The Dr. Hyman Show - The 5 Main Ways To Prevent Alzheimer's & Dementia

Episode Date: January 17, 2022

This episode is brought to you by Rupa Health and Paleovalley.   Protecting your brain and cognitive function is not just for the elderly. It’s never too early to start protecting your brain, which is something we should all think more about as Alzheimer’s and dementia rates continue to rise. We can start with healthy lifestyle choices that affect diet, sleep, stress management, and more. The bonus of brain-healthy lifestyle choices like these is that they protect the health of your entire body as well.   In this episode of my new Masterclass series, I am interviewed by my good friend and podcast host, Dhru Purohit, about Alzheimer’s and dementia. We talk about early detection, contributors to cognitive dysfunction, foods that fuel the brain, and so much more. We also discuss how other factors, such as toxicity, sleep apnea, and even lack of community, affect brain health. Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30+ million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset. This episode is brought to you by Rupa Health and Paleovalley.   Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. You can check out a free live demo with a Q&A or create an account at RupaHealth.com.   Right now, Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal.   In this episode, we discuss (audio version / Apple Subscriber version):   Things to do in your 20s, 30s, and 40s to reduce your risk of cognitive decline (4:23 / 1:15) Using brain scans to detect Alzheimer’s and dementia (10:37 / 7:26)  Contributors to cognitive dysfunction (13:30 / 10:00)  Fueling your brain with a healthy diet (18:16 / 15:07)  The importance of movement to reduce your risk of cognitive decline (28:34 / 25:10)  Ineffective pharmaceutical interventions for Alzheimer’s (31:51 / 28:08)  Why sleep apnea increases your risk of cognitive decline (38:24 / 34:48)  The effects of chronic toxicity on the brain (49:34 / 46:14)   5 things everyone can do to improve brain health (54:01 / 50:24)  Significant signs of cognitive decline (1:05:57 / 1:02:49) 

Coming up on this episode of The Doctor's Pharmacy. The science of brain health and the science around dementia and Alzheimer's has just exploded. And it's taking a very different tack. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me, helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to understanding what each individual person and body needs is testing, which is why I'm excited to tell you about Rupa Health. Looking at hormones, organic acids,

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cinnamon, ginger, and turmeric, all of my favorites. Right now, Paleo Valley is offering my listeners 15% off their entire first order. Just go to paleovalley.com forward slash hymen to check out all their clean paleo products and take advantage of this deal. That's paleovalley, P-A-L-E-O-V-A-L-L- l e y.com slash hyman. Now let's get back to this week's episode of the doctor's pharmacy. Hey everybody, it's Dr. Mark Hyman. Welcome to a new series of the doctor's pharmacy called masterclass. And that is where we dive deep into popular health topics, including inflammation, autoimmune disease, brain health, and much more. And today I'm joined by my guest host, good friend and business partner, Drew Prowitt, who's the host of the Drew Prowitt podcast. And we're going to be talking about how to prevent and maybe even treat and maybe even

reverse Alzheimer's and dementia. All right, Drew, we're going. Mark, let's jump right in. Alzheimer's, dementia, two of the scariest conditions that somebody could imagine. And there's a lot of fear associated around those, especially because it feels like there's not much that we can do, at least in terms of traditional medicine. We're waiting for a miracle drug to bail us out of this mess. But from the world of functional and integrative and precision medicine, there's actually a lot that we can do and take advantage of. So can you talk to us about the few things that we could be doing early in our 20s, 30s, and 40s to help us prevent dementia and Alzheimer's? Absolutely, Drew. I mean, this is an extraordinary year to be alive.

I mean, thank God we're alive now and not 20 or 30 or 40 years ago because the science of brain health and the science around dementia and Alzheimer's has just exploded. And it's taking a very different tack than the pharmaceutical approach, which has been so focused on. And literally,

there's been over $2 billion and probably 400 plus studies, all of which on pharmacology, all of which have basically failed. There's a couple of drugs that squeak through that have marginal benefit. Like, okay, well, maybe you end up delaying admission to the nursing home by three to six months. Is that a win? Hell no. So what has actually emerged in the science now that's helped us to understand a different way of thinking about Alzheimer's? The first is our understanding of what the etiology, the cause, the causes of Alzheimer's. And we call these things dementogens. I call them dementigens. And my friend Dale Bredesen came up with a wonderful concept called a cognoscopy. It's

like a colonoscopy except for your brain. And it's the idea that there are a lot of biomarkers and things we can measure and look at that will determine your risk and trajectory around brain health and obviously even general health. So what we've come to understand is in your 20s, 30s, and 40s, it's a critical time to act. Because when we look at the imaging studies and we look at early diagnostic studies and we look at the processes that are happening in the brain, we can often detect changes 20, 30, 40 years before anyone has their first symptom of memory loss. And that's staggering. And it sounds scary, but it's actually great news. Because if you detect it early and you modify the risk factors and you optimize your biology,

you literally can stop and even reverse this process. So it's obviously the things that we know as foundational for health, right? Healthy diet. And we'll talk about what that is. So what is a brain healthy diet? What's the importance of exercise and what kind of exercise works for your brain? Sleep. Stress reduction.

Because stress literally shrinks your brain and causes dementia. No joke. The memory center in the brain called the hippocampus literally shrinks when you're under chronic stress. So foundational lifestyle factors are so key and there's tweaks to them that are unique to keeping your brain optimally functioning. And then of course, there's deeper layers on the cognoscopy to look at. What are your heavy metal levels like? What's your microbiome like? Do you have inflammation? Are you exposed to mold? Have you had tick infections? Do you have allergies? Are you sensitive to gluten? What's happening with your mitochondria?

What's happening with your detoxification process? All of these things are things that we can look at and measure and see where they're at. What's your nutrient status? I mean, just for example, if you are low in certain B vitamins like B12, folate, and B6, and you have a high homocysteine of, let's say, 14, which is even in the conventional labs is considered, quote, normal. It should be like six to eight, but if it's 14 year risk of getting Alzheimer's is 50% higher. And that's just,

you know, multivitamin basically. So we have so many amazing tools and techniques to use now to one, evaluate the dementia genes through a cognoscopy and to create a science of brain health and optimization, which is really what we need to do. Now, you said 20s, 30s, and 40s, but there's going to be a lot of people that are listening here that are 40 and above. Are they out of luck or are there still things that we could be doing so that there may not be a diagnosis yet, knock on wood, but is there still hope for people in the 40 plus crowd? I hope so. Cause I'm in that crowd. And actually a number of years ago when I was 40, I had a brain

scan and it was frigging scary, Drew. It showed a really dramatic under-functioning hypo, hypo functioning of the brain. And when you see this,po-functioning, it has to do with various insults to the brain that can be reversed. And at the time, I had mercury poisoning, mold toxicity, Lyme disease. All of these are reversible causes of cognitive dysfunction and decline. And so I worked really hard on myself to clear all these things, to get healthy, to get rid of my Lyme, to get rid of my mold, get rid of my mercury, and many other things, get my microbiome healthy. And I repeated the scan, you know, about 10, 15 years later, and my brain had completely healed. It was really amazing. All the brain blood flow is back. My brain function centers were working. And it was like, you can at any age.

