The Dr. Hyman Show - How To Heal The Brain And Prevent Alzheimer's Disease

Episode Date: January 16, 2023

This episode is brought to you by InsideTracker, Athletic Greens, and Paleovalley.   Until recently, the most popular approach to treating Alzheimer’s has been to focus on managing the symptoms in the brain. Now brain experts and neurologists know that a better, more effective approach to helping Alzheimer’s patients requires a full-body assessment with all-encompassing, highly individualized treatment that includes improving the microbiome, a healthy diet, plenty of exercise, hormonal balance, adequate sleep, and more. In today’s episode, I talk with Dr. Richard Isaacson, Dhru Purohit, and Dr. Dale Bredesen about why Alzheimer’s is not just a disease of the brain, but one of the entire body. Dr. Richard Isaacson serves as Director of the Center for Brain Health and Director of the Alzheimer’s Prevention Clinic (APC) at Florida Atlantic University’s Schmidt College of Medicine. He previously served as Director of the APC at the Weill Cornell Memory Disorders Program, Assistant Dean of Faculty Development, and associate professor of neurology at Weill Cornell Medicine & NewYork-Presbyterian. He remains an adjunct associate professor of neurology in the Department of Neurology at Weill Cornell. Prior to that, he served as associate professor of clinical neurology, Vice-Chair of Education, and Education Director of the McKnight Brain Institute in the Department of Neurology at the University of Miami Miller School of Medicine. Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset.   Dr. Dale Bredesen is internationally recognized as an expert in the mechanisms of neurodegenerative diseases such as Alzheimer's disease and is the author of the New York Times bestsellers The End of Alzheimer's, The End of Alzheimer's Program, and his latest book, The First Survivors of Alzheimer's: How Patients Recovered Life and Hope in Their Own Words. This episode is brought to you by InsideTracker, Athletic Greens, and Paleovalley.  InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman. Right now when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman. Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal. Full-length episodes of these interviews can be found here: Dr. Richard Isaacson Dhru Purohit Dr. Dale Bredesen

Coming up on this episode of The Doctor's Pharmacy. Alzheimer's is not a brain disease. Correct. It's a systemic disease that affects the brain. Hey everyone, it's Dr. Mark. Now something I get more and more excited about every year is personalized medicine. Now when I began practicing functional medicine over 20 years ago, it was clear to me we have to look at how unique each body is.

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week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. Alzheimer's disease adversely impacts millions of lives, but the process of aging doesn't have to be accompanied by cognitive problems. And age-related cognitive diseases like Alzheimer's can be prevented and even reversed. They no longer have to be the death sentence so many of us have believed them to be. It starts with taking a good look at your entire body, not just your brain, to determine where imbalances might be. In today's episode, we feature three conversations from the doctor's

pharmacy on how we can improve our brain health and even prevent Alzheimer's. Dr. Hyman speaks with Dr. Richard Isaacson on why Alzheimer's is not just a disease of the brain, but of the entire body. With Drew Prowitt on five things you can do right now to protect your brain from Alzheimer's. And with Dr. Dale Bredesen on what to look at in your body to reduce your Alzheimer's risk. Let's jump in. Alzheimer's disease is a medical disease. Yeah. Full stop. That's it. There's this thing called the skull and it's a hard thing that affects you when you fall, but it's just like, it's like when you have medical conditions, you can affect your kidneys. When you have medical conditions, it can affect your eyes. It can affect your heart. The same thing, it can affect your brain.

And I couldn't agree with you more. People can take different roads to Alzheimer's and you have to figure out what word they're on and get the, get them the heck off that road. Women, for example, are unfortunately many times in the fast lane to Alzheimer's women, two out of every three brains affected by Alzheimer's are women's brains. And five, 10 years ago, I would say I didn't know why. And now I think I can answer that question. And it's related to the perimenopause transition. It's related to specific life factors.

It's related to women being maybe a little bit more at risk if they have the APOE4 variant. So the take-home point here is if you understand a person's individual risk factors, whether it's biological sex, whether it's medical conditions, whether it's what's floating around in their blood, whether it's what is their cognitive function at baseline, you have to figure these things out and then you have to target that plan and personalize that plan. I mean, Alzheimer's disease and brain health needs to be treated in a medical way. Because if it's not, if you're just targeting amyloid, you're missing the boat. You know, amyloid is a marker.

And I think hopefully one day we're going to have just like we treat diabetes with lifestyle interventions and exercise and as well as certain targeted drugs that honestly, some of them actually do tend to work pretty well. I'm not the biggest fan of insulin like that doesn't that's maybe band-aiding to me. That's probably too late. I mean, I'm not the best, whatever, but some of these new, you know, new things that are pretty interesting. I won't get into specifics, but I hope that one day we treat Alzheimer's disease and cognitive decline, like any other chronic disease of aging, where we hit things with a multimodal evidence based and safe approach that requires a medical intervention. So essentially what you're saying to paraphrase is that Alzheimer's is not a brain disease. Correct. It's a systemic disease that

affects the brain. Yeah, I really believe that. I have to be careful saying that. Is this being recorded? Yes, and it's going to be broadcast to billions of people around the world. Great. Great. My field. I was just gaining some fans in my field, and now it's all a decade of work. Oh, no, no. You were at the forefront of a paradigm shift that's happening throughout medicine, which

is the breakdown of the old concepts of disease from simply this reductionist organ-based symptom-based model to systems thinking and network medicine. And that's really all you're talking about. And, you know, you've touched upon some of the most easily accessible and modifiable factors, which is what we eat, how we exercise, how we handle and manage stress, how we sleep. Those four pillars are huge. And then there's the fine tuning with managing metabolic risk factors or getting their nutrient levels up to a certain level. But there's a whole treasure trove of stuff that we, I think, still haven't even dug into. It's like I visited Ephesus in Turkey, and it's the largest Roman city during the Roman Empire. It was incredible. It was all

buried under dirt and rubble, and they excavated it. But they're still excavating it 100 years later. And it's just fascinating to see that there's so much we don't know. And I would say, in my experience as a functional medicine doctor, I've seen things that have impact on the brain that aren't really included, like heavy metals. Do we even have a way of testing that is in conventional medicine for heavy metals? Not really. We just do a blood test, and then we don't worry about it if it's okay. But there may be total body burden of toxins we don't look at.

The microbiome is another huge factor that affects the brain in Alzheimer's. And mitochondrial function is something we talk about, but it's often ignored. And we have latent infections that may be affecting the brain that cause inflammation, whether it's herpes 2 maybe linked, but there may be other things. I mean, Chris Gustafsson had Lyme disease and got diagnosed with dementia. There may be environmental factors like mold that have impact on inflammation. So we know that the brain with patients with dementia is inflamed. And then the causes of that inflammation can be multiple. And so part of the diagnostic dive that you're doing, and I would just sort of

encourage you to think about this, is that you're getting to all the stuff that we do know that's so clearly evidence-based. But then there's a whole treasure trove of things to look at that we're kind of ignoring. And I'm just going to take like two seconds. I know it's my podcast, but you're talking. But I'm just going to just talk about this one patient because it was the first patient I had where I'm like, came in the guy with Alzheimer's. I'm like, can you do anything? I'm like, I have no clue.

