The Checkup with Doctor Mike - How To Strengthen Your Brain As You Age | Dr. Majid Fotuhi

Episode Date: June 29, 2026

I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Check out Dr. Majid Fotuhi's book here: https://a.co/d/0go6ywgt00:0001:30 His Background08:35 Improving Memory19:25 Alzheimers26:38 Why are they buying in?36:46 Adherence Long Term43:15 Breathing Exercise53:32 The Psychology Of Influence58:30 How to reduce your own risk1:11:52 Lifespan / Aging1:19:30 Genetic Tests / Full Body MRI1:32:30 Diet / Supplements1:38:15 IQ TestsHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, and many other perks for just $10 a month. Become a Resident today: https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

Speaking of healthy food, what's the healthiest food or diet that you can eat for your brain? The Mediterranean diet has the strongest data for reducing risk of stroke, reducing risk of heart attacks, reducing risk of Alzheimer's disease by a lot. The people with a Mediterranean diet have a brain that's up to 18 years younger compared to people who did not eat a Mediterranean diet. The Mediterranean diet is foods, vegetables, whole foods, you know, whole foods, you know, extra original olive oil from fish. And it, to me, it happens to be the one that's most. studied in these scenarios. I think you're right. It's almost studied. It doesn't mean it's the best diet. So if you are from China and usually have lots of fruits and vegetables anyway, then that's

good. It doesn't have the Mediterranean. All Mediterranean means is that it's a healthy food. It's whole food that has really good marketing behind it. Yeah. Welcome to the checkup podcast. My guest today is Dr. Majid Fatuhi, world-renowned neurologist and adjunct professor at Johns Hopkins, who's redefining how we think about aging, intelligence, and brain health. In his new book, The Invincible Brain, Dr. Fatouhi shares remarkable insights he's gleaned over decades of research into conditions like Alzheimer's. We dove deep into tips on how to reduce your risk of contracting the disease and how to improve your overall memory and brain health.

We also discussed the faulty promises of genetic testing and full body MRIs, what diet changes can actually make a difference in your life, and the reality of taking an IQ. test. Please help me in welcoming Dr. Fatuhi to the checkup podcast. Dr. I'm really excited to have you on to chat about the brain. And this is a topic that I have a lot of interest in. Personally, because my brain gets hit sometimes. I do a little bit of boxing on the side and I worry about how that's going to impact my brain. I've also seen that as we've become older as a society because we've solved acute disease and we've had so many improvements in treating acute disease that as we're living longer, we're moving into the era of more chronic

disease states, one of which a large one being brain disease. So you being a person that's been able to fight back against that gets me really excited. So very excited to chat with you on the topic. What got you interested, even like going back to study the brain? Why was that of interest to you? I became interested in studying the brain when I was seven years old, eight years old. My father told me the story of a young girl who was born without arms. And out of necessity, she had learned to use her toes to paint or to open doors or to cook. And he said, Majid, look at this young woman.

She's doing everything with her toes. which is something you think would be never possible. So our brain has a lot of power and capacity that we usually don't use it. You can do anything. You can get a PhD. You can get an MD. You can be an author.

You can change the world. And people who have changed the world were regular kids one day. They were not born as like geniuses. They were like kids like you. So ever since I was a kid, I was really interested in the brain. And I actually wrote a book when I was 14,

years old. Wow. About how to become successful in life. What was the title of that book? Exactly that. Get rich. No, how to book successful. Not necessarily be rich. But I know I talk about Thomas Edison, Matma Gandhi, John F. Kennedy. Wow. Okay. You've already studied them by age 14. Yeah. Yeah. I became interested in how different people had achieved remarkable things. How did they do it? And I realized some common themes, which of course, you know, people know very well these days, in persistence, setting goals, having purpose, feel passionate, and all that. And then when I went to medical school at Harvard, I became even more interested

in neurology, and I did my residency neurology at Johns Hopkins, and I was seeing patients who were diagnosed with Alzheimer's disease. But when I examined them more closely, I realized that often they had many treatable symptoms, but those symptoms were not acknowledged as a part of what caused them to have dementia. So, for example, we now know that things like sleep apnea, insomnia, poor diet, stress, all of those things can shrink the brain. We know that for a fact in a dose-dependent way. And so I had many patients who had all these conditions and have cognitive decline and were

diagnosed with Alzheimer's disease. And I thought, this doesn't add up. They have six causes for their cognitive decline. all those medical conditions, obesity, diabetes, depression, all these things. And they're diagnosed with Alzheimer's. Alzheimer's, we should think of plaques and tangles, these proteins that tangle up, and they form like gum-like pieces that trigger inflammation and cause brain atrophy. So then I become really interested to educate the world that, hey, what we call

Alzheimer's is often over-diagnosis, that Alzheimer's is not a single, entity is a super problem. So I wrote my first book, actually when I was a resident at neurology and Johns Hopkins, I took two weeks off and I just sat one chapter a day and I finished it. I was called the memory cure. And that book was met with much criticism from my colleagues in academia because they thought, well, who are you to talk about preventing Alzheimer's disease? We can't prevent Alzheimer's disease. I argued that if you prevent and treat the reversible components, then you can reduce the load of pathology in the brain so you can slow the rate of decline.

That concept is now well accepted. That concept is not something that anyone would question or argue. What were they concerned about that? You were giving false promise or something? Because even in 2002, people thought, if you have Alzheimer's disease, you have Alzheimer's disease. And there's nothing that you could do to slow the progress or prevent it.

Back then, we still were thinking plaques and text. are the primary causes and there's other things, like vascular problems, inflammation, reduced rinsing up the brain at night. Those are like a little side things. The main things are these plaques and tangles. And over the past 30 years, we've come to appreciate that, no,

every person's brain contains many components of all these things I just mentioned. And yes, if we address those other things, then there will be changes in cognitive function. And you know what? In 2010, I started my own neurology practice. I felt like at the time I was an assistant professor of neurology at Hopkins, and it was very difficult to get a whole thing going at Hopkins.

So I started my own neurology practice, and I put together a 12-week program. I argued that if it's true that exercise improves the brain, grows the brain, if Mediterranean diet reduces plaques and tangles, if meditation improves blood flow and grows the brain, if all those things are true, and if it's true that if you treat the treatable components, like if you treat the sleep apnea and insomnia and depression

and all the other things that patients have, if you do all of them at once, you should see significant benefits in a short period of time. So I started a nine-month program, which I called Brain Fitness Program back then, 2012, 2013. How did Hopkins react to you, your own practice doing this. No.

They were like, no. I mean, not Hopkins is a big place. And I had my colleagues and, you know, many people thought that maybe I'm doing the right things and there was no hard fairly. Was Hopkins not doing that kind of work about getting people focused on their sleep, on their fitness, on their diet? Yes, I think. Is this a blind spot of the industry?

I think, I think that, you know, there are things in science that are fashionable. For example, these days it's very fashionable to talk about longevity. Longevity has always been a main topic for centuries, forever. But in the past 10 years, there's been a lot more conferences, a lot more interest. Why do you think that is? I think generally people, like you mentioned, a lot of acute things are being managed and now are people thinking about long term. So back then in 2012, 2013, when I started my program, I saw patients in their 60s and 70s

who are typical older adult, they're sitting doing cross-foot puzzles, they forget things, they're not going outside as much because they keep forgetting things, they repeat themselves sometimes, the condition we call mild cognitive impairment. And when I started to do my program, which I just told you, to reduce the bad things and have brain coaches who help them improve the good things. And I saw that patients got better a lot sooner than I expected. So instead of nine months. So I thought, you know, people were getting better in like four months, three months.

So I first was nine months, then I made it six months. And I thought, you know, these people are getting better sooner. So I made it three months and said, that's, they're still getting better. I made it six weeks and it wasn't enough. Okay. So I found by trying and error that if I bring my patients to my brain center, meet with them twice a week. and our brain coaches were like enthusiastic cheerleaders. They would say, hey, Mr. Smith, how are you doing?

Tell me, how much did you walk yesterday? 10 minutes? Awesome. Good job. You know, that sugar you eating is not good for you. Can you please cut that back? I mean, maybe we can have half as much as the sugar stuff. It's very bad for you.

So my brain coaches talk to our patients about all the elements that shrink their brain and all the elements that grow the brain. I had to read my book. I had written the second book by then, boost your brain. in 2012, which was about all the factors that shrink or grow their brain. So I had my brain coaches read the book and pass a test, a three-hour test, to make sure that really understood all those things. And so we saw that patients were getting better in three months,

twice a week, 90 minutes, they were getting better. How are you judging their improvements? Uh-huh. We decided to obtain objective improvements because everybody said they felt better. You know, the family members would come to me and say, I can't believe my spouse is the same person. He couldn't remember five things. I told him to go shopping and now he memorizes 20 words.

I can't believe this. We obtained objective cognitive tests which were administered through computer programs. So it wasn't like it was our people doing it. So less chance of bias. Third party and it was computer based so we couldn't really manipulate change. It was objective third party cognitive cognitive cognitive cognitive cognitive test.

And many of the studies that I had read talked about how you can grow the part of the brain that's important for memory called hippocampus. You know, hippocampus is the size of your thumb. There's one on the right, one on the left. And this is the part of the brain that's critical for learning new things. And this part of the brain shrinks with Alzheimer's. And so I decided to do quantitative MRIs on my patients. And guess what?

We saw that half the patients had increased in the volume of the hippocampus between 1% to 3%. half of them did not. Half of them reduced. They still declined, probably declined less than they would have been otherwise. But there was a... So this isn't just microscopic. You're seeing this on a macro level.

Yes, and that's the thing that was amazing. To me, I was pleasantly surprised. And let me tell you what made me start my own program. Like it was a big leap to leave my cushy job. You know, like, you're a professor, you teach, you see patients. It's very comfortable. I don't like money.

I don't like business. I know studying my own practice. was a big undertaking. I had to get out of my comfort zone to do that. But there was one study that really convinced me to do it. And this study was done in a group of 30 or 40 patients, and they wanted to know if exercise can grow the size of the campus.

