The Dr. Hyman Show - Is Alzheimer’s Preventable? The Power Of A Personalized Medicine Approach with Dr. Richard Isaacson

Episode Date: November 17, 2021

This episode is brought to you by Essentia, BiOptimizers, and Joovv. There are so many simple steps we can take every single day to strengthen our brains and reduce the risk for Alzheimer’s. Considering that this disease starts in the brain 20 to 30 years before the first signs of memory loss, we should all be thinking about prevention. Today, I’m so excited to welcome Dr. Richard Isaacson to talk about taking care of the brain in a whole new way.    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 as Adjunct Associate Professor of Neurology in the Department of Neurology at Weill Cornell. This episode is brought to you by Essentia, BiOptimizers, and Joovv. It’s the perfect time to try Essentia, since they’re having their biggest Black Friday sale of the year. You can get 25% off plus 2 free pillows and an extra $100 off a queen, king, or California king mattress at learn.myessentia.com/drmarkhyman. For the entire month of November, BiOptimizers is offering up to 10% off every order and access to over $200 in free gifts including books and other great products. Just use the code HYMAN10 at magbreakthrough.com/hyman. For a limited time, Joovv is offering $50 off your first order with the code FARMACY at Joovv.com/FARMACY. Some exclusions apply. Here are more of the details from our interview (audio version / Apple Subscriber version):  What you can do today to prevent Alzheimer’s disease (8:40 / 4:02) Using food as medicine to prevent and treat Alzheimer’s disease (12:17 / 8:13) ABCs of Alzheimer's prevention management (17:47 / 14:15)  Tracking your sleep, exercise, blood sugar, and more for brain health (22:48 / 19:12) Eating and fasting for cognitive health (25:02 / 21:32) Approaching Alzheimer’s as a systemic disease that affects the brain, not a brain disease (34:13 / 28:52)  Challenges to applying preventative Alzheimer’s research in patient care (43:08 / 39:09) Is Alzheimer’s reversible? (51:32 / 46:06)  Blood pressure, cholesterol, diabetes, belly fat, and Alzheimer’s disease (58:33 / 53:10)  Hopeful Alzheimer’s patient cases (1:12:05 / 1:04:40)  Support Dr. Isaacson’s Alzheimer's prevention work at fauf.fau.edu/alzp. Get access to his free Brain Health Course at faumedicine.org/alz/course and learn more at faumedicine.org/alz.

Coming up on this episode of The Doctor's Pharmacy. If your listeners take home one thing from this podcast, hopefully it's that they're not powerless, but if they take home two or three things, I hope that they take home the fact that everyone should know their blood pressure. Everyone should know their waist circumference. Everyone should know their body fat.

Everyone should know these numbers. Hey everybody, it's Dr. Mark. Let's talk about sleep. I used to think that MD stood for medical deity, meaning I didn't have to follow the same sleep rules as every other human being. I stayed up late, working long shifts in the ER, ignoring the demands of my body to rest. But that lack of high quality sleep is associated with tons of health problems like insulin resistance, obesity, cardiovascular disease, mood disorders, poor immune function, and lower life expectancy. And when I wised up, I noticed an amazing change in my health and overall well-being. What we need to do is ready

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And if you have a brain, this conversation is going to matter to you because you're going to learn how to take care of your brain in ways you never thought possible. In fact, you are going to learn potentially how to prevent, stop, and maybe even reverse dementia. So let's get into it with our guest, who is an extraordinary scientist, Dr. Richard Isaacson. I've been dying to have him on the podcast for years. Finally got him to agree. He's the director of the Center for Brain Health and Director of Alzheimer's Prevention Clinic, now at Florida Atlantic University Schmidt College of Medicine. He was previously the director of the same Alzheimer's Prevention Clinic at the Weill Cornell Memory Disorders Program and a distant dean faculty of development. He also is an associate professor of neurology at Weill Cornell Medicine and

you're a Presbyterian and he just does so many cool things, but that is the least of it. He has literally been diving into an area of research that a few have feared to tread, which is can we, using a very radically different approach than the drugs, which we've used to try to deal with Alzheimer's, actually stop, prevent, reverse Alzheimer's? We've spent, I don't know, billions, literally, I think maybe $2 or $3 billion in over 400 studies to try to find the cure for Alzheimer's, much of it funded by the government. And honestly, most of us failed. Over 99.6% of the studies failed. And the ones that succeeded were like, well, you can maybe keep them out of the nursing home for a couple of months. So it wasn't like

a slam dunk. So I'm so excited to have Dr. Isaacson on the podcast. Welcome. Dr. Hyman, thank you so much. It's a privilege to be here. It's great to be here. Lots to share. I just want to know, I have so many people that are fans of yours that are just going to be gaga that I'm finally talking to the Dr. Hyman on his podcast. I got Christina S. I got a couple of Christina S's. I can keep name dropping, but I'll stop for now. See, I don't get excited by talking to celebrities. I get excited by talking to people like you. I get nervous. I'm like, oh, Dr. Isaac, you guys do all this amazing work. And I just am so excited to learn about what you're doing and share it with everybody. Sure. You know, let's just get right into it. We're in a kind of a pickle.

Our brains are getting better, not worse. There's 46 million Americans that have Alzheimer's that is actually starting up in their brains and that don't have symptoms. Most people don't even know that you can actually detect the changes in the brain with Alzheimer's 20 to 30 years before you forget your case, right? So we're going to get into your research, which is really extraordinary that shows that, and I'm going to sort of give the punchline away, that a disease that we previously thought untreatable is now potentially treatable, but not in the traditional ways we have thought, which is medication or typical medical treatments that manage the typical things that we do. It's really a radical approach using a systems model, what we call functional medicine, which is essentially looking at multimodal interventions, you know, with multiple causal factors applied at the same time in a personalized way to radically change your biology, which

changes your brain. So your body affects your brain and you're treating all the factors that affect the brain. And as we learned in medical school, the brain obviously has nothing to do with the rest of the body, right, Richard? It's just disconnected. There's this brain, blood-brain barrier, and, you know, nothing passes between it except maybe some sugar. We've learned that that's just nonsense. So take us down, what are, just to get ready, what are the top things that determine a brain healthy lifestyle and a brain healthy diet that people can do to prevent preclinical or pre-symptomatic Alzheimer's? In other words, what is this whole field of preventive neurology that you're talking about? Yeah.