I don't know. But I'm just going to apply the model of systems of biology and functional medicine. Let's see what we do. We found he was severely insulin resistant. He had, which is, you know, we talk about Alzheimer's is type 3 diabetes in the brain. He had very high homocysteine levels and methylation problems. So his genetics were off around metabolizing B vitamins in the right way, which we know is a risk factor for Alzheimer's. He had the ApoE4 double 4 gene, so he's the 1%.

He was 7 years old, cognitively impaired, diagnosed with Alzheimer's, basically at home, not able to do anything, depressed, not functioning. It was the former CEO of his company. He also had other nutritional efficiencies like vitamin D, and he had been living in Pittsburgh. And in Pittsburgh, it's the capital of steel. And for a century, they've been burning coal for the steel plants. And they use coal there for the streets on the winter for ice. They put it on the fields for fertilizer and what they do, it's everywhere. And all my patients in Pittsburgh have high mercury levels. And he had very, very, very high mercury levels when we did a challenge test, he just had a mouthful of fillings. And we know that

if you look at, you know, amalgam scores, surface area, and you look at animal studies, the more amalgams you put in their mouth, the more mercury ends up in their brain. And so I said, well, I don't know well i don't know i don't know if anything i'm going to do is going to work but let's fix your insulin resistance let's fix your also he had terrible gut issues he had irritable bowel for 30 years and was on stella zine for his stomach which is a psychotic anti-psychotic drug to kind of calm his stomach down and i fixed his stomach i cleaned up his diet fixed the insulin resistance i fixed the b vitamin thing i got rid of the metals and the guy came back to life and it was really remarkable and he

was able to go back to work and function again and be part of his family and be part of his society in a way that i was just shocked and so i i think that you know there's a level of stuff that we're looking at and then there's a whole bunch of stuff we're not looking at so i'd love you to comment on that and what your thoughts are about all that other stuff that we're looking at, and then there's a whole bunch of stuff we're not looking at. So I'd love you to comment on that and what your thoughts are about all that other stuff that's going on. Yeah, so, and thanks for sharing the story, because, you know, every story is instructive, because this is-

I'll send you the article that I described. As an editorial I wrote for a medical journal, I'll just, because you'll go, wow, you know, this is interesting. So, you know, the thing that resonates me with the story is, you know, when you have people with APOE4-4s, those are just different eggs. And, you know, E4-4s may be, you know, for example, E4-4s may be preferentially responsive to vitamin D, for example. So, you know, some studies show that vitamin D, eh, maybe it's not really that preventative. Oh,

some studies show, oh, maybe it is more preventative. Well, people with two copies of the E4 variant, which is again, not, not super common. Those people really need to have their vitamin D's up. And that's, and you know, that's, that's just an example there, but you know, people with the APOE4 variant, you know, uh, pesticides, DDT and DDE, the interaction between E4 and pesticides increases Alzheimer's risk several fold. If people don't have the APOE4 variant, maybe they're not as exposed or maybe they're not as increased risk to Alzheimer's. So when you look at a whole population, you don't tease out for E4 positive versus negative. The studies may not show any correlation, but in practice, we see the correlation. And in other studies, you do see

the correlation. So I think, you know, something I learned, I was at a conference in Canada. You have a lot of fans in Canada, by the way, just, just your name came up there. It's true. It's everywhere. I mean, I'm in Istanbul at the airport and some guy from the security comes running up to me. I thought I like was going to get arrested for smuggling something. Smuggling my Turkish delights back to America. And he's like, Dr. Hyman, can I take a picture with you and i'm like oh fine okay international so i was at this i was at this thing in canada and amazing people just smart people and and you know we were giving presentations and of course i'm like you know

the science guy and i'm like a i'm a clinician i'm like a i'm like a regular doctor i don't say joe schmo like you and me but like you know but but i was thrown into this clinical research thing and and again i had research resources, did work hard to learn, hired the right people. So, yes, I've done research. And when you do research, you need to have objective measures to follow that you can track. I was at this group in Canada, this guy named Gary and Elizabeth. Elizabeth's a naturopathic doctor. And Gary is just really, really, really smart.

And they were working together, really, really smart. And they were working together to present on a topic. And it's kind of like a bulb light bulb came off my head. And I said, you know, I'm so focused in the objective because I need to be because I'm a researcher. If I'm going to say something and think it, I need to then prove it. Because if I'm in an academic environment, you know, I was at Weill Cornell Medicine for a New York Presbyterian for almost eight, nine years. And now I'm at Florida Atlantic University doing a really, really exciting program in brain health and Alzheimer's prevention, Parkinson's prevention, dementia with Lewy body prevention. I get to do some really cool things.

Maybe I'm missing the boat a little bit because if I'm just focusing on the objective that I need to track and prove, there's a lot of stuff under the surface that I can't really track and prove because I don't have a biomarker to do that. So I guess what I'm trying to say is as I've, I know what I know and I don't know and I don't know. I'm consciously incompetent about things. And the story that you say is, yeah, no, I am, there are people that are unconsciously incompetent about things and and the story that you that you say is yeah no i'm i'm i am there are people that are unconsciously incompetent and those people drive me a little

bit uh batty but i am i'm with you i'm on your team i'm on the i know what i don't know yeah i know what i don't know and and i'm i'm willing to have my eyes opened and um you know the stories that you say it's like as a physician, you, you, you have to treat someone in a certain way to try to make them better, but we don't always have all the objective, you know, evidence and, and the types of work that we do on patients. It's really hard to study. Like I have empathy for people, you know, in our boat who are trying to study the rigorous, you know, rigorously study because what's moving the needle to me, I don't care what's

moving the needle. People were criticizing, you know, one of my research paper's moving the needle? To me, I don't care what's moving the needle. People were criticizing, you know, one of my research paper, oh, you recommended 21 things. What if 18 of them are helping and three of them are harming? You'll never know. And I said, okay, but look at the results. 18 months later, people with amyloid in their brain with mild cognitive impairment due to Alzheimer's disease that followed this plan. 18 months later, as long as they followed 60% or more of what I recommended, had better cognitive outcomes. 18 months later, we were able to improve symptoms. There's no drug that can improve symptoms. Slowing decline is one thing, improving symptoms. So I'm zen with not being able to precisely understand which of my 21 things are working.

But I think as clinicians, I think we just have to do the best we can. And we want to promise not to overpromise. I think that's important too. You said at the beginning when you were seeing that patient, I'm not 100% sure, yada, yada, but I'm going to try all the usual things. And, you know, something worked. So I think as long as we have honest conversations with our patients and do the best, you know, people like us that have academic appointments and are in that, you know, realm, I think it's, you know, it's my duty in some ways at this time in my life, in my career to try to prove as much as I can. But I think the field and I think people need to realize

that some things are really hard to study and prove. Yeah. And they are, but what's happening now is with the acceleration of our understanding of how to map biology and things we couldn't even measure before, we're able to start to look at different diagnostics than we ever did before and find things we never found before and and within the diaspora of medicine which is where i've been most of my life there there has a there's a lot of people doing really interesting diagnostics that are ignored like heavy metal testing for me that's like a that's like a blood pressure when someone comes in and they have any kind of you know toxic or immune or cognitive or any chronic symptoms, I look at it because it's often

an annoying factor. It was actually how I figured this all out was through my own mercury poisoning from living in China. And I had severe cognitive impairment and also immune dysregulation and gut issues. And I think the, you know, the gut stuff is such a big deal. And that's something we can start to understand with the microbiome and its effect. And there's data coming out. But the question is, as clinicians, we never learn, well, how do we repair a microbiome that's off, right? How do we do that? Like that's, okay, well, we may know, okay, if you're low in vitamin D, take vitamin D. But like, if we test the microbiome, and there's all this inflammation and dysbiosis, and like the average doc has no clue where to start. So I think that's part of

the problem is we just don't have one, some of the diagnostics we need, or if we do, the average practitioner has no clue what to do with it. And I think all that's going to change. I think what you're talking about is managing something that until now I don't think has been able to be managed by the average doctor, which is, God, there's 100 things we could find that could affect the brain. I think there's probably 1,000 or maybe there's a hundred things we could find that could affect the brain that i think there's probably a thousand or maybe there's ten thousand but the average person and the average doctor cannot process all that and make the connections but with the advent of quantified self-metrics which you talked about with the advent of advanced diagnostic metrics and metabolomics and the you know the understanding even the microbiome metabolomics, for example. Nobody talks about that, but it's the metabolome of the microbiome.

