Dhru Purohit Show - Neurophysiologist Shares Top 3 Drivers of Alzheimer’s Disease, How to Reduce Your Risk of Cognitive Decline at Any Age, and How to Build a Super-Brain with Louisa Nicola

Episode Date: June 26, 2024

This episode is brought to you by Momentous, Our Place, and Air Doctor.  We know that the seeds of Alzheimer’s disease are planted at least twenty years before a diagnosis. It’s never too early to think about the lifestyle changes that can influence brain health and reduce the risk of developing neurodegenerative diseases. With all the health and wellness advice out there, it can be challenging to know what to prioritize and what truly matters when it comes to protecting our brain health. Today’s guest breaks it down for us and gives us actionable steps we can implement immediately, regardless of age. Today on The Dhru Purohit Show, Dhru sits down with neurophysiologist Louisa Nicola. Louisa shares the top three lifestyle factors that can influence our risk for Alzheimer’s disease. She helps us sort through the most current research and uncovers the biggest myths. She also shares the top two supplements that are critical for protecting brain health and the optimal prescription for exercise and resistance training. Looking to protect your brain health? Louisa shows us how. Louisa Nicola, an Australian-born neurophysiologist and sports scientist, has made significant strides in the field of brain performance and human potential. In 2016, she founded Neuro Athletics, a consulting firm dedicated to optimizing brain health and performance for athletes, executives, and high performers. Louisa's innovative methods improve reaction times, decision-making, and mental acuity. Her vision is to expand Neuro Athletics' reach, empowering more individuals to achieve their full potential through enhanced brain function and mental resilience. In this episode, Dhru and Louisa dive into (audio version / Apple Subscriber version): The alarming increase in Alzheimer's disease despite genetics (00:00:36 / 00:00:36) Why sleep is a critical factor in preventing disease (2:55 / 2:55) The impact of a sedentary lifestyle on increasing your risk for Alzheimer’s disease and tips for beginners (14:00 / 10:30) Physiology as we age (28:00 / 24:30) Fundamental pillars of nutrition and the power of Omega3 fatty acids (36:00 / 31:43) Creatine for neuroprotection, energy, and reversing osteoporosis (49:00 / 44:14) The biggest myth about Alzheimer’s disease (56:00 / 51:10) What motivated Louisa to study Alzheimer’s disease (1:03:00 / 58:02)  Actionable steps you can implement to reduce your risk (1:07:00 / 1:02:10) Implementing sauna into your routine to induce good stress (1:10:00 / 1:05:30) Brain optimization beyond the fundamentals (1:13:00 / 1:08:40) Social connections that power health (1:21:00 / 1:16:30) Bigger Muscles-better brain health (1:29:00 / 1:24:30)  Also mentioned in this episode: Omega Quant Test Neuroathletics Instagram Sleep Regularity as a Predictor of All Cause Mortality Study  For more on Louisa, follow her on Instagram, Twitter, and YouTube, or visit her website. Optimize your energy and mental clarity with the purest form of creatine made by and used by the best. Go to livemomentous.com and enter promo code DHRU to get 20% off any order. Reduce your toxic load by starting with your cookware! Go to fromourplace.com and enter the promo code DHRU at checkout to get 10% off any order.    AirDoctor is offering my community $300 off. Just go to dhrupurohit.com/filter/ to clean up your home’s air and feel better today. Learn more about your ad choices. Visit megaphone.fm/adchoices

Louisa, welcome to the podcast. You know, I want to start off with something pretty mind-blowing that I learned from you. So globally, we have about 50, 55 million people diagnosed with Alzheimer's disease. But the crazy part is that that's set to triple by, I think, 2050 is what I learned from you. But even crazier than that is that only 3 to 5% of all diagnosed disease are driven by our genetics. So that begs the question for my son. in our audience, what the heck is happening for the other 95 to 97% of people who unfortunately are ending up with this super scary disease?

It is super scary. So you're right. 55 million people worldwide have Alzheimer's disease. That number will triple by the year 2050. And it seems to be a cascade of different factors that affect it. It's my sole understanding that it comes down to three factors. The first one being inactivity, so lack of exercise, lack of adequate sleep, and then lack of proper nutrition. Let's unpack those.

Let's start off with the first one, which I actually want to kind of go out of order. Yeah. So let's start off with the first one and talk about sleep. Everybody sleeps or you would hope so, but what is going on in our modern day society that we're not sleeping good enough that's impacted? our brain? Well, we have to understand, first of all, the pathophysiology of Alzheimer's disease. So we know in these neurodegenerative diseases, okay, neurodegenerative, so they build up over time. More often than not, you're getting diagnosed with your first symptom of Alzheimer's disease around 65 years old. And the first sign is episodic memory. That is the first thing

that starts to go. What you did that day, somebody's name, somebody that you met, you know, that short-term memory. That's the first thing to go. And then you actually get diagnosed at about 70 years old with the disease. And this is an accumulation of amyloid beta, which is a protein. I'm not going to call it a toxic protein. I'm just going to call it a protein in the brain that we all have that aggregates, it clumps together over time, and it eventually leads to neuron cell death. So this is a long progression. It's, It starts around 25 years old, 30 years old. So the things that we're doing from our 30s impact how our brain will survive at age 70 onwards.

Sleep is so fundamentally important for many reasons. One is, and we'll talk about the different sleep stages, but sleep is where you can repair your brain. You have to think of your brain. It is an organ, but it's also like a muscle fundamentally. we need to rest our body, right, in order for our muscles to grow, regenerate. We need to rest them. We need to hydrate them. We need to fuel them.

That's what sleep does for your brain. And sadly, we're going through an epidemic of sleep deprivation, which is classified as six hours or less. Now, I live in New York. You probably look around you. Most people are sleeping around six hours or less. That's just due to the busy city life. But during sleep, we go through.

different stages. And the most important stages are deep, slow wave sleep, which is your stage three sleep. Then we're going to REM sleep and that's stage four. And both serve very, very, very important factors for the brain. Because during deep, slow wave sleep, and you can see this on an MRI and an fMRI, right, a functional imaging machine. Your brain, we have different types of cells. You've got glial cells, which are immunity cells for the brain. We've got neurons. We've got many different other cells. But these glial cells, right? They come from the Greek word glue. It's because they stick and bind to neurons. And what happens during deep, slow wave sleep is they shrink in size. And then when they shrink, there's the passage way,

it allows for the passage of the cerebral spinal fluid in your brain to flush and clean out all of the debris, all of the toxins that are built up throughout the day, amyloid beta. You've got another toxic protein in the brain that builds up and aggregates, that kills cells. You've got environmental toxins that build up during the day. All these toxins build up during the day, and it's just a natural process of humans. But that's why we sleep. We sleep to replenish the brain. So if we're not getting into deep sleep, deep slow wave sleep, We're not getting the activation of the glymphatic system. So we're not able to clear out the debris.

So what happens over time? It's like compound interest, okay? We don't clean it out one night. It may not do any harm. But if we don't clean it out two, three days a week and that compounds over the course of 10, 20, 30 years, what happens? It's like waste products just build up the garbage. You've got to throw out the trash.

If you don't, if the garbage man doesn't come and take the trash out, what happens? Piles and piles and piles and out of nowhere, it becomes a clump. And that is then an amyloid beta. I would say ball in your brain that eventually leads to neuron death. So one thing that's important is, of course, making sure that we get six or more hours, right? But also the other thing that I'm hearing from me that's just as important, if not more important, is that your different stages of sleep, especially deep sleep, are not disrupted. Correct.

And a lot of people, even if they think they're getting six or more hours, you see this trend of disrupted sleep that everybody's going through. Exactly. And, you know, now the latest research is showing that even more important than quality and quantity is regularity of sleep, what time you go to sleep and what time you wake up, which makes sense when you understand the evolution of the brain, because your brain loves certainty. It loves regularity.

It loves to know that you're doing the same thing over and over again. So if you can be going to sleep at the same time and waking up at the same time every day, you're going to just naturally increase your deep and slow wave sleep because you're going to be waking up with the sun, going to sleep when the sun is going down, and you're going to get this natural rhythm, if you will. Yeah, we wrote a newsletter about this, but there was that study from the UK. Correct. It was like 66,000 patients that they looked at.

and the people that had the most variation in sleep timing had a higher risk of all cause mortality. I believe it was only over 10% variation, wasn't it? Okay, you would know better than me. We'll link to it in the show notes so that people can see it. Yeah, correct. So you don't want a lot of variation. You want to maybe regularity.

Regularity, exactly. And that's literally just to bank on the slow wave sleep, the deep sleep, stage three, and also the non-REM sleep. That is non-REM sleep and also REM sleep, which is stage four. So just two quick things before we get into exercise and, of course, diet, which you're going to break into, including one of your top recommendations for supplements. And I know you're not like a huge supplements person.

