Dhru Purohit Show - Overlooked and Shockingly Simple Tools to Assess and Mitigate the Risk of Alzheimer’s Disease with Dr. David Perlmutter

Starting point is 00:00:00 Hi everyone, Drew Prode here. One of my main motivators in prioritizing my health, in addition to just wanting to feel good day to day, is to protect my brain and my cognitive health, especially as I age. And if you've ever wondered whether cognitive decline is truly preventable or how much control we really have over our brain's destiny,

Starting point is 00:00:19 today's episode is for you. Today, I'm sharing a portion of my conversation with Dr. David Perlmutter on often overlooked but shockingly simple tools that can have help us assess and mitigate our risk for neurodegenerative diseases like Alzheimer's disease. These aren't expensive tests or obscure biomarkers. They are things that you can actually do today. Now, a little bit about Dr. David Perlmutter.

Starting point is 00:00:46 He's a board-certified neurologist and a five-time New York Times bestselling author. He serves on the board of directors and is a fellow of the American College of Nutrition. He also serves as a member of the editorial board of the Journal of Alzheimer's Disease, and has published extensively in peer-reviewed scientific journals, including the archives of neurology, neurosurgery, and the Journal of Applied Nutrition. So let's dive right into my conversation on the key factors that determine our risk for Alzheimer's with Dr. David Perlmutter. You mentioned four things at the beginning and the opening of his podcast that sounds so simple, but are worth just touching on for a minute when it comes to identifying our risk in developing.

Starting point is 00:01:33 these neurodegenerative conditions. The first one was incredibly simple, and most people listening to, they probably have it at home, and it was a tape measure. What does a tape measure have to do with us understanding how well our body, our body, and therefore our brain are running or not running? Very simple. Increased body fat around the belly, around the middle is a marker of metabolic dysfunction. It's correlated with higher markers of inflammation.

Starting point is 00:02:03 increased resistance of the body's ability to use insulin, higher blood sugar, increased action of damaging free radicals. There it is, just a measurement of your belly. So, you know, what could be more simple? You know, and then I did describe you in various other perhaps more sophisticated ways of looking at your metabolism, but that's a good place to start and get your blood pressure checked, for example. That's pretty straightforward.

Starting point is 00:02:31 If we want to take it further, then by all means, get a sense as to what is your fasting blood sugar. And if you really want to be, you know, aggressive and get the most out of that day, then try wearing a continuous glucose monitor for a couple of weeks and get a sense not only what your blood sugar was on a particular morning, but what is it throughout the day? What is it in terms of its average? How do you respond to carbohydrates in your meal? What is, you know, what is the maximum blood sugar that you might experience in the day? not going to know if you go to the doctor every year and have a fasting blood sugar that people

Starting point is 00:03:06 actually train for. It's a much better understanding of the dynamics of sugar metabolism in your body. Nothing could be more important for your brain. In my opinion, that's probably the most important thing to consider as it relates to Alzheimer's risk. I wrote brain brain and people kind of talked about the fact that, well, that's a book that talks all about gluten issues in how even in the brain, gluten sensitivity can affect the brain. Well, we did talk about gluten quite a bit. But the main issue with respect to the grains was the processed grains raising blood sugar and the relationship, even when I wrote that book in 2012, the relationship of markers of blood sugar to the risk of developing either brain shrink,

Starting point is 00:03:57 or actual Alzheimer's or even cognitive decline. And that information was published even back then. I quoted a study from, I believe, the author was named SETI in the New England Journal of Medicine, who described a powerful relationship between average blood sugar measurement, which is called the hemoglobin A1C, and rate of brain shrinkage, a perfect correlation. Higher levels of A1C, faster rates of brain shrinkage. Couldn't be more simple than that.