In your blood, there's probably 20% to 50% of the metabolites in your blood come from the bugs in your gut, right? And how does all that work? Well, that's going to require big data and machine learning and artificial intelligence and start to see the data and the patterns and connections. So I think that's where this is all headed. And, you know, we have to stop this paradigm of being reductionist and saying, just take this one drug for Alzheimer's.

And I get so frustrated when I hear these studies come out and they had big news articles and, oh, this helps or that helps. I'm like, what about all the rest of this stuff that Richard's talking about? It's got to be frustrating for you too because you see it. You see your patients get better and you go, like, um, why don't you try this? And what do your friends say who are also neurologists or memory specialists? Do they think you're a quack or listening or they, you know, I'm, I'm a pretty resilient guy.

I gave my first talk in 2007 about, um, you know, how MCI mild cognitive impairment due to Alzheimer's and, you know, in this, this pre symptomatic, I, I, I, I didn't like that term. I just felt it should be, you know, prodromal at risk. You know, I felt like we should be treating people before they had dementia. And when I kind of set that stage and I wrote about this in one of my books names, not naming names, but, and I didn't name the name there too, but one of the giants in the field was sitting there and just, I don't want to say rolled their eyes, but there's no evidence. There's nothing you can do. There's no evidence for this. There's

no evidence for that. But there was no impetus to even aim to study it. You know, I started seeing Alzheimer's prevention patients in 2009. Dr. Arthur Agatson was one of my mentors. Oh, yeah, Arthur. Yeah, amazing guy. You know, he was my attending at Mount Sinai Medical Center when I was an intern. Oh, yeah, I like him. Yeah, before the South Beach Diet, before, you know, he's the South Beach Diet guy. But to me, he's the Agatson calcium score guy.

Like, to me, he's the visionary thatzen calcium score guy. To me, he's the visionary that was one of the first preventative cardiologists. Preventing disease and starting before there are symptoms, the tomatoes that were thrown at me were the big vine-ripe tomatoes. Now, I don't know if my reflexes are better. I have cat-like reflexes. Now I have a cat behind me, but I can dodge the tomatoes better. My armor is thicker. The tomatoes are not being thrown as quickly. But it's also because, you know, we've now published, we've published results. And, you know, I would talk to a journal editor five, six years ago, and I said, well, this, this, and this, and this, and this is what I see. And, you know, it's, it's, it's clear. And he said, well,

it may be clear to you, but you need to prove it. And then you need your peers to review the article and accept that your, that your thoughts and your observations are substantiated by evidence. And I feel like in the last five years, just eight years, actually, we've, we've been able to do about as good of a job as possible with the limited resources that we have. Now, if 1% of the billions of dollars or, heck, 10% of the billions of dollars would have come in the prevention bucket, I can tell you if someone drops a very large sum of money in our research program to prove this, we can do it, but it's hard. Prevention studies are expensive because they take longer. Prevention studies, you need to follow people for years rather than six months or nine months or a year. So I think the reason that my colleagues are coming around is because of the publications

and building the body of evidence. I think the other reason that my colleagues are coming around is several of them have come visit. I've had over 45 other physicians and other healthcare providers come visit me and sit next to me. And if someone isn't willing to sit next to me and if someone is willing to criticize the work we do but not willing to come sit next to me and spend spend a couple hours and just watch just look it's it's oh this is only one patient it doesn't mean anything when you see this once and you see it again and you see it at nine o'clock ten o'clock

eleven and then one o'clock two o'clock and three yeah you you just you know like okay fine prove it i get that but um there are still skeptics out there there are still skeptics and i still get criticism every day and um i don't want to say i'm jaded but um you know haters gonna hate i'm gonna keep doing my thing and uh well you know well you know you know what Max Planck said, right? No. He said science. He said that? That was Max Planck? No, he said science, but you could say medicine, doesn't evolve by convincing your opponents and helping them see the light. Because they eventually die and a new generation grows up that's familiar with it.

In other words, medicine progresses one funeral at a time. That's kind of mean, but that's familiar with it in other words medicine progresses one funeral at a time that's kind of mean but that's what he said and and I think you know the other point is that the absence of evidence isn't the evidence of absence right if we haven't spent billions of dollars studying nutrition and Alzheimer's how the heck do we know anything we spent billions of dollars studying drugs that don't work but not not the right things. And the other thing, Richard, I'm going to push back pretty hard on this for you because you keep talking about preventive neurology and preventing Alzheimer's. And yes, yes, we should do all that. But your study, your own study showed that you can not only prevent it, but reverse the symptoms. Now, how far can we go to reverse it? How much can we reverse it? How far can these treatments work? How far can these

treatments work? What if we added 10 other things that maybe we haven't even thought of that might be as or more impactful than the 25 things you're already doing? You know, I would push back and start to encourage you to think about treatment studies, not reversal studies, because those you'll see outcomes much quicker. And if you can take a group of 10, 20, 50 people and be really aggressive, and it's not easy because changing, and I have these patients, I'm treating many of them right now. It's the roughest thing because if you have an engaged patient, you know, someone's had a heart attack and you tell them to change their diet and eat their vitamins and exercise, they'll go, I get it. But you've got someone with dementia or who's cognitively impaired, they can't remember

stuff. You need a full-time like body, bodyguard literally with them telling them what to do and helping them do it. But if you did those kinds of studies, I think you would see dramatic changes. So, you know, I'm really cautious, and I would use the term hesitant. And actually, I would use the term, I don't use the term reverse. And the reason is, and let me explain my position here. Because, you know, I respect where you're coming from. And I see why that term has been used in the past. But until I have definitive biomarker evidence that I am reversing the signs of pathology. Now, if I would have done my study, and we had the blood test, the amyloid blood test out, now it's out, now it's out. So if 2015, 2014, if we would have gotten the amyloid samples

in the blood and then 18 months later, we got them again. And if I would have shown, not only did we improve symptoms, so you, you can either use the term symptomatic benefit, improve symptoms. You can use the term reverse symptoms. I don't like that term because the term reverse to me implies neuropathological reversal. And I want to be like, I'm trying to build bridges here and I'm trying to bring my enemies closer. I know where you're coming from. Yeah. But listen, if we can show that we can improve symptoms and amyloid goes down in the blood well that then we've just reversed all time i will be the first person to plant the flag in the ground and say we have just reversed all time i will be the first person to do it and my next studies that show that hippocampal

volumes go up that you can improve the neurocognitive testing that you see all those hardcore biomarker changes i mean there's enough of that data, but there's some of that data out there. Oh, I mean, you're preaching to the converted here. I mean, I have this amazing guy in Italy who, you know, the first MRI baseline. Oh, and by the way, hippocampal volume, hippocampus is, for those listening, is the part of your brain that's the memory part that shrinks as you get older and shrinks a lot when you get dementia.