And so they had a control group that played football, something that doesn't require too much effort, and another group that did cycling. It did four times a week, 45 minutes to an hour of vigorous cycling. And what was interesting about that study is that all of the control groups did not have any change, but all the active group,

all the individuals who exercise, who did the cycling grew the size of the campus. Not half of them, all of them. And I thought, if exercise alone can go to the size of a campus, of course, if you combine it with diet, improving sleep, you know, meditating, on other things, you will definitely see results. So when I did my own MRIs on patients

and they improved, I was in Cloud 9. I never forget, aerodialogist called me. You know, this was Baltimore, an radiologist called me. You said, I've noticed a bunch of your patients are coming back and we do quantum MRIs and the size of the campus is getting bigger. What are you doing?

Because this is an heard of, and heard of that. What's happening that the volume is expanding? Is there new synapses forming, neuron regenerating? what's happening? Yes. There are four things that happen that grows the brain. Number one is increased blood vessels. When you stimulate your brain with exercise particularly, but these other things that I call five pillars of brain health, you increase the number of blood vessels, you increase the number of synapses, you increase the number of connections, and you increase

the overall capacity of the brain. So more synapses and more connections, more blood vessels are more neurons, four things, neurogenesis. So part of the brain for memory hippocampus is capable to generate new neurons at any age. So those four elements accounts for that three to five millimeter increase in volume that we see in hippocampus. What changed? Because I believe in my education,

maybe it was pre-med, not med school, there was the notion that the brain does not regenerate. Neurons do not regenerate. It's unlike your liver. That was the joke that all the classmates made. where is the state of research now when it comes to brain regenerating itself? It's compelling evidence that a human brain

is capable of generating new neurons at any age in the hippocampus, not all over the brain, only in the hippocampus, mainly in the hippocampus, there's some other parts of the brain. And the research started animals. There was a professor, Fred Gage, who put mice in two groups.

One group was put in a cage with a running wheel, and another group was placed in a cage without a running wheel. And he saw that the animals which were in the cage without a running wheel and actually exercised for a few hours daily over a matter of, I think it was six weeks or two months,

had larger hippocampus, and then when they sliced it and looked on the microscope and they stained these sections for new neurons, they saw new neurons. And then they stained it for components of neurons that are important for. synapses. In other words, these are not immature, premature stem cells. These were mature neurons. And then they stained them with antibodies to actually see dendrites and growth. So that was established.

But then the question became, does this happen in humans? And they did a very interesting study, which probably they couldn't do these days, is that there was a group of people in Sweden, and I think it was somewhere in Northern Europe. And they had that cancer. and we're going to die soon. So the researchers went to them and said, listen, you know, we're doing this research and we want to see if hippocampus generates new neurons. Do you mind if I give you something if you pass away?

Then we, you know, want to slice your brain. And they agreed. And they saw that even in this group of patients, patients with cancer who are dying, that the hippocampus was generating new neurons. And more recently, you know, there are surgical procedures for tumor epilepsy. so doctors, surgeons can go inside the hippocampus

and take some part out as a part of treatment for epilepsy. And when they look on the microscope, they see evidence of new neurons. So now we have compelling evidence that hippocampus can generate new neurons at any age, and we know that there are a few things that can generate this process of neurogenesis and exercise number one on that list.

Anyway, going back to the story of my 12-week program, I published that result that the campus grows with the 12-week program in the journal prevention of Alzheimer's disease. And as I provided this program for more patients, there were other patients who said, well, can we join this program? You know, I had concussion, hasn't gotten better. And I thought, you know what?

Let's try it. And so I put a group of patients with persistent post-concussion syndrome, not a concussion patient gets better a week later. These are patients who are three, six months later, a year later, they still can't function. And we saw that 80% of patients with persistent post-concussion syndrome had objective improvements in their cognitive test.

Not just I feel better, which most of them did, objective improvements. And then I provide this program for teenagers and adults at ADHD, and again, 80% of patients improved. So there's one thing very clear. There's a concept called neuroplasticity, which means our brain has the capacity

to change and grow at any age. And if you take care of the negative things that usually shrink the brain, poor diet, poor sleep, sedentary lifestyle, all those things that shrink the brain, if you avoid those,

and if you replace them with exercise, brain training, meditation, optimal sleep, that you can see results in a matter of weeks, not months or years, in a matter of weeks. So as I was doing these things,

my program became busier and busier at an office in Northern Virginia. we had 25 brain coaches. And we became so busy that my office was open seven days a week from 8 a.m. to 8 p.m. And it was like incredible to see people come from all corners of the country.

We have people from Arizona, Connecticut, Florida. It will come for the 12-week program. They would actually stay in a hotel near our office and doing this. And that's when I thought, you know what, this is too good to be just offered, to be offered just for a small group of people in Northern Virginia. This is something

that can change the lives of a lot of people around the world. And the thing is that in parallel to all the things I've been doing, other people have been doing the similar things. What I did back then, it was novel. In 2012, the idea of having a multimodal lifestyle and fashion program

was a new thing. But since then, there have been at least 100 studies. I mean, every combination has been tried. And you know what's interesting? Recently, as you may know, there are these new drugs for Alzheimer's disease. You know, there are antibodies that target amyloid in the brain, and they reduce the amyloid in the brain by like 35% or 27%. And there's a modest slowing of cognitive decline in this patient population. So instead of going down by, you know, nine point, they go down by four points. They still go down, but less so.

So then I wanted to know if this multimodal life's interventions can have similar effect as these drugs using the same outcome measures. So these studies usually use something called ADAS COG, which is a paper and pencil, this is a computer-based program. It takes about, I think, 45 minutes an hour to do it. It asks for memory, orientation, doing things.

it's the cognitive test. And there were at least five studies I found, which were placebo-controlled, randomized control trial, using the same population as the population that drug companies use. You know, patients in their 60s, 70s, early 80s maybe, who have early stages of Alzheimer's disease or this condition called mild cognitive impairment, and they use the same test.

Guess what? the studies that used ran the multimodal lifestyle interventions, diet, exercise, brain training, and so forth, had more benefits than these drugs. This drug slowed the rate of cognitive decline. These interventions improve cognitive function. And then they usually talk about the drug companies, talk about the 27% change between the control group and the intervention group, and the nanomab is like 35%.

When you look at the multimodal lifestyle interventions, it's 200% to 400%. It's incredible. The numbers are amazing. And I'm curious twofold about those medications. I know that from when they initially were announced, they've been a little bit of a letdown for the pharma companies in the sense that patients find them expensive, inaccessible, don't see the benefit from the small amounts that they could benefit from them as opposed to doing lifestyle changes.

Second, there's been some talk in the imaging community, the neuroimaging community, about how has the amyloid hypothesis been thrown under some scrutiny lately? Have you seen that? What are your thoughts on the issue? Yes. With manipulated images and so forth. I don't think it's necessary to talk about a few papers which were manipulated. I think that was not a good thing they did.

However, there are thousands of studies. And so I don't think it was a one paper that manipulated the data which resulted in all the things they've done. I think in general, people want a quick result. In general, people, especially Americans, want a quick result, a quick cure for every problem.

And unfortunately, in the scientific community, many of my colleagues have focused on plaques and tangles. They see the world as plaques and tangles with a little bit of other things. They have not come to appreciate that an 80-year-old brain has a super problem. There's inflammation, there's blood flow problem, and there's difficulty with rinsing of the brain,

those three things. And plaques and tangles are a part of this picture. And so if this is really true, then if you just treat the amyloid plaques, you only removed, at the best, 20% of the problem. So you should not see great results. And this is exactly what has happened. See, the amyloid cascade hypothesis

talks about how this amyloid somehow triggers a formational tau, which is the next level of these aggregates. And then once you have tau, then everything is over. And it's true in early onset Alzheimer's disease. If you have a 55-year-old who has plaques and tangles and nothing else, that's what happens to them. They usually have nothing else. Plaxantangles destroys their brain and they develop dementia and their miserable life.

People in their 80s, late 70s and 80s, have a super problem. And plaques and tangles are a small portion of that. So in them, targeting the amyloid will produce very little results, which is exactly what we've seen. And I think more and more are coming to appreciate that we need a multimodal intervention because what we call Alzheimer's disease, it's a multimodal, multifactorial condition. Now, one of my petfives is we overdiagnosed Alzheimer's disease. We put the label of Alzheimer's disease on many people who have only part of this soup.

I wish we would call people as having cognitive impairment. You have mild cognitive impairment? you have moderate cognitive impairment and you have severe cognitive impairment. We wouldn't label it as the cause. When you say somebody has Alzheimer's disease, you're implying the plaques and tangles that triggered all the problems.

But if you say somebody has cognitive decline, then you're more prone to look for causes. And I think as a primary care physician, you need to know that when somebody comes in with cognitive decline, let's say you have a 78-year-old who comes to see you They're forgetting names, they have missed some appointments,

they're not as social as they used to be, they're confused at times. You shouldn't jump to a diagnosis of Alzheimer's disease. You do cognitive testing, their memory is not good. Unfortunately, a lot of doctors, when they see that result, especially if they order these new biomarkers that look for plaques and tangles, they say, well, you have Alzheimer's disease. But the answer is no.

They have placentangles, but they have these other things that are treatable. So let's think of other things that are treatable. Do you have depression? Yes or no. Depression is treatable. I mean, especially elderly, a small dose of SSRIs can actually help. If you put them in a social environment where they can be useful,

you put them in a church and they say, why don't you join this club, this community in the church? Why don't you become a volunteer in the local museum or local elementary school? If you do those things, they perk up. And that's what I see in my practice. Patient after patient after patient that will come up, I will do these little things

that will regain their confidence and they will do more. And it's not just me. Again, I don't want to pretend like I've solved the problem with Alzheimer's diseases in the world. There's a study that was done in Japan. They look at all the people who were diagnosed with MCI. Everybody's MCI.

They looked at them a year later. 30% of that population had reverted to normal. And those are patients who had done social activity, They had done more exercise. So usually 20% 10 to 20% of people who get a diagnosed of MCI spontaneously revert to normal because life circumstances can affect your brain function.

