The Dr. Hyman Show - Is Alzheimer’s Reversible? Getting to the Root Causes with Dr. Dale Bredesen

Episode Date: April 21, 2021

Is Alzheimer’s Reversible? Getting to the Root Causes | This episode is brought to you by BiOptimizers, Thrive Market, and TrueDark Alzheimer’s doesn’t just happen overnight; it’s the severe end of a spectrum, that comes after decades of changes have already been occurring in the brain. So why is it that we’ve grown accustomed to dreading this diagnosis, instead of doing what we can to proactively stop it in its tracks? For one, we’ve long been told that once the brain starts downsizing we can’t reverse the process. Now, we know that’s not the case. It’s possible to avoid brain degradation and actually even rebuild it. Today’s guest on The Doctor’s Farmacy has been a pioneering detective for Alzheimer’s and other neurological issues. Dr. Dale Bredesen is internationally recognized as an expert in the mechanisms of neurodegenerative diseases and the author of the New York Times bestseller, The End of Alzheimer's. His latest book, The End of Alzheimer’s Program, goes into greater detail on the protocol he uses with his patients and how it can be tailored to anyone’s needs, at any age. Dale held faculty positions at UCSF, UCLA, and the University of California, San Diego, and directed the Program on Aging at the Burnham Institute before coming to the Buck Institute in 1998 as its founding president and CEO. He is currently a professor at UCLA and the Chief Science Officer at Apollo Health. This episode is brought to you by BiOptimizers, Thrive Market, and TrueDark. Right now, BiOptimizers is offering my community 10% off their CogniBiotics. Just go to cognibiotics.com/hyman and use code hyman10 at checkout. Thrive Market is offering all Doctor's Farmacy listeners an extra 25% off your first purchase and a free gift when you sign up for Thrive Market. Just head over to thrivemarket.com/Hyman.  Right now, TrueDark is offering podcast listeners 15% with code DRHYMAN15. Just go to truedark.com/hyman. Here are more of the details from our interview:  Addressing the root causes of dementia, cognitive decline, and Alzheimer's disease (8:02) How a ketogenic diet and metabolic flexibility can support brain function (11:52) The way your brain responds to inflammation and how inflammation drives cognitive decline and Alzheimer's disease (15:46) What is a cognoscopy and how can you get one? (26:01) Your brain can grow and improve, even after an Alzheimer’s diagnosis (31:10) The gut-brain connection (33:18) Heavy metals and their effects on the brain (36:31) Hormonal dysfunction and risk of Alzheimer’s disease (41:28) How nutrient deficiencies drive cognitive decline and the diet that is best for your brain (45:01) Is it possible to reverse Alzheimer’s disease, and if so, to what degree? (58:30) Learn more about Dr. Dale Bredesen’s work at https://www.apollohealthco.com/. Get his book, The End of Alzheimer’s Program: The First Protocol to Enhance Cognition and Reverse Decline at Any Age, at https://www.apollohealthco.com/book/the-end-of-alzheimers-program/. Follow Apollo Health Co on Facebook @ApolloHealthCo and on Twitter @apollohealthco.

Coming up on this episode of The Doctor's Pharmacy. Calling someone Alzheimer's is like saying late-stage cancer, metastatic cancer, because it's a very late stage of this process that's been going on typically for 20 years. Hey everyone, it's Dr. Mark. If you've been listening to the podcast for long, I'm sure you've heard me talk about the gut-brain connection. Now this powerful link means that an imbalance in the gut can cause a huge range of brain symptoms, including mood imbalances, things like depression, anxiety, which might be a little surprising. But when you consider that 90% of our happiness hormone, serotonin, is made in the gut and that our gut microbes can

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Dr. Mark Hyman, and that's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversation that matter. And if you have a brain, you better listen to this podcast because it's going to matter to you because it's about how do we prevent and even reverse the worst condition that afflicts humanity, which is Alzheimer's and dementia and neurodegenerative disease. In other words, our brains are facing an onslaught of insults that are treatable, that can literally reverse and even prevent diseases like Alzheimer's and Parkinson's, which sounds kind of crazy because everything we've done hasn't worked. And today our guest is an extraordinary doctor, a friend of mine, a pioneer in the field of neurodegeneration, whose broken ground that few have treaded on. And it's none other than Dr. Dale Bredesen, who you may remember from our previous podcast, where we discussed his book,

The End of Alzheimer's. His latest book is called The End of Alzheimer's Program, which is a much more robust programmatic insight into how to actually use the protocol that he uses with his patients that I use and how we can tailor it to anybody at any age and any part of the journey along protecting your brain or fixing your brain. He's been on the faculty of UCSF, UCLA, University of California, San Diego. He's directed the program on aging at the Burnham Institute before coming to the Buck Institute in 1998 as its founding president and CEO. And he's currently a professor at UCLA and the chief science officer at Apollo Health,

which is a great online platform for addressing neurodegenerative disease. So welcome, Dale. Thanks so much for having me on, Mark. I really appreciate it. Okay, so let's get into this because, you know, most people worry about heart disease or obesity or diabetes, but it doesn't take away who you are. Alzheimer's takes away who you are. Neurodegenerative disease takes away your soul, in a sense, your memory, which is really what we're made of, is memories. And I think that it's a terrifying disease for so many. It's growing in scope. It's affecting millions and millions of Americans. I think about 5 million now, projected to be about 14 million in a few years.