And if it grows, it's not supposed to grow. Right. Yeah. And so I, you know, again, this is an anecdotal story, but there have been studies that have shown this also. I remember the, you know, one of the first times I saw, I saw a guy's brain, a guy from Italy, nice guy. He came in this really fancy Italian suit.

He was well-dressed. He was skinny fat though. He was skinny fat. I mean, he had elevated body fat, although you couldn't see it because of the fancy clothes. And, you know, after a year and a half, he came back and we looked at his brain. This was, you could see it through the eyes. You could see it through computer automated software. The memory center in the brain, after following a comprehensive plan through exercise, I think

exercise is a big driver of volume, brain size, making the brain bigger. I think it is a big driver of volume, brain size, making the brain bigger. But I think it was everything. But you could see with your own eyes, an untrained eye could see that the hippocampus got bigger a year and a half later. His cognitive function got better. Memory function was better. He was no longer skinny fat. He gained muscle mass and lost body fat around the waist size.

The bigger the belly, the smaller the memory center in the brain. He got rid of the belly fat. the memory center in the brain got bigger. Now, this is an anecdotal study. And some of the naysayers out there would say, oh, stop already. You're just given this N of one, one study. But no, there's actual research that shows this too, that exercise increases hippocampal volume. So, you know, if I think the holy grail and the next big study that we do and it's going to have to be multi-site um and we were just starting to to work on this before covid and then covid you know really really messed things up and obviously for the world but also for alzheimer's disease research um our goal is to to do uh what we're trying to plan is more of a telehealth telemedicine study where doctors can take care of people at risk for Alzheimer's. And we can do a lot through telemedicine so we can, you know, break down

barriers, keep the cost low, but then get blood tests, get amyloid at baseline, get amyloid at follow-up, maybe get MRIs at baseline, MRIs at follow-up, and basically try to enroll people from all over the place rather than just one site, because we were the main site that enrolled it in New York. We're going to basically try to prove this time that not only are we improving symptoms, are we slowing decline, but I would love to be able to shout off the mountaintops that we were able to reverse Alzheimer's disease and prevent it from a neuropathological perspective and if we have those data um i really believe that you know we're we're the the naysayers aren't going to have any tomatoes to throw uh because well i mean not it's not only about the naysayers it's about all the people suffering to have finally hope i mean people with cancer have hope people with heart disease have hope people with diabetes have hope

people with alzheimer's it's Alzheimer's, it's like, oh, wow. It's like dropping a nuclear bomb on somebody. And it's kind of the worst diagnosis you can possibly get because you lose yourself. Hey everyone, it's Dr. Mark here. If you've been following me for a while, you know that I often talk about how eating organ meats is so good for your health. Now I know it can be hard to work them into your diet, but when we don't eat things like liver, kidney, and heart regularly, we're missing out on wonderful sources of essential nutrients. Organ meats are nature's multivitamins and the richest sources of natural vitamin A, B vitamins, and minerals that we have. But liver isn't everyone's first choice for a delicious meal, which is why my friends at Paleo Valley created their Grass-Fed Organ Complex Supplement.

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Just go to paleovalley.com slash hymen to check out all their clean paleo products and take advantage of this deal. And now, let's get back to this week's episode of The Doctor's Pharmacy. So give us three things that pretty much everybody can do. Only three. Can I do five? Do five. Let's do five. Let's do five. Okay. The first one is just upgrade your diet to food as medicine upgrade your diet to food medicine cut out the processed foods cut out the sugar and starch you know you want to have

it as a treat occasionally fine not staples increase the phytochemical richness of your diet you know and a great starting place for that would be the pegan diet would you say the pegan diet yes pegan diet is way to go it's just it's all the pegan diet would you say the pegan diet yes pegan diet is way to go it's just it's all the pegan diet essentially is is non-denominational it's sort of like the uh it's sort of like the unitarian church of food and essentially it's essentially like eat real food don't eat crap increase your phytochemical richness of your diet think of food as medicine personalize your diet eat whole foods that's medicine. Personalize your diet. Eat whole foods. That's it. It's pretty simple. Second would be exercise. Do something. Walk. Do jumping jacks,

burpees. Do some weight training. Do some yoga and stretching. Just simple stuff. Sleep. Make sure you prioritize sleep. Super important. Eight hours. Make sure your quality of sleep is good. And there's all sorts of great resources on how to sleep. And we've had podcasts on that. We have a lot of articles on that. And the last obviously is stress. And I think we talked about the effects of stress on the brain, but meditation, hugely important for brain function. And I think I was talking to someone about a study that was just done on meditation and how it actually regulates biological age. So I think it's really cool. And lastly, I would think, you know, in addition to the four basic foundational lifestyle factors

of diet, exercise, sleep, and stress management, would be taking a few of the right supplements. And what are those for your brain? It doesn't have to be crazy. Get a multivitamin with good levels of methylating nutrients, B12, folate, B6, and make sure that they're bioavailable. Make sure they're the right forms of nutrients. Also, fish oil. Make sure you take fish oil. Your brain is 60% DHA, which is basically fish oil, omega-3 fats, or eat sardines three or four times a week, make sure you take a good level of vitamin D. You want your vitamin D of 50 or more, 50 to 75, 80 is good. You have to measure. Sometimes

people need a thousand, sometimes 5,000, 10,000, depending on your genetics and what you can absorb, but vitamin D is critical. And then, you know, that will be good for most people. If you want to go a little more, you can add magnesium. Magnesium is great for your brain as well and relaxing a lot of your nervous system. And it's great for sleep and stress reduction and so forth. So those would be the five things that I would say would be critical. And those are things that are easy to do. They're inexpensive and they're available to almost everybody. I mean, the supplements can be a little more, but everything else is stuff that you really don't need any money for. Fantastic.

