The Rich Roll Podcast - Alzheimer’s Can Be Prevented & Reversed: Drs. Dean & Ayesha Sherzai On Optimizing Brain Health

Episode Date: November 27, 2017

While other major diseases are in decline, deaths from Alzheimer's have increased dramatically in recent decades. In fact, Alzheimer's is currently the 6th (and due to massive under-reporting may be as high as the 3rd ) leading cause of death in the United States. Right now, over 47 million people worldwide currently live with Alzheimer's. By 2050, it's predicted this form of dementia will plague 135.5 million people across the globe. This disease has become so pervasive, chances are you have been directly or indirectly impacted through an afflicted loved one. If so, then you know first hand the devastation it creates. You've seen it's ravaging effects. Perhaps you've even shouldered the immense emotional, financial and social burden it produces — and the hopelessness it provokes. The sad truth is that Alzheimer's is a condition that Western medicine has utterly failed to combat, let alone cure. Simply put, there is no pharmaceutical or surgical treatment to effectively prevent or reverse this savage and cataclysmic condition. But there is hope. Alzheimer's isn't a genetic inevitability. A diagnosis doesn't have to come with a death sentence. In fact, according to this week's guests, 90% of all Alzheimer's cases can be prevented. And for the 10% with a strong genetic risk for cognitive decline, the disease can be delayed for ten to fifteen years. These are not estimates. Nor are they wishful thinking. They are conclusions based on rigorous science performed by neurologists Drs. Dean and Ayesha Sherzai. Co-directors of the Brain Health and Alzheimer's Prevention Program at Loma Linda University Medical Center, Team Sherzai is the dynamic husband and wife duo behind the largest clinical and observational study on Alzheimer's to date as well as the co-authors of The Alzheimer's Solution*, a must-read primer that details their extensive research, chronicles the remarkable results they have experienced working with patients first-hand, and sets forth the first ever comprehensive program to prevent Alzheimer's disease, improve cognitive function, and ultimately optimize long-term brain health. The solution might surprise you. It's not due to a breakthrough in surgical procedures. It's not the result of new pharmaceutical trials. Instead, as far fetched as it may sound, the answer is rooted in fundamental, simple changes in nutrition and lifestyle. Dr. Dean Sherzai, M.D., PhD., completed his medical and neurology residencies at Georgetown University with a subsequent fellowship in neurodegenerative diseases at the National Institutes of Health, followed by a second fellowship in Dementia and Geriatrics at the University of California, San Diego. He also holds two Masters Degrees; in advanced sciences at UCSD and a Masters in public health from Loma Linda University. Finally, he has received a Ph.D. in Healthcare leadership at Loma Linda/Andrews University. Dr. Ayesha Sherzai, M.D., completed her medical residency at Loma Linda University. She subsequently completed a residency in preventive medicine and neurology and thereafter received a fellowship in vascular neurology from Columbia University, and is currently finalizing her PhD in Epidemiology at Loma Linda University. Ayesha also has a culinary degree, giving her a unique understanding of nutrition as a powerful tool for disease prevention. Peace + Plants, Rich

There are a few genes in Alzheimer's disease, maybe less than 5% of the genes that completely determine whether somebody gets Alzheimer's or not. As a matter of fact, if you have those genes, you're definitely going to get it. But even for those, you can push it off for a very long time. For the rest of them, for the 95 plus percent of the genotypes. It's quite clear that what you do in your life, the type of food that you eat, whether you exercise or not, or the level of stress that you have, determine whether you're going to get the disease in your early 60s or in your late 90s. That's Dr. Aisha Sherzai, along with Dr. Dean Sherzai,

this week on the Rich Roll Podcast. The Rich Roll Podcast. Hey, everybody. How are you guys doing? Greetings. How did it go? Thanksgiving? Was it good? Did you guys survive?

I hope so. I hope you kept your food intake in check. I hope you resisted the urge to splurge, that you stayed away from the mall on Black Friday, and enjoyed your loved ones, all the good things. My name is Rich Roll. This is my podcast. Thanks for dropping by. Today on the show, we're going to dive into a subject that I've been wanting to explore for a very long time. It's an important subject, and that is brain health with a focus on dementia and our quickly growing epidemic of Alzheimer's, which is this devastating disease that's destroying lives at quite an alarming rate. Right now, Alzheimer's is currently the sixth leading cause of death in the United States,

and that could be as high as the third leading cause of death due to massive unreporting. Currently, 47 million people worldwide live with Alzheimer's. And what's interesting is that while other major diseases are in decline, deaths from Alzheimer's have increased radically. By 2050, they're predicting that it's a disease that will afflict 135 million people. And I'd be willing to bet that most of you guys out there listening have been impacted by this disease either directly or indirectly through somebody in your circle that you love.

And if you have, then you know how ravaging and devastating it is and how hopeless it can leave you because in truth, it's a condition that Western medicine has really failed to overcome. There is no pharmaceutical or surgical treatment for this, as well as for related diseases like Parkinson's. And the emotional, financial, and social burden of this and related diseases is just immense. Certainly, genetics play a role in your risk, but that's hardly the whole story. There is a silver lining.

There is a silver lining. There is hope. And according to today's guess, 90% of Alzheimer's cases can be prevented and symptomology can even be reversed. And this is not achieved through the latest breakthrough in surgical procedures or new pharmaceutical remedies, but as wild and as far-fetched as it may sound through something as simple and fundamental as wild and as far-fetched as it may sound, through something as simple and fundamental as nutrition and lifestyle. To walk us through all of this is the husband and wife duo, Drs. Dean and Aisha Sherzai, Team Sherzai, as they call themselves. Drs. Dean and Aisha are the directors of the Alzheimer's Prevention Program at Loma Linda University Medical Center and are the authors of an amazing new book entitled The Alzheimer's Solution, which outlines the first comprehensive program for preventing Alzheimer's disease and improving cognitive function based on this tremendous research that they performed, which involved the largest clinical and observational

study of Alzheimer's to date. which involved the largest clinical and observational study of Alzheimer's to date. Dr. Dean Sherzai finished his medical and neurology residences at Georgetown University with a subsequent fellowship in neurodegenerative diseases at NIH, the National Institutes of Health, followed by a second fellowship in dementia and geriatrics at the University of California, San Diego. He also holds two master's degrees in advanced sciences at UCSD and a master's in public health from Loma Linda University. He also has received a PhD in healthcare leadership from Loma Linda slash Andrews University. Dr. Aisha Sherzai completed her medical residency at Loma Linda.

She subsequently completed a residency in preventive medicine and neurology, and thereafter received a fellowship in vascular neurology from Columbia University, and is currently finalizing her PhD in epidemiology at Loma Linda. Dr. Aisha also has a culinary degree, giving her a really unique understanding of nutrition as a powerful tool for disease prevention. These are smart people, and this is a very powerful, important conversation. And of course, as always, there's a few more things I want to say about what is to come, but first. We're brought to you today by recovery.com.

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It's a conversation that I think is going to leave you rethinking everything you thought you knew, not just about Alzheimer's, but about brain health in general and the power of food and lifestyle to heal. Rather than list out the many subjects we cover, I think I'm just going to suggest that you listen keenly to the entire podcast and take notes because this one truly is potentially life-changing and with that here is me and doctors Dean and Aisha shares a ready to go we are thank you so much for making the trip all the way out here I'm delighted to talk to you guys.

The book that you have written, The Alzheimer's Solution, it's super powerful. And I have no doubt that it's already helping lots of people and has the potential to really be a healing, curative treatment for so many people. Like it's a, it's an incredible work and I'm just so excited to unpack it with you guys. So thank you for coming out. Thank you for having me. Thank you so much for having us. Right. So we met at Rachel's event initially, right? At Rachel Abrams event. So we share Rachel and Doug Abrams as common friends.

Doug, I went to college with Doug. Oh my goodness. Yeah, he was a college classmate of mine. And I've had Doug and Rachel have both been on the podcast about a year ago. So it comes full circle. That's amazing. And here we are talking.

So I think maybe the best way to kind of launch into this is perhaps to define our terms a little bit. You know, what do we mean when we're talking about Alzheimer's? And perhaps it would be worth explaining the difference between Alzheimer's and other forms of dementia. So Alzheimer's is a fairly new disease in the sense that it's beginning to be well be well known in the in in in in our society especially first world society it's not a new disease in the sense as far as a new infection

or something of that nature it's been known for a hundred years or so and defined by dr alzheimer's of all people it's like 1901 or something like that exactly and but but for the longest time even now in many communities they call it senility they call it part of just normal aging just today i saw a patient full-blown alzheimer's advanced the family didn't know that this person had alzheimer's and all the things they had to do either to prevent or even now that they have it to how to deal with it alzheimer's is a subcategory of the bigger disease process which is dementia dementia is the big group which is like cancer and the alzheimer's is a subtype of it um but it's the biggest category 60 to 70 percent of all dementias is alzheimer's and um

since 1990s when first president reagan was, and from then on, it became more known and more studied and billions of dollars spent in research in the field. So why you say it's a relatively new disease? I mean, it's discovered in 1901. And now we're seeing it in epidemic levels and the growth curve is insane. So why is, you know, why is it a recent disease? Why is it just coming online now? And why is it accelerating at such a rapid rate? I was, it was a play on words. It's not a new disease in the sense that in the human experience, it's a new disease as far as our understanding of it, it's prevalence, it's

massive growth. I mean, we're talking about every other disease in decline, pretty much every other disease, or death from every other disease in decline. Yet mortality and death from Alzheimer's in just the last 10 years has grown more than 80%. Part of that is because we're aging society. We're doing better with the, yeah, we have more diabetes, we have more obesity, we have more of all these other diseases, but we're surviving them with machines, with

surgeries, with these catheters, all these things we're living past what we would have lived before. We can survive diseases that used to kill us. But when it comes to what's left behind is our brain. At the end of the day, we're left with our brain. behind is our brain. At the end of the day, we're left with our brain. And that's the cumulative problems over 50, 60 years that actually end up in being Alzheimer's at the end or dementia in general Alzheimer's. And that's where we bring the new kind of conversation that we have to approach it in that sense. We have to approach it as a lifestyle disease. And that's why it's

so important. Right. And we're going to work our way towards that. But just to approach it as a lifestyle disease and and that's why it's so important right and we're gonna we're gonna work our way towards that but just to kind of lay a little foundation when I was going through your book I mean the statistics are staggering six leading cause of death but perhaps as high as third because it's so underreported two hundred and twenty six billion dollars are spent in the U.S. to treat this, and $604 billion worldwide. It's working its way towards the trillions. By 2050, we're looking at 135.5 million people suffering from this disease. I mean, this is something that's, if it's not touching you directly, it's certainly touching you indirectly. Absolutely. I think it's probably one of the scariest things out there. And you quoted the

numbers. And it's so sad that all this research throughout the years by big organizations, whether it's Alzheimer's Association or others, they haven't really done much there there's really no medication for this for this disease there is this incredible failure rate for uh for finding a treatment for alzheimer's disease about a 99.6 percent failure rate which is probably 100 call it like a medication worth even considering with that level of failure rate. There is no treatment for it. And the minute number, actually, are medications that are used for allaying some of the symptoms. For a few years. Yeah, just for a few years.

It doesn't work long-term at all. And the reason is because everybody's been focusing on one molecule, on one small process, instead of stepping back and looking at the bigger picture and the complexity of the disease so yeah i think i think there's a lot to be done in that area yeah i mean it was basically a death sentence you would go to your doctor and the doctor would say well we'll try to make you comfortable and uh here are some options in terms of places where you can get assistance with your lifestyle, but you're just going to ride this out and that's it.

And we see these pharmaceuticals that are available now, but they really just don't. They're not effective. Not at all. Not at all. It's so depressing being a neurologist in that field because we went through it in the past. in that field because we went through it in the past. A person would come in, we would diagnose them with Alzheimer's disease or our supervisor, whoever the neurologist was, and the next conversation would be, you need to get ready to let go of your finances,

you need to find a nursing home, you need to bring your family members so that they're aware of how you're going to lose parts of yourself as you move along. And that was basically it. How do you handle that as a doctor, having to have that conversation over and over and over again? It's worse than a death sentence for a great majority. They've done studies, and for many Americans, it's worse than death to know that you're having Alzheimer's. And the approach from the medical field is actually even worse.

You have 20 minutes with a patient. Hi, how are you doing? How is it going? You do the cursory check of the heart, tapping the knee. And then at the last five minutes, you have Alzheimer's, and this is what you have, and this is what you have to do, and here are some pills. And the pills don't change the progression of the disease they just help you with the symptoms this is this is a

process that's going to increase accelerate every family every family in America will be affected by it either directly or indirectly and we need to do some something to kind of either curb it or have a new approach to it um and what we're doing is actually we whenever we bring this topic they tell us um but are you blaming the person it's not about that it's about giving hope it's about starting a new process a new direction um that was the whole goal and came from our experiences in the communities. We live in Loma Linda. Right. The story of how you evolved into this perspective for treatment and prevention is unbelievable, right? Because you're coming, you're hard-nosed scientists, immersed in the scientific method, raised to be doctors in the Western tradition and had your experience with that and then kind of evolved into what you're doing now.

