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Episode 480
The Doctor's Farmacy

The 5 Main Ways To Prevent Alzheimer’s & Dementia

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Protecting your brain and cognitive function is not just for the elderly. It’s never too early to start protecting your brain, which is something we should all think more about as Alzheimer’s and dementia rates continue to rise. We can start with healthy lifestyle choices that affect diet, sleep, stress management, and more. The bonus of brain-healthy lifestyle choices like these is that they protect the health of your entire body as well.

In this episode of my new Masterclass series, I am interviewed by my good friend and podcast host, Dhru Purohit, about Alzheimer’s and dementia. We talk about early detection, contributors to cognitive dysfunction, foods that fuel the brain, and so much more. We also discuss how other factors, such as toxicity, sleep apnea, and even lack of community, affect brain health.

This episode is brought to you by Rupa Health and Paleovalley.

Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. You can check out a free live demo with a Q&A or create an account at RupaHealth.com.

Right now, Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal.

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dhru Purohit

Dhru is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30+ million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset.

Transcript

Speaker 1:
Coming up on this episode of The Doctor’s Farmacy…

Dr. Mark Hyman:
The science of brain health and the science around dementia and Alzheimer’s has just exploded, and it’s taking a very different tack.

Dr. Mark Hyman:
Hey, everybody, it’s Dr. Mark Hyman. Welcome to a series of The Doctor’s Farmacy called Masterclass. And that is where we dive deep into popular health topics, including inflammation, autoimmune disease, brain health, and much more. Today I’m joined by my guest host, good friend, and business partner, Dhru Purohit, who’s the host of the Dhru Purohit Podcast. We’re going to be talking about how to prevent and maybe even treat and maybe even reverse Alzheimer’s and dementia. All right, Drew, we’re going.

Dhru Purohit:
Mark, let’s jump right in. Alzheimer’s, dementia, two of the scariest conditions that somebody could imagine. There’s a lot of fear associated around those, especially because it feels like there’s not much that we can do at least in terms of traditional medicine. We’re waiting for a miracle drug to bail us out of this mess. But from the world of functional and integrative and precision medicine, there’s actually a lot that we can do and take advantage of. So can you talk to us about the few things that we could be doing early, in our twenties, thirties, and forties, to help us prevent dementia and Alzheimer’s?

Dr. Mark Hyman:
Absolutely, Drew. I mean, this is an extraordinary era to be alive. I mean, thank God we’re alive now and not 20 or 30 or 40 years ago, because the science of brain health and the science around dementia and Alzheimer’s has just exploded. And it’s taken a very different tack than the pharmaceutical approach which has been so focused on. Literally, there’s been over $2 billion and probably 400-plus studies on pharmacology, all of which have basically failed. There’s a couple of drugs that squeaked through that have marginal benefit. Like, okay, well, maybe you end up delaying admission to the nursing home by three to six months. Is that a win? Hell no.

Dr. Mark Hyman:
What has actually emerged in the science now that’s helped us to understand a different way of thinking about Alzheimer’s? The first is our understanding of what the etiology, the causes of Alzheimer’s, and we call these things dementegens. I call them dementegens. My friend, Dale Bredesen, came up with a wonderful concept called cognoscopy. It’s like a colonoscopy, except for your brain. It’s the idea that there are a lot of biomarkers and things we can measure and look at that will determine your risk and trajectory around brain health, and obviously even general health. What we’ve come to understand is in your twenties, thirties, and forties, it’s a critical time to act, because when we look at the imaging studies and we look at early diagnostic studies and we look at the processes that are happening in the brain, we can often detect changes 20, 30, 40 years before anyone has their first symptom of memory loss. And that’s staggering. It sounds scary, but it’s actually great news because if you detect it early and you modify the risk factors and you optimize your biology, you literally can stop and even reverse this process.

Dr. Mark Hyman:
It’s obviously the things that we know as foundational for health, right? Healthy diet, and we’ll talk about what that is. So what is a brain healthy diet? What’s the importance of exercise, and what kind of exercise works for your brain? Sleep, stress reduction, because stress literally shrinks your brain and causes dementia. No joke. The memory center in the brain called the hippocampus literally shrinks when you’re under chronic stress. So, foundational lifestyle factors are so key, and there’s tweaks to them that are unique to keeping your brain optimally functioning. And then, of course, there’s deeper layers on the cognoscopy to look at. What are your heavy metal levels? What’s your microbiome like? Do you have inflammation? Are you exposed to mold? Have you had tick infections? Do you have allergies? Are you sensitive to gluten? What’s happening with your mitochondria? What’s happening with your detoxification process?

Dr. Mark Hyman:
All of these things are things that we can look at and measure and see where they’re at. What’s your nutrient status? I mean, just for example, if you are low in certain B vitamins like B12 folio and B6, and you have a high homocysteine of, let’s say, 14, which even in the conventional labs is considered “normal”, it should be like six to eight, but if it’s 14, your risk of getting Alzheimer’s is 50% higher. And that’s just multivitamin basically. We have so many amazing tools and techniques to use now to, one, evaluate the dementegens through cognoscopy and, two, create a science of brain health and optimization, which is really what we need to do.

Dhru Purohit:
Now, you said twenties, thirties, and forties, but there’s going to be a lot of people that are listening here that are 40 above. Are they out of luck or is there something-

Dr. Mark Hyman:
No, that’s me, that’s me.

Dhru Purohit:
… that we could be doing? There may not be a diagnosis yet, knock on wood, but is there still hope for people in the 40-plus crowd?

Dr. Mark Hyman:
I hope so, because I’m in that crowd. Actually, a number of years ago when I was 40, I had a brain scan. And it was fricking scary, Dhru. It showed really dramatic underfunctioning hypofunctioning of the brain. When you see this hypofunctioning, it has to do with various insults to the brain that can be reversed. At the time, I had mercury poisoning, multi toxicity, Lyme disease. All these are reversible causes of cognitive function and decline. And so, I worked really hard on myself to clear out these things, to get healthy, to get rid of my Lyme, to get rid of my mold, get rid of my mercury and many other things, get my microbiome healthy. I repeated the scan about 10, 15 years later, and my brain had completely healed. It was really amazing.

Dr. Mark Hyman:
All the brain blood flow is back. My brain function centers were working, and I was like, “You can at any age.” I can tell you, case after case, and we can get into it a little bit later, I can tell you case after case of patients who have come to me with cognitive dysfunction, memory loss, early dementia, even more advanced dementia, and we see dramatic changes. So, the brain is able to repair and heal at any age. You always think, “Oh, you have got so many brain cells and basically that’s it. If you drink too much and party too hard in college, well, that’s it, you’re screwed, and you’re never going to get it back.” Well, that absolutely is not true. We know from actually autopsy studies they’ve done, for example, on brain… I mean, sorry, on cancer patients, and they found that they gave them these radioactively labeled dyes that were only inactively replicating neurons. In other words, in new brain cells, you only see this thing being picked up if they were making new brain cells. And they literally were dying of cancer and they were still making new brain cells, which you could detect on imaging. That’s really remarkable.

Dr. Mark Hyman:
We know there’s the whole field of neuroplasticity and neurogenesis, meaning we can make new brain cells, we can actually increase the connections in the brain. I’m learning tennis. I’m 15 years or so into it, and I keep improving, improving, and working on it. My tennis coach was like, “Yeah, this is really good for your brain and learning new connections.” In fact, tennis players live an average of seven years longer. And part of that is you’re constantly working on different aspects of motor coordination, visual. It’s a thing, right? It’s like you absolutely can modify this risk at any age.

