Dhru Purohit Show - The Top Brain-Boosting Foods and Neuro-Protective Lifestyle Tips with Max Lugavere

Episode Date: August 14, 2024

This episode is brought to you by Momentous, Our Place, and Fatty15. The rates of Alzheimer’s disease are on the rise and are set to triple by 2050. What’s causing this increase, and what can be done in midlife to prevent a late-life diagnosis? Today’s guest is passionate about this topic and is on a mission to share what he has found through his research to prevent others from suffering from an Alzheimer’s diagnosis.  Today on The Dhru Purohit Show, Dhru interviews health and science journalist Max Lugavere. Max shares insights from his research on Alzheimer’s and the critical role of diet in midlife to prevent a diagnosis. He also discusses which foods should be prioritized and avoided and provides general guidelines for sustainable, long-term eating success. Additionally, Max explores the role of exercise and other lifestyle factors in reducing the risk of an Alzheimer’s diagnosis and protecting overall brain health. Max Lugavere is a health and science journalist and author of the New York Times best-seller Genius Foods: Become Smarter, Happier, and More Productive While Protecting Your Brain for Life and The Genius Life: Heal Your Mind, Strengthen Your Body, and Become Extraordinary. Max also hosts The Genius Life, a top health and wellness podcast.  In this episode, Dhru and Max dive into (audio version / Apple Subscriber version): The Role Of Diet In Alzheimer’s Diagnosis (00:00:07 / 00:00:07) Foods To Prioritize (04:00 / 04:00) Why Traditional Medicine Doesn’t Prioritize Diet In Prevention (13:24 / 10:00) The Foods That Negatively Impact Brain Health (17:54 / 14:30) Guidelines On Eating: The 80-20 Rule (23:54 / 18:33) Exercise As A Crucial Component Of Prevention (34:21 / 29:00) What Prior Generations Were Told About Diet And Movement (38:21 / 33:00) Prioritizing Prevention And Modifiable Risks (51:21 / 46:00) High LDL (1:07:52 / 1:02:31) Why Max Created The Documentary And His Hopes For Viewers (1:24:11 / 1:18:50) Why The Air You Breathe Is Critical (1:38:51 / 1:33:30) Also mentioned in this episode: Little Empty Boxes documentary 2024 Lancet Report Dementia Prevention  For more on Max Lugavere, follow him on Instagram @maxlugavere, Twitter @maxlugavere, YouTube @maxlugavere, and through his website, maxlugavere.com. This episode is brought to you by Momentous, Our Place, and Fatty15.  Optimize your Omega-3 levels by choosing a quality fish oil 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.   Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Learn more about your ad choices. Visit megaphone.fm/adchoices

Max, welcome back to the podcast. You know, 55 million people worldwide are diagnosed with Alzheimer's disease and dementia. And the crazy part is that we know from the stats that that number is set to triple by 2050. When my audience hears that, a lot of them are scratching their heads and they're wondering, first of all, what the hell is going on? And number two, what can I be doing today to make sure that I don't end up statistic in that category. What does our audience need to know about diet and what they're eating? And if that plays a role of them ending up with the diagnosis or not ending up with a diagnosis?

Unfortunately today, if you make it to the age of 90, you have a one in two chance of being diagnosed with Alzheimer's disease. So that's a coin toss. And what I think is really important for your listeners and viewers to know is that the foods that you eat today are potentially paving a path towards cognitive health or disease, not tomorrow, not next year, but decades down the line. Alzheimer's disease is essentially a disease of midlife with symptoms that appear in late life. So this is not a condition that begins overnight. By the time you reach a diagnosis of Alzheimer's disease, for example, and likely other forms of dementia as well, this is a disease process that's been simmering under the brain for decades, for decades. And so when it comes to nutrition,

I think nutrition is certainly incredibly important. It's not the only variable that matters, but certainly there's a lot to talk about with regards to food for the brain. And, you know, I take an omnivorous approach. I think it's really important to prioritize foods of both plant and animal origin for some benefits that are overlapping and some that are distinct. I think when it comes to foods to avoid, the data is now piling up,

showing us that ultra-processed foods really are at the cornerstone of the epidemic of non-communicable disease. Seventy-three percent of the items in your average supermarket today are ultra-processed in origin, which means they come from a plant, essentially, not the form that, the kind that grows in the ground, but, you know, labs where these foods are engineered to be hyper-palatable, super-calorie dense, have shelf lives that seemingly, you know, stretch on forever. And there was a study that came out over the past two to three years. And this study wasn't even available when I wrote my first book, Genius Foods,

but that found that for every 10% increment in ultra-processed food consumption, people incurred an additional 25% increased risk, relative risk of developing Alzheimer's disease. So we want to avoid those foods to the best of our ability. And I think, you know, when it comes to prioritizing whole foods, I mean, that's step one.

That's like the bottom of the food pyramid hierarchy, in my view. You know, people love to argue all day long, the so-called diet wars, you know, my diet's better than yours, carnivore versus vegan, low-carb versus low-fat. I think if you're prioritizing whole foods, I mean, you're you're so far ahead of the game in terms of, you know, general population statistics where 60% of the calories that your average person consumes comes from these ultra-processed foods. So any improvement on that, I think, you know, one is likely to see, you know, a long-term health benefit. Now, when it comes to the specific foods, I think, you know, there is certainly merit.

to integrating animal source foods. So foods like oily fish, fatty fish, wild salmon, herring, mackerel, sardines, things like that. We know that they contain copious omega-3 fatty acids, which are the most important structural building block of the brain. The brain also requires omega-6 fats, but the Western diet is typically pretty replete with those forms of fats, with those types of fats. So prioritizing omega-3-rich foods in the diet from, you know, wild fish, or even farm raised, to be honest, I think is a really smart move. I also think there's a ton of merit to integrating grass-fed, grass-finished beef. And if you can't afford or access grass-fed, grass-finished beef,

I think conventional beef is still one of the most nutrient-dense foods available to your average shopper. So there's that. I think eggs are incredible. And by the way, this is data-back. This is not just my opinion. There was a study that found recently that egg consumers compared to non-consumers had a 50% risk reduction for the development of Alzheimer's disease. This was a study of about 1,500 people.

It was an observational study, but we know that eggs are one of the top sources in Western diets for the nutrient coline, which is incredibly important. It serves as the backbone to the neurotransmitter acetylcholine, which is important for learning and memory. It creates the skeleton molecule that insulin, translates and protects and allows for the transmission of messages from neuron to neuron or neuronal cell membranes. Eggs are also, they contain a little bit of essentially everything that nature has determined to be important to grow a brain, a chicken brain, but a brain

nonetheless. And so it's no wonder that egg yolks contain cholesterol. The brain is rich in cholesterol. You don't need to consume cholesterol for anybody, you know, for anybody wondering where I was going to go with that. The brain contains 25% of the body's cholesterol contained in a an organ two to three that accounts for two to three percent of the body's mass. So it's no wonder that egg yolks contain cholesterol foods that contain cholesterol tend to be rich in other nutrients that are beneficial to the brain. But again, you don't need to consume cholesterol for brain health. The brain produces all the cholesterol that it needs, de novo cholesterol synthesis.

But they contain vitamin B12. Egg yolks contain protein. They contain vitamin E. They contain carotenoids, which we know are very protective. of brain cell membranes. And again, coline, in fact, in that study where they found a 50% risk reduction for Alzheimer's disease, about 40% of the effect

they thought was attributed to the higher intake of chlorine. Egg yolks, you know, I think are a wonderful food. And so that's kind of just like, you know, my views on animal source foods. I don't think there's any good reason to avoid them. You know, there's a lot of really weak data that might suggest otherwise, but that data, again, is incredibly weak

and often stretched beyond the limits of what that data is meant to convey, because most of it is observational, epidemiologic in nature. And so, yeah, so I'm a huge fan of animal source foods. But I'm not a carnivore dieter. I think that there are a lot of benefits to be gained from plant-based foods. And when I say plant-based foods, I don't mean replacement meat products. I mean whole plants, like dark leafy greens are, I think, incredible for the brain.

They're one of the most nutrient-dense foods. also due to their low caloric density and their abundance of micronutrients like vitamin C, like folate. Folate is actually named after we get the term foliage from folate or folate is actually named after foliage, which is the, you know, obviously leaves. So dark leafy greens are a great source. Also a good source of magnesium. Carotenoids.

I think in my book Genius Foods, I was one of the first people, if not the first, to break the news on the value of carotenoids for brain health. We've known for decades that carotenoids like beta-carotene, also lutein, and ziozanthin are beneficial to eye health. But now we know there's a mountain of evidence showing us that carotenoids, lutein and ziazanthin also accumulate in brain tissue, where they help to protect essentially the integrity of our brain cell membranes. There are even randomized control trials showing us that supplemental lutein and ziozanthin

can boost visual processing speed, which is super important. So, yeah, I'm a big fan of dark leafy greens. I also think, you know, there's a lot of talk of berries as the ultimate sort of brain fruit. And berries are incredible for the brain. I'm not denying that. But I actually think that avocados are the best brain fruit, so to speak, because of their abundance of lutein and ziazanth, these carotenoids, which are super beneficial to brain health, great source of potassium, twice the potassium of a banana, is to be found in a medium-sized avocado.

