standard American diet is, you'll do 20 percent better in your health care. What does that mean? That means an Alzheimer's that's 80 billion dollars saved per year.

Right.

Right. Well, it's been a couple of 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 we are seeing a lot of 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 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 now.

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. You guys, I'm delighted that you're here today.

We're going to pick things up where we left off with them a couple of years ago, but. I got to get this out of out of the way first, I got to talk about your kids because I'm obsessed with how accomplished these two young people are. You've got your son, Alex. He's is he 15 now?

He's 15. He's in college. Yes, right. Sofia 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.

But just to give listeners, our viewers, a sense of what's going on here, Alex mastered calculus at eight, correct?

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 international neuroscience conference.

True or false? Yes, true. Okay, he's a pianist. He's a composer. Meanwhile, Sofia was reading fluently at two and a half.

She was? Yes, good lord. 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 L.A. in 2017 and 2018. 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.

And congratulations, by the way.

Oh, no. No, not at all. The most important thing is.

So I'm sorry if the mother she's she's actually the reason. No, no, not at all. No, I think it's teamwork. And I think I just want to say something first. 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 and five years after they go through their teenage years, but 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. It's a challenge even now.

I mean, the expectations, as I said, sometimes bombastically, that the secret to life is management of expectations.

But it's Michael expectations minute by minute expectations from so early on.

It wasn't about them following your curriculum, throwing things in front of them in the shower curtain was the periodic table and the wall was the map.

And so throwing in front of them and seeing what which proclivities and then you build around that and build around that small micro almost like, you know, skinners reinforcements.

So you saw a little bit of improvement here or attention and then you you moved it along or moved along.

And then before you knew it, I mean, Alex had one of his proclivities early on was it doesn't matter what it is, if you find that little Naidus, it just grows. It was memorizing capitals.

So by two and a half, three.

Right. He had memorized and we have video memorized all of the world's capitals, all the state's capitals. And I couldn't even I'm terrible.

I got to know Nana Revo Antananarivo, remember. Yeah.

So, I mean, you would show misshape and he would say, oh, this is this country in the cap. I 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 was like, Who's Molly, honey? No country, Molly. And he would just take another look. Kenia it's just like a visual learner.

It was so amazing to see him absorb all this information.

Again, I work in progress.

We have the teenage periods where they get, you know, the frontal lobe and we tell them, there it is, there is the emotional brain taking over.

But reality is, 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 are 15000 to 30000 connections, one quadrillion connections, one times tentative, fiftieth 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'll 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 Petrov's 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 deal. 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 calling deficient because they're not getting, you know, eggs 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, 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 one selves 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. And after a while, we saw that the the speed with which they were learning was probably inhibiting them to be creative in that environment. And there were a couple of stories 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 realized that I think Dean is fearless and he's way more fearless than I am, he said, 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, but it was just a an amazing. Example of how the brain works, where they would just, you know, go deep into a subject and progressed so much into it that a point can work. We weren't able to help them with their homework anymore.

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 they took their seats and they did very, very well. And we were thinking for our program.

How old were they when they did the SATs? They were 10. They both they both did.

I remember we we went to the woods at 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 in the hallway for him and we were so scared. Yes.

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 all in all, he he just aced it. Wow. It was wonderful.

I feel bad for the kids that were flanking him on each side.

Year old taking the test next to them.

The thing is, I mean, it's not about so much them getting high school at 10:00 or it's about, ah, it's not even about school or college.

I mean, we're I think we're the only parents, although they're in Caltech at Cal State, L.A. right now, has a special program called him. We tell them, you know, if you drop out of college, doesn't matter to us. Yeah. I mean, for somebody you know, my cousin say that we have more degrees than a thermostat.

It was useless for all of them. It's not about that.

It's about creativity. It's about this incredible potential of the brain being off offered 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. And finishing a high school early or college are great.

What can you do? Not bring this incredible potential of the brain to its full fruition?

That's that's the goal in creating a love of learning, lifelong learning. And there is something to touch on. Something you said a second ago.

I share about about depth versus breadth, 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 three hundred and sixty 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.

Yeah, absolutely. Well, we've we've witnessed it firsthand with the kids where 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 it really becomes a part of your experience as a person.

Right. You're not going to forget that. No. Right.

Amazing. Yeah. All right. Well, I think it would be worth taking a few moments to just share a little bit about what you do and your experience. I mean, as I said earlier, you were on the show a couple of 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. 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 Herron's in different villages to talk to women of. 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 cute, like a rom com guy. I'll tell you the true version.

Yeah, but I was I was amazed at him with all the amazing community work that he was doing, which is a whole another story.

And we talked about our grandparents and we were just so amazed at how these incredible human beings, our heroes are intelligent, 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 we we talked about them and we were kind of blown away that these these people with this kind of my capacity would actually succumb to Alzheimer's.

And so we came back to UCSD, which was the main dementia number one neuroscience program, it with Leon Thol and was a giant. And we worked in his clinic and his lab. I said, it's amazing work with that from our eyes 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 and mice, they all get better.

I mean, every day you see a publication, you know, this drug work. And then when you look at 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 are risk takers. And we said we're going to go to Loma Linda because most of the lifestyle stuff that were coming to us of the work that Elizabeth Barrett, O'Connor and others were doing were working what was congruent with Loma Linda, which is a Seventh Day Adventist institution where they've shown lifestyle has a profound effect on brain.