But to give it some context, maybe let's explain a little bit of your background. I mean, I know you met in Afghanistan, which that's probably, we could spend two hours on that probably. But I mean, Dean, you were at NIH, yes? Correct, correct. And Aisha, you were, is it Aisha and aisha you were is it aisha how do i say it aisha aisha you were at uh uc san diego correct yes both practicing neurology absolutely yeah we actually came into this field because we both had grandparents who had dementia severe dementia and um you know they were incredible human beings and they were our heroes. And I remember having my grandfather's picture on my desk throughout my medical school

because I wanted to be like him. And I saw how slowly and gradually grandfather lost himself to the point where he didn't recognize his children, didn't recognize any of his grandchildren. And that was just devastating. I saw the pain that my parents went through. And for this brilliant person to slowly and gradually become a child again. So it affected us. And we wanted to study neuroscience and the brain and its beauty and its complexity. But as you go on through the period of getting educated in the medical field, you come to a point where you're in a clinic with a dementia patient and there's really nothing you can do about it. And that was just depressing. Yeah.

Well, it's a powerlessness. Very. UCSD at the time with Leon was number one neuroscience program in the country. NIH is NIH. It was number one neuroscience program in the country. NIH is NIH. And we were actually at UCSD and study after study after study, billions of dollars. A mouse model.

It worked on mice. So let's apply it to humans. Again, a failure. That's at least $100 to $300 billion, a million dollars per study, you know. And it was just incredibly frustrating. First of all, the mouse models, 50, 60 things have worked on mice for even blueberries work on mice. I mean, I think if you just look at them in the right way, they will work on the mice. Mice do not men make.

And after a while we just said, this is, this is just too much. So we decided to look for an alternative. We looked around Dan Buechchner, read about him and his book, and we found out about Loma Linda. And then the rest just followed. But that transition was painful and scary. Right. There were a lot of impediments in the way. Sorry to cut you off. No, please go. Because the way you're trained in the medicine world is to look at cause and effect and look at a linear path of how A affects B.

How does A influence B and what are some of the other factors that come to it? It's very, very myopic. IH or other governing bodies is just that, to have a linear model of looking at associations. And studies after studies after studies have just looked at very small things at a time and not the bigger picture. And we were so excited to see studies from Loma Linda or the Blue Zones coming and showing that there is a different perspective to look at. There is lifestyle. There is this complex nature of the foods that you eat or whether you exercise or not. And the interactions between these lifestyle factors, they matter.

And it was painful because I remember clearly when we were showing interest in doing something of that nature or studying populations, we were told by our mentors and some of the prominent people at universities, things like, oh, this is career suicide for you. You do know that there's no future in this. If you decide to leave UCSD and this fabulous, say, for example, molecular research that you're doing, and you're going to go and study epidemiology and population studies, nobody's going to fund your research. Right. Yeah, you're breaking ranks with core tradition, and that's a frightening thing.

And just to touch on what you said earlier, that is, by its very nature, the reductive nature of the scientific method, right? And there's reason and rationality for that, and it works in many cases, but it's inherently flawed with respect to some ways of approaching problems, right? Because it's not just one thing. It's a matrix of an infinite number of cofactors that interrelate in this interplay of things that coalesce to create this situation. You can't extract out the one variable the b12 or the beta carotene exactly exactly and and come up with a solution for this absolutely so so that's interesting so the so loma linda comes onto your radar and dan butner in his you know amazing books and all the incredible work that he's done and you decide to

pack your bags and head out to the one blue zone in the United States and hang out with the Seventh-day Adventists. Yes. It was a frightening endeavor. I was the director of the Brain Health Center. She did her. So we said we're going to go all out. So she did a preventive medicine residency, a neurology residency,

and then with two kids with us um i was in loma linda as the director of brain health center and aisha went to columbia university to study vascular and epidemiology at columbia university two years flying back and forth every two weeks we said we're gonna go all out we're gonna go all out wow and study and at night she would study culinary. I went to cooking school. Right, I know. You did the Roubaix school? I did. No, I actually went to

Nashville Gourmet Institute and then went to Ruby. I did the Ruby online as well. You're just like collecting all kinds of degrees. It was fun. To be honest with you, I think I probably would make more difference talking to some of my patients about changing their dietary patterns than just pushing aspirin and statins. I found that useful in so many occasions and just personalizing lifestyle for them.

So I think it was a great decision. And what is the rationale behind getting a degree at Columbia in, what was it, vascular? Yes, it was vascular neurology and epidemiology. So it was a combined training in stroke, understanding diseases of the brain, especially vascular disease of the brain. And the epidemiology side highlighted prevention and understanding how disease patterns exist in population it was so funny that the world while she was there in first year that they want to get you into research molecular research and she said no I'm going to study population research that okay there's the study and California

teachers study why don't you look into that data so she flew to California collected the data and did that study with Mediterranean diet, plant-based component of it, and stroke. And lo and behold, that paper was highly touted. She won the youngest researcher award for American Heart Association. And the Columbia people all of a sudden turned around. So everybody was excited. So she was the youngest plenary speaker in the American Heart Association talking about lifestyle and stroke. So the very thing that they thought that would not really amount to anything all of a sudden turned out to be.

So every step we've taken, completely non-trad lifestyle, closer adherence, as low as 44%? Had about 40% lower risk of having strokes. Wow. 40%. 40%. In a very, very large population. That's amazing. Yeah.

So when you're in this situation in San Diego being frustrated with the sort of standard operating procedure of treating these patients with dementia, did you, I mean, were you already looking at lifestyle and getting interested in that? And were you sold on that and the plant-based diet and all of that? or did that come in turn with coming out to Loma Linda and kind of immersing yourself in in the way that they are tackling these problems and looking at how people are living in that in that part of the world yeah as a scientist you want to make sure that your your personal biases do not bias your sign right that's kind of what I'm getting yeah yeah I know and and and we were already vegetarians for other reasons. We are for ethical reasons and all that. And this came in the middle of Afghanistan, of all places.

We decided that we're going to... You were a vegetarian in Afghanistan. Vegetarian in Afghanistan, yes. And that in itself is another book of this slippery slope of... I was the deputy minister of health. I went from NIH to Afghanistan, became the the deputy minister of health i went from nih to afghanistan became the youngest deputy minister created this whole women's empowerment but my downfall was that i became vegetarian uh-huh nothing else all because like political suicide

yeah almost almost absolutely but um but but that aside when we came to Loma Linda, we really, even now, we, for example, some of the things we say is sugar is worse. But we let the science do the talking. As a scientist, you can't let your personal biases direct the science. But the science is just overwhelming. It's not just us. It's, you know, yeah, you get these little blurbs of fat diets here and there. Let's do keto. Let's do this. Let's do that. Plant-based living has been proven over a hundred years, thousands of papers, validated papers. It doesn't mean that somebody just did one little paper,

five other people repeated it. This has been powerfully shown. The Evans Health Study showed that people who live a certain life, more plant-based, live 10 years longer and healthier than everybody else. In JAMA, not just a regular journal, top journal in the world that was published, and many other things. Cancer risk is lower and everything else. The only thing that was left to show was brain. So we studied the brain. And while there, we actually looked at my clinic or our clinic, which we saw thousands of people. And this is at the center of this Seventh-day Adventist community.

There's nowhere else for them to go. Right. Either they come to me or they just stay home as far as that goes. Yeah. And you're looking for candidates to study, right? Yes. And there's nobody to study because you go to the gym and everyone's 90 and they're doing push-ups. Absolutely.

I mean, Dr. Wareham did surgery at 95. It's insane. It is. And he's still running around, you know. He's not practicing medicine anymore, right? No, he retired because he wanted to travel. Right. Not because he had a tremor or he was feeling tired.

He's just an incredible, strong, and very, very healthy person even now. I had patients 80- saying that you know i'm running the the marathon in la uh are you joining him i was like a little embarrassed i was like no not this year yeah but this is 80 something you're all running a marathon i mean that's amazing yeah it's not unusual to see that on a regular basis absolutely so so this is uh and then the clinics were more people from outside. Right. Right beyond 10.

So, yeah. So you come to Loma Linda. We're going to study brain health. We need all these people that we can evaluate to create this population study. No one's showing up at the clinic. And ultimately, you have to kind of go across the tracks over to San Bernardino, where there's a lower socioeconomic class of people. And people are suffering terribly there from all manner of lifestyle illnesses. Absolutely. tracks over to San Bernardino where there's a lower socioeconomic class of people and people are suffering terribly there from all manner of lifestyle illnesses. Absolutely. The disparity is

just enormous. And the devastation that you see from Alzheimer's disease and other, you know, all the other risk factors for Alzheimer's disease is just incredible. And so, you know, of course, you know, they're the same population. They're living under the same sun and probably the same zip code, and they have the same supermarkets and restaurants, so it had to be something else. And that gave us a very good opportunity to compare the populations and study lifestyle and how it affects brain health.

It's so crazy. Yeah, like over here, you have people in Loma Linda who are living crazy long lives, active lives. And, you know, literally, you know, right next door, you have a population of people who are having an extremely different experience. That's right. That's, that's a great place to, um, begin a study, right? I mean, that juxtaposition is quite potent. Dean and I would go to some of the churches and some of the synagogues in the area to speak about brain health.

And how many talks have we done? Yeah, over 100 talks. I say that I've given more talks in churches than some of the ministers. I mean, we went to church after church after church in order to draw people, because I think it's a great place. And they were very willing, the Catholic diocese and everybody willing to listen.

And it was overwhelming. Yeah, yeah. Most of their male leaders, faith leaders were not there. It was mostly run by women because they would pass away, you know, after, say, for example, age 65. You would barely find anyone beyond age 65 there. And the ones that were there had a lot of health issues. So it was quite prominent, even without doing any research, just by having conversations with the society, the communities,

that there was this incredible amount of need for health awareness and disease prevention. So you then spend the better part of the next like 15 years studying these people, right? Correct. Absolutely. I mean, my PhD thesis was on seeing how you can get information into different communities. And this is a little bit of digression, but we looked at African-American, Hispanic, and Caucasian population. We realized it's not even the race thing. It's socioeconomic and availability and access. Access is always access to information, access to right foods and all that.

In certain populations, this lower socioeconomic information, knowledge about stroke, about dementia, about all these diseases was non-existent. It was just disease of aging, just a clump. And access to the kind of foods, the kind of environment to walk, the kind of communities that actually build around health, the blue zones, was not available. And then most importantly, where they deemed, where they thought that information could be given to them, they could be receptive, we had it all wrong. A survey that was created in Boston and Harvard, or Harvard, and then applied by 60-year-old, 50-year-old men to 70-year-old Hispanic women doesn't make sense yeah so we realized

that that's not where you do the training that's not where you do the education the clinics it's in the communities that's where actually that's where this whole book we created the community driven brain health or healthy minds initiative and all the profits from the book will go into building community awareness in different communities throughout the world as far as brain health is concerned so these people start coming into your clinic and the idea was what like we want to understand how all of these people are living what is contributing to this disease of the brain and start experimenting with protocols to

reverse it or prevent it correct that's sort of the the master statement experimenting with protocols to reverse it or prevent it. Correct. Is that sort of the master statement behind this? That's exactly right. And then what do you start to learn? So we collect data on nutrition, exercise, the things that we know. The only thing that we didn't collect was stress. But as far as physical activity, as far as all these elements, sleep and mental activity, not profound data,

just superficial data, just conversational, and we collected it. And over and over again, we realized that the people that were healthy, 90-year-old that just had minor memory problems, they were the people that kept their mind active. They walked all the time. They were more plant-based diet. Consistently, that was the component. And we realized, so this is, yeah, genetics. Put that aside. It cannot be genetics. It cannot be driven by genes. It had to be environment. And thousands of patients. So we started applying it.