The caregiver burden is enormous that goes along with this. The costs are even more than taking care of a patient with cancer or heart disease. And this is an epidemic really. And globally, it's, you know, literally hundreds of millions of people are going to be affected by this. Now you've been on the forefront of Alzheimer's research, and you've seen amazing results in helping people prevent dementia through various protocols that are based on functional medicine. And your wife is a functional medicine doctor and introduced you to this many years ago. And you often tell

the story of how you came across my book, The Ultra Mind Solution, which I wrote about 12 years ago that mapped out how we can start to think about treating the system, not just the brain itself. And you created the Bredesen Protocol that fundamentally changes how we think about cognitive decline. So tell us about how you came to understand that what you learned as a neurologist and as a researcher around Alzheimer's corresponded with these emerging ideas around functional medicine and how that led to you develop the Bredesen Protocol. Yeah.

And thank goodness there was functional medicine or we would still be figuring out how do we put all this together. So we were interested for 30 years in the laboratory and we're simply going in, as you said, people have been unable to treat these diseases, Alzheimer's, frontotemporal dementia, ALS, neurodegenerative disease has been the area of greatest biomedical therapeutic failure. So we were trying to study what are the molecular drivers of this process. And what we could see with research was that there is a central switch, APP, which is literally integrating over all these signals. So the big surprise was that everybody was talking about Alzheimer's had the wrong idea. They've told you it's misfolded

proteins, it's reactive oxygen species, it's prions, it's tau, amyloid, all this stuff. But the reality is when you look at it, at the heart of Alzheimer's is an insufficiency. You have an insufficiency of signaling, which is picked up by this molecule APP, which then is protecting your brain for downsizing. It's very much, by the way, what's happened with COVID-19. We have an insult, SARS-CoV-2, and of course we're supposed to be sheltering in place and social distancing. But what's happened with that, with less interaction,

we have a recession. This is exactly what goes on in the brain of an Alzheimer's patient. You have insults, and these are everything from herpes simplex type 1, P. gingivalis from your mouth, various molds from your sinuses, leaky gut, as you know, on and on and on, dozens and dozens of these things. And these insults trigger your brain to say, okay, I need to downsize. I need to shelter in place, literally. And it produces something

that is an antimicrobial, which is the amyloid. So as long as you don't find those things and correct them, you're going to keep downsizing, downsizing until you can't dress yourself, you can't speak. And unfortunately, when you go in to see some doctor, an expert in Alzheimer's, they don't look for those things. And this is a critical piece. So what we studied was what is the fundamental nature of this problem and the nature of it? It is an insufficiency in the network that mediates plasticity. And so what happens? You lose that plasticity and you start downsizing just as you see with COVID-19. What is plasticity? So plasticity is the ability to change, you know, from plasticos in synapses so that we can fight these things?

You're going to use your resources now to fight the various pathogens or toxins or changes in insulin sensitivity and things like that, but you're going to have to live with a smaller function, basically, just as we are stuck with with the recession here in the United States right now. Yeah. So, your neuroplasticity is essentially all the networks that tie everything together in your brain, all the connections between the cells, all the messaging, all the new wiring that helps you learn and grow. That diminishes with all these insults that cause your brain to, as you say, downsize. Yeah. It is protecting itself. And what we've always learned is that once you go down, you're not going back up. That once you lose your memory, it ain't coming back.

And that the best we can do is maybe slow it down. And the best research, we're talking about billions of dollars, hundreds of studies over many decades, have really come up with a big fat zero when it comes to any meaningful result to stop, to slow, or to treat Alzheimer's or dementia. And we've spent so much money and got so little because we've been focusing on the wrong thing. So in your program, the End of Alzheimer's program, you talk about what we actually should be focusing on. And you talk about these metabolic factors that can literally trigger this downsizing. So what are those factors and how do we rebalance

them so we don't end up having this decline in brain function? Yeah, it's a great point. And so, you know, we can actually see people improve just as you described in your 2007 book. And so this shows that there is a set of things that are synaptoblastic, making connections and keeping connections, and a set of things that are synaptoclastic, pulling back. And when you're young, there's this beautiful balance. You know, you're actively forgetting the seventh song that played on the radio in the work yesterday and stuff, that sort of thing. But then what happens with everybody with Alzheimer's, too high on the synaptoclastic, too low on the synaptoblastic side.

So what are the things that are synaptoblastic? Well, step one, there is an energy gap. This turns out to be one of the most important parts about the Alzheimer's brain. As you know, if you just look at a PET scan, an FDG PET scan, you see that there is a decrease in the utilization of glucose by your temporal lobe and your parietal lobe. That is the hallmark, the signature of Alzheimer's disease, and it's present for about 10 years before a diagnosis. So you have a critical energy gap that you need to change. You need to address that gap. And the best way to do it, of course, is with ketosis. And you can, you know,

Stephen Kinane showed years ago, you can ramp those ketones up to one, two, three millimolar beta-hydroxybutyrate, and you can address that energy gap. That's the first thing. The second thing is, when we used to grow the neurons... So basically using a ketogenic diet, you can increase the way the brain uses energy and make it basically have more energy by feeding it fat instead of sugar and carbs. Exactly. And there are two problems there. One is that you've lost the flexibility. You've lost the ability. Everyone's stuck on the glucose side. They're not able to use the ketone side. You have to have the flexibility. And then the second is that they have the insulin resistance.

So that even though they're trying to use the glucose, which is what they've used for years and years and years because of the standard American diet, they're now unable to do that because you literally have changes in the ability of insulin to signal. You change your insulin signaling IRS1 molecule from tyrosine phosphorylation, which is active, to serine and threonine phosphorylation, which is inactive. You literally shut it down. And when we used to grow neurons in a dish, you know, in the lab. So basically what you're saying is that sugar kind of screws up your brain's ability to metabolize energy.