Also, fiber. We know that fiber is incredibly important. You know, there's a lot of debate within the carnivore community about the value of fiber, and I continue to believe that fiber is actually quite beneficial to health, particularly today in the context of the standard American diet. And avocados are a rich source of fiber, highly satiating, great source of mono-unsaturated fat, which we know is beneficial to the cardiovascular system. Berries are really a wonderful brain food in their own right.

Studies show that people who consume once two servings of berries a week have brains that appear to be about two and a half years younger. I believe that comes from the nurse's health study or it could be from N. Haynes data. I don't recall, but berry consumers seem to have reduced brain aging. and yeah there's a lot of good to be gained from whole plant. So basically I like to split my plate. I like to have, you know, 50% of my plate is usually reserved for some high quality source of animal protein.

And then the other 50% dark leafy greens, crucifers, vegetables, things like that. How's that for a starting place? That's a great starting place. And I think that the question for a lot of people is if they've ever, unfortunately, I know you've been in this situation. I've been in the situation with my grandfather. If you have a family member who unfortunately gets a diagnosis of cognitive decline, dementia, Alzheimer's disease, why isn't it that the doctor is talking to you really about prioritizing these foods and most importantly, staying away from ultra-processed foods? Yeah, it's a great question. Well, it takes on average

about 20 years for what's discovered in science to be integrated into day-to-day clinical practices. So there's this huge gap in terms of what we understand about brain food, so to speak, and the impact that that's having on our health to the degree that it can actually move clinical biomarkers in favor of prevention. And, you know, most medical doctors, you've had a million conversations about this on your podcast, as have I. Most doctors are undertrained when it comes to nutrition. and then you take a specialty like neurology, where for many decades it was thought that the brain sat in this ivory tower atop the body

essentially immune to what was going on down below. But now we know that the brain is highly influenced by the body and food plays a major role in our physical health. I mean, we know that. We know that about 80% of non-communicable disease today is mediated to some degree by diet and lifestyle, by our dietary and our lifestyle choices. These are not genetic conditions that we're suffering from today.

Cancer, heart disease, dementia. These are, you know, the heritability for these conditions is typically very low. Diet and lifestyle play a huge role in determining long-term health, particularly today. So I think now it's starting to, we're starting to gather data showing us that this is, in fact, also the case for the brain, that the same factors that might, you know, move the scale. in a more positive direction or improve markers of, say, metabolic health or activities that might improve, for example, blood pressure actually do have a really significant role in terms of the prevention of these kinds of conditions. But again, you have to start early. Like these are conditions of, you know, you can't, you know, start eating a bunch of blueberries or, you know,

initiating a gym membership and expecting to, you know, prevent the dementia that was going to be diagnosed tomorrow or next week. This is something that you have to begin now. The sooner the better. It's never too late, but these are conditions essentially of midlife. That's why you see epidemiologic data, for example, linking midlife obesity to dementia diagnosis down the line. Obesity later in life, as measured by the BMI, is actually associated with reduced risk for dementia in late life because somebody who's frail who's small you know they have a they have a higher odds of being diagnosed with dementia there could be reversed causation there but in generally in general somebody who is obese in midlife somebody who has hypertension in midlife dislypidemia in midlife

those are the conditions that set the stage for poor brain health down the down the road and that's actually the reason why I believe and what the data shows is makes these conditions so hard to treat once they've been diagnosed. Because by the time they're diagnosed, we're catching them essentially too late. It's very similar to what everybody knows about pancreatic cancer.

My mom actually passed due to pancreatic cancer. And by the time pancreatic cancer is diagnosed, the vast majority of the time, unfortunately, and I've seen this personally in my own life, it's too late. The real impetus for, I think, for patients, for consumers, for civilian citizens, is to be mindful of these sorts

of risk factors, these modifiable risk factors earlier. These are not old persons conditions. Again, these are conditions that are essentially simmering under the surface right now. The question is what are you going to do about it? You know, you talked about a big part of the equation is not having enough whole foods and within that, enough of both the plant and the animal foods

that we know are connected to a better brain. And you touched on ultra-processed foods and how damaging they are, but I often find that a lot of people actually sometimes need a reminder of like, what are we talking about? So when you look at the standard American diet, because everybody thinks that they're healthier than they are, what are those foods that you're saying are the biggest negative contributor to poor brain health? I think you have to set the stage first to understand that processing, food processing is a continuum. And we've gained a

lot as a society, I think, for our ability to process foods to make certain foods safer, more widely available, cheaper. And there is a difference between food processing and ultra-processing. A processed food, I mean, you essentially are processing an apple when you cut it up on your cutting board in the kitchen. You're processing it further when you blend it up and you turn it into a smoothie or when you juice it. And you're ultra-processing it when you turn into a fruit snack with a shelf life that is years down the line. And what we're starting to see, it's not necessarily the processed foods, but it's the ultra-processed foods that are correlated to. So, strongly to disease. But even within the bucket of ultra-processed foods, I mean, there are some

that are better than others. I think that we don't yet have the specificity to understand which ultra-processed foods are most harmful from the standpoint of brain health. But, you know, there are, for example, high-protein cereals or chips on the market now that are made using way protein, which are actually a pretty nutrient-dense food despite being, quote-unquote, ultra-processed. So, but, you know, again, the vast majority, ultra-processed, you know, the, you know, the the term ultra-processed is a very useful screening tool to identify foods that you're better off avoiding, right? So these are the foods that you couldn't possibly make in your own kitchen if you tried. They incorporate ingredients that are not typically found in an average kitchen.

That's one of the defining characteristics of an ultra-processed food. But similar to BMI where, you know, BMI is a great screening tool for obesity, but it's not a good diagnostic tool because if you were to use the BMI as a diagnostic tool, well, then the rock would be, obese, right? I might even be obese, but, you know, we know that people who are more well muscled that are heavier for a given height, you know, they might tip the scale and set off that red flag. But that's why the BMI is an imperfect tool, because it might highlight somebody, it might identify somebody as obese when they just have a lot of lean mass, which we know is actually positive from a longevity standpoint. So making the connection back to ultra-processed foods,

So yeah, in general, most ultra-processed foods, you're better off avoiding. And those tend to be the foods that are, you know, grain-based, incorporate a lot of added sugar, usually with the intent of making them hyper-palatable. So these are the kinds of foods that you can't stop eating. You know, it becomes really difficult to pump the brakes when you're eating these foods. They're very difficult to moderate. By the time you've eaten them to satiety, you've already over-consumed them, which was shown in a seminal study funded by the NIH by Kethe.

Kevin Hall, who's a noted obesity researcher. And so, you know, and they also tend to incorporate unhealthy oils like ultra-refined grain and seed oils, which, you know, the jury is still out on whether these oils are, you know, benign from the standpoint of brain health or not so great from the standpoint of brain health. And so those are the foods generally that you're better off avoiding. The ultra-processed foods that tend to be in the aisles of our supermarkets. Again, they tend to be replete with ultra, you know, refined grains, usually wheat, rice, copious added sugar, which now thankfully is identified on the Nutrition Facts label. You can actually look on the back of a product and see how much added sugar, how much sugar has been added to that product.

And then, you know, I think the presence of these refined bleached and bleached and deodorized seed oil is also a great, you know, proxy surrogate indicator that. what you're consuming might be ultra-processed. People are often wondering that when it comes to these ultra-processed foods, we don't have to be, you're not advocating for people to never eat them. Correct. So what are some guidelines that you recommend to people that if they want to have, you know, chips sometimes like potato chips, Doritos, Oreos, they want to have a store-bought slice of birthday cake or a cookie,

or a cookie, which all fall in this category, right, of ultra-processed foods, what are the guidelines that you recommend that truly actually allows some flexibility in people's diets, but also respects the fact that we can't ignore that most people are basing a lot of their calories around these foods? Yeah, that's a great question. I mean, I think you're better off, look, you are better off avoiding them entirely, but that's not realistic. It's not practical. And you can integrate a proportion of them into your diet and be totally okay. Like no single meal in any significant way influences your long-term health. It might influence how you feel. We all know that, that what you're eating might influence how you feel, you know, post-consumption an hour or two

hours later. But in terms of your long-term health, I mean, we do, humans are highly adaptable. And it's ultimately about the dietary pattern as a whole. And so again, Americans today are consuming 60% ultra-processed foods. That proportion is higher for children. It's about 70% ultra-processed foods. And for certain demographics, the proportion is even higher. So black Americans, last I checked, 80% ultra-processed foods, which, you know, there are obviously socioeconomic factors here, systemic issues that are that are having an impact. So, you know, I'm not reducing all of our problems to choice, but the more you can reduce your consumption of these foods and, in fact, favor whole foods because when reducing your intake of ultra-processed foods, it's not necessarily

that the foods themselves are so toxic or so poisonous. That's not true. But what they do is they displace other more nutritious foods in the diet. So, you know, if your diet is ultra-processed foods by a margin of 60 percent and you're consuming, and by the way, ultra-processed foods typically are nutrient impoverished, this is one of the reasons why 90 percent. of Americans today have at least one are deficient in at least one essential nutrient, that's leaving only 40% of your calories for nutrient-dense whole foods. So, you know, part of the, part of the harm from as a result of over-consuming these foods is that they displace more nutritious foods in the diet. But if you were to take, say, 80-20 position and consume 80% whole

foods and 20% ultra-processed foods, I think you'd be fine. And even, that's probably, you know, my position, that's probably what I do. Because when I'm on the road, you know, and I'm eating, you know, essentially out of airports and whatever's available to me when I'm traveling, I mean, you know, sometimes you can find a decent protein bar or, you know, now again, they have these like protein-rich chips on the market. I'm not saying that these are better than whole foods. You're better off reducing your consumption of those kinds of foods as well if they're making up a significant proportion of your diet. But even within that bucket of ultra-processed foods, yeah, there is a sort of continuum.