You want them to be tailored, but there's one supplement that you're a huge fan of across the board. We'll get to that in a second. But before we go to that, as I mentioned, exercise. a sedentary lifestyle, its impact on the brain, why being sedentary is so damaging. Give two quick tips on the topic of sleep that's there. One of them you just shared, which is try to maintain a schedule. Don't have too much variation, you know, maybe plus or minus 30 minutes is fine, but try to keep a standard sort of going to sleep time and a standard sort of waking time, right?

That is correct. Yeah. You also want to ensure that you are warming up for sleep. If you treat sleep like a sport, then you've got to think about it like, okay, it's 8.30 p.m. I want to be asleep by 10 p.m. That's the golden rule with me, bed by lights out 10 p.m. If you want to have that as your sleep time, that means you're going to have to start warming up for sleep at 8.30 p.m. That may involve having your last meal at 8 p.m. It turning down the lights, getting relaxed, don't answer emails, don't be doing anything too chaotic. and, of course, staying clear of alcohol and marijuana if you are a regular user. Yeah.

Let's talk about the intersection of exercise or lack of exercise and the brain. I don't know many people that know as much about this topic and the combination of those two as you. We'll talk about your story in a second, but first, tell us why a sedentary lifestyle is so damaging for the brain, but also is so likely to increase your risk of getting Alzheimer's one day. The most powerful intervention that we have to slow the progression of these disease states is exercise. Exercise can be broken up into three categories. You've got resistance training. You've got aerobic training.

And then you've got neurocognitive training. Aerobic training is absolutely fundamental for the brain and for this specific reason. reason. It can help with the growth and proliferation of new neurons. So you can literally grow new brain cells in your brain, in specific areas that are involved in the degeneration of or the accumulation of Alzheimer's disease. So you've got a little area in your brain. It's deep in the temporal lobes, which sit behind the ears. It's called the hippocampus. It's a seahorse-shaped structure. That's where we hold, that's where we hold all of our memories. memory formation, learning as well.

And that's the first thing to shrink. The structure of it shrinks, the volume size, and the neurons inside it shrink. So evidently, when that shrinks, any part of the brain that shrinks and dies off, we lose aspects of what that controls. So that's why we lose our memory. But we've known now since 1960 to be exact, or the 1960s, that we can grow new neurons in the brain. brain, which can help with better learning, better memory. We also know that through aerobic physical

activity, I'm talking your long runs, your zone two cardio, we know that you can actually build greater connections. So your brain cells synapse with each other. They connect with one another to provide our thoughts and our actions. And we can now see that with more exercise, you can get more connections between brain cells. So you can grow the cortex of your brain. We've known that since the 1960s because the first studies ever done were on mice where they, you know, they subjected mice to a little shoebox, one group, you know, which didn't have much activity, much light. It was a very dull environment. They weren't doing much movement. Then they put another set of mice in this Wonderland, if you will, well, they had circuits. They had so many things

going on and over the course of six months they saw that these mice actually grew the cortex, the outer layer of the brain, and they grew new connections in the frontal part of the brain. The frontal part drew is what is responsible for our executive functions, information processing speed, your ability to think, your ability to make sound decisions. These areas grow thickness-wise just through aerobic physical activity. Wow, that's incredible. So, we've always known exercise is good. But what seems to be coming today and the research that you're going to be talking about and presenting and already have been presenting is that we're learning even more exactly the mechanisms

of how exercise supports the brain. But also the other side of that coin is we're learning that when we don't have that just how damaging it can be. If somebody is living a sedentary lifestyle, which I think here in America, that's less than 4,000 steps a day, right? And a lot of people actually don't know, they're getting 4,000 or less steps a day. And they're not prioritizing

some sort of movement, aerobic training, resistance training. How bad is that for their brain? Absolutely detrimental. In fact, it's over 70% of U.S. adults don't meet the physical activity guidelines. The CDC states that we need to be doing at minimum 150 minutes to 300 minutes

of moderate to reasonable, to rigorous physical activity per week. I think that there is a nomenclature mishap there, because physical activity, a lot of people think, is doing the gardening. When I would lobby against that and say we should change the words to exercise, because exercise is going out and stressing your body. You need a place stress upon a system in order for it to grow, and that's what you do when you exercise. So the mere fact that we are living this sedentary lifestyle, increasing the risk factors for Alzheimer's disease is detrimental. People think that, oh, I'm just going to exercise to look good. That's how I think we view exercise still. We don't go to the gym for our brain. We don't go to

the gym for our heart. Most people are going to the gym or exercising just to look good. So if you've got that in your head, you may think, well, I kind of look good today. I don't really feel like working out. If you don't really understand how fundamental it is for the health of your brain and body and how you actually live your life, like quality of life, you're probably going to be sedentary. You know, for a lot of my audience, especially on YouTube, that's in the 50 plus age group, 50 to 60, 60 to 70, and shout out to everybody who's listening, who's 70 and above. They maybe didn't grow up exercising. It wasn't part of their culture.

They didn't have a dad or a mom or a family member. They're not used to it. And they're hearing about just how important exercise is. But then they hear the word gym. And there's a little bit of nervousness that's there. when it comes to tips to getting movement in, are there any things that you can recommend for people, right? Anybody at any age group,

especially with a little bit of training in the beginning, you can get into the gym and it doesn't have to be intimidating. But for the folks that are intimidated by it, what other things can they be doing to get that movement in? This is not new information for me. I often refer to my parents who are late 60s, okay, my father, early 70s. They didn't grow up exercising,

but now it's an actual family law now that they are exercising. And the way that I got them to start was just walking, just getting your steps in. And that's the first thing. You know, you don't want to shock your brain. I know that you know a lot about dopamine. And dopamine is that molecule. It's that neuromodulator that gets released in pursuit of a goal. And if you set yourself up to achieve an unachievable goal, like going to the gym or going

and doing a huge run. you're probably not going to achieve and it's going to scare your brain. And you're probably not going to wake up and do it the next day. I want everyone to start really easy. You can get so much benefits from walking. I don't know why we've demonized walking. I consider walking one of the best exercises. It's not the only thing we should be doing.

But if you are completely sedentary, only meeting three or four thousand steps a day, set yourself a goal of just doing a walk, an extra walk. Just walk. that's all you need to do to start. Then maybe that walk gets a bit faster. Maybe that walk turns into a jog. Maybe it's a full walk with a 10-minute walking lunges, if you will.

Notice I didn't use the gym there or weights. Nothing is scary about walking. Even walking uphill. Even walking up a hill, exactly. You want to stress yourself just a little bit, but even getting steps in, the amount of benefits it does for your brain. and your cognition is, oh my God, it's unbelievable.

I've heard a little bit about the origin of the 10,000 steps. It kind of was just like made up a little bit just as a benchmark for people. But is that still a good thing to shoot for? Especially because we know that a lot of people are living a sedentary lifestyle, getting four to five thousand or less steps a day. I think that we should be shooting for 12.5,000 to be. Talk about why? I think so it comes down to just.

just how much you are pumping blood throughout your body, right? The way that this actually affects brain health actually comes from the heart. Because what we're doing is your brain is the most vascular rich organ in the entire body, meaning it's got so many blood vessels. You've got capillaries, which are these one cell thick blood vessels. You've got veins and you've got these big arteries, okay? And every single vessel feeds the brain with blood. And the moment that that little vessel dies off, you will lose blood supply to that neuron.

That neuron isn't fed with oxygen and nutrients, which is what blood does. So therefore, it's got no use, so it'll die off. We've got around 87 billion neurons in the brain. And so if they start to die off over time, that's what we get with impairments in our cognition. So walking is just a way to just keep flowing blood throughout the body and to the brain because your capillary isn't there. We need to be using them. So every time you are pumping blood, you know, anything above your baseline. So right now we're probably depending on how fit we both are, our resting heart rate may be in our 50s, right? So we're pumping, we're doing 50 beats

per minute. Whereas if you're just out there walking, you're probably reaching about 100, 110, 130. So you're getting more blood flow than if you were just sitting down. That's my take on the 12.5,000 steps per day. I love that. And you know, you have a fantastic quote. I don't know what order it's in, but what's good for the brain is good for the heart. What's good for the heart is good for the brain. What's good for the heart is what's good for the brain. But I guess both are true, right? Like anything that you can do that's going to be supporting your brain health, generally speaking, those things are all good for the heart. But in the way that you're talking about it, really if you can prioritize your cardio

training just by a vigorous walk that's there or other things that are supportive and you start where you are and you build up further, sure, if you can work your way slowly up to resistance training, that's going to be helpful. But those things are going to be good for your heart, but they're also going to be super powerful for your brain. Connect the dots of why would that be that all this movement would be supporting either a delayed diagnosis of Alzheimer's disease or hopefully knock on wood, you know, not getting Alzheimer's disease in the first place. So let's actually take a bit of a physiology lesson, if we will. And I really want to go back to your previous comment about

your viewership being in that 50 to 60 year old. Right, on YouTube. Okay. On audio a little bit. But that's really important because I actually have, as a woman, I have a strong relationship with the association between postmenopausal women and dementia. We know that two out of three cases of Alzheimer's disease is women, right? So we have to understand why that is and we have to understand the role that estrogen plays, our dominant hormone.