So it was 60 miles away or 80 miles. Right.

We called like a cold called the dean of the university. I said, you know, I'm coming from UCSD. Can I start a brain and brain center here? And so, absolutely, we went in and started a brain health institute. I should a double fellowship that will residency preventive and neurology.

I went to preventive medicine. And 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 Illinois, 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 is contesting that fact.

Five miles away across ten, you know, San Bernardino, one of the unhealthiest place.

So it's not an environment. It's not even socioeconomic and racial. There's a little bit of it is it is the most important thing in public health access, access to information, access to resources, access to health care. There's a huge disparity where a Seven Day Adventists are health center 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 old was struck 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 realized that Alzheimer's stroke, dementia can be prevented. And initially when we came out like 10 years ago, the incredible pushback. Whereas two years ago a, you know, Alzheimer's International Conference and the big plenary talk, big sign was prevention. Is the new treatment. Oh, that's amazing.

Yes. I don't think we ever hi5 in a conference, but we were just so happy that finally they're there recognizing the importance of lifestyle.

How many practitioners are there in neurology right now that have prevented a preventive focus?

Goodness, I don't I don't know if maybe we don't know in neurology.

I don't know if there is. Hopefully, yes.

Hopefully there's going to be a speech from somebody, but not so many people doing it. No.

And, you know, and it is interesting, like when you started it was considered career suicide and to, you know, plant your roots 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.

They're 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, 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.

But that makes for, you know, you know, a ripe environment for doing the kind of work that you do to kind of ab test.

Yes. These populations.

Absolutely. 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 two healthy factors, healthy lifestyle factors, whether it's food and opportunity to move naturally or stress and so on and so forth, but access to information and access to resources to apply that in their lives and to have health as a part of your language every single day where you see left and right in front behind you, there's health everywhere.

That is what differentiates between two communities, you know, one, when the Seventh 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 know its situation. I mean, all of us get caught up in the in the cycle, and especially when when you have to work continuously the closest healthy food resources 20 miles away.

So it's so with that in mind, initially we went to Cedar Sinai as the director of brain health program there, prevention and and then an opportunity arose where in beach cities, which is Manhattan Beach, Redondo Beach, Hermosa Beach.

They had this program that Dan Buettner, our friend that had started, that's one Redondo blue zone cities that created Blue Zone.

And they had done such an amazing job as far as making it a lived concept that they offered is there are 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 leave Cedar Sinai one day of clinic for Hollywood.

Crowd You're insane.

Yeah, but it's been so long since the two years that we talked, we've been actually growing that program. It is there are there are other studies like Poynter and others that are doing clinical research on lifestyle. Bring but again, more of a laboratory kind of a thing.

This is a live concept, I think we don't need to we don't need to recreate know whether, you know, what is it broccoli works versus, you know, beef jerky. We know.

Yeah, I think I think we know that already. Yes. There's enough information. I don't know. There are some people that are confused about there. Yeah.

There's always going to be noise. There's always going to be people who are going to say the earth is flat, will 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 community.

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 information.

And we're really excited about that, because I think one of the things that what one of the things that fails in most studies is, again, not understanding what works for at an individual level and at the community level.

I think if if we find out specifically 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 acclimate to that new healthful environment. It sticks. Otherwise, it's just me giving someone a brochure and say broccoli's good.

Right? Right. I mean, that's that's a play right out of Dan Beutner's playbook, which is you have to create the environment that's conducive to the healthy choice so that 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 tremendous. It's scary.

You know, everybody talks about Alzheimer's and dementia as if it's a disease that just starts at one point. 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 addressed that. And it's not just brain health.

You know, 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 us. It's that isness. You know, it's it's the sense of 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 alarmed and 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 as 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 are 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 GWAS 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 driven by genes, meaning that if they have these genes, they will get it.

And genetic terms, it's called 100 percent penetrance like Huntington's disease.

If a person has the Huntington gene on that chromosome four, they'll get it right. But the percentage of Alzheimer's cases that are like that is only up to three percent.

The other 97 percent are affected by genes, but they're they are only risk genes, meaning that those genes increase your risk, but they are not a foregone conclusion. It doesn't mean it doesn't mean that you will get it. The next highest risk gene is APOE four.

About two percent of population has a boy is a boy for positive, so if you have one of those genes coming from one parent, your risk goes up four times.

If you have to one from each parent about 12 times, that number varies, but roughly that 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 percent don't get it. Why?

And when you look at the data coming from Nigeria, where the population had higher proclivity for APOE you, when they came to us, the disease went up.

When you look at the studies that came from UK, which lifestyle increased risk six times, even in lieu of Apoe before you realized, even with the higher genetic risk of a plea for 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, are all our lifestyle genes.

How your lifestyle affects those genes, which means you have control over. Even the most benign studies, the ones that had minimal effect, the mind study and other mine study just looked at diet very well done.

Study just a diet adjustment, reduce your risk of Alzheimer's by 53 percent. Wow.

And that was a watered down version of the diet we think is optimal at what how how how long would you need to be 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, childbirth, like multiple variables.

But in reality, if you're on the 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 the bacon and come off that you know, well then the more years you pass, I believe in smoking. It's after five years, five to seven years, seven years.