We didn't apply it to Alzheimer's patients. We applied it to people with what they call mild cognitive impairment, people who are at risk, very high risk. People who are mild cognitive impairment, they have a 50% of them go on to develop Alzheimer's. So we applied these changes, small changes, according to what they could do. And even small changes affected their livelihood, their progression. This was miraculous, remarkable. So, from there we decided to do something bigger. And that's where we are now. And when you were seeing those changes, like how are you quantifying like

cognitive degeneration versus improvement? So there are measurable metrics. For example, the MOCA and the mini mental status. And then there's these bigger neuropsych batteries, which is two hours where you do really long paper and pencil and find out where people's changes are. Repeatedly, you would see differences in those. There are other measures such as MRIs, which actually measure the volume of the brain. And even those, you saw some changes. When it comes to the human brain,

what's interesting, it's not the volume. We have 87 billion neurons and one quadrillion potential connections. So this machine, what they say, one times 10 to the 50th power, it's not the cells. We could lose a billion cells. Of course, not all at once, that would be bad. But slowly, we could lose a billion cells. But the rest is what matters. And that's the concept of cognitive reserve, which is incredibly exciting. And that basically means that it's not the number of cells that determine your cognitive prowess. It's actually the connections. And the exciting thing is those connections are made and broken on a daily basis. It's up to us what we do to create those

connections. And it's like putting money in a bank account for a rainy day. Making more connections actually staves off disease, but at the same time builds a better brain. So you feel sharper, better, and bring forth the full capacity of the brain. And I think this is the language that we use in our clinic. And this is the language that we've tried to use in our research as well to make people understand that it's in their power to actually make it happen in their lives. make it happen in their lives. Yeah, the brain is so mysterious, right? In so many ways. And that idea that, you know, I don't know whether it's apocryphal or to what extent it's true that we're only using a small portion of it and that we could lose all these cells, but that it's more about how we're using what we have.

They're saying that we use 10%, but actually we use all of the brain, but we use it incredibly inefficiently. So a lot of people compare the brain to a muscle. And I say, what a disservice to the brain to compare it to a muscle. Way more complicated. Way more powerful and resilient. So the biggest guy we know, let's say Arnold Schwarzenegger, that's the only one I can think of.

There are many others I know. He built his muscle four times the average mass, let's say. So an average brain, an average neuron can have a few connections or as many as 30,000 connections. That's not four times, many as 30,000 connections. That's not four times that's 30,000 connections. So the idea is here's a neuron. And of course this metaphor, and here's a memory you're trying to get to. If it's a couple of connections to that piece of memory, one of them at age 70

is severed by a little microvascular infarct and another one by amyloid plaque. There it is. Memory's gone. Of course I'm making it. Imagine there are 30,000 connections to that piece of information. It will never be severed. That's the power that you have by

building these connections. And actually, they've done experiments where they can see it grow on a daily basis. That's what we can do on a daily basis. And we understand how to grow those, like how to strengthen, how to create more of those connections. You and I are doing it right now. The longer we talk, the less likely we are to forget each other.

Correct. Challenge. So one of the things, sorry, I'm going to digress, but one of the things people say, what do I do for brain activities? I said, not Sudoku. I hate Sudoku. If I have to do Sudoku, I'm going to get dementia. Not that there's anything wrong with Sudoku. If you like it, it's great,

but it's not complex. Your brain did not evolve with adding numbers to nine. I mean, when did that happen? While we were being chased by saber-toothed tigers? No. Our brain evolved through complexity. So one of the things we say, you want to build your brain, get a group of friends, play cards. The act of me listening to you, having sense of your emotions, that's brain is being processed. So your brain is processing this. Your mirror neurons is checking your emotions. And my frontal lobe is processing what you just said. My memory centers goes back and sees what relevance that has. Then comes up with an answer then the motor cortex you've just used the entire brain brain plus the emotional component that's not sudoku that's a that's a complex behavior building

connections so music music is to me is my favorite aisha is a professional singer i'm i say i'm the worst guitarist in history of mankind he's not but the cacophony i create is you know you're listening to your own music you're playing which is motor cortex with the fingers you're memorizing remembering recalling some tunes or some notes so that's your memory centers You're processing that through How it's supposed to be played in my case is just simple and that involves the entire brain plus the emotional component That's building connections. And in fact, they've done studies fMRI studies that have shown that this makes the connections The taxi driver study people have heard about this. So let's go to that the London taxi drive We just came from London. Yes our book tour, and I can understand why. It makes more sense now.

It makes more sense. Not in the realm of GPS anymore, but a while ago, if you needed a taxi license, you had to memorize all the streets in London. My goodness. Wow. So the average person doing this study was 50-something. So not a young person. And they all did all did it they did studies volumetric studies volume of the hippocampus the memory centers before they started studying and after the brain had actually grown after this grown in volume in a relatively short period of time very short period so that tells you

that your brain is active at any age and can grow connections of course the cells didn't grow although now we know that even they grow to some extent especially with exercise with neurotrophic factors and all that you've done a lot of good to your brain with exercise yeah i've probably damaged it in many other ways. There's reserve. There's plenty of reserve. But those connections grow, and we see them by volume. So it's wonderful. So it's a book of hope, you know, that you can do something.

And it's not even about Alzheimer's. Now, he was like, talk about the dropping ball. It's about avoiding Alzheimer's. It's about resilient, fulfilled, vibrant brain activity late into your 80s, 90s, and beyond. Using the full potential of the brain. Right. So when you begin this journey 15 some odd years ago,

I would imagine, like you kind of alluded to earlier, your colleagues are like, this is queer suicide. What are you doing? You're going to start looking at, you know, lifestyle medicine for this. And so I think it would make sense to kind of explain, or at least talk through some of the myths and the misconceptions about this disease, particularly this notion that it's a purely genetic situation. Like if you have the gene, this is what's going to happen. There's nothing you can do about it.

Right. That has been the misunderstanding for such a long time. And, you know, there are a few genes in Alzheimer's disease, maybe less than 5% of the genes that, you know, completely determine whether somebody gets Alzheimer's disease, maybe less than 5% of the genes that, you know, completely determine whether somebody gets Alzheimer's or not. As a matter of fact, if you have those genes, you're definitely going to get it. But even for those, you can push it off for a very long time. For the rest of them, for, you know, the 95 plus percent of the genotypes, it's quite clear that what you do in your life, the type of food that you eat, whether you exercise or not, or the level of stress that you have, determine whether you're

going to get the disease in your early 60s or in your late 90s. Right. So this, as I understand it, This gene, the primary gene, is the APO4. E4. E4, yes. And this can be expressed in a variety of ways. Like you either have it as like a recessive allele, right, or you have it as like, I don't know how you describe it. Dominance. Dominance. Yes.

And then if you have it like, what is it, twice over? How did you describe that? Yeah, if you get a certain at least from your mom and dad right which is actually rare two percent of people your risk goes up 20 fold but even of those that have the two alleles only 50 percent of get alzheimer's so yeah it increases your risk but it doesn't mean it's it's it's destiny genes and Alzheimer's do not make destiny so I was talking about the 5% that are very heavily driven but the other 90 or 90 plus percent are we know now there are like 30 genes we'll probably identify

further that increase your risk of Alzheimer's and those plus a boy for now what are these genes these other genes for the ones that we think we can reverse now we know that a proportion of them are genes with vascular response Now, what are these genes, these other genes, for the ones that we think we can reverse? Now we know that a proportion of them are genes with vascular response. Others are immune response. Others are garbage disposable, meaning that as you gauge, you accumulate this garbage in the cells and how well is your garbage disposal. And then the ApoE4 is lipid and inflammation.

So they're lifestyle genes. So these genes give you a range of anywhere between 10 to 30 years. What you do in life determines if you're going to get it early on or as late as 90 or beyond. Right. So the magnitude of how these genes are expressed is contingent upon what you're eating and how you're moving and how you're living your life. Absolutely. Right. Completely. And, and what's interesting, let's, let's get into like the contributing factors before we get into the solution. Cause you kind of broke this down into four categories. We have inflammation, we have oxidation, we have glucose deregulation, and we have lipid dysregulation, right? So these are the four main things that are

driving the expression of this. Absolutely. Absolutely. So when we're talking about inflammation, let's just go through these like seriatim, if we could quickly and explain what these mean. Yeah. So inflammation is a normal part of the body. Yes. It's a constant process that goes on and we have mechanism in place that get rid of them. And Alzheimer's disease and so many other diseases. And that actually shows us the commonality between, you know, degenerative disease of the

brain and vascular diseases of the brain and the body. Right. Sorry, I don't mean to interrupt. Not at all, please. If you could indulge me. Yeah. What's amazing is how much so much of this tracks what we know about heart disease and diabetes. Like when we're looking at chronic inflammation and the incidence of these diseases, it's like completely overlaps in the Venn diagram with what you guys are talking about with the brain. And that is something that we have been focusing upon. And it was almost a eureka moment for us. We knew it. But the fact that the processes that are going on in the brain goes on

in the body as well. For such a long time, people always, people and scientists specifically, always thought that the brain was a black box. It was a separate organ that had a completely different type of physiology. And the things that affected the heart, say for example, the kidneys, the lungs, couldn't affect the brain. But that's not true. It's the same process. We talked about inflammation. You know, there are certain mechanisms that are not working very well, and inflammation builds, and that's how it starts destroying the brain structure, whether it's the cells, the connections, the supporting structures of the brain. and the inflammation is actually associated with the other processes, with glucose dysregulation, which is essentially the glucose not being able to be used properly by the cells.

Lipid dysregulation, where the proper fat cells that create and metabolize cells, they stop working. And then all of them together start depositing the bad proteins, which is essentially what all the scientists have been focusing on, but not looking at the upstream processes. So it's almost like all these paths lead to one point, the amyloid, which actually starts 20 years, 10 years before. And then everybody just focuses on that endpoint. We've made an animation, hopefully coming out soon. It's a little boat. You're in your 30s. In your 30s, you start having some blood pressure.

So the boat is an analogy of a person. Or the brain. And then there's a little hole in the boat. And then there's inflammation because of overwhelming bad food and things of that nature. So that's a crack in the boat. And then oxidative byproducts because of the the fact that you had certain trauma or because of head trauma or other things and so by by 50 or 40s the amyloid which is water

starts seeping in and the holes are accumulating because of all these other things and then about 60 or 65 the the person is sitting on a boat and they feel the water, but the boat's already one third full of water. And for the last 30 years, all we've been doing, billions of dollars, taking a little cup, trying to get rid of water. You could get rid of all of the water, but if you don't address the inflammation, the crack,

if you don't address the glucose dysregulation, the boat's still gonna sink that's the the mentality the the concept is wrong because we're we're looking at it completely in the wrong end should be looked at at the lifestyle side right and not only that not even really looking at it or addressing it until the boat's half full exactly right like oh well now that you have this thing it's like well actually this has been building for the last, you know, 21 years, you know, and it's not any one of these four facts. I mean, these are all interrelated. I mean, if you, if you are chronically inflamed, then you're going to have problems with oxidation and free radicals and, you know,

glucose deregulation leads to insulin resistance. These are, these are all related to the foods that we're eating and how we're living our lives and how we're sleeping or not sleeping and the stress and all of that plays into that. And these are the same four factors that are contributing to diabetes and heart disease. Absolutely. To make it a little anticlimactic, take the power away from the book. Whatever you knew about heart disease applied to brain disease. When you're talking about amyloid, you're talking about the plaques that the amyloids create in the brain, right?

And so, I mean, is it fair to draw an analogy to the plaques that are in our arterial system with heart disease? Is there a rationale in comparing those two, or is it completely a different thing? It's a different kind of plaque. Amyloid, although you have amyloidosis and other diseases that happen systematically as well. But the amyloid in the brain is a little different. But in reality, it's the same process. The body is overwhelmed because of inflammation, because of oxidation and everything else.

So it actually starts making bad proteins. Simply. A bad protein in one place is tau, in another place is synuclein, in another place is amyloid, but it's because it's been overwhelmed by inflammation, glucose dysregulation, lipid dysregulation.

It's time for us to just say, the brain is complex, great, but the mechanisms are the same. But just so much more. I mean, this little three-pound organ uses 25% of the body's energy. Of course, it's going to be much more. I mean, this little three-pound organ uses 25% of the body's energy. Of course it's going to be overwhelmed more. It makes it one of the most susceptible organs in the body

as well as the most resilient one because of its activity, because it's always trying to consume so much energy. So whatever we do, we kind of joke about it in our talks. We say, sorry, cardiologists, the heart is there to support the brain. But it is so. Whatever we do to it actually affects it first and then the rest of the body. Right. But in the same way that a cardiologist is sort of focused on stents and bypass, they're looking at the end product of this disease. In your field, it's all about amyloid and how do we get rid of this stuff or as opposed to looking at the factors that are contributing to the

production of it in the first place we think that actually even exponentially more for the brain if you take care of your brain you've taken care of all the body because now this this thing that we're trying to create living mind kind it's about the mind mindful living and so this affects the totality of your body for brain it's something more than that because you here you have emotions as well you have motivation you have all this so though one of the elements of our book is not just saying this is bad and this is good but where we have failed people is we just throw it at

them without giving them the tools of how to apply it to their life. So mindful living is the unique thing about our book, more than even the science. And it's a regular basis can help you take better care of yourself. So there you go, you have a healthy brain, you have the tools to take care of your heart and the rest of your body. Right. And everything follows. Depression. Recently, papers came several, I mean, whenever as a science, we don't say paper came, heart and the rest of your body right and everything follows depression recently papers came several i mean whenever as a science we don't say paper came paper means nothing it has to be multiple and validated um otherwise you every day you say science says this who's this mr science

that keeps saying these things that you got to give me more than that but lots of papers say that one of the major causes of depression, inflammation. Yeah. So it keeps coming back, yet we keep slipping. I call it logic slip. And a lot of times when you have debates, you keep building these logical sequence and you work past the fallacies and everything, and then it slips again. That's what's happening in nutrition and lifestyle. And you make the case.