Starting point is 00:04:27 was important was that these relationships began at an A1C of around 5.8, where a doctor is going to say, hey, you're doing great. You're not even pre-diabetic yet. And other studies, and also from the New England Journal of Medicine way back then, showing that having a blood sugar, even 100 to 105, where you're going to get a pat on the back and be told come back next year, associated with increased risk of developing dementia. So, you know, we have to redefine, well, we have to get away from defining normal or in the normal range, which is, you know, when you

Starting point is 00:05:08 take a thousand people, what's normal, basically what is average, to really focus on what is optimal, what's best for an individual. And I can assure you it's not having a blood sugar of 100 to 105. We now know quite clearly that's not good enough. You're not doing your job. That's the blood sugar unlike anything humans have experienced in their past, I would suspect. You know, just to connect the dots even a little bit further off of what you shared, and again, I'm pulling a quote from you, if your blood glucose is high, right, you're on your way to pre-diabetes. We know that millions of people, I think the estimates are 80 million people in America are in that pre-diabetic range. Then you're well on your way at that point in time to, you know,

Starting point is 00:05:52 getting diabetes. And you share the statistic that if you have diabetes, you are for X, forexing your chances, quadrupling your chances of ultimately ending up with Alzheimer's. Is that accurate? With ultimately ending up with the disease for which there is no pharmaceutical fix, you're paving the way to be stuck. And what a horrible disease. I mean, And, you know, there are some innovative approaches to actually treating Alzheimer's. You're familiar with the work of Dr. Dale Bredesen, amazing pioneering work. But it's not one thing that he does. It's a multitude of what he calls holes in the roof that he plugs to keep it from raining in.

Starting point is 00:06:41 But the idea that, you know, there's a drug out there right now that's going to turn a person around. That's not reality. We're nowhere near that. though I do have some ideas that we'll talk about later that may open the door to that to that type of approach. Well, we talked about the tape measure and by proxy essentially an at-home ability to look at just how much excess weight is your body carrying around and storing. You know, if you can go a step further, people can get an in-body scan or a dexas scan.

Starting point is 00:07:12 They can get a body composition of themselves. You know, these days there's also even a step further. You have a lot of imaging centers that are looking at also visceral fat as a byproduct of, you know, the most dangerous type of fat inside of the, you know, body that would also be increasing our risk of a lot of these metabolism or actually a byproduct of the fact that we have such bad and poor metabolic health. You talked about blood sugar in detail, the importance of not just relying on a fasting glucose, but potentially if you can afford it or you can convince you. your doctor using something like a continuous glucose monitor or trying one of these, you know, direct-to-consumer solutions that are there. And now how blood sugar is largely in this elevated state for so many millions of people because they are consuming first and foremost a lot of ultra-processed calories from both sugar and refined carbohydrates. Carbohydrates can be good. We don't want to demonize

Starting point is 00:08:13 them, but we're talking about the refined excess levels of carbohydrates in, The diet. What are some examples of those just so people can connect the dots? Well, basically, pretty much anything in a package, you know, any carbohydrate in a package, whether they're derived from grain or other type of carbohydrate that's been modified in such a way that when we consume them, we are basically consuming sugar. So the pastas, the refined rice, the crackers, cookies, cakes, anything from flour. Even if it's organic, you know, organic flour that was made and blessed by elves. It doesn't matter. It's going to raise your blood sugar. But the point is that I'll say it's likely to raise your blood sugar. It's really valuable to know

Starting point is 00:09:01 what in terms of an individual is going to raise his or her blood sugar. So it's a bit of a personalized approach in terms of what we should be eating. Everybody's trying to talk about, you know, this diet being the best diet, whether it's pescatarian, vegetarian, vegetarian, vegan, paleo, carnivore, or only eating foods that start with a vowel, whatever it may be. The point is, you know, for me, I've come to a place in life where my response is two things, or three things. I want to see a diet that's got a lot of fiber of color, meaning lots of colorful vegetables, and a diet that keeps your blood sugar under control.