So I choose to avoid generally foods that contain, you know, refined bleached and deodorized seed oils. I think that that's worthwhile effort because we don't yet have all the data on how long-term over-consumption of these oils are impacting the brain. There was a, and this is not conspiracy. This is not, I mean, this isn't pseudoscience. This is an ongoing debate in the field of, in the field of nutrition research. There was a review published by Taha, single author paper. I think he is out of UC Davis, who the paper, anybody watching this, listening to this, can literally Google the title of the paper. It was linoleic acid, good or bad for the brain. And it poses some really, I think, important questions about what the overconsumption

of these fats might be doing. to brain health long term. I know that there's a lot of debate. Now it's almost like it's become a very inflamed topic, for lack of a better term. You know, you so much as mention concern around seed oils on social media and, you know, the pitchforks come out.

I think that's problematic. And there is disagreement and there should be disagreement. That's how science advances, right? As long as we're able to have a respectful discourse about these questions, I think that's ultimately a net positive. But generally, so when assessing an ultra-processed food and whether or not I want to consume it, is this going to be a food that's going to be so hyper-palatable for me that I'm going to be,

that it's going to be impossible for me to, you know, pump the brakes and only consume a serving size? That's a consideration that I make. Does this contain a significant amount of, you know, these refined, bleached and deodorized seed oils? If you look on the ingredients list and there's, say, soybean oil, but you look at the total fat content of the product, and there's a gram of fat or two grams of fat, then is that worth, you know, worrying about? Likely not because the total amount of fat in that product is very low. So I think we have to take a nuanced approach. How much added sugar is in the product?

It's not that added sugar is inherently fattening or inherently poisonous or, you know, at the root cause of chronic diseases, some have suggested. But sugar calories add up. They're not satiating and they displace the calories from more nutritious foods that you might otherwise opt. for in your diet. And then there are, you know, other additives that I try to avoid. I try to avoid emulsifiers in my ultra-processed food choices.

You know, one of the more pernicious aspects of ultra-processed foods that is often not discussed is that they are a Trojan horse for endocrine disrupting compounds, forever chemicals and additives that are not necessarily indicated on the ingredients list. But they're not labeled on front of package labeling. You won't find them identified in the ingredients. These are compounds like thallates and bisphenols and other endocrine disrupting forever chemicals that are inadvertently added to these ultra-processed foods by way of the production process.

We see that people who consume more ultra-processed foods, they tend to have higher level in their bodies of certain thallates and things like that, which we know are not beneficial from the standpoint of hormonal health. And so, you know, those are kind of, that's generally my overarching, you know, philosophy there. But I try to minimize my intake of them just across the board as best I can.

Just a couple examples of those foods that people wouldn't think that might have these, and they're ultra-processed foods. They seem largely benignified. but the production process could be potentially exposing people to a whole host of chemicals that are throwing off their hormones. What are some examples? Yeah, these are chemicals that are not added for any benefit. They're not added for any nutritional benefit. They're not added even to make the product taste any better. They're just, they're, they're able to make their way into these

products by way of whether it's the production process or how these products are stored. So there was a, I believe it was consumer reports or consumer labs. There was a big expose published a couple months ago that found that even bottled water, you know, these days. Certain certain types of bottled water are, you know, have very high levels of, you know, certain phthalates. Thalates are endocrine disruptors. So they're plasticizing chemicals. So when you are eating an ultra-processed food in a container that's made of plastic, certain food types, you know, fatty foods, for example, salty foods, I believe, have the

capacity to leach some of these plastic-related chemicals from the container in which they're stored. And we don't know how food products, particularly those that are not, you know, particularly those that are shelf-stable that don't need to be under constant refrigeration, we don't know if those products have been sitting in the bed of a truck for days, weeks, months, And, you know, often those containment units are not refrigerated if they don't need to be, right, as a cost-saving measure. So they could be, you know, sitting at very high temperatures, which catalyzes the leaching of these, you know, plastic-related compounds. And there's data showing us that, you know, incrementally for the more we, the higher degree our intake of ultra-processed foods, the more we tend to ingest of these, you know, endocrine disrupting compounds, bisphenols, again, thalates and things like that. So yeah, it's it's pretty scary.

There's no way to identify them again because they're not listed on the ingredients lists. The best way to reduce your exposure to them, you know, from a food intake standpoint, is to, again, to reduce your consumption of ultra-processed foods. You know, like an avocado is not harboring thalates. You're not going to find thallates in an avocado. You're not going to find thallates in dark leafy greens. I mean, there are other issues, dark leafy greens, depending on where they're grown. they can suck up heavy metals from the from the ground right that's a concern for all plants pretty much but these xenobiotic compounds these industrial synthetic additives that are unintentionally added

to our foods um i mean i think you know this is i think one of the i think most important questions of our time from the standpoint of public health is like how can we reduce our intake of our exposure to these compounds. And the food supply is rife with them. You know, you were mentioning earlier that Alzheimer's, dementia, cognitive decline, even though these are things that people typically, you know, get diagnosed with later on in life,

they start in our midlife. And the foundation of so much of what you talk about is diet, but diet is just the beginning of the story. What have you seen out there in the other list of things that people can prioritize, and it's never too late, regardless of what age somebody is, to start doubling down on these things.

What are the other categories that are most important? Which one can we go into next? Well, physical activity is crucial. Exercise. What's interesting about exercise is that the long-term data is equivocal, and it's based largely on a combination of observational data and mechanism.

You know, we don't have long-term data where we've got randomized groups randomized to either a sedentary lifestyle or a lifestyle rife with exercise and you know to have a real cause and effect signal there but we do know that exercise you know can prevent these other conditions which we know are risk factors for dementia so we know that exercise resistance training in particular is a fantastic way to ward off insulin resistance, which is at the cornerstone of type 2 diabetes, which is a modifiable risk factor for dementia. If you have type 2 diabetes, your risk for developing Alzheimer's disease increases between 2 and 4 fold. So, I mean, right there, if you can snipe that as a potentially

as a modifiable risk factor, I mean, you're doing pretty well. And we know that exercise is crucially important for maintaining insulin sensitivity, for improving glucose regulation, glucose homeostasis. We know that exercise is just as effective as drugs for helping to regulate blood pressure. So hypertension is another modifiable risk factor for dementia for Alzheimer's disease and other forms of dementia. About one and two adults today have hypertension, which is high blood pressure. And there have been studies that have shown that, for example, the Sprint Mind trial, which is a seminal paper in the field of dementia prevention, that when people are pharmacologically treated

for their high blood pressure, their risk for developing mild cognitive impairment is significantly reduced. And we know that exercise, we have now meta-analyses showing us that exercise both resistance training and consistent resistance training to a vigorous degree,

as well as aerobic exercise, are both great from the standpoint of blood pressure. When the conversation of blood pressure usually tends to focus on dietary sodium intake. But, you know, for people who are eating largely whole foods diets, you know, sodium and also it's a very small proportion of adults who are maybe not very small, but it is a minority of adults who are sodium sensitive hypertensives. And so I think the fact that we're not talking about exercise as a means of normalizing

blood pressure, I think that's really important. And so, yeah, making sure that you don't have hypertension. And this is something that, you know, I highly recommend people having blood pressure cuffs in their own homes. This is something that you can easily purchase on Amazon for 20, 30 bucks. And a lot of people when getting their blood pressure measured in, you know, in the clinic, in the doctor's office, will experience white coat hypertension. So their blood pressure increases because of the anxiety of being in a doctor's office. And so, you know, that doesn't always, that can sometimes give the false positive. positive of hypertension.

And so I think it's very valuable for people generally to have a sense of, you know, just like having a scale in the bathroom is important, not as good as having like a, you know, something that can more accurately measure your body composition, but just like it's probably worthwhile to have a scale in the bathroom, having a blood pressure coughing your home, super easy way to keep tabs on your blood pressure, because again,

this is a really important modifiable risk factor for dementia decades down the line. You know, you talked about your mom a little bit earlier and how she ultimately passed of pancreatic cancer. And we've talked about your mom a little bit on past episodes. But, you know, just recently this project that you've been working on for years now, a documentary about your family's story and your mom's story navigating this space of cognitive decline and the different diagnoses that she ended up with.