I love it. So can you talk to us about the few things that we could be doing early in our 20s, 30s, and 40s to help us prevent dementia and Alzheimer's? Absolutely, Drew. I mean, this is an extraordinary year to be alive. I mean, thank God we're alive now and not 20 or 30 or 40 years ago, because the science of brain health and the science around dementia and Alzheimer's has just exploded. And it's taking a very different tack than the pharmaceutical approach, which has been so focused on. And literally there's been over $2 billion and probably 400 plus studies, all of which on pharmacology, all of which have basically failed. There's a couple of drugs that squeak through that have marginal benefit. Like, okay, well maybe you end up delaying admission to the nursing home by three to six months. Is that a win? Hell no. So what has actually emerged in

the science now that's helped us to understand a different way of thinking about Alzheimer's? The first is our understanding of what the etiology, the cause, the causes of Alzheimer's. And we call these things dementogens. I call them dementogens. And my friend Dale Bredesen came up with a wonderful concept called a cognoscopy. It's like a colonoscopy except for your brain. And it's the idea that there are a lot of biomarkers and things we can measure and look at that will determine your risk and trajectory around brain health and obviously even general health. So what we've come to understand is in your 20s, 30s, and 40s, it's a critical time to act. Because when we look at

the imaging studies and we look at early diagnostic studies and we look at the processes that are happening in the brain, we can often detect changes 20, 30, 40 years before anyone has their first symptom of memory loss. And that's staggering. And it sounds scary, but it's actually great news. Because if you detect it early and you modify the risk factors and you optimize your biology, you literally can stop and even reverse this process. So it's obviously the things that we know as foundational for health, right? Healthy diet. And we'll talk about what that is. So what is a brain healthy diet? What's the importance of exercise and what kind of exercise works for your brain? Sleep, stress reduction, because stress literally shrinks

your brain and causes dementia. No joke. The memory center in the brain called the hippocampus literally shrinks when you're under chronic stress. So foundational lifestyle factors are so key and there's tweaks to them that are unique to keeping your brain optimally functioning. And then of course, there's deeper layers on the cognoscopy to look at. What are your heavy metal levels like? What's your microbiome like? Do you have inflammation? Are you exposed to mold? Have you had tick infections? Do you have allergies? Are you sensitive to gluten? What's happening with your mitochondria? What's happening with your detoxification process? All of these things are things that we can look at and measure and see where they're at. What's your nutrient status? I mean, just for example,

if you are low in certain B vitamins like B12, folate, and B6, and you have a high homocysteine of let's say 14, which is even in the conventional labs is considered quote normal, it should be like six to eight. But if it's 14, your risk of getting Alzheimer's is 50% higher. And that's just multivitamin basically. So we have so many amazing tools and techniques to use now to one, evaluate the dementia genes through a cognoscopy and to create a science of brain health and optimization, which is really what we need to do. Now you said 20s, 30s and 40s, but there's going to be a lot of people that are listening here that are 40 and above. Are they out of luck or are there still things that we could be doing so that there may not be a diagnosis yet, you know, knock on wood,

but are there still, is there still hope for people in the 40 plus crowd? I hope so. Cause I'm in that crowd. And actually a number of years ago, when I was 40, I had a brain scan, and it was frigging scary, Drew. It showed really dramatic under-functioning, hypo various insults to the brain that can be reversed. And at the time, I had mercury poisoning, mold toxicity, Lyme disease. All these are reversible causes of cognitive dysfunction and decline. And so I worked really hard on myself to clear all these things, to get healthy, to get rid of my Lyme, to get rid of my mold, get rid of my mercury, and many other things, get my microbiome healthy. And I repeated the scan about 10, 15 years later, and my brain had completely healed. It was really amazing. All the brain blood flow was back. My brain function centers were working and it was like, you can at any age. And I can tell you case after case, and we can get into

it a little bit later. I can tell you case after case of patients have come to me with cognitive dysfunction, memory loss, early dementia, even more advanced dementia, and we see dramatic changes. So the brain is able to repair and heal at any age. And you always think, oh, you know, you have got so many brain cells and basically that's it. And if you drink too much and party too hard in college, well, you're, that's it. You're just kind of screwed and you're never going to get it back. Well, that absolutely is not true. We know from actually autopsy studies they've done, for example, on brain, I mean, sorry, on cancer patients. And they found that they gave them these radioactively labeled dyes that were only inactively replicating neurons.

In other words, in new brain cells, you only see this thing being picked up if they were making new brain cells. And they literally were dying of cancer and they were still making new brain cells, which you could detect on imaging. That's really remarkable. And we know there's the whole field of neuroplasticity and neurogenesis, meaning we can make new brain cells. We can actually increase the connections in the brain. You know, I'm learning tennis.

I'm like, you know, I'm 15 years or so into it. I keep improving and improving and working on it. And my tennis coach was like, yeah, this is really good for your brain and learn new connections. In fact, tennis players live an average of seven years longer. And part of that is you're constantly working on different aspects of motor coordination, visual. It's like, it's a thing, right? So it's like, you absolutely can modify this risk at any age. Just for a clarification for the audience, what was the brain scan that you did? What was the type of brain scan that you did? And would you recommend it to individuals who are listening today if they're trying

to get a sense of where their brain health might be? Yeah. So there are many types of brain scans. A typical brain scan for Alzheimer's is an MRI, which can look at both brain volume, overall volume of the brain and shrinkage. It can look at hippocampal volume, which is the size of the memory center of the brain and shrinkage. It can look at hippocampal volume, which is the size of the memory center of the brain, which shrinks with dementia and actually can grow back when you apply some of these principles of functional medicine to brain health. And that's sort of the standard

test. And it can also look at amyloid. There's actually imaging that looks at amyloid plaque in the brain. So you can see various amounts of amyloid, which is the thing that actually seems to cause the gunking up of the brain. The question is, what is the amyloid? What's it doing? Should we be trying to deal with it? There's a whole deeper conversation we can have, but it's kind of a rabbit hole. But essentially, it's inflammation. And then there's even more advanced scans that can look at early inflammation in the brain. Now there's a sort of more advanced functional MRI scans that can look at inflammation. And those are really emerging. Honestly, if those were readily available and the cost was reasonable, which I think it will be eventually, right? We're seeing exponential technologies where the price goes down and the power goes up. And we're seeing that across the spectrum, including

imaging. When that happens, we're going to be able to sort of really early assess these patients. What I had was a little different. I had a SPECT scan, which is essentially a blood flow scan looking at areas of the brain and blood flow. And it's a more general test, but it really showed hypofunctioning of many areas of the brain. And so you can actually modify that. I had another patient with early cognitive decline, and he had really impaired hypofunctioning of his whole brain. And so you can actually modify that. I had another patient with early cognitive decline and he had really impaired a hypofunctioning of his whole brain. And when we, when we treated him, I sent him back to Harvard where he had the initial scan at the memory disorder unit

and, and it got better. And the neurologist there who was the head of the memory disorder center was so inspired that he started a brain health, brain health clinic. Cause he's like, Whoa, we can actually do something about this. So it really was great. That's fantastic. And so just again, clarification, because I know people are always curious. So the SPECT scan, was that through like the Amen Clinic or something? Yeah, that was through the Amen Clinic. Yes. The Amen Clinic has really pioneered a lot of the work on the SPECT scan. And I did it at the Amen Clinic. So I did it twice there. So it was really great. Fantastic. Now let's go back to

the common root causes of Alzheimer's and dementia. And let's talk about your brain and what you were seeing in that scan that you did when you were younger than you are right now. And that you were seeing that your brain wasn't optimizing and wasn't operating in a functional, in the best high functioning way. So what was causing, what were some of the lifestyle factors that were going on? We'll get to environmental factors and we'll get to, you know, toxins and heavy metals and other stuff in a second. But what were some of the other things that you were doing that you think were that were causing your brain to shrink and not perform at its best?

