Dhru Purohit Show - Neurologist Sounds the Alarm: Silent Symptoms of Dementia & Brain Decline with Dr. David Perlmutter

Episode Date: March 13, 2024

This episode is brought to you by Birch Living and Bioptimizers.  According to today’s guest, the seeds of Alzheimer’s are planted at least twenty years before a diagnosis. So, it’s never too early to think about the lifestyle changes that can influence brain health and the risk of developing neurodegenerative diseases. Dr. David Perlmutter shows us what we can do to protect our brain health and lower our risk.   Today on The Dhru Purohit Show, Dhru sits down with Dr. David Perlmutter to discuss research around the top four factors that can determine the risk of developing Alzheimer’s and his lifestyle tips on prevention. Dr. Perlmutter shares the tools we can use to analyze our brain’s use of energy and discusses the importance of engaging in physically and mentally stimulating activities. He also shares his hot takes on the community’s top questions and reiterates the importance of changing our minds and keeping up with the latest research.   Dr. David Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition. He is the author of Grain Brain, among other books, and his most recent book, Drop Acid. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease and has published extensively in peer-reviewed scientific journals, including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition. In this episode, Dhru and Dr. Perlmutter dive into (audio version / Apple Subscriber version): Early warning signs of Alzheimer’s and dementia (00:00:40 / 00:00:40)  Influences you can have over your lifestyle (6:50 / 5:44)  4 factors that determine our risk of Alzheimer’s (12:28 / 11:00) The role of oral microbiome in our brain health (28:41 / 25:31)  Tools to analyze our brain’s use of energy (31:49 / 28:46) The risks of a sedentary lifestyle on brain health (34:06 / 30:55) The importance of engaging in mentally and physically stimulating activities (49:10 / 45:30) Sleep as a powerful pillar in Alzheimer's prevention (52:30 / 49:35) Key supplements for brain health (58:46 / 55:40)  Future therapeutics that could help Alzheimer’s patients (1:20:10 / 1:17:20) Dr. Perlmutter’s hot takes on community questions (1:23:13 / 1:20:10) Also mentioned in this episode: Fygg toothpaste  Try This-Can Multivitamins Prevent Dementia  To get 20% off your Birch Living mattress plus two free eco-rest pillows, head over to birchliving.com/dhru today. Go to bioptimizers.com/dhru now and enter promo code DHRU10 to get 10% off any order and up to 2 travel-size bottles of Magnesium Breakthrough for a limited time.  Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. David Perlmutter, today we're talking all things dementia, Alzheimer's, and neurodegenerative diseases, how to catch them early so we can prevent them from developing in the first place. You know, one of the mind-blowing things that many people, including myself, have learned from your work, is that these diseases, like Alzheimer's and dementia, are not something that we one day just wake up with, that all of a sudden we're okay and then one day we're not. In fact, for the vast majority of people, people, their diagnosis was years and often decades in the making. So I'd love to start there. What are some of the earliest warning signs well before these diseases develop that someone is on their way to developing them? Let me first say that your risk of becoming an Alzheimer's individual

if you reach 85 years of age is 50-50. So we're talking about an awful lot of people. And for younger people who want to know, are there issues that might be indicative of increased risk at this stage of my life when I'm 30, when I'm 40? There are. And these are actually very straightforward metrics. And they can be determined with, for example, a tape measure around your belly or your blood sugar or your blood pressure or your level of physical activity. With those four issues being brought into line, I'll just step out here and indicate that you might be able to reduce your risk of Alzheimer's by around 70%. Wow. Yeah. And what you said actually is true and really important, and that is that the seeds of Alzheimer's are sown 20 to 30 years prior to the clinical manifestations, the clinical manifestations being things

like failing memory, poor judgment, difficulties with what we call executive function, putting together complex ideas to carry out an activity. We can actually determine that early on and predict who is going to end up with Alzheimer's by looking at brain metabolism. We now have the ability to measure in real time how is the brain using glucose. And you can see early on prior to any clinical manifestation as long as much as two decades or three decades ahead of time that there are areas of the brain important areas the temporal parietal area areas like the hippocampus for example, that demonstrate deficiencies or lower levels of metabolism. So metabolism is the delivery of blood and the utilization of fuel. And in this case, we're talking basically about glucose.

And you can see in these brain scans that people may have issues with that early in life to the extent that the brain is going to fail. The brain is highly active from a metabolic perspective. At rest, your brain is consuming about a quarter of all your body's energy utilization at any given time, while it only occupies about 3 to 4% of your body weight. So it's really power hungry, as you would expect, as computers are, right? But it's when the abilities of the brain to metabolize, to use fuel begin to become compromised, that cells become less functional. Not that they necessarily die. You know, we used to look at these scans and say, oh, these are neurons that are no longer functioning. Well, they're functional and not functioning. They could be

brought back online, for example, by utilizing an alternative fuel source for the brain, like ketones, for example. We see that in these individuals who show deficiencies of brain metabolism as it relates to the primary fuel called glucose, that when they are provided ketones, that those areas actually work. And in fact, some research has actually demonstrated in full-blown Alzheimer's, improvement in cognitive function by utilization of a ketogenic diet who knew. But having said that, if we're talking about metabolism, then we are talking about the incredibly important role of our lifestyle choices when we are younger, that the biggest threats to our metabolism are the development of pre-diabetes or full-blown diabetes,

it's obesity or overweight and elevation of our blood pressure. These are things that are demonstrative of deficient or compromised metabolism. The brain is just can't take it. You might think that, well, you know, I'm a little overweight. My blood sugar is a little elevated, as is my blood pressure. Things that you should know, you're not going to know unless they're measured. But the brain is already suffering and is already beginning to decline. So you are correct that by the time people,

begin to demonstrate obvious issues with their cognitive function, this process has been going on for decades. And so our mission is really to intervene when people are healthy. As John Kennedy said, the time to fix the roof is when the sun is shining. Or as Desmond Tutu said, while it's important to take people out of the river, we need to find out why they're falling in in the first place, keep them from falling in. That's really the mission, is prevention of this disease, which is at hand today. Today's episode is brought to you by the birch mattress by Helix.

So we all know that getting a good night's sleep is super important, not just for our health in general, but for being a functional and thriving human being. I can tell you that when my sleep suffers, the next day is rough. That's why I'm so psyched about today's sponsor, Birch mattress

by Helix. I've been sleeping on my birch mattress for three years now. True story, and it's the real deal. The birch mattress is certified eco-fifference, friendly, organic, and fair trade, plus they're made from natural non-toxic materials. That's important for a couple reasons. First, with Birch, I'm avoiding a ton of VOCs and off-gas and chemicals that most other mattresses emit and that mess with the quality of my sleep, and probably yours too.

Secondly, I can sleep better at night knowing that I'm supporting a company that does right by their employees in the environment. You just can't find that at a typical mattress store. I absolutely love my Birch mattress, and right now, now, you can get your own for 20% off plus two free eco-rest pillows at birchliving.com back-slash-drew. So get ready for the best, most eco-friendly sleep of your life. Visit Birch, B-I-R-C-H-L-I-V-N-G dot com slash Drew. That's D-H-R-U to get 20% off plus two eco-rest pillows today.

You know, you have a great quote that you've shared before. most people ignore their brain until it's too late. And today's conversation is reminding people that, yes, if you're in your 30s, your 40s, your 50s, it's not too late. But also, if you're in your 50s, your 60s, your 70s, as long as you can actually have agency over your lifestyle, which we're going to get into the things that you can actually influence today, then you can make changes at any stage that positively impact the brain. Is that a fair statement to say? It is, it's breathtakingly fair, yes. And, you know, the, the sad commentary is that we live in Western society with the notion that we can pretty much live our lives however we choose. And when there's a problem, modern medicine is going to come along and fix it for us. Well, you know, the, the idea that we can fix so many of our maladies, I think is off base. We don't have any treatment for, diabetes. There's no pharmaceutical treatment for diabetes whatsoever. There are certainly

medications that will bring your blood sugar down, that's for sure. But when you stop taking those medications, your blood sugar goes right back up because your diabetes hasn't been treated. You still have it. You still have your high blood pressure. It goes right back up when you stop the medication. So the medicines that we have at our disposal are treating the smoke and ignoring the underlying problem. They're ignoring the fire. And when we discuss Alzheimer's, we actually don't have anything to even treat the symptoms these days to improve the memory, improve the cognition. We heard in the spring of last year, the wonderful announcements that Alzheimer's treatment had reached a new threshold that suddenly it's been a game changer with drugs that were designed to rid the brain of this terrible protein called beta amyloid. And the reality was that these drugs, three of which, well, at least two that were popularized,