You back to baseline, right?

Meaning you're back to the lowest risk factor.

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 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 idea density.

That idea density. Yes. It's a great, great concept. They both both our grandparents had immense idea density 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, high sedentary, bad food, then exercise. Philosophers are not supposed to exercise for some reason, but so you have to do all of it, right. We'll be right back. But first, we're brought to you today by Audible, a leading provider of spoken word entertainment all in one place. I love reading, but probably like you, my life is nuts. It's kind of insane.

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All right. Back to the show. 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 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 are going into the brain, you know, putting things in your brain and taking them out, et cetera. And and when you think about, you know, heart disease, 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 but you put it beautifully. 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 about two percent of your body's energy.

And when you look at the tissues and the vessels, there are the same vessels that are in your heart and in your kidney in your body. I'm a vascular neurologist. 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 in 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 and to end, it would span about 400 miles. So just imagine all of these tiny hairline arteries taking in oxygen and nutrients to these susceptible areas of the brain for this this incredible organ organ to function.

And at any moment, our brain as little and as small as it is, it can consume up to 25 percent 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 cardiologist friends don't really like that, but we said 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. Kaczynski from Canada and he summarized the concepts. But the vascular factors actually predate, you know, the popular thing that we hear, amyloid plaques and tangles.

Vascular pathology predates those things with the newer tools, with newer, more sophisticated Amara's.

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 percent plus you can avoid Alzheimer's, but more importantly, sustain cognitive capacity and grow cognitive capacity.

We we know that our we don't use the full potential of the brain. And 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 are overwhelmed. Multitasking, which we say there's no such thing as multitasking, is doing multiple things badly. Right. It just accumulates and accumulating. 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 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. Super interesting.

When we think of again, back to the kind of heart analogy, we think of plaque build up 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 not a good stroke.

It's that it's 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 between the neurons in between neurons. Right. OK, 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 are learning more and more. The neurofibrillary tangles are really interesting.

There are these scaffoldings that hold the microtubules inside the cells. Then the microtubules are it's it's almost like we're doing we just got the occulus.

And I was doing the and it's a crazy thing.

We're doing the roller coaster thing and you see this roller coaster throughout the planet 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 phosphorylation and they come off and then you see these scaffoldings fall apart and klop together.

So from for many years, we've thought that that's a separate process, it's a genetic proclivity, and there is there are those three percent variety. But we know that inflammation also attributes to that multiple traumas that I had 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. Correct. We have control over those. Right. Right.

Yeah. So that's amazing.

Like, just just just the realization that we do have some domain over this thing that we've always kind of thought of is 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 damage to the arteries or sustained attack, let's just say, you know, and attacked the system. So the body and the brain especially is constantly trying to reverse any damage. You know, we have damage control mode and we have a thrive mode. 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 a 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 MRI's. What we see is these patterns called white matter disease, white matter diseases when there is damage to the blood vessels.

And so those parts of the brain are inflamed, but 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 want 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.

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.

Oh, absolutely. Absolutely, because it's variability in high blood pressure that matters as well. And I'm so excited about, you know, new technology coming out, whether it's, you know, the watches or, you know, any wearable devices that can give. 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 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 difference with the difference between all of these terminology.

Yeah.

So dementia is the umbrella category and dementia is 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 directions.

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, we, without knowing you, kind of pass off your activities to others. And when you ask the family, 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 checked them, they have had loss of capacity.

That's dementia. It's an umbrella category. Alzheimer's is a subtype of dementia. It's a major one, 60 to 70 percent of all Alzheimer's dementia is Alzheimer's. But there are other types of dementia, such as frontotemporal 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 frontotemporal dementia is more genetically driven, that dementia is early in life.

Sometimes it affects language. So like primary progressive aphasia, the person 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 synuclein 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, then 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 covid now in the west, we're talking about about six million individuals in US. Thirty five million worldwide. And this number we have to read, 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 had recently 47 million people worldwide.

Yes. So we have to change it. Yeah, yeah, yeah.

And and estimates are that it's projected to triple by 2050.

Yes, it is. Yes. And so everybody is going to be impacted.

Everybody in fact, even now, if you if you ask families why did my PhD thesis run community based but participatory research and the and the minority populations and and those populations are 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 covid did in the tsunami.

This population was the most affected population in the world, the Alzheimer's population.

But the cost, the second costliest diseases, heart disease at one hundred twenty billion cancers, 70 billion combined Alzheimer's direct cost three hundred five billion, indirect costs, two hundred and forty billion right now.

And it's climbing up to one point one to three trillion dollars directed and our by 2050, which will collapse our system altogether. 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 Aricept, Namenda, 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 symptomatic, but a lot of money spent there and care, nursing home and others.

The indirect cost 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 all of that.

That happens.

Right, right. Devastating. And on top of that, we have covid right now. And covid is it's really drastically impacting the Alzheimer's community. Right.

I got I saw on Twitter like two days ago there was a Barron's article about this that was like trending, you know, what is the future of Alzheimer's look like? And I know that you guys 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 so multifactorial. Like Dean said. I mean, the numbers are scary. We were we were actually reading an article the other day, and Alzheimer's patients are dying faster, not because of the infection or covid related consequences, but because of their disease. I think the number was six percent higher rate of mortality in that population. And it has to do with loneliness, disconnection, isolation, isolation from human experience. And, you know, the brain is hungry for information and for connection.