So if you are born a female with, if you are born with a uterus and ovaries, that's what I mean when I say female, you have more estrogen receptors in your brain. And evidently as we go through the women, go through the menopausal stages, varies in age. Maybe it's around 52. I think that's the global average age. You start to get less estrogen. We don't produce any more estrogen. Therefore, estrogen is, if that is the most dominant hormone in the brain, we have a higher

efficacy of getting these neurodegenerative diseases. So we need to understand, especially as females, just how important exercise really is for a healthy functioning brain, for a healthy brain in terms of function and structure. And I really think that females have been dramatically understand. when it comes to these diseases in academic medicine. We won't go into that because I have beef with Charles Darwin, so we won't go into that. But I really wanted to highlight that and the importance of, you know,

ladies in their, you know, in their 50s, in their 60s who are leading up to that stage, how fundamental exercise really is. Is it too aggressive to say that a sedentary lifestyle? It impacts everybody, regardless of your gender, but in particular because of our modern lifestyle, a sedentary lifestyle is going to take its biggest toll on women. Is that too aggressive to say? That's not too aggressive at all.

So that's a true statement. That's a true statement from me. It's an important thing to talk about because we want to protect everybody in society, but it's important for women to know how they might be more vulnerable because of their unique situation with hormones. Yes. And when I said the statistic, two out of three women, two out of three, two out of three, Alzheimer's cases are female, we still don't know why because women are understudied in science.

So we need greater advocacy for understanding that. We need to understand why that is, but we do have a rudimentary understanding and it does come down to estrogen. Yeah. There's a lot of really great researchers in that space that I'm sure you know Lisa Mascone and other individuals that are doing some great work. But yes, we need more of it. So let's go back to the physiology lesson and we can understand why the heart plays a really important

role. And this actually comes from Ben Levine, who's a sports cardiologist. And he's done absolutely foundational work when it comes to the structure of the heart. So what happens, just like the brain, as we age, the brain changes. It ages too. We see a decrease in our cell size because as we age, like we get a decrease. decrease in cell size, it's just part of the natural brain aging process. You're never going to get to age 100 and see thicker cortical areas in your brain as opposed to a 20 year old. So we just know that.

The heart ages too. So as we get older, we get stiffening of the arteries. The arteries, those big pumps that come out of the aorta that pump your entire body of blood. They get stiffer as we age. What also happens is we have a left ventricle of the heart. We've got a right ventricle. The right ventricle pumps blood to the lungs. The left pumps blood to your entire body, the organs, the muscles. That left ventricle over time gets stiffer. So we get something called left ventricular hypertrophy. So the walls of the left ventricle thicken as we age. Now, Ben Levine was really, he's wonderful. he did a study where he took 53, 50-year-olds. He subjected them over the course of two years to maximal aerobic exercise.

I think it was around three to four hours per week. Maximal aerobic exercise is when you're pushing past your limits. You're huffing, you're puffing, you're going really hard. He pushed him to that zone. And he took, you know, he took images of the heart. He did echo cardiograms. He did every image of the heart to see the, structures. Over the two years, at the end of the two years, he rescanned the hearts of these 50-year-olds

and he found that he reversed the age-related changes in the heart by 20 years. Wow. So these 50-year-old hearts looked like 30-year-old hearts. Specifically, what he saw was that left ventricle. It actually the walls got thinner. So the ventric got bigger, so he could allow more blood flow to come in. Therefore, more blood to the muscles and more blood to the brain. And over how much of a period of time?

That was over two years. And that was maximal. And we'll go into that as well because we haven't even touched on resistance training. But we know that you can change the structure of your heart. It's actually called cardiac remodeling. You can remodel your cardiac system. So what happens when we do that?

We get a stronger heart, a stronger foundation to pump blood through the aorta. Now, your aorta comes up and out of the aorta, we've got branching of two main sets of arteries. You've got the carotid arteries on both sides, obviously, and they supply the frontal part of your brain, the anterior part of the brain with blood. Then you've got the vertebral arteries. They supply the posterior aspect of your brain. So the better structured your heart, the better structured your aorta, the more blood will pump more efficiently to the brain.

So two years of vigorous exercise led to an almost biological age reversal of the heart of 20 years. I don't know anybody that wouldn't want that. Absolutely. So what does that mean? Let's go back to aerobic training. You can't just perform maximal exercise. That is just, that is silly.

I would never get a 65-year-old who is completely sedentary to go from that to maximal exercise. You don't go from zero to 100. Correct. That's why you want to walk. You want to set the foundations. Everything is done in levels. You set the foundations. You build up some angiogenesis, the creation of new blood vessels.

You build up your muscles. You build up your tolerance to, CO2, right? Then what you want to do is you want to pick it up a notch. Maybe you jog, maybe you get on a bike, you go a bit harder, and then you build yourself up to be doing maximal aerobic exercise. That's fascinating. You know, another thing on the topic of exercise that you've been known to talk about. In fact, I think it's one of your most viral clips. You connect the dots between gray matter in the brain and exercise. Can you chat about that? And a lot of our audience, give them a refresher on what gray matter is, why it's so important.

So we've got gray matter in the brain and that sits on the outer cortex and they are the cell bodies of the neuron. So the neuron being the chief brain cell, the only electrically active brain cell consists of a cell body just like the cells in your body. And then you've got this axon that comes off it. The axon has the myelin sheath and that's where that's called the white matter. Okay. So that's the white matter of the brain. And that's where we have speed of thought. Okay, we call it conduction velocity in neurophysiology. So that's where our myelinated neurons are.

That's the white matter. The gray matter is the cell bodies. That sits on the outside. And we know now that around 70 to 80% of brain gray matter is modifiable by exercise. Modifiable. Now, the cell body has these little legs that come out. called dendrites. And those dendrites will stick to other dendrites of nearby cells. And when they connect, they create a synapse and electrical chemical reaction that happens. And that's what produces

our thoughts and our actions. But over time, those dendrites die off. But we can grow new dendrites. And that's what is responsible for greater cortical area and greater cortical mass. And we do that through exercise. So you get greater connections between these cells. So more connections, therefore speed of thought is happening, greater capacity to hear, to learn, to remember, to tell yourself to go to sleep. All of this matters. So if you care about brain health, you have to care about exercise.

If you care about your brain, you have to love exercise. And treat it like hygiene, just the same as you brush your teeth. That's super powerful. You know, we were going through your list of three most important things if we want to avoid Alzheimer's disease or at least greatly reduce our risk for it. And we already covered the first two. Let's talk about the third one, which is nutrition. Okay.

Nutrition is a topic that a lot of people are concerned about and care. about, but there's a lot of confusion around the topic. So what are the most fundamental pillars, regardless of what diet people choose to partake in, not partake in when it comes to eating to support your brain health? I really love this topic, A, because I'm nowhere in the nutrition space. That's why I love it so much. And B, because I really want to demystify some of the myths that I see on Instagram and other social. platforms. The first one being, you ever think about how your brain is what it's made up of? Do you ever think about that? All the time. I do too. It's interesting because I've seen the brain

as I'm an operative neurophysiologist. So I go into brain surgery. So I get to see brains and spinal cords. And it's pretty fascinating when you look at it. And it's like tofu, the consistency of tofu. And you look at it and you know that most of it is made around 60 to 70% of it is made of fat, then the rest is water. And then we've got this growing body of work that shows that cholesterol, you know, it is made of cholesterol. But that doesn't mean that dietary cholesterol is made for the brain. And I constantly see that on social media, you know, constantly see that people think that dietary cholesterol is what is feeding your brain. But I have to say to you that the cholesterol molecule cannot actually penetrate the brain. It can't cross the

blood brain barrier unless your blood brain barrier is compromised. And that's when you've got more issues. Leaky brain. Correct. And you would know what that is. But that's the first thing that we need to demystify. Cholesterol diet cholesterol does not go into your brain and feed your brain, even though your brain predominantly is made of fat. 20% of the total lipid content in your brain. The total fat content is actually made from DHA. DHA is omega-3 fatty acids. So this is why I advocate for high omega-3 fatty acid content. Amiga-3 fatty acids are made of EPA, D-H-A, and ALA. But I'm going to stick to the most important ones being EPA and D-HA. We've seen numerous studies now, clinical studies on humans, showing that if you feed your

brain, four to six grams. Some people would argue that that's too much, but we know that four grams of EPA and DHA is absolutely fundamental for brain health. And that's what I'm having every day, four grams. So two grams of DHA, two grams of EPA. And just so people are following along, that could come obviously from food. It can come from supplementation. How is your mix? How are you getting to that four to six grams a day? If I was living in a little island in Greece, I probably wouldn't be supplementing. And that is because the fish there is fresh. They're catching it from the ocean that is not polluted with plastics and God knows what else. So you can't really rely on getting four grams of EPA and DHA from fatty fish alone. You'd be having tons of it.