And you use the term radical, right? And it's not radical. It's just straightforward. And there's all these terms that are flying around. When we publish, we talk about precision medicine, and we use the terms individualized care. And there's all these terms, and you can call it what you will in semantics, but it's just regular, what should be regular medical care. It's just it doesn't turn out that way because our medical system is, you know,

sideways and you can't spend time talking to patients. You know, I'm actually like you, I'm a clinician. I talk to patients. I wasn't really a researcher. I kind of got, went into the research through the side door, this academia kind of thing kind of just sprouted upon me. But, you know, what can people do? I think people can grab the bull by the horns and say, I can make a difference in my brain health by making incremental changes today. And you don't have to start tomorrow. You don't just start next week. You can start today.

And there are little incremental changes people can make to really promote their brain health over time. And I just want to just reiterate something you said. Alzheimer's disease starts in the brain over 20 to 30 years before the first symptom of memory loss begins. This leaves an ample amount of time, this critical window of opportunity for people to just, you know, get educated and get informed. So if someone had to do something today, but first they take a deep breath. There's a lot to it. There we go. Right before we were starting the podcast, we each took some deep breaths. Everything was cool. But take a deep breath because Alzheimer's is among America's most feared diseases.

It is a terrible condition. I have four family members with Alzheimer's. It's a sad, terrible, horrible, I hate the disease. I hate, it's a strong word, but I hate Alzheimer's. I hate what it's done to my family members, my patients and, and, and, and their family members, their caregivers. But I think it's important to take a deep breath and understand that there are so many things that we can do to put the ball back in our court, to write this script and tell our own story. You know, can you definitively 100% prevent Alzheimer's in every case? Well, no. I mean, there are certain pretty rare genetic causes where basically just about anything you're going to do, you're going to get Alzheimer's and it's going to probably start early. And that's unfortunate, but that is an exceptionally rare number of cases.

Most cases of Alzheimer's, you can do something about it. Based on the 2020 Lancet commission, an amazing study based on 12 modifiable risk factors, we can, the person makes brain healthy choices, prevent four out of every 10 cases of Alzheimer's disease. Wow. Like we didn't learn that in med school. Medical students now aren't learning that in medical school. It takes 10, 15, 20 years for something to be learned in medical science, to be translated into clinical practice. And I think it's important for this podcast and people like us to, to share this news because there are so many things a person can do.

So you asked me, what can a person do? I want, I want them to know there's so many things a person can do. So you asked me, what can a person do? I want, I want them to know there's so many things. At least 12. At least 12. So, you know, in our study, I think there's more, but there's at least 12, at least 12, you know, in our study, we recommended on average, 21 different things that a person can do. And those were individualized per person. In our whole universe of our study, we recommended almost 50 things that a person can do. 50 things that influence the brain that you've identified. Yep. And this isn't radical.

This isn't rocket science. This isn't like, you know, I'm a simple man. I did not graduate first in my med school class. I did pretty good and I worked pretty hard. But, you know, I try to just see things from the patient's perspective. And there are so many things that are evidence-based and safe. The two categories I would start with, just to kind of set the stage, are pharmacologic

and non-pharmacologic. And I want to get granular because the word pharmacologic doesn't just mean drugs and prescription drugs. It also means- You mean food is medicine? is that food is definitely medicine although that got that got sidetracked to non-pharmacological but i can vitamins are medicine oh i mean i would challenge you richard because i i think that food is actually real medicine the phytochemicals compounds in food are biological response modifiers or signal transduction changes. And they have a similar effects as drugs. In fact, many drugs come from

the phytochemicals in plants. So I would just kind of make us think about that a little bit. Well, actually, so I'm glad you brought that up. I would say that traditionally speaking, and let's talk through this. This is a great opportunity. So traditionally speaking, I've always framed it, and I'm open-minded, so this is great. I'm just teasing. This is exactly why we're doing this. This is exactly a meeting of the mind. Gloves are off. Let's go. So drugs, vitamins, supplements supplements and medical foods are the classic things that i personally have categorized in the pharmacologic session and then in the non-farm section i've

included diet exercise sleep stress a whole bunch of things learning new things but what you bring up is is important and you have a colleague named dr robert krikorian and he's an amazing guy he's a neuropsychologist and he's fought the good fight, you know, kind of like us. He's, I don't want to say he's had, yeah, in some ways that contrarian views because he's tried to do randomized studies using nutrition. He's done studies on the ketogenic diet and Alzheimer's and Parkinson's, and he's done, you know, studies on blueberries and omega-3s. And what he's done is he's taken the food and he said, okay, it's not just about the blueberries. We did the study and wild blueberries are better. Well, why?

Because of this, it's called anthrocyanin. And then he gets down deep into it. So I completely agree that food is medicine. A hundred percent agree. I completely agree that the specific chemical nutrient compounds can be isolated. But I think it's, it's too reductionist to just say, let's just put a pill of anthocyanins and prescribe that because it's, it's the milieu it's right. It's like with caffeinated coffee is good for brain health. Well, is it the caffeine? Is it the coffee? Well, no,

they think it's like some substance X during the brewing process. Right. So, so, you know, depending on which way you look at the science, I would prefer that food is medicine. It's just sometimes- I agree with you. I understand the bucket. So I'm just kind of playing with you, but I- I love it. But I think, I mean, when I, when I, when I put a patient, for example, on a ketogenic diet with Alzheimer's and they wake up and their brain becomes alert and they remember their son and their daughter. And I'm like, well, how is that less a drug than some other drug that doesn't work that we're using like Aricept, right? Yeah. It's impressive.

Yeah. No, I mean, I just feel like all of the different paths, like, you know, some people call like nutrition, I don't know, not mainstream medicine. To me as a Western doctor, that doesn't make any sense to me. Nutrition is like I got very little nutrition education in medical school, and I think that's a terrible thing. I learned a ton, and I had to – my better half has a master's degree in nutrition from Columbia, and she's taught me a lot, I think, through osmosis. That explains everything.