And when that withers away and 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, mundane conversation about food or clothes or just a normal walk in the park and the the basically the brain just completely withdraws and withers away.

And there's profound 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, 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 now, right? Anxiety. I say you and I and we treat anxiety more than we treat the memory component because it's a quality of life issue, isn't it? I mean, and patients with Alzheimer's anxiety is ubiquitous and rapidly growing.

I and I give an analogy like and it's not a patient that 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, then a different country, then 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 reason for the greater mortality is not so much that because they were enclosed environments, therefore they suffered from also from a covid, but because of the greater loneliness in the population that could afford that the least.

Mm hmm. Yeah. I mean, I've had some personal experience with with people that are suffering from Alzheimer's.

And my sense and this is just purely anecdotal is, first of all, you can you can read the anxiety coming a million miles away, like you could tell these people are not settled in who they are, that there are some confusion. And what I see more often than not is almost like a veneer of of denial 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 is 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 that experience, which was profound and important.

And I should have been more aware and but but that that's she is 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 distinct and 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. The others push away the fight and it's not a not often, it's not a conscious awareness that something is wrong. It's a discomfort that manifests in those two outcomes. 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 the Alzheimer's is coming and the manifestation is this behavior and all and turns out really bad.

And with my grandmother, it was 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 think, again, it it varies it depends on the history that the caregiver has had with the patient, 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.

There are two separate things and I entities 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's saying she was part of her church, so on and so forth.

And slowly she started forgetting things and now she can't do any of those things. So the family and the caregiver 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 a reminder of who she is and how she's contributed to this world and the symptoms of forgetfulness, of making mistakes, of seeing strange, inappropriate things or acts that are inappropriate.

That's the disease. That's not her.

And that that resolves some of the anxiety within the patient with the caregiver.

Caregivers tend to have this need to fix things. We always want to fix people. We want to fix patients. 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 then actually has this beautiful I love that that you do with 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 his wife is still the island, the central island that's connected.

So 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 terrors 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 experiences when you went to some island as a family or some some some, you know, some resort or somewhere.

And you had that enjoyment and he or she remembers that 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 Bill, 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 anxieties just rest.

Yeah. And you build on those islands, especially early on, build on those islands of memory and connect them for their own. And that becomes your best anxiety reducer.

You know, what's another great island which actually passes way beyond the loss of language music?

Hmm.

Repeatedly we've seen where this person can no longer connect with anybody and now they can't even remember 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 the oldies.

So you use those stories to create a latticework or like a matrix that forms the underpinnings of identity and that gets rooted in that.

This is not fair. You know, so much that's beautiful.

But also nobody nobody wants to befall this fate. Right. 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.

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 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 in 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 train from the Northern Manhattan study or from the Rush 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, its nutrition, its exercise, its stress, its sleep, and the one that we added, it's cognitive activity.

So that's the one with the optimism. That's right. So when we wrote the first book, we came with this acronym Neuro NCUA. Oh, of course, it's self explanatory. And it was good because we're neurologists and helped us a lot to get together. It came together and, you know, and it's for nutrition. Knees for exercise, use for unwind, which is stress management, not just getting rid of stress, but increasing good stress and getting rid of bad stress and ask 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. And yet also I mean, I think the nutrition piece, everybody knows you got it. If you want to take everybody, you got to eat. Right, right.

Sleep, exercise, 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?

Is there one that stands out as more important than the others or do these all works? Work, obviously is the holistic thing. So they're all interconnected. But if you had to pick one, is that even possible?

I don't think it's fair. I guess I don't sleep at all in a perfect diet is not going to matter. 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 now?

I fully agree with you. I think all of it has to be done incredibly empowering to know that, because every time we say to somebody says, oh, my you know, my friend did all of it, but none of us did all of it.

And we're talking about living a let's I'm not the food part is pretty specific.

I mean, we don't have that many communities that lived in the way that we were talking about. And we'll talk about it. You know, as far as healthful food, health plan based, we're talking about exercise, significant exercise.

We're not talking about whenever we talk to our patients. Oh, I got Deen. I'm fine.

I would do the gardening I do to walk, you know, or, for example, my patients when they say I'm walking all day long from my living room to the kitchen, back to the living room, that's all that's got to be a significant amount of exercise and then a stress management.

It's not about just getting rid of bad stress, by the way. We none of us are doing that. Well, and it's not just because you meditated.

Meditation is phenomenal, but it's got to be an all day, but also a good stress. 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 a restorative sleep where people go through the circadian, you know, the four phases of sleep, four to five times a night deeply.

We invest in incredible resorts. We've been invited to different venues.

I say take that money and put it in a in your bedroom. There's a reason why we're knocked out evolutionarily. How would it make sense that you are 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? Yeah, we study.

We're doing the largest one with the sleep study is shows that 70 percent increased risk of dementia for those who have bad sleep. And then there's optimization, which is challenging mental activity. If you think you retired and you can go lie down 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 of this brain, which is consuming 25 percent of your body weight and realizes, oh, I'm not being used, especially at a time where you're aging and what it will do is 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 the diet de jure or the new resolution, walk, 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 percent reduction in Alzheimer's dementia, stroke without any biohacking or vitamin D or any of that stuff.