were absolutely demonstrated to lower that sticky protein in the brain. No question. They worked in terms of either keeping that amyloid from being produced or actually using what are called monoclonal antibodies to rid the brain of beta amyloid in comparison to placebo. But what didn't happen was there wasn't really any change in cognitive decline, by the time, these were 18-month studies, by the time you got to the 15th month, both the treatment and the placebo groups in these wonder drugs fell off a cliff. So, in fact, one very, very well-publicized drug called Adjuhelm was taken off the market about two weeks ago

and by its manufactured biogen. They finally said, look, it's not working. The other thing that we've noticed, and this is, I think, very important for your audience to, embrace is that we need to practice medicine under the doctrine of primum non-noser, above all, do no harm. And what didn't receive much publication was the fact that these drugs were associated with significant issues. One classification is called amyloid-related imaging abnormalities or arias. And these are areas in the brain that they were blaming on the amyloid, therefore we get get rid of it, areas of the brain of swelling and hemorrhage. And these were seen in over 20% of the treatment groups and, you know, less than around 4% of the placebo groups. This is brain hemorrhage

that we didn't talk about. And the other thing that's really interesting to note, and that is that a group in Australia got access to the data from these research studies and looked at the specifically the MRI scans that were done in a series. fashion throughout the 18-month study. And suddenly they were, you know, surprised to note that in comparing those who received the medications versus those who had not, that there was a dramatic shrinkage in the brains of people who were given the drugs to the extent that their Alzheimer's was significantly further along the continuum in terms of brain shrinkage than one would expect. And then in in comparison to the placebo group. So, you know, this notion that Alzheimer's is caused by beta

amyloid, take the amyloid away, problem solved, didn't pan out. We're not there. One new drug was announced in November of 2003, published in the New England Journal of Medicine two different independent studies revealed dramatic reduction in the beta amyloid, zero change in comparison of placebo to treatment group in terms of cognitive decline. So we've got to look elsewhere. And And, you know, an interesting study was published in the Journal of the American Medical Association in 2020 saying that basically entitled that, entitled along the lines of in Alzheimer's, the spotlight moves to metabolism. So again, we're back to this notion that the metabolic issues of the brain, how it utilizes fuel is really front and center in terms of what leads to Alzheimer's and purposes of our discussion today. what can we do to prevent it?

And where we're going to go later in our discussion today is what about novel ideas targeting metabolism to actually treat this problem? Fantastic. Well, you mentioned four things at the beginning and the opening of this podcast that sounds so simple, but are worth just touching on for a minute when it comes to identifying our risk in developing these neurodegenerative conditions. The first one was incredibly simple. and most people listening today probably have it at home, and it was a tape measure.

What does a tape measure have to do with us understanding how well our body, our body, and therefore our brain are running or not running? Very simple. Increased body fat around the belly, around the middle is a marker of metabolic dysfunction. It's correlated with higher markers of inflammation, increased resistance of the body's ability. to use insulin, higher blood sugar, increased action of damaging free radicals. There it is, just a measurement of your belly. So, you know, what could be more simple? And then I did describe you to various other perhaps more sophisticated ways of looking at your metabolism. But that's a good

place to start and get your blood pressure check, for example. That's pretty straightforward. If we want to take it further, then by all means get a sense as to what is your fasting blood sugar. And if you really want to be, you know, aggressive and get the most out of that day, then try wearing a continuous glucose monitor for a couple of weeks and get a sense not only what your blood sugar was on a particular morning, but what is it throughout the day? What is it in terms of its average? How do you respond to carbohydrates in your meal? What is, you know, what is the maximum blood sugar that you might experience in a day, which you're not going to know if you go to the doctor every year and have a fasting blood sugar, that people actually train for the blood sugar. That people actually

trained for. You know, it's a much better understanding of the dynamics of sugar metabolism in your body. Nothing could be more important for your brain. In my opinion, that's probably the most important thing to consider as it relates to Alzheimer's risk. I wrote grain brain and people kind of talked about the fact that, well, that's a book that talks all about gluten issues in how even in the brain, gluten sensitivity can affect the brain. Well, we did talk about gluten quite a bit. But the main issue with respect to the grains was the processed grains raising blood sugar and the relationship, even when I wrote that book in 2012,

the relationship of markers of blood sugar at to the risk of developing either brain shrinkage or actual Alzheimer's or even cognitive decline. And that information was published. even back then. I quoted a study from, I believe the author was named SETI in the New England Journal of Medicine, who described a powerful relationship between average blood sugar measurement, which is called the hemoglobin A1C, and rate of brain shrinkage, a perfect correlation. Higher levels of A1C, faster rates of brain shrinkage. Couldn't be more simple than that. What's important was that these relationships began at an A1C of around 5.8, where a doctor is going to say,

hey, you're doing great. You're not even pre-diabetic yet. And other studies, and also from the New England Journal of Medicine way back then, showing that having a blood sugar, even 100 to 105, where you're going to get a pat on the back and be told come back next year, associated with increased risk of developing dementia. So, you know, we have to redefine, well, we have to get away from defining normal or in the normal range, which is, you know, when you take a thousand people, what's normal, basically what is average, to really focus on what is optimal, what's best for an individual. And I can assure you it's not having a blood sugar of 100 to 105. We now know quite clearly that's not good enough. You're not doing your job. That's

of blood sugar unlike anything humans have experienced in their past, I would suspect. You know, just to connect the dots even a little bit further off of what you shared, and again, I'm pulling a quote from you, you know, if your blood glucose is high, right, you're on your way to pre-diabetes. We know that millions of people, I think the estimates are 80 million people in America are in that pre-diabetic range. Then you're well on your way at that point in time to, you know, getting diabetes. And you share the statistic that if you have diabetes, you are forexing your chances, quadrupling

your chances of ultimately ending up with Alzheimer's. Is that accurate? With ultimately ending up with a disease for which there is no pharmaceutical fix. You're paving the way to be stuck. And what a horrible disease. I mean, you know, there are some innovative approaches to actually try. treating Alzheimer's. You're familiar with the work of Dr. Dale Bredesen, amazing pioneering work, but it's not one thing that he does. It's a multitude of what he calls holes in the roof that he

plugs to keep it from raining in. But the idea that, you know, there's a drug out there right now that's going to turn a person around. That's not reality. We're nowhere near that. though I do have some ideas that we'll talk about later that may open the door to that to that type of approach. Well, we talked about the tape measure and by proxy essentially an at-home ability to look at just how much excess weight is your body carrying around and storing. You know, if you can go a step further, people can get an in-body scan or a dexas scan. They can get a body composition of themselves.

You know, these days there's also even a step further. You have a lot of imaging centers that are looking at also visceral fat as a byproduct of, you know, the most dangerous type of fat inside of the, you know, body that would also be increasing our risk of a lot of these metabolism or actually a byproduct of the fact that we have such bad and poor metabolic health. You talked about blood sugar in detail, the importance of not just relying on a fasting glucose, but potentially if you can afford it or you can convince you. your doctor using something like a continuous glucose monitor or trying one of these, you know, direct-to-consumer solutions that are there. And how blood sugar is largely in this elevated state for so many millions of people because they are consuming first and foremost a lot of ultra-processed calories from both sugar and refined carbohydrates. Carbohydrates can be good. We don't want to demonize them, but we're talking about the refined excess levels of carbohydrates in

The diet. What are some examples of those just so people can connect the dots? Well, basically pretty much anything in a package, you know, any, any carbohydrate in a package, whether they're derived from grain or other type of carbohydrate that's been modified in such a way that when we consume them, we are basically consuming sugar. So the pastas, the refined rice, the crackers, cookies, cakes, anything from flour. Even if it's organic, you know, organic flour that was made and blessed by elves, it doesn't matter. It's going to raise your blood sugar. But the point is that I'll say it's likely to raise your blood sugar. It's really valuable to know what in terms of an individual is going to raise his or her blood sugar. So it's a bit of a

personalized approach in terms of what we should be eating. And everybody's trying to talk about this diet being the best diet, whether it's pescatarian, vegetarian, vegetarian, vegan, paleo, carnivore, or only eating foods that start with a vowel. Whatever it may be, the point is, you know, for me, I've come to a place in life where my response is two things or three things. I want to see a diet that's got a lot of fiber of color, meaning lots of colorful vegetables, and a diet that keeps your blood sugar under control. If you can do those two things, I don't care.