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I'm curious from the primary care state of things because I try and be, you know, very holistic and not think about one organ or one disease condition. So the things that you're doing in these brain fitness programs, brain coaching programs, I'm preaching to my patients whether they're 75 years old with mild cognitive impairment or they're 25 years old with pre-diabetes, right? Because I'm going to try and treat their depression. I'm going to try and treat their blood flow, their exercise, their diet. I'm trying to get that instilled early on in my patients.

And in every physical, I'm trying to push that in because I'm trying to think about prevention. In fact, you mentioned how society has this new obsession with longevity doctors and longevity specialists. I actually find that hilarious because I think every doctor, with one exception, is a longevity doctor. And that's hospice doctors, because they're the one doctor that's probably not thinking about longevity.

And that's not their fault. but we're all trying to make our patients live a longer and a higher quality of life. But when I think about the struggles that I have with my patients in terms of getting them, like I get them diagnosed with sleep apnea, getting them to wear their CPAP, patients that desperately would benefit from exercise from a metabolic standpoint of their heart, their brain, every organ in their body. Even depression gets better with exercise. The patients who have depression either can't access mental health services or feel a stigma to those services or medications.

So I'm curious what makes your brain fitness program so successful that almost everyone seems to buy in so well. I think part of it was what happened in our waiting room. People will come in, the new patients will come in, and they would talk with other patients who were, you know, halfway in the program, with their finishing program, and they would tell these other patients it's in question. incredible. You will love this. Also, we had very good reviews. I mean, I had more than 300 reviews on like Google reviews and it was five out of five for every patient. Patient after patients said things like, we changed my life. It was the best thing ever. It was not a single bad review. At a single bad review over all these 15 years that I provided program. Not once. Not even once. You know, you're a doctor. You know that there always someone was unhappy about

something. Not only they were not unhappy, people always said the good things. I think, I think, So when people saw that it's possible, I think the problem is that most people don't realize that these five pillars of brain health, exercise, sleep, diet, stress reduction, and brain training, these five pillars of brain health are simple but powerful. People always think that if it's something powerful, it must be expensive, it must be some kind of injection, it must be like a difficult protocol. but the truth of the matter is, these are simple and powerful,

that they do make a difference in people's lives and that you can see results in a matter of weeks, not years. And so I think those are the elements. If people see that's going to happen, a lot of people can believe that, you know, everybody says diet and exercise, since when diet and exercise can change things. But if you do it,

and not only diet and exercise, but there's five pillars of brain health, you will see significant improvements. The other thing I hope will become a trend is once a few people start doing it and they write about it on social media and it becomes a thing, then everybody else said.

Let me give you an interesting story. In 1950s, there was no evidence that exercise is good for you. In fact, if somebody had a heart attack or something, the prescription was rest. and they would point to a few people who had died with a marathon who had died as maybe exercise is not a good thing. And so in 1950s, 1960s, there were a few cardiologists who said, you know, exercise is good.

And the reason was a Harvard study that showed, if you look at bus drivers and bus conductors and monitored them over 10 years, the bus conductors that move up and down in and out of the bus are far less likely to get heart attacks than the bus drivers which were sitting all the time. And that was one of the first studies

that made people realize maybe exercise is a good thing. And I think it was Dr. White who was the cardiologist for, I think Roosevelt, who said, you know what? Exercise is good for you. And this was a shock.

In 1960s or in 1970s, there was an article in New York Times. A few cardiologists believe exercise is good for you. This was the title of the article. It's funny hearing it now, obviously. I know. I know. So it was a paradigm shift.

It took obviously 30 years before we see a gym in every corner. That's where we are with realizing that brain training, feeding the brain the right things, making sure that you sleep so that the cleansing happens, the brain, these things will one day, become so obvious that will be programs left and right. I am certain that it will happen. Why aren't they happening now, do you think?

I mean, we have such great data already. Well, it takes a while. Is it medical inertia? It took, you know, how long do you take for smoking cessation to happen in the United States? You know, smoking was very common in 1960s and 70s. It took 20, 30 years until these days there's no smoking restaurants or public places. and usually it takes a person and event something that turns the clock and turns to, you know, that everybody does that. I think once it becomes what everybody else does, then it becomes acceptable.

You know, most ideas start with, oh, that's nonsense. Well, sure. Or some people then after a while say, well, maybe some tooth in it. After a while, they say, there's really good truth in it. And then after a while they say, well, it's obvious, you know. A lot of new ideas. Where do you think we are on that stage? We are at the one stage before.

It's obvious. I think we're on that stage. There's good data. There's good data. There's some good suggestion. I mean, part of our problem is like it's too good to be true. That's part of the problem. I feel like that's not the problem.

And I'm curious what you think about my opinion. Because when I tell my patients these things, they say it's obvious, but it's hard for them to change their behavior. And it's hard for me to modify their behavior because I don't have a brain. fitness program active in my hospital where I can get them involved in it or their life situation doesn't allow them to get involved in it. So to me, it's the motivating factor. In fact, I just did a debate against individuals who support the current Maha movement. I don't know if you're familiar with it, the RFK's movement to make America healthy. And they say that they're sick and tired of the fact that America has this chronic health disease burden, and it's so high, and we in health care

keep trying to medicalize it when the solution is simple. The brain fitness program basically is what they're saying. And I agree, and I see so much value from getting people moving, exercising, eating well, sleeping well, but I have such a hard time getting my patients to change their behaviors. And that's why when like a new medication, like these GLP-1s come about, which is really a behavior modification medication more than it is anything else, that's a big change that we can make in our patient's lives, but then they become subjugated to taking the medication forever. So to me, it's less that the patients don't believe it's obvious. They know that they would get healthier if they exercise, if they sleep well, they quit their bad habits, smoking,

excess drinking, et cetera. But it's the lack of motivation or behavior change that I struggle with the most. I don't know from a neurological perspective if you have some insight into that. Yeah, you're absolutely right. And I think that's why our brain coaches were such a critical component of our success, because these were young

employees who had a background in psychology or social work. And I had a protocol for them that, you know, we personalize a program. Not everybody needs to work under five players of brain health at the same time. Right. So, for example, you may be fit already, and

and you may be eating well, and you may benefit of some meditation. Like slow breathing, just breathing slowly for five minutes, ten minutes can actually change the activity in the brain. I think the key is to reduce the five pillars of brain health to two pillars of brain health for someone. And so, okay, you need to work on these things for the next four weeks, set a goal, and come back.

So in my book, I try to help people personalize the program so they can do it. I'm also working on an app to help people to incorporate these things. I've talked with some health care systems, and they would like to do it,

but the brain coaching is not covered. It's not a, there's no code for it. Yeah, that whole thing of our health care system is the worst part of our health care system. That plus the mental health aspect, I think is the worst, because everyone wants to blame doctors

for not being preventive, enough in terms of improving longevity, but it's not up to us. I wish my patients can afford to do a program like that, but if their insurance won't cover it, they're likely not going to do it. So that's where the investment needs to happen from a system-wide perspective. And I feel like these touch points that they had with the brain coaches, that carries so much value. I remember when I was a resident, we had to do a quality improvement project. And the one that I chose to do was exercising with my patients who were previously sedentary to see if it would motivate them after they finished the program. Because obviously, when they're coming in to see me twice a week to exercise,

they're excited because they get to see their doctor more. They're doing something new under very careful guidance. The question is, what would happen six months after the program was over? And the majority of them incorporated some level of physical activity. It wasn't a huge win. Obviously, I'm a resident, two other residents doing a small project. I'm curious, what your outcomes were after the 12 weeks, what was the success rate moving forward? Yes, I did exactly that. So I looked at patients at three months and six months and not only talk with them, we did objective testing. So when patients finished the program, three months later they would come, it was just to check up, see how are they doing, and they did cognitive testing,

and I would talk with them, and then it was six months. And it was always, I mean, I can't think of any patient who came back who told me I stopped doing things. Maybe patients that didn't make the appointment are the ones who didn't keep up. Selection. But the ones who showed up did tell me that they had kept up with the exercises and things like that. For one thing, once you get to a new level of

mental fitness, it's self-motivating. That alone becomes a reward. And the other thing is that they form habits. So for example, they would not eat junk food again. Once you start not touching junk food and that becomes a habit, then it's a habit next time you see it. Like I hardly ever eat French fries or I never eat a donut.

You can't force me to eat a donut. And once people see results and that becomes a habit, then they don't have to think about it. It is not a question. Like you become into a routine that on Monday, Wednesday, Wednesday, I'm going to exercise. It's like brushing the teeth. There's nothing to think about. And the other thing we did is that, you know, one of the patients I was seeing who did a program

and then three months later, her brain had grown. A year later, she actually came back to me, said, Dr. Furti, can you do one more MRI? I'm just curious. You know, her brain had actually approved 8%, which was the largest we ever saw. Usually it's 1 to 3%, which is equivalent to the brain that's about 1 to 3 years younger in 12 weeks. And she had kept everything. And then she came a year later, and her brain had... had grown one more percent on her own.

We didn't do repeat MRIs on our patients because it was hard to justify it from insurance point of view. But I think if the insurance companies realized that these programs will save them money, they would pay for it. I mean, Medicare doesn't pay for it either. It's interesting to me that there is no code for brain rehabilitation unless somebody has a stroke

or a concussion. There's no code that we could use to charge Medicare for improving people. There are some codes for lifestyle modifications and they're like very modest payments. But you know this, as you see, patients, is that these interventions are simple but powerful.

Very powerful. And in the long run, the health systems will, the insurance company, would actually save money. Because if you don't get the heart attack, if you don't get the stroke, you save money. Yeah, I talked to Dr. Sanjay Gupta about this.

I believe in changing our rules, actually may have been Ezekiel Emmanuel, about changing the rules for insurers because they don't cover the same patient for an extended period of time. Usually people swap in and out of coverages throughout their life. They don't have to think about prevention because they're thinking about saving money today. But if you create some sort of rule that when someone signs up in year one, they don't have to re-enroll for five more years or ten more years, now they're going to start thinking about prevention of trying to keep that person healthy. And the incentives shift in that direction.