Starting point is 00:09:44 If you can do those two things, I don't care. I'm fine because you're going to get your nutrients. You're going to have fiber to nurture your microbiome. And you're going to be on a program, whatever it may be for you, that keeps your blood sugar under control. And I want to comment, you said something earlier about it. You can afford it. CGM continuous glucose monitor. If that's an issue, a simpler thing to do, not as effective, but very informative,

Starting point is 00:10:13 the next time a person goes to the doctor for that annual blood work, including the fasting blood sugar, make sure they do a fasting insulin level as well. Because that's going to tell an individual where he or she is in terms of insulin functionality, insulin sensitivity, meaning that you might have a normal blood sugar, but it's only normal because your body is putting out a lot of insulin to keep that blood sugar where it needs to be. In other words, the pancreas is working overtime, and that is a bit of a harbinger for future insulin resistance, but should have then coming up and ultimately becoming pre-diabetic and diabetic. So it's, you know, a good test to have. Is it as effective as a wearing a glucose monitor

Starting point is 00:10:59 for a period of time? I don't think so. But still, it's something we could add to that list of potential studies we could get. You know, and one of the thing that you mentioned was blood pressure. Where does blood pressure and, you know, getting your regular blood pressure checked, where does that fall into and why is it considered a risk factor? The supplement space is full of trends. But real performance, that starts with the fundamentals. As someone who's always believed in doing the basics with excellence, it's a lot about what we talk about on this podcast and what I write about in my newsletter.

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Starting point is 00:15:55 And it's interesting that both blood pressure and function of insulin slash glucose are regulated upstream by the same chemical, which is nitric oxide. So nitric oxide, yes, plays a role. It was the original vascular endothelial factor that was involved in allowing blood vessels to expand, to improve blood supply, blood flow when needed to various organs in the body. In fact, the Nobel Prize was awarded in 1988 because of that discovery that it was a gas, nitric oxide in the body.

Starting point is 00:16:28 Who knew a gas would have such? activity. But more recently, it's been discovered that this nitric oxide gas actually plays a fundamental role in regulating how insulin works in the body. The functionality of insulin is dependent, a significant degree, on the presence of nitric oxide. So that said, we lose nitric oxide as we age. Our nitric oxide levels decline in lockstep with various changes that occur in the mouth, for example, with respect to the mouth organisms, the bacteria living in the mouth, the oral microbiome, if you will, who knew, that about 50% of the nitric oxide in our bodies is a consequence of what bacteria on the door, on the top of the tongue, are able to do with the food that we eat.

Starting point is 00:17:27 When we eat colorful vegetables like beets that are high in nitrates, those nitrates are converted into nitrite in the bacteria, by virtue of the bacteria that live on the back of the ton, the top of the ton, and that nitrite is the raw material from which our bodies are able to manufacture this nitric oxide than in the rest of the body. So you can imagine if we were to damage those bacteria somehow, in some crazy way that perhaps their ability to ultimately allow us to have adequate amounts of nitric

Starting point is 00:18:06 oxide might be compromised. And what might that do? Well, it might affect blood pressure, it might affect blood sugar. It turns out that this was studied back in 2019. Two studies demonstrated that when people use mouthwash that is antibacterial two or more times a day, a three-year study, it was demonstrated that there was about a 49% increased risk of becoming a diabetic. When you used a mouthwash two or more times a day over a three-year period, risk of being diagnosed with hypertension increased close to 100%. And what are you doing? You're killing off bacteria that are there to help you and make nitric oxide available in your body to control your blood sugar. to control blood supply to your organs.

Starting point is 00:18:58 So, you know, now we've talked for an awful long time about the value and the importance of our gut microbiome. Now we're talking about the mouth microbiome and the importance of these bacteria and the fallacy of us being told to use this mouthwash because it kills 99.9% of germs. They're not germ. If germs are pejorative, they're bacteria

Starting point is 00:19:21 that we have co-evolved with for tens of thousands of years, that now have had their functionality delineated such that those bacteria, when you connect the dots, are controlling our blood sugar and blood pressure. Who knew? Who knew? So quick recommendations. If somebody's using mouthwash out there today, chuck it in the trash, give it away, donate it, whatever you want to do.