And I'm sorry, I'm not too sure that in this country in the United States that we're actually getting the recommended dose, even minor dose of EPA and DHA from fatty fish due to the way that it is actually served to us. So that's why we have to turn to supplementation. I don't like putting pills in my mouth. I would rather get it from food, but we just can't. So we have to be getting it from supplements. I like taking my pills. It makes me feel good. It makes you feel good, yeah. But I'll tell you what else it does. You're not just feeding your brain. I would say that the omega-3 or the EPA and DHA has a safety profile of an FDA-approved drug, so it's completely safe to take.

This is why I recommend this for everybody. But what it has is it just feeds your brain and your body in so many ways. One thing that it does is we know that it can decrease inflammation. Who wants to be in a chronically inflamed state? We know that it can really decrease inflammation. We're seeing studies of it ameliorating, getting rid of and clearing out amyloid beta, which is that toxic protein in the brain that builds up in Alzheimer's disease. But we also know that it can help with cell membrane fluidity,

the way that your cells are moving throughout your body and in your brain. So it does so much. I could list about a thousand things that the omega-3 fatty acid pill does. So the most important thing for people to take away from this is that EPA, BHA in these omega-3 fatty acids. Yes, we can get it from consuming fish, hopefully high quality, but often to get to that four to six grams you're talking about, we need a little bit of supplementation. Yeah. It's neuroprotective. It is neuroprotective. So it's going to be helping us, again, delay that diagnosis, God forbid, or help us, in my case, I'm not trying to

get Alzheimer's at all. So I'm trying to do all the things that are there. So hopefully we're reduce your risk that we know for sure, but in an optimal world, if we're doing everything, do you think it's possible that, you know, if your genes are not those particular ones that you talked about before, that maybe you could live your entire life and you don't get Alzheimer's. Do you think that's possible? I want to first clarify it. I think this is really important to understand the difference between genetic mutations and genetic risk factors.

So when we have genetic mutations, let's just say we have, you know, we've got around 25 thousand genes in the human genome. If we have a miscalculation on one of those genes, you will have a certain disease. You know, if you've got a mutation on chromosome four, you'll get Huntington's disease. A genetic mutation in the dementia space involves three genes. You've got pre-Sinel and two and the APP gene, right? They are mutations. So if you have these three genes, you have these three genes, we know that you are going to get some form of dementia. The other risk factor genes, which I know that you know what they are, we've got two of them called APOE4. If you have the APOE4 allel, you know, you get one from mom, one from dad, it raises your risk of getting the disease. So they are

risk genes. So I think it's really important to differentiate between the two. So what's happening now is that out of that 55 million people that have the genetic risk factors for Alzheimer's disease, only 3 to 5% have the APOE4 gene, either one or two. So they have a higher risk of getting the disease. But the other 95% are getting diagnosed with Alzheimer's disease without having the mutations or the risk genes. So that begs the question of why. You could live your entire life and not get Alzheimer's.

Correct. Even, you know, regardless of genes, by the way, regardless of not having the genes. I truly believe that. I do believe at end of life we are going to die of something. Right. But Alzheimer's disease is a preventable disease. So you can slow the progression if you've got mild cognitive impairment or you can completely prevent it through precision medicine, lifestyle interventions.

Yeah, I asked my dad one time, I was like, do you remember? any of, and I think he even knew his great-grandmother, do you remember any of your grandparents, great-grandparents, having, you know, cognitive decline to the degree of how we see Alzheimer's today? And he says, he can't think of one person that was in the family tree that had that. And then you have to question why that is. Now, there was a really famous study, and I hope I don't butcher this study, but there was a famous study that was done in Nigeria, where they did find And that there was a large population per capita that actually possessed the APOE 4 gene. Okay, the two alleles.

You got one, some of them had, there was a high population that had two. However, they didn't get the disease. Why is that? It most likely is because of their lifestyle interventions, which are much different to those in the United States. So true. What else do you want to say about nutrition? You're talking about how protective having EPA and DHA in your diet is. Yeah.

And actually one follow-up question for you on that. We're going to dive deeper into some of these topics. But do you recommend that people do something like an omega index test to get a sense of where they stand and how much EPA, DHA, or even things like trans fats they have in their body? Yeah. So the omega three index text, which was formulated by Dr. Bill Harris, it's a great test. It measures the amount of omega-3s in a red blood cell. This is different from if you go to your PCP and ask for an omega-3 test.

That is not the same. I would generally recommend getting, and it's a really simple test. It's just a pinprick test. And it's like $59 is like the cheapest version. I think it's $99 if you want to see the full profile, which I like because it shows you if you have like trans fats, if you're consuming too much of those. was no affiliation. I've had Dr. Bill Harris in the podcast and I've talked about my own experience. I actually took that test when I was still deciding about whether or not I wanted to be a

vegan many, many years ago. And my results came back and they showed me that actually I need to have fish in my diet because my ratio was completely off. Oh, wow. See, there you go. You want that, you want a correct ratio. But you also want to be shooting. I don't know if you remember what your percentage was. I'll have to dig it up. So mine, so what we know now is that most of US population is around 4% or less, which is scary because you are increasing your mortality rate with an omega 3 index test of 4% or less. We want to be aiming for an Amiga 3 index score of 8% or more. Yeah, I'm about 8.5 or something like that right now. But back in the day, I was probably even less than 4. And that's scary, right? I actually tested I was 10.5. That's amazing.

It is. But I'm very, I'm very meticulous with my supplementation. Yeah. So I do believe everyone should get that. But on that as well, I think everyone should be getting a blood test, standardized every, if they can do it twice a year, just to see what is happening. You know, something as simple as having a vitamin D deficiency is crucial as well. Like, you don't want to have a vitamin D deficiency.

You don't want to have a magnesium deficiency. We now know that we have vitamin D deficiency. receptors on the brain. In fact, that there are vitamin D receptors on our brain stem. And this is very much correlated with sleep. So we want to have a good understanding of what is happening in our body. And I would caution against taking any supplement other than omega-3 fatty acids and creatine outside of a blood test. So don't just take vitamin D because you think it's good for you. Go and check. Yeah, fantastic. On the topic of nutrition, one thing that we didn't talk about, even though that's not your primary

wheelhouse, is what are the most damaging over-consumed foods or nutrients that are causing damage to the brain? Anything that you could talk about at the highest level. The standard American diet. We know that we want to stay far away from your fried foods, from your packaged foods, from your sugary foods. We don't want that. What your brain loves, because we didn't actually touch on this, your brain loves, it turns out antioxidants, specifically vitamin E, vitamin C, selenium, you know, blueberries, raspberries are some of the most

important things for your brain. Your brain loves that. Have it, feed it, what it loves. And I think instead of talking about what's damaging for the brain, let's stay away from that, why not talk about what is good for the brain and what are you doing to eat that? Are you eating antioxidants every day? It does love plants. In fact, I'm an omnivore. I eat everything. I don't subscribe to any specific diet. But I would say now my diet is around 70% plants. By volume, not by calories? By volume, yes. 70% plants. I do have red meat. I love red meat. And it is not bad for the brain. I do have a lot of fish as well. But really understanding the antioxidant profile,

vitamin A as well, your brain loves that. So if you can just stick to that first and foremost, it kind of takes care of itself. You don't need to be eating the foods that we know are fundamentally going to cause mitochondrial dysfunction, metabolic dysfunction. And we also want to maintain a good lipid profile. That is understanding your LDL, your APOB, you know the plaque that forms in the arteries. That's, again, what is good for your cardiovascular system is good for your brain. So you don't want to be overloading yourself with these fats that are going to infiltrate the arteries of the wall. Now, you quickly touched on it, but it deserves its own little segment here on the podcast, which was one of your other top.

supplement recommendations. You're so excited about the supplement. You actually put your parents on it, even though they're not bodybuilders. And that supplement is creatine. Why are you so excited about creatine? Oh my gosh, creatine. Creatine has got to be the best thing that you can be taking for cell energy metabolism, for the energy of your brain. I think everyone should be taking at minimum five grams of creatine per day for several reasons. You mentioned a word earlier, neuro protection. We want to protect our brain, protect it from something that might occur, whether that is getting hit in the head or just protecting it from our life. Like let's admit, there's 2024, every single day we have to wake up. It's like the hunger games. Like we are getting so many things thrown at us,

notifications, stressful events, where we're trying to navigate this food system, where we're trying to find healthy food. So our brain is under attack 24-7. Protecting your brain with creatine is fundamentally so incredibly important. What it does is it, first of all, the cell energy metabolism, it helps create ATP, which is our energy source, our energy currency. I love it for several reasons as well. It's because we used to think of it as the bodybuilding drug, but we now know that this can be implicated in neurodegenerative diseases. We're seeing mouse models being studied where they're dosing them up with like 15 grams of creatine per day,

and we're seeing great benefits. We're also seeing postmenopausal women who were on the track to becoming osteoporotic, actually reversing that because they're able to work out more due to creatine. And actually, Dr. Darren Kandall was the one who did this wonderful study with women, where he dosed them. I think the dosage was 12 grams a day. And he increased their bone density and their muscle mass. We increased bone density.