It's out now. People can find it. Little empty boxes. We have a link in the show notes. It's a fantastic film, and I really encourage everybody to check it out. But I want to go to these two categories that you started off with and have you weave in your mom's story. Because brain decline largely starts in our midlife, what was your mom told or not told about the importance of diet and movement and exercise when she was. growing up. Yeah, that's a great question. I mean, my mom, it's my mom was very much,

she very much bought into the low fat, low cholesterol dogma of the 70s, 70s and 80s. And that's something that I grew up with. You know, we very loosely abided by the food pyramid in my house. You know, my, my kitchen was repleteers. with grain-based products. Generally, if there was a red heart-healthy logo on it in the supermarket, it would have been in my shopping cart and made its way through my kitchen at some point during my childhood. My mom was very concerned about heart disease.

The narrative in my family was that my mom's dad had passed due to heart disease. And so my mom was, and she also had had a procedure really early on in life that made her very just cautious. I mean, she had a lot of anxiety. about heart disease. And so the messaging about avoid dietary cholesterol, avoid saturated fat, that really had a huge impact on my mom's dietary, you know, philosophy over the course of her life. And I'll never know what caused my mom's dementia. It might have had something to do with nutrition. It might have had nothing to do with nutrition. But what I know is that, you know,

we ate a certain way. And that way, the way in which we ate was very much influenced by these dietary guidelines that I essentially grew up with and that my mom, you know, in, in, you know, in her early adulthood encountered as well, which was to avoid food sources of dietary cholesterol, like egg yolks, red meat, things like that, avoid saturated fat. For a certain period, it was avoid total fat, which became more specific and we were warned about the potential dangers of saturated fat instead at a certain point. And growing up, you know, I had the plastic tub of corn oil at all times out by the stove, which was my mom's, which was the preferred cooking oil of choice in my house.

We never had any butter. We only had margarine in the, it was Fleischman's margarine in the yellow plastic tubs. I don't know if anybody, I don't even know if that brand is still around. But I remember that. Yeah, it was always margarine in my house. Lots of grain products. It wouldn't matter, you know, so, As long as the grain product was low in fat, you know, had zero cholesterol.

I remember, you know, we would just go to town on these products. My mom had a tendency towards vegetarianism. She wasn't a vegetarian, but she had a, she was also a lifelong animal rights advocate. My mom was a super compassionate, amazing woman and loved animals and campaigned on their behalf throughout my life. in her life and never ate any red meat. Again, I don't know if that contributed to what she developed, but she never ate any red meat. I never saw her eat eggs only until very late in the game.

I was able to convince her to start integrating, you know, eggs here and there for breakfast. But even when she served me, my first egg as a child, she warned me to not consume them too frequently because they might clog my arteries, you know. And, you know, it's fine. People avoid certain foods for all different kinds of reasons, food sensitivities, moral reasons, and the like.

But it's like the question becomes, what are you replacing those foods with? And were you getting the nutrients that you are failing to ingest in any significant way as a result of the exclusion of those foods? So, for example, you know, my mom didn't eat red meat or eggs. Where was she getting her coline from? You know, coline is a really important nutrient for brain health. what is, you know, what is the downstream effect of potentially overindulging on these grain-based foods? You know, heart-healthy whole grains. What, you know, if we base our diets around those foods,

I mean, certainly whole-grain consumption is associated with reduced risk for chronic disease. But my suspicion is that that's largely attributed to healthy user bias, the fact that in today's food landscape, somebody who's eating mostly whole grains is probably a health conscious person, doing other healthy things in their diets and lifestyles. So that's kind of, yeah, that's, that's in broad strokes. That was my mom's dietary pattern. She occasionally ate lean chicken breast, you know, the salad with lean chicken on it. She occasionally ate fish. But generally, you know, her generation, I don't think, was privy to the value of protein beyond just knowing that it was an essential nutrient.

Didn't really make any effort to optimize for protein in her diet and the like. So yeah, so all that, you know, whether it's given me a sort of bias, that's possible. But it's certainly, you know, that's sort of where I began my investigation, looking into her dietary pattern and looking into the dietary recommendations as a whole and seeing how that matches up against, you know, what the science says as well as our, you know, you know, our biological needs, trying to understand what our biologically appropriate diet is, also applying an evolutionary lens. You know, if you're telling me that, for example, refined bleach and deodorized seed oils are essential for health, and yet they've only been on the market for 50 or so years, how does that add up? So, you know, asking all these kinds of questions has really been the foundation for,

my work. And I think it's given me an advantage because I didn't come at this with any, you know, preconceived notions about diet or anything like that. You know, I certainly, I'm an omnivore, which I think is biologically appropriate for the, for the human animal. But that's pretty much it. You know, that's, yeah. So, you know, you talked about diet and how you guys grew up. what about the second pillar that you doubled down on the movement piece? What was your mom taught about? And not to make this just about her story, but really, I think a lot of our audience will see themselves because many grew up in that same generation.

And they're often wondering what myths, misconceptions, belief systems that they had that are contributing to the worsening of their health in many situations. So what was your mom's sort of thought process and approach to movement if there was any resistance training? And then additionally, when the decline started and your mom finally ended up with the diagnosis, was she told to prioritize this area of movement in a specific enough way that you feel matches the best scientific recommendations that are out there today. Yeah, she didn't. I mean, I think her generation, you know, there was probably more of an emphasis on aerobic training, particularly for females. I think there was a big emphasis

placed on aerobic training. And it has taken a few decades for the research with regards to resistance training and its impact, particularly on brain health to catch up. In fact, our mutual friend, Louise and Nicole, was the first author on a review that was just published looking at the mechanisms behind which resistance training actually improves brain health. So, I mean, all this data is now sort of coming to a head seemingly. But for decades, I don't think that, I think resistance training was something that was largely thought to be a niche interest. And if you look from a societal standpoint, I mean, it was people like Arnold Schwarzenegger who helped popularize weight training, right? and having a gym membership and things like that. Like public, like high-end gyms didn't really become a thing

until maybe the late 80s possibly. So yeah, my mom's generation, you know, maybe they were told that aerobic activity was worth investing in, walking, you know, just being generally active. But she's not somebody who really prioritized, you know, exercise with any, with any, in any significant. way and certainly not training the way we're now all starting to talk about resistance training as a you know as a as a means of of of encouraging whole body vigor and vitality and the like my dad is not

somebody who's ever exercised and so this is something that's definitely come out over the past handful of decades and um you know my mom she really i think she yeah i mean she she she adopted resistance training, I think, you know, late in life, which is unfortunate. I mean, it's a huge part of my life. I mean, I don't know, you know, from a mental health standpoint, from a body composition standpoint, from a metabolic health standpoint, it's a crucial part of my, you know, my general wellness philosophy. But yeah, she wasn't a big, she wasn't a big exerciser. She was a New Yorker, so she had a lot of just general movement. She was like, you know, she was an avid walker. But I don't think that walking is sufficient.

You know, sometimes older adults get the, you know, they'll hear the advice to just stay active, which I think is good advice. It's like, you know, it's better to be active than to not be active. Inactivity is a killer. But I think we do need to continue to beat the drum that, you know, resistance training,

challenging your body, challenging your muscles is really an important part of the longevity equation. And that's not something that her generation was, was privy to. And females in general, you know, have been fairly late to the resistance training game. Although I'll concede that now, I mean, you know, women are, I see women training in the gym. It's, you know, the playing field has leveled and it's an amazing thing. I think part of that has to do with, you know, some really great work on behalf of, you know, fitness experts, debunking myths like weight training is going to make you bulky. I know it's a concern for many women.

It's a myth that doesn't happen. I've been weight training my whole life. I'm not bulky, you know. So yeah, so I'm very optimistic. And all the research really does seem to be coming out, showing us that resistance training is fantastic from a standpoint of brain health. And I wish my mom had started earlier.

Yeah, so much of that generation, you know, my mom's in the same bucket. The focus was on just not being overweight or obese. So whatever you had to do, however you had to eat to say thin or not overweight or not obese, whatever lifestyle you had to do to adopt that, that was health. And there wasn't a lot of awareness about these other factors. You know, from everything you've looked at in the space, besides sort of auditing our diet, as you've given some clear examples of staying away from ultra-processed foods and are we prioritizing

the right types of whole foods in our diet. And then are we taking our movement landscape seriously and ideally prioritizing some form of resistance training of wherever we're at right now. Maybe that's not the gym for you at the moment, but at least band workouts, body weight workouts, ideally working with a trainer to give you some guidance. So we know those two things are important. What else? Are there any labs? Are there any other things that we should be doing if we don't have a diagnosis, knock on wood, that can help us prevent ending up in that position. What are the things that are out there that we should be auditing in our lives? Yeah, so very apropos that we're having this conversation because the 24 Lancet guidelines on dementia prevention were just published from the Lancet Commission on dementia prevention.

prior to this new publication that just came out, it was 2020 where the previous guidelines were published. And previously we had our three non-modifiable risk factors for the development of dementia and 12 modifiable risk factors. So the three non-modifiable risk factors are age, genetics, and gender. You can't change your gender, you can't change your age, and you can't change your genes. You can change how your genes express themselves. And that's where the modifiable risk factors come in.