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

And they found that they gave them these radioactively labeled dyes that were only inactively replicating neurons. In other words, in new brain cells, you only see this thing being picked up if they were making new brain cells. And they literally were dying of cancer and they were still making new brain cells, which you could detect on imaging. That's really remarkable. And we know there's the whole field of neuroplasticity and neurogenesis, meaning we can make new brain cells. We can actually increase the connections in the brain. I'm learning tennis. I'm 15 years or so into it. I keep improving and improving and working on it. And my tennis coach was like, yeah, this is really good for your brain and learn new connections. In fact, tennis players live an average of seven years longer. And part of that is you're constantly working on different

aspects of motor coordination, visual. It's like, it's a, it's a thing, right? So it's like, you absolutely can modify this risk at any age. Just for a clarification for the audience, what was the brain scan that you did? What was the type of brain scan that you did? And would you recommend it to individuals who are listening today if they're trying to get a sense of where their brain health might be? Yeah. So there are many types of brain scans. A typical brain scan for Alzheimer's is an MRI, which can look at both brain volume, overall volume of the brain and shrinkage. It can look at hippocampal volume, which is the size of the memory center of the brain, which shrinks with dementia and actually can grow back when you apply some of

these principles of functional medicine to brain health. And that's sort of the standard test. And it can also look at amyloid. There's actually imaging that looks at amyloid plaque in the brain. So you can see various amounts of amyloid, which is the thing that actually seems to cause the gunking up of the brain. The question is, what is the amyloid? What's it doing? Should we be trying to deal with it? There's a whole deeper conversation we can have.

It's kind of a rabbit hole. But essentially, it's inflammation. And then there's even more advanced scans that can look at early inflammation in the brain. And now there's a sort of more advanced functional MRI scans that can look at inflammation. And those are really emerging. Honestly, if those were readily available and the cost was reasonable, which I think it will be eventually, right? We're seeing exponential technologies where the price goes down and the power goes up. And we're seeing that across the spectrum, including imaging. When that happens, you know, we're going to be able to sort of really early

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

And the neurologist there, who was the head of the memory disorder center, was so inspired that he started a brain health clinic. Because he's like, whoa, we can actually do something about this. So it really was great. That's fantastic. And so just again, clarification, because I know people are always curious. So the SPECT scan, was that through like the Amen Clinic or something comparable? Yeah, that was through the Amen Clinic. Yes. Daniel Amen has really pioneered a lot of the work on the SPECT scan. And I did it at the Damon Clinic. So I did it twice there. So it was really great. you were younger than you are right now and that you were seeing that your brain wasn't optimizing and wasn't operating in a functional, in the best high functioning way. So what was causing, what were some of the lifestyle factors that were going on? We'll get to environmental

factors and we'll get to toxins and heavy metals and other stuff in a second. But what were some of the other things that you were doing that you think were that were causing your brain to shrink and not perform at its best? Well, you know, um, I mean, I've, I've led a relatively healthy lifestyle my whole life. Um, eat mostly clean. I surely was eating more carbohydrates back in the day when low fat was bad, was good. And pasta was the health food. So I was definitely on that train early on in my thirties and so forth. I exercise, I always did yoga. I did have sleep issues. I think that may have affected it just working in the emergency room, working long hours, not sleeping for days, being a single father, high stress. So it wasn't so much the diet and exercise part for me. It was more

the sleep and the stress part. But the truth is, Drew, that wouldn't have caused the level of cognitive dysfunction that I had. It really was these outside factors. And the truth is, for most people, though, for most people, it's the fundamental lifestyle factors. It's not the things that I had. And there's a subset of people who have, yes, who have heavy metal poisoning, who have mold exposure, who have Lyme disease, like Chris Christopherson had Lyme disease, was diagnosed with dementia. He gave me antibiotics and boom, he was better. So I think mine was a little bit of a unique case. I wasn't insulin resistant. I wasn't overweight. I exercised. I tried to meditate, did yoga. I was working on stuff, but it was these other outside factors that are often ignored.

And I wouldn't even just say ignored, but I would say that are not even on the radar of most clinicians. Dismissed even sometimes. Yeah, they're dismissed or not even on the radar of people who are actually fully engaged in the Alzheimer's research. However, there are leading Alzheimer's researchers that are on board with this 100%, like Rudy Tanzi at Harvard, who discovered the presenilin genes, who was one of the key sort of, one of the key researchers in all of Alzheimer's research. He's on board with this. He completely gets this. So there's a lot of opportunity for real change. And I see more and more of this happening within the space. I see guys like Richard Isaacson, who's amazing. He's formerly

at, I think, Weill Cornell. And he's actually done some incredible research looking at simple lifestyle interventions that are personalized based on biomarker analysis to what he was trying to do was just delay or slow the progression. I think they were shocked to find that by aggressively optimizing diet, exercise, sleep, stress, the nutrient levels, treating homocysteine, dealing with insulin resistance, dealing with all the variables. And by the way, he wasn't even dealing with all the things we deal with in functional medicine. He was just doing the first pass, which is way more than most doctors do because they're looking at a single drug, a single intervention. They're not using multimodal,

multidimensional interventions, which are, you know, lifestyle, broad lifestyle approach and so forth, and personalization. And he found not only did they not progress, but they actually reverse cognitive decline, which is incredible. There are other studies also that have been done. His was the most personalized and specific and had the most impact. But there are other trials like the finger trial, there's another called the pointer trials coming up. These use lifestyle interventions for people with cognitive decline, optimizing risk factors, and they found significant improvement in cognitive function in pre-dementia patients. It's called pre-dementia or MCI or mild cognitive impairment. That's impressive because there is no drug that can do that.

Well, you were mentioning some of those lifestyle factors that are there for most people. It wasn't the situation in your case. Let's walk through them. What could a diet look like that was designed? If you had to design a diet that was supposed to shrink someone's brain and eventually lead to Alzheimer's and dementia, what would that diet look like? Again, this is a diet designed to shrink somebody's brain. For breakfast, you have like a glass of orange juice, some Froot Loops, a muffin, a bagel,

and French toast with some maple syrup. And then, then for lunch, uh, you maybe have, uh, a big bun with, uh, uh, you know, maybe some American cheese and processed meat. And then for dinner, you have a big bowl of pasta, a giant glass of a bottle of wine and, uh, a side of bread and potatoes. And then for dessert, you got ice cream and cookies and yeah, pretty much that's what you're going to be eating, which is a very inflammatory, high carb, high starch sugar diet. And I'm sure there's some people that are listening today that are like, whoa, he just described my diet. Okay. So walk us through that. What is the common themes? What are the common themes of that diet that you just described and, um, and what's missing from it that, um,

that makes it so detrimental to brain health? So when I was in medical school, we were trained that your brain is the number one utilizer of energy in the body. The number one utilizer of glucose. It's, you know, it's like, I don't know, 2% of your weight, but 25% of your glucose consumption. And so the whole idea is you need sugar for your brain. It's not true. It turns out that your brain runs much better on fat, particularly ketones. Your brain is about 60% fat. And that there's brain phenomena, which they're calling type three diabetes, which is really what they're now calling Alzheimer's because inside the brain, you get insulin resistance. Think of it as diabetes of the brain. And when you get that, you get increased inflammation, you get increased oxidative stress, you get the production