We increased muscle mass because muscle is an endocrine organ. And we're going to get into what that is. You have better brain health. greater leg size, greater leg strength, bigger brain. So it's all intertwined. So if there are people listening and they think, oh my gosh, but I'm scared to take creatine, I'm scared that it's going to make my hair fall out. There's been no, that is just a myth.

It does not increase DHD. So fellas, you can take your creatine. Ladies, it's not going to make you big. A lot of ladies are scared that they're going to get big and bulky. It's not going to do that. If it did that to women, every guy in the gym would be jacked. Exactly. And I can tell you, not every guy is.

And they're all taking creatine. And I've got to tell you, it is also, it's the most widely studied supplement on the market. So it is the safest. So just a couple questions about that because people see all sorts of things on the market. They'll see creatine gummies. They'll see that. Recommendations of types of creatine and then dosing and anything people should be aware of when it comes dosing creatine. Yeah.

So there was actually a study where they actually looked at the creatine gummies, and they found that there was no creatine in the actual gummies, because what happens is it's got a short half-life. You want to be taking creatine monohydrate in powder form, and you actually don't want to mix it with anything. And I'm seeing now, like there's this rise in creatine research. So many supplement companies are becoming attuned with the science, which is great. but they're now creating drinks. You know, I think their energy drinks where they're mixing creatine.

And you should know that creatine actually dissolves and you don't get the benefits from it. So you actually, if you're putting creatine with another drink and you're mixing it and you're having it a day later or two, three days later, you're not actually getting creatine. What if I have like creatine and my electrolytes? I typically would do that and I mix it and I drink it through my workout. Yes, you can do that. But if it's left, you don't want to have it standing around. You do not want to have a standing around. And you don't want to buy creatine already in a pre-made drink.

Correct. Because it's impacting the degradation of the creatine. That is correct. Instead, just get the powder. Get the powder. Get the powder. And you can mix it and drink it pretty much right away to get the benefits. Doesn't have any taste.

The best way to do it is put it in your morning coffee. That's what I do with my parents. Wow. Yeah. So putting your morning coffee, go about your day, have it every day. Some people ask, should I have it prior to a workout? It doesn't matter when you have it, as long as you do have it. I do have it prior to my workout.

It's maybe getting two in the weeds on it, but if it's so sensitive that it can degradeate, does heat impact it at all? No, it's just time. Yeah, and I know this because I interviewed the founder of Momentus, which is a supplement brand where they do heavy research on this one product. So back to the gummies, you don't want to. be having gummies because the degradation has already disappeared. Wow.

That's great. Dosing. Sometimes you hear people talk about how if you're not used to taking creatine and you jump to, you know, taking five grams immediately or five to ten grams immediately, you can get some loose stools. I've anecdotally heard that happen to some folks. I think even my, a family member was trying it. And so it's been recommended for some people, you know, you can start small.

and work your way up. Do you believe that? Of course. Anything is better than nothing. And you've got to remember, we get creatine naturally in our body already, but we also get it from beef. We get it from liver. We just can't get, just like the omega-3 fatty acids, we can't be having that much beef and liver in one day to get the necessary creatine that we need. If you start on 2.5 grams a day, then that is fine. If you can tolerate it, you should always start with a small amount of anything, really. Even omega-3 fatty acid. If you can tolerate it, if you don't get any distress, I know a lot of women may even feel

discomfort with it. You just have to try it out for yourself. If that does well, for a week, two weeks, up the dose. And then it's also dependent on body size. You know, I wouldn't recommend a LeBron James being how big he is, having the same as maybe me or a smaller female. So it's all dependent on body size, what you're doing. You know, there are some men who are having. having 20 grams per day. And they're not experiencing any kidney issues. I just want to put that out there. Yeah, that's fantastic.

You know, I want to zoom out for a quick second before we share a little bit about your story and the work that you're involved in is what are some of the still biggest misconceptions you see about Alzheimer's disease today? The biggest misconceptions that I see with Alzheimer's disease is that it is just something you get as we get older. But I have to say that dementia is not part, not a natural aging disease.

We do not have to get this disease. It is completely preventable. A lot of people think you're living your life, you're healthy, and then one day you just get it. And that's not true. That is not true. The earliest signs of Alzheimer's disease can be seen 10, maybe even 20 years before you end up with a diagnosis. Is that accurate? Yeah, so what you end up doing, you get a pre-dementia state is called mild cognitive impairment.

And we can test this. I've done several brain scans and I've picked up on mild cognitive impairment. It's a pre-dementia state. So now you've reached healthy to pre-dementia. So if we are in that category, then it becomes how can we slow the progression of getting Alzheimer's disease, rather than getting it in 10 years or 15 years? how do I eventually get it in 30 years? So these diseases start in your 30s.

For somebody who's listening today, who is in their 50s or 60s or 70s and beyond, and they're listening to you, nodding their head in agreement and excitement, but then they're also thinking, I have not been doing these things. Is my brain basically effed at this point? point. No, look, it's always a good time to start working on your brain. One thing I will tell you, if this is not going to shock people, is we've just had in the United States a new FDA-approved drug that came out on the market. This was around two weeks ago, lacanamab or lekembe. And it's a monoclonal antibody. It's done via an IV. So if you have the disease, what it does is you put

the IV in and over some time, it can apparently, ameliorate the amyloid beta, freeing up the brain to get back to its normal state. So many things wrong with that. First and foremost is while that may be true, in the process of it doing that, we've seen patients actually get brain bleeds and affecting the ventricles of the brain. So even though you may be ameliorating some of the amyloid beta, which by the way, it's a very small amount, a very small amount. In that time, you've wasted, it's around $60,000 a year for that drug.

You're also increasing your risk of hemorrhaging, like brain bleeds, affecting the ventricles of the brain. And so I think to myself, no matter what, you do not want to get the disease because it's not going to be good for somebody who you're living with. it's not going to be good for your economic status because it's around $60,000 a year. And at the end of the day, it's having maybe a 0.1% change in your brain. Yeah. And, you know, based on the accounts that you read out there, the FDA sort of felt pressured to approve it because they didn't want to discourage

pharmaceutical companies from continuing further innovations in Alzheimer's, even though they know that the benefit is so low compared to the cost and the risk. risks that are there. And the Alzheimer's category has had a few drugs in this space. What was the other one? Adjuvan or something like that. Yeah, correct. Yeah, adiucanamab. From biogen, which was actually retracted. Yeah, it was retracted. And all these insurance companies came out and said, we're not going to pay for this. If everybody who had the potential of getting Alzheimer's was on it because it was so expensive, it would have bankrupted our country. Exactly. And this goes to a larger area before we get into your why of what drives you and how you got into the space is that

I feel that partly the reason that you're here to talk to our audience is that while modern science is so amazing we are not even close to being able to deal with this tripling of Alzheimer's disease that's well on its way that's happening that's great greatly and disproportionately impacting women that are out there through any pharmaceutical intervention. So if we wait for somebody to save us, we're going to be waiting forever and our brain is going to be dying along the way. So we have to take our health back into our own hands. Is that correct? That is correct. And you, we are all at the mercy of these massive conglomerance that are putting the narratives of our lives.

together and essentially dictating how we are going to live for the rest of our lives. And that is because if we get our information from the CDC, the government, where does the government get funded to give us this information through mainstream media? They are getting their money from the pharmaceutical industry, from the big food conglomerates, and then from the industrial military complex. So if the pharmaceutical company is feeding the government and the government is going to mainstream media with their information and we're looking at mainstream media, really you are putting your life and the course and the quality of your life in the hands of a pharmaceutical company who really are just banking on you getting this disease so you can be giving them a yearly subscription of $60,000. to feed them. They are just the same as Netflix.