Would 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 big 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. Really is. It really is. And so I think more focus needs to go towards that. The translation of all this amount of. We have and people are very good at at estimating or calibrating 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 pretty good, like, you know, everything in moderation. And, you know, these things are divorced from reality often.

They're not. Yeah, absolutely. Um, 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 it's so it's important to operationalize motivation and small success of 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 reduced to process that's in your lived life and you don't enjoy that process.

And even if you achieve the goal, then it becomes anticlimactic.

OK, 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. Don't want to sound like those philosophers. The thinking itself is the process, not the goal, not the dyad, not there. 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 say, oh, then it's all about moderation. But you just had four steak's words.

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 when we know, people say, but then you just change your perspective on all of it. 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 may not be perfect, but it's a methodology that's changeable with not with people's ideas, but with the process.

And and if it changes tomorrow, might it was not effective. So we have to kind of move that.

And if we do that, I think 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. 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 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 on diet and brain health, the elements that stand out there, all plants, you know, whether it's studies coming from northern Manhattan study or Advanta study and all these other epidemiological studies that I mentioned earlier, that the the foods that have the most antiinflammatory agents, that have antioxidants, that have a proper synergistic combination of micronutrients and macronutrients happened 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 battler's, there are some that seem to be more beneficial and there are some that seem to be harmful.

And so when you and I have had the opportunity and the the privilege to work with some database's, the California teachers 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 mind diet, again, the food that come on top are our vegetables and plants, their 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 ageing they have. And they've been associated with vascular risk factors like high blood pressure, high cholesterol, diabetes. The 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 there's 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. 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 a Mediterranean diet, I'm always befuddled because I'm not sure whether that's the they're referring to, you know, a robust, you know, panoply of fruits and vegetables and nuts, seeds and legumes, or we're talking about wine and cheese and olive oil like I as somebody like 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 is there are different processes and there are 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.

So, 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 just this manipulation of data, what like how is that study set up?

The study is well designed. The source of funding is questionable. And so we want go go there.

But but so it speaks to how science can be manipulated even and in the right environments, it 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 can afford to care of themselves, and who did you compare against people who had very low socio economic 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 California teachers study actually was the main author of this one hundred thirty three thousand people over 20 years having this health study, 97000 people over 50 years.

We're talking about, you know, the Harvard study and women's health study, large studies, the massive data shows and rush study, same things, 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 are, then they should reduce the processed food.

Mm hmm. 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.

As we say, plant based, but thought out planned, for example, that we are now pushing a little bit more olive oil and even there are 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're just at the end of 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 3s, whatever your source seem to be, there's a trend against science that there might be a need for it. So there is 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 gives you all the nutrients you ever need, all the deficiencies that you hear in the media iodine deficiency or B 12 difficile.

Either they're not real or they can be easily mitigated while retaining all the benefit.

That's why the data's been shown repeatedly to be better. Right. Well, let's dive into that a little bit more more deeply. And maybe we could start with fish. I mean, you hear all the time, especially in the context of brain health, like o 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 Foods 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 going to 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?

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 their body, and especially causing inflammatory changes in the brain and insulin resistance, so 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 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 animal proteins being a bio magnifier. 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 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 hopefull plant based diet eliminates that risk and that we can get the omega three fatty acids that are that come from marine animals with a plant based diet. If we take supplements, 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 three fatty acids derived from marine algae, which doesn't really absorb much of those the elements.

So 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 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 how you're thinking about this is that. Given the importance of Omega three, that there is something about plant based omega 3s that aren't as bioavailable 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 them on his wonderful Plant Proof podcast.

But you did like a whole episode. I don't make a three, so we're not going to spend two hours on omega 3s. But like, I do want to get this right. Sure, sure. Yeah.

So we don't know the total picture. I mean, this is the humility of science is to say this is how much I know this is what we don't know.

And I we hate this battles, but absoluteness absolutely not needed or absolutely needed. We don't we don't have that.

DARBYSHIRE 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 a need for Omega three 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 young woman in your 30s and 40s, if you want to take supplements, that's fine.

But we think that there's enough data that if you have enough chère 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 three, four developing brains where it's doubling every other week and size and numbers.

And the one thing you need for brain development that can't produce is DHEA and Omega's. 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 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 conversion issue. When we're talking about omega 3s, we're talking about DHEA, ala EPA. 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 I've never heard this, but I thought about it the other day. I was like, wait a second, why are we worry so much about conversion?

Do we have enough or not? For example, nothing in our body gets converted to 100 percent. We don't have 100 percent bioavailability for anything unless you inject it into the artery. You don't have bioavailability a hundred percent 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 that, with the rest of it.

And then whatever is bioavailable with Alade, the percentage varies. Some people say five percent, some people say eight percent. Others say up to that. It'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 chia, which has it's a great food or flax seed or hemp, one of the few foods where the omega three ratio compared to Omega six is higher.

Right. You don't even have that in animal foods.

So you have much higher absorption of Eilidh. Now, conversion of that to EPA and DHEA is slower, but you can still get plenty. The problem is when you need more, we think that when your brain, which actually incorporates rapidly DHEA might not be getting enough with just those sources. And is there some idea that if you're beginning to experience cognitive decline or you're at 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. Mild cognitive impairment. Yeah.