Is that what you're saying? That's exactly right. Okay, because I don't know what tyrosine and serine is. I think that's a basic take-home point is that when you're saying? That's exactly right. Okay, because I don't know what tyrosine and serine is. I think that's a basic take-home point is that when you eat sugar, your brain doesn't like it and it starts to shut down and it leads to Alzheimer's. It becomes resistant to it. Exactly right. It's resistant to the insulin effects, which are so critical for keeping your neurons alive.

So the beautiful thing here is that what we saw in the lab reflected beautifully what you and David Perlmutter and Jeffrey Bland were saying clinically. So that, you know, if we hadn't had all the great work you did, we would have been stuck. Say, okay, what's the next step we take now from the lab? But here's this beautiful functional medicine all ready to plug in the underlying science of Alzheimer's disease. So in that sense, very helpful. And as you said, sugar damages your ability to support your synapses. So you've got to address, with ketones, you've got to address the energy. You've got to adjust the insulin sensitivity. You've got to get insulin sensitive instead of insulin resistant, which virtually everybody with Alzheimer's is. And then you have to reduce any inflammation. Your brain responds to inflammation by saying, I am being attacked. There's some organism out there. So I'm going to

make this amyloid, which kills these microorganisms. But in so doing, I, again, I'm downsizing. So you've got to get rid of that inflammation, not just get rid of the inflammation, resolve it, but you also have to find out what's causing it and address that. So those are the first three things. And then you've got to have the support. You've got to have hormones and trophic factors and nutrients that are critical for rebuilding those synapses. Fortunately, before you actually lose the neurons, you first lose the efficiency of the synapses. The synapses don't work well, but they're still in place, thankfully. So when we do the right things, these start working well again. Yeah, you know, it's interesting. I remember reading this article, because what you're talking

about is multiple different factors that explain the phenomena we see as dementia, but that it's not one disease, that it's many diseases and many dysfunctions manifesting as a particular set of symptoms that are common among people, but it doesn't tell you why. So everybody you look at who's got cognitive decline or Alzheimer's, you have to be a detective and find out what is their particular issue. Is it more insulin resistance? Is it more of an infection? Is it a mold? Is it a toxin? Is it some other nutritional deficiency or hormonal lack, like too much of something, not enough of something else? And what's really striking is that the inflammation is this common theme in all brain dysfunction,

whether it's depression or ADD or autism or Alzheimer's or Parkinson's or whatever, it's inflammation in the brain. And so a lot of your work has really been in understanding what is driving that inflammation. Because the amyloid, like you said, is not the problem. It's actually your body's attempt to fix the problem. It's the band-aid that the body uses to deal with the inflammation and the microbial factors, which often can come from gut and other factors. So talk to us about how we need to rethink this.

Because I remember reading this article years ago in JAMA, which was called Shifting Thinking About Dementia. And there was a great line in there that says, we combine categorical misclassification with etiologic imprecision. And what that means in English is that we, we categorize people according to symptoms, not causes. Right. And we are not really good at finding the etiology or the cause. Right. So we kind of just like throwing, you know, spaghetti at the wall, trying to see what works and what you've done with the

Bredesen protocol and the end of Alzheimer's program is to really map out systematically the ways in which you can identify those factors that are harming your brain. You call them dementogens. And what are those factors that we need to provide the body to optimize and enhance brain function, right? Exactly. So, you know, what happens in COVID-19, again, is cytokines. And so, you know, cytokines are killing people. As you know, the cytokine storm is the problem. Well, part of the inflammatory cascade, part of your innate immune system activation is amyloid.

So we have to quit thinking of amyloid as the cause of Alzheimer's. Amyloid is just like cytokine storm, except it's longer. Of course, COVID-19 has compressed all the things that go wrong in Alzheimer's into two weeks instead of 20 years. But it's the same idea. As long as you have something that is saying, hey, something's wrong with your brain, you are going to continue to make that amyloid.

That's part of the response. So you're absolutely right. You have to determine what these factors are and it's often there are often biotoxins or organic toxins or metallotoxins air pollution of course has turned out to be a big one so all of these critical things and then various pathogens and there are several of these chronic pathogens from Babesia to Bartonella to Borrelia to various mold species to herpes simplex type 1 to HHV6A. These are all chronic pathogens. And typically, as you know, we don't know that we have them. So as you said, you know, this is interesting to me that we used to talk

about people dying of fever. You know, in the 1600s, people died of fever all the time. And so now people talk about people dying of Alzheimer's. It's no different than fever. You shouldn't have a period after fever and fever due to what? And you shouldn't put a period after Alzheimer's. Alzheimer's due to what? That's the critical piece. And so the doctors have always put the period.

They say, you have Alzheimer's, but we need to know why for each person. And it's not one thing. It's not like tuberculosis. It's always the tubercle bacillus, all these different things. So that's, it is a systems disease. That's the point. Yeah, it's so true. You know, I think in neurology, there's a famous joke that you see the doctor and it's basically diagnosed and adios. Here's the name for the condition you have. And there's not much we can do about it. Goodbye. Get your life in order. And that makes me crazy because, you know, over 25 years of doing this and working with people's brains, I wrote about this 12 years ago, I've seen more and more since

then of how we can really impact these patients. I mean, I saw a patient who had dementia. She had Lewy body dementia, which is sort of a combo of Alzheimer's and Parkinson's. She couldn't walk. She was in a wheelchair. She had real cognitive issues. She was trying to run her business. She couldn't function anymore. And we essentially did this detective work that you're talking about using the approach that's described in the end of Alzheimer's program in the Bredesen Protocol. And we found she had tremendous gut issues, tremendous overgrowth of bacteria and yeast in her gut, massive nutritional deficiency. She was diabetic, poorly controlled. Her thyroid wasn't working.