Netflix is, you know, you need to be paying, what is it, $17 a month, and that's how they thrive as a massive conglomerant in and of itself. We've all got Netflix. It's a subscription. Pharmaceutical company also needs a subscription of some kind. So if mainstream media is what you are watching, we need to get out of there, and we need to get into the free market,

which is podcasts like yours. getting information, that is true. That is going to help you survive. That is going to help you stave off these neurodegenerative diseases so you can have a healthy life. You know, as I mentioned earlier, you're one of the top experts in this space. I want to know, and the audience wants to know, what's your why? Why is a young person like yourself so passionate about this topic of Alzheimer's disease? I get asked often, did somebody in your family have it? And the truth is no, my father in 2019

had a stroke. And I've seen some cognitive decline there, but it's actually more of a systemic issue that I feel like I'm fighting here. And to tell you the truth, there's not a lot of us fighting this big fight. And it's a huge fight. This epidemic is big. And it comes from a patient that I saw. You know, I mentioned to you that as a neurophysiologist, we do a lot of brain scans. You know, you often see, if you've had an epilepsy, for example, or a seizure, you go and seeing neurophysiologist, they'll scan your brain. That was my primary role. Scan brains, I think I've done around 1,000 plus. But there was one woman who stood out to me, and she was, we'll call her Betty, 52 years old, and she kept coming in with complaints of memory decline,

brain fog. By the way, we'll keep hormones out of this. We'll keep the menopausal, you know, conversation out because we were just looking at her brain. And she was given all the recommendations from the CDC, you know, just eat a balanced diet, look at the food pyramid, do your exercise, which, you know, which was the CDC guidelines. She was just doing what she thought was good, really not exercising, not properly hydrating, not sleeping well. Over time, she, she's She ended up getting the disease. And it was a scary thing because this disease is the only disease that robs you of who you are. When you have end stage cancer or cardiovascular disease,

at least you can understand who you are as a person, your soul, your brain. You go to sleep with your brain and you wake up with your brain and it's just yours. No one else is in there. Imagine losing that. And I saw that because Betty looked at me and said, who are you? Who am I? Where am I? And it had this, it had this effect on me. And it was scary because she would look at her kids and she'd be like, who are you? And so that's when I thought to myself, this is larger than just Betty, because if Betty was living a healthy life and she didn't have the APOE4 genes, she was living such a

a healthy in her head, a healthy life deemed by the information she was receiving, then this is why it's affecting so many people. And let me tell you, Alzheimer's disease doesn't just affect the person affected. It affects the family around you. Somebody's going to be a carer. Your money's going to go just to medications and you lose everything. So that's why I'm so passionate about it because I know there is there is information out there that we have to show that you don't have to get the disease.

It upsets me that we are at the mercy of these huge conglomerants that are banking on us, getting the disease so they can profit, so we can put money in their pockets, so they can have a wonderful life. While the people down here who may not have the correct education, may not know how to get the resources to understand the education, They're the ones that are suffering, and it doesn't have to be that way. Which is why I think you're so incredible at making sure that all the advice that you give is clear, but also actionable and doable.

When you add up the list of the things that you've been recommending, and we'll do a little bit of a recap here just so our audience can follow along with us, it's not crazy, but the crazy thing is that a lot of us are not. not even doing the basics. So just give us a little bit of a reminder of the three categories that you had, some actionable things that we can all do today to at least delay the onset if we're going to get a diagnosis, but an ideal world for many people who want to stay committed over the long haul, hopefully never get a diagnosis of Alzheimer's disease in the first place.

Give us a little bit of a recap. Okay, you want to be exercising, resistance training. If you can, find a training. or just start lifting weights or doing body weights if you haven't done that. If you're starting from complete zero. You want to be doing aerobic training. Every day move your body. Make it like hygiene the same way that you brush your teeth.

That's the first aspect. The second one is work out your sleep. You don't want to skimp on sleep, making sure that you're improving quality, quantity and regularity of sleep. then at the top of my pyramid you've got nutrition, antioxidant rich foods. You want to maintain a good cholesterol panel, your lipids, you know, test them aggressively. Because even if you are, if you do have the APOE4 gene, that is involved. That is the gene that helps transport the cholesterol around the brain.

So if that becomes misfolden and it doesn't work well, which is what happens when you've got APOE4, then you really need to protect your brain from a high lipid profile. So you really want to protect your brain in that way. Above that as well, we also have in nutrition is hydration. I really love electrolytes. When I mentioned that your brain cells synaps together, they use a sodium and potassium pump. They are electrolytes, maintaining good hydration throughout the day.

That's your pyramid. right then we've got accessory items it's like the icing on the cake they are only there to do if you've achieved the pyramid they are saunas ice baths things like that that are going to maybe just put a 1% change can we talk about a couple of those things we'll pull on this thread a little bit further so on the topic of sauna i think one of the reasons that a lot of folks who care about their aging parents. And I know you're in this category. My mom turned 70 this year. My dad turned 75. And they have been working on getting more active. You know, we come from traditional Indian lifestyle. The highest achievers in sort of our, you know, category of family and community were the people

who sat at a desk all day and became a doctor and studied or a computer scientist or an engineer or CEO. There wasn't a lot of examples growing up of people being incredibly fit. That's changing in a lot of categories and different demographics that are out there. My parents, especially my mom, they are working and slowly heading in that right direction, doing the first thing that, you know, you shared earlier that you have your parents doing, which is just walking more. You know, I'm very proud to say my mom, you know, gets at least 10,000 steps a day and probably many days over, you know, 12,000. My dad is a big walker and it's probably getting about like, 18,000 steps a day. Now, for them, the reason that I'm so excited about sauna is that I think I

heard from Dr. Ronda Patrick that if your parents aren't working out at the moment and the goal is definitely to get them to work out, the closest thing to taxing the body in a healthy way, healthy stress would be sauna at the recommended levels, which I think are at least two times a week at that 100 and, you know, 50 degrees, I think it is, and being in there for at least 20 minutes. What's your take on that? Is there a truth to that? There is. And it's often said that you can mimic the effects of cardiovascular training. So in case you've had, let's just say you've sprained your ankle and instead of being completely sedentary, you can mimic the effects of cardiovascular training with these heat shock proteins,

these heat shock proteins that are released when you are hot. It's basically signaling to your brain and your body. Guys, she's very hot right now. We need to activate certain systems to cool her down. So it does put you in a stressful situation. Remember, the word stress, you know, there's a term, you know, called allostatic load. You want to stress your body in a good way. You don't want this chronic stress.

You want to stress it in a good way. And that's what heat stress does. it literally is a stressor, but it's a good stressor. And the way that it mimics cardiovascular training is through the blood flow because if you are increasing your heart rate because you're getting hot, that means you're getting more blood pumping. And you can actually look at your heart rate. I've measured it.

And I'm sitting around my zone three when I'm in there. That's above aerobic zone, moving into threshold zone. So I'm in that zone three. So my body is pumping blood. What is that doing? that means my heart is getting worked out, left ventricular hypertrophy is going down, I'm increasing the thickness of that arterial wall because the arteries have got muscles around them, so they're squeezing together, so they're getting a workout.

You're doing a lot. And we've also got studies that show that you can also have an effect on the amyloid beta in the brain. Again, another way to just completely downregulate that system. So you operate in two worlds. And one of the worlds is your outward communication to a lot of individuals like that patient that you had one day who ended up getting Alzheimer's disease of the most evidence-based things that people can do to, again, delay that diagnosis or optimally avoid it in the first place.

So that's Alzheimer's disease prevention and avoidance. But you also maintain a practice where you work with some of the top most elite athletes. as well as the highest performers, CEO type individuals. I want to talk about what a lot of those individuals care about, and they're coming to you for brain optimization. Now that we've covered a lot of the basics, and the basics, as you mentioned, that's the foundation that's there, and then there can be things that are icing on the cake.

What are some of the most exciting things? Let's start off with biomarkers or tests. that you care about when it comes to optimization, whether you're an athlete, whether you're a high performer, or somebody that wants to kind of operate like those individuals. What do you care about the most when it comes to biomarkers? The most exciting part of the practice when I work with these people is doing a brain scan, which consists of an EEG and a QEG.

So we're measuring the electrical activity in the brain, but we're also time locking it, meaning that we're picking up on their processing speed, their reaction time and their visual acuity. We know that the eyes are just two pieces of the brain on the outside of our body. So we can do so much by understanding how well is your brain functioning from this EEG. So that's one thing that we do, and I'll go into that a bit more. The second most exciting part of it is doing a VO2 max test. Now, I love this because I truly believe that the V-O-2 max is the strongest predictor of longevity that we have.

We know that maintaining, which is a measure of your peak aerobic fitness, basically measuring how well does your body utilize oxygen when you are at your peak zone? And it's just like a 15-minute test, which is actually quite grueling. I don't know if you've done one. Yeah. Were you in the elite category? I was elite for my age group, and I've talked about this on the podcast a little bit. I've written about it. I scored a 45, 6, somewhere right around there. I placed you in the elite category. Yes.

It placed me in the top. I got to look at the chart. Okay. But for my age, I'm about to turn 42. I did it when I was 41. It placed me at the top percentile for my age group. Brilliant. And I also end up having to end the test a little early. So I went to a place, shout out to TriFit here in Santa Monica and Los Angeles. And there's different ways to do the test, as you know.

You could do it running. Some people do it on a bike and then some people do it rowing. I really hate running and I have probably bad, I don't probably. I definitely have bad biomechanics. I also, prior to that test that I did with the V-O-2 Max, I don't know when the last time it was that I ran with like shoes on. I love sprinting at the beach. I love like these short bursts. I wore the wrong shoes.

I wore my like Vivo trainers that I wear at the gym. And so at the very end, I was talking to, you know, with the mask on and everything, I was talking to the individual who was facilitating the test. And I was like, my knee really hurts. I think I wore the wrong shoes, that, and I ended up having to stop the test before I was fully sort of gassed out. So I'm going to go back and do the test. There's a doctor here in Los Angeles. It also does a test.

Shout out to Dr. Mary Perdee, who people can hire and you can, you know, do the test at her clinic. I want to do it again because I felt that I really should have been, and we'll test the hypothesis. I thought I would have been at least at about a 50, which would have put me at, I think, elite. I think I was in the top percentile from my category, but I don't think I was at elite for the age group. I think I would have had to score a 50 to be in the elite category. Did you gas out? I didn't gas out.