I'm fine because you're going to get your nutrients. You're going to have fiber to nurture your microbiome. And you're going to be on a program, whatever it may be for you, that keeps your blood sugar under control. And I want to comment, you said something earlier about it if you can afford it, a CGM continuous glucose monitor. If that's an issue, a simpler thing to do, not as effective, but very informative, the next time a person goes to the doctor for that annual blood work, including the fasting blood sugar, make sure they do a fasting insulin level as well. Because that's going to tell an individual where he or she is in terms of insulin functionality,

insulin sensitivity, meaning that you might have a normal blood sugar, but it's only normal because your body is putting out a lot of insulin to keep that blood sugar where it needs to be. In other words, the pancreas is working overtime, and that is a bit of a harbinger for future insulin resistance, but sugar then coming up and ultimately becoming pre-diabetic and diabetic. So it's, you know, a good test to have. Is it as effective as a wearing a glucose monitor for a period of time? I don't think so. But still, it's something we could add to that list of potential studies we could get.

You know, and one of the thing that you mentioned was bloodline. pressure where does blood pressure and you know getting your regular blood pressure checked where does that fall into and and why is it considered a risk factor well blood pressure really relates to blood flow and ultimately the higher a blood pressure is ultimately uh the less blood flow we're going to get to our organs and that's you know the real um the real issue with why even subtle elevations of blood pressure are risky because of the associated risk with cardiovascular disease and stroke. So we want to keep our blood pressure low so that our blood vessels remain resilient and we can continue to

supply blood to areas that are needed. And it's interesting that both blood pressure and function of insulin slash glucose are regulated upstream by the same chemical, which is nitric oxide. So nitric oxide, yes, plays a role It was the original vascular endothelial factor that was involved in allowing blood vessels to expand, to improve blood supply, blood flow when needed to various organs of the body. In fact, the Nobel Prize was awarded in 1988 because of that discovery that it was a gas, nitric oxide in the body. Who knew a gas would have such activity? But more recently, it's been discovered that this nitric oxide gas actually,

plays a fundamental role in regulating how insulin works in the body. The functionality of insulin is dependent, a significant degree, on the presence of nitric oxide. So that's it. We lose nitric oxide as we age. Our nitric oxide levels decline in lockstep with various changes that occur in the mouth, for example, with respect to the mouth organisms, the bacteria, living in the mouth of the oral microbiome, if you will, who knew? That about 50% of the nitric oxide in our bodies is a consequence of what bacteria on the door, on the top of the tongue are able to do with the food that we eat. When we eat colorful vegetables like beets that are high in nitrates, those nitrates are converted into nitrite in the bacteria, by virtue of the bacteria

that live on the back of the tongue, the top of the tongue. And that nitrite is the raw material from which our bodies are able to manufacture this nitric oxide than in the rest of the body. So you can imagine if we were to damage those bacteria somehow in some crazy way, that perhaps their ability to ultimately allow us to have adequate amounts of nitric oxide might be compromised. And what might that do? Well, it might affect blood pressure, it might affect blood sugar. Well, it turns out that this was studied back in 2019. Two studies demonstrated that when people use mouthwash that is antibacterial, two or more times a day, a three-year study, It was demonstrated that there was about a 49% increased risk of becoming a diabetic.

When you used a mouthwash two or more times a day over a three-year period, risk of being diagnosed with hypertension increased close to 100%. And what are you doing? You're killing off bacteria that are there to help you and make nitric oxide available in your body to control your blood sugar, to control blood supply to your organs. You know, we've talked for an awful long time about the value and the importance of our gut microbiome. Now we're talking about the mouth microbiome and the importance of these bacteria. And the fallacy of us being told to use this mouthwash because it kills 99.9% of germs.

They're not germ. Germs the pejorative. They're bacteria that we've co-evolved with for tens of thousands of years that now have had their functions. delineated such that those bacteria when you connect the doctor controlling our blood sugar and blood pressure who knew this episode is brought to you by bi optimizers are you tired of feeling tired do you always hit the snooze button and slam your head straight back to the pillow with all of life's demands between home work family friends it's no wonder that so many people are tired you take care of a lot of things and there's a lot of things on your plate but the question is who takes care

of you. Magnesium breakthrough is an all-natural supplement that takes care of you and helps reduce fatigue and helps you sleep more peacefully. The types of magnesium included in it have even been shown to strengthen muscle and improve your heart and brain function. While most magnesium supplements aren't full spectrum, magnesium breakthrough is the only magnesium supplement on the market that contains the optimal ratio of all seven essential types of magnesium. Imagine having the strength and energy to get out of bed every morning and face the day, courageously, to be able to show up as your best self and keep your energy up throughout the day while magnesium is a big part of that. So if you want to feel more energized and get your best night's sleep ever, check out buy optimizers.com

slash DHRU now and enter the promo code DHRU 10 to get 10% off any order. DHRU 10, that's me, Drew, to get 10% off any order. So two things to remember, buy Optimize, dot com slash drew and promo code drew 10 dhru 10 to get 10% off any order you'll be amazed at how much better you feel making magnesium breakthrough part of your daily routine who knew so quick recommendations somebody's using mouthwash out there today chuck it in the trash give it away donate it whatever you want to do you know you've done some episodes with some great people in the space like dr mark berhana who's a great educator you know your recommendations for just solid oral health, which also, you know, maintaining good oral health and reducing the risk of

things like ginger vitus, you know, coming later on in life, also is supportive for avoiding these neurodegenerate diseases as well. Is that correct? That's right. Well, let's first talk about Dr. Mark Berhenna. So I have had him on my podcast, and that podcast on YouTube absolutely went viral. I mean, in the first couple of weeks, there were, I think, 800,000 views because he's an amazing speaker. He's incredibly knowledgeable, and this is a very, very important and not talked about topic that we need to nurture our oral microbiomes. And he made it very clear that fluoride-containing mouth, toothpaste, mouthwashes threaten the oral microbiome. And various things that we do threaten the oral microbiome. And, you know, what should we do? We should floss.

We should brush and use a, I guess it's a brand name, sorry, water pick. Whatever, there's got to be a name for it, a water flosser of some sort. And in fact, you know, I have a USB rechargeable one. I don't even know the brand, and I travel with it because I use it all the time. Dr. Brayna has developed a type of toothpaste that nurtures the oral microbiome. It's called FIG, F-Y-G-G, which stands for For Your Good Guys. So he's trying to care and love the oral microbiome. And I think it's really very, very valuable. It's a new frontier. We hadn't considered that before. But look, you know, 10 years ago, when we talked about the gut-brain connection, you know, people thought that I had a screw. grew loose and maybe I did, but you know, now everybody seems to be talking about the deaf brain connection and the brain gut connection as well. It's bidirectional. But that said, it's, you know, recognizing what you had mentioned, that the, that poor oral health bodes poorly for the brain. Periodontal disease is clearly associated with cardiovascular disease

and neurodegenerative conditions as well. When there is an overgrowth of various types of bacteria one in particular called porphromonis ginger valis it's threatening to the brain we can detect breakdown products of that bacterium in the brain and with inflammation around it so you know we're learning an awful lot these days about what goes on in one part of the body and how it affects the brain and other parts of the body yeah i love that also i'm a big fan of fig i use it every day my wife loves it i have no affiliation i just thought that They did an incredible job in making a better for you toothpaste that's out. And I have no affiliation either, but shout out for fig, F-Y-G-G-G-G.

It's a good thing to do. Yes, absolutely. We'll link it in the show notes if anybody wants to check it out. There was one other one that you mentioned, which was brain metabolism. And of course, that is, you know, really the big picture conversation here. How does our brain use energy? But you mentioned something that was very curious to me. You said, we have tools these days.

to actually kind of see how good our brain is utilizing, is at utilizing energy. What are some of those tools, and are they available to the people that are listening today? First tool would be simply a neurocognitive test. If you, you know, they're available multiple sites, have them online and they're free. I know that Dr. Bredesen's site has it. And that's going to give you an indication. If you're not up to speed based upon age adjustment, that's an indication. that's an indication that your brain metabolism is off.

But there is the development now of a unique type of MRI skin, no radiation, that is going to be able to measure brain metabolism being developed by Dr. Raj Atariwala in Vancouver. He pioneered total body MRI, which I just had, gosh, about three weeks ago. I traveled to Vancouver to spend some time with Dr. Atariwala to discuss the total body MRI and specifically the upcoming development of brain functional imaging as it relates to brain metabolism. So I think it's going to be something that will be available to people soon. The studies that I mentioned earlier that predict difficulties with the brain two decades ahead of time are really research study. they are using a radioactive tagged glucose called fluorideoxy glucose. And these are really just designed for research application, unfortunately.