She was postmenopausal and had all these various issues. And we simply corrected those things that we found. And she came back incredibly and her energy came back, her cognitive function came back. She was able to be in her business again. She was a relatively famous person, was able to record another album and write songs and write a book where she'd been totally dysfunctional and non-functional before and was able to even get up out of her wheelchair and start walking. So it's quite remarkable. And this was even over 80 years old. So no matter where you are in the spectrum, we see these remarkable changes that people just don't think are possible. And when you talk to traditional doctors about it,

they kind of dismiss it. But there has been research on this. One of our colleagues, and you've published a number of papers looking at these case studies, but one of our colleagues, Richard Isaacson, did an incredible study that looked at similar kind of personalized interventions, not even the full protocol, and saw that he could not only stop, but he could slow it, and he could also reverse some of the symptoms of cognitive decline. So can you talk a little bit more about, you know, what kind of approaches you do to looking at the factors that are going on and maybe sort of list some of the key factors that you're finding

that are common among these patients? Yeah. And I think the best way to do that is to talk about the subtypes. So what we described back in 2015 is when you start to look at these, to do the very evaluation that you just talked about, then in fact, what you find is that there are people, although there are multiple contributors, people tend to have specific subtypes. So type one, inflammatory. These are people who have exposure. They may have leaky gut. They may have periodontitis. They may have metabolic syndrome, lots of reasons that they have inflammation, and that's the critical driver. And you can literally follow the molecular pathway from NF-kappa B activation, part of the inflammatory pathway, to where it's producing the amyloid, which, as I mentioned, is part

of the inflammatory pathway. So that's the type one. And those people, you need to look for things like HSCRP, TNF-alpha, things like that. And then you need to use resolvins to improve these. And then you need to identify where this is coming from and attack that. So getting, again, upstream is critical. Then there's type two, which is atrophic. And these are the people where they have low vitamin D, pregnenolone, progesterone, estradiol, testosterone, you know, on and on. The critical supports for

this nerve growth factor, brain-derived neurotrophic factor, B12, all these things. It takes, as you know, it takes a lot to keep a brain functional. You have over 500 trillion synapses in your head. You've got an amazing supercomputer inside your skull. So you've got to keep that supported and prevent it from downsizing. Again, this is a disease of insufficiency. And by the way, one of the most common things we're seeing now, nocturnal hypoxia. People don't realize it. The doctors don't check it. They say, oh, I don't snore. I don't need to look at this. And it turns out that when you actually look at it, you see that the oxygen has crept down during the night into the

80s, even into the 70s, we see people in the low 70s who don't realize that they have problems with oxygenation. So sleep apnea, you mean, sleep apnea. It's often without sleep. That's the key. Sleep apnea is the tip of the iceberg. But there's upper airway resistance syndrome as another one of these. And there are people who just don't get enough oxygen at night,

even though they don't have full-blown sleep apnea. So that's critical to check. And then, of course, we talked about the ketones earlier. Then there's the type 1.5, which is glycotoxic. And this is the people where they've got both inflammatory changes because of glycation of hundreds of proteins. And they've also got the atrophic effect because they now have resistance to the insulin. So that's type 1.5 or glycotoxic. Those are the factors. You got to look at their hemoglobin A1C, their HOMA-IR, stuff like that. And glycotoxic means sugar being toxic to the brain and it forms these crusts sort of like a creme brulee on the top of your brain. So it can't really work properly. And that you talked about atrophic, which means lack of things to help the brain grow. Trophic factors are essentially the fuel or the food or

the ingredients that the brain needs to function, including hormones and the right nutrients and vitamins and fish oil, all kinds of stuff that the brain actually needs to function. So you talk about the way you identify this, and I thought this was brilliant the first time I heard about it. You know, everybody knows they should get a colonoscopy to check their colon, but you come up with this term called a cognoscopy, which I love, which is essentially how do you do a deep dive into your brain and all the things that affect your brain that cause risk of cognitive issues?

And by the way, all the things that you measure with a cognoscopy are all the things that affect your brain that cause risk of cognitive issues. And by the way, all the things that you measure with a cognoscopy are all the things you measure for any chronic illness to look at. And some are more prevalent in different illnesses. But with Alzheimer's, you really come up with a model of a cognoscopy. So can you talk about what is a cognoscopy? What should we be looking for? How do we get it? Can we get it with a regular doctor?

Or is this something that you really need specialized care for? Yeah, it's a great point. And people have told me don't use that term cognoscopy. It sounds so horrible. I love it. But it's simple. It's easy to remember. And we all know we should get a colonoscopy when we turn 50. So we recommend everybody 45 or over get a cognoscopy. And as you said, it is things related to chronic illness. But the key is to prioritize. I mean, that's the key. The people who are getting the best results, as you know, are the ones who are prioritizing the things that are the most important drivers. It's different for each person. For some person, you know, it's going to be getting at that Borrelia. For the other person, it's going to be getting at that Mycotoxin. And

another person, it's going to be the Glycotoxicity. So today, it's very simple to get a colonoscopy. One might be mold, one might be lime, one might be sugar, right? One might be mercury, right? And might be vascular. A common one is people just don't have the vascular support for their brain. And this is why they are downsizing. And so if we return that support, we return the oxygenation and the blood flow, they do better. Hey everyone, it's Dr. Mark. Decades ago, I read a book about how light dramatically influences our health because of its impact