My knees kind of were hurting so much. I had to stop early and I wasn't gassed out at that time. But I still scored pretty well. I'll have to go back. I shared it with the audience, but it was right around somewhere between a 44 and a 46. On our intake forms, we often ask, what are you just naturally good at? So I love running. so I will do mine running.

But the really wonderful thing about it is if you scored in the, let's just say you scored in the average and you want to go up a category, just by going from average to elite or whatever sits between average and elite, let's just to say you want to jump that category, you can actually get a 45 day life extension just from going from average to elite. So you can increase, I believe, it's 45 days or it's actually more than that. It even goes up to five years from going, below average to elite, you can get a five year increase in life expectancy. So you can increase

your longevity from this. And so when we do this, it's really beautiful to see the changes in somebody. And that's because, and I want to be clear about this, when you get a blood test, and just say someone comes back with a vitamin D deficiency, we can up that. Let's just say they've got 20 nanograms per deciliter for their vitamin D. We dose them with 5,000 IUs per day. Maybe we test them three months later and we'd see an increase in vitamin D. Whereas to go from average to elite for VO2 max, the process that you must take is so beautiful

because you have to increase mitochondria during training. You have to increase your lung capacity. You have to increase stroke. volume, the amount of things that you increase during the journey of improving your VO2 max is the name of the game there. So it's not about the metric. It's not about gaining the 50 or the 45. It is the journey that I'm going to take to get there because that's what's going to increase your life expectancy. That's fantastic. Anything else in that category of what elite individuals are coming to you for that are things that our audience could benefit from hearing

about that is also protective to the brain, the body, the heart. Yeah, I think the elite part really comes down to doing, we do blood, urine, stool, saliva samples. So we're getting to know every single piece of you through all these different metrics. You know, we're doing around 16 different tests. But if we can understand all of the areas in your body through blood work, we can understand genetic profiles, we can cross correlate that with your blood biomarkers, we can put you on a, we can do a calculator to figure out your mortality risk. If we put that together with the brain scan, now we're also doing full body MRIs. We're also doing the dexas scan, which is coming out with bone density, muscle mass.

We get to know the entire individual. The thing that really separates it is actually we've worked really hard on the emotional aspect of our component. And I don't think a lot of people think about that. There was a Harvard study done where they tracked individuals over the span of 80 years to see, well, what is the number one thing that can improve brain health as you age? And it turns out that the number one thing is social connections. So we want to ensure that your emotional aspect of who you are is thriving.

Because if we can get that right, it'll improve sleep. It'll improve exercise. It'll improve your relationship with food, the quality of your relationships with other people, the way that you go out and see the world. Your brain wants to see different things. It loves nature. It loves seeing so many things holding different things. So if we can do that, then that's true.

truly what's going to make you a high performing individual. In your life, and I'll share about my own, what are a couple of ways that you make sure to keep that strong social connection going that reminds you that you're not alone in this world and that people have your back? I maintain extremely beautiful friendships that are like relationships, if you will, to some extent. I have a close group of girlfriends who I, you know, I don't treat them really any differently than I would a partner.

Just, you know. They're like family. They're like family. Correct. But I maintain them to an extent where I do put in a lot of time and a lot of energy and understanding who they are. And I always say this, whenever one of us goes through something, we all go through it. And so I really put them in that category of like they are family.

So I try and maintain them over a long period of time. But then also just social connections. You know, I live in New York. I'm here in L.A. for two weeks. Every day I'm meeting with people who are in my network, who share the same vision as me for health and performance. And when I'm with them, it feels like I'm getting a burst of energy. That's powerful.

I've talked about this in the podcast before, but I'll add in something for the last almost eight, nine years here in Los Angeles when I moved from New York City, I used to live in New York, I didn't have a solid group of friends here because I didn't know a lot of people that were here. And when I would meet, anytime I meet another guy who I thought like was interesting and also women that I was coming across to, I would organize sort of like an impromptu informal weekly hike. And then for one month, there was a group of guys that kept on showing up. And one of my friends who was there, Nerov, was like, this is pretty great.

like we're all going and hiking on Thursday morning. Maybe we make this like man morning, right? A group of supportive men who all get together, we're doing something like a hike or a walk. And it naturally led to, because it's a bunch of interesting people, it naturally led to somebody asking a question of the day. Eight, nine years later, we've kept this up.

And we have man morning every Thursday. Here somewhere in Los Angeles, we'll meet together. There's a captain of the month who then brings a question of the week. something that allows the group to open up. And when we don't have a standard question, when we don't have a specific question, we ask a general question, which is tell us one thing in your life you're celebrating and tell us one thing in your life you're navigating. As you know, women are so much better at that social glue and opening up. And there's this crisis of men that's happening today where men are more likely to commit suicide.

They're more likely not to have a best friend above the age of 50. they're more isolated than women. They're really struggling in this camp in general. So we're trying to be both an example, but also support our own selves, you know, inspired by this Harvard data and some of the studies that are out there, showing that if you have people in your life

who you feel have your back, you're so much more likely to feel that resilience, especially as you age. So yeah, we just ask each other, what are you celebrating? what are you navigating? We stole that question from this group called Summit Series that I'm part of. And it's the thing that I look forward to, one of the top things that I look forward to the most is every Thursday morning, us a group of guys getting together. And whether somebody wants to create

a goddess morning or whatever it might be, maintaining these friendships takes work, but it's one of the biggest return on investments that you can get in life. Absolutely. Off air, we were mentioning one of my dearest friends, who is Casey Means, Dr. Casey means, who I know that you've interviewed. Casey came into my life when I actually interviewed her and she's remained, you know, and when we, I interviewed her for my podcast and this was back before she had a book and she was talking to me about blood glucose and this was back in very early 2020. And we, it was like an instant connection. And when I'm with her, it is like, you know, we share so much about the, the, the, the

world and about health and performance, metabolic dysfunction. But I describe her. Her book, it's funny, her book is called Good Energy. But when I describe it, she gives me energy. And that's what I look for. It's like a life force. And it's a really beautiful thing. When you do put in the time and effort to find your people, you do get a high ROI from it.

Did you ever read or hear about the story of that town in Pennsylvania, Rosetta? No. Okay. So this is worth mentioning. I've shared the story a couple times on the podcast, but there was a town in Pennsylvania, and in the 1950s, around 1940s, 50s, I think it was founded. And it was called the town of Rosetta. And it was primarily filled with Italian immigrants who all moved to this region and were trying to figure out and make a life for themselves here in America. And one of the interesting things was there was a local physician who was kind of, you know, the main physician.

for this group of people that were there in this town. And one day he went to a conference about the latest practices in medicine. And he was at a bar grabbing a beer. And he was talking to one of the researchers that were there. And he said, you know, there's something really interesting. Not one person in this town that I take care of has died of a heart attack under the age of, I think it was like 65 or 70. And the researcher was like, huh, that is really interesting.

because at that time in America, there was this whole craze about focusing on heart disease and what was going on, Teddy Roosevelt, et cetera. So the researchers got together and they said, let's study this town. What is it? Is it, you know, the water they're drinking? You know, they had all these different hypotheses. Over a period of time as they tracked this town, what they found out is that it wasn't necessarily the water.

I'm sure maybe food they were eating a little bit more. more closer to the diet that was there. There was not as much ultra-processed food, especially back then. So I'm sure food played a little bit of a role, but they rolled out food comparatively to what everybody else was eating. And they actually found that it was social connection. Yes. The people that were living in this town of Rosetta, the Italian immigrants, they were living

in multi-generational households. They often would have, you know, young grandkids and a grandparent all in the same household with parents that were there. The average guy, I think, was in, you know, two social clubs. And they had this sort of town center piazza type replication where every evening the town would kind of gather together. And the interesting thing is that as the years went on and they continue to track this town into the 60s, 70s and beyond, as they started to lose that social framework that was there. And Malcolm Gladwell has written about this. We'll link to a couple documentaries below too.

they started having the same level of heart disease as the rest of the population in America. And now the town is largely non-existent in its traditional form, and the population set just looks like the regular part of America. This effect was so profound that this was nicknamed the Rosetta effect, that our social relationships, our friendships, our closeness with our family could have such a protective effect over our health that it could, this was the theory from the researchers, potentially protect us from something like cardiovascular disease. Oh my gosh, that is so beautiful. I'm so happy that you mentioned that to me because now I'm going to be just looking this up and researching it and

probably putting it out there. I'm putting the message. Talk about it on another podcast. I'd be remiss though if we don't actually touch on and I'm moving away now because my juice is a fly. I'm just very excited. We didn't even touch on resistance training. Let's talk about that. Let's talk about that because that is my actual thesis and I just had a review article get published, which is all based on resistance training. So what we know is that resistance training is absolutely crucial for the brain. We know that it can build better brains, but the mechanism is what I want to talk about. Like how does growing bigger muscles or is simply the journey of growing bigger muscles improve brain health?