Dhru Purohit:
Just for clarification for the audience, what was the brain scan that you did? What was the type of brain scan that you did? And would you recommend it to individuals who are listening today if they’re trying to get a sense of where their brain health might be?

Dr. Mark Hyman:
Yeah. There are many types of brain scans. So typical brain scan for Alzheimer’s is an MRI, which can look at brain volume, overall volume of the brain and shrinkage. It can look at hippocampal volume, which is the size of the memory center of the brain, which shrinks with dementia and actually can grow back when you apply some of these principles of functional medicine to brain health. That’s the standard test, and it can also look at amyloid. There’s actually imaging that looks at amyloid plaque in the brain. So you can see various amounts of amyloid, which is the thing that actually seems to cause the gunking up the brain. The question is, what is the amyloid? What’s it doing? Should we be trying to deal with it? There’s a whole deeper conversation we can have, but it’s kind of a rabbit hole. But essentially it’s inflammation.

Dr. Mark Hyman:
And then there’s even more advanced scans that can look at early inflammation in the brain. Now there’s more advanced functional MRI scans that can look at inflammation. Those are really emerging. Honestly, if those were readily available and the cost was reasonable, which I think it will be eventually, right, all the… We’re seeing exponential technologies where the price goes down and the power goes up, and we’re seeing that across the spectrum, including imaging. When that happens, we’re going to be able to really early assess these patients.

Dr. Mark Hyman:
What I had was a little different. I had a SPECT scan, which is essentially a blood flow scan looking at areas of the brain and blood flow. It’s a more general test, but it really showed hypofunctioning of many areas of the brain. And so, you could actually modify that. I had another patient with early cognitive decline, and he had really impaired hypofunctioning of his whole brain. When we treated him, I sent him back to Harvard where we had the initial scan at the Memory Disorder Unit, and it got better. The neurologist there who was the head of the Memory Disorder Center was so inspired that he started a brain health clinic, because he’s like, “Whoa, we can actually do something about this.” Really, it was great.

Dhru Purohit:
That’s fantastic. And so just again clarification because I know people are always curious, so the SPECT scan, was that through like the Amen Clinic or something [crosstalk 00:09:44].

Dr. Mark Hyman:
Yeah, that was through the Amen Clinic. Yes.

Dhru Purohit:
Okay, thanks.

Dr. Mark Hyman:
The Amen Clinic has really pioneered a lot of the work around the SPECT scan, and I did at the Amen Clinic. I did it twice there, so it was really great.

Dhru Purohit:
Fantastic. Now, let’s go back to the common root causes of Alzheimer’s and dementia, and let’s talk about your brain and what you were seeing in that scan that you did when you were younger than you are right now, and that you were seeing that your brain wasn’t optimizing and wasn’t operating in the best high functioning way. What were some of the lifestyle factors that were going on? We’ll get to environmental factors, and we’ll get to toxins and heavy metals and other stuff in a second, but what were some of the other things that you were doing that were causing your brain to shrink and not perform at its best?

Dr. Mark Hyman:
Well, I mean, I’ve led a relatively healthy lifestyle my whole life. Eat mostly clean. I surely was eating more carbohydrates back in the day when low fat was good and pasta was the health food. So I was definitely on that train early on in my thirties and so forth. I exercised always, did yoga. I did have sleep issues. I think that may have affected it, just working the emergency room, working long hours, not sleeping for days, being a single father, high stress. So it wasn’t so much the diet and exercise part for me, it was more the sleep and the stress part. But the truth is, Dhru, that wouldn’t have caused the level of cognitive dysfunction that I had. It really was these outside factors. The truth is for most people though, for most people, it’s the fundamental lifestyle factors.

Dr. Mark Hyman:
There’s a subset of people who have, yes, who have heavy metal poisoning, who have mold exposure, who have Lyme disease. Like Chris Christofferson had Lyme disease, was diagnosed with dementia. They gave antibiotics, and boom, he was better. I think mine was a little bit of a unique case. I wasn’t insulin resistant. I wasn’t overweight. I exercised. I tried to meditate, did yoga. I was working on stuff. But it was these other outside factors that are often ignored. I wouldn’t even just say ignored, but I would say that are not even on the radar of most clinicians.

Dhru Purohit:
Dismissing it sometimes.

Dr. Mark Hyman:
Yeah, they’re dismissed or not even on the radar of people who are actually fully engaged in the Alzheimer’s research. However, there are leading Alzheimer’s researchers that are on board with this 100%, like Rudy Tanzi at Harvard who discovered the presenilin genes, who’s one of the key research is in all of Alzheimer’s research. He’s on board with this. He completely gets this. So, there’s a lot of opportunity for real change, and I see more and more of this happening within the space. I see guys like Richard Isaacson who’s amazing. He’s formerly at, I think, Weill Cornell. He’s actually done some incredible research looking at simple lifestyle interventions that are personalized based on biomarker analysis. What he was trying to do was just delay or slow the progression. I think they were shocked to find that by aggressively optimizing diet, exercise, sleep, stress, the nutrient levels, treating homocysteine, dealing with insulin resistance, dealing with all the variables…

Dr. Mark Hyman:
By the way, he wasn’t even dealing with all the things we deal in functional medicine, he was just doing the first pass, which is way more than most doctors do. Because they’re looking at a single drug, a single intervention, not using multimodal, multidimensional interventions which are broad lifestyle approach and so forth and personalization. He found not only did they not progress, but they actually reverse cognitive decline, which is incredible. There are other studies also that have been done. His was the most personalized and specific and had the most impact. But there are other trials like the FINGER trial. That’s another called the POINTER trial coming up. These use lifestyle interventions for people with cognitive client, optimizing risk factors, and they found significant improvement in cognitive function in predementia patients. It’s called predementia MCI or mild cognitive impairment. That’s impressive because there’s no drug that can do that.

Dhru Purohit:
Well, you were mentioning some of those lifestyle factors that are there for most people, it wasn’t the situation in your case. Let’s walk through them. What could a diet look like that was designed? If you had to design a diet that was supposed to shrink someone’s brain and eventually lead to Alzheimer’s and dementia, what would that diet look like?

Dr. Mark Hyman:
[crosstalk 00:14:16].

Dhru Purohit:
Again, this is a diet designed to shrink someone’s-

Dr. Mark Hyman:
For breakfast, you have a glass of orange juice, some fruit loops, a muffin, a bagel, and French toast with some maple syrup. And then for lunch, you maybe have a big bun with maybe some American cheese and processed meat. And then for dinner, you have a big bowl of pasta, a giant glass of a bottle of wine, and a side of bread and potatoes. And then for dessert, you got ice cream and cookies. Yeah, pretty much that’s what you’re going to be eating, which is a very inflammatory, high carb, high starch, sugar diet.

Dhru Purohit:
And I’m sure there’s some people that are listening today that are like, “Whoa, he just described my diet.” Okay, so walk us through that, what are the common themes-

Dr. Mark Hyman:
Okay.

Dhru Purohit:
… of that diet that you just described, and what’s missing from it that makes it so detrimental to your brain health?