Well, you know, I mean, I've led a relatively healthy lifestyle my whole life. Eat mostly clean. I surely was eating more carbohydrates back in the day when low fat was bad, was good, and pasta was the health food. So I was definitely on that train early on in my 30s and so forth. I exercise always, did yoga. I did have sleep issues. I think that may have affected it just working in the emergency room, working long hours, not sleeping for days, being a single father, high stress. So it wasn't so much the diet and exercise part for me. It was

more the sleep and the stress part. But the truth is, Drew, that wouldn't have caused the level of cognitive dysfunction that I had. It really was these outside factors. And the truth is, for most people, though, for most people, it's the fundamental lifestyle factors. It's not the things that I had. And there's a subset of people who have, yes, who have heavy metal poisoning, who have mold exposure, who have Lyme disease, like Chris Christofferson had Lyme disease, was diagnosed with dementia, they gave him antibiotics and boom, he was better. So I think mine was a little bit of a unique case. I wasn't insulin resistant.

I wasn't overweight. I exercised. You know, I tried to meditate, did yoga. I was working on stuff. But it was these other outside factors that are often ignored. And I wouldn't even just say ignored, but I would say that are not even on the radar of most clinicians. Dismissed even sometimes. Yeah, they're dismissed or not even on the radar of people who are actually fully engaged in the Alzheimer's research. However, there are leading Alzheimer's

researchers that are on board with this 100%, like Rudy Tanzi at Harvard, who discovered the priest's nilin genes, who was one of the key sort of, it's one of the key researchers in all of Alzheimer's research. He's on board with this. He completely gets this. So there's a lot of opportunity for real change. And I see more and more of this happening within the space. I see guys like Richard Isaacson, who's amazing. He's formerly at, I think, Wild Cornell. And he's actually done some incredible research looking at simple lifestyle interventions that

are personalized based on biomarker analysis to what he was trying to do was just delay or slow the progression. I think they were shocked to find that by aggressively optimizing diet, exercise, sleep, stress, the nutrient levels, treating homocysteine, dealing with insulin resistance, dealing with all the variables. And by the way, he wasn't even dealing with all the things we deal with in functional medicine. He was just doing the first pass, which is way more than most doctors do because they're looking at a single drug, a single intervention, not using multimodal, multidimensional interventions, which are, you know, lifestyle, broad lifestyle approach and so forth, and personalization. And he found not only did they not progress, but they actually reverse cognitive decline,

which is incredible. There are other studies also that have been done. His was the most personalized and specific and had the most impact. But there are other trials like the finger trial. There's another one called the pointer trials coming up. These use lifestyle interventions for people with cognitive decline, optimizing risk factors. And they found significant improvement in cognitive function in pre-dementia patients. It's called pre-dementia or MCI or mild cognitive impairment. That's impressive because there is no drug that can do that. Well, you were mentioning some of those lifestyle factors that are there for most people. It wasn't

the situation in your case. Let's walk through them. What could a diet look like that was designed? If you had to design a diet that was supposed to shrink someone's brain and eventually lead to Alzheimer's and dementia, what would that diet look like? Again, this is a diet designed to shrink somebody's brain. For breakfast, you have like a glass of orange juice, some Froot Loops, a muffin, a bagel, and French toast with some maple syrup. And then for lunch, you maybe have a big bun with maybe some American cheese and processed meat. And then for dinner, you have a big bowl of pasta, a giant glass of a bottle of wine, and a side of bread and potatoes.

And then for dessert, you got ice cream and cookies. And yeah, pretty much that's what you're going to be eating is a very inflammatory high carb high starch sugar diet and I'm sure there's some people that are listening today they're like whoa he just described my diet okay so walk us through that what is the common themes what are the common themes of that diet that you just described and what's missing from it that makes it so detrimental to brain health. So when I was in medical school, we were trained that your brain is the number one utilizer of energy in the body, the number one utilizer of glucose. It's like, I don't know, 2% of your weight, but 25% of your glucose consumption. And so you need, you know, the whole idea is you need sugar for your brain. Turns out it's not true. It turns out that your brain runs much

better on fat, particularly ketones. Your brain is about 60% fat and that there's brain phenomena, which they're calling type three diabetes, which is really what they're now calling Alzheimer's, because inside the brain, you get insulin resistance. Think of it as diabetes of the brain. And when you get that, you get increased inflammation, you get increased oxidative stress, you get the production of what we call ages, or we call advanced glycation end products think of it like the the crispy thing on a creme brulee or the crust of bread or crispy or the crust on a bread or our crispy chicken skin those are proteins and sugars combining to form this crust that's what happens in your brain and and you end up having this this really terrible inflammatory brain degrading process called insulin resistance

within the brain. And so you want to design a way of eating that keeps your insulin levels as low as possible. If there's one single thing that we know about aging and all age-related diseases, the single common denominator across almost all of them, and there are exceptions, but pretty much for the common stuff, it's insulin resistance, meaning your body makes too much insulin in response to the carbohydrate load that you're eating. And it gets worse and worse over time. So it's a vicious cycle where you eat more carbs, you get more insulin resistance, you can eat more insulin, you eat more carbs because you're hungry and crave them, and you end up actually getting very high levels of insulin. That is just a

disaster because when that happens, you're getting not only belly fat storage, you're getting increased hunger, increased cravings for carbohydrates, you're slowing your metabolism, you're causing your brain to get demented, you're causing heart disease, you're causing cancer, you're causing kidney failure, you're causing high blood pressure, you're causing all the things that we think of as diseases of aging, and we treat them in silos. We treat them all as separate problems, but they're not. They're all connected by this underlying mechanism. So insulin resistance, I've written many, many books about it, but essentially, if you're going to design a brain healthy diet, it would be extremely plant rich. So you'd get all the colorful plant compounds that you see from colors of reds, blues, yellows, greens, orange, purple, all in fruits and vegetables. So eat as many deep colored varieties of vegetables as fresh as possible, as local as possible, as nutrients dense as possible.

Second is you need a lot of fat. And fat is really important for the brain. So you need olive oil, avocados, nuts and seeds, and something called MCT oil, which is really a super fat. And the brain loves this fat. It's great for mental clarity. It's great for focus. It's the preferred fuel for your mitochondria, which is the energy production organelles inside your cells. So that's really key. And you also want a diet that's high in omega-3 fats. So you want sardines, mackerel, herring, small fatty fish, not the big fish, because that has mercury and that's going to cause a problem. And you could even take fish oil. You also want a diet that's very rich in choline and B vitamins. So choline comes from eggs,

comes from sardines, and also the B vitamins, B6, B12, folate, which are critical in this particular pathway called methylation. And I just had a quick story of a patient who was about maybe 75-ish, and she was diagnosed with early dementia by her doctor and told to get her affairs in order. She was a very wealthy woman. She was on the boards of all these companies, but she couldn't function anymore, and she had to pull back from everything. And she came to see me, and she had a relatively simple problem to solve, which is that she had a homocysteine that was really high and a methylmalonic acid that's high.

And those are blood tests that measure a more accurate functional measurement of B12 and folate. And so I gave her B12 shots of methyl B12. I gave her a high dose of methylfolate and B6 and the whole cocktail of methylation support, which is critical cycle in your brain and the rest of your body. And she was completely cured. And about maybe five, six, seven years later, she was like 84 or something. I got a call from her. I thought, you know, you know, because the thing is with functional medicine, you're like, you get people better, you teach them how to take care of themselves. And you may never hear from them again, right?