So I thought that would be really cool because I think about all the negative things people say about doctors. Oh, you guys just think about disease. I see why they're saying that because I can write a prescription for my patient to get physical therapy if they sprained their calf muscle. But I can get them physical therapy when they're pre-diabetic, which is a way bigger issue will carry so much more benefit. And yet if I write pre-diabetes as the reason I want them to exercise with the

therapist, denied. Make it make sense, right? I think this is what will change in 10 to 15 years. That's where I think will change because it's so obvious. It's a no-brainer. This is obvious. And I think you and, you know, I think thousands of, if not tens of thousands of other physicians feel the same way.

And I think there will be enough of incentive for insurance companies or at least Medicare to change their attitude toward encouraging, patients to participate in programs and pay for them. Yeah, that's a big value that I feel like we're missing out on as a society. Just because I feel the only patients that get it are ones who are highly motivated that seek it out. I'm curious, actually, for your research and your practice that you started, where did those patients come from?

Were they pre-selected in that they came or you just had the patients that you had? Yeah, any patients who came through the door, we offered a program too. But you said that they were coming from different states and stuff, so they were pretty excited about it. Yeah, I think initially, I didn't have any patients. When I started a program,

I had like five patients a day, and, you know, when I talk about these things, they were skeptical. And then as the program evolved and became more structured, then we saw more results. There were more patient reviews online, and then more patients came. So grew organically?

Yeah, I had patients from Boston, Florida, like I said, Arizona, Connecticut, everywhere. Any missteps when you started it that you learned from in starting that journey, whether it was creating the program, patient motivation-wise, anything that you learned in those beginning stages? I think I learned to make it more structured. You know, initially we would tell people to, you need to exercise. But then I realized that every person has. has different level of fitness.

And we can't say the same thing to everyone. Right. So I decided to do what's called V-O-2 max testing. Are you familiar with it? Yes. So I actually bought the stationary bike to do fitness testing in my neurology office. And I remember the rep who brought the machine. He said, I've never sold one of these machines to neurologists.

What are you doing here? And you know the V-O-2 max, the measure of your fitness is perhaps a single, most important determinant of whether you're going to stay healthy for a long time, whether it's going to stay sharp or get demented. That one measure, the V-O-2 max, the measure of your fitness is more important than anything else. So I would do a fitness testing on my patients, and I think one of the things I helped my patients that I show them data. I would actually bring up the papers on my computer screen.

I said, look at this number. This is your V-O-M-M-X, and people who have a higher, You are 2 Macs, have a larger hippocampus, they have better memory, and they'll reduce your scope of Alzheimer's disease. You are here, you want to go there. And I think that really motivated them to see that it's not just, or just exercise and trust me, you'll be good.

Right. And then the other thing we did was with, for example, with HRV biofeedback, we would measure their HRV at baseline, and they would provide them the HRB biofeedback so they can see objective. how they improve. What does that look like so patients can,

or viewers can visualize what that means? Like HRV, biovica. Yeah, let's stay together. Are you for it? Yeah. All right, just sit up at a level straight. So what we're going to do, let me tell you the science of it, and then we'll do it together.

So the idea is that when you're sitting down breathing, your heart rate changes just a little bit. Your heart is of 60 per minute. It doesn't beat one every second. every second. It's like 1.1.9, 1.2.98 is a little little variability in your heart rate. And the heart rate variability turns out to be a good thing. It means that there's a lot of elasticity in your sympathetic and parasypatic nervous

system. It's a good thing. So if your heart rate changes from B2B... It's being adaptable, flexible. It's an adaptable, flexible thing. And it turns out that if you increase that period of the variability, that you're not that you're that it stimulates the vagus nerve from your heart goes to your brain, and that sets your mind at a common level.

You do this as cortisol level, and that's good for your brain. It also improves blood flow to your brain. So how do you increase that heart rate viability? It turns out that the best way to do that is just to sit there and breathe slowly. What I do is the count of 636, which we'll do in a minute. So when you do that slow breathing, you can just see on the screen the heart rate viability improves. And there are biofeedback tools that you can find on internet,

for example, that when HRV improves, it's a balloon that goes up in the air. So that provides feedback for you, so you stick with it. So here's what we're going to do. So we're going to breathe in with a count of six. We're going to hold for a count of three, and we're going to breathe out for the count of six, and we're going to do that for three cycles.

Don't fall asleep on me. Okay. I might get so relaxed. You just lose me. Okay. Here, go. Here we go. So I do it and you breathe, okay.

one, two, three, four, five, six. Now hold, one, two, three. Breathe out, one, two, three, four, five, six. Okay, take a deep breath in. One, two, three, four, five, six. Hold, one, two, three. And breathe out, one, two, three. three, four, five, six.

Breathe in. One, two, three, four, five, six. Hold. One, two, three. Breathe out one, two, three, four. Now, it's amazing. When I do that, I actually, from common myself. Yeah.

And we just did it three circles. Now imagine you just do this for ten minutes. Actually, just two minutes. during the day, if you're a busy day, just two minutes or five minutes, ideally five minutes, but even two minutes. And the thing is that it's one of those examples

of things that are simple, but powerful. This breathing intervention reduces stroke risk, reduces heart attack risk, improves mood, reduces depression, and longevity. There's so many studies

of this breathing exercise. You're not meditating, you're not repeating a mantra, although that would be like a plus sign on top of everything else. You're just breathing, just breathing. And I, like talking about hacks. I mean, I don't like to talk this kind of lingo, but it's a hack. Because it's simple.

It doesn't cost anything. You don't have to buy any equipment. You could get the apps you can get, like it's a calm app, that's a free app that helps you with this breathing exercise. But the benefits are incredible. There was a study that showed heart rate benefits. heart rate viability training by feedback improves depression. So they had a control group and a depressed group.

And no, no, the depressed group in both groups, one group got heart rate variability. The other group just sat there relaxed. And then the group that received heart rate variability after three months had better scores on mood. Then they said, okay, you guys go home, don't do any heart rate variability training, come back three months later.

Three months later, where they had not done heart rate viability for three months. They still had a last. They still had benefits. It's incredible. Like, you know, a lot of people talk about drugs. If they were a drug that would be so powerful, so many people would buy it. Yeah.

I mean, it's incredible why it's so hard to get people to make a behavior change when there's so much value in changing. I think people need to have an aha moment. This is what I did with my patients. See, one of the things I did with my patients actually enjoyed was to get to know them. So when I started seeing patients, I wouldn't say, what brings you here? So how are you doing?

What do you do? Do you have kids? They have pets? I would heard about their pets and the kids and the grandkids. I would get to know them. That's unusual for a special. No, no, I have an hour with my patients. And I think is that I knew what I was doing.

I didn't have to, you know, I've done the same thing thousands of times, so it's not like this rush. And I allowed one hour. I could have done in 20 minutes. But I thought if I wanted to see results, the patient needs to trust me. and a patient needs to have an aha moment. So I would establish,

and I learned a lot through those simple conversations. I would learn about what kind of day they usually have, what their environments like. I learned a lot from those simple conversations. In fact, perhaps more so than a lot of formal things we do in medicine. And then I would hear them out, like what do they think is causing their memory problems? Because everybody comes in thinking of Alzheimer's disease, obviously.

and then I would hear them out. I would hear as of what they think is going on. And then I would talk with them. I will, again, I have so many studies on my computer. I would just say, listen, here's what stress and anxiety does to your brain. When you stress out, you have higher cortisol levels. The higher the cortisol levels, the more your hippocampus shrinks. And it's not like, you know, it's anything else.

It's very simple. It's very simple. Cortisal levels, chronic high stress. I mean, it's okay to be stressed if a car accident, there's a leak in the basement, there are financial problems. Acute stresses. But if you stress every day all the time,

you have higher cortisol levels. Cortisol is toxic to the hippocampus. And so you really want to see hippocampus drinks. And the more hippocampus drinks, the more likely is you get Alzheimer's disease. What we call Alzheimer's is basically shrinkage of hippocampus and the cortex. And so when I thought that,

there was a conclusion of silence. And there was a, oh, my God. Oh, really? And that's what I think the magic happened, that aha moment. And the thing is that the aha moment is different for different people. And some people need a little bit of conversation.

Some people need a lot of conversation. And a lot of, there's misconception. You have to sort of listen here and iron out the misconceptions with data. Sure. I think once people see the data and they believe it in their heart of hearts, that's when the magic happened.

A lot of times, patients who left in my office to make appointments, they would say the nicest thing about me to my staff. Just the first visit. The first visit would be like a life-changing appointment for a lot of them. And I realized that if I wanted to program to be successful, I couldn't cut that shorter. Because I had so many patients.

There were so many patients in my waiting list. It would have been easier if I just cut in half an hour and just move on. But I felt like if I spent enough time with patients and they had that aha moment, they were going to stick with it. They were going to stick with the program. Investing that alliance was valuable. Yes. And they had to learn what we were doing, the shrinking of the brain, the growing of the brain.

We had a lot of pamphlets about things that shrink your brain, things that grow your brain. And of course, my brain coaches reinforce it as well. Yeah. Yeah, that's really interesting because I want to get better at it. at that in terms of not necessarily the alliance. I think we do a pretty good job of that when we have the time in family medicine, but more so getting people excited about it. Because I spend a lot of time studying the psychology of influence, especially given the work that I do on social media. It's being an influencer, right? So I've seen how the psychology of influence can actually

work against patients, where when you're selling them something, a miracle product, a miracle program that is very expensive that they can't afford. A lot of times they've used. A lot of times they've used, that as more effective simply because it costs more. Like if you market a product as more expensive, they assume it's better. Exactly. Whereas this is simple. It's not expensive. People think they need a gym membership where I can design a body weight program for

them of doing squats, pushups, and maybe pull-ups at most. And yet the buy-in is very, very hard to get these days with people being busier, being distracted by activities that are not necessarily healthy, that are very addictive. foods that are ultra-processed, that are tasty and easy, that oftentimes aren't the most nutritious, anxieties keeping up people at night. When they are depressed, they're feeling low motivation levels as is to even shower,

let alone exercise. So there's a lot of things working against us in the primary care space. I'm optimistic, though. I think it's going to change. I think, but one thing, I think if you go to a gym these days, you see a lot more older adults.