Dr. Mark Hyman:
So when I was in medical school, we were trained that your brain is the number one utilizer of energy in the body, the number one utilizer of glucose. It’s, I don’t know, 2% of your weight but 25% of your glucose consumption. And so, the whole idea is you need sugar for your brain. Turns out it’s not true. It turns out that your brain runs much better on fat, particularly ketones, that your brain is about 60% fat. And that there’s brain phenomena which they’re calling Type 3 diabetes, which is really what they’re now calling Alzheimer’s. Because inside the brain, you get insulin resistance. Think of it as diabetes of the brain. When you get that, you get increased inflammation, you get increased oxidative stress, you get the production of what we call AGEs, or we call advanced glycation end products. Think of it like the crispy thing on a creme brulee or the crust of bread or the crust on a bread or a crispy chicken skin.

Dr. Mark Hyman:
Those are proteins and sugars combining to form this crust. That’s what happens in your brain. And you end up having this really terrible inflammatory, brain-degrading process called insulin resistance within the brain. And so, you want to design a way of eating that it keeps your insulin levels as low as possible. If there’s one single thing that we know about aging and all age-related diseases, the single common denominator across almost all of them, and there are exceptions, but pretty much for the common stuff, it’s insulin resistance, meaning your body makes too much insulin in response to the carbohydrate load that you’re eating. And it gets worse and worse over time. So it’s a vicious cycle where you eat more carbs, you get more insulin resistance, you’re going to need more insulin, you eat more carbs because you’re hungry and crave them and you end up actually getting very high levels of insulin.

Dr. Mark Hyman:
That is just a disaster because when that happens, you’re getting not only belly fat storage, you’re getting increased hunger, increased cravings for carbohydrates. You’re slowing your metabolism. You’re causing your brain to get demented. You’re causing heart disease. You’re causing cancer. You’re causing kidney failure. You’re causing high blood pressure. You’re causing all the things that we think of as disease of aging, and we treat them in silos. We treat them all as separate problems, but they’re not. They’re all connected by this underlying mechanism.

Dr. Mark Hyman:
Insulin resistance, I’ve written many, many books about it, but essentially if you’re going to design a brain healthy diet, it would be extremely plant rich. So you’d get all the colorful plant compounds that you see, from colors of reds, blues, yellows, greens, orange, purple, all in fruits and vegetables. So eat as many deep colored varieties of vegetables, as fresh as possible, as local as possible, as nutrients dense as possible.

Dr. Mark Hyman:
Second is you need a lot of fat, and fat is really important for the brain. You need olive oil, avocados, nuts and seeds, and something called MCT oil, which is really a super fat. The brain loves this fat. It’s great for mental clarity. It’s great for focus. It’s the preferred fuel for your mitochondria, which is the energy production organelles inside your cells. So that’s really key. And you also want to diet at this high in omega three fats. So you want sardines, mackerel, herring, small fatty fish not the big fish, because that has mercury and that’s going to cause a problem. You could even take fish oil. You also want a diet that’s very rich in choline and B vitamins. Choline comes from eggs, comes from sardines, and also the B vitamins, B6, B12, folate, which are critical in this particular pathway called methylation.

Dr. Mark Hyman:
I just had a quick story of a patient who was about maybe 75-ish. She was diagnosed with early dementia by her doctor and told to get her affairs in order. She was a very wealthy woman. She was in the boards of all these company but she couldn’t function anymore. She had to pull back from everything. She came to see me, and she had a relatively simple problem to solve, which was she had a homocysteine that was really high and a methanoic acid that’s high. And those are blood tests that measure your… a more accurate functional measurement of B12 and folate. And so, I gave her B12 shots of methanoic 12. I gave her high doses of methyl folate and B6 and a whole cocktail of methylation support, which is this critical cycle in your brain and the rest of your body, and she was completely cured.

Dr. Mark Hyman:
About maybe 5, 6, 7 years later, she was like 84 or something, I got a call from her. I thought, “You know… Because the thing is with functional medicine, you get people better, you teach them how to take care of themselves, and you may never hear from them again, right? Which is actually the good thing. You don’t want annuity of patients coming back for their refills on their blood pressure or cholesterol or their dementia medication. I was like, “Oh, maybe she went downhill. Is she all right?” So I was worried about her. I got on the phone with her, I’m like, “Hey, how is it going?” She’s like, “Well, I’m planning a trip to Bhutan trekking, and I just want to know what I should take with me from a medical point of view.” I’m like, “Oh, God, okay.”

Dr. Mark Hyman:
Sometimes it’s as simple as that. Sometimes it’s more complicated. Sometimes people have tick infections or mold or they have mercury or they have other issues, but hers was relatively straightforward. We look at all those things and food. How do we upgrade those nutrients through colorful, crispy, fresh vegetables that are full of folate and vitamins? Maybe eat liver. Liver is probably one of the greatest brain foods. I know people go, “Ugh, liver,” but I thought liver was a gourmet food. Because when I was a little kid, we lived in Queens, my mom, my sister, and I in a one-bedroom apartment, and we were very poor. I mean, she worked as a teacher in Harlem. And for dinner, we’d have fried onions and chicken livers over rice. I was like, “This is a gourmet meal.” It was so good.

Dr. Mark Hyman:
But it’s actually surprising. We all think plant foods are the most nutrient-dense foods, the most vitamins, the most minerals. If you look at liver and then you look at the best vegetables on the planet and you compare them side to side, basically the liver looks amazing and the vegetables look like chump change. It’s pretty impressive to see. If you look at a bar graph, all the nutrients on the liver are like this, and all the rest are like down here. There’s a lot of ways to get these nutrients through food. Obviously, supplements can be helpful. But the diet is so key. So lots of good fats, lots of phytochemicals, very low starch and sugar and obviously microbiome healthy diet. The microbiome is super important. I’ve written a lot about this, but how do you create a healthy microbiome is really a critical factor through tending your inner garden. We’re coming out with a new product called Gut Food, which is just a one-stop multivitamin for your gut to help the bugs grow good and have good bugs in there.

Dr. Mark Hyman:
But there’s a lot of ways to tend your inner garden through eating pre and probiotics, through eating lots of fibrous foods that actually help fertilize the good bugs. That’s also really important. So you got to look at the whole spectrum of your diet, and how do you optimize for immunity? How do you optimize for insulin? How do you optimize for your microbiome? How do you optimize for your mitochondria? How do you optimize for your methylation? As a doctor, I’m thinking, “I got this whole like pharmaceutical cabinet full of powerful drugs that is basically what it ends up on the end of your fork.” And that’s the stuff that actually really works, and it works better than most drugs. And there’s many studies on this. There’s the men diet, which was showing really amazing results in terms of dementia. And it wasn’t even that great of diet, honestly. It was kind of a Mediterranean diet, a little bit healthier that most people eat, but they showed significant improvement in cognitive function.

Dr. Mark Hyman:
I just did a podcast with my friend Kara Fitzgerald, and it was amazing. They did a functional medicine, food is medicine intervention, very, very nuanced selection of different foods that specifically contain nutrients that regulate aging and your biology. They were able to do this really in a very prescribed way using food as pharmacology and actually reversed biological age by over three years within an eight-week period, which is staggering. I mean, nobody’s able to show that even in these other drug studies, intervention studies. It was mind-boggling. Basically, they didn’t have supplements. All she did was basically use foods and identified the most important nutrients around regulating biological aging, and she gave those nutrients in the form of food. And it worked so much, and it was so much more powerful than any other intervention. That’s the kind of thing we think about when we look at food and diet.