And what's so exciting about the modifiable risk factors is exactly as the word implies, we can modify our risk, which gives us agency, which gives us a degree of control in terms of our cognitive destiny. And so those 12 modifiable risk factors included risk factors like, as I've already mentioned, hypertension, obesity, type 2 diabetes, but there was also depression. So depression was a modifiable risk factor. Early life education, that was a modifiable risk factor. Although it's hard for it, we're unable at this juncture to go back in time. Maybe Elon Musk will be able to fix that at a certain point. We can't change our early life, you know, level of education, but we can change, you know, we can continue to challenge our brains as we age. So Dr. Tommy Wood, he's a, he's a

neuroscientists who have had on my podcast. He's a fantastic expert in the field. He talks about the value of integrating if you're going to do a form of physical activity, maybe try a form of physical activity that both includes a degree of physical coordination where you have to learn a certain skill, skill-based training. Or maybe it's picking up a, you know, starting, beginning to learn a musical instrument or learning a new language. These are ways to challenge your brain to build what's called the cognitive reserve, which essentially what that implies is the more you, have, the more you have to lose before you lose it, essentially. So learning, continuing to, being a life learner, I think is incredibly valuable. It's one of the reasons why they say,

you know, anecdotally that retirement is death. Because, you know, once you retire, if you're, if you then relegate yourself to somebody who's essentially just a couch potato, that's not good from the standpoint of brain health. On the other hand, on the other hand, if you retire and you dedicate yourself to your hobbies and your passions and your, you know, other creative pursuits. I think that's probably that can be a very helpful thing from the standpoint of brain health. We know that social isolation is a risk factor, a modifiable risk factor. So you want to do your best to stay socially connected. That's super important. Traumatic brain injury. You want to protect your head. You don't want to get hit in the head, particularly if you're a carrier of the APOE4

allele, which seems to increase risk for neurodegeneration. And so, you know, I had an experience where in 2020 I took up boxing and I did it for about a year and a half until, you know, and my intent was never to become a professional boxer or anything like that. I just enjoyed the skill-based, you know, aspect of it and I enjoyed the improvements in my fitness that I was experiencing. But, you know, we were sparring one day and I got hit in the head and I was like, okay, that's it for me. I'm not doing this anymore because getting hit in the head, you know, you want to protect

your noggin. Smoking. You know, you definitely want to stop smoking. know how many of your listeners at this point are still smoking. Thankfully, it seems to be on the decline, at least where we live here in Los Angeles, but smoking destroys your vasculature. It's highly inflammatory. It depletes your body's antioxidants. And, you know, that's a big no-no. Now, you can potentially do all these things right and still develop dementia, unfortunately. These are all sort of associations. Whenever we talk about risk, we're talking about correlation.

But smoking, we know, is not good. Excessive alcohol intake, no bueno. And then where things start to get more interesting is with, for example, hearing loss. So midlife hearing loss is a newly, as of 2020, identified risk factor for dementia. And the thinking there is that, you know, as your hearing goes, you tend to become more isolated. You tend to become more closed off from the world, which reduces stimulation. it's one of your major senses, you know, and might predispose you to a degree of social isolation, depression,

things like that. So there is actually, I believe there's data showing that a hearing aid could be a potentially modifiable, you know, way to improve that situation. You know, if you're suffering from hearing loss, you want to do what you can to protect. Well, you definitely want to protect your hearing, and there are ways that you can do that, but you also want to cater to your hearing loss. treat it if you're experiencing that. Can I add one thing on that? Yeah. One thing that I've noticed

from some of the older people in my family is when you get, if anybody's at that place where you are debating about whether you get a hearing aid and you end up getting one, one thing that's extremely common is that if you regularly wear your hearing aid, your natural sort of discharge of earwax doesn't just sort of kind of fall out on its own. And you often will get a backed up level of earwarks. This is extremely common. This happens to a lot of people. And it further stunts your hearing. And in particular, with men who tend to not be the first person, especially as they go to the doctor to say, hey, I have these new hearing aids. And on top of that, I'm experiencing worse or hearing like, I don't want to go to the doctor to figure it out. It's often the case

that check with your doctor. You have to have regular ear cleaning to make sure you're not getting a bunch of backed up ear wax which further degrades your hearing. Yeah. Yeah. I mean, that's super interesting. You definitely want to be cognizant of that. And I certainly, you know, I do my best to protect my hearing.

There are a few really interesting studies that have found that supplemental magnesium can mitigate noise-induced hearing loss. It would be unethical to expose people to extremely loud noises to the degree that it might harm their hearing. And so they do these studies at military bases where service men and women are exposed to very loud noises, whether on aircraft carriers or to gun noises and things like that.

And so they've randomized that population in a handful of studies, more than one, to either no intervention or a magnesium supplement. And they find that magnesium dietary or Supplemental magnesium is able to significantly reduce noise-induced hearing loss. That's fascinating. Yeah. I will tell you, any wedding I go to now, any concert, I'm always bringing these little gel

earplugs. I like the ones that kind of mold because my ears are a little bit, you know, the regular earplugs don't fit in. And I have no problem wearing them because once you see just how crucial it is to protect your hearing and once you also audit how loud. these environments are. Like if you have an Apple Watch, you know, it'll alert you and say how loud this is. And I think it's, if you're exposed to 80 decibels or more for prolonged periods of time, that has been demonstrated to show hearing loss. And again, all these things build up. You think

you're invincible when you're 20, 30, 40, even 50 years old. These things build up and they become another factor to make it more likely you could end up with cognitive decline if enough of these things add up. So I am religious about making sure that I take earplugs to different venues and situations where just even five years ago I'd have been like, I don't know if I want to. It's annoying. I got to put in my ear. And now I'm just like, I don't care. I'm just going to do it. Yeah, I very much appreciate that. I've always tried to take really good care of myself. And I think this has to do with the fact that when I was a kid, I used to get laryngitis a lot. I used to get a lot of colds and I used to get, I would lose my voice a lot.

And so I've always kind of had this sense of being fragile. I don't know, you know, if others have experienced that. But it's led to, from a really young age, me being really kind of cognizant of protecting my hearing, my other senses and doing what I can to promote health. Like the concept of health, especially long-term health, I think for younger people can be an abstraction. because like you said, we all tend to feel invincible. You know, and I certainly felt a little bit of that. But I also felt my own fragility from a really young age. And I think that's part of the reason why this has been such a lifelong passion for me.

Oh, that's great. Your weakness ended up being something that was protective for you. Yeah. I have that with seed oils. From the time that I was young, if I have too much canola oil, things cooked in sort of seed oil, soybean oils, my throat and tonsils flare up. Wow. And I didn't know it when I was younger.

I didn't even know the word seed oil. And but then I got into high school and I started, sorry, I got into my later high school, early college. And I ended up understanding like processed food versus not processed food. This is now over 20 years ago. And I moved to a very extreme vegan diet, you know, because that's what I kind of believed at that time period. But a lot of that was actually I was moving away from. from a lot of just processed food in general. And my acne cleared up.

I didn't get like strep throat, you know, anymore. I wasn't getting this blown up throat. And then I'd go out to like a vegan restaurant where they have all these fried foods and other things. And I would eat that and immediately all that throat congestion, mucous production. If I had it a few days in a row, I'd get all the white dots in the back of my throat.

And I'd have to go get checked for strep. or this thing. So whatever the debate is out there, I've always known, extremely minimized my own exposure to seed oils. Doesn't happen with avocado oil, olive oil, these other foods that are there. But I've always had this issue with super denatured foods and fried foods being my Achilles heel. So I've just, you know, avoided them. Yeah. The irony that it's so hard to find good Indian food, that isn't just doused, saturated with seed oils. Basically, that's why I like, I don't eat Indian food, unless it's home cooked. Yeah, and I love Indian food.