Ah, there we go. It's always the better half, and she informs the less enlightened one. So, you know, I guess what I'm trying to say is nutrition is the cornerstone of how we practice. Physical exercise and precision exercise, precision nutrition, these are all the things that are developing and really become the cornerstone of our care. So you're talking about the 12, then the 21, and then the 50, and maybe there's going to be 100. Tell us more about the granularity on that. Sure.

You were using these, you know, and I just want to sort of frame it for people. You did a study that you published, I think in 2019, which surprised even you, were using this approach, looking at a personalized assessment of these biological factors that could be modified, and then individualizing the treatment, that you not only slowed the decline, you not only stopped the decline, but you reversed the decline, which is something that has never really been seen except in a couple of trials like the finger trial. And I think there's a new one coming out, the pointer trial. So those are, those are also lifestyle trials. And so you, you really have, have sort of cracked the egg and published something that should have been on the front page of every major newspaper, the lead story in every evening news. And yet it was like crickets.

Yeah. Well, I, I mean, we got the wall street journal and cnn and this mother so i'm i'm okay i'm okay but for me it was like it was it should have been like the nih should have gone oh richard here's 10 billion dollars well get going on this like that's what it should have i have to be careful but you know the nih doesn't really fund what we do and that's been it's very hard and listen the nih i've engaged with the NIH over the last year or two, and there's definitely been more interest. But, you know, I, you know, talk about crickets years ago, a decade ago, when I started this whole thing, more 15 years ago, there was nothing, there was no, there was no funding for any of this. So, you know, what I would say is, what our work shows is that when you individualize care and you give people a plan,

and I know you've asked me at least three times now, well, what should people do? What I'm trying, why I'm delaying things is because it really truly needs to be individualized. And what we use is a term called the ABCs of Alzheimer's prevention management. Based on the data, we get data on A's, the B's, and the C's. A stands for anthropometrics. Anthropometrics is basically a fancy A word for body composition. What is your body fat? What is your waist circumference? What is your muscle mass? Depending on these factors, we're going to change the recommendations we give. The B stands for blood-based biomarkers. We're going to look at markers of lipids, cholesterol markers, also advanced

markers that preventative cardiologists use, for example, that, you know, most neurologists honestly don't really pay attention to. We look at metabolic markers, insulin resistance. We look at inflammatory markers. We look at nutrition markers. You know, instead of, you know, saying, okay, well, go eat fish. It's good for you. We're going to look at the markers in the blood. We're then going to tell you based on your blood and based on your genetics, how much fish you should be eating, what types of fish. So, so the, the take-home point is we're going to get granular with every patient. The other thing we do is in the blood-based biomarkers, we look at genetics. We look at the APOE4 variant. It's the most common risk gene. Doesn't mean you're going to get

Alzheimer's if you have the variant, but it increases your risk. Well, if I know that you have the APOE4 variant, they check for this in 23andMe and millions of people have gotten this checked. I'm going to personalize your care differently. If you have the variant, I'm going to give you plan A, B, and C. If you don't have the variant, I'm going to give you a little bit modified plan X, Y, and Z. If you have two copies of the variant, you have a different plan altogether. That's only 1 percent of the population so you know the the take home is we take all these markers and the c is cognitive function and we understand a person's cognitive baseline we look at memory function language abilities learning abilities uh speed of processing attention and executive function which is higher order processing. We take all of this and the patient's medical history. We learn about the patient. We

learn everything we can about them, about their family, and then we personalize a plan. So those 21 different things are based on that person individually. And there's a lot of overlap. If you want me to say, okay, well, what are the core things? Well, exercise on a regular basis. Okay. Well, exercise on a regular basis. Okay, well, exercise on a regular basis is good, but every person gets a different plan. If we're putting someone on a plan for body fat loss, we're going to give them a different plan. Steady state cardio, for example. Some people would call that zone two training.

Steady state cardio at 60 to 65% of your heart rate. There's different ways to do this through lactate testing, through a variety of things that we do, you know, more precisely in our clinic, but we put people on these steady state cardio plans fasted in the morning, as long as they can tolerate it because that way it jumpstarts body fat loss. If we have people that don't do any muscle strength training because they don't like it, we educate them to say, I don't like it either. I'm not Mr. Big Muscles over here, but I have to do strength training once or twice a week minimum, because if you don't have muscles, you can't boost metabolism. So we put people on these very specific plans. High-intensity interval training. I really believe that high-intensity interval training is almost necessary for people with at least one copy

of the APOE4 variant. And this is what has been studied now in a couple of studies. And yes, we need more, we need more research and studies out of Norway were good, but we, we need to personalize an exercise plan. We need to personalize a nutrition plan. We need to personalize a vitamin and supplement plan. In some people, we do use drugs. It's, you know, drugs are actually not commonly used at all in our research, although we do use them on occasion. We'll use a variety of drugs, usually at much lower doses than maybe the regular community uses. But, you know, when it comes to, you know, management, unequal opportunity. If there's data and it's relatively safe, you know, I it comes to, you know, management, equal opportunity, if there's data, and it's

relatively safe, you know, I'll entertain it. So we recommend, you know, cognitive activities that will have a spillover effect, learning something new, learning how to play a musical instrument, learning a new language, these are things that may have a protective effect build backup pathways, believe it or not, even learning how to play a musical instrument in midlife has protective effects on cognitive outcomes in late life and that's hope for me yet there's hope there's hope for me yet i got my bass guitar over there i got blisters on my fingers play the guitar i'm trying but i just so but my big problem is i don't know how to tune it and i don't i i'm so musically inept that i i'm probably there are good apps and how to tune it and I don't I am so musically inept that I probably there are good

apps and things to do it there's there's a website it's called you got a pen it's called YouTube YouTube you may have heard of it almost as many people watch YouTube as listen to your podcast so you can learn how to play guitar on YouTube I I think you can do it um okay I'm gonna try for sure that's my December. Excellent. End of January and February and March. So the take-home point is engage your brain. Treat your brain with respect. Love your brain. Make a plan for your brain. What does that mean? Make a plan for sleep. If you exercise and exercise and exercise, some people say colloquially that that loosens the amyloid, the bad protein that gets built up in the brain of a person with Alzheimer's. But if you're burning

the candle at both ends and you're not sleeping during sleep, especially deep sleep, that's when a person has the trash come. The trash man comes, they pick up the garbage and they take it out and they take it to the trash heap. That is the restorative part of sleep. And if someone isn't sleeping, you know, at least seven, seven and a half, eight hours of sleep is usually the goal. As we get older, it's, you know, harder to sleep that much. But making a plan for sleep, prioritizing sleep, you know, we have people that track their sleep, that track their exercise. I'm wearing a wrist device here. I have nothing to disclose, but we've done, you know, several research using this device. I track people on my phone.