Dhru Purohit:
One of the things, including that study, which I’d love to have you talk about a little bit was targeted spices, things like spices and herbs, like rosemary, other things. Well, how important are spices to be including in our repertoire when it comes to our brain health?

Dr. Mark Hyman:
It’s huge. I mean, you’re Indian, Dhru, and India is just the king of spices over there. It’s a country of spices. I think it’s a very powerful way to upgrade your diet with extremely powerful phytochemicals that are found in things like curcumin and cumin. I mean, for example, Nigella seed, black cumin seed is very effective against viruses, and it’s being used in poor countries, for example, for treating COVID. We really have to look at the world of spices as an adjunct to our pharmaceutical cabinet of food. I have a giant drawer at home. It’s like this big and it’s like really deep, and I’ve got rows and rows of spices. I’m a very big spice guy because they’re so powerful in regulating inflammation, detoxification. They’re made with polyphenols in them, can be great for your microbiome. So it’s really important to think about using some of these things like rosemary and curcumin. Peppers, chili peppers are amazing. There’s all kinds of things you can use, but I encourage people to really focus in on spices.

Dhru Purohit:
Another lifestyle factor that we talked about earlier that you’d always have a good dose of in your life, which is exercise, actually has some really strong data when it comes to helping to prevent and reduce our risk of Alzheimer’s and dementia. Can you chat a little about movement? I know you’d like to drop the word exercise and you want to have people think more in terms of just movement overall.

Dr. Mark Hyman:
Play. I like to think about it as play.

Dhru Purohit:
Play. Talk a little bit about play.

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

Dr. Mark Hyman:
That’s super critical. We know that you can actually improve the mitochondria function, which is so important for health and aging. We can improve insulin resistance. We can improve methylation even, DNA methylation, the epigonal function, which genes get turned on and off through exercise, so is a critical component. And it makes you feel good, and it makes you actually reduce the hormones that can cause shrinkage of the brain like cortisol. Cortisol is an important hormone, is a stress hormone, you need it, but most of us have way too much being produced because of chronic stress. So cortisol, we know if you actually look at the studies, shrinks the hippocampus, which is the memory center in the brain. They’ve done in animal studies, for example, where they’ll actually give them sort of an equivalent of a Cushing’s disease, where they have a lot of cortisone with an adrenal tumor. And then they’ll take it out and their brain literally grows back. The hippocampus grows back.

Dr. Mark Hyman:
So, we know chronic stress plays a huge role as well. All these things we can actually play with. And when you exercise, you’re reducing cortisol, you’re increasing growth hormone, you’re increasing testosterone, you’re increasing all the things you want to increase and you’re lowering all the things you want to lower. So it’s really kind of a one-stop shop. Honestly, if exercise was a drug, it probably would be the most powerful drug on the planet. I mean, just food and exercise are the most powerful drugs, and they work in ways that you can’t even imagine that no drug could ever do. “No, we’re waiting for the pill for this or the pill for that.” Good luck. I mean, maybe I’m wrong, I hope I’m wrong, because, yeah, I would like to be able to eat a pill and have my pint of Chunky Monkey ice cream every night. I just don’t think that’s going to happen.

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

Dr. Mark Hyman:
The whole history of drug discovery in Alzheimer’s has been a disaster. Like I said earlier, billions of dollars, over 400 studies, basically nothing. Everybody’s desperate because, one, Alzheimer’s is increasing at dramatic rates. We’re going to see triple the cases within a few years. We have probably 50 million people who probably are at risk, have predementia in America. It is a staggering problem. It is the most expensive condition, and there’s just a desperation to try to find an answer.

Dr. Mark Hyman:
And as is typical in traditional medicine, they’re looking for a single pathway and a single drug. So, they create different hypotheses, “oh, it’s amyloid. Amyloid is the problem.” Which is this sticky stuff that glums around the brain and gums up the works. They’re like, “Well, we need to find drugs that stop amyloid.” So there’s billions of dollars spent on drugs that stop amyloid, didn’t do a thing. In fact, what was really fascinating is that Rudy Tanzi talks about this, there’s a subset of patients who have totally normal brain function, cognitively alert, focused, no memory loss. They die, they do autopsy studies, and their brains are full of amyloid, which you’d see on Alzheimer’s patients. But what they don’t have is inflammation. So absent inflammation, the amyloid doesn’t do anything. And they have some gene deletion that prevents them from mounting a big inflammatory response, which ends up being very protected.

Dr. Mark Hyman:
So, people are looking really for these single pathways, these single mechanisms. They’re looking at [inaudible 00:30:27] and amyloid, and none of them really worked because they’re looking at the downstream consequences of the problem. It’s like bailing the boat with a hole in it instead of fixing the hole, and it’s never going to work. The other problem is that dementia isn’t one thing. There was a great article in JAMA a number of years ago which was called Shifting Thinking About Dementia. They said, “We combine categorical misclassification with ideological imprecision.” What that means in English is that we classify according to symptom not causes. And that’s a mistake.

Dr. Mark Hyman:
So like I said, dementia, even though the end result may look similar in a patient, their memory loss and all the clinical symptoms and so forth, the causes for any one patient might be different. For one patient, it might be that they have insulin resistance, pre-diabetes or diabetes. Diabetics have four times the risk of Alzheimer’s. Or it might be they have severe methylation problems. Or it might be that they have a chronic infection with Lyme disease or some tick infection, or maybe because they have high mercury or maybe because they’ve been exposed to a lot of mold or maybe because their microbiome is creating general inflammation throughout their body. Or maybe they have some weird copper, zinc, metabolic pathway that’s not working. Or maybe they’ve had sleep apnea for years and is causing cognitive decline.

Dr. Mark Hyman:
You’ve got to really look at all the individual factors. That’s why I was talking about a cognoscopy earlier, which is this idea that you can actually start to look for these root cause things into a root cause analysis and then treat each of these things. What needs to happen is a multimodal approach to dealing with all the causes. This is what we call network medicine, systems biology medicine, functional medicine, whatever you want to call it. Dale Bredesen talks about it. If a roof has 36 holes in it and you fix three of them, it’s still going to rain in your house. Even if you fixed 30 of them, it’s still going to rain in your house. You got to find and fix everything. And that’s the approach of functional medicine, and it’s the antithesis of traditional medical research, which is a randomized, double-blind, placebo controlled trial.

Dr. Mark Hyman:
The idea will be to get 100 people, divide them in two groups. They’re all identical, 70-year-old white male from Minnesota who eat cheeseburgers on Fridays and watch football. I mean, that’s basically what they try to do, match controls. So they’re identical as possible. And then they try to use a single agent to create a single effect on a single pathway to create a single outcome. Now, for some things that can be effective, right? If you look at pneumonia from streptococcal pneumonia, you take penicillin, it’s a single bug causing a single illness cured by a single drug. However, I would even challenge that notion because the host determines whether or not someone’s going to sick or not. Look at COVID, COVID doesn’t affect everybody the same way. Same virus, very different outcomes, depending on your underlying health, your immune system, your age, your chronic disease burden. So even with infectious disease, it’s not as simple.