It's just, it's always like a stomachache afterwards, typically. So you were going through the list of these modifiable risk factors, and you were saying that there were some interesting things, things that maybe we wouldn't necessarily thought of, and you brought up one of them being hearing loss. Are there any other things like that inside of the report? Yeah, well, as of 2024, vision loss, as well in late life. So hearing loss seems to be a modifiable risk factor in midlife. In late

life, it's vision loss. And I think, I mean, if I had to speculate on why that would be the case, it would be essentially for similar reasons that as you become more closed off from the world, your brain is exposed to less stimulation. Probably there's a degree of social isolation that occurs. So you want to protect your vision as best you can. Now, some people obviously are going to believe that there is a, you know, whether a congenital component or, you know, that you can't do anything to change your vision, well, carotenoids like Lutein and Ziazanthin, which are, which we now know are very beneficial from the standpoint of brain health, are also very helpful to maintaining and improving eye health. So that's where, again, the value of dark leafy greens

and avocados play a massive role. You can essentially improve your vision by integrating more of these carotenoid compounds. If you look at any eye supplement, generally they're going to have Lutein and Ziazanthin, and this is in part because we've known for decades that those compounds, I believe 12 milligrams per day as a dose,

can help protect against age-related macular degeneration. So this is a really good reason why we should be prioritizing dark leafy greens in our diets so that we can, you know, so that we're regularly ingesting these carotenoid compounds like Lutin Zazanthin. What about vitamin E? Sometimes you hear people say that that's connected to vision. Do you know anything about that? Yeah. I mean, it wouldn't surprise me. I know that vitamin E is a vitamin that has, that's been a significant focus for brain-related research because it's a very important fat-soluble antioxidant.

And the brain is comprised of fat. And so vitamin E helps to protect our brain cell membranes against oxidation. And the mind diet is a dietary pattern devised at Rush University by Martha Claire Moore. E was identified as being a really important nutrient to prioritize in food. And so almonds are a fantastic source of vitamin E. Grass fed, grass finished beef, great source of vitamin E. I think there's a little bit of vitamin E and egg yolks. I could be wrong. But avocados are a fantastic source of vitamin E. And your eyes are essentially fatty structures as well. And so yeah, prioritizing vitamin E is as a smart move. So that was the category of vision and the importance of eating for that. Anything else you want to add in vision, the importance of being outside, sunlight exposure.

Do you know anything about that? Yes. Yes. Well, sunlight exposure has been, especially in early life, has been linked to reduce risk from myopia or short-sightedness. But generally, we know it's really beneficial to our eyes to, you know, to be exposed to the ambient bright light of the sun during the day. You don't want to obviously look directly at the sun.

but it's a really important way to strengthen our eyes to be, you know, outside and to be able to, you know, observe the ambient light from the sun without sunglasses or, you know, without being through, you know, a tinted car window, for example. So that's crucially, crucially important. There is some data on red light photo biomodulation that red light is actually, as an intervention, can help improve eyesight. There was one study that I'm thinking of, and I don't recall the details of it,

but some of those red, those, you know, red wavelengths of light you receive during dawn and dusk, like when the sun is sort of low in the sky. And so I think that just all kind of comes back to the value of nature and how important it is to, you know, just get outside and to allow your eyes exposure to daylight over the course of the day. it's not just like get outside on your lunch break you know and like that's not sufficient i think

there are certain points in the day where certain frequency certain wavelengths are coming through um that seem to have distinct benefits to eye health to um whole body vitality that you know we're just at the very in the infancy of this type of research but um but yeah daylight seems to be seems to be important and why wouldn't it be you know we've evolved under the sun. You were mentioning this paper. We'll link to in the show notes, the dementia prevention updated guidelines from the Lancet, 2024. There's something in there that's a little bit controversial, and I'd love for you to get a chance to go into it. It's this idea of midlife high LDL. Can we talk about that for a second? Yeah, absolutely. What is it and why is it controversial?

Yeah. Well, it's, I guess, LDL is a very hot button topic amongst the diet tribes. You know, there are some that argue on social media today that, you know, there essentially is no upper limit for LDL cholesterol. We can, you know, we should all be on these, you know, high animal fat carnivore diets and there essentially is no upper limit to what our LDL cholesterol may be. Whereas other, you know, others on the other side of the aisle, like vegan zealots and people with more plant-based ideological leaning tend to promote the idea that we should. have essentially newborn levels of LDL cholesterol. And so I think the truth is probably somewhere in the middle, as with most things. But in this 2024 paper, they found that in midlife, high LDL cholesterol is associated with increased risk.

About 7% of dementia cases might be attributable to high LDL cholesterol in midlife. Now, what I think is really important about this, well, first of all, you know, I'm not of the position that there is no upper limit of LDL cholesterol. I think it's an important biomarker. If your cholesterol is extremely high, we should identify why that might be, right? But we do, I think, need to untether conversations about LDL and ultimately APOB from conversations around food. Because first of all, LDL and APOB are, you know, highly genetically influenced. and they're also influenced by foods, but not all foods that might raise LDL are equally

contributory to our risk for cardiovascular disease. And one thing that I think is fairly counterintuitive is, for example, well, for one, dietary cholesterol for most people, and I think this is becoming fairly accepted wisdom, is that dietary cholesterol has very little impact for most people on their LDL cholesterol. Saturated, certain saturated fatty acids do have an impact on LDL cholesterol, but within the food matrix, within whole foods, you get a mixture of fatty acids. And it's not always easy to predict how those foods are going to impact somebody's lipids. Most people will point a finger at red meat.

A lot of people in the plant-based community will use this as a way to point a finger at red meat, for example, and say, see, I told you red meat is not good for you. It's not good for the brain. It increases LDL cholesterol and therefore it's increasing our risk for dementia. However, only 3% of the saturated fat that your average American ingests today comes from unprocessed red meat. Yeah, so you make a social media post about this. We'll maybe put up the graphic over here. We'll link to it. It's fascinating. So what are some of those other sources? Yeah, so confectionary foods desserts. Dairy is a major source of saturated fat. But here's where it gets nuanced, and we need to talk about this nuance, is that from a heart health standpoint, from an LDL

standpoint, dairy saturated fats might have no impact. They might be completely cardiovascularly neutral from a lipid standpoint. And this is because milk fat tends to be contained in what's called milk fat globule membrane, which basically affects how we respond to those fats. The exception within the category of dairy might be butter, because butter, the process that we, the process used to create butter disrupts this milk fat globule membrane. And so they found that when feeding isochloric amounts of, you know, heavy cream or butter, and butter comes from heavy cream, it's just turned cream. Butter causes LDL to increase and heavy cream seems to have a neutral effect.

But again, most Americans fat intake is likely not even coming from butter. It's coming from cheeses and things like that, which seem to have, again, a neutral and possibly even a beneficial impact. In fact, there have been observational studies that have shown that full fat dairy, as compared to low fat and fat-free dairy, actually leads to an improvement in certain markers of cardiometabolic health. And I'm not even so convinced that a food that might raise your LDL, again, is as equally contributory to cardiovascular risk as another food, say, an ultra-processed food.

For example, red meat might raise your LDL somewhat as compared to an isochloric, you know, food replacement with the equivalent amount of protein. but there are all kinds of really important nutrients in red meat, for example. There are nutrients that are supportive of metabolic health. There are nutrients that are supportive of brain health, creatine, for example, carnitine, carnitine, all to be found in red meat. So, you know, this idea that high LDL equals, oh my God, we've got to cut red meat out of the diet, makes no sense.

It makes about as much sense as demonizing table salt because most Americans overconsumed sodium. Most Americans exceed the American Heart Association's intake for sodium on a daily basis. But it's not due to the salt that's coming from their salt shakers. It's due to the overconsumption of ultra-processed foods. So it makes no sense to demonize table salt as a result of the fact that most Americans are over-consuming sodium. Similarly, 3% of the saturated fat that your average American is ingesting is coming from red meat. So to demonize red meat makes no sense. About 4% of the sodium that your average American ingests comes from the salt shaker.

The vast majority comes from ultra-processed foods. Similarly, with saturated fat, most of the saturated fat that your average American ingests is coming from desserts, cream sauces, ultra-processed foods, mixed dishes, so like lasagna, pizza, things like that. You know, and we attribute the health impacts of those foods to red meat when what the people in these epidemiologic studies are actually eating couldn't be further from a lean steak. And so that's where I think it's, that's where I think the controversy comes from. But, you know, in midlife, if you have high untreated LDL, you know, I would first seek to get my weight in check because when you lose weight, your LDL can potentially normalize. I would seek to improve my insulin resistance.

I would seek to reduce my intake of ultra-processed foods. I would seek to reduce my intake of dessert foods and the like. I would also increase importantly my fiber intake. For every one gram of soluble fiber you ingest, your LDL can drop up to one point. So one milligram per deciliter. So if you add 15 grams of soluble fiber to your diet, your LDL might come down 15 points. Most people, you know, they'll cut out the meat and therefore, you know, thereby foregoing the super high quality protein, all the nutrients that come in that, you know, in that whole food,

when I think just adding more dietary fiber is a super valuable dietary intervention that most people don't consider. Oh, that's a great breakdown. I'm definitely one of those people that's in the category of major genetic influences for my high LDL and APOB. For a long time, I thought it was familial hyper-cholesterolemia, and then I started working with this cardiologist named Michael Twyman, great guy, who really sort of took a lot of these things in a much deeper lens and has access to a bunch of advanced laboratory testing

and advanced CCTV scans to actually look at how much soft and hard plaque is in the heart. And one of the things that I found through genetic testing is that I don't have family hyper-cholestrelemia. I have, I'm a hyper-reabsorber of cholesterol. two separate things because they're treated in different ways. In my case, where I've had many doctors in the past say, you're South Asian, you're Indian, they have the highest risk of any ethnic minority here in America for developing cardiovascular disease. In fact, at Stanford, there's an entire department dedicated to the South Asian Center for Studies for Heart Disease, because it's that big of an issue for Indians, Pakistanis, people from Bangladesh in that region.