It turns out that when we exercise our muscles, let's just say we're contracting our muscles, our muscles are like a storage sink of these amazing pharmaceutical molecules. They're called myokines. So they're muscle-based proteins. They live in the cell body of the muscles. And when you contract your muscles, they get excreted, they go out into the blood, and they go into necessary organs. They pass the blood-brain barrier, these little molecules,

and they help with the growth and proliferation of BDNF. So BDNF is brain-derived neurotropic factor. It's one of the key ingredients in growing new brain cells in that hippocampal region. Another one called IRISON, which was named after the Greek god of Iris. It's a messenger molecule. So when that gets excreted from the muscle belly and goes into the brain, it actually tells BDNF to express itself even more.

We've got cathepsym B, myostatin, we've got isle 6, interleukin 6, which is originally a pro-inflammatory cytokine. But when it's released from the muscle specifically, it becomes anti-inflammatory. So there we go. We're going to be down-regulating inflammation from resistance training. So you can build a better brain through resistance training alone.

We're now even seeing maximal aerobic exercise and resistance training having an effect on circulating tumor cells. So when a tumor is formed, for example, this is a really great study in cell press. It was to do with prostate cancer

and the inhibition of prostate cancer via these myokines. But what happens is, let's just say you form a mass, if you will, at stage one. That tends to break, and I'm not an oncologist, but I'm reading the research, that tends to break off and you get these circulating tumor cells, and they end up going and aggregating and forming another tumor, which ends up becoming metastases, right? we now have evidence that the sheer force and shunting of blood flow through aerobic and maximal exercise can ameliorate these circulating tumor cells and not just that these myokines can inhibit

the growth of these prostate cancer cells. So you're not just having an effect on the brain. we're now seeing exercise and cancer, this cross talk between the two. So we're just probably at the early stages of that. But resistance training should be part of your hygiene as well, your daily hygiene. That's incredible. I've heard you talk about this as you've been getting into it. And it's so fascinating. And I've learned a lot.

I'll get back to what I learn in a second as I'm navigating some aspects of my health. but I first want to come back to, you know, the first part of the episode was all about how do we make sure we get the basics, especially for age groups and individuals who might be looking after their parents. And the idea of jumping to resistance training, they still have a few steps to take before they get there. Not that you can start at any age. And we've had examples.

We had the oldest American Ninja Warrior who didn't start training until she was in her late 60s because she was diagnosed with osteopena and in a matter of months became like a competing athlete and is now a super ripped, you know, grandmother who like competes in all these competitions. Ginny was on the podcast. We'll link to the show notes below. So you can do resistance training safely at any age. But at the beginning of the podcast was how do we make sure we have the basics? So now for those that are in the category who are like, hey, I want to shoot towards optimal.

what is the resistance training dosages that we should be shooting for on a weekly basis? You want to be shooting for three to four days a week of resistance training, but here's the caveat. You have to be going hard. We know that more is better when it comes to how many myokines are released. So when I say more, meaning that you really want to stress the muscles of, You really want to stress your biceps, for example. So you want to be lifting at around 75 to 80% of your one repetition max.

A lot of people may be saying, well, what is that? Basically, you want to be lifting to the point where you get to rep six. It's really difficult, like you're shaking. So you really want to be working hard out. You want to be doing three to four days a week of resistance training alone. You want to be doing three hours a week at minimum of aerobic zone. to training. That's fantastic.

I've been cheering with my audience. I've been on that journey for the last two years. I didn't grow up working out. I wasn't eating enough protein as a vegetarian and then later vegan. And so when I was getting close to turning 40 and really starting to even learn more in this category of wellness, I said, I have to step into this. I was always active. I'd play tennis.

I'd go hiking, other stuff. I've always been generally very lean, even sometimes like skinny fat because that's a big problem in the Indian demographic that's there. But as I've gotten super into the resistance training piece, I can say definitively, I've never felt better, not just in my body, but my brain health has never felt better. And the number one motivator for me for working out is having a clear head and feeling energized mentally. When I feel that way, it becomes addictive. Yeah. You know, going back to these, what did you? call them myo-myokines, myokines. You know, one of the things that I've been digging into my bloodwork

and why I was so fascinated to see you talking about this is I didn't know that about interleukin-6. I know. My IL-6 since I've been working out pretty intensely compared to the baselines that I had years ago has been a little elevated. So I'd been working with my cardiologist of he would say, you know, did you just have COVID or did something go on? Were you sick recently? It's not super elevated. It's just a little elevated. I don't remember the number offhand. And I thought, okay, I was avoiding dairy for a long time. Is it because I've been having more weight protein? Is that it? Is it something else? But it stayed elevated. And what I'm taking away from you, not that I'm asking for a diagnosis or anything, is that it might be worth digging into a little

bit more because if it's just slightly elevated, could it be a good thing as a byproduct of just me working out more if everything else in my blood work, especially when it comes to like CRP or something else, isn't a good place, right? Is that possible in the way that I'm understanding it? Yeah. And the way that they measured this, Bentap Peterson was the one who actually coined the term myokine and her first work was done. I believe she's an endocrinologist was done on aisle six. She was doing it for immunity purposes. She was doing immunity studies. And when she found that aisle six is elevated in the blood, I mean, I think there was a half-life to it as well. Like she was doing it probably three or four hours after intense training. So I don't know how far

it would be, but it would be elevated to some extent. Got it. Yeah. So it might have something to do with what I'm dealing with, but I think more likely probably not because my blood work, you know, they tell you not to intend, not to exercise so intensely right before sometimes you give that blood work. So I still need to do a little bit more digging. Exactly. But bottom line there is that resistance training is, is, it serves as this, I guess, as this protective shield for your brain and your body as you get older. Yeah.

And just touch on this for a second, you know, connect the dots here. Why is, that's important for everybody. man or woman. But is there anything specific that you want to say for the female demographic that's listening when it comes to specifically about resistance training and why it's something now more than ever you want that category? You want everybody to do it, but why is it so important for women, especially? I think women have been served with this fear that they may get big if they lift weights, which is a very big misconception. And I want females to understand the relationship between bone density and estrogen because there is a reason why postmenopausal women are more prone to

osteoporotic fractures. It's because of the loss in estrogen. Therefore, we need to increase our bone density. And the way that we do that, apart from nutrition, is via resistance training. It's the best way to improve bone density. Because when you are obviously lifting weights and you are contracting your muscle. That muscle is pulling on the tendon and the tendon is connected to the bone. So you're getting your bone is stressing. And what happens when we stress a system breaks down and it builds back stronger. So resistance training fundamentally important for these for women everywhere because of this reason. That's fantastic. Louisa, I could probably go for another hour, but I know you have a hard stab. You got to get to West Hollywood. This has been a fantastic conversation.

and there have been so many actionable items for people in all sorts of different life stages or backgrounds. And that's why I was so pleased. Shout out to our mutual friend, Joe, who's been on this podcast, Dr. Joe Zendell, Joseph Zendell, for recommending you on today's episode. I couldn't think of a better person to connect all the dots in this category. You know, you said it best yourself. Alzheimer's disease and anything that impacts the brain or contributes to cognitive decline is truly the most scary thing anybody could imagine because you're losing your sense of self.

If I've always known you as one type of person who's bubbly, sharp, smart, remembers my birthday, you know, has great conversations. And now as a caretaker, I'm seeing you decline and you're not yourself. It's taxing not only in the individual that's going through it, but it's taxing for the family as well. And let's create a world, which is what your episode is about today, where it doesn't have to be that way. And a lot of that is available through us through lifestyle changes, which you're here to remind us about. I'll give you the opportunity. We're going to link to your podcast below.

People should check that out or follow you on YouTube. There is your practice as well. And I know you don't work with a lot of people, but if people have interest, can they reach out to you? 100%. But there's a subcategory of our practice, which is we're also an education company. So we teach coaches, trainers, executive coaches about these six fundamentals of performance and longevity. So if anybody's interested in that, definitely give that a look at two. So you're educating the educators. Yes.

So if you're a physician, a health coach, even a biological dentist, anybody who's intersecting with people at any level of health, and you want to go deeper into this and learn the latest, you guys have courses for that. The neuroathletics coaching certificate. Amazing. So we'll link that below. And then remind us, what's the podcast? The neuro experience.

Amazing. Anything else that you want to direct our audience to before we give you the final word. Come over to Instagram and say hi, Louise and Nicola underscore. Incredible. Some final thoughts from you before we conclude today. You have the power to change the course of your life. Every single day you have the opportunity to refabricate your brain through lifestyle choices. Your brain is made from the foods you eat and the exercise you do and the quality of sleep that you have.

So bank on those because it will be the greatest investment in your life that you can ever have. Louisa, thank you for your work that you do, you and your team. Thank you for coming on this podcast. And it's a pleasure to finally meet in person. Thank you, Drew, you too. 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 make. mean the world to me. And it's the number one thing that you can do to support this podcast is share 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. And 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-H-I-T-com and click on the tab that says, try this.