There was even a slow slowing of the progression of MCI and even reversed 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 for lack of better studies does not negate trend and risk benefit analysis, given that this is the most important one of the most important micronutrients in the body.

The, um, well, the omega six omega three ratio thing is super interesting because sort of if you look back 50 years.

A 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 six. So now we're all taking in tons of omega six, not enough omega three.

And so how much of of our omega three intake or supplementation, how much of that is to kind of calibrate that ratio versus what we need independent of Omega six?

In other words, if we're eating tons of omega six, it it it seems to follow that we would then need to take in more omega three to create that correct ratio.

There's a bigger problem which speaks to why we have to go a whole plant based.

So if you're eating Omega six, the pathway of conversion of the EPA is actually a great limiting step.

So if you're having more Omega six is you actually convert, though, you can't get enough the conversion. So one of the things you have to do is reduce the Omega six conversion as well, because the same enzyme that actually does the conversion is limited by both of them. If you have more omega six, it stops and that becomes the rate limiting step of conversion of failure to DHEA.

Correct. So it's critical that not just to increase omega 3s, Alpha and others, but also reduce omega six resource as sources.

And what are those sources, all the foods that have increased in the last actually 70, 80 years, which are there processed meats and cheeses and butters and and actually all processed foods that are out there have profound amounts of we talk about some foods have 4000 to 8000 as much omega six to omega three.

We weren't like that.

You'll never be able to correct that ratio is to eliminate those foods. And by going Whole Foods plant based, you're getting rid of a lot of those nasty omega six is that you don't want and the benefit is exponential.

You're reducing the harm fast, rapidly, and this rate limiting inflammatory.

And so let's talk about omega six, omega three quickly. So these are not unnatural pathways.

Your body needs Omega six, your body needs omega three one. And of course, that's simplification. But Omega six is the inflammatory coagulation pathway.

You need clotting don't and you need inflammation.

And Omega three is the opposite as it happens that. As we get older, we need more antiinflammatory because it 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 inflammatory granulation. 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 get through. It doesn't matter. Right. All right.

Let me throw this one at. 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.

So walk, walk, walk us through this one, huh?

That drives me crazy. But I think if you look at the structure of the brain, yes, the brain is made out of a lot of fat. The numbers vary. They say, you know, 60 percent, 70 percent fat. But that calculation doesn't really separate the amount of fluids that are in the brain, too. It's actually less than 60 percent, 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, but on a daily basis are omega three fatty acids and those are small enough to actually go be used. And that's basically 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 a 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 talk about saturated fat more broadly in terms of brain health. I mean, we are like there are these crazy diet wars going on right now. Everybody's, you know, planning their flag and various corners of the Internet. We've got the carnivores and we've got the Akito people. And, you know, you will see this all the time. Like, you know, people will say, you know, 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 to speak, this a little bit.

I think that they do feel more focused and I believe them. I think that short term they actually do better cognitively, not better than any other day, 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 this seizure is stopped. That's not representative.

And then the other thing is how long how how long can you maintain that under normal circumstances, these children were kept in special wards or what 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.

It's very difficult. Most of the people that sit, they say that they have their own ketogenic diet. They've never achieved Ketel ketosis. They're just eating more meat and 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 a long term benefit to one population which has the 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 on and so on. A ketogenic diet, you're depriving it of glucose and it's being forced to run on ketones. Correct. So is there some scientific sensibility of how the brain functions on ketones versus glucose?

Yeah, analogy. You want to tell them the analogy? Well, go ahead. I'll tell you right now, I'll let you this. I'll do the nicer part I call ketogenic diet.

As of now, it might be pejorative, but almost like a cheating on your wife kind of a thing.

And so how dare you? I know.

I mean, terrible, but I'm so glucose is the main molecule that cell requires if there's fuel preferred fuel. We did a study in Heyns, one of the largest databases, looking at even insulin resistance, not the diabetics.

We took them out and looked at insulin, that lower cognitive state. So insulin resistance is what we are 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 coming as a suitor for you, son or daughter, and they knock at the door and there are too many people.

The door just closes, it 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, it's OK.

Well, an 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 an 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 take a look at Kitto Body's ketone bodies. There are 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 feel so ketone bodies might work short term because it's a quick burst. Right. Even for the mitochondria. But where does it in the biochemistry textbooks or any biochemical process?

Does it say that doing the quick thing in the biochemical processes is long term benefit?

From my reading and I was reading and our research in 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 it's under a shock state. So, you know, and most of the studies that have been done on ketone bodies 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 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 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. 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 your physiology is in crisis. Is there a downstream impact on on your neurological functioning? Like are you in a in a, you know, a sort of sympathetic nervous system, state of high alert when that's going on, right?

Yes, we think so. We think I think it's a survival state and 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 a long term benefit.

It's not. So we think that at least biochemically, even evidentially 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 is just as 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 going to you're going to get away with a grade on the test, but a month later, you're not going to remember anything.

I can say that's much better than my story.

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 super foods, 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, consumption of green leafy vegetables, for example, seems to be very helpful.

And it's a unanimous result that you see across different studies, berries such as blueberries and strawberries. They stand out whether it's the mind 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 antiinflammatory and it seems to bind with amyloid, which is the bad protein associated with Alzheimer's disease, and it removes it.