I mean, the case for diet has been made over and over again and then all since slipping it now we know inflammation and all these things actually even affect the depression anxiety everything are all of these diseases right you can't you can't extract one thing from the other right and it seems like the the advent of functional medicine, lifestyle medicine is is growing and people are starting to embrace this idea that it's not just one treatment protocol that we have to kind of look at a person in a holistic way and, you know, treat them, you know, all the way down to, you know, how they interact with their family members and at work and what's their relationship with their boss. And, you know, all of that stuff is crucial, right, to kind of solving this problem. Well, let's talk a little bit about the path forward in terms of prevention and reversal. Like you break this down into five categories, right?

Nutrition, exercise, unwind, restore, and optimize. So maybe we can spend a little bit more time in unpacking the nutrition part of this in detail. Yeah, absolutely. It's been quite clear from studies coming from the Adventist Health Study and from the Women's Health Initiative and decades of data that show that a whole food, which is unprocessed, plant-based diet, low in sugar, seems to be the best dietary pattern for the brain. And it affects all those processes that we just talked about, lowering inflammation, managing glucose metabolism, managing lipid metabolism, providing the best source of macro and micronutrients for the brain to thrive, to grow, to heal itself.

And study after study shows the same thing over and over again. And by just looking at populations, the seven-day Adventist population, you rarely see dementia. And the ones that do have dementia either have it very late in life or they have had other uncontrolled risk factors in their life. And so the idea of nutrition, we try not to tell people to become vegetarians in the clinic. It doesn't work that way.

And especially for people who have not been vegetarians throughout their lives um not just gonna hit them with that right over their head right when they walk doesn't work that way and i think and i think as scientists and as doctors we failed over and over again because we have this um cookie cutter approach for everybody just do what i just do this and you'll become better it doesn't work that way it has to be tailored according to their resources, to their likes and dislikes, to what they can own at that moment in their life and move forward with it. So it's making small incremental changes on a daily basis. One of the talks we gave to one of the African-American churches,

afterwards they invited us and it was all women of course and wonderful and said that shares it was a wonderful talk yeah we love you very much we love you so much but if you expect us to go vegan overnight it's not gonna happen no no no that's not the aim the aim is to work towards so in the book we've said wte wti work towards eliminating work towards increasing It's small incremental changes. And the most interesting thing is in that research project that I conducted in the California Teacher Study, we essentially created a statistics to look at adherence levels to a plant-based diet. adherence levels to a plant-based diet. And every incremental change, every increase in the score of adherence to the best diet, lowered risk of stroke, lowered risk of brain diseases. And, you know,

to tell people that even if you replace, you know, an unhealthy meal with a small salad or just replacing small, making small changes actually makes a big difference. And we've seen that in the clinic. And I think that's empowering. At the actually makes a big difference. And we've seen that in the clinic. And I think that's empowering. At the core of this is motivation. And the word motivation is a terrible word. And my daughter reminded us how terrible it was. My 10-year-old daughter, they're both,

my son is fairly driven. He's 12 years old. And she came to us, you know, and she's actually very good. She's 10 years old. She's in ninth grade. And she said- We'll call it, she's in ninth grade. She's 10 years old and in came to us you know and she's actually very good she's 10 years old she's in ninth grade and she said hold on she's in ninth grade she's 10 years old and in ninth grade and our son is already yeah no but but all right she comes in i gotta know more about that i said mom is all motivated and you're motivated and alex is motivated so what's going on why i don't feel motivated she told us so i realized wait second, what is this motivation thing?

So because we throw it at children and if they don't own this big monosyllabic thing, like as if, you know, one of those movies where you're charging. You're Tony Robbins. Yeah, exactly. Then you're not doing the right thing. There's something wrong with you. I said, there's no motivation. doing the right thing, there's something wrong with you.

I said, there's no motivation. Motivation is small increments of success in a direction that you've set that incidentally your brain and your brain always does this. I'll give you a perfect example of that. You have a blind spot. We can do experiment and we can figure out where your blind spot is. Your brain fills in that space. And hundreds of experiments like that, where your brain fills in information, fills in color, fills in knowledge. When somebody's drunk, they confabulate. People say, oh, he's lying. No,

your brain is forced to create a story. So this filling in is a natural part of human brain to make itself comfortable. So when you have a series of successes in a direction with a vector, with a purpose, purpose, purpose is the key. Your brain creates an emotion to it. And that emotion has a direction. That's motivation. So we just operationalize motivation. And so if you want to change people's behavior,

you don't just throw it at them. In fact, the reason that most of healthcare is a failure because it's sick care. In medicine, we don't learn behavioral modification at all. Four fact, the reason that most of healthcare is a failure because it's sick care. In medicine, we don't learn behavioral modification at all. Four years of college, highly driven people whose mom or dad told them to become a doctor. I've just offended a bunch of people, but for a large percent. Pretty much true for a lot of people. Exactly. And then so it's like study, study biochemistry, this and this, but nothing about lifestyle and all this. Or understanding human behavior and how to relate to another human being.

No, because they're hyper-driven people. The rest of the people, you know, medical school, worse. So it's just biochemistry, anatomy, histology, memorization. Then four years of residency. My gosh, that was until recently, that was just going through, you know, military school. So that's 12 years and then fellowship so you come out as a leader now you're a doctor patients come to you and by the way 50 percent of your pay is going to be how to train them and train the patient or teach the patient

about lifestyle never happens you don't know so what do you do you at the door you've done the check you've done the knee thing you've said and and it's how health care reimburses you they reimburse you more on the notes and your examination and what five minutes of counseling yeah not even at the door you say by the way eat healthy and most of the doctors don't know about what that means so they've googled like everybody else so it's either this gimmick or that gimmick ketogenic diet or paleo and things like that and then the person is left at the door in the clinic lost. So they look at this. This is incredible.

I want to actually create controversy so that there's conversation. Controversy is great. Conversation. What happens is the patient's left. I have blood pressure. I have diabetes. And I know that it's related to my diet. And he said, I have to eat healthy.

There's no information. Forget about information. Forget about behavior. They give up on it. Not only do they give up on that, they also give up on their medicines. You've done double damage. It's time to change the conversation towards how you truly empower patients. You go to their communities or in the clinic, give them one behavior.

We give one behavior. We know what sugar is. Cut your sugar. We know what saturated fat is. You're eating this much cheese in a week? How about here's a plant-based cheese that you can get from this place. Just change that for a week. Right.

Something very specific and doable that they can master or that they can work on. Exactly. Something to check off on a regular basis so that it becomes a deep bound habit and they feel success in doing it. And then we'll have to think about it. And that's when you introduce the next step. Yeah. Just get almond milk, not regular milk or whatever. Just make that one change. You know, getting back to your earlier point, it's a systemic problem. I mean, these doctors are well-intentioned, you know, whether they understand nutrition or not, like everybody wants to help their patients. They're under their own pressures, right? They

got to move on to the next person. And you hear time and time again, well, I could tell them to do this or that, but they're not going to do it. Right. And there, there's sort of a pessimism, I think, and a condescension that's built into that, but there's also a truth, right? Because if they just tell them to do something, but there's no accountability and there's no community and there's no follow-up and there's no structure in place where, you know, that, that doctor's office can reach out and check on that person, or they're supposed to come back and there's a program that they can, where they have support for making this change. You know, if that's not available, then they're right. Like just telling them to do that thing is probably not

going to work. So it's bigger than just get involved in the community. It's sort of like, well, how do we create a system where the doctors can be incentivized and and taken care of for taking that you know step and making that effort absolutely that you hit it right on yeah incentivize I mean they have to make a living and not only forget about living the doctors are willing to sacrifice their money their time but there has to be time allotted and a system created that where even the doctors see their behavior coming to a success. So the doctors are motivated. So the first step in everything is conversation.

I think one of the most important things we can do, and it started, it has started, is to say the way we're doing medicine right now is not health care. It is important. Sick care is important. When a person comes with an infection, they need a medicine. When a person comes with a blood pressure of 200, you're not going to say, go eat this. That's a long-term thing. You have to take your medicine. That's sick care.

It's important. But there's another side, which is healthcare, which has to be incentivized. There has to be a mechanism. People can't just rely on goodwill where I'm going gonna go at nights to clinics or this or that or to churches There has to be a system created where we can prevent but you know what? That system when it's created will reduce the cost of health care by 80 to 90 percent by itself That's pretty staggering statistic. Yeah, so we just have to make the choice as a society and even the choice you know we get caught up in the politics of right left no once there's enough information that overwhelms and and and everybody

sees the benefit in this for their kids I mean we don't what this book is not about just Alzheimer's end-of- I mean, our kids are overwhelmed by sugar. And then we tell them they have ADHD. Well, they might, but a great proportion just have a lot of sugar. Yeah, there's no question about that. And also, you know, I want to get back to the nutrition piece in a minute. But, you know, what I took away from it is that it's a book about how to live your life now so that you don't have to deal with this. Like if you could read this book as a 20-year-old and say, well, I want to take care of my brain,

and this is the way to do it because those amyloids and all this sort of stuff that goes into creating the dementia and the Alzheimer's, this is going on all the time, right? So it doesn't just suddenly strike you at age 65. Just like heart disease, you're working on this your whole life and it has to do with the diet and the lifestyle. Absolutely. So on the nutrition piece, just so we're totally clear, as scientists who have studied this disease for a long time and treated a lot of people, you're sold on the whole food plant-based diet. This is the way to go. Absolutely. As a scientist, we say to the best of our knowledge today,

that to me is the most powerful, the most humble statement in English language. I think forced certainty is the cause of a lot of our conflicts. Science is open to change. I mean, tomorrow if they say if you eat a steak, I'm not going to because of other reasons, but I would say, okay, sure.

I doubt that it's going to come, but right now, the data is just overwhelming. And a lot of times in discussions, any discussion, they fail you by falsely holding you to absolutes, saying, but there's not cause and effect. Science cannot create cause and effect. It can create strong correlations, very strong. Even now, we can't create cause and effect with cigarettes because you can always talk your way out of it you know even if you give people even if it was ethical but there's a

tremendous amount of data that a whole food plant-based diet is overwhelmingly protective yeah is there any uh positive benefit with respect to brain health for is there any argument that there's something healthy about eating meat when it comes to cognitive health like well yeah go ahead sorry so nutrition sciences um you know has its flaws um the way we're recording diet right now is through food frequency questionnaires or diet food diaries and things of that nature. And, you know, it has its strengths when you look at the different components of meat, the saturated fats and the animal proteins, you know, whether it's animal studies or human studies, they're not good. I mean, the data over and over comes back and shows us that saturated fat actually causes those plaques

in the arteries in the brain that supply oxygen and nutrition to the different areas of the brain and they get clogged when saturated fat is very high in your diet plus inflammation everything else plus inflammation plus affecting glucose metabolism as well and on the contrary so in comparison to you know other types of fats such as polyunsaturated fats and monounsaturated, they're actually beneficial. The most important element of the Mediterranean diet that everybody's been talking about for heart health and for brain health are those poly and monounsaturated fats, and they come from plants. So when you look at different comparisons of whether they're the types of fats that you eat or the antioxidants that you get from plants, it's quite clear. And when you look at meat, other than fat and protein, it doesn't have anything else.

It doesn't have any fiber. And some of the minerals that are there, they're just minimal. So you get more benefit from eating a whole food plant-based diet. The two things that they always talk about is protein. And how about lean meat? Okay. So these are oxymorons, lean meat, because it's the fat not that you see and you strip away. The cells in their cell wall have these kind of saturated fats.

That's the component that we're talking about. So when they say chicken is lean meat, well, first of all, we're eating three times more chicken than anything else, actually much more. So therefore, by volume. It's the main source of cholesterol in our diet. Chicken's the big problem. It is. It is. But at the same time, the fat is not what you see as white streaks it's what's in the cell wall the cell wall structure is different so that's one thing the second thing is protein it's as if plants don't have protein the protein the majority of protein we get is not in the form

of muscle the majority of protein we get is in the ribosomes and proteins within the cells. So to say that plants don't have protein is not understanding the mechanism of the cell. So we have plenty of protein within the cell, and then we have other plants that have protein even outside, like beans and others. So those are the two contradictory things. The one thing, though, that we always talk about that they've seen in vegans is lack of B12. B12 and the way it's bound to meat, it's actually much more bioavailable in the meat form than it is in the plant form. Right. So anybody who's purely vegan should definitely supplement themselves with B12.