Dr. Mark Hyman:
We’ve got our methodology of thinking all wrong in terms of our scientific methodology, and we have to start to think of systems research, of looking at multiple complex factors, of looking at treating the individual not the group. And that’s where we failed. I think what’s happening now is that you’ve got people like Rudy Tanzi, you’ve got people like Dale Bredesen and others, Richard Isaacson who are saying, “You can’t just do one thing. You got to do everything.” And when we do that, we see a much better approach. I mean, I had this conversation with one of the head researchers at Cleveland Clinic, and I’m like, “These are the things that your body needs to function right. We have to do all these things in order to get an outcome.” He’s like, “No, no. First we study exercise. Then we study diet. Then we study sleep. Then we study this vitamin. Then we study that vitamin.” I’m like, “No, it doesn’t work like that. It’s like if you want to be healthy, you have to eat right. You have to exercise. You have to sleep. You have to deal with stress. You have to optimize your nutrient levels. You have to deal with all these factors. You can’t just do one thing.”

Dr. Mark Hyman:
So that’s really what this failure is. This new drug was approved because I think, this is my opinion obviously, is that it was approved because everybody’s desperate for something because it’s been a massive failure of research. And so, anything that has any incremental benefit, even if the side effects are high, even if the cost is astronomical, which it is for this drug, they’re like, “Okay, let’s try this.” But I’m like, “This is just dumb because we know so much about brain science now and we’re just not applying it.”

Dhru Purohit:
You mentioned we have to look at all aspects. You talked about sleep earlier and you just mentioned sleep apnea. Sleep apnea, when people often think about who’s the common person that has sleep apnea, They think of often a male, a little bit older, and is somebody who’s overweight and that’s the classic person.

Dr. Mark Hyman:
Big fat neck, big jaws, yeah.

Dhru Purohit:
Right. But sleep apnea actually is something that a lot more people than that struggle with. Talk a little bit about it and who should be considering maybe getting a sleep study to make sure that they don’t have sleep apnea and maybe even start off with how could something like sleep apnea actually make your likelihood of Alzheimer’s and dementia stronger, make you more likely to end up getting those diseases later on.

Dr. Mark Hyman:
Yeah, okay. Well, it’s a very common problem and there are a lot of causes of it. There’s central sleep apnea, there’s obstructive sleep apnea where it’s from the airway obstruction. They’re treated a little differently. There are diagnostic tests. There’s actually home testing now. We do this offer at The UltraWellness Center, you can do a home test. We give you a little machine. You take it home, and you wear it at night, and it’ll measure everything, and we can prescribe the treatment.

Dr. Mark Hyman:
The treatment can be varied. It can be surgery that opens up your airways, fix your deviated nasal septum. It could be a CPAP machine. It could be mouth tape. Mouth tape is a whole new trend. It’s sort of trending, which I think is actually a really good thing. It could be changing your breathing techniques. There’s a simple app that I think I recommend people try it, it’s free, it’s called Sleep Cycle. You can put your phone on airplane mode and put it by your bed and then push this on when you go to sleep and it records your breathing at night. It records the sound of you. If you’re snoring, it will pick up your snoring. And so-

Dhru Purohit:
A lot of people don’t know that they’re actually snoring. Even if [crosstalk 00:36:28] you’re snoring.

Dr. Mark Hyman:
Of course. They’re sleeping. They’re sleeping. They’re sleeping. Unless you have a partner who’s like, “You were snoring.” But your partner may not notice. So try that and see. That’s a cheap, free test with no equipment except your phone and an app to detect the snoring. If that’s the case, then it’s probably good to check it out.

Dr. Mark Hyman:
Now, why does sleep apnea cause a problem? It’s really essentially where you stop breathing at night or you shallow breath and you end up actually getting low oxygen. That creates a massive stress in your body, and it kicks in the stress response. Cortisol goes up. Your glucose goes up. It puts pressure on your blood vessels. Your heart muscle can get enlarged because of the pressure on the heart from low oxygen. So you get heart failure, and it causes cognitive decline and dementia. Sleep is so critical. So if you’re not having deep restorative sleep, your brain can’t clear up. At night, we’ve learned that the brain has its own lymph system. We call it the glymphatic system. The lymph system is designed to clear up metabolic waste, clear up all the junk in your body and get rid of it.

Dr. Mark Hyman:
So, when you don’t sleep well, your glymphatic system doesn’t work, and you basically have severe cognitive impairment. And so, it’s really important to sleep for that reason. It also tends to cause high blood pressure. It tends to cause insulin resistance. It causes diabetes. And so, it’s a really important thing. It’s often really underdiagnosed. Now, there’s some really interesting work being done out there, which is not typically recommended for people with sleep apnea. It has to do with regulating your breath in different ways.

Dr. Mark Hyman:
I just did a podcast with James Nestor about his book, Breath. There’s another book about breath. It looks at how do we modify the breathing patterns that we have and start to breathe through our diaphragm, how to breathe through our nose, take deep breaths. And there’s different techniques that are actually teaching you to regulate your CO2 better. For example, one that I’m using now is essentially where you sit and get quiet and you just breathe normally, and then you exhale completely. And then you take 40 steps holding your breath. And then you sit back down and let your heart rate come down to normal and do that 10 times. You do 40 steps, hold your breath, and then breathe when you sit down and then get your heart rate back to normal. That helps retrain your ability to actually manage CO2 in your body and manage the whole regulatory cycle around sleep. There’s also sleep masks. Actually, there are oxygen deprivation masks that help you to actually regulate your ability to manage CO2 in your blood, which is often what happens at night. We often go to bed stressed, and it’s a way to sort of reset your nervous system.

Dr. Mark Hyman:
There’s a lot of techniques out there, as I mentioned, from these breathing techniques to mouth tape, to surgery, to CPAP, to what I call the tennis ball treatment, which is the cheapest one, which basically you wear a t-shirt and you sew a tennis ball in the back of your t-shirt, because if you roll on your back, it’s going to hurt. So you roll back over your side and you’re less likely to snore and have sleep apnea.

Dhru Purohit:
That’s great. A lot of great suggestions and recommendations. Mark, you shared a case study earlier of a woman who was on a board and was told to get her affairs in order. Any other case studies that come to mind of someone who was headed down the pathway, whether they had a diagnosis or they were on the path to maybe developing Alzheimer’s and dementia because they had cognitive decline and some interventions they did to actually get better?

Dr. Mark Hyman:
Yeah, I have a couple that are really profound. The first it was what got me like, “Whoa, what the heck is going on here?” In medical school, well, we never learned how to treat dementia. I mean, there’s no treatment. You could give them aricept, which doesn’t work. There are really no good treatments. So, I was like, “Well, I don’t know what to do, but you’re asking for help, so let’s just do the basics of functional medicine. Let’s look at what you need to get rid of. Let’s do a cognoscopy. Let’s measure all these things that are potentially a factor in dementia, and let’s treat them. This guy was 70 years old, had his own family business, a company, quite big business, was a CEO and just couldn’t function anymore. He was basically sitting in a room by himself, depressed and drooling, and his wife and his family didn’t want to be around him.

Dr. Mark Hyman:
He just completely changed his personality. Severely cognitive impaired. Couldn’t be social in any way and just was on his way out. He even had more than predementia, he was further down the road. We did a really deep dive on his biology, and here’s what we found. One, and this is one of the primary factors, he lived in Pittsburgh. I have a lot of patients from Pittsburgh, and in Pittsburgh they have the steel, US Steel, and all the effluent from the coal burning to make the steel. The coal has mercury in it, and it’s used to cover the streets, it’s used for ice, for example, or on farms and stuff. It’s just full of mercury and lead.