I have my phone right here, and I can check how much exercise they've been doing, how their sleep, how much deep sleep. I can see their blood sugar control. I can see all these different things on my phone because my patients share their data with me. And when I talk about data sharing, it's not just about tracking sleep. It's not just about tracking sleep. It's not just about doing exercise. It's about tracking it, determining the response, talking to your physician about it. Granted, it's hard to find physicians that will take the time to talk to you

about this kind of stuff, tracking your blood sugar. There's, you know, at-home devices called continuous glucose monitors. In our program, we take a very, very deep dive and we learn about all of these different metrics and we refine or fine-tune the plan that we give them based on their real-time measurements. So, you know, I can keep going. There's stress modification, you know, transcendental meditation.

Bob Roth's taught me a ton about this. What about mindfulness-based stress reduction? You can take a course online. Mindfulness-based stress reduction has amazing outcomes when it comes to brain health. The list goes on and on. There's no one magic pill or one magic cure, but there are a variety of, I was going to say pharmacological and non-pharmacological, but you're reevaluating how I say this now. There are a variety of interventions that are evidence-based and safe that I think all of us need to learn about. You know, whether we talk about fasting. And I like the term time-restricted eating better, meaning not eating for 12, 14, 16 hours overnight, at least four or five days a week. I use the term fasting for a more prolonged fast, you know, 24 hours or more. And that's a different discussion. There's the ketogenic diet. There's the's a different discussion. There's the ketogenic

diet. There's the Mediterranean style diet. There's the mind diet. There's components of each diet, green leafy vegetables, wild salmon, grass-fed beef better than non-grass-fed beef because of the omega-3s. There's so many devils in the details. Half a couple blueberries and strawberries two to three times a week you know leads to better brain health outcomes and cognitive outcomes in the nurse's health study you know many years later on there's dark cocoa powder there's so many things that i can drop in as as key things but and take home point is all of these things need to be individualized so let me let me ask you this because i mean you know first I want to just kind of feedback

because what I'm listening to you thinking, you're a neurologist, but you're also an immunologist, a cardiologist, an endocrinologist, a gastroenterologist, a nutritionist, right? Yeah. You're breaking down the paradigm of medicine, which is we should stay in our lane, focus on our organ, and leave the rest to everybody else. Yeah. And your insight here is that the body is a system, that everything's connected to everything. You can't just pick out one thing and work on that,

like amyloid or tau or whatever, and get to the problem. And it's sort of like trying to bail the boat while there's holes in it. You got to fix the holes. And essentially the holes that you're talking about are all these ways in which our brain gets injured by our lifestyle and by our environment. And you didn't mention toxins, but that also plays a large role. And so all of a sudden we have to sort of rethink our whole approach, which has really been a reductionist approach. Single disease, single drug with a single outcome. Hey everyone, it's Dr. Mark. Now I keep hearing my friends and patients say they're dreading the darker, colder winter months. It can be a tough time of year for me too, but there is one tool

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to your qualifying order. Again, that's J-O-O-B-B.com, Forsyth's Pharmacy with an F. Some exclusions apply, and this is a limited time offer. So make sure you check it out today. Now let's get back to this week's episode of The Doctor's Pharmacy. There was an article in JAMA a number of years ago called Shifting Thinking in Dementia. You probably saw it. And they said in that article that we combine categorical misclassification with etiologic imprecision. And in English, for those listening, that means we categorize dementia according to symptoms, not the causes. And we are not very focused on the etiology or the causes. We're focused on the symptoms. And we say, well, you can't remember this,

and you fit this profile on your neurocognitive testing. You have Alzheimer's or you have this kind of dementia or Lewy body or blah, blah, blah. And the reality is that you could have 10 people with Alzheimer's who need 10 different treatments. And that's exactly what you're talking about. That's heresy, Richard. That's heresy in medicine, honestly, because we really have a very, very restricted reductionist view of disease that doesn't let us actually even study these things. And I've literally had arguments with top leading researchers, like heads of research at major institutions saying, these are all the factors that affect the brain. We want to study them together.

So, oh, no, you have to study one thing at a time and then see how that works. So, study exercise, and then study nutrition, and then study vitamin D, then study fish oil. I'm like, no, that's not how things actually work. It's like you have to use the whole picture. The other thing I sort of wanted to sort of touch on was that you're sort of introducing a concept of the personalization, which, again, is very different in medicine. It's not one size fits all. And you're talking about very sophisticated personalization based on a whole set of biomarkers and tests and things that are easily accessible but that aren't normally looked at and that aren't normally tested. You know, you get your typical panel, you get your thyroid, your B12, you get your spinal

fluid done, you get your MRI, and you go, okay, you got Alzheimer's. It's sort of a little bit more complicated than that, but it's really a fairly narrow window of biomarkers and metrics. And there's bazillions of them. And I think we're just sort of touching the sort of tip of the iceberg on this. And I've seen in my patients, when you start to apply these concepts of personalized care around food, around exercise, around sleep, around stress, around supplements, around everything, that you really begin to see dramatic changes in brain function. Yeah. I, you know, I, I, I often joke that I'm like a one third neurologist,