And then what we say is along with b12 everybody not just vegans that a DHA no may get three should be because the synergy between b12 and and Omega and beat DHA seems to be pretty powerful more will be coming out on that we're big time about synergy of vitamins not singular in other words like taking those together to increase the bioavailability of the b12 correct exactly yeah i haven't heard that before yeah not so much that bioavailability but they seem to work together more in the body and and many studies we did four reviews which is these collecting all the papers and then coming out with what those said so

which is the most painful kind of research and and on nutrition and parkinson's nutrition and stroke and nutrition and dementia and the thing that stood out the most was synergy absolutely so these micronutrients whether they're vitamins or minerals they don't work um alone um you know it's actually the combination and the levels of the different kinds of micronutrients that matter and they synergize each other's availability. And that makes sense. And that's why hundreds of studies on, say, for example, vitamin E and brain health or vitamin C and Alzheimer's or Parkinson's disease have come back with no results, with no particular correlation and effect but and and when you eat it in a whole form when you eat it in a you know plant farm all of these micronutrients are well

balanced and they're bound to other macronutrients they're bound to the fiber as well which increases their bioavailability One of the things that you hear is that you need healthy fats for brain health. Like the brain needs good fats, right? So that's true, correct? So when we're talking about healthy fats, what are those healthy fats? We talked a little bit about saturated fat and animal fat, but how do we parse the difference between a healthy fat and an unhealthy fat we say focusing too much on fat or one food product is just getting reductionist yeah yes exactly but i mean

that's what you hear you're like oh if you right i've heard that many times like oh to combat alzheimer's or if you don't want to get dementia, like you have to make sure you're getting enough of your omega-3s and your healthy fats and your diet. Right. I think just focusing on eating unprocessed whole foods, mostly plants, is the best way to go about it because you get your protein, you get your carbohydrates, you get the best types of fat by just eating those normal foods. If we focus too much on one micronutrient and one macronutrient, it doesn't do anything. Eat your olives, eat your avocados, and you've got your fats. Eat some nuts here and there, and you're fine.

There was much ado about coconut oil recently and the impact on brain health, and you were pretty unequivocal in your book about that. And you wanted to, we've been attacked by, it seems to be clans. Yeah, people are very sensitive and passionate. There's certain things that people get really upset, get very passionate about. Coconut was one of them we learned very early. Well, it goes back and forth on coconut oil too,

but go ahead, sorry. Right, no, it's interesting because, you know, all of this started with one study. Not study. One person. One person. One person giving coconut oil to her husband who had Alzheimer's disease. So no, supposedly had Alzheimer's.

Supposedly had Alzheimer's disease and supposedly got better. But then we found out later that he got worse later as well. So we don't know whether it was coconut oil or whatever it was. So he's this guy's like patient zero, like for this for this whole story yeah that's like a sociological experiment like how did that happen it happens because people are looking for anecdotes and fallacies so why are we keep why do we keep struggling because we're our brain is designed to hear stories and if somebody tells a good story that's more powerful than a thousand studies. And because the studies don't have stories in them and they're not associated with faces.

Maybe they should. Yeah, maybe they should. Do a little storytelling in JAMA. Probably, I'll make a case series. I think that would actually sit with the population much better. But it's just, you know, you pointed it out. Like we're storytellers, when you don't associate a cause and an effect with a person or with a particular situation, it's very difficult to see it. I mean, the thousands of people that have been studied and you have these phenomenal results, they don't have any faces.

They're just numbers and people don't see themselves be a part of that yeah this this study although there's there were some data so let's just talk about the science of the coconut oil medium chain fatty acids and coconut oil has been studied in many things and there's some some some signals that people get here and there um there's some evidence to the best of our knowledge today that the medium chain part which is about 88 of the total fat the other 90 is 90 to 92 is saturated fat but the medium chain when people have looked at that seems to have some benefit. And even that has to be reproduced and shown. So we're okay with that.

I mean, we have no skin in the game on one side or the other. What works? And so what we say is, to the best of our knowledge today, with the data, true data, there doesn't seem to be a strong relation between coconut oil and brain health. The medium chain part, there seems to be some, what we say, qualitative and further study that needs to be done and that is being done. And we welcome that.

But to extrapolate from one case and from few studies to say that it's beneficial for your brain, don't you think somebody would have shown those cases in a much better way? They would have made millions by now. Yeah, but that would require us to actually read, right? Yeah. We don't wanna do that. No, no, no, no, no. A lot of the, it seemed that a lot of the research

that you kind of plow through in the book and has kind of informed your protocols, some of it comes from looking at the Mediterranean diet, right, versus like a whole food plant-based diet, probably because there's just been more studies on that. I don't know. Right. So how does that play out in terms of meat intake

and also things like olive oil, processed vegetable oils, coconut oil? It actually has helped us. It has actually helped us understand the nuances of plant-based diet and its benefit because the way the dietary scoring system, for the lack of a better term, is structured is, you know, you get positive scores for a plant-based diet. And you get negative scores for sugar, meat, and dairy, and things of that nature. So the higher you go on that scale

means the more adherent you are to a whole food plant-based diet. But because this Mediterranean diet was structured and it was given a label and it was started in an area where people had the least amount of cardiovascular disease, it just stuck that way. But we now know that, you know, different scientists and different doctors at different universities have actually come up with a better definition of dietary patterns. And there are different statistical processes like factor analysis to

see, you know, what dietary pattern stands out in the healthiest population and um we we see this uh this picture being translated uh in different populations that a plant-based diet seems to be the healthiest and the factor analysis is looking at what component of this thing is most beneficial and it's not the fish right it's the plants over and over again it's the beans it's that that component so even though it's not the fish right it's the plants right over and over again it's the beans it's that that component so even though it's not completely a let's say plant-based diet but we can actually distill because these are large studies 144 000 you know um we can it's large enough we can actually then break it down into what component of the diet had the greatest benefit because this group ate more of this versus this.

So we now have enough data from all these big studies to strongly, consistently say that it's the plant-based component of even of the Mediterranean that's most beneficial. That's interesting. But by far and away, the large culprit here is sugar. Correct. Correct. Even with us. I mean, meat is bad.

Saturated fat is bad. Let me actually take a step back. So let's get back to the disease, diseases of the brain. When it comes to stroke, it's fairly well known. Stroke is vascular. So it's going to be mostly driven by saturated fat and sugar then. For Alzheimer's, it's a catch-all category. In a few years, we will realize that there are many types of Alzheimer's.

Those that come to it from vascular side, those that come to it from inflammatory side, those that come from other sides, the football players that have been hit multiple times with trauma, that's more inflammation versus those who have lipid dysregulation. So to talk about that, there are those that are more driven by sugar and glucose dysregulation, but there are others, especially the ones with APOE4 that we believe that are driven by sugar and everything and inflammation, but dominant feature is fat and saturated fat. So it depends which direction. And I say, since we don't know that yet, although we can get a good picture of it,

especially in our clinic and others, it would behoove us to kind of limit all of those bad things, you know, sugar and saturated fat in steps. Right. What about gluten? I'll leave that to you. Yeah. No, that was another one. But it didn't seem like, was it, I didn't see it in the book.

Did you guys make a decision to not address that? Oh, well, because there really isn't any data that supports the idea that gluten is, you know, causes harm to the brain. There's, you know, probably one or 2% of the population that are sensitive to gluten, and they have specific allergies. And that creates inflammation. It creates inflammation, and it actually has other repercussions in the body, gut health and skin health and musculoskeletal issues as well. So it's a constellation of problems that people suffer from. For gluten to just affect the brain, there's really no data that supports that.

And there have been some authors that have actually made a lot of fortune pushing the idea that gluten is bad for you and that you have to stay away from it and that you just have to eat a lot of fat and protein. and that's just not true. The important thing is here is I always say it's not the struggles we have as humanity is not truth. Everybody has their truth. It's the weight of the truth. If somebody overstates a weight of a truth, they're creating fallacy. If they're understating, it's creating fallacy. Is gluten bad for people who have celiac disease? Absolutely. They should avoid it. Is gluten bad for people who have celiac disease absolutely they should avoid it is gluten bad for another percentage which we we still don't fully know i mean look at this we we don't know something fully yet we're making these huge public health uh actions and i'll tell you where the public

health component comes in um let's say that that other group beyond celiac disease is at three percent we don't even know that let's say if it's that bad for them they should be studied identified and they should avoid it but to say that gluten is bad which actually what's now the common law or language out there means that 90 percent or more have to avoid gluten which means that with that comes what they have to avoid because we don't have a good way of doing that so it's a blunt mechanism we give up on all whole grains whole grains yeah so look at weight of truth with this three percent benefited the three percent that was supposedly gluten sensitive but the 95 or 90 whatever percent that would have benefited from a whole wheat and and you know

they are going to suffer because of because of over generalization of three percent that's a common problem in science yeah no i get that i get that and i think it gets even more complicated because we've hybridized our wheat and most of the wheat is it's so stripped of any of its nutritional value anyway and it ends up in these packaged foods. I mean, I just know if, if I eat like crappy pizza crust, like my eyes get puffy and like,

I feel terrible. Like I'm like, that's not good for me. Like my research is done. Like I know, like I don't know where I fall in the spectrum of gluten sensitivity, but I can tell you straight up that it's creating an inflammatory response in my body and that can't be good. And I terrible absolutely I mean and I keep eating it like so it's like it's like well

what is in our wheat and is it the gluten or is it something else about like how we've you know kind of you know hybridized these foods that are staples because at its core of course whole grains are great and now it's almost like if you say, well, you should eat whole grains, people are like, ah, whole grains, like they're afraid of whole grains. Yeah, so that 3%, 4%, 5% let's say, is dictating health for the 90% that would have benefited from whole grain.

I mean, if we give up fats, saturated fats, and especially, let's say fats, sugars, and then grains as well what are we going to eat right people throw up their hands they get despondent and oh and that's what i was getting to one of the things that not to be a conspiracy theorist or anything like that one of the ways you fail people is by throwing so much information false and and play with the weights of truth that people just finally give up and say I'm gonna do whatever I have to And we can't afford that

So you operate with what you know to the best of our knowledge and say I'm fully on board to study Coconut oil, but am I going to make public health decisions for general population on that? No, not yet I'm fully on board to studying gluten Absolutely. Are we at the apex at the full knowledge of all of nutrition? Not at all. Not at all. But what do we make public policy on is with the best data we have right now. Otherwise, you're going to be all over the place and people give up.

And we know that diet kills and diet saves. And so we have to operate with what we know that diet kills and diet saves. So we have to operate with what we know and leave the rest open to research. On the subject of research and diet, what is your perspective on the ketogenic diet? Because this is getting a lot of attention and a lot of press. And there's a lot of talk about the impact of being in ketosis in terms of disease prevention and reversal, et cetera. So like, what do you know about it? What is your understanding of it? What's your perspective? So the process of ketosis is essentially a period of starvation for the body and for creating alternative fuels that the body can use.

And it has been studied. Specifically, we'll talk about the brain diseases for certain epilepsy diseases of children. Not all epilepsy. There are certain epilepsies and it's helpful. It actually makes them have less seizures and it makes them function better in their lives. and it makes them function better in their lives. But usually, it's a very short period, a very quick, blunt method of controlling seizures in that population. Beyond that,

ketosis hasn't been studied in any other disease, and it hasn't really generated a large amount of evidence for us to apply it in public health. For individuals with Alzheimer's disease or cognitive impairment, the studies that have actually shown that ketosis or a ketogenic diet is showing some benefit, they were done in a very small population, and the amount of ketosis wasn't measured well, and it was studied for a very short period of time. It makes sense when you look at the cellular structure for the ketone bodies to provide fuel for cells that can't use glucose anymore for advanced stages of the disease

because the cell structure has been destroyed and there's been a lot of inflammation and dysregulation going on. However, to use this particular technique or this approach for a long term, I mean, we know that down the road they will have plaques in their arteries if they keep up the ketogenic diet. They will have glucose dysregulation. They will have lipid dysregulation. All these processes that we just talked about, and it causes a lot more inflammation. So it doesn't make sense that this diet would actually work long term. Do people feel good using it initially?

Absolutely. And I'll tell you why. And do people lose weight? Absolutely. Because if you're going to stay away from carbs, let's say, you hold about two to three pounds or more of carbs in your muscles. And as that gets burned away, used, and the water that's connected to it, anywhere between six to 10 to 12 pounds of weight is lost. So, wow, I just lost weight. Absolutely. Great. Why do you feel good?