So, which is actually the good thing. You don't want an annuity of patients coming back for their refills on their blood pressure or cholesterol or their dementia medication. And I was like, oh, maybe she went downhill. Is she all right? So, I was worried about her. So, I got on the phone with her. I'm like, hey, how's it going? You know, she's like, well, I'm planning a trip to Bhutan trekking, and I just want to know what I should take with me

from a medical point of view. I'm like, oh, God, okay. So sometimes it's as simple as that. Sometimes it's more complicated. When a neurologist makes a diagnosis of Alzheimer's or pre-Alzheimer's, the best thing the neurologist can do is refer the patient to a functional medicine doctor to deal with all the things that are driving this problem. But of course, the neurologists have felt like, oh, this is our province. We have to give the drug and watch you go downhill, which is really unfortunate. I think that's going to change. So absolutely, the gut is a driver. And I think one of the most interesting studies that was done in the last couple of years was a group, they were actually studying rodents, but what they were doing was injecting candida.

And they thought, they wanted to see how long does the blood-brain barrier keep the candida. They injected it into the blood vessels and asked, okay, what happens when it goes by the brain? How long can the brain keep it out? And the answer was, it went in immediately. So there is, yeah, candida, this is in a normal animal. So the fact of the matter is, there is much more communication, just as you pointed out and as Rudy has been pointing out, there is much more communication between the brain

and the periphery than anyone thought possible. And what have the pathologists shown us? When they look in the brains of patients with Alzheimer's, what do they see? Herpes simplex in the brain. They see candida in the brain. They see Borrelia in the brain. They see P. gingivalis from your dentition in the brain. All these different gum disease. So, the bottom line is our brains are communicating with the periphery much more than anyone thought before. And as you said, we actually probably have a normal brain, as much as that kind of blows my mind, we actually probably do have a normal brain microbiome. And we're going to have to have probiotics for our brain at some point. Cognobiotics, right? Cognobiotics. Yeah, there we go. Wow, that's incredible. Well, you

know, the approach also that is needed is something we don't do in traditional medicine, which is how do you restore a healthy microbiome, right? And this is what the focus of functional medicine is. How do you take the symptoms that people have, or even they may not have any symptoms in the gut, but look at the environment in there and optimize it by taking out the bad stuff, putting in the good stuff and using the functional medicine approach to really heal the gut. So I think what you're saying is that each patient is different and some may have gut issues, some may have other issues. One of the other issues that really affects people is heavy metals. And there's been a lot of talk in the past about aluminum and Alzheimer's, but it was sort of

ignored. And I remember a patient I had, one of the first patients that I was like, I don't know what I'm doing with Alzheimer's. This patient has been diagnosed with Alzheimer's dementia. I have no clue if anything I'm going to do is going to work, but I'm going to try my basic framework of functional medicine to see if we can just take out the bad stuff and put in the good stuff. So I did a cognoscopy of sorts, got rid of the dementogens. And what was really striking about this guy, Dale, was he was seven years old. He was a CEO of his major family business, couldn't function at all. So it was in the corner,

basically depressed and not functioning. Nobody wanted to be around him. And he had pretty significant dementia. But when I looked at his story, he grew up in Pittsburgh and he lived in Pittsburgh and there's a steel plants there. And almost every patient of mine from Pittsburgh is mercury toxic because they put coal ash on the streets. They put it on the fields, gets in the food, it's in the air. And he had a mouthful of fillings. And normally, you know, normally when you do a challenge test for mercury with a patient in functional medicine, you know, you see a level of 20 or 50. That's like, you worry about that. That's high. Yeah. A hundred, you know, I've had, you know, maybe 20 in my whole life of doing maybe 10 to 20,000 tests. His was 350. I'd never seen anything

like that. I had one other patient, I think I had 400, but almost nobody liked that. And I got rid of his fillings. We detoxed him from the mercury. He also had all these genes like APOE double four. He had methylation gene problems that has to be vitamins. He had genes that affect insulin resistance. He had years of gut issues. He'd had irritable bowel for decades and was on Stelazine for his gut. And so he had all these issues that we treated. So we fixed his insulin and blood sugar. We fixed his gut. We fixed his B vitamins.

We got rid of the mercury. And the guy literally came back like Rip Van Winkle from the dead. And it was the most striking thing I'd ever seen in my life. I was like, holy cow. Like I just cured Alzheimer's. And I'm like, and this was like 15 years ago. And I'm like, what? And that was really began the process of me going, wait a minute, the brain is so fixable if we understand the insults,

which you have mapped out so well in the end of Alzheimer's. And if we understand how to actually repair and heal the system. So talk about mercury and the metals and how these affect the brain, because this is not to say that everybody with Alzheimer's has heavy metals, so they don't, but I've had a number of patients that makes a huge difference when you deal with it. Yeah, but as you said, you know, a certain number of them, that is the key piece. And here's the thing, you know, I mentioned earlier, your brain makes amyloid when it is under attack by microbes because it's trying to kill the microbes. But interestingly, the gene itself that amyloid comes from, which is called amyloid precursor protein, is a gene that is

responsive to metals. So there's literally a metal binding region on the RNA, this piece that's going to be making the protein. So it responds to mercury, it responds to copper, zinc, iron. So this thing is part of what's binding up those metals. So it actually binds up. So what happens is you can actually give mercury, and as you indicated, mercury is literally a cause of Alzheimer's. Not in everybody, but in a small group of people, probably something like three to five percent of all Alzheimer's patients, which still is a lot of them. There are going to be 45 million people with it who are the currently living Americans. 45 million of us will develop Alzheimer's during our lifetime.

5% is a couple of million people have metal issues. Exactly. This is a big problem. So this is why, as you said, you want to check this on everybody, because if that's one of the contributors, you need to deal with it. And when you do, they do better. And it does, it increases the production of the amyloid. And it both, interestingly, it induces the amyloid and it induces the tau as well. So it is a great way. If you want to give yourself Alzheimer's, take some mercury.

Eat some sushi. Exactly. But the funny thing is, you know, not everybody accumulates the mercury. And it has a lot to do with genetic variation. I personally had mercury toxicity and I had cognitive dysfunction. I felt like I had dementia. Really, I did. My level wasn't 350.

It was 187, which is bad enough. Still, yeah. And still bad enough. And so I understand from a personal point of view what this does. And it's one of the most potent toxins on the planet, probably second only to plutonium. It is the most potent neurotoxin. And it's just, it's inconscionable to me that we don't as a profession really think about the role of toxins.

We check the blood levels, but that doesn't really reflect the total body burden of these metals. And so there are ways through functional medicine and the approach you're talking about to really do this. Let's talk about the next topic, which is, you know, hormones. And I think, you know, I've seen some really interesting responses to hormones around thyroid, sex hormones. This is what we call a trophic factor.

So it's not something that's hurting you. It's something that you're lacking, that your brain needs to function. So talk about some of the big hormonal findings and what you're seeing with these patients. Yeah. And there's some elegant work published out of the Mayo Clinic a number of years ago, where they simply looked at women who had oophorectomies for whatever reason. Take their ovaries out. Move it up the ovaries, right? At the age of 40 or younger, who did not get BHRT versus one who

did not get hormone replacement versus those who did get hormone replacement. And even though the hormone replacement has been imperfect for many of these, there was a striking difference. The ones who did not get the hormone replacement had a more than doubling of the risk for developing Alzheimer's, even though the Alzheimer's wasn't diagnosed till years later. It goes perfectly with the science that we talked about earlier. This APP is looking for support. And when it does not get that support, it's flipping over to the synaptoclastic. It's saying, we can't support this brain. And it goes beyond just estradiol to progesterone and pregnenolone and testosterone and vitamin D and all these things, thyroid hormone as well. These are all critical. And so repeatedly people have come

upon the fact that you're getting this at the time often when you're losing those hormones or down the road from this. And we see a lot of people now, something I never saw when I was training, people who are in their fifties, women who are going through menopause or perimenopause, who have their first symptoms at that time. So for a number of reasons, it's huge, not only the support side, but also as Dr. Chris Shade has pointed out, progesterone is one of the most critical parts for your detoxification apparatus. So when you now get this relative lowering of so-called relative estradiol excess or estrogen excess. This is because you've lost both, but you've lost the progesterone to a greater extent.