of what we call ages or we call advanced glycation end products. Think of it like the crispy thing on a creme brulee or the crust of bread or the crust on a bread or crispy chicken skin. Those are proteins and sugars combining to form this crust. That's what happens in your brain. And you end up having this really terrible inflammatory brain degrading process called insulin resistance within the brain. And so you want to design a way of eating that keeps your insulin levels as low as possible. If there's one single thing that we know about aging and all age-related diseases, the single common denominator across almost all of them, and there are exceptions, but pretty much for the common stuff, it's insulin resistance, meaning your body makes too much insulin in

response to the carbohydrate load that you're eating. And it gets worse and worse over time. So it's a vicious cycle where you eat more carbs, you get more insulin resistant, you can eat more insulin, you eat more carbs because you're hungry and crave them, and you end up actually getting very high levels of insulin. That is just a disaster because when that happens, you're getting not only belly fat storage, you're getting increased hunger, increased cravings for carbohydrates, you're slowing your metabolism, you're causing your brain to get demented, You're causing heart disease. You're causing cancer. You're causing kidney failure. You're causing high blood pressure. You're causing all the things that we think of as

diseases of aging. And we treat them in silos. We treat them all as separate problems, but they're not. They're all connected by this underlying mechanism. So insulin resistance, I've written many, many books about it. But essentially, if you're going to design a brain healthy diet, it would be extremely plant rich. So you'd get all the colorful plant compounds that you see from colors of reds, blues, yellows, greens, orange, purple, all in fruits and vegetables. So eat as many deep colored varieties of vegetables as fresh as possible, as local as possible, as nutrients dense as possible. Second is you need a lot of fat and fat is really important for the brain. So you need olive oil, avocados, nuts and seeds, and something called MCT oil, which is

really a super fat. And the brain loves this fat. It's great for mental clarity. It's great for focus. It's the preferred fuel for your mitochondria, which is the energy production organelles inside your cells. So that's really key. And you also want a diet that's high in omega-3 fats. So you want sardines, mackerel, herring, small fatty fish, not the big fish, because that has mercury and that's going to cause a problem. And you could even take fish oil. You also want a diet that's very rich in choline and B vitamins. So choline comes from eggs, comes from sardines, and also the B vitamins, B6, B12, folate, which are critical in this particular pathway called methylation. And I just had a quick story of a patient who was about maybe 75-ish, and she was diagnosed with early dementia by her doctor and told to get her

affairs in order. She was a very wealthy woman. She was on the boards of all these companies, but she couldn't function anymore. And she had to pull back from everything. And she came to see me and she had a relatively simple problem to solve, which is when she had a homocysteine that was really high and a methylmalonic acid that's high. And those are blood tests that measure your, a more accurate functional measurement of B12 and folate. And so I gave her B12 shots of methyl B12. I gave her a high dose of methylfolate and B6 and a whole cocktail of methylation support, which is this critical cycle in your brain and in the rest of your body.

And she was completely cured. And about maybe five, six, seven years later, she was like 84 or something. I got a call from her. I thought, you know, because the thing is with functional medicine, you're like, you get people better. You teach them how to take care of themselves. And you may never hear from them again, right? So, which is actually the good thing. You don't want an annuity of patients coming back for their refills on their blood pressure or cholesterol or their dementia medication.

And I was like, oh, maybe she went downhill. Is she all right? So, I was worried about her. So, I got on the phone with her. I'm like, hey, how's it going? You know, she's like, well, I'm planning a trip to Bhutan trekking and I just want to know what I should take with me from a medical point of view. I'm like, oh God, okay. So, you know, sometimes it's as simple as that. Sometimes it's more complicated. You know, sometimes people have tick infections or mold or they have mercury or they have other issues. But hers was relatively straightforward. So we look at all those things and food, how do we upgrade those nutrients through colorful cruciferous

vegetables that are full of folate vitamins? How do we maybe eat liver? Liver is probably one of the greatest brain foods. I know people go, ugh, liver. But I thought liver was like a gourmet food because when I was a little kid and we lived in Queens and my mom, my sister and I in a one bedroom apartment and we were very poor. I mean, she worked as a teacher in Harlem. And for dinner, we'd have fried onions and chicken livers over rice. And I was like, this is a gourmet meal. It was so good. But if you actually, it's actually surprising. You know, we all think plant foods are the most nutrient-dense foods, the most vitamins, the most minerals. If you look at liver and then you look at the best vegetables on the planet and you compare them side to side, basically the liver looks amazing and the vegetables look like, you know, chump change. And it's pretty impressive to see. It's like, if you look at a bar graph, all the nutrients on the liver like this and all the rest are like

down here. So, you know, there's a lot of ways to get these nutrients through food. Obviously, supplements can be helpful, but the diet is so key. So lots of good fats, lots of phytochemicals, very low starch and sugar, and obviously a microbiome healthy diet. The microbiome is super important. So I've written a lot about this, but how do you create a healthy microbiome? It's really a critical factor through tending your inner garden. We're coming up with a new product called Gut Food, which is just sort of a one-stop multivitamin for your gut to help the bugs grow good and have good bugs in there. But there's a lot of ways to tend your inner garden through eating pre and probiotics, through eating lots of fibrous foods that actually help fertilize the good bugs. So that's also really important. So you got to kind of look at the whole spectrum of your diet

and how do you optimize for immunity? How do you optimize for insulin? How do you optimize for your microbiome? How do you optimize for your mitochondria? How do you optimize for methylation? So as a doctor, I'm thinking, I got this whole pharmaceutical cabinet full of powerful drugs that is basically what ends up on the end of your fork. And that's the stuff that actually really works. And it works better than most drugs. And there's many studies on this. There's the MEND diet, which is showing really amazing results in terms of dementia. And it wasn't even that great a diet, honestly. It was like kind of an old Mediterranean diet, a little bit healthier than most people eat, but they showed significant improvement in cognitive function. So when you push the envelope, and I

just did a podcast with my friend Cara Fitzgerald, and it was amazing. They did a functional medicine, food as medicine intervention, very, very nuanced selection of different foods that specifically contain nutrients that regulate aging and your biology. And they were able to do this really in a very prescribed way, using food as pharmacology and actually reverse biological age by over three years within an eight-week period, which is staggering. I mean, nobody's ever to show that even in these other drug studies, intervention studies. It was mind-boggling. And basically, nobody's ever to show that even in these other drug studies, intervention studies, it was mind boggling. And basically they didn't have supplements. All she did was basically use foods and identify the most important nutrients around regulating biological aging.