Because here's a cell that needs glucose. It needs energy. I mean, we talked about how much energy it needs needs the usual mechanism or the usual energy source is glucose the most effective way the the functional energy source but in order for glucose to get in it needs receptors it's not it's a very fickle process it has to find the receptor and if there's too much sugar in the body what happens the cell internalizes the receptor because it's shocked so now there's it's swimming in sugar but starving of energy so it's it's very difficult process of getting not difficult but more complex than then click keto of getting sugar into the

cell what ketones it's small molecule gets right into the cell so it has the cell has energy so what so people say i feel better i feel more awake of course you do initially and for a while but that doesn't mean that long-term benefit is there now let's look at how you achieve ketosis it's not a natural state you have to have this incredible diet that is also high in saturated fat and or fat and very little in carbohydrates, less than 5% of carbohydrates. Initially, there's even reduction in inflammation with ketone studies. But long-term, it's always about the long game. If people want short game, I'll give you 50 different ways where you will lose weight,

cut off your arm. They will actually feel better. I have lots of pills out there that'll make you feel better. Long-term game. Everything we're talking here is about long-term game. The long game. I'm a Pittsburgh Steeler. It's a long game. It has to think about what could truly, how did your body evolve? Did it really evolve in this way? They said they bring paleo. Really? You're going to bring example of people who only lived up to 30 years of age to give me health care for me living at 80 years of age.

Does that even make sense? And if you think meat was the way to go, I was a hunter. We had a farm in Virginia with a shotgun. I barely shot anything weekend after weekend. Go chase a rabbit without a gun. I can't see. I'm trying to picture you with a shotgun. That was terrible.

That was a long, long time ago. Long time ago. But so the science, the paleo, you know, the anthropology, everything is so wrong. I still say we're open. Show us the data. Let's not jump ahead of ourselves because it has public health implications. We're just beginning as physicians we're terrible with this prevention side we're just beginning to accept some of the

things that have been proven to apply behaviorally now all of a sudden because somebody wants to sell the book of the day and by the way you know plants are poisonous to you and the first reference is wrong in the book i mean so that's why it's, I think I know what book you're talking about, but we need to say what works, what has been proven. We're open. Let's apply this. And if anybody brings newer ideas, like eating paint off the wall is going to, you know, give you less Alzheimer's. Let's study that. But I would like you to try that first. Right.

So the research right now is pretty unequivocal. Like adopting a whole food plant-based diet is going to have a big impact in a positive way. If I'm not mistaken, aren't there studies being done now on psychedelics, on brain health and dementia? Is that true? Marijuana is one of the components of it yeah and all the other components are being studied and and and you know we're excited because for a long time social biases were stopping these powerful drugs from being studied

again either this way or this way we don know, but a chemical that directly binds to specific receptors is going to have consequences. So that should be studied and many other drugs should be studied and in a very scientific and responsible way. Right. All right. So we went through the nutrition part, but there's four other things here in your book, right?

We got, I mean, exercise is kind kind of self it's self-evident right all right well what do you mean by that so everybody comes to us and says what i i walk i walk around my neighborhood an inflated sense of what of what they're actually i'm active i walk around my living room in my kitchen all day long and we tell them well that's wonderful but that's not exercise that's meditation you know walking's not exercise. That's meditation. You know, walking around the neighborhood may be good for you. You're moving naturally, but for brain health, it has to be strenuous. There has to be some level where you're breaking a sweat and you're not able to finish a sentence when you're speaking. And there's been studies

that actually show that in those moments where your strenuous activity comes to that moment where, you know, your heart rate is raised, that's when the chemicals start being released in your blood, whether it's brain-derived neurotrophic factor or others. And those are the ones that make those connections. Those are the ones that increase the size of your hippocampus. a matter of fact there was a study a couple of years ago where they actually yeah the one particular one in a large sample population where they compared um individuals who just you know did stretching and some Pilates and yogas and the others were um working with a physical trainer and they did strenuous physical activity three to four times a week. And after

two years, they had, they literally grew the size of their hippocampi. That's crazy. You know, and these are individuals who are, you know, in their, in their midlife. And that's, I think that's such an incredible empowering piece of information for all of us. When you're talking about exertion, can we get specific in terms of whether we're talking about aerobic exercise versus anaerobic exercise? So the data is still coming. Some of the data is kind of interesting, exciting, and kind of throws us for a loop. For example, people with bigger legs had lower dementia.

A twin study. Really? Twin study. dementia a twin study really twin studies bigger meaning like more muscle like a more muscle mass so the ones who are more active actually had a bigger brain from the same genetic background yeah so was it so in research they have bigger legs because they're they're exercising more or yeah exactly so it's not just they have no no no muscle mass because they have same genes so there has to be something else but directionality in science is important were they healthy therefore they retain their muscle more or something but then other studies show that

leg strength has correlation with brain brain health and kind of makes sense because your blood gets to your heart well your blood gets to your heart because your legs have the muscles have to pump the veins to get it to the heart to the brain so that seems to be so even anaerobic exercise seems to have relationship with brain better brain health but definitely aerobic exercise repeatedly has been shown to to have tremendous positive effect on the brain so that's that's one thing that that as much as what was it? One study was 40%, nearly 40% reduction in chance of getting Alzheimer's. Yeah. 40%. Wow. That's, these are

not small numbers, 40%. Right. But when you're, when you were kind of chagrined at the person who said, well, I walk around the block. I mean, that's kind of a blue zones thing, right? Like it's, it's not about exerting you know over exerting yourself it's just these are populations of people that are just kind of in slow perpetual motion throughout the day so so it's not one thing so you said you hit it on a very good good point so a lot of people are highly educated yet to get dementia or others who have very little education yet they didn't get dementia because they ate well and others who didn't who ate you know their diet was okay and their education was okay but they just did lots of exercise and others

who just had complex jobs so my grandfather and her grandfather were probably the most brilliant people you can imagine yet they got the alzheimer's for them it was diet and lack of activity and these kind of things so it's it's the different contributors that's why we say it's a whole person component it's not just diet it's not just this it's the being mindful of a life that encompasses all of those things so the more of those things you do the more protected you are but even if you do some of them, that gives you a measure of protection. Can you exercise too much? Does it become bad? I'm asking for a friend.

I don't know. I don't know. I think, like Dean said, it just depends on everything else. If too much exercise is causing stress, then you're probably not doing yourself a favor. I just want to make sure I'm not injuring my brain by running long distances i'm not banging my head against anything that's the thing yeah if you do if i fall down right yeah no no it's different your balance is probably better than 99 of people that know absolutely if you're doing like boxing and that kind of exercise is absolutely that's doing damage or getting hurt on a regular basis

inflammation inflammation in your legs and in your arms during physical activity. That definitely causes some level of damage. Do you see patients with TBI regularly? Yes, we do. It's interesting how that's really come into the conversation as a real thing. And the impact on the NFL and kids playing football and everything. It is. It's quite scary we actually are in the process of trying well it's with the nfl the retired nfl group uh uh bringing him into our uh clinic which hasn't finalized or anything but but there's no doubt that people who get hit or not even hit to the head sudden deceleration you know this is a

bony structure i mean if you ever get a skull you'll actually be worried that you know there are bony edges there and the brain is floating in a liquid and it's not even a gelatinous liquid it's a liquid that easily moves the brain it's a little more um little more viscous than water, but it still moves easily. So anytime you come to sudden stop, that brain is still moving. So they say, oh, we created this new helmet and this and that. How is that helmet going to stop the brain from moving within this call? Right. Yeah.

And my son always comes up with these things. What was this? The superhero where the girl is falling at fast speed and this superhero always comes up with these things what was this the superhero where the the girl is falling at you know as fast speed and this super picks him up that nope there is she's she's dead the brain stuff it's a lot of fun watching marvel movies brain damage yeah you're like buzz killing every time you know so so repetitive trauma or repetitive deceleration absolutely the small bridging veins are going to be cut and the inflammation that builds up absolutely you don't have to lose consciousness necessarily you get brain damage even you know the lack of loss of consciousness and do these five factors of nutrition exercise sleep stress you know engagement all of that, can those work to, when you have somebody who

has TBI, traumatic brain injury, can these factors work to prevent the further development of that turning into a more profound dementia or Alzheimer's, or can it be reversed, or are those people just, it's about managing it? That's a great question. And that's where the idea of personalization of brain health comes in. So you look at the factors that affects them the most and you address that aggressively. And of course, you know, bringing in the whole comprehensive lifestyle. For example, if somebody has, we'll talk about it later, but if somebody has sleep apnea, you know, they're not sleeping well. And there are moments during their sleep where

they're not getting oxygen into their brains you give them blueberries and the healthiest diet in the world and they're not going to benefit from it so it just depends on what areas need to be attended first yeah addressing that's one this cookie cutter concept that's where we go wrong when it comes to brain health it's complex not to perseverate and repeat what you said but we have every person comes to this journey of brain aging on in their own terms we have to identify that that that focus that area that has affected their brain brain negatively and that area that they can actually create success. That's where the personalization takes place.

So unwind, this is the next category, right? And this is about stress reduction, mindfulness, and specifically meditation. Yes. It's not stress reduction. It's identifying your stresses in life. And there's a definition that we use, you know, good stress and bad stress. And it kind of sounds funny, but we do believe that there is actually a thing such as good stress. And, you know, those are the activities that you own. Those are the situations that you understand and you can manage on a regular basis.

And it is bound to a purpose in life. And that's necessary because that keeps you challenged. That keeps you on the edge. That keeps you awake. And that keeps you motivated enough to do something about your life to move forward. Right. Like I'm thinking about, sorry, I interrupted you again, but like I'm thinking about, sorry, I interrupted you again. No problem. But like I'm thinking about the person who's retired, right? And then suddenly finds himself in the lazy boy chair, bored and unchallenged, right?

Is lacking that good stress that leads to, you know, the advancement of aging. In fact, that's the one state that has shown to be the biggest determiner of decline. If a person at a high level job, by the way, the most protective thing, even beyond food and everything, we would love to say food, it's the level of complexity of the job. If they had a complex job that they loved all their life, that was protective even beyond bad food and everything else. I'm not saying that people should just do that, but it's protective. But if they had a high-level job and then they retired and they didn't do anything that determined the highest rate of decline in brain health

that's interesting that's super interesting life with purpose yeah sorry i interrupted you where i where you were we're flowing we're flowing it's a conversation i love it yeah so keeping keeping yourself stimulated while also reducing the bad kind of stress. Yes. Yes. It can literally eat away your brain. I mean, we have studies that show that people who had a rough childhood, whether it was physical or mental abuse, they actually have a higher risk for developing dementia later on in life. And it makes sense when you look at people going through stress, there's specific hormones that are secreted in the brain, cortisol and others that change the

physiology of the brain, that change the amount of blood supply going into the brain. And it actually causes formation of a lot of oxidative byproducts that reduce those connections that jeopardize the structure of brain cells. And they're shrinking. There's literal shrinking of the brain during stress. And so identifying what stress is and getting rid of it. And not in a magical way. We don't ask people to just sit down and not do anything but to try to focus on managing um our lives and managing and being organized like for example and trying to minimize things and attending to all of them in a way that you can yeah just being in the present and that's the best way to go forward this is the one chapter that's a little different than the other chapters we go into why meditation why mindfulness right what it does it actually gives you ability to

step back from the moment we live people think that urgent living so living from minute to minute to minute it increases cortisol levels and all that stuff the ability to step back, be it consciously or through, gives you a higher view of everything and actually completely reduces those hormones. They've done a study after and increases oxytocin levels. Paul Zak and his oxytocin. The happy hormone. The happy hormone. The love hormone.

So it increases that. These are important things. The moments that you can actually create that actually increase the oxytocin and positive hormones and reduce the negative hormones determine the shrinkage of the brain, literally. So we've instituted this in our household with our children, Sophie, Tan, and Alex. And so what we do with them is mindful breathing. And we do this in lectures. Yes. We're huge. We did this in lectures yes we're huge

we did this in the sinai temple 500 people 500 individuals i said close your eyes so they close i said something very simple you'll see it's kind of so breathe in breathe out just be aware of that breathing in and breathe out next muscles you don. You know how it is. The muscle relaxation. Then put yourself in a beautiful place. And next, focus on one item. And we did this for 15 seconds. Yes. I said, open your eyes.

And I mean, this incredulous population, the elderly in the churches and the community centers, every time they say, this was amazing for 15 seconds. So the other day, we do this twice a day with the kids. And my daughter came and said, Dad, my life has changed. And we were like laughing. I said, you have no right to say that. You're 10 years old. But this is important.

And Beach Cities, Manhattan, Redondo, they do this in schools. Do they really? Yes. Mindfulness. Yeah, we're part of that project. We're actually implementing brain health. Is that part of the Blue Zone stuff that's adopted down in Redondo? Yes, that's how it all started.