But, you know, again, it is a radioactive tracer, so it wouldn't be fully considered non-invasive. But I think the MRI scans that he is, Dr. Tadio Wallace developing are going to be available, probably, you know, throughout North America. And I think it's going to be, for those of us who are involved in research in this area, going to be very, very helpful. You know, something you've been posting about as long as I can remember is really helping people understand the risks of a sedentary lifestyle as being another risk factor when it comes to the brain. When your brain, when your body is sedentary and you don't get exercise, you in a way have a sluggish brain. brain and a sluggish brain is a brain that is at a higher risk, a much higher risk of developing

Alzheimer's, dementia, other neurodegenerative diseases. Talk to us about exercise and how people can benchmark the level of exercise they're getting or in some cases not getting at any age, 30, 40, 50, 60, 70, 80, and beyond as a measure of what their likelihood is of developing a brain disease. Well, you know, it's been said that sitting is the new smoking. And, you know, with all the things that we do, pretty much you could be sitting all day. And, you know, the relationships between the sedentarity and risk of neurodegenerative conditions, I think is really quite profound. But it solves cardiovascular issues, diabetes, obesity, it's hypertension. We have a very cushy life now. We don't have to do anything. We have to, you know, make ourselves get up and do things, unless you really find

something that you really, really like, and it's an impetus to stay active. For me, lately, it's been pickleball. Cats me out. Love the sport. Anyway, so one study published last year in the Journal of the American Medical Association indicated, looked at individuals over a long period of time and had them, eight-year period of time, had them wear what's called a wrist accelerometer that measured their walking, and that's just one form of activity. And it's strongly correlated increased number of steps per day with decreased risk of cognitive decline. Perfect correlation.

They found that the ideal sweet spot was somewhere around 9,800 steps per day, so just around the so-called 10,000 steps per day. Another study that was published in the journal BMJ in January, of 2023 was a 10-year study looking at, I believe, 80,000 individuals. And it looked at a variety of lifestyle metrics, including physical activity, socialization, in other words, interacting with the people, challenging oneself cognitively, cigarette smoking, alcohol consumption, and nutrition, as all variables over which we had control.

And what was really fascinating about the results, was that you know where this is going. Those who had the most healthy lifestyle based upon the various parameters I just mentioned had a dramatically lower risk for cognitive decline. But here's the take-on message that I think is so profound is that it included even they teased apart those individuals who carried the APOE4 allele.

In other words, the so-called Alzheimer's risk gene. The same results were seen. and those individuals who heretofore were condemned to thinking that they were going to get Alzheimer's because they carried APOE4, which about 23% of Americans actually carried. It's an allele. It's a variable type of gene, if you will. You can have APO 2, APO 3, APO 4, and you have two shocks at it. So having 1-4 or 2-4s, we've always said, oh, that's a dramatic increased risk of Alzheimer's. This study showed that, guess what, if you maintain healthy lifestyle, that despite carrying

the APOE4 allele, healthy lifestyle offsets that risk and allows you to be in the group that's protected moving forward. So this information is absolutely profound, in my opinion, that here is this incredibly threatening disease affecting 55 million people worldwide for which risk can be offloaded by simply making good choices today while you're cognitively intact. Again, you know, fixing the roof while the sun is shining. On that note, Dr. Prameter, why do you think, you know, you've been doing this thing for a little while, even though you look super young? Why do you think that that message still, with all the information that's out there,

with so many people like yourself, especially championing this, why has. that message not penetrated the zeitgeist to the degree that people who are so afraid of developing dimension in the future, Alzheimer's, any of these neurodegenerative diseases, they are not forming groups in societies where they're like, hey, let's regularly play pickleball for our brain health. Let's actually start making home-cooked meals together in a group and be accountable to each other. You know, why is that not penetrated minus a small percentage of the population? It's a great question. And here's a bit of cynicism.

And that is that, you know, what people generally pay attention to is what's fed to them and through media. And, you know, all you have to do, if you want to answer your question, is watch the evening news tonight or any night, for that matter. And all you see are advertisers for this drug or that drug. And when the Alzheimer's drugs were first approved, that'd be another thing to talk about, our medical journals were saturated with ads. In fact, I read another neurology journal last night, and on page two was an ad for one of these beta amyloid drugs,

despite what I've just told you. So I think people are really receiving the message that our wonderful modern breakthroughs in science are here to fix all your ills, enjoy the party. And it's just not that way. And I think people want to believe that they can get away with it all. And look at the soaring rates of diabetes, hypertension, and obesity. Those metrics are clear indicators that there's a storm on the horizon as it relates to Alzheimer's disease.

And, you know, the threat that isn't considered as it relates to Alzheimer's disease is that we're going to lose cognitive reserve as a a society. We're losing all the smarts of elderly people and frankly not such elderly people. You know, and that's that's worrisome because there's great wisdom to be passed on from generation to generation. But having said that, again, the messaging is that there's going to be something developed very, very soon, go ahead and continue to do what you want, behave from the level of the amygdala, eat what you want, act like you want, stay up late, watch TV, party like it's, oh, you know, there's no tomorrow. And there may not be if you continue to, you know, make those lifestyle choices. It would be great. I would welcome a cure for this

horrendous disease. You know, it's been estimated by 2050. We won't have, we'll have twice as many Alzheimer's patients in America. That's, that's a horrendous increase. And the cost of just caring for these individuals right now is about 350 billion with a B, a year. A year. We are just in our country alone. By 2050, that number is expected to be more than $1 trillion caring for Alzheimer's disease, a disease, which is pretty much preventable if this message were to get out. So, May, there's a week in May every year that is Alzheimer's Awareness Week. And we're all aware of Alzheimer's.

What's the point to be aware of this so that we can have walks to be. raise money for development of drugs or who knows where that money goes. So a bunch of us got together, people that you know, Rhonda Patrick, Dale, Greta, Sincere, Gottfried, myself, Jim Quick. A lot of people got together and said, we ought to do better. So we've created on May the 15th, 2024. I know this is Evergreen, sorry, Alzheimer's Prevention Day. And we're going to launch that globally, and this is going to be a web presence that gives people all of this information, interviews with thought leaders to give out this information like we're sharing right now, a robust resource as it relates to searchable publications that can confirm what we're talking

about and give you chapter in verse how to do it, how to exercise, what kind of diet is best, how to measure blood sugar. All of these metrics will be made available to people to be really facilitated in terms of making important changes to protect your brain. We are the architects of our brain's destiny, not pharmaceutical companies. And that's the message that I think is so important. And I think gets to the heart of why you just ask me that question because I think by and large people and medical doctors think otherwise. There was an interesting report that appeared in consumer reports in the late 1980s by a doctor Jerry Avorn from Harvard who indicated, did a study asking doctors, where do you get the most information when you

read a medical journal? And most of the information, more than 70% came from the ads. So ads direct to medical doctors are very, very powerful and help dictate how they practice medicine. And truthfully, it is a lot easier and quicker to write a prescription than it is to talk to an individual about the various lifestyle choices that she or he should be making in order to safeguard their brains moving forward. Such an important point. And, you know, one of our friends recently, Callie Means, I don't know if you're connected with Callie, incredible guy.

Interviewing Callie in next week. Yeah. So he's been all over X.com, formerly known as Twitter. really helping sound alarm and piggybacking off of the statement that you just shared, reminding people that the primary reason that pharmaceuticals sponsor, you know, the nightly news and pretty much everything that we watch, it isn't to necessarily market to all of us because we can't always remember which drug is what, but it's basically to control the conversation.

Because if you can influence the individuals who are writing about things, And if you are 30, 40, 50, up to 70% of all the ads that are there on TV, especially, then who's going to come after you or threaten you or threaten your position? And it's something that the American public in particular, because it's so egregious here, they're waking up to and they're starting to be a very strong revolt that we all feel like we've been manipulated in the way. And that's a good thing. It's okay to get angry.

We just don't want to stay there. now that has to lead to action and change. I think to be fair, people should hear both sides of the discussion, not only one side. That's why over the years I've commended you for your podcast, because that's exactly what you're doing. And a lot of times you're not actually taking sides. You're just allowing the other side to be aired, if you will. And, you know, I also want to say that I'm not anti-drug. If there is the development of a pharmaceutical product that can do, good things. I'm all in. Count me in. We've got to look at the risk benefit ratio, and we've got to make sure that we're not harming people. Above all, do no harm. And when drugs

are developed, that can accomplish those tasks. I'm supportive. I think that I wouldn't turn my back. That's not part of the oath I take. And I want to use as many tools in the toolbox as possible. And my mission is just to keep that toolbox filled with new and exciting developments. You know, people have said, well, gosh, it sounds like you really want to function out of the box. And that's not my mission at all. My mission is to make the box bigger and be inclusive as it relates to novel ideas. And no matter what area of health we're talking about or disease for that matter. That's a great statement.