And she gave those nutrients in the form of food and it worked so much and it was so much more powerful than any other intervention. So that's the kind of thing we think about when we look at food and diet. One of the things included in that study, which I'd love to have you talk about a little bit, was targeted spices, things like spices and herbs like rosemary, other things. How important are spices to be including in our repertoire when it comes to our brain health? It's huge. I mean, you're Indian, Drew, and India is just like the king of spices over there. It's a country of spices. And I think it's a very powerful way to upgrade your diet with extremely powerful phytochemicals that are found in things like curcumin and cumin. I mean, like, for example, nigella seed, black cumin seed

is very effective against viruses and it's being used in poor countries, for example, nigella seed, black cumin seed is very effective against viruses and it's being used in poor countries, for example, for treating COVID. So we really have to look at the world of spices as an adjunct to our pharmaceutical cabinet of food. So I have, if you look at my, I have like a giant drawer at home. It's like literally, it's like this big and it's like really deep. And I've got like rows and rows of spices. And I'm a very big spice guy because they're so powerful in regulating inflammation, detoxification. They're made the polyphenols in them can be great for your microbiome. So it's really important to think about using some of these things like rosemary and curcumin, like peppers, chili

peppers are amazing. So there's all kinds of things you can use, but I encourage people to really focus in on spices. Another lifestyle factor that we talked about earlier that you'd always have a good dose of in your life, which is exercise, actually has some really strong data when it comes to helping to prevent and reduce our risk of Alzheimer's and dementia. Can you chat a little about movement? I know you'd like to drop the word exercise and you want to have people think more in terms of just movement overall. Play. I like to think of it as play. Play. Talk a little bit about play. The interesting data is that, you know, if you look at some of the just large studies that have

been done, like in the New England Journal or JAMA, the major medical journals, I think just walking every day can dramatically reduce your risk of Alzheimer's, just that alone. But we know that there's ways to really upgrade that. And it's really looking at how exercise affects the brain. Obviously, it increases oxygenation and improves insulin resistance, but it actually stimulates a really important molecule when you exercise called BDNF or brain derived neurotrophic factor. And it's a big mouthful, but essentially what it means, it's like miracle growth for the brain. The more you have of this, the more connections you get in your brain, the more cells you get, brain cells. And it's super important for helping to regulate your brain function. So that's super

critical. And we know that you can actually improve the mitochondrial function, which is so important for health and aging. We can improve insulin resistance. We can improve methylation, even DNA methylation, the epigenome function, which genes get turned on and off through exercise. So it's a critical component and it makes you feel good and it makes you actually reduce the hormones that can cause shrinkage of the brain like cortisol. Cortisol is an important hormone. It's a stress hormone. You need it. But most of us have way too much being produced because of chronic stress.

So cortisol, we know, if you actually look at the studies, shrinks the hippocampus, which is the memory center of the brain. And they've done the animal studies, for example, where they'll actually give them sort of like a equivalent of a Cushing's disease where they have a lot of cortisone in the adrenal tumor, and then they'll take it out and their brain literally grows back, like the hippocampus grows back. So we know chronic stress plays a huge role as well. All these things we can actually play with.

And when you exercise, you're reducing cortisol, you're increasing growth hormone, you're increasing testosterone, you're increasing all the things you want to increase, and you're lowering all the things you want to lower. So it's really kind of a one-stop shop. And honestly, if exercise was a drug, it probably would be the most powerful drug on the planet. I mean, it's just food and exercise are the most powerful drugs and they work in ways that you can't even imagine that no drug could ever do. So we go, we're waiting for the pill for this or the pill for that. Good luck. I mean, maybe I'm wrong and I hope I'm wrong because yeah, I would like to be able to eat a pill and have my pint of chunky monkey ice cream every night. I just don't think that's going to happen. Well, speaking of pills, there was a big hoopla around a medication that was being looked at,

potential FDA approval last year. And it was a lot of controversy around it because going back to one of your original statements, the drug had very little efficacy in terms of being able to move the needle forward. And more importantly, there was a risk that if the drug was largely prescribed, it could potentially bankrupt Medicare with how many people are struggling with Alzheimer's and dementia. Can you chat a little bit about that, just high level and talk about the general pharmaceutical approach to trying to get to the root cause? Even if it's a little bit misguided, at least right now with the technologies we have, what are they trying to do with these

drugs? So the whole history of drug discovery in Alzheimer's has been a disaster. Like I said earlier, billions of dollars, over 400 studies, basically nothing. And everybody's desperate because one, Alzheimer's is increasing at dramatic rates. You know, we're going to see triple the cases. And, you know, within a few years, we have probably 50 million people who probably are at risk of predimension in America. It's a staggering problem. It is the most expensive condition. And there's just a desperation to try to find an answer. And as is typical in traditional medicine, they're looking for a single pathway and a single drug. So they create different hypotheses. Oh, it's amyloid.

Amyloid's the problem, which is this kind of sticky stuff that clombs around the brain and gums up the works. And they're like, well, we need to find drugs that stop amyloid. So there's billions of dollars spent on drugs that stop amyloid. They didn't do a thing. And in fact, what was really fascinating is that Rudy Tanzi talks about this. They have patients, there's a subset of patients who have totally normal brain function, like cognitively alert, focused, no memory loss. And they die, they do autopsy studies, and their brains are full of amyloid,

which you'd see in Alzheimer's patients. But what they don't have is inflammation. So absent inflammation, the amyloid doesn't do anything. And they have some gene deletion that prevents them from mounting a big inflammatory response, which ends up being very protective. So people are looking really for these single pathways, these single mechanisms, looking at tau and amyloid. And none of them really worked because they're looking at the downstream consequences of the problem. It's like bailing the boat with a hole in it instead of fixing the hole. And that's never going to work. And the other problem is that dementia isn't one thing. There's a great article in JAMA a number

of years ago, which was called Shifting Thinking About Dementia. And they said, we combine categorical misclassification with etiologic imprecision. And what that means in English is that we classify according to symptoms, not causes. And that's a mistake. So like I said, dementia, even though the end result may look similar in a patient, their memory loss and all the clinical symptoms and so forth, the causes for any one patient might be different. For one patient, it might be that they have insulin resistance, or prediabetes, or diabetes. Diabetics have four times the risk of Alzheimer's. Or it might be they have severe methylation problems. Or it might be that they have a chronic infection with Lyme disease or some tick infection.

Or maybe because they have high mercury. Or maybe because they've been exposed to a lot of mold. Or maybe because their microbiome is creating general inflammation throughout their body. Or maybe they have some weird copper zinc metabolic pathway that's not working. Or maybe they've had sleep apnea for years and it's causing cognitive decline. So you've got to really look at all the individual factors. That's what I was talking about a cognoscopy earlier, which is this idea that you can actually start to look for these root cause things and do a root cause analysis and then treat each of these things. So what needs to happen is a multimodal approach to dealing with all the causes.

And this is what we call network medicine, systems biology medicine, functional medicine, whatever you want to call it. Dale Bredesen talks about it. If a roof has 36 holes in it and you fix three of them, it's still going to rain in your house. Even if you fix 30 of them, it's still going to rain in your house. You got to find and fix everything. And that's the approach of functional medicine.