If you go to a gym, it's not uncommon to see people hold their 70s or 80s. And I think that people have caught on that exercise is really important for longevity. So we see more older people in gyms than we used to. I was actually, I did a triathlon a couple years ago. And I was so proud of myself. I had done the one mile of swimming and I had done, you know, 26 miles of biking. And I was doing my eight miles of running. and it was toward the end

and I was so proud of myself to finish. I was going, I saw this older gentleman who was clearly in his 80s. It was passing me. I said, wait a minute, I'm not going to let that happen. But I think, you know, it is the case that a lot of people are getting older to realize

that they can get better if they stick with it. You know, there was a gentleman who was a 105 who did a marathon and in Toronto, Mr. Singh. And they interviewed him, say, how long have you been, doing marathons.

So, you know, in his 80s, his wife died. And he was sad. So he went for runs. He enjoyed the running. And he just ran more and more and more. And now he's a marathon runner. He does the marathon every year. And I think more and more people are catching on.

And, you know, in the Western European countries, more and more people are doing all the things we talk about. I was in Netherlands a couple years ago. I see everybody on bikes. And, you know, you don't see any junk foods. places around the city, people are very conscious of their environment, and studies have shown that the incidence of Alzheimer's disease is actually decreasing in Western European countries like Netherlands and Sweden, Denmark, places like that, because people are realizing that these

things do make a difference in the long term. And I think that's what's going to happen in the United States. And part of the United States, this is happening, you know, about Framingham study, Sure. So one of my colleagues did a study of looking at people who have been a part of the Framingham study. And, you know, as a part of Framingham study, so many people have had brain MRIs and, you know, blood pressure testing and cognitive testing and everything else. And so he looked at the brains of these individuals born 1930s, 40s, 50s, 60s, and 60s in that group. And then he looked at the size of the brain of people born in these different decades.

And he saw that with every generation, their brain is slightly larger. In fact, between the first decade and fourth decade, you know, 1930s, 1960s, 50s, there was a 6% larger hippocampal volume in the newer generation. So the new generation early, at least in Massachusetts,

where the Framingham study was done, people are exercising more, they have better education, they're doing something right. The incident of Alzheimer's disease is going down, even though people are living longer. And I think that's what's going to happen in the United States.

I think 10 years from now, 20 years from now, people are going to look back and say, how did you miss it? It was so obvious. How do you miss it? I see a lot of this happening discordantly, so with different populations differently. So I work at a community health center,

so the people I take care of, a lot of times either aren't privy or don't participate in this type of fitness and health curiosity. So I do see what you're talking about, the 105-year-olds running marathons. I don't know if that's representative of the larger portion of the population because if you see the numbers of who's pre-diabetic, who's morbidly obese, now from an overweight obese category, BMI-wise, we're over 50%.

So I'm hoping the successes in the upper part of the United States, meaning upper ranges, starts translating to across the board. I'm also curious, for those who are health curious, health conscious, they're already eating a decent diet, they exercise regularly. They think about their mental health. They try and sleep well. For those people, what is something they can do to improve their chances of decreasing, to decrease their chances of developing Alzheimer's? Yes. In my book, I have a list of 40 questions that I check for all the reversible causes. of cognitive decline and brain aging. For example, hearing loss, vision loss, working too much, concussions.

And so there's a list of 40 things that people can check to find out, well, if I'm doing everything right, what are the issues, high blood pressure, diabetes, obesity, those are the obvious ones. So I think that's one way to look at all the possible things that can increase just of dementia.

And that way people can figure out what the problem is. So the, I mean, you may probably have heard of this study that was published in Lancet as by an international group of scientists that showed that 45% of dementia cases in the world can be prevented by addressing 14 things. Now, imagine 45% of dementia cases in the world can be prevented by 14 things. And those 14 things are the things we just talked about,

the hearing laws, the air pollution, poor diet, and they didn't even include sleep. I think, you know, there were not enough randomized, they're enough of data, but that's an obvious one. If you have poor sleep, you have sleep apnea, that's another factor. So I think every person is different and many medical conditions and environmental conditions can cause it. And if you go through them one by one, you can pick five. that are contributing.

And if we can limit them to like three or five, then you can address them. But one thing you said earlier, which I'd like to elaborate and actually truly agree with you, is the cost of food. It's so much cheaper to buy a sandwich with French fries and a sugary soda

than to get one pound of grapes or, you know, one pound of blueberries. And that's unfortunate. That's really unfortunate. Yeah, fresh, produce is tough to get. Also, the ease of eating a sandwich versus using silverware cutleries. So I see people make that choice all day long during a busy job. They run and get a bagel or something. Yeah. Not very nutritious. With all your years of research, what are the most toxic

habits that people have for their brains? Stress. Because stress is interesting because stress can sometimes be valuable, especially in acute setting. But are you talking about chronic stress? I'm talking about excessive daily stress when it's not necessary. There's a level of stress that's good for you. It's called U-S-Stress, E-U-S-T-R-E-S-S-S, U-Sress. So, for example, if you're stressing out about a deadline, if you're stressing about finishing a job right, or if you're stressing about finishing a project that you have

and there's something going on, that's good stress. It sort of primes you to have more attention and to do more, and that's healthy. When you exercise, clearly, you put your body through stress, and that's called a good stress. The bad stress is where everything is an emergency. Like you are late for work every day. Dealing with this boss or coworkers is always stressful.

Dealing with children is always anger-related, angry interactions with children. You're frustrated with the economy. You're frustrated with the government. You're frustrated with everything. You're just upset all the time. And I think that is really bad for you because your stress response is meant to kick in when there is an emergency. You don't want to have that all the time. When you're constantly stressed, your cortisol and adrenaline levels higher, your heart rate is beating faster, your heart rate variability is lower.

You're more prone to get strokes, heart attacks, dementia. It's horrible, horrible. And the thing is, it boils down to your mindset. and the solution is so simple. The solution is a changing mindset. Now, a lot of people say, what are you talking about? You know, the traffic is horrible.

I spend an hour in traffic. Well, if there's traffic one hour every day, that's called life. You choose to go somewhere else. You choose to live earlier. Instead of complaining about the same thing every day, change it. The other big thing is expectations.

Because we expect something, we get disappointed. And that gap determines how frustrated we are. So if your expectation is that coworkers do their job right and that you cooperate with them and everybody else is doing right and everything goes smoothly, then you're happy. But reality is people have different lives. We have different priorities. Some people have marital problems. Some people have problems with their children. Some people have addiction. Some people have different childhood education, childhood, we have, you know, lifestyle.

And so we can't expect everybody to just be perfect, assuming you're perfect, and let's not talk about the fact that you may not be perfect after all. So I think if you reduce your expectation, and if, you know, this is not, oh, come on, you can't do that. Yes, you can.

And you're not saying reduce your expectations, like live a lower quality of life. No. Work on yourself instead of forcing other people to do what you want them to do. That's a difference. And that's doable. You know, people, for example,

worry about, they say the same thing over and over again. Only if my wife or my husband did this. As if the whole life would be totally different if the spouse did things correctly. And, you know, face it, you're not perfect. What should they be perfect?

And why not you work on yourself? Why not let people do what they want to do? You do what's right. And if they do the right thing, great. If they don't, well, it's too bad for them. You know, we're talking about behavior modifications. I mean, you can also call it manipulation. If your spouse likes flowers or if your spouse likes compliments,

maybe you can try to compliment them or buy a gift and see what happens. Don't complain. To me, complaining means you failed. When you complain about things, I'm sorry to just. say, it's on you. Like, somebody chewing gets on your nerve. It's not on them, it's on you. You are interpreting their chewing a person loudly as inappropriate and it's making

you angry. But it's your choice to get angry or not angry. What if you just get up and go somewhere else? What if you smile and talk to them so it's not chewing? I mean, think of something creative to do. Don't complain. Have you noticed the shift in our society with this focus? for the negative?

I think unfortunately, especially this part of the world, and I travel a lot. I mean, I've been to 40 countries and I give lectures everywhere. And so I get to see a lot of different cultures. I think when I come to this part of the world, I feel like a lot of people have a sense of entitlement, like, you know, tend to be rude with people in the customer service.

Like if you go to the airport and things are not right. And I think the people who lose are the people who get angry. Not the people who are the subject of anger, although they're frustrated too. Yeah. Well, it becomes a never-ending cycle because what do they say? Hurt people, hurt people. So the more you get upset. I think the mindset is the single most important thing for having a happy life.

Yeah. Yeah. Thinking about your response to all this outside stimuli as opposed to the stimuli, right? Because you're always going to have challenges or things that upset you. Here's a aha moment that I like a lot of your listeners to. to think about. There's no such thing as reality. You see the things around you

and then your brain interprets them and then that's the reality you formed based on what you saw. And if you put five people next to each other, each person will create a different reality. Like you go to the airport, it's crowded. And, you know, there's a big lineup.

You can interpret that many different ways. You can interpret, what a chaos, what are no more organized. You can think, like, it's a good thing. The economy must be good. So many people aren't there. It's a good thing, you know. You can interpret everything so differently. And that should give you some degree of humility

that don't get too excited about this. This is not reality. The reality is what you create in your brain. It's not what's actually happening. our eyes convert what we see as facts to what happens in the brain. And of course, you know, just watch the news. I mean, unfortunately what happens in the news and how people interpret it so differently.

And you can't blame them, you know, if they have brought up with a certain way of looking at things. Let me give you an example. I once had gone skiing in South Lake City and I was alone. I decided to go skiing alone for fun of it. And then we came back and there was a little jacuzzi in the condominium was staying and there were a bunch of people. And I was just gentleman who was just talking with other people and he was saying, you know, God helps me every hour. Every hour God helps me.