And I wholeheartedly agree with that. You know, speaking of the tools of the toolbox, right? There's these incredible points that you've mentioned about. being proactive with our body composition, making sure we're not walking around with so much weight, getting our blood sugar in check by not having refined carbohydrates in particular and processed, ultra-processed calories, sugar as well, breakfast, lunch, and dinner. There's nothing wrong with having some oatmeal here and there and having some almond butter and other things. There's plenty of ways to make a lot of foods that are out there in a healthy way. It's when they become

the complete opposite of healthy and they become the base of our diet that people, you know, suffer. In addition to that, you had a fantastic post that I just share here really quickly just to kind of, you know, recap with some with the audience. This is a post that you had on Instagram, including some of the other factors that we didn't mention. So being overweight before the age of 65, not engaging in regular exercise. You talked about that. Smoking tobacco for our audience. So hopefully that's a given. Would you put other things inside of that category of smoking? If people are smoking marijuana or anything else, I don't partake in that, but is that a risk factor?

Yeah, it is. I mean, oddly enough, I interviewed today Dr. David Rabin, and he has a company called Apollo. It's a wearable. But he's also, he's a MD PhD psychiatrist. and he was actually talking about some therapeutic benefits in certain clinical situations of cannabis. And, you know, I can understand there may be some application there, but aside from the neuroactive components, you're inhaling heated chemicals, which can be damaging to you. So, yeah, I think I can't see a role for smoking anything, frankly. Okay, great. Thank you for that

clarification. Becoming a type two diabetic, we talked about that. And this is, one that I'd love to just touch on for a moment, not engaging in mentally stimulating activities, like reading, playing chess, et cetera. You know, we went through this massive wave of Sudoku, and everybody thought that that's the thing that's going to keep your brain healthy. So anywhere I would fly all the time, you saw individuals doing puzzles on the plane, thinking that that was going to be the primary way to make sure that they kept stimulating their brain and hopefully lowering their risk of developing a neurodegenerative disease. Nothing against Sudoku, but why is that maybe not the full story? Why do we need something a little bit more challenging and a variety

of things that are challenged? Yeah. Well, let's go to the variety in just a moment. But the first requirement is that there has to be some way of, you know, of evaluating what the activity did. Let me give you an example. I had a patient, actually her husband, said that she's doing everything she can and to keep her brain healthy. And he said, she reads the New York Times

cover to cover every single day and in front of her. And I said, oh, what was the headline today? No idea. So it's all well and good to say I do, this and the other, but it has to be validated that you've actually engaged with that subject. I, you know, I learned a new song on the guitar today. Okay, can you play it for me? Oh, well, maybe not. So you've got to have some reference point completing the puzzle or playing against another person in chess so that you're constantly engaged in evaluating

yourself and holding basically your feet to the fire. So to get to the variety, you know, you want to recruit different parts of your brain in terms of different levels of functionality. And there needs to be, in my opinion, you know, physical activity involving. It would be a great thing to get involved, like learning and new, learning to dance, on a ballroom dancing, playing a competitive sport, because then you're getting, you know, this is happening at a time when you're creating chemicals for your brain like BDNF to really take full advantage of the fact you're trying to learn new information. So I think that's important, but also a different various types of stimuli, whether it's auditory or visual or tactile or even

smell as in learning to cook, learning to create things in the kitchen or who knows, you know, other things that you might, you know, maybe you're going to mix essential oils. But all of these ways are going to enhance the functional connectivity of the brain. That's really very, very important. because that's what starts to go as we begin to decline. Yes, there are disruptions at the synapse level, too, but there are levels at the network. There's dysfunction at the network level as well. The functional connectivity between areas of the brain

ultimately suffers as our brain function declines. So it's the integration of the various areas of the brain that happens when we engage in a variety of different activities that we need to preserve. It's been said that neurons that fire together, wire together. And what Dr. Heb was getting at, Canadian researcher in 1950s, was that late 1940s actually, was that when we do things, ultimately, the more we do them, ultimately, it makes those connections more indelible or more permanent, if you will.

But we want to do that across multiple areas of input to activate different. areas of the brain to keep, you know, to keep a lot of cohesion going. One area that we hadn't touched on, but is part of your framework when it comes to maximizing our brain's health, especially over the years. And that's the topic of sleep. You know, for a long time, people didn't talk about sleep. And then I finally feel like in the last maybe five years or so, it's been getting a lot more attention as it well deserves. What do you want to tell people about the topic of sleep as it's connected to dementia, Alzheimer's and these neurodegenerative conditions.

So whatever we choose to do is going to have a powerful influence on our health. And, you know, this is an activity that should be something we do for a third of our lives, that eight hours a day, one third of the 24-hour period, is dedicated to this activity. It's not like we exercise eight hours a day and not like we eat for eight hours a day, although I'm sure some people might do that. But, you know, this is a profound activity. And as it relates to the brain, it's a very active event. It's when the brain is doing some very, very important things

that are required for that brain to survive. It's when the brain is able to purify itself, rid itself of defective components, rid itself of misfolded proteins, debris from bacteria, you name it, during sleep, particularly during deep sleep when we activate a system called the lymphatic system. It's when we contextualize, pack away, and consolidate our experiences of the day. Those experiences are related to previous experiences that are packed away in areas of the brain of memory. And then those new experiences are related to past experiences and then stored.

So a lot is going on. The brain doesn't necessarily itself shut down. Our physical body doesn't move because of the brain tells it not to. We inhibit downward moving signals from the brain send that would otherwise have moved our arms and legs. We dramatically inhibit that at the moment we fall asleep. And then the brain becomes very active. And as you would expect, any factory that's working as hard as the brain does in relation to other factories, You know, the brain is far more metabolically active than anything else in your body.

And it accumulates a lot of debris during the course of the day that needs to be dealt with. So it's fundamental. When we have either issues with quality or quantity of our sleep, we dramatically increase our risk for metabolic issues like diabetes, obesity, and hypertension, and senile dementia of the Alzheimer's type, i.e. Alzheimer's disease, cardiovascular disease as well. But a powerful risk factor for the development of Alzheimer's is not getting enough quality sleep. How would you know? You would know because you use a wearable device of one or another, whether it's the aura ring or other wearable device that will tell you the very next morning. How much sleep did you get? How long did it take you to fall asleep?

How many times did you wake up? How much time did you spend in that deep sleep where that lymphatic system is active? How much time did you spend in REM sleep when you can sleep? consolidate and contextualize your memories. These are good metrics to know. Why? Because you can change things during the day and evening before you go to sleep. That can have a huge bearing on the quality and quantity of your sleep. Whether it's deciding to have a caffeine curfew at 2 o'clock in the afternoon,

meaning no coffee after 2 or caffeine of any sort, choosing the time of day that you want to exercise, whether it's morning or evening, depends on the individual. How late did you have your meal? How much carb was in your meal? Did you have a dessert and high sugar? And now your body is trying to deal with that while you're trying to fall asleep? Is the room dark? Is it cooler than you might be comfortable with that first?

Does your partner snore? Does your partner have restless leg syndrome? Is there noise outside that may compromise your sleep? What time did you go to sleep in relation to the time that you think you're going to wake up? These are all variables over which you have control that you can determine may or may I not affect the quality of quantity of your sleep. There was a period of time when I didn't, I wasn't happy with the amount of deep sleep that I was getting on rare occasion. And I'd look at my report the next day and it would say, hey, you only got 30 minutes of deep sleep. And I would say, I can do better than that.

And I realized that on that night, that evening that I didn't get enough deep sleep, I had that second glass of wine. So make a simple behavioral shift. If I don't have a second glass of wine, if I have eight glass of wine, I can get away with it. I have plenty of deep sleep. But that second glass just doesn't work for me. Though there are upsides to wine, I get all that. I don't do that because I need my deep sleep at my age with a family history of Alzheimer's,

frankly. So it might be other things for other people. They may do better by exercising in the afternoon or in the morning or by having a smaller dinner and eating a bigger breakfast. Who knows? But you're never going to know until you gain the data. You're not going to gain the data until you decide to wear a wearable device and find out what in the heck is going on in the background.