And it's the antithesis of traditional medical research, which is a randomized, double-blind, placebo-controlled trial. So the idea would be to get like 100 people, divide them in two groups. They're all identical. 70-year-old white male from Minnesota who eat cheeseburgers on Fridays and watch football. I mean, that's basically what they try to do, match controls. So they're identical as possible. And then they tried to use a single agent

to create a single effect on a single pathway to create a single outcome. Now, for some things that can be effective, right? If you look at pneumonia from streptococcal pneumonia, you take penicillin, it's a single bug causing a single illness cured by a single drug. However, I would even challenge that notion because the host determines whether or not someone's going to get sick or not. Look at COVID.

COVID doesn't affect everybody the same way. Same virus, very different outcomes depending on your underlying health, your immune system, your age, your chronic disease burden. So even with infectious disease, it's not as simple. So we've got our methodology of thinking all wrong in terms of our scientific methodology. And we have to start to think of systems research, of looking at multiple complex factors, of looking at treating the individual, not the group. And that's where we failed. And I think what's happening now is that you've got people like Rudy Tanzi, you've got people like Dale Bredis and others, Richard Isaacson who are saying, you can't just do one thing. You got to do everything. And when we do that, we see a much better approach. I mean, I had this conversation with one of the head researchers at

Cleveland Clinic. And I'm like, these are the things that your body needs to function, right? We have to do all these things in order to get an outcome. He's like, no, no, no. First, we study exercise. Then we study diet. Then we study sleep. Then we study this vitamin. Then we study that vitamin. I'm like, no, it doesn't work like that. It's like, if you want to be healthy, you have to eat right. You have to exercise. You have to sleep. You have to deal with stress. You have to optimize your nutrient levels. You have to deal with all these factors. You can't just do one thing. So that's really what this failure is. And this new drug was approved because I think this is my opinion, obviously, is that it was approved because everybody's desperate for

something because it's been a massive failure of research. And so anything that has any incremental benefit, even if the side effects are high, even if the cost is astronomical, which it is for this drug, they're like, okay, let's try this. But I'm like, this is just dumb because we know so much about brain science now and we're just not applying it. You know, you mentioned we have to look at all aspects. You talked about sleep earlier and you just mentioned sleep apnea. Sleep apnea, when people often think about who's the common person that has sleep apnea, they think of often a male, a little bit older, and it's somebody who's overweight and that's the classic person. Big giles, yeah. Right. But sleep apnea actually is something that a lot more people than that struggle with. Talk a little bit about it and who should be considering maybe getting a sleep study

to make sure that they don't have sleep apnea and maybe even start off with how could something like sleep apnea actually make your likelihood of Alzheimer's and dementia stronger, make you more likely to end up getting those diseases later on? Yeah. Okay. Well, it's a very common problem and there are a lot of causes of it. There's central sleep apnea, there's obstructive sleep apnea where it's from airway obstruction. They treat a little differently. There are diagnostic tests. There's actually home testing now. We do this offer at this, at the Ultra Wellness Center. You can do a home test. We give you a little machine. You have to go home and you wear it at night and it'll measure everything and we can prescribe the treatment. And the treatment can be varied. It can do a home test. We give you a little machine. You can go home and you wear it at night and it'll measure everything and we can prescribe the treatment. And the treatment

can be varied. It can be surgery that opens up your airways, create your fixture deviated navel septum. It could be a CPAP machine. It could be mouth tape. Mouth tape is a whole new trend. It's sort of trending, which I think is actually a really good thing. It could be changing your breathing techniques. And I think, you know, there's a simple app that I think I recommend people try it. It's free. It's called Sleep Cycle. And I think, you know, there's a simple app that I think I recommend people try. It's free. It's called Sleep Cycle. And essentially, you can put your phone in airplane mode and put it by your bed and then push this on when you go to sleep.

And it records your breathing at night. So it records the sound of you. So you can, if you're snoring, it will pick up your snoring. And a lot of people don't know that they're actually snoring. Of course not. They're sleeping. They're sleeping. Unless you have a partner. So you're snoring, but your lot of people don't know that they're actually snoring. They're sleeping. Unless you have a partner, you're snoring, but your partner may not notice. So try that and see if that's sort of a cheap, free test with no equipment except your phone and an app to detect

the snoring. If that's the case, then it's probably good to check it out. Now, why does sleep apnea cause a problem? It's really essentially where you stop breathing at night or you shallow breathe and you end up actually getting low oxygen. and that creates a massive stress in your body and it kicks in a stress response cortisol goes up your glucose goes up it puts pressure on your blood vessels your heart a muscle can get enlarged because of the pressure on the heart from low oxygen so you get heart failure and it causes cognitive decline and dementia and sleep is so critical. So if you're not having deep restorative sleep, your brain can't clear up. And at night, we've learned that the brain has its own lymph system. We call it the glymphatic

system. And the lymph system is designed to clear up metabolic waste, clear up all the junk in your body and get rid of it. So when you don't sleep well, your lymphatic system doesn't work and you're basically have severe cognitive impairment. And so it's really important to sleep for that reason. So, uh, and it also tends to cause high blood pressure. It tends to cause insulin resistance. It causes diabetes. Uh, and so it's a really important thing. It's often really underdiagnosed. Now there's some really interesting work being done out there, which is not typically recommended for people with sleep apnea. It has to do with regulating your breath in different ways. So I just did a podcast with James Nestor about his book, Breath. There's another book about breath that looks at how do

we modify the breathing patterns that we have and start to breathe through our diaphragm, how to breathe through our nose, take deep breaths. And there's different techniques that are actually teaching you to regulate your CO2 better. So for example, one that I'm using now is essentially where you, you sit and get quiet and you just breathe normally and then you exhale completely. And then you take 40 steps with holding your breath. And then you sit back down and let your heart rate come down to normal and do that 10 times.

And, and you do 40 steps, um, hold your breath and then, uh, breathe when you sit down and let your heart rate come down to normal and do that 10 times. And you do 40 steps, hold your breath and then breathe when you sit down and then get your heart rate back to normal. And that helps to retrain your ability to actually manage CO2 in your body and manage the whole regulatory cycle around sleep. There's also sleep masks you can take actually that are oxygen deprivation masks that help you to actually regulate your ability to manage CO2 in your blood, which is often what happens at night. And we often go to bed stressed and it's a way to sort of reset your nervous system. So there's a lot of techniques out there, as I mentioned, from these breathing techniques to mouth tape, to surgery, to CPAP, to what I

call the tennis ball treatment, which is the cheapest one. Basically, you wear a t-shirt and you sew a tennis ball in the back of your t-shirt because if you roll on your back, it's going to hurt. So you roll back over your side and you're less likely to snore and have sleep apnea. That's great. A lot of great suggestions and recommendations. Mark, you shared a case study earlier of a woman who was on a board and was told to get her affairs in order. Any other case studies that come to mind of someone who was headed down the pathway, whether they had a diagnosis or they were on the path to maybe developing Alzheimer's and dementia because they had cognitive decline and some interventions they did to actually get better? Yeah, I have a couple that are really profound. The first was sort of what got me like,

whoa, what the heck is going on here? Because in medical school, like, well, we never learn how to treat dementia. I mean, there's no treatment. You give them Aricep, which doesn't work, and there are really no good treatments. So I was like, well, I don't know what to do, but you're asking for help. So let's just do the basics of functional medicine. Let's look at what you need to get rid of. Let's do a cognoscopy. Let's measure all these things that are potentially a factor in dementia and let's treat them. And this guy was seven years old, had his own family business company, quite big business, was a CEO and just couldn't function anymore. And he was sort of basically sitting in a room by himself, depressed and drooling. And his wife and his family didn't want to be around him. He was

just completely changed his personality, severely cognitive impaired, couldn't be social in any way. And just, you know, was on his way out. So he had more, he even had more than pre-dementia. He was, he was further down the road. And, and we did a really deep dive on his biology. And here's what we found one um and this is one of the primary factors he lived in pittsburgh and and i i think you know i have a lot of patients from pittsburgh and in pittsburgh they have the steel u.s steel and all the effluent from the coal burning to make the steel and the coal has mercury in it And it's used to cover the streets. It's used on, you know, for ice and things, for example, or on like farms and stuff. And it's just full of mercury and lead.