but a preventative neurologist at that. I'm a one third make-believe I will full disclosure. I'm not a preventative cardiologist, but I may make-believe preventative cardiologist. I'm a one third primary care doctor and make-believe preventative endocrinologist. I don't even know any preventative endocrinologists. If you find one, introduce them to me. I was trained in an environment. I went to a six-year medical program where I was in med school from day one, University of Missouri, Kansas City. I knew I wanted to be a doctor when I was five, 17 years old, wearing my white coat. And I did so much internal medicine during med school i had like an extra year of medicine because that's the way our training was and i don't know if it was that or i'm not sure exactly what it was but 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 protects you when you fall but it's just like it it 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 road they're on and 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, do tend to work pretty well. I'm not the biggest fan of insulin like that doesn't, that's, that's maybe band-aiding to me. That's probably too late. I mean, I'm not the best, whatever, but, 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. My field, I was just gaining some fans in my field, and now it's all a decade of work. 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'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 link, 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, you know, 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 your podcast, my podcast, but you're talking, but I'm just going to just talk about this one patient because it just, it was the first patient I had where I'm like, came in the guy with Alzheimer's, 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 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 a boat e4 double for gene so he's the 1% he was 7 years old cognitively impaired diagnosed with Alzheimer's basically home and not able to do anything depressed 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 also 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 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 Stelazine 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, 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 think that 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'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 a editorial I wrote for a medical journal. I'll just, cause you'll go, wow, you know, this is interesting. So, you know, you know, the thing that resonates me with the story is, you know, when you have people with APOE44s, those are just different eggs and, and, you know, E44s may be, you know, for example, E44s 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, 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 FYI. 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. My God, smuggling my Turkish delights back to america and you're like dr hyman

can i take a picture with you and i'm like oh fine okay international um 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 again, I had research resources, infrastructure 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 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 what I'm trying to say is,

as as I've, I know what I know, and I don't know, no, and I don't know what 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 and those people drive me a little bit 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 I'm willing to have my eyes opened. And, you know, the stories that you say, it's like, as a physician, 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.

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 I'm, I'm, I'm Zen with not being able to precisely understand which of my 21 things are working. But, but I think, you know, as clinicians, I think we just have to do the best we can. And we want to, you know, promise not to over promise. I think that's important too. You, you, you said at the beginning when you were seeing that, that patient, I'm not a hundred percent sure, you know, yada, yada, but I'm going to try all the usual things and, and, you know, something worked. So I think as long as we have honest conversations with our patients and, and, and do the best, you know, people like us that have academic appointments and are in that realm, I think we, it's, it's, you know, it's, 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 within the diaspora of medicine, which is where I've been most of my life, there has, 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 fact 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 i think the you know the gut stuff is such a 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 we're all going to, 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 a hundred things we could find that could affect the brain. I think there's probably a thousand or maybe there's 10,000, 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 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? You know, it's got gotta be frustrating for you too, because you see, you see it, you see your patients get better and you go, Hey guys, 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? Are they listening? Are they, you know, I'm, I'm a pretty resilient guy. I gave my first talk in 2007 about, you know, how MCI, mild cognitive impairment due to Alzheimer's and, you know, in this pre-symptomatic, 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, not naming names, 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 this there's no evidence for that but there was no impetus to even aim to study it um you know i started seeing alzheimer's prevention patients in 20 2009 dr um arthur aggotson was one of my mentors oh yeah arthur yeah amazing guy you know he was my my attending at mount sinai medical center when i was an intern yeah before the south beach diet before you know he's the south beach diet guy but to me me, he's the, he's the Agatzen calcium score guy. Like to me, he's, he's the visionary that, that was one of the first preventative cardiologists and, and preventing disease and starting before there are symptoms. It was so the tomatoes that were thrown at me were you know, 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, uh, 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 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, so, so I think, you know, the reason that my colleagues are coming around is because of the publications and building the, you know, the body of evidence. I think the other reason that my colleagues are coming around is several of them have, have come visit. I've invited 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, if someone is willing to criticize the work we do, but not willing to come sit next to me and spend a couple hours and just watch, just look, 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, 10 o'clock, 11, and then one o'clock, two o'clock and three, 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 going to hate, I'm going to keep doing my thing. And, you know what Max Planck said, right? No.

He said science. Haters going to hate. 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 what he said. 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 spend billions of dollars studying drugs that don't work, but 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? 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 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 don't even know. I get it. I get it. I get it.

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, then we've just reversed Alzheimer's. I will be the first person to plant the flag in the ground and say, we have just reversed Alzheimer's. I will be the first person to do it. And my next study-

There are 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 not 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, I, the first, I got MRI baseline. Oh, and by the way, 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, you know, again, this is an anecdotal story, but there have been studies that have shown this also. I remember, you know, one of the first times I saw a guy's brain, a guy from Italy, nice guy. He came in in this really fancy Italian suit. He was well-dressed. He was skinny fat, though. He was skinny fat though. He was skinny fat, meaning 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, but it was, 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 giving 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, if I think the, the, 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 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, is more of a, a telehealth tele, 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 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, I really believe that, you know, we're the naysayers aren't going to have any tomatoes to throw because. Well, I mean, 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 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. You could be in bed with cancer and waste away to nothing, but your soul and your brain, who you are is still there. And that's the hardest part about this disease and its impact on families and caregivers. And I mean, you know, you've experienced that. I've experienced that. It's just devastating. And it's scary how much it's increasing. And I think, am I correct to say that it's not just because the population is growing, but the actual incidence per capita is growing? Is that true? So, you know, it depends on how you slice the data. But, you know, we have an aging population.

Age is the number one risk factor for Alzheimer's. I do think that some data actually show that, you know, in areas where blood pressure and diabetes is being under somewhat better control, Maybe the incidence is coming down a little bit, but the data, the data are what the data are. But what I would say is, you know, we have the power to make changes in our lifestyles today. We have the power to have conversations with our doctors today. You know, even like, for example, vascular risk factors, high blood pressure, high cholesterol, diabetes, these are things that fast forward Alzheimer's disease, pathology, we can say it pathology as well as Alzheimer's, you know, disease, but also cognitive decline.

Diabetes doubles your risk of, of, of having Alzheimer's disease. When it comes to blood pressure, this is just, this is just, actually, I really want to share this because if your listeners take home one thing from this podcast, hopefully it's that they, they, they're not powerless, but if they take home two or three things, I hope that they take home the fact that everyone should know their blood pressure. Everyone should know their waist circumference. Everyone should know their body fat. Everyone should know these numbers.

Yes, this is a lot to track, but these are, these are things that are not expensive to track. Anyone can go to their doctor's office or go to the pharmacy and check their blood pressure. And anyone can buy a scale at home that has a body fat metric. And yes, it's a couple hundred bucks, but it's a really good investment. It's a ballpark one. It's not, it doesn't. Exactly.