And God is helping me to do things and make me happy every hour. Look at you. God put you here so I can have this conversation and enjoy myself. God allowed me to come to be able to come to skiing. God allowed me to have enough money to come to this next condominium. And every hour God is helping me. He may be right. But I realize that in his view, every hour he's looking for the evidence that God is helping him.

And there's no doubt in his mind that is what's happening. And of fairness, he may be right. I can't argue that it's not right. But you could also have the same view about so many other things, about the generalizations that you make. So if you change that point of view and decide that, you know, I live in a beautiful world,

life is not fair, who said life is fair? I'm going to take ownership of my problems. I'm not going to affect other people and I'm not trying to control other people. I'm going to control my life. And I'm going to try to improve my fitness and instead of arguing about

what people haven't done their job, I'm just going to do more of my job. It may be a little extreme because people argue, well, that's not fair. But which way are you happier? You're happier if you work on yourself, expect the least and be happy with anything more than the least. Sure. And those things make a difference in your brain function. See, but everyday habits can either shrink your brain or grow your brain.

If you smoke, if you eat sugary food, if you stress too much, if you spend most of your time at night scrolling and not sleeping enough, every one of those habits shrink your brain by just a millimeter, a little bit. If you exercise, if you smile more often, if you, you know, challenge your brain, those five pillars of brain health, every one of those can change your brain by a millimeter every day. And we know for a fact that people who do those things, over the years have either a healthy, strong brain or sort of a normal aging brain.

And that's the latest in the neuroscience field. Based on the concept of neuroplasticity, we know that aging does not have to be necessarily continuous decline. Aging does not mean that your brain will shrink automatically. What will shrink your brain is if you have poor habits, sedentary lifestyle, you don't sleep enough, you drink a lot of beer, you watch TV all the time,

we don't do anything exciting to your brain. If that's what aging is, your brain will shrink. But if you do all the opposites, every day your brain is a much larger. And I'm confident that people can become what I call a brain superager. A brain superager is someone who's healthy, sharp in well into the 80s. So my goal is to be 90 years old, sharp and independent. I'm 63 now. And based on all the things I know, I think there's like a 95% chance I'll get there.

What's the highest lifespan for the human brain? I think a lifespan is something in 90s. Why 90s? What happens after 90s? That's a very good question. I think this is called program cell death. All species have a finite lifespan, cockroaches, fish, birds. Well, Brian Johnson would disagree with you.

I don't know who that is. I know by Brian Johnson. And I'm curious to see what happens to him. Are you though? You know what's going to happen to him. Yeah, yeah. So I think that there is the program cell death. Of course, there's a telomeres shrinking that happens with aging,

and at some point the telomeres are getting too short to, you know, maintain and everything falls apart. And the other thing that happens is the mitochondria. Monocondria, as you know, are important for generating ATP energy in the cells. And as the number of mitochondria goes down, then things start to fall apart. So I think it's a natural process for people to die. And I think it's fine. I'm ready to die when time comes.

I don't fear it because my goal is to live a happy life and then die and get over with. I do not plan to have this gradual decline over the years. And if there are people who think that as they grow older, they just everything goes downhill and it's a downhill process, then they need to rethink that mistaken idea. Because I think midlife especially should be a new childhood. That's what Shakespeare said. A midlife is a new childhood.

This is when you are where you are in life, you have a job, you have family, you have what you want to do, and you can actually build stronger brain every year or at least avoid that decline that happens if you slow down. see people slow down and things fall apart. I was with some friends not too long ago and he's in his 60s, 760s, what do you expect? I said, what are you talking about?

I'm in my 60s. I mean, I bike for 100 miles. I swim. I do things. I'm always active. What is it that I want to do that I can't do? But if you keep telling yourself, I know my joints are falling apart, I'm getting old.

No, if your joints are hurting, if his arthritis, treat it. with something else treated. And also, if you exercise, you have more muscles that protect your joints and you have less joint problem. If you have, whatever it is, there is some decline, let's say 5%, and that's fine. You may be slower in thinking by 5%, but what's the rush?

So you're 5% slower. I mean, you're not doing quantum physics and on a rush to be able to, like, that 5 seconds, make a difference. Right. People need to have a positive outlook about, aging. That's my message. Don't look at aging as a downhill course. Look at aging as something you look forward to, that you're excited to. Like, I look forward to being 70 and show off how I can do everything, you know? It sounds like you're very focused on living a very balanced

homeostatic lifestyle to live to the top of your potential. There exists this world that I have spoken negatively about that is very focused on hyper-optimization. And a lot of that comes from these hormone clinics that are promising different infusions of hormones and supplements. What's your take on that longevity world where they are almost outpacing the speed of research themselves? Yes, I don't agree with them. I know, for example, there are many peptides that are recommended for longevity.

And I know that there is... And recommend that you're using that term very loosely. Yeah, like, you know, if you watch social media, I guess, it's not recommended. physicians. There are people who are on podcasts who talk about these things. And then I know that, for some, creatine is something that people recommend. And I'm not a fan of these supplements or, you know, these interventions that are beyond healthy living. You know, when I go into Europe, for example, I'm walking a small town, village, and in Greece. Nobody's doing anything exotic. You know, they're older, they're sitting around, they're playing cards, or they're doing something together, laughing, they're going hiking.

And, you know, you see a lot of older people in Tibet and in a lot of places, they're not doing any exotic supplements. They're living life. And I think... You mean they're not doing NAD infusions on the mountain side? They're not doing any D infusion in the mountain. No. And the thing is that our body generates BDNF, brain driving or trophic factor, which is a neuroprotective compound that keeps your brain healthy.

So if you can generate your own BDNF with exercise, why would you want to go get an infusion for an hour and then a week later, a month later, a month later, but then a month later or a certain period of time, you have to keep getting these things. Why not generate your own? And why do you need that extra? Why do you need that extra?

I mean, I think we go back to the mindset. You need to be happy. You need to find the happy people. place for yourself. And a happy place is not with Botox and all these peptides and exotic infusions is being happy with yourself to enjoy life. Is there anyone who's doing anything revolutionary in the neuroscience space that you're excited about? Or is it just back to the basic principles that you've talked about? I think what's revolutionary are these multimodal lifestyle interventions which have shown incredible results

in reducing the early stages of Alzheimer's disease. See, we always talk about preventing Alzheimer's disease. I have been talking about preventing Alzheimer's disease for 30 years. I always believe that if you do all those things we talk about, you reduce your risk to get to the point of confusion, to the point where you're not sure what here it is or things like that.

And what's exciting to me is that these multimodal, lifestyle interventions, which are randomized controlled trials. It's hard to do randomized control trials. Show that these interventions that are so simple are able to reduce the amyloid level in the brain. See, there are three things that we talk about other than amyloid. There's inflammation. There's reduced blood flow and there's release cleansing of the brain. Those three processes can shrink the brain.

and then you have plaques and tangles, which are the markers of Alzheimer's disease. But mostly these days are biomarkers that are available. We don't have a biomarker for a simple biomarker for blood flow. We don't have a simple biomarker for inflammation. We don't have a simple biomarker for this brain cleaning that happens at night. But the markers that we have, this amyloid plaques, amyloid levels, are something we can measure. And so when I see that you have patients with a diagnosis of early-stage Alzheimer's disease who do the programs, and then the amyloat level in the brain goes down,

a lot more so than other things. That, to me, is revolutionary. We are for the first time reversing what we call Alzheimer's disease. What's your take, and I'll tell you mine, on genetic tests that try and predict whether or not someone has proclivity or a higher chance of developing Alzheimer's. Recently, a famous movie star, Chris Hemsworth,

went on a TV show and got tested, found out he's high risk, and now he's very worried about it, and he's making all these lifestyle changes. To me, I'm not a big fan of recommending these tests generally, perhaps case by case it's going to be different. Because I feel it implants this fear that is not very changeable with the exact opposite. It is changeable through lifestyle changes. but to me, do those lifestyle changes without knowing the risk. I'm curious what your thoughts on the matter. 100% agree with you.

So you don't recommend people get a test. The test that people talk about is called apole lipoprotein E4. This gene comes in three variations, 8.4, 2, 3, and 4. People have APOE2 version seem to be less likely to develop as Alzheimer's disease.

People have APE4 variation are more likely to get Alzheimer's disease. And a difference is a matter of six years or eight years or ten years. So if you have 4-4, you may develop it at age 72. If you have 2-2, you may develop at 85. That's what the data shows. What people don't talk about is that there are multiple other genes that we haven't discovered yet.

So just not everybody has APO4 or even APO4-4 develop Alzheimer's disease during their lifetime. Not everybody does. And people have 8.4 who exercise regularly have the same level of amyloid as people are 8.4 too. In other words, exercise negates the effects of the gene. So two things. Number one, there are at least 10 genes involved in longevity and brain functions, at least in the minimum. 8.4 is just one of them.

We haven't discovered so many other ones. So it's incomplete information. Let me give a little story. A friend of my, a patient came to see me from Florida. Her name is Gene Carper. She made a documentary and talked about this thing so I can tell her name. So Gene Carper was told that she has APO4 gene and that she is going to develop Alzheimer's disease.

Now, she used to be a CNN reporter, so she did an investigative reporting, and to her credit, she talked with a lot of prominent experts in the country about this. And then she had read some of my papers, so she came from Key West, she flew all the way to Baltimore to see me. When I talked with her, she gave me the story. Yeah, I was told I have 5'4. I'm going to get Alzheimer's disease.

What can I do? So I talked to her, and I gave her a list of 15 things. I should remember 12 of the 15 things, which is incredible. Back then she was 82. And then I did a fitness testing on her because I had fitness testing in my office. She did really well.

And I said, Jean, you don't have Alzheimer's disease, and you're very unlikely to develop it, giving how well your brain is working now is extremely unlikely that in 10 years just abrupt fall. And so she actually videotaped me and she made a documentary called Monster in the Mind, talking about Alzheimer's disease,

and actually a significant portion of it toward end is talking with me. But I've stayed with her. She invited me to go visit her in Q.S. I went, and now she's 93 years old. She's still doing, She lives by herself. She actually had an art exhibition recently.