So I had doctors that would suggest in the past, hey, you should really be on a statin because you're high LDL. That's not even a thing that would have really significantly moved the needle forward for me for my quote unquote high LDL that was there. And so after weighing a lot of different options, you know, I understood that high LDL, high APOB over the course of the lifetime. These are shots on goal. And from my understanding, from again, the cardiologist that I work with, you know,

having an extremely healthy endothelium, which is that protective layer for your arteries, is super important because that's like having an incredible goalkeeper. And that endothelium, a lot of things influence it. High production of nitric oxide. Making sure that you have your blood pressure is really great. And within that, I decided still, I don't want super high LDL APOB. So I made the personal choice. I've talked about on the podcast a lot.

I made the personal choice of starting on a low dose of acetamide, which out of all the options that were out there seem to be the thing that, you know, people generally are not really worried about any side effects that are there. And it helps me with some reabsorption of that cholesterol inside of the body. And it did bring my LDL and my APOPB down pretty simple. significantly within a short period of time. And I'm still prioritizing everything else. Now, will I stay on it long term?

Part of the thing that I'm wondering when you talk about looking at your health through an evolutionary lens, I ask my cardiologist, like, with so many people genetically being hyperproducers, like, don't you think that there's a reason why the body would be doing this? Like, our bodies are not generally speaking, except for very extreme and rare genetic issues that are out there. Our bodies don't just want to mess up and do something to damage us. And he said, listen, this is just the theory. But I think from the region that you're part of, India, it's a tropical region. There's a lot of viruses, parasites, different things that are

out there. And cholesterol is a huge part of our body's building blocks to keeping a strong immune system. And so it makes sense to me that, this is my cardiologist speaking, that this is my cardiologist speaking, that there's reasons why people from those regions had to actually have hyperproduction in some cases, which would keep their cholesterol levels elevated. The challenge is we're taking those people, and if you know anything about, you know, my fellow Indians that are out there, a lot of them are skinny fat, they're sedentary, their doctors, accountants, CFOs, computer programmers, they're sitting all day. They don't have healthy diets.

Indian food is terrible for you. Even the ones that eat protein are significantly under-eating on protein. So you're taking us out of our super active lifestyle largely as farmers and, you know, herders of cows and animals and different things like that. And you're putting us into this sort of Western life. It's not going to do well for our bodies. So no wonder all of them have insulin resistance and heart disease. So just wanted to share that little anecdote in context of what you're talking about because I'm still prioritizing all other things that are there. And sometimes you might want to find a functional.

medicine doctor or an open-minded, you know, individual to explain to you why there might be more of the story that's out there. And then you can come up with your own treatment options that are right for you. Yeah, well said. What you've just illustrated exemplifies how complicated, you know, all this is. And all we have really are epidemiologic studies. And I think when it comes down to individual care, you have to think of yourself as an end of one experiment. And, you know, I, it's true, LDL, you know, LDL, these LDL lipoproteins do play an antimicrobial role. If I recall correctly, I don't want to butcher this, but I think, you know, there is a docking site on the LDL lipoprotein for endotoxin. So when you, you know, people who have leaky gut and the gram

negative bacteria in their clonic environment, you know, secrete essentially these endotoxins that, you know, in the setting of intestinal permeability, can essentially, enter the system. This is what causes sepsis or endotoxemia. And we see that LDL increases when people have leaky gut. There's also, and I failed to mention this earlier, you know, if you have even subclinical hypothyroidism can cause an increase in LDL cholesterol. So, you know, for people just to like see, oh my God, LDL is a risk factor for dementia down the line. There are all these other things that like might be playing a role. And LDL might be a red flag in terms of, you know, it might be an important red flag to look at and say, okay, maybe my thyroid isn't functioning

as well as it ought to, or maybe I have leaky, you know, so-called leaky gut. Maybe I'm not, you know, maybe there are nutrients that I'm not ingesting adequately. We know that vitamin C plays a really important role in lipid homeostasis, even selenium. There was a study that found that just eating a handful of Brazil nuts every day, which I do every day I try to eat two to three Brazil nuts led to an acute drop in LDL cholesterol because of its support for thyroid function was the speculative. in the paper. So yeah, there are all these, you know, overlapping factors, and I just think it's really important to bring nuance to the conversation, whereas I know that many in the so-called

diatribs will point to LDL, you know, as being a something that we don't need to worry, either something that we don't need to worry about at all, and we should essentially just ignore on our labs, which I don't believe, or that we should, we should be doing whatever we can and pharmacologically juicing ourselves up to the degree that we should have. the LDL of like newborns, which I don't believe either. It's all just data. And we need to, you know, take that data into account in the context of what else we know about health and and make decisions for ourselves. I think that's the, that's the way to approach it as you have. You know, Max, I want to get a chance to pivot back to your mom's story in the documentary

because it really truly is a fantastic documentary. And it's been a labor of love and so many emotions you've put into this. And when you first started in the documentary for anybody that checks out the trailer and we'll link to it below and the place that they can, you know, purchase it, your mom is very much, you know, a part of it. She was living at the time. You shared earlier that she passed away ultimately have pancreatic cancer separately from her diagnosis of dementia. And you've been working on this documentary for now, how many years? Ten years. Ten years. And while our audience is listening in here, and they may not have the full context of it.

What was your driving motivation behind putting this documentary out there? Back when I started production on little empty boxes, I was just a concerned son. I mean, I didn't know anything about anything. I was really interested in fitness and nutrition, but as a private passion, mostly for vanity reasons, to be honest.

And my mom was the most important person in my life. And when she became sick at a young age, she still had all the pigment in her hair. She was youthful and sprightly. It was like an atom bomb going off in my world. I'm the first born in a super small family. I've got two younger brothers. I've always had the closest relationship with my mom.

And whenever growing up as a child, I had so much as a cough. A few hours later, I was in the pediatrician's office. My mom was that hands-on with my health. And so when she became sick, and I think most people who's ever had a sick loved one or who, you know, might have been at some point sick or is sick themselves, it can be a really scary, scary, frustrating, confusing place. And navigating the healthcare system is just can be incredibly frustrating and maddening at times. When you have a cognitive disorder, it becomes exponentially more so.

So for me, I was in between jobs at the time. I was a journalist. So I actually had studied documentary filmmaking in college. I had been on a pre-med track for a couple years before that. So my intent was actually to go into medicine, but I ended up falling in love with storytelling and documentary filmmaking as a way to make an impact on the world. And that led to me getting a job working as a journalist.

So for six years, I worked for a TV network in the U.S. That was a journalism platform to empower citizen journalists around the world and to tell important stories that nobody else was telling. And I did that for about six years. I left that job. And like a perfect storm, I was in between jobs and that's when my mom got sick. And it was a blessing and a curse because I had the time to spend more time with her. And ultimately, I made the decision to move back from L.A., which is where I had been living at the time, to New York, to tend to her and to start visiting doctors with her. And I went in with no preconceived

notions, just totally open mind. And what I experienced in every doctor's office, I've come to call diagnose and adios. Basically, you know, a doctor would run a battery of esoteric tests, try a new prescription with my mom, and send us on our way. But the diagnosis had always been kind of murky. It was unclear. In fact, early on, my mom's psychiatrist actually thought that all of her symptoms were due to depression, which just goes to show you, you know. there's this whole idea of the hysterical woman. And to me, it's no wonder that one in four women over the age of 40 are on some kind of antidepressant drug. He ultimately ended up prescribing drugs for my mom to treat the depression that he thought that she had.

And so it wasn't until we, you know, we weren't seeing any reprieve from her symptoms. They were getting worse. We had to take a trip to the Cleveland Clinic in Ohio where my mom was diagnosed for the first time with a neurodegenerative condition. And at that moment, I mean, that was the moment that everything changed in my world. And I became obsessed with trying to understand everything I could about dementia, about diet, about lifestyle, about Parkinson's disease. And I started doing the research, so to speak. I mean, I had been a journalist, so I knew where to find credible, credible research. And I started asking questions.

And before very long, I stumbled upon a few. insights which were completely shocking to me that I felt needed to get out to a broader audience. And one of those insights is that dementia is not genetic. There are genetic risk factors. We all know that to be true. If we have a family member who's had dementia, it's pretty clear that we might have had some kind of genetic influence. But by and large, the vast majority of dementia cases and Alzheimer specifically are due to an interaction between our diets and our lifestyles. I also thought, you know, previous to my research, that dementia was an old person's condition. Well, my mom was not old. So right there, that was shattered. And the heritability of these

conditions is very low. My mom's, my mom's mom was in her 90s of the time and cognitively totally healthy, whereas my mom was, her daughter, my mother, was succumbing to, you know, neurodegeneration right before our very eyes. And then I also thought, you know, at some point, at some point that it's just par for the course of normal aging. And what I learned is that that's not true either. So, you know, all of these, these important insights stood out to me as being really important and completely under discussed. And so, I decided to embark on this documentary project, which was my first effort in this space

before my podcast, before my books, to finally put that filmmaking degree to work and to get to talk to experts who were behind closed doors really hoping to get the message that dementia is a potentially preventable condition out to a larger audience. And so for me, it was on the one hand

to pay homage to the science and to accelerate its, the progress that I was seeing being made, you know, in these labs that I was visiting, but then also to break it out to an audience where I felt like I could actually move the needle and to actually reduce suffering in the world and help pave a path towards better cognitive health. And that began 10 years ago. So it's been quite the journey. But the film is, yeah, it's now out at littleemptyboxes.com.