They're not perfect. Right, right. And there's gold standard. It doesn't tell you where the fat is, if it's in your butt or your stomach. Correct. Actually, anyone for no cost can measure their waist circumference. And if their waist circumference is more than an inch or so greater than it was in their early 20s during high school and college, that probably means that there's a problem. So that's actually the poor man's way to do it.

And we talked about this. I think you actually have to pay for the tape measure. I have a cheaper one. It's called the mirror test. You look in the mirror, jump up and down. And if your stomach jiggles, then you probably have a problem great you're hired that's a that's a great test um when it comes to blood pressure if this is something that people remember because blood pressure is just so important the sprint mind study published a couple years ago showed that people that had a blood pressure

in the 140s over 80s which back then was considered as normal all right no that's not that's completely not normal but that's a different discussion topic for another day but this whole this whole concept of normal versus optimal versus you know what what 50 percent of the population has there's a big difference when we're talking preventative health we want to go optimal so when it comes to blood pressure, people in a randomized study that were randomized to 140s over 80s or 120s over 70s or below, okay, in just three years, they stopped the study early. In just three years of tighter blood pressure control, which is 120s over 70s, but goal was below that, people were able to reduce their chances of developing the earliest phases of symptoms related to dementia by almost 20%.

In three years, just by lowering blood pressure by 20 on the systolic, the top number, and 10 on the diastolic. When you add the blood pressure control, plus the nutrition changes, plus the exercise, plus the other stuff and the vitamins. And once you add all these different things, this is when we, when we, when we can really, you know, put a damper in and listen, if we have, again, I'm sorry to keep pandering to the naysayers out there, but if there are people that, you know, don't believe if you can even delay Alzheimer's delay it from happening by a year, two years, three years, or five years. And in that timeframe, a blockbuster drug comes, okay, great. That drug comes. Well, well, well, great. Then that person prevented their own Alzheimer's. If we can delay

it longer than that. And they, you know, unfortunately if they pass from something else, then, then at least they lived a great quality of a better quality of life and they never got Alzheimer's. So whether you talk about prevention or delay or reversal or symptoms let's not get caught up in the semantics and let's just you know all unite and say there are things that we can do today to improve our brain health tomorrow uh and it's um it's things that that are that are tangible and available for everyone well if anybody's listening has got a foundation, is a billionaire, is somebody from the government or the NIH or anybody listening to this, if what the two of us are saying, Dr. Isaacson's research is on the right track,

how could we not put our resources toward that? How could we not focus on that instead of spending another billion dollars on another drug study that's going nowhere? Because there's a really simple rule in functional medicine, which is if you're standing on a tack, it takes a lot of aspirin to make it feel better. And the second rule is if you're standing on two tacks, taking one out doesn't make you 50% better. You've got to deal with all the factors. You can't just say we're going to study food or we're going to study exercise or we're going to study vitamin D or fish oil or flavonoids or blah, blah, blah. We've got to really look holistically at how do we optimize health. And you said something that is also a little bit of heresy because, you know, in medicine, you know, when your lab tests are in

the normal range, you're normal. The doctor goes, you're fine. But what you're talking about is treating to a standard that's beyond normal, that's optimal. So if your homocysteine is 413, it's considered normal on most lab tests. If you look at the data, if your homocysteine is 14 and above, your risk of Alzheimer's is 50% higher than the average population. So should your homocysteine be 13 or 12 or 11 or 10, maybe it's six or eight. And how do you treat to that metric? And I think that's what really we do in functional medicine is how do we create optimal function? I mean, people, what is functional medicine? It's pretty simple. It's learning how to create health through optimizing function and every aspect and all the areas of the body that are off balance. And that's

essentially what your work has done. And it's really so groundbreaking. And I know you might sometimes feel like a lonely warrior out there with arrows in your back and a bunch of bumps on your head and struggling. But I encourage you to continue because you are on the right track. And, you know, folks like you and, you know, Dale Bredesen, who's definitely got a lot of flack, you know, they have, you, you've shown that there is a possibility that this is not a, a disease that we can't tackle, that we can't learn more about, that we can't actually have an impact on and have hope for, because that's the worst part. It's just this devastating lack of hope. And I'm actually excited when I get to see a patient who's got cognitive impairment, because I know there's stuff we can do. And I would say, sometimes I see

miracles. Sometimes I try everything I know how to do, and it doesn't work, and I don't know why. But, you know, we're learning, right? So we we're learning. And it's a really, it's exciting moment in medicine, exciting moment in science, exciting moment in neuroendocardioimmunogastrology. Well, Mark, I mean, I really appreciate that. You know, it's striking to me that with the billions and billions of dollars invested in this field, you know, our study that we published, again, I was psyched it made the Wall Street Journal, but it didn't make the first page. So you're right. You're right. Alzheimer's is the most costly disease to our society.

It is easily one of the most challenging, just sad, damaging, just, just, just obliteratingly terrible disease. And you're right. Maybe that study should have made the front page. I want you to know that that study was funded like barely between 10 and $12 million for a five-year study. Like that's it. That's, that's, which is, which it was some $10 million is not, not a trivial amount of money, but it's like, this was, this was, you know, like, you know, paradigm shifting. This was a study that actually was, was, was, was, you know, move the needle and truly, you know, move things forward. So if there is someone out there, you know, I'm, I'm not, you know, selling anything.

I do have a book, but I, I just, just, I, I, I'm not trying to sell a book. I'd rather you help our research. Um, I, uh, I'm in academic medicine. I still have student loans. Um, I live in a very small apartment in academics. Um, I don't make a lot of money. So, um, if there's something, if there's somebody out there that wants to do something to help, um, please, um, I will, we will make good use of the funds. I can give you a link. May I share the link? What is the link? We'll put it in the show notes, but what is the link? Sure.

So it's an amazing opportunity because I just started a new position at Florida Atlantic University. I have an entire building that I can use. I have equipment. I have, I mean, this now would be the time where a gift or support to our program could literally just fast forward progress. So the link, I'm going to give you the link. It's F-A-U-F, like Florida Atlantic University Foundation, F-A-U-F dot F-A-U dot E-D-U

backslash A-L-Z-P, like Alzheimer's prevention. F-A-U-F dot F-A-U dot E-D-U backslash A-L-Z-P. Sorry for the word salad, but if you remember that, it means that your brain's working pretty good. That's okay. We're going to put in the show notes, so don't worry. Excellent. This is amazing. And who else is doing this around the world? Because there are other people also. I mean, you've got the pointer study that was being done, the finger study that was done. There's people in Europe. Who else is on this? Yeah. So, you know, in Europe, I think Europe's just a little bit more ahead in some ways. They have something called EPAD, the European Prevention of Alzheimer's Disease kind of program. And they're doing something pretty good.