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Doctor's Pharmacy. So the way you can get a cognoscopy, it is three things. It is number one, a set of blood and urine tests, easy to do. Number two, it is a simple online cognitive assessment. And if you're completely asymptomatic and doing great, and you're just in for prevention, you can stop there. Just those two things. If you have any symptoms or you're not scoring well on the cognitive tests, you want to include number three, which is an MRI with volumetrics. You want to know the volume of your hippocampus. You want to know the volumes of your frontal lobes and your parietal lobes and things like that. And hippocampus is that little memory center in the brain, tends to shrink. Right. And I've heard you present some cases that when you've done these cognoscopies,

you start these interventions that are in the End of Alzheimer's program, your new book, which everybody should get. And you map out the changes over time when you implement the Bredesen protocol. And remember the story you told of the neurologist, the neuroradiologist, who looked at the scans and was like, this is before and this is after. This doesn't make any sense. I've never seen this in my entire life to go from like 20% of what it should be to 70% or 80% or 90% of what it should be.

Can you explain how that happens? Absolutely. And, you know, we see this again and again and again. We're actually just publishing another paper showing not only increase in hippocampal volume, but also improvement in PET scans, where you go from a PET scan that shows Alzheimer's to a PET scan that doesn't show Alzheimer's. We also see improvements in electrophysiology. So improvements in EEG, improvements in evoked responses, and of course, improvements repeatedly in cognitive scoring and testing. So this is happening because you are putting the things in that actually support the brain. You're getting hormones and trophic factors that are critical. So the brain is now making the synapses once again. Now, we don't know yet, is it making more neurons? Is it making just more synapses?

Is it changing in terms of its astrogliosis? We don't yet know what's happening at the cellular level, but we do know that that atrophy is improving in many of these people. So you said two things there that sort of struck me. One is that your brain can grow. You can rebuild brain tissue that's been damaged by the insults and literally grow your memory center, which correlates with improved cognitive function on the brain cognitive testing. And second, you said you can do a brain scan that you can see Alzheimer's on.

You can repeat the brain scan and the Alzheimer's markers on the brain scan are gone. That's like what? Stop presses, headline news. Why isn't this on the cover of New England Journal, JAMA, cover of New York Times, Wall Street Journal? What's going on here? Yeah, well, partly because, of course, the standard is, you know, do a thousand people and then do the whole study. So, you know, at the beginning, you have to start somewhere. You know,

we're just getting the airplane off the ground. You've got to start somewhere. So we're looking, as you said, at these various cases. We are in the midst, I should say, of the first trial in history in which we look at all the different contributors for each person and address all these different things. We'll be finished with that in December. So very enthusiastic about that trial. But yes, we do see in these anecdotes that we're now looking at, we see improvements in PET scanning and electrophysiology and hippocampal volume and all these things. When you are getting these people to improve and to do the right things, you're literally just restoring a synaptoblastic neurochemistry. And what that means is you're creating a brain that likes to build new brain cells.

That is capable. And you know, it's over almost 30 years ago it was discovered. It was, of course, I was taught years and years ago that, you know, the brain doesn't make new neurons. You get the ones you have and that's it. And then about 30 years ago, it became clear that, hey, there are neural stem cells and you actually do make new neurons throughout life. And so it's a question of which ones do you keep? And do you have, do you have them interact with other neurons? Do they become part of the functional

network? So it turns out you do make more of them. And if you do the right things, you can keep them and you can keep their interactions. Now, one of the big topics that you cover is the microbiome, leaky gut, inflammation, Alzheimer's. And so most neurologists aren't saying, well, let me look at your digestive system. Let me look at your gut and seeing if there's inflammation there. And how does that connect to the brain? And we've talked to a colleague of ours, Rudy Tanzi, who's been pioneering some of the work around finding microbes in the brain. We thought the brain was sterile. We thought the brain had a blood-brain barrier that prevented anything bad from getting in. Well, it turns out that barrier is only semi-permeable and that things can get in and they can be even microbes. So can you talk about this amazing research on

the gut and the brain and the microbiome and how that impacts what we have to do with patients with Alzheimer's? And by the way, that patient that I had who had really had brain dysfunction, her main issue was her gut. And we fixed it up after decades of being constipated, needing enemas to go to the bathroom and laxatives and tons of bad bugs growing in there. It was just amazing what happened. We fixed all of that. Absolutely. And I think that, you know, 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 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 was he was seven years old. He was a CEO of his major family business, couldn't function at all. Sort of 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 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 like 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 do with the vitamins. He had genes that affect insulin resistance. He had years of gut issues. He had irritable bowel for decades and was on Stelazine for his gut.

And so he had all these, 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, and, and it was, 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, a certain number of them, that is the key piece. And here's the thing. 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 5% 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'sheimer's take some mercury eat some sushi exactly but the funny thing is you know that not everybody accumulates the mercury and it's a lot has 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 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 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 50s, 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, get you get the better outcome than this worry? 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, your family history, what actually is going on with your genetics, your 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 all the 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, you might, and that's what we're all dealing with every day. So if you see- Brad Johnson Crap fuel. Dr. Justin Marchegiani Crap 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 do, you get the appropriate phytonutrients. And by the way, one of the most common deficiencies, choline. As you know, choline is needed to make acetylcholine, 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 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? Nutrients. What nutrients? I'll take flavanols. Flavanols 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, all helpful to give you the flavonols.