Dr. Mark Hyman:
He also had a mouthful of fillings. I said, “Well, let’s check your mercury.” Normally, if your level’s over 20, I get a little worried, 50 I’m like, “Oh boy,” 100, handful of patients in 30 years have had that. His level was 350. I’m like, “Oh boy, mother load.” So that was one thing. We treated that through getting rid of his fillings, got him off fish, through chelation, operating all his pathways, IV nutrition, glutathione. We did a whole very aggressive strategy. If you want to learn more about our approach to mercury, just google Hyman mercury, and you’ll come up with all the articles I’ve written about it.

Dr. Mark Hyman:
The second thing we found with him was he had a collection of genes that are really common, that often are predispositions to Alzheimer’s. We had what we call APOE 44. Now, APOE is a apolipoprotein. It’s a lipid-caring protein, and it plays a huge role in regulating heart disease and Alzheimer’s and many other things. There’s three versions of it; two, three, and four. Two is the best. That’s called the jackpot gene. If you got that gene, you’re more likely to live forever. And if you have two copies of it, you’re the kind of person that can smoke and drink whatever they want, lives to be 120. It’s like Eubie Blake. He’s was over 100 years old. He was a famous musician. He’s like, “Well, if I’d known I was going to live so long, I would’ve taken better care of myself.” Because he smoked and he drank and he partied and he was fine. Or like [inaudible 00:42:45], she probably had the jackpot gene because she lived to be like 122 or something, and she was a smoker her whole life. That’s not to say you should smoke. But you got the jackpot gene, you’re…

Dr. Mark Hyman:
I’m lucky, I have one copy of the jackpot gene, which I’m super happy about. I don’t know if you know that, Dhru, but I’m going to be around for a while.

Dhru Purohit:
Great. You got a lot of work to do.

Dr. Mark Hyman:
I got a lot of work to do. The other thing is a APOE 4,, one copy is bad, two copies is really bad, and you’re going to have a much higher risk of having Alzheimer’s, like a 75% chance. Although, it’s not inevitable. I had another patient who was a dentist who was in their nineties, still working, highly functional, had a double APOE 4, but she was a health nut her whole life. She exercised. She ate perfectly. She took her vitamins. She didn’t have any decline on her cognitive function. So it’s not a guarantee you’re going to get dementia. It’s not like you have Down syndrome, you have Down syndrome. It’s a predisposition.

Dr. Mark Hyman:
Second, he had methylation problems, which is B vitamins. We know how important these are, B12, folate, B6. He had a very high homocysteine, which is a marker of impaired methylation. And that plays a big role in dementia. He also had glutathione gene. So not even in mercury, but he had genes that were impairing his ability to make glutathione, which is the key detoxifier in the body that gets rid of metals and other toxins. So that’s really important. And then we had to give him special things to help boost glutathione, like increased broccoli family in his [inaudible 00:44:15] diet, give him N-acetylcysteine, IV, glutathione, lots of things we did to fix that.

Dr. Mark Hyman:
And then he also had irritable bowel for 30 years. He was on stelazine, which was an antipsychotic drug to calm his gut down, which was a terrible shock. But he had a terrible microbiome, and we know the microbiome plays a massive role in inflammation throughout the body, and Alzheimer’s is a disease of brain inflammation. We know from Rudy Tanzi’s work that it turns out that there’s a lot of microbes in the brain that we’re now finding. It’s not a sterile place. The blood brain barrier’s not just a fixed thing, it’s permeable. So there’s such a potential for actually having really powerful effects using things that actually improve the function of your gut and optimize your microbiome and reduce the inflammation and all the metal ion from the gut that can be really toxic to the brain.

Dr. Mark Hyman:
So we worked on his gut, we worked on his methylation, we got rid of the mercury. And then he also had in some resistance. He was a thin guy, but he had a belly, he had a little poochie thing. And that belly fat was super active, creating inflammation, creating insulin resistance. We treated him with a very low starch, sugar diet, more protein, good fats, and we reversed all this. So, we looked at all those biomarkers, there’s objective biomarkers I could see get better. Who cares if the test get better? He got better. His gut normalized. His insulin normalized. His homocysteine normalized. We got rid of the mercury. And guess what? He got better and was able to go back to work and function. Would I say he was like as sharp as he was when he was 30? No. But from where he was, he was back going out to his friends, functioning, could remember things and actually still work. So that was a profound story. And I have more, but that’s a good one.

Dhru Purohit:
That’s an incredible story. Thank you for walking us through that and getting a chance to share. In both his instance and your instance, you both struggled with mercury toxicity, so-

Dr. Mark Hyman:
Yeah.

Dhru Purohit:
… how much of a problem are environmental toxins, and how would somebody begin to know that environmental toxins could be playing a role in their chronic disease and, in this case, potentially putting them on the track of developing Alzheimer’s and dementia?

Dr. Mark Hyman:
Yeah. Typically, in medicine, we don’t learn about nutrition and we don’t learn about toxics. We learn about toxicology, which means if you had an overdose or an acute poisoning, then we know about it. But chronic low level toxicity is just not a thing, except for lead. Lead is something that we did identify as a problem in children. We looked at their dentine lead levels that their baby teeth came out. We looked at lead levels. We correlated that with all kinds of cognitive impairments, aggression, behavior changes, ADD and so forth in kids. So that’s why we got lead out of gasoline. That’s why we got let out a paint. And there’s even an approach to treating it using DMSA, which is a chelator approved for lead. However, most people don’t know how to do that in medicine.

Dr. Mark Hyman:
But most doctors are not trained how to look at low level toxins. They don’t even accept them as a thing. I literally had a patient yesterday… Well, it was actually not even a patient, someone just randomly emailed me, but I was like, “Oh God.” This patient was a pescatarian in order to be healthy, and he was eating tuna four or five times a week and fish all the time. He was feeling all these secondary consequences of fatigue and cognitive impairment. He went to his doctor, and his doctor said, “Well, look, there’s no point in doing any testing because there’s nothing to do about it. All you have to do is stop eating fish.” And I’m like, “Ugh.” One, there is a lot you can do. Two, there’s a lot of importance in testing to know your burden and how much there is. And so, it just makes me so furious when I hear the level of ignorance in the traditional medical community around this.

Dr. Mark Hyman:
There are tests, heavy metal challenge tests we do or you can look at a blood test or you can look at a test looking at when you take a chelator, how much metals come out of your system. That’s a really important one. There’s also urinary tests for various kinds of toxins, for phthalates, BPA, pesticides, organic phosphates, BPA. And we can use various urinary markers to look at those toxins and get a sense of your burden. The best test is probably a fat biopsy. The problem is we’re all poisoned. I mean, the degree is different for different people, but when the Environmental Working Group funded a study looking at the toxin load of infants, these are babies who are just born, drawing their umbilical cord blood, basically their blood before they take their first breath, from in utero, there were 287 known toxins that were measured in their blood, including about 207 neurotoxins, pthalates, PCBs DDT, pesticides, flame retardants, heavy metals. I mean, it’s crazy.

Dr. Mark Hyman:
And when you look at studies, for example, of fat biopsy, studies where someone will do a liposuction or get a breast reduction or something like that, or tummy tuck, which is a tummy tuck is basically they slice you open from end to end, the fat biopsy showed everybody, everybody had really high levels of toxins, dioxin, things that had been banned for decades, DDT still floating around, and we get it in our food, air, and water. So we’re all basically walking waste dumps. And if we were food, we would not be safe to eat. However, we know that we can measure the amount of these toxins. We know that we can actually do things to help regulate your detox pathways, and we can help your body reduce the load of these toxins through things like heat and cold therapy, through [inaudible 00:50:10], through helping excretion through your microbiome and fiber. I mean, there’s a lot of strategies that we use, but there is a whole science of detoxification.