And I talked to her. She's as lively as ever. So the point is this. Yes, she did have EP4, but she probably has a lot of other good genes, and she has the best lifestyle. So I don't recommend APO4 testing because just like you said, I'm going to do everything myself. Irrespective of the test. And I don't want the nagging thing in the back of my mind. Now, there are people who say, no, I want to know.

If you're prepared to deal with this idea that I have an Alzheimer's gene in my brain and you're comfortable with that, then fine. But I feel much better not to do that test because I know my lifestyle dimensions are the best things I'm going to do either way. So why add that extra anxiety? And it's a cost in a day and age where people's financial budgets for health care is lower. I think should not be allowed to be tested.

You think it shouldn't even be allowed? No. it doesn't give a full story. I find it very... Well, they probably write a disclaimer that it's... They write a disclaimer, of course. Wouldn't find print that you can see. And these days you can get these things

for free. You can buy them on internet. And I think that's irresponsible to provide these tests which can have profound implications for a naive person who just buys a test. Well, it's because they're trying to sell them. And gets the, you know, the little comment that this is more commonly seeing Alzheimer's disease. It is true.

It's commonly seen in. in Alzheimer's disease, but there's a whole lot of information that is not provided. And they already made the $500, whatever it is they made. And I think that's irresponsible and it should not be available to general. It should at best be available only talking to a physician

who can provide counseling for you. And data privacy, who knows who owns that data now, especially with companies being bought out. I know. 23M. Yeah, yeah. So we did actually a video on 23 and me covering all this before that.

that happened. So it was interesting to see it like we told the future in that regard. I've even seen some of these genetic tests, even outside of the brain health space make statements like, you're very low risk for developing type 2 diabetes. So what? Now go eat Skittles? What is the, to me, again, because I function in primary care, there's so many tests I can order. If my test that I'm ordering is not going to provide information that's going to change management, there's no need to order the test. Exactly. That's exactly the point. But that's lost in healthcare. If the test is also not going to change in management, you shouldn't get it. Yeah. That doesn't exist in, okay, so I'm wrong. That exists in healthcare, but that notion in wealthy individuals, they don't

believe in that. I don't know why. They want too much control. I think people want to be proactive. I mean, there are people who get a whole body MRIs. Curious your thoughts on that as well. No, because what happens is, what happens is that, you're going to get a little this here, little that there, and then that requires a lot more testing and biopsies and everything else. I think the risks of complications with the results that come in, incidental findings, is more than whatever potential benefit. I mean, it's extremely unlikely that you're going to catch a pancreatic cancer.

I mean, you do MRIs every year. You're going to do every month. I mean, at some point, you have to work. I had a very uncomfortable conversation with the CEO of Pernuvo sitting across for me in that same way. And I don't, I don't, I understand where the fear is coming from that people have. And they do a very good job through marketing of instilling that fear and the hope of being able to catch something. But it's not honest about what is actually found most of the time, what's missed most of the time. And it provides this conversation where it's,

seems like people believe that I don't want to find things in them when in reality they're getting worse care, even though they're spending more money on it, which is weird to say. I think it's fair enough to do things that are recommended by national organizations. Like you want to get a pap smear, you know, colonoscopy. You want to, you know, do a baseline cardiac evaluation. I think those are the common sense things that have been accepted by the medical community as standard protocols. I think that's fair. But to do random testing, and there are some companies that check your gut biome, and then they tell you eat more fiber.

Yeah. I can tell you that for free. I got it. You don't need to do it. So, yeah, it's ridiculous. It's just, it's a hypermonetized world of health care. I know. Because the average person that's spending the money on it has incomplete knowledge,

and they have a fear of being sick, and they have the hope that someone with money can give them the answer. and it just can't, and they don't want to believe that. So they want to buy the health. The best investment people can make in their future is to re-evalue their mindset. I think people who have a healthy, positive mindset have such a better life experience. If you feel life is good, you wake up in the morning, think today is going to be a great day. And then you look for good opportunities and you're kind of people.

and you enjoy your day, and then you go exercise, you feel, oh my God, I feel wonderful that I exercise. You go home, eat a healthy meal, and, you know, you do the evening, the things you like, whether you take a dance class, or you do something from the family, or you learn something new, whatever it is, and you go to sleep thinking, you know, life is great. I had a wonderful day today, and I'm so lucky to have the life I have, that is priceless. No money can buy that. You can't pay for that. And it's easy.

It's not difficult. I think what it requires to pause and say, what if I try that for a day? Just a day. And if just a day, just one day and see how much of a difference it will make on your experience of life, an experience of life is not just how you feel. It changes your physiology. The sympathetic and parasympathetic nervous system are constantly being alternating.

People who have a lot of anxiety about, oh, what did the test show? What happened? I'm late and not good. Why is everything going wrong in my life? They actually increase cortisol. They have more sympathetic drive. They have small heart rate variability.

And these are the people who are more prone to strokes and heart attacks. And a simple, inexpensive mindset. can really give you a better quality of life and help you live a longer life. And, you know, one thing I find interesting is that we talk about longevity a lot, but we don't talk about quality of life.

You know, I think it was Kennedy who said, we just don't want to add years to our life. We want to add life to our years. I think we really want to focus on the quality of the years. You don't want to live to age 90 and be stressed out all the time. Yeah. And I think to add,

quality to a year, you need to work on your mindset. If you have that mindset, great, enjoy it. If you don't, realize it doesn't take therapy, it doesn't take expensive things, it takes five minutes of you writing down, what are things that are important to you? What do you find passion? What do you find meaningful? What are you passionate about? Write those things down and tell yourself, like, I want to be X, Y, and Z. These are the things I like about my life. These are the things I don't like about my life. Try to remove, eliminate, reduce those things you don't like and spend more time with things you do like.

And tell yourself, I'm going to have a good life. It's not that complicated. I mean, that is like, we're talking about hacks. That's the biggest hack that you change your mindset and all of a sudden you see the world to a different lens. I actually envy that guy. Remember the guy I told you in the jacuzzi, in South Lake City? I mean, he's living life.

He's living life. I mean, with a lot of gratitude. With a lot of gratitude. And, you know, I don't know if he's right or not, but he definitely, I mean, he was actually getting annoying to me. Because he said, God put you here so that I can talk with you and enjoy this conversation. And I realized, well, I can't get annoyed because if I get annoyed, that's on me. So I'm not going to go there.

And I actually envied him for a moment. I said, he's just living life. I mean, that's extreme. I think it's possible to enjoy every day of life and knowing that if you have that kind of mindset, you're more likely to go through life with ease. So you don't want to be confrontational with exercise, with diet choices.

You want to be moving through life with ease. So you don't want to fight the fact that you're eating your food that's healthy but you don't like. Well, choose a food that is tasty and healthy, and there's a lot of options. Speaking of healthy food,

what's the healthiest food or diet that you can eat for your brain? There's one big rule for me, which is the number one thing I recommend to my patients is don't eat junk food, period. None, zero, absolutely nothing. Because as you mentioned earlier,

this highly processed food, it's really not food. It's a bunch of chemicals with some spices on top. And it's the spices that people like and they don't know what they're eating. It's not really food. And if you eat junk food

and that's all you do, you're more than 70% in what's good for the brain. If you don't eat sugary food and things in high in trans fat, high processed food, which we're surrounded with, you're good to go. You eat whatever else you want.

Now, if you want to go one step further, say, okay, fine, I've cut back on junk food, what's good for you? There are a few things that I know, good for you. Again, the principles are increased blood flow, reduced inflammation, improve the cleaning that happens in the brain, the cleansing happens in the brain.

So one of my few favorite foods are blueberries. Blueberries are really dense source of nutrients, antioxidants, and the increased levels of BDNF in the brain. So that's good. The other thing I like is pomegranate, and the pomegranates are known to increase blood, uh, blue blood flow in the brain. And dark chocolate actually is surprisingly good. I mean, usually people think if something is good for you is not tasty, but dark chocolate, cocoa is good for you. You want a dark chocolate that increases blood flow to the brain. And that's been shown to increase blood flow in the brain. So these are some of the food that I like. But in general, fruits and vegetables, legumes, some meat, not so much red meat, but, you know, chicken, fish.

I eat, say, once a week maybe on average. I try chicken or fish more often. So the point and the secret is, every food has a collection of vitamins and minerals. Whatever you eat, that's natural, has some zinc and some other chemicals, nutrients, and vitamins are good for you. There's no one particular diet.

The Mediterranean diet has the strongest data for reducing risk of stroke, reducing risk of heart attacks, reducing risk of Alzheimer's disease by a lot. One study showed that if you monitor people for 20, 30 years until they die, and then you look at their brain after they passed away, you measure the amounts of plaques and tangles,

not all the other things we talk, just the plaques and tangles. And compare the brains of these people who usually ate a Mediterranean diet and these people who didn't eat a Mediterranean diet. The people with a Mediterranean diet have a brain that's up to it. 18 years younger compared to people who did not eat a Mediterranean diet. So we know for a fact that a Mediterranean diet is particularly good for you.

Now, the Mediterranean diet is fruits, vegetables, whole foods, you know, whole foods, you know, extraviction of olive oil, some fish. And it, to me, it happens to be the one that's most studied in these scenarios. I think you're right. It's the most studied. It doesn't mean it's the best diet. So if you are from China and usually have, you know, lots of food, of fruits and vegetables anyway, then that's good.

It doesn't have the Mediterranean. All Mediterranean means is that it's a healthy food. It's whole food that has really good marketing behind it. Yeah. Yeah. And I think part of it is a Mediterranean lifestyle too. Right. Like you mingle, like imagine Italian.

By the sea. Yeah, it's an Italian family all sitting around, you know, eating, and they don't eat large portions. And that's the other thing. You want to have small portions. You don't have to eat. Like I eat a breakfast. you know, some oatmeal, some blueberry, something.