And then the flavonoids, things like blueberries and things like that, all critical. So those are like 25,000 different phytochemicals in plant foods. And flavonols 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 said, 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 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, I saw my schedule, 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, 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 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 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 going to do anything to fix your risk of heart disease, right? So you have to look at everything together. Absolutely. not going to do anything to fix your risk of heart disease, right? So you have to look at everything together. So let's talk about this concept you talked about called keto flex. We've touched on it a number of times, but what is the diet that's best for your brain? And what is the diet that's best for your brain if you actually have Alzheimer's? Yeah, great point. So let me preface this by saying I know far less about nutrition than you do. So, you know, I'm really talking to someone who's an expert here.

I'm looking at the neurochemistry. So I'm interested in, you know, synapses, how they're made, how you keep them. And so this is Ketoflex 12-3 is nothing more than what's the thing we can use to drive your biochemistry toward an optimal biochemistry for making and keeping synapses. And so what do you need? You need to have ketosis. You need to have all the nutrients we were just talking about for support. You need to have high fiber because you need to help yourself detox. You need to improve your microbiome, all those sorts of things. You need to have appropriate probiotics to support your microbiome. And you need to have fasting periods for autophagy, fasting periods for helping you to get into ketosis, fasting periods for all the great things that fasting does, even things like lowering your

blood pressure. Hypertension is another big risk factor for Alzheimer's. So if you put all that biochemistry together and you mix it up in a blender and you say, what's the diet? We named it KetoFlex 12-3. It's ketotic. It's mildly ketotic. It's plant rich. This is not a bacon related ketogenic diet. This is a plant rich, high good fats, intermediate proteins, low carb and no simple carbs. It is flexitarian, and I realize flexitarian means you have to eat some meat and fish. It's really more about flexibility. You want to be a vegetarian? No problem. Make sure to check your homocysteine and your vitamin D and things like that, but fine. If you want to have some meat, have some fish.

It's hard to be, I i think keto if you're not eating animal protein i mean you can do it as a vegan or vegetarian but it's harder because you it's harder hard to eat reduce the carbohydrate load because you need the protein from beans and grains and things like that so how do you do that with those patients yeah that's a great point and so you know again because getting into ketosis is so critical for supporting brain energetics, we tell them, just start by taking some exogenous ketones. Do it for a couple of months, no problem, because we need to get that energy up. So taking it as a supplement.

Exactly. Then you can get yourself into endogenous ketosis. And we do that by increasing the fat consumption and all the appropriate oils and the nuts and the seeds and all the things oils and the nuts and the seeds and all the things that you've written about that are excellent sources of good dietary fats. And then again, and then if they can't get into enough ketosis, okay, we can supplement that a little bit to get them where they need to be. So that's the flex part. And then 12-3 is 12 hours as a minimum. And if you're ApoE4 positive, you should really make it 14 to 16 hours of a fast between when

you finish your dinner, when you start your breakfast, brunch, or lunch. And then the 3 is for 3 hours before you go to bed. You don't want to be eating right before bed because it'll spike your insulin, reduce your growth hormone in your melatonin, and so forth and so on. So this is why KetoFlex 12-3 is essentially our attempt to take the neurochemistry of synaptogenesis and to put it into a diet. That's so incredible. So you're saying you don't have to be keto if you're not having Alzheimer's for prevention. This is more for treating the patient, right?

It's a great point. And this is one of the things that we've been arguing about lately. If you're just there for prevention, do you want to get yourself into ketosis? It depends on how concerned you are. If you are really concerned about prevention, then you probably want to get at least part-time, getting yourself into some mild ketosis. But you're right.

You don't have to. For someone who's trying to reverse, absolutely. It doesn't reverse well if you don't have to, for someone who's trying to reverse, absolutely. It doesn't reverse well if you don't get into ketosis because you're missing that energy gap. And I, yeah, I've seen, I've seen that with my patients when I, when I put them on ketosis, if they're struggling, because often people will get better without it, but you know, it's not a low glycemic diet, but then you really want to push that envelope. They seem to do a lot better. And what about ApoE4? Because this is a common gene that increases your risk, and you have one or two copies. And there may be some interesting data that I'd love to explore

with you, because historically, there was concern that these patients should not eat saturated fat, that they may have more problems with cardiovascular disease and dementia. What is the current status of the data on these ApoE4 patients, which are a lot? I mean, there are, what, about 45 million or something in America? Yes, 75 million. So here's the thing. Three quarters of the population is ApoE4 negative, and one quarter of the population is ApoE4 positive. So it's incredibly common, and there are some advantages you have to being ApoE4 positive. So it's incredibly common. And there are some advantages you have to have it to being ApoE4 positive. And so in third world countries, it actually gives you a big

advantage because you have a more pro-inflammatory state. You're better at fighting off pathogens, and you're actually better if you have a starvation diet. If you're starving, you want to be ApoE4 positive because you are a better fat absorber. So 75 million Americans have one copy, and they are at 30% lifetime risk for Alzheimer's. If you're negative, about 9% lifetime risk. One copy, 30%. Two copies, well over 50%. Most likely, you will develop Alzheimer's. And that's 7 million Americans.