And he also had a mouthful of fillings. I said, well, let's check your mercury. You know, normally, you know, your levels, like if your level is over 20, I get a little worried. 50, I'm like, oh boy, 100, you know, handful of patients in 30 years have had that. His level was 350. I'm like, oh boy, mother load. So that was one thing. And we treated that through getting rid of his fillings, got him off fish, through chelation, upbreaking all his pathways, IV nutrition, glutathione. We did a whole very aggressive strategy. And if you want to learn more about approach to mercury, just Google Hyman mercury, and you'll come up with all the articles I've written about it. The second thing we found with him was he had

a collection of genes that are really common that often are predispositions to Alzheimer's. So we had what we call APOE double four. Now, APOE is an apolipoprotein. It's a protein, a lipid carrying protein, and it plays a huge role in regulating heart disease and Alzheimer's and many other things. There's three versions of it, two, three, and four. Two is the best. That's called the jackpot gene. If you got that gene, you're more likely to live forever. And if you have two copies of it, it you know you're the kind of person that can smoke and drink any whatever they want lives to be 120 uh it's like uv blake he was like over 100 years old he was like a famous musician and he's like well you know if i'd known i wasn't gonna live so long i would have taken better care of myself you know because he

smoked and he drank and he partied and he was fine so we're like was that madame clement she probably like she probably had the jackpot gene because gene because she lived to be like 122 or something, and she was a smoker her whole life. That's not to say you should smoke. But you've got the jackpot gene. And I'm lucky. I have one copy of the jackpot gene, which I'm super happy about. I don't know if you know that, Drew.

But I'm going to be around for a while. Great. You've got a lot of work to do. I've got a lot of work to do. I've got a lot of work to do. So the other thing is ApoE4, one copy is bad, two copies are really bad. And you're going to have a much higher risk of having Alzheimer's, like a 75% chance. Although it's not inevitable. I had another patient who was a dentist who was in her 90s, still working, highly functional, and had a double ApoE4, but she was like a health nut her whole life.

She exercised, she ate perfectly, she took her vitamins. She she was like a health nut her whole life. She exercised, she ate perfectly, she took her vitamins. She didn't have any decline in her cognitive function. So it's not a guarantee you're going to get dementia. It's not like you have Down syndrome, you have Down syndrome. It's a predisposition. Second, he had methylation problems, which is B vitamins. We know how important these are, B12, folate, B6. So he had a very high homocysteine, which is a marker of impaired methylation. And that plays a big role in dementia. He also had glutathione genes. So nothing to do with mercury, but he had genes that were impairing his ability to make glutathione, which is the key detoxifier in the body that gets rid of metals and other toxins. So that's really important. And then

we had to give him special things to help boost glutathione, like increase broccoli family in his diet, give him anacetocysteine, IV glutathione, lots of things we did to fix that. And then he also had irritable bowel for 30 years. It was on stelazine, which is an antipsychotic drug to calm his gut down, which was terrible. But he had a terrible microbiome. And we know the microbiome plays a massive role in inflammation throughout the body. And Alzheimer's is a disease of brain inflammation. And we know from Rudy Tanzi's work that it turns out that there's a lot of microbes in the brain that we're now finding. It's not a sterile place. The blood-brain barrier is not just a fixed thing. It's permeable. So there's such potential for actually having really powerful effects using things that actually improve the function of your gut and optimize your microbiome and reduce the

inflammation and all the metabolites from the gut that can be really toxic to the brain. So we worked on his gut. We worked on his methylation. We got rid of the mercury. And then he also had insulin resistance. So he was a thin guy, but he had a belly. He had like a little poochy thing. And that belly fat was super active, creating inflammation, creating insulin resistance.

And we treated him with a very low-starved sugar diet, more protein, good fats, and we reversed all this. So we looked at all those biomarkers. There's objective biomarkers I could see get better. And you know, who cares if the tests get better? He got better. So he actually, his gut normalized, his insulin normalized, his homocysteine normalized. We got rid of the mercury. And guess what? He got better and was able to go back to work and function. And would I say he was like as sharp as he was when he was 30? No. But from where he was, he was back going out to his friends, functioning, could remember

things and actually still work. So that was a profound story. And I have more. That's a good one. Oh, it's an incredible story. Thank you for walking us through that and getting a chance to share. You know, in both his instance and your instance, you both struggled with mercury toxicity. So how much of a problem are environmental toxins?

And how would somebody begin to know that environmental toxins could be playing a role in their chronic disease? And in this case, potentially putting them on the track of developing Alzheimer's and dementia. Yeah. So typically in medicine, we don't learn about nutrition and we don't learn about toxins. We learn about toxicology, which means if you had an overdose or an acute poisoning, then we know about it. But chronic low-level toxicity is just not a thing, except for lead. And lead is something that we did identify as a problem in children. We looked at their dentin lead levels, that their baby teeth came out.

We looked at lead levels. We correlated that with all kinds of cognitive impairments, aggression, behavior changes, ADD add um and so forth in kids so that's why we got lead out of gasoline that's why we got lead out of paint um and there's some recognition all and there's even sort of an approach to treating it using dmsa which is a chelator approved for lead however most people don't know how to do that in medicine um but most doctors are not trained how to look at low-level toxins. They don't even accept them as a thing. I literally had a patient yesterday, or it was actually not even a patient. Someone just randomly emailed me, but I was like, oh God, this patient had been eating, you know, it was a pescatarian in order to be healthy. And he was eating tuna four or five times a week and fish all the time. And it was feeling all

these secondary consequences of fatigue and cognitive impairment. And he went to his doctor and his doctor said, well, look, there's no point in doing any testing because there's nothing to do about it. All I have to do is stop eating fish. And I'm like, oh, you know, one, there is a lot you can do. Two, there's a lot of importance in testing to know your burden and how much there is. And so, you know, it just makes me so furious when I hear the level of ignorance in the traditional medical community around this. So there are tests, heavy metal challenge tests we do, or you can look at a blood test, or you can look at a test looking at when you take a chelator, how much metals come out of your system. That's a really important one.