You are at increased risk for toxin-related Alzheimer's disease, and you're now getting this synaptoclastic burst. You are re-releasing these toxins, including mercury, that you have sequestered for so many years. So by multiple mechanisms, having too low a support from your hormones is a critical risk factor for cognitive decline. Yeah. And there is controversy about hormone replacement, particularly around cancer. Do you worry about that? Do, absolutely. And so I think it's critical to have people see experts in this area, you know, Dr. Anne Hathaway, Dr. Prudence Hall,

and many people who are BHRT experts who look at, you know, when's the best time to do this? What are the best doses? Where, you know, when, if you, can you improve, can you get the better outcome than this worry? And yeah, there is a worry about cancer, although some of the studies have actually shown reduced, with appropriate use of estrogen and progesterone, reduced likelihood of cancer. So you really want to stack those against each other. And there's very personalized approaches to this, depending on your genetics or family history, what actually is going on with you, what your biology is, and actually helping women to personalize the treatment using the biological hormone replacement, not actually the kind that comes from horse urine, which is what a lot of studies were done. So we

don't even have big studies on the good stuff. Let's talk about nutrition. We're going to talk about diet in a little bit, but I want to talk about the widespread nutritional deficiencies that you're seeing and how those play a role in the brain and cognitive decline and what are the most important nutrients we need to be focusing on. Yeah. You know, it's amazing to me because we've got so many things working against us. And obviously you've written probably more on this than anyone, looking at the critical nature of nutrients for your health, you know, looking at all, you know, changing the world one bite at a time and all these fantastic things that you've done. And this fits, again, it just fits perfectly with the science that we've studied over the years. And so, you know, Paul Clayton from Oxford

has pointed out that we don't even have the nutrients in the soils that people had 100 years ago, 200 years ago, when we were thinking, you know, these people, wow, they didn't know what they were doing. They were doing much better than we are. Because they actually he's pointing out that, you know, Henry VIII had better nutrition than we do. Of course, he ended up being obese and had problems with arthritis and things. But the key is that they actually had better soil. So we've got essentially a triple whammy. Number one, we have poor soils, and therefore we have poor overall nutrition. Number two, we're eating food that's way too high in sugar, obviously,

and way too high in processed foods and all these issues. So we're eating stuff that's toxic. And then number three, we're not getting nearly enough fiber, nearly enough phytonutrients. So we have this system. It's as if you took your car out and you're trying to drive this car that needs appropriate fuel. And you're putting stuff in that is very low octane. It's just sputtering. It's spluttering.

It's having trouble getting out of the block. It's just, you know, you might go a little way. And that's what we're all dealing with every day. So if you see- Crappy fuel. Crappy fuel. You optimize those things. You get people into some ketosis. You get them appropriate fiber for detox and for their microbiome. You get them appropriate low-carb diet. You get the appropriate phytonutrients. And by the way, one of the most common deficiencies choline as you know choline is needed to make acetyl choline which is a critical neurotransmitter for memory and is

reduced in people with Alzheimer's and I've checked myself on a chronometer and I realize I'm not getting enough choline in my diet you know we should be getting around 550 milligrams or so of choline each day. Which you get from where? Eggs and sardines. You get it from eggs and from, yes, from sardines, from liver, obviously, you know, organ meats, things like that, from oysters, things like that, a number of vegetables as well. Or you can, if you're not getting it from there, take some citicholine. This is why Professor Wertman from MIT found that citicholine is so helpful for synapse formation. So lots of ways to get choline, but please make sure that you get it up. So all of these things are critical. So what besides choline is so important for the brain?

Oh, well, I'll take flavonols. Flavonols and flavonoids, those alone, a study that just came out showing that over thousands of people, those who were in the highest quartile of flavanols had a much lower dementia risk than those who were in the lowest quartile of flavanols. So things like strawberries and things like grapes and things like that are all helpful to give you the flavanols. And then the flavonoids, things like blueberries and things like that, all critical. So those are like 25,000 different phytochemicals and plant foods. Exactly. And flavonoids and flavonoids are part of those. And so eating a rainbow colored diet where half

your plate is vegetables is a simple take home to protect your brain and pretty much everything else that could go wrong with you. So we've got choline, we've got flavonoids and phytonutrients. What other major nutrients are an issue? Well, you know, the minerals. So the key ones that almost all of us are deficient, as you know, in zinc. And zinc has become a huge issue because of COVID-19. So many of the people who are deficient in zinc are reduced and have an increased poor outcome, increased risk for having a poor outcome from COVID-19. So zinc, magnesium, iodine, potassium, those are the big four that most of us are deficient in. And then of course, vitamin D, as you know, the study that just came out about 10 days ago, showing if you take the people who are low in vitamin D, they

have a much worse outcome in COVID-19 than the people who have sufficient vitamin D and of course Alzheimer's is no different the same thing you see people who are low in vitamin D more likely to get Alzheimer's people who are sufficient vitamin D and of course same thing in multiple sclerosis high vitamin D associated with better outcomes so as you, it's multiple diseases that all depend on these critical factors. Some of the most important things I found are B vitamins. I once had a patient who was about 80 something years old. She was on multiple boards, very successful woman, but was noticing depression and really severe cognitive decline and been

diagnosed with MCI or pre-dementia. Told her to get her affairs in order. She came to see me and I'm like, checked her levels and found she had a really high level of something called methylmalonic acid and homocysteine, which are things that most doctors don't check, but reflect your status of B12, which is methylmalonic acid and homocysteine, which is the folate and even B6. So I basically gave her B12 shots, high doses of methylfolate, which is a particular kind. Saw she had some genes that made her need a special kind of folate. And she called me back and was doing amazing and all of her symptoms had gone away. And then a few years later, maybe four

or five years later, she called me up. And I thought, oh, I saw my schedule. I'm like, maybe she's not doing well. She's declining. I kind of worry about her a little bit. And she's like, Dr. Hyman, you know, I'm going trekking in Bhutan and I want to know what I should do to prepare and what I should be taking with me. So I was like, okay. And I think, you know, sometimes it's that simple, but it's not always that simple. But I think understanding the role of nutrients and nutritional deficiencies is huge. It's far more common than we think. You can't get everything you need from food. I think a lot of the reason the studies on vitamins have failed in Mars trials, whether it's far more common than we think. You can't get everything you need from food. I think a lot of the reason the studies on vitamins

have failed in Mars trials, whether it's for cancer or heart disease, is because they're not dealing with the whole system. They're just like, if you're eating donuts all day, you can take all the fish oil or vitamin D you want. It's not gonna do anything to fix your risk of heart disease, right? So you have to look at everything together.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize

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