So critical for all of these people to be on prevention, absolutely. And as far as the fats, it's a good point, and this is a controversial area still. Some arguments would say, yes, a limited amount of saturated fats, okay. I think most people who are ApoE4 positive would like to stick with the monounsaturates and polyunsaturates and stay away. So typically we don't recommend, for example, coconut oil, MCT oil. We recommend if you want to get into ketosis exogenously, just take some exogenous ketone, take ketone salts, take ketone esters, those sorts of things. You can do that a couple of times a day and get nice

spikes in your ketone levels. And then ultimately, again, you want to get into it endogenously. So if I had to say one way or the other today, I would say the preponderance of the evidence today is on the notion that you would want to stay away from saturated fats. Having said that, there are people who do have some saturated fats in their diet and have beautiful lipid profiles, despite the fact that they are ApoE4 positive. So you want to check your blood work and see how they're responding to your diet, not just guess, right? Absolutely. Check your LDL particle number. Try to keep that between 800 and 1200. Or if you want, check your calcium score and make sure that you don't have any cardiovascular disease. But of course, there's an increased risk for cardiovascular disease as

well with people who are ApoE4 positive. So as you said, check to see where you stand to make sure you're doing well. Now, a lot of people listening, and if they're medical professionals listening, they probably think it's heresy to say that we can reverse Alzheimer's, that it's providing false hope, that we don't have the science behind it. And it's really not possible. But you and I both seen that it is possible. And it's not always 100%. But the question is, you know, really, to what degree in your experience is this reversible? And how far along can you be before you can, you know, be confident that it's going to be reversed? Otherwise, is there a time when it's too late?

So can you talk about what that is? Maybe a case or two that explains really how this works in practice. Absolutely. So we can think of this in four phases. Phase one is where people are asymptomatic, but they already have the pathophysiology ongoing. And those people are the ones for prevention, and they do very well. And let me ask you a question. Have you ever had a person who came to you for Alzheimer's prevention who then developed Alzheimer's while on your program? I think I've had people, you know, progress slowly

over 10 years. You know, like I've had people kept them good for 10 years. And then sometimes if they slip off the program, that's when they get into trouble. Well, exactly. Slipping off the program. So I asked this to many functional doctors. Typically, very few people have seen this. When you're on prevention and you start, when you're asymptomatic, you do very well. Then the next phase is SCI, subjective cognitive impairment, which actually lasts about 10 years, where you know there's something wrong. Often your spouse does, but you're still scoring well on the testing. Those people, virtually all of them get better because these are still early stages. Then the next stage is mild cognitive impairment. And these

are people who are scoring 23, 24, 25 on the MOCA scores or 26. This is Montreal Cognitive Assessment scores out of 30. Yeah. So they clearly have significant early Alzheimer's, but we call it mild cognitive impairment at that point. And the majority of those people will increase their scores. And we wrote a paper on this with 100 documented improvements and published it in 2018 with 15 different laboratories. And the average improvement in score was 4.9. So if you came in at 22, you ended up around 27 typically. So that's clearly improving, and they typically sustain it. Then the ones who then are all the way to Alzheimer's, they're now losing activities

of daily living. You know, calling someone Alzheimer's is like saying late stage cancer, metastatic cancer, because it's a very late stage of this process that's been going on typically for 20 years. Some of those people improve. And we've had people with MOCA scores of zero improve. But when they improve, they go from zero to five. They dress themselves again. They speak again, they interact with their families again, they can even do emails again, but they're not normal. So we're not, so far, not able to take someone from zero to 30. And that's one of the big research questions right now. What is missing? They come to a next plateau. What do we need to get them to a higher plateau? Is there a rate-limiting step that's preventing, or is it just the massive loss of

synapses? Do we need to then think about stem cells, intranasal trophic factors, methylene blue, all these sorts of things that are coming. EWOT, that's another thing we've been interested in, exercise with oxygen therapy, all the things that we can bring to bear. So the bottom line is the farther along, the harder it is and the less complete the improvement. But if you catch people early or even in mid-stage, you can do a lot just as you've indicated. Absolutely. I've seen that. So can you share maybe a story or two of a patient you treated, what you found and what kind of things you did and how they improved? Yeah. Oh, absolutely. There are hundreds and hundreds like this. So, simple example of a woman,

amazing lady, who's a psychiatrist, who was having major problems. And in fact, her husband said to her that, he said, your memory is disastrous. She got to the point where she just couldn't remember anything. She's 73 years old. And actually, she contacted me by email a few years ago. And we started going back and forth. And she started checking all the various things. And she had initially had a lot of the type 2, reduced estradiol, progesterone. No surprise, she was 73. Reduced vitamin D, poor thyroid, all those.

So all those were addressed. She then improved. And she actually went from nine. So she was in the ninth percentile on her initial cognitive scores. She's now at the 97th percentile on her cognitive scores. So she's just dramatic. She got very, as you've seen yourself, people get into this. And she started doing this game called Elevate as well as Brain HQ.

These are brain training programs. And she just got into this stuff and started working it. She started dealing with all these things. Like brain exercises. Brain HQ. These are brain training programs. And she just got into this stuff and started working it. She started dealing with all these things. Brain exercises. Brain exercises. And then interestingly, she optimized her various nutrients. And then it turned out, said, wait a minute, we haven't checked all the pathogens here. She ended up having Ehrlichia. She was from the New York area. And she ended up having exposure because of a tick bite. When that was treated, she continued to improve, and she's just done well. Interestingly, she had not only improvement in her MRI hippocampal volume, she also had a PET scan.

Her first PET scan was diagnosed as looks like early Alzheimer's. Her latest PET scan looks like early Alzheimer's. Her latest PET scan looks like no Alzheimer's. So she actually improved her PET scan, improved her MRI, improved her cognitive scores. And as she said, you know, her significant others said to her, you know, you went from disastrous to just plain lousy, and then from just plain lousy to normal. And so she now plays, she goes out and plays golf with her friends, and they can't cheat her anymore. She knows how many strokes they've taken. Incredible. And what did her neurologist say? Yeah, interestingly, her neurologist said, in fact, she went in, she said to me that she went in there and there were all these people.