And then I usually skip lunch. I usually have just a small bowl of yogurt for lunch. And then I have a meal around 5, 6 o'clock for dinner. And I find that's enough. I don't need to eat a lot. So quantity matters and quality matters. And the basic principle is if you don't eat junk food, you're good. Where do you see the future?

Where are we going? Where are we going to be in 10 years? I'm optimistic. I'm optimistic. I'm waiting for that turning of the trends. See, people follow a trend. Like it's a trend to do something and everybody does it. As I mentioned, we're in that stage.

Like, you know, 40 years ago, Alzheimer's was the disease. You only find the amyloid cure, you're done. Then there was some question, oh, maybe there's something we could do. Maybe it's not all that. And, you know, now it's like, oh, my God, there's so much data. not everybody knows about this but there's a lot of data. The amount of data that's available

for all the things I talked about is beyond compelling. It's like, how could we not? Why is it everybody doing this? A lot of my brain coaches will come to me, say Dr. Fatoui, why is this not the prime news and CNN everywhere else?

Why is this not everywhere? And sometimes I feel like going on rooftops and say people. Well, this is your rooftop right now. You can reverse Alzheimer's disease. You don't, you know, aging doesn't have to be declined. your brain has malleability, your brain can change,

your future is bright, you don't have to necessarily get frail as you get older, come on guys. And I think 10, 20 years from now, people are going to look back and say, what were they thinking? Like, why we're not doing these things? And there will be special programs

for brain fitness programs everywhere. Like you go, every city you go, and every other block there's a gym. There's so many gyms everywhere. And this was not the case in 1950s. 1960s, and 1970s. It was not the case. Well, the question, are people going now? I know a lot of people are signed up for gyms.

I don't know if they're using them. You're right. Good point. But I think more people at least are going. Yeah, thinking about it and are opening their minds to it. You know what I forgot to ask you? Are IQ tests BS? Yes. Why?

They are BS because our brain can have different cognitive capacity. There's a part of the brain called the cortex, which is the outer layer of the brain. And it is the hippocampus, which is the size of your thumb. You have one on the right, one on the left. The cortex and the bicampus together mediate your higher cognitive abilities, how to read, write, type, drive, do your taxes, do your podcast, plan your days. These are called higher brain functions. And they all emanate from networks of connections between different parts of the cortex.

and a big campus. Got it? Okay. So historically, people have been talking about IQ tests, which measure only a handful of your cognitive abilities, logic, processing speed, mathematics, literature, or comprehension, special reasoning, very few. They do not test the whole spectrum of cognitive functions that a person can have. For example, to do a podcast, it takes a lot of intelligent. Like, why isn't everyone's podcast as successful as yours? You've done something right.

If you're a good dancer, if you're doing these performances on ice, you know, that people do, if you're a good chef, if you're a good comedian, you are intelligent in those areas. Who is there to say that being good with math and logic is better than being good with doing all these other cognitive abilities. And I think this is not a benign distinction. I've seen, I want to say thousands, but really thousands of patients who come to see me, and they always assume that other people are smarter

because they think that other people have better memory, other people can think better, other people have better scores on IQ tests, and you don't appreciate that they themselves are so intelligent and there are other people who envy them. because your cognitive capacity comes from a network of connections between different parts of your cortex and hippocampus. So, for example, you have a network for language. And some people are using that network and they can improve on it.

That's the beauty of the brain. You can acquire any form of intelligence. So we have, you know, you speak English, let's say, but that's one little part of the network. but you can modify the network and improve on it. So now you can have, you know, you can speak two languages. And so another network could be for memory. Another network is for attention to sustain your attention. Another network is for exactly function for you to sequence things and get things done.

Of course, it's a network for doing nothing, like an idol where you just sit there and you don't do nothing. That's a network itself. It's a background network. So there are two types of intelligence. innate intelligence and acquired intelligence. It is true that everybody is born with some kind of cognitive function

that comes easy to them. Some people are naturally good at playing the music, playing the piano, for example. You don't really need some instructions. They somehow just play it. Somehow some people learn languages easily. Like I know five, six languages, and I find it comes easy to me.

I don't have to work as hard. And other people are very good with numbers. They don't try hard. They're just generally good with numbers. And that's the thing. They have some innate talents they're born with. It's just the factory that comes that generates that brain. It comes with pre-assembled networks that are in some areas better.

But here's the thing. Our brain has the capacity to acquire any other form of intelligence. Let's say I want to become a good cook. Let's say I want to become a good accountant. I have the brain wiring to get good at it. If I spend 10,000 hours on anything, I'll get good at it. If I can spend 10,000 hours on accounting and doing taxes, I'll be one of the best tax accountants ever.

And so this is what people miss. They assume that IQ tests determine intelligence. They probably don't do well on those IQ tests. Therefore, they're not intelligent. Therefore, they're not smart. Therefore, they can be successful in life. And that's unfortunate tragedy that these companies that market and sell the IQ test. And the general public assumes that if you do well on those tests, you're good at it.

Like, take a quarterback. You know, watch football these days. And these quarterback are able to send a ball 50 yards away just within inches of two to the other. And the thing is that they send a ball where the wide receiver will be. not where the right receiver is. And they see that three other people, three other players from other team are going to them.

They send it within inches of where the ball is supposed to be. That is intelligence. But we never think of that as intelligence. So, bottom line is this. Intelligence emanates from the functions of cortex and a bicampus. Cortex is like a mosaic of areas

that are covered the whole brain, like a blanket. And hippocampus in the middle in either side. And there are millions of connections, the networks. Like you see the networks you see on like airline connections,

the networks. So there's so many networks. And each network does something, language, attention, executive function, math, other things. And these people are born with certain of these networks

that are already pretty good to begin with. But we can form new ones. I mean, form new networks. We grow our brain. There are at least 50 studies. I teach a whole course called

advances in neuroplasticity and its applications in neurology at Johns Hopkins. And I spent 26 hours about all the things that shrink and grow the brain. And one of them is how different forms of cognitive stimulation, different times of brain training, can grow the size of cortex and the pecanpus

and make these networks more sophisticated. So is a bigger brain a better brain? A bigger brain is a better brain. Especially when it comes to cortex into the becampus. So if you do things that increase the size of the cortex and the panace, the five pillars of brain health, exercise, sleep, nutrition, mindset, brain training. These five pillars of brain health have been shown individually to increase the size of the cortex antipacampus by a lot.

So every day, if you do a little bit of these five things, you have a trajectory of having a healthy brain. And if you do the five negative ones, sedentary lifestyle, a junk diet, porous sleep, stressed out lifestyle and never challenge your brain, then your brain increases inflammation, it reduces blood flow, and a cleaning that happens at night with the sleep doesn't happen.

So you have two sets of choices, and each one of them will take your brain in this trajectory or that trajectory. So if you do the things that help to grow your brain, you have a larger brain reserve. You increase resilient to your brain. I call my book The Invincible Brain, meaning that if you do all this thing I just told you,

you make your brain invincible, you make your brain more resistant to anything bad that can happen to your brain. And so, you know, sometimes I talk to it as if it's a retirement plan. If you do everything, so many things that I just talked about, the five pillars of brain health, you have a larger brain retirement fund.

So when you get to your 70s and 80s, and let's say this plaques and tangles come out of nowhere, you will be able to still function. People need to know that it is possible to have Alzheimer's disease in your brain and have no symptoms if your brain is healthy and is strong otherwise. That's a well-established fact.

And for example, the nun study showed that's elderly women in their 80s had busy lives that were teaching others, community work, they were crocheting, driving, and many of them who died had loads and loads of these plaques and tangles. And Dr. Snowden and other colleagues were puzzled.

Like, do you have Alzheimer's disease in your brain? Why aren't you having symptoms? And the secret was their brain was healthy otherwise. They were not drinking alcohol too much. They were not stressed out too much. They were praying. They had a sense of purpose. They were active.

They were engaged. They were doing all. the right things. So plaques and tangles who came were faced by huge brain reserve and they did not cause symptoms. And that's what I tell you. My goal is to get to age of 90 and be sharp and independent. Why? Because every day I'm working on my brain reserve. And I think that when I get to my 80s, I say, and there was some plaques and tangles out of nowhere, for whatever reason, my brain will be able to still function well despite that. And I think that. And I think. I think that's the secret to build a strong brain so that you'll be more resilient against

the effects of Alzheimer's disease if at all happens. Got it. Well, I'll tell you what. I'm motivated. I'm going to go through the checklist and make sure that I'm doing everything. And I'm sure everyone at home will probably be doing the same thing. Besides the book, where can people follow along your journey? I have a website, Dr.Fa T-O-T-U-H-I-com.

And I am posting on Instagram and YouTube. I'm starting to do more of them because I feel like these are important information that people can benefit from. So between Instagram, YouTube, and my website. Cool. I also have a new app that I have developed for people to have three sets of questionnaires.

I have a brain fitness questionnaire that tells you where your brain functions are overall today in terms of the trajectory. I have a cognitive questionnaire that people can decide what are the issues that they need to work like if you go to a gym, do you work on your biceps,

triceps, core, or legs. So I have a questionnaire that helps people identify where the strength are and where are the weaknesses they can work on and have a questionnaire for behavioral, emotional things

that may be affecting people's life. Anxiety, OCD, fatigue, brain fog, these things that could be and those three sets of questionnaires can really help people establish their baseline such that they can follow it six weeks and 12 weeks. And those are on the app that will be available, the invincible brain.

Thank you so much for your time, doctor. I appreciate you. My pleasure. Hope you had fun. I had an update. Awesome. Thank you. In this interview, I talked to Dr. Fatouhi about my interview with Andrew Lacey, the CEO

of Pernuvo, the full-body MRI scanning company. Scroll on back to find that one as you'll enjoy the really tense and valuable conversation. There's a lot to learn. And if you enjoyed this episode, please don't hesitate by giving us a five-star review, dropping a comment down below, sharing this episode with your friends or family, as it helps us find new listeners and viewers.

And as always, stay happy and healthy.