Fantastic. Going back to this idea of tools in the toolbox, Dr. Prometar, you talk about how lifestyle is first and foremost. And a lot of those things are free and easy tools that. we have available to us, exercise, our dietary choices that are there, the community that we spend time with, doubling down on sleep, challenging our brain by being novel and doing things that we can kind of measure. And then once we have those basics, which you've covered many of them here, now we can look at, you know, the additional things that we can begin to do that can also

be supportive. Again, these are all tools in the toolbox. And on those topics of tools, you've mentioned and you've written about how many supplements have shown demonstrated ability to be part of a healthy brain protocol and hopefully reduce our risk of developing some of these neurodegenerative diseases in the future. And one in particular that you've been championing for a long time is DHA and as a byproduct, of course, fish oil supplements as a whole. Tell us why they're so important to the brain and why you're such a big fan of people getting adequate amounts. Well, this goes back many years when I was first impressed with the work of a Dr. Martha Clara Morris at Rush who demonstrated that people who have hired DHA seem to be more

resistant to cognitive decline. And so, gosh, this was maybe 15 years ago. When I saw that literature, I began to ask myself, what does DHA do? Why might it be important? It turns out, that it's a really important from the perspective of being a building block of brain cell membranes. So, you know, the membranes where all the action is, is where brain cells sense things that are around them, is what, you know, how they are signaled, where the receptors are, that change what goes on inside the neuron, but also how one brain cell connects to the next brain cell through the synapse. That takes place at the level of this, what we call a synaptic cleft, where there's a giver and a receiver,

but the membranes that are involved in that have a lot of DHA in them. And basically, we're going to build those membranes based upon the fats that are available in our bodies. If we don't have adequate amounts of DHA, then we're going to use other fats that are going to be less functional. So from just the mechanics of how the brain works,

it started to make sense that DHA seemed to be pretty important. That's why early on it began and incorporating DHA into my protocols. We've then learned that DHA is a natural, what we call Cox II inhibitor, cyclooxygenase 2 inhibitor. And cyclooxygenase is an enzyme that increases inflammation. There were a bunch of drugs that were developed,

that were Cox 2 inhibitors to reduce inflammation. Even aspirin to some degree works as a cox 2 inhibitor. But DHA is nature's cox to inhibitor. So it tends to tamp down inflammation throughout the body, and that would be certainly valuable in the brain. But perhaps one of the biggest pluses of DHA is that it stimulates the body to produce something called BDNF or brain-derived neuroshardic factor, which is a growth antrophic hormone for brain cells.

It allows, it stimulates the growth of new brain cells, it protects existing brain cells, it reduces the destruction of brain cells, and it nurtures the synapse, where one brain cell connects to the next, which is certainly something at threat when we consider neurodegenerative conditions. As again, Dr. Bredesen has talked about Alzheimer's is a synaptoclastic disease, he says, meaning that the synapses are being destroyed, and that's, you know, one of the fundamental mechanisms. So it's really valuable. to have a lot of DHA on board. It's why fish has been always called a brain food. These days, unfortunately, a lot of the fish that is available would be contaminated. More than 90%

of freshwater fish in America now is significantly contaminated with a variety of chemicals, not the least of which are these PFEAS chemicals or these persistent forever chemicals, if you will. My vote is that wild fish, if you can find them, are still the best choice. Farm-raised salmon, depending on where it comes from. Norway, I think, is still pretty good at raising farm-race salmon with very little contamination and pretty good levels of DHA. That said, there are some really high-quality DHA products, oil, products available on the market, several brands are out there that are really very, very clean.

and there's even a vegetarian type of DHA that's made from algae. So I think you've got to do your best to get a lot of DHA into your diet. 100 to 150 milligrams a day of DHA, I think is reasonable. And people who are already suffering with cognitive issues, I use a lot more, recommend a lot more. But that's really, you know, beyond the lifestyle factors, I think that's really, as we start to get in something, one of the, you know, one of the, on the top of the list.

Just to clarify that, I've seen you written write different posts and communication that that one gram of DHA would be optimal. Is that, is that accurate? Yeah, I mean, I'm talking about the getting by if people are using a, you know, if they're just looking at a wide program, that 100, 150 milligrams would be at the, at the least what you want to consume in looking at both, you know, your supplement and, and how much DHA you might get from fish. But I will push it, you know, 500 milligrams, a thousand milligrams easily and not be concerned about it. Now, there's been some discussion that more so for the EPA that, you know, there might be some issues with respect to blood thinning.

And frankly, DHA, no matter, even at high levels, doesn't seem to have an interaction with blood thinners or put people at risk for hemorrhage. So I have no problem with going to higher levels. Is it fair to say, just to put a button on the fish oil conversation, would you say that when it comes to supplementation and people thinking about the, you know, there's only so much that you can do, there's only so much that you can prioritize, people are trying to get their workout in, etc, other things. And we as human beings tend to like to, you know, prioritize and compartmentalize to make sure that we get the best of the best. would fish oil in particular making sure we had the adequate amount of DHA, which is one part of a fish oil supplement, would that be your number one recommendation on the supplement side? Yeah, you know, it's hard to rank. It really depends on the individual. Would I say that DHA would be the number one recommendation for a person whose vitamin D level was really, really low? No, I wouldn't. I'd say, let's get that vitamin D level up first. That's first and foremost. What I say DHA is the go-eat. to if a person has a very high homocysteine level, I'd say no, multi-B complex with methylated B vitamins would be what is needed for that person. So it's a bit of a personalized medicine kind of a

recommendation, but it's really very, very important. So, you know, if I had to make a recommendation for just as a general recommendation, I'd probably agree with you that DHA would be at the top of that list. Well, another one, it seems like you've also put into the top of the list. And again, This is all about personalization. So people got to dig in a little bit. Maybe sometimes work with their practitioner. But you shared a post recently that my team had shared with me. And it was on the topic of glutathione.

And even when I read it, I was pretty astonished by the post itself. It says for those that are listening, researchers found that those with the lowest glutathione levels had a 70% increased risk for declined cognitive function. Talk to us about glutathione. and why you believe it's so important. What does it do in the body? Why is it so important? So glutathione has been called the master antioxidant.

And as such, it's protective over DNA, over proteins and fat, in terms of allowing them not to be as damaged by the production, the ubiquitous production in the body of three radicals, of damaging chemicals. So that's one of the jobs of glutathione. But in addition, Blutathione through glutathione as transferase is important in terms of detoxification as well. So it plays a fundamental role in helping us rid our bodies of many of the toxins to which

are exposed on a daily basis. So we look at both antioxidant functionality and detoxification, those are really big threats to the body and to the brain. So it's not surprising then that, you know, having a lower level of glutathione is related to, as it were, cognitive decline, and even certainly Parkinson's as well. Now, this is data that we looked at many, many years ago, that Parkinson patients have significantly lower levels of reduced glutathione. Should probably open that up in just a moment. And that led us to actually provide glutathione intravenously,

reduced glutathione to patients with Parkinson's, And what did we find? We found in some patients pretty remarkable improvements right away in their functionality. I think that the test that needs to be done is the administration of intervention mutathion over a long period of time to chart the decline or cessation of decline in Parkinson's patients. But, you know, we have to ask them then what can we do for maintaining our glutathione levels? And I would say that the ability for us to regenerate glutathione by taking a so-called glutathione supplement, I think, has not been adequately demonstrated as yet. I mean, there are a lot of products out there that are glutathione-based, whether they are liposomily encased or whatever, you know, given orally. Turns out that glutathione, which is a, it's basically three amino acids put together.

We call it a tripeptide. is pretty well broken down in the stomach and the digestive system into those amino acids. What has been demonstrated to increase glutathine are a couple of supplements. One is called alpha lipolytic acid that regenerates glutathone from its oxidized or less valuable state to its reduced state, which means you can then participate as an antioxidant. N acetyl cysteine or NAC has also been demonstrated to improve glutathic. levels. And frankly, we can improve glutathione levels by simply consuming higher amounts of cruciferous vegetables that are rich in sulfur. So there are ways of improving our glutathione status.

The other thing that should be considered is to offload the stress on glutathione in the human body and recognize that things that we might do that increase free radical production are going to consume glutathione in the body and hence our levels of reduced glutathione are going to be less, we'll still have higher levels of oxidized or damage glutathione. Glutothion exists in two forms. It's reduced form, which is the active form as it relates to free radicals. And when it quenches those three radicals, it sacrifices itself and becomes oxidized. So rather than oxidative damage to proteins, fat or DNA and our bodies, glutathone sacrifices itself and says, I'll take the hit, I'll become oxidized.