And now we're involved on the brain health side. And they've done this way before us. Imagine teaching kids to manage stress. What better gift? Yeah, that's a beautiful thing. It is. And it's really cool to hear that coming from you guys from and from the perspective of neurologists right who are like rooted in

the hard science but you didn't expect that from cardiologists did you no yeah no but i mean i have like two days ago i was doing a podcast with guru singh who's like a kundalini master he's like i talked to a lot of guys like that yes it's amazing i can you know i expect to hear these sorts of things from them but like to hear to hear it come from you know hardcore scientists like it's it's cool right so in that in that vein are there studies where you can see the before and after mris and kind of really gauge the impact on on brain health with somebody who is you know performing a consistent meditation practice? There hasn't been a lot of studies, but yes, there are studies that have looked at, say, for example, Buddhist monks who meditate on a regular basis, and they have lower risk of brain

diseases. But I think it's an area that is expanding more, and people are very excited about it. And thankfully, we have tools. have functional mris and other mri sequences that actually goes deep down into the brain to see how meditation affects right those those cells and connections actually the two years or year of research at ucst fmris yes these are mris that actually look at your brain while you're thinking you're doing things so they've done all these kind of studies free will studies and other things that have done with these mris they give you functions like memory cards and things to learn and think about and listen to music and you see how the brain functions right yeah so they've done that with meditation and and repeatedly we know that the

different parts of brain are brought into function um the brain actually works at a different level the brain actually works at a different level the greater detail has to be worked up as far as how this has to works for your long-term health and as far as brain health why is it not being done because first of all it's costly second of all you have to get rid of a lot of what in science we call confound other things that could be contributing so if you bring a buddhist monk and put him on fmri and you see brain has changed, then you have to say, well, this guy is doing a lot of other things that are beneficial as well. So, right. There's a lot of co-founding factors. Exactly. Exactly. Sleep. Talk about sleep a little bit.

Big, big, big part of our book. It's something that's not really discussed much. And, you know, we, we lived in Los Angeles and Dean and I joke about this all the time you know you there's always some detox going on you know detox of the day eat this or do that and our opinion the best type of detox is actually sleep. People talk about that in LA? They do. I didn't know. Some people do. And the best detox is just sleep. Restorative sleep. Yes.

So what does that mean? That means that one is able to go through all the stages of sleep without any interruption. And there's been studies where one night of sleep deprivation has increased the amount of amyloid in the brain and the cerebrospinal fluid or the fluid that surrounds the brain exponentially and wow it's an inflammation that's just one night of bad sleep for anybody or is that like a function of whether you have the proper gene or or disposition to dementia or No, no. No, for anybody. Because those factors were actually taken into consideration during the analysis. And that's just incredible.

And they've done studies among night shift workers who have completely challenged their cycle, their biology, and they seem to not do very well in a lot of memory testing. and they seem to not do very well in a lot of memory testing. And even among college students, you know, a good night's sleep actually tends to increase their scores if they studied very hard. And if they sleep well, they have higher score compared to those who don't sleep well. Who pull the all-nighter and cram. That doesn't work.

And when you look at the physiology, you know, sleep is a mechanism where your memory is consolidated. Or just to put it in simple terms, there are files and folders created in the brain where all of these memories are placed. So it's easier for one to go and retrieve it later. And it also gets rid of all the quote-unquote garbage that is deposited in the brain during the day. So it's essentially, you know, a garbage cleaning system and it consolidates memory in the brain. And it's a very, very important thing to talk about. And so what are some of the things that affect sleep? Yeah, maybe, you know, not having the time to go to sleep or a job, but even, you know, things such as sleep apnea, which is just crazy. Sleep

apnea is a disease where you have a number of periods during your sleep where you stop breathing and your brain doesn't get oxygen. And in one population, sleep apnea increased the risk of Alzheimer's disease by 70%. Wow. 70%. And how many people suffer from sleep apnea? Way more than you would expect, especially as we get older or people are a little overweight or have these other chronic diseases. Sleep apnea is a very common finding.

It goes unnoticed most of the time because people don't actually say, hey, I snore or I wake up multiple times and I have a hard time breathing. Or I slept eight hours, but I was still tired the whole day. I feel terrible. Exactly. Exactly.

And that's sleep apnea. So it prevents you from entering that deep restorative phase of sleep. Absolutely. And then the other thing about medication. I mean, you know, as physicians, we are so quick on giving medication to make sure that one sleeps. Medications don't help because, yeah, it knocks you out. But again, all of that sleep rhythm and sleep cycles are messed up. Yeah, you're not going through the proper cycles.

Exactly. So many people are on those pills. Yeah. So these are, again, easy remedies. Easy remedies. Do you want to knock somebody out? I mean, we saw Michael Jackson. I mean, propofol.

This is a medicine you give for surgery. In ICUs. In ICUs. So you can knock people out, but it doesn't mean they have restorative sleep. Sleep cleans the brain. And when people do another thing during sleep, if you're not getting good sleep, these microglia, these are the molecules that actually clean up a brain, they start eating away at its own brain, a good brain,

or at least the connections, the axons. So in one paper we wrote and some others, that if you don't get good sleep, the brain starts eating itself. What do you mean eating itself? So microglia are these cells that actually clean up. They're the cleanup molecules or cells. Janitor cells. Janitor cells.

And their job is at night, you have good night's sleep. The connections that are bad connections, it actually goes and eats those connections away or breaks them up and eats the other garbage that's there. It starts eating them up. there it starts eating them up if you don't have good sleep they've seen that actually these microglia go and break up good connections in the brain and eat up cells so it is actually destroying its own literally cannibalizing yourself you're cannibalizing yourself because of lack of sleep so sleep is important uh sleep we don't talk about it because what you know you just go to sleep go in the night you, in a room and get knocked out. One of the most common problems in our population is sleep problems.

And the ones that have good sleep, they think they have good sleep because they're taking medication. So if we could do anything beyond diet and everything, it would be create a sleep center that teaches people simple things. Sleep hygiene. diet and everything that would be create a sleep center that teaches people simple things sleep hygiene you know we don't recognize that as we get older we don't digest food as well that we might not hear it hear the sound or the gurgling and all that but you're still your stomach's fun uh working so eating an hour before sleep it doesn't you're you're that's going to keep you awake and it doesn't necessarily have to be caffeine it can be anything just the process of digestion keeps us awake i do that all the time yeah i did that i mean you read in the book that was a common thing yeah and when i stopped that and a couple of other things and my sleep became a lot better now the book is keeping me up

up and that's a different problem you gotta go back to the paleo people attacking me are they yeah i should get so many names so many names who's attacking you no it's like it's just the cults sometimes because they don't agree with you they start attacking and i well it's you know this this whole diet thing is very tribal you know is. You know, I just watched a video earlier today, our friend Garth Davis, who bravely went on the doctor's. You saw that? Oh, my God. I didn't watch it at the time. And I saw Garth write about what the experience was like for him and his frustration about it.

And then Plant Based News, which is a big YouTube channel, like he put together kind of like a whole video where he goes back and forth and does some analysis on it to kind of try to explain what's going on and and it's just it's like wow this is so emotional on both sides you know and and and we're so dug in you know and and you know these debates where we're putting you know the garths and the lustigs or whoever it is and pitting them against each other it's like it's like dog, you know, the Garsts and the Lustigs or whoever it is and pitting them against each other. It's like, it's like dogfighting, you know, and it's like, it's not, it's not leading to a greater understanding. It's just creating tribalism in the same way that we're seeing it being played out politically. And, you know, it's, it's a tricky thing. Like, I don't know what the way forward is, but the way that we're kind of navigating it right now, it doesn't seem to be functioning in a helpful way it's a confirmation bias one

of the biggest problem we have in as human beings our brain was designed what they call type 1 error if you're running around let's say paleolithic time and you're just worried about survival and reproduction mostly survival and there's a bush there and you look at the bush and you say if i do this um and i do the safe thing it's a you know walk away um or the tiger is going to attack me or the saber tooth our decision is is to do what we want to confirm what we know so our brain is designed to confirm the things that we're comfortable with at any cost it doesn't matter how much education you have in fact the education just creates language to better that confirmation bias so i think the way out if

possible is to step back and not argue the thing but the way to the thing it's almost like philosophy so you know it's what is the method we're using to come to conclusions so the paleo people attacked that but I have you know we had 20 people in your I have 5,000 people following me I said that's appeal to masses but I have these doctors that said that's appeal to authority but but you know this person did this and that's an anecdote appeal to anecdote the only way person did this, and that's an anecdote, appeal to anecdote. The only way we can make decision is

not absolute cause and effect. Who has the most data that shows, and the right kind of data, that shows an outcome? Let's follow that for now and test the rest of them. Yeah, I think so. I think that what's so baffling about the whole thing is that everybody's a scientist, right? So it should be about data and facts. And we're expecting it to play out that way. And we're underappreciating some of the things that you just referenced, like the level of emotion that goes into this and the confirmation bias on both sides You know this gets played out But it's like these are the guys who are supposed to be

Above this like you're not supposed to get emotional about it is supposed to be about the data and it's just more complicated than Alright Optimize what are we talking about here? This is the fifth pillar in your protocol, your program. That's the fun part. I love the concept of optimization because that's, again, probably the core of personalization. Optimizing cognitive activity. What does that mean? Keep yourself on the edge.

Keep yourself motivated and keep yourself challenged at all times. And, you know, we see brain games and crossword puzzles and Sudoku, which you don't like very much being thrown at people. But that's not what makes the brain. It has to be something that one can own and it has to be personalized. So for example, when Dean and I see some patients, we ask them, so what did you do before you got to this point in your life? You know, what, what were your hobbies? And, and for example, we had, we had a patient who was a car mechanic and he hated his job and he had retired and he was having some cognitive impairment. And we talked him into

getting back into something that he loved and it was making cars so he just got some cars in his garage and he started fixing them and he felt so much better and you know over over a couple of years his his scores cognitive scores actually got better so it has to be something that one can do on a regular basis that brings a lot of fun and it has to be something that one can do on a regular basis that brings a lot of fun. And it has to be something that involves all of the domains of the brain, whether it's vision, whether it's hearing, whether it's judgment, decision making, all of these have to come work in concert. Yeah, getting back to blue zones. So yeah, they ate well, they walked naturally. So that might have helped and not better than not walking, Yeah, they ate well.

They walked naturally, so that might have helped. Better than not walking, that's better than driving everywhere. But the mental activity there is the social activity. Right, it's the social engagement, right? That's really at the core of this whole thing. That's exactly right. It actually maximizes the cognitive activity. Right, so if you're just sitting alone at home in a dark room doing crossword puzzles, that's not what you're talking about.

Another measure of disengagement was a couple of studies came as far as hearing, and we see this often. Yes. As people get older, as their hearing diminishes, I don't mean deafness, even minimally, there's a correlation between loss of hearing and cognitive capacity. So even if it's not even social, just ambient noise seems to keep the...

Because unconsciously your brain is doing things that you're not even aware of. So as you lose hearing, of course your connection with the people goes down. You have a conversation with somebody and you're a millisecond off because of hearing. That's going to make you, without thinking thinking that language, you remember I said earlier, you come up with, I don't like this anymore.

So they become disengaged from communities. Hearing loss is almost a surrogate of loneliness. It is. It's you being completely disconnected. Yeah. And 10% increase that just hearing loss contributed to 10 of dementias so one of the first things we do is check the hearing i mean they think they're not having bad hearing but as we get older we do the most shocking statistic in your book was uh the

statistic that um the spouse of someone with alz Alzheimer's is 600% more likely to develop the disease. It's incredible. 600%. It's incredible, isn't it? And it plays to that social piece, right? I mean, what is going on with that? That is a phenomenal example of the complexity of the disease. I mean, obviously, it's not genetics that causes it.

So it has to be shared environment you know after living together you eat the same thing you move the same way you sleep your sleep patterns are similar you engage in the community in the same way so obviously because because the um the unhealthy environment caused alzheimer's in partner, it affects the other one as well. The stress levels. The stress, of course. Yes. Imagine the stress levels that Aisha causes in my life.

I reduce it. It's completely the opposite. She's the anti-inflammation person. And you're the anti-stress. No, it's the shared environment. Absolutely. I mean, repeatedly, you start eating the same foods. Even though, well, you were a chocolate person and I was a steak and cheese person.

But now we're kind of, well, we're plant-based now, but very much the same activity level. We exercise together. So that's critical. In fact, in our program, we encourage people, husbands and wives or partners to come together. Because it's impossible for us to apply diet change to one person and the other person is doing whatever they want. No. The household has to change. Of course.

Of course. Makes it a disease of the family. If your kitchen is not changed entirely. And obviously there will be times when you will eat unhealthy food. We once involved, what, how many family members in your clinic? Fourteen. entirely and obviously there'll be times when you will eat unhealthy food so we have we once involved what how many family members in your 14 yeah remember like 14 individuals came to this clinic because they all wanted to invest in this lifestyle and that's how it works i love the grandchildren to be involved because if we want culture change we know now no data shows that

if you start earlier there the the teenagers actually change the food in the household more than the other way around so i had the the grandchildren there and giving them speech and giving them you know kind of coax them into it and say you have the power to change the family and uh and and that's a good way to learn empathy where your grandfather is suffering from alzheimer's yeah and you don't preach empathy you live it. So we love the involvement of the entire family. What have been some of the success stories that you've experienced with some of your patients that you've put through this program? Many, many. Oh my goodness, there are many. They've been particularly with this whole comprehensive approach, not just diet, not just exercise.