Oh, wow. We measured the amount of amyloid, the amyloid load in RadNet, and after giving them high amounts of turmeric, we actually saw the term binding to the amyloid in the retina, which is really, really interesting. And we're learning more about it as we speak.

And yes, so high fiber, green leafy vegetables and berries and spices, especially turmeric, seems to be on the top.

She and flaxseed oil, flaxseed oil are amazing sources of plant based omega three fatty acids, hemp seeds, nuts like walnuts, whole grains.

And 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 different.

Yeah, a lot of people love coconut. I know.

I'm sorry, but you I love to be the thing. The coconut oil for brain health, you know, and unfortunately, the data is pretty flawed. When it came out, it was based on a couple of case studies. And it has it happened. Somebody gave their loved one coconut oil and they seem 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 a 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 in two vascular damage.

And the reason being it is because coconut oil is one of the few plant oils that is more than 90 percent saturated fat.

So as palm oil and the little nuances, says the Mukti medium chain triglyceride triglycerides. And that has to be studied and we're open to that.

I mean, we think that if that those studies come back and show some benefit, we would be more than happy because we need any anything that's out there that's going to help. So far, no data, right, tangible data, but with coconut oil, doesn't that 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 no. 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 atherogenic and inflammatory component that predominates. Interesting.

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.

Talk about controversial.

Yeah, we were actually ostracized by some communities for this, which I never thought that was a heated debate going on because people are very strong opinions about this.

It's so funny. You know, we worked in Afghanistan and were ostracized by Taliban. So some plant based people ostracizing us doesn't scare us too much. But yeah, so we've ostracized as a way or we're not as well and not as well armed.

So much lovelier people anyway. So the reality is we're open to data.

It's not about dogma. There are a couple of lines of argument. And it's not always because we looked at the Mediterranean diet. We're actually in the middle of doing a meta analysis.

The data is, again, trend and nutrition data is tough.

So you have to go with trends and multiple domains of trends. And that appears that some and here's another controversial term.

Some olive oil seems to help with cognition, seems to help with health in general and specifically even, 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. But but we just want it to open up the realm, even though we might make people angry.

That's OK. That's our life. But if it's data shows this way, we've got to start talking about it.

And at the same time.

When we go to these churches and faith communities, which we are, another one of our projects is a woman centered, faith based community brain initiative in African-American churches were disproportionately impacted by this.

And also, more importantly, as I was finishing 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 heart initiative. It should be around women.

So especially African-American women or black women and 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. Nadine 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 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 one hundred percent studies and in a lab, we think that's as important.

Well, compliance is everything if you don't have compliance, it doesn't matter, 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 balancing act. So we say, what's the optimal, especially people who have complexities. You know, somebody said, I think somebody we know said that the entire problem we have in this world is I think that it's 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.

If people don't like that. I know, I know it's hard, but I'm saying the truth will set you free.

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 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 like my sense of who I am is being pulled out from underneath me. And emotionally, it's very difficult.

You know, one of the people we admire greatly, we're not going to name names. And we 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 plant based diet.

Just because we say add a little bit of olive oil and everything gets more and more specialized, they're used to just be vegetarianism and then it's a vegan and vegetarianism. And then within those categories, there's there's, you know, more and more silo's 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.

And that's where this is headed.

That said, Aisha, 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, it just allows me to to experience life in its fullest. And, you know, having so I have a master's 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 realized 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 is 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 a tremendous amount of stress because of the situation in the world and told them, you know, just to meditate every day.

Meditation is really good for you. 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 having worked with different individuals and especially in their faith based communities, the one thing Dede 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 are the best representatives of that unit in the community. And when you look at different models of success in the world, one of them that came from Dr.

Yunus, who was the Nobel Peace Prize laureate, he's the father of microcredit where he, you know, essentially helped women and their small businesses.

And he he made some profound statement. 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 women know how to invest in their families and in their units.

And so I'm pursuing this 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 I'm going to say that story for you.

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 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.

So knowing knowing the the politics and the bureaucracy, what Dean did was essentially a social jujitsu where he trained, he created the establishment to train 20000 girls who were, you know, went to school up to sixth grade because after that, they usually there's no education available for girls and the provinces.

And so he took 6th grade educated girls and he wanted to train them in just basic health 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 rehydration 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. They said, no, 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, nurses and midwifery program to examine patients.

And guess who would get sick after a few. 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 turned the relationship that just fucks up their whole mindset of sort of the jujitsu here is you don't have to confront cultural paradigms.

You jiujitsu around it.

And it would most of health care. Thank you so much for telling that story.

That's amazing, by the way. Like, incredible. We wrote a paper together. Yeah, it's actually and Lance said it's how to apply 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 power we know, we know. What do you mean by. 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 household right there making the decisions about they're making decisions and everything with their kids? 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 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 jujitsu maneuver to, you know, empower these women, enlist 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 in a loving place, but at the same time from a very powerful place. I'm just so excited to be in that.

Yeah, there's there's no bounce to the upside of that. I think that's right. Well, let's talk about the new book.

I mean, you guys wrote this amazing book, The Ultimate Solution that came out a couple of years ago.