She said it was a very depressing kind of typical neurologist's office. Everything's bad. And she said he came out and he was so excited because he saw how much better she was doing. And he started saying to her, you know, what have you been doing? This is incredible. And we hear this a lot. People will come out and say, whatever you're doing, keep doing it because something is working here. Well, this is really exciting. What is on the horizon in terms of the research you're doing? Because, you know, clearly you and I have had experiences, we're seeing this over and over, our colleagues who are doing this in functional medicine are seeing these results, but it's still pretty

much dismissed by most traditional neurologists and Alzheimer's researchers. And even all the Alzheimer's funding isn't going toward this. Absolutely. What is on the horizon that gives you hope around the research that we can show the data and begin to change the conversation? You know, this is a great point because we really do have the opportunity now to reduce the global burden of dementia dramatically. And, you know, people wiped out things like polio and smallpox with vaccines, global programs. We need to have a global program to reduce

the burden of dementia around the world by doing these correct things. And this is not magic. This is our complex organism that we're dealing with. And you have to look at the right things and do the right things to do that. Where the research is going is to take these same principles. What we're finding, of course, is that the supply is being exceeded by the demand in all of these diseases. So we have to increase the supply, reduce the demand. And there's a unique chemistry for each of these, for macular degeneration, for frontotemporal dementia, for ALS, for Lewy body disease, and on and on. And adjusting this sort of approach to each of these, we should be able for the first time to make improvements in all of these different

neurodegenerative diseases. Yeah, I think it's true. And I'm excited. We really are at this forefront of an era when our rethinking of disease is going to provide the key that unlocks so many of our dilemmas in health, everything from these neurodegenerative diseases to mood disorders to ADD and autism, and of course, even all the other chronic diseases. And so the approach of functional medicine provides a roadmap to really look at what's going on with any patient. So you talk about a cognoscopy, it's the same approach to look at whatever's going on with any patient. So you talk about a cognoscopy, it's the same approach to look at whatever's going on with somebody. And what are the dementia genes?

And they're the same and similar things that cause all diseases. So it's not like there's 4,000 causes of disease, there's a short list of things that cause problems and a short list of things the body needs to actually heal and repair. And what you've done is laid that out so beautifully in the end of Alzheimer's program.

It's called The First Protocol to Enhance Cognition and Reverse Decline at Any Age. And I really believe that people get this book and they look at it carefully. It's going to provide insights, not just to the brain, because you're a neurologist, you're focused on the brain, but I see this from the context of chronic disease in general, to help really understand what's going on. And you've really mapped out what are these dementogens? It's things like our diet that's full of starch and sugar. It's our widespread nutritional deficiencies. It's things like heavy metals. It's infections like tick infections. It's toxins like mold toxins. It's microbiome issues in our gut. It's our oral health. It's all of these things that are driving these problems that are

causing inflammation. And then at the same time, like what are all those components that we need to be healthy, the right kind of diet, ketones and nutrients and hormones and probiotics and all the things we need to actually add to the body to create health. And you do this with any patient, their health is going to improve. And you particularly do it with a patient with cognitive issues and any age spectrum. And I wrote I wrote an article years ago, which, which I was very proud of because it was way before anybody was talking about this, but I think Alzheimer's and autism are often very similar diseases at different ends of the age spectrum. And if you look at the biology of what's going on with these patients, there's amyloid and stuff is different, but their brains are both inflamed. They often

have the same causes of the inflammation and fixing them is often very similar. So I think this is really the most exciting era. And I, and I, you know, I think you should get the Nobel prize for what you're doing. I really do. I think, I think you're way ahead of your time. And I think we, we really need to think about getting in the research. If anybody's listening to this, who has Alzheimer's, who's knows someone who's Alzheimer's, who has cares about this issue. I think, you know, we need to fund some big studies to look at this and get this done rigorously. And I think it's a really exciting moment where we can begin to do this because we know enough about the brain and we have the big data analytics, the artificial intelligence, and the science of functional

medicine and system biology to really put it all together. So Dale, I can't thank you enough for your work and what you're doing to advance these ideas in medicine and to give people hope where there really was none. Thanks so much, Mark, and thanks for having me. And as you know, you and I are both on the same panel with Maria Shriver and a number of others to change the way we think about this. And the problem, of course, is that there's going to be pushback. And so, you know, over time, I think we need to get people to understand that, yes, there really is something to do, especially in the prevention and early reversal area. And we really can reduce the global burden of dementia. So thanks so much for the great work you're doing.

Thanks so much for having me on. I really appreciate it. Stay safe. Of course. And everybody should check out the End of Alzheimer's program, the first protocol to enhance cognition, reverseline at Any Age. If you go to ApolloHealthCo.com, ApolloHealthCo.com, you can learn more about the book, learn more about his program, learn more about how to actually learn about what you need to learn for your health and your family. It's

just an incredible resource, and I hope everybody takes advantage of it. And if you love this podcast, please share with your friends and family on social media. Leave a comment. Tell us about your story of how you've identified ways to help enhance your brain. And subscribe wherever you get your podcasts. And we'll see you next time 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. 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 to 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 and enhance our health and i'd love you to sign up for the weekly newsletter i'll only send it to you once a week on fridays nothing else i promise and all you do is go to drhyman.com forward slash pics to sign up that's drhyman.com forward slash pics p-i-c-kS, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Hi, everyone. 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 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.