You know, I have collaborators throughout the country that I work with. You know, I'm the one talking to you today, but, you know, we had 31 collaborators worked with on, on that research study. You know, we had a satellite program in Puerto Rico. We have collaborators in LA. You know, there's, there's just the fact that there's only a handful of people that are focusing that, you know, if someone wants to go to a doctor for Alzheimer's prevention, Parkinson's prevention, Lewy body dementia prevention, you know, we, we just started before I left Cornell, a Parkinson's disease prevention clinic. We're going to be starting one, um, you know, in, in, in Florida soon, um, next year. But I think, I think the fact that we're only having like less than a dozen people focusing on the area of Alzheimer's and neurodegenerative disease

prevention, there should be one of these programs and centers on every corner in every community, because if someone wants to talk to a doctor about how they can protect their brain health and be proactive, they should have every right to do that. And so while we do have a handful of people that are doing this, you know, we don't, we don't have enough. I literally have trained 45 or more people. I've, I've been asked to consult for different programs in Canada and New York and Australia, three different programs in Australia. But we just don't have, I would say, the funding and the infrastructure to really make all these programs be able to talk to each other on a regular basis. And we just haven't had enough, you know, support yet.

And I think it's coming. It's coming. It's paradigm shifting. And I just it's coming. It's coming. It's paradigm shifting. And I just congratulate you. And I'd like to sort of close by having you share a story or two. And I'd like to share one and just give people hope and talk about what we've learned. And yes, it's an anecdote. But I think what's happening, and even the NIH is now recognized and funding what we

call N of 1 studies, which is essentially looking at a person before and after treatment in a very sophisticated way that helps to validate the science about the change in their biology. And so to me, it's relevant. And in fact, that's how all good discoveries happen is through clinical observations and then extrapolating those and studying them and proving them. So tell us about your, your, a few cases or one case that you'd like to share. Oh boy. I mean, it's, it's a beautiful thing that there are so many that I can't even think of just one. But, you know, I guess what I would say is we're after COVID, you know, COVID hurt us a lot because, you know, we were in person.

We did the blood draws. We did the cognitive testing. And then when COVID hit, you know, we had to recalibrate. And what we did was we basically put everything online. And now we do the cognitive assessments online. We can get the blood draws remotely. So if someone lives out of town, a third of our patients don't, you know, prior patients didn't even live in the state we were in. So, you know, we've moved to telemedicine, we've moved to remote care. And I guess what I would say is it also allowed us to

take a deeper dive in some things like genetics. And what we've done over the last year is when we truly have the resources and time to go deep, and I mean not just as deep as you and I usually go, but go as deep as possible, whole genome sequencing. Look at mitochondrial haplogrouping. Look at polygenic risk scores. Having a neurogeneticist, a PhD in Alzheimer's precision medicine. For a year and a half, we went.

Now you're talking baby. Oh, Oh, Oh, Oh, I got to share with you some of this stuff. And we went deep on, on 17 patients and six of their family members. Now, remember we spent a year and a half on 17 patients and six family members, which is not, you know, that's not, that's not feasible in the normal thing. But what I can tell you is what we've learned in the last year and a half. Now I have no publications yet on this. I have a draft manuscript on my desktop. I have Excel spreadsheets open on my desktop as we speak. At some point, I hope in the next year to year and a half, we're going to publish a paper that has really, I think this will be my best or maybe

second best contribution to science because we've, there's a, there's a patient in his early fifties. Okay. So this is, I guess where it comes down to. So patient is early fifties. This is the first patient we ever did this on. It's a guy in early, his early fifties and he's got a kid, he's got a young, young child. Okay. A couple of years old and he was diagnosed with Alzheimer's disease. He was diagnosed with mild cognitive impairment due to Alzheimer's and he was diagnosed with alzheimer's disease he was diagnosed with mild cognitive impairment due to alzheimer's and he's in his early 50s and he just had a child finally he waited all this time and he has a child um we went as deep as any person science clinic research program could

have possibly gone and we found something um in his genetics that explained, you know, he's had high cholesterol since his 20s and 30s, and his father passed away, you know, early as well. And we found the reason why he had high cholesterol. So he had been, you know, on a variety of different drugs, he was prescribed, you know, you know, go eat a healthy diet, go exercise on a regular basis, that that's what he was prescribed, you know, you know, go eat a healthy diet, go exercise on a regular basis. That that's what he was recommended. There was no precision. There was no details. What we did for him is we literally told him to do everything. He was insulin resistant. He didn't know it. His belly fat wasn't a big deal, but it was there. He

literally did every single thing we told him to do. We changed one of his drugs. Now, this is again, this is one of the drugs we did use because of a genetic thing we found in his DNA. We added the drug, we changed, we took him off more drugs. Actually, he's on less drugs now than he was. We added some supplements and vitamins. We changed his entire framework. He doesn't eat breakfast anymore. He skips breakfast and he feels great and he's lost a lot of weight. You know, it's not just about what you eat. It's about when you eat it. It's not just about how much time you exercise. It's about what you do and how you structure it. So we put him on an exceptionally detailed plan. He's no longer having mild cognitive impairment. He still has preclinical Alzheimer's.

I mean, he still has amyloid in his brain as far as I know, but he has no symptoms. Yeah. He is functioning normally. He's now to the point where he decided to have another child when prior to meeting us, he decided that he was probably going to retire early. We just created life by prolonging someone's brain health.

And, you know, we have so many babies that have come out of the Alzheimer's prevention clinic because, you know, like women are coming to see us for brain health, but then they create life. And I guess what I would say is that we can really help people. And when you empower people to feel better and they go on living their life and you break the fear and you break the stigma. I had a young woman that said, well, I don't want to give, look what it's going through. Look what I'm going through with my mom.