Dhru Purohit:
So Mark, before we go into a few community questions that we have for today’s topic, Alzheimer’s and dementia, I want to do a little bit of a recap because there’s a lot that we got a chance to cover-

Dr. Mark Hyman:
Yeah, I know.

Dhru Purohit:
… testing, so many things. But what you’re really great at, and what you do in your books and on this podcast as well, you’re really good at giving people a handful of things that anybody can do and start off today, the most important, right? So if you can give us the three most important things, high level, that we have control over. Not everybody maybe has access to a functional medicine doctor. Not everybody has access to more advanced testing. But there are things that we can do today to reduce our risk of Alzheimer’s and dementia. So give us three things that pretty much everybody can do.

Dr. Mark Hyman:
Only three? Can I do five?

Dhru Purohit:
Do five. Let’s do five. Let’s do five.

Dr. Mark Hyman:
Okay. The first one is just upgrade your diet to food is medicine. Upgrade your diet to food is medicine. Cut out the processed foods. Cut out the sugar and starch. If you want to have it as a treat occasionally, fine, not staples. Increase the phytochemical richness of your diet. Have-

Dhru Purohit:
And a great starting place for that would be the pegan diet, would you say? [crosstalk 00:51:24].

Dr. Mark Hyman:
The pegan diet. Yes, pegan diet is way to go. The pegan diet essentially is non-denominational. It’s sort of like the unitarian church of food. It’s essentially like eat real food, don’t eat crap, increase your phytochemical richness of your diet, think of food as medicine, personalize your diet, eat whole foods. That’s it. It’s pretty simple. Second would be exercise. Do something. Walk. Do jumping jacks. Burpees. Do some weight training. Do some yoga and stretching. Just simple stuff. Sleep. Make sure you prioritize sleep, super important. Eight hours. Make sure your quality of sleep is good. There’s all sorts of great resource on how to sleep, and we’ve had podcasts on that. We’ve a lot of articles on that.

Dr. Mark Hyman:
The last obviously is stress. I think we talked about the effects of stress on the brain. But meditation, hugely important for brain function. I think I was talking to someone about a study that was just done on meditation and how it actually regulates biological age. It’s really cool. And lastly, I would think in addition to the four basic foundational lifestyle factors of diet, exercise, sleep, and stress management would be taking a few of the right supplements. And what are those for your brain? It doesn’t have to be crazy. Get a multivitamin with good levels of methylating nutrients, B12 folate, B6. Make sure that they’re bioavailable, make sure that the right forms of nutrients. Also fish oil, make sure you take fish oil. Your brain is 60% DHA, which is basically fish oil, omega 3 fats. Or eat sardines three or four times a week. Make sure you take a good level of vitamin D. You want your vitamin D of 50 or more, 50 to 75, 80 is good. You have to measure. Sometimes people need 1,000, 75,000, 10,000, depending on your genetics and what you can absorb, but vitamin D is critical.

Dr. Mark Hyman:
That will be good for most people. If you want to go a little more, you can add magnesium. Magnesium is great for your brain as well and relaxing a lot of your nervous system. And it’s great for sleep and stress reduction and so forth. So those would be the five things that I would say would be critical. And those are the things that are easy to do, they’re inexpensive, and they’re available to almost everybody. I mean, the supplements can be a little more, but everything is stuff that you really don’t need any money for.

Dhru Purohit:
Fantastic. I love it. All right, let’s take a few audience questions, if you’re up for it, Mark. Let’s jump in with the first one. “My parents both got dementia. I’m 48 years old now. Am I doomed to step into the same fate?”

Dr. Mark Hyman:
Hell no, and here’s why. What we know now is that this is not an inevitable process. Two, that even if you have symptoms of predementia or dementia, that you can reverse it. Dr. Isaacson’s study, the FINGER study, Dr. Dale Bredesen work, there’s ample data now that gives tremendous amount of hope for even arresting it and slowing it and reversing it even once you have it. If you start early, you’re going to be in great shape. So 48’s not too late, but you got to work at it. Here’s the thing, I have, for example, had three back surgeries. If I don’t do my workouts every day and my back exercises, I’m in pain. Do some days I just want to be lazy and not do it? Yeah. But I do it because I don’t want to be in pain.

Dr. Mark Hyman:
So, you need to do more stuff if you have bigger risk factors, right? Unless you’re an APOE 22, and like Eubie Blake and can smoke and drink and live forever, you’re going to have to double down on all the things we’ve been talking about and get rid of all the dementegens. Check for them all. Check for heavy metals. Check for insulin resistance. Check your homocysteine. Check methylation. Basically, get that cognoscopy not when you’re 60 and starting to forget stuff, get a cognoscopy now as soon as possible and fix all the things that are wrong.

Dhru Purohit:
Beautiful. “When do we ideally start working on prevention?” is the question. “What is the ideal age?”

Dr. Mark Hyman:
The ideal age is zero. The ideal age is actually minus zero. It’s actually when you’re in utero. It’s actually getting your mother, before you’re born, to eat healthy, to get rid of her mercury, to optimize her nutritions, to detoxify, to improve methylation, and get all that stuff working. Basically, that’s the answer. Basically, you start on day one. The reason is that we are constantly bombarded with insults and you have to constantly be working against the entropy that cause a degrading of our biology. And that’s possible. So the sooner you start the better, but it’s never too late, but better start early.

Dhru Purohit:
Yeah. I think that’s an important message that’s here. It’s that it’s never too early to start and, yet, because of everything that we know, especially if you’re focused, it’s never too late to start as well.

Dr. Mark Hyman:
Exactly.

Dhru Purohit:
Even as somebody who’s my grandfather… If I could just chime in for a second, my grandfather developed dementia at the end of his life. At that point in time, he had pretty significant cognitive decline. He wasn’t able to remember us a lot, and occasionally he would have his memory come back in. But even with him suffering so much and us not being able to be able to reverse what he was going through because he was quite far along and he had some other diseases like cancer, when we made some major lifestyle changes for him, to the best degree we could, we did see his symptoms lessen. In his case that meant less agitation, less outbursts, less anger at his wife, which was my grandmother. So even if you have a full-blown diagnosis, you can see an improvement in the symptoms-

Dr. Mark Hyman:
Absolutely. Absolutely.

Dhru Purohit:
… that are there by changing some of these factors.

Dr. Mark Hyman:
Absolutely. I mean, ketogenic diets can be extremely helpful in Alzheimer’s. You can just go on PubMed, which is the national library of medicine, and google ketogenic diets and Alzheimer’s, and there’s really good research showing that even in advanced cases you can change the biology of the brain by getting rid of all the carbohydrate in your diet and eating fat as 70% of your diet.

Dhru Purohit:
All right, let’s go into the next question we have here. “How much socialization does an older person living alone need?” We didn’t talk about community and socialization, but it’s an important part of the conversation, would love to hear your thoughts.