That's what brought you on the show back back then, which is basically an incredible primer on all the research that you've done, case studies, your work with your patients in terms of implementing lifestyle interference to interrupt this brain dementia issue that is mushroom cloud in our society. But the new book, The 30 day Alzheimer's Solution. Right. Is more of 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 easy for people to to to do as possible. So it's great. I love it. 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 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 we're very proud of it.

It was it was difficult to put our experiences in a way where it's translational and palatable, pardon 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 brain?

No, but I think it's a 30 day journey or a plan towards that direction.

And 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 made.

One of the key things in 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 anticlimactic.

And then what? It's process that's important. Systems have to be established. So the 30 days is attempting.

And I never want to do hyperbole as 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 they get all kinds of my goodness, I never thought that at NIH I would be doing this, but in any case or turned into a marketer.

But nonetheless.

But it is actually I think 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 honor system. You don't have to buy the book.

You can get access to a 30 day course that starts at the 1st of April, up to the end where we have sleep, doctors, stress, doctors, nutritionists, lots of data and equipment and cooking sessions 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.

We've spoken to an amazing atomic habits, James Clapper.

I love the idea.

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 individualise and habits. Yeah, yeah.

I like how you broke it all down and you didn't sugarcoat it either. You're like, look, this is gonna be hard if you're going to get off, cheese is going to be uncomfortable. Like you're not trying to say it's all going to be awesome all the time.

Like it's it's, you know, making any kind of change is difficult and this is no different. But what you find on the other side is worth it. And you give the right amount of like encouragement and you couche motivation in the right context. And I appreciate that as well. But you you paint with a broad brush so that anybody could pick this up and, you know, get their head around what the right path is.

That was the goal. That was the goal. For now. We basically wrote this for our caregivers and the patients and everybody that's been touched 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, let's talk about a motivation problem like that.

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. You get them interested in taking care of their brain so that they don't fall prey to this later in life.

Absolutely. I think I think it's important to say that way.

Right.

And for us, we we have the Healthy Minds initiative, which is a non for profit, where our goal is hopefully that we can promulgate and spread this concept of coaching, women's centered coaching throughout the country.

And whatever comes out of this book goes towards that effort. Whoever wants to help us out goes towards that effort. And I think it's a worthwhile endeavor. Would I send the lead? And I'm the I'm the drive, right. We're a team.

Well, so all proceeds from the book go to the nonprofit, all of it for all the all the profits. Yeah. And and that nonprofit 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. Yeah, that's right.

So 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 coaches who can be brain health representatives and ambassadors in their community and just move it forward.

Right. Awesome. Well, we got to land this plane, but 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, to 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 and but it would be community based because if just like mouse models that work, you know, 400 mouse models for Alzheimer's work, zero worked on humans the same way there's these little contrived 100 percent, 200 percent 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 going forward. So we're doing the data capture in our national, but we'll take care of the funding there.

We don't have the funding for imaging. We don't have the funding for blood tests. And the regular funding sources don't seem to get it. They're not adjusting.

Saying, look, we'll take care of the educational component, we'll take care of the resources, that technology will 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 will look at because it's a large population will no data on ketogenic will, no data on plant based food.

We will know data on Omnivore or even Pescatore, and 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 on not only once a year basis where the food frequency questions are, but actually on a monthly or weekly basis.

We have the tools now. We actually using that in beach cities are using iPads and computers.

We can collect the data.

And 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.

So those two big components and as far as teaching them using Zoom for a zoom was now actually yesterday we had a zoom session with our teaching population of our over one hundred people. So that's even taken care of. We will 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 cost we've taken care of.

OK, last question. I can't answer whether I asked you guys this last time you're here. If I did, I'm going to ask you again. I remember what you said anyway. If not, if you woke up tomorrow and realized you'd been appointed as surgeon general of the United States. Goodness. And given the kind of metastasizing Alzheimer's problem like this 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? OK, well, I would say. I would say. I would say more and more resources for communities about managing their lifestyle. I think most of the funding goes into very specific molecular data. 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 to focus on.

I fully agree. Yeah. I mean, we were talking about we talk about mind diet at one point, which is not an optimal diet. Even the people, the main pie passed away.

Recent Martha, Martha, Martha, Martha, even she said it's not the optimal diet, but yet.

Fifty three percent reduction in Alzheimer's. And I'm sure that the same number would apply, if not more, for stroke and everything with this mindset.

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 Iesha. That would be the investment. Yeah, it seems like more local based medicine, an overhaul of health care to really sort of reconfigure it around prevention, very close to diagnosis and prescribing people. Absolutely. But, yeah, we need a lot of changes the way 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 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, this is this is truly important thing to help you guys out.

Thank you. Reach out. Thank you. That was amazing.

Appreciate you guys to the new book is called The 30 Day Alzheimer's Solution. That's available March. Twenty third carets pub date, right? Yes.

It is a 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 Solution, their first book. It's amazing you can find these guys at Team Shirzai on the Internet site and anything else anywhere else to point people. Is there a website for your nonprofit?

If people want to learn more about Healthy Minds Initiative Dog? Yes, Healthy Minds Initiative dot org. And they can contact us. And if they're interested in volunteering or having us come to their communities, we'd be happy to do that.

Awesome. All right. And you guys are welcome here. Any time to talk to me again, OK? Thank you so much. Thank you.

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