I don't want to have a child. I don't want to do this to someone. I don't want to give my child an Alzheimer's gene. And when you just have honest conversations and you explain, well, actually that's not exactly how these genetics work. And Alzheimer's is going to be a different disease for you in five or 10 years for your child. That is the absolute furthest thing. So, you know, from whether it's breaking stigma, education, or helping people in real time,

I don't know. I've just seen, I mean, in some ways it's miraculous, but it's just, it's just, you know, good comprehensive clinical care. It really is, you know, Richard. And I think that, that, you know, brings to mind a case that I had of a woman who was basically on her way to check out. She was kind of early eighties, had an extraordinary career, you know, ran a business, and had Lewy body disease, which is sort of, for those who don't know what it is, it's a combination of Parkinson's and Alzheimer's. Got dementia with motor symptoms. So she was in a wheelchair. She couldn't walk. She came to my office. Literally three people had to pick her up and put her on the scale to stand. And I just,

I said, let's look at everything. Let's, let's get a map of what's happening with your biology. And we found she had type two diabetes. Her A1C was nine. Okay. And like, wasn't really treated well. She was on metformin, but her diet was kind of sugar and starchy. She had menopause and there's some evidence that maybe hormones play a role. She wasn't sleeping right on Klonopin, which we know affects the brain adversely. She had kind of marginal thyroid function. Her TSH was 6.7. Ideal should be like, you know, one or two, right? It's not the worst, but it's not optimal. She also had terrible gut. Like she had severe constipation her whole life, laxatives forever, enemas every day. And we looked at her gut. She had severe constipation her whole life, laxatives forever, enemas every day. And we looked at her gut. She had very low short-chain fatty

acids, really bad bacteria in her gut, leaky gut, dysbiosis. She had rashes all over her. She had some doctor who was giving her steroid shots for energy on a regular basis. And she had, which by the way, shrinks the hippocampus and regular basis. And she had, which by the way, shrinks the hippocampus and causes dementia. And she had yeast growing everywhere under her breasts and her butt. And it was like a fungal mushroom all over her body. She was taking acid blockers for years, which blocked B12 and had done many antibiotics over the years for all kinds of stuff. And she had all these immune issues and uh and mitochondrial dysfunction and we found also she had really low levels of b12 and high homocysteine

and low vitamin d and so so i just kind of treated all that i got her thyroid tuned up fixed her diabetes got her in more keto diet uh gave her the vitamins she needed b12 shots gave her any fungal fixed her gut. And I'm like, again, I'm like, I've never had a patient with Lewy body dementia. I'm like, I'm not a neurologist, right? I'm like, let's just try this model of tuning everything up. And she came back to life. She walks.

She doesn't have a wheelchair anymore. She is running her business again. And she recorded an album and wrote a book in the year after I treated her. And I'm like, wow, like that, that just shouldn't happen. But when you, when you have even one patient like that, to me, if you have one patient like that in the universe, then the scientific community should go, oh, if it's possible in one, is it possible in many? And how do we direct our resources and our thinking to reimagine research, to reimagine our approach to getting to the root causes of this problem and treating it in a very different way. So you're a hero to me. I really admire you, Richard. I want to give you, if I was Jeff

Bezos or Elon Musk, I would give you $100 billion right now, at least 10. And I seriously think we are on the verge of a real transformation. And I just, anybody listening, Richard Isaacson is a extraordinary doctor. He's not only a humanitarian and a kind-hearted guy, but he's a brilliant scientist. And the work he's doing is going to change the face of medicine. So I don't say this very often on podcasts, but if your work could get to the next level that you want it to get, that we see it's possible, it's going to create a paradigm shift that's going to ripple throughout all of medicine, not just around Alzheimer's, but for everything. Because every disease we treat in the same way,

whether it's rheumatoid arthritis or heart disease or cancer, it's all reductionist and you're breaking that paradigm. So thank you so much for what you do. And I'm sorry if I'm, I sound like a fangirl, but I just, I just really love what you're doing. And I'm so grateful you finally agreed to be on my podcast. Well, Mark, I really appreciate it, Dr. Hyman. It's been a pleasure. Thank you for helping me and us spread the message far and wide.

I just, just, just, there's people need to know that there's things that people can do for their brain health. The brain is not just like, you know, organ that's like tucked away that you can't have any control over. It's, it's, it's, it's not the next frontier. We can do it today. And I really appreciate you giving me the time and the platform to share this education. Yeah. And we're going to put in the show notes the links to your research papers where you show,

okay, this is the kind of diet they did. This is the kind of exercise. This is the supplements they took, you know, vitamin D, fish oil, B12, and so on. These are the kind of plant compounds that can be beneficial. This is the kind of sleep therapies we do, the stress reduction therapy. So it's all in there for people wanting more granular detail, which I wish we had time to get into today. But I think, you know, it's all there. And your work is out there in the public domain. And everybody's going to find out how to find more about you in your show notes. And if you're listening to this and you have the resources, please, please help Richard.

And we're, and we're in process. We, we should, I'm not sure when the podcast will be live, but pretty soon in a couple of months or less, there'll be a multi, you know, 10 hour, everything you need to know about brain health, all the questions you asked, but, but I had 10 hours to answer them um will be uh live on uh on our website at florida atlantic university so stay tuned for that too uh we recorded it now we're just putting the finishing touches on that uh hopefully so that's a free consumer course totally totally yeah it's like uh it's like basically they stuck me in front of a teleprompter and there was no teleprompting because there was no words and i just talked for 12 and a half hours and uh they got it on video so everything that people need to know hopefully

came out that day and that'll be live on the site free totally free available so basically you the user's manual for your brain i hope i hope it's well received i i was bleary-eyed at the end and there was no i was not reading off the teleprompter. So I may have been a little bit. That is, I've done that. It is way harder than you think. Yeah, an hour and a half. I got tired. Congratulations, Richard. And thanks for being on the podcast. Everybody who's heard this podcast, I think it's your moral duty to share with everybody you know, because almost everybody in this country is impacted in some way by this disease and everybody should hear this message. So please share it, leave your comments,

how you approached this in your family and yourself, leave a comment, we'd love to learn and share it and subscribe wherever you get your podcasts and we'll see you next week on The Doctor's Pharmacy. 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

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I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner

who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.