Dr. Mark Hyman:
I think the truth is, and I hate to say this because I’m a food-is-medicine guy, but I think community as medicine is actually a bigger, more powerful intervention than food. I say that because when you look at all these cultures that live forever, like the blue zones, their social networks, their social integration, their care for each other, their love for each other, their showing up for each other is so powerful. I mean, I just spent New Year’s and Christmas with a group of about 30, 40 friends in Costa Rica. I just felt high from it. I felt so happy. I felt so full. I felt so alive. I felt like my nervous system was so great and de-stressed. It’s a drug, and it was just so beautiful.

Dr. Mark Hyman:
I think when you look at the data, for example, if you belong to a bowling group or a knitting group, your longevity is dramatically increased. It doesn’t have to be something fancy like living in a commune, it just has to be collecting some good friends, whether it’s two or three. Everybody should have at least one or two people you can call and tell anything and everything to. I think loneliness is one of the biggest epidemics in this country. If you look at the data on loneliness and isolation, it’s probably the biggest killer. It leads to a lot of lifestyle factors that also exacerbate it. Dr. Vivek Murthy, who’s our Surgeon General now for a second time, wrote a book about this. It’s a really profound problem in America and I think increasingly around the world. In many cultures, they still have their social networks and their fabrics.

Dr. Mark Hyman:
I mean, I was in Sardinia this summer, it was amazing. This guy I met, Sylvia [inaudible 00:59:35], he lived on top of this mountain. He was a shepherd. His family lived with him, his son, his daughters, his aunt or whatever. And then they all worked together, cooked together. They had a little restaurant they made in their house. They had people coming up the top of the mountain. I would say, well, he’s got his group of friends. They go hunting together. When it’s time to shear the sheep, they all show up. They have festivals together. Their weddings, birthdays, gatherings, celebrations. It’s just part of the culture. So you’re belonging.

Dr. Mark Hyman:
So belonging is also a key piece of being healthy. It’s a hard thing in this culture because we’ve got such an individualist culture. It’s really been good in a lot of ways because we’re really innovative and we’ve had all these incredible advances in entrepreneurs and people being very successful, but there’s a dark side to that, which is that individualism often actually interrupts our ability to focus and prioritize friends and community. It’s so important. I think as I get older it’s more and more important. I think for everybody listening, if you are isolated, if you’re alone, it’s important to start to think about how do you cultivate people that are your friends. I would say just go to where people are that are doing things you like to do. If you like to do yoga, go to yoga class, meet people there. If you like to drink coffee, go to a coffee shop and meet people there. Whatever you like to do, start to get involved because cultivating friends and community is one of the most important things. And it turns out to be one of the most critical things for longevity.

Dhru Purohit:
That’s great. Awesome, Mark. “Any books on that topic or resources that you found over the years that you find are helpful for people to be thinking about this or expanding their mind around it?”

Dr. Mark Hyman:
About brain health or about community?

Dhru Purohit:
Around loneliness, community, connection, anything on that topic?

Dr. Mark Hyman:
Well, yes. I think Dr. Murthy’s book is great. I think there’s a wonderful book called Belong by Radha Agrawal, which talks about building community. So it’s more of a practical approach to how do you start to create belonging in your life. I think that’s one of the best books I’ve seen on it. I think there’s… What else is there? There’s faith-based belonging approaches. I wrote The Daniel Plan, which is really centered around the power of community as medicine and using faith-based wellness as a tool. Excuse me. Using faith-based wellness as a tool to use community for healing. And we saw amazing results with that.

Dr. Mark Hyman:
So I think whatever it is, it’s got to feel good to you. I mean, they did Jogging for Jesus, they had all kinds of fun stuff they did together. Whatever it is that lights you up, you’ve got to find your community and get out of your box and push yourself a little bit. Everybody’s struggling. Everybody wants to be loved more. I wish I got Kara to talk about the data, but they actually included the whole concept of cuddling as a medicine. So they were looking at the more cuddling you had, the healthier you were, the longer you lived. So that was great.

Dhru Purohit:
Oh, that’s great. All right, last question we have here, Mark, before we wrap up. “What are some of the early signs of Alzheimer’s and dementia for those that aren’t aware?” We all forget our keys here and there, but what is really a sign that our brain is headed towards cognitive decline?

Dr. Mark Hyman:
There’s really three stages, right? Maybe four. There’s the preclinical stage where you’ve got damage in your brain that is happening. You can see that on an MRI scan. And you may never know it. And you’re fine cognitively. The second is what we call SCI, or subjective cognitive impairment. That’s where you, “Geez, I think it’s me forgetting things,” and you kind of know it. Then there’s MCI, which is mild cognitive impairment. This is challenging because you’re still functional, but you don’t know you’re forgetting stuff. So if you’re like, “Oh shoot, I remember that I forgot that. I had an appointment, I forgot it.” Then you’re probably not demented. If you are like, “Oh shoot, I forgot my keys,” it’s probably stressed. Right? But if you don’t know that you aren’t remembering things, that’s a problem. So that’s one of the early symptoms.

Dr. Mark Hyman:
And third would be the full-on dementia where you’re really in it. Often it’s early subjective signs. There is a test, it’s called the MoCA test, M-O-C-A, which is the Montreal Cognitive Assessment Test. You can google it. You can go online, you can download it. It’s a one-page test that has a series of questions, “Draw a clock. Draw a box. Name these animals. Remember these three things. Remember these five words,” and all these things. “Say these numbers backwards, forwards.” So it just gives you a lot of mental exercises that are designed to work different parts of your brain. And then you get a score out of 30. So if your score is 30, you’re good. If your score is 29, you’re probably okay. If it starts to go 26, 25, 24, 23, you’re in trouble. You can start to see these changes early on through this MoCA test, and that’s a really early diagnostic tool. It’s sort of a screening test. There are much more advanced neurocognitive tests you can do.

Dhru Purohit:
Excellent information, Mark. Let’s take people out and conclude the episode with some final thoughts here on the topic of Alzheimer’s and dementia.

Dr. Mark Hyman:
Well, I just want people to have hope. My friend, Dale Bredeson, wrote a book called The First Alzheimer’s Survivors. There’s cancer survivors, but who knows an Alzheimer’s survivor? Nobody. Well, there are those now out there, and I think we should have hope. We shouldn’t be looking for a pharmaceutical solution, although there may be pharmaceuticals that could be helpful along the way. It’s really more addressing these global issues around what causes brain dysfunction, getting rid of those, and what causes brain optimization and putting those things in. And it’s all the stuff we talked about today. So whether you are someone who’s got early memory loss, whether you have a family history like that woman who’s 48, or whether you just want to optimize your brain, it’s really important to look at all these things.

Dr. Mark Hyman:
We all talk about heart health and so forth and know how to prevent heart disease. Nobody’s really talking about how do we create brain health. That’s really why I wrote the book, The UltraMind Solution in 2009, which still I think is way ahead of its time. There’s a lot more that we’ve learned since then, but still, it was really pretty amazing to see that the things that I talked about then are now coming into normal discourse. So, I would have hope, I wouldn’t be afraid, and I would focus on getting a cognoscopy, getting rid of the dementegenes, and optimizing your brain through the fundamental things we talked about and also the next level steps with functional medicine.

Dr. Mark Hyman:
So that’s it for this week’s masterclass. I hope you’ve enjoyed it. If you have really liked it, please share it with your friends and family. I think everybody could benefit from listening to this. Leave a comment, how you helped improve your brain health. And subscribe wherever you get your podcast. We’ll see you next week for another episode of The Doctor’s Farmacy.
Speaker 1:
Hi, everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search there “Find a practitioner database”. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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