The good news is it can vacillate between oxidized form, damage form, and being available, again, the reduced form. And that's where these other ideas come into play, like alpha lipolaric acid, in terms of allowing glutathione to become regenerated and become functional again. As such, looking at a blood test of total glutathione, since it measures both oxidized and reduced levels to make the total, doesn't really give you a sense as to where that individual is in terms of the functionality or the availability of glutathione to do its magic. You really want to look at the ratio of oxidized and reduced glitthine,

and you want higher levels of reduced glutathine. And again, the ways to do that would be to consider NACs, alpha lipoic acid, a really powerful supplement we might touch upon it, and cruciferous vegetables, and as I mentioned, reduce oxidative stress in your body, and that will reduce the consumption of reduced plutophon and allow it to be more available. Well, one of my most favorite recent episodes that you did on your show on YouTube, and please everybody, please follow out. Dr. David Prilmutter will link to his show in this podcast. You interviewed Dr. Ray Dorsey about his new book.

ending Parkinson's disease that he wrote with a few of his co-authors. And he talked about the importance of minimizing our exposure to things like air pollution, pesticides, as well as the dry cleaning chemical that I can't always pronounce tetrachlorhydrogen or something like that. And it's sister chemical that is very similar that has not yet been banned, even though the first chemical has been banned. So living a lower toxin lifestyle to avoid development. In his case, he's talking about Parkinson's disease. My guess is that those same things that would be contributing to the risk and likelihood of Parkinson's disease are also going to be making the body say, ouch, in other ways that could lead it to developing other neurodegenerate diseases

because they would be greatly depleting, you know, glute of ion levels as one aspect of, you know, what was happening inside of the body. So two things. Number one, love that interview. because of that, I ended up reaching out to Dr. Ray Dorsey and having a good podcast. So thank you for that. And number two, just another reminder that we have to be vigilant and protect ourselves in this world that is, we're not always aware of how these things contribute in a massive way to our risk of decline later on in life. Yeah. And oddly enough, in neurology reviews, which comes out, I guess, every month. And it's sort of a summary of the literature.

Last night, I was reading exactly about this topic. And, you know, they made it very clear that it's a big concern beyond Parkinson's, that it may well relate to Alzheimer's. Why would we be surprised? And, you know, not just these neurodegenerative conditions, but neurodevelopmental issues as well. So a threat to children. And, you know, just how pervasive these chemicals are in our environment, that, you know, you have them in your blood, as do I.

And that's just because we live in the times in which we live. And, you know, there are some that are still being manufactured, although that we hope it's going to be curtailed. They're called forever chemicals because they were developed to be pervasive and rather to be long-lived. You know, it's, you know, companies that made these chemicals years ago and we got wonder products like Teflon and non-stick bags, paper bags, and plastics. there's a price to pay.

And our immune systems, for example, are ill-equipped to deal with this onslaught of chemicals for which they have never been exposed. And we're seeing the consequences of this exposure. And I will say Dr. Dorsey has been a challenge for him. Because here he's good science that he's producing and demonstrating, these relationships between these exposures and risks for diseases for which we treat only the symptoms, i.e. Parkinson's. This relationship of environmental toxins and Parkinson's, it's something we've been talking about for at least 20 years, that pesticides, insecticides, for example, are

manav and mankozeb, are used in experimental animal studies to create Parkinson's, and you can buy these chemicals on Amazon to put on your vegetable garden. I mean, there's something really wrong with that. What's wrong with this picture? So, you know, it's true, though, that, you know, people want their wonder products and really want to just turn away and live their lives. But for those who care to listen, there are, you know, beacons out there like Dr. Ray Dorsey, who are making it very clear that, you know, these are clear and present danger for all. all of us. We were chatting about the topic of supplementation. There were a few papers recently, and I unfortunately, I didn't bring them up, but I can link to them in the show notes,

that we're talking about the importance of a multivitamin, especially when it comes to lowering the risk of developing neurodegenerate disease in the future. Did you by any chance to come across any of these? Yes. As you might expect, when something like that gets published, you know, everybody puts it to my inbox. I don't miss it. It wasn't a dramatic effect, but it was, and I've actually made some slides from that research. It was, you know, not insignificant. And, you know, we talk about supplements being supplemental by definition.

That means, oh, you would have them as a supplement if you didn't have a good diet. Well, how do we define a good diet? We know that, for example, trace mineral levels in our vegetables these days, even organic ones, are not at the levels that we need in terms of things like copper and zinc and selenium and certainly magnesium. Therefore, if there is a sweet spot for each of these and so many other things in human nutrition, we're not reaching it. We're not at the mid part of the bell curve. And that's why supplements are important. So a multivitamin with minerals, I think makes a lot of sense. And you know, the quality of those products is so highly variable.

Some will say, well, we supply 100% of the RDA, the required daily allowance. To me, that doesn't mean a whole lack of a lot. There's certain areas that we really want to boost what we are taking as relates to, for example, the B vitamins, magnesium, and certainly vitamin D. and a multivitamin will probably not contain DHA, for example. So we have to be a little bit more comprehensive in our messaging and in terms of what people are able to glean from what we're talking about in terms of then what they choose to do for themselves.

Yeah, that's fantastic. So just to kind of summarize that, and I did find the paper. It was shared in the American Journal of Clinical Nutrition. Yep. And it was the effects of multivitamin mineral supplementation versus placebo. cognitive function. And so if I'm understanding what you're talking about correctly, because so much percentage of the diet, especially here in America, and increasingly exported to the rest of the world, is so low in trace minerals and all those stuff and just people are eating ultra-processed foods.

People are so deficient that even having a multivitamin could be pushing them in the right direction. But really, if we're paying attention. Yes. But, you know, this was an interventional placebo-controlled trial. And if you read the article, you realize that I think it was Centrum. I think it was a, you know, a very inexpensive multivitamin. And which is great. Here the study proves that even this inexpensive multivitamin was able to bring about this difference in these individuals. Just think, you know, that might indicate that perhaps. stepping up the game a little bit in several areas that are included in multivitamin might get even a better result. Now, this was a randomized placebo control trial. So think about the notion of a personalized approach to supplementation in an individual who wants to do the best for themselves in terms of brain health. And you are able to have the luxury of doing blood work to determine where that person is as a relationship.

relates to B vitamin status, looking at things like homocysteine related to B vitamin status, looking at vitamin D levels, looking at essential fatty acid panels, for example, and then cultivate a unique program based upon that individual's needs, not just based upon their vitamin panels, but even looking at their genetic panels in terms of what their risks might be and how vitamins and other parts of supplementation might play into that. So, you know, this was a a very crude but powerful revelation that a relatively inexpensive multivitamin could have this effect. Powerful.

You know, at the beginning of the interview, you were mentioning that there's a topic that we might get into, which was the idea of, if I understood correctly, like maybe therapeutics or other things that could be helpful or could be developed in the future. Does that ring a bell? Okay, great. I'd love to just hand over to you to talk about that and explain, you know, what is it that you're thinking about or what is it that you're potentially excited about that could be coming down the line.

Well, you know, again, it circles back to our discussion on brain metabolism being front and center as it relates to what makes a good brain go bad. And that metabolism is really predicated, good metabolism on insulin functionality and delivering delivering glucose and other nutrients to the brain via the blood supply. So blood supply and insulin functionality are the central pillars of what I believe will ultimately be a powerful therapeutic intervention that will, I believe, help Alzheimer's patients. And the master regulator of the functionality of both those entities is nitric oxide. This gas nitric oxide that is produced in the body that regulates how insulin

works and regulates blood flow. So I'm actually involved in research with a company called Brian Therapeutics where we're using a validated pharmaceutical intervention that's already received FDA approval for utilization in another context. We're developing a trial where we're going to use virtually the same neurocognitive indices that have been used in the beta emaloid trials. apply the same ones over the same length of time in an interventional way. And in this case, not target beta amyloid, but target brain metabolism.

And with the hope of at least showing parity with these drugs in terms of slowing cognitive decline, I think we're going to do better than that. I think we're going to, my hope is that we're going to have some pretty dramatic results. So that's what the future holds from my perspective in terms of, finally approaching this problem from an interventional perspective as well as prevention. Amazing. So it would be some type of drug that you would take that would help increase or maintain higher levels of nitric oxide instead of the body. That's right. We've already seen this prove its merit in treating COVID and also in cardiovascular disease. So, you know, it's basically

repurposing and seeing where we go with this. And I'm very, very excited about it. Beautiful. Well, I can't wait to hear how all that goes and we'll have you back on to talk about it at that point in time. That's very exciting. Dr. Promoter, as we're winding down here with our time together, I ask my community, you know, what are there sort of questions they have for you that I would bring up in sort of our hot takes portion of the conversation? And so there is a few questions that I have here and I'll jump right into the first one. there is a trend on YouTube in particular where a lot of people are championing essentially quitting coffee and they're promising miraculous benefits that would happen to the body and sometimes even the brain if somebody quits coffee for 30 days, 60 days and potentially beyond. I'd love for you to chime in on the thoughts about coffee, how you use it and any kind of

recommendations that you would have, and if there's any truth to this idea that people should be considering, you know, quitting coffee? Well, there's two sides of that discussion. And I think that there are downsides. And I think there are coffees on the market that are infested with mold. I think people tend to overdue coffee in terms of having too much caffeine and especially later in the day such that their sleep might be dysfunctional. And I, you know, we certainly unpack that topic at length. You know, I think it's important to recognize that caffeine as part of the coffee discussion, though there are 90 or more bioactive constituents of coffee that have generally, you know, positive effects on health, including chlorogenic acid. But, you know,