There's also urinary tests for various kinds of toxins for phthalates, BPA, pesticides, organophosphates, BPA. And we can use various urinary markers to look at those toxins and get a sense of your burden. The best test is probably a fat biopsy. And the problem is we're all poisoned. I mean, you know, the degree is different in different people. But, you know, the degree is different, different people. But, you know, when the environmental working group funded a study looking at the toxin load of infants, these are babies who are just born, drawing their umbilical cord blood, basically their blood before they take their first breath from the in utero, there were 287 known toxins that were measured in their blood, including about 207 neurotoxins, phthalates, PCBs, DDT, pesticides, flame retardants,

heavy metals. I mean, it's crazy. And when you look at studies, for example, fat biopsy studies where like someone will do like a liposuction or get a breast reduction or something like that, or, you know, tummy, tummy tuck, which is not a tummy tuck. It's basically they slice you open from end to end. The fat biopsy showed everybody, everybody had really high levels of toxins, dioxin, things that have been banned for decades, DDT, still floating around and we get it in our food, air and water. So we're all basically walking waste dumps. And if we were food, we would not be safe to eat. However, however, we know, we know that, you know, we can measure the amount of these toxins. We know that we can actually do things to help regulate your detox pathways and we can help your body

reduce the load of these toxins through things like heat and cold therapy, through uplifting the throat, through helping excretion through your microbiome, fiber. I mean, there's a lot of strategies that we use, but there is a whole science of detoxification. So, Mark, before we go into a few community questions that we have for today's topic, Alzheimer's and dementia, I want to do a little bit of a recap because there's a lot that we got a chance to cover. Testing, so many things. But what you're really great at and what you do in your books and on this podcast as well, you're really good at giving people a handful of things that anybody can do and start off today the most important. So if you'd give us the three most important things, high level that we have control over, not everybody maybe has access to a functional medicine doctor. Not everybody has access to more advanced testing. But there are things that we can

do today to reduce our risk of Alzheimer's and dementia. So give us three things that pretty much everybody can do. Only three. Can I do five? Do five. Let's do five. Let's do five. Okay. The first one is just upgrade your diet to food as medicine. Upgrade your diet to food as medicine upgrade your diet to food medicine cut out the processed foods cut out the sugar and starch you know you want to have it as a treat occasionally fine not staples increase the phytochemical richness of your diet you know and a great starting place for that would be the pegan diet would you say the pegan diet yes pegan diet is way to go it's just it's all

the pegan diet essentially is is non-denominational it's sort of like the uh it's sort of like the unitarian church of food and essentially it's essentially like eat real food don't eat crap increase your phytochemical richness of your diet think of food as medicine personalize your diet. Think of food as medicine. Personalize your diet. Eat whole foods. That's it. It's pretty simple. Second would be exercise. Do something. Walk. Do jumping jacks, burpees. Do some weight training. Do some yoga and stretching. Just simple stuff. Sleep. Make sure you prioritize sleep. Super important. Eight hours. Make sure your quality of sleep is good. And there's all sorts of great resources on how to sleep. And we've had podcasts on that. We have a lot of articles on that. And the last obviously is stress. And I think we talked about the effects of stress on

the brain, but meditation, hugely important for brain function. And I think I was talking to someone about a study that was just done in meditation and how it actually regulates biological age. So I think it's really cool. And lastly, I would think, you know, in addition to the four basic foundational lifestyle factors of diet, exercise, sleep, and stress management, would be taking a few of the right supplements. And what are those for your brain?

It doesn't have to be crazy. Get a multivitamin with good levels of methylating nutrients, B12, folate, B6, and make sure that they're bioavailable. Make sure they're the right forms of nutrients. Also, fish oil. Make sure you take fish oil. Your brain is 60% DHA, which is basically fish oil, omega-3 fats, or eat sardines three or four times a week. Make sure you take a good level of vitamin D. You want your vitamin D of 50 or more, 50 to 75, 80 is good.

You have to measure, sometimes people need a thousand, sometimes they need 5,000, 10,000, depending on your genetics and what you can absorb, but vitamin D is critical. And then that will be good for most people. If you wanna go a little more, you can add magnesium. Magnesium is great for your brain as well and relaxing a lot of your nervous system, and it's great for sleep and stress reduction and so forth.

So those would be the five things that I would say would be critical. And those are things that are easy to do. They're inexpensive and they're available to almost everybody. I mean, the supplements can be a little more, but everything else is stuff that you really don't need any money for. Fantastic. I love it. All right. Let's take a few audience questions. If you're up for it, Mark, let's jump in with the first one. My parents both got dementia. I'm 48 years old now. Am I doomed to step into the same fate? Hell no. And here's why. What we know now is that this is not an inevitable process. Two, that even if you have symptoms of pre-dementia or dementia, that you can reverse it. Does your Isondix study, the finger study, Dr. DelBrettis' work. There's ample data now that

gives tremendous amount of hope for even arresting it and slowing it and reversing it even once you have it. If you start early, you're going to be in great shape. So 48 is not too late, but you got to work at it. Here's the thing. I have, for example, had three back surgeries. And if I don't do my workouts every day and my back exercises, I'm in pain. So do some days I just want to be lazy and not do it? Yeah, but I do it because I don't want to be in pain. So, you know, you need to do more stuff if you have bigger risk factors, right? Unless you're an ApoE double two and like you be Blake and can smoke and drink and live forever, you're going to have to double down on all the things we've been talking about and get rid of all the dementogens. Check for them all. Check for happy metals. Check for insulin

resistance. Check your homocysteine. Check methylation. Basically get a cognoscopy, not when you're 60 and starting to forget stuff, get a cognoscopy now as soon as possible and fix all the things that are wrong. Beautiful. When do we ideally start working on prevention is the question. What is the ideal age? The ideal age is zero. The ideal age is actually minus zero. It's actually when you're in utero.

It's actually getting your mother before you're born to eat healthy, to get rid of her mercury, to optimize her nutritions, to detoxify, to improve methylation and get all that stuff working. Basically, that's the answer. So basically you start on day one. And the reason is that, you know, we are constantly bombarded with insults and you have to constantly be working against the entropy that causes degrading of our biology. And that's possible. So the sooner you start, the better, but it's never too late, but better start early. Yeah. I think that's an important message that's here. It's that it's never too early to start. And yet, because of everything that we know, especially if you're focused, it's never too late to start as well. Exactly. have his memory come back in. But even with him suffering so much and us not being able to be able to reverse what he was going through because he was quite far along and he had some other

diseases like cancer, when we made some major lifestyle changes for him to the best degree we could, we did see his symptoms lessen. And in his case, that meant less agitation, less outburst, less anger at his wife, which was my grandmother. So even if you have a full-blown diagnosis, you can see an improvement in the symptoms that are there by changing some of these factors. Absolutely. I mean, ketogenic diets can be extremely helpful in Alzheimer's. And you can just go on PubMed, which is the National Library of Medicine, Google ketogenic diets in Alzheimer's. And there's really good research showing that, you know, even in advanced cases, you can change the biology of the brain by getting rid of all the carbohydrate in your diet and

eating fat as 70% of your diet. All right, let's go into the next question we have here. How much socialization does an older person living alone need? We didn't talk about community and socialization, but it's an important part of the conversation. We'd love to hear your thoughts. You know, I think the truth is, and I hate to say this because I'm a food is medicine guy, but I think community is medicine is actually a bigger, more powerful intervention than food. And I say that because when you look at all these cultures that live forever, like, you know, this, the blue zones and their social networks, their social integration, their care for each other, their love for each other, their showing up for each other