Starting point is 00:19:46 You know, you've done some episodes with some great people in this space like Dr. Mark Verhanna, who's a great educator, you know, your recommendations for just solid oral health. which also, you know, maintaining good oral health and reducing the risk of things like ginger vitus, you know, coming later on in life, also is supportive for avoiding these neurodegenerate diseases as well. Is that correct? That's right. Well, let's first talk about Dr. Mark Berhenin. So I have had him on my podcast, and that podcast on YouTube absolutely went viral. I mean, in the first couple of weeks, there were, I think, 800,000 views because he's an amazing.

Starting point is 00:20:26 He's incredibly knowledgeable, and this is a very, very important and not talked about topic that we need to nurture our oral microbiomes. And he made it very clear that fluoride containing mouth, toothpaste, mouthwashes threaten the oral microbiome and various things that we do threaten the oral microbiome. And, you know, what should we do? We should floss, we should brush, and use a, I guess it's a brand name. Sorry, water pick. Whatever.

Starting point is 00:20:59 There's got to be a name for it. A water flosser of some sort. And in fact, you know, I have a USB rechargeable one. I don't even know the brand. And I travel with it because I use it all the time. Dr. Berhina has developed a type of toothpaste that nurtures the oral microbiome. It's called fig, F-Y-G-G, which stands for for your good guys. So he's trying to care and love the oral microbiome.

Starting point is 00:21:27 And I think it's really very, very valuable. It's a new frontier. We hadn't considered that before. But look, you know, 10 years ago when we talked about the gut brain connection, you know, people thought that I had a screw loose. And maybe I did. But, you know, now everybody seems to be talking to the deaf brain connection and the brain gut connection as well, it's bidirectional.

Starting point is 00:21:48 But that said, it's, you know, recognizing what you had an end. mention that the poor oral health blows poorly for the brain. Periodontal disease is clearly associated with cardiovascular disease and neurodegenerative conditions as well. When there is an overgrowth of various types of bacteria, one in particular called porphromonous ginger valis, it's threatening to the brain. We can detect breakdown products of that bacterium in the brain and with inflammation around it. So, you know, we're learning an awful lot these days about what goes on in one part of the body and how it affects the brain and other parts of body.

Starting point is 00:22:30 Yeah, I love that. Also, I'm a big fan of fig. I use it every day. My wife loves it. I have no affiliation. I just thought they did an incredible job in making a better for you toothpaste. That's out. And I have no affiliation either, but shout out for fig, FYG-Z. That's a good thing to do. Yes, absolutely. We'll link it in the show notes if anybody wants to check it out. There was one other one that you mentioned, which was brain metabolism. And of course, that is really the big picture conversation here. How does our brain use energy? But you mentioned something that was very curious to me. You said, we have tools these days to actually kind of see how good our brain is utilizing, is at utilizing energy. What are some of those tools, and are they available to the people that are listening today?

Starting point is 00:23:18 First tool would be simply a neurocognitive test. If you, you know, they're available multiple sites, have them online and they're free. I know that Dr. Bredesen's site has it. And that's going to give you an indication. If you're not up to speed based upon age adjustment, that's an indication that your brain metabolism is off. But there is the development now of a unique type of MRI skin, no radiation, that you It is going to be able to measure brain metabolism being developed by Dr. Raj Atari Walla in Vancouver. He pioneered total body MRI, which I just had, gosh, about three weeks ago.

Starting point is 00:24:03 I traveled to Vancouver to spend some time with Dr. Atariwala to discuss the total body MRI and specifically the upcoming development of brain functional imaging as it relates to brain metabolism. So I think it's going to be something that will be available to people soon. The studies that I mentioned earlier that predicts difficulties with the brain two decades ahead of time are really research study. They are using a radioactive tagged glucose called fluorideoxy glucose. And these are really just designed for research application, unfortunately. But, you know, again, it is a radioactive tracer. so it wouldn't be fully considered non-imbasid. But I think the MRI scans that he is, Dr. Tyler while is developing,

Starting point is 00:24:54 are going to be available probably throughout North America. And I think it's going to be, for those of us who are involved in research in this area, going to be very, very helpful. You know, something you've been posting about as long as I can remember is really helping people understand the risks of a sedentary, lifestyle as being another risk factor when it comes to the brain. When your brain, when your body is sedentary and you don't get exercise, you in a way have a sluggish brain. And a sluggish brain is a brain that is at a higher risk, a much higher risk of developing Alzheimer's, dementia,