understand that caffeine has a half-life in the human body of six hours. So if you have a double espresso at three and a clock in the afternoon, I mean, it's just. just early afternoon, I should be fine. At 9 o'clock, six hours later, half that caffeine is still in your body. So it's like you just had an espresso at 9 p.m. So I think some of the bad rap that coffee is getting comes from its effects on our chronobiology when used inappropriately. So, you know, I think the notion of a caffeine curfew beyond coffee, tea, whatever it may be, Red Bull, Coke, you name it, chocolate, whatever caffeine sort. there is. I think the notion of a caffeine curfew is really important that you don't have caffeine in the

afternoon. For me, it's, you know, two o'clock is the cutoff. I think that significant issues can happen when people don't have adequate sleep because of their misuse of coffee. I drink one and a half cups or times two cups in the morning. I enjoy the heck out of it. And there's something to be said about the fact that I enjoy the heck out of anything that a person derives pleasure from something, I guess within reason. But, you know, and to be clear, there is something called decaf coffee that is out there that has pretty much the entire spectrum of health benefits in, you know, in relationship to caffeinated coffee, provided that caffeinated, the caffeine has been removed in a, you know,

a water bath type of distillation process that removes the caffeine and doesn't use chemicals to make that happen. So I vote for a third-party, mold-free, organic, regenerative agriculture-produced type of coffee. That's what I drink. That's what I travel with. And I'm willing to hear both sides of this discussion. I didn't say argument. I said discussion.

Thank you for that. All right. The next question that we have here is that with so much more emphasis, even since the last time that we've had you on the podcast, there's been so much more individuals talking about prioritizing protein and the importance of getting enough protein as primarily a byproduct of maintaining healthy muscle mass, especially as we age 40, 50, 60, and beyond. and how muscle is an important part of maintaining protection for our bones, but also strong metabolic health as we age. What is your thoughts on the protein discussion, is an individual asking? And have you changed your mind at all over the years in terms of how much protein you are prioritizing on getting in your own diet? First, I'll say I do consume more protein now than before.

and it is exactly because of what you mentioned. I want to maintain muscle mass, so I consume more protein, and I also consume creatine monohydrate, and I'm using a topical testosterone gel, all designed to increase or preserve muscle mass. I think one of the worst things that we can do is threaten one of our most important endocrine glands in the body. Now, which endocrine gland am I talking about?

Is it the thyroid, is it the pancreas, Is it the pituitary gland? No, it's the muscles. And I think for your viewers, that may raise some eyebrows. What is an endocrine gland? An endocrine gland is a part of the body that secretes a chemical that has functionality elsewhere in the body. And as it relates to the muscles, the muscles do exactly that and should be considered therefore endocrine glands. Muscles create a variety of chemicals like interleukin 6 and lactate and ketones and erasin, cathepin B, and brain-derived neurotrophic factor. Those are some of the chemicals produced by muscle that have distant effects.

In fact, everything I just mentioned has an effect within the brain. As it relates to interleukin 6, interleukin 6 directly stimulates a very important metabolic pathway in our body called AMP kinase. A&P kinase is what allows us to have adequate metabolism, to burn fat as a fuel, to make less blood sugar, to stimulate the growth of new mitochondria in our cells, including in the brain and in the muscle. So I think, you know, for people to say,

oh, well, Dr. Promoto, you said something different five years ago. And now you're saying, you've changed your messaging. Yep. And five years ago, I'll probably tell you something different. Who knows? I hope that I do. because science changes and I think our understanding this notion of the muscles as an endocrine gland and you know our studying of all of the things related to muscle called the myokininome is relatively new

and as such you know there is you know suddenly a surge of interest in muscle and preventing at all costs sarcopenia or wasting of muscles which typifies growing older so you know I'm 69 and as we age, it's more and more difficult to preserve muscle mass. I have to exercise more and I have to spend more time lifting weights and I've done those other things like the creatine, the higher levels of protein and, you know, using topical testosterone for example. So I think that things are changing with time and I think, you know, the notion of having about a gram or pointing to a gram of protein per day per pound of ideal body weight makes sense. Fantastic.

Thank you for that breakdown, that clarification, and may we all evolve with our own thoughts in a way that benefits our life and the lives of people around us, right? That's the way we're all here. All right. Last question I have here. In the lightning round. Yeah, the last question to light. These two points is double point value.

It's true. It's true. Can you ask Dr. David Perlmutter, what is something, no matter how big or small, that has had the biggest impact on his health in the last year? Something big, something small that's had the biggest impact on your health in the last year. And biggest can be relative to you. And it doesn't have to be a supplement. It doesn't have to necessarily be a food. It could be community.

It could be this. I'm going to give an answer. And it's a bit of a surprise answer. Okay. Give it to us. So I learned, I experienced atrial fibrillation, went to a cardiologist, and he said that, well, he asked me. He said, let me guess. We see it in NBA basketball players and long-distance runners. And he looked at me and he said, probably not NBA long-distance running. And I said,

yeah, because I was a long-distance runner for years and years. I mean, I would still do it. But now I realized that's what gave me occasional events of atrial fibrillation. So the biggest event was I had a procedure, which was called a cardiac ablation procedure, where this cardiologist went in and found the genesis in my heart for the atrial fibrillation, and he froze it. And gosh, that might have been close to a year ago now, I think it was last spring. And I've been perfect since then. So that's, you know, that's the biggest health event that I've had to experience. And I think, you know, that's probably a surprise interest. People say, well, I started taking XYZ. There is a, there are a couple of XYZs I've added to the program and I might, I might go for that. I've added a new

probiotic called Accuramancea. I think it's, there's a lot of good data behind it. I've increased my Quercetin consumption for, you know, it might take some time to unpack why I did that. And I think from that perspective, supplement perspective, probably nothing else really dramatic. I'm using a lot of alulose as a, alulose as a sweetener. We see that alulose is what we call a GLP1 agonist. So it acts in very favorable ways in human body to help control blood sugar. but so there you go going back to the aphib and for anybody not familiar you know essentially an abnormal heartbeat heart rhythm what was your understanding of long distance running

and how that contributes to individuals developing aphib i don't know the mechanism it probably has to do with perhaps dilutation of the heart of the atria and probably maybe even of the aorta and the Superior Vienicava as well. And, you know, it's hard to say, but, you know, there's a strong relationship between endurance athletes and the development of atrial fibrillation. So, you know, I felt like, well, I'm in good company,

but he said, your heart is great, but we'll fix it. And, you know, I may have mentioned that I live on a boat for four months a year when we're really far away from anything. And, you know, the cardiologist said to me something I'll never hear. He said, listen, what happens to you when you're a boat They're on the boat away from anybody, just you and your wife and you go into AFib.

What are you going to do? I said, sign me up for the ablation. I was in the hospital the next week and left. And gosh, he said, I'll give you an 80% likelihood that this will be curative. And it was. I'm really, really happy. Incredible. Hats off to modern medicine.

Yeah. I'm all right. I'm all right. To the table. Dr. David Perlmodo, this has been fantastic. Thank you so much for being on the. podcast today, would love to just give a shout out to your show, which we have a link to in the show notes. You have incredible interviews, especially a bunch of them on YouTube that I found, you know,

just incredibly fascinating. And I've gotten excited and booked some of those same guests on my own podcast because I saw your interview with them. And then also you and your team were part of a docu-series that occasionally launches, you know, here and there. People can stay tuned to it. Would you mind mentioning the website of where people could go to? Actually, there's a new one. and that's actually being shown right now. It's called the Better Brain Blueprint. Yeah, we're sending out to our list.

Yeah, that's our latest, our latest summit, as it were. And the response has been over the top. I mean, it's been really, really helpful. So, yeah, I'll get you that information, Better Brain Blueprint. Yeah, The Better Brain Blueprint.com. And if you wouldn't just mind, like, who should watch this new series?

that's available. I would say the only people who should watch it are people who have a vowel in their names. So that could be anybody ask yourself, if you have a vowel in your first or last name, you should watch this summit. Well, if you want a better brain, that's what you should check out. We have links to Dr. David Perlmutter's Instagram, social media, etc, where you post fantastic information. And again, David, thank you for being on the podcast today. Reminding, yeah, such a pleasure to have you on. And thanks for reminding us that there is a lot that we can do to protect our brain. as we each. You bet.

Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do

to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. It's called Try This. Every Friday, yes, every Friday, 52 weeks a year,

I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free, and get my weekly step-by-step protocols for whole-body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says, try this.