I mean, there are stories in particular ones as well. But, you know, we remember that lady who was a high functioning person, professor, very knowledgeable. And she was stunned that she was you know experiencing cognitive impairment but we found out that she had sleep apnea and we found out that she had incredible amount of stress in her job I mean there were things that were completely out of her control so just to identify those you know treating her sleep apnea modifying her diet and for her to look into other venues that were close to her um job and to her you know um her level of education or qualifications um she completely turned around and she actually became an advocate for for brain health wow that's amazing yeah those to me i like

the ones that were it's not that that magic thing that we find. Sleep apnea is easy. You find that, you correct that, you see a huge difference. You see people who are on their own diet and they think they're on the right diet and you change that. And you definitely see it. For example, sugar. First three weeks, four weeks, people have a hard time giving up sugar. I mean, very hard time. By the fifth week, sixth week, they come and say, I feel a fog lifting. So that's not one case.

Always talk about multiple cases of this. I mean, over and over again. But the cases I love is that when we applied one little thing here, one little thing here, one little, you know, and each of the domains. And, and, and of course you saw the difference, but you see a change in level of motivation. These people become, they want to be coaches. They want to be your coaches out there. That's cool. So that makes medicine completely different than cutting and pilling,

you know, giving pills. Here's a prescription. And it makes it so much more fun. Very fulfilling. I just lost my train of thought. What was I going to ask? I had this awesome question. Now, one thing, well, it'll come back to me in a minute,

but another statistic that I thought was interesting was that two-thirds of the people that suffer from this are women. Yes. And that we don't really know why that's the case. Is that correct? That's true. There's some theories out there that explain some part of that picture.

So, people have looked at hormones and how after menopause the physiology of a woman changes, or the effect of multiple pregnancies on brain health and body health in general. But one of the strongest and most interesting concepts that has surfaced is the fact that the women who have Alzheimer's disease now and have been detected to have cognitive impairment come from a time where they were probably not as challenged

as men were as far as their job is concerned. And the amount of stress that was put on these women was much higher than women now. We've evolved as a society. And so we're trying to find out, you know, what were the differences as far as education level is concerned, as far as cognitive reserve, and as far as the amount of stress and other physiological determinants that made these women have more Alzheimer's now. So we're still trying to understand it better. But it's a crazy number, and more women are suffering. Yeah, I was not aware of that.

That's crazy. And then two-thirds of caregivers are also women. Yes. And they suffer from the consequence of taking care of a father and mother that has... Which puts them at a higher risk. What is your opinion on people who go and get their genetic testing done, the 23andMes and all of that, and come to you and say,

I have the gene or I don't have the gene or what have you. Yeah, that happens a lot. So I have two grandparents who had Alzheimer's and you have had, and I forget a lot of things. I lose a lot of things. I can attest to that. He forgets his jackets all the time. Marceduca. Probably would be much more rapid decline.

probably would be much more rapid decline no it's so at this point and and it's evident that it's because we're we live the most crazy love busy and passionate and loving you know lovely life i mean but but it's very busy multiple a lot of elements a lot of elements very colorful and um but if let's say i take the gene genetic test and i find out that i have apo e4 and another april before and some other genes so now now I forget my, uh, something. What do you think I'm going to do? I'm going to attribute it to my genes. Immediately leap to, Oh, this is in here. It's happening. Yeah. You know, and that, that's not just me being motivated. So a lot of people say that's good for me because I'm going to be motivated.

No, that's not motivation. That is going to be at a level of stress and anxiety that you, that is going to be motivated. No, that's not motivation. That is going to be at a level of stress and anxiety that is going to be damaging. It's almost becoming a self-fulfilling prophecy. Whatever you do, you attribute it to that. And we've seen people do that all the time. Exactly. So I say, live as if you have the genes. And let the outcome speak for itself.

Because if you find out that you have the genes the anxiety because we don't have a cure for the genes at this point maybe in a few years with this crisper thing and all these genetic manipulations that we can do and it will happen no matter how many people say this is not natural that's it's definitely gonna happen it's gonna happen it's already happening it is leukemia and other diseases and and sickle cell i mean we've seen children suffer from sickle cell like yeah i don't want to see the forefront of what's happening with that right now. But even with these genes, it will happen. But until then, do you want to live with that kind of anxiety?

Every time you forget where your car was parked last night? We walked for such a long time. So I say, if it's not in the research setting, there's no benefit at this point. Live as if you have the genetic risk. Change your lifestyle because not just for Alzheimer's, that lifestyle is going to affect your heart, your immune system,

your mood, depression, anxiety. Studies have shown that the best form of treatment of depression, 300% better than any drug out there, is exercise. Exercise, yeah. So live it, and then let the genes play themselves out. Among these five factors, nutrition, exercise, sleep, stress management, engagement,

is there one that's more important than the other? Is it the interplay of the five? Like if somebody had to pick one thing to begin with and they're overwhelmed by the five, what is the most important of all of these to kind of catalyze that journey? I think for the majority it's food, without a doubt. Because how could it not be?

It's something that we put in our bodies three or four times a day. It's the most important environmental factor for us. It makes or breaks your brain. But then again, it depends on, you know, what are some of the proclivities for Alzheimer's disease or for brain diseases in general, and to focus on the one that is the most affected. I agree with you fully. I mean, let's take the personal thing out.

Let's say that we don't find something unique in this person that we need to address right away. In general, we would say food. Definitely. And then the easiest one is exercise. And for me, exercise is not going to the gym. I mean, when I say to people, some of these gyms, you have to get dressed up more than some clubs. It's so tough going to the gym. Anything that takes away impediment towards exercise. They say, oh, you have to get dressed up more than some clubs you know it's so tough going to the gym anything that takes away impediment towards exercise they say oh you you want to

exercise run to the gym i said no i want a limo to come and pick me up nobody does but let's say maybe when you were at cedar sinai maybe no we were we were the directors of brain health program and we were the only one with a toyota s that you saw. But the most important thing is that it institutes, do something that's proximal and easy. So I say, if I was Secretary of Health and Human Services, I would have connected everybody's TV to a recumbent bike, so it wouldn't work unless they're rolling. That would have reduced healthcare costs significantly.

Nobody's going to do that. Nobody's going to vote for you. No, nobody will. It's not a voting position. healthcare I like cost significantly nobody's gonna do that but but it is important to bring it to your living space and then whatever else you do extra is fantastic so for my 60 year olds and 50 year olds I said get a little foot pedal exerciser or a recumbent bike watch your news and then go slow roll slow yeah you know two miles an hour an hour a mile an hour and then every few commercials just rev it up you've just changed your life use the commercials to do your intervals

yes yes interval yeah i mean how how beautiful is that so you're getting the aerobic and the anaerobic exactly so there's no balance problem because you're sitting there's no clothing you know you can do it naked if you want that i would rather not if they they can they can do it in the privacy of their home they can read something while doing that they can watch and learn something on youtube so to me that would be wonderful and it's cheap if you can't afford the recumbent bike get one of those foot pedal exercisers and put it on your beautiful comfortable seat so the seat's not uncomfortable and you just do that and you've done aerobic you've done anaerobic and you know it's wonderful that's my easy addition prescription i think you you usually the way that i we got to wrap it up but the way

that i end conversations when i have doctors on the show is I ask them if they woke up in a parallel universe and found themselves to be the surgeon general, what would be the first order of business or what are the policies, the legislation that you would like to see get pushed forward? So we have the bike power and the TVs. We're going to put that into motion. We're going to pass that law. What else would you do if you were in that capacity? There are a lot of things I would, I would probably make every restaurant offer one healthy dish, one heart healthy dish that has been approved for the brain. I think people need to have choices. A lot of us want to be with friends, want to be with family members, but health doesn't necessarily have to be synonymous with deprivation.

Absolutely. And I would focus on prevention. I would actually create incentivized prevention. So doctors, healthcare systems would have educational programs for what prevention means first of all and then incentivize it financially both at the public health side which is the community and in the hospital and clinic side to actually do prevention instead of sick care only that would be wonderful and in a way if you can if you do the lump payment where this person's life is let's say eight thousand dollars and if if that actually incentivizes it meaning that if you keep them out of the hospital you get more of the money so how do you keep them out of the hospital is teach them how to how to prevent the disease themselves i, I think the keys to the kingdom really are in finding a way to revolutionize our

healthcare system to prioritize prevention. You know, it's like, it's just not set up that way right now. And until we shift focus, we're going to continue down this path that we know is not working. Yes. Absolutely. Absolutely. Well, thank you for doing this and sharing your message. You know, I think as a sort of primary takeaway from your book, I think it's really empowering, you know, because

it's basically telling people like, look, you can control this, like whatever your genetic disposition is, you know, that gene need not be necessarily expressed. And here are the things that you can do that we have seen, and that has been proven to maintain your brain health and take, you know, set you up in the best position to avoid having to go down this road, because this really is an epidemic that is just decimating lives everywhere we look. And the rate at which it's accelerating is beyond alarming, right? So to the extent that we can all, to heart these measures and start to implement these changes in our lives and try to serve as a lighthouse or a source of inspiration for our loved ones who we see heading in this direction, I think this is really important work. And I thank you for writing this book and for the work that you do.

Thank you. Thank you. You said it beautifully. What do you got? What's up? What's next for you guys? Are you writing another book? What are you doing? We are. Yes, we are working on that. We're working on that and really putting in a lot of effort to expand this into different communities, whether it's in San Bernardino or the beach cities, and involving and training community members to take it upon themselves to spread the message. Yeah.

And like I said, most of, actually all of the profits go to this foundation. And if anybody wants to partner with us, for us to come there and give workshops on lifestyle and prevention, we're willing to pay out of our own pocket to come and fly there and help the community. That's amazing. Absolutely. So if somebody's listening to this and they want to take you up on that, how do they get in touch with you?

They can get in touch with us through our website and our social media. We are TeamSherzai.com and we're very responsive and we'd be happy to set something up with them. Right. TeamSherz i.com okay that's cool have you i know you know dan butener um have you spoken to him about perhaps collaborating with the work that he's doing with blue zones in some kind of official way like it seems like it would be there's a natural fit we have we have and we will and so far we're actually

picking the fruits of that he's laid down which is in the beach cities we're doing the brain health side of it but we would love to because i told him several times we told him yes the public health that that he's doing is more beneficial than a thousand doctors because it makes it so easily palatable. I mean, he shows it in populations. People, you said it, if they don't see it in this story format, they're not going to believe it. But he shows the stories in thousands of people in regions.

It's wonderful. It's unbelievable. Yeah, it is. All right, thanks, you guys. Thank you. So I end the show by saying peace and plants at the very end. But I thought since there's two of you, usually I'm just talking to one person. You guys can like take us out by saying that.

Peace and plants. Thanks, you guys. Awesome. Cool, thank you. Great. Okay, we did it. What'd you guys think? I thought it was pretty incredible.

Potentially life-changing, life-saving, not just for yourself, but for your loved ones. A really important conversation. I hope you took it to heart. If you want to learn more about Drs. Dean and Aisha Sherzai, go to teamsharzai.com, S-H-E-R-Z-A-I. And they're also Team Sherzai on both Twitter and Facebook. And please pick up their new bookai on both Twitter and Facebook. And please pick up their new book, The Alzheimer's Solution. Like I said, a really profound work that I think has the potential to save so many lives. We have a full video version of the podcast up on YouTube, youtube.com forward slash richroll.

Thank you for all the kind comments we've been getting about the move to video. We just eclipsed 50,000 subscribers on that platform, which is great. It's awesome. And, uh, we're learning, we're trying to get better. We're trying to find our groove and, uh, our unique approach in that medium on that platform, uh, slowly. And as we go, as I mentioned in the last episode, I'm currently looking for a new filmmaker slash photographer slash editor to collaborate with for a rundown on the exact details and qualifications for the gig, please see the blog post for this episode

at richroll.com. And while you're there, please be sure to check out this week's show notes on the episode page, tons of links to help expand your understanding, your education about brain health and dementia. So please make a point of digging in there. If you would like to support this show and my work, share it with your friends and on social media, leave a review on Apple podcasts, but perhaps the most important thing, hit that subscribe button. It only takes a minute. It helps us so much. It helps raise visibility for the show to get new listeners. So if you're a fan of what I've been doing, but you have not yet subscribed to the show on Apple podcasts on iTunes, please do that. Also, thank you to everybody who supports my work on Patreon. I really appreciate that. I'm

going to be scheduling a new AMA. Ask me anything on that platform soon available only to people who contribute on Patreon. I'll make that announcement on that page. If you want to learn more about my Patreon, click the Patreon banner ad on any episode page at richroll.com. Did you guys navigate Thanksgiving okay? Did you stay on track or did you go off the program? Did you go off the reservation completely?

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I know it does for me. It always takes a little bit of extra effort and time and diligence to comport myself, uh, to be the person that I want to be to kind of navigate, like I said, these treacherous waters. So in any event, I'll be back with you guys soon until then peace plants. Thank you.