Starting point is 00:25:35 other neurodegenerative diseases. Talk to us about exercise and how people can benchmark the level of exercise they're getting or in some cases not getting at any age 30, 40, 40, 50, 50, 60, 70, 80, and beyond as a measure of what their likelihood is of developing a brain disease. Well, you know, it's been said that sitting is the new smoking. And, you know, with all the things that we do, pretty much you could be sitting all day. And, you know, the relationships between the sedentarity and risk of neurodegenerative conditions, I think, is really quite profound. But it solves the cardiovascular issues, diabetes. obesity, it's hypertension.

Starting point is 00:26:18 We have a very cushed life now. We don't have to do anything. We have to, you know, make ourselves get up and do things, unless you really find something that you really, really like, and it's an impetus to stay active. For me, lately it's been pickleball. Cats me out. Love the sport.

Starting point is 00:26:35 Anyway, so one study published last year in the Journal of the American Medical Association indicated, looked at individuals over a long period of time, and had them, eight-year period of time, had them wear what's called a wrist accelerometer that measured their walking. And that's just one form of activity. And it strongly correlated increased number of steps per day with decreased risk of cognitive decline.

Starting point is 00:27:03 Perfect correlation. They found that the ideal sweet spot was somewhere around 9,800 steps per day. So just around the so-called 10,000 steps per day. Another study that was published in the journal BMJ in January of 2023 was a 10-year study looking at, I believe, 80,000 individuals and looked at a variety of lifestyle metrics, including physical activity, socialization, in other words, interacting with people, challenging oneself cognitively, cigarette smoking, alcohol consumption, and nutrition, as all the other words, interacting with people, challenging oneself cognitively, and nutrition, as all. all variables over which we had, have control. And what was really fascinating about the results was that, you know, where this is going, those who had the most healthy lifestyle based upon the various parameters I just mentioned,

Starting point is 00:27:58 had a dramatically lower risk for cognitive decline. But here's the take-all message that I think is so profound, is that it included even they teased apart those individuals who carried the 8,000, APOE4 allele. In other words, the so-called Alzheimer's risk gene. The same results we're seeing in those individuals who heretofore were condemned to thinking that they were going to get Alzheimer's because they've carried APOE4, which about 23% of Americans actually carried. It's an allele. It's a variable type of gene, if you will. You can have APO2, APO 3, APO 4, and you have two shocks at it. having one, four or two fours, we've always said, oh, that's a dramatic increased risk of Alzheimer's.

Starting point is 00:28:48 This study showed that, guess what, if you maintain healthy lifestyle, that despite carrying APOE4 allele, healthy lifestyle offsets that risk and allows you to be in the group that's protected moving forward. So this information is absolutely profound, in my opinion, that here is this incredibly threatening disease affecting 55 million people worldwide, for which risk can be offloaded by simply making good choices today while you're cognitively intact. Again, you know, fixing the roof while the sun is shining. Despite all the information Dr. Perlmutter shared, there is such a widespread misunderstanding when it comes to our long-term brain health that the idea, and this is the misunderstanding,

Starting point is 00:29:43 that our genetics are the primary factor at play. My hope is that this conversation gave you a deeper understanding of how small actions and most importantly, daily habits like checking your waistline, dialing in your blood sugar, and protecting your oral microbiome can have a massive impact on preventing diseases like Alzheimer's. And if you'd like to go deeper, I highly recommend checking out the full-length conversation with Dr. David Perlmutter. We cover topics including the early warning signs of Alzheimer's and dementia, how sleep

Starting point is 00:30:12 acts as one of those powerful tools for prevention, and the key supplements that Dr. Perlmutter personally recommends for brain health. And as always, if you found today's episode valuable, please take a moment to share it with someone you love. Until next time, thanks for tuning in.

Dhru Purohit Show - Overlooked and Shockingly Simple Tools to Assess and Mitigate the Risk of Alzheimer’s Disease with Dr. David Perlmutter

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