is so powerful. I mean, I just spent New Year's and Christmas with a group of about 30, 40 friends in Costa Rica. And, you know, I just felt high from it. I felt so happy. I felt so full. I felt so alive. I felt like my nervous system was so great and de-stressed. And it was like, it's a drug. And it was just so beautiful. And I think when you look at the data, for example, if you belong to a bowling group or a knitting group, you know, your longevity is dramatically increased. So, you know, it doesn't have to be something fancy like living in a commune. It just has to be collecting some good friends, you know, whether it's two or three, everybody should have at least one or two people you can call and tell anything and everything to. And I think, you know, loneliness is one of the

biggest epidemics in this country. It's if you look at the data on loneliness and isolation, it's probably the biggest killer. And it leads to a lot of lifestyle factors that also kind of sort of exacerbate it. Dr. Vivek Murthy, who's our Surgeon General now for a second time, wrote a book about this. And it's a really profound problem in America. And I think increasingly, you know, around the world, you know, in many cultures, they still have their social networks and their fabrics. I mean, I was in Sardinia this summer. It was amazing. You know, like this guy I met, Silvio Bertinelli, he lived on top of this mountain. He was a shepherd. His family lived with him, his son, his daughters, his aunt, or whatever. And then they all like worked together, cooked together. They had a little restaurant. They

made their house. They had people coming up the top of the mountain. Uh, I would say, well, he's got his group of friends. They go hunting together. When it's time to shear the sheep, they all show up. They have festivals together, their weddings, birthdays, gathering celebrations. It's just, it's just part of the culture. So you're, you're belonging. So belonging is also a key piece of, of being healthy. And, and it's a hard thing in this culture because we've got such an individualist culture. It's really been good in a lot of ways because we're really innovative

and we've had all these incredible advances in entrepreneurs and people being very successful. But there's a dark side to that, which is that the individualism often actually interrupts our ability to focus and prioritize friends and community. It's so important. And I think as I get older, it's more and more important. And I think for everybody listening, if you are isolated, if you're alone, it's important to start to think about how do you cultivate people that are your friends. And I would say, just go to where people

are that are doing things you like to do. If you like to do yoga, go to yoga class, meet people there. If you like to drink coffee, go to a coffee shop and meet people there. Whatever you love to do, start to kind of get involved because cultivating friends and community is one of the most important things. And it turns out to be one of the most critical things for longevity. That's great. Awesome, Mark. Any books on that topic or resources that you found over the years that you find are helpful for people to be thinking about this or expanding their mind around it? About brain health or about community?

Around loneliness, community, connection, anything on that topic? Well, yes. I think Dr. Rima McMurthy's book is great. I think there's a wonderful book called Belong by Radha Agarwal, which talks about building community. So it's more of a practical approach to how do you start to create belonging in your life. I think that's one of the best books I've seen on it. I think there's, what else is there? You know, there's faith-based belonging approaches. I wrote the Daniel Plan, which is really centered around the power of community as medicine and using faith-based wellness as a tool to use community for healing. We saw amazing results with that. So I think whatever it is, it's got to feel good to you. I mean, they did jogging for Jesus. They had all kinds of fun stuff they did together. Whatever it is that

lights you up, you've got to find your community and get out of your box and push yourself a little bit. And everybody's struggling. Everybody wants to be loved more. You know, I was looking at, I wish I could got Karen to talk about the data, but they actually included the whole concept of cuddling as a medicine. So they were looking at, you know, the more cuddling you had, the healthier you were, the longer you lived. So that was great. Oh, that's great. All right. Last question we have here, Mark, before we wrap up, what are some of the early signs of Alzheimer's and dementia for those that aren't aware? You know, we all forget our keys here and there, but what is really a sign that our brain is headed towards cognitive decline? There's the preclinical stage where you've got damage in your brain that is happening. You can see on an MRI scan and you may never know it.

And you're fine cognitively. The second is what we call SCI or subjective cognitive impairment. That's where you kind of know, geez, I think it's me forgetting things. And you kind of know it. Then there's NCI, which is mild cognitive impairment. And this is challenging because you're still sort of functional, but you don't know you're forgetting stuff. So if you're like, oh, shoot, I remember that I forgot that. Like I had an appointment, I forgot it. Oh, then you're probably not demented. If you're like, oh, shoot, I forgot my keys, it's probably stress, right? But if you're like, oh shoot, I forgot my keys, it's probably stress, right? But if you're like,

you don't know that you aren't remembering things, that's a problem. So that's one of the early symptoms. And third would be the full-on dementia where you're really in it. So often it's really the early subjective signs. There is a test. It's called the MOCA test, M-O-C-A, which is the Montreal Cognitive Assessment Test. You can Google it. You can go online. You can download it. It's a one-page test that has a series of questions.

Draw a clock. You know, draw a box. Name these animals. Remember these three things, remember these five words, and all these things, say these numbers backwards, forwards. So it just gives you a lot of mental exercises that are designed to work different parts of your brain. And then you get a score out of 30. So if your score is 30, you're good. If your score is 29, you're probably okay. If it starts to go like 26, 25, 24, 23, you're in trouble. So, you know,

you can start to see these changes early on through this MOCA test. And that's a really early diagnostic tool. It's sort of a screening test. There are much more advanced neurocognitive tests you can do. Excellent information, Mark. Let's take people out and conclude the episode with some final thoughts here on the topic of Alzheimer's and dementia. Well, you know, I just, I just want people to have hope. I think, you know, my friend Deb Bredesen wrote a book called The First Alzheimer's Survivors. Like there's cancer survivors, but who knows an Alzheimer's survivor? Nobody. Well, there are those now out there. And I think we should, we should have hope and we shouldn't be looking for a pharmaceutical solution. Although there may be pharmaceuticals that could be helpful along the way. It's really more addressing these global issues around what

causes brain dysfunction, getting rid of those, and what causes brain optimization, and putting those things in. And it's all the stuff we talked about today. So whether you are someone who's got early memory loss, whether you have a family history like that woman who's 48, or whether you just want to optimize your brain, it's really important to look at all these things. You know, we all talk about heart health and so forth and know how to prevent heart disease. Nobody's really talking about how do we create brain health. And that's really why I wrote the book, The Ultra Mind Solution in 2009, which still, I think, is way ahead of its time.

And I missed, you know, there's a lot more that we've learned since then, but I still, it was really pretty amazing to see that the things that I talked about then are now coming into sort of normal discourse. So I would have hope, I wouldn't be afraid, and I would focus on getting a cognoscopy, getting rid of the dementigens and optimizing your brain through the fundamental things we talked about, and also the next level steps with functional medicine. So that's it for this week's masterclass. I hope you've enjoyed it. If you have really liked it, please share it with your friends and family. I think everybody could benefit from listening to this. Leave a comment. How have you helped improve your brain health?

And subscribe wherever you get your podcasts. And we'll see you next week for another episode of 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 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-K-S, 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 provided on the understanding

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