Anybody can go and watch it. and we actually just reduced the rental price. It's been not just a 10-year-long journey, but an exorbitantly expensive project. And documentaries are very seldom profitable, so we're not trying even to make profit from it. We're trying to recoup some of our costs. So anybody in the world now can rent it

at littleemptyboxes.com. And yeah, I think it's the most important thing I've ever done. What's your hope for anybody who wants to check it out once they see your mom's journey, your journey as a loving son, your family's journey, doing their best to find answers for the mom that they love and care about who raise them and they see all that, you know, what's your hope for people after watching this? I think my hope is that people feel less afraid about the condition. last I checked Alzheimer's disease was America's most feared condition.

So the fact that we do have a degree of agency, we don't have all the answers, certainly not, but we do have a semblance of a roadmap in terms of how we might potentially prevent this condition. I think insofar as we can reduce fear, whether or not you are an APOE4 allele carrier, I think that's a really positive thing. but I also think insofar as it can make sufferers or their family members feel less alone. I think that's one of my goals as well because I know how alone I felt. Once you've seen one case of dementia, you've seen one case of dementia. Every case is different.

It's very alienating. It's a major stressor on the family. You know, me and my brothers, we experienced this. I mean, it was an incredibly stressful time. I think, you know, you can feel very isolated. It's very hard for others to understand what it is that you're going through. You have dementia in the family

or when you have dementia yourself, I would imagine. And so, yeah, I would say there are three primary goals for the film. One is so that people feel less afraid. Two is that is, you know, for people to feel less alone. And three is to provide some real, you know, information. And the film doesn't take any, the film doesn't plant a flag in any one dietary ideology.

It's not like a nutrition documentary, even though it does talk about nutrition. You know, I think we live in an era where people want black and white answers. You know, we've relegated, you know, our insistence on nuance to, our desire for fast food information, there are no easy answers with dementia. And so the film doesn't try to provide an easy silver bullet, one-size-fits-all solution. But it does highlight the fact that, you know, when we started to demonize back in the 60s and 70s animal source foods like red meat, eggs and things like that, what we've replaced them with, you know, aren't much, you know, it hasn't seemed to do our health any favors.

and when you remove a whole nutrient dense food from your plate, you've got to replace that food with something. And that initiative, that experiment ultimately played out on the public stage might have led to disastrous results. I mean, that might have paved the path for the fact that 60% of your average adult's calories today comes from ultra-processed foods. The fact that so many of us still fear animal source foods. And in today's food environment, if you're still out there fear mongering any whole food, whether plants of plant origin or of animal origin, I think that you're doing a major disservice to your followers.

And so, yeah. So that's from the dietary standpoint. But then there are other, you know, suggestions in the film as well that are perhaps a little bit more counterintuitive. For example, the film touches on the fact that excessive surgeries predispose you to developing dementia. So anesthesia poses a threat to the brain. And my co-director in the project, Chris Newhart, just after he had undertaken working on the project with me, his mother-in-law went in for a surgery cognitively healthy and came out needing around-the-clock care. Wow. Yeah.

Wow. So this is why so many of my doctor friends, I mean, we're thankful for anesthesia, just like we're thankful for antibiotics. But I have many doctor friends who are quite religious about avoiding any unnecessary anesthesia. Like if they would rather take some pain than be put under if it's optional for a procedure because they know some of these stats. Yeah. I mean, anesthesiologists have seen some stuff, I bet.

You know, I mean, it is scary. But yeah, it's, again, you know, in broad strokes. For some, it might be stress. It might be an inactive lifestyle. It might be overconsumption of ultra-processed foods. We try not to overwhelm the audience. But yeah, you know, insofar as you can just gain awareness over, I think, these factors, I think that's a good thing. I think there's a phenomenon called the Hawthorneth

effect that once you just start observing your actions with the awareness that your actions ultimately do have an impact on your brain health, I think that will, that awareness inherently will improve your behavior to the degree that you don't have to obsess over it. It becomes what psychologists have referred to as conscious, unconscious competence. So your awareness of, you know, eating, you know, a less refined diet or the value of exercise or avoiding exposure to air pollution or environmental toxicants like thalates and things like that. You know, you don't have to obsess over this stuff, but I think the more you can kind of ingrain this awareness into your consciousness, at a certain point, it becomes unconscious. And yeah, I think

that's totally worth it. Well, a huge part of that journey is having access to, you know, education, to at least show you what's possible. And then being exposed to sort of the ongoing education information that also can make you motivated, that there is hope, that there is hope, that there are things that you can do. And I want to acknowledge you because, you know, you're playing in both of those areas. The documentary film is so touching and well edited, and it's the true life story of a son trying to look out for his mom

and navigating that and teaching the audience along the way of all the frustrations and things that come along that journey. But again, the goal reminding people that they're not alone, no, regardless of what, you know, disease a family member might be facing. And then separately, you have your genius life, platform, which includes books, New York Times bestsellers, genius foods, the Genius Life book as well, the Genius Life podcast. We'll link to all those things below. Max, any final words you want to leave our audience with or anywhere you want to send them? Oh, man. Well, I guess the last

thing I would say is be mindful of the air that you're breathing. I had one of the more mind-blowing conversations that I've had over the past couple years, over the past year in particular was with a neurologist who's focused on Parkinson's disease prevention. And I know that you're a fan of his as well, Dr. Ray Dorsey. Dr. Ray Dorsey is great. Yeah. So I try to bring as much attention to his work as I as I can as well because I think what he's doing is super important. So, you know, one thing that that I've learned from him is that the nose is the front door to the brain. And so you just want to be careful of the air quality that you're breathing. And in fact, we didn't even touch on this, but air pollution as of 2020 was also a newly

identified risk factor for dementia. But it might also be, and the data seems to support that it's also a risk factor for Parkinson's disease as well. So you just want to be careful with the air that you're breathing. I try to change the filter in my HVAC system regularly. It's very low cost. It costs me $10 every three to six months. to change the filter in my HVAC system.

I've put air purifiers in my rooms in my bedroom, in my living room. Now, I also live in Los Angeles, which is a bit more polluted than other parts of the country, although it's improved over in recent decades. So you might not necessarily need one, but I think there's value to purifying your air, breathing in clean air. The EPA has suggested that indoor air can be an order of magnitude more polluted than outdoor air actually. Thousand times more polluted.

That is a big part of the equation as well. And, you know, my mom is a born and bred New Yorker, spent her whole life in New York City. And I know that New York, like Los Angeles, has made some effort to clean up the air quality there over the past few decades, but it's far from perfect. And so, you know, that may or may not have put a role in what she ultimately developed, which was actually a Parkinsonian condition. It was actually Louis body dementia, which has more in common with Parkinson's disease than Alzheimer's disease. And Ray Dorsey's done a lot of advocacy on behalf of, you know, the awareness around certain herbicides and pesticides and the impact that they might have

on, you know, certain dopamine-producing neurons in the brain, as well as the exposure to certain chemicals like trichloroethylene or TCE. And so I got to speak. I was super, did I meet right through you? Yeah, I introduced you guys. Yeah, super grateful for that. Yeah, he's a great guy. Yeah. They work at University of Rochester is just incredible. Very grateful to you, Drew, for introducing me to him. I think we have his book up here ending Parkinson's disease. Yeah, fantastic. I have subsequently gotten to, he invited me to moderate a panel at the Brain and Environment Symposium in Washington, D.C. a couple months ago. And so I've gotten to do some advocacy work on on behalf of the research on Parkinson's disease and, you know, certain environmental pollutants. So yeah, clean up,

clean up your food, clean up your air, clean up your water, move more, lift some weights. Yeah, I think you're setting yourself, you know, up for success in that regard. And again, we don't know everything, but I think as far as a general, you know, semblance of a roadmap is concerned, I think we do have, you know, really solid data today, elucidating how we might live to avert these kinds of conditions, which once you're diagnosed, I mean, it's unfortunately pretty bleak. And I hope that changes. I do hope one day we develop the blockbuster drug to help patients like my mom was. But until then, you really do have to be mindful of this stuff and just do your best.

Do your best. There's a lot you can do. Max, thank you for reminding me and the audience of all those things that we can do. Super appreciate you, brother. Thank you, Drew. Likewise. Hi, everyone. Drew here.

Two quick things. Number one, thank